Treatment of H1N1 Infection Prevention of H1N1 Infection ... · • A new highly contagious flu...

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Th H1N1 P d i

Overview

•The H1N1 Pandemic

• Prevention of H1N1 Infection

• Treatment of H1N1 Infection

The H1N1 Pandemic

*Images from www.news4u.com, www.fox44.com, and www.javno.com

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"About three out of five Americans believe there will be widespread swine flu cases

this fall or winter, but most are not worried it will strike them or their family…about 25percent said they probably would lose

their job or business."j

-Harvard School of Public Health SurveyJune 2009

* Available from: http://www.wtop.com/?nid=220&sid=1719055

What is H1N1?

• A new highly contagious flu virus of swine origing

• First caused illness in Mexico and the United States in March 2009

• The virus is a mix of genes from:• The virus is a mix of genes from:– Bird– Pig– Human

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What is H1N1?

• Flu-like symptoms:– Fever – HeadacheFever– Cough– Sore throat– Body aches

S d th h

– Chills– Fatigue– Nausea, vomiting

and/or diarrhea

• Spreads through:– Coughs and sneezes – Touching contaminated surfaces (elevator

buttons, doorknobs, keyboards) and then eyes, nose or mouth

Who is at Risk for Complications?

• Pregnant women• Those with chronic health disorders orThose with chronic health disorders or

compromised immune systems– Asthma, COPD, diabetes, heart disease,

kidney disease– Morbid obesity – Medications that cause suppression of theMedications that cause suppression of the

immune system (e.g., chemotherapy, post-transplant)

• Children <5 years, Adults >65 years

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Where did “Swine Flu” Come From?

• Viruses easily pass from:BIRD PIG PIG HUMAN HUMANBIRD PIG PIG HUMAN HUMAN

– By breathing infected particles (NOT by consuming pork, chicken, etc)

• Pigs can harbor several flu viruses, may mix and create a new viral strain

Pigs = Good breeding grounds for viruses

Confirmed and Probable Novel H1N1 Cases

36000

40000

History of H1N1

12000

16000

20000

24000

28000

32000

Cas

es

0

4000

8000

12000

28-M

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4-Ap

r11

-Apr

18-A

pr25

-Apr

2-May

9-May

16-M

ay23

-May

30-M

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6-Ju

n10

-Jun

16-Ju

n24

-Jun

3-Ju

l10

-Jul

Week Ending Date*www.cdc.gov/H1N1

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H1N1 Becomes Pandemic

• June 11, 2009: World Health Organization raises gworldwide pandemic alert level to Phase 6– Based on spread of the virus– At the time, more than 70 countries had reported

cases; since then, nearly double

What is a Pandemic?

*Available from: http://www.who.int/csr/disease/influenza/GIPA3AideMemoire.pdf

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H1N1 Becomes Pandemic

• June 11, 2009: World Health Organization raises gworldwide pandemic alert level to Phase 6– Based on spread of the virus– At the time, more than 70 countries had reported

cases; since then, nearly double

What is a Pandemic?

*Available from: http://www.who.int/csr/disease/influenza/GIPA3AideMemoire.pdf

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History of Pandemics

• Three Pandemics in Past 100 Years1918: Spanish Flu– 1918: Spanish Flu• High severity• Highest death rate: adults 20 to 50 years old• 675,000 deaths in the U.S.

– 1957: Asian Flu• Highest death rate: the elderly• 69,800 deaths in the U.S.

– 1968: Hong Kong Flu • Mild severity• 33,800 deaths in the U.S.

*http://www.pandemicflu.gov/general/historicaloverview.html

Prevention of H1N1 Infection

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Preventing the Spread: Employees

• Ask yourself daily before coming to work: – Do I have a fever?– Do I have a sore throat?– Am I coughing? – Do my muscles ache?– Do I feel ill?

• If you answered “yes” to any of the questions• If you answered yes to any of the questionsabove:– Do not report to work; stay at home– Notify your supervisor as soon as possible– Seek medical guidance


1. Cough/Sneeze ‘Etiquette’– Cover mouth and nose with tissue;

t htrash– If tissues not available, use

elbow/shoulder, not hands

2. Hand Washing – Soap and water for 20 seconds (hum

“Happy Birthday”)If t il bl h d iti– If not available, hand sanitizer• Before and after preparing food or eating• After using the restroom• Before and after touching nose, eyes, or

mouth

*Available from: http://www.cdc.gov/h1n1flu/antiviral.htm

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• Facemasks and respirators:– generally not recommended for non-healthcare

kworkers• Unless increased risk of severe illness• May choose to wear on voluntary basis

• If work activities include contact, workers should:– Maintain distance of 6 feet or more– Keep interactions as brief as possible– Ask ill person to follow good cough etiquette,

hand hygiene and to wear facemask

*CDC Recommendations for Facemask and Respirator Use: http://www.cdc.gov/h1n1flu/masks.htm

• Provide:– Flexible leave policies to encourage sick to stay home

Preventing the Spread: Employers

– Written guidance on H1N1 flu – Facilities for hand washing, alcohol-based hand

sanitizers in common workplace areas – Disinfectants, disposable towels for cleaning work

surfaces

• Disinfect hard surfaces such as keyboards, d k bdoorknobs

• Display posters about hand washing and cough etiquette (free posters at:http://www.cdc.gov/germstopper/materials.htm)

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• “Social distancing” in the workplaceNo handshakes and no crowded elevators– No handshakes and no crowded elevators

– Spread out – offices, cubicles, conference rooms

– Email and phones for conversations– Staggered shifts or schedules

H1N1 Vaccine

• Currently in development by five manufacturers

• Estimated shipping to start mid-October

• Purchased by the U.S. government; will be available to vaccinators at no cost.

• May require two doses of vaccine about 3 weeks apart

*Available from: http://www.cdc.gov/h1n1flu/vaccination/provider/preparing.htm

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Who Should Get the Vaccine (First)?

• Pregnant women• Live with or care for children younger than• Live with or care for children younger than

6 months of age• Healthcare and emergency medical

services personnel• Anyone 6 months to 24 years of ageAnyone 6 months to 24 years of age• Anyone 25 to 64 years of age with chronic

health disorders or compromised immune systems


Who Should Not Get the Vaccine?

• Persons who have:Allergy to eggs– Allergy to eggs

– Had a severe reaction or developed Guillian-Barré syndrome after an influenza vaccination in the past

– Moderate or severe illness with a fever (should wait until symptoms lessen)(should wait until symptoms lessen)

• Children less than 6 months of age


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• “Social distancing” in the workplaceNo handshakes and no crowded elevators– No handshakes and no crowded elevators

– Spread out – offices, cubicles, conference rooms

– Email and phones for conversations– Staggered shifts or schedules

H1N1 Vaccine

• Currently in development by five manufacturers

• Estimated shipping to start mid-October

• Purchased by the U.S. government; will be available to vaccinators at no cost.

• May require two doses of vaccine about 3 weeks apart


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Who Should Get the Vaccine (First)?

• Pregnant women• Live with or care for children younger than• Live with or care for children younger than

6 months of age• Healthcare and emergency medical

services personnel• Anyone 6 months to 24 years of ageAnyone 6 months to 24 years of age• Anyone 25 to 64 years of age with chronic

health disorders or compromised immune systems


Who Should Not Get the Vaccine?

• Persons who have:Allergy to eggs– Allergy to eggs

– Had a severe reaction or developed Guillian-Barré syndrome after an influenza vaccination in the past

– Moderate or severe illness with a fever (should wait until symptoms lessen)(should wait until symptoms lessen)

• Children less than 6 months of age


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Oral Antivirals for Treatment

– Tamiflu® (oseltamivir) – Relenza® (zanamivir)Relenza® (zanamivir)

• Maximum efficacy when started soon after getting sick

*CDC Definitions. Available at http://www.emergency.cdc.gov/agent/agentlist-category.asp#catdef


• Given daily for 5 days to people withGiven daily for 5 days to people with suspected or confirmed H1N1 infection, with priority for:

Hospitalized patientsThose at high risk for complications

*CDC Treatment Recommendations: http://www.cdc.gov/h1n1flu/recommendations.htm

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• Maximum efficacy when started soon after getting sick

*CDC Definitions. Available at http://www.emergency.cdc.gov/agent/agentlist-category.asp#catdef


• Given daily for 5 days to people withGiven daily for 5 days to people with suspected or confirmed H1N1 infection, with priority for:

Hospitalized patientsThose at high risk for complications

*CDC Treatment Recommendations: http://www.cdc.gov/h1n1flu/recommendations.htm

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Antivirals Pre-Exposure for Prevention

• Given daily during potential exposure• Given daily during potential exposureperiod and continued for 10 days after last known exposure to contagious person (confirmed, probable, or suspected)

Treatment of H1N1 Infection

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Oral Antivirals for Prevention


• 70% to 90% effective

• Contagious?g– Beginning one day before symptoms to up to

7 days after illness

• Given daily for 10 days to close contacts

Antivirals Post-Exposure for Prevention

• Given daily for 10 days to close contactsof people who are contagious (confirmed, probable, or suspected)

*At high-risk for complications *Health care personnel, public health workers, or first responders

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Oral Antivirals for Prevention


• 70% to 90% effective

• Contagious?g– Beginning one day before symptoms to up to

7 days after illness

• Given daily for 10 days to close contacts

Antivirals Post-Exposure for Prevention

• Given daily for 10 days to close contactsof people who are contagious (confirmed, probable, or suspected)

*At high-risk for complications *Health care personnel, public health workers, or first responders

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When to Return to Work?

• After fever (100° F) or signs of a fever is• After fever (100° F) or signs of a fever isgone for at least 24 hours– Without the use of fever-reducing medications

*Available from: http://www.cdc.gov/h1n1flu/guidance/exclusion.htm

Influenza in Influenza in PandemicPandemic ProportionsProportionsPreparing for a Crisis without the Pandemonium

Mary Andrawis, Pharm.D., M.P.H. Director, Clinical Guidelines and Quality ImprovementThe American Society of Health-System Pharmacists

Email:[email protected]

Treatment of H1N1 Infection Prevention of H1N1 Infection ... · • A new highly contagious flu...

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