Influenza AH1N1 New Virus, New Challenges

1
Influenza A/H1N1New Virus, New Challenges

• Pam Pontones, MA
• Director, Surveillance and Investigation
• 30 April 2009

2
What Is A Pandemic?

• Pandemic worldwide epidemic
• Three factors must happen
• Novel (new) disease agent -- yes
• Must cause severe disease in humans ? yes
• Must be easily transmitted person-to-person ?
  yes
• WHO phase 5 pandemic imminent
• National public health emergency has been
  declared

3
Background

• On 23 April, CDC described 5 cases of novel
  influenza virus (A/H1N1/North America/Human)
• 3 from San Diego area
• 2 from San Antonio, TX
• Other surveillance information indicated a
  respiratory outbreak in Central Mexico, including
  Mexico City, for previous three weeks
• Hundreds of cases
• Some deaths, mostly in young adults (20-45 years
  old)
• As of 24 April, 7 of these cases matched same
  H1N1 strain as US cases

4
Viral Reassortment
Reassortment/ mutations in birds
Pandemic virus

• Reassortment
• in humans

Human virus

• (2) Reassortment
• in swine

Pandemic virus
5
A/H1N1/North America/Human

• North American swine strain
• European swine strain
• Avian strain
• Human strain

Current Outbreak Virus
6
A/H1N1/North America/Human

• Incubation 2-7 days
• Symptoms fever, cough, sore throat, headache,
  body aches, some vomiting/diarrhea
• Transmission person-to-person
• respiratory droplet or hand contact to
  eyes/nose/mouth
• not transmitted by contact with pigs or eating
  pork
• Communicability usually 1-2 days prior to
  symptoms until symptoms cease
• Vaccine availability none
• Antivirals
• Susceptible to Tamiflu, Relenza
• Resistant to amantidanes

7
Current Status
8
Global Status

• Mexico
• 1000 cases reported as of 27 April, 1600
• Over 100 deaths
• 23 confirmed positive for A/H1N1/North
  America/Human
• Other countries Several over 4 continents
• World Health Organization (WHO)
• No travel or trade restrictions issued
• Avoid non-essential travel to Mexico
• Those ill advised to avoid international travel
• Pandemic level raised to 5 (sustained
  person-to-person transmission in large
  populations pandemic imminent)

9
National Status

• 90 confirmed cases as of 29 April, 1600 in many
  states
• National public health emergency declared
• US Department of Homeland Security has assumed
  lead role for response
• Strategic National Stockpile (SNS) being deployed
  for states antivirals, respiratory equipment
• CDC issuing guidance and recommendations
• Enhanced surveillance
• Community mitigation measures
• Use of antivirals

10
Indianas Status

• One confirmed case as of 30 April, more expected
• Four probable cases as of 30 April, likely to
  confirm
• Specimens collected on suspect cases and sent to
  ISDH Laboratory
• Specimens sent to CDC if test positive for
  influenza A but cannot be subtyped with seasonal
  flu reagents

11
Current Suspect Case Definition

• A person with compatible symptoms of influenza
• Fever 100F
• Cough
• Sore throat
• Headache and body aches
• AND
• Travel to a state or country with confirmed cases
  within 7 days of illness OR contact with someone
  ill who has traveled to a state or country with
  confirmed cases within 7 days of illness
• OR
• Rapid test positive for influenza A

12
ISDH Role

• Conduct case investigation, surveillance, contact
  tracing
• Provide laboratory testing and specimen
  collection kits
• Track national and international disease trends
• Develop educational messages and press releases
• Provide subject matter expertise
• Communicate with health care providers, local
  health departments, governmental agencies, and
  other partners
• Call center and dedicated ISDH web site link
  under development

13
What You Can Do
14
Practice Good Hygiene

• Wash hands well and often, especially after
• Contact with other people and common surfaces
• Helping someone who is ill
• Using facial tissues
• Use respiratory etiquette
• Cough or sneeze into your elbow/upper sleeve
• Discard used tissues promptly
• Avoid using handkerchiefs
• Avoid touch eyes, nose, mouth
• Stay home if you are sick and encourage others to
  do so

15
Get Credible Information

• Local health departments
• ISDH
• www.in.gov/isdh
• Call center to be established 28 April
• CDC www.cdc.gov/swineflu
• WHO www.who.org

16
Very simple measures that everyone can do will
make a big, positive difference
17
(No Transcript)
18
Questions?