Commonwealth of the Northern Mariana Islands
Department of Public Health
Emergency Operations Plan for Pandemic Influenza
A. Purpose of the CNMI Pandemic Influenza Emergency Operations Plan
This Pandemic Influenza Emergency Operations Plan (Pan Flu EOP) is designed to provide an overview of the activities and responses that will be required from the Commonwealth of Northern Marianas Islands Department of Health to prepare for, mitigate and respond to an influenza pandemic. It should be read in conjunction with the Department of Public Health (DPH) Emergency Operations Plan (EOP) and the Commonwealth Health Center (CHC) EOP.
B. Influenza background information
Influenza is an illness caused by viruses that infect the respiratory tract in humans. Signs and symptoms of influenza infection include rapid onset of high fever, chills, sore throat, runny nose, severe headache, nonproductive cough, and intense body aches followed by extreme fatigue. Influenza is a highly contagious illness and can be spread easily from one person to another. It is spread through contact with droplets from the nose and throat of an infected person during coughing and sneezing. The period between exposure to the virus and the onset of illness is usually one to five days. Influenza is not an endemic disease.
C. WHO Phases of Influenza Pandemic
Due to the prolonged nature of a pandemic influenza event, the World Health Organization (WHO) has defined phases of the pandemic in order to facilitate coordinated plans. This document will utilize the most recent 2005 WHO guidelines. See Annex 1 for a comparison of the new 2005 guidelines to the previous 1999 version.Table One: 2005 WHO Guidelines for Phases of Influenza PandemicInter-pandemic periodPhase 1: No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals. If present in animals, risk of human infection or disease is considered to be low.Phase 2: No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease. Pandemic alert periodPhase 3: Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact.Phase 4: Small cluster(s) with limited human-to-human transmission but spread is highly localized; suggesting that delay the virus is not well adapted to humans.Phase 5: Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk). Pandemic periodPhase 6: Pandemic: increased and sustained transmission in general population.Post-pandemic periodReturn to inter-pandemic period.
D. Planning Assumptions for Influenza Pandemics.
The following assumptions were considered in developing this Pan Flu EOP:
- Influenza is a highly contagious illness that is easily spread by direct personal contact, respiratory secretion droplets that may travel within 3-6 feet of the affected patient and by smaller, microscopic airborne particles that extend well beyond this distance.
- Influenza viruses mutate frequently. These mutations result in changes of two surface proteins on the virus: Hemagluttin (H) and Neuroamindase (N).
- When animal, (mostly swine or aquatic fowl), and human influenza serotypes are mixed during a concomittent infection, the resultant viral mutations may result the development of new influenza serotypes. When new serotypes occur, immunologically nave populations have no immunity to the resultant new or novel strain of influenza virus.
- Due to the highly contagious nature of influenza and its propensity for mutation, worldwide pandemics have been known to occur on a regular basis.
- An influenza pandemic is inevitable.
- Pandemic influenza is a unique public health emergency. No one knows when the next influenza pandemic will occur. However, when it does occur, it will be with little warning.
- Experts believe that we will have between one to six months between the identification of a novel influenza virus and the time that widespread outbreaks begin to occur in the mainland United States. This time may be shorter in the Pacific where direct flights from Asia occur on a daily basis.
- Effective preventive and therapeutic measures, including vaccines and antiviral agents, will likely be in short supply during an influenza pandemic, as will some antibiotics to treat secondary bacterial infections.
- Healthcare workers and other first responders will likely be at higher risk of exposure to influenza than the general population, further impeding the care of patients.
- Widespread illness in the community may also increase the likelihood of sudden and potentially significant shortages of personnel who provide other essential community services.
- To some extent, everyone will be affected by the influenza pandemic.
- Medical services and healthcare workers will be overwhelmed during the influenza pandemic
- Healthcare workers may not be able to provide essential care to all patients in need
- Unlike the typical disaster, because of increased exposure to the virus essential community services personnel such as healthcare personnel, police, firefighters, emergency medical technologists, and other first responders, will be more likely to be affected by influenza than the general public.
- Also unlike typical natural disasters, during which critical components of the physical infrastructure may be threatened or destroyed, an influenza pandemic may also pose significant threats to the human infrastructure responsible for critical community services due to widespread absenteeism in the workforce. This will impact distribution of food, home meal deliveries, day care, garbage collection and other critical services
- The first wave of the pandemic may last from 1-3 months, while the entire pandemic may last for 2-3 years.
- It will take six to eight months after the novel virus is identified and begins to spread among humans before a specific vaccine would likely be available for distribution.
To read further, please download the CNMI Pandemic Flu Plan (350Kb). This document is still a work in progress and is NOT FINAL.
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