Seasonal and Pandemic (H1N1) Influenza Prevention...•Pandemic influenza A (H1N1) continues to...
Transcript of Seasonal and Pandemic (H1N1) Influenza Prevention...•Pandemic influenza A (H1N1) continues to...
Seasonal and Pandemic (H1N1) Influenza Prevention
Anju Goel, MD, MPHDeputy Public Health Officer
Marin Health and Human ServicesSeptember 30, 2009
Background• Novel flu virus: pig,
human, avian • Identified April 2009• Spreads person to
person • Limited immunity• 1000’s of deaths &
hospitalizations• Pandemic declared
June 2009
Statistics
Cases Hospitalizations Deaths
Marin (9/25/09)
115 3126% ICU
4
CA (9/16/09)
2,01227% ICU
302
Worldwide (9/20/09)
>300,000 lab confirmed
3917 191 countries
Background
• Like seasonal flu– Severity
• Unlike seasonal flu– Different medications– More severe in:
• young• pregnant• chronic medical
conditions
Groups at High Risk
• Children < 5 years• Pregnant women• Chronic illness or
immunosuppression– Cardiac– Metabolic (diabetes)– Pulmonary (asthma)– Neurodevelopmental
• Persons > 65 yrs
2009-10 Flu Season
• Expect seasonal and H1N1 flu
• May have more illness, hospitalizations, fatalities
• H1N1 virus could change– Become more virulent– Become resistant to
medications
Goal: Prevent Spread
• Education• Social Distancing• Medication• Vaccination
School Response Critical
• 1/5 of country’s population
• Half of ill are <18 years• Spreads easily in
young• More severe in young,
esp. <5 years
Education
• Respiratory etiquette– Cover cough/sneeze– Have tissues
available
• Hand hygiene– Wash hands
frequently – Alcohol based hand
sanitizer
Hand Sanitizer• Anti-bacterial, anti-
viral• Use when enter/exit
classroom• When hands not
visibly soiled• > 60% alcohol• Studies show
effectiveness• Monitor allergies
Social Distancing
• The Public Health Practice of encouraging people to keep their physical distance from each other during disease outbreaks in order to slow the spread of infection
Contacts for Teenager 1 (T1)
Stay Home When Sick
• Ill students/staff stay home for 24 hrs after fever resolves [w/o medication]
If Increased Severity
• High risk students/staff stay home• Ill students/staff stay home for longer
period• Students with ill family
members stay home
School Social Distancing
• Rotate teachers instead of students
• Outdoor classes• Cancel/postpone field
trips• Discourage school
buses/public transit• Move desks/classes
School Dismissal
• Types– Reactive: Can’t function normally– Preemptive: Increased severity– Selective: At-risk population
Decision re: Closure
• Pros– Reduced transmission– Reduce
hospitalizations & deaths
• Cons– Social disruption– Missed learning– Nutrition– Job security– Child safety
Medications
• Resistant to adamantanes• Susceptible to oseltamivir, zanamivir
– Used to:• Treat ill persons• Prevent exposed persons from becoming ill
H1N1 Vaccination
• Different from seasonal flu vaccine
• H1N1 vaccine in clinical trials
• Expected availability mid-October
• Number of doses needed TBD
H1N1 Information
• Marin HHS: www.Marinflu.org
• CDC: http://www.cdc.gov/h1n1flu/
• CDPH: http://www.cdph.ca.gov
• WHO: http://www.who.int/en/
Lisa Gelling, MPHPublic Health Preparedness Program
County of Marin Dept. of Health & Human ServicesSeptember 30, 2009
Pandemic (H1N1)2009 Pandemic (H1N1)2009 Update:Update:
Epidemiology in Children
EpidemiologyEpidemiology
“The study of how disease is distributed in populations,
and the factors that influence this distribution.”
Source: Gordis, L. Epidemiology – 3rd ed. (Saunders, 2004)
Seasonal InfluenzaSeasonal Influenza
Each year in the U.S.:• 200,000+ persons are hospitalized due
to severity of illness– Approximately 10% of those hospitalized
cases are children younger than 5 yrs.
• An average of 36,000 deaths are associated with seasonal flu infections
‐About 90% of fatal cases are in older adults (> 65 yrs.)
Distribution of cases by age group is markedly different compared to seasonal influenza• Higher proportion of hospitalized cases in children and young adults
• Few cases in older adults
Source: ACIP Influenza Workgroup Considerations. ACIP Meeting, July 29, 2009
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Pandemic Influenza (H1N1): Pandemic Influenza (H1N1): Key Epidemiologic Findings in the U.S.Key Epidemiologic Findings in the U.S.
§
Novel H1N1 Confirmed and Probable Case Rate in the United States, By Age Group
Pandemic Influenza (H1N1): Pandemic Influenza (H1N1): Key Epidemiologic Findings in the U.S.Key Epidemiologic Findings in the U.S.
• Highest incidence of laboratory‐confirmed infections is among school‐age children
Lower immunityHand hygiene
Lack of social distancing
• 0 – 4 year olds have highest hospitalization rates
Epidemiology/SurveillanceHospitalization Rate per 100,000 Population by Age Group (n=7,090*)
2009-H1N1, 08/13/2009Epidemiology/Surveillance
Hospitalization Rate per 100,000 Population by Age Group (n=7,090*) 2009‐H1N1 – 13 AUG 2009
6.1
2.9
1.8 1.9
2.8
0
1
2
3
4
5
6
7
0-4 Yrs 5-24 Yrs 25-49 Yrs 50-64 Yrs ≥65 Yrs
Age Group
Hos
pita
lizat
ions
per
1
00,0
00
Pop
ulat
ion
inA
ge G
roup
n=1288
n=2366
n= 1915
n= 436
n=1085
Pandemic Influenza (H1N1)Pandemic Influenza (H1N1)
CaliforniaOver 25% of cases of H1N1 requiring hospitalization in the ICU have been
younger than 18 yrs.
Marin County31 hospitalized cases
• Five (16%) were under age 18 (Age range: 2 mos – 5 yrs.)
• None of the hospitalized children required ICU care
•• Pandemic influenza A (H1N1) continues to circulate in our communPandemic influenza A (H1N1) continues to circulate in our community.ity.
Vaccination is the most effective tool • for preventing influenza.
• Vaccinating school‐age children protects them and safeguards the health of people at around them:
• ‐‐ Younger siblings• ~pre‐schoolers, toddlers, infants• ‐‐ Pregnant women• ~ teachers, relatives, mothers of their classmates & friends• ‐‐ Elderly adults• ~ grandparents• ‐‐ Family members and friends with chronic medical conditions
H1N1 Flu Vaccine ProgramChristine Stipp, BSN, PHN
Supervising Public Health Nurse
Vaccine Background• FDA approved
– 6 months and older• Number of doses
TBD• Clinical studies
pending• Multiple formulations
– Nasal– Injected
• No shortage expected
ACIP Priority Groups• Pregnant women• Everyone age 6 months –
24 years• Household
contacts/caregivers of children < 6 months
• Healthcare and EMS personnel
• People 25 - 64 years of age w/chronic medical illness
Priority Groups if Shortage• Pregnant women• Children age 6 months –
4 years• Household
contacts/caregivers of children < 6 months
• Healthcare and EMS personnel
• Children 5 - 18 years of age w/chronic medical illness
Where Can I Get H1N1 Vaccine?
• Healthcare providers• Pharmacies• Public Health flu clinics (if no provider)
– Dates, locations TBD