Transcript Outbreak of 2009 Pandemic Influenza A (H1N1) Virus on a University Campus – Delaware, April-May 2009 A.

Outbreak of 2009 Pandemic
Influenza A (H1N1) Virus on a
University Campus – Delaware,
April-May 2009
A. Danielle Iuliano, PhD MPH
Division of HIV/AIDS Prevention
May 27, 2010
Outline
Background
• Description of the Outbreak
• Epi-Aid objectives
• Studies
• Conclusions
• Recommendations
•
Influenza
•
RNA virus
Common types A and B
– Affects 5-20% of the U.S. population
– 200,000 hospitalizations
– 36,000 deaths
–
•
•
Virus spread: person-to-person via
respiratory droplet
Prevention
Seasonal influenza vaccine
– Post-exposure prophylaxis
– Non-pharmaceutical interventions
–
Spectrum of Influenza Illness
•
Symptoms
–
–
–
–
–
–
–
•
•
•
Fever (≥ 100º F)
Feverish (chills/sweats)
Sore throat
Runny nose/nasal congestion
Cough
Shortness of breath
Abdominal Pain
–
–
–
–
–
–
Diarrhea
Nausea/vomiting
Headache
Muscle/joint aches
Ear pain/pressure
Fatigue
Several case definitions for surveillance
Duration of Illness
4 – 7 days
– Some symptoms may linger
–
2009 Pandemic Influenza A (H1N1)
Swine-origin influenza virus
• April 15, 2009
•
–
First identified human infection
H1N1 Diagnosis
•
Reverse transcriptase polymerase chain
reaction (RT-PCR)
– Used to subtype influenza viruses
– H1N1 initially unsubtypeable at state labs
– Early samples sent to CDC for
confirmation
•
Rapid influenza test
– Can determine influenza type (A or B)
H1N1 Treatment
Treatment
– Oseltamivir (Tamiflu®)
– Zanamivir (Relenza®)
• Most effective within 48 hours of onset
•
University of Delaware (UD)
•
•
Campus: Newark
University Population
– 18,872 students
5,871 faculty/staff
University health clinic
– Located on campus
– Open 24 hrs/day, 7
days/week
–
•
The Outbreak
University clinic
saw rapid increase
in student visits
4 samples sent to
state for subtyping
April 27
The Outbreak
4 probable H1N1
cases identified
Campus wide
H1N1 alert issued
University clinic
saw rapid increase
in student visits
4 samples sent to
state for subtyping
April 27
April 28
The Outbreak
4 probable H1N1
cases identified
Campus wide
H1N1 alert issued
University clinic
saw rapid increase
in student visits
Overflow clinic opened
University cancels
social/academic events
4 samples sent to
state for subtyping
April 27
Epi-AID Requested
April 28
April 29
The Outbreak
4 H1N1 cases
confirmed by CDC
4 probable H1N1
cases identified
Athletic events
canceled thru weekend
Campus wide
H1N1 alert issued
University clinic
saw rapid increase
in student visits
Overflow clinic opened
University cancels
social/academic events
4 samples sent to
state for subtyping
April 27
CDC arrives
Epi-AID Requested
April 28
April 29
April 30
Headlines
At the time of this investigation
•
H1N1 unknown characteristics
– Severity of illness
– Attack rate
– Age distribution of illness
– Effectiveness of seasonal influenza
vaccine
– Risk factors for transmission
– Use of community mitigation measures
Epi-Aid Investigation Objectives
•
Examine increase in clinic visits at the UD
health clinic
•
Describe the epidemiology of H1N1 in the
university community
•
Identify risk factors for transmission on
campus
Studies Conducted
•
Review of health clinic visit data
•
Clinical chart abstraction
•
Online H1N1 survey
•
Qualitative study: focus groups and
individual case interviews
Health Clinic Data
Review of Health Clinic Data
•
Objectives
–
Describe the number of respiratory illness
visits (ICD-9)
–
Compare visits: 2008 and 2009
Respiratory Illness
•
Defined by diagnostic code (ICD-9):
– Upper and/or lower respiratory infection
– Influenza
– Otitis media
– Respiratory failure
– Respiratory distress
– Asthma/chronic obstructive pulmonary disease
– Fever
– Pneumonia
– Pharyngitis
– Laryngitis
– Sore throat
– Nasal congestion or rhinorrhea
– Cough
Student Health Clinic Respiratory Visits,
March 22 – May 9, 2009
200
180
April 29
140
120
Spring Break
100
80
60
40
20
0
3/
22
3/
24
3/
26
3/
28
3/
30
4/
1
4/
3
4/
5
4/
7
4/
9
4/
11
4/
13
4/
15
4/
17
4/
19
4/
21
4/
23
4/
25
4/
27
4/
29
5/
1
5/
3
5/
5
5/
7
5/
9
Number of Visits
160
Date
UD Health Clinic Visits (2008 vs. 2009)
April 27 – May 3,
2008
April 26 – May 2,
2009
960
1,430
--
300
325
1,080
Rapid Influenza Tests
--
92
Oseltamivir distributed
--
> 500
Number of Visits
All Visits
Overflow Clinic
Visits for Respiratory Illness
•
Increase in respiratory illness visits:
– More than four times the number of
respiratory visits compared with 2008.
Online H1N1 Survey
Online H1N1 Survey
•
Objectives
–
Estimate attack rates
–
Examine health seeking behaviors
–
Measure risk factors for ILI
Survey Methods
•
•
•
•
Cross sectional survey
Conducted May 10 to May 18, 2009
Online survey: University emailed link to
entire university population
Included questions on:
–
–
–
–
–
Illness and symptoms since March 27, 2009
Health seeking behaviors
Risk factors for transmission
Community mitigation measures
Messages about H1N1
Analytic Methods
•
Demographic characteristics provided by UD
•
Respiratory illness definitions
Acute respiratory illness (ARI)
• Reported fever, cough, sore throat or
nasal congestion/rhinorrhea
• Between March 27 – May 9, 2009
– Influenza-like illness (ILI)
• Fever plus cough or sore throat
–
Survey Response
Respondents
Students
N=18,872
n (%)
Faculty/Staff
N=5,871
n (%)
6049 (32%)
1401 (24%)
2050 (34%)
3999 (66%)
518 (37%)
883 (63%)
Gender
Men
Women
Age
Median (IQR)
21 (18-23)
Survey Response
Respondents
Students
N=18,872
n (%)
Faculty/Staff
N=5,871
n (%)
6049 (32%)
1401 (24%)
2050 (34%)
3999 (66%)
518 (37%)
883 (63%)
Gender
Men
Women
Age
20-29
30-39
40-49
50-59
> 60
Median (IQR)
21 (18-23)
66 (5%)
232 (17%)
334 (24%)
488 (39%)
281 (20%)
Attack Rates for ILI
Acute respiratory illness (ARI)
Influenza-like illness (ILI)
Students
N=6049
Faculty/Staff
N=1401
1545 (26%)
194 (14%)
604 (10%)
73 ( 5%)
Attack Rates for ILI
Risk Factor
Total
ILI
N (%)
1609
3941
534
479
576
311
168 (10)
412 (11)
31 (6)
19 (4)
34 (6)
12 (4)
RR
95% CI
P-value
Age
18-19
20-29
30-39
40-49
50-59
> 60
RR=Relative Risk, 95% CI=95% Confidence Interval
referent
1.0 (0.8-1.2)
0.99
0.6 (0.4-0.8) 0.003
0.4 (0.2-0.6) <0.001
0.5 (0.4-0.8) 0.002
0.3 (0.2-0.6) 0.002
Attack Rates for ILI
Risk Factor
Total
ILI
N (%)
1609
3941
534
479
576
311
168 (10)
412 (11)
31 (6)
19 (4)
34 (6)
12 (4)
RR
95% CI
P-value
Age
18-19
20-29
30-39
40-49
50-59
> 60
RR=Relative Risk, 95% CI=95% Confidence Interval
referent
1.0 (0.8-1.2)
0.99
0.6 (0.4-0.8)
0.003
0.4 (0.2-0.6) <0.001
0.5 (0.4-0.8)
0.002
0.3 (0.2-0.6)
0.002
Attack Rates for ILI
Risk Factor
Total
ILI
N (%)
RR
95% CI
1931
5196
173 (9) 1.0 (0.8-1.2)
461 (9)
referent
P-value
Seasonal Influenza
Vaccine
Yes
No
RR=Relative Risk, 95% CI=95% Confidence Interval
0.91
ILI Characteristics and Healthcare
(N=677)
n (%)
Median duration of illness (IQR)
Missed Work/Class
6 (4-9)
403 (60)
Median days missed (IQR)
2 (1-3)
Visited a healthcare provider
395 (58)
Stayed overnight in hospital
4 (<1)
Onset of Reported ILI, Students
Campus wide
(n=604)
Cases
alert issued
50
45
Overflow Clinic
Opens
Peak in reported
illness
40
35
30
25
20
15
10
5
Date
2
4
6
8
5/
5/
5/
5/
30
4/
28
4/
26
4/
24
4/
22
4/
20
4/
18
4/
16
4/
14
4/
12
8
4/
4/
6
4/
10
4
4/
4/
2
4/
31
3/
29
3/
3/
27
0
Student Risk Factors for ILI
Total
ILI
N (%)
RR
95% CI
Pvalue
2410
3639
261 (11)
343 (9)
1.2 (1.0-1.4)
referent
0.08
Yes
No
95
5954
22 (23)
582 (10)
2.4 (1.6-3.4)
referent
<0.001
‘Greek’ Society Member
Yes
No
770
5258
129 (17)
475 (9)
2.0 (1.6-2.5)
referent
<0.001
‘Greek Week’ Participation
Yes
No
589
5402
107 (18)
491 (9)
2.2 (1.8-2.8)
referent
<0.001
Risk Factor
Housing
On Campus
Off Campus
Travel to Mexico
RR=Relative Risk, 95% CI=95% Confidence Interval
Student Risk Factors for ILI
Total
ILI
N (%)
RR
95% CI
Pvalue
2410
3639
261 (11)
343 (9)
1.2 (1.0-1.4)
referent
0.08
Yes
No
95
5954
22 (23)
582 (10)
2.4 (1.6-3.4)
referent
<0.001
‘Greek’ Society Member
Yes
No
770
5258
129 (17)
475 (9)
2.0 (1.6-2.5)
referent
<0.001
‘Greek Week’ Participation
Yes
No
589
5402
107 (18)
491 (9)
2.2 (1.8-2.8)
referent
<0.001
Risk Factor
Housing
On Campus
Off Campus
Travel to Mexico
RR=Relative Risk, 95% CI=95% Confidence Interval
Cases
50
45
Onset of Reported ILI, Students
in reported
(n=604) Peakillness
ILI - Other
ILI - Mexico Travelers
40
35
30
25
Spring Break
Travel to Mexico
20
15
10
5
3/
27
3/
29
3/
31
4/
2
4/
4
4/
6
4/
8
4/
10
4/
12
4/
14
4/
16
4/
18
4/
20
4/
22
4/
24
4/
26
4/
28
4/
30
5/
2
5/
4
5/
6
5/
8
0
Date
Cases
50
45
40
35
30
25
Onset of Reported ILI, Students
in reported
(n=604) Peakillness
ILI - Other
ILI - Mexico Travelers
13 of 20 travelers became sick
during trip or within 7 days of
returning
Spring Break
Travel to Mexico
20
15
10
5
3/
27
3/
29
3/
31
4/
2
4/
4
4/
6
4/
8
4/
10
4/
12
4/
14
4/
16
4/
18
4/
20
4/
22
4/
24
4/
26
4/
28
4/
30
5/
2
5/
4
5/
6
5/
8
0
Date
Student Risk Factors for ILI
Total
ILI
N (%)
RR
95% CI
Pvalue
2410
3639
261 (11)
343 (9)
1.2 (1.0-1.4)
referent
0.08
Yes
No
95
5954
22 (23)
582 (10)
2.4 (1.6-3.4)
referent
<0.001
‘Greek’ Society Member
Yes
No
770
5258
129 (17)
475 (9)
2.0 (1.6-2.5)
referent
<0.001
‘Greek Week’ Participation
Yes
No
589
5402
107 (18)
491 (9)
2.2 (1.8-2.8)
referent
<0.001
Risk Factor
Housing
On Campus
Off Campus
Travel to Mexico
RR=Relative Risk, 95% CI=95% Confidence Interval
Onset of Reported ILI, Students
(n=604) Peak in reported
Cases
illness
50
45
‘Greek Week’
40
35
30
Spring Break
25
20
15
10
5
2
4
6
8
5/
5/
5/
5/
30
4/
28
4/
26
4/
24
4/
20
22
4/
Date
4/
18
4/
16
4/
14
4/
12
8
4/
4/
6
4/
10
4
4/
4/
2
4/
31
3/
29
3/
3/
27
0
ILI Rate by ‘Greek Week’ Participation
35
'Greek-Week' Participants
non-Participants
‘Greek Week’
25
20
15
10
5
Date
5/
8
5/
6
5/
4
5/
2
4/
10
4/
12
4/
14
4/
16
4/
18
4/
20
4/
22
4/
24
4/
26
4/
28
4/
30
4/
8
4/
6
4/
4
4/
2
0
3/
27
3/
29
3/
31
Rate per 1000 people per day
30
Limitations
•
H1N1 confirmatory testing for small subset
– Unknown how many positive for H1N1
•
Low response rate to online survey
•
Self-reported responses
•
Generalizability
– May not be representative of university
population
– May be different than non-participants
Conclusions
•
Large outbreak of respiratory infections on UD
campus in April and May 2009
•
Outbreak overwhelmed health system
•
Attack rate: two times higher for students
compared with faculty/staff
•
No deaths were reported
Conclusions
•
Risk of ILI decreased in older age groups
•
No difference in the risk of ILI by seasonal
influenza vaccine
•
Risk factors for transmission
–
–
Travel to Mexico
‘Greek Week’ participation
Investigation helped to answer
•
H1N1 unknown characteristics
– Severity of illness
– Attack rate
– Age distribution of illness
– Effectiveness of seasonal influenza
vaccine
– Risk factors for transmission
– Use of community mitigation measures
Severity of Illness, Delaware, 2009
University of
Delaware:
1918
pandemic
1968
pandemic
AR: 10%
CFR: 0%
AR: 30%
CFR: 2 %
AR: 37%
CFR: 0.2 %
Population
18,872
18,872
18,872
ILI
1,887
5,662
6,882
113
14
Healthcare visits 1,132
Hospitalizations
11
Deaths
0
AR: Attack Rate, CFR: Case Fatality Rate
Recommendations
•
Provide information to the university
community
– Signs/symptoms
– How virus spreads
– Prevention methods
– Who should seek care
– When to seek care
•
Distribute through multiple media sources
•
Provide regular updates
Recommendations
•
Prepare for surge in individuals seeking care
– Developed in conjunction with local health
authorities
– Plan for additional clinic location and staff
– Call center
•
CDC guidance for universities
–
http://www.cdc.gov/h1n1flu/institutions/guidance/
Acknowledgments
University of Delaware CDC
–
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–
–
Sharon Bathon
Steve Grasson
Richard Sacher
Joseph Siebold
Sheryl Whitlock
Marcia Nichol
Delaware Health and
Social Services
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–
–
–
–
–
–
Paul Silverman
Paula Eggers
Leroy Hathcock
Ashley Love
Rick Hong
Karyl Rattay
Sue Shore
Crystal Webb
–
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–
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–
Dave Swerdlow
Carrie Reed
Alice Guh
Deborah Dee
Tarissa Mitchell
Greg Armstrong
Kathy Byrd
Mitesh Desai
Hannah Gould
Preeta Kutty
Roni Werman
Gavin Grant
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Mark Lamias
Lyn Finelli
Victor Babalban
Harvey Lipman
Mehran Massoudi
Dan Fishbein
Micah Milton
Carolyn Bridges
Michael Lynch
Mark Sotir
Joan Brunkard
Phil Ricks
Thank you!
Extra Slides
University Challenges
•
Health system overwhelmed
–
•
Unexpected and rapid increase in visits
Decision to cancel or not cancel classes
–
–
–
Students may leave campus
Community spread of the virus
Classes not canceled
H1N1 Case Definitions
•
Probable case:
–
•
Positive influenza A, but unsubtypeable on
RT-PCR at state laboratories
Confirmed case:
–
Positive for H1N1 on RT-PCR at CDC
Clinic Visit Data
Date
5/
8
5/
6
5/
4
5/
2
4/
30
4/
28
4/
26
4/
24
4/
22
4/
20
4/
18
4/
16
4/
14
4/
12
4/
10
4/
8
4/
6
4/
4
4/
2
3/
31
3/
29
3/
27
Frequency of Clinic Visits
Student Health Service Visits,
March 27 – May 9 2008 & 2009
400
350
300
250
200
150
100
50
0
2008
Date
2009
5/
8
5/
6
5/
4
5/
2
4/
30
4/
28
4/
26
4/
24
4/
22
4/
20
4/
18
4/
16
4/
14
4/
12
4/
10
4/
8
4/
6
4/
4
4/
2
3/
31
3/
29
3/
27
Number of Visits for Respiratory Illness
Student Health Services Visits For
Respiratory Illness, 2008-2009
200
180
160
140
120
100
80
60
40
20
0
3/30
3/31
4/1
4/2
4/3
4/4
4/5
4/6
4/7
4/8
4/9
4/10
4/11
4/12
4/13
4/14
4/15
4/16
4/17
4/18
4/19
4/20
4/21
4/22
4/23
4/24
4/25
4/26
4/27
4/28
4/29
4/30
Number of Confirmed Cases
Onset of Illness, Confirmed Cases
(n=24)
10
9
8
7
6
5
4
3
2
1
0
Onset Date
Chart Abstraction
Clinical Chart Abstraction
Clinical Chart Abstraction
•
Objectives
–
Describe the spectrum of illness in students
seeking medical care
Who were the students presenting?
• Were they worried ill or worried well?
• Did they likely have H1N1?
•
Examine severity of H1N1
– Compare confirmed H1N1 cases to
–
•
•
Afebrile respiratory illness (Non ILI)
Seasonal influenza A
Clinical Chart Abstraction
•
•
Reviewed electronic medical charts
From April 5 – May 8, 2009:
All confirmed Influenza A (H1N1)
– Random sample of other respiratory illness
–
•
•
Afebrile (25% sample abstracted)
Febrile (50% sample abstracted)
– Influenza-like illness (ILI)
Fever
•
+ cough or sore throat
From February – March, 2009
–
Seasonal influenza A
Flow Chart for Selection of Charts
Student Health Clinic
4/5/2009–5/8/2009
Respiratory Illness
n = 1102
2/1/2009–3/21/2009
Seasonal Influenza A
n = 44
With Fever
n = 492
241 abstracted
Without Fever
n = 610
132
abstracted
ILI: n = 237
Confirmed H1N1: n = 24*
*Data for 6 patients from external sources (CCHS, State DPH interviews)
Confirmed H1N1 vs. ILI
Clinical Characteristics and Outcome
Symptoms
Cough
Sore throat
Nasal congestion / rhinorrhea
Gastrointestinal symptoms
nausea, vomiting, diarrhea
Myalgia
Headache
Fatigue
Confirmed
N=24 (%)
ILI
N=213 (%)
P-value
24 (100)
15 (63)
19 (79)
158 (74)
174 (82)
142 (67)
0.002
0.03
0.21
8 (33)
14 (58)
15 (63)
12 (50)
36
98
90
91
(17)
(46)
(42)
(43)
0.05
0.25
0.06
0.50
Underlying Medical Conditions
Asthma
1 (4)
32 (15)
0.22*
Hospitalizations / Deaths
0 (0)
0 (0)
-
* Fisher’s Exact Test
Confirmed H1N1 vs. Afebrile Illness
Clinical Characteristics and Outcome
Symptoms
Cough
Sore throat
Nasal congestion / rhinorrhea
Gastrointestinal symptoms
nausea, vomiting, diarrhea
Myalgia
Headache
Fatigue
Confirmed
N=24 (%)
Afebrile
N=136 (%) P-value
24 (100)
15 (63)
19 (79)
83 (61)
103 (76)
89 (65)
<0.001
0.17
0.19
8 (33)
14 (58)
15 (63)
12 (50)
7
18
39
21
<0.001
<0.001
0.001
<0.001
(5)
(13)
(29)
(15)
Underlying Medical Conditions
Asthma
1 (4)
25 (18)
0.13*
Hospitalizations / Deaths
0 (0)
0 (0)
-
* Fisher’s Exact Test
Confirmed H1N1 vs. Seasonal Influenza A
Clinical Characteristics and Outcome
Symptoms
Fever
Cough
Sore throat
Nasal congestion / rhinorrhea
Gastrointestinal symptoms
nausea, vomiting, diarrhea
Myalgia
Headache
Fatigue
Confirmed
N=24 (%)
Seasonal
N=44 (%)
24 (100)
24 (100)
15 (63)
19 (79)
42 (95)
40 (91)
33 (75)
38 (86)
P-value
0.55
0.28
0.50
0.24
0.10
0.93
0.99
8 (33)
14 (58)
15 (63)
12 (50)
9 (20)
34 (77)
28 (64)
22 (50)
Underlying Medical Conditions
Asthma
1 (4)
9 (20)
0.09*
Hospitalizations / Deaths
0 (0)
0 (0)
-
* Fisher’s Exact Test
Clinical Chart Abstraction
•
Reviewed patient medical charts:
Confirmed Influenza A (H1N1)
– Acute febrile respiratory illness (AFRI)
–
•
•
•
Fever (100°F or feverishness or chills) plus
Cough, sore throat, nasal congestion, or
rhinorrhea
ILI: fever plus cough or sore throat
Other upper respiratory infection (URI)
– Seasonal influenza A, February/March 2009
–
Flow Chart for Selection of Charts
Student Health Clinic
Respiratory Illness
4/5/2009–5/8/2009
n = 1102
2/1/2009–3/21/2009
Seasonal Influenza A
n = 44
Febrile
n = 492
Afebrile
n = 610
241 abstracted
Confirmed H1N1
n = 24*
132
abstracted
ILI
n = 213
*Data for 6 patients from external sources (CCHS, State DPH interviews)
Summary
•
Individuals seeking care
Worried ill
– Presented with spectrum of illnesses
– Many same symptoms reported
–
•
•
Possible H1N1
Severity of H1N1 illness
Mostly mild
– Similar clinical illnesses between H1N1 and
seasonal influenza although the numbers
were small
–
Survey Data
Methods
Examined demographic characteristics
– Calculated attack rates for ILI
– Identified factors associated with
transmission among students
–
–
Examined community mitigation
measures
Percent
Survey Response
Students
•
–
6,049 (26%) participants
Faculty/Staff
•
–
1,401 (24%) participants
Men
70
60
50
40
30
20
10
0
Students
Survey Respondent Type
Faculty/Staff
Women
Student Symptoms Reported
Symptoms
Fever
Sore Throat
Cough
Runny Nose/Nasal
Congestion
Headache
Nausea/Vomiting
Diarrhea
Shortness of Breath
Muscle Aches
Fatigue
ILI
(n=604)
N (%)
Other respiratory
illness (n=941)
N (%)
604 (100)
509 (84)
475 (79)
61 (6.5)
625 (66)
609 (65)
508 (84)
426 (71)
118 (20)
131 (22)
204 (30)
361 (60)
470 (78)
771 (82)
402 (43)
80 (9)
99 (11)
171 (16)
169 (18)
397 (42)
Attack Rates for ILI
Total
Risk Factor
ILI
N (%)
RR
95% CI
P-value
Underlying Health
Condition*
Yes
No
1995
5455
193 (10) 1.1 (0.9-1.3)
484 (9)
referent
0.29
Yes
No
1195
6255
133 (11) 1.3 (1.1-1.6)
544 (9)
referent
0.007
Asthma
RR=Relative Risk, 95% CI=95% Confidence Interval
* Underlying health conditions include: Asthma, chronic lung disease, chronic heart or
circulatory disease (including diabetes); kidney disease, recent cancer,
immunosuppressive condition, neurologic/neuromuscular disorder
Attack Rates for ILI
Total
Risk Factor
ILI
N (%)
RR
95% CI
P-value
Underlying Health
Condition*
Yes
No
1995
5455
193 (10) 1.1 (0.9-1.3)
484 (9)
referent
Yes
No
1195
6255
133 (11) 1.3 (1.1-1.6)
544 (9)
referent
0.29
Asthma
0.007
RR=Relative Risk, 95% CI=95% Confidence Interval
* Underlying health conditions include: Asthma, chronic lung disease, chronic heart or
circulatory disease (including diabetes); kidney disease, recent cancer,
immunosuppressive condition, neurologic/neuromuscular disorder
Health Seeking Behaviors
70
60
Percent
50
40
30
20
10
0
Sought healthcare
ILI
P < 0.0001
ARI
Health Seeking Behaviors
80
70
70
60
60
50
40
50
30
20
40
10
30
0
Reasons for Seeking Health Care,
ILI
20
Very Sick
Concerned about H1N1
Advice from Family/Friends
Media Coverage
10
0
Visited healthcare
ILI Other Respiratory Illness
Health Seeking Behaviors
60
70
50
60
40
30
50
20
40
10
30
0
Reasons for Seeking Health Care,
Other Respiratory Illness
20
Very Sick
Concerned about H1N1
Advice from Family/Friends
Media Coverage
10
0
Visited healthcare
ILI Other Respiratory Illness
Self-Protective Measures:
All Students
•
•
•
43% concerned about catching H1N1
65% did something to protect themselves
from catching H1N1
Most common self-protective measures
Increased hand washing (96%)
– Avoided sick people (69%)
– Did not share drinks/utensils (58%)
–
H1N1 Survey Summary:
Students and Faculty/Staff
•
Illness on campus widespread
Student attack rate higher than faculty/staff
– Older age associated with decreased risk of
ILI
–
•
No protective effect of seasonal influenza
vaccine
•
H1N1 media coverage and fear influenced
decision to seek care
H1N1 Survey Summary:
Students
•
Risk factors for transmission
–
ILI risk increased with travel to Mexico
• Associated with early transmission
–
ILI risk increased with ‘Greek Week’
participation
• Likely to be associated with peak in illness
Measures Taken:
Students with Respiratory Illness
•
Respiratory illness
Cough, sore throat, nasal congestion
– With or without other symptoms
– Since May 1, 2009
–
•
To assess behaviors following
recommendations provided by UD
Measures Taken:
Students with Respiratory Illness
•
Increased personal hygiene measures
75%
– 68%
– 51%
– 11%
–
•
increased hand washing
covered cough/sneeze
did not share drinks/utensils
wore face mask
Disregard for isolation measures
95% left household during 7 days after
illness onset
– 77% attended class
– 39% attended social events
–
Qualitative study
Confirmed Case Interview Findings
•
Followed recommendations to prevent
transmission
–
Practiced social isolation
–
Washed hands often
–
Some reported wearing masks
•
Compliant with antiviral medication
•
Many attributed disease spread on campus to
‘Greek Week’ activities or travel to Mexico
H1N1 Prevention
H1N1 Vaccine
• Wash hands often with soap and water or
alcohol-based hand rub
• Avoid touching eyes, nose or mouth
• Avoid close contact with sick people
•
Conclusions
•
Risk factors for transmission
–
–
•
Travel to Mexico
‘Greek Week’ participation
Community Mitigation Efforts
–
–
All student participants used some protective
measures to prevent illness
Students with acute respiratory illness
•
•
Practiced good hygiene measures
Did not follow isolation recommendations
Recommendations
•
•
•
•
Prepare for surge in individuals seeking care
– Truly ill and worried well
– Use gymnasiums or other large open venues as
emergency clinic space
Set up an call center
Consider cancelling large social events
In the event of another outbreak
Provide information early with clear, easily
accessible and concise
– Provide rationale behind university decisions
–
•
Increase student awareness about university
health system
CDC Recommendations
•
Experiencing ILI
–
–
–
•
Facilitate self-isolation of residential students
Promote self-isolation of non-resident students,
faculty and staff
Discourage attendance at campus events
General recommendations
–
–
–
–
–
Increase hand washing
Cover cough or sneeze
Seasonal influenza vaccine
Seek medical advice if experience illness
Complete routine cleaning of high touch areas
http://www.cdc.gov/h1n1flu/institutions/guidance/
IT recommends technology options for course continuity in event of H1N1 outbreak
http://www.udel.edu/healthalert/