1. Human Swine Influenza virus A (H1N1) Steven Skov Public Health Physician Centre for Disease Control As of 11 June 2009

2. WHO notified world on 24 April Outbreak virulent flu in Mexico with cases in USA and Canada

3. World situation (11 June 2009) >29,000 confirmed cases in 74 countries Mexico 6241 with 108 deaths USA 13217 with 43 deaths Canada 2978 with 4 deaths Chile 1694 with 2 deaths Argentina 256 Spain 331 UK 750 Japan 491

4. Current “hot list” Mexico USA Canada Japan Panama Chile Argentina (to be considered in relation to “suspect” cases)

5. Australia 1307 confirmed cases: no deaths 1011 cases in Victoria NSW 115 Qld 77 NT 11 of which 2 in Tiwi 1 in Yuendumu resident

6. WHO pandemic level 6 Australia pandemic level “CONTAIN” Victoria ”MODIFIED SUSTAIN”

7. Who’s running the show? Australian Health Protection Committee Communicable Disease Network of Australia Australian Health Management Plan for Pandemic Influenza

8. Incubation period 3-7 days Infectious period 24 hours pre onset 7 days post onset or until symptoms resolved (the longer) Children may be longer but for case and contact management purposes use 7 days

9. Outside of Mexico seems a relatively mild illness Mainly affecting younger people med age in USA and Canada 16-18yrs Reproduction number in Mexico = 1.4

10. 71% Mexican deaths aged 20-54 yrs Outside Mexico hospitalisation rate ~ 3% death rate in USA ~ 0.3% death rate in Canada ~ 0.13% Some serious cases reported from northern Canadian Aboriginal communities

11. Case definitions Suspected case Confirmed case Probable case

12. Suspected case Acute, febrile, respiratory illness and onset within 7 days of being in Victoria or “hot list country” OR Acute respiratory illness and Onset within 7 days of contact with confirmed or probable case

13. Confirmed case positive lab result for H1N1 influenza Probable case fever and respiratory illness with onset within 7 days of contact with a confirmed case in absence of lab test result

14. What do do clinicians: suspect or probable cases Reception triage Mask for patient PPE for clinician if suspect or probable case Swab (+/- serology) influenza A PCR: NB specify is suspect or probable case on request form Call CDC MO Arrange oseltamavir if < 48 hours symptoms (Tamiflu): if high risk consider oseltamavir if symptoms longer than 48 hrs Home isolation

15. Using oseltamavir See http://www.health.nt.gov.au/H1N1_Infl uenza/REMOTE_HEALTH/index.aspx

16. Tamiflu For suspected, confirmed and probable cases For contacts of confirmed /probable cases only NOT for contacts of suspected only cases

17. Home isolation: for suspect cases and cases Stay at home (no going out to the shop or down the road for visit etc) Wear ordinary surgical mask when in same room as other people Tamiflu treatment 75mg twice a day for 5 days

18. Home isolation duration: for suspect cases and cases For suspect cases until PCR test excludes diagnosis If confirmed /probable case, 7 days after onset of symptoms or until symptoms resolved (whichever is longer) OR until has been on oseltamavir for 72 hours and has no fever

19. Contacts: for confirmed and probable cases Someone who: spent the night in the same house as the case while they were infectious had sex with the case while they were infectious spent 15 minutes continuously within 1 metre of the person while they were infectious

20. Home quarantine: for contacts Stay at home (no going out to the shop or down the road for visit etc) No need for mask Tamiflu prophylaxis 75mg once a day for 10 days

21. Home quarantine duration: for contacts Until test in the case is negative For 7 days after last contact with the case OR Until 72 hours of oseltamavir and NO symptoms (but must finish the course)

22. Advice for well people Normal business No panic Cough etiquette and handwashing Personal space (1 metre)

23. Bush preparations Pre positioning of initial supplies of tamiflu and PPE Remote flu strategy committee Website High risk patients: what to do??

24. Managing in the bush Immediate care Case and contact follow up Supervision of tamiflu Prioritisation of activities: some program activities may need to go on hold to manage the flu situation

25. Remote health http://www.health.nt.gov.au/H1N1_Influenza/REMOTE_HEALTH/index. aspx Dept Health and Ageing http://www.healthemergency.gov.au. Very practical FAQ from AMA to GPs: http://www.ama.com.au/node/4603 RACGP pandemic flu kit: http://www.racgp.org.au/pandemicresources NT Centre for Disease Control http://www.health.nt.gov.au/Centre_for_Disease_Control/index.aspx

26. Contact CDC Office hours 89228044 After hours via RDH switchboard 89228888

27. Border measures Positive Pratique Health Declaration Cards Thermal scanners AQIS Border nurses

28. Information flow Letters from CMO Letters from CDC Posters for waiting rooms etc Exclusion from schools for returning travellers Posters for backpackers Guidance for hotels