Update: New Flu Activity and Community Mitigation

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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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Pandemic Strain Emergence Direct Infection vs.
Reassortment
Direct Infection
Human virus
Avian virus
Avian Reservoir
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Criteria for Pandemic
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H5N1 vs. H1N1 Characteristics
As of May 11, 2009
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H1N1 in US and VA
As of May 11, 2009
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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-pharmaceutica
l 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 hygiene Cough
etiquette Infection control Living space
control Isolation of ill Designated care
provider Respiratory protection
Community Isolation of ill Treatment of
ill Quarantine of exposed Prophylaxis of
exposed School/daycare closure Social
distancing - Community - Workplace Liberal
leave policies Snow days Travel restrictions
International Containment-at-source Support
efforts to reduce transmission Travel
advisories Layered screening of travelers Health
advisories Limited points of entry
Targeted, Layered Containment (TLC) utilizing
multiple partially effective interventions
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What was recommended?

• Infection control and hygiene
• Isolation
• Public education
• Containment of clusters
• Social distancing some
• Use 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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Were claiming a success

• Questions and Discussion