Preparing for the Flu including H1N1

1
Preparing for the Fluincluding H1N1
2
What is the flu?

• The flu is a contagious respiratory illness
  caused by influenza viruses.
• It can cause mild to severe illness, and at times
  can lead to death.
• Influenza and pneumonia combined - 7th leading
  cause of death in the U.S.
• The economic impact is very high.

3
Typical Influenza Season

• Northern Hemisphere (Oct. to May)
• Southern Hemisphere (June to Sept.)
• Influenza can occur any time in the tropics

4
Epidemiology

• 5 to 20 of the population gets the flu each
  year.
• More than 200,000 people are hospitalized from
  flu complications and 36,000 die.
• Some people, such as the elderly, young children,
  and people with certain health conditions, are at
  high risk for serious flu complications.

5
Influenza Reservoirs

• Type A constantly circulates in natural
  reservoirs
• Birds are the natural reservoir of all subtypes
  of Influenza A viruses
• Migratory waterfowl
• Chickens, turkeys, ducks, geese
• Pigs
• Horses
• Whales, seals
• Dogs, cats, ferrets
• Humans

6
H1N1 Virus
7
What is novel H1N1?

• Novel H1N1 is a new influenza virus causing
  illness in people. It was first detected in
  people in the United States in April 2009. This
  virus is spreading from person-to-person
  worldwide, probably in much the same way that
  regular seasonal influenza viruses spread. On
  June 11, 2009, the World Health Organization
  (WHO) signaled that a pandemic of novel H1N1 flu
  was underway.

8
What is a pandemic?

• A pandemic is a global disease outbreak. An
  influenza pandemic occurs when a new influenza A
  virus emerges for which there is little or no
  immunity in the human population, begins to cause
  serious illness and then spreads easily
  person-to-person worldwide.

9
History of 20th century pandemics

• 1918 influenza pandemic caused at least 675,000
  U.S. deaths and up to 50 million deaths worldwide
  
• 1957 influenza pandemic caused at least 70,000
  U.S. deaths and 1-2 million deaths worldwide
• 1968 influenza pandemic caused about 34,000 U.S.
  deaths and 700,000 deaths worldwide

10
Why is H1N1 virus sometimes referred to as swine
flu

• This virus was originally referred to as swine
  flu because laboratory testing showed that many
  of the genes in this new virus were very similar
  to influenza viruses that normally occur in pigs
  (swine) in North America.
• Further study has shown that this new virus is
  very different from what normally circulates in
  North American pigs. It has two genes from flu
  viruses that normally circulate in pigs in Europe
  and Asia and bird (avian) genes and human genes.

11
How is H1N1 virus transmitted?

• Influenza-type viruses are among the most
  communicable viruses of man and can produce
  explosive outbreaks
• Primarily transmitted by hand transmission and
  droplets spread during coughing and sneezing

12
What are the H1N1 symptoms?

• Fever and chills
• Cough
• Sore throat
• Runny or stuffy nose
• Body aches and fatigue
• Headache
• Some individuals may have diarrhea and vomiting  

13
How long is one contagious?

• Persons with the H1N1 virus may be contagious
  beginning one day before they develop symptoms
  until up to seven days after they get sick.
  Children, especially younger children, might be
  contagious for longer periods.

14
Worldwide

• As of August 13, 2009
• 182,166 confirmed cases of H1N1 (swine)
• Most Countries in the World
• 1799 deaths

15

• Please keep in mind that given that countries are
  no longer required to test and report individual
  cases, the number of cases reported actually
  underestimates the real number of cases.
• Only a small proportion of persons with
  respiratory illness are even tested for H1N1.

16
Total U.S. 2009 H1N1 Flu Hospitalizations and
Deaths

• Posted August 21, 2009
• 53 reporting states and territories
• 7,983 hospitalized cases
• 522 deaths
• CDC discontinued reporting of individual
  confirmed and probable cases of 2009 H1N1
  infection on July 24, 2009.
• CDC will report the total number of
  hospitalizations and deaths weekly, and continue
  to use its traditional surveillance systems to
  track the progress of the 2009 H1N1 flu outbreak.

17
Spread of both seasonal and 2009 influenza A
H1N1 viruses as of August 15, 2009
18

• As of July 31, 2009, Missouri has reported 183
  confirmed cases of H1N1 infections, including one
  death.

19
Summary of H1N1 key points

• Once emerged, pandemic H1N1 virus spread to all
  50 states and globally very quickly
• Some areas more affected than others
• There has been continued summertime circulation
  with focal outbreaks Summer camps, military
  bases
• Elderly seemingly relatively spared-ages 5-24
  hardest hit
• Capable of causing severe disease and death
• - Most severe outcomes among people with
  underlying health problems that are associated
  with high risk of influenza complications
• Virus remains sensitive to oseltamivir and
  zanamivir

20
Current Observations

• The 2009 H1N1 influenza virus is the predominant
  influenza virus in circulation worldwide.
• The epidemiology of the disease caused by the
  2009 H1N1 influenza virus in the Southern
  Hemisphere is very similar to that described in
  the United States this past spring.
• There have been no significant changes detected
  in the 2009 H1N1 influenza virus isolated from
  persons in the Southern Hemisphere as compared to
  viruses isolated from persons in the Northern
  Hemisphere.

21
Immunization News

• On July 29, 2009, the Advisory Committee on
  Immunization Practices (ACIP)an advisory
  committee to CDCrecommended that novel H1N1 flu
  vaccine be made available first to the following
  5 groups
• Pregnant women
• Health care workers and emergency medical
  responders
• People caring for infants under 6 months of age
• Children and young adults from 6 months to 24
  years
• People aged 25 to 64 years with underlying
  medical conditions (e.g. asthma, diabetes)
• Combined, these groups would equal approximately
  159 million individuals. 

22
Vaccine Release

• The first volunteers to test the new vaccine were
  inoculated in August, and because most people
  will not have any existing immunity to H1N1, it
  will require two shots, spaced three weeks apart,
  to educate the immune system to recognize H1N1,
  and another six to eight weeks after that to
  generate true immunity to the virus.
• It appears the immunization may not be widely
  available until Oct.

23
What can we do in the interim??
24
CDC recommendations to keep students and staff
healthy
25
(No Transcript)
26
Practice good hand hygiene

• Scientists estimate that people are not washing
  their hands often or well enough and may transmit
  up to 80 of all infections by their hands. Hand
  washing may be your single most important act to
  help stop the spread of infection and stay
  healthy.
• Wash hands with soap and water for at least 20
  seconds (sing Happy Birthday song twice)
• Alternatively use alcohol-based hand cleaners
  with at least 60 alcohol

27
(No Transcript)
28
Practice respiratory etiquette

• Educate about the importance of covering coughs
  and sneezes. Use elbows instead of hands when a
  tissue is not available. Deposit all tissues in
  the trash.
• Provide easy access to tissues and running water
  and soap or alcohol-based hand cleaners.

29
Send the sick home

• Send sick students, teachers, and staff home and
  advise them and their families that sick people
  should stay at home until at least 24 hours after
  they no longer have a fever or signs of a fever
  (without the use of fever-reducing medicine).

30
Clean surface and items

• Clean surfaces and items that are more likely to
  have frequent hand contact such as desks, door
  knobs, keyboards, or pens, with cleaning agents
  that are usually used in these areas.
• Studies have shown that influenza virus can
  survive on environmental surfaces and can infect
  a person for 2 to 8 hours after being deposited
  on the surface

31
Isolation

• Move students, teachers, and staff to a separate
  room if they become sick at school until they can
  be sent home.
• Limit the number of staff who take care of the
  sick person and provide a surgical mask for the
  sick person to wear if they can tolerate it.

32
Further recommendations

• Have Personal Protective Equipment (PPE) such as
  masks available and ensure the equipment is worn
  by school nurses and other staff caring for sick
  people at school.
• Encourage early medical evaluation for sick
  students and staff at higher risk of
  complications from flu.  People at high risk of
  flu complications who get sick will benefit from
  early treatment with antiviral medicines.
• Stay in regular communication with local public
  health officials.

33
If the flu conditions become MORE severe, schools
should consider

• Extend the time sick students, teachers, or staff
  stay home for at least 7 days, even if they feel
  better sooner. Those who are still sick after 7
  days should continue to stay home until at least
  24 hours after symptoms have gone away.

34

• Allow high-risk students, teachers, and staff to
  stay home.  These students, teachers, and staff
  should make this decision in consultation with
  their physician and/or health professional.
• Conduct active fever and symptom screening of
  students, teachers, and staff upon arrival at
  school. Any sick students, teacher, or staff
  should be separated from others, offered a
  surgical mask, and sent home.

35

• Find ways to increase social distances (the space
  between people) at school such as rotating
  teachers between classrooms while keeping the
  same group of students in one classroom, moving
  desks farther apart, or postponing class trips.
• Consider how and when to dismiss students by
  working closely with your local and state public
  health officials. If you decide to dismiss all
  students, notify CDC and your state health and
  education agency by reporting a school or school
  district dismissal at www.cdc.gov/FluSchoolDismiss
  al. 

36
Specific Action Steps for Teachers

• Educate and encourage students to cover their
  mouths and nose with a tissue
• Remind students to practice good hand hygiene
• Be a good role model
• Keep an eye out for sick students
• Assure surfaces and items are clean
• Stay home when sick

37

• If you are pregnant, have asthma, diabetes, or
  other conditions that put you at higher risk,
  contact your doctor as soon as possible
• If you have children, plan ahead for childcare in
  the event of illness or school dismissals
• Be prepared in case the flu becomes more severe

38
Specific Action Steps for Schools

• Education of staff, parents, and students
• Review and revise existing pandemic plans
• Update student and staff contact information
• Identify and establish a point of contact with
  local public health agency
• Develop a plan to cover key positions
• Set up a separate room for holding of ill people
• Purchase PPE such as masks