San Francisco Department of Public Health

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Novel Influenza A H1N1 2009 - Swine Flu -

• San Francisco Department of Public Health
• August 14, 2009

Note Information in this presentation is
current as of 8/10/09. Recommendations are
likely to change with the evolving situation.
Please check www.sfcdcp.org/h1n1 for current
information and guidance.
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Contents

• H1N1 Swine Flu Overview
• Guidance for Schools
• Resources

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H1N1 Swine Flu Overview
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What is Novel influenza A H1N1 (swine flu)?

• H1N1 swine flu is a strain of flu came to the US
  in 2009 and because it is new
• most people have no protection against it.
• Seasonal flu and H1N1 swine flu are spread the
  same way and for most people
• result in mild disease.
• Both seasonal and swine flu can cause severe
  disease and death in some people such as those
  who have certain medical conditions.
• Influenza is spread through tiny drops when an
  infectious person coughs, sneezes, or touches
  surfaces with hands that have the drops.
• Infected people may be contagious beginning 1
  day before symptoms develop and up to 7 or more
  days after becoming sick but most transmission
  occurs in the first 2-3 days of illness.
• Infected people should stay home until 24 hours
  after they no longer have a fever (without taking
  fever-reducing medications).

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What are the symptoms?
The symptoms are similar to that of seasonal flu

• Fever (gt100)
• Cough
• Sore Throat
• Body Aches
• Vomiting
• Shortness of Breath

• Head Aches
• Runny nose
• Diarrhea
• Chills
• Fatigue

Most people who have these three symptoms will
not need to see a health care professional for a
diagnosis and can assume they have influenza .
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How can you prevent getting influenza?

• Wash your hands often.
• Avoid touching your mouth, nose, eyes.
• Stay away from people who are ill.
• Get vaccinated against seasonal flu (vaccine
  available later this month).
• Get vaccinated against H1N1 swine flu (available
  in October).

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How can I obtain the vaccines?

• Seasonal and H1N1 swine flu vaccines should be
  available at the same sites (doctors offices,
  clinics, etc).
• Seasonal flu vaccine should be available late
  August and H1N1 in October.
• There are several priority groups targeted for
  H1N1 vaccination, including children 6 months
  24 years of age.
• The SFDPH, SFUSD, and Mayors office are
  discussing options for vaccinating large numbers
  of school-aged children in a short time period.

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How can you prevent spreading disease?

• Stay home when sick for 24 hours after fever is
  gone without taking fever-reducing medications.
• Cover coughs and sneezes -throw used tissues into
  a waste basket.
• Try to avoid coughing or sneezing into your
  hands.
• Wash your hands frequently.
• Masks are not currently recommended but may be
  recommended in certain situations (in a medical
  office waiting room).

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Is there medication for H1N1 swine flu?

• There is medication available from health care
  providers.
• The medication is recommended for people with
  certain medical conditions or other factors that
  place them at high risk of severe disease.
• Antivirals can reduce the severity and duration
  of disease by 1 day if started within 48 hours
  of symptom onset.
• Antivirals are not recommended as prophylaxis
  for the general public.
• Some individuals at high risk may be advised by
  their doctor to take antivirals as prophylaxis.
• For current guidance check www.sfcdcp.org/H1N1flu.
  html.

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Will this flu season be worse than usual?

• Nobody knows what will happen
• It is reasonable to assume there will be
• A continuation or increase in H1N1 swine flu
  cases
• A restarting of seasonal flu cases
• Flu viruses regularly mutate and characteristics
  of the virus may change
• Internationally, nationally, and locally we are
  monitoring different characteristics of the virus
  including severity, transmissibility, antiviral
  resistance, mutations, etc.
• Currently H1N1 swine flu appears be genetically
  stable and has not changed in severity of disease
  or populations affected.

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Guidance and Plans for Responding to Influenza in
Schools
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Goals

• To minimize the spread of influenza viruses
  (seasonal and H1N1).
• To minimize disruption to school and day-to-day
  activities.
• To reduce the serious consequences of influenza.
• To monitor influenza activities in order to
  respond rapidly.

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CDC Recommendations for Schools

• All students and staff with symptoms of influenza
  should stay home until 24 hours after fever has
  subsided (without taking fever-reducing
  medications).
• Students who become ill at school should be
  separated from other students (wait for parents
  in the office).
• Staff who become ill at school should go home.
• Ill students should not ride the school bus and
  if possible, ill students and staff should avoid
  public transit.
• Hand hygiene and respiratory etiquette should be
  prioritized.

• San Francisco Department of Public Health is
  working with SFUSD and schools
• to ensure that recommendations are practical at
  a local level.

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• Students and staff at high risk for complications
  of influenza should speak with their health care
  provider as soon as possible after exposure to
  influenza.
• Schools that cater to high risk populations (e.g.
  school for pregnant teens) may choose to dismiss
  students if community levels of influenza are
  very high and vaccine coverage low.
• If influenza causes more severe disease than has
  happened so far, additional measures will be
  considered
• Screening students and staff for fever, cough,
  sore throat.
• Keeping high-risk students and staff home.
• Students with ill family member stay home.
• Social distancing.
• Longer exclusion period.
• School closures.

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How will decisions be made?

• SFDPH, SF Department of Emergency Management, and
  SFUSD are developing communication protocols to
  ensure consistent and timely messages in upcoming
  flu season.
• The SFDPH and SFUSD are working together to
  develop ways to implement prevention and control
  strategies, monitor influenza, and respond to
  outbreaks.
• Monitoring influenza in schools is best done
  through attendance records.
• Centrally available attendance records for SFUSD
  cannot differentiate absences due to illness.
• SFDPH would like to work with SFUSD to develop
  simple, timely, and effective ways to track the
  number of staff and students at each school who
  are absent due to illness.

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General school activities to reduce disease

• Make tissues, trash cans, paper towels, and
  alcohol-based hand sanitizer available.
• Post signs encouraging staff to utilize healthy
  habits. Free signs are available from the health
  department www.sfcdcp.com/materials_request.html
• Encourage seasonal and H1N1 swine flu shots.
• Keep frequently used surfaces (such as door
  knobs) clean using regular cleaning products.

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Where can I get more information?

• SFDPH websites
• www.sfcdcp.org/h1n1
• www.sfcdcp.org/infectmenot.html
• To speak with someone directly call 311 (in SF).
• Attend the DPH sponsored Flu Forum
• Thursday August 27 from 930-1130
• 101 Grove Street, Rm 300