H1 N1/ Pandemic Flu 2009
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Here is the H1N1 Pandemic Flu powerpoint and notes from our Sept 19th seminar.
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H1 N1/ Pandemic Flu 2009
- 1. Pandemic H1N1 In flu enza Central Ohio’s Public Health Response Janie Van Gilder, RN, BSN September 18, 2009 Industrial Security Services
- 11. (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
- 28. 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
- 32. Stay safe and be well Questions?
- 33. Pandemic H1N1 Influenza Central Ohio’s Public Health Response Janie Van Gilder, RN, BSN September 18, 2009 Industrial Security Services
Editor's Notes
- 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.