H1N1 Update: Safeguards Against the Novel Flu

1. H1N1 Update: Safeguards Against the Novel Flu St. Clare Hospital & SMDV Clinics Updated: Fall of 2009

2. OBJECTIVES: Explain difference between seasonal and H1N1 flu patterns Discuss who should be immunized and why Review preventative steps Explain process of what to do if one develops symptoms

3. This is NOT spread from SWINE!!

4. WHAT’S IN A NAME? • China & Russia banned pork imports from USA & Mexico this past April • Stock prices of leading pork companies decreased • Hog futures took a nose dive this Spring

6. PHASE 6 PANDEMIC • Community level outbreaks in at least one other country in a different WHO region in addition to Phase 5 criteria • Phase 5 is at least 2 countries reporting on one WHO region • Last pandemic was in `57-`58 • 70 countries have reported cases • Illness has ranged from mild to severe

7. First Things First:Seasonal Flu • 36,000 die each year • 200,000 people are hospitalized • Those over 65 years of age most susceptible • 90 million vaccines administered last year

8. Seasonal Flu • This year’s seasonal flu vaccine is the first and most important step in overall protection. • A seasonal vaccine will NOT protect you against novel (new) H1N1. • While there are many different flu viruses, the seasonal flu vaccine protects against the THREE seasonal viruses that research suggests will be most common.

10. H1N1 NOVEL FLU

11. Pandemic Flu (H1N1) Vaccine • Mist vaccine being given to HCW’s now • Vaccine is purchased by Federal Gov’t. • All orders are placed through the WI Immunization Program and then distributed to local public health departments and private clinics/hospitals • Some vaccinations may occur at schools, daycares • “Race against time; distribution may be the Achilles Heal of this entire process”- On Point • Age impact: majority of patients 10-16 years of age

12. Big Difference: Seasonal vs. H1N1 • Elderly NOT specifically targeted to receive H1N1 vaccine • Because elderly men and women appear to have higher levels of immunity to the virus- possibly from the `57-`58 pandemic • Out of 8000 cases, only 15 were over age 60 • People over the age of 50 or those in long-term/group care facilities should still receive their SEASONAL flu vaccine.

15. Challenges: Possible Mutation • What could still happen? • Changes in antiviral drug resistance • Changes in vaccine effectiveness (drift away from vaccine strain)- so far, vaccines have hit the “bull’s eye” • Changes in severity of illness and death rates • Even small changes could impact healthcare; very little “surge capacity” in some areas

16. It Could Be Anywhere… • Schools & Daycares • Workplace • Stores, Grocery, Mall • Transit: Planes, Buses, etc. • Recreational Activities • Kids’ Sports Teams/Athletic Events • Churches

17. Why Schools are Susceptible • Youth from diverse areas are together for long periods of time—excellent for spread • Less-than-ideal hygiene at times • Kids then return home to spread/transmit to adults/parents/caregivers

18. Reducing Transmission Rates—New School Guidelines Fall ‘09 • Encouraging Vaccination • Keep children WITH FEVER home until symptoms have subsided for 24 hours, then kids can return to school • Increase hand washing and cleaning of surfaces • Decrease sharing of supplies, food, drink, points of contact

19. Reducing Transmission Rates – Work Settings Fall ‘09 • Encourage vaccination • Encourage employees with fever, cough or sore throat to stay home from work and other activities • Wait until AFTER you are fever-free for at least 24 hours • Provide hand washing/sanitizer and mask access • Clean frequently touched surfaces with normal cleaners • If you travel for work, monitor int’l advisories • Inquire about/consider working from home

20. What St. Clare Hospital & SMDV Clinics are Doing… • Top Priority = Influenza Vaccinations • Keeping Clinics Clean • Hand Cleansing • Cough/Sneeze Hygiene; Masks Available • Increased disinfecting of clinic surfaces • Policy in place to keep employees with symptoms at home and away from clinics to prevent spread • Plans for working with higher absenteeism

21. Reception will want you to put on a mask if you do go into the clinic or hospital with symptoms of the flu

22. CDC Surveillance • Will detect any increasing severity by tracking • Hospitalizations • Deaths • Track movement of all flu viruses through various populations • Track antiviral medication resistance • Track impact on healthcare sector • Track private sector absenteeism

23. What are Our State & Local Health Departments Doing? • WI State Health Dept. • Tracking Influenza cases by county & region • Educating and updating local public health departments and private clinics on latest flu information and data • Wisconsin is just one of a few states to have a system like this in place • Sauk County Public Health Dept. • Offering immunization clinics/ school clinics • Contact/Follow-up with H1N1-positive patients

25. H1N1 Testing • Testing = nasal and/or oral swabs • Testing helps define the spread and severity of the outbreak. • Testing for H1N1 will also be determined based on the volume of suspected cases (higher numbers = harder to test everyone, may be unnecessary) & if pt is in high-risk group • Test results may take 2-3 business days through state testing labs • Treatment could include antiviral therapy, which is most effective if started within 48 hours of the onset of symptoms

26. Testing recommended for: • Those sick enough to be hospitalized • HCW with S/S of influenza • Residents or staff of residential facilities who have S/S of influenza unless already established there • Consider for those with severe resp illness unless in an aggregate setting

27. Testing NOT recommended for: • Persons with mild illness • Family members of a person with known or suspected H1N1 influenza

29. Antiviral Drugs-Good For Both! • If you get seasonal or novel H1N1 flu, you may or may not need antiviral drugs. • Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. • Antiviral drugs may prevent serious flu complications. They are for those who need to be hospitalized, pregnant women, infants less than 6 mo old, or if someone has a chronic lung disease or is immune-suppressed. • For treatment, antiviral drugs work best if started within the first 2 days of symptoms. • Resistance will increase if these drugs are given too freely as we have seen with antibiotics

30. Post-exposure Chemoprophylaxis • Consider for someone in high-risk group who had contact with someone who likely was infectious with influenza • Treat for 10 days after date of exposure • Medication will lower but not eliminate risk of getting influenza • Protection stops when med is stopped • Those on prophylaxis to need to be seen if they develop S/S of influenza

31. “Individuals do not need to be cured of diseases they do not contract.” Dr. Robert Belshe, MD St. Louis University Center for Vaccine Development

32. HAM HAM

33. H1N1 Vaccine • Live, attenuated form as a nasal spray • Inactivated form as injection; those less than 10 years old will need 2 doses 21 days apart; all others need only one shot • May have some immunity if one has already had the infection, but vaccination still recommended if in high-risk group • 194 million doses ordered by the US gov’t • Immunity 7-14 days after vaccine given

34. U.S. Advisory Committee on Immunization Practices • Children and young adults 6months-24yo • Pregnant women • Those who live with or care for children younger than 6 months of age • Healthcare and EMS personnel • Those ages 24-64 who are higher risk of complications: chronic lung, heart, etc. disease and immunosuppressed

35. Challenges in Distributing Vaccine • This is the first urgent large-scale campaign since 1976 • Uncertain when vaccine will arrive and how much of it (quantity) will arrive • The target populations are different this time around: • Healthcare workers • Young children • Young Adults 19-24 • Pregnant Women • Infant Caregivers • Chronically ill

36. Why pregnant women? • Pregnancy changes a woman’s immune system to allow the fetus to be present and grow • As the baby grows the lungs become compressed which can lead to pneumonia • Fluid accumulation can lead to “wet lungs” which raises risk of pneumonia • 28 pregnancy deaths; >100 in ICU

37. Decrease your Risk of Getting or Spreading the Flu • One is infectious 1 day before getting sick and for 5-7 days after • Cover nose & mouth with tissue with coughing or sneezing and toss into trash • Wash hands with soap/water often or use an alcohol-based gel or wipes • Avoid touching your eyes, nose or mouth • Avoid contact with sick people

38. MOST IMPORTANTLY… • STAY HOME FROM WORK OR SCHOOL IF YOU HAVE A FEVER, cough, sore throat, runny or stuffy nose, body aches, H/A, chills and fatigue. • Have tissue, soap/gel wipes on hand to avoid having to go to the store • May return to work or school when fever-free for 24 hours

40. WARNING SIGNS- CHILDREN • Fast or trouble with breathing • Bluish or gray skin color • Not drinking enough fluids • Severe or persistent vomiting • Not waking up or interacting • Irritable to point of not wanting to be held • Flu-like sx’s improve but then return with fever and worse cough

42. WARNING SIGNS- ADULTS • Difficulty breathing or shortness of breath • Pain or pressure in chest or abdomen • Sudden dizziness • Confusion • Severe or persistent vomiting • Flu-like sx’s that improve but then return with fever and worse cough

43. Today’s To Do List for Seasonal & Swine Flu • Obtain seasonal influenza vaccine early • Identify household members who are: • Early targets for new H1N1 vaccine • At higher risk for serious flu complications • Monitor local situation & information • Pandemic.Wisconsin.Gov • Local Health Department • Dial “211” for questions • Create a household plan for illness or related emergencies • Call “before you go” to clinic or hospital, except for life-threatening emergencies

44. SMDV Health System Options • Seasonal flu shot clinics at the clinic began the week of September 8th • Flu Vaccine Information line (24/7) • (608) 250-1383 or • (877) 277-3326 (toll free) • Also visit www.deancare.com/flu • H1N1 (Swine Flu) vaccine will be available in late October at the earliest. Once it is available, we will establish clinics to administer it.

45. Preparing for Fall: Pandemic Influenza A (H1N1) • Much is unknown; what is known may change • Efforts coordinated with seasonal influenza efforts • Up-to-the minute updates: • www.pandemic.wisconsin.gov • www.cdc.gov • Dial 211 in Wisconsin for more info

46. OBJECTIVES ACHIEVED? Explain difference between seasonal and H1N1 flu patterns Discuss who should be immunized and why Review preventative steps Explain process of what to do if one develops symptoms

48. Comments? Questions?