Influenza Seasonal and H1N1 Patricia Ingraham, MPH Communicable Disease Control

1. Influenza Seasonal and H1N1 Patricia Ingraham, MPHCommunicable Disease Control NH Department of Health and Human Services Division of Public Health Services

2. NH Department of Health and Human Services Division of Public Health Services

3. Outline • Brief history • What is Influenza • General Epidemiology • Treatment • Vaccine • Prevention NH Department of Health and Human Services Division of Public Health Services

4. H1N1 Back? • Influenza A H1N1 never left • Influenza like illness present through summer NH Department of Health and Human Services Division of Public Health Services

5. What is Influenza? • Influenza (aka “flu”) is an illness caused by a virus. • There are several strains of flu viruses • The flu virus causes symptoms we think of as a cold. • There are many other viruses capable of causing cold-like symptoms. NH Department of Health and Human Services Division of Public Health Services

6. Regular Influenza Season • Each year the virus circulates throughout the world • Each year minor changes in the virus occur; yearly flu vaccine based on these changes • In most healthy persons, the immune system protects them from severe disease, so they suffer only from a mild flu NH Department of Health and Human Services Division of Public Health Services

7. Impact of Influenza • Influenza, however, can be far more serious for some people: • Elderly • Young children • Persons with serious medical conditions • Each year ~30 - 40,000 persons in the U.S. die from influenza or it’s complications • In NH ~ 200 people die from influenza each year NH Department of Health and Human Services Division of Public Health Services

8. Influenza Virus SPREAD Droplet spread from coughing/sneezing up to about 6 feet Direct contact- Hand to face (eyes, nose, mouth) after touching infected areas Infectious on surfaces only 4-8 hours INCUBATION PERIOD 1- 7 days (average for H1N1 3-4 days) DURATION OF SYMPTOMS 3-7 days may be up to 14 (average for H1N1 3-5 days) CONTAGIOUS 1 day before symptoms to about 10 days after NH Department of Health and Human Services Division of Public Health Services 8

9. Influenza Like Illness • Must-have symptoms • Fever plus sore throat or • Fever plus cough • Other symptoms • Headache • Muscle & joint aches • Nausea, vomiting, or diarrhea • Fatigue • Pneumonia • Shortness of breath NH Department of Health and Human Services Division of Public Health Services

10. Seasonal InfluenzaWho should be Vaccinated Each Year • All children aged 6 months to the 19th birthday • Pregnant women • People 50 years of age and older • People who live in nursing homes or other long-term care facilities NH Department of Health and Human Services Division of Public Health Services

11. Seasonal InfluenzaWho should be Vaccinated Each Year • People any age with certain chronic medical conditions • Heart disease, lung disease, asthma, metabolic disease; diabetes • Muscle or nerve disorders (seizure or cerebral palsy) • Weakened immune system caused by HIV/AIDS or medications • Children 6 months to age 18 on long-term aspirin treatment NH Department of Health and Human Services Division of Public Health Services

12. Seasonal InfluenzaWho should be Vaccinated Each Year • People who live with or care for those at high risk for complications from flu, including: • Healthcare workers • Household contacts of persons at high risk for complications from the flu • Household contacts and out-of-home caregivers of children younger than 5 years and adults older than 50 years of age NH Department of Health and Human Services Division of Public Health Services

13. Seasonal Influenza • Influenza Vaccine is recommended for anyone who wants to reduce their chance of getting influenza! NH Department of Health and Human Services Division of Public Health Services

14. Seasonal Influenza • There are 2 types of influenza vaccine • One is an injection. Anyone 6 months of age or older can receive this vaccine • The second is a nasal mist version and can only be used for healthy people age 2-49 years of age and who are not pregnant NH Department of Health and Human Services Division of Public Health Services

15. Seasonal Influenza • People who SHOULD NOT be vaccinated: • Those who have a severe allergy to chicken eggs • Those who have had a severe reaction to an influenza vaccination in the past • Those who developed Guillain-Barré (GBS) within 6 weeks of getting an influenza vaccine in the past • Children younger than 6 months of age • Those who have a moderate-to-severe illness • with a fever should wait to get vaccinated until symptoms lessen NH Department of Health and Human Services Division of Public Health Services

16. Influenza A H1N1 New strain of Influenza A; subtype H1N1 Contains gene segments from 4 different influenza subtypes North American swine North American avian North American human Eurasian swine Contagious Spreads human-to-human The subtypes not necessarily new but the combination is NH Department of Health and Human Services Division of Public Health Services 16

17. Human Virus Avian Virus Avian/Human Reassorted Virus Swine Virus NH Department of Health and Human Services Division of Public Health Services Reassortment in Pigs

18. H1N1 Influenza Epidemic Status Worldwide NH Department of Health and Human Services Division of Public Health Services 18

19. General Epi Regular flu - infects approx. 10% of people in any given community -gets transmitted in households in 20% of the times where there is case in such household • So far H1N1 is behaving similar H1N1 • Unusual late seasonal transmission persisted through the summer months (not good news in general) • High attack rate younger people • Most hospitalizations/deaths in high risk groups • Generally mild illness in healthy persons NH Department of Health and Human Services Division of Public Health Services

20. What to Expect this Season • Presently it is expected that the current H1N1 flu pandemic will affect 30% population over six month period with <1% mortality rate • Most cases will be mild: • People will be sick at home for a week • High risk groups more likely to be hospitalized or die • Vaccines available for: • Seasonal influenza (now and ongoing) • H1N1 (expected in October) NH Department of Health and Human Services Division of Public Health Services

21. Flu Treatment • Interim recommendations from the Centers for Disease Control (CDC) states that persons who are not at higher risk for complications do not require antiviral medications. NH Department of Health and Human Services Division of Public Health Services

22. Flu Treatment • Antiviral treatment is recommended: • Hospitalized patients • Pregnant women • Children younger than 5 years old • Adults 65 years and older • Children and adults with chronic medical conditions, immunosuppression or receiving long-term aspirin therapy • Residents of nursing homes and other chronic care facilities NH Department of Health and Human Services Division of Public Health Services

23. Prevention after Exposure • Should be considered for persons who meet BOTH of the following: • Close contact with a H1N1 case (confirmed, probable or suspected) during the infectious period • At high risk of influenza-relatedcomplications OR working as a healthcareworker with risk of transmission to patients at high risk for flu-related complications and can be started within 48 hours after exposure NH Department of Health and Human Services Division of Public Health Services

24. Prevention for Childrenafter exposure • Antivirals recommended for children younger than five years old OR if they have a medical condition that puts them at high risk for complications. • Recommendation to be used if contact is within 48 hours after close contact to a H1N1 case NH Department of Health and Human Services Division of Public Health Services

25. Prevention for Pregnant Womenafter exposure • Pregnant women who are close contacts with suspected, probable or confirmed cases of H1N1 influenza should receive antiviral medications NH Department of Health and Human Services Division of Public Health Services

26. NH Department of Health and Human Services Division of Public Health Services

27. Recommendations for Prevention Hand washing Cover your cough If you are sick, stay home (schools, office, etc..) Stay out until 24 hours after the resolution of fever (without fever reducing meds) Surface cleaning with appropriate cleaners commonly touched surfaces as needed NH Department of Health and Human Services Division of Public Health Services 27

28. Get Influenza Vaccinations • Seasonal “flu shot” • May protect against seasonal influenza • Reduces circulating flu • Reduces confusion with pandemic • Prevents gene swapping • Pandemic flu strain vaccine, when available • Requires 4-6 months to make • Manufacturing capacity limited NH Department of Health and Human Services Division of Public Health Services

29. Initial Target Groups for H1N1 Vaccine • Pregnant women • Health care workers and emergency services personnel • People who live with or provide care for infants under 6 months of age • Children and young adults from 6 months to 24 years • People aged 25 to 64 years with underlying medical conditions (e.g. asthma, diabetes) The groups listed above total approximately 159 million people in the United States. In NH – approx. 700,000 NH Department of Health and Human Services Division of Public Health Services

30. A limited supply? – following groups be vaccinated first- Subsets of initial target groups • Pregnant women • Children 6 months to 5 years • Health care workers and first responders with direct patient contact Followed as soon as possible by: • Children 5 through 18 years of age who have chronic medical conditions. • Household contacts of children less than 6 months of age, especially siblings • Young adults 19 – 24 years of age with medical conditions NH Department of Health and Human Services Division of Public Health Services

31. Don’t Forget the Basics • Wash your hands frequently • Always cover your cough • Avoid touching your eyes, nose or mouth • Do not share drinking/eating utensils • Avoid contact will ill persons if possible • Clean frequently used surfaces • Monitor your own health • Stay home if you are sick NH Department of Health and Human Services Division of Public Health Services

32. Thanks – Questions ? NH Department of Health and Human Services Division of Public Health Services