H1N1 Update

1. H1N1 Update September 11, 2009 Savannah Chatham School Nurses

2. What exactly is H1N1? • Novel Influenza A (H1N1) is a new flu virus of swine origin that was first detected in April 2009. It continues to infect people and spread from person to person. • This new H1N1 flu virus is a reminder of the ever-changing and unpredictable nature of influenza

3. What is a pandemic? • A pandemic means: • There is a new strain of influenza A virus and • humans have little or no immunity to it • The virus spreads from person-to-person • There is a global outbreak with sustained • person- to-person transmission

4. Pandemic Timeline •  Major pandemic 1918 Pandemic“Spanish flu” H1N1The most devastating flu pandemic in recent history, killing more than 500,000 people in the United States, and 20 million to 50 million people worldwide.

5. How Contagious is H1N1? Novel H1N1 influenza shares characteristics with seasonal flu, and studies have shown that with seasonal flu people may be contagious from one day before they develop symptoms to up to 7 days after they get sick.

6. H1N1 symptoms • Fever • Cough • Lethargy • Lack of appetite • Runny Nose • Sore Throat • Some report nausea, vomiting and diarrhea Basically, no different than seasonal influenza

7. The transmission of novel H1N1 is similar to seasonal flu - Spreads through coughing or sneezing of infected people Some people may become infected by touching something with flu viruses on it and then touching their mouth, nose or eyes. How H1N1 virus spreads

8. 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

12. Novel H1N1 Confirmed and Probable Case Rate in the US, By Age Group

13. Novel H1N1 U.S. Hospitalization Rate per 100,000 Population, By Age Group

14. Novel H1N1 U.S. Deaths, By Age Group

15. Pediatric Complications from H1N1 • Of 477 deaths with confirmed H1N1 flu in the Us as of 8/8/09, 36 were in children < 18 y.o. • 67% of children who died had at least one high risk medical condition • Among high risk medical conditions, more than 90% had neurodevelopmental conditions, such as developmental delay and cerebral palsy

16. Recommendations • Wash frequently with soap and water (use alcohol-based hand sanitizer if soap is not available) • Cough into your elbow • Cover mouth and nose when sneezing and throw away the tissue • Avoid touching mouth, nose, and eyes

17. Recommendations • Stay home if you are sick with influenza like illness (at least 24 hours fever free) • Keep sick children home from school, daycare, camp, etc. • Avoid contact with sick people • Stay informed!

18. For Schools • Separate/Isolate students who appear to ILI at arrival or become ill during the day; recommended 6 ft distance between the ill person and others • Limit # of persons designated to care for ill persons • If severity increases, consider active fever and respiratory infection screening of students and staff when they arrive • Provide parents with written information; encourage parents of children with ILI to contact health care provider

19. Signs/Symptoms Requiring More Urgent Medical Attention • Fast breathing or difficulty breathing • Bluish or gray skin color • Severe or persistent vomiting • Not drinking enough fluids • Not waking up or not interacting • Flu-like symptoms improve but then return with fever and worse cough

20. Testing • Confirmatory testing for H1N1 available through the GA State Public Health Laboratory for hospitalized patients primarily and for surveillance purposes (NOT diagnostic) • Rapid Influenza Tests are generally not very specific or sensitive; sensitivity ranges from 10-70% • Most influenza like illness (ILI) circulating NOW is likely H1N1; but cannot distinguish clinically from other respiratory viruses (e.g. parainfluenza, RSV in infants/toddlers, seasonal flu)

21. Treatment • Decision based on guidelines and clinical assessment by providers • Recommended antivirals that appear to be effective are oseltamivir (TamiFlu) and zanamivir (Relenza) • Rx recommended for persons with suspected influenza at higher risk for complications: children < 5 y.o. pregnant women persons with chronic medical and immuno- suppressive conditions adults > 64 y.o.

22. Exclusion Guidelines • Staff/students should stay at home for at least 24 hours after fever has resolved without the use for fever reducing medicines like tylenol or ibuprofen • Certain circumstances may dictate longer periods of exclusion • Should severity of influenza increase, the recommendations for exclusion are likely to be revised

23. Importance of Vaccination When it comes to protecting people from influenza, vaccines are an important tool! Seasonal vaccine still important but will not protect from H1N1

24. ACIP Target Groups for H1N1 Vaccination • Pregnant Women • Household Contacts/caregivers of children < 6 months • Health care workers and Emergency Service Personnel • Persons ages 6 months through 24 years of age • Non-elderly adults (25-64) with underlying medical conditions

25. Coastal Health District/Chatham County Health Department Activities Ongoing Surveillance Activities Vaccination (Seasonal and H1N1)/Mass Vaccination Planning Community Education and Preparedness

26. Pandemic Preparedness Resources • www.gachd.org • www.cdc.gov/h1n1flu/ • www.pandemicflu.gov • www.health.state.ga.us/h1n1fl • Questions????