Rich Feifer, MD, MPH, FACP April 27, 2009 Swine Flu Update Rich Feifer, MD, MPH, FACP April 27, 2009

What is “Swine Flu”? Swine Flu is a type of influenza Usually infects pigs Human transmission from pigs has regularly but infrequently occurred over the years Human-to-human has previously been rare What is happening now? One type of swine flu, H1N1, has undergone a change into a new virus subtype: Now has the ability to more easily spread from human to human To avoid confusion: Swine Flu H1N1 is different from Human Flu H1N1

World Health Organization (WHO) Pandemic Phases

World Health Organization (WHO) Pandemic Phases Phase 1: No cases of animal influenza virus in humans Phase 2: Human infection by animal influenza virus Phase 3: Sporadic cases or small clusters, but no sustained human-to-human spread (Current Level) Phase 4: Sustained human-to-human spread in communities Media frenzy Minimal disruptions to business or clinical care Phase 5: Sustained human-to-human spread in multiple countries within a global region Localized disruptions Fear Phase 6: Full Pandemic (eg, world) Multiple “waves” Healthcare system completely overwhelmed Social isolation strategies adopted and enforced Pharmacy supply chain disruptions Pharmacy and medical regulations liberalized Government use of emergency powers Timing ? Weeks to Months

Current Status We are not currently in a pandemic, but we are closer to one than we were last week…. A US “Public Health Emergency” was declared on 4/26 This is just a preparedness step, not a description of current pandemic epidemiology or severity Involves deployment of Federal stockpile of medications to regional sites

When is “the flu” NOT the flu? Symptoms of influenza are severe High fever Cough Sore throat Body aches Headache Extreme fatigue Occasional diarrhea or vomiting Most respiratory infections are not the influenza (the flu), they are a cold Symptoms may be similar to above, but are milder More likely to have a runny or stuffy nose

Protection Measures Contact avoidance Hand washing and hand sanitizers Antiviral medications Tamiflu and Relenza – YES Treatment (suspected vs confirmed H1N1 swine flu) Pre-exposure prophylaxis Post-exposure prophylaxis Amantadine and Rimantadine – NO Vaccines – NOT YET

Important Resources Primary CDC website for influenza http://www.pandemicflu.gov/ Link to state-level pandemic preparedness and response http://www.pandemicflu.gov/whereyoulive/index.html http://www.pandemicflu.gov/plan/states/stateplans.html http://pandemicflu.gov/plan/states/antivirals.html (dated 9-08) Checklist for corporate pandemic preparedness http://www.pandemicflu.gov/plan/pdf/businesschecklist.pdf Interim guidance on antiviral drugs for swine flu http://www.cdc.gov/swineflu/recommendations.htm http://www.cdc.gov/flu/professionals/antivirals/dosagetable.htm#table

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