pandemic influenza update pandemic influenza update name, credentials and contact information of...
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Pandemic Influenza UpdatePandemic Influenza Update
Name, Credentials and Contact Information of Presenter
www.kdheks.gov
Location and Date
Our Vision – Healthy Kansans Living in Safe and Sustainable EnvironmentsOur Vision – Healthy Kansans Living in Safe and Sustainable Environments
Acknowledgements for Content
Jason Eberhart-Phillips, MD, MPHKansas Department of Health and Environment
Centers for Disease Control and PreventionWorld Health OrganizationUS Health and Human Services
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Pandemic Influenza
Background
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What is a Pandemic?
“A pandemic is a global disease outbreak. An influenza pandemic occurs when a new influenza A virus emerges for which there is little or no immunity in the human population, begins to cause serious illness and then spreads easily person-to-person worldwide” (Flu.gov, 2009).
For additional information on pandemic influenza visit: www.pandemicflu.gov
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Prerequisites for Pandemic Influenza
•A new influenza virus emerges to which the general population has
little/no immunity
•The new virus must be able to replicate in humans and cause disease
•The new virus must be The new virus must be efficiently efficiently transmitted from one human to anothertransmitted from one human to another
•The new virus must be The new virus must be efficiently efficiently transmitted from one human to anothertransmitted from one human to another
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Circulating Influenza Strains and Pandemics in the 20th Century
• 1920 1940 1960 1980 2000H1N1
H2N2H3N2
1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu”20-40 million deaths 1-4 million deaths 1-4 million deaths
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Pandemic influenza typically comes in waves. The great 1918-1919 pandemic came in 3 distinct ‘waves’The second wave was very different – much more lethalOver the summer the virus had changed
What We’ve Learned from History
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The First Flu Pandemic of the 21st Century
On June 11, 2009WHO raised pandemic
alert level to Phase 6A global pandemic was
underwayCommunity-level
outbreaks in multiple parts of the world
Declaration was reflection of the spread of the virus – not of the severity of the disease it causes World Health Organization, Retrieved July 7, 2009, form
http://www.who.int/csr/disease/avian_influenza/phase/en/index.html
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Influenza A (H1N1): What We Do Know
This is an entirely new virus Genetic bits come from flu viruses
that infect pigs, birds and humans It is easily transmitted among
humans, especially the young No one, except those who have been
infected, is immune Illness from the virus could become
widespread quickly No previous vaccine, including seasonal
flu vaccine, protects against infection
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Seasonal Epidemics vs. PandemicsSeasonal Influenza
A public health problem each year
Usually some immunity built up from previous exposures to the same subtype
Infants and elderly most at risk
Influenza Pandemics
Appear in the human population rarely and unpredictably
Human population lacks any immunity
All age groups, including healthy young adults
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How the Virus Spreads
The same way seasonal flu viruses spread Respiratory droplets Coughs and sneezes Touching objects touched by an
infectious person, then touching your nose or mouth
Droplets aren’t able to travel long distances through the air 3-6 feet maximum
Virus survives up to 72 hours on surfaces, depending on moisture
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The Clinical Picture…So Far
Symptoms like other flu infections Abrupt fever, >100˚ F Cough, sore throat, runny nose Aches, chills, fatigue Unusual: diarrhea and vomiting
Almost everyone infected so far has recovered fully, but Hospitalization rate higher than
expected for seasonal flu The virus is affecting younger
populations than seasonal flu This picture could change, as the virus
changes its genetic make-up
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What can we do to Reduce the Spread of Influenza?
Plan, Prepare, Prevent, Protect - Be Healthy
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Community Measures
The Goal of Community Mitigation
•Pandemic Outbreak: No Community Measures Used
•Pandemic Outbreak: With Measures TakenN
um
ber
of
Dai
ly C
ases
Days Since First Case
Delay onset of outbreak
Reduce the peak burden on hospitals/infrastructure
Decrease a) number of cases of death and illness and b) overall health impact
1
2
3
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Key Community Mitigation Messages
Wash your hands often with soap and water, especially after you cough or sneezeAlcohol-based cleaners okay
Cover your nose and mouth when you cough or sneezeNot with your bare hands!Use a tissue; throw it away‘Dracula cover’ is okay, or
“Sneeze in your sleeve”
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What Social Distancing Means
Educating the public To recognize the disease Keeping distance from other people
who appear ill Stay home until no longer infectious,
except to obtain medical care
Educating employers and schools To recognize the disease Dismiss workers and students who
develop symptoms immediately Consider closing, if severe
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Droplet Precautions: Surgical Masks
Source: Rosie Sokas, MD MOH UIL at Chicago
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Current Status of H1N1 Response
No vaccine is currently available, but is being produced and will likely be available in October
Vaccine will be given first to priority groups
Antiviral treatment will be targeted
Everyone must practice good hygiene and use guidelines to prevent disease
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Implications
During peak periods of peak influenza illness we will need to consider how to:Care for sick family membersCare for children if schools or daycare providers are
closedRemain home or leave work if illKeep schools and business open with potentially
significant absences.Failure to educate the public and be prepared could result
in increased incidence of viral spread
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Steps We All Can Take
Seek guidance on pandemic influenza ~ ask questions! Your state health departments are
providing the most appropriate and current information
In your communities Local health departments Local emergency planning Local physicians and other
healthcare providers
Be vaccinated with seasonal influenza vaccine
Image source: Retrieved July 24, 2009 fromhttp://flushots2009.com/images/flu_vaccine_2009.jpg,
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Use of Vaccine and Medication
Pharmaceuticals
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Vaccination for Influenza Will Prioritize Groups at Risk
Pregnant women
Health care workers and emergency medical responders
People caring for infants under 6 months of age
Children and young adults from 6 months to 24 years
People aged 25 to 64 years with underlying medical conditions (e.g. asthma, diabetes) July 29, 2009, the Advisory Committee on Immunization Practices
(ACIP), http://www.pandemicflu.gov/
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Mobilizing for a Vaccine Campaign
For public health, a challenge of unprecedented scale this fall
Planning is already underway
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Treatment
Antivirals aren’t usually necessary for mild illness (except perhaps for those who are at high risk for complications)Rest and fluids work bestVirus is currently sensitive to two antiviral drugs
Tamiflu (pills, liquid)Relenza (inhaled powder)
Should be started early for maximum effectivenessState/federal stockpiles have been sent to designated providers
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Planning for Staying Healthy
Healthy People, Healthy Families, Healthy Workforce, Healthy Kansas
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What Basic Steps Can You Take to Assure Health?
Eat healthy and get rest
http://healthy-values.info/images/apple.jpg
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Wash Your Hands the Right Way
Wet your hands with clean running water and apply soap. Use warm water if it is available.
Rub hands together to make a lather and scrub all surfaces.
Continue rubbing hands for 15-20 seconds. Need a timer? Imagine singing "Happy Birthday" twice through to a friend.
Rinse hands well under running water.
Dry your hands using a paper towel or air dryer. If possible, use your paper towel to turn off the faucet.
Always use soap and water if your hands are visibly dirty.
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If Soap and Clean Water Are Not Available: Use Alcohol-based Hand Sanitizer
Effective if hands not visibly soiledMore costly than soap & waterAlcohol-based hand rubs significantly reduce the number
of germs on skin and are fast-acting.When using an alcohol-based hand sanitizer:
MethodApply appropriate amount to palms
(about 1 coin-sized drop) Rub hands together, covering all surfaces until dry
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Cough etiquette
Respiratory etiquette Cover nose / mouth when
coughing or sneezing
Practice infection prevention by educating and displaying posters on respiratory hygiene, cough etiquette, and proper hand washing
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Steps We All Can Take
Know the symptoms of influenza and monitor your health
Stay home and away from school and workplace when sick
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What About Home?
Keeping Yourself and Your Family Healthy
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What Should Your Home Checklist Include?
Personal planning for stockpiles of food, bottled water, and medication. Store a two week supply of food and water, Periodically check your regular prescription drugs to ensure a continuous supply in your home. Have any nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins.
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What Should Your Home Checklist Include?
Get vaccinated with seasonal flu and pneumococcal vaccine (if indicated)
Planning for extended care of family at home
Monitoring of own health and staying home when sick
Find healthy ways to deal with stress and anxiety
Use PPE and implement infection control guidance at home
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Patients Cared for at Home
Contact a health care provider if pregnant, five years of age and under or have a health condition such as diabetes, heart disease, or asthma.
Get plenty of rest. Drink clear fluids (such as water, broth, sports drinks, electrolyte
beverages for infants) to keep from being dehydrated. A sick person should stay away from other people as much as
possible. Sick persons should use proper hand hygiene and respiratory etiquette. Wear a facemask – if available and tolerable – when sharing common
spaces with other household members to help prevent spreading the virus to others. This is especially important if other household members are at high risk for complications from influenza.
Stay home until free of fever for at least 24 hours without the use of fever reducing medications such as Tylenol®.
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Emergency Warning Signs
Be watchful for emergency warning signs that might indicate
you or family members need to seek medical attention.
Get medical care right away if the sick person at home: has difficulty breathing or chest pain has purple or blue discoloration of the lips is vomiting and unable to keep liquids down has signs of dehydration such as dizziness when standing, absence of
urination, or in infants, a lack of tears when they cry has seizures (for example, uncontrolled convulsions) is less responsive than normal or becomes confused
Warning! Do not give aspirin (acetylsalicylic acid) to children or teenagers who have the flu; this can cause a rare but serious illness called Reye’s syndrome.
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What about Schools?
Considering Students and Staff
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Key Issues for Schools
Absenteeism is likely to be increased for students and staff.“Normal” flu produces a 4% to 5% peak rate.Experience in other countries suggests peak may be
10% to 15%. Infection control policies will be very important.
Aimed at reducing risk of school dismissals and unnecessary absenteeism
Schools as venues for mass immunization.Coordinate with local health departments
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Stepped up Hygiene and Cleaning
Frequent hand washing, with adequate facilities and time made available.Alcohol-based hand sanitizers can be used; others if last
resort.
Respiratory etiquette, modeled by staffCoughing/sneezing into tissues followed by hand washingCough or sneeze into sleeve as alternative.
Routine cleaning around school.Viruses can be transmitted from flu droplets on surfacesRegular detergent cleansers are sufficient.
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Primary Strategy
Separate ill students and staff from the well population.Ill students need to remain at home and avoid contact with
others except to seek necessary medical care.Exclude sick students and staff from school until 24 hours
after fever has resolved (without use of fever-reducing medications). Antiviral drug use does not effect this rule.
Rapidly isolate students and staff who become ill at school until they can be sent home.Set aside space to separate sick persons until they can be
sent home.Limit staff assigned to care for ill studentsConsider providing surgical masks to place on ill person.
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Selective School Dismissal
These steps should prevent most schools from closing, butIf absenteeism in any particular school is too large, school
dismissal may be necessaryEarlier dismissal also may be necessary in schools that
serve pregnant or medically fragile students, if they cannot be protected.
Decisions should be made in collaboration with local and state health officials
Dismissal should last 5 – 7 days, then reassess.Consider continuing to allow well staff access to buildings.Other measures will be recommended if the pandemic
strain becomes more virulent.
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New Mindset
Expect the unexpected
Parents, teachers and administrators all need to work hard to keep schools open, and be ready if schools must close suddenly
Give up the notion that absences are to be avoided at all costs
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Immunizations in Schools
Immunizing in schools offers advantagesConvenient for parentsExcludes no oneEnables followup
Efforts will be made to minimize the disruption of normal school activities
With cooperation and guidance of school boards and administration
No child would be immunized without written consent from parent or guardian
All immunizations would be performed by persons qualified to give injections
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What About the Child Care?
What can providers and parents do?
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Steps Child Care Providers Can Take Now
Maintain regular communication with the local health department to obtain guidance about reporting flu-like illness in child care.
Visit the KDHE website at http://www.kdheks.gov for additional materials and updated resources. Child care providers are encouraged to check the website regularly for the most current guidance concerning H1N1 flu.
The Centers for Disease Control and Prevention (CDC) at http://www.cdc.gov/h1n1flu/
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Steps Child Care Providers Can Take Now
Develop a plan to address possible disruptions in learning and program operation. A useful planning tool is available at http://www.pandemicflu.gov/planpdf/child care.pdf
Higher absentee rates among children and staffDisruptions in supportive services and the delivery of
suppliesLoss of income or delay in paymentsReview policies for the exclusion of sick children and staff. Review children’s files and update contact information.
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Steps Child Care Providers Can Take Now
Make plans for the isolation and supervision of sick children, until their parents can pick them up.
Recognize the symptoms of H1N1 flu and exclude sick children and staff promptly.
Clean toys and commonly shared items, and touched surfaces like handrails and doorknobs at least daily and whenever visibly soiled.
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Steps Child Care Providers Can Take Now
Avoid over-crowded conditions. • Spread out during story and circle times• Allow more than the 2 ft. required by regulation between
cribs, cots and sleep mats. • Place cribs, cots, and sleep mats so that children rest
“head to toe” rather than “face to face”. Have adequate supplies on hand
• Hand soap and paper towels• Facial tissues and waste containers• Cleaning supplies
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Steps Child Care Providers Can Take Now
Incorporate learning activities that promote healthy practices and good hygiene.
Teach parents simple things they can do to keep their families health and to reduce the spread of disease. Check the KDHE website at http://www.kdheks.gov and the CDC website http://www.cdc.gov/h1h1flu/ for downloadable resource materials.
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Parents Can help
Parents can help reduce the spread of flu like illness and other diseases in child care settings by:
Keeping sick children home. Sick children should not attend school, child care or other group setting. Children should be fever free, without the use of fever-reducing medications for at least 24 hours before returning to school, child care or other group setting.
Having a back up plan in place in case your child is sick or in case your school or child care closes due to illness
Practicing good health habits at home and encouraging your children to do the same.
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What About the Workplace?
Employer and Employees
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Principles of Mitigation Apply
Good hygiene practices
Social distancing at work
Avoid handshakes (and kissing!)
Stay home when sick
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Considerations for Business, Industry, and Government
Protection of workforce
Continuation of service or business
Economic impact for organization and employees
Consideration of current policy related to sick leave
Alternate plans for conducting business / providing services
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What About Faith based and Community Organizations?
Remembering the Most Vulnerable
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Faith-Based and Service Organizations
Consider suspending faith-based practices or rituals that may involve contact with hands, i.e. communion, greeting, etc.
The impact of school closures and loss of income,
differentially impacts low income individuals and groups. In the United States, 48% of workers have no sick leaveMany low income families rely on free and reduced
breakfast and lunch programs to help feed their childrenChildren who are released from school may be left
unattended and/or be at risk for greater violence in their communities
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Faith-Based and Service Organizations
Other vulnerable populations include:
Single individuals, especially the elderly, who may have no assistance if they fall ill or run out of supplies
People with disabilities who may rely on others for their basic care
Individuals who may not speak or understand EnglishShelters serving homeless persons
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Plan, Prepare, Prevent, Protect - Be Healthy
WHAT CAN YOU DO TO REDUCE RISK OF INFLUENZA?
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PLAN Take Time to Plan
Work, business and
government
Work, business and
government
Family and communityFamily and community
Vulnerable populationsVulnerable populations
Schools, universities
and child care
Schools, universities
and child care
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PREPARECaring for Self, Family and Community
School closing arrangementsSchool closing arrangements
Alternative child care
arrangements
Alternative child care
arrangements
Non-perishable foods and waterNon-perishable foods and water
Medications and
health supplies
Medications and
health supplies
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PREVENTHealthy Habits to Reduce Risk of Infection and Illness
Cover your coughCover your cough
Wash hands often and use
alcohol-based hand sanitizer
Wash hands often and use
alcohol-based hand sanitizer
Vaccinate against diseaseVaccinate against disease
Prevent and manage
chronic disease
Prevent and manage
chronic disease
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PROTECTResponding to Influenza to Reduce Risk of Exposure
Know when to see doctor Know when to see doctor
Protect vulnerable peopleProtect vulnerable people
Know symptoms of fluKnow symptoms of flu
Breastfeed your babyBreastfeed your baby
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YOUYOU CAN REDUCE THE SPREAD AND RISK OF INFLUENZA
Plan, Prepare, Prevent, Protect - Be Healthy!Be Healthy!
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Learn More!
Centers for Disease Control and Prevention http://www.cdc.gov/h1n1flu/
Pandemic Flu Planning http://www.pandemicflu.gov/ Kansas Department of Health and Environment
http://www.kdheks.gov/ Things you can do
http://www.kdheks.gov/H1N1/H1N1_things_you_can_do.htm Individual Planning
http://www.pandemicflu.gov/plan/individual/index.html
www.kdheks.gov
Thanks for Listening!