Novel H1N1 Influenza Public Health Approach to Pandemic Influenza

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Novel H1N1 InfluenzaPublic Health Approach to
Pandemic Influenza

• Joseph P. Iser, MD, DrPH, MSc
• Yolo County Health Officer

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Public Health Approach

• Population based, not individual care
• Surveillance
• In California, HOs have significant police powers
• Quarantine, closures
• Funding from DHHS and less from DHS (along with
  sheriff/police and fire officials)

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Surveillance

• Track national and state epidemiology
• Surveillance of school absences
• Viral testing (Novel vs seasonal and other causes
  of ILI)
• Hospitalizations and deaths due to influenza and
  pneumonia

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Interventions Available

• Three phases
• Information/Education
• Public Education
• Encouraging behavior change
• Partner (sheriff/fire and medical)
  Information/Education and Coordination
• Planning and delivering seasonal vaccine
• Planning and delivering N H1N1 vaccine

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Public Information/Education

• Coordinating education campaigns with other local
  counties/schools/cities/media
• Provided 20 public education presentations
  throughout the county
• Included background information on influenza,
  seasonal influenza, and Novel H1N1, with a focus
  on prevention

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Public Information/Education

• What is influenza?
• Origins and history of Novel H1N1
• Epidemiology and surveillance in Yolo County,
  region, state, and national
• Seriousness (36,000 vs gt90,000 deaths)
• Goal was to increase awareness, decrease fear,
  encourage behavior change

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Public Information/Education

• How Does Novel H1N1 Influenza Spread?
• Change behavior to decrease risk of spread
• Symptoms
• Warning Signs
• When to go/talk to doctor or emergency department

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Program Specific Information

• Schools/colleges/universities
• Businesses
• Religious institutions
• All based on continuity of operations
• Potential closures
• Businesses and schools plan for illnesses
• Parents need to plan for their own absences and
  for when their children are ill

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Partner Information

• Sheriff/Police/Fire
• Met regularly to discuss coordination/risk/educati
  on/ planning/risk vaccination
• Electronic information sent every 1-2 weeks,
  depending on change in information
• Coordinated vaccine administration
• Medical Partners
• Also met regularly, usually conference calls
• Communication of new medical information
  (pediatric compounding) and other partner
  communications
• Developed triage device
• Planning for health worker vaccinations/masks/medi
  cations

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Influenza Self-Screening Questionnaire 11/16/2009
FINAL DRAFT If you have symptoms of flu and
have concerns regarding managing your illness,
please call the SHS Advice Nurse at 530.752-9649
for consultation rather than presenting in person
to the student health center. Do not call to
schedule an appointment before calling the SHS
Advice Nurse for consultation. The SHS Advice
Nurse is a free service available to UC Davis
students during SHS hours of operation. In
general, if you are not experiencing high fever,
difficulty breathing, chest pain, persistent
vomiting, severe diarrhea or instability related
to dehydration, you will be advised how you can
manage symptoms with home care. Below is a
self-screening questionnaire to help you
determine what to do and when medical care may be
necessary.

• Your illness is unlikely to be influenza but may
  be another virus. If you have significant
  concerns about your illness, please contact the
  SHS Advice Nurse at 530.752.9649 during regular
  working hours.
• Otherwise, you may care for your illness with
  rest, plenty of fluids and follow-up as needed.
  If you develop a fever greater than or equal to
  100?F and symptoms of sore throat or cough,
  please repeat this self-screening questionnaire.
• If you are a dorm resident, contact your RA.
• If you are missing class work, notify your
  professors.

Have you had a fever of 100?F (37.8?C) or higher?
Or have you had shaking chills or night sweats?
Have you had symptoms of sore throat or cough?
Seek medical care immediately. If you feel this
is a life-threatening emergency, call 911 or go
to the nearest emergency room. Otherwise, please
come to SHS for care during our normal hours of
operation Monday, Tuesday, Thursday, Friday 8 am
- 530 pm Wednesday 9 am - 530 pm Saturday 930
am 1 pm Or contact the SHS Advice Nurse at
530.752-9649. After hours, seek care at the
nearest emergency room. The emergency facility
nearest to campus is Sutter Davis Hospital, 2000
Sutter Place, Covell Blvd. at Hwy. 113 -
530.756.6440.

• If you have any of the following symptoms, please
  seek medical care immediately
• Trouble breathing
• Rash
• Severe headache with blurred vision or vomiting
• Mental changes, e.g., confusion, not responding
• Neck or back stiffness
• Severe abdominal pain
• Persistent vomiting/dehydration

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Contact the SHS Advice Nurse at 530.752.9649
during SHS business hours if you have any
questions managing your illness. SHS staff are
here to help you. Please feel free to visit our
H1N1 Information Page for helpful tips and more
information.
Are you pregnant?
Do you have a chronic illness such as asthma,
diabetes, liver disease, or a suppressed immune
system?

• Do you have any of the following symptoms?
• Trouble drinking fluids
• Fever lasting longer than 72 hours
• Sore throat increasing in pain after 3 days
• Ear pain or discharge from ears
• Severe sinus pain
• Wheezing
• Chest pain
• Painful urination
• Abdominal pain

It is likely that your symptoms indicate
influenza infection. Most people with this
infection recover within one week. According to
information you have given, you are considered to
be a low risk for complications from influenza
and an antiviral medication is NOT needed. You
may care for your illness with rest, plenty of
fluids and acetaminophen or ibuprofen as needed
to treat fever and achiness. You are potentially
contagious to others please stay home (and away
from others as much as possible) for at least 24
hours after you no longer have a fever or signs
of fever without the use of fever-reducing
medicine. If you are a dorm resident, notify
your RA. If you are missing class work, notify
your professors. If your symptoms worsen or you
have any concerns, please seek medical care or
contact the SHS Advice Nurse at 530.752.9649.


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Seasonal Vaccinations

• Health Departments were told seasonal influenza
  was to be delivered early
• Scheduled mass vaccination clinics (PODs) October
  3
• Delivered 2300 doses in 3.5 hours (gt1)
• No more vaccine
• Plan on additional clinics once seasonal vaccine
  becomes available again

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Novel H1N1 Vaccinations

• Planning with medical partners
• Planning with sheriff and fire
• Planning with cities for PODs
• Schools
• Volunteers
• County employees as disaster service workers

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Health Department Responsibilities

• Community PODs (primarily undocumented/un-/underin
  sured)
• First Responder PODs
• County employees (Disaster Service Workers)
• Various very high risk groups
• Assuring equitability of vaccine deliveries

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Problems

• Seasonal influenza vaccine early
• Not enough seasonal influenza vaccine
• Much delayed Novel H1N1 vaccine
• Inequities in distribution
• Kaiser
• Medical providers
• Counties
• Budget cuts

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Resources

• Yolo County Public Health
• www.yolocounty.org
• California Department of Public Health
• www.cdph.ca.gov
• 1-888-865-0564 (Hot line)
• Centers for Disease Control Prevention (CDC)
• www.cdc.gov/h1n1flu/
• www.cdc.gov/h1n1flu/espanol/
• www.flu.gov
• 1-800-CDC-INFO (1-800-232-4636)(Hot line)