Influenza AH1N1 New Virus, New Challenges

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Influenza A/H1N1New Virus, New Challenges

• Judith A. Monroe, M.D.
• State Health Commissioner
• 28 April 2009

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What Is A Pandemic?

• Pandemic worldwide epidemic
• Three factors must happen
• Novel (new) disease agent --gt yes
• Must cause severe disease in humans ? yes and no
• Must be easily transmitted person-to-person ?
  likely
• Pandemic has not been officially declared
• National public health emergency has been
  declared

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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

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Viral Reassortment
Reassortment/ mutations in birds
Pandemic virus

• Reassortment
• in humans

Human virus

• (2) Reassortment
• in swine

Pandemic virus
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A/H1N1/North America/Human

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

Current Outbreak Virus
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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

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Current Status
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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 Canada, Spain, Britain, France,
  New Zealand, Israel
• World Health Organization (WHO)
• No travel or trade restrictions issued those ill
  advised to avoid international travel
• Pandemic level raised to 4 (sustained
  person-to-person transmission in clusters)

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National Status

• 40 confirmed cases as of 27 April, 1600
• California 7
• Kansas 2
• New York City 28
• Ohio 1
• Texas 2
• US Department of Homeland Security has assumed
  lead role for response
• Strategic National Stockpile (SNS) being deployed
  for states antivirals, respiratory equipment

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Indianas Status

• One confirmed case as of 27 April, more expected
• 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

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Current 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

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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

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What You Can Do
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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

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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

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Very simple measures that everyone can do will
make a big, positive difference
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Questions?