Transcript H1N1 Presentation Primary Care

Pandemic (H1N1) 2009
Presentation
(Massey University)
29 July 2009
Tui Shadbolt BHlthSci, MVS (candidate)
Coordinator Health Protection MidCentral
Public Health Service
Seasonal influenza
• Relatively minor epidemics of influenza
typically occur in NZ during winter
• Predominantly affects the elderly and very
young
• Serious illness in those with underlying
illnesses and in pregnancy
Seasonal Influenza
• Between 10 and 20% of the population are
infected with influenza each year
– (380,000 to 760,000 people).
• On average, 2.7% of the population (53,000 to
156,000 people) will consult a GP because of
influenza each year (1990-99)
• 266 to 874 New Zealanders end up in hospital
each year because of influenza
• 4 to 95 New Zealanders could die as a result of
being infected with influenza.
NZ Influenza-like-illness Sentinel
Surveillance
• 2008 estimated ~48 000 ILI presentations
to general practice (~33 000 in 2007)
– 1.2% population
– Deemed moderate
• Currently ILI is similar to 2008 (up to 12
June)
• Seasonal A(H1N1) has gene for
resistance to Tamiflu
Seasonal Vaccine
• Protective against the resistant A(H1N1)
• Too early to determine match with
circulating strains
• Vaccination period being extended to
September
Pandemic Influenza
• Global disease outbreak
– Causing disease in many parts of the world
• Can only occur when 3 conditions have
been met:
– New influenza virus subtype emerges
– Infects humans, causing significant morbidity and/or
mortality
– Spreads easily and sustainably among humans
20th Century Pandemics
• 1918 (Spanish Flu)
– 40-50 (poss 100) million deaths worldwide
– 8000 + deaths in NZ (>0.8% population)
• 1957 (Asian Flu)
– High illness rate, low death rate
• 1968 (Hong Kong Flu)
– Relatively benign
Pandemic (H1N1) 2009
• New influenza virus, first detected in April 2009
in Mexico and shortly after in the USA
• Referred to as “swine flu” because preliminary
laboratory testing showed that many of the
genes were similar to influenza viruses that
normally occur in pigs in North America
• Further testing has shown that this new virus
contains two genes from flu viruses that
normally circulate in pigs in Europe and Asia
and avian genes and human genes
(“quadruple reassortment” virus)
Pandemic (H1N1) 2009
• Symptoms
– Flu symptoms: fever, cough, sore throat,
runny/blocked nose, headache and body aches,
fatigue, vomiting/diarrhoea
• Infectious period
– 1 day before until generally 4 days after symptom
onset (potentially up to 7 days & longer in children
<5yrs)
• Incubation period
– Usually within 3-4 days of exposure, but potentially
up to 7 days
70
60
50
40
30
20
10
Age Group Years
65
+
64
45
to
44
25
to
24
15
to
14
to
5
1
to
4
0
<1
Rate Confirmed
Cases/100000 population
MDHB Confirmed H1N1 Rate to 22-07-09 by Age
Group
Rate Confirmed
Cases/100000 population
MDHB Rate Confirmed H1N1 to 22-07-09 by
Ethnicity
50
40
30
20
10
0
European
Maori
Pacific
Ethnicity (prioritised)
Other
Rate of Confirmed
Cases/100 000 Population
MDHB Confirmed H1N1 Rate to 22-07-09 by TA
(excludes Kapiti Portion of MDHB)
40
35
30
25
20
15
10
5
0
Horowhenua
District
Manawatu
District
Palmerston
North City
Territorial Authority
Tararua District
How Infectious is Pandemic (H1N1)
2009?
• Reproductive number
– Measures how many cases a single infectious case
causes in a susceptible population
• Seasonal Influenza R=1.2-1.4
– Partially susceptible population
• Estimates for Mexico
 2.2-3.1 (Eurosurveillance)
 1.4-1.6 (Science)
• Estimate for New York School
 2.7
Phase changes
Trigger for phase change
– Resources overwhelmed for stamp it out
phase
• Public health, primary care, laboratory and other
support services
– Evidence of sustained community
transmission
• Cases identified with no epidemiological link to
confirmed case or travel history
• Sentinel GP influenza-like-illness surveillance
• Routine ILI viral swabs
Phases so Far
• “Keep it out”
– Border response
• “Stamp it out”
–
–
–
–
Border response (intense)
Contact tracing
Tamiflu (treatment and prophylaxis)
Quarantine and isolation
• “Manage it”
– Cluster control
– High risk institutions
– Tamiflu (severe illness, underlying illness, high risk
institutions – minimal prophalaxis)
CIMS
• NHCC activated on the 25 April combined
Keep it out/stamp it out
• New Zealand went to Manage it phase
19th June 2009
• MidCentral PHS activated 27th April
– the last region to identify community spread
within sentinel surveillance sites moved to
“manage it” on 2 July 2009
New Zealand Cases
As at 1500hrs 28 July 2009
• 2704 Confirmed cases
• 13 Deaths
MidCentral PHS case numbers
• 61 confirmed cases
• 1 Death
• 60 (Wanganui)
• 0 Deaths
Isolation
• Reduce close contact with other people as much as
possible
– Separate rooms
– Avoid communal eating
– Staying at least 1 metre away wherever possible
• Preferable length of isolation is until no longer
considered infectious
– Children <5yrs old infectious longer (5 days of treatment or
symptom free)
– Adults without treatment (considered no longer infectious after 7
days or if well)
– Vulnerable treated with Tamiflu and recovered (72 hrs or
symptom free whichever is longest)
Strategies to manage isolation
Staff
• Reinforce sickness policy i.e. don’t come to work if you are
sick
Students
• Reinforce “don’t come to lectures or communal spaces if
you are sick”
• Taped lectures (for anxious conscientious students)
• Food eaten in rooms
• Increased cleaning in affected hostels
• Separating ablutions for those well and those who are sick
• Rubbish bags in open bins for easy disposal of tissues
• Easy access to hand washing facilities and handsanitiser
• Surgical masks for sick people when outside rooms
Infection Control
when dealing with people
with ILI
•
•
•
•
•
•
•
Physical Distancing
Isolation
Hand hygiene
Cough/sneezing hygiene
Ventilation
PPE
Cleaning
Key messages
If/when Massey has an outbreak
• Standard precautions
– Resources
– Knowledge
• Case logs in hostels
– For knowledge about those who are sick
• Staff and residents
– Information on how the outbreak progresses and
when it ends
• Liaison with Public Health
– How/if we use of National stockpile of Tamiflu and its
release
Signs and Symptoms
Symptoms are the same as for normal seasonal flu
Signs and symptoms of the new Influenza A (H1N1)
virus are similar to the symptoms of seasonal flu and can
include:
• fever (a temperature ≥38 °C), cough, sore throat, runny
or stuffy nose, body aches, headache, chills, fatigue.
• Some people also experience diarrhoea and vomiting.
Also, like seasonal flu:
• the worst symptoms usually last about five days, but
coughing can last up to two to three weeks
• some very young children, people with some long-term
medical conditions, pregnant women, and older people,
can get very sick
Care of those unwell in hostels
• Mild Flu like illness in most people
– Fever can be managed with fever lowering meds such as
paracetamol
– Important for them to be well hydrated (access to hydration drinks)
– Health line Number 0800 611 116
• Those who develop severe symptoms and you /or them
have concerns for their health
– Ring the health line, Massey Doctor or A/H call the Emergency
department advise severe ILI symptoms (wear a mask if going)
• Those who are pregnant or have underlying illnesses
most at risk e.g. Asthma, diabetes, chronic illness or are
immunocompromised - can these be identified
– These people need to be medically assessed within 48 hours of
onset of illness – ring the Dr for an appointment advise ILI
– They need to have good monitoring of the progression of their
illness if they deteriorate seek medical help
Health Line Phone Number
0800 611 116
•
•
•
Health line is a free service
operates 24 hours a day, 7 days a
week
staffed by registered nurses
If the wait is a long time and you
have concerns for your health
ring the DR or ED
What are the symptoms of most
concern and likely to indicate the need for
urgent medical assessment
•
•
•
•
•
•
starts to feel better, then gets worse
has a temperature of 38°C or greater
has chills or severe shaking
has difficulty breathing or chest pain
has purple or blue discolouration of the lips
is less responsive than normal, is unusually quiet, or
becomes confused
• is vomiting and unable to keep liquids down
• has signs of dehydration such as dizziness when
standing, not urinating, and in infants, a lack of tears
when they cry
• has seizures or convulsions.
Resources
• Travel
– www.safetravel.govt.nz
• General Queries from Public
– Healthline 0800 611 116
– www.moh.govt.nz
• CBAC planning
– Frances Guthrie at Compass Health first point of contact
• Public Health Surveillance Weekly Update
– http://www.surv.esr.cri.nz/virology/influenza_weekly_update.php
• Information Sheets
General Info Sheet
Cold vs Flu – Influenza Info Sheet
Thank you