2. TANEY COUNTY HEALTH DEPARTMENT AUGUST 2009 Situation Update: H1N1 Influenza A

3. Overview Define “the flu.” Describe the unique features of influenza viruses Describe the illness caused by influenza Explain how influenza spreads Discuss epidemics vs. pandemics Discuss the H1N1 virus Describe ways to reduce risk of disease

4. Influenza Virus Strains Type A  moderate to severe illness  all age groups  humans and other animals Type B  changes less rapidly than type A  milder epidemics  humans only  primarily affects children

5. N N H Subtypes of type A determined by hemagglutinin (H) and neuraminidase (N) Influenza Type A Subtypes Recent Viruses in the News: H5N1 H1N1 H3N2

6. Signs and Symptoms Symptoms of novel H1N1 flu are similar to those of seasonal flu. Fever Cough Sore throat Runny or stuffy nose Body aches Headache Chills Fatigue In addition, vomiting (25%) and diarrhea (25%) have been reported. (Higher rate than for seasonal flu.)

7. How does H1N1 Influenza spread? This virus spreads the same way seasonal flu Primarily through droplets (Not Airborne)  Coughing  Sneezing  Touching respiratory droplets on yourself, another person, or an object, then touching mucus membranes (e.g., mouth, nose, eyes) without washing hands

8. Infectious and Incubation Period Infected persons are assumed to be contagious from one day prior to illness onset until at least 24 hours after fever is gone.  Fever should be gone without the use of fever- reducing medicine. Incubation period: 1-4 days could be as long as 7 days, 2 days average (similar to seasonal flu)

9. Seasonal Flu Pandemic Flu Respiratory illness caused by a flu virus. Some local outbreaks or epidemics Some immunity among people in the community About 20% of population ill during flu season Global flu outbreak Occurs when new influenza A virus emerges Little or no immunity in people Large numbers of people become ill and many die Approximately 30-50% of population ill. What is the difference between Pandemic Flu and Seasonal Flu?

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

11. August 13, 2009: 1,799 deaths

12. August 20, 2009: 7,983 Hospitalizations, 522 deaths

13. H1N1 Influenza CDC estimated >1 million cases had already occurred. CDC expects that more cases, more hospitalizations, and more deaths from this outbreak will continue to occur. Seasonal influenza results in approx. 36,000 deaths and more than 200,000 hospitalizations. Because this is a new virus, most people will not have immunity to it. The H1N1 vaccine is currently in clinical trials…..

14. Public Health Actions Implemented the emergency response plan Information Dissemination CDC’s Division of the Strategic National Stockpile (SNS) has sent 25% of the SNS stockpile of antiviral drugs to local jurisdictions Meetings with response partners and community organizations Inventory of PPE and local needs Epidemiology and Planning Activities (surveillance, disease investigation, antiviral distribution planning, mass vaccination clinic planning, etc.)

15. Prevention Messages Hand washing and use of hand gels Avoid touching your Eyes, Nose and Mouth Stay home if you are ill and keep children home if they are ill. Cough Etiquette Vaccination Family Preparedness

16. What are the signs and symptoms of the flu? What are warning signs that require evaluation by healthcare provider? What is social distancing and why it is important? What can families do to prevent the spread of flu?

17. Get medical care right away if the sick person at home: has difficulty breathing or chest pain has purple or blue discoloration of the lips is vomiting and unable to keep liquids down has signs of dehydration such as dizziness when standing, absence of urination, or in infants, a lack of tears when they cry has seizures (for example, uncontrolled convulsions) is less responsive than normal or becomes confused

18. Take these everyday steps to protect your health Cover your nose and mouth with a tissue or the crook of your elbow when you cough or sneeze. Throw the tissue in the trash after you use it. Avoid touching your eyes, nose or mouth. Germs spread this way. Hand washing Avoid contact with sick people.

19. If you get sick… Stay home if you’re sick.  Until you’ve been free from a fever for 24 hours, without the use of fever reducing medications. If you are sick, limit your contact with other people as much as possible.

20. Social Distancing Social distancing measures include:  Closing schools  Canceling public gatherings or events  Planning for work leave policies  Working from home  Staying home if sick Some or all of these may be recommended for the public depending on the situation.

21. Personal Preparedness For Pandemic Plan  How will ill family members be cared for, identify needed supplies, unemployment? Prepare items for an extended stay at home  Food, medications, medical supplies Preventing the spread of illness  Knowledge (Hand washing, social distancing, etc)  Personal protection equipment (masks)  Cleaners/disinfectant  Plan for social distancing measures Listen for information.

22. Summary For the most current information on the H1N1 influenza outbreak, visit http://www.cdc.gov/h1n1flu/ and www.taneycohealth.orghttp://www.cdc.gov/h1n1flu/www.taneycohealth.org Missouri, CDC, WHO, and public health officials worldwide are carefully monitoring the situation. Follow all recommendations for preventing the spread of influenza.

23. http://www.cdc.gov/h1n1flu/ http://www.cdc.gov/h1n1flu/espanol/ 1-800-CDC-INFO (1-800-232-4636) http://www.who.int/csr/disease/swineflu/en/index.html http://www.cdc.gov/h1n1flu/guidance_homecare.htm  http://www.epa.gov/oppad001/influenza-disinfectants.html http://www.epa.gov/oppad001/influenza-disinfectants.html Resources