1. Update: “New Flu” Activity and Community Mitigation Diane Woolard, PhD, MPH Director, Division of Surveillance and Investigation Virginia Department of Health

2. Outline Update on H5N1 and H1N1 activity –Comparison of the two Review of purpose and strategies for community mitigation Community mitigation recommendations for the new H1N1 virus situation

3. Avian Reservoir Avian virus Human virus Pandemic Strain Emergence: Direct Infection vs. Reassortment other mammals? New reassorted virus Direct Infection

4. Criteria for Pandemic H5N1H1N1Criterion √√Novel strain that is not recognized by the human immune system √XCauses increased sickness and death X√-Sustained person-to-person transmission

5. H5N1 vs. H1N1 Characteristics H5N1H1N1 Cases4234694 Deaths25853 Countries1530 Case-fatality61%1% Year began1997, 20032009 * As of May 11, 2009

6. H1N1 in US and VA USVirginia Cases261817 Deaths30 Distribution44 states6 districts Case-fatality0.1%0% * As of May 11, 2009

8. Inter-pandemic phaseLow risk of human cases1 New virus in animals; no human cases Higher risk of human cases2 Pandemic alertNo or very limited human-to-human transmission3 Virus causes human casesEvidence of increased human-to-human transmission 4 Evidence of significant human-to-human transmission 5 PandemicEfficient & sustained human-to-human transmission 6 WHO Pandemic Alert Phases

9. Community Mitigation Goal: Slow disease spread –allows time for vaccine development, manufacturing, distribution and antiviral distribution Barrier: Influenza is hard to control –Short incubation period; non-specific nature of clinical illness; easy to spread, even before symptoms

10. Community-Based Interventions

11. Community Mitigation Strategies (Non-pharmaceutical interventions) Infection control and hygiene Social distancing Community education Cluster containment Data collection and management to guide decisions

12. A Layered Approach Individual / Household Hand hygiene Cough etiquette Infection control Living space control Isolation of ill Designated care provider Respiratory protection Community Isolation of ill Treatment of ill Quarantine of exposed Prophylaxis of exposed School/daycare closure Social distancing - Community - Workplace Liberal leave policies Snow days Travel restrictions International Containment-at-source Support efforts to reduce transmission Travel advisories Layered screening of travelers Health advisories Limited points of entry Targeted, Layered Containment (TLC) utilizing multiple partially effective interventions

14. What was recommended? Infection control and hygiene Isolation Public education Containment of clusters  Social distancing – some  Use of information to guide decisions

15. Social Distancing for H1N1 Quarantine – consider minimizing time in crowds, isolate on first sign of illness Airport screening – observe & report ill School closure – strongly consider to consider to local decision – –Early identification of ill –Stay home with sick –Cough etiquette, handwashing –Closure at discretion of local authorities

16. Social Distancing, continued College/university – treat as community – isolate, cover cough, no cancelling Mass gatherings – –if ill, stay home –if high risk, consider risk, consider avoiding Business – telecommuting & snow days – not really emphasized [Respiratory protection – mask if ill and in public; respirator if caring for ill]

17. Use Information to Guide Decisions Epidemiology – studying patterns of disease in population –What is illness – case definitions –How much illness is occurring – surveillance; testing recommendations; assess severity and spread –What populations are affected – descriptive –What are the risk factors – analytic Use this information to develop prevention messages and recommendations

18. Challenges that Arose Definition of community – case definition included travel to affected community Data release at district level – citizens wanted to know city/town Testing purpose and protocol – public health and clinical management Interpretation of recommendations – school/childcare, masks

19. We’re claiming a success Questions and Discussion