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H1N1: SWINE FLU UPDATE

H1N1: SWINE FLU UPDATE. Sources: www.cdc.gov/h1n1flu/surveillanceqa.htm www.kdheks.gov Linn County Health Department-Donna Thomas, RN http://flu.gov/plan/schoolsguidance.html. US H1N1 FIRST DETECTION.

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H1N1: SWINE FLU UPDATE

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  1. H1N1: SWINE FLU UPDATE Sources:www.cdc.gov/h1n1flu/surveillanceqa.htm www.kdheks.gov Linn County Health Department-Donna Thomas, RN http://flu.gov/plan/schoolsguidance.html

  2. US H1N1 FIRST DETECTION • Mid-April 2009, CDC began working with states to collect, compile, and analyze information regarding the swine flu outbreak. • On July 24, 2009 official reporting of individual cases of confirmed and probable novel H1N1 infection was discontinued. • Below is a summary of information gathered during the first weeks of the outbreak. • Aggregate national reports of hospitalizations and deaths continue.

  3. From April 15, 2009 to July 24, 2009, states reported a total of 43,771 confirmed and probable cases of novel influenza A (H1N1) infection. Of these 43,771 reported cases… 5,011 people were hospitalized. 302 people died. How many cases have been reported in the US?

  4. Kansas Update: • Kansas Department of Health and Environment (KDHE) estimates that at least 10,000 Kansans have already been infected with the novel H1N1 influenza A virus. • The first case was identified 110 days ago. • Viral activity has been confirmed in 46 counties. • Most have suffered relatively mild illness, but at least 23 persons have been hospitalized. • One patient died. • The average age for confirmed cases is 17 years, with approximately 80% of cases occurring in persons under 35 years of age. • Current flu activity in Kansas, as in the rest of the US, is unusually high for the summer months. • The first Linn County cases have been confirmed by lab testing starting Friday, August 7, 2009. • Many people are ill in our community as reported by local health care providers.

  5. Estimates of how many people have been infected in the US • The CDC model was developed to try to determine the true number of H1N1 flu cases in the US. • The model took the number of cases reported by states and adjusted the figure to account for known sources of underestimation (not all cases with H1N1 seek medical care, and not all people who seek care have specimens collected by their health care provider). • Using this approach…it is estimated that more than one million people became ill with novel H1N1 flu between April and June 2009 in the US.

  6. Secondary Attack Rate • This reflects the risk of someone being infected with a disease by an ill close contact.

  7. ARI versus ILI • Acute respiratory-illness (ARI) the secondary attack rate was 18-19%. • Acute respiratory-illness is defined as two or more of the following: fever, cough, sore throat, and runny nose. • Influenza like illness (ILI) the secondary attack rate was 8-12%. • Influenza like illness is defined as fever and cough or sore throat.

  8. Community rates of influenza-like illness Based on community surveys and population based telephone surveys in areas with focal outbreaks of H1N1 flu: • Approximately 6% of the population reported influenza-like illness in the areas surveyed. • New Yorkers had 6.9% influenza-like illness between May 1 and May 20, 2009, based on New York City Health Dept. data from phone surveys.

  9. US age group impact in terms of infection with H1N1 • The information analyzed by the CDC supports the conclusion that H1N1 has caused greater disease burden on people younger than 25 years of age than older people.

  10. Graph A: Novel H1N1 Confirmed and Probable Case Rate in the United States, By Age Group

  11. This data supports… • That older people may have pre-existing immunity to the novel H1N1 flu virus. • This age distribution is very different from what is normally seen for seasonal flu, where older people are more heavily impacted.

  12. How have age groups been affected in terms of hospitalizations? • These estimates are based on the 4,738 hospitalizations that were reported to CDC from April 15 to July 24, 2009. • The reported hospitalization rate per 100,000 people was highest among children in the 0-4 years of age group, and the next highest group hospitalized was the 5-24 years of age group. • Underlying medical conditions such asthma, diabetes, heart disease, and pregnancy place people at greater risk of serious flu-related complications.

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

  14. Symptoms of H1N1 Table: Symptoms of hospitalized novel H1N1 patients Symptom Number (%) Fever* 249 (93%) Cough 223 (83%) Shortness of breath 145 (54%) Fatigue/Weakness 108 (40%) Chills 99 (37%) Body aches 96 (36%) Runny nose 96 (36%) Sore Throat 84 (31%) Headache 83(31%) Vomiting 78 (29%) Wheezing 64 (24%) Diarrhea 64 (24%)

  15. Age groups affected by death CDC studied the hospital records of 268 patients hospitalized with novel H1N1 flu early on during the outbreak. • The number of deaths was highest among people 25-49 years of age (39%), followed by people 50-64 years of age (25%), and people 5 to 24 years of age (16%). • This is very different from seasonal influenza, where an estimated 90% of deaths occur in people 65 years of age and older.

  16. Graph C: Novel H1N1 U.S. Deaths, By Age Group

  17. Reducing the risk of infection: • Wash hands frequently with soap and water • Alcohol based hand cleaner use when soap and water is not available. • Cover mouth and nose with a tissue when coughing or sneezing. • Avoid touching eyes, nose and mouth. • Avoid close contact (within 6 feet) with those who are ill. • Keep surfaces clean with disinfectant cleaners.

  18. What people should do if they get sick with influenza-like symptoms: • Stay home and keep away from others as much as possible. • Contact your family doctor for treatment recommendations. Antiviral medications are being reserved for high risk populations and those people hospitalized at this time. • Notify Dr. office of symptoms before arrival so isolation from others can be planned. • Practice good cough etiquette and hand hygiene. • A face mask may be worn if available and able. • Remain isolated from others until fever free for 24 hours before resuming normal activities. • Keep in contact with physician for any symptoms not resolving or worsening.

  19. Recommended school responses for the 2009-2010 school year Under conditions with similar severity as in spring 2009 Stay home when sick: Those with flu-like illness should stay home for at least 24 hours after they no longer have a fever, or signs of a fever, without the use of fever-reducing medicines. They should stay home even if they are using antiviral drugs. (For more information, visit http://www.cdc.gov/h1n1flu/guidance/exclusion.htm.) Separate ill students and staff: Students and staff who appear to have flu-like illness should be sent to a room separate from others until they can be sent home. CDC recommends that they wear a surgical mask, if possible, and that those who care for ill students and staff wear protective gear such as a mask. Hand hygiene and respiratory etiquette: The new recommendations emphasize the importance of the basic foundations of influenza prevention: stay home when sick, wash hands frequently with soap and water when possible, and cover noses and mouths with a tissue when coughing or sneezing (or a shirt sleeve or elbow if no tissue is available).

  20. More for schools… Routine cleaning: School staff should routinely clean areas that students and staff touch often with the cleaners they typically use. Special cleaning with bleach and other non-detergent-based cleaners is not necessary. Early treatment of high-risk students and staff: People at high risk for influenza complications who become ill with influenza-like illness should speak with their health care provider as soon as possible.  Early treatment with antiviral medications is very important for people at high risk because it can prevent hospitalizations and deaths. People at high risk include those who are pregnant, have asthma or diabetes, have compromised immune systems, or have neuromuscular diseases. Consideration of selective school dismissal:  Although there are not many schools where all or most students are at high risk (for example, schools for medically fragile children or for pregnant students) a community might decide to dismiss such a school to better protect these high-risk students.

  21. Pandemic Viruses • Are unpredictable. • Based on experience in other regions, an escalation in cases will occur in the coming months. • As many as 20-40% of the population in Kansas (between 550,000 and 1.1 million individuals) can expect to be infected in the next two years. • Waves of infection lasting several weeks may be seen.

  22. High Risk Groups People who: • Are pregnant • Have asthma • Have diabetes • Have a compromised immune system • Have a neuromuscular disease

  23. Monovalent H1N1 Vaccine is in production: • Expected to be available as early as September. • Advisory Committee on Immunization Practices has recommended initial vaccination efforts for five key populations (details of vaccination order, etc. are pending): • All people 6 months through 24 years of age. • People who live with or care for children younger than 6 months of age. • All pregnant women. • Healthcare and emergency medical services personnel • People aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza. • As supply increases further, immunization can be extended to others.

  24. Seasonal Flu Vaccine: • Will be available in Kansas soon. • KDHE strongly encourages all Kansans, particularly those at high risk, to get immunized. • Vaccines given in August or September will cover the flu season.

  25. We will do all we can at PV to be safe… Thank you, Pam Johnson, RN 8/11/2009

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