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Basic Base Gatherings Between meeting Work Bunch Synopsis Joint ACIP/NVAC Meeting on Pandemic Flu Immunization Prioritization Atlanta, GA June 15-16, 2005 Boycott Allos, ACIP Carolyn Spans, NIP, CDC Dale Chestnut, DHS Louisa Chapman, NIP, CDC Elizabeth Falcone, NVPO
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Basic Infrastructure Groups Inter-meeting Work Group Summary Joint ACIP/NVAC Meeting on Pandemic Influenza Vaccine Prioritization Atlanta, GA June 15-16, 2005

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Ban Allos, ACIP Carolyn Bridges, NIP, CDC Dale Brown, DHS Louisa Chapman, NIP, CDC Elizabeth Falcone, NVPO Kathy Gensheimer, CSTE Penina Haber, OD, CDC Paul Hightower, DHS Arnold Kaufman, NCEH, CDC Max Kiefer, NIOSH, CDC Teri Palermo, NIOSH, CDC Ben Schwartz, NVPO Ray Strikas, NIP, CDC Marion Warwick, DHS David Weissman, NIOSH, CDC Pascale Wortley, NIP, CDC Participants

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Goals of Group Define bunches crucial to support of discriminating foundation in the U.S.: That would be a piece of flu pandemic reaction and/or Whose capacity may be generously affected by a pandemic Healthcare specialists considered by discrete work aggregate so excluded Identify extents of persons inside of every gathering that would most noteworthy need for inoculation (still in advancement) Prioritize among the gatherings, if conceivable

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Overall Goals for Pandemic Planning First, to minimize extreme bleakness and mortality Second, to save working of basic framework and minimize financial misfortune

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Process Taken by Group Developed a rundown of presumptions on effect of a pandemic Reviewed information on size and elements of basic base gatherings in view of prior work in light of sources from: White House, The National Strategy for the Physical Protection of Critical Infrastructures and Key Assets, February 2003 Congressional Research Service, Critical Infrastructures: What Makes an Infrastructure Critical? January 2003 New information from the Department of Homeland Security Public Health Agency of Canada’s flu pandemic arrangement Considered Experiences from late table top activities from non-flu related occasions Relative lack of data in vital administrations capacities in former pandemics Major changes in business rehearses that may make frameworks more defenseless

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What is Critical Infrastructure? The structure of free systems and frameworks including identifiable commercial ventures, foundations and appropriation abilities that give a solid stream of items and administrations fundamental to the safeguard and financial security of the U.S., smooth working of government at all levels, and society in general. President’s Commission on Critical Infrastructure Protection, 1997

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Key Assumptions I Influenza immunization is essential method for flu prevention Overall objective of antibody project will be to inoculate all in U.S. who wish inoculation HOWEVER, antibody supply prone to be constrained at any rate toward the start of a pandemic

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Key Assumptions II Prioritized those capacities that would most specifically be included in pandemic reaction, bolster upkeep of the medicinal services framework, and keep up open wellbeing and working of discriminating foundation

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Key Assumptions III Vaccine generation and utilization Time from competitor immunization strain to first measurements likely 6 or more months Current U.S. creation limit 5 M measurements for every week 2 dosages/individual likely required Dept of Defense likely will be high need for inoculation 0.5 M-1.5 M persons Thus, requirement for method of reasoning, express prioritization of antibody

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Key Assumptions IV Health effect of a pandemic 25% (territory in working age 20-30% in all likelihood) of persons may turn out to be sick in significant wave Additional persons should be home to administer to sick relatives Outbreak period in a group 6-8 weeks for every wave with perhaps >1 wave in a group Illness span anticipating work for uncomplicated case 5 days Rates and age circulation of flu related hospitalizations and passings may differ considerably from 1918 to 1968 situation 1-10% sick persons may be hospitalized 0.1–1% sick persons may bite the dust

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Principles for Prioritization of Vaccine Among Key Resource Workers in Critical Infrastructure Groups the study of disease transmission of the following pandemic may manage adjustment of prioritization suggestions Local needs and inclinations might likewise modify prioritization at nearby level Vaccination methodologies must be doable to actualize and justification utilized for choice unmistakably logical Because avoiding extreme sickness and demise is the first objective, discriminating framework gathers most specifically attached to this objective were organized Also, assembles basic to support of basic foundation organizes to meet auxiliary objective of pandemic arranging

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Major Limitation Very little data on effect of earlier pandemics on basic base outside of human services segment Because of changes in business administration rehearses, especially in past decade, experience from former pandemics may have less importance

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Two Main Tiers Defined I Tier one Persons working in flu immunization and antiviral prescription generation 10,000-20,000 persons Key government wellbeing leaders basically those in official branch of neighborhood/state/encouraged government who create and execute wellbeing related approach aggregate number persons not yet decided Non-social insurance specialists in general wellbeing expected to survey pandemic effect apportion assets create and actualize pandemic-related arrangement and direction help with conveyance antibody and antivirals aggregate number of persons not yet decided

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Two Main Tiers Defined II Tier one, con’t Public security laborers (fire, police, restorative office, dispatchers) Critical for reacting to crises with wellbeing ramifications and liable to be approached to guarantee request at inoculation/antiviral centers and keep up open request Total number: 2,987,000 Critical number: yet to be resolved Utility administration laborers (water, power, sewage administration) Provide fundamental administrations for medicinal services framework and every single other part where loss of administration would liable to add to extra ailment and ensure general open wellbeing and basic base Total number: 364,000 Critical number: yet to be resolved

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Two Main Tiers Defined III Tier two Transportation laborers to keep up basic supplies of sustenance, water, fuel and therapeutic materials or why should likely transport human services laborers and patients to therapeutic offices Total number: 3.8 million (DHS industry appraisal including trucking, traveler ground transportation, rail and water transportation) Critical number: yet to be resolved Telecommunications Essential for getting to and conveying human services and reaction to crises and upkeep of basic base Total number: 1.08 million Critical number: yet to be resolved

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Two Main Tiers Defined IV Tier two, con’t Mortuary administrations Deaths anticipated that would rise. Albeit most likely minimal direct wellbeing effect, extensive deferrals in these administrations could have generous social/mental effect Total number: 61,780 persons Critical number: yet to be resolved Waste administration With vast decreases in this administration, could make wellbeing dangers Total number: 321,190 persons Critical number: yet to be resolved

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Two Main Tiers Defined V Tier two, con’t Judicial branches of government Some working required for support of group capacity Total number of persons: 72,980 Critical number: yet to be resolved Financial Services Some fundamental working essential for upkeep critial societal administration This division has created assessment of discriminating staff to anticipate money related framework breakdown Critical number: 1,000 persons

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Critical Infrastructure Groups Considered Personnel Cumulative Element (1,000’s) all out (1,000’s) Health care 11,830 11,830 Ambulatory services 885 12,715 Vaccine and antivirals manu. 20 12,735 Key Executive Branch personnel ?100 12,835 for human services choices Non-medicinal services PH workers ?200 13,035 Public safety 2,987 16,022 Utilities 364 16,386 Transportation 3,800 20,186 Telecommunications 1,052 21,986 Funeral chiefs/embalmers 62 21,238 Waste management 321 21,559 Judiciary 73 21,632 Financial industry 1 21,633 High hazard persons (all) 88,300

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More Work to Be Done Critical base gatherings portrayed in prioritization are horribly characterized Additional assessment expected to Further characterize particular areas of every gathering basic for support of capacity Evaluate surge limit Establish systems for distinguishing these faculty and practical means for immunization and/or antiviral drug conveyance Identify extra gatherings along supply chains that may likewise should be organized (e.g. basic nutritional categories expected to supply sustenance for transportation)

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Other Recommendations Recommend government support for extension of U.S. flu immunization fabricating limit Evaluation of advancements to speed antibody creation and survey measurements saving methods (e.g. utilization of adjuvants, intradermal conveyance) likewise high need to enhance immunization accessibility Set aside some antibody and antivirals to inoculate gatherings of laborers who may need to react to unanticipated crises

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Pandemic immunization system progress toward meeting 80% objective for target gatherings, expecting 5 million measurements accessible per week** Pandemic starts ???? No. dosages for resistance Vaccinated Population (total millions) High Risk + HCW High Risk Only HCW Only Critical Infrastructure Only * Also, generally equivalent to inoculating 80% of all youngsters less than 18 years old ** Assume no waste and all immunization goes to target bunch .:t

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