Chris Adamski RN, MSN Chief, Disease Control DPHS - NH DHHS September 25, 2009

1. 2009 H1N1 Influenza Virus: Update for Best Practices Conference on School Operations, Finance and Business Leadership Darlene Morse RN, M.Ed., CHES Public Health Nurse Manager Communicable Disease Control Section Chris Adamski RN, MSN Chief, Disease Control DPHS - NH DHHS September 25, 2009 Division of Public Health Services NH Department of Health and Human Services

2. Pandemic Influenza Intervals E Peak Transmission G Resolution C Initiation D Accel-eration F Deceleration A Investigation B Recognition Division of Public Health Services NH Department of Health and Human Services

3. What to Expect this Season • Presently it is expected that the current novel H1N1 flu pandemic will affect 30% population over six month period with <1% mortality rate • Most cases will be mild: • People will be sick at home for a week • High risk groups more likely to be hospitalized or die • Replacement season or increase ? • Vaccines available for • Seasonal influenza (now and ongoing) • H1N1 (expected in October) Division of Public Health Services NH Department of Health and Human Services

4. Case Counts • Case counting is an important tool early on in a pandemic • After reaching a critical level, individualized counting is not a Public health need. • Influenza surveillance is done by aggregating the results of several systems • Asymptomatic populations • Mild symptoms in some. • Wide spectrum of symptoms • How will we know what is going on? • Sentinel influenza surveillance system • Automated Hospital Emergency Department surveillance • Volunteer school absenteeism surveillance system • Laboratory reporting • National trends Division of Public Health Services NH Department of Health and Human Services

5. Global Situation Update • 2009 H1N1 influenza virus continues to be the dominant influenza virus in circulation in the world. • Since April 2009, 60.7% of influenza specimens reported to WHO were 2009 H1N1 viruses. • In regions of the Southern Hemisphere, disease due to 2009 H1N1 is largely declining. • In tropical regions, there is still substantial disease due to 2009 H1N1. • In regions of the Northern Hemisphere, there is some increased disease activity due to 2009 H1N1, including in parts of the United States, Canada and Europe. Division of Public Health Services NH Department of Health and Human Services

6. National Situation Update • Influenza activity continued to increase as compared with prior weeks. Twenty-one states are reporting widespread influenza activity at this time. • Almost all of the influenza viruses identified so far are 2009 H1N1 influenza • Several schools/university outbreaks. Division of Public Health Services NH Department of Health and Human Services

7. Percentage of Visits for Influenza-like Illness (ILI) Reported by the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet), National Summary 2008-2009 and Previous Two Seasons Division of Public Health Services NH Department of Health and Human Services

8. College ILI Reporting* • Weekly case data for the period September 12-18, 2009- a total of 7,696 new ILI cases were reported (10 hospitalizations) among campus populations totaling over 3 million. • Ninety-one percent of the 267 colleges and universities reported new ILI cases, compared to 83% the prior week. • The nationwide attack rate was 24.7 cases/10,000 students, 15 percent higher than the prior week’s rate. *Data from the American College Health Association http://www.acha.org/ILI_Surveillance.cfm Division of Public Health Services NH Department of Health and Human Services

9. Current Testing Guidelines for H1N1 in NH Hospitalized patients with influenza like illness Healthcare workers with ILI in direct care patient services after consultation with their healthcare provider Selected patients suspected to be part of a cluster of undiagnosed respiratory illness and only in consultation with public health Testing ongoing with Sentinel providers Mild cases will not / should not be tested: Result of a test does not change clinical or public health recommendations, management or outcome Division of Public Health Services NH Department of Health and Human Services

10. Main High Risk Groups for H1N1 Hospitalizations & Death Respiratory illnesses (e.g. Asthma, COPD) Cardiovascular Disease Diabetes Pregnancy Immunocompromised individuals Young people Division of Public Health Services NH Department of Health and Human Services

11. Public health Goals & Strategies Inform and educate Prevent people from becoming ill Vaccination Hand washing Prevent spread between people Hand washing Cover nose/mouth with arm/tissue: not with your hand Stay home when you are ill until fever-free for 24 hrs Treat people who are ill Mild disease: stay home, rest, fluids, acetaminophen Call physician if ill or have chronic medical condition Division of Public Health Services NH Department of Health and Human Services

12. General Strategies • Strengthening of Public Health Emergency Response capacity • Internal : Temporary reallocation of personnel across the Department • Reinforcement of the All Health Hazard Regions (AHHR) • Internal DHHS workgroups on clinical guidelines, med surge, vaccination, communications, and supplies management Division of Public Health Services NH Department of Health and Human Services

13. Strategies cont… • State government coordination • Governor meetings with agency heads • HSEM, Insurance dept, Corrections, Dept of Adm, Dept of Educ, AG, DRED, Safety, etc • Outreach to key players • Education (Conference calls, development of Kit, meeting with superintendents, school nurses training) • Hospitals and clinical community • Mass Communication and messaging: Overcommunicate • Media outreach (Phone bank WMUR) • Mass communication health risk planning vaccination planning Division of Public Health Services NH Department of Health and Human Services

14. NH School ILI Monitoring and Reporting • School web-based reporting tool went live Sept 1st. Schools asked to report daily absenteeism among students and staff, as well as school nurse visits for influenza-like illness. • Over 80 schools were reporting as of September 18th. • As of Sept 24th over 175 schools reporting. • One cluster detected through this system. • As of Sept 24th ILI clusters occurring in public and private schools as well as universities. Division of Public Health Services NH Department of Health and Human Services

15. ThanksQuestions/ Discussion Division of Public Health Services NH Department of Health and Human Services