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Update: “New Flu” Activity and Community Mitigation
Diane Woolard, PhD, MPH
Director, Division of Surveillance and Investigation
Virginia Department of Health
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Outline
• Update on H5N1 and H1N1 activity– Comparison of the two
• Review of purpose and strategies for community mitigation
• Community mitigation recommendations for the new H1N1 virus situation
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Avian Reservoir
Avian virus
Human virus
Pandemic Strain Emergence: Direct Infection vs. Reassortment
other mammals?New
reassorted virus
Direct Infection
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Criteria for PandemicH5N1 H1N1 Criterion
√ √ Novel strain that is not recognized by the human immune system
√ X Causes increased sickness and death
X √- Sustained person-to-person transmission
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H5N1 vs. H1N1 Characteristics
H5N1 H1N1
Cases 423 4694
Deaths 258 53
Countries 15 30
Case-fatality 61% 1%
Year began 1997, 2003 2009
* As of May 11, 2009
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H1N1 in US and VA
US Virginia
Cases 2618 17
Deaths 3 0
Distribution 44 states 6 districts
Case-fatality 0.1% 0%
* As of May 11, 2009
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Inter-pandemic phase Low risk of human cases 1
New virus in animals; no human cases
Higher risk of human cases 2
Pandemic alert No or very limited human-to-human transmission 3
Virus causes human cases Evidence of increased human-to-human transmission
4
Evidence of significant human-to-human transmission
5
Pandemic Efficient & sustained human-to-human transmission
6
WHO Pandemic Alert Phases
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Community Mitigation
• Goal: Slow disease spread – allows time for vaccine development,
manufacturing, distribution and antiviral distribution
• Barrier: Influenza is hard to control– Short incubation period; non-specific nature of
clinical illness; easy to spread, even before symptoms
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Community-Based Interventions
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Community Mitigation Strategies(Non-pharmaceutical interventions)
• Infection control and hygiene• Social distancing• Community education• Cluster containment• Data collection and management to guide
decisions
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A Layered Approach
Individual / Household
Hand hygieneCough etiquetteInfection controlLiving space controlIsolation of illDesignated care
providerRespiratory protection
Community
Isolation of illTreatment of illQuarantine of exposedProphylaxis of exposedSchool/daycare closureSocial distancing
- Community- Workplace
Liberal leave policiesSnow daysTravel restrictions
International
Containment-at-sourceSupport efforts to
reduce transmissionTravel advisoriesLayered screening of
travelersHealth advisoriesLimited points of entry
Targeted, Layered Containment (TLC) utilizing multiple partially effective interventions
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What was recommended?
Infection control and hygieneIsolationPublic educationContainment of clustersSocial distancing – someUse of information to guide decisions
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Social Distancing for H1N1
• Quarantine – consider minimizing time in crowds, isolate on first sign of illness
• Airport screening – observe & report ill• School closure – strongly consider to consider
to local decision –– Early identification of ill– Stay home with sick– Cough etiquette, handwashing– Closure at discretion of local authorities
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Social Distancing, continued
• College/university – treat as community – isolate, cover cough, no cancelling
• Mass gatherings – – if ill, stay home– if high risk, consider risk, consider avoiding
• Business – telecommuting & snow days – not really emphasized
• [Respiratory protection – mask if ill and in public; respirator if caring for ill]
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Use Information to Guide Decisions
• Epidemiology – studying patterns of disease in population– What is illness – case definitions– How much illness is occurring – surveillance;
testing recommendations; assess severity and spread
– What populations are affected – descriptive– What are the risk factors – analytic
• Use this information to develop prevention messages and recommendations
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Challenges that Arose
• Definition of community – case definition included travel to affected community
• Data release at district level – citizens wanted to know city/town
• Testing purpose and protocol – public health and clinical management
• Interpretation of recommendations – school/childcare, masks
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We’re claiming a success
Questions and Discussion