Decision Making During a Novel H1N1 Influenza Epidemic

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Prepared by Dr Alissar Rady, WHO Lebanon

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Presentation transcript:

Decision Making During a Novel H1N1 Influenza Epidemic Katrina Hedberg, MD, MPH Oregon Public Health Division

H1N1 (Swine) Influenza: Why Worry ? March-April: Outbreaks in Mexico March 28 & 30: Case onsets in CA San Diego and Imperial Counties No known connections Possible Pandemic Strain April 15 & 17: Novel flu confirmed at CDC A/California/04/2009

direct avian-human transmission Generation of New Influenza A Virus Subtypes with Pandemic Potential avian host direct avian-human transmission human virus avian virus swine host Figure 4. Generation of New Influenza A Virus Subtypes with Pandemic Potential. Two possible forms of transmission are shown. The first involves reassortment of influenza A virus genomic segments from an avian and human source in an intermediate swine host and then subsequent transmission among humans. The second involves direct transmission of an avian influenza subtype to humans and subsequent adaptation to enhance human-to-human transmissibility. new reassorted virus subtype Adapted from Gerberding, J. L. et al. N Engl J Med 2004;350:1236-1247

Influenza A virus in humans since 1918 H1N1 H1N1 H2N2 H3N2 Spanish flu Asian flu Hong Kong flu 1918 1957 1968 1977 Influenza A reservoir 15 HA subtypes 9 NA subtypes ?

The Plan versus Reality Plan: Based on severity determined abroad Reality: Spread within N. America & US first; severity unknown

Decision-Making Process Incident Command Structure: staffing, role of subject matter experts Pandemic Influenza Coordinating Committee: LHD, medical, ethics Antivirals Mitigation

Surveillance & Lab Testing Detect novel influenza virus in Oregon Define groups at highest risk for infection, hospitalization and death Flexible: intensive investigation around individual cases; later, may be focused on societal impact Testing: information on epidemiology mirrors who is being tested

Antiviral Issues Determining priority populations Prophylaxis versus treatment: scarce resource Allocation and distribution: public versus private sector Local health departments: Not open 24/7 ? Legal authority for drug distribution

Community Control Measures less Isolation of the ill Management of patient contacts Quarantine of recent Mexico travelers Cancellation of specific events Closure of schools/ daycare Closure of facilities and transportation Widespread community quarantine Restrictive more

more Aggressiveness of Action less less more Amount of Information

Local Situations Cinco de Mayo festival in Portland Thousands of participants, many from Mexico Backlash against Mexican community

Local Situations Rural county First case teenaged girl: hospitalized with ARDS Highest rates in Oregon

Pandemic H1N1 Oregon, 2009* n = 219 *data as of June 22, 2009 1 1 3 39 64 1 19 44 31 2 2 10 2 *data as of June 22, 2009

“What’s in a name? That which we call a rose By any other name would smell as sweet.” H1N1 (Swine) Influenza H1N1 Influenza A (Novel) H1N1 (Pandemic) Flu

Communication Coordination Public information vs anxiety producing Local PH investigation of cases/ contacts Communication Coordination Other partners Schools, university, daycare Latino community Congregate settings Legislature/ Governor’s office Medical community testing/ treatment

Local epidemiology National recommendations (CDC) differ from local experience Constantly changing situation and messages Daily briefings Date / time all guidance Communication Issues

Eneas De Troya Spanish flu, 1918 Swine flu, 2009