Influenza H1N1 A (Swine Influenza)

1. Influenza H1N1 A (Swine Influenza) Information for Agilent’s Employees

2. H1N1 Swine Influenza Agenda: • General Information about H1N1 Swine Influenza • Protective Measures for the Prevention of H1N1 Swine Influenza Infection Note: Information sources for this presentation include the US Centers for Disease Control (CDC) and the World Health Organization (WHO).

3. General Information About H1N1 Swine Influenza

4. H1N1 Swine Influenza – Types of Influenza • Influenza- illness caused by viruses that infect the respiratory tract. • 3 Types – A, B, & C • A & B are responsible for epidemics of respiratory illness • Type A viruses are divided into subtypes based on differences in two viral surface proteins called the haemagglutinin (H) and the neuraminidase (N) • Four main influenza type A virus subtypes that have been isolated in pigs: H1N1, H1N2, H3N2, and H3N1 • H1N1 Swine influenza is caused by a Type A virus subtypes H1 & N1, first isolated in 1930. • Most of the recently isolated influenza viruses from pigs have been H1N1 viruses.

5. H1N1 Swine Influenza - What we Know • H1N1 Swine influenza is a contagious disease endemic in the pig population and can be caused by Type A (subtype H1N1 and H3N2) strains of the influenza virus.  • Outbreaks among pigs normally occur in colder weather months (late fall and winter) • In the US studies have shown that between 30 and 50 percent of the pig population has been exposed to H1N1 infection at some time • Recombination of North American swine influenza, North American avian influenza, human influenza virus, and Eurasian swine influenza. • New recombination of virus strains, not previously isolated. • Began initially March 2009 in the Federal District, Guanajuato, State of Mexico, and San Luis Potosi and spreading globally • Virus has spread globally within 6 weeks but severity is considered mild in the majority of cases.

6. H1N1 Swine Influenza – WHO 7/16/09 • Further spread of the pandemic, within affected countries and to new countries, is considered inevitable. • H1N1 influenza pandemic has spread internationally with unprecedented speed within 6 weeks • Increasing number of cases in many countries with sustained community transmission is making it extremely difficult, if not impossible, for countries to try and confirm them through laboratory testing • This pandemic has been characterized, to date, by the mildness of symptoms in the overwhelming majority of patients, who usually recover, even without medical treatment, within a week of the onset of symptoms. • There is still an ongoing need in all countries to closely monitor unusual events, such as clusters of cases of severe or fatal pandemic (H1N1) 2009 virus infection, clusters of respiratory illness requiring hospitalization, or unexplained or unusual clinical patterns associated with serious or fatal cases. • WHO will no longer issue the global tables showing the numbers of confirmed cases for all countries. However, as part of continued efforts to document the global spread of the H1N1 pandemic, regular updates will be provided describing the situation in the newly affected countries.

7. H1N1 Swine Influenza – Pandemic Threat Pandemic An epidemic (a sudden outbreak) that becomes very widespread and affects a whole region, a continent, or the world. New viral strain and sustained human to human transmission. Epidemic More than the expected number of cases of disease occurring in a community or region during a given period of time. Endemic Present in a community at all times but in low frequency.

8. H1N1 Swine Influenza – Pandemic Threat Pandemics in 20th Century • 1918-19, "Spanish flu," [A (H1N1)], • > 50 Million Deaths Worldwide • > 50% Young Healthy Adults • 1957-58, "Asian flu," [A (H2N2)], • First identified in China in late February 1957, the Asian flu became pandemic by June 1957 • >70,000 Deaths in U.S.; Estimated 2 million deaths worldwide • 1968-69, " Hong Kong flu," [A (H3N2)] • >34,000 Deaths in U.S.; Estimated 1 Million deaths worldwide • 2003 to present “Avian Flu” [A (H5N1)] • Clusters in Asia, Africa, Europe, Near East, Indonesia and Vietnam • 421 cases and 257 deaths (laboratory confirmed for both) • “Influenza pandemics are rare but recurring events . They have typically occurred every 10 -50 years throughout recorded history” - WHO

9. How is H1N1 Swine Influenza Transmitted ? • Transmission among bird/pig population is usually through spread of respiratory droplets or contact with droppings. • Main way influenza spreads from human to human is droplet spread (~ 3 ft.) coughing, sneezing, or less frequently with contact especially hands with contaminated objects. • H1N1 Swine Influenza is not transmitted through fully cooked and properly handled pork products

10. H1N1 Swine Influenza – Incubation Period • Incubation period: 1 to 2 days prior to symptoms-7 Days or possibly longer (average 1 to 4 days) • Infectious period – 7 to 10 days adults • Note may be contagious a day or two before symptoms appear similar in Avian Flu (key distinction from SARs)

11. Symptoms of H1N1 Swine Influenza • Typical Flu like symptoms • High fever (>100.4 F or >38.0 C) • Cough, sneezing, sore throat • Body Aches • Difficulty breathing, shortness of breath • Additional symptoms may include: • Muscle and joint pain, diarrhea, vomiting • Headache and other flu-like symptoms • Can progress to pneumonia, severe respiratory diseases such as acute respiratory distress especially in people with chronic health problems

12. Control Measures for H1N1 Swine Influenza • Engineering Controls • Vaccines (not available yet for this type of H1N1 Influenza – under development) • Anti-viral Medications • Administrative Controls • Procedures, Plans to limit contact and transmission of disease (limiting public settings, travel restrictions) • Individual Worker Controls • Personal Hygiene • Infection control procedures • Case management

13. Control Measures for H1N1 Swine Influenza • Engineering Controls • Vaccine: Human and Pandemic flu • Currently no vaccine available for current H1N1 virus, manufacturing has started as of May 2009, initial vaccine in limited quantities September 2009 • Large scale production (to closely match pandemic virus) may be limited until several months after outbreak • Anti-Viral Medications • 2 drugs - oseltamivir (Tamiflutm) and zanamivir (Relenzatm) can reduce the severity and duration seasonal influenza if given within 48 hours after symptom onset. • May improve prospect for survival for H1N1 human infections • Drug resistance over time could be an issue (7/09- limited sporadic resistance identified to Tamiflu) • Major obstacles – price & availability (many governments are beginning to stockpile supplies limiting availability to private sector) • Stockpiles are being released for use currently

14. Control Measures for H1N1 Swine Influenza Administrative Controls • reducing the number of people exposed and duration of exposure to the hazard (social distancing measures) • isolating the hazard (screening procedures, quarantine) • introducing equipment to control the hazard • maintenance of protective equipment or clothing • introducing better working practices and systems

15. Control Measures for H1N1 Swine Influenza Personal Prevention of H1N1 Swine Influenza • Cover your coughs & sneezes • Frequent hand washing with liquid soap and water is the most important way to prevent spread of infection. Alcohol based hand sanitizer is also effective. • Avoid touching eyes, nose and mouth • Get vaccinated (prevent simultaneous infection – viral mutation) – if vaccine available

16. Personal Prevention of H1N1 Swine Influenza Personal Protective Equipment (PPE) • Recommended for worker protection (case management or infection control procedures) • N-95 Respirator (CDC Training Podcast) • Exam Gloves • Infection control gowns • Face & eye protection • Surgical Masks are more appropriate for patients suspected of Swine flu infection

17. Swine Influenza – Current Situation Pandemic Planning Stages (WHO) Phase 6 on June 11, 2009 Characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5 which includes human to human spread. Designation of this phase will indicate that a global pandemic is under way.

18. Resources • Agilent H1N1 Website: http://essq.corporate.agilent.com/ehs/Avian_Flu/swine_flu.htm • Agilent Crisis Management Website: http://www.agilent.com/crisis/ • Agilent Travel Health Website: http://www.internationalsos.com/members_home/login/clientAccess.cfm?CustNo=11BCPA000051 • World Health Organization Website: http://www.who.int/csr/disease/swineflu/en/index.html • U.S. Center for Disease Control: http://www.cdc.gov/h1n1flu/ • International SOS: http://www.internationalsos.com/pandemicpreparedness/index.aspx?languageID=ENG