2009 H1N1 Influenza Summit

Current Status of the H1N1 Flu

Jerry Gibson MD, MPH

State Epidemiologist and Director, Bureau of Disease Control, South Carolina Department of

Health and Environmental Control

10/20/09

Thanks to Dan Drociuk, Chasisity Springs, Riyadh Muhammad, Claire Youngblood

What is Seasonal Influenza (flu)?What is Seasonal Influenza (flu)?• Virus infection with cough, sore throat, body

aches, weakness, and often fever. Usually begins abruptly.

• Comes every year, appears December to February in SC

• Virus spreads person to person by large droplets or direct contact (face to face long enough to have a sustained conversation, shaking hands, etc

• An average 800 people die in S.C. annually from “flu”. 36,000 in the US

• Most are under 2, over 65, or have a chronic illness like heart or lung disease

Pneumonia/Influenza Death Rates in 122 Cities from 2005 - 2009

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6

8

10

12

31 40 50 10 20 30 40 50 10 20 30 40 50 10 20 30 40 50 10 20 30

Weeks

% o

f All

Dea

ths

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to P

&I

2009200820062005Centers for Disease Control, Influenza Division

White=P&I epidemic threshold

What is 2009 Pandemic H1N1 What is 2009 Pandemic H1N1 Influenza (“swine flu”)?Influenza (“swine flu”)?

• In April 2009 a brand-new H1N1 virus appeared. Its hemagglutinin is totally different and people under 60 have almost no immunity.

• First detected in Mexico in 3/2009; in SC on 4/20/09.

• Symptoms are similar to regular seasonal flu.

• Declared a ‘pandemic strain’ by WHO

• A “pandemic” is an epidemic that spreads everywhere.

SC H1N1 Influenza Case Rate by Age Group

Rates of Serious H1N1 flu in SC by Pregnancy Status

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5

10

15

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25

Not pregnant Pregnant

Hospitalized/100,000women

CHESS Disease Reports, 10/15/09

As of 10/19, we have had 374 hospitalizations and 14 deathssince August 30, 2009. There have been 43 child deaths in the US.

Cumulative Hospitalization Rates per 100,000 US population

0

1

2

3

4

5

6

7

80-4 yrs

5-24 yrs

25-49 yrs

50-64 yrs

25-64 yrs

≥65 Yrs

Ho

spit

aliz

atio

n r

ate

per

100

,000

po

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lati

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2009

Influenza-Like Illness in 9 Large Hospital Emergency Departments

South Carolina Aberration Alerting Network (SCAAN)

Everyday Steps to Everyday Steps to Protect Your HealthProtect Your Health

• Wash your hands often with soap and warm water. Wash for 15-20 seconds – about the time it takes to sing the “Happy Birthday” song twice.

• Alcohol-based hand wipes or gel sanitizers are also effective.

• Don’t touch unwashed hands toyour mouth, eyes, or nose because that’s how viruses get into your body.

Everyday Steps toEveryday Steps toProtect Your HealthProtect Your Health

• Get a flu shot.– Get the seasonal flu vaccination every year to boost

your immunity.– Get the 2009 H1N1 vaccination, which is becoming

available. This requires one shot, or two for children 6 months to 9 years old.

– Flu shots do not cause flu and are among the safest immunizations that are given.

– The 2009 H1N1 flu vaccine is made, tested and licensed by the FDA exactly the same way as other flu vaccines.

Vaccination: 4-7 months with current technology

How do I slow the spread of flu How do I slow the spread of flu if I get sick?if I get sick?

• Stay home for at least 24 hours after fever is gone without the use of fever-reducing medicines.

• Cover your nose and mouth with a tissue every time you cough or sneeze. Throw the used tissue in a waste basket.

• If you don't have a tissue, sneeze or cough into your sleeve.

What to do if a family member gets the flu? Most people with flu have mild symptoms and

can be cared for better at home.

• Who is more likely to get a complication, and should consider seeing a doctor?– Children under 5, especially under 2 years old– Pregnant women– Over 65– If you have: cancer, sickle cell disease, chronic lung or

heart disease, diabetes, kidney or liver disease, neurological/neuromuscular disorders, weak immune systems (e.g. AIDS)

• It is possible for healthy people to get severe flu, too.

When a household member gets flu

• If a household member has a high-risk disease, avoid close contact (< 6 feet) with the sick person

• Ask your doctor if they should take preventive medicine – Tamiflu or Relenza

• Keep the sick person in a separate room, with one family member caring for them

• Wear a mask when giving care. Disposable gloves to clean up body fluids

• Everyone washes hands!• Avoid having visitors

For the person with flu:

• Check with your doctor about special care

• Ask also if you should take antiviral medicine

• Rest

• Drink plenty of fluids (electrolyte drinks for infants)

• Tylenol or ibuprofen (Motrin) for fever (aspirin is safe only for adults)

• Humidifier and suction bulb for infants noses

• Go outside when fever has been gone for 24 hours

When Should I Call the Doctor?When Should I Call the Doctor?

Most people should be able to recover at home, but watch for emergency warning signs that mean you should seek immediate medical care.

In adults:• Difficulty breathing or shortness of breath• Pain or pressure in the chest or stomach• Sudden dizziness• Confusion• Severe or persistent vomiting• Flu-like symptoms improve but then return with fever and worse cough

When Should I Call the Doctor?When Should I Call the Doctor?

If your child gets sick and experiences any of these warning signs, seek emergency medical care.

In children:• Fast breathing or trouble breathing• Bluish or gray skin color• Not drinking enough fluids• Severe or persistent vomiting• Not waking up or not interacting• Irritable, the child does not want to be held• Flu-like symptoms improve but then return with fever and worse cough

How can we slow spread of this pandemic virus in the community:

Social Distancing

1. Stay home from school or work when you are sick with flu!

2. School closures (very costly)

3. Businesses have staff work from home, in separate shifts, or physically separate

4. Discouraging large gatherings

Pandemic influenza mortality:Pandemic influenza mortality: A tale of two cities, 1918 A tale of two cities, 1918

1918 Death Rates: Philadelphia v St. Louis

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16000

Date

Death

s R

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00 P

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Basis

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Philadelphia

St. Louis

No social distancing in Philadelphia in 1918

For More InformationFor More Information

• DHEC Web site: http://www.scdhec.gov/flu

• CDC H1N1 Flu Web site: http://www.cdc.gov/h1n1flu

• Call your county DHEC public health department

• Call 211 or 1 800 27 SHOTS