Solid Waste Issues Related
to Avian Influenza H5N1
Twin Cities Metro Advanced Practice Center
May 2007
Outline
• Overview of Environmental Health
• Overview of Advanced Practice
Center work
• Environmental Health
Preparedness
• Waste and Disease
• Influenza and Solid Waste Issues
Environmental Health
The science and art of:
– identifying agents of disease or injury,
– designing and implementing programs to
prevent transmission of the agent in the
environment, and
– protecting people from exposure to the agent.
Minnesota Department of Health
Environmental Protection
The science and art of:
– identifying threats to environmental quality,
– designing and implementing programs to
prevent degradation of the environment, and
– preventing environmental contamination or
degradation.
Minnesota Department of Health
Preparedness Issues
Protecting health and the environment is
critical during emergencies. Professionals who
work in environmental health and
environmental protection use many of the
same tools during normal activities and during
emergency response.
Environmental Health: Actions to
Protect Public Health Every Day and
During Emergencies
• Food safety
• Lodging safety
• Recreational water quality
• Public pool safety
• Lead hazard control
• Water quality
• Wastewater management
• Outdoor air quality
• Indoor air quality
• Sustainable building &
design
• Public health nuisance
control
• Solid waste management
• Hazardous waste
management
• Housing regulation
• And more
This work is a product of the Twin Cities Metro
Advanced Practice Center for Public Health Preparedness
APC Purpose:
To create models for implementing information
technology and training in support of bioterrorism
preparedness and emergency response.
Twin Cities Metro APC
• Collaborative approach for Environmental Health
preparedness in an urban area
• 10 goal areas over three years
• Focus on:
– Products
– Building EH capacity
– Sustainable tools
Twin Cities Metro APC
• Training Tools
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Emergency Handbook for Food Managers
EH Preparedness Plans
Resource Tool Kit for EH Preparedness
Emergency contact system
Electronic data systems
Thanks For Some Materials
Goes To:
Buddy Ferguson
Risk Communication Specialist
Minnesota Department of Health
Seasonal Influenza
• Caused by a virus
• Easily transmitted by
– talking, coughing, sneezing
– touching infected person or contaminated
surface – then touching eyes, nose, mouth
Seasonal Influenza
• Symptoms include:
– sudden onset
– fever, headache, muscle aches, severe weakness
– respiratory symptoms
(cough, sore throat, difficulty breathing)
• There is no such thing as “stomach flu”
Seasonal Influenza
• Seasonal influenza is a big deal
• Flu and its complications are
– the 7th leading cause of death nationally
– the 8th leading cause of death in Minnesota
(700-800 deaths a year)
Seasonal Influenza
• People usually don’t get excited about it.
• Exceptions:
– February 2007 – Child deaths
– October 2004 (Chiron vaccine recall)
– December 2003 (“kid-killer” flu)
Changes in Influenza Virus
• Drift – gradual change
– addressed through annual reformulation of vaccine
– based on WHO/CDC surveillance
• Shift – major, abrupt change (possibility of a
global epidemic – also known as a pandemic)
Three Kinds of Flu
• Influenza C – not a big problem
• Influenza B – relatively stable but still
subject to drift
• Influenza A
– unstable
– subject to both drift and shift
An Aside About “H” and “N”
• Hemagglutinin (H) and neuraminidase
(N) are types of proteins
• H and N are found on the
outer surface of the flu virus
• H and N come in different “flavors”
•
Recent human flu epidemics have
been cased by H1N1 and H3N2
viruses
Animals Can Get The Flu
• Different strains of influenza A can
affect birds, pigs or humans
• Avian flu can be high-path or low-path
• Different strains can combine,
jump from species to species or mutate
• That’s how you get new strains
What We Have Now
“High path” (highly pathogenic)
H5N1 avian influenza
Why Is It a Public Health
Concern?
• Some human cases (300+ since 2003)
• Not easily spread human-to-human
• Very virulent (50%+ death rate – 200+ deaths
since 2003)
• Attacks young adults (like 1918 virus)
• Could adapt to humans
• But could change in process of adapting
Are We Going to Have a
Pandemic?
Some kind of pandemic
Not if…..but when
1918 (or worse) pandemic
Not when…..but if
Are We Going to Have a
Pandemic?
H5N1 could:
– become human virus & remain highly
virulent
– become human virus & change radically
– go away & never cause a pandemic
How Bad Could It Be?
• Multiple waves of
illness, lasting 6-8
weeks
• 2nd and subsequent
waves could be milder
– or worse
• Waves could be
several weeks – or
several months – apart
• 30% of population ill
• 32,000 deaths in
Minnesota
• 172,000 hospitalized
in Minnesota
• Widespread social
disruption
Recap
We have an event that:
– may – or may not – happen in the short
run
– is almost certain to happen in the long run
– may – or may not – be really, really bad
when it does happen
Protecting Public Health
• Surveillance: look for
disease/condition
• Identify the source
• Act to disrupt
transmission of
disease/condition
This works for biological,
chemical, and physical
causes of illness and
injury
Model of Disease Transmission
Chain of Disease Transmission
“R.E.T.E.R.”
Reservoir
Exit Route
Mode of
Transmission
Entry Route
Receptive
Host
Quiz Time: Foodborne Illness
•
•
•
•
•
•
Agent
Reservoir
Mode of Exit
Mode of Transmission
Mode of Entry
Host
• Human
• Contaminated ground
beef
• Beef gut
• Eating a rare burger
• Cattle feces
• E. Coli 0157
Quiz Time – Chemical
•
•
•
•
Agent
Reservoir
Mode of Exit
Mode of
Transmission
• Mode of Entry
• Host
• Human that likes fish
• Burning coal in power
plants
• Mercury
• Coal
• Mercury accumulating
in the food chain
• Human eating fish
Environmental Health Role
• Among other jobs, EH will need to assure that
solid waste continues to be managed in a manner
to protect public health.
• Key questions:
– What wastes are associated with H5N1 flu in animals?
– What wastes are associated with H5N1 flu in humans
– Is any special management of wastes required?
Waste Management & H5N1
• What are the risks* associated with wastes
from birds that are infected with HPAI
H5N1? Are those wastes safe to handle?
• What are the risks* associated with wastes
from humans infected with H5N1? Are those
wastes safe to handle?
* Risks: public health, occupational health,
animal health, environmental protection
Waste Management and
Disease Outbreaks
• Little guidance for local public health
• Little information available in the literature
regarding risks to workers who come in
contact with wastes associated with flu, any
flu, including H5N1
• Little information available regarding
industry practices and risk
Purpose of This Work
Create a decision-making model for the
management of wastes associated with
H5N1 that is based on widely agreed upon
scientific principles and practices.
Why?
• Our literature review showed little practical
information available
• Federal and state guidance is varied and
vague, and refers to local decision making.
• History of infectious waste management in
Minnesota – a risk communication issue
• Avoid panic, create understanding
Isn’t this just a rural,
agriculture-related problem?
Pecks and the City
“Fowl play or good eggs?
Minneapolis poultry owners
assert their flocks' right to roost.”
By Rachel Hutton
Photo by Curtis Johnson
Typical Federal Statement
“The decision making for disposal occurs at
the state and local levels, with technical and
resource support in place from federal
agencies…”
U.S. EPA – “Disposal of domestic birds infected by Avian Influenza –
an overview of considerations and options. August 11, 2006. EPA530R-06-009
Federal Direction on Animal
Carcass Disposal
“Primary resources are at
the local level. State
resources may be used.
Need for Federal resources
is limited.”
Homeland Security Presidential
Directive – 9 Federal Food and Agriculture
Decontamination and Disposal Roles and
Responsibilities November 2005.
Minnesota DNR
“If you find a dead bird that must be moved,
place it in a plastic bag and dispose of it in
the garbage. Be sure to wash your hands
thoroughly.”
Minnesota Department of Natural Resources: Monitoring for Avian Influenza.
www.dnr.state.mn.us
Minnesota’s Pandemic Flu Plan
“The MDH Clinical Infection Control Team (C-ICT) is responsible for
developing, disseminating, and revising infection control guidance for
patients, healthcare workers, other caregivers, volunteers and the
public…In addition, the C-ICT…will develop and disseminate key
infection prevention and control messages for the public and partners.
Infection control guidance will include, but is not limited to,
recommendations for…
– Appropriate types of infection control precautions…to be used
– Personal Protective Equipment (PPE)…
– Airborne infection isolation room requirements…
– Cleaning and disinfection of equipment, linen, and the patient care
environment; and
– Waste disposal”
Draft Version 2.5 April 2006
Technical Section D: Infection Control
Private Sector
“Waste management companies
need to decide soon what role
they are going to play in the
management of infected
carcasses and associated
materials, including the
transportation and disposal
issues as well as whether their
employees are willing to handle
these types of materials.”
NSWMA, “Avian Influenza: The hunt and peck for
answers.” October 2006
Non-Profit Sector
• “Farm personnel involved
in the culling of sick
poultry, as well as
transporting/or disposing
carcasses should wear
personal protective
equipment…”
Decision-making Model:
Process
• Assess the risk via literature review and
interviews
• Identify types of wastes associated with flu in
birds and humans
• Assess risk for different elements of waste
management
• Peer review
• Conclusions
Collaborators
• Minnesota Department of
Health
– Environmental Health
– Office of Emergency
Preparedness
– Acute Disease Investigation
and Control
• Local public health
(Epidemiology and
Environmental Health):
– Hennepin County
– Washington County
– City of Minneapolis
• Minnesota Pollution Control
Agency
• Minnesota Department of
Natural Resources
• Region’s Hospital
• Minnesota Board of Animal
Health
• Minnesota Occupational Safety
and Health
• University of Minnesota School
of Public Health
• Mayo Clinic
Assess Risk Associated
with H5N1
• H5N1 found in wild and
domestic waterfowl and
shorebirds
• Wild birds can infect domestic
poultry
• Human susceptibility is not
known, but transmission from
birds to humans appears to be
inefficient
• H5N1 virus survival appears
similar to seasonal influenza
viruses
Seasonal Influenza in Humans
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•
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Agent
Reservoir
Mode of Exit
Mode of Transmission
• Mode of Entry
• Host
Flu virus
Humans that have flu
Respiratory secretions
Virus particles in
aerosols, large droplets &
on surfaces
Inhalation or hand-tomouth, nose or eyes
Humans
H5N1 Infection in Humans
Associated with Birds
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•
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Agent
Reservoir
Mode of Exit
Mode of Transmission
• Mode of Entry
• Host
H5N1 Flu virus
Wild and domestic birds
Bird feces, blood and
respiratory secretions
Aerosols or virus
particles on surfaces
Inhalation or hand-tomouth, eyes or nose;
relative importance of
each is unknown
Humans
Waste Types
• H5N1 in Birds: Types of waste:
wild and domestic bird
carcasses, bird feces, bedding,
cages, food and water dishes,
cages, feathers, innards, egg
crates, other equipment
• H5N1 in Humans: tissues,
bedding, masks, gloves,
clothing, leftover food, bed
pads, beverage bottles, cleaning
materials
Waste Management
• Storage
• Collection
• Transport and Transfer
• Disposal
Decision Tree for the Assessment, Evaluation and
Management of Wastes Associated with Highly Pathogenic
Avian Influenza (HPAI) H5N1 Virus
Implications for Waste Management
Conclusion
• Based on current science and epidemiology,
wastes that have come in contact with H5N1 in
either birds or humans do not pose a risk to the
waste handler or public.
• Recommend the use of personal protective
equipment that may already be part of normal
daily operations.
Basic Prevention…Break
the Chain of Transmission