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Response to Pandemic Influenza during the 2009 –2010 School Year

Response to Pandemic Influenza during the 2009 –2010 School Year. Jeffrey Engel, MD State Health Director North Carolina Division of Public Health. Outline. Influenza overview Pandemic H1N1: The current situation Mitigation strategies/control measures Pandemic influenza vaccination

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Response to Pandemic Influenza during the 2009 –2010 School Year

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  1. Response to Pandemic Influenza during the 2009–2010 School Year Jeffrey Engel, MD State Health Director North Carolina Division of Public Health

  2. Outline • Influenza overview • Pandemic H1N1: The current situation • Mitigation strategies/control measures • Pandemic influenza vaccination • Specific guidance for school settings

  3. The Enemy

  4. How Flu Spreads • Most spread through coughing and sneezing • Contact transmission also important • Hand to hand, contaminated surfaces • Airborne transmission possible

  5. Pandemic H1N1 Case Rates by Age Group www.cdc.gov/h1n1flu/surveillanceqa.htm

  6. Confirmed NC Cases by County of Residence — August 12, 2009 Alleghany Gates Vance Currituck Rockingham Northampton Surry Camden Caswell Ashe Granville Stokes Warren Person Hertford Pasquotank Halifax Watauga Perquimans Wilkes Alamance Yadkin Forsyth Chowan Avery Mitchell Franklin Bertie Guilford Orange Nash Davie Caldwell Durham Alexander Yancey Edgecombe Tyrrell Madison Davidson Iredell Wake Martin Washington Dare Burke Randolph Chatham Wilson Catawba Rowan Pitt McDowell Buncombe Beaufort Greene Swain Haywood Johnston Hyde Lincoln Lee Rutherford Cabarrus Montgomery Graham Henderson Harnett Wayne Gaston Jackson Polk Moore Cleveland Stanly Lenoir Craven Mecklenburg Cherokee Macon Transylvania Pamlico Cumberland Clay Sampson Hoke Jones Anson Richmond Duplin Union Onslow Scotland Carteret Robeson Bladen Pender Columbus New Hanover Brunswick Confirmed Cases, N=687 (75 counties)

  7. Emergency Departments Doctors’ Offices

  8. NC State Lab Influenza Virus Testing Results by MMWR Week, 2008–2009

  9. Pandemic Mitigation Strategies • Vaccination • Antiviral treatment and prophylaxis • Non-pharmaceutical interventions • Respiratory hygiene • Isolation and quarantine • Social distancing (school closures, cancellation of large gatherings, teleworking, etc.) • Strategies are guided by severity of illness

  10. Pandemic H1N1 Vaccine • Separate from seasonal flu vaccine • Both vaccines important for protection • Pandemic vaccine will probably require two doses • Clinical trials in progress, evaluating • Safety / adverse events • Interval between doses • Administration with seasonal vaccine

  11. Pandemic Vaccine Availability • Considering “early roll out” in late September • 20 million doses • First large bolus expected mid-October • 40 million doses • Monthly shipments of 40 million doses • Total amount dependent on uptake

  12. Pandemic Vaccine Distribution • Centralized distribution • Supplies shipped with vaccine – needles, syringes, etc. • List of pandemic vaccine providers compiled by Local Health Departments • 100 dose minimum shipments • Need for state and local coordination on school vaccination programs

  13. Vaccination in Schools Benefits: • Brings vaccine to target population • Many districts experienced with seasonal flu and hepatitis B campaigns Obstacles: • Issues with parental consent • Potential disruption

  14. Pandemic Vaccine: Priority Groups • Pregnant women • People who live with or care for children younger than 6 months of age • Health care and emergency services workers • People 6 months through 24 years of age • People 25 through 64 years of age at high risk for complications of influenza

  15. Priority Groups: Smaller * • Pregnant women • People who live with or care for children younger than 6 months of age • Health care and emergency services workers with direct patient contact • Children 6 months through 4 years of age • Children 5 through 18 years of age who have chronic medical conditions * If supply is limited

  16. School Guidance: Goals • Decrease risk of hospitalization and death • Minimize disruption of day-to-day social, educational, and economic activities • Goal is NOT to eliminate all transmission of influenza in schools • Might change if severity increases

  17. School Guidance: “Similar Severity” • Stay home when sick • At least 24 hours after fever resolves without use of fever-reducing medicines • Separate ill students/staff • Emphasize hand hygiene • Routine environmental cleaning • Early treatment of high-risk students and staff • Consideration of selective dismissal

  18. Current Isolation Recommendations* • Home until at least 24 hours after fever resolves (without fever-reducing medications) • 3–5 days in most cases • Duration NOT influenced by use of antivirals • Longer isolation period for health care settings, other settings with many high-risk persons • Practice good respiratory hygiene after return • Might still be shedding virus *Recently revised by CDC

  19. School Dismissal Considerations • Number and severity of cases • Local, state, and national levels • Balance between risk of infection and problems that school dismissal can cause • Different types of dismissal (selective, reactive, and preemptive).

  20. Categories of Dismissal • Selective • Most students in the school are high risk • May close while other schools in the community are open • Reactive • Used when many students and staff are sick • Preemptive • Used early during a flu response to decrease spread before many students and staff get sick • Only considered if severity increases • Probable declared state of emergency

  21. School Guidance: “Increased Severity” • Active screening for illness • High risk students/staff stay home • Students with ill household members stay home • Increase social distancing • Extend exclusion period to at least 7 days • Consider preemptive dismissals

  22. Roles and Responsibilities • State and local health agencies • Collect and share relevant epidemiological data • Have regular channels of communication to share information • Jointly make decisions with school officials • State and local education agencies • Work with public health and social service counterparts to ensure health and safety for students and staff • Disseminate emerging guidance • Promote teaching and learning – even if school is dismissed

  23. ABCD of School GuidanceDo this now… • Respiratory hygiene • Hand hygiene • Exclusion of ill students • Routine cleaning

  24. School Dismissal Reporting • Reporting of all flu-related school dismissals requested by CDC • Report via www.cdc.gov/FluSchoolDismissal

  25. Public Health Resources • www.flu.nc.com • www.cdc.gov/h1n1flu

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