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Influenza A/H1N1 New Virus, New Challenges

Influenza A/H1N1 New Virus, New Challenges. Judith A. Monroe, M.D. State Health Commissioner 28 April 2009. What Is A Pandemic?. Pandemic = worldwide epidemic Three factors must happen Novel (new) disease agent --> yes Must cause severe disease in humans  yes and no

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Influenza A/H1N1 New Virus, New Challenges

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  1. Influenza A/H1N1New Virus, New Challenges Judith A. Monroe, M.D. State Health Commissioner 28 April 2009

  2. What Is A Pandemic? • Pandemic = worldwide epidemic • Three factors must happen • Novel (new) disease agent --> yes • Must cause severe disease in humans  yes and no • Must be easily transmitted person-to-person  likely • Pandemic has not been officially declared • National public health emergency has been declared

  3. Background • On 23 April, CDC described 5 cases of novel influenza virus (A/H1N1/North America/Human) • 3 from San Diego area • 2 from San Antonio, TX • Other surveillance information indicated a respiratory outbreak in Central Mexico, including Mexico City, for previous three weeks • Hundreds of cases • Some deaths, mostly in young adults (20-45 years old) • As of 24 April, 7 of these cases matched same H1N1 strain as US cases

  4. Viral Reassortment Reassortment/ mutations in birds Pandemic virus Reassortment in humans Human virus (2) Reassortment in swine Pandemic virus

  5. A/H1N1/North America/Human • North American swine strain • European swine strain • Avian strain • Human strain Current Outbreak Virus

  6. A/H1N1/North America/Human • Incubation: 2-7 days • Symptoms: fever, cough, sore throat, headache, body aches, some vomiting/diarrhea • Transmission: person-to-person • respiratory droplet or hand contact to eyes/nose/mouth • not transmitted by contact with pigs or eating pork • Communicability: usually 1-2 days prior to symptoms until symptoms cease • Vaccine availability: none • Antivirals • Susceptible to Tamiflu, Relenza • Resistant to amantidanes

  7. Current Status

  8. Global Status • Mexico • 1000+ cases reported as of 27 April, 16:00 • Over 100 deaths • 23 confirmed positive for A/H1N1/North America/Human • Other countries: Canada, Spain, Britain, France, New Zealand, Israel • World Health Organization (WHO) • No travel or trade restrictions issued; those ill advised to avoid international travel • Pandemic level raised to 4 (sustained person-to-person transmission in clusters)

  9. National Status • 40 confirmed cases as of 27 April, 16:00 • California: 7 • Kansas: 2 • New York City: 28 • Ohio: 1 • Texas: 2 • US Department of Homeland Security has assumed lead role for response • Strategic National Stockpile (SNS) being deployed for states: antivirals, respiratory equipment

  10. Indiana’s Status • One confirmed case as of 27 April, more expected • Specimens collected on suspect cases and sent to ISDH Laboratory • Specimens sent to CDC if test positive for influenza A but cannot be subtyped with seasonal flu reagents

  11. Current Case Definition • A person with compatible symptoms of influenza • Fever ≥ 100°F • Cough • Sore throat • Headache and body aches AND • Travel to a state or country with confirmed cases within 7 days of illness OR contact with someone ill who has traveled to a state or country with confirmed cases within 7 days of illness

  12. ISDH Role • Conduct case investigation, surveillance, contact tracing • Provide laboratory testing and specimen collection kits • Track national and international disease trends • Develop educational messages and press releases • Provide subject matter expertise • Communicate with health care providers, local health departments, governmental agencies, and other partners • Call center and dedicated ISDH web site link under development

  13. What You Can Do

  14. Practice Good Hygiene • Wash hands well and often, especially after • Contact with other people and common surfaces • Helping someone who is ill • Using facial tissues • Use respiratory etiquette • Cough or sneeze into your elbow/upper sleeve • Discard used tissues promptly • Avoid using handkerchiefs • Avoid touch eyes, nose, mouth • Stay home if you are sick and encourage others to do so

  15. Get Credible Information • Local health departments • ISDH • www.in.gov/isdh • Call center to be established 28 April • CDC: www.cdc.gov/swineflu • WHO: www.who.org

  16. Very simple measures that everyone can do will make a big, positive difference

  17. Questions?

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