George A. Ralls M.D. Dave Freeman Health Services Department September 1st, 2009

1. INFLUENZA UPDATE George A. Ralls M.D. Dave Freeman Health Services Department September 1st, 2009

2. H1N1 INFLUENZA • Brief History • Current Situation • Disease Projections • Mitigation Efforts • CDC Guidelines

3. PRESENTATION OUTLINE H1N1 INFLUENZA • Brief History • Current Situation • Disease Projections • Mitigation Efforts • CDC Guidelines

4. H1N1 INFLUENZA • March & April of 2009 • New form (Novel) of Influenza found to cause disease in Mexico and Southern US • Spread rapidly across North America • By May 2009 “Swine Flu” identified in many areas of the world

5. H1N1 INFLUENZA • Symptoms of H1N1 are similar to those of seasonal flu: • Fever • Cough • Sore throat • Runny or stuffy nose • Body aches • Headache • Chills • Fatigue

7. H1N1 INFLUENZA • On June 11th, 2009 the WHO declared a worldwide pandemic (pandemic level 6) • Uncontained community level transmission in many areas of the world

8. H1N1 INFLUENZA Reassuring early trends • Symptoms no worse than seasonal flu • Most patients recovered with no treatment • Case mortality rate low • Deaths in predisposed patients

9. PRESENTATION OUTLINE • Brief History • Current Situation • Disease Projections • Mitigation Efforts • CDC Guidelines

10. 2185 Deaths Worldwide

12. H1N1 INFLUENZA • Estimated over 1 Million infected in US since outbreak • 8843 Hospital Admissions • 556 deaths

14. H1N1 INFLUENZA • 605 Hospital Admissions • 66 Deaths Florida

15. % of Florida ED Visits for ILI

16. Seasonal Flu –vs- H1N1 Positive Tests

18. H1N1 INFLUENZA Florida H1N1 Deaths (N=66)

19. H1N1 INFLUENZA H1N1 Related Deaths (US)

20. PRESENTATION OUTLINE • Brief History • Current Situation • Disease Projections • Mitigation Efforts • CDC Guidelines

22. H1N1 INFLUENZA Second Emergence 87.7% of US population is less than 65 years old

23. Deaths attributed to pneumonia and influenza are low and within bounds for what is expected in the summer

24. PRESENTATION OUTLINE • Brief History • Current Situation • Disease Projections • Mitigation Efforts • CDC Guidelines

25. MITIGATION

26. MITIGATION

27. MITIGATION

28. H1N1 Vaccine • Delivered in October or earlier? • Distributed from FDOH Central Pharmacy • Coordinated through CHDs • Requires 2 shots – 28 days apart • Priority groups for vaccinations

29. H1N1 Vaccine Priority Groups • Pregnant women • People who live with or care for children younger than 6 months of age • Healthcare and emergency medical services personnel • Persons between the ages of 6 months and 24 years old • People ages of 25 through 64 years of age who are at higher risk because of chronic health disorders or impaired immune systems

30. H1N1 INFLUENZA • Brief History • Current Situation • Disease Projections • Mitigation Efforts • CDC Guidelines

32. www.cdc.gov www.flu.gov

33. H1N1 INFLUENZA CDC Guidelines • Parents & caregivers • Pregnant women • Clinicians • Businesses & employers • Schools, colleges & universities • Persons with chronic conditions • Travelers & travel industry

34. H1N1 INFLUENZA • Sick persons should stay home • Expect sick employees to be out for about 3 to 5 days in most cases • Ensure that your sick leave policies are flexible • Do not require a doctor’s note for workers who are ill with ILI to validate their illness or to return to work Employer Guidelines

35. H1N1 INFLUENZA Employer Guidelines • Employees who are well but who have an ill family member at home with influenza can go to work • Should monitor their health status closely & stay home if they become ill

36. H1N1 INFLUENZA Employer Guidelines Influenza widgets and /or links on Intranet

37. H1N1 INFLUENZA Exclusion Period CDC recommends people with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F), or signs of a fever without the use of fever-reducing medications Persons NOT working in a Healthcare Setting

38. H1N1 INFLUENZA Work Force Protection • Review and revise COOP • Mass Vaccination for Priority Employees • Employee Workplace Policies • Hygiene • Social Distancing • Don’t come to work when sick • Personal Protection Equipment

39. What Can You Do Now? • Cough or sneeze into tissue and throw it in trash or use upper arm if no tissue available • Wash hands for 15-20 seconds or use alcohol-based hand gel often • Keep hands away from eyes and mouth unless hands were washed • Get a pneumonia shot if in high risk group: prevents secondary infections after the flu • Avoid others if you are sick or if they are sick • Develop an Individual/family plan

40. What is Florida Doing? • Monitoring CDC and WHO influenza response recommendations and activities • 25% of the SNS stockpile of antiviral drugs, personal protective equipment, and respiratory protection devices has been recieved • 25% additional coming soon • State and local public health agencies have been developing, exercising, and revising their mass vaccination plans since 2001

41. What is Orange County ESF8 Doing? • Orange County is reviewing and updating its response plan • Surveillance for influenza is ongoing • Currently working with local public health and hospital partners to identify gaps in preparedness and response • Incident Management Team is organized and overseeing planning process

42. SUMMARY • Rapidly developing situation • Develop good habits now • Cover your cough • Wash your hands • Avoid touching your face • Follow advice of public health officials • Talk to a healthcare provider about “Flu” shots • Stay informed • www.cdc.gov • www.flu.gov

43. H1N1 INFLUENZA Questions?