2009 H1N1 flu. H1N1 update US. H1N1 update US

Transcription

1 2009 H1N1 flu Ned Calonge, MD, MPH Chief Medical Officer Colorado Department of Public Health and Environment H1N1 update US US: 593 deaths reported 9,079 hospitalizations in US since spring CDC has officially started surveillance for the fall 2009 flu season, tracking primarily hospitalizations and deaths; has added school closures CDC reports 90 (23 H1N1) pediatric flu deaths since 9/08 H1N1 update US Hospitalized patients have been younger than for seasonal flu Death rate consistent with that for seasonal flu No evidence of increased mortality in ANY age group Almost all deaths in patients with significant co-morbidities 1

2 H1N1 update US Transmission rates higher among younger family members, less among parents Older individuals have some immunity with detectable antibody and have not been impacted much by H1N1 HIN1 update worldwide Southern hemisphere flu season is winding down, H1N1 circulated with seasonal viruses H1N1 was dominant in Central/South America, Australia and New Zealand Overall severity is not different from seasonal flu, although experience suggests that what severe illness there is in younger adults is more severe Contagiousness appears to be higher While there have been some school closures in Southeast Asia, this is not prevalent in other areas such as Australia H1N1 update Colorado Colorado H1N1 hospitalizations for the spring and summer were 43, with 32 cases under age 40, 1 death (woman in her 40s) Colorado reported no H1N1 pediatric flu deaths (but 5 from seasonal flu last season) The virus continued to circulate in the summer, with 28 summer camps closed due to reported cases, 5 associated hospitalizations 2

3 H1N1 predictions for fall/winter CDC anticipates H1N1 will co-circulate with seasonal flu viruses this flu season and be the dominant strain; the timing, spread and severity of H1N1 is uncertain (as it is with the seasonal strains) Worst case scenario is 50% infected, 90,000 deaths (translates to 1600 deaths in Colorado, twice normal) There has not been this degree of severity in the Southern Hemisphere season 3

4 H1N1 Phases Phase 1: pre-vaccination phase now until mid-october Phase 2: vaccination phase mid- October through December Phase 1 H1N1 is present in the community as schools have opened We are already experiencing school infections, transmission and outbreaks REMEMBER: this is the flu Phase 1 Primary efforts are around personal responsibility and community mitigation» Hand washing» Cough etiquette» KEEP SICK CHILDREN HOME» Don t go to work sick Keep those tolerating ILI ok at home and OUT of the doctor s office or ED: TREAT LIKE THE FLU 4

5 Testing It is NOT necesssary or feasible to test every person with influenza-like illness (ILI) for H1N1 Persons with uncomplicated ILI who are not at high risk for complications do NOT need to be seen by a health care provider and do NOT need to be tested for H1N1 Testing State laboratory testing for H1N1 is for surveillance only (eg, hospitalized patients) and is NOT available for diagnosis and clinical management H1N1 testing (by PCR) is available through several commercial laboratories (Quest and Labcorp) To date, nearly all influenza specimens subtyped by the state laboratory have been 2009 H1N1 90% of type A strains nationwide are H1N1 Treatment (antivirals) Treat all hospitalized patients (suspected/confirmed) Treat as early as possible and don t wait for laboratory confirmation Treat patients (suspected/confirmed) at increased risk for complications:» Pregnant women» Children under 2 years» Those with chronic illnesses» Those 65 and older 5

6 High risk conditions Chronic pulmonary (including asthma) cardiovascular (except hypertension), renal, hepatic, hematologic (including sickle cell), neurologic, neuromuscular, or metabolic (including diabetes) disorders Immunosuppression (chemo, HIV) Under age 19 on long-term ASA therapy Treatment Persons who are not at higher risk for complications or do not have severe influenza requiring hospitalization generally DO NOT require antiviral medications for treatment or prophylaxis Persons with suspected 2009 H1N1 influenza or seasonal influenza who present with an uncomplicated febrile illness typically DO NOT require treatment Treatment Any suspected influenza patient presenting with warning symptoms (e.g., dyspnea) or signs (e.g., tachypnea, unexplained oxygen desaturation) for lower respiratory tract illness should promptly receive empiric antiviral therapy 6

7 Treatment Treatment should not wait for laboratory confirmation of influenza because laboratory testing can delay treatment and because a negative rapid test for influenza does not rule out influenza Other approachs to decrease time to treatment for those at risk should be considered (eg,prescribing after telephone consulation) Antiviral prophylaxis Consider for:» Persons at higher risk for influenza-related complications who have had close contact with someone likely to have influenza during that person s infectious period» Health care personnel, public health workers, or first responders who have had a recognized unprotected close contact exposure to a person with suspected or confirmed influenza during that person s infectious period Antiviral prophylaxis PROPHYLAXIS is NOT recommended:» If more than 48 hours have elapsed since the last contact with an infectious person» Post-exposure in healthy children or adults Antivirals should not be used for continuous prophylaxis, even if at higher risk for complications 7

8 Learnings from Australia Hospitalization rate was not different from seasonal flu Cases were younger than seasonal flu Hospitalized patients tended to be more severe: 25-27% of hospitalized cases were admitted to the ICU Stresses were seen in EDs and ICUs, but overall the healthcare system responded well Note: no available vaccine Vaccine updates H1N1 vaccine production is well underway Clinical trials of vaccine efficacy and safety are underway CDC estimates 43 million doses available by mid-october (translates to 750,000 doses for Colorado) Supply should be 20 million doses per week afterwards (over 200,000 doses/wk) Vaccine updates H1N1 vaccine will be a 100% federal purchase and state and local public health is charged with coordinating distribution and administration 8

9 Vaccine updates The vaccine is free The vaccine will be distributed with the necessary distribution supplies Providers can charge an administration fee, although NO fee should be charged to the uninsured (no barriers to immunization) Vaccine updates Australian studies, and now US studies indicated that, contrary to earlier concerns, a single dose of inactivated vaccine will confer immunity Live-attenuated vaccine studies due out soon are expected to show the same Vaccine updates As the vaccine will not be available all at once, priorities for earlier vaccine have been set by CDC:» Pregnant women» Healthcare and emergency medical services personnel» Household contacts/caretakers of children under 6 months» Children, adolescents and young adults 6 months to 24 years» Adults 25 to 64 with chronic disease This list covers about half of the population, so further prioritization will have to occur early on 9

10 Vaccine updates Seasonal flu vaccine will be distributed through the usual annual process Vaccine is already available and we are recommending early administration There have been suggestions that this vaccine may not be a good match for the H3N2 strain that is circulating in the Southern Hemisphere Vaccine distribution and administration Federal plans are to use large distribution warehouses (McKesson) CDPHE s involvement will primarily be to assure distribution to local public health and support their local plans for distribution and administration Pre-registration of providers/physicians has been completed Interested physician must contact their local public health agency to inquire about participation Vaccine distribution and administration planning Currently we are pursuing four major strategies for administration approaches:» Hospitals for administration to healthcare and EMS workers» Schools and colleges for students May use pediatric care providers to reach chronically ill children, adolescents and young adults first» Obstetrical care providers for pregnant women» The usual seasonal flu system (health care provider offices, retail outlets, Visiting Nurse Association, hospital programs, worksites programs, etc) for all other adults 10

11 Other vaccine issues Vaccination will be voluntary We are not planning on making H1N1 vaccination a school requirement Assuming evidence of efficacy and safety, we will be strongly recommending the vaccine as the best strategy for flu protection Antiviral updated We still have about 170,000 courses of Tamiflu from the national stockpile prepositioned at local distribution points, intended for use for the un-insured HHS is adamant that current commerciallyavailable supply is adeqaute The circulating seasonal flu strains are largely resistant to Tamiflu There are a few instances of H1N1 resistance H1N1 response planning We continue to work with the Department of Education to support school plans that stress keeping schools open but keeping/sending ill students home DOE and Local Public Health Agencies are working with school nurses and school-based health clinics on their surveillance and response activities Higher ed institutions have their plans up and running, coordinated with LPHAs 11

12 H1N1 response local public health agencies We are working regularly with local public health officials; we expect them to work directly with the school superintendents in their jurisdictions on response plans and closure decisions They will take the lead for local outbreak surveillance, investigation and mitigation They are in charge of distribution plans for vaccine in their jurisdictions They are in charge of SNS antiviral distribution in their jurisdictions H1N1 response communication CDPHE is pursuing several strategies to decrease the use of the health care system by otherwise healthy children and adults with ILI:» Mass media/press releases» CoHealth phone line» Home treatment manual» On line home triage tools» Social media Resources COHelp Google group (daily updates): Other 12