Download Disaster Preparedness Scenario: Pandemic Influenza

H1N1 (Swine Flu)
Pandemic Influenza
Gordon C. Manin, MD, MPH
Medical Director
Overview
 Definitions/Background
 Annual/Seasonal
Influenza
 H1N1 (Swine Flu)
 Prevention & Treatment
Definitions
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Influenza (Flu): three types of Flu in humans
(A, B, C); only type A further classified by
subtypes that differ based on different surface
proteins (HA, NA)
H1N1 (Swine Flu A), Avian Flu A (H5N1)
Influenza Epidemic: caused by subtypes of
virus already circulating among humans,
“seasonal outbreaks”
Antigenic Shift: abrupt/sudden major change in
influenza A virus
Influenza Pandemic: new influenza A virus
effecting humans, global outbreak, causes
serious illness, easily spread from person to
person
Pandemic Influenza History
Date
Subtype
Worldwide
deaths
Highest
mortality
Waves/
duration
1918-1919
H1N1
20 – 50
50,000,000 year olds
3 waves
2 years
1957
H2N2
1968
H3N2
2009-?
H1N1
2,000,000
Elderly
1,000,000
Elderly
?
25 – 45
Year olds
2 waves
2 years
? 2 waves
3 years
?
Perspective from Seasonal
Influenza Outbreaks
 Usually
Occur Dec-March
 Primarily Spread Person to Person by
Respiratory Droplets from Coughs
and Sneezes
 Complications Include:
– Bacterial Pneumonia
– Dehydration
– Worsening of Chronic Medical Conditions
Perspective from Seasonal
Influenza Outbreaks
 Incubation
Time 1-5 Days (Average
2 Days)
 Typically Contagious 1 Day before
Symptoms to 5 Days after
Symptoms develop
 5-20% Get the Flu Each Year in USA
 200,000 Hospitalized Each Year in
USA
 36,000 Americans Die Annually
Awareness Phases
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W.H.O.* created 6 phases of awareness
1 Low risk to humans
2 High risk to humans
3 Human disease, no spread
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4 Small clusters human-human spread
5 Large clusters human-human spread
6 Sustained transmission in humans**
Level of risk/preparation increases as
levels increase
– Over time, levels may go up and down
– Geographic regions may be at different phases
simultaneously
– Unclear how much publicity will be given to
Phase changes
* World Health Organization
** As of June 11th, 2009
International Co-circulation of 2009 H1N1 and Seasonal Influenza
(As of September 20, 2009)
International Co-circulation of 2009 H1N1 and Seasonal Influenza
(As of October 16, 2009)
Weekly influenza activity estimates reported by state and territorial
epidemiologists (activity levels indicate geographic spread of both
seasonal and 2009 influenza A (H1N1) viruses, September 19, 2009
Weekly influenza activity estimates reported by state and territorial
epidemiologists (activity levels indicate geographic spread of both
seasonal and 2009 influenza A (H1N1) viruses, October 10, 2009
Current H1N1 Situation
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H1N1 a novel influenza virus, isolated April 2009
Incubation period unknown (Could range 1-7
days, more likely 1-4 days)
Infectious period for a Confirmed case of H1N1, 1
day before symptoms to 7 days after onset
As of July 31st, 2009, median age was 12 years,
with highest infection incidence among those
between 25 and 45 years of age
Lowest incidence of infection among persons age
≥ 65 years
WHO Declared Worldwide Pandemic June 11, 2009
Current H1N1 Situation
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Relatively Few Severe Cases in Older Persons
As of July 31st, 2009, Median Age of Hospitalized
Persons was 20 years, with highest Incidence in
those < 4years
Highest Hospitalization Rates Among Persons <
65 years
Median Age Among Persons who Died with Novel
H1N1 was 37 Years
Signs and Symptoms Similar to Seasonal
Influenza
Specific Diagnostic Testing Required to
Distinguish H1N1 from Seasonal Influenza
Symptoms
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Seasonal Influenza
Fever
Headache
Extreme Tiredness
Dry Cough
Sore Throat
Runny or Stuffy Nose
Muscle Aches
*Children may also experience
nausea, vomiting, or diarrhea
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Swine/H1N1 Influenza
All symptoms of
Typical Influenza
Diarrhea and Vomiting
High Risk Patients
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High risk for seasonal influenza (Patterns
are emerging for H1N1) complications
include:
– Children < 5 years old;
– Persons aged 50 years or older;
– Children and adolescents (aged 6 months to
18 years) who are receiving long-term aspirin
therapy and who might be at risk for
experiencing Reye syndrome after an influenza
infection;
– Pregnant women;
– Adults and children who have chronic
pulmonary, cardiovascular, hepatic,
hematological, neurologic, or metabolic
disorders
Prevention
Cover your nose and mouth with a tissue
when you cough or sneeze, dispose of
tissue
 Wash your hands often with soap and
water (alcohol-based hand cleaners are
also effective)
 Avoid close contact with people:
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– Stay home if you are sick for 7 days after your
symptoms begin or until you have been fever
(100o F) free for 24 hours, whichever is longer
vs. 24 hours free of fever
Current Seasonal Influenza
Vaccination Recommendations
Should Get Vaccinated
 People at High Risk
 All Children 6 months18 years
 People over 50
 People Who Can
Transmit to Others at
High Risk
 Residents of ChronicCare Facilities
 Pregnant in Flu Season
 Anyone Who Wants to
Reduce their Risk
Should not Get Vaccinated
 Severe Allergy to Eggs
 Severe Reaction to Flu
Vaccine in Past
 GBS within 6 Weeks of
Getting Flu Vaccine in
Past
 Children < 6 Months of
Age
 People with Moderate or
Severe Illness Should
Wait
H1N1 Vaccination
Sept. 15th, 2009, FDA Approved Four
H1N1 Vaccine Manufacturers
 State Health Departments Received First
Shipments September 30th, 2009
 Immune Response in Most Healthy Adults
8-10 Days After a Single Dose
 Manufactured with and without Thimerosal
 Same Contraindications and Side Effects
as Seasonal Influenza Vaccine
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Current ACIP H1N1 Influenza
Vaccination Recommendations
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Initial Target Groups (order of target
groups does not indicate priority):
– Pregnant women
– Persons who live with or provide care for
infants aged < 6 months (i.e. parents, siblings,
and daycare providers)
– Health-care and emergency medical services
personnel
– Persons aged 6 months to 24 years, and
– Persons aged 25-64 years who have medical
conditions that put them at higher risk for
influenza-related complications
Current ACIP H1N1 Influenza
Vaccination Recommendations
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Subset of Target Groups During Limited
Vaccine Availability:
– Pregnant women,
– Persons who live with or provide care for
infants aged < 6 months (i.e. parents, siblings,
and daycare providers),
– Health-care and emergency medical services
personnel who have direct contact with
patients or infectious material,
– Children aged 6 months to 4 years, and
– Children and adolescents aged 15-18 years
who have medical conditions that put them at
higher risk for influenza-related complications
What Should I Do If I Get Sick?
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Contact a Health Care Provider if:
– You live in areas where cases have been identified
and you develop influenza-like symptoms
– You are a high risk patient and develop influenzalike symptoms
– You are worried about your symptoms
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CALL BEFORE GOING TO PHYSICIAN’S OFFICE!!
– Not everyone needs to be seen, tested, or treated
– Medical providers need to be prepared
– Should patient be seen by personal physician or
company physician
Current Antiviral Oral
Medications
 Amantadine: Swine (H1N1) Flu Currently
Resistant
 Rimantadine: Swine (H1N1) Flu Currently
Resistant
 Oseltamivir
(Tamiflu)
 Zanamivir (Relenza)
*Avoid Aspirin if 18 years or younger
Other Recommendations
 Dietary
Restrictions
 Contact with Pigs
 Travel
 Vaccination for Seasonal Flu
 Oral Medications
 Masks
Possible Scenarios
 If
pandemic occurs:
– High absentee rate
 Employee
illness (30 – 40%)
 Family illness/death
 “Precautionary absence”
– Likely to occur in waves of 3-6 months
over total duration of 1-2 years
– Medical care system will be severely tested
Issues Disaster Preparedness
Teams Must Consider
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Relapsing high absentee/death rates in
employees
 Protective
measures (masks, gloves, surface
disinfectants) for those at work
 Virtual Office
 Pay policies for “precautionary absence”
Insufficient vaccine/medication
 Federal/state/local coordination
 Employee communications
 Other …
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Resources
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Occupational Health Disaster Expert Network
www.ohden.sph.unc.edu:9002/pandemic
Department of Health and Human Services
www.pandemicflu.gov
Centers for Disease Control
www.cdc.gov
World Health Organization
www.who.org
Pennsylvania Department of Health
www.health.state.pa.us/health/site
Conclusions
Pandemic H1N1 Influenza is Upon Us
 Experts have been Predicting that
Pandemic Influenza will Return at Some
Point
 Base Actions on Best Available Evidence
 Communicate with Your Providers,
Employees, and Stakeholders
 Organizations Should Take the Time Now
to Gather Accurate Information and Plan
for How Your Organization will Respond to
any Disaster (Intentional, Unintentional,
or Natural)
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