Novel H1N1 Influenza A: Protecting the Public Humayun J. Chaudhry, DO, MS, SM, FACOI, FACP, FAODME President, American College of Osteopathic Internists; Clinical Associate Professor of Preventive Medicine, Stony Brook University School of Medicine, N.Y.; Adjunct Clinical Associate Professor of Medicine, NYCOM
Outline Suffolk County Department of Health Services Definitions Novel H1N1 Influenza A Virus in Spring, Summer, and Fall of 2009 Symptoms and Transmission Patterns Suffolk County s s H1N1 Plan H1N1 Influenza A Vaccination Q&A
Kobe, Japan May 19, 2009
Daily Swine Flu Exam: China, May, 2009
Suffolk County,, Long Island, New York September 3, 2009
Suffolk County Department of Health Services Senior Leadership
Endemic, Epidemic, and Pandemic Defined Malarious Area www.cbsnews.com Endemic A A disease that already occurs at a high rate in a given population Epidemic An outbreak of new cases of a disease in numbers that exceed what is expected Pandemic An epidemic that spreads worldwide
Influenza Viral Morphology Influenza Type A, B, C - based on antigenic properties of nucleoproteins (NP) and matrix (M) proteins Hemagglutinin protein that helps the virus attach to a healthy cell (15 types) Neuraminidase protein that helps release viruses into the body (9 types)
How Influenza Viruses Change Antigenic Drift: Small changes in viruses over time New strains appear May not be recognized by antibodies Antigenic Shift: Abrupt, major change (reassortment) Results in novel strain or new subtype Can cause pandemic influenza
Seasonal Influenza, 2009 Annual seasonal influenza epidemics >36,000 deaths in US from seasonal influenza (~100( 100-200 deaths in Suffolk County each year) >200,000 hospitalizations from flu each year Over 85% mortality in persons 65 yrs Severe disease in infants, young children, and elderly individuals Attack rate of 5-15% (Nursing home attack rate of 60%) Potential for pandemic
Novel H1N1 Influenza A Virus
H1N1 Influenza A (Swine Flu), 2009 WHO Phase 6 Pandemic (declared June 11, 2009) >1 1 million cases in the U.S. >40,617 confirmed cases in U.S. >263 confirmed deaths in U.S. >153 confirmed cases in Suffolk County (6 deaths) Imminent Public Threat declared by NYSDOH August 6, 2009 A brand new virus A quadruple reassortment of 2 swine strains, 1 human strain, and 1 avian strain of influenza virus Mean age of cases in Suffolk County and in U.S.: 12 Severe infection occurs in individuals who are not at the extremes of age Attack rate of 22-30% initially
Novel H1N1 Influenza A Symptoms (Fever, cough,, and/or sore throat),, malaise, and headache Vomiting and diarrhea (unusual for seasonal influenza) Chills, myalgias, and arthralgias Infants: fever, lethargy, +/- cough Elderly individuals and immunocompromised hosts may also have atypical presentations
Risk Factors for Novel H1N1 Influenza A Virus Complications Chronic lung disease (especially asthma, COPD) Immunocompromised states (including pregnancy) Cardiac disease (other than HTN) Diabetes Mellitus Obesity? *Most Common Reasons for Hospitalization: Pneumonia and Dehydration
Management of Novel H1N1 Influenza A Infection This virus is sensitive to Tamiflu and Relenza, two antiviral medications It is resistant to other antiviral medications Treatment is currently recommended for All hospitalized patients with confirmed, probable or suspected cases Patients who are at higher risk for seasonal influenza complications Tamiflu and Relenza are not antibiotics and are most effective when used within 24-48 48 hours of an influenza illness
Transmission of H1N1 Primarily by respiratory droplets (sneezing and coughing) Incubation Period: 1-44 days Viral shedding (contagiousness) Begins 1 day before symptoms Peak shedding is during first 3 days of illness with fever Lasts 7 days in adults or 10+ days in children
Flu Pandemics: A Comparison YEAR 1918 2009 World Population 1.8 Billion 6.8 Billion Primary Mode of Transportation Ships, Railroad Jet Aircraft, Automobile Time for Virus to Circle the Globe Estimated Dead Worldwide 4 months 4 days 20+ Million?
Personal Hygiene is Best Tool Handwashing with soap and water is critical Virus can spread by contamination of hands that is then followed by hand contact with mucous membranes Alternatives to soap and water exist Alcohol-based hand gels
Masks May Also Play a Role Use of masks may decrease the spread of virus between people Widespread use during SARS outbreak May prevent children from putting hands/objects into their mouths
This Should Help Chicken Soup Orange Juice Vitamin C Multivitamins OMT
School Closure, Deer Park School District, Suffolk County, N.Y., May, 2009
Why do we think vaccines work? Viral Disease Year of Peak U.S. Prevalence Peak Number of Cases per Year in U.S. Number of Annual U.S. Cases in Modern Vaccine Era (2007) Hepatitis A 1971 59,606 3579 Hepatitis B 1985 26,654 4713 Measles 1958-1962 1962 503,282 715 Mumps 1967 185,691 30 Polio 1951-1954 1954 16,316 0 Rubella 1966-1968 1968 47,745 11 Congenital Rubella 1966-1968 1968 823 0 Smallpox 1900-1904 1904 48,164 0
How Are We Doing With Seasonal Influenza Vaccination Rates in the U.S.? Healthy People 2010 influenza vaccination targets are 90% among persons aged 65 years 60% among persons aged 18-64 years CDC Data from the 2006-07 07 Influenza Season indicate vaccination rates of 72.1% among persons aged 65 years 35.1% among persons aged 18-49 42.0% among persons aged 50-64 Source: MMWR, September 26, 2008
Suffolk County s s H1N1 Plan for Fall 1) Two possible scenarios Moderately severe illness Slightly more cases than in Spring, 2009 Increased severity of illness No indication from CDC or WHO that this is happening, or will happen, but we will be prepared 2) Stay Home if You Are Ill Influenza-like like Illness (ILI): Fever, Cough Suffolk County s s definition of fever: >100ºF F or feeling warm/hot plus chills/sweats
Suffolk County s s H1N1 Plan for Fall 3) H1N1 vaccination and seasonal influenza vaccination will be urged for target populations Hospitals, Private Physician Practices, Pharmacies 10 SCDHS Health Centers and >50 Vaccination Clinic PODs (Points of Dispensing) throughout County Schools, if they wish to have vaccination clinics Mandatory in NYS for all physicians and staff at hospitals, Article 28 facilities, Home Health Care, Hospice (NYSDOH Emergency Regulation) 4) Upon request, SCDHS will provide guidance and education to public and private school nurses and physicians about H1N1 vaccination procedures, techniques and precautions
Suffolk County s s H1N1 Plan for Fall 5) SCDHS will provide, upon request, educational and other curricular material about H1N1 and preventive hygiene to public and private schools 6) Regular schedule of meetings and communications between SCDHS and school officials in Suffolk County
Suffolk County s s H1N1 Plan for Fall 7) Communication to the public Posters on buses, PSAs (radio, TV, print media), press releases, weekly electronic updates, SCDHS website announcements, press conferences SCDHS H1N1 Telephone Hotline,, started September 9 8) If increased severity of illness, selective or pre-emptive emptive school closures may be considered as a last resort, especially if school operations disrupted September 3, 2009
Suffolk County s s H1N1 Plan for Fall 9) If increased severity of disease, communications will be enhanced and more frequent SCDHS H1N1 Hotline Hours Extended Enhanced surveillance of severity of disease Daily electronic updates 10) First Responders (EMS, Police) may be asked to wear N-95 masks this Fall. All other health care personnel may be asked to wear N-N 95 masks or disposable masks
Points of Dispensing (POD) September 3, 2009
Review Suffolk County Department of Health Services Definitions and a History of Pandemics Novel H1N1 Influenza A Virus in Spring, Summer, and Fall of 2009 Symptoms and Transmission Patterns Suffolk County s s H1N1 Plan H1N1 Influenza A Vaccination Plan Q&A
How Bad will the Novel H1N1 Influenza A Virus be in the Fall/Winter of 2009? September 3, 2009
Thank You! hchaudhr@nyit.edu September 3, 2009