H1N1 Update

1. H1N1 Update Tina Kitchin Department of Human Services, SPD 9/24/09

2. Goals • Understand the flu • Current status of the pandemic • Understand the steps you can take to protect yourself and your clients • Know where to turn with questions

3. Influenza • Symptoms: • Respiratory Illness, fever, headache, myalgia, cough • Transmission • Droplet (3–6 feet) • Incubation: • 1–3 days

4. Impact of Influenza: Typical Year • 10%–20% ill • U.S. • ~225,000 hospitalizations • ~36,000 deaths • Oregon • ~2,750 hospitalizations • ~450 deaths

5. Influenza Virus Changes • “Antigenic drift” • Minor changes to strains each year, need new vaccine • Antigenic shift” • Major reassortment, nobody has immunity Widespread pandemic

6. Generation of New Influenza A Virus Subtypes with Pandemic Potential Gerberding, J. L. et al. N Engl J Med 2004;350:1236-1247

7. Why worry about pandemic H1N1?

8. Pandemic H1N1 worldwide • Pandemic H1N1 is widespread: • confirmed in more than 170 countries • Cases =296,471; Deaths = at least 3,486* • WHO / CDC have stopped tracking individual cases • Focus on impact (deaths) • Circulating virus types

9. Oregon status • Oregon no longer counting every case • Disease widespread • Hospitalizations = 139* • (about 11 counties) • Deaths = 13* (about 11 counties) • Cases occur sporadically and in clusters • * PHD data as of 9/18

10. What makes Pandemic H1N1 different?

11. Hospitalizations over the summer, Oregon, 2009* *as of 11 Sep 2009

12. Different age distribution of Hospitalizations * *as of 31 Jul 2009

13. Pandemic H1N1 deaths in younger people, US Deaths 5-24 Age Group

14. Pandemic H1N1 Influenza strain Predominates* A (H1) A (H3) A (Unk) B Novel H1N1 Oct Nov Dec Jan Feb Mar Apr May Jun Jul *through 08/01/2009

15. # of flu-like illnesses as of 9/12

16. Influenza • Symptoms: • Respiratory Illness, fever, headache, myalgia, cough • Transmission • Droplet (3–6 feet) • Incubation: • 1–3 days

17. Only You Can Stop the Flu • Stay home if you are sick • Try to stay 3 ft away from sick people • Wash your hands or use alcohol-based hand sanitizer • Disinfect contaminated and high-touch surfaces (door knobs, microwaves, remotes, phones, etc.)

19. Vaccination • Seasonal Vaccine – • Protects against 3 other strains for flu. • Recommended for everyone! • Distributed in same way as every year • H1N1 Vaccine • Protects only against the new H1N1 strain • Targeted for priority groups • Distributed only through Public Health

20. Pregnant women Persons between six months and 24 years of age People who live with or care for children younger than six months of age Health care and emergency service personnel People age 25 through 64 years who are at high risk for complications 60,127 1,222,286 60,006 155,467 381,141 Total Population 1, 879, 027 Total Doses 3, 758, 054 Vaccination target populations

21. H1N1 Vaccination Priority Groups • High Risk people, age 25 – 64 • chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/ neuromuscular, hematologic, or metabolic disorders (including diabetes mellitus) or immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus)

22. H1N1 Vaccination Priority Groups • Health Care Worker • nursing homes, skilled nursing facilities, physicians’ offices, urgent care centers, and outpatient clinics, and to persons who provide home health care • Clarification from PH: This includes ALFs/RCFs, CCRCs, AFHs, and HCWs. It does not include any day programs, senior centers, etc.

23. Is the vaccine safe?????? • This is the same vaccine that is made every year for flu, made in the same way. Every year it include 3 different, new strains. This vaccine will just include a 4th strain. There just wasn’t time to get it into the seasonal vaccine. • There have been no significant side effects in the current trials.

24. Office Implications • Asked to plan for 40% absenteeism • In your office • In facilities/homes, Home Care Workers, etc. • Possibly some interruption in supply chains, needed services, etc. • Take Seriously the need for Business Continuity Plans • Consider cross training now

25. Protect yourself and others • Make it easy for folks to wash their hands or use hand sanitizer – purchase the sanitizer for common areas and staff who go into facilities and home • Encourage people who are sick to stay home • Get immunized for the flu as soon as it is available for you

26. Keep In Touch • http://www.flu.oregon.gov/ • http://www.oregon.gov/DAS/HR/flu.shtml • http://www.dhs.state.or.us/admin/hr/h1n1/ • Look for the development of a SPD website for information that has been sent out, FAQs, policies, etc. • SS-IM-09-048 on SNAP and H1N1

27. What we need from you • A heads-up if and when there are significant impacts in your office, with your providers, etc. • Policy/Rules that you think may need to be relaxed if this has a significant impact • Your ideas about how to get providers vaccinated • A heads-up of rumors that you are hearing

28. Don’t Get Crazy

29. Key points • Pandemic H1N1 flu is here; few people have immunity • We will likely see more illness, more hospitalizations • Vaccine is our best weapon: • Challenge: vaccinate ~2,000,000 Oregonians • Community Mitigation: • Stay home when sick, cover cough, wash hands • Schools, business, health care systems need plan for business continuity

30. Tina Kitchin, MD, FAAP Tina.c.kitchin@state.or.us