August 26, 2009 Florida Flu Information Line

Transcription

1 August 26, p.m. Florida Flu Information Line On Monday, August 24th, Florida Department of Health launched a toll-free number to provide public health information and updates on H1N1 Swine flu. The information line is available from 8 a.m. to 8 p.m. EDT, seven days a week. Information is available in English, Spanish and Creole. Additional laboratory confirmed H1N1 Swine Flu deaths have been verified in that of the following: A 34-year-old male in Polk County, a 56-year-old female in Orange County, a 22-year-old female in Hillsborough County, a 57-year-old male in Miami-Dade County, a 50- year-old female in Miami-Dade County, a 24-year-old male in Miami-Dade County, and a 54- year-old male in Broward County. While most cases of H1N1 Swine Flu are mild, there are exceptions. Pre-existing health conditions often play a role in how individuals react to the flu. To date, there have been 66 laboratory confirmed H1N1 Swine Flu deaths in Florida. "Our hearts and prayers go out to the family and friends of these individuals, " said Surgeon General Dr. Ana Viamonte Ros. " H1N1 Swine Flu, like seasonal flu, can in some circumstances be very serious, therefore, all of us should continue to adhere to good health practices including, stay home if sick, cover cough and sneeze, and wash hands frequently." All four Department of Health laboratories have received testing supplies from the Center for Diseases Control and can test samples to confirm H1N1 Swine Flu. This testing capability allows the Department to expedite results as we no longer need to send probable cases to CDC laboratories. The Department of Health continues its enhanced surveillance and outreach to physicians, hospitals, and other health care professionals. The surveillance system, consisting of sentinel physicians reporting influenza activity, DOH laboratories receiving specimens from physicians and hospitals, and our ability to monitor emergency room cases is fully operational. We have activated our response plan and are ready to respond if needed. The World Health Organization (WHO) alert level is at Phase 6 "pandemic." The pandemic (WHO level 6) status is based on geographic distribution and not the severity of swine flu. In effect the WHO is saying that swine flu H1N1 is now circulating world-wide.

2 The State Surgeon General provided these recommendations: People with respiratory illness should stay home from work or school to avoid spreading infections, including influenza, to others in the community. Avoid close contact with people who are coughing or otherwise appear ill. Avoid touching your eyes, nose and mouth. Wash hands frequently to lessen the spread of respiratory illness. People experiencing cough, fever and fatigue, possibly along with diarrhea and vomiting, should contact their physician. If you think you have influenza, please call your health care provider and discuss whether you need to be seen in their office, emergency department or stay home.

3 Novel H1N1 (Swine) Influenza Patricia Stuart, RN, MSN, ARNP Orange County Health Dept. Assistant Director of Nursing Immunizations, School Health, NCF

4 What is H1N1 (Swine flu)? The H1N1 (referred to as swine flu early on) is a new influenza virus causing illness in people. This virus was originally referred to as swine flu because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs in North America.

5 Where are we now? New virus emerged early 2009 in Mexico It s H1N1, but not like other recent human H1N1 s New virus has pieces that came from birds, pigs, and people Several pieces are descendants of the 1918 virus Highest attack rate in children and young adults Adults born before 1957 seem to be spared Continuing activity this summer 3

6 How Does the H1N1 Virus Spread? Spread of this new H1N1 virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their eyes, mouth or nose.

7 What Are The Signs and Symptoms of This Virus in People? Similar to the symptoms of seasonal flu. Fever Cough Sore throat Runny nose Body aches Headache Chills Fatigue Stomach symptoms such as nausea, vomiting and diarrhea

8 Infectious period The duration of shedding with novel influenza A (H1N1) virus is unknown. Therefore, until data are available, the estimated duration of viral shedding is based upon seasonal influenza virus infection. Infected persons are assumed to be shedding virus from one day prior to illness onset until resolution of symptoms. In general, persons with novel influenza A (H1N1) virus infection should be considered potentially infectious from one day before to 7 days following illness onset. Children, especially younger children, might be infectious for up to 10 days. Self-isolation (no school or work) should be recommended for all patients presenting with ILI (Influenza Like Illness) for 7 days or until symptoms resolve, whichever is longer.

9 Relationships among viruses Infection with seasonal H1N1 provides no protection against novel H1N1. Vaccination with recent seasonal vaccines also provide no protection against novel H1N1. Older people are more likely to have antibodies against the H1N1 that circulated before This may explain the age distribution of the current pandemic. 7

10 Influenza case and death counts as of 8/05/ confirmed cases in FL 509 known hospital admissions 40 deaths 40 cases in pregnant women Novel H1N1 is consistently sensitive to Tamiflu and Relenza Probably capturing 5% of morbidity this way We will stop publicizing case count -- will show impact in other ways 8

11 Deaths associated with novel H1N1 More than half have underlying chronic disease. Concerned about possible late initiation of antiviral treatment. Age distribution is different from that for all confirmed cases. 9

12 Cases and deaths by age group Deaths are occurring in older age groups than cases Number of Deaths Age Group Newly reported Year-to-date 10

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14 Percentage of Visits for Influenza-like Illness

15 What is Going on in Florida? As of July 30, laboratory confirmed deaths 3,321 confirmed cases

16 Newly reported from July 22 to July 29

17 Existing Influenza Surveillance in Orange County Purposes of current surveillance system: Monitor beginning, peak and end of season Determine which viruses are causing illness Network of sentinel physician practices Influenza-like illness as percentage of office visits Influenza cultures in selected practices Influenza culture specimens received, positive results, at state PH lab

18 High Risk Groups for H1N1 Children age 6 months to 24 years Day care and School staff Pregnant Women Health Care Workers Individuals age 24 years to 64 years with chronic disease

19 Confirmed and Probable cases by age, Florida Number of Cases 2,000 1,800 1,600 1,400 1,200 1, Age Group Newly reported Year-to-date

20 Looking ahead Expect widespread influenza activity in schools as soon as school starts Expect 1 to 3 months of community influenza activity BEFORE vaccine becomes available Excess morbidity and mortality may be substantial The vaccine will not be 100% effective We could have 5 million infections If one infected person per 1000 dies, that will be 5,000 deaths in Florida 18

21 Overview Vaccine H1N1 2 doses days apart. Vaccinations will be on a voluntary basis. Providers will be able to order vaccine late September to early October. Decision still being considered regarding mass vaccination versus going to individual schools/daycares. Use of reporting log to identify clusters. Parent letter

22 Action Steps to Prevent the Spread of H1N1 Educate students and staff to cover their mouth and nose with tissue when they cough and/or sneeze. Practice good hand hygiene. Send sick students, teachers, and staff home. Check cleaning supplies: antiviral and antibacterial.

23 Action Steps to Prevent the Spread of H1N1 Designate a room for isolation in the event that students teachers or staff become ill. Limit the number of individuals contact with the sick person. Have PPE supplies available. School-age children enrolled in day cares will need to be monitored if sent home for possible school dismissals.

24 Thank You!

25 Steps Every Employer Can Take to Reduce the Risk of Exposure to Pandemic Influenza in Their Workplace The best strategy to reduce the risk of becoming infected with influenza during a pandemic is to avoid crowded settings and other situations that increase the risk of exposure to someone who may be infected. If it is absolutely necessary to be in a crowded setting, the time spent in a crowd should be as short as possible. Some basic hygiene (see and social distancing precautions that can be implemented in every workplace include the following: Encourage sick employees to stay at home. Encourage your employees to wash their hands frequently with soap and water or with hand sanitizer if there is no soap or water available. Also, encourage your employees to avoid touching their noses, mouths, and eyes. Encourage your employees to cover their coughs and sneezes with a tissue, or to cough and sneeze into their upper sleeves if tissues are not available. All employees should wash their hands or use a hand sanitizer after they cough, sneeze or blow their noses. Employees should avoid close contact with their coworkers and customers (maintain a separation of at least 6 feet). They should avoid shaking hands and always wash their hands after contact with others. Even if employees wear gloves, they should wash their hands upon removal of the gloves in case their hand(s) became contaminated during the removal process. Provide customers and the public with tissues and trash receptacles, and with a place to wash or disinfect their hands. Keep work surfaces, telephones, computer equipment and other frequently touched surfaces and office equipment clean. Be sure that any cleaner used is safe and will not harm your employees or your office equipment. Use only disinfectants registered by the U.S. Environmental Protection Agency (EPA), and follow all directions and safety precautions indicated on the label. Discourage your employees from using other employees' phones, desks, offices or other work tools and equipment. Minimize situations where groups of people are crowded together, such as in a meeting. Use , phones and text messages to communicate with

26 each other. When meetings are necessary, avoid close contact by keeping a separation of at least 6 feet, where possible, and assure that there is proper ventilation in the meeting room. Reducing or eliminating unnecessary social interactions can be very effective in controlling the spread of infectious diseases. Reconsider all situations that permit or require employees, customers, and visitors (including family members) to enter the workplace. Workplaces which permit family visitors on site should consider restricting/eliminating that option during an influenza pandemic. Work sites with on-site day care should consider in advance whether these facilities will remain open or will be closed, and the impact of such decisions on employees and the business. Promote healthy lifestyles, including good nutrition, exercise, and smoking cessation. A person's overall health impacts their body's immune system and can affect their ability to fight off, or recover from, an infectious disease. Workplaces Classified at Lower Exposure Risk for Pandemic Influenza: What to do to protect employees If your workplace does not require employees to have frequent contact with the general public, basic personal hygiene practices and social distancing can help protect employees at work. Follow the general hygiene and social distancing practices previously recommended for all workplaces (see page 26). Also, try the following: Communicate to employees what options may be available to them for working from home. Communicate the office leave policies, policies for getting paid, transportation issues, and day care concerns. Make sure that your employees know where supplies for hand hygiene are located. Monitor public health communications about pandemic flu recommendations and ensure that your employees also have access to that information. Work with your employees to designate a person(s), website, bulletin board or other means of communicating important pandemic flu information. More information about protecting employees and their families can be found at:

27 Preventing the Flu: Good Health Habits Can Help Stop Germs Fact Sheet* Avoid close contact. Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too. Stay home when you are sick. Stay home from work, child care, school, and errands when you are sick, except to seek medical care. Keep sick children at home except to see medical care. You will help prevent others from catching the illness. Cover your mouth and nose. Cover your mouth and nose with a tissue when coughing or sneezing. Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Wash your hands often. Washing your hands and the hands of your children often will help protect you from germs. Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Practice other good health habits. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. There is no vaccine available at this time for this new flu virus, so it is important for people living in the affected areas to take steps to prevent spreading the virus to others. If people are ill, they should stay at home and limit contact with others, except to seek medical care. Healthy residents living in these areas should take the everyday preventive actions listed above. People who live in these areas who develop an illness with fever and respiratory symptoms, such as cough and runny nose, and possibly other symptoms, such as body aches, nausea, or vomiting or diarrhea, should contact their health care provider. Their health care provider will determine whether influenza testing is needed. *

28 Swine-Origin Influenza A (H1N1) Information for Child Care Providers Page last updated April 29, :45 PM ET CDC has identified cases of swine-origin influenza A (H1N1) virus infection in people from several states including California, Kansas, Texas, New York and other states (see updates at CDC is working with local and state health agencies to investigate these cases. It has been determined that this virus is spreading from human to human. As of April 29, 2009, of 91 patients identified thus far in the US, most have recovered, but five have been hospitalized and one patient, a child, has died. Right now, there is no vaccine for this new virus and the current seasonal influenza is thought to be unlikely to provide protection against this new strain. Child care providers in community-based child care programs in all settings including both center-based and family child care programs should: Review their plans for responding to a pandemic. Make sure that they are up-to-date and that parents know what they are. Remind parents and enforce policies for having ill children stay at home during their illness. Children with symptoms of an influenza-like illness should not come to school. Symptoms of influenza include fever, cough, sore throat, body aches, headache, chills, fatigue, and, in some cases diarrhea. The child's health care provider will determine whether influenza testing is needed and when the child can return to child care. In most areas, children with other, mild respiratory illnesses including allergies may be allowed to attend child care as long they are able to participate comfortably and their care does not result in a greater need for care than the staff can provide without compromising the health and safety of the other children (Caring for Our Children- Standard 3.065). Remind workers not to come to work while if they have an influenza-like illness. They should consult their health care provider to determine whether influenza testing is needed. Health departments in areas where cases of persons affected with this new virus have been identified may recommend more rigid exclusion policies so providers will need to stay informed on what is happening in their communities. Child with influenza may be infectious for up to 10 days after illness onset with influenza while adults are thought to likely infectious for 5-7 days. Public health investigators are working to more precisely learn the length of infectiousness. If a child has been confirmed to have swine-origin influenza, then seek the advice of the child s health provider and the health department about when the child can return to the child care program

29 Be familiar with local/state plans for child care in the event of a mild or severe pandemic. This information may be available from state or local health authorities, child care licensing agencies or resource and referral agencies. If these plans do not include specific approaches to communicate with and handle situations in child care, do what you can to advocate for updating the plans. Develop and implement a system to track illness and absence due to illness among children and staff if one is not already in place. The system should be simple and easy to maintain but should record the number of persons with various illnesses (e.g. respiratory, diarrhea, rash) by day or at least by week. (see Caring for Our Children Standards and for information on how to do this ( - page 2) Review and implement CDC Guidelines and Recommendations for Preventing the Spread of Influenza (the Flu) in Child Care Settings: Guidance for Administrators, Care Providers, and Other Staff, ( Make sure staff are familiar with the above guidelines and that they are being followed in your program. Remind child care staff to clean/disinfect frequently touched surfaces within the facility. Provide information to parents on steps that they could take to prevent flu. (See attached fact sheet that could be distributed to each parent or posted on a door to the facilities with providers calling attention to the posted fact sheet). Monitor the postings on the CDC web site about this virus ( and information from state or local health departments to see if child care facilities should begin preparing for possible closure or changes in operation. Work with parents to consult the child s health provider if you have questions about a child with a respiratory illness or if you suspect a child might have influenza. Contact your child care health consultant or local public health department if you need help to make decisions promptly that affect the children as a group. Child care and preschool programs can help protect the health of their staff and the children and families they serve by calling attention to the every day preventive actions that parents can initiate to protect their children. (Please consider posting or distributing the attached message in your child care facility). More information on preventing the spread of influenza can be found at: For generic information on disaster preparedness, see NACCRRA s web site

30 Additional generic planning information for child care programs and schools, including examples of state and local plans, can be found on the Department of Education's website at: Note: Conditions and situations are rapidly changing and these recommendations may change over time. # # #