Welcome The Cold and Flu Webinar will begin momentarily'

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Welcome!The Cold and Flu Webinarwill begin
momentarily.

• September 24, 2009

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The Soap and Detergent AssociationWashington, DC
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Participant Reminders

• Please be aware that we are recording this
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• Please use the control panel on the question bar.
  
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Goals

• Provide up to the minute update on H1N1
• Share science-based information from trusted
  sources
• Make you aware of educational materials
• Motivate you to get involved to do something
• Answer your questions

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Speaker Panel

• Diane Allensworth, PHD
• Centers for Disease Control and Prevention
• Barbara Hyde, MBA, CAE, Director, Communications
• American Society for Microbiology
• Nancy Bock, M.Ed., Vice President, Education
• The Soap and Detergent Association
• Martha Chapin, Manager, Education
• The Soap and Detergent Association

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Cold Flu Season Predictions

• Diane Allensworth
• Centers for Disease Control Prevention

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Novel H1N1 Influenza

• Background
• General Information

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2009 H1N1 Activity Update

• Influenza illness, including from 2009 H1N1, is
  ongoing in the U.S.
• As of August 14, 2009, state and local public
  health departments have reported
• 7,511 2009 H1N1 hospitalizations
• 477 deaths

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2009 H1N1 Flu

• 2009 H1N1 flu virus is the predominant flu virus
  in circulation worldwide.
• Epidemiology of disease in Southern Hemisphere
  very similar to spring/summer in U.S.
• Disease may be decreasing in South America and
  part of Australia, but continuing to increase in
  Southern Africa.

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Is This a Pandemic?

• During regular flu season we anticipate
• gt200,000 hospitalizations / year
• 36,000 deaths / year
• Substantial economic impact 37.5 billion in
  economic costs

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Pandemic (H1N1) 2009 influenza - Summary of key
epidemiologic findings in the US

• Distribution of cases/hospitalizations/deaths
• Highest incidence lab confirmed infections in
  school age children
• Highest hospitalization rates among ages 0
  through 4
• Hospitalization rates for Apr-Jul 2009 approach
  cumulative rates for seasonal influenza among
  school age children and 19 through 49 year old
  adults
• Fewest cases but highest case-fatality ratio in
  older adults

ACIP Influenza Workgroup Considerations. ACIP
Meeting, July 29, 2009.
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Pandemic (H1N1) 2009 influenza - Summary of key
epidemiologic findings in the US

• Distribution of cases by age group is markedly
  different compared to seasonal influenza
• Higher proportion of hospitalized cases in
  children and young adults
• Few cases in older adults
• No outbreaks among elderly in long term care
  facilities
• 70 of hospitalized cases have an underlying
  medical condition that confers higher risk for
  complications
• Pregnancy is a higher risk condition

ACIP Influenza Workgroup Considerations. ACIP
Meeting, July 29, 2009.
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What Are the Symptoms?

• The symptoms of this novel H1N1 Influenza
  (formerly referred to as swine flu) in people are
  similar to the symptoms of regular human flu
• Fever, cough, sore throat, body aches, headache,
  chills and fatigue.
• Some people have reported diarrhea and vomiting.

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How Influenza Viruses Spread

• Primarily through respiratory droplets
• Coughing
• Sneezing
• Touching respiratory droplets on self, another
  person, or an object, then touching mucus
  membranes (e.g., mouth, nose, eyes) without
  washing hands

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Can You Get Novel H1N1 Influenza (Formerly
Referred to as Swine Flu)By Eating Pork?

• No. You cannot get the novel H1N1 Influenza Swine
  by eating pork, pork products, or any food.
• These influenza viruses are not spread by food.
• Eating properly handled and cooked pork products
  is safe.

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What Can You Do to Protect Yourself?

• First and most important wash your hands
• Try to stay in good general health
• Get plenty of sleep
• Be physically active
• Manage your stress
• Drink plenty of fluids
• Eat nutritious food
• Try not to touch surfaces that may be
  contaminated with the flu virus
• Avoid close contact with people who are sick

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What Can You Do to Protect Yourself, Cont?

• Secure a vaccination, when available
• CDCs Advisory Committee on Immunization
  Practices (ACIP) met July 29, 2009 to make
  recommendations on target groups for initial
  vaccination efforts.
• All people age 6 months through 24 years
• Household and caregiver contacts of children
  younger than 6 months of age (e.g., parents,
  siblings, and daycare providers)
• All pregnant women
• Healthcare and emergency services personnel
• People age 25 through 64 years with health
  conditions associated with higher risk of
  influenza complications

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What Should I Do if I Get Sick?

• Warning Signs in Children
• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Irritable, the child does not want to be held
• Flu-like symptoms improve but then return with
  fever and worse cough
• Fever with a rash
• Warning Signs in Adults
• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting

• If you are sick, you should stay home and avoid
  contact with other people as much as possible.
• If you get sick and experience any of these
  warning signs, seek emergency medical care.

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Treatment

• For novel influenza A (H1N1), CDC has determined
  that the benefits of treatment or
  chemoprophylaxis with zanamivir or oseltamivir
  likely outweigh the theoretical risks of
  antiviral use.
• Interim antiviral guidance recommends that
  hospitalized patients be treated with antiviral
  medications and that sick patients who are at
  high risk of serious seasonal flu-related
  complications also receive antiviral treatment

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Treatment cont.

• For prevention (chemoprophylaxis), CDC recommends
  that clinicians consider use of antivirals in
• People who are at high risk of serious seasonal
  flu-related complications and have been in close
  contact with someone who is ill with novel H1N1
  virus.
• Health care workers, public health workers and
  emergency responders who have been in close
  unprotected contact (ie, no personal protective
  equipment) with persons who are sick with novel
  H1N1.

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2009 Novel H1N1 Planning Objectives

• Coordinate with government partners to
• prepare for vaccine dissemination
• allow for joint response
• support testing and surveillance
• harmonize guidance and communication

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Other CDC Response

• 25 percent of the SNS supplies has been deployed
  to all 62 states or project areas.
• CDC-developed PCR diagnostic test kits to detect
  this virus.
• Test kits have been distributed to all 50 states,
  DC, Puerto Rico and internationally.

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What is CDC doing now to prevent and control the
spread of H1N1?

• - CDC works very closely with state and local
  officials in areas where human cases of H1N1
  infections have been identified. EpiAid teams
  have been deployed, and many other
  epidemiological activities are taking place or
  planned.
• - CDC is developing guidance for specific groups.

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Recommended school responses under conditions
with similar severity as in spring 2009

• Stay home when sick
• Separate ill students and staff
• Hand hygiene and respiratory etiquette
• Routine cleaning
• Early treatment of high-risk students and staff
• Consideration of selective school dismissal

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Recommended school responses under conditions of
increased severity compared with spring 2009

• Active screening
• High-risk students and staff members stay home
• Students with ill household members stay home
• Increase distance between people at schools
• Extend the period for ill persons to stay home
• School dismissals
• Reactive
• Preemptive

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Recommended Strategies Stay home when sick

• Individuals with ILI should remain home for at
  least 24 hours after they are free of fever or
  feverishness without the use of fever-reducing
  medications
• 3 to 5 days in most cases
• Avoid contact with others
• Can shed virus before fever, gt 24 hours after
  fever ends, without any fever, and while using
  antivirals
• Hand hygiene
• Respiratory etiquette
• Longer exclusion period may be appropriate for
  settings with high numbers of high-risk persons

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Recommended strategies Separate ill students
and staff

• Move students and staff with ILI symptoms to
  separate room immediately until they can be sent
  home
• Have them wear surgical masks when near others
• Designate non-high-risk staff with limited
  interactions with others to provide care
• Staff who provide care for persons with ILI
  should use appropriate personal protective
  equipment

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Recommended strategies Hand hygiene
respiratory etiquette

• Wash hands often especially after coughing or
  sneezing
• Time, facilities and materials should be provided
  for students to wash hands as needed
• Alcohol-based hand cleaners are also effective
• Cover nose and mouth to cough or sneeze
• Discard tissue after use

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Recommended strategies Routine Cleaning

• Regularly clean areas and items likely to have
  frequent hand contract and when visibly soiled
• Use cleaning agents usually used
• Not necessary to disinfect beyond routine
  cleaning
• Train custodians and others who clean (classroom
  teachers)

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Summary

• For the most current information on the H1N1
  influenza outbreak, visit http//www.cdc.gov/h1n1f
  lu/
• CDC, WHO and public health officials worldwide
  are carefully monitoring the situation.
• Follow all recommendations for preventing the
  spread of influenza.
• For local guidance, contact your state, local, or
  county health officials.

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The Science of Hand Hygiene

• Barbara Hyde
• The American Society for Microbiology

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Clean Hands Telephone and Observational Studies

• 92 SAY they wash their hands after using a
  public restroombut only 77 observed doing so
• By gender, one-third of men dont wash their
  hands, while 88 of women lather up
• Harris Interactive Poll 2007

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Why hand hygiene matters
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Transmission of Influenza A

• Hand contact may be more effective than airborne
  transmission
• A review article concludes transmission occurs
  at close range rather than over long distances,
  suggesting that airborne transmission, as
  traditionally defined, is unlikely to be of
  significance in most clinical settings.
• The Lancet Infectious Diseases, 7(4), 257-265,
  2007

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Virus Shedding Persists

• Two new research studies presented at the 49th
  annual Interscience Conference on Antimicrobial
  Agents and Chemotherapy, September 2009, suggest
  that patients with H1N1 flu may continue to shed
  the virus up to 8 or more days after becoming
  ill, even after treatment with Tamiflu. Neither
  study, however, determined if people were
  shedding enough virus to spread infection.

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Hand-to-Face Contact is Frequent

• Many respiratory illnesses are thought to be
  transmitted via contaminated hand contact with
  mouth, eyes, or nostrils. Videotape study of 10
  subjects doing office work showed average total
  contact more than 15 times per hour.
• J Occup Environ Hyg. 2008 Jun5(6)347-52

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Hand Hygiene Removes Flu Viruses

• A study of 20 volunteers in Australia measured
  the effect of hand hygiene interventions by
  coating hands with large amounts of H1N1 seasonal
  flu virus, equivalent to the amount retained on
  hands after wiping a runny nose.
• Soap and water or alcohol-based sanitizers were
  very effective in reducing or eliminating the
  virus on the subjects hands. The investigators
  also report that soap and water were somewhat
  more effective in reducing the number of viruses
  on the hands than the hand rubs.
• Clin Infect Dis 2009 Feb148(3)285-91

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Hand Sanitizer Use Reduces Illness

• University of Colorado controlled study with
  ready access to hand sanitizers in dorms
• 1/3 fewer complaints of cough, congestion, fever
• Risk of getting sick 20 lower
• Missed 43 fewer school days
• Source GOJO Industries, Inc

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When and how to wash
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When to Wash . . .

• Before preparing food.
• After eating meals and snacks.
• After using the restroom.
• After touching animals.
• When hands are dirty.
• When you or someone around you is ill.

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How to Wash Your Hands

• Wet hands with warm running water and add soap.
• Rub hands together to make a lather.
• Wash for at least 20 seconds.
• Rinse hands.
• Dry hands thoroughly.

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No Soap Water?

• Hand Sanitizers
• Use one or two squirts or pumps of the product.
• Rub hands together briskly, including the front
  and back, between fingers, around and under nails
  until hands are dry.
• Wipes
• Wipe all areas of hands until they are visibly
  clean.
• Use one or more wipes and dispose in an
  appropriate trash container.
• Let hands air dry.

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www.microbeworld.org
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Educational Resources
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Clean Hands Coalition
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CDC Resources

• http//www.cdc.gov/h1n1flu/
• http//www.pandemicflu.gov/
• http//www.who.int/csr/disease/swineflu/en/index.h
  tml

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CDC
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CDC Kid Friendly Sites
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SDA Resources

• www.itsasnap.org
• www.cleaning101.com
• Twitter.com/Cleaning101
• Twitter.com/itsasnaporg
• education_at_cleaning101.com
• [phone]

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AgainstDisease.com

• A historical and technical record on the role of
  sanitation, medical advances, cleanliness and
  hygiene on public health and infection control.

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Scrub Club
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Fight BAC!
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National Coalition for Food Safe Schools
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Events
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Clean Hands Week
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Global Handwashing Day

• October 15, 2009
• Public Private Partnership

www.globalhandwashingday.org
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National Handwashing Awareness Week

• First full week of December each year since
  1999. 
• Dec. 6 12, 2009

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QUESTIONS AND ANSWERS
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Thank you!

• Get involved in cold and flu preparedness!
• Please send your program successes to
  nbock_at_cleaning101.com.
• Share this webinar with others.
• Use the free resources that are available.
• Tell us what you thought about the webinar!

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Websites

• The Centers for Disease Control and Prevention
• www.cdc.gov
• The American Society for Microbiology
• www.asm.org
• The Soap and Detergent Association
• www.cleaning101.com