Transcript SARS Preparedness Planning for Infection Control

10/29/09 Brain Trust
H1N1 & You
H1N1 Influenza and the
Community
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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
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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
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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
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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
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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
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Marked difference in pathology and cellular
tropism compared to seasonal influenza
infection
Pathology:
 Diffuse Alveolar Damage (ARDS)
 Primary viral pneumonia with infection of:
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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
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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
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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
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Early allocation: Limited supply of FluMist
– Target healthcare workers for initial doses
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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)
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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
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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%)
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Recent surveys suggest not all eligible persons will
seek vaccination
Vaccine Supply
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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®?
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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
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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
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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
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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
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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.
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Business Continuity Plans
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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