1. Tina Kitchin Department of Human Services, SPD 9/24/09
H1N1 Update
Tina Kitchin
Department of Human Services, SPD
9/24/09

2. Goals Understand the flu Current status of the pandemic
Understand the steps you can take to protect yourself and your clients
Know where to turn with questions

3. Influenza Symptoms: Transmission Incubation:
Respiratory Illness, fever, headache, myalgia, cough
Transmission
Droplet (3–6 feet)
Incubation:
1–3 days

4. Impact of Influenza: Typical Year
10%–20% ill
U.S.
~225,000 hospitalizations
~36,000 deaths
Oregon
~2,750 hospitalizations
~450 deaths

5. Influenza Virus Changes
“Antigenic drift”
Minor changes to strains each year, need new vaccine
Antigenic shift”
Major reassortment, nobody has immunity
Widespread pandemic

6. Generation of New Influenza A Virus Subtypes with Pandemic Potential
Figure 4. Generation of New Influenza A Virus Subtypes with Pandemic Potential. Two possible forms of transmission are shown. The first involves reassortment of influenza A virus genomic segments from an avian and human source in an intermediate swine host and then subsequent transmission among humans. The second involves direct transmission of an avian influenza subtype to humans and subsequent adaptation to enhance human-to-human transmissibility.
Gerberding, J. L. et al. N Engl J Med 2004;350:

7. Why worry about
pandemic H1N1?

8. Pandemic H1N1 worldwide Pandemic H1N1 is widespread:
confirmed in more than 170 countries
Cases =296,471; Deaths = at least 3,486*
WHO / CDC have stopped tracking individual cases
Focus on impact (deaths)
Circulating virus types

9. Oregon status Oregon no longer counting every case Disease widespread
Hospitalizations = 139*
(about 11 counties)
Deaths = 13* (about 11 counties)
Cases occur sporadically and in clusters
* PHD data as of 9/18

10. What makes Pandemic H1N1 different?

11. Hospitalizations over the summer, Oregon, 2009*
*as of 11 Sep 2009

12. Different age distribution of
Hospitalizations *
*as of 31 Jul 2009

13. Pandemic H1N1 deaths in younger people, US
5-24
Age Group

14. Pandemic H1N1 Influenza strain Predominates*
A (H1)
A (H3)
A (Unk) B
Novel H1N1
More H3 than H1 subtyped at OSPHL.
26 Influenza A (H1) and 32 influenza A (H3), 2 influenza A (unsubtyped), 108 influenza B at OSPHL
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
*through 08/01/2009

15. # of flu-like illnesses as of 9/12

16. Influenza Symptoms: Transmission Incubation:
Respiratory Illness, fever, headache, myalgia, cough
Transmission
Droplet (3–6 feet)
Incubation:
1–3 days

17. Only You Can Stop the Flu
Stay home if you are sick
Try to stay 3 ft away from sick people
Wash your hands or use alcohol-based hand sanitizer
Disinfect contaminated and high-touch surfaces (door knobs, microwaves, remotes, phones, etc.)

19. Vaccination Seasonal Vaccine – H1N1 Vaccine
Protects against 3 other strains for flu.
Recommended for everyone!
Distributed in same way as every year
H1N1 Vaccine
Protects only against the new H1N1 strain
Targeted for priority groups
Distributed only through Public Health

20. Vaccination target populations
Pregnant women
Persons between six months and 24 years of age
People who live with or care for children younger than six months of age
Health care and emergency service personnel
People age 25 through 64 years who are at high risk for complications
60,127
1,222,286
60,006
155,467
381,141
Total Population , 879, 027
Total Doses , 758, 054

21. H1N1 Vaccination Priority Groups
High Risk people, age 25 – 64
chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/ neuromuscular, hematologic, or metabolic disorders (including diabetes mellitus) or immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus)

22. H1N1 Vaccination Priority Groups
Health Care Worker
nursing homes, skilled nursing facilities, physicians’ offices, urgent care centers, and outpatient clinics, and to persons who provide home health care
Clarification from PH:
This includes ALFs/RCFs, CCRCs, AFHs, and HCWs. It does not include any day programs, senior centers, etc.

23. Is the vaccine safe??????
This is the same vaccine that is made every year for flu, made in the same way. Every year it include 3 different, new strains. This vaccine will just include a 4th strain. There just wasn’t time to get it into the seasonal vaccine.
There have been no significant side effects in the current trials.

24. Office Implications Asked to plan for 40% absenteeism
In your office
In facilities/homes, Home Care Workers, etc.
Possibly some interruption in supply chains, needed services, etc.
Take Seriously the need for Business Continuity Plans
Consider cross training now

25. Protect yourself and others
Make it easy for folks to wash their hands or use hand sanitizer – purchase the sanitizer for common areas and staff who go into facilities and home
Encourage people who are sick to stay home
Get immunized for the flu as soon as it is available for you

26. Keep In Touch http://www.flu.oregon.gov/
Look for the development of a SPD website for information that has been sent out, FAQs, policies, etc.
SS-IM on SNAP and H1N1

27. What we need from you
A heads-up if and when there are significant impacts in your office, with your providers, etc.
Policy/Rules that you think may need to be relaxed if this has a significant impact
Your ideas about how to get providers vaccinated
A heads-up of rumors that you are hearing

28. Don’t Get Crazy

29. Key points Pandemic H1N1 flu is here; few people have immunity
We will likely see more illness, more hospitalizations
Vaccine is our best weapon:
Challenge: vaccinate ~2,000,000 Oregonians
Community Mitigation:
Stay home when sick, cover cough, wash hands
Schools, business, health care systems need plan for business continuity

30. Tina Kitchin, MD, FAAP