Public Health Aspects of H1N1 VIHA Family Practice Council

1. Public Health Aspects of H1N1
VIHA Family Practice Council
September 17, 2009

2. Reassortments
leading to the
evolution of
2009 Influenza
A H1N1
Trifonov, NEJM, July 2009

4. Clinical Presentation of Initial US H1N1 Cases
fever
cough
sore throat
diarrhea
vomit
0 20 40 60 80 100
percent of cases

5. Influenza Like Illness Clinical
Case Definition
• Fever(*) AND Cough
• AND at least one of:
– Sore throat
– coryza
– Myalgia
– Arthralgia
– Diarrhea/vomiting
*Fever may be absent in young children and seniors

6. Surveillance Plan for H1N1
• Detailed data collection from all hospitalized cases
• Lab based surveillance of all submitted specimens
• Sentinel physicians
• MSP data monitoring
• Reporting of high absenteeism in schools/daycares
• Active follow up with remote First Nations
communities

9. H1N1 Vaccine
• Produced by GlaxoSmithKline
• Adjuvanted (AS03) single Ag, split virus
• Initial trials safe and immunogenic after
single dose (similar vaccines from other
manufactures showing similar results)
• Initial shipments expected in mid-
November; then weekly for about 2 months

10. H1N1 Vaccine Priority Groups
– persons with chronic medical conditions
– pregnant women
– children 6 months to less than 5 years of age
– persons residing in remote and isolated settings or
communities
– health care workers involved in pandemic response or
who deliver essential health services
– household contacts or caregivers of those at high risk
who cannot be immunized
– populations otherwise identified as high risk
• There will be sufficient H1N1 vaccine available in Canada
for everyone that needs and wants to be immunized. No
one will be left out.

11. H1N1 Vaccine Delivery
• Expected to start in mid-November
• Physician and public health delivered
– Physicians will have a critical role in providing
to their patients in a timely way
• 10 dose vials
– e.g. could plan for 10 patients in ½ hour block
• IM injection (likely single dose)
• Further information including ordering
forms will be sent by mail in October.

12. Tamiflu
• Commercial supply currently available
through community pharmacies
• Provincial stockpile to be released to
community pharmacies Oct 1.
• Available with physician prescription
– Consider providing high risk patients a
prescription in advance that could be filled
during fall if they develop influenza

13. Tamiflu Indictions
• Early treatment of influenza in:
– patients with underlying conditions: Pregnancy,
respiratory, cardiovascular disease, diabetes,
obesity, immunocompromised
– Children 2 years and under
– *Aboriginal people living on reserve
• Treatment of severe influenza cases
– (severity may be indicated by deterioration in
condition with dyspnea, tacchypnea, reduced
oxygen sats, hypotension)

14. Tamiflu dosing

15. H1N1 and Schools
• Schools can facilitate virus amplification
• However, based on mild virus profile,
closures of schools are not warranted.
• Instead, approach is:
– Attempt to exclude those with influenza until
recovered
– Strong emphasis on hygeine and cough
etiquette
– Emphasis on cleaning common surfaces