The purpose of this site is to educate
the public regarding pandemic and how to prepare for it. This site will
also serve as the central point of communication for the ND Department
of Public Instruction and the local education agencies regarding pandemic
preparations. The site will be updated as new information becomes available
- refer to this site as often as you need information. Any site visitor
can ask questions in the space provided below; all inquiries will be answered
by DPI staff and posted to the Pandemic Frequently Asked Questions (FAQ)
This site is designed to provide the following information:
February 1, 2007 Update From CDC
On February 1, the Centers for Disease Control and Prevention (CDC)
announced the availability of an essential new resource for communities,
schools, and colleges that offers guidance on community strategies that
would delay or reduce the impact of a severe pandemic by limiting the
spread of disease until a vaccine is available. This guidance document,
Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic
Influenza Mitigation in the United States (Community Mitigation Guidance),
contains important planning information on a variety of subjects, including:
- Community-based strategies. In the early phase of an influenza pandemic,
a pandemic influenza vaccine is unlikely to be available. Therefore,
it will be important to implement a variety of community-based interventions
to help reduce the spread of disease. These interventions include
social distancing, such as staying home when sick and avoiding large
prolonged school closings, and planning for alternative work schedules.
- Pandemic Severity Index (PSI). This will help communities gauge the
potential severity and impact of a pandemic and the appropriate actions
communities can take to limit the spread of the disease.
- Triggers for
initiating community interventions. These are based on the level
- Consequences of community interventions, such as prolonged
school closings. These should be anticipated and addressed in local
- Specific planning guidance. This is tailored for
businesses and other employers, child care programs, elementary and
secondary schools, colleges
and universities, faith-based and community organizations, and individuals
The document is available at http://www.pandemicflu.gov/plan/community/mitigation.html
encourage you to share this link with your staff and colleagues working
on emergency response plans for an influenza pandemic.
Pandemic School Closure
Exercise -- January 26, 2007
On January 26, 2007, the North Dakota Department of Health in conjunction
with local public health units organized a state-wide exercise. The exercise
focused on pandemic influenza and school issues focused around that topic,
specifically school closure issues. Although this exercise focused on
pandemic influenza, school closings can be a result of many different
scenarios ranging from natural disasters to terrorism or other violent
attacks. As requested, an after-action report has been generated to capture
comments and issues discussed during the exercise. Please see the following
document. School Closure
If you have any further questions about pandemic influenza planning
and planning for other emergencies, please contact your regional emergency
- Divide, McKenzie, Mountrail, Williams counties:
- Bottineau, Burke, McHenry, McLean, Renville, Sheridan, Ward counties:
- Benson, Cavalier, Eddy, Pierce, Ramsey, Rolette, Towne counties:
- Griggs, Grand Forks, Nelson, Pembina, Walsh counties:
- Adams, Billings, Bowman, Dunn, Golden Valley, Hettinger, Slope,
- Burleigh, Emmons, Grant, Kidder, Mercer, Morton, Oliver,
Sioux counties: Cheryl Underhill
- Barnes, Dickey, Foster, LaMoure, Logan, McIntosh, Stutsman,
- Cass, Ransom, Richland, Sargent, Steele, Traill counties:
Basic Pandemic Facts and Information
An influenza (flu) pandemic is a widespread outbreak of disease that
occurs when a new flu virus appears that people have not been exposed
to before. Pandemics are different from seasonal outbreaks of influenza.
Seasonal flu outbreaks are caused by viruses that people have already
been exposed to; flu shots are available to help prevent widespread
illness an impacts on society are less severe. Pandemic flue spreads
easily from person to person and can cause serious illness because
people do not have immunity to the new virus.
A pandemic may come and
go in waves, each of which can last for months at a time. Everyday
life could be disrupted due to people in communities
across the country becoming ill at the same time. These disruptions
could include everything from school and business closings to interruption
of basic services such as public transportation and health care.
severe influenza pandemic could lead to high levels of illness, death,
social disruption and economic loss.
A pandemic is a global disease
outbreak - a pandemic is a local crisis worldwide. It can happen in
every state and every city and every town
at almost the same time. A flu pandemic occurs when a new influenza
virus emerges for which people have little or no immunity, and for which
is no vaccine. The disease spreads easily person-to-person, causes
serious illness, and can sweep across the country and around the world
It is difficult to predict when the next influenza pandemic
will occur or how severe it will be. Health professionals are concerned
continued spread of a highly pathogenic avian H5N1 virus across eastern
Asia and other countries represents a significant threat to human health.
The H5N1 virus has raised concerns about a potential human pandemic because:
- It is especially virulent
- It is being spread by migratory birds
- It can be transmitted from birds
to mammals and in some limited circumstances to humans, and
- Like other
influenza viruses, it continues to evolve.
Since 2003, a growing number of human H5N1 cases have been
reported in Azerbaijan, Cambodia, China, Egypt, Indonesia, Iraq, Thailand,
and Vietnam. More than half of the people infected with the H5N1 virus
have died. Most of these cases are all believed to have been caused by
exposure to infected poultry. There has been no sustained human-to-human
transmission of the disease, but the concern is that H5N1 will evolve
into a virus capable of human-to-human transmission. Containing or slowing
an influenza pandemic demands that a nascent outbreak anywhere in the
world be recognized and confirmed within 1 to 2 weeks.
As of April 2006,
H5N1 has spread to 37 nations on three continents; 175 people have
been infected and 96 of them have died. To date, most
of those people were exposed to infected poultry. Fortunately, there
has been no sustained human-to-human transmission of the disease, but
the rapid spread of H5N1 is reason for concern.
As the avian infection
moves closer to America, the Departments of Agriculture, Interior and
Health and Human Services are stepping up the monitoring
and testing of migratory birds. This surveillance is essential to provide
early warning so the disease does not spread to people, poultry and pets
and to insure the safety of the nation’s food supply.
The best defense
against influenza is vaccination. It is also the most difficult defense
to achieve. A fully effective vaccine cannot be developed
until the virus strain it must protect against has evolved and been
identified. And once developed, there must be the production capacity
enough vaccine to protect the population.
There currently is no commercially
available vaccine to protect humans against the H5N1 virus that is
being seen in Asia, Europe, and Africa.
A pandemic vaccine cannot be produced until a new pandemic influenza
virus emerges and is identified.
How Does Seasonal Flu Differ From Pandemic Flu?
Outbreaks follow predictable seasonal patterns; occurs annually,
usually in winter, in temperate climates
Occurs rarely (three times in 20th century - last in 1968)
Usually some immunity built up from previous exposure
No previous exposure; little or no pre-existing immunity
Healthy adults usually not at risk for serious complications; the
very young, the elderly and those with certain underlying health
conditions at increased risk for serious complications
Healthy people may be at increased risk for serious complications
Health systems can usually meet public and patient needs
Health systems may be overwhelmed
Vaccine developed based on known flu strains and available for annual flu season
Vaccine probably would not be available in the early stages of a pandemic
Adequate supplies of antivirals are usually available
Effective antivirals may be in limited supply
Average U.S. deaths approximately 36,000/yr
Number of deaths could be quite high (e.g., U.S. 1918 death toll
Generally causes modest impact on society (e.g., some school closing,
encouragement of people who are sick to stay home)
May cause major impact on society (e.g. widespread restrictions
on travel, closings of schools and businesses, cancellation of large
Avian Bird Flu
- Avian influenza - commonly
called "bird flu" - is an infection
caused by influenza viruses that occur naturally in birds.
- Wild birds
can carry the viruses, but usually do not get sick from them. However,
some domesticated birds, including chickens, ducks, and turkeys,
can become infected, often fatally.
- One strain of avian influenza, the
H5N1 virus, is endemic in much of Asia and has recently spread into
Europe. Avian H5N1 infections have
recently killed poultry and other birds in a number of countries.
of avian H5N1 influenza may infect various types of animals, including
wild birds, pigs, and tigers.
The Avian H5N1 Flu in humans is currently very limited and not a pandemic.
Seasonal (or Common) flu is a respiratory illness that can be transmitted
person to person. Most people have some immunity, and a vaccine is
Avian (or bird) flu is caused by influenza viruses that occur naturally
among wild birds. The H5N1 variant is deadly to domestic fowl and can
be transmitted from birds to humans. There is no human immunity and no
Pandemic flu is virulent flu that causes a global out-break, or pandemic,
of serious illness. Because there is little immunity, the disease can
be spread easily from person to person.
Currently, there is no pandemic
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In the event of a pandemic
Education and outreach are critical to preparing for a pandemic. Understanding
what a pandemic is, what needs to be done at all levels to prepare for
pandemic influenza, and what could happen during a pandemic helps everyone
make informed decisions.
A pandemic may come and go in waves, each of which can last for six
to eight weeks. An especially severe influenza pandemic could lead to
high levels of illness, death, social disruption, and economic loss.
Everyday life would be disrupted because so many people in so many places
become seriously ill at the same time. Impacts can range from school
and business closings to the interruption of basic services such as public
transportation and food delivery. Historically, the 20th century saw
three pandemics of influenza:
- 1918 influenza pandemic caused at least
500,000 U.S. deaths and up to 40 million deaths worldwide
influenza pandemic caused at least 70,000 U.S. deaths and 1-2 million
- 1968 influenza pandemic caused about 34,000
U.S. deaths and 700,000 deaths worldwide
Characteristics and challenges of a pandemic
Rapid Worldwide Spread
- When a pandemic influenza virus emerges, its global
spread is considered inevitable.
- Preparedness activities should assume
that the entire world population would be susceptible.
- Countries might,
through measures such as border closures and travel restrictions,
delay arrival of the virus, but cannot stop it.
Health Care Systems Overloaded
- Most people have little or no immunity
to a pandemic virus. Infection and illness rates soar. A substantial
percentage of the world’s
population will require some form of medical care.
- Nations unlikely
to have the staff, facilities, equipment and hospital beds needed
to cope with large numbers of people who suddenly fall ill.
- Death rates
are high, largely determined by four factors: the number of people
who become infected, the virulence of the virus, the underlying
characteristics and vulnerability of affected populations and
the effectiveness of preventive measures.
- Past pandemics have spread globally
in two and sometimes three waves.
Inadequate Medical Supplies
- The need for vaccine is likely to outstrip
- The need for antiviral drugs is also likely to be inadequate
early in a pandemic.
- A pandemic can create a shortage of hospital
beds, ventilators and other supplies. Surge capacity at non-traditional
such as schools
may be created to cope with demand.
- Difficult decisions
will need to be made regarding who gets antiviral drugs and vaccines.
Economic and Social Disruption
- Travel bans, closings of schools and
businesses and cancellations of events could have major impact
on communities and
- Care for sick family members and fear of exposure can
result in significant worker absenteeism.
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What is North Dakota doing about the Pandemic
On March 9, 2006 Health & Human Services (HHS) Secretary Mike Leavitt
and Governor John Hoeven signed a Planning Resolution detailing HHS'
and North Dakota's shared and independent responsibilities for pandemic
planning. North Dakota will receive more than $600,000 from the HHS to
use for pandemic planning activities. The State of North Dakota, HHS
and other federal agencies held a pandemic planning summit on March 9,
2006 with public health and emergency management and response leaders
within the state.
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The ND Department of Public Instruction is one of many participating
state agencies working together to prepare for a pandemic outbreak.
Mutual goals include detection, response, and slowing down the progression
In the event of a pandemic, the ND Department of Public Instruction
will coordinate support to local and tribal governments for:
- Evacuation and transportation support;
- Transportation and or
facilities for mass inoculation;
- Facilities for emergency medical
- Assistance to local schools with displaced students.
DPI will support the ND Governor’s Office and the ND
Department of Health and communicate with LEAs regarding:
- Disease identification
- Disease control;
- Criteria for school closing;
- Criteria for student re-entry / school
- School staff management of disease and services.
DPI will follow their agency crisis management plan. Communication is
key among internal staff as well as with the LEAs. Communication with
LEAs would be through the existing DPI list serves created for ALL superintendents
and building principals – public, private and tribal – in
addition to this website.
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Local educational agencies (LEAs) play an integral role in protecting
the health and safety of their district's staff, students and their
families. The Department of Health and Human Services (HHS) and the
Centers for Disease Control and Prevention (CDC) have developed a checklist
to assist LEAs in developing and/or improving plans to prepare for
and respond to an influenza pandemic. [http://www.pandemicflu.gov/plan/schoolchecklist.html]
Building a strong relationship with the local public health units is
critical for schools and communities to develop a meaningful plan.
See the ND Department of Health website http://www.health.state.nd.us/localhd/ for local health unit contact information.
Obvious questions involving identification of a pandemic, decision about
school closings, guidance about school re-opening, staff, ADM and fiscal
payments have been discussed, but no formal decisions have been determined
at this time pending continued planning and communication with the Governor’s
office and the Department of Health.
In the event of a pandemic, the local schools will play many roles.
Among the many roles each school will play in the event of a pandemic,
it is likely the school building will serve as central communications
and location for community members. Community planning may include the
use of school buses for transportation of citizens to/from the school
for vaccine inoculations, use of the school facility for mass vaccine
inoculations, use of school facilities and stockpiled food for mass meal
distribution, medical care and triage, etc. In addition, the school district
should evaluate options and develop suggestions for home learning activities.
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In the event of a pandemic, it is a normal reaction to be at home with
your family to take care of loved ones and avoid public contact. There
is no need to panic or worry – information will be readily available
at the appropriate time. However, families can begin preparing now.
Information is readily available on the US government pandemic website
about staying healthy and being prepared. Knowing the facts is the
best preparation for your self, your children and your family.
ND Pandemic Summit webcast
US Government Pandemic website
ND Pandemic State Plan http://www.health.state.nd.us/EPR/resources/PandemicInfluenzaPlanSummary.pdf
Pandemic Flu Planning Checklist for Individuals and Families
Pandemic Presentation – Dept of Health and Dept of Public
Frequently Asked Questions
- How much truth is the May 9th ABC television network made-for-TV
movie titled “Fatal Contact: Bird Flu in America” which
follows an outbreak of the H5N1 avian flu virus from its origins in
a Hong Kong
market through its mutation into a pandemic virus that becomes easily
transmittable from human to human and spreads rapidly around the world?
The ABC Movie “Fatal Contact: Bird Flu in America” is a
movie, not a documentary. It is a work of fiction designed to entertain
not a factual accounting of a real world event. Please remember that
there is no influenza pandemic in the world at this time. It is important
to also remember that H5N1 avian influenza is almost exclusively a
disease of birds. The H5N1 virus has not yet appeared in the U.S. Should
H5N1 virus appear in the U.S., it does not mean the start of a pandemic.
- Is a pandemic imminent? Will the bird flu cause the next influenza
Many scientists believe it is a matter of time until the next
influenza pandemic occurs. However, the timing and severity of the
cannot be predicted. Influenza pandemics occurred three times in the
past century — in 1918-19, 1957-58, and 1968-69. Avian influenza
(bird flu) is a disease of wild and farm birds caused by influenza viruses.
Bird flu viruses do not usually infect humans,
but since 1997, there have been a number of confirmed cases of human
infection from bird flu viruses. Most of these resulted from direct or
close contact with infected birds. The spread of bird flu viruses from
an infected person to another person has been reported very rarely and
has not been reported to continue beyond one person. A worldwide pandemic
could occur if a bird flu virus were to change so that it could easily
be passed from person to person.
- Is it safe to eat poultry?
Yes, it is safe to eat properly cooked poultry. Cooking destroys
germs, including the bird flu virus. The US bans imports of poultry
products from countries where bird flu has been found.
- Is influenza
A (H5N1) virus the only avian influenza virus of concern regarding
Although H5N1 probably poses the greatest current pandemic threat,
other avian influenza A subtypes also have infected people in recent
For example, in 1999, H9N2 infections were identified in Hong Kong;
in 2002; and 2003, H7N7 infections occurred in the Netherlands
infections occurred in Canada. These viruses also have the potential
to give rise to the next pandemic.
- Why won't the annual flu vaccine
protect people against pandemic influenza?
Influenza vaccines are designed to protect against a specific virus,
so a pandemic vaccine cannot be produced until a new pandemic influenza
virus emerges and is identified. Even after a pandemic influenza virus
has been identified, it could take at least six months to develop,
test and produce vaccine.
- How much time does it take to develop
and produce an influenza vaccine?
The influenza vaccine production process is long and complicated.
Traditional influenza vaccine production for the U.S. relies on long-standing
based on chicken eggs. This production technology is labor-intensive
and takes nine months from start to finish.
The flu vaccine production process is further complicated by the
fact that influenza virus strains continually evolve. Thus, seasonal
must be modified each year to match the strains of the virus that are
known to be in circulation among humans around the world. As a result
of this constant viral evolution, seasonal influenza vaccines cannot
be stockpiled year to year. The appearance of an influenza pandemic
virus would likely be unaffected by currently available flu vaccines.
are making and testing possible H5N1 vaccines now. Large amounts of
vaccine cannot be made before knowing exactly which virus will cause
It could then take up to six months before a vaccine is available and
in only limited amounts at first. Research is underway to make vaccines
- How will vaccine be distributed if a pandemic breaks out?
Who will decide who gets vaccination first and who will have priority?
Most likely, the federal government will work with manufacturers, distributors
and states and the states will develop distribution plans at the local
level. States are developing and improving plans to distribute a vaccine
rapidly. These plans build on experience gained from other emergencies.
The greatest risk of hospitalization and death—as seen during the
last two pandemics in 1957 and 1968 pandemics and during annual influenza—will
be in infants, the elderly, and those with underlying health conditions.
These individuals, along with health care providers, who are critical
to maintaining a health care system in a pandemic, would likely be
the first individuals to receive the first supplies of vaccine. However,
in the 1918 pandemic, most deaths occurred in young adults, highlighting
the need to remain flexible on determining priorities for vaccination
groups based on the epidemiology of an emerging pandemic.
As part of
planning efforts, two Federal advisory committees—the
Advisory Committee on Immunization Practices and the National Vaccine
Advisory Committee—have made recommendations for prioritizing critical
populations that might receive the first supplies of vaccine. These recommendations
can be found in the Health & Human Services Pandemic Plan, which
is available at http://www.pandemicflu.gov.
a shortage of Tamiflu (or other anti-virals) anticipated? If so, what
is the government doing to prevent such a shortage?
HHS is stockpiling enough anti-virals to treat 25% of the U.S. population
should a pandemic occur in the U.S. This figure is based on historical
data from past pandemics indicating that roughly 25% of the population
would get sick in a pandemic and would benefit from antiviral treatment
if started early in the course of illness. To date, the U.S. government
has purchased 26 million antiviral treatment courses and expects to
have on hand a total of 81 million treatment courses by the end of
- What strategies will help protect Americans?
In the event of a pandemic, certain public health measures may be
important to help contain or limit the spread of infection as effectively
possible. This could include:
- Isolating sick people in hospitals,
homes, or other facilities,
- Identifying and quarantining exposed
- Closing schools and workplaces as needed,
- Canceling public
- Restricting travel.
In addition, people should protect themselves
- Getting seasonal flu shots,
- Washing hands frequently with soap
- Staying away from people who are sick, and
- Staying home if sick.
- Will wearing a surgical mask protect people
from the flu?
Surgical masks are recommended for health care workers who are subjected
to repeated exposure to multiple patients. For health care workers
performing certain medical procedures on infected patients, respirators
are recommended. Surgical masks are also recommended for patients
who are infected to help reduce the potential for spread of virus when
these people cough or sneeze.
- In addition to coughing and sneezing, can
one acquire the virus by handshakes, kissing, sharing drinks, etc.?
Influenza virus is primarily spread by airborne droplets that reach
the eyes, nose or mouth but can also spread by touching contaminated
and then touching one’s face. This highlights the importance
of learning and practicing good personal hygiene, including:
- Wash hands
frequently with soap and water.
- Cover your mouth and nose with a tissue
when you cough or sneeze.
- Put used tissues in a wastebasket.
- Cough or sneeze into your upper
sleeve if you don't have a tissue.
- Clean your hands
after coughing or sneezing. Use soap and water or
at home if you are sick.
- Could terrorists spread
the avian influenza viruses to create a worldwide pandemic?
Experts believe it highly unlikely that a pandemic influenza
virus could be created by terrorists. Developing a pandemic
influenza virus would
require extraordinary scientific skill as well as sophisticated scientific
equipment and other resources.
- How would pandemic flu affect communities
If an influenza pandemic occurs, many people could become sick at
the same time and would be unable to work. Many would stay at home
for ill family members. Schools and businesses might close to try
to prevent disease spread. Large group gatherings might be canceled
public transportation might be scarce. These are examples of challenges
that local communities, schools, civic organizations, and businesses
will have to work together on to plan for a pandemic response.
February 1, 2007 Update From CDC
To ask a question of DPI staff regarding the pandemic, please
use this link.
Please refer to this website for all question responses. Thank you.
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