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Overview and Update on H1N1 Influenza Statewide Symposium Albuquerque, NM October 2, 2009. C. Mack Sewell, DrPH, MS State Epidemiologist New Mexico Department of Health. H1N1 History and Update.

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overview and update on h1n1 influenza statewide symposium albuquerque nm october 2 2009
Overview and Update on H1N1 InfluenzaStatewide SymposiumAlbuquerque, NMOctober 2, 2009

C. Mack Sewell, DrPH, MS

State Epidemiologist

New Mexico Department of Health

h1n1 history and update

H1N1 History and Update

April 17, 2009 Report of two cases of swine influenza A (H1N1) from CA.

April 23, 2009 Report of additional cases of influenza A (H1N1)-TX and CA.

The TX and CA cases were genetic matches and constituted a novel influenza virus with genetic material from swine, avian, and human influenza strains

April 26, 2009 Release of 25% of the Strategic National Stockpile

April 29 2009 New Mexico’s first probable case confirmed on May 2, 2009

Within one month there was spread of H1N1 worldwide

June 11, 2009 WHO declares a pandemic

slide4
Map: International Co-circulation of Novel and Seasonal Influenza(As of Sept 20, posted September 25, 2009, 11:00 AM ET)
current numbers of cases of h1n1 influenza world u s and new mexico as of 9 25 09
Current Numbers of Cases of H1N1 Influenza: World, U.S., and New Mexico-As of 9/25/09
  • Worldwide

>318,925 cases (Countries have stopped counting cases)

3917 deaths

74 countries

  • U.S. (States have stopped counting cases)

43,771+ cases

936 deaths

10,082 hospitalized

47 pediatric deaths since April 2009

50 states

  • New Mexico (NM stopped counting cases)

156 cases

7 deaths (includes 2 children <18 years of age)

85 hospitalized

percentage of visits for influenza like illness ili 2008 2009 and previous two seasons
Percentage of Visits for Influenza-Like Illness (ILI) 2008-2009 and Previous Two Seasons

H1N1

epidemiology of h1n1 influenza
Epidemiology of H1N1 Influenza
  • Signs and symptoms may include fever (variable), cough, muscle aches, or diarrhea
  • Short incubation period: time from exposure to illness—about 1-2 days
  • H1N1 resistant to the antiviral drugs amantidine and rimantidine, but susceptible to Tamiflu and Relenza (the two drugs in our federal and state stockpile). Resistance to antiviral agents has been reported rarely.
  • Transmitted through the respiratory route-small particle aerosols and direct contact
  • Younger people more affected than older (over 70% younger than 25 years of age, CDC)
  • Relatively mild disease except for those at high risk
surveillance for h1n1 infections
Surveillance for H1N1 Infections
  • Sentinel surveillance

-Outpatient providers and labs

  • Hospitalization surveillance
  • Institutional outbreaks
  • Death surveillance

-Vital Records: pneumonia and influenza deaths

-Office of the Medical Investigator

It is not necessary to identify all cases of influenza----in fact, it is impossible to do so. Therefore, our disease surveillance is focused on severe cases (persons hospitalized or deaths).

slide16

Chinese Airline Checking Temperature of Passengers

Photo Credit: Bob Rej, Director, Clinical Chem and Hematology

NYS Dept. Health (China: all passengers temp. screened before let off plane)

novel h1n1 vaccine recommendations
Novel H1N1 Vaccine Recommendations
  • Pregnant women
  • Household contacts of children < 6 months of age
  • Healthcare and emergency medical services personnel
  • All people 6 months-24 years of age
  • Persons aged 25-64 years with chronic medical conditions
if vaccine is limited
If vaccine is limited
  • Pregnant women
  • Household contacts of children < 6 months of age
  • Children 6 months-4 years of age
  • Children 5-18 years of age who have chronic medical conditions
new mexico department of health vaccination program for h1n1
New Mexico Department of Health Vaccination Program for H1N1
  • Identifying direct “ship-to” sites
  • Working with hospitals, clinics, schools, pharmacies, and public health sites
  • Vaccine expected Oct-initially Live Attenuated Influenza Vaccine (LAIV)
  • One dose except for young children
  • Great need for a public/private partnership
  • Need for vaccinators-nurses, EMTs, pharmacists, any licensed provider
  • Volunteers can sign up at www.NMServes.org
antiviral stockpile
Antiviral Stockpile
  • Once the federal government released antiviral agents from the Strategic National Stockpile (SNS), the NM Department of Health positioned these drugs in hospitals and primary care clinics across the state
  • Approximately one half of the state’s currently available stockpile was distributed to hospitals/clinics (about 70,000 courses out of 140,000 courses)
antiviral recommendations
Antiviral Recommendations
  • Treatment is recommended for:
    • Hospitalized patients with confirmed, probable, or suspect H1N1 influenza
    • Patients at higher risk for complications

Children < 2 years of age, adults 65 and older, chronic pulmonary, cardiovascular, renal, hepatic, and hematologic, neurologic, neuromuscular, or metabolic disorders, immunosuppression, pregnancy, person <19 years of age receiving long-term aspirin therapy, residents of nursing homes

infection control recommendations
Infection Control Recommendations
  • Hand hygiene
  • Cough etiquette
  • Vaccination for both seasonal and H1N1 influenza once vaccine becomes available
  • Triage considerations/signage/surgical masks for coughing patients
  • Examinations in separate rooms if available
  • Consider private rooms or cohorting of patients depending on situation
  • Persons with influenza-like illness should stay home until 24 hours after fever resolved
  • N-95 mask should be used by health care workers (including EMS) when performing aerosol-generating procedures on patients with suspected or confirmed H1N1
  • Surgical masks should be used by health care workers when providing direct patient care to persons with suspect or confirmed H1N1
laboratory testing
Laboratory Testing
  • The Centers for Disease Control and Prevention have made test materials available to our state laboratory—The Scientific Laboratory Division
  • Since testing capacity is limited, the state lab will only be testing for H1N1 in hospitalized patients, sentinel sites and epidemiologic investigations
  • The private clinical laboratories will have these test materials available to them soon.
communications
Communications
  • New Mexico Department of Health issues regular press briefings
  • Health Alert Network (HAN) messages
  • Contact Paulette Johnston at paulette.johnston@state.nm.us or call 505 476-8225 to sign up for HAN messages
planning efforts
Planning Efforts
  • Plans are being developed for increased influenza activity
  • The federal government is proceeding with a new vaccine against H1N1 influenza-----and NM DOH will plan accordingly
  • A new vaccine would be in addition to the regular seasonal influenza vaccine
  • Additional planning around supplying antiviral agents to medical facilities and the use of personal protection equipment (masks) will also be conducted
possible issues
Possible Issues
  • Policy development
  • Vaccine development and distribution
  • Surveillance
  • Lab testing
  • Antiviral distribution
  • Communication (HAN, Media, internal/external)
  • DOC operations (planning, operations, logistics, finance)
  • PPE (e.g. masks) availability and use
  • Infection control
  • Patient surge/demand for care
  • Inventory tracking
  • Declaration of emergency
  • Schools/daycare
  • Institutions/prisons/jails
examples of nm department of health collaboration with tribes and tribal health providers
Examples of NM Department of Health Collaboration with Tribes and Tribal Health Providers
  • Included IHS and 638s in antiviral distribution in the spring deployment
  • Including IHS and 638s in planning for vaccine distribution
  • Included an earmark for tribes in new H1N1 pandemic influenza funding (CDC)
  • Included IHS hospitals in funding from the Hospital Preparedness Program
  • Included IHS hospitals in the HaveBed System
  • Need to complete a gap analysis