H1N1 Update 9-29-09

Cindy CunninghamJohn LevitowFrisbie Memorial Hospital

H1N1 Pandemic Timeline

• First illnesses Mexico & US 3/09• First lab confirmed case in US 4/15/09• Pandemic declared 6/11/09; Today over 140

countries reporting infection• 6/15/09 all US states, DC, Puerto Rico and US

Virgin Islands with cases• Pregnant population has highest mortality rate:

6% of those deceased

WHO

Clinical Information for H1N1

• Incubation period 1-7 days• Symptoms: Fevers, chills, headache, cough,

sore throat, difficulty breathing, muscle aches, joint pain, fatigue, vomiting and diarrhea

• Testing: Under DHHS control– Influenza-like illness– Hospitalized– High-risk patient

Influenza-like illness (ILI) & High-risk patients

• Fever– T 100F or 37.8C or

greater• Cough +/-• Sore throat

• <5 years old• >65 years old• Underlying medical

conditions• Immunosuppression• Pregnancy• <19 years old on aspirin• Nursing home/LTC

H1N1 Testing

• Limited to select populations– Specimen must meet at least one of the following

criteria to be tested. • Hospitalized patient with severe illness• Health Care Worker in consultation with health care provider• In consultation with public health as part of a cluster or outbreak• Requesting provider participates in the ILI Sentinel Provider

Network

H1N1 Testing

• Nasopharyngeal Aspirate

• Nasopharyngeal Swab (Specimen of choice)-This is what we do here. Available in Lab

• Nasopharyngeal Wash

H1N1 Testing

• Can be done in the offices• Wear a surgical mask when obtaining the

specimen.• Fill out the lab slip for H1N1 (on the portal)

Age Groups Infected

Hospitalizations by Age Group

Key Points from HAN 09/16

• H1N1 outbreaks have been ongoing since April 2009 – confirmed a number of school outbreaks since classes

resumed several weeks ago.• There is no current shortage of seasonal influenza vaccines

– Some manufacturers have delayed their shipments; State is monitoring the situation.

• H1N1 vaccine trials have shown excellent immunity after a single dose of inactivated vaccine for persons aged 10 and up.

H1N1 Vaccine

• Many unknowns about the vaccine:– Number of doses required for immunity– When and amount of vaccine available– Whether the seasonal & H1N1 can be administered

at the same time– Forms of vaccine available (i.e. nasal mist,

preservative free)

Vaccine Distribution

• Coordinated by CDC• CDC will distribute vaccine and supplies at no

cost• Distribution in NH will be based on application

process

Most Recent Vaccine Information

• All information changes daily:– State expects 1st shipment of vaccine does the week

of 10/05– Initial number of doses reported as 45,000 for the

state; followed by 20,000 a week– NH State Immunization Program will be assigned

liaison for each AHHR– Reports are first does may be flu-Mist

Vaccine Allocation-CDC Recommendations

• First Round– Vaccine 3 Groups:

• Pregnant women• HCW (direct patient contact & care)/EMS with direct patient

contact• Children 6m-18Yrs with medical conditions

Vaccine Allocation-CDC Recommendations

• Second Round– Vaccinate 2 additional groups:

• All children 6m-4Yrs old• Persons caring for or living with infants<6months old

Vaccine Allocation-CDC Recommendations

• Third Round– Vaccinate 3 additional groups:

• All HCW and EMS• Ages 6m-24 Yrs• Ages 24-64Yrs with medical conditions

Response to H1N1• WHO has raised it’s alert level;

– Change signifies that the likelihood of a pandemic has increased. Now Phase 6

• US has declared a public health emergency– Declaration mobilizes resources to address a public health situation– Focus has shifted to vaccine development

• State of NH: Monitoring the spread of the flu– Developing clinical guidance– Clearing house for H1N1 vaccine

• Regional EOC is not open

Community Planning

• Community response managed by Health and Safety Council of Strafford County

• FMH is the Medical Command and Control in Northern Strafford County

• Community Vaccination Clinics and Medical Surge Plan is driven by AHHR

Frisbie Preparedness

8 Planning Teams– Communications: Michelle Landry/Dee Sheing– Supplies: Brooks McQuade– Pharmacy: Marcia Montminy– Employee Health: Janice Parker

Frisbie Preparedness (cont)

8 Planning Teams– Human Resources: Carol Themelis– Hospital Care: Mary Nutter/Sally Reeves

• In-patient• ED

– Office Care: Leslie Logel– Community: John Levitow