Patricia Heinsohn, PhD, MPH, CIH

 Acute viral disease of respiratory tract transmitted primarily by inhalation  Characterized by fever, headache, myalgia, prostration, sore throat, cough  Usually self-limiting resolving within 2-7 days in most people  Three types of influenza virus: A, B, C  Type A has 15 subtypes, only two of which are associated with epidemics (subtypes H1 and H3) Patricia Heinsohn, Ph.D., MPH, CIH

 35,000-60,000 people die in US each year from seasonal flu  Usually affects very young, elderly, and those with certain underlying disease  Usually occurs in winter in temperate climates  There is usually some immunity built up from past exposures and vaccines are effective for specific strains  Antiviral treatment generally available  Public health infrastructure can usually handle incidence Patricia Heinsohn, Ph.D., MPH, CIH

 Avian influenza virus typically infects wild and domestic birds  Including: chickens, turkeys, ducks, domestic geese, quail, pheasant, gulls, shorebirds, seabirds, eagles  Avian type A has 3 subtypes: H5, H7, and H9  Avian influenza is highly contagious and 100% fatal in many flocks Patricia Heinsohn, Ph.D., MPH, CIH

 Poultry and wild birds in parts of Asia, Siberia, Africa, the Middle East have been infected with strains of avian A/H5N1  Strains of H5N1 have infected birds in 54 countries as of June 2006  Millions of infected birds have died and millions have been killed  Between 2003 and 2009, there have been 262 human deaths in 442 infected people with H5N1  Scientists believe the next pandemic will involve H5N1 due to its pathogenicity and ability to mutate Patricia Heinsohn, Ph.D., MPH, CIH

 Influenza infection in pigs happens regularly  With influenza A subtypes H1N1, H1N2, H3N1, and H3N1  Swine influenza A is passed to humans infrequently  Between Dec 2005 and Feb 2009, there were 12 human cases of swine flu and these had contact with pigs  Human A/H1N1 is different from swine A/H1N1 Patricia Heinsohn, Ph.D., MPH, CIH

 Pandemic influenza strains originate in non- human species  Little or no immunity in humans  Not seasonal; three pandemics in 20 th century; 1918, 1957, 1968  US dead from Asian flu 1957: 70,000+  US dead from Hong Kong flu 1968: ~34,000  million died worldwide in Spanish Flu pandemic of 1918  Spanish Flu hit US in three waves between 1918 and 1919; US dead: 500,000 Patricia Heinsohn, Ph.D., MPH, CIH

 Spanish Flu pandemic was an avian influenza virus  Attacks healthy people  Scientists predict worse than 1918; between million and million deaths  Antivirals will be limited  Vaccines will be limited  Public health infrastructure will be overwhelmed  There will be a major impact on society Patricia Heinsohn, Ph.D., MPH, CIH

 WHO global preparedness plan  US DHHS developed a pandemic influenza plan in 2005  US National Stockpile of antivirals for treatment and prophylaxis  Vaccine given first to “critical infrastructure”: healthcare, law enforcement, fire, and emergency medical services  Originally none to individual households Patricia Heinsohn, Ph.D., MPH, CIH

 Phases 1-6  Now at alert level 6 of a strain of A/H1N1  This strain is swine/bird/human  Check out: WHO and pandemic flu alert level on internet Patricia Heinsohn, Ph.D., MPH, CIH

 Mexico 1,112 lab confirmed cases, 42 deaths  US 642 lab confirmed cases, 2 deaths  23 countries  Total 2,099 cases worldwide  Mexico: same  US: 896 cases, 2 deaths  24 countries  Total 2,371 cases Patricia Heinsohn, Ph.D., MPH, CIH

 Mexico: 1,364 lab confirmed cases, 45 dead  US: 1,639 lab confirmed cases, 2 dead  27 countries  Total >3,000 cases worldwide Patricia Heinsohn, Ph.D., MPH, CIH

 WHO reports 254,206 laboratory- confirmed cases with at least 2,837 deaths worldwide  Not a reportable disease  Per Shasta County DPH: 167 deaths with 2,000 hospitalizations and/or fatalities in CA  As of , there were 1,000 US deaths Patricia Heinsohn, Ph.D., MPH, CIH

 Depends on distinguishing swine A(H1N1) from seasonal human A(H1N1) influenza  Various tests done  Testing not currently done in Shasta County due to cost  Diagnosis is based only on symptoms  Reporting of the incidence of both diseases will be inaccurate as the symptoms are generally indistinguishable  Seasonal flu season: October – March/April Patricia Heinsohn, Ph.D., MPH, CIH

 Of the 4 FDA-approved antiviral drugs, only 2 are effective against A(H1N1): ◦ Relenza (Zanamivir) ◦ Tamiflu (Oseltamivir)  6% of US isolates were resistant to Tamiflu  Effective as prophylactic only if exposed while taking it  Only 70-90% effective as a prophylactic Patricia Heinsohn, Ph.D., MPH, CIH

 Available early to mid-October in limited supply  Vaccine produced by 4 companies using same process  Estimated production could be ~3 billion doses per year (world population ~6.8 billion)  Early clinical trials indicate that most adults have robust immune response w/in 8-10 days Patricia Heinsohn, Ph.D., MPH, CIH

 Side effects for injected vaccine: ◦ Soreness at the injection site ◦ Mild fever ◦ Body aches ◦ Fatigue  Side effects of nasal spray vaccine: ◦ Runny nose and nasal congestion for all ages ◦ Sore throat in adults ◦ Fever in children 2-6 years old Patricia Heinsohn, Ph.D., MPH, CIH

 Current government recommended target groups: ◦ Pregnant women ◦ Household contacts and caregivers for children less than 6 years old ◦ Healthcare and emergency medical services ◦ All people 6 months to 24 years old ◦ People between 25 and 64 with chronic health conditions including:  Chronic pulmonary  Cardiovascular except hypertension  Renal  Hepatic Patricia Heinsohn, Ph.D., MPH, CIH

◦ Cognition ◦ Neurologic/neuromuscular ◦ Hematologic or metabolic disorders (including diabetes) ◦ Immunosuppression (including HIV and medication related)  Following vaccination of ‘target’ groups, the government recommends that everyone between 25 and 64 be vaccinated Patricia Heinsohn, Ph.D., MPH, CIH

◦ Who’s left? ◦ The only people the government does not recommend be vaccinated are 64 and older ◦ This does not appear to be consistent with the epidemiology of the pandemic Patricia Heinsohn, Ph.D., MPH, CIH

 There are thimerosal and thimerosal- free formulations  Thimerosal-free legally required in CA for pregnant women and children under 3 due to risk for autism  No one with chicken egg allergies should receive the vaccine Patricia Heinsohn, Ph.D., MPH, CIH