1. 2009 H1N1 Influenza Summit Current Status of the H1N1 Flu Jerry Gibson MD, MPH State Epidemiologist and Director, Bureau of Disease Control, South Carolina Department of Health and Environmental Control 10/20/09 Thanks to Dan Drociuk, Chasisity Springs, Riyadh Muhammad, Claire Youngblood

3. What is Seasonal Influenza (flu)? Virus infection with cough, sore throat, body aches, weakness, and often fever. Usually begins abruptly. Comes every year, appears December to February in SC Virus spreads person to person by large droplets or direct contact (face to face long enough to have a sustained conversation, shaking hands, etc An average 800 people die in S.C. annually from “flu”. 36,000 in the US Most are under 2, over 65, or have a chronic illness like heart or lung disease

4. Pneumonia/Influenza Death Rates in 122 Cities from 2005 - 2009 2009200820062005 Centers for Disease Control, Influenza Division White=P&I epidemic threshold

7. What is 2009 Pandemic H1N1 Influenza (“swine flu”)? In April 2009 a brand-new H1N1 virus appeared. Its hemagglutinin is totally different and people under 60 have almost no immunity. First detected in Mexico in 3/2009; in SC on 4/20/09. Symptoms are similar to regular seasonal flu. Declared a ‘pandemic strain’ by WHO A “pandemic” is an epidemic that spreads everywhere.

8. SC H1N1 Influenza Case Rate by Age Group

9. Rates of Serious H1N1 flu in SC by Pregnancy Status CHESS Disease Reports, 10/15/09

10. As of 10/19, we have had 374 hospitalizations and 14 deaths since August 30, 2009. There have been 43 child deaths in the US.

11. Cumulative Hospitalization Rates per 100,000 US population Hospitalization rate per 100,000 population 2009

12. Influenza-Like Illness in 9 Large Hospital Emergency Departments South Carolina Aberration Alerting Network (SCAAN)

13. Everyday Steps to Protect Your Health Wash your hands often with soap and warm water. Wash for 15-20 seconds – about the time it takes to sing the “Happy Birthday” song twice. Alcohol-based hand wipes or gel sanitizers are also effective. Don’t touch unwashed hands to your mouth, eyes, or nose because that’s how viruses get into your body.

14. Everyday Steps to Protect Your Health Get a flu shot. –Get the seasonal flu vaccination every year to boost your immunity. –Get the 2009 H1N1 vaccination, which is becoming available. This requires one shot, or two for children 6 months to 9 years old. –Flu shots do not cause flu and are among the safest immunizations that are given. –The 2009 H1N1 flu vaccine is made, tested and licensed by the FDA exactly the same way as other flu vaccines.

15. Vaccination: 4-7 months with current technology

16. How do I slow the spread of flu if I get sick? Stay home for at least 24 hours after fever is gone without the use of fever-reducing medicines. Cover your nose and mouth with a tissue every time you cough or sneeze. Throw the used tissue in a waste basket. If you don't have a tissue, sneeze or cough into your sleeve.

17. What to do if a family member gets the flu? Most people with flu have mild symptoms and can be cared for better at home. Who is more likely to get a complication, and should consider seeing a doctor? –Children under 5, especially under 2 years old –Pregnant women –Over 65 –If you have: cancer, sickle cell disease, chronic lung or heart disease, diabetes, kidney or liver disease, neurological/neuromuscular disorders, weak immune systems (e.g. AIDS) It is possible for healthy people to get severe flu, too.

18. When a household member gets flu If a household member has a high-risk disease, avoid close contact (< 6 feet) with the sick person Ask your doctor if they should take preventive medicine – Tamiflu or Relenza Keep the sick person in a separate room, with one family member caring for them Wear a mask when giving care. Disposable gloves to clean up body fluids Everyone washes hands! Avoid having visitors

19. For the person with flu: Check with your doctor about special care Ask also if you should take antiviral medicine Rest Drink plenty of fluids (electrolyte drinks for infants) Tylenol or ibuprofen (Motrin) for fever (aspirin is safe only for adults) Humidifier and suction bulb for infants noses Go outside when fever has been gone for 24 hours

20. When Should I Call the Doctor? Most people should be able to recover at home, but watch for emergency warning signs that mean you should seek immediate medical care. In adults: Difficulty breathing or shortness of breath Pain or pressure in the chest or stomach Sudden dizziness Confusion Severe or persistent vomiting Flu-like symptoms improve but then return with fever and worse cough

21. When Should I Call the Doctor? If your child gets sick and experiences any of these warning signs, seek emergency medical care. In children: Fast breathing or trouble breathing Bluish or gray skin color Not drinking enough fluids Severe or persistent vomiting Not waking up or not interacting Irritable, the child does not want to be held Flu-like symptoms improve but then return with fever and worse cough

22. How can we slow spread of this pandemic virus in the community: Social Distancing 1.Stay home from school or work when you are sick with flu! 2.School closures (very costly) 3.Businesses have staff work from home, in separate shifts, or physically separate 4.Discouraging large gatherings

23. Pandemic influenza mortality: A tale of two cities, 1918

24. No social distancing in Philadelphia in 1918

25. For More Information DHEC Web site: http://www.scdhec.gov/fluhttp://www.scdhec.gov/flu CDC H1N1 Flu Web site: http://www.cdc.gov/h1n1flu http://www.cdc.gov/h1n1flu Call your county DHEC public health department Call 211 or 1 800 27 SHOTS

26. What are the symptoms of Influenza? Fever higher than 100 degrees Fahrenheit Cough Body aches Sore throat Headache Chills Fatigue Some people have nausea, vomiting, or diarrhea Usually know when got sick within a couple of hours