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Novel Influenza A (H1N1) &
Pandemic Information
UWSP Safety & Loss
2009
Content Source:
U. S. Centers for Disease Control and Prevention
Influenza
• Influenza is a viral infection that attacks the respiratory system, including your nose,
throat, lungs. Influenza, commonly called the flu, is not the same as the stomach
viruses.
• Flu viruses travel through the air in droplets when someone with the infection
coughs, sneezes or talks. You can inhale the droplets directly (most likely exposure
route), or you can pick up the germs from an object, such as a telephone or
computer keyboard, and then transfer them to your eyes, nose or mouth.
• The flu is caused by three types (strains) of viruses — influenza A, B and C. Type A
can be responsible for the deadly influenza pandemics (worldwide epidemics) that
strike every 10 to 40 years. Type B can lead to smaller, more localized outbreaks.
Either types A or B can cause the flu that circulates almost every winter. Type C is
fairly stable has never been connected with a large epidemic. Types A and B are
constantly changing, with new strains appearing regularly. Once you've had the flu,
you develop antibodies to the strain that caused it, but those antibodies won't
protect you from new strains. That's why annual flu shot is recommended.
Influenza Virus Types
• There are many terms used to describe various influenzas (Bird Flu,
Swine, Avian, Seasonal, etc.).
• Influenza A viruses are found in many different animals, including
ducks, chickens, pigs, whales, horses, and seals.
• Influenza A has many subtypes, classified according to 16 ―H‖ and 9
―N‖ proteins
• There are and can be various combinations of the H & N
proteins.
• The current novel influenza A (H1N1) is a heightened concern due to
the fact humans have little or no immunity to this novel (new) virus.
• Note: Another influenza virus, the H5N1 (Avian Influenza), found in
birds in Asia and Europe is an extremely severe virus (60% fatality
rate in those infected). But has not be able to transmit from person to
person well at this time. H5N1 is not in North America at this time.
Influenza Virus Example
Influenza viruses can change in
two different ways.
• Antigenic drift
– Changes in proteins by genetic point mutation & selection
– Ongoing and basis for change in vaccine each year
• Antigenic shift
– Changes in proteins through genetic reassortment
– Produces different viruses not covered by annual vaccine
• Reassortment, or Viral Subunit Reassortment, is the exchange of DNA between viruses
inside a host cell. Two or more viruses of different strains (but usually the same species)
infect a single cell and pool their genetic material creating numerous genetically diverse
progeny viruses.
• It is a type of genetic recombination.
• Reassortment can lead to a viral shifts under some conditions .
• When shift happens, most people have little or no protection against the new
virus.
Seasonal Influenza
• Seasonal Influenza - A respiratory illness that can be transmitted
person to person. Most people have some immunity, and a
vaccine is available. This is also known as the common flu or
winter flu. (H3N2 is one example of seasonal influenza strain).
• In the US each year ~35,000 deaths are attributed to seasonal
influenza resulting in >200,000 hospitalizations.
• Seasonal Influenza verses Pandemic Influenza - for more info on
this see: http://www.flu.gov/general/season_or_pandemic.html
Novel Influenza A (H1N1) – Cause of
Current 2009 Pandemic
• Novel Influenza A (H1N1) (referred to a swine flu early on) is a
new influenza virus that is currently spreading from person-to-
person. Spread can be very rapid.
• The 2009 flu outbreak in humans that is widely known as
"swine flu" is due to an apparently virulent new strain of
influenza A virus subtype H1N1 that was produced by
reassortment from one strain of human influenza virus, one
strain of avian influenza virus, and two separate strains of
swine influenza.
• CDC declared public health emergency and WHO declared
global pandemic for this virus last spring. The virus is
widespread in the United States internationally.
Pandemic
• Epidemic: A disease occurring suddenly in humans
in a community, region or country in numbers
clearly in excess of normal.
• Pandemic: The worldwide outbreak of a disease in
humans in numbers clearly in excess of normal.
• Pandemic Phases 1 – 6.
– Currently (08/09) at Phase 6 – increased and sustained
transmission in general public.
• See WHO for more details.
WHO Pandemic Phases
Pandemic Influenza Information
• Occur rarely (three times in 20th century - last in 1968)
• No previous exposure; little or no pre-existing immunity. Likely a
NEW influenza strain.
• Healthy people may be at increased risk for serious complications.
Capacity to cause severe disease in nontraditional groups.
• Health systems may be overwhelmed. Sharp increase in demand.
• Vaccine probably would not be available in the early stages of a
pandemic
• Effective antivirals may be in limited supply
• Number of deaths can be quite high
• Symptoms may be more severe and complications more frequent
• Major impact on society and economy.
Past Pandemics
• Pandemics Death Toll Since 1900
– 1918-1919
• U.S.... 675,000+
• Worldwide…50,000,000+
– 1957-1958
• U.S....70,000+
• Worldwide…1-2,000,000
– 1968-1969
• U.S.... 34,000+
• Worldwide…700,000+
– 2009 – Thousands so far - plus ?
Pandemics
• Pandemics are unpredictable
– Mortality, severity of illness, pattern of spread
• Waves of infection
– Ages/areas not initially infected likely vulnerable in future waves
– Subsequent waves may be more severe
• 1918- virus mutated into more virulent form
• 1957 schoolchildren spread initial wave, elderly died in second wave
• Public health interventions delay, but do not stop pandemic spread
– Quarantine, closings, travel restriction show little effect
• Does not change population susceptibility
• However, forced restrictions may occur if deemed necessary (i.e.
extremely high rates of infection). Would be by order of Public Health
Department.
– Delaying spread is desirable
• Fewer people ill at one time improve capacity to cope with sharp increase in need
for medical care.
CDC Pandemic Severity Levels
(Currently at Level 1)
Novel Influenza A (H1N1)
• Though severity still relatively low, need to take
seriously.
• Virus - very rapid spread.
• Higher rates of adverse affects (including death) on
certain age groups (under age 50, young adults,
teens and children) compared to seasonal influenza
affects.
• New virus – full picture still unclear.
Signs and symptoms
Symptoms of novel H1N1 flu in people are similar to those
associated with seasonal flu.
• Fever
• Cough
• Sore throat
• Runny or stuffy nose
• Body aches
• Headache
• Chills/Shivering
• Fatigue
• In addition, vomiting (25%) and diarrhea (25%) have been
reported. (Higher rate than for seasonal flu.)
How does Novel Influenza A (H1N1) spread?
• This virus is thought to spread the same
way seasonal flu spreads
• Primarily through respiratory droplets
– Coughing
– Sneezing
• Close contact (about 3 ft or less)
necessary for above.
• Also may be spread by touching respiratory
droplets on yourself, another person, or an
object, then touching mucus membranes (e.g.,
mouth, nose, eyes) without washing hands.
– One study showed that influenza virus can survive
on environmental surfaces and can infect a
person for up to 2-8 hours after being deposited
on the surface.
Can you get Novel Influenza A (H1N1)
from eating pork?
No.
You cannot get novel H1N1 flu from eating
pork or pork products. Eating properly
handled and prepared pork products is safe.
What can you do to protect yourself
from getting sick?
• Vaccine is currently being developed. When and if
available to you obtain vaccine ASAP. Oct./Nov.
timeline. Availability will be determined. Priority will
likely be established. UWSP will work to have
vaccination clinic available if necessary.
Also, everyday actions can help prevent spread of
germs that cause respiratory illnesses like influenza.
See following slides.
Take these everyday steps to protect
your health
• Wash your hands often with
soap and warm water,
especially after you cough
or sneeze. Wash for 15 – 20
seconds. Watch:
http://www.youtube.com/watch?v=XHISh559oho&feature=channel_page
• Alcohol-based hand
wipes or gel sanitizers are also
effective. Use those that contain at least 60% alcohol.
Take these everyday steps to protect
your health
• Cover your nose and mouth with a tissue
when you cough or sneeze. Throw the
tissue in the trash after you use it. Or
sneeze cough into elbow.
• Watch – ―Why Don’t We Do It In Our
Sleeves” Watch: http://coughsafe.com/media.html
• Wash hands after sneezing and coughing.
• Avoid touching your eyes, nose or mouth.
Germs spread this way.
• Avoid contact with sick people. Social
Distancing. Stay home (see later slide)
• See CDC poster: Cover you Cough
Infectious Period
• How long can an infected person spread this virus to others?
People infected with seasonal and novel H1N1 flu shed virus and
may be able to infect others from 1 day before getting sick to 5 to
7 days after. This can be longer in some people, especially
children and people with weakened immune systems and in
people infected with the new H1N1 virus.
• How long can influenza virus remain viable on objects (such
as books and doorknobs)?
Studies have shown that influenza virus can survive on
environmental surfaces and can infect a person for up to 2-8
hours after being deposited on the surface.
Cleaning Surfaces
• UWSP Custodial Services have implement plans for stepped up cleaning of
Academic Buildings, Administrative Buildings, following the CDC’s Interim
Guidance on Environmental Management of Pandemic Influenza Virus.
• Have disposable disinfectant wipes, and Kleenex available in your areas.
UWSP Departments should purchase these for their areas.
• Disinfectant wipes and cleaners can be used by employees and students to
routinely wipe down frequently touched surfaces (doorknobs, elevator
buttons, rails, shared computers, remote controls, table tops, other work
surfaces, etc). Ensure items are dispose of properly in garbage containers.
– Hand Sanitizer, disposable sanitizing wipes, gloves and Kleenex all
available to order through UWSP Central Stores (x3897).
• Most household disinfectant cleaners and detergents are effective for
influenza. Any cleaner questions contact UWSP EHS Department at 2320.
• Gloves would be prudent or wash hands afterward. Respirator or mask not
needed for cleaning regular surfaces.
• Haz Com. Review MSDS for cleaner and safety measures with employees.
Masks/Respirators/Gloves
• N95 vs. Basic Masks. See http://www.cdc.gov/h1n1flu/masks.htm.
– Use of mask for all in normal every-day situations not recommended.
Individuals that are ill should be asked to go home and seek appropriate
treatment. If persons with (ILI) must leave their home or dorm room (i.e., to
seek medical care or other necessities) they should cover their nose and
mouth when coughing or sneezing. A basic nuisance or surgical loose-fitting
mask can be helpful for persons who have access to these. A tissue or other
covering would be appropriate as well.
– N95 Respirators recommended for health care providers and those caring for
ill in certain situations. Patients may need to wear surgical masks while being
cared for.
– Contact EHS (x2320) for guidance on selection of proper respirators and
masks. N95 use by employees has requirements.
• Gloves (basic exam gloves such as nitrile) worn by health care providers or when
cleaning or garbage disposal operations. Wash hands after using gloves.
• Follow regular laundry procedures. Wash hands after putting into washer.
Respirator vs. Masks
• N95 Respirator (NIOSH • Basic Mask
certified)
UWSP Employee Wellness Group
• Take advantage of improving your wellness through
UWSP Employee Wellness programs.
• See http://www.uwsp.edu/hphd/empwell/
If you get sick…
• Those with influenza like illness (ILI) should
stay away from work and classes and limit interactions with other people
(called ―voluntary self-isolation‖), except to seek medical care, for at least 24
hours after they no longer have a fever, or signs of a fever, without the use of
fever-reducing medicines. They should stay away from others during this
time period even if they are taking antiviral drugs for treatment of the flu. (For
more information, visit http://www.cdc.gov/h1n1flu/guidance/exclusion.htm.). This
includes all students, employees, student employees, and other campus
visitors. See UWSP Residential Halls letter.
• If you are sick, limit your contact with other people as much as possible.
• See CDC site Taking Care of a Sick Person in Your Home
• Seek medical attention as necessary.
– However be prepared for limited healthcare availability during major events.
– See http://www.flu.gov/individual/index.html for home/personal preparedness.
Watch for emergency warning signs
According to the CDC many 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 abdomen
• Sudden dizziness
• Confusion / Not waking up and interacting.
• Severe or persistent vomiting
• Flu-like symptoms improve but then return with
fever and worse cough
• Have pre-existing conditions that may compromise
response to the virus.
Higher Risk Groups*
• The information analyzed by CDC supports the conclusion that novel H1N1
flu has caused greater disease burden in people younger than 25 years of
age than older people. At this time, there are few cases and few deaths
reported in people older than 64 years old, which is unusual when
compared with seasonal flu. However, pregnancy and other previously
recognized high risk medical conditions from seasonal influenza appear to
be associated with increased risk of complications from this novel H1N1.
These underlying conditions include asthma, diabetes, suppressed
immune systems, heart disease, kidney disease, neurocognitive and
neuromuscular disorders and pregnancy.
• Other areas of concern that are being reviewed include smoking & obesity.
• *Remember the disease is new and being studied. All individuals should be
prepared for prevention and response to the virus.
• See: CDC’s site at http://www.cdc.gov/h1n1flu/guidance/exclusion.htm for
further discussion on high risk groups.
What is CDC doing?
• CDC has implemented its emergency response.
• CDC continues to issue new interim guidance for clinicians and
public health professionals.
• CDC’s Division of the Strategic National Stockpile (SNS) has sent
25% of the SNS stockpile of antiviral drugs, personal protective
equipment, and respiratory protection devices to all 50 states and
U.S. territories to help them respond to the outbreak.
• CDC is working closely with state and local officials nationwide.
• CDC also is coordinating closely with the World Health
Organization and other international partners.
• Monitoring potential changes in virus.
UWSP
• Following CDC, State of WI Dept. of Health Services,
Portage County guidance.
• Developed Pandemic Plan. Individual department
responsibilities. MOD updates.
• Work with Portage County and Providers to offer
vaccination clinics when they are available.
• UWSP Health Services efforts for students.
• Recommendations within this presentation.
• Continue to monitor and respond. See
http://www.uwsp.edu/ehs/emp/pandemic.html Also MOD.
Summary
Influenza should always be taken seriously. This Novel H1N1 outbreak
certainly poses the potential to be at least as serious as seasonal flu, if
not more so, especially given the fact that there very limited immunity
which can make the illness more severe and widespread. Also
adversely affecting different age groups vs. seasonal influenza.
CDC anticipates that there will be more cases, more hospitalizations
and more deaths associated with this new virus in the coming months
because the population has little to no immunity against it.
Follow all recommendations for preventing the spread of influenza.
Proper hygiene and staying home when you are seek are the two key
measures.
• We must all work together to limit and control the transmission of novel
H1N1 influenza. Help spread the word and use proper measures.
Resources
• US Centers for Disease Control (CDC) http://www.cdc.gov/h1n1flu/
• Flu.gov - Contains good home preparedness information.
• WI Pandemic Flu Resource at: http://pandemic.wisconsin.gov/
• Info line - 1-800-CDC-INFO (1-800-232-4636)
• World Health Organization (WHO)
http://www.who.int/csr/disease/swineflu/en/index.html
• UWSP Pandemic Page at http://www.uwsp.edu/ehs/emp/pandemic.html
• Grainger.com Many Supplies available at discount. See MDS system.
• Do I have the flu? - take this quick self-assessment
• CDCStreamingHealth on YouTube at:
http://www.youtube.com/user/CDCStreamingHealth
• Note – recommendations from CDC are dynamic. Various changes occur
based on studies and other analysis.
Questions?
• May contact Jeff Karcher x3901 or email at
jkarcher@uwsp.edu
• Thank you.
