Transcript Slide 1

H1N1
Preparing for the Flu Season
Elisabeth Whitney
Program Coordinator
San Francisco CARD
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1. We’re not sure how severe this flu season
will be
• Mild – 1957 Type of Pandemic
• Severe – 1918 Spanish Flu
2. There are no guaranteed medical means to
avoid the virus
• Vaccines will be available this fall / winter
• For both seasonal flu and H1N1
• Antivirals are options for treatment
3. What is H1N1 or Swine Flu?
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Influenza – A Little FYI
•Influenza is a highly contagious respiratory disease spread
by tiny, wet droplets produced when a person
•Coughs, sneezes or talks
•Touching your face
•Poor Cough Hygiene
•When are we contagious?
Swine Flu or
H1N1
•Every year 10 – 20% of the world’s population gets
influenza causing associated deaths of from 500,000 – 1
million deaths
•In Epidemic years 25% of the population get it
•In the U.S, annual seasonal flu results in approx. 36,000
deaths and 114,000 hospitalizations
•Some 90% of people who die during a regular flu season
are over 65 years old. By contrast, Swine flu (H1N1)
disproportionally affects younger people
Influenza – A Little FYI
• Who is more likely to get very sick with the
flu?
– People with lung disease like asthma
– People with other medical conditions like diabetes, heart disease,
kidney or liver disease, blood cell disease including sickle cell, or
neurological disease that affects swallowing or breathing
– Pregnant women and women who have given birth within 2
weeks
– Children age 2 years and under
– Adults age 65 years and over
– People with weak immune systems (due to disease or medicines)
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Underlying Conditions
Pandemic Hospitalizations Reported to CDC Underlying Conditions as of June 19, 52009
Influenza – A Little FYI
• Is it a cold or the flu?
Symptom
Flu
Cold
Fever
Usually 102 degrees F, but can go up
to 104 degrees F and usually lasts 3
to 4 days.
Rare in adults and older children, but
can be as high as 102 degrees F in
infants and small children.
Sudden onset and can be severe
Rare
Usually, and often severe
None or mild
Can last 2 or more weeks
Mild
Sudden onset and can be severe
Never
Sometimes
Often
Sometimes
Often
Sometimes
Often
Usually, and can become severe
Mild to moderate
Headache
Muscle Aches
Tiredness and Weakness
Extreme Exhaustion
Runny Nose
Sneezing
Sore Throat
Cough
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Clinical Characteristics
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Epidemiological/Surveillance Pandemic H1N1 Hospitalizations Reported to CDC as of June 19, 2009
Course of Influenza in Adults
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1
2
3
4
5
6
7
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Day 0
Become infected
Day 1 – 4
Disease Incubation (average 2 days)
Day 1 – 6
Contagious (one day before symptoms
to 5 days after symptom onset)
Day 2 – 9
Symptomatic (usually 2 – 5 days)
Day 4 to ? Decreased energy (one week or more)
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Percent of Visits for Influenza-like
Illness
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Influenza – Statistics
Data by Epidemiologic Week 43:
United States
New cases
Total cases
Deaths
6834
57,602
1123
California cases
~5000
Source: http://new.paho.org/hg/images/atlas/en/atlas.html
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Current Conditions
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Novel H1N1 Confirmed & Probable Case Rate in
the U.S.
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Novel H1N1 U.S. Hospitalization Rate per
100,000 Population by Age
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CDC Summary
•Uncertain how serious or severe H1N1 will be in terms of:
•How many infected people will develop serious complications or die
•How the virus may affect the U.S. during the flu season in fall and winter
•Because this is a new virus (for the given population), there
will be little or no immunity, resulting in more severe and
widespread illness
•Vaccines will be available, but may be in limited supply
•With this new virus, CDC speculates:
•More cases
•More hospitalizations
•More deaths
for this season . . .
Most Recent
Guidance
•H1N1 Vaccine will not protect against seasonal flu
•The FDA has approved the use of one dose of H1N1 (swine) flu vaccine for
persons age 10 years and older
•Children 6 months old to 10 years need two doses separated by 3-4 weeks, and
it is best to use the same type of vaccine for the first and second dose.
•You may get seasonal and H1N1 vaccinations at the same time.
•If your child got a dose of the recalled vaccine (ages: 6 months to 35 months),
you do not need to revaccinate them.
•It was recalled for potency not safety reasons!
•H1N1 vaccines are being made available to all persons over 3 at the DPH
Travel Clinic (101 Grove Street) by appointment. Call (415) 554-2625 and
17 press
5 to make an appointment.
H1N1 Vaccination
Priorities:
•Pregnant women
•Caregivers for children younger than 6 months
•Healthcare and EMS personnel
•People ages 6 months – 24 years
•People with underlying medical conditions
associated with higher-risk of complications
associated with flu (ages 25 – 64 years)
Latest on Vaccines
Global doses to be manufactured and distributed ~ 3 billion.
2009 H1N1 Influenza Vaccine Supply Status
November 6, 2009, 1:30 PM ET
Doses Allocated as of 11/05/09 35,618,800
Doses allocated to project areas for ordering are those that are at the
distribution depots and ready for project areas to order.
Vaccine is allocated to each project area in proportion to its population (pro
rata).
Doses Ordered as of 11/04/09 28,036,300
Doses Shipped as of 11/04/09 26,248,100
There is a lag time between allocation, ordering, and shipment of doses as
project areas place orders and those orders are processed and shipped.
Vaccine Shipment Status by Project Area
Project Areas Total Doses Shipped as of 11/04/09
California 2,953,000
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Source: http://www.cdc.gov/h1n1flu/vaccination/vaccinesupply.htm
Vaccines
• Types of influenza vaccines available this
flu season
• LAIV
• Inactivated shot
• H1N1 LAIV and seasonal LAIV should not
be given together
• 2009 H1N1 LAIV may be given at the
same time as most other vaccines
• people who are allergic to eggs should not
get the vaccine
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Flu Antiviral Drugs
• There are two commonly used antivirals in
the US
1. Tamiflu ® (oseltamivir)
Do not confuse with Theraflu ® an over
the counter cold medication. It is not an
antiviral medication!
2. Relenza ® (zanamivir)
• Can children take antiviral drugs?
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10 Lessons from the Frontlines
1. Investments in pandemic planning and stockpiling
antiviral medications paid off
2. Public health departments did not have enough
resources to carry out plans
3. Response plans must be adaptable and science-driven
4. Providing clear, straightforward information to the public
was essential for allaying fears and building trust
5. School closings have major ramifications for students,
parents and employers
Trust for America’s Health, June 5 2009
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10 Lessons from the Frontlines
6. Sick leave and policies for limiting mass gatherings
were problematic
7. Even with a mild outbreak, the health care delivery
system was overwhelmed
8. Communication between the public health system and
health providers was not well coordinated
9. WHO pandemic alert phases caused confusion
10. International coordination was more complicated than
expected
Trust for America’s Health, June 5 2009
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So, What Might be Next?
•H1N1 Could disappear (unlikely)
•H1N1 didn’t cause worst case scenarios in
So. Hemisphere
•H1N1 Could:
•Be our next pandemic (it already is)
•Continue to be mild-to-moderate (1957 or ’68like)
•Increase virility to 1918 pandemic levels
What Does That Mean to You?
• For a bad flu season (1957 or ‘68-like)
– Many sick employees, volunteers and clients
• From 25 – 40%
– Higher levels of absenteeism
• Comes in waves
– Possibility of some deaths in the ‘family’
– Adverse impact on your organizations’
operations
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Action Agenda
• Prepare your organization
– COOP works, once sick it is too late
• Identify your mission critical functions
– Those operations that must continue – without
them your organization will not function
• It can be integral to a device or system that makes
that function possible
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Questions to ask:
• How is demand for your product or service likely to be
affected during and between each pandemic wave?
• What are your requirements and commitments with
suppliers and customers? How might these be affected
when the pandemic is at its peak?
• What circumstances could precipitate a shutdown of
your workplace?
• What trigger will you use to re-open the workplace?
• Are alternative work arrangements available for
employees who are not ill but still able to come in?
• How will you communicate with your employees at
different points in the pandemic wave? What message
will you broadcast?
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Source: http://www.ems-solutionsinc.com/pdfs/Lessons-from-H1N1-FirstWave.pdf
Considerations for Human Resources
• Review and update sick leave policies
– Flu absences may be a long-term issue
– Staff may be absent due to:
• Family members that are sick
• Schools and childcare facilities closed
• Most important consideration
– Please stress “don’t come to work sick!”
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Guidelines for Managers: Communicating
with Staff about Influenza A (H1N1)
1.
Consider including medical staff, counselors, and peer helpers in
group meetings on the topic, to respond to questions about health
risks and protection.
2.
It is important for staff and families to be given facts about the
situation and have their immediate concerns addressed in order to
dispel rumors.
3.
Note that action is an antidote for feelings of helplessness.
4.
Regular briefings in all offices are essential to contain staff anxiety
as well as rumor circulation. Efforts should be made to keep the
discussion supportive and do not attempt to deny or minimize the
potential impact on staff.
5.
Also, pay attention to what is unspoken and to staff who may be
withdrawn.
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Is Working Off-Site
Realistic?
• Needs a robust workfrom-home program
• High Speed Internet
• Organization provides
equipment
• Work from home at
least once a month
– Confirms that person can
work from home
• Alternate plans if
working remotely fails
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• Volunteer Management
– How do we make it safe for our volunteers to
continue helping?
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Summary of
Education
• Influenza basics
• Workplace strategies &
cleaning
• Hand washing techniques
• Cover your cough
campaign
• Polite social distancing
• Stay home if sick policy
• Virtual meeting strategies
• Strategies to minimize
face to face contact with
clients
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Education Con’t.
Hand Maintenance
•Hand-washing is most
effective
•Hand Sanitizers
•Nearly as effective as
hand-washing but not
quite. However, it is a
good alternative
•Must be at least 60%
alcohol
Organization Education Campaign
•Potty Posters
•Desk and wall
postings
•Staff briefings
Social
Distancing
•Develop guidelines for
social distancing
•Floor plans for spreading
staff out at least six feet
from each other
•Investigate shift work and
weekend work
•Avoid shared equipment
•Clean often if you must
share
Impact of Social
Distancing
1. Delay outbreak peak
2. Decompress peak burden on hospitals and infrastructure
3. Diminish overall cases and health impacts
Cleaning
•Use disinfectants that
match the surface
needs
•Virus Survival
•Virus lives on hard nonporous surfaces > 24
hours
•On porous surfaces 24
– 48 hours
•Swiss banknotes up to
17 days!
Cleaning
•High touch Areas and
Surfaces require increased
frequent and more intense
cleaning
•Doorbells
•Intercoms
•Handrails
•Door handles
•Elevator buttons
•Steering wheels
•Common controls (levers,
buttons)
Cleaning – Infection Control at Work
•Top four germy
office work
areas
•Telephone
•Keyboard/mou
se
•Desk surface
•Doorknob
PPE – Personal
Protective Equipment
•Should you wear
PPE?
•When & Why
•Masks
•N95
•Surgical masks
•Gloves
•Latex
•Nitrile
PPE Recommendations
•Surgical masks for
most organizations
•N95 masks for most
health care providers
It’s Time to Prepare!
•Evaluate your preparedness
•HR Dept should create or evaluate plans
•Adapt to different issues and situations
•Communicate effectively (to staff, volunteers and
clients)
•Keep Informed
•No one knows what will happen
•Different recommendations will surface and
conflicting information may go viral
•Follow your local Dept. of Public Health
Guidance
Keep Current
• 211 – good source of information and it is in multiple languages
http://www.211.org/
• For the most current local information:
http://www.sfcdcp.org/flu
• For email answers to your specific questions:
http://[email protected]
• For questions:
415-554-2905
• California Department of Public Health (CDPH) H1N1 Flu Hotline:
1-888-865-0564
• The Centers for Disease Control (CDC) website:
http://www.cdc.gov/swineflu/
• World Health Organization (WHO) website:
http://www.WHO.int/csr/disease/swineflu/en/
Questions?
However, I stress again, that any specific
medical or legal questions are best
answered by the appropriate specialist.
Thank you!
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