OMSI Science Pub - H1N1 Flu

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"Spread the Word, Not the Flu: H1N1 and You"

This Science Pub took place on Monday, November 2, 2009, at the Bagdad Theater in Portland, Oregon. It was presented by Gary Oxman, MD, MPH, and by Paul Lewis, MD, both from the Tri-county Health Officer Group of Clackamas, Multnomah, and Washington Counties. (There were some sound issues at the venue but this recording is clear.)

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  • Contagious respiratory illness Caused by influenza viruses (A and B) Can cause mild to severe illness Spreads from person to person Droplets – important Contact – important Through the air - much less important Prevention: Wash your hands Cover your cough Stay home when you’re sick Vaccination
  • Over the years the slowly shifting sands move great amounts of material and even reshape the entire landscape. The changes are inexorable but not instantaneously dramatic
  • In a pandemic shift, like an earthquake, the change occurs in an instant with dramatic results. The shifting sands and earthquake are metaphors for annual and pandemic influenza. The pandemic earthquake is more dramatic but the annual toll of influenza is of similar or greater magnitude but is spread over a longer period of time
  • www.cdc.gov/H1N1FLU/surveillanceqa.htm
  • July, 2009-CDC ‘ H1N1 is a new virus, . . . illness may be more severe and widespread as a result.’ July, 2009 (Australian Gov) “ disease is mild in most cases, severe in some and moderate overall’ –
  • We have a prevention opportunity Getting vaccinated is the single most effective thing you can do to prevent the flu Vaccine production is moving at a slower pace then originally anticipated Local decision-makers are making week to week decisions on how best to utilize this resource to prevent illness in high-risk groups
  • OMSI Science Pub - H1N1 Flu

    1. 1. Spread the Word-Not the flu November 2nd 2009 OMSI Science Pub Gary Oxman, MD, MPH Paul Lewis, MD Tri-county Health Officer Group Clackamas, Multnomah, Washington Counties
    2. 2. Desired Outcomes for Session Participants will… <ul><li>Be introduced to a framework for thinking about emergencies </li></ul><ul><li>Understand the basic science behind Influenza </li></ul><ul><li>Understand the current pandemic influenza situation </li></ul><ul><li>Become familiar with the Public Health response to H1N1 </li></ul><ul><li>Have questions answered or acknowledged </li></ul>
    3. 3. H1N1 Preparedness & Response A Framework for Action Read this book!* * Available in Paperback
    4. 4. The Unthinkable - B asics <ul><li>Through evolution, people are built to cope with disasters </li></ul><ul><li>Individual capacity </li></ul><ul><ul><li>We all can cope, but some cope better than others </li></ul></ul><ul><ul><li>All of us can improve our coping capacity </li></ul></ul><ul><li>Group capacity </li></ul><ul><ul><li>People naturally support each other to cope with disaster </li></ul></ul>
    5. 5. The Unthinkable - Basics <ul><li>Three stages of human response to disaster </li></ul><ul><ul><li>Denial – not understanding the new realities </li></ul></ul><ul><ul><li>Deliberation – considering possible actions </li></ul></ul><ul><ul><li>Decisive moment – taking action </li></ul></ul><ul><li>Dysfunctional responses do occur </li></ul><ul><ul><li>Inaction/paralysis – very common </li></ul></ul><ul><ul><li>Poor choices of action </li></ul></ul><ul><ul><li>Panic – rare </li></ul></ul>
    6. 6. The Unthinkable Take away points <ul><li>People are built to cope with disaster </li></ul><ul><li>Understand that the response is in ordinary people’s hands – your hands </li></ul><ul><li>Be prepared; rehearse </li></ul><ul><ul><li>Understand the situation </li></ul></ul><ul><ul><li>Have a focused, realistic plan </li></ul></ul><ul><li>When disaster happens, act on your plan! Listen to authorities, but don’t wait. </li></ul>
    7. 7. Influenza Basics
    8. 8. Influenza
    9. 9. Influenza Symptoms <ul><li>It's NOT the common cold </li></ul><ul><ul><li>Fever, body aches, cough, sore throat </li></ul></ul><ul><ul><li>Notably ill for 3-5 days </li></ul></ul><ul><li>Diagnosis – by health care provider (lab tests usually not necessary) </li></ul><ul><li>Great majority recover without treatment </li></ul>
    10. 10. Influenza Types & Definitions <ul><li>Seasonal Influenza </li></ul><ul><li>Occurs every year </li></ul><ul><li>Affects ~10-15% of population yearly </li></ul><ul><li>Kills ~36,000 people in the US every year – mostly elderly </li></ul><ul><li>There is a vaccine every year </li></ul><ul><li>Pandemic Influenza </li></ul><ul><li>A world-wide outbreak of influenza </li></ul><ul><li>Occurs a few times per century </li></ul><ul><li>Caused by a new influenza virus strain </li></ul><ul><li>Illness can be mild to severe </li></ul><ul><li>Can affect ~20-35% of the population </li></ul>
    11. 11. Biology of Pandemics
    12. 12. Influenza Virus
    13. 13. Changes in the Flu Virus <ul><li>Drift: continuous small RNA mutations </li></ul><ul><ul><li>H and N evolve during and between seasons </li></ul></ul><ul><ul><li>Vaccine requires frequent modification to be effective </li></ul></ul><ul><ul><li>Over many years a specific H or N-type can become much different from its origin </li></ul></ul>
    14. 14. <ul><li>Drift: continuous small RNA mutations </li></ul><ul><li>Shift: major changes </li></ul><ul><ul><li>Non-human virus infects humans </li></ul></ul><ul><ul><li>Combining of genes between human and animal strains </li></ul></ul><ul><ul><li>Shift required to produce a Pandemic </li></ul></ul>Earthquake fault, New Zeeland Health Emergency Management, NZ Changes in the Virus
    15. 15. Genesis of New Influenza A Virus Subtypes with Pandemic Potential Gerberding, J. L. et al. N Engl J Med 2004;350:1236-1247
    16. 16. NIH Web conf
    17. 17. Pandemic H1N1 Genetic History www.sciencexpress.org / 22 May 2009 / Page 4/ 10.1126/science.1176225
    18. 18. Current Situation
    19. 19. Likely Origin Winter 2009 <ul><li>Rapid, global, spread April-June 2009 </li></ul><ul><li>WHO declared pandemic in June </li></ul><ul><li>Overall severity mild </li></ul><ul><li>Shift in severe disease away from elderly </li></ul><ul><li>48 states in US reporting widespread flu activity at this time-very early </li></ul>Current Flu Situation
    20. 21. Hospitalizations by Age Group, Oregon* *data as of 10/09/09
    21. 22. US Pandemic Severity Scale Anticipated range of H1N1 severity during 2009-2010
    22. 23. How bad is it ? <ul><li>Assumptions: </li></ul><ul><li>20 to 30% of the population will get influenza </li></ul><ul><li>Death rate is same as seasonal flu (0.05% or 1 in 2,000) </li></ul><ul><li>Metro area population is 2 million people </li></ul>400,000- 600,000 Sick 1,400,000- 1,600,000 Well 200 - 300 Severely ill or dead
    23. 24. Risk Factors <ul><ul><li>Pregnancy </li></ul></ul><ul><ul><li>Heart disease </li></ul></ul><ul><ul><li>Kidney disease </li></ul></ul><ul><ul><li>Immune system problems </li></ul></ul><ul><ul><li>Diabetes </li></ul></ul><ul><ul><li>Obesity </li></ul></ul><ul><ul><li>Cancer </li></ul></ul><ul><ul><li>Asthma & other lung diseases </li></ul></ul>About 2/3 of severe H1N1 illness and hospitalization impacts people with risk factors:
    24. 25. H1N1: Some Take-home Points <ul><li>Typical influenza virus with typical symptoms, complications – a “mild” influenza </li></ul><ul><li>Can be treated with antiviral drugs </li></ul><ul><li>Most cases recover uneventfully </li></ul><ul><li>Compared with seasonal flu, shift to younger ages for hospitalization and death </li></ul>
    25. 26. Public Health & Medical Response
    26. 27. Goals of Pandemic Response <ul><li>Minimizing death and disability as much as practical given available resources, and </li></ul><ul><li>Maintaining an intact community – one that is poised to resume normal life physically, socially, economically, emotionally and spiritually following the pandemic </li></ul>
    27. 28. Public Health Response Strategies <ul><li>Prevention through appropriate individual and institutional behaviors to protect self and others </li></ul><ul><li>Vaccination </li></ul><ul><li>Medical care to treat illness and prevent complications </li></ul>
    28. 29. Preventing Illness Through Appropriate Behavior <ul><li>The mantra </li></ul><ul><ul><li>Wash you hands </li></ul></ul><ul><ul><li>Cover your cough </li></ul></ul><ul><ul><li>Stay home when you’re sick </li></ul></ul><ul><li>Sounds simple, but…”The choices people make are driven by the choices they have” </li></ul><ul><li>Choice requires </li></ul><ul><ul><li>Information for people (and their friends, family and coworkers) </li></ul></ul><ul><ul><li>Supportive policies (e.g., sick time policies) </li></ul></ul><ul><ul><li>Absence of disincentives (e.g., losing pay or job) </li></ul></ul>
    29. 30. ACIP H1N1 2009 Vaccine Recommendations (not in order of priority) <ul><li>Pregnant women </li></ul><ul><li>Live with or care for infants < 6 mo old </li></ul><ul><li>Healthcare/EMS workers with direct contact with patients or infectious material </li></ul><ul><li>People 6 months – 24 years old </li></ul><ul><li>People 25 - 64 years old with high-risk medical conditions </li></ul>http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5810a1.htm ~ 50% Of USA
    30. 32. PH Strategy: Access to Medical Care <ul><li>Goals: </li></ul><ul><ul><li>Treat illness </li></ul></ul><ul><ul><li>Prevent complications </li></ul></ul><ul><li>Two Approaches </li></ul><ul><ul><li>Providers continue to care for their established patients </li></ul></ul><ul><ul><ul><li>Anticipate surge in demand – visits calls </li></ul></ul></ul><ul><ul><ul><li>Plan ahead – office protocols, methods for testing, prescribing antivirals </li></ul></ul></ul><ul><ul><li>Regional Access to Care initiative for those without a medical home </li></ul></ul>
    31. 33. Temporary healthcare reform Access to care during a pandemic
    32. 34. Supporting PH Strategies <ul><li>Communication </li></ul><ul><ul><li>Information for the public </li></ul></ul><ul><ul><li>Partner and Clinician outreach and communication – e.g., detailed clinical practice guidelines </li></ul></ul><ul><li>PH surveillance and investigation </li></ul><ul><ul><li>Tracking hospitalized cases, deaths – now reportable </li></ul></ul><ul><ul><li>Tracking hospital/health care utilization </li></ul></ul><ul><ul><li>Outbreak investigation – selected situations only </li></ul></ul>
    33. 35. Questions and Dialogue

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