1. Our vision: Healthier communities, Excellence in healthcare Our values: Teamwork, Honesty, Respect, Ethical, Excellence, Caring, Commitment, Courage Swine flu to boils it is reducing the risk that counts Prepared by Peter Massey CNC, Program Manager Health Protection HNE Population Health Nov 2009

2. 2 Swine flu

3. 3 "In the absence of a pandemic, almost any preparation will smack of alarmism. If a pandemic does break out, nothing thats been done will be enough. Tony Abbott, Pandemic influenza conference, Ottawa, 25 September 2005

4. 4 Influenza pandemics 1918-1919, Spanish Flu, H1N1 1957-1958, Asian Flu, H2N2 1968-1970, Hong Kong Flu, H3N2 2009-????, Swine Flu, H1N1

5. 5 AHMPPI Pandemic projections Based on a 1918 scenario: 40% attack rate (AUS 8.5million) 2.4% mortality (AUS 200,000) Up to 50% absentee rate Expect several waves Economical impact lasting two years

6. 6 April 09: Mexico City – a state of emergency with 1.1% mortality rate

7. 7 AHMPPI Pandemic projections Based on a 1918 scenario: 40% attack rate (AUS 8.5million) 1.1% mortality (AUS 100,000) Up to 50% absentee rate Expect several waves Economical impact lasting two years

8. 8

9. 9 Novel influenza strains are just one of many emerging diseases that we face and which have to be addressed through disaster preparedness and generic business continuity planning

10. 10 Hendra, ABL, Nipah….

11. 11 Encroachment on wildlife habitat

12. 12 Climate change

13. 13 Natural disasters Storms 2007

14. 14 The 2009 Influenza Pandemic

15. 15 April 2009 Mexican deaths

16. 16 Where are the football crazy Mexicans?

17. 17 Outside the ground!!

18. 18 H1N109 Timelines 3/09Outbreaks of H1N109 in Mexico 24/4/09WHO informs Aus of new influenza strain 28/4/09DELAY Phase implemented -8/5/09Activation: Call centre, GPs, Local Governments, national medical stockpile, Ref Labs 19/5/09First Aus case 22/5/09CONTAIN Phase implemented 25/5/09Cases arrive on international flights & cruise ship 3/6/09State of Origin in Melbourne

19. 19 There was a rugby player named Kurt Playing in Melbourne during the swine flu alert Although the virus was piddly It travelled back with young Giddly Twas a cert it was the dirt on his shirt

20. 20 First confirmed case in Australia

21. 21 H1N109 Timelines (contd) 11/6/09WHO declares a pandemic 06/09Local transmission identified in Vic & NSW 06/09Flu Clinics set up in many states 06/09Massive influx of H1N1 lab requests 17/6/09PROTECT Phase implemented 29/6/09First H1N1 related death recorded 30/9/09Vaccination roll out

22. 22 H1N1 (October 2009) 343,298 confirmed cases globally (Aus 36,910) 4,108 confirmed deaths globally (Aus 185) 198 countries, uneven impact In Australia ~ 8-10% attack rate Risk groups e.g. pregnancy, Indigenous 4,830 hospitalisations, 20% in ICU!

23. 23 The surveillance pyramid

24. 24

25. 25 Emergency Department ILI presentations

26. 26

27. 27 So what was different? pH1N1 vs seasonal flu: –younger hospitalised, ICU & death –pregnancy –Indigenous people –next waves Did Tamiflu work? Home isolation & home quarantine? How would we go if pH1N1 and H5N1 mixed?

28. 28 Panvax Myths & facts 30 Sep 09 Myths v Facts presentationFinal.pdf

29. 29 Debriefs Between waves of pandemic is a great time to debrief What worked well at your Practice, what didnt work so well and what needs to be changed? What worked well with HNE services, what didnt works o well and what needs to be changed? Also, there is more to life than swine flu……

30. 30 Brucellosis Staying on the pig theme…. Brucella suis in the Moree area 4 cases All pig hunters Some delays in diagnosis Surveillance & testing project

31. 31 Q fever – not pigs! Table 1: Ongoing health conditions in people notified with acute Q fever in the Hunter New England Area, 2007.

32. 32 HNE Q fever 2007 As a result of their Q fever illness 50/54 (93%) people had time off work or school, with a median of 21 days off and a range of 2-296 days. Twenty-nine respondents were hospitalised for a median six days and a range of 1-42 days. At the time of the structured interviews (conducted 28-93 weeks after illness onset) 34/54 (63%) people reported they had not fully recovered.

33. 33 Q fever

34. 34 Some other issues….. caMRSA: what are the proven methods of control???.................

35. 35 Pertussis Who needs preventative treatment in a household with a confirmed case? –Under 2 yr old is the decision point Swab or serology? –swab in first 3 weeks –serology after that if needed

36. 36 Some other projects Acute Flacid Paralysis surveillance through ICUs Polio virus in sewage Effect of Rotavirus vaccine on gastro admissions for under 2 yr olds Pneumococcal Zoonotic potential of crypto on dairy or beef farms Swine flu & Aboriginal communities (just to complete the circle of these slides…

37. 37 Acknowledgements With grateful acknowledgements of: –David Durrheim & team at Public Health –Deepal, Louise, Di –Barwon Div GP Hunter New England Population Health is a unit of the Hunter New England Area Health Service. Supported by funding from NSW Health through the Hunter Medical Research Institute. Developed in partnership with the University of Newcastle.