H1N1 Influenza Update (formerly known as Swine Flu)

1. H1N1 Influenza Update(formerly known as Swine Flu) 11/10/09 Stephen Motzko, CSP

2. H1N1– What Is The Big Deal? Novel H1N1 (referred to as swine flu early on) is a new influenza virus that is spreading from person-to-person. Media Attention Varies

3. Novel H1N1 Influenza • Influenza is always serious – each year in the United States, seasonal influenza results, on average, in an estimated 36,000 deaths and more than 200,000 hospitalizations from flu-related causes. • This outbreak certainly poses the potential to be at least as serious as seasonal flu, if not more so. • CDC expects that more cases, more hospitalizations, and more deaths (up to 90K) from this outbreak will occur this year. • While past diseases of SARS (2003) and Bird Flu H5N1 (2005+) have had little impact on most of us, there can be significant impacts.

4. Lessons from SARS (2003) • Economic disruption led to loss of 2% of East Asian GDP in the second quarter of 2003 • In the US, SARS blamed for losses of 15% of sales in tech sector • SARS outbreak in Toronto led to sharp drop in tourist visits, costing US $850 million in GDP • During SARS outbreak, Cathay Pacific carried only 30% of its usual passengers – stock price decreased nearly 20% Source/Footnote: Maplecroft Website

5. H1N1 & Pandemic Planning

6. Let’s Talk H1N1 • Issues, Issues, Issues –Why We Care • Productivity • Human Resources Issues • Supply Chain • Travel • Background Information • Where To Find Information • Avoiding Information Overload

7. Business Issue - Employees • Employee Health & Absence • Telecommuting Options/Feasibility • Business Travel • Exposure While Traveling • Contributing to Spread • Quarantines • Evacuation from Infected Areas • Visitor Exposures (incl. Vendors and Contractors)

8. Business Issue - Logistics • Transfer of Operations/Business • Avoid Restricted/Quarantined Areas • Avoid Bottlenecks • Leverage Existing Plans/Capabilities • Supply Chain Management • Outsourcing of Operations/Services • Integration with Existing Disaster Response & Recovery Planning Procedures/Programs

9. H1N1 Influenza – Travel Alerts • Due to the outbreak of novel H1N1 flu occurring in the United States and many other countries, airport staff in some countries may check the health of arriving passengers. • If you are sick with symptoms of influenza-like illness, you should not travel.

10. H1N1 Influenza – Travel Alerts • Travel Alert: China - H1N1 Quarantine Measureshttp://travel.state.gov/travel/cis_pa_tw/pa/pa_4238.html • Due to the outbreak of novel H1N1 flu occurring in the United States and many other countries, airport staff in some countries may check the health of arriving passengers. Many countries, including Japan and China, are screening arriving passengers for illness due to novel H1N1 flu. These health screenings are being used to reduce the spread of novel H1N1 flu. • If you are sick with symptoms of influenza-like illness, you should not travel. These symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting. • Since the novel H1N1 flu outbreak is occurring in the United States, flights from the United States arriving in other countries may be specifically targeted for screening. Travelers coming from the United States may be checked for fever and other symptoms of novel H1N1 flu, and their travel may be delayed.   • Consult the embassy of the country, or countries, in your travel itinerary for information about entry screening procedures (see Websites of U.S. Embassies, Consulates, and Diplomatic Missions for contact information). Source / CDC Traveler’s Health (Updated – 9/11/09)

11. H1N1 Influenza – What Is Simpson Strong-Tie Doing? • We are following the precautions and guidelines set by the World Health Organization (WHO) and the U.S. Centers for Disease Control (CDC) • Recognized, credible sources for current information about the situation • Continuously updating the statusof known facts • News headlines can sometimes be premature or misinterpreted, and although they can provide some highlights, we defer to the international health agencies for reference guidance

12. H1N1 Influenza – Our Response • Information is kept current on our Intranet (Jobsite) in the form of a PowerPoint presentation, updated regularly • Resources (posters, flyers, etc.) are also available • Flu vaccines are provided (Seasonal Flu) • Branches/locations have contingency plans • for absences; especially smaller Branches with few employees • Branch/site plans include keeping soap and towels in bathrooms in adequate supply, available for employees • Encourage sick employees to stay home! Adjust policies

14. Jobsite PowerPoint Guidance • Hygiene precautions (hand washing, cough and sneeze etiquette • Guidance on staying home when sick • Current status and news about H1N1 • Travel Precautions (Before-During-After) • Where to go for more information

15. H1N1 Influenza (Swine Flu) – What Is It? Sample from Presentation Novel H1N1 (referred to a swine flu early on) is a new influenza virus that is spreading from person-to-person. The United States government has declared a public health emergency in the U.S. in response to the H1N1 outbreak. CDC’s response goals are to: • reduce transmission and illness severity • provide information to help health care providers, public health officials, and the public address the challenges posed by this emergency. Source / CDC (5/11/09)

16. Novel H1N1 Influenza Sample from Presentation • The first cases of human infection with novel H1N1 influenza virus were detected in April 2009 in San Diego and Imperial County, California and in Guadalupe County, Texas. • The virus has spread rapidly. • The virus is widespread in the United States at this time and has been detected internationally as well. Source / CDC (5/11/09)

17. Signs and symptoms Sample from Presentation Symptoms of novel H1N1 flu in people are similar to those associated with seasonal flu. • Fever • Cough • Sore throat • Runny or stuffy nose • Body aches • Headache • Chills • Fatigue • In addition, vomiting (25%) and diarrhea (25%) have been reported. (Higher rate than for seasonal flu.) Source / CDC (5/11/09)

18. How does novel H1N1 Influenza spread? Sample from Presentation • This virus is thought to spread the same way seasonal flu spreads • Primarily through respiratory droplets • Coughing • Sneezing • Touching respiratory droplets on yourself, another person, or an object, then touching mucus membranes (e.g., mouth, nose, eyes) without washing hands Source / CDC (5/11/09)

19. Can you get H1N1 from eating pork? Sample from Presentation No. The novel H1N1 influenza virus (formerly referred to as swine flu) virus is not spread by food. You cannot get novel H1N1 flu from eating pork or pork products. Eating properly handled and cooked pork products is safe. Source / CDC (5/11/09)

20. Take these everyday steps to protect your health Sample from Presentation • Wash your hands often with soap and warm water, especially after you cough or sneeze. Wash for 15 to 20 seconds. • Alcohol-based hand wipes or gel sanitizers are also effective. • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. • Avoid touching your eyes, nose or mouth. Germs spread this way. • Avoid contact with sick people. Source / CDC (5/11/09)

21. If you get sick… Sample from Presentation • Stay home if you’re sick for 7 days after your symptoms begin or until you’ve been symptom-free for 24 hours, whichever is longer. • If you are sick, limit your contact with other people as much as possible. Source / CDC (5/11/09)

22. Watch for emergency warning signs Sample from Presentation Most people should be able to recover at home, but watch for emergency warning signs that mean you should seek immediate medical care. • In adults: • Difficulty breathing or shortness of breath • Pain or pressure in the chest or abdomen • Sudden dizziness • Confusion • Severe or persistent vomiting • Flu-like symptoms improve but then return with fever and worse cough Source / CDC (5/11/09)

23. Emergency warning signs in children Sample from Presentation If a child gets sick and experiences any of these warning signs, seek emergency medical care. In children: • Fast breathing or trouble breathing • Bluish or gray skin color • Not drinking enough fluids • Severe or persistent vomiting • Not waking up or not interacting • Irritable, the child does not want to be held • Flu-like symptoms improve but then return with fever and worse cough Source / CDC (5/11/09)

24. International Travel Sample from Presentation If you travel internationally from the United States, you may be asked to: • Pass through a scanning device that checks your temperature. (The device may look like an airport metal detector, a camera, or a handheld device.) • Have your temperature taken with an oral or ear thermometer • Fill out a sheet of questions about your health • Review information about the symptoms of novel H1N1 flu • Give your address, phone number, and other contact information • Be quarantined for a period of time if a passenger on your flight is found to have symptoms of novel H1N1 flu • Contact health authorities in the country you are visiting to let them know if you become ill • If you have a fever or respiratory symptoms or are suspected to have novel H1N1 flu based on screening, you may be asked to: • Be isolated from other people until you are well • Have a medical examination • Take a rapid flu test (which consists of a nasal swab sample) • Be hospitalized and given medical treatment, if you test positive for novel H1N1 flu • Please note that the U.S. Department of State usually cannot interfere with the rights of other countries to screen airline passengers entering or exiting their countries, nor can it influence the number of days in quarantine. • Because these outbreak-related delays, which could include several days of quarantine, may affect planned activities and lead to unexpected costs, CDC strongly recommends that travelers consider purchasing travel insurance. To find a list of possible travel health and medical evacuation insurance companies, visit Medical Information for Americans Abroad (U.S. Department of State). Source / CDC Traveler’s Health (Updated – 9/11/09)

25. H1N1 Influenza – Travel Precautions - Before Sample from Presentation • Prepare for your trip before you leave • Visit CDC's Travelers’ Health Website to learn about any disease risks and CDC health recommendations for areas you plan to visit. • Be sure you are up-to-date with all your routine vaccinations, including seasonal influenza vaccine if available. • Identify the health-care resources in the area(s) you will be visiting. Source / CDC Traveler’s Health (4/27/09)

26. H1N1 Influenza – Travel Precautions - During Sample from Presentation • Monitor the local situation • Pay attention to announcements from the local government. • Follow local public health guidelines, including any movement restrictions and prevention recommendations. • Practice healthy habits to help stop the spread of influenza • Wash your hands often with soap and water.  This removes germs from your skin and helps prevent diseases from spreading. • Use waterless alcohol-based hand gels (containing at least 60% alcohol) when soap is not available and hands are not visibly dirty. • Cover your mouth and nose with a tissue when you cough or sneeze and put your used tissue in a wastebasket. • If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands. • Wash your hands after coughing or sneezing, using soap and water or an alcohol-based hand gel. • Follow all local health recommendations.  For example, you may be asked to put on a surgical mask to protect others. • Seek medical care if you feel sick Source / CDC Traveler’s Health (4/27/09)

27. H1N1 Influenza – Travel Precautions - After Sample from Presentation • Closely monitor your health for 7 days • If you become ill with fever and other symptoms of swine flu like cough and sore throat and possibly vomiting and diarrhea during this period, call your doctor or clinic for an appointment right away. Your doctor may test you for influenza and decide whether influenza antiviral treatment is indicated. • When you make the appointment, tell the doctor the following: • Your symptoms, • Where you traveled, and • If you have had close contact with a person infected with swine flu. • Avoid leaving your home while sick except to get local medical care, or as instructed by your doctor. Do not go to work or school while ill. If you must leave your home (for example, to seek medical care) wear a surgical mask to keep from spreading your illness to others. • Always cover your nose and mouth with a tissue when you cough or sneeze. Throw away used tissues in a trash can. • Wash your hands with soap and water often and especially after you cough or sneeze. If soap and water are not available, use an alcohol-based hand gel containing at least 60% alcohol. • Avoid close contact with other people as much as possible. • Wear a surgical mask if you are in contact with other people. Source / CDC Traveler’s Health (4/27/09)

28. Weekly Updates of WHO & CDC Sample from Presentation The following slides summarize the weekly updates from the World Health Organization (WHO) and the Center for Disease Control (CDC). • On the basis of available evidence and expert assessments of the evidence, the scientific criteria for an influenza pandemic have been met. • The Director-General of WHO raised the level of influenza pandemic alert from phase 5 to phase 6. "The world is now at the start of the 2009 influenza pandemic," she said at a press conference 6/11. • On present evidence, the overwhelming majority of patients experience mild symptoms and make a rapid and full recovery, often in the absence of any form of medical treatment. • Worldwide, the number of deaths is small. Each and every one of these deaths is tragic, and we have to brace ourselves to see more. However, we do not expect to see a sudden and dramatic jump in the number of severe or fatal infections. Source / WHO (6/11/09)

29. H1N1 Flu – Present Situation - WHO Sample from Presentation Pandemic (H1N1) 2009 - update 73 • As of 1 November 2009, worldwide more than 199 countries and overseas territories/communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 6000 deaths. • As many countries have stopped counting individual cases, particularly of milder illness, the case count is likely to be significantly lower than the actual number of cases that have occurred. WHO is actively monitoring the progress of the pandemic through frequent consultations with the WHO Regional Offices and member states and through monitoring of multiple sources of data. • Intense and persistent influenza transmission continues to be reported in North America without evidence of a peak in activity. The proportion of sentinel physician visits due to influenza-like-illness (ILI)(8%) has exceeded levels seen over the past 6 influenza seasons; 42% of respiratory samples tested were positive for influenza and 100% of subtyped influenza A viruses were pandemic H1N1 2009. Rates of ILI, proportions of respiratory samples testing positive for influenza, and numbers of outbreaks in educational settings continues to increase sharply in Canada as activity spreads eastward. Significantly more cases of pandemic H1N1 have been recorded in Mexico since September than were observed during the initial springtime epidemic. • In Europe and Central and Western Asia, pandemic influenza activity continues to increase across many countries, signaling an unusually early start to the winter influenza season. Active circulation of virus marked by high proportions of sentinel respiratory samples testing positive for influenza has been reported in Belgium (69%), Ireland (55%), Netherlands (51%), Norway (66%), Spain (46%), Sweden (33%), the United Kingdom (Northern Ireland:81%), and Germany (27%). In addition, there is evidence of increasing and active transmission of pandemic influenza virus across Northern and Eastern Europe (including Ukraine and Belarus), and eastern Russia. For details on the situation in Ukraine please refer to the Disease Outbreak News update below. In Western Asia and the Eastern Mediterranean Region, increasing activity has been reported in Oman and Afghanistan. • Link to WHO Update 73 http://www.who.int/csr/don/2009_11_06/en/index.html Source / WHO (11/6/09)

30. Spread of Influenza A(H1N1) Sample from Presentation

31. H1N1 Flu – Key Flu Indicators11/6/09 Sample from Presentation During week 43 (October 25-31, 2009), influenza activity remained elevated in the U.S. • 5,258 (37.2%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza. • Over 99% of all sub typed influenza A viruses being reported to CDC were 2009 influenza A (H1N1) viruses. • The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold. • Eighteen influenza-associated pediatric deaths were reported. Fifteen of these deaths were associated with 2009 influenza A (H1N1) virus infection and three were associated with an influenza A virus for which the subtype was undetermined. • The proportion of outpatient visits for influenza-like illness (ILI) was above the national baseline. All 10 regions reported ILI above region-specific baseline levels. • Forty-eight states reported geographically widespread influenza activity, two states reported regional influenza activity, the District of Columbia reported local influenza activity; Puerto Rico and Guam reported sporadic influenza activity, and the U.S. Virgin Islands did not report. Source / CDC (11/6/09)

32. H1N1 Flu – Present Situation - CDC Sample from Presentation Source / CDC (11/6/09)

33. Who will be recommended to receive the 2009 H1N1 vaccine? Sample from Presentation • CDC’s Advisory Committee on Immunization Practices (ACIP) recommends that certain groups of the population receive the 2009 H1N1 vaccine first. These target groups include pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months and 24 years old, and people ages of 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems. • Vaccine to protect against the 2009 H1N1 flu virus is available; however, initial supplies are limited. The Advisory Committee on Immunization Practices (ACIP) has recommended that the following groups receive the vaccine before others: pregnant women, people who live with or care for children younger than 6 months of age, health care and emergency medical services personnel with direct patient contact, children 6 months through 4 years of age, and children, especially those younger than 5 years of age and those who have high risk medical conditions are at increased risk of influenza-related complications. For a more detailed description of children at highest risk, read Children with Developmental Disabilities and Chronic Medical Conditions • The committee recognized the need to assess supply and demand issues at the local level. The committee further recommended that once the demand for vaccine for these target groups has been met at the local level, programs and providers should begin vaccinating everyone from ages 25 through 64 years. Current studies indicate the risk for infection among persons age 65 or older is less than the risk for younger age groups. Therefore, as vaccine supply and demand for vaccine among younger age groups is being met, programs and providers should offer vaccination to people over the age of 65. Source / CDC (11/5/09)

34. Follow Reputable Information/Sources • What is CDC’s recommendation regarding "swine flu parties"?"Swine flu parties" are gatherings during which people have close contact with a person who has 2009 H1N1 flu in order to become infected with the virus. The intent of these parties is for a person to become infected with what for many people has been a mild disease, in the hope of having natural immunity 2009 H1N1 flu virus that might circulate later and cause more severe disease. • CDC does not recommend "swine flu parties" as a way to protect against 2009 H1N1 flu in the future. While the disease seen in the current 2009 H1N1 flu outbreak has been mild for many people, it has been severe and even fatal for others. There is no way to predict with certainty what the outcome will be for an individual or, equally important, for others to whom the intentionally infected person may spread the virus. • CDC recommends that people with 2009 H1N1 flu avoid contact with others as much as possible. If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Stay away from others as much as possible to keep from making others sick.

35. Commercial Tracking Available – E.G. iJet Source/Footnote: CDC Website - http://www.ijet.com/swinefluresources/images/WW-human-cases-LATEST.gif

36. CDC Business Pandemic Influenza Planning Checklist Source/Footnote: CDC Website - http://www.pandemicflu.gov/professional/pdf/businesschecklist.pdf

37. H1N1 Influenza For additional Information • H1N1 Influenza resources: • World Health Organization: http://www.who.int/csr/disease/swineflu/en/index.html • Centers for Disease Control: http://www.cdc.gov/h1n1flu/1-800-CDC-INFO (1-800-232-4636) • CDC Travel Advisories & Alerts: http://wwwn.cdc.gov/travel/notices.aspx • U.S. State Department Travel Alerts: http://travel.state.gov/travel/cis_pa_tw/pa/pa_1766.html • U.S. state Department Travel Warnings: http://travel.state.gov/travel/cis_pa_tw/tw/tw_1764.html

38. MORE…H1N1 Influenza Information • More H1N1 Influenza resources: • Flu.gov Communication Toolkit for Businesses and Employers: http://www.pandemicflu.gov/professional/business/toolkit.html • SHRM - Human Resources H1N1 Page: http://www.shrm.org/hrdisciplines/safetysecurity/articles/pages/swineflunewsresources.aspx • CNN H1N1: Fighting the Flu : http://www.cnn.com/SPECIALS/2009/h1n1/ • International SOS – Pandemic Preparedness: http://www.internationalsos.com/pandemicpreparedness/ • Marsh Flu Pandemic Page: http://global.marsh.com/risk/pandemic/index.php

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40. H1N1 Influenza Update(Swine Flu)Thank You 11/10/09 Stephen Motzko, CSP