pandemic influenza update pandemic influenza update name, credentials and contact information of...

Pandemic Influenza UpdatePandemic Influenza Update

Name, Credentials and Contact Information of Presenter

www.kdheks.gov

Location and Date

Our Vision – Healthy Kansans Living in Safe and Sustainable EnvironmentsOur Vision – Healthy Kansans Living in Safe and Sustainable Environments

Acknowledgements for Content

Jason Eberhart-Phillips, MD, MPHKansas Department of Health and Environment

Centers for Disease Control and PreventionWorld Health OrganizationUS Health and Human Services

Our Vision – Healthy Kansas Living in Safe and Sustainable EnvironmentsOur Vision – Healthy Kansas Living in Safe and Sustainable Environments Aug 31, 2009

Pandemic Influenza

Background


What is a Pandemic?

“A pandemic is a global disease outbreak. An influenza pandemic occurs when a new influenza A virus emerges for which there is little or no immunity in the human population, begins to cause serious illness and then spreads easily person-to-person worldwide” (Flu.gov, 2009).

For additional information on pandemic influenza visit: www.pandemicflu.gov


Prerequisites for Pandemic Influenza

•A new influenza virus emerges to which the general population has

little/no immunity

•The new virus must be able to replicate in humans and cause disease

•The new virus must be The new virus must be efficiently efficiently transmitted from one human to anothertransmitted from one human to another

•The new virus must be The new virus must be efficiently efficiently transmitted from one human to anothertransmitted from one human to another


Circulating Influenza Strains and Pandemics in the 20th Century

• 1920 1940 1960 1980 2000H1N1

H2N2H3N2

1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu”20-40 million deaths 1-4 million deaths 1-4 million deaths


Pandemic influenza typically comes in waves. The great 1918-1919 pandemic came in 3 distinct ‘waves’The second wave was very different – much more lethalOver the summer the virus had changed

What We’ve Learned from History


The First Flu Pandemic of the 21st Century

On June 11, 2009WHO raised pandemic

alert level to Phase 6A global pandemic was

underwayCommunity-level

outbreaks in multiple parts of the world

Declaration was reflection of the spread of the virus – not of the severity of the disease it causes World Health Organization, Retrieved July 7, 2009, form

http://www.who.int/csr/disease/avian_influenza/phase/en/index.html


Influenza A (H1N1): What We Do Know

This is an entirely new virus Genetic bits come from flu viruses

that infect pigs, birds and humans It is easily transmitted among

humans, especially the young No one, except those who have been

infected, is immune Illness from the virus could become

widespread quickly No previous vaccine, including seasonal

flu vaccine, protects against infection


Seasonal Epidemics vs. PandemicsSeasonal Influenza

A public health problem each year

Usually some immunity built up from previous exposures to the same subtype

Infants and elderly most at risk

Influenza Pandemics

Appear in the human population rarely and unpredictably

Human population lacks any immunity

All age groups, including healthy young adults


How the Virus Spreads

The same way seasonal flu viruses spread Respiratory droplets Coughs and sneezes Touching objects touched by an

infectious person, then touching your nose or mouth

Droplets aren’t able to travel long distances through the air 3-6 feet maximum

Virus survives up to 72 hours on surfaces, depending on moisture


The Clinical Picture…So Far

Symptoms like other flu infections Abrupt fever, >100˚ F Cough, sore throat, runny nose Aches, chills, fatigue Unusual: diarrhea and vomiting

Almost everyone infected so far has recovered fully, but Hospitalization rate higher than

expected for seasonal flu The virus is affecting younger

populations than seasonal flu This picture could change, as the virus

changes its genetic make-up


What can we do to Reduce the Spread of Influenza?

Plan, Prepare, Prevent, Protect - Be Healthy


Community Measures

The Goal of Community Mitigation

•Pandemic Outbreak: No Community Measures Used

•Pandemic Outbreak: With Measures TakenN

um

ber

of

Dai

ly C

ases

Days Since First Case

Delay onset of outbreak

Reduce the peak burden on hospitals/infrastructure

Decrease a) number of cases of death and illness and b) overall health impact

1

2

3


Key Community Mitigation Messages

Wash your hands often with soap and water, especially after you cough or sneezeAlcohol-based cleaners okay

Cover your nose and mouth when you cough or sneezeNot with your bare hands!Use a tissue; throw it away‘Dracula cover’ is okay, or

“Sneeze in your sleeve”


What Social Distancing Means

Educating the public To recognize the disease Keeping distance from other people

who appear ill Stay home until no longer infectious,

except to obtain medical care

Educating employers and schools To recognize the disease Dismiss workers and students who

develop symptoms immediately Consider closing, if severe


Droplet Precautions: Surgical Masks

Source: Rosie Sokas, MD MOH UIL at Chicago


Current Status of H1N1 Response

No vaccine is currently available, but is being produced and will likely be available in October

Vaccine will be given first to priority groups

Antiviral treatment will be targeted

Everyone must practice good hygiene and use guidelines to prevent disease


Implications

During peak periods of peak influenza illness we will need to consider how to:Care for sick family membersCare for children if schools or daycare providers are

closedRemain home or leave work if illKeep schools and business open with potentially

significant absences.Failure to educate the public and be prepared could result

in increased incidence of viral spread


Steps We All Can Take

Seek guidance on pandemic influenza ~ ask questions! Your state health departments are

providing the most appropriate and current information

In your communities Local health departments Local emergency planning Local physicians and other

healthcare providers

Be vaccinated with seasonal influenza vaccine

Image source: Retrieved July 24, 2009 fromhttp://flushots2009.com/images/flu_vaccine_2009.jpg,


Use of Vaccine and Medication

Pharmaceuticals

Our Vision – Healthy Kansas Living in Safe and Sustainable EnvironmentsOur Vision – Healthy Kansas Living in Safe and Sustainable Environments

Vaccination for Influenza Will Prioritize Groups at Risk

Pregnant women

Health care workers and emergency medical responders

People caring for infants under 6 months of age

Children and young adults from 6 months to 24 years

People aged 25 to 64 years with underlying medical conditions (e.g. asthma, diabetes) July 29, 2009, the Advisory Committee on Immunization Practices

(ACIP), http://www.pandemicflu.gov/


Mobilizing for a Vaccine Campaign

For public health, a challenge of unprecedented scale this fall

Planning is already underway


Treatment

Antivirals aren’t usually necessary for mild illness (except perhaps for those who are at high risk for complications)Rest and fluids work bestVirus is currently sensitive to two antiviral drugs

Tamiflu (pills, liquid)Relenza (inhaled powder)

Should be started early for maximum effectivenessState/federal stockpiles have been sent to designated providers


Planning for Staying Healthy

Healthy People, Healthy Families, Healthy Workforce, Healthy Kansas


What Basic Steps Can You Take to Assure Health?

Eat healthy and get rest

http://healthy-values.info/images/apple.jpg


Wash Your Hands the Right Way

Wet your hands with clean running water and apply soap. Use warm water if it is available.

Rub hands together to make a lather and scrub all surfaces.

Continue rubbing hands for 15-20 seconds. Need a timer? Imagine singing "Happy Birthday" twice through to a friend.

Rinse hands well under running water.

Dry your hands using a paper towel or air dryer. If possible, use your paper towel to turn off the faucet.

Always use soap and water if your hands are visibly dirty.


If Soap and Clean Water Are Not Available: Use Alcohol-based Hand Sanitizer

Effective if hands not visibly soiledMore costly than soap & waterAlcohol-based hand rubs significantly reduce the number

of germs on skin and are fast-acting.When using an alcohol-based hand sanitizer:

MethodApply appropriate amount to palms

(about 1 coin-sized drop) Rub hands together, covering all surfaces until dry


Cough etiquette

Respiratory etiquette Cover nose / mouth when

coughing or sneezing

Practice infection prevention by educating and displaying posters on respiratory hygiene, cough etiquette, and proper hand washing


Steps We All Can Take

Know the symptoms of influenza and monitor your health

Stay home and away from school and workplace when sick


What About Home?

Keeping Yourself and Your Family Healthy


What Should Your Home Checklist Include?

Personal planning for stockpiles of food, bottled water, and medication. Store a two week supply of food and water, Periodically check your regular prescription drugs to ensure a continuous supply in your home. Have any nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins.


What Should Your Home Checklist Include?

Get vaccinated with seasonal flu and pneumococcal vaccine (if indicated)

Planning for extended care of family at home

Monitoring of own health and staying home when sick

Find healthy ways to deal with stress and anxiety

Use PPE and implement infection control guidance at home


Patients Cared for at Home

Contact a health care provider if pregnant, five years of age and under or have a health condition such as diabetes, heart disease, or asthma.

Get plenty of rest. Drink clear fluids (such as water, broth, sports drinks, electrolyte

beverages for infants) to keep from being dehydrated. A sick person should stay away from other people as much as

possible. Sick persons should use proper hand hygiene and respiratory etiquette. Wear a facemask – if available and tolerable – when sharing common

spaces with other household members to help prevent spreading the virus to others. This is especially important if other household members are at high risk for complications from influenza.

Stay home until free of fever for at least 24 hours without the use of fever reducing medications such as Tylenol®.


Emergency Warning Signs

Be watchful for emergency warning signs that might indicate

you or family members need to seek medical attention.

Get medical care right away if the sick person at home: has difficulty breathing or chest pain has purple or blue discoloration of the lips is vomiting and unable to keep liquids down has signs of dehydration such as dizziness when standing, absence of

urination, or in infants, a lack of tears when they cry has seizures (for example, uncontrolled convulsions) is less responsive than normal or becomes confused

Warning! Do not give aspirin (acetylsalicylic acid) to children or teenagers who have the flu; this can cause a rare but serious illness called Reye’s syndrome.


What about Schools?

Considering Students and Staff


Key Issues for Schools

Absenteeism is likely to be increased for students and staff.“Normal” flu produces a 4% to 5% peak rate.Experience in other countries suggests peak may be

10% to 15%. Infection control policies will be very important.

Aimed at reducing risk of school dismissals and unnecessary absenteeism

Schools as venues for mass immunization.Coordinate with local health departments


Stepped up Hygiene and Cleaning

Frequent hand washing, with adequate facilities and time made available.Alcohol-based hand sanitizers can be used; others if last

resort.

Respiratory etiquette, modeled by staffCoughing/sneezing into tissues followed by hand washingCough or sneeze into sleeve as alternative.

Routine cleaning around school.Viruses can be transmitted from flu droplets on surfacesRegular detergent cleansers are sufficient.


Primary Strategy

Separate ill students and staff from the well population.Ill students need to remain at home and avoid contact with

others except to seek necessary medical care.Exclude sick students and staff from school until 24 hours

after fever has resolved (without use of fever-reducing medications). Antiviral drug use does not effect this rule.

Rapidly isolate students and staff who become ill at school until they can be sent home.Set aside space to separate sick persons until they can be

sent home.Limit staff assigned to care for ill studentsConsider providing surgical masks to place on ill person.


Selective School Dismissal

These steps should prevent most schools from closing, butIf absenteeism in any particular school is too large, school

dismissal may be necessaryEarlier dismissal also may be necessary in schools that

serve pregnant or medically fragile students, if they cannot be protected.

Decisions should be made in collaboration with local and state health officials

Dismissal should last 5 – 7 days, then reassess.Consider continuing to allow well staff access to buildings.Other measures will be recommended if the pandemic

strain becomes more virulent.


New Mindset

Expect the unexpected

Parents, teachers and administrators all need to work hard to keep schools open, and be ready if schools must close suddenly

Give up the notion that absences are to be avoided at all costs


Immunizations in Schools

Immunizing in schools offers advantagesConvenient for parentsExcludes no oneEnables followup

Efforts will be made to minimize the disruption of normal school activities

With cooperation and guidance of school boards and administration

No child would be immunized without written consent from parent or guardian

All immunizations would be performed by persons qualified to give injections


What About the Child Care?

What can providers and parents do?


Steps Child Care Providers Can Take Now

Maintain regular communication with the local health department to obtain guidance about reporting flu-like illness in child care.

Visit the KDHE website at http://www.kdheks.gov for additional materials and updated resources. Child care providers are encouraged to check the website regularly for the most current guidance concerning H1N1 flu.

The Centers for Disease Control and Prevention (CDC) at http://www.cdc.gov/h1n1flu/



Develop a plan to address possible disruptions in learning and program operation. A useful planning tool is available at http://www.pandemicflu.gov/planpdf/child care.pdf

Higher absentee rates among children and staffDisruptions in supportive services and the delivery of

suppliesLoss of income or delay in paymentsReview policies for the exclusion of sick children and staff. Review children’s files and update contact information.



Make plans for the isolation and supervision of sick children, until their parents can pick them up.

Recognize the symptoms of H1N1 flu and exclude sick children and staff promptly.

Clean toys and commonly shared items, and touched surfaces like handrails and doorknobs at least daily and whenever visibly soiled.



Avoid over-crowded conditions. • Spread out during story and circle times• Allow more than the 2 ft. required by regulation between

cribs, cots and sleep mats. • Place cribs, cots, and sleep mats so that children rest

“head to toe” rather than “face to face”. Have adequate supplies on hand

• Hand soap and paper towels• Facial tissues and waste containers• Cleaning supplies



Incorporate learning activities that promote healthy practices and good hygiene.

Teach parents simple things they can do to keep their families health and to reduce the spread of disease. Check the KDHE website at http://www.kdheks.gov and the CDC website http://www.cdc.gov/h1h1flu/ for downloadable resource materials.


Parents Can help

Parents can help reduce the spread of flu like illness and other diseases in child care settings by:

Keeping sick children home. Sick children should not attend school, child care or other group setting. Children should be fever free, without the use of fever-reducing medications for at least 24 hours before returning to school, child care or other group setting.

Having a back up plan in place in case your child is sick or in case your school or child care closes due to illness

Practicing good health habits at home and encouraging your children to do the same.


What About the Workplace?

Employer and Employees


Principles of Mitigation Apply

Good hygiene practices

Social distancing at work

Avoid handshakes (and kissing!)

Stay home when sick


Considerations for Business, Industry, and Government

Protection of workforce

Continuation of service or business

Economic impact for organization and employees

Consideration of current policy related to sick leave

Alternate plans for conducting business / providing services


What About Faith based and Community Organizations?

Remembering the Most Vulnerable


Faith-Based and Service Organizations

Consider suspending faith-based practices or rituals that may involve contact with hands, i.e. communion, greeting, etc.

The impact of school closures and loss of income,

differentially impacts low income individuals and groups. In the United States, 48% of workers have no sick leaveMany low income families rely on free and reduced

breakfast and lunch programs to help feed their childrenChildren who are released from school may be left

unattended and/or be at risk for greater violence in their communities


Faith-Based and Service Organizations

Other vulnerable populations include:

Single individuals, especially the elderly, who may have no assistance if they fall ill or run out of supplies

People with disabilities who may rely on others for their basic care

Individuals who may not speak or understand EnglishShelters serving homeless persons


Plan, Prepare, Prevent, Protect - Be Healthy

WHAT CAN YOU DO TO REDUCE RISK OF INFLUENZA?


PLAN Take Time to Plan

Work, business and

government

Work, business and

government

Family and communityFamily and community

Vulnerable populationsVulnerable populations

Schools, universities

and child care

Schools, universities

and child care


PREPARECaring for Self, Family and Community

School closing arrangementsSchool closing arrangements

Alternative child care

arrangements

Alternative child care

arrangements

Non-perishable foods and waterNon-perishable foods and water

Medications and

health supplies

Medications and

health supplies


PREVENTHealthy Habits to Reduce Risk of Infection and Illness

Cover your coughCover your cough

Wash hands often and use

alcohol-based hand sanitizer

Wash hands often and use

alcohol-based hand sanitizer

Vaccinate against diseaseVaccinate against disease

Prevent and manage

chronic disease

Prevent and manage

chronic disease


PROTECTResponding to Influenza to Reduce Risk of Exposure

Know when to see doctor Know when to see doctor

Protect vulnerable peopleProtect vulnerable people

Know symptoms of fluKnow symptoms of flu

Breastfeed your babyBreastfeed your baby


YOUYOU CAN REDUCE THE SPREAD AND RISK OF INFLUENZA

Plan, Prepare, Prevent, Protect - Be Healthy!Be Healthy!


Learn More!

Centers for Disease Control and Prevention http://www.cdc.gov/h1n1flu/

Pandemic Flu Planning http://www.pandemicflu.gov/ Kansas Department of Health and Environment

http://www.kdheks.gov/ Things you can do

http://www.kdheks.gov/H1N1/H1N1_things_you_can_do.htm Individual Planning

http://www.pandemicflu.gov/plan/individual/index.html

www.kdheks.gov

Thanks for Listening!

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