FPNANSH1N1 Information Session

October 17, 2009

Current Situation: WHO Level 6

H1N1 Pandemic

Signs and Symptoms

H1N1 (Human Swine Influenza) is defined as:

“fever and/or cough with one or more of sore throat, sore muscles, sore joints or extreme fatigue. Although other symptoms, including diarrhea may be present (especially in children), those noted above remain the most common and prominent”

H1N1Transmission:• Direct: droplet spread – coughing or

sneezing• Indirect: contaminated surfaces

Virus can survive for:• ~ 5 min on hands• Up to 12 hrs on cloth/paper/tissue• Up to 2 days on hard surfaces

H1N1

Seasonal Influenza:

• 10-25% population

• 4,000 deaths

• 20,000 hospitalizations

Epidemic curve of laboratory-confirmed cases of H1N1 by date of symptom onset, Nova Scotia, July 17, 2009 12h00 ADT (n=376)

0

10

20

30

40

50

60

70

80

90

100

21-M

ar

28-M

ar

4-A

pr

11-A

pr

18-A

pr

25-A

pr

2-M

ay

9-M

ay

16-M

ay

23-M

ay

30-M

ay

6-J

un

13-J

un

20-J

un

27-J

un

4-J

ul

11-J

ul

18-J

ul

25-J

ul

1-A

ug

Week Ending

Num

ber

of C

ases

H1N1:Wide Spectrum of Disease

NS: 1

NS: 570 (lab confirmed)

NS: 18 (8 ICU)

NS: Number unknown

Data as of August 2009

Laboratory-confirmed cases of H1N1 by DHA, Nova Scotia, July 17, 2009 12h00 ADT (n=376)

Lab Confirmed H1N1 in NS

0

20

40

60

80

100

120

140

160

<1 1-9 10-19 20-29 30-49 50-69 70+

Age group (years)

Rat

e pe

r 10

0,00

0 po

pula

tion

• Widespread in the community

• Younger age groups most affected

• Reported case numbers decreasing

• Surveillance efforts shifted to monitoring severity

Rates as of August 10, 2009

Predictions for 09/10

• Many unknowns– Second wave timing– Virulence/Severity– Attack rate

• 30% of Nova Scotians may be ill over a several month period

• May or may not have seasonal influenza as well

Objectives of Health System Planning and Response

• Prevent infection/reduce spread:– hand hygiene and cough etiquette– self-isolation and self-care– immunization– return to work

• Care for the ill – Tool Kits and Advice

• Keep the health system going - HHR

Immunization Planning• Advice around

vaccine use and “sequencing” has just been released

• Planning for distribution is proceeding

Key Workplace Strategies• Source control

– Screening– Maintaining spatial distance– Limit sharing of equipment

• Basic IP&C steps– Hand Hygiene key– Respiratory etiquette– Clean workstations– Use your sick time if you are unwell!– Education!

Sick at Work?• Go home and self isolate

• Use basic infection prevention and control practices while you are waiting to leave the workplace

• Clean/ disinfect work station as per usual routine

• Confidentiality should be maintained

Sick at Home?• Minimize contact, and encourage self-isolation • Encourage hand hygiene & respiratory etiquette• Avoid sharing of toiletries and other items• Disinfect commonly used surfaces (door knobs,

taps, etc.) by cleaning with a household cleaner or a mixture that is 1 part bleach and 10 parts water.

• Ensure to eat a healthy diet & fluids (what your mother told you!)

• Avoid smoking particularly around ill individuals• Treat the symptoms i.e. fever, cough

When to seek medical attention…?

– Fever subsides, but then returns as illness worsens

– Chest pain

– Wheezing, shortness of breath

– Decrease in level of consciousness, unusually quiet

– Bloody phlegm

– Hallucinations

– New onset diarrhea, vomiting or abdominal pain

Return to Work / School

“Remain home until feeling well and able to resume normal day-to-day activity”

Pregnancy

• Not more at risk for acquisition

• If in 2nd or 3rd trimester with flu-like symptoms, seek medical attention

• Should not provide care to someone with influenza like illness (in the home setting)

• Basic IP&C practices and vaccination

Pandemic Model of Care

Does patient meet clinical definition ILI? Usually: sudden onset fever and cough.Common: fatigue, muscle aches, sore throat, headache, decreased appetite, runny nose.Sometimes: nausea, vomiting, diarrhea.

CLINICAL ALGORITHM for PATIENTS WITH RESPIRATORY SYMPTOMS DURING PANDEMIC H1N1 (2009)

Presence of pH1N1Is the pandemic H1N1 (2009) virus known to be circulating in the community?

YES NO

YES NO

Usual Care

Usual Care

Risk FactorsDoes the patient have any risk factors for complications from pandemic H1N1?

1. < 5 years of age 2. pregnancy (especially 2nd and 3rd trimester)3. chronic conditions:

- heart disease- asthma and chronic lung disease- hepatic disease- renal disease- blood disorders (e.g. sickle cell anemia)- diabetes and other metabolic disorders- neurologic and neuron-developmental disorders- severe obesity- immuno-compromised

Other ConsiderationsRemote and Isolated or Aboriginal populations (First Nations, Inuit and Metis)

YES

YES NO See Below

Severity IndicatorsDoes the patient display any severity indicators?•shortness of breath, wheezing, tachypnea•chest pain•cyanosis/grey skin color•bloody or coloured sputum•sudden dizziness•confusion/disorientation•severe or persistent vomiting•high fever > 3 days•low blood pressure

Additional Symptoms in Children:- anorexia and not drinking- somnolence and lack of interaction- irritability and lethargy

Plan:If ILI + no risk factors Recuperate at home until 24 hours after symptoms subside.If ILI + risk factors Consider antiviral medicationsIf ILI + any severity indicators consider need for hospitalization or close follow-up.

Clinical discretion is always advised.

Health Communications

Resources:• Schools/Universities• Summer camps• Child care• Practitioners tool kits• Health Link 811 • Go to: www.gov.ns.ca/hpp

Centre for Infection Prevention And Control

3rd Floor Joseph Howe BuildingHalifax, Nova Scotia

(902) 424-0416

Director Erin AndersonInfection Control Consultants Patsy Rawding

Suzanne Rhodenizer-Rose

Questions ?

Senior Physician Advisor Ken BuchholzNS Department of Health ken.buchholz@gov.ns.ca

424-0449