1. H1N1 Update 9-29-09 Cindy Cunningham John Levitow Frisbie Memorial Hospital

2. H1N1 Pandemic Timeline First illnesses Mexico & US 3/09 First lab confirmed case in US 4/15/09 Pandemic declared 6/11/09; Today over 140 countries reporting infection 6/15/09 all US states, DC, Puerto Rico and US Virgin Islands with cases Pregnant population has highest mortality rate: 6% of those deceased

3. WHO

5. Clinical Information for H1N1 Incubation period 1-7 days Symptoms: Fevers, chills, headache, cough, sore throat, difficulty breathing, muscle aches, joint pain, fatigue, vomiting and diarrhea Testing: Under DHHS control –Influenza-like illness –Hospitalized –High-risk patient

6. Influenza-like illness (ILI) & High-risk patients Fever –T 100F or 37.8C or greater Cough +/- Sore throat <5 years old >65 years old Underlying medical conditions Immunosuppression Pregnancy <19 years old on aspirin Nursing home/LTC

7. H1N1 Testing Limited to select populations – Specimen must meet at least one of the following criteria to be tested. Hospitalized patient with severe illness Health Care Worker in consultation with health care provider In consultation with public health as part of a cluster or outbreak Requesting provider participates in the ILI Sentinel Provider Network

8. H1N1 Testing Nasopharyngeal Aspirate Nasopharyngeal Swab (Specimen of choice)- This is what we do here. Available in Lab Nasopharyngeal Wash

9. H1N1 Testing Can be done in the offices Wear a surgical mask when obtaining the specimen. Fill out the lab slip for H1N1 (on the portal)

10. Age Groups Infected

11. Hospitalizations by Age Group

12. Key Points from HAN 09/16 H1N1 outbreaks have been ongoing since April 2009 –confirmed a number of school outbreaks since classes resumed several weeks ago. There is no current shortage of seasonal influenza vaccines – Some manufacturers have delayed their shipments; State is monitoring the situation. H1N1 vaccine trials have shown excellent immunity after a single dose of inactivated vaccine for persons aged 10 and up.

13. H1N1 Vaccine Many unknowns about the vaccine: –Number of doses required for immunity –When and amount of vaccine available –Whether the seasonal & H1N1 can be administered at the same time –Forms of vaccine available (i.e. nasal mist, preservative free)

14. Vaccine Distribution Coordinated by CDC CDC will distribute vaccine and supplies at no cost Distribution in NH will be based on application process

15. Most Recent Vaccine Information All information changes daily: –State expects 1 st shipment of vaccine does the week of 10/05 –Initial number of doses reported as 45,000 for the state; followed by 20,000 a week –NH State Immunization Program will be assigned liaison for each AHHR –Reports are first does may be flu-Mist

16. Vaccine Allocation-CDC Recommendations First Round – Vaccine 3 Groups: Pregnant women HCW (direct patient contact & care)/EMS with direct patient contact Children 6m-18Yrs with medical conditions

17. Vaccine Allocation-CDC Recommendations Second Round – Vaccinate 2 additional groups : All children 6m-4Yrs old Persons caring for or living with infants<6months old

18. Vaccine Allocation-CDC Recommendations Third Round – Vaccinate 3 additional groups: All HCW and EMS Ages 6m-24 Yrs Ages 24-64Yrs with medical conditions

19. Response to H1N1 WHO has raised it’s alert level; –Change signifies that the likelihood of a pandemic has increased. Now Phase 6 US has declared a public health emergency –Declaration mobilizes resources to address a public health situation –Focus has shifted to vaccine development State of NH: Monitoring the spread of the flu – Developing clinical guidance –Clearing house for H1N1 vaccine Regional EOC is not open

20. Community Planning Community response managed by Health and Safety Council of Strafford County FMH is the Medical Command and Control in Northern Strafford County Community Vaccination Clinics and Medical Surge Plan is driven by AHHR

21. Frisbie Preparedness 8 Planning Teams –Communications: Michelle Landry/Dee Sheing –Supplies: Brooks McQuade –Pharmacy: Marcia Montminy –Employee Health: Janice Parker

22. Frisbie Preparedness (cont) 8 Planning Teams –Human Resources: Carol Themelis –Hospital Care: Mary Nutter/Sally Reeves In-patient ED –Office Care: Leslie Logel –Community: John Levitow