Public Health Preparedness

Our mission is to be prepared to serve and protect the citizens of Johnston County in the event of a biological, chemical, or radiological emergency.

History of Public Health Preparedness and Response

The first steps toward establishing a state office specifically designed to address biological attacks began in November 2001 when more than $3 million from the state's "Rainy Day Fund" was made available to public health officials. In addition to bioterrorism preparedness, the Division of Public Health was tasked with revitalizing the department's disease prevention and detection infrastructure. At this time, the North Carolina State Office of Public Health Preparedness and Response (PHP&R) was created.

To make efficient and effective use of the funds, the PHP&R office created seven Public Health Regional Surveillance Teams (PHRSTs) to provide support to local health agencies serving all 100 counties.

In 2011, the PHRSTs were changed into regional offices. Johnston County Public Health Preparedness is supported by the Central Regional office. This team of specialists consists of a pharmacist, human services specialist, planner, nurse trainer, industrial hygiene consultant, and an administrative support staff.

Most importantly, the central regional office is on call 24/7 to aid Johnston County in the event of an actual or suspected biological, chemical, or radiological emergency. The team also holds regional monthly preparedness coordinator meetings, aids in county training, training exercise design and leadership, and holds informative seminars.

Pandemic Flu Planning

This is the Johnston County Public Health Preparedness website for information about pandemic flu. This website is updated with the most recent information we have from the World Health Organization (WHO), the federal government, NC state government and Johnston County government. Johnston County Public Health Preparedness is working and preparing in the event of pandemic flu.

Pandemic Flu Defined
WHO Alert Phases
Talking Points
Frequently Asked Questions (FAQs)
Individual Preparedness
Business Preparedness
Links

What is Pandemic Flu?

A pandemic is a global disease outbreak. A flu pandemic occurs when a new influenza virus emerges for which people have little or no immunity and for which there is no vaccine. The disease spreads easily person-to-person, causes serious illness, and can sweep across the country and around the world in a very short time.

It is difficult to predict when the next influenza pandemic will occur or how severe it will be. In the past century, pandemics occurred in 1918-1919, 1957-1958, 1968-1969, and 2009.

Wherever and whenever a pandemic starts, everyone around the world is at risk. Countries might delay arrival of the virus, through measures such as border closures and travel restrictions, but they cannot stop it.

Avian (Bird) Flu

Avian (bird) flu is caused by influenza A avian viruses that occur naturally among birds. There are many different subtypes of type A influenza viruses. All known subtypes can be found in birds. The avian flu currently of concern is the H5N1 subtype. Avian H5N1 flu in humans is currently very limited and not a pandemic.

Although H5N1 probably poses the greatest current pandemic threat, other avian influenza A subtypes also have infected people in recent years. For example, in 1999, H9N2 infections were identified in Hong Kong; in 2002; and 2003, H7N7 infections occurred in the Netherlands and H7N3 infections occurred in Canada. These viruses also have the potential to give rise to the next pandemic, but is not guaranteed.

Seasonal Flu

Seasonal flu is a respiratory illness that is transmissible from person to person. Most people have some degree of immunity and vaccine is available.

WHO Alert Phases

We are currently at WHO Alert Phase THREE:

Interpandemic Period

Phase One: No new subtypes have been detected in humans. An influenza virus subtype that has cause human infection may be present in animals. If present in the animals, the risk of human infection or disease is considered to be low.

Phase Two: 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 Period

Phase Three: 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 Four: Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.

Phase Five: Large cluster(s) but human-to-human spread is still localized, suggesting that the virus is becoming increasingly better adapted to humans but may not yet be fully transmissible (substantial pandemic risk).

Pandemic Period*

Phase Six: Pandemic phase: increased and sustained transmission in the general population.

*Second or subsequent pandemic waves may follow the initial wave, usually within three to nine months.

Postpandemic Period

Return to Interpandemic Period (Phase One)

Talking Points

Currently, there is no influenza pandemic in the world.
Although world health officials are currently closely monitoring the Avian Influenza Virus, it does not necessarily preclude that the Avian Influenza Virus will cause a pandemic. A pandemic can also be caused by another flu type.
For the status on recent news concerning avian influenza, please visit www.pandemicflu.gov.
There are steps you can take to decrease your chances of getting or spreading influenza including:
- Thorough and frequent hand washing:
  - Use soap and water or alcohol-based hand solutions.
  - Wash hands before and after meal preparation.
  - Wash hands before and after touching face.
  - Wash hand after contact with germ contaminants.
- Cough etiquette -- sneeze or cough into tissues or the bend of your elbow.
- Social distancing -- keep a distance of about three feet or more from other people during conversation or other interaction.
- Stay at home if you are sick.

For more information about Pandemic Flu, Avian Flu, and how to best prepare your business, family and home, visit www.pandemicflu.gov.

Frequently Asked Questions

Q: Do we have Avian Flu in the US?
A: Currently, there are avian flu varieties in the US that do not pose a health threat to humans. (August 2006)

Q: Is North Carolina ready to respond if a pandemic flu develops?
A: North Carolina is better prepared to respond to a flu pandemic or any other public health threat emergency than we have ever been before. In large part this is the result of new federal funds invested in public health following the events of September 11, 2001.

NC has had a Pandemic Flu plan since October, 2004.
The Office of Public Health Preparedness and Response has been created to provide expertise, establish partnerships with other first responders and lead the response.
Most local health departments have preparedness coordinators, who are working at the local level to prepare for a pandemic flu and other public health threats.
Twelve NC hospitals have medical epidemiologists in place to further enhance public health surveillance.

Q: How can I protect myself from the flu?
A: The best defense is a good offense. Get a flu shot every year. Practice good health hygiene - wash hands frequently, cover your mouth when you cough or sneeze, stay home from work if you are sick, and keep children at home if they are not well. Contact your physician if you become ill so you can be evaluated for the flu.

Q: Is is safe to eat chicken now?
A: Yes, chicken available in the US is safe to eat. Always cook it thoroughly to protect yourself from foodborne illness like salmonella.

Q: Should I worry about wild birds around my house?
A: No. The strain of avian flu that has public health experts concerned is not found in North Carolina or North America.

Q: How will I know if a pandemic flu is occurring?
A: Communication has improved dramatically since the last pandemic in 1968. Today, we will know very quickly if a flu virus mutates and starts affecting humans in large numbers. Public health experts will advise the public on how they can best protect themselves and their families.

Q: Who is in charge of the NC response to pandemic flu?
A: Many state and local agencies are involved in the response. The NC Pandemic Flu Response Plan is part of the NC Emergency Operations Plan, which outlines who is responsible for the different components of an effective response. Public Health, working with laboratories and healthcare providers, will probably be the first to identify potential pandemic flu cases in NC, but the rapid response will involve many other partners.

Q: What is isolation and quarantine?
A: Isolation is when a person who is already ill is kept away from others to keep from spreading the disease. Quarantine is when people who may have been exposed to a contagious disease but not yet sick are kept away from others also to keep from spreading the disease. Both measures will be important to controlling disease in a flu pandemic.

Individual Preparedness

To reinforce national, state, and local preparedness measures, it is necessary that you, the individual, think and prepare for challenges you may face in a pandemic flu outbreak.

Visit the CDC's pandemic flu page for more information.

Business Preparedness

Business and industry that provide critical infrastructure services, such as power, telecommunications, food distribution and medical supply have an special responsibility to plan for continued operation in a crisis and need to plan accordingly. The Health and Human Services Department and the Centers for Disease Control have developed guidelines to assist business in planning for a pandemic outbreak as well as other comparable catastrophes.

Visit the CDC's pandemic flu page for more information.

What is Epidemiology?

Epidemiology is the scientific study of factors affecting the health and illness of individuals and populations, and serves as the foundation and logic of interventions made in the interest of public health and preventive medicine. It is considered a cornerstone methodology of public health research, and is highly regarded in evidence-base medicine for identifying risk factors for disease and determining optimal treatment approaches to clinical practice.

The acting epidemiologist works on issues ranging from the practical, such as outbreak investigation, environmental exposure, and health promotion, to the theoretical, including the development of statistical, mathematical, philosophical, and biological theory. To this end, epidemiologists employ a range of study designs from the observational to experimental, with the purpose of revealing unbiased relationships between exposures such as nutrition, biological agents, stress, or chemicals to outcomes such as disease, wellness and health indicators.

Epidemiologic studies are generally categorized as descriptive, analytic (aiming to examine associations, commonly hypothesized causal relationships), and experimental (a term often equated with clinical or community trials of treatments and other interventions).

Epidemiologists work in a variety of settings. Some epidemiologists work 'in the field', i.e., in the community, commonly in a public health service, and are often at the forefront of investigating and combating disease outbreaks.

The term 'epidemiologic triangle' is used to describe the intersection of Host, Agent, and Environment in analyzing an outbreak.

Epidemiology Response Team

The Johnston County Health Department has a deployable Epi-Response Team on call 24/7. The team members consist of the health director, communicable disease nurses, environmental health specialists, health educators and administrative support. Inside the health department the preparedness coordinators and registered dieticians act as an additional pool of resource personnel. Also, outside county agencies such as animal control, law enforcement and emergency services serve as additional resources for the Epi-Response Team.

The team responds to public health disease outbreaks by investigating and putting interventions into place in an effort to quell or stop the spread of disease. For example, the Epi-Response team will react when there is a suspected E. Coli or Legionellosis outbreak.

Geographic Information Systems (GIS) and Public Health

North Carolina Public Health is currently in the forefront in the use of Mobile GIS technology in the field. What began as an idea (see Page 8 of the winter 2006 issue) in 2001 blossomed into a statewide collaboration between state regional surveillance team 5, the University of North Carolina at Greensboro, ESRI business partner Bradshaw Consulting Services, Inc. and local health departments.

In early winter 2006, Regional Surveillance Team 5 began a movement to assure that not only the regional surveillance teams are Mobile GIS ready, but all regions in North Carolina are Mobile GIS ready. Technology grants and training (via a request for proposals) were awarded to selected local health departments who contrived unique field usage of GIS within the scope of public health. The selected health departments (of which Johnston County was an awardee) received a series of intense three day trainings and are scheduled to receive their equipment in mid July. The new Mobile GIS teams joined a statewide two day exercise in August and tested ideas and readiness.

We are currently in the planning process of how to optimize the use of handhelds in Johnston County.

National Incident Management Systems (NIMS)

NIMS establishes standardized incident management processes, protocols, and procedures that all responders -- Federal, state, tribal, and local -- will use to coordinate and conduct response actions. With responders using the same standardized procedures, they will all share a common focus, and will be able to place full emphasis on incident management when a homeland security incident occurs -- whether terrorism or natural disaster. In addition, national preparedness and readiness in responding to and recovering from an incident is enhanced since all of the Nation's emergency teams and authorities are using a common language and set of procedures.