2009-2010 H1N1 Response and Vaccination Campaign Stephanie A. Dopson, MSW, MPH, ScD. Candidate Influenza Coordination Unit Centers for Disease Control and Prevention
CDC H1N1 Response In late March and early April 2009, cases of human infection with a novel H1N1 influenza virus were first reported in Southern California and near Guadalupe County, Texas. 25 percent of the SNS supplies were deployed to all 62 states or project areas. CDC-developed PCR diagnostic test kits to detect this virus. Test kits have been distributed to all 50 states, the District of Columbia and Puerto and are being distributed internationally.
2009 H1N1 Outbreak Response Occurred very late in the season Remarkable heterogeneity across US Affected young people disproportionately Caused widespread illness; some severe or fatal Socially disruptive, especially for schools Tens of thousands of health workers and others responding worldwide
Avian virus Human virus Reassortment in humans Reassortment in swine Pandemic reassortant virus
Influenza Seasonal Flu - Contagious respiratory illness caused by influenza viruses 5-20% of U.S. population 200,000 hospitalizations 36,000 annual deaths Avian Flu Occurs naturally in birds; occasionally infects humans (e.g. H5N1) Pandemic Flu Influenza that spreads easily among people during a global outbreak 5
Epidemiology/Surveillance Weekly Influenza Activity Reported by SLTT s
Novel H1N1 Flu: Current Epidemiologic Situation Median age of US confirmed cases: 15 years (range: 1 months 86 years) 62% cases under 18 years Unlike seasonal influenza, which typically affects the very young and very old Most US cases have no history of travel Incubation period estimated 1-7 days Human-to-human transmission of H1N1 occurring No contact with pigs Severity so far similar to seasonal flu Activity now increasing dramatically in the Southwest Source: WHO, CDC & ProMED
It s Not Over Continuing spread in US Outbreaks in >50 summer camps, some communities Antiviral resistance to oseltamivir (Tamiflu) detections Denmark, Japan, U.S.-traveler to Hong Kong Virus remains genetically stable: Good target for H1N1 vaccine Susceptible to oseltamivir and zanamivir Systems to monitor H1N1 patterns, hospital & ICU utilization, vaccine uptake, vaccine adverse events
H1N1 Outbreaks at Universities - Students returned from diverse locations - Close, physical contact University of Delaware (April/May) >20 cases Air Force Academy (June/July) >65 cadets confirmed Emory University (Current) >100 students self-isolated Washington State University (Current) ~2000 students affected
H1N1 Four Pillars of Action Surveillance (Situational awareness) Domestic and Global Health care system Mitigation Vaccination Communication
Pillar 1: Enhanced Surveillance Surveillance addresses five key needs: Finding out when and where influenza activity is occurring Tracking influenza-related illness Determining what influenza viruses are circulating Detecting changes in influenza viruses Measuring the impact influenza is having on deaths
Pillar 2: Vaccination CDC has isolated the new H1N1 virus and modified the virus so it can be used to make hundreds of millions of doses of vaccine Making vaccine is a multiple step process which takes several months to complete State health departments started ordering Novel H1N1 vaccine on September 30th Novel H1N1 vaccine is expected to be widely available to the public by early November Clinical trials will be conducted to assess immune responses and safety of novel H1N1 vaccine
Components of a National Voluntary H1N1 Vaccination Program Program planning Engaging partners in government (state, tribal, local) and private sector Financing of program and vaccine administration costs Implementation and vaccine distribution Assessing how many people receive the vaccine Communications General public Health professionals Monitoring vaccine safety Assessing vaccine effectiveness
Pillar 3: Community Measures CDC is updating guidance to help local communities make decisions about how to: Keep healthy students in school and sick people at home Determine when/if more disruptive measures (such as cancellation of mass gatherings, school dismissals) should be used
Pillar 4: Effective Communication Continued outreach to: Parents Pregnant Women Child Care Programs Schools, Colleges and Universities Travelers and Travel Industry Clinicians Laboratorians Businesses and Employers Correctional facilities Homeless shelters Migrant farm workers
Communication
http://m.cdc.gov 95,701 views of mobile H1N1 flu pages since April 22 nd
Communication Challenges Motivation for vaccination dependent on risk perceptions and strength of endorsement Seasonal flu often not seen as serious threat Many medically high-risk persons do not self-identify Recommendations for children and pregnant women generate heightened safety concerns Multiple doses, combination of seasonal and 2009 H1N1 vaccine, access for priority groups Divergent views among experts
What can you do to protect yourself and others? Get vaccinated when shots are available CDC recommends a yearly seasonal flu vaccine as most important step to prevent seasonal flu A new vaccine against H1N1 will be available
What can you do to protect yourself and others? Chief Mitigation Measures: Staying home when ill with a flu-like illness Providing early treatment to people with influenza who have a high risk condition or are hospitalized Precautions to take regarding large public gatherings Other social distancing measures that might be recommended depending on the severity of the influenza season
Ensure communities continue to function Role of Businesses/Employers in Pandemic Planning and Response Protect the workforce Encourage ill staff to stay home Do not punish staying home Plan for/support telework Encourage vaccination, especially of high-risk workers Keep businesses operational (esp. Critical Infrastructure)
Resources Website for most updated guidance: www.cdc.gov/h1n1/guidance - Guidance for Business and Employers - Travel - Epidemiology and Surveillance - Clinicians - Patients and Pregnant women
Frequently Asked Questions Can you take the H1N1 vaccine at the same time as the seasonal flu vaccine? The H1N1 Vaccine can be taken at the same time as the regular seasonal flu vaccine. Orders were placed by states on September 30th, and the vaccine is now being delivered. Who is recommended to receive the vaccine? All people from 6 months through 24 years of age Children from 6 months through 18 years of age because cases of 2009 H1N1 influenza have been seen in children who are in close contact with each other in school and day care settings, which increases the likelihood of disease spread. The Vaccine will be administered to kids 6 months to 18 years old. Not younger than 6 months. Pregnant women cannot take LAIV.
Frequently Asked Questions What are recommendations for the nasal spray? Two 0.2 ml doses approximately 1 month apart for children 2 to 9 -Single 0.2 ml dose for persons 10-49 Type: LAIV;Intranasal spray Is the virus live or dead? The virus is dead for both seasonal and H1N1. The nasal spray is a live virus.
Frequently Asked Questions Q. Will insurance plans reimburse private providers for administration? America's Health Insurance Plans (AHIP) provided this response: "Every year health plans contribute to the seasonal flu vaccination campaign in several ways: Just as health plans have provided extensive coverage for the administration of seasonal flu vaccines in the past, public health planners can make the assumption that health plans will provide reimbursement for the administration of a novel (A) H1N1 vaccine to their members by private sector providers in both traditional settings and in non-traditional settings, where contracts with insurers have been established.
Frequently Asked Questions Q. Will private providers be able to charge patients for vaccine administration if they are uninsured? Yes, providers may charge patients if they are uninsured. The administration fee cannot exceed the regional Medicare vaccine administration fee. Q. Can persons be charged for vaccine administration in public health-organized large scale vaccination clinics? There will be no administration fee for vaccination in public-health organized large scale vaccination clinics.
Frequently Asked Questions Q. Is there resistance to Oseltamivir? As of September 30 th, CDC has tested 1,678 2009 H1N1 specimens for oseltamivir resistance, and resistance was present in 0.6% of the cases. 705 specimens have been tested for zanamivir resistance and none were resistant. Q. How many doses have been distributed? As of COB Monday (10/19), 82 M doses of seasonal flu vaccine have been distributed, and 10.2 M doses of H1N1 had been ordered by the U.S. states and territories.
Frequently Asked Questions Q: Will the H1N1 strain be included in the seasonal influenza vaccine for next year? The vaccine strains are chosen in September and February. In September, the Southern Hemisphere strain was chosen and is included in the seasonal flu vaccine strain for the Southern Hemisphere.