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Influenza A H1N1: A Pandemic in Real Time – What’s Next?. Danny Chen, MD FRCPC MSc Infectious Disease Specialist Grand Rounds, York Central Hospital September 9, 2009. SEX. PB2. PB1. PB2. PA. PB1. HA. PA. NP. HA. NA. NP. MP. NA. NS. MP. NS. PB2. PB1. PA. HA. NP. NA. MP.

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Influenza a h1n1 a pandemic in real time what s next

Influenza A H1N1: A Pandemic in Real Time – What’s Next?

Danny Chen, MD FRCPC MSc

Infectious Disease Specialist

Grand Rounds, York Central Hospital

September 9, 2009



Genetic origins of the pandemic h1n1 2009 virus quadruple viral reassortment

PB2

PB1

PB2

PA

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HA

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NP

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NA

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MP

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NS

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PB2

PB1

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Genetic origins of the pandemic (H1N1) 2009 virus: Quadruple viral reassortment

N. American H1N1

(swine/avian/human)

Eurasian swine H1N1

Pandemic (H1N1) 2009, combining swine, avian and human viral components

Classical swine, N. American lineage

Avian, N. American lineage

Human seasonal H3N2

Eurasian swine lineage



Symptoms
Symptoms

  • Definition of Influenza-like Illness (ILI):

    • Acute onset fever and cough

      AND

    • one or more of:

      • Sore throat, arthralgia, myalgia, or prostration,

    • In children < 5 years of age, GI symptoms may also be present.

    • In patients < 5 years of age or >65 years fever may not be prominent.

Guidance for Management of Patients with Influenza-like Illness

(ILI) in Emergency Departments, MOHLTC June 4, 2009



Prevention
Prevention

ENHANCED

DROPLET

PRECAUTIONS

  • Hand hygiene always

  • Gown, gloves, eye protection, N95 mask

    = droplet + contact + N95


Treatment recommendations
Treatment Recommendations

  • Oseltamivir recommended within 48 hours of the onset of symptoms:

    • ILI requiring hospitalization OR

    • ILI and at risk for complicated disease

  • Other patients with ILI do not require treatment.


Laboratory confirmed cases of pandemic (H1N1) 2009 in Ontario by week between April 13 and August 29, 2009


Hospitalizations among confirmed cases of pandemic h1n1 2009 in ontario april 13 september 3 2009
Hospitalizations among confirmed cases of pandemic (H1N1) 2009 in Ontario, April 13 – September 3, 2009


Incidence of hospitalization and death due to ph1n1 in ontario april 13 to september 3 2009
Incidence of hospitalization and death due to pH1N1 in Ontario, April 13 to September 3, 2009


Seasonal influenza
Seasonal influenza Ontario, April 13 to September 3, 2009

  • Every year:

  • 5 million Canadians (1 in 6) will be infected

    • Up to 75,000 hospitalized

    • 2000-4000 people will die

      • 90% are >65 yrs

        • half of those in LTCHs

      • Bacterial pneumonia

      • Cardiac failure

  • Mortality rate:

    • 13/100,000 population

    • 0.2% of cases


So what next
So What Next Ontario, April 13 to September 3, 2009


“Potential for catastrophe…” Ontario, April 13 to September 3, 2009

vs

“…a pandemic dud.”


Laboratory confirmed cases of pandemic h1n1 2009 in australia to 28 august 2009 by jurisdiction
Laboratory confirmed cases of pandemic (H1N1) 2009 in Australia, to 28 August 2009 byjurisdiction



Rates of absenteeism of greater than 3 days absent, National employer, 1 January 2007 to19 August 2009, by week


Hospitalised confirmed cases of pandemic (H1N1) 2009, by length of hospital stay and agegroup, to 28 August 2009, Australia


Age specific rates of hospitalised confirmed cases of pandemic (H1N1) 2009 compared with average annual age specific rates of hospitalisations from seasonalinfluenza, Australia


Hospitalised confirmed cases of pandemic (H1N1) 2009 in pregnant women by weeks ofgestation, to 28 August 2009, Australia


Numbers of deaths among confirmed cases of pandemic (H1N1) 2009, by age group andsex, compared with total laboratory confirmed pandemic (H1N1) 2009 notifications by age group

Median age = 54 (cf seasonal flu: 83yo)


Percentage of all deaths classified as influenza and pneumonia, WA Registry of Births,Deaths and Marriages, 1 January 2008 to 23 August 2009


But no room for complacency
But no room for complacency pneumonia, WA Registry of Births,

  • Pandemics take some time to get going (1918 and 1968).

  • Some pandemic viruses have ‘turned nasty’ (1918 and 1968).

  • There will be severely ill people and deaths — in risk groups (young children, pregnant women and especially people with underlying illnesses).

  • Health services capacity?

  • Resistance to antivirals?

  • Attack rate?

  • An inappropriate and excessive response to the pandemic could be worse than the pandemic itself…


“…the H1N1 influenza and influenza generally is unpredictable...”

Dr. Anne Schuchat, CDC


Pandemic model york region impact
Pandemic Model unpredictable...”York Region Impact

  • 35% of the population, including YCH staff, will be infected during the first wave of pandemic influenza

  • Need to MAXIMIZE CAPACITY to manage increased patient volumes in the face of depleted resources


Summary
Summary unpredictable...”

  • H1N1 now the dominant virus strain

  • Large populations susceptible to infection

    • Vaccine?

  • Not the same as seasonal influenza

    • Age distribution

  • Influenza is unpredictable

  • Be prepared

    • Capacity, resources


Summary1
Summary unpredictable...”

  • What next…

    • Replay the Australian experience?



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