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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. 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?

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  1. 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

  2. SEX

  3. PB2 PB1 PB2 PA PB1 HA PA NP HA NA NP MP NA NS MP NS PB2 PB1 PA HA NP NA MP NS 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

  4. WHO phases of pandemic alert

  5. 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

  6. Transmission

  7. Prevention ENHANCED DROPLET PRECAUTIONS • Hand hygiene always • Gown, gloves, eye protection, N95 mask = droplet + contact + N95

  8. 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.

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

  10. Hospitalizations among confirmed cases of pandemic (H1N1) 2009 in Ontario, April 13 – September 3, 2009

  11. Incidence of hospitalization and death due to pH1N1 in Ontario, April 13 to September 3, 2009

  12. Seasonal influenza • 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

  13. So What Next

  14. “Potential for catastrophe…” vs “…a pandemic dud.”

  15. Laboratory confirmed cases of pandemic (H1N1) 2009 in Australia, to 28 August 2009 byjurisdiction

  16. Rate of ILI reported from GP ILI surveillance systems from 2007 to 23 August 2009 by week

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

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

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

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

  21. 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)

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

  23. But no room for complacency • 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…

  24. “…the H1N1 influenza and influenza generally is unpredictable...” Dr. Anne Schuchat, CDC

  25. Pandemic Model 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

  26. Summary • 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

  27. Summary • What next… • Replay the Australian experience?

  28. http://www.sesamestreet.org/video_player?p_p_lifecycle=0&p_p_id=videoPlayer_WAR_sesameportlets4369&p_p_uid=140598a2-90b4-461f-82d4-53011bdf3849http://www.sesamestreet.org/video_player?p_p_lifecycle=0&p_p_id=videoPlayer_WAR_sesameportlets4369&p_p_uid=140598a2-90b4-461f-82d4-53011bdf3849

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