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					          Swine Flu
          H1N1 Influenza 09

Dr Thérèse Jones, Acting Manager Population Health
Ms Liz Stubbs, Public Health Epidemiologist
                 What is Swine Flu
   New Influenza Type A virus
   First detected in Mexico
   RNA virus
   It is a recombinant virus with components of human,
    avian and swine flu strains
   Swine Influenza: H1N1
   Sensitive to Oseltamivir (Tamiflu) and Zanamivir
    (Relenza), resistant to amantadine
   Seasonal Influenza:
       H1N1 – large proportion resistant to Oseltamivir
       H3N2 – sensitive to Oseltamivir
     Why are we worried about it?
   Attack rate is expected to be at least 20% (seasonal
    influenza 10%)
   We usually have a surge in GP presentations and
    hospitalisations with seasonal influenza that stretch our
    resources
   If we have double the hospitalisations this will impact
    on ICU’s (ventilators), HDU & staff requirements
    In USA
     10% of hospitalisations admitted to ICU
     16% of ICU admissions were <5yrs
Why are we worried about it? (cont)
   Humans have little or no immunity to the virus
   There has been rapid spread in multiple
    communities
   It is affecting unusual age groups (USA figures)
     5-18yrs      57% of confirmed cases
     19-47yrs     27% of confirmed cases
   Greatest risk of hospitalisations and deaths in
    children, young and middle aged adults.
 WHO Pandemic Phases
The current WHO phase of pandemic alert is 6




      http://www.who.int/csr/disease/avian_influenza/phase/en/index.html
Australian phases
       ALERT
       DELAY
       CONTAIN
       SUSTAIN
       CONTROL
       RECOVER


        National Action Plan for Human Influenza Pandemic April 2009
           Protect Phase
Pandemic virus is mild in most but severe in
some and moderate overall. This phase sits
alongside CONTAIN and SUSTAIN phases
with a greater focus on treating and caring
for those more vulnerable to severe
outcomes.



                       Australian Health Management Plan for
                       Pandemic Influenza April 2009
               Current situation
   WHO declared Phase 6 Pandemic
   This means it is occurring in more than one region of
    the world and involves human to human transmission
   Australia currently in the PROTECT phase
   Australia has 5,298 cases and 10 deaths (5 July)
                                                  th



   NSW: 1470 cases, 96 hospitalised, 2 deaths
   Community transmission in NSW
   GWAHS: 21 confirmed cases
                           DoHA http://www.healthemergency.gov.au
                           NetEpi:https://wwwepi3.health.nsw.gov.au/swine/
                           app.py#cur
             Epidemiology
25th April: DELAY Phase
            First Public Health Teleconference
20th May: First positive case in NSW confirmed
22nd May: CONTAIN Phase announced
17th June: PROTECT Phase announced
Epidemiology




               NSW Health 2009
Epidemiology




               NSW Health 2009
Epidemiology




               NSW Health 2009
               Source: PHREDSS
   Current Case Definition (NSW) for
           H1N1 Influenza 09

Confirmed case
 A confirmed case is a person with H1N1
 influenza 09 virus infection confirmed by one or
 more of the following laboratory tests:
 - Viral sequencing
 - H1N1 influenza 09 specific-PCR
 - Isolation of H1N1 influenza 09 virus
 Any specimen which is positive for influenza A
 virus will be sub-typed and tested for H1N1
 influenza 09.
                                     NSW Health 2009
      CLINICAL CRITERIA FOR FREE
             TREATMENT

Patients are eligible for free treatment if they:
1. a) present with fever 38ºC or a good history of fever, and either a
    cough or sore throat, and
    b) are at risk of severe illness because they are pregnant, have
    underlying chronic disease or immunosuppressant, are of
    Aboriginal or Torres Strait Islander background or are morbidly
    obese, and
    c) present within 48 hours of symptom onset.

        OR
2. present with moderate or severe acute febrile respiratory illness,
   or are rapidly deteriorating.

                                                     NSW Health 2009
        CLINICAL CRITERIA FOR FREE
             TREATMENT (cont.)
   Chronic diseases such as
       Chronic respiratory disease (including asthma)
       Chronic cardiac disease
       Chronic renal disease
       Haemoglobinopathies
       Chronic neurological conditions
       Metabolic disorders eg diabetes
       Immunosuppression (including cancers, through certain
        medications, or HIV/AIDS infection
       Morbid obesity
       Pregnant women (particularly 2nd and 3rd trimester)
       Aboriginal and Torres Strait Islander people of any age
    What is the Public Health role?
   Swine Flu Steering Committee: Chair Thérèse Jones
   Modified ICS structure
   HSFAC: Michele Pitt
   Disaster Response Coordinator: Chris Druce
   Biopreparedness Officer: Linda Mason
   Facilities:
       Advice to ED’s
       Liaison with facilities
       Support for Flu clinics as required
   Urgent transport of specimens
   Warehouse: Distribution to facilities of Tamiflu, PPE, isolation
    packs etc
             Public Health Role
             CONTAIN Phase
   Assessment of patient against the case
    definition, recommendation and endorsement of
    swabbing
   Advice on eligibility for Tamiflu
   Surveillance & management of cases and their
    contacts
   Home isolation
   Monitoring daily of those in isolation
              Public Health Role
              CONTAIN Phase
   Data entry for all cases, contacts & daily follow
    up
   Monitoring of database for results
   Release from isolation
   Liaison with institutions eg schools
   Advice to facilities
   Advice to GP’s & ED’s
              Public Health Role
              PROTECT Phase
   Notification of confirmed cases to PH
   Advice and support to ED’s, Flu Clinics, GP’s
   Public Health role in Flu Clinic planning and
    monitoring
   Notification to NSW Health re hospitalisations
       GP Role PROTECT Phase
   Assessment and management of patients with
    flu like illness
   Assessment for co-morbidities
   Assessment for qualification for free Tamiflu
    treatment
   Sentinel GP practices for surveillance
               NSW Health
http://www.emergency.health.nsw.gov.au/swineflu/index.asp
Wiki
The database: NetEpi
NetEpi
    Case Study: The Pacific Dawn
Cruise 1:
    Returned Sydney 25th May 2009
   Approx 3,000 passengers
   172 symptomatic people
   55 cases associated with this cruise
   2 in GWAHS
   Accommodation, isolation, contact follow up, daily
    follow up, release, quarantine/isolation packs, Tamiflu
    Case Study: The Pacific Dawn
Cruise 2:
    Returned Sydney 1st June 2009
   3 staff members only, isolated during Cruise 2
   Infectious Diseases doctor and PH nurses on
    board
   Swabs of symptomatic travellers
   All results negative
   All able to disembark
    Case Study: WA Indoor Cricket
   Under 16’s Indoor Cricket Tournament
   1st week of June 2009
   16 confirmed cases in NSW
   2 Teams from NSW, 1 Team from Dubbo
   Travelled to Sydney by bus, flight to and from
    Perth, bus to Dubbo
   4 confirmed cases in GWAHS
    Case Study: WA Indoor Cricket
   Case 1:Dubbo Christian School
       Attended school on return
   Case 2: Family member of Case 1
   Case 3: South Dubbo High School
       Attended school on return
   Case 4: Indigenous student
                 Challenges…
   Increased presentations
   Increased hospitalisations
   Clusters of cases in institutions – boarding
    schools, aged care facilities etc
   Staff absenteeism
   Surveillance
           Some useful websites
WHO
http://www.who.int/csr/disease/swineflu/en/index.html
Department of Health and Ageing
http://www.flupandemic.gov.au/internet/panflu/publishing.nsf/C
   ontent/home-1
NSW Health Emergency
  http://www.emergency.health.nsw.gov.au/swineflu/index.asp
               Contact Information
Dr Thérèse Jones
Acting Manager Population Health
A/Senior Lecturer, School of Public Health, University of Sydney
Greater Western Area Health Service
The Lodge Bathurst
63395600
therese.jones@gwahs.health.nsw.gov.au

Ms Liz Stubbs
Public Health Epidemiologist
Greater Western Area Health Service
The Lodge Bathurst
63395184
liz.stubbs@gwahs.health.nsw.gov.au

				
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