The Facts about h1n1 flu

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The Facts abouth1n1 flu

• Prepared by
• Becky Corman, RN, BSN
• Panhandle Public Health District
• Emergency Response Coordinator Public Health Nurse

Last updated 04/30/2009
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Objectives

• Define the flu.
• Explain how influenza spreads
• Discuss epidemics vs pandemics
• Describe H1N1 Flu
• Share strategies to deal with influenza pandemics

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What is the flu?

• Answer An illness caused by influenza virus
• A sudden onset respiratory illness accompanied by
  fever
• Flu causes yearly epidemics worldwide

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Are there different types of flu?

• Answer Yes!
• Type A moderate to severe illness
• All age groups many animals
• Type B milder than A
• Humans only mainly children
• Type C rarely reported in humans
• No epidemics

ABC's
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Time out, coach! How are viruses different from
other germs?

• Much smaller than animal cells or bacteria
• Viruses need to get a life!
• Need to be inside our cells to live
• Our cells become virus factories
• Influenza virus kills cells in breathing passages

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What does an influenza virus look like?

• Hemagglutinin protein
• Allows virus to stick to cells of some animals
  and not others
• Neuraminidase protein
• Helps release new virus from cells
• Genes (RNP) divided into 8 parts
• Allows 2 viruses to mix and match genes

Fig.1 Electron micrograph
Fig.2 Schematic of influenza virus
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Why are the H and N numbered?

• Answer They stand for different hemagglutinins
  (H) and neuraminidases (N)
• Used to subtype influenza A strains
• 16 different Hs
• 9 different Ns
• Current human subtypes
• A(H1N1) and A(H3N2) primarily
• Antibodies against Hs and Ns made by our immune
  system protect us
• H and N subtypes are basis for flu vaccines

H5N1
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How is influenza spread?

• Answer Very quickly due to short incubation!
• 2 days after you catch the virus, you feel sick
• Infected people shed virus make others sick
• Shedding can begin 1 day BEFORE you feel sick
• Peak shedding first 3 days of illness
• Subsides by 5-7 days
• Can be 10 days in children

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Is flu only spread through the air?
Answer Mainly spread by large droplets in air.

• Large droplet mostly
• Generated by coughing, sneezing, talking
• spitting distance
• Contact with contaminated hands or surfaces,
  sometimes
• Microscopic droplets less common

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What are the symptoms of influenza?

• Sudden fever, muscle aches, headache, lack of
  energy, dry cough, sore throat, runny nose
• Fever and body aches last 3 to 5 days
• Cough and lack of energy 2 weeks
• Symptoms similar to other respiratory infections

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What is the difference between an epidemic and
pandemic?

• Answer They primarily differ in scope and the
  mechanisms by which they occur.
• Epidemics occur every year due to minor changes
  in influenza A viruses that circulate
• Same H and N as previous years
• Pandemics happen only occasionally when a
  completely new influenza A virus circulates
• DIFFERENT H and/or N from previous years

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How do yearly epidemics occur?

• Answer A process called antigenic DRIFT.
• Imperfect manufacturing of virus
• Small changes in H and N
• Partial immunity in population
• Incomplete protection still get sick
• Need new flu vaccine every year

Mutation
H3N2
H3N2
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What drives the occurrence of a pandemic?

• Answer
• Instead of antigenic DRIFT occurring,
• an antigenic

SHIFT
H5N1
happens.
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How does antigenic shift happen?
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What is required for a pandemic to occur?

• Answer A new virus with person-to-person spread.
• Novel virus to which population has little or no
  immunity
• Virus that causes severe illness in humans
• Virus must be capable of sustained
  person-to-person transmission

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What is H1N1 Flu?

• Respiratory disease of pigs caused by type A
  influenza viruses that causes regular outbreaks
  in pigs
• People do not normally get swine flu, but human
  infections can and do happen
• Have been reported to spread from person to
  person
• In the past transmission has been limited and not
  sustained beyond 3 people

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Signs and Symptoms of H1N1 Flu

• Fever
• Cough
• Sore throat
• Body aches
• Headache
• Chills
• Fatigue
• Diarrhea and Vomitting

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How does H1N1 flu Spread?

• Person to person through coughing or sneezing of
  infected people
• By touching a surface contaminated with the virus
  and then touching your mouth or nose
• --------------------------------------------------
  ----You cannot contract H1N1 flu by
• eating pork

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Are there medicines to treat H1N1 Flu?

• Antivirals
• Oseltamivir or Zanamivir
• Work best if started soon after getting sick
• May make illness milder and make you feel better
  faster

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What should I do to keep from getting H1N1 Flu?

• Avoid close contact
• Stay home when you are sick
• Cough etiquette
• Wash your hands often
• Avoid touching you eyes, nose, or mouth
• Practice good health habits

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What should I do if I get sick?

• Contact your health care provider (by phone if
  possible) before seeking care at a clinic or
  hospital
• Stay home and avoid contact with other people as
  much as possible (7 days after onset of illness
  or at least 24 hours after symptoms have
  resolved, whichever is longer.)

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Household contacts who are well should

• Remain home at the earliest sign of illness
• Minimize contact in the community to the extent
  possible
• Designate a single person to take care of the ill
  person and limit the interaction with the ill
  person

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Emergency Warning Signs

• Children

• Adults

• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want
  to be held
• Flu-like symptoms improve but then return with
  fever and worse cough
• Fever with a rash

• Shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting

SEEK EMERGENCY TREATMENT WITH ANY OF THESE
SYMPTOMS!
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Where are we now?
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World Health Organization Pandemic Phases
Phase 5 Larger cluster(s) but
human-to-human spread is still localized,
suggesting that the virus is becoming
increasingly better adapted to humans but may not
yet be fully transmissible (substantial pandemic
risk)
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Insert most recent case information here, can be
found at http//www.cdc.gov/h1n1flu/
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Public Health Efforts

• Enhanced surveillance
• Import and Travel limitations
• Limit travel to/from countries/continents
  affected by pandemic
• Isolate ill and quarantine exposed
• Trace contacts
• Cancel public gatherings (school, meetings,
  sporting events)
• Stockpile antivirals and supplies
• Education- Personal and Business Preparedness

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Whos watching in Nebraska?

• Influenza Sentinel Provider Surveillance System
• 11 providers (report to CDC)
• LHDs have flu surveillance plans
• Lab test result reporting
• 65 labs report
• School absenteeism survey
• LHD enter data
• Influenza-Like-Illness admissions
• 19 district/local health departments
• 89 acute care hospitals

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How can businesses prepare?

• Answer Make business continuity plan.
• Identify staff for critical functions
• Suspend non-critical functions
• Build depth by cross-training workers
• Alternative work schedules
• Explore telecommuting possibilities
• Teach workers cough etiquette and hand hygiene
• Use government pandemic planning checklist
• http//www.pandemicflu.gov/plan/

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Medical Clinic Planning

• System in place to monitor and review influenza
  activity in patients
• Collaboration with local health department for
  reporting unusual circumstances
• Contact Person Identified
• Patient Education
• Management and Triage Planning
• Infection Control
• Staff Reductions
• Following Treatment Recommendations
• Surge Capacity
• Stockpiling of Supplies
• Tracking of Special Needs Patients

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Acknowledgements

• This presentation was developed from a variety of
  resources including but not limited to
• The Infectious Diseases Society of America
• Centers for Disease Control and Prevention
• World Health Organization
• Joann Schaefer, MD Chief Medical Officer,
  Nebraska Health and Human Services System
• Center for Biopreparedness Education

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• Questions?
• For more information log on to
• www.pphd.org