Transcript H1N1:Wide Spectrum of Disease

FPNANS
H1N1 Information Session
October 17, 2009
Current Situation:
WHO Level 6
H1N1 Pandemic
Signs and Symptoms
H1N1 (Human Swine Influenza) is defined as:
“fever and/or cough with one or more of
sore throat, sore muscles, sore joints or
extreme fatigue. Although other
symptoms, including diarrhea may be
present (especially in children), those
noted above remain the most common and
prominent”
H1N1
Transmission:
• Direct: droplet spread – coughing or
sneezing
• Indirect: contaminated surfaces
Virus can survive for:
• ~ 5 min on hands
• Up to 12 hrs on cloth/paper/tissue
• Up to 2 days on hard surfaces
H1N1
Seasonal Influenza:
• 10-25% population
• 4,000 deaths
• 20,000 hospitalizations
Epidemic curve of laboratory-confirmed cases of
H1N1
by date of symptom onset, Nova Scotia,
July 17, 2009 12h00 ADT (n=376)
100
90
70
60
50
40
30
20
10
Week Ending
1-Aug
25-Jul
18-Jul
11-Jul
4-Jul
27-Jun
20-Jun
13-Jun
6-Jun
30-May
23-May
16-May
9-May
2-May
25-Apr
18-Apr
11-Apr
4-Apr
28-Mar
0
21-Mar
Number of Cases
80
H1N1:Wide Spectrum of Disease
NS: 1
NS: 18 (8 ICU)
NS: 570 (lab confirmed)
NS: Number unknown
Data as of August 2009
Laboratory-confirmed cases of H1N1 by DHA,
Nova Scotia, July 17, 2009 12h00 ADT (n=376)
Lab Confirmed
H1N1 in NS
160
Rate per 100,000 population
140
• Widespread in the community
• Younger age groups most affected
• Reported case numbers
decreasing
• Surveillance efforts shifted to
monitoring severity
120
100
80
60
40
20
0
Rates as of August 10, 2009
<1
1-9
10-19
20-29
Age group (years)
30-49
50-69
70+
Predictions for 09/10
• Many unknowns
– Second wave timing
– Virulence/Severity
– Attack rate
• 30% of Nova Scotians may be ill
over a several month period
• May or may not have seasonal
influenza as well
Objectives of Health System
Planning and Response
• Prevent infection/reduce spread:
– hand hygiene and cough etiquette
– self-isolation and self-care
– immunization
– return to work
• Care for the ill – Tool Kits and Advice
• Keep the health system going - HHR
Immunization Planning
• Advice around
vaccine use and
“sequencing” has
just been released
• Planning for
distribution is
proceeding
Key Workplace Strategies
• Source control
– Screening
– Maintaining spatial distance
– Limit sharing of equipment
• Basic IP&C steps
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–
–
–
–
Hand Hygiene key
Respiratory etiquette
Clean workstations
Use your sick time if you are unwell!
Education!
Sick at Work?
• Go home and self isolate
• Use basic infection prevention and
control practices while you are
waiting to leave the workplace
• Clean/ disinfect work station as per
usual routine
• Confidentiality should be maintained
Sick at Home?
•
•
•
•
Minimize contact, and encourage self-isolation
Encourage hand hygiene & respiratory etiquette
Avoid sharing of toiletries and other items
Disinfect commonly used surfaces (door knobs,
taps, etc.) by cleaning with a household cleaner
or a mixture that is 1 part bleach and 10 parts
water.
• Ensure to eat a healthy diet & fluids (what your
mother told you!)
• Avoid smoking particularly around ill individuals
• Treat the symptoms i.e. fever, cough
When to seek medical attention…?
– Fever subsides, but then returns as illness
worsens
– Chest pain
– Wheezing, shortness of breath
– Decrease in level of consciousness, unusually
quiet
– Bloody phlegm
– Hallucinations
– New onset diarrhea, vomiting or abdominal pain
Return to Work / School
“Remain home until
feeling well and able to
resume normal day-today activity”
Pregnancy
• Not more at risk for acquisition
• If in 2nd or 3rd trimester with flu-like
symptoms, seek medical attention
• Should not provide care to someone
with influenza like illness (in the
home setting)
• Basic IP&C practices and
vaccination
Pandemic Model of Care
CLINICAL ALGORITHM for PATIENTS WITH RESPIRATORY SYMPTOMS
DURING PANDEMIC H1N1 (2009)
Does patient meet clinical definition ILI?
Usually: sudden onset fever and cough.
Common: fatigue, muscle aches, sore throat, headache, decreased appetite, runny nose.
Sometimes: nausea, vomiting, diarrhea.
YES
NO
Usual Care
Presence of pH1N1
Is the pandemic H1N1 (2009) virus known to be circulating in the community?
YES
NO
Usual Care
YES
Risk Factors
Does the patient have any risk factors for complications from pandemic H1N1?
1. < 5 years of age
2. pregnancy (especially 2nd and 3rd trimester)
3. chronic conditions:
- heart disease
- asthma and chronic lung disease
- hepatic disease
- renal disease
- blood disorders (e.g. sickle cell anemia)
- diabetes and other metabolic disorders
- neurologic and neuron-developmental disorders
- severe obesity
- immuno-compromised
Other Considerations
Remote and Isolated or Aboriginal populations (First Nations, Inuit and Metis)
YES
NO
See Below
Severity Indicators
Does the patient display any severity indicators?
•shortness of breath, wheezing, tachypnea
•chest pain
•cyanosis/grey skin color
•bloody or coloured sputum
•sudden dizziness
•confusion/disorientation
•severe or persistent vomiting
•high fever > 3 days
•low blood pressure
Additional Symptoms in Children:
- anorexia and not drinking
- somnolence and lack of interaction
- irritability and lethargy
Plan:
If ILI + no risk factors
Recuperate at home until 24 hours after symptoms subside.
If ILI + risk factors
Consider antiviral medications
If ILI + any severity indicators
consider need for hospitalization or close follow-up.
Clinical discretion is always advised.
Health Communications
Resources:
• Schools/Universities
• Summer camps
• Child care
• Practitioners tool kits
• Health Link 811
• Go to: www.gov.ns.ca/hpp
Centre for Infection
Prevention And Control
3rd Floor Joseph Howe Building
Halifax, Nova Scotia
(902) 424-0416
Director
Erin Anderson
Infection Control Consultants Patsy Rawding
Suzanne Rhodenizer-Rose
Questions ?
Senior Physician Advisor
NS Department of Health
Ken Buchholz
[email protected]
424-0449