1. Judith A. Monroe, M.D. State Health Commissioner 28 April 2009 1

2. What Is A Pandemic? Pandemic = worldwide epidemic Three factors must happen Novel (new) disease agent --> yes Must cause severe disease in humans  yes and no Must be easily transmitted person-to-person  likely Pandemic has not been officially declared National public health emergency has been declared 2

3. Background On 23 April, CDC described 5 cases of novel influenza virus (A/H1N1/North America/Human) 3 from San Diego area 2 from San Antonio, TX Other surveillance information indicated a respiratory outbreak in Central Mexico, including Mexico City, for previous three weeks Hundreds of cases Some deaths, mostly in young adults (20-45 years old) As of 24 April, 7 of these cases matched same H1N1 strain as US cases 3

4. Viral Reassortment (2) Reassortment in swine Pandemic virus Reassortment in humans Pandemic virus Reassortment/ mutations in birds Human virus

5. A/H1N1/North America/Human North American swine strain European swine strain Avian strain Human strain 5 Current Outbreak Virus

6. A/H1N1/North America/Human Incubation: 2-7 days Symptoms: fever, cough, sore throat, headache, body aches, some vomiting/diarrhea Transmission: person-to-person respiratory droplet or hand contact to eyes/nose/mouth not transmitted by contact with pigs or eating pork Communicability: usually 1-2 days prior to symptoms until symptoms cease Vaccine availability: none Antivirals Susceptible to Tamiflu, Relenza Resistant to amantidanes 6

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8. Global Status Mexico 1000+ cases reported as of 27 April, 16:00 Over 100 deaths 23 confirmed positive for A/H1N1/North America/Human Other countries: Canada, Spain, Britain, France, New Zealand, Israel World Health Organization (WHO) No travel or trade restrictions issued; those ill advised to avoid international travel Pandemic level raised to 4 (sustained person-to-person transmission in clusters) 8

9. National Status 40 confirmed cases as of 27 April, 16:00 California: 7 Kansas: 2 New York City: 28 Ohio: 1 Texas: 2 US Department of Homeland Security has assumed lead role for response Strategic National Stockpile (SNS) being deployed for states: antivirals, respiratory equipment 9

10. Indiana’s Status One confirmed case as of 27 April, more expected Specimens collected on suspect cases and sent to ISDH Laboratory Specimens sent to CDC if test positive for influenza A but cannot be subtyped with seasonal flu reagents 10

11. Current Case Definition A person with compatible symptoms of influenza Fever ≥ 100°F Cough Sore throat Headache and body aches AND Travel to a state or country with confirmed cases within 7 days of illness OR contact with someone ill who has traveled to a state or country with confirmed cases within 7 days of illness 11

12. ISDH Role Conduct case investigation, surveillance, contact tracing Provide laboratory testing and specimen collection kits Track national and international disease trends Develop educational messages and press releases Provide subject matter expertise Communicate with health care providers, local health departments, governmental agencies, and other partners Call center and dedicated ISDH web site link under development 12

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14. Practice Good Hygiene Wash hands well and often, especially after Contact with other people and common surfaces Helping someone who is ill Using facial tissues Use respiratory etiquette Cough or sneeze into your elbow/upper sleeve Discard used tissues promptly Avoid using handkerchiefs Avoid touch eyes, nose, mouth Stay home if you are sick and encourage others to do so 14

15. Get Credible Information Local health departments ISDH www.in.gov/isdh Call center to be established 28 April CDC: www.cdc.gov/swinefluwww.cdc.gov/swineflu WHO: www.who.orgwww.who.org 15

16. 16 Very simple measures that everyone can do will make a big, positive difference

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