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10/29/09 Brain Trust H1N1 & You H1N1 Influenza and the Community What are the origins of H1N1 How does its impact compare with seasonal influenza, age groups, severity, impact on my business Who should get H1N1 Vaccine? Where is my vaccine? Business Continuity Plans Reservoirs of Influenza A Aquatic birds are reservoirs for all 15 subtypes of Influenza A. They can carry these in their intestines without illness but if they pass it on to chickens, the chicken can get sick. Aquatic Birds are migratory. They fly up and down our coasts. Avian viruses that mutate or recombine are often the source of mammalian viruses and pandemic strains – 1 gram of feces can contain 10 million viral particles viable in water for 40 days at 4 C Unless there is massive exposure like cleaning a large chicken coop without a mask Humans do not get bird flu from migratory water fowl, domestic ducks or chickens Birds do not get human influenza from humans Humans do not usually get swine flu from pigs But the poor pig Can get bird flu from a bird Can get human influenza from humans If the pig gets both at the same time you get a really sick pig Genetic recombination can occur in the pig creating a novel virus that contains elements of avian influenza, swine flu and human influenza. Some of these novel recombinant viruses can spread from pigs to humans, then from human to human. That has the potential to start a pandemic Influenza A Hosts in Nature This time it resulted in A H1N1(Swine Flu) a quadruple recombinant virus What are the symptoms of Influenza Like Illness Fever above 100 degrees Sore throat and cough Body and muscle aches Headache With H1N1 some people also experience nausea, vomiting and diarrhea Bell shape curve but most people say it is significant. You know when you have it. Clinicopathologic Features of Fatal Novel H1N1 Marked difference in pathology and cellular tropism compared to seasonal influenza infection Pathology: Diffuse Alveolar Damage (ARDS) Primary viral pneumonia with infection of: Pneumocytes lining alveoli Bronchial epithelial cells and submucosal glands I will translate this slide for you Public Health - Seattle and King County Sentinel Provider Influenza Surveillance Laboratory Confirmed Isolates A-novel H1N1 A-H1 30 100 A-H3 25 20 influenza B 15 50 Percent positive 10 5 0 Week Ending 9/5/09 8/8/09 7/11/09 6/13/09 5/16/09 4/18/09 3/21/09 2/21/09 1/24/09 12/27/08 11/1/08 0 Percent positive A-unknow n 10/4/08 Number of Positive Specimens 35 Age of persons hospitalized with lab-confirmed influenza U.S. 2007--08 winter influenza season & April 15 - 11 Aug. 2009 MMWR. August 28, 2009 / Vol. 58 / No. RR–10 Use of Influenza A (H1N1) 2009 Monovalent Vaccine. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009 Groups Recommended to Receive Novel H1N1 Influenza Vaccine – June, 2009 Pregnant women HH contacts and caregivers for children <6 mo. of age Healthcare and emergency medical services personnel All people from 6 months - 24 years of age Persons aged 25 - 64 years who have health conditions associated with higher risk of medical complications from influenza including obese people. These five target groups comprise an estimated 159 million persons in the United States Use of Influenza A (H1N1) 2009 Monovalent Vaccine. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR August 21, 2009 / 58(Early Release);1-8 Groups Recommended to Receive Novel H1N1 Influenza Vaccine First When Supply is Limited Pregnant women People who live with/care for children <6 months of age Health care and emergency medical services personnel with direct patient contact Children 6 months through 4 years of age Children 5 through 18 years of age who have chronic medical conditions This subset of the five target groups comprises approximately 42 million persons in the United States Novel Influenza A H1N1 Vaccine Early allocation: Limited supply of FluMist – Target healthcare workers for initial doses Regular shipments of licensed vaccine expected to begin mid-October 2009. It is anticipated that seasonal flu and 2009 H1N1 vaccines may be administered on the same day. – Only formulations that can not be co-admiistered are two live virus vaccines (seasonal and H1N1 FluMist) For most people, a single dose of the 2009 H1N1 vaccine is necessary for protection against the 2009 H1N1 virus. – Children under 10 years of age are likely to be recommended to receive two doses. Novel Influenza A H1N1 Vaccine Target groups in King County (approximately 900,000) and uptake of seasonal influenza vaccine – 79,000 HCW (45%) – 550,000 6 months - 24 years (35-40%) – 250,000 adults with underlying high risk conditions (30%) – 18,000 pregnant women (16%) – ? Healthy household contacts (23%) Recent surveys suggest not all eligible persons will seek vaccination Vaccine Supply Not possible to predict with certainty timing of delivery or specific formulations If current unofficial production and distribution planning targets are met, we could receive over 300,000 doses by end of OCT However, the virus is growing slowly in the vaccine manufacturing pharmacies so we only have 90,000 doses Estimate 900,000 total in target groups in King County By end of OCT we could have vaccine for more than a third of eligible persons, close to the number who receive annual seasonal influenza vaccine…new schedule this will be late Nov and Dec. Who Can’t Get FluMist®? People less than 2 years or over 49 years of age Pregnant women People with underlying chronic medical conditions placing them at high risk for influenza People who are in contact with others with severely weakened immune systems when they are being cared for in a protective environment (for example, people with hematopoietic stem cell transplants People who have contact with others with lesser degrees of immunosuppression (for example, people with diabetes, people with asthma taking corticosteroids, or people infected with HIV) can get LAIV (FluMist®). Antiviral Treatment Treatment is recommended for all persons with suspected or confirmed influenza requiring hospitalization. Treatment is recommended for persons with suspected or confirmed influenza who are at higher risk for complications – – – – children <2 years old adults >64 years old pregnant women persons with certain chronic medical or immunosuppressive conditions – persons <19 years of age taking long-term aspirin therapy Treatment is recommended for persons with suspected influenza and more severe symptoms such as evidence of lower respiratory tract infection or clinical deterioration, regardless of previous health or age Exclusion of Ill Persons CDC recommends that people with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F [37.8°C]), or signs of a fever without the use of fever-reducing medications. – This is a change from the previous recommendation that ill persons stay home for 7 days after illness onset or until 24 hours after the resolution of symptoms, whichever was longer. – The new recommendation applies to camps, schools, businesses, mass gatherings, and other community settings where the majority of people are not at increased risk for influenza complications. –. Business Continuity Plans Keep sick people home or away from others Screen staff for symptoms Have staff know symptoms and when to seek care. Call first unless 911 need Modify sick leave policy if necessary Cross train, plan for abseenteism If someone can work from home, have systems in place to allow that