Tamara ChavezLindell, MPH

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Novel H1N1 Influenza

• Tamara Chavez-Lindell, MPH
• Regional Epidemiologist
• Juli Allen, RN, MPH
• Emergency Preparedness Nurse Consultant
• East TN Regional Health Office

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What do we know?

• New influenza virus causing illness in people
• Initially thought to be a swine flu
• Now known to be a quadruple reassortment virus
• 2 genes from flu circulating in pigs (European
  Asian strains)
• Also contains avian human flu genes

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What do we know? (2)

• It is contagious and can spread person-to-person
• It has generally been mild but can be dangerous
• Severe illness and deaths have occurred, mostly
  in individuals with other medical conditions
• It has been determined to be at a pandemic level
• Note pandemic does not imply anything about
  disease virulence describes only current spread
  and transmissibility

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Why is it called H1N1?

• H1N1 refers to specific proteins on the virus
  surface
• There are other H1N1 strains in circulation
• This particular strain is new, however

• Flu vaccine includes 3 strains selected each year
  based on circulating types, but always includes
• Influenza A/H1N1 (previous strain)
• Influenza A/other (strain varies)
• Influenza B (strain varies)

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Seasonal Flu vs. Novel H1N1 Flu

• Symptoms
• -fever
• -cough
• -sore throat
• -runny or stuffy nose
• -body aches
• -headache
• -chills
• -fatigue

• Symptoms
• -fever
• -cough
• -sore throat
• -runny or stuffy nose
• -body aches
• -headache
• -chills
• -fatigue
• -diarrhea and vomiting

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Treatment of Flu

• Antibiotics DO NOT CURE the flu virus
• Antibiotics ONLY help if you develop a secondary
  bacterial infection
• Antivirals can decrease the severity of the flu
  or shorten the illness if started promptly
• Note 2009 H1N1 strain is resistant to 2 commonly
  used antivirals, but susceptible to Tamiflu
• Your doctor may not prescribe medication if you
  are not at high risk of complications!
• Most people will get better in 7-10 days w/o
  treatment
• Do not want to risk the virus developing
  additional
• resistance to Tamiflu

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Prevention

• Cover your nose and mouth with a tissue when you
  cough or sneeze -- Throw away the tissue

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Prevention

• Avoid touching your eyes, nose and mouth
• Wash your hands often with soap and water

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Prevention

• Try to avoid close contact with sick people
• Stay home if you are sick for 7 days or until
  symptom free for 24 hours (whichever is longer)

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Prevention

• Cover your nose and mouth with a tissue when you
  cough or sneeze -- Throw away the tissue
• Wash your hands often with soap and water
• Avoid touching your eyes, nose and mouth
• Try to avoid close contact with sick people
• Stay home if you are sick for 7 days or until
  symptom free for 24 hours (whichever is longer)

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Who infects whom?
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H1N1 Flu U.S.

• As of 07/17/09
• 55 states/territories
• 40,617 cases, 263 deaths
• CDC encouraging preparation now for potential
  waves
• Pandemic Planning Response in place prior to
  H1N1
• Primary objective
• Minimize sickness and death
• Secondary objectives
• Preserve functional society
• Minimize economic disruption

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H1N1 Flu TN

• As of 07/22/09
• 37 counties have reported cases
• 282 cases, 2 deaths
• Planning for subsequent waves underway
• County-level pandemic flu plans required
• Guidance for organizations/facilities
• Preparation for vaccination campaign
• Joint review of plans with bordering
  regions/states

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The 2009-2010 Flu Season

• Unknown how the novel H1N1 flu virus will affect
  the upcoming flu season
• Increased virulence?
• Separate vaccinations understood by public?
• Media attention to make public more prepared?
• Vaccine trials currently underway
• Vaccine production planned for late summer
• Public-ready vaccine anticipated fall 2009
• Likely to require 2 doses for H1N1 in addition to
  seasonal flu

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Anticipated Vaccine Distribution

• Specific details are pending at this time
• 5 companies to produce the vaccine
• Initial vaccine shipment expected mid-October
  (production delays may occur due to delicate
  process)
• Distribution determined based on production
  levels
• Likely to be distributed as seasonal flu vaccine,
  mostly via private providers
• Community-based mass dispensing

• The Advisory Committee on Immunization Practices
  and other federal agencies will determine
  priority categories

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Achieving 100 Vaccination Role of Schools

• Children are a high-risk category likely to be
  targeted for vaccination schools will be key in
  achieving this
• Clearinghouse for information to families re flu
• Educating students regarding prevention skills
• (handwashing!)
• Maintaining accurate absentee records
• May be asked to house after-hours vaccination
  clinics
• Staff likely to be among the high-risk categories
  targeted for vaccination include
• Pregnant women
• People over 65
• People with other medical conditions

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Planning Assumptions Disease Transmission

• No one is immune 30 of population will fall
  ill
• Most will become ill 2 days (range 1-10) after
  exposure
• People may be contagious 24 hours before symptoms
• People are most contagious the first 2 days of
  illness
• Sick children more contagious than adults
• On average, each ill person infects 2 or 3 others
• (if no precautions are taken)
• Pandemics move through community in waves
• Each wave will last 6-8 weeks
• Pandemic period may last 18 months to 2 years

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Educational Resources

• Kidtastics Podcasts by CDC
• Free downloads available!
• Hand washing http//www2a.cdc.gov/podcasts/playe
  r.asp?f11072
• Novel H1N1 Flu http//www2a.cdc.gov/podcasts/play
  er.asp?f11416
• Novel H1N1 Flu (Spanish) http//www2a.cdc.gov/pod
  casts/player.asp?f11417
• Germ Stoppers Posters http//www.cdc.gov/germstop
  per/materials.htm

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Additional Information

• Sources
• CDC H1N1 Flu and You http//www.cdc.gov/h1n1flu/
  qa.htm
• CDC H1N1 Vaccine http//www.cdc.gov/h1n1flu/vacc
  ination/public/vaccination_qa_pub.htm
• CDC Podcasts http//www2a.cdc.gov/podcasts/index
  .asp
• Pandemic Flu Preparedness school tools,
  checklists http//www.pandemicflu.gov/plan/school/
  index.html
• CDC Flu widgets for websites http//www.cdc.gov/
  widgets/
• Cover Your Cough Poster http//www.cdc.gov/flu/p
  rotect/covercough.htm
• School Network for Absenteeism Prevention (SNAP)
  Toolkit http//www.itsasnap.org/snap/pdfs/SNAP2
  0Toolkit20FINAL204.pdf

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Questions?
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Thank you for your attention!