1. Stay Healthy This Flu Season
Public Health Preparedness & Planning
October 12th, 2009
Nina M. Oliver, MS
Rowan County Health Dept.

2. Overview: Define “the flu.” Describe the illness caused by influenza
Explain how influenza spreads
Discuss medications used to prevent the flu
Discuss how to protect yourself

3. What is ‘the flu’? An illness caused by the influenza virus.
Affects nose, throat, air passages, and lung
Abrupt onset of fever, cough, sore throat, chills, and body aches
Not typically associated with vomiting or diarrhea
Yearly epidemics
In the U.S each year:
-36,000 deaths
-200,000 hospitalizations 3 3

4. What are the symptoms of influenza?
Sudden fever, muscle aches, headache, lack of energy, dry cough, sore throat, runny nose
Supportive care:
Rest, fluids, anti-cough, anti-fever meds
Antivirals if you have had symptoms less then 48 hours
Source: Centers for Disease Control and Prevention
Source: CDC Flu Factsheet 4 4

5. Are there different types of flu?
Answer: Yes!
Type A– moderate to severe illness
All age groups
Humans and other animals
Type B– milder epidemics
Humans only
Primarily affects children
Type C– rarely reported in humans
No epidemics
ABC's

6. How Flu Spreads Large droplet mostly
Generated by coughing, sneezing, talking
“spitting distance”
Rarely ‘airborne’
Contact with contaminated hands or surfaces
Examples: Contaminated hands, toys, doorknobs, keyboards
Source: U.S. Department of Health & Human Services 6 6

7. What is the difference between an epidemic and pandemic?
Epidemics occur every year due to minor changes in influenza A viruses that circulate; it is wide- spread, but not worldwide.
Pandemics happen only occasionally when a completely new influenza A virus circulates.
It is worldwide/ global
Influenza epidemics and pandemics differ primarily in scope and the mechanisms by which they occur. Epidemics occur every year due to minor changes (AKA mutations) in the influenza viruses that circulate. This results in an upswing of cases over about 6 weeks in a given community with an associated increase in hospitalizations and deaths. By contrast, pandemics happen only occasionally when a completely new influenza virus starts to circulate resulting in a really large worldwide epidemic often with multiple waves of illness. Pandemics result in more severe illnesses and more deaths than usual…especially if both the H and N components are novel. There were 3 pandemics in the last century. 7

8. What is required for a pandemic to occur?
Answer: A new virus with person-to-person spread.
Novel virus to which population has little or no immunity
Virus that spreads quickly and widely
Virus must be capable of sustained person-to-person transmission
The H1N1 virus has a high likelihood of becoming the next pandemic strain of influenza. 8

9. Influenza Pandemics 20th Century
Credit: US National Museum of Health and Medicine
1918: “Spanish Flu”
1957: “Asian Flu”
1968: “Hong Kong Flu”
A(H1N1)
A(H2N2)
A(H3N2)
20-40 m deaths
675,000 US deaths
1-4 m deaths
70,000 US deaths
1-4 m deaths
34,000 US deaths

10. Who is Most Affected?

11. Vaccine and Antivirals
Can not make vaccine until viral strain is identified
Vaccine grown in eggs
Very long process (3-9 Months)
An injectable vaccine and nasal spray is available to prevent H1N1 flu
Flu vaccine is made in hen's egg. image: CDC

12. Antivirals Concerns: Anti-virals help to: Prevent the flu
Treat the flu
Eases Flu Symptoms
Concerns:
Have to take it within 48-hours of symptom onset
Will need MASSIVE amounts (10 pills per person for treatment and 40 for prevention)
Expensive

13. Who should get the H1N1 vaccine?
Target groups have been identified by the Center for Disease
Control and Prevention (CDC):
Pregnant women
Household contacts and caregivers for children younger than 6 months of age
Healthcare and emergency medical services personnel
Persons 6 months through 24 years of age
Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.
Everyone should get the seasonal vaccine!

14. If I get sick with the flu, when should I call my provider?
If you have difficulty breathing
If unable to drink fluids, have dark urine, or feel dizzy when standing (signs of dehydration)
If you have a fever for more than 3 to 5 days
If you start to recover from the flu symptoms and you get fever again.
Dizziness or confusion

15. Influenza. Don't let it catch you!
Flu Prevention:
Influenza. Don't let it catch you! 

16. Prevention: What Can You Do?16

17. Prevention Step #1
Maintain a healthy lifestyle through rest, diet, exercise, and relaxation. 17

18. Prevention Step #2
Wash your hands frequently with soap and warm water for 20 seconds. 18

19. Alcohol-based hand sanitizers
An excellent alternative to hand washing - when soap and water aren't available.
Apply about 1/2 teaspoon of the product to the palm of your hand.
Rub your hands together, covering all surfaces of your hands, until they're dry.
Bottle must contain at least 60% alcohol. 19

20. Help children wash their hands for about 15 seconds or long enough to
sing the ‘Happy
Birthday’ song
twice.
A Must:
Warm water and soap 20

21. Prevention Step #3
Avoid touching your nose, mouth, and eyes. Germs spread this way. 21

22. Prevention Step #4
Cover your coughs and sneezes with a tissue, or cough and sneeze into your elbow. 22

23. What's wrong with this picture?23

24. Prevention Step #5
Keep frequently touched common surfaces clean, such as telephones, computer keyboards, doorknobs, etc. 24

25. Where Do Germs Live? Germs can stay alive for hours, even days, on …
Door knobs Chairs
Light switches Bathroom
Eating tables Sinks
Soft and hard toys Faucets
Floors Changing tables
Tables Telephones
Keyboards, etc. 25

26. Stay home at least 24 hours after you are free of fever and cough
Prevention Step #6
Don't spread the flu! If you are sick with flu-like illness, stay home. Symptoms include:
Fever (100 degrees Fahrenheit or 38 degrees Celsius)
Chills and cough or sore throat.
Stay home at least 24 hours after you are free of fever and cough 26

27. Prevention Step #7
Get vaccinated against seasonal flu and H1N1 when a vaccine is available (if you fall into the priority groups). 27

28. Prevention Step #8 Create a Preparedness Kit/Plan: Identification;
Medication that you are taking or need
Health conditions;
Allergies, etc.
Next of kin contact information 28 28

29. Preparedness and Partners:
Rowan County Telecommunications
Rowan County Emergency Services
Rowan County Sheriff
Salisbury Police Dept
Rowan Rescue Squad
American Red Cross
Rowan-Salisbury School System
Rowan Cabarrus Community College
Rowan County IT
NC Highway Patrol
Dept. of Social Services
Daymark Recovery Health
City of Salisbury
Food Lion LLC
Spencer Police
China Grove Police
Livingstone College
VA Hospital
Rowan Regional Medical Center

30. Questions? Nina Oliver, MS Preparedness Coordinator 704-216-8811