Transcript Slide 1

Novel Influenza
A (Pandemic)
H1N1
Rachel Long, MT MSEd, CIC
Public Health Epidemiologist
Infection Control
Objectives
• Describe the Epidemiology of H1N1
• Identify signs and symptoms of H1N1
• Discuss ways to prevent illness from spreading
• Describe vaccines for this season
• Describe anti-virals and their use
Influenza Overview
Structure: 16H and 9N
Terms:
– Pathogenic
– Virulent
H1N1
– Pathogenic (spreads easily)
– Low virulence (can cause death
Vocabulary
• Endemic
• Epidemic
• Pandemic
Pandemic Levels
Past Pandemics due to Flu
• 1918: 20- 100 million deaths world wide
– 500,000 to 675,000 in US
– Came in waves
• 1957: 45 million infected, 70,000 died
• 1968-69: 50 million infected, 33,000 died
• 1976: swine flu event/500 cases recorded
Differences in Seasonal and Pandemic
Strain
• Age groups affected
– Seasonal:
• >65 and <1 year of age
• 90% of death in >65 year old group
– Pandemic H1N1:
• young >5 <24 years of age
• Death in adults under the age of 50 is most common
• Severe disease in young otherwise healthy (ICU stays)
Differences
in Seasonal
NC H1N1
Cases by Week ofand
ReportPandemic
Strain
Confirmed Cases
• 100Age groups affected
– Seasonal:
80 • >65 and <1 year of age
• 90% of death in >65 year old group
60
– Pandemic H1N1:
• young >5 <24 years of age
20 • Death in adults under the age of 50 is most common
• Severe disease in young otherwise healthy (ICU stays)
40
0
4/11 4/18 4/25 5/2 5/9 5/16 5/23 5/30 6/6 6/13 6/20 6/27 7/4 7/11 7/18 7/25
Week Ending Date
World Preparing for Second Wave
•
•
•
•
Monitoring in other parts of world now
Has not changed (mutated) at this time
H1N1 (Pandemic strain) is dominant
Clinical picture consistent across all countries
– Mild illness for most
• Monitoring Drug Resistance
– Some found but not propagated at this time
2 flu Seasons?
• Regular Flu Season
• H1N1 Flu season
• Could get here before vaccine
• Shouldn’t be any more sever than the spring
• Vaccination important for HCW
ED Visits and Admissions for
Influenza-Like Illness
How does Flu Spread
• By droplets: 3-6 feet
• Droplets are spread when:
– Cough
– Sneeze
– Talk
– Breathe
Clinical Features among NC Cases
Fever
Cough
315/323 (98%)
289/307 (94%)
Sore Throat 122/201 (61%)
Coryza
114/211 (54%)
Myalgias
123/203 (61%)
Diarrhea
38/234 (16%)
Vomiting
52/241 (22%)
Hospitalized
87/406 (21%)*
* Reflects disproportionate testing of
hospitalized patients
Spread of H1N1
• Infectious Period
– For a confirmed case is 1 day prior to the cases illness onset to 7
days after onset
• Close Contact
– Being within 3 feet of an ill person who is a suspected or
confirmed case of H1N1 during the” infectious period”
• Clinical care givers: Use Standard Precautions for your protection
as well as your patients when dealing with respiratory regardless of
isolation
Flu Vaccine
•
•
•
•
Inactivated virus (dead)/lasts 1 year
Many will need a seasonal (1) and H1N1 (1)
Both this year are made exactly the same way
Works by stimulating the immune system to provide
protection
National
H1N1 Vaccination Program
• H1N1 Vaccine Not Yet Available
– Release date mid October 2009
• Initial Amount
– 40 Million Doses During First Month
• Subsequent Weekly Production
– 10 to 30 Million Doses
Mission will receive weekly allotments after initial
High Risk Groups For H1N1 Vaccine
• Pregnant women
• Children under 4 years old
• Contacts of infants less than 6 months old
• Healthcare workers
• Those aged 25 to 64 with high risk conditions
H1N1 Vaccine Facts
( as of Sept 7, 2009)
•
2009 H1N1 influenza vaccines are well tolerated and induce a strong immune response
in most healthy adults when administered in a single unadjuvanted 15-microgram dose
•
Vaccine availability depends on several factors including manufacturing time and time
needed to conduct clinical trials
•
seasonal flu vaccine is not expected to protect against the 2009 H1N1 flu
•
do not expect that there will be a shortage of 2009 H1N1 vaccine
•
availability and demand can be unpredictable
*1976 swine flu virus and the 2009 H1N1 virus are different enough that its unlikely a
person vaccinated in 1976 will have full protection from the 2009 H1N1
http://www.hhs.gov/news/press/2009pres/09/20090911a.html
Declination Statement
Mission Hospitals has recommended that I receive influenza vaccination in order to protect myself and the
patients I serve.
The reason I am choosing not to take the influenza vaccine is:
(Circle all that apply)
I have gotten the vaccine in the past and it made me sick.
I received the vaccine elsewhere.
Fear of Gillian Barre Syndrome.
I am allergic to eggs.
I never get the flu.
Mission Hospital will require
either vaccination or sign
declination statement
I acknowledge that I am aware of the following facts:
Influenza is a serious respiratory disease that kills as average of
36,000 persons and hospitalizes more than 200,000 persons in the
United States per year.
Influenza vaccination is recommended for me and all other healthcare
workers to prevent influenza diseases and its complications, including death.
If I become infected with influenza, even when my symptoms are mild, I can spread severe illness to others.
I understand that the strains of virus that cause influenza infection change almost every year, which is why a different influenza vaccine is
recommended each year.
I cannot get the influenza disease from the influenza vaccine.
The consequences of my refusing to be vaccinated could endanger my health and the health of those with whom I have contact, including:
Patients at Mission Hospitals
My Family
My Co-workers
My Community
Despite these facts, I am choosing to decline influenza vaccination right now.
Flu Myths
Some common myths that are NOT true
include:
Myth 1: "The flu shot will give you the flu.“
Myth 2: "The flu shot does not work.“
Myth 3: "The flu shot makes me sick.”
Myth 4: "I never get sick, so I don't need to
get vaccinated
Fall 2009: What to
Expect in the Workplace
Absenteeism
• H1N1 Illness is now in the general population
– Up to 30% of Population (according to CDC)
• 50 to 100 Million People will get
H1N1 Will Have a Greater Affect on Workforce
Population
• We are expecting a 10‐Fold Increase in
Absenteeism at the Pandemic’s Peak
Mission Information
www.missionhospitals.org
Visitation Limited at 2% ILI Activity in
State
H1N1 flu
is widespread
For our patients’ health –
and yours – please:
Visit only if you are immediate family or
patient’s caregiver
No teens or children
Do not visit if you are sick
Wash your hands frequently
Thank you for helping prevent the
spread of flu.
September 7, 2009
Policy number: 200.096
If you are Sick with H1N1 flu
•
•
Stay home :
24 hours after their fever is gone (without the use of fever-reducing medicine). A fever
is defined as having a temperature of 100 degrees Fahrenheit or 37.8 degrees Celsius or
greater.
•
•
Get plenty of rest;
Drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants)
to keep from getting dehydrated (loosing too much fluid);
•
•
Cover coughs and sneezes;
Clean hands with soap and water or an alcohol-based hand rub often, especially after
using tissues and after coughing or sneezing into hands;
•
Avoid close contact with others, including staying home from work or school; and
•
Be watchful for emergency warning signs that might indicate you need to seek medical
attention
Signs of Severe Illness
1.
2.
3.
4.
5.
6.
7.
Pediatric
Tachypnea
Blue or Grey Skin color
Not Drinking enough fluids
Alterations in mental
status
Irritability beyond normal
Fever with rash
Flu symptoms that
improve and then return
•
•
•
•
•
Adult
Difficulty breathing or
shortness of breath
Chest pain or pressure
Sudden dizziness
Altered Mental Status
Severe or persistent
vomiting
Antiviral Uses
• Treatment: timing critical first 48 hours of
symptoms.
– Everyone does not need Tamiflu who has
Influenza…
• hcw with direct patient care who is high
risk
• Ill person with co-morbitidies
• Prophylaxis: Prevention/Post Exposure timing
(1-2 days)
Face Mask and Respirator Use
• Droplet/Contact until test comes back
• Droplet for confirmed A or confirmed H1N1
• Except for aerosol generating procedures
– Use N-95 or PAPR..this includes
• collection of specimen
• Suctioning
• Nebulizer Treatment
• Respiratory specimen
• Intubation
• Bronchoscopy
http://flu.nc.gov/epi/gcdc/H1N1flu.html
Website for Division of Public Health Information
Patient Information
Nursing Policy 5.08: Nasopharyngeal
Specimens
Collection Steps
1. Explain procedure to
patient
2. Have needed supplies/PPE
3. Place head slightly tilted
back
4. Have patient blow nose to
remove mucous (no snot)
NC State Lab Influenza Virus Testing Results by
MMWR Week, 2008–2009
80
90%
70
80%
70%
60
60%
50
50%
40
40%
30
% Positive†
#Positive Specimens
Influenza Positive Tests Reported by the N.C. State Laboratory of Public Health by Week
30%
20
20%
10
10%
0
0%
40 41 42 43 44 45 46 47 48 49 50 51 52 53 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
MMWR Week
Seasonal A (H1)
Seasonal A (H3)
A unsubtypable*
Seasonal B
Novel A (H1N1)
Percent Positive†
Accuracy of Flu Screens
• Accuracy Depends Upon Prevalence
• The positive and negative predictive values vary considerably
depending upon the prevalence of influenza in the community.
• False-positive (and true-negative) influenza test results are more
likely to occur when disease prevalence is low, which is generally at
the beginning and end of the influenza season.
• False-negative (and true-positive) influenza test results are more
likely to occur when disease prevalence is high, which is typically at
the height of the influenza season.
• Viral Panels do not guarantee identification of H1N1
• Flu Screens are only 50% sensitive for H1N1
It’s a “FARES” Event
• Fluid
• And
• Rapidly
• Evolving
• Situation