The purpose of this plan is to provide a guide for the Wyoming Department of Health (WDH) for detecting and responding to an influenza pandemic. This plan must be periodically reviewed and updated to ensure that its assumptions, resources, priorities, and plans are consistent with current knowledge and changing infrastructure. In addition, in the event of a pandemic, the judgments of the public health leadership, based on the epidemiology of the outbreak and the extent of population infection, may alter or override anticipated strategies and plans.
III. FEDERAL RESPONSIBILITIES
The federal government is responsible for nationwide coordination of the pandemic influenza response. Specific areas of responsibility include the following:
• Surveillance in the U.S. and globally
• Epidemiological investigation in the U.S. and globally
• Development and use of diagnostic laboratory tests and reagents
• Development of reference strains and reagents for vaccines
• Vaccine evaluation and licensure
• Determination of populations at highest risk and strategies for vaccination and antiviral use
• Assessment of measures to decrease transmission (such as travel restrictions, isolation, and quarantine)
• Deployment of federally purchased vaccine
• Deployment of antiviral agents in the Strategic National Stockpile
• Evaluation of the efficacy of response measures
• Evaluation of vaccine safety
• Deployment of the Commissioned Corps Readiness Force and Epidemic Intelligence Service officers
• Medical and public health communications
IV. STATE RESPONSIBILITES
States are responsible for coordination of the pandemic influenza response within and between their jurisdictions. Specific areas of responsibility include the following:
• Identification of public and private sector partners needed for effective planning and response.
• Development of key components of pandemic influenza preparedness plan (surveillance, vaccine and antiviral distribution, disease control, and communications) following guidance provided by the Department of Health and Human Services (HHS) in the national Pandemic Influenza Preparedness and Response Plan.
• Integration of pandemic influenza planning with other planning activities conducted under Centers for Disease Control and Prevention’s (CDC) Public Health Preparedness and Response and Health Resources and Services Administration’s (HRSA) Hospital Preparedness Program cooperative agreements with states.
• Coordination with local areas to ensure development of local plans as called for by the state plan and provide resources, such as templates to assist in planning process.
• Development of data management systems needed to implement components of the plan.
• Assistance to local areas in exercising plans.
• Coordination with adjoining jurisdictions.
• A novel influenza virus strain will likely emerge in a country other than the United States, but a novel strain could emerge first in the U.S.
• The pandemic may occur during time periods not normally associated with the usual influenza season, and the pandemic strain may attack categories of people at different rates than that which normally occurs during the influenza season.
• There may be as little as one to six months warning before outbreaks begin in the U.S., if the pandemic emerges outside this country.
• Although there may be isolated pockets, the pandemic could affect all areas of the state.
• When the pandemic occurs, vaccines and antiviral medicines will be in short supply and will have to be allocated on a priority basis.
• It will take six to eight months after the novel virus is identified before the vaccine is available for distribution, unless a DNA vaccine is developed and deemed safe and necessary.
• A second dose of vaccine (two to four weeks after the first) may be required to develop immunity to the novel virus.
• In a pandemic, vaccine purchase and distribution options include:
o public sector purchase and distribution of all pandemic influenza vaccine
o a mixed public-private system where public sector supply may be targeted to specific priority groups (e.g., health care workers and those providing essential public safety services) and those who may be underserved by the current system
o maintenance of the current, largely private, system
• The federal government has assumed responsibility for devising a liability program for vaccine manufacturers and persons administering the vaccine.
• Secondary bacterial infections following influenza illness may stress antibiotic supplies.
• Response to the demand for services may require non-standard approaches, including:
o Discharge of all but critically ill hospital patients
o Expansion of hospital capacity by using all available space and less than code beds
o Increase of patient ratio to hospital staff
o Recruitment of volunteers who can provide custodial services under the general supervision of health and medical workers
o Relaxation of practitioner licensure requirements as deemed appropriate, and
o Utilization of general purpose and special needs shelters as temporary health facilities.
• Educating the public about the rationale for priority groups for antivirals and vaccine will be an important aspect of public education.
• There will be widespread circulation of conflicting information, misinformation, and rumors. Communication must be coordinated among all relevant agencies to ensure consistent messages to the general public.
VI. COMMAND, CONTROL, AND MANAGEMENT PROCEDURES
A. Command Structure
The WDH Director (or his/her designee) is responsible for officially activating the Wyoming Pandemic Influenza Response Plan during an influenza pandemic. The WDH Emergency Operations Plan (EOP) describes the WDH National Incident Management System Incident Command System structure that will be implemented in the event of a public health emergency, including an influenza pandemic. In addition, the EOP outlines the procedures for activating and operating the WDH Intervention Resource Center (IRC). The WDH Director will decide when to activate this command system and/or the WDH IRC based on current information and recommendations from the State Health Officer and the State Epidemiologist.
1. Pandemic Influenza Working Group
WDH has designated a working group to oversee planning, response and mitigation efforts and ensure that this plan is developed, reviewed, and periodically revised. This group will develop this response plan and other materials related to a pandemic influenza response. During a pandemic response, this group will be responsible for developing recommendations and guidelines, particularly for the use of limited vaccine and antiviral supplies. The Working Group may need to be expanded to include other subject matter experts as a pandemic situation develops. Current group members are listed in Appendix A.
2. Pandemic Influenza Advisory Committee
WDH has designated an advisory committee consisting of stakeholders and representatives from WDH and partnering state agencies. A list of committee members is included in Appendix A.
B. Powers of the State Health Officer
1. Quarantine and Isolation
The WDH, through the State Health Officer, or under his/her direction and supervision, has the power to establish, maintain and enforce isolation and quarantine, and in pursuance thereof, and for such purpose only, to exercise such physical control over property and over the persons of the people within this state as necessary for the protection of the public health (W.S. 35-1-240). Any person who has been quarantined may appeal to the district court at any time for release from the quarantine (W.S. 35-4-112).
2. Closing of Public Buildings and Events
The State Health Officer has the authority to close theaters, schools and other public places, and to forbid gatherings of people when necessary to protect the public health (W.S. 35-1-240).
3. Mandatory Vaccination
In most cases, the State Health Officer does not have the authority to subject any person to any vaccination or medical treatment without the consent of that person (W.S. 35-4-113). However, during a public health emergency, the State Health Officer may subject a person to vaccination or medical treatment without consent in the following circumstances:
• If the parent, legal guardian or other adult person authorized to consent to medical treatment of a minor child cannot be located and consulted and the vaccination of or medical treatment for the minor child is reasonably needed to protect the public health or protect the minor child from disease, death, disability or suffering;
• If the person authorized to consent on behalf of an incompetent person cannot be located and consulted and the vaccination of or medical treatment for the incompetent person is reasonably needed to protect the public health or protect the incompetent person from disease, death, disability or suffering.
• If a person withholds or refuses consent for himself, a minor or other incompetent when the vaccination or medical treatment is reasonably needed to protect the health of others from a disease carrying the risk of death or disability, then the person for whom the vaccination or medical treatment is refused may be quarantined by the State Health Officer.
During a public health emergency any health care provider or other person who in good faith follows the instructions of the State Health Officer is immune from any liability arising from complying with those instructions (W.S. 35-4-114). This immunity does not apply to acts or omissions constituting gross negligence or willful or wanton misconduct.
Complete bird flu plan link