Pandemic (H1N1) Preparedness: Medical Aspects

Dr. Esther TanMedical Services Division

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What is the Pandemic H1N1 Virus?

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• H1N1 is a completely new strain of influenza virus

• Genetic material from pig, bird and human

combined to form this unique strain

• Is very contagious, spreads from person-to-person through coughing or sneezing of ill persons

• Despite term “swine flu”: Infections not associated with contact with pigs or pork meat

So What?

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• This new influenza virus has already sparked a pandemic

• A pandemic is world-wide epidemic

• Results from emergence of a new virus in which overall population has that no immunity

• Severity can vary

Past Influenza Pandemics

1900

1850

1950

2000

1847

1889

1918

19571968

42 yrs

29 yrs

39 yrs

11 yrs

Pandemic usually occur every 30 – 40 years

Last Pandemic was ≈ 40 yrs ago, in 1968....

Last Pandemic was ≈ 40 yrs ago, in 1968....

“2009 Flu Pandemic” Declared

As of 25 Oct:>440,000 lab-confirmed cases

5700 deaths

What We Know About Pandemics

• More than one pandemic wave likely• Can be weeks or months between waves• Severity of waves unpredictable: subsequent

wave could be worse than first• Typically affects young, healthy adults (unlike

regular seasonal flu)Severe wave

Severe waveMild

wave

Mild wave

Why Must the UN Prepare?

• A severe pandemic can have great impact on organization’s operations

• Social disruption due to fear and panic

• Routine life could be affected

• High absenteeism everywhere – staff focus on own families’ health

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In March 2006, the Secretary-General directed all UN offices to

prepare for a pandemic

In March 2006, the Secretary-General directed all UN offices to

prepare for a pandemic

Situation in the US

April – July 2009:Est. 1.8-5.7 million cases

9000-21000 hospitalizations

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2006-07

2007-08

2008-09

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Spring outbreak:Est 750,000 to 1 mil cases

Identified 930 hospitalized, 54 deaths

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Situation in NYC

H1N1 Compared With Seasonal Flu Cases So Far?

• Consistent with a pandemic, most cases identified are young, between 5 to 24 yrs, > 65 yrs not at risk

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What To Expect For Upcoming Fall/Winter Season?

• Both seasonal influenza and pandemic H1N1 viruses will circulate

• H1N1 not likely to cause high rates of severe illness– Virus appears stable

• Number of people ill cannot be predicted

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Some Facts About the Flu Virus

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Common Flu Signs & Symptoms?

• Fever, chills, dry cough, sore throat• Extreme fatigue• Muscle/body aches, headache • Stuffed/runny nose• No appetite or desire to drink• Nausea, vomiting and diarrhea

especially in children• Not every case will have fever

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May need 1-2 weeks to recover1-4 days incubation

• Anyone who:– Has difficulty breathing or chest pain– Sudden dizziness– Is less responsive than normal or becomes

confused– Severe or persistent vomiting and unable to

keep liquids down– Has uncontrolled fits– Has signs of dehydration:

• dizziness when standing, absence of urination, or in infants a lack of tears when crying

Warning Signs of Severe Disease?

• Most cases recover without any treatment; if healthy with no underlying condition: “Rest it out”

• Staff at higher risk of severe disease:

– Those > 65 years, or < 5 years of age– Anyone with lung, heart, kidney,

liver or blood disorders, or diabetes– Anyone with a weak immune system– Pregnant women– Those <19 yrs on long-term aspirin

therapy

What Should I Do If I have Mild Flu?

Contact your doctor as soon as possible!Contact your doctor as soon as possible!

Antiviral Medication (e.g. oseltamivir)

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• Reduces duration and severity of flu symptoms

• Currently not recommended for healthy persons with uncomplicated flu; only recommended for persons with flu and who are at at “higher risk” of severe symptoms

• NYC DOH and UNMS have enough stockpiles to treat all expected to be ill

• Consults with your family doctor for first line health services

• Search for a local doctor and nearest hospital to where you live

• Use network of participating physicians under your health insurance plan to identify your doctor (http://www.un.org/Depts/oppba/accounts/insurance/healthPlans.htm ).

• Staff with no health insurance can look up the New York City Health and Hospitals Corporation (HHC) directory  (http://www.nyc.gov/html/hhc/html/facilities/directory.shtml

Getting Prepared: Choosing A Local Health Care Provider

How Does the Flu Virus Spread?

1. Droplet transmission

2. Contact transmission

3. Airborne transmission

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Droplet Transmission

• When ill person cough or sneezes, heavy droplets land on the mouth, eyes, nose of others

• Virus then enter the other person

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3 feet3 feet

Contact Transmission

• Direct: Virus directly transferred from ill person to another person

• Indirect: Virus is on a surface, and person touches that surface

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Be “Touch Aware”

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Airborne Transmission

• Limited to healthcare or clinical laboratory settings

• Specific procedures can generate tiny “aerosols” that float in air and can be inhaled deep into lungs

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Action Steps to Limit Influenza Exposure

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Stay Home If Ill

• Stay home and do not come to work if you are ill

• Stay home until fever-free for 24 hrs, without use of fever medications

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If staff is exposed to ill person, but is well with no flu symptoms, can still come to work

Cover When Cough/Sneeze

• Don’t use bare hands!

• Use disposable tissue or your sleeve

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Wash Your Hands Frequently

Get Vaccinated – The Most Effective Strategy!

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Influenza Vaccines This Season

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• Two types available this season: seasonal & pandemic (H1N1) flu

• Seasonal flu vaccine recommended for specific risk groups (elderly, very young, pregnant women)

• In initial period, due to limited supply, pandemic flu vaccine recommended only for specific groups (medical staff, pregnant women, those caring for children < 6 months..etc)

• [See 9 October iSeek post by MSD]

Pandemic H1N1 Vaccine

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• Two types – Flu shot (killed/inactivated virus) and Flu Mist/Nasal Spray (weakened virus)

• Persons with severe allergy to chicken eggs should not be vaccinated

Is the Pandemic H1N1 Vaccine Safe?

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• Manufactured in the same way, expected to have similar safety profile to seasonal flu vaccine;

• Side effects rare. If occurs, similar to seasonal flu vaccine:Soreness/redness/swelling, Headache, muscle achesFeverNausea

• Life-threatening allergic reactions to vaccines very rare

Thimerasol in Vaccines

• Mercury-based preservative used in multi-dose vials to prevent contamination

• No scientific evidence of harm caused by the low doses of thimerosal in vaccines

• No conclusive scientific evidence that any vaccine or vaccine additive increases the risk of developing autism or any other behavior disorder

• Single-dose shots and nasal spray of the H1N1 vaccine does not contain thimerasol

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Pandemic H1N1 Vaccine isInitially Recommended For:

• Pregnant women• People 6 mths to 24 yrs• People 25 to 64 yrs with chronic conditions

– Asthma, diabetes, heart, kidney, neurologic, and immune system disorders

• People who live with or care for children less than 6 mths

• Healthcare workers and emergency medical responders

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Where to Get Vaccinated?

• Your personal / family doctor, pediatrician, obstetrician

• UN Medical Services for seasonal flu vaccine

• NYC “Flu locator” (www.nyc.gov/flu) and other health departments

• Pharmacies

• School-based vaccination

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See ISeek Announcements on MSD Webpage

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Use of Masks

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Types of Masks

• Two Types:– Surgical masks or Respirators/N95

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When To Use A Surgical Mask?

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• WHO: No scientific evidence that wearing surgical masks in community setting is effective

• Currently recommended only for ill persons and in health care settings and medical staff caring for suspected patients

• May still wish to wear it – but must remember it should be combined with other public health measures

Stockpile Supplies, including Surgical Masks

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In Severe Flu Scenario

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Possible Additional Actions by UN

• Implement social distancing in the workplace

• Enhanced workplace cleaning

• Active screening of staff before coming into workplace

• Establish separate “flu” clinic for symptomatic staff

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In Case of Medical Emergencies

• No different from routine

• Follow instructions available on iSeek

Medical Emergency Protocol

1. Call 9-911

2. Render first aid assistance if you are trained

3. Call 3-5555 or 212-963-5555 (UN Fire & Safety Unit)

UN Pandemic Booklet

http://www.un.org/staff/pandemic/

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