H1N1 Update: EMHD Local Perspective Presented to GEM MRC By Dorothy Jubon 15 August 2009 Data courtesy of Alana Sulka, MPH EMHD, Epidemiology Director

H1N1 FAQs Why "swine" flu? Initial laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs (swine) in North America … since found to be untrue How long can an infected person spread this virus to others? People infected with seasonal and novel H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children and people with weakened immune systems and in people infected with the new H1N1 virus.

H1N1 FAQs How long can influenza virus remain viable on objects (such as books and doorknobs)? Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface. What kills influenza virus? Influenza virus is destroyed by heat ( °F [ °C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time.

Status of H1N1 Infections As of July 31 st, 2009 CDC reported 5,514 cases 353 deaths Individual case reporting ceased on July 24 th Only hospitalizations and deaths will now be reported CDC estimates that there have been over 1 million cases of H1N1 since April 2009 Novel H1N1 viruses now account for more than 98% of all sub-typed Influenza A virus The timing, spread, and severity of novel H1N1 virus – in addition to regular seasonal influenza viruses – are uncertain Novel H1N1 Influenza Updated key Talking Points July 31, 2009

162,380 cases and 1154 deaths reported worldwide as of July 30, 2009

Epidemiology/Surveillance Pandemic H1N1 Hospitalizations Reported to CDC Clinical Characteristics as of July 9, 2009 (n=268) Data from COCA Call slide set: Joseph Bresee H1N1 Update: Epidemiology and Clinical Features July 15, 2009

Epidemiology/Surveillance Pandemic H1N1 Cases Rate per 100,000 Population by Age Group As of July 9, 2009 (n=35,860*) *Excludes 1,386 cases with missing ages. Rate / 100,000 by Single Year Age Groups: Denominator source: 2008 Census Estimates, U.S. Census Bureau at: n=3621 n=5774 n=1673 n=382 Data from COCA Call slide set: Joseph Bresee H1N1 Update: Epidemiology and Clinical Features July 15, 2009

Epidemiology/Surveillance Pandemic H1N1 Hospitalization Rate per 100,000 Population by Age Group (n=3,779) as of July 9, 2009 *Hospitalizations with unknown ages are not included (n=353) *Rate / 100,000 by Single Year Age Groups: Denominator source: 2008 Census Estimates, U.S. Census Bureau at: Data from COCA Call slide set: Joseph Bresee H1N1 Update: Epidemiology and Clinical Features July 15, 2009

Epidemiology/Surveillance Pandemic H1N1 Hospitalizations Reported to CDC Underlying Conditions as of June 19, 2009 (n=268) *Excludes hypertension Data from COCA Call slide set: Joseph Bresee H1N1 Update: Epidemiology and Clinical Features July 15, 2009

Pandemic H1N1 Cases by State Rate / 100,000 State Population As of July 9, 2009 Data from COCA Call slide set: Joseph Bresee H1N1 Update: Epidemiology and Clinical Features July 15, 2009

Epidemiology/Surveillance Pandemic (H1N1) – 9 JUL 2009 U.S. WHO/NREVSS Collaborating Laboratories Summary, Data from COCA Call slide set: Joseph Bresee H1N1 Update: Epidemiology and Clinical Features July 15, 2009

Epidemiology/Surveillance Pandemic H1N1 – July 9, 2009 Percentage of Visits for Influenza-like Illness (ILI) Reported by the US Outpatient Influenza-like Illness Surveillance Network (ILINet),National Summary and Previous Two Seasons † There was no week 53 during the and seasons, therefore the week 53 data point for those seasons is an average of weeks 52 and 1. Data from COCA Call slide set: Joseph Bresee H1N1 Update: Epidemiology and Clinical Features July 15, 2009

Summary of Antiviral Resistance, U.S Influenza viruses Antiviral Seasonal A (H1N1) Seasonal A (H3N2) Seasonal B Pandemic H1N1 Adamantanes SusceptibleResistantNo activityResistant Oseltamivir Resistant Susceptible Zanamivir Susceptible Data from COCA Call slide set: Joseph Bresee H1N1 Update: Epidemiology and Clinical Features July 15, 2009

EMHD Morbidity, as of August 5, 2009 Cases Median Age Range Hospitalizations N (%) Gwinnett18 34 (2 – 69) 17% Newton3 37 (15 – 53) 0% Rockdale3 11 (6 – 12) 0% Total24 27 (2 – 69) 12.5%

H1N1 Vaccine Supply Five manufacturers are producing a US-licensed vaccine Each are conducting clinical trials to test safety and efficacy Vaccine will roll in waves Focus should be placed on high priority groups It is anticipated that there will be no shortage of vaccine Public health will partner with medical community to provide vaccine PH’s focus will be Mass vaccination in the schools Vaccinations for those without a medical home

H1N1 Vaccine Supply Assumptions Planning assumptions include: Vaccine will be readily available Potentially as early as October Vaccine will require two doses and may be given concurrently with seasonal flu vaccine Vaccine will be shipped with syringes, needles, alcohol swabs, and sharps containers Vaccine (and supplies) will be provided free of charge Administration fees will be reimbursable by Medicaid and private insurance companies Reporting requirements will accompany vaccine

ACIP H1N1 Vaccine Recommendations Initial efforts should be placed on vaccinating Pregnant women Household contacts and caregivers for children younger than 6 months of age Healthcare and emergency medical services personnel Children 6 months through 18 years of age Young adults 19 through 24 years of age Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza Key populations total 159 million Americans Voted on by ACIP on 7/29/09

If vaccine demand exceeds availability, focus should be placed on vaccinating Pregnant women Household contacts and caregivers for children younger than 6 months of age Healthcare and emergency medical services personnel with direct medical contact with patients or infectious materials Children 6 months through 4 years of age Children with health conditions under 19 years of age ACIP H1N1 Vaccine Recommendations (cont.) Voted on by ACIP on 7/29/09

What Should You Do?

For Your Health … and Ours Cover your cough – cough into your elbow Wash your hands frequently – teach your children to wash their hands Keep your hands away from your face (nose and mouth) If you have a fever, stay home for at least 24 hrs after that fever has ended Get a seasonal flu vaccine as soon as possible and the novel flu vaccine when it becomes available

H1N1 FAQs What household cleaning should be done to prevent the spread of influenza virus? Keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) wiped down with a household disinfectant.

H1N1 FAQs What surfaces are most likely to be sources of contamination? Germs can be spread by touching something that is contaminated and then touching eyes, nose, or mouth. Droplets from a cough or sneeze move through the air. Germs can be spread when a person touches respiratory droplets left on a surface like a desk, and then touches their own eyes, mouth or nose before washing their hands.

H1N1 FAQs How should linens, eating utensils and dishes of persons infected with influenza virus be handled? Items belonging to those who are sick do not need to be cleaned separately, but should not be shared without cleaning thoroughly first. Linens (bed sheets and towels) should be washed with household laundry soap and tumbled dry on a hot setting. Avoid “hugging” laundry to prevent contamination. Wash hands with soap and water or alcohol-based hand rub immediately after handling any soiled item.

Store a two week supply of water and food. Periodically check your regular prescription drugs to ensure a continuous supply in your home. Have any nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins. Planning for a Pandemic from CDC

Talk with family members and loved ones about how they would be cared for if they got sick, or what will be needed to care for them in your home. Volunteer with local groups to prepare and assist with emergency response. Get involved in your community as it works to prepare for an influenza pandemic. Planning for a Pandemic from CDC

Final Points … Remember cash Paper products – plates and cups so if you don't feel well you don't need to do dishes PPE – masks don't have to be N95 – flu spreads through droplets Stay home if you are sick … keep your children home if they are ill WASH YOUR HANDS

Websites For the most current information …

QUESTIONS?????