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H1 N1/ Pandemic Flu 2009

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Here is the H1N1 Pandemic Flu powerpoint and notes from our Sept 19th seminar.

Here is the H1N1 Pandemic Flu powerpoint and notes from our Sept 19th seminar.

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  • Seasonal Flu: In flu enza virus causes the flu-in simplified terms, a “cold” virus causes colds, GI symptoms are not normally associated with seasonal flu- stomach flu or viral gastroenteritis is often from the norovirus, a whole different disease. A virus is just genetic material and protein that must go into a host cell to become active causing illness. Flu virus host cell is in lining of respiratory tract and the lungs usually affecting the upper respiratory tract in seasonal flu epidemic (from Greek epi- upon + demos people) occurs when new cases of a certain disease occur in a given human population, during a given period, substantially exceed what is "expected," based on recent experience Fairly predictable coming around year after year usually worse in the colder months so for here was November to February/March. This year did have cases reporting year round, but not many in summer months. Many, many different strains over the years-over 1000 different specific strains (combinations) have been seen over the years (JVG need to find numbers-read someplace that the seasonal flu strains have exceeded 200 now…) Some people get really sick, others are not so sick-seasonal flu mostly affects the young and old plus the medically fragile who have other chronic diseases i.e. asthma “ Seasonal Flu has the highest death rate of all vaccine preventable diseases in the US,” Dr. Long, Health Commissioner, writes, “200,000 hospitalizations, 36,000 deaths/year-more than any other vaccine-preventable disease”.
  • 3 things necessary to be called a pandemic:1) new virus 2) causes illness 3) spreads easily from person to person happening anytime and spreads globally; -WHO phase 6 “Pandemic” declared from geography ONLY not a measure of disease severity
  • H1N1 is an entirely NEW virus. Because it is new , human bodies don’t really know what to do with it. These new virus strains are very unpredictable H1N1 seems to be more contagious than seasonal flu While H1N1 was originally called “swine” (pig) virus, it has nothing to do with pigs…this is a new virus spread from human to human from the very beginning. There are reports that pigs are getting the H1N1 flu from an infected people working with them, but haven’t seen reports of humans getting this H1N1 from pigs. Because this new H1N1 virus is not spread from pigs to humans, there is no indication that pork is unsafe to eat-the normal cooking requirements for food safety still apply. Severity index is now based on the same categories as seen with hurricanes category 1 is mildest and category 5 is severe. Seasonal flu seems to stay in level 1 year after year and currently H1N1 is a Level 2= Mild outbreak Vaccine development takes 4-6 months to develop and this virus seems to be changing as it evolves and adapts. This is an entirely new virus so the seasonal flu vaccine is not a match to this strain of H1N1. We are expecting the first H1N1 vaccines in October 09
  • CDC officials predicted H1N1 could strike up to 50% of Americans over the next two years with second wave perhaps beginning now .and up to several hundred thousand could die (twice the number of people who usually get sick in a normal flu season) if a vaccine campaign and other measures aren't successful. Seems to settle into the lower respiratory tract causing respiratory distress in these high risk populations giving them more intensive care needs. Who is at risk: Pregnant women Children and young adults 5-24 most severe disease Individuals with chronic medical problems like asthma & COPD Minority populations 4X more likely to need to be in the hospital
  • This is VERY different from seasonal flu in our seniors!! -Seeing most of seasonal flu hospitalizations in seniors. Their immune systems are weakened by the seasonal flu viruses and they are getting quite sick by the bacterial secondary infections. -With H1N1 it seems that over the years our oldsters/elderly may have some immunity from their bodies remembering good fighting responses from pasts exposures to some of the protein combinations in this new H1N1 virus over the years -Our seniors have lived through many infectious diseases in the years when we didn’t have antibiotics and their parents passed down very strong messages for infection control ie “Don’t you sit down at this table without scrubbing those hands!” or men with handkerchiefs covering coughs and sneezes… Their infection prevention habits as a result are so much better than our cultural generations today… our young people need to practice better better handwashing, cover cough, etc! They are too used to taking a pill to make themselves feel better!
  • Emphasize similarity to seasonal flu… Flu viruses are spread mainly from person to person through coughing or sneezing by people with flu. Seasonal flu viruses travel about 3 feet then drop off. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose. This H1N1 virus seems to last greater than two hours on surfaces and scientists are suggesting that 5-6 feet should be a safe range to stay apart. With seasonal flu, studies have shown that people may be contagious from one day before they develop symptoms to up to 7 days after they get sick. Children, especially younger children, might potentially be contagious for longer periods-their bodies just try to get rid of the viruses. Current guidelines are for people to stay home for at least 24 hours after they are fever-free without the use of fever reducing medications. Some newer studies are saying that they may still have some contagiousness until they stop coughing and sneezing….
  • Symptoms of this new H1N1 flu are very much like those of seasonal flu. Flu is different from colds in that it seems to begin suddenly and has an associated fever with body aches. Today some are presenting with lower fevers so new assessment is for fever >100 f. We are seeing the usual runny/stuffy nose, cough and sore throat. Some are reporting considerable muscle aches. A number of people (28%) who have been infected with this new H1N1 virus also have reported diarrhea and vomiting which we do not really see in regular seasonal flu unless it is in the younger toddler ages. The “high risk for severe disease” group ages 5-24 should go in right away to their doctor to get on antivirals sooner so their disease does not get so bad…remember antivirals only help to control the viruses, they do not “ kill ” viruses inside the body
  • President Obama declares a PH emergency April 26, 2009 Renewed July 24 th . Pandemic declared in June 11, 2009, the World Health Organization (WHO) declared that H1N1 was a Pandemic More than 170 countries are now reporting cases of human infection with novel H1N1 flu. It is too difficult to accurately track individual cases so only mainly reporting new countries. They continue to try capturing the picture of the disease case numbers and deaths which they say are under reported CDC declared H1N1 widespread so reporting hospitalizations and deaths only now On Aug. 5, 2009, the Ohio Department of Health (ODH) changed the way it reports H1N1 influenza activity to the Centers for Disease Control and Prevention (CDC) and the public to mirror surveillance of seasonal influenza. Individual cases will no longer be reported. We are gearing up for 2 nd wave
  • • H1N1 Diagnosis ○ Based on existence of flu-like symptoms only now ○ Rapid tests for Influenza A can help but aren’t foolproof-many false negatives • Antiviral treatments-now used for treatment only and can be used for prevention in those at very high risk if exposed: ○ Can prevent complications if taken in time-need to get the 5-24 year olds to doctors when they begin symptoms (difficult with young people lacking insurance and their used to their bodies being able to fight things off so don’t seek the care early enough…) ○ Tamiflu is currently effective against influenza A virus (H1N1) ○ May not be effective if H1N1 virus changes ○ Resources could be prioritized based on national guidance
  • • Pandemics happen in waves lasting 12-16 weeks. The first wave historically is fairly mild. The second pandemic wave usually occurs approximately three months after the first wave and continues in these wave cycles for 18 months to 2 years as the virus adapts into our populations and environments. The second wave tends to be more widespread and can make people more sick. Our objective now is to lower this wave mountain into more of a hill using our mitigation strategies as we “buy time” to get vaccine and immunity built up in our populations.
  • Public health is not a primary care provider for the flu, we will however direct the local response effort to try to contain the spread of this illness. We will work tirelessly to
  • Red Cross Home Care for Pandemic Flu is still the gold standard-want to call your attention to the 2 recipes with the one for a disinfecting solution using bleach (note that bleach is less stable in water so should be mixed daily). The other recipe is an electrolyte drink recipe which is actually pretty good to which some people add a drop of flavoring. Fever causes fluid shifts and loss in people so replacing liquids and minerals are recommended, but no need to pay for the expensive Gatorades, etc… Those in the high risk categories are recommended to get into see their healthcare providers ASAP to get on antivirals if they are to help reduce the severity of the disease.
  • Vaccines are a very important part of a response to pandemic influenza and the U.S. Government is aggressively taking early steps in the process to manufacture a novel H1N1 vaccine, working closely with manufacturers. CDC has isolated the new H1N1 virus, made a candidate vaccine virus that can be used to create the vaccine proteins. Manufactures are working diligently to produce the vaccine in quantities for the whole population. It is in full testing and the early reports are looking quite good. NO STEPS ARE SKIPPED in the approval process for this vaccine FDA approval. Was approved as a vaccine Tuesday September 15 th . Local Health Departments expect to receive the first shipments of H1N1 vaccine in mid-October. Clinical trails are being conducted to know the # of doses Because there will not be enough vaccine available for everyone at first, the CDC’s Advisory Committee on Immunization Practices has developed recommendations for vaccine priority groups. (next slide)
  • -Risk of flu can be reduced through a combination of infection control, site/environmental control, and social distancing. No single action will provide complete protection! Wash your hands! Practice cough etiquette! STAY HOME IF YOU ARE SICK! Get a seasonal flu shot-lets work to change the course of this disease -H1N1 Protection is a shared responsibility- between you and family between family and schools between you and workplace We cannot stop this virus spread but we can slow it down. Our goal is to keep healthy children in school and healthy adults at work, working together to protect you AND y our family or someone you don’t even know. Our community will not have much immunity until December or even later.
  • Really, really, really emphasize this concept! The fingers are the top ten ways we spread infection- watch people in a meeting and see how many times their hands touch their mouth, their eyes, their nose, someone else’s hand or property. See how easy it is for that germ to hitch a ride? Washing with soap and warm water is the very best method to use -please emphasize. While it is a very simple concept it is the most important tool in our box to help prevent the spread of disease. Cover hand washing technique.
  • Hand sanitizer [Purell is a common brand] is handy to have when a sink is not available to wash your hands. It kills over 99% of the most common germs that make us sick. Most products sold in stores do have at least 60%alcohol. Keep it in your car, at your desk, in your pocket, in your lunch bag and anywhere groups might come together. Great after you have been places where a lot of people touch the same surfaces such as airplanes, grocery stores and church.
  • Cough etiquette- what is the best way or the most polite way or the smart thing to do when you have to cough or sneeze? When we cough or sneeze the air is filled with germs that others can breathe in or pick up on their hands. The flu virus spreads through the air and by contaminating surfaces that we touch with our hands and then touch our nose and mouth. Please demonstrate covering a cough or sneeze with sleeve and elbow. Also emphasize that when coughing or sneezing into a tissue, throw the tissue away and go wash hands. When the cough or sneeze is covered- the germ is intercepted and the play is incomplete.
  • It will be very culturally difficult to stop the handshaking and hugging in our community-our PR people have taught us well in customer service and ingrained this “personal touch” requirement throughout our business communities…. How about the popular campaign “Reach out and touch someone…” Even the knuckle bump is better if you just can’t stop yourself…. Infection control is infection control and we are learning with these viruses that we may need to be more mindful of our individual responsibilities to get better with keeping our germs to ourselves. How about a verbal greeting, “Welcome, I am so glad to see you! I am not shaking your hand today because I care about your well being and will not knowingly put you at more risk of catching this virus…”
  • Stay home if you are sick! Please emphasize this message - It is our individual responsibility to help keep our community safe from infection spread. According to the CDC: “If you are sick, you may be ill for a week or longer. You should stay home and avoid contact with other persons, except to seek medical care. If you leave the house to seek medical care, wear a mask or cover your coughs and sneezes with a tissue. In general you should avoid contact with other people as much as possible to keep from spreading your illness. A person should call their healthcare provider if they are experiencing any life threatening symptoms from the H1N1 illness.
  • Hit cross protection (cool thing about the body’s immune system is that it remembers how to respond to different infections-the memory may need refreshed with a ‘booster’ shot, but the memory mostly stays on how to fight that particular infection so will be better at doing it-the very basis of immunization in the first place. Some studies have also shown that season flu shots may decrease chance heart attack during flu season as if don’t get the flu the compromised heart can get on with its normal jobs of daily living and not be further challenged to beat if the body is not also trying to win a battle over flu symptoms… If time can cover “herd” immunity-20% of the population will be unable to take a flu shot for whatever reason-allergy to eggs, chemotherapy, etc so to protect them the other 80% should be vaccinated/immunized 2009-2010 recommendations say that all (change) children 6 months to age 18 should get a flu shot. The initial seasonal flu shot is given in 2 doses to be most effective and get the body ready to fight seasonal flu viruses. Also want to remind them that since babies under 6 months can’t be immunized from the flu, people who care for them should get their flu shot to be protective of these precious treasures. See video by CDC “ Personal Stories: Why Flu Vaccine Matters” at http://www.cdc.gov/CDCtv/PersonalFluStories/
  • Site control strategies are ways we can make the places around us healthier. Cleaning is removing dirt and grime, d isinfection is the d estruction of germs. The flu virus is fairly easy to take care of on surfaces. Common products you buy to clean your kitchen and bathroom kill the flu virus. Clean and disinfect surfaces frequently to make them germ-free. Surfaces include tables, counters, sink tops, shared desks and phones and registration windows. Light switches, handrails and doorknobs also can collect germs. If there is visible dirt- you can wash the surface first and then disinfect. Use gloves for disinfection. How often should you disinfect? It depends on what you normally do – remember that cold and flu season may require more frequent disinfection, and you may want to disinfect more often if some surfaces are getting more frequent use. Bleach solution must be prepared daily as it is not stable in water. NOTE: 2 Tablespoons of bleach in 4 Cups of water makes the same proper combination as listed above; just a smaller quantity.
  • Think cowboys and dust…
  • Risk of flu can be reduced through a layered approach which is to say the combination of infection control, site/environmental control, and social distancing. No single action will provide complete protection! Remember: -Wash your hands! -Practice cough etiquette! -Increase disinfection of frequently touched surfaces -Avoid going out and crowded/congested social settings Other important infection control practices: Frequent hand-washing, cough etiquette, isolating infected clients, good environmental/site control measures, food safety, and using appropriate social distancing
  • It will take all of us working together Some of the agencies have resources specific to PI Planning Others don’t have those resources – namely community centers We wanted to help the community centers in Columbus to start planning for a severe pandemic (H5N1)
  • Online: ( Columbus & Franklin County Public Health Partnerships) www.columbuspandemicflu.com – central Ohio specific info, resources on Pan flu in general and specific toi H1N1, preparing and care at home – Driving visits to our site here. www.cdrsinfo/H1N1flu.html - Communicable disease Reporting System – healthcare providers guidelines and information. Facebook – combo of CPH and FCBH – frequent updates
  • Phone: Central Ohio Community Flu Hotline 211 (221-2255) - 24/7 for public general flu questions Health Provider Hotline (614) 355-0461 National Source: www.flu.gov and http://www.cdc.gov/H1N1FLU/ For guidelines by audience and reosurces.

H1 N1/ Pandemic Flu  2009 H1 N1/ Pandemic Flu 2009 Presentation Transcript

  • Pandemic H1N1 In flu enza Central Ohio’s Public Health Response Janie Van Gilder, RN, BSN September 18, 2009 Industrial Security Services
  • Seasonal In flu enza
    • Caused by a virus
    • Occurs annually, predictable
    • Is a mild to severe illness
    • Many, many different seasonal flu virus strains with very minor year to year changes
    • Affects the very young and elderly
    • Causes an average of 200,000 hospitalizations and 36,000 deaths each year in the U.S.
  • Pandemic In flu enza
    • Caused by a new virus
    • Can cause serious illness because there is little to no immunity in humans
    • Spreads easily from person to person
    • Can happen any time of year
    • Uses WHO Phases/US Stages for planning and outbreak
    • Becomes globally widespread
    View slide
  • Pandemic H1N1 In flu enza
    • The H1N1Virus
      • Brand new combination of swine, bird
      • and human influenza viruses
      • Spreads easily from human to human
      • Learning about virus and watching
      • closely for changes
    • Illness and immunity
      • Humans have little to no immunity to virus
      • Severity Index Measures
    • Vaccine
      • New vaccines need 4-6 months to develop, test, manufacture and dispense
    View slide
  • H1N1 Update Public Health Planning
    • Pandemic H1N1
    • Could strike up to 50% of U.S population
      • More contagious than seasonal flu
      • Estimated 100,000 deaths or more
    • Absenteeism in the workplace around 38%
    • New at-risk groups:
      • Pregnant women
      • Young persons
        • 6 month – 24 year olds
        • 5-24 year olds seem to have most severe disease
      • Minority populations
        • Four times more likely to be hospitalized
  • H1N1 Flu Senior Citizens
    • Are experiencing much less severe disease
    • Not seeing in the ages reported as needing hospitalization
    • May have some small immunity from lifetime exposures with proteins of this new virus
    • Better infection control habits
    • Note: Seasonal Flu is a very different story!
  • Flu Spread
    • Spread of H1N1 like spread of seasonal flu
    • Can be spread through:
      • Respiratory droplets (coughing, sneezing or talking)
      • Touching surfaces contaminated with virus
    • Infected people spread the flu:
      • People are contagious 1 day prior to symptoms and for a min. of 7 days after symptoms begin
      • Incubation is about 1-4 days
      • Children normally shed more virus than adults
  • H1N1 Symptoms
    • Like those of seasonal flu…
    • Sudden onset
    • Fever > 100°F (38°C)
    • Runny or stuffy nose
    • Cough
    • Body aches
    • Headaches
    • Sore throat
    • Chills
    • Fatigue
    • Diarrhea and vomiting are reported for some
  • Pandemic H1N1 Update 2009 Timeline
    • March Virus first appears in a human in Mexico
    • April First case in U.S.
    • June H1N1 found in all 50 states
    • June 11 WHO declares H1N1 is a Pandemic
    • July 16 WHO declares H1N1 widespread and
    • no longer tracking individual cases and
    • numbers of countries
    • July 24 CDC reporting only hospitalizations and deaths
    • August 5 ODH no longer reporting individual cases as is
    • widespread in the community
    Preparing for 2nd wave of pandemic this fall/early winter
  • Pandemic H1N1 Testing & Medical Treatment
    • H1N1 Diagnosis
      • Existence of flu-like symptoms
      • Now so widespread in community
      • -assume it is H1N1 if have flu symptoms
      • Rapid tests for Influenza A
    • Antiviral treatments
      • Can prevent complications if taken in time
      • Tamiflu currently effective against influenza A virus (H1N1)
      • May not be effective if H1N1 virus changes
      • Resources are prioritized based on national guidance:
        • Use for treatment
        • Prevention if exposed and at very high risk of complications from H1N1 flu (i.e. pregnancy)
  • (Spring 2009- Spring 2010) Pandemic H1N1 Waves Pandemics are experienced in community outbreak waves: 4/27 5/25 6/25 7/25 8/25 9/25 10/25 11/25 12/25 1/25 2/25 2009 2010 Spring 2009 Fall 2009 Spring 2010
  • Public Health & Pandemic H1N1
    • Role of local health department:
    • Coordinate local response effort
    • Surveillance and tracking
    • Public information & communication
    • Antiviral & vaccine delivery when available
    • Case management
    • Community containment
      • I solate = I nfected or I ll
      • Quarantine = Exposed
  • H1N1 Flu Home Care
    • Care for H1N1 flu is like seasonal flu care :
      • Monitor symptoms
      • Use meds to treat symptoms
      • Prevent dehydration
      • Reduce Fever
    • Increase disinfection of home surfaces
    • Separate ill household member
    • from others- use one person as caregiver
    • It is OK to wash dishes and clothes together-use soap and hot water
  • About Vaccines Pandemic H1N1 Influenza Vaccine
    • Seasonal flu shot will not protect against H1N1
    • H1N1 shot will not protect against seasonal flu
    • Fall H1N1 Vaccination Effort
      • Scheduled for mid/late October, through winter
      • Specifics unknown for - # of doses - timing
  • Vaccine Priority Pandemic H1N1 Influenza Vaccine
    • Vaccination Priority Groups
      • Pregnant women
      • Household contact of children less than 6 months
      • Healthcare workers and emergency personnel
      • Children and young adults 6 months – 24 years
      • Non-elderly adults 25-64 with underlying conditions
      • -Approximately 160 million Americans in total
  • What Can You Do?
    • Wash your hands
    • Cover your cough
    • Stay home if you’re sick!
    • Get your seasonal flu shots
  • Limiting the Spread Wash Your Hands
    • Handwashing is the single most important action
    • you can take to prevent the onset of
    • illness ! -According to the Centers for
    • Disease Control and Prevention (CDC)
    • Proper Handwashing
      • W et hands with warm water
      • A pply soap
      • S uds and s crub all parts of hands for 20 seconds
      • H andle faucets and door knobs with towel
      • for hands stay clean when leaving bathroom
  • Limiting the Spread Use of Hand Sanitizers
    • When you can’t use soap and warm water, hand sanitizer is effective:
      • Use at least 60% alcohol  
      • Put nickel-size amount in palm, do fingernails first, and rub hands for full 15 seconds.
      • Let air dry, do not wipe off.
      • Wash with soap and water after every 5 to 10 sanitizer uses
    • Avoid touching your eyes, nose and mouth-if touch then wash right away
  • Limiting the Spread Cover Your Cough
    • Prevent the spread of infection from sneezing or coughing
    • Proper ways to cover your cough:
      • Cover your mouth and nose with tissue and throw away after one use then wash hands
      • Cough or sneeze into your upper sleeve or bend of the elbow, covering your mouth and nose not into hands
    Entertaining 4 minute video available at http://www.coughsafe.com/media.html
  • Social Distancing
    • Social distancing allows space
    • between people so the virus does
    • not land on them and spread this
    • way
    • Stop shaking hands
    • Stay 6 feet away all around from someone coughing and sneezing
    • Avoid crowded settings
  • Limiting the Spread Stay Home If You’re Sick!
    • Staying home helps protect others from your germs
    • Take responsibility :
    • - Don’t go to work if you’re sick
    • - Keep kids out of school or
    • childcare if they are sick
    • Stay home for 24 hours after fever-free without fever-reducing medications
    • Call your healthcare provider if you experience very high fevers, have difficulty breathing or chest pain, are unable to drink enough fluids or have difficulty keeping those fluids down
  • Vaccines Seasonal In flu enza Vaccine
    • Are available now
    • Will decrease risk of getting seasonal flu
      • You cannot get the flu from the flu shot
    • Must get seasonal vaccine every year
    • Anyone who wants to decrease risk of getting flu should be vaccinated
    • CDC 2009-2010 recommended groups:
      • Children 6 months – 18 years
      • Adults 50 years or older
      • Pregnant women
      • Anyone with medical conditions
      • Those who live with or care for people at high risk
  • Limiting the Spread Surface Cleaning
    • Cleaning removes dirt and grime; d isinfection d estroys germs.
    • Flu viruses are fragile on surfaces so easier to destroy
    • Multi-use surfaces include counters, sinks,
    • telephones, hand rails, door knobs, light switches.
    • Common area disinfectants include
    • normal household products:
        • Alcohol
        • Household sani-wipes
        • Bleach solution- use ¼ cup bleach mixed in 1 gallon of water mixed
        • new daily
  • A Word About Facemasks
    • Facemasks are fluid resistant loose-fitting, disposable
    • They cover the nose and mouth
    • They are made of soft materials and comfortable to wear
    • Include products labeled as surgical, dental, medical procedure, isolation, and laser masks
    • Come with ear loops, ties, or elastic to stay on
    • Facemasks are a barrier protection only!
  • Facemasks
    • Routinely, “In community and home settings, the use of facemasks and respirators generally are not recommended .” according to the CDC  
    Facemasks are worn when coughing or sneezing to protect others from your germs!
    • Infection Control
    • Safer Environments
    • Social Distancing
    • Antivirals and vaccine
    Virus Infection Control A Layered Approach It takes use of all strategies to reduce the spread of flu viruses:
  • Home Pandemic Flu Planning
    • Create an emergency plan for both your family and workplace.
    • Gather food and medicine for two weeks.
    • Keep cleaning supplies on hand.
    • Make continuing plans for children if schools and/or childcares need to close.
    • Practice infection control in your home and at work.
    • Teach children and their caregivers about your plans.
    • Stay tuned for updates from local public health sources.
    Make a plan, Make a kit, Listen for information
  • Pandemic H1N1 We All Have a Part To Play Police Social Agencies Hospitals Public Health Community Centers Faith Based Schools Businesses Utilities Fire Working together to protect our community
  • Help Your Community
    • Volunteer in your neighborhood
    • Volunteer in emergency response organizations:
      • Community Emergency Response Team (CERT)
      • Medical Reserve Corps (MRC) 
    • Support and follow your local health department guidance
    • Get your flu vaccines
    • Help spread the word, not your germs!
  • Information Sources
    • Columbus/Franklin County
      • www.columbuspandemicflu.org – main local source
      • www.cdrsinfo - healthcare guidelines
      • Facebook & Twitter - social media, ongoing info
      • Sign up for E-health Alerts - email updates www.publichealthcolumbus.gov
  • Information Sources
    • Phone
      • Central Ohio Community Flu Hotline 211 (221-2255)
      • Seasonal Flu – Vaccine4me (614) 437-2900 or toll-free (888) 202-1319
    • National
      • www.flu.gov
      • www.cdc.gov/H1N1FLU/
  • Stay safe and be well Questions?
  • Pandemic H1N1 Influenza Central Ohio’s Public Health Response Janie Van Gilder, RN, BSN September 18, 2009 Industrial Security Services