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NCSL Influenza Report

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February 2007

Overview

A global emergence of avian influenza has made state and local authorities mindful of the potential impact a pandemic of any origin may have on our daily lives.  Even the most common forms of influenza will hospitalize on average more than 200,000 people every year. According to the Centers for Disease Control and Prevention (CDC), infections caused by influenza virus A or B have resulted in 36,000 deaths in the United States between 1990 and 1999. Over the last three years avian influenza has claimed the lives of 241 people in 10 countries as well as adversely affecting the poultry industry worldwide. Many scientists believe it is only a matter of time until the next influenza pandemic occurs.  Shortages of the influenza vaccine supply in three of the last five flu seasons and the possibility of an outbreak of more serious strains of influenza have called into question the nations ability to endure a pandemic outbreak.

Pandemic Timeline Pandemic Facts Pandemic Preparedness Vaccines/Antivirals and Medical Supplies and Resources The Economic Impact of Pandemic Flu  Business Continuity Planning New Developments

Preparation by private sector organizations is just as essential as the efforts of government to ensure the security of our nations critical infrastructure. The recently released National Strategy for Pandemic Influenza Implementation Plan approximates that 85 percent of the nation's critical infrastructure is owned or operated by the private sector.  AMR Research recently released a study they conducted focused on the readiness capability of large companies in the event of  influenza pandemic. AMR Research is the No. 1 advisory firm focused on supply chain, enterprise applications, and infrastructure. Founded in 1986, AMR Research provides advisory services and peer networking opportunities to supply chain and technology professionals in the manufacturing and retail sectors. They found that 68 percent of companies with more than $1 billion in revenues are not prepared for a pandemic, such as an avian flu outbreak.  The survey highlights the fact that a majority of companies have not implemented a risk management strategy. Department of Labor Guidance for Workers The U.S. Department of Labor (DOL) has issued guidance for employers in their efforts to protect their workers against an outbreak of various strains of influenza. Most influenza is spread through virus-laden droplets that have been expelled through coughing or sneezing. In an agricultural setting, animal manure containing influenza virus can contaminate dust and soil causing infection when inhaled. Contaminated equipment can carry infected matter from farm to farm. According to the DOL guidance, the virus can survive, at cool temperatures, in contaminated manure for at least three months. In water, the virus can survive for up to four days at 72 degrees F and more than 30 days at 32 degrees F. For the highly pathogenic form of influenza A, studies have shown that a single gram of contaminated manure can contain enough virus to infect one million birds. DOL also points out that another workplace setting of concern is food handling and preparation. Avian influenza could be transmitted from uncooked birds or bird products, it has even been found in imported frozen duck meat. The federal government has placed a ban on importation of all birds from Cambodia, Indonesia, Japan, Laos, People's Republic of China, including Hong Kong, SAR, South Korea, Thailand, and Vietnam. The ban applies to all birds, whether dead or alive. Farm workers or animal handlers should be provided with equipment and training sufficient to protect themselves in the event they are required to cull and infected flock of birds. They should be instructed that hand hygiene is essential and hands must be washed frequently. Adequate hand washing involves soap and water with vigorous rubbing for 15 to 20 seconds or the use of other hand-disinfection procedures prescribed by the state government, or other authoritative guidance. Protective equipment should include clothing capable of being disinfected or disposed of, gloved, respirators as described in 29CFR 1910.134, goggles and boots or protective foot covers.  Unvaccinated workers should receive available seasonal flu vaccinations and all workers receive antivirals daily for the duration of the time they are in direct exposure. Since influenza A (H5N1) is classified as a select agent and must be worked with under Biosafety Level (BSL) 3+ laboratory conditions, controlled access to laboratory facilities must be maintained. Laboratory workers must have access to showers within the controlled access area and have a changing room within this section of the facility. Employers must comply with all provisions of 29CFR 1910.1030 for employee protection against blood borne pathogens.   Medical workers should observe isolation precautions identical to those recommended for SARS including strict hand hygiene before and after all patient contact, use of gloves and gown during patient contact, use of eye wear within three feet of the patient, and airborne precautions including: placing the patient in an airborne isolation room with monitored negative air pressure, use of disposable respirators or masks, and during transport ensure that the patient wears a surgical mask or some other means of containing respiratory secretions. Federal Resources for Businesses Department of Health and Human Services (HHS) Business Pandemic Influenza Checklist CDC Business Home US Department of Labor Guidance for Protecting Workers Against Avian Flu DOL provides additional guidance for food handlers, airline flight crews and travelers at http://www.osha.gov/dsg/guidance/avian-flu.html. USDA Draft Summary of the National Avian Influenza (AI) Response Plan, May 2, 2006 (Full Plan) File Size 737 KB FDIC Interagency Advisory on Pandemic Flu Preparedness Office of Personnel Management Guides for Federal Agencies

For further information, please call NCSL staff Joy Johnson Wilson, Health Policy Director at 202-624-8689 or Rachel Morgan RN, BSN, Senior Health Policy Specialist at 202-624-3569.