H1N1 Update

1. H1N1 Update Alameda County Public Health August 28, 2009 Note: Recommendations and data on H1N1 are changing daily. Information here is effective for August 28, 2009.

2. Novel Influenza A H1N1 Timeline • March 2009: New flu virus first reported in Mexico. • April 14: First case of Novel H1N1 (swine) flu reported in Southern Calif. • April 25: World Health Organization declares global public health emergency • April 26: U.S. declares a public health emergency

3. Timeline • April 28: California declares state of emergency • April 30: Alameda County reports 1st case of H1N1 flu • May 8: Alameda County declares state of emergency • June 11: World Health Organization declares H1N1 a pandemic based on the number of global cases • Today: H1N1 has spread internationally with more than 209,000 cases and 2,100 deaths as of 8/23. Alameda County has reported 11 H1N1 deaths and roughly 100 hospitalizations.

4. H1N1 flu status During the week of Aug. 22, a total of 8,843 hospitalizations and 556 deaths in the U.S. associated with H1N1 were reported to the CDC - an increase from 7,983 hospitalizations and 522 deaths the prior week.

5. What is Public Health doing? • Disease control • Case investigation • Sharing guidance for schools, child care facilities, businesses, employers, vulnerable populations (e.g. homeless, persons with disabilities) • County-wide emergency medical planning & coordination of hospitals, clinics, 911 responders, emergency planners • Resource coordination • Communication

6. H1N1 overview

7. Unlike any other flu season • Flu season 2009 is the first time health officials have had to handle two flu viruses – seasonal and H1N1 - and two separate vaccines during one flu season. • We now know more about H1N1 but still cannot predict how the virus will behave during the fall and winter months. • Because H1N1 has spread throughout our communities, the focus no longer is on containment but mitigation. • Mass H1N1 testing is no longer being done. Based on CDC guidance, medical providers determine who needs to be tested. • Public health’s focus is on H1N1 clusters, hospitalizations and deaths.

8. H1N1 basics • H1N1 is a new virus that quickly has spread globally. • The virus is transmitted human-to-human and is contagious. • Because H1N1 is new no one has immunity. • Persons who get sick can have mild to severe symptoms. • Persons who have pre-existing chronic conditions are more vulnerable.

9. How serious is H1N1? Centers for Disease Control (CDC) continues to study the illness as the prevalence of H1N1 cases increases, even during summer months. • Most H1N1 cases are mild and people are able to manage their symptoms at home. • Certain groups appear to be more vulnerable: pregnant women, persons with chronic conditions (obesity, respiratory problems), and children.

10. Fever Cough Sore throat Runny or stuffy nose Body aches Headache Chills Fatigue Diarrhea Vomiting H1N1 symptoms Symptoms are similar to those of seasonal flu and include:

11. How is H1N1 spread? The same way as seasonal flu: • Person-to-person through droplets that are air-born when one coughs or sneezes • Sometimes people may become infected by touching something with flu viruses on it and then touching their face.

12. How is H1N1 different from seasonal flu? • Greater disease burden among persons younger than 25 years of age. • Fewer deaths reported among people over 64 years. • More H1N1 complications among persons who are pregnant or have pre-existing chronic conditions

13. How long can an infected person spread the virus? CDC believes that H1N1 is similar to the seasonal influenza in that: • People may be contagious from 1 day before they develop symptoms to 5-7 days after they get sick. • Children and persons with weak immune systems may be contagious longer.

14. Who’s most at risk? Persons who are: • Pregnant • Have chronic conditions (asthma, diabetes, heart, liver problems) • Immune compromised conditions (HIV/AIDS) • Morbidly obese • 6 months – 4 years of age

15. Prevent spreading disease Stay home if you’re sick at least 24 hours after your fever is over. Cover your cough and sneeze Wash hands frequently Use a disinfectant to clean Prevent getting sick Wash your hands with soap & water Stay home from school or work if you’re sick. Stay away from sick people Avoid touching your eyes, nose or mouth

16. Warning signs for children • Fast breathing or trouble breathing • Bluish or gray skin color • Not drinking enough fluids • Severe or persistent vomiting • Not interacting • Lethargic • Unusual irritability • Flu-like symptoms that may return with fever and worse cough

17. Warning signs for adults • Difficulty breathing or shortness of breath • Pain or pressure in the chest or abdomen • Sudden dizziness • Confusion • Severe or persistent vomiting • Flu-like symptoms improve but then return with fever and worse cough

18. Are there medications? • Yes. CDC recommends the use of certain antiviral medications to treat H1N1 flu: Tamiflu or Relenza • Antiviral drugs can make your illness milder and make you feel better faster. • However, ACPHD does not recommend taking these medications unless a person has been diagnosed with H1N1.

19. Wear a mask or not? • Public Health is not currently recommending that individuals wear masks in community and home settings. • Persons may wear masks when sharing common spaces with someone who has the flu. • Some healthcare providers may ask patients to wear a mask when sitting in their offices, especially during flu season. • Healthcare workers (doctors, dentists, hygienists) will continue to wear masks when in close contact with patients

20. If you get sick… and do not appear to be recovering: • Contact your physician or seek medical care • Your provider will determine whether you need flu testing or treatment • If you do not have a medical provider, contact the Alameda County Public Health Clearinghouse for a referral.

21. H1N1 Vaccine Scientists are working on a H1N1 vaccine that is expected to be available in mid-October. Clinical trials began in early August and will run 2-4 more weeks. These trials will help determine the vaccine’s dosage and side effects. The national vaccine program will be voluntary.

22. H1N1 Vaccine • H1N1 vaccine will be administered in two doses given 21-28 days apart. • Vaccine is expected to be available through multiple sources, including private physicians, hospitals, clinics and public health. • Target groups for the vaccine are K-12 students and staff; pregnant women; healthcare providers; and persons with chronic health conditions, which could add up to 120 million U.S. citizens.

23. Be prepared!

24. New H1N1 Guidance for schools CDC has written new guidance for schools to help prevent the spread of flu among students and staff. Schools should: • Tell parents to keep children home if they are sick • Separate sick students/staff from others until they are able to leave the school. • Practice good hand hygiene and respiratory etiquette (cover your cough, sneeze) • Encourage ill staff/students at higher risk of flu complications to seek early treatment.

25. What you can do now • Again, remind parents early and often that sick children will be sent home. • Encourage parents to have a flexible flu response plan (e.g. alternative child care) in case their children get sick. • Tell parents to check with their healthcare provider if they have questions about seasonal or H1N1 flu. • If parents don’t have healthcare providers, refer them to Alameda County Public Health’s Clearinghouse (toll free: 888 604-4636) for a referral.

26. Etiquette counts! Regularly remind students of good personal hygiene: • Cover a cough and sneeze. If tissue is not available, cough or sneeze into the sleeve. • Wash hands frequently with soap & water or if appropriate use hand-sanitizers. • Wash hands after coughing or sneezing into hands, before eating, after using the restroom. • Don’t share personal items like eating utensils, cups, lipstick.

27. Routine cleaning • Schools should clean all areas and items that are more likely to have frequent hand contact, including keyboards and desks. • Use EPA-approved disinfectants for routine cleaning. • Additional disinfection of other areas is not recommended.

28. Home care Sick persons who are staying at home recovering from flu symptoms should make sure they have appropriate supplies so they do not need to circulate in the public. Your home care kit should include: Food • Liquids (bottle water, juices) • Ready-to-eat canned fruits, vegetables, beans, soups, meats • Baby food • Pet food

29. Stock up on these… Medical supplies • Soap or alcohol-based hand cleaners • Thermometer • Vitamins • Medicines for fever • Prescriptions • Anti-diarrheal meds

30. Student dismissals Alameda County Public Health Department and other local health jurisdictions have the authority to close schools if the local Health Officer feels that it is in the best interest of the school population. Student dismissal will be considered after evaluating the number of sick persons at a school, and after proper notification to the impacted school and district administrators.

31. Stay informed …and • California Schools Boards Association • Alameda County Public Health • California Department of Public Health • Centers for Disease Control (CDC) • World Health Organization • U.S. Dept. of Health and Human Services

32. Call us if you have questions! Alameda County Public Health Department www.acphd.org 510 267-8000