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H1N1 SWINE FLU UPDATE by pengxuebo



  Linn County Health Department-Donna Thomas, RN
• Mid-April 2009, CDC began working with states
    to collect, compile, and analyze information
    regarding the swine flu outbreak.
•   On July 24, 2009 official reporting of individual
    cases of confirmed and probable novel H1N1
    infection was discontinued.
•   Below is a summary of information gathered
    during the first weeks of the outbreak.
•   Aggregate national reports of hospitalizations
    and deaths continue.
How many cases have been
reported in the US?

 From April 15, 2009 to       Of these 43,771 reported
 July 24, 2009, states                  cases…
 reported a total of 43,771
 confirmed and probable       • 5,011 people were
 cases of novel influenza A     hospitalized.
 (H1N1) infection.

                              • 302 people died.
Kansas Update:
   Kansas Department of Health and Environment (KDHE)
    estimates that at least 10,000 Kansans have already been
    infected with the novel H1N1 influenza A virus.
   The first case was identified 110 days ago.
   Viral activity has been confirmed in 46 counties.
   Most have suffered relatively mild illness, but at least 23
    persons have been hospitalized.
   One patient died.
   The average age for confirmed cases is 17 years, with
    approximately 80% of cases occurring in persons under 35
    years of age.
   Current flu activity in Kansas, as in the rest of the US, is
    unusually high for the summer months.
   The first Linn County cases have been confirmed by lab
    testing starting Friday, August 7, 2009.
   Many people are ill in our community as reported by local
    health care providers.
Estimates of how many people
have been infected in the US
   The CDC model was developed to try to determine the true
    number of H1N1 flu cases in the US.

   The model took the number of cases reported by states and
    adjusted the figure to account for known sources of
    underestimation (not all cases with H1N1 seek medical care,
    and not all people who seek care have specimens collected by
    their health care provider).

   Using this approach…it is estimated that more than one million
    people became ill with novel H1N1 flu between April and June
    2009 in the US.
Secondary Attack Rate

• This reflects the risk of someone being
 infected with a disease by an ill close
ARI versus ILI
• Acute respiratory-illness (ARI) the secondary
  attack rate was 18-19%.
    Acute respiratory-illness is defined as two or more of
     the following: fever, cough, sore throat, and runny

• Influenza like illness (ILI) the secondary attack
  rate was 8-12%.
    Influenza like illness is defined as fever and cough or
     sore throat.
Community rates of influenza-like
    Based on community surveys and population
    based telephone surveys in areas with focal
    outbreaks of H1N1 flu:

• Approximately 6% of the population reported
    influenza-like illness in the areas surveyed.
•   New Yorkers had 6.9% influenza-like illness
    between May 1 and May 20, 2009, based on
    New York City Health Dept. data from phone
US age group impact in terms of
infection with H1N1

• The information analyzed by the CDC
 supports the conclusion that H1N1 has
 caused greater disease burden on people
 younger than 25 years of age than older
Graph A: Novel H1N1 Confirmed and Probable
 Case Rate in the United States, By Age Group
This data supports…

• That older people may have pre-existing
 immunity to the novel H1N1 flu virus.

• This age distribution is very different from
 what is normally seen for seasonal flu,
 where older people are more heavily
How have age groups been affected in
terms of hospitalizations?
• These estimates are based on the 4,738 hospitalizations
  that were reported to CDC from April 15 to July 24,

• The reported hospitalization rate per 100,000 people
  was highest among children in the 0-4 years of age
  group, and the next highest group hospitalized was the
  5-24 years of age group.

• Underlying medical conditions such asthma, diabetes,
  heart disease, and pregnancy place people at greater
  risk of serious flu-related complications.
Graph B: Novel H1N1 U.S. Hospitalization Rate per 100,000 Population,
                          By Age Group
     Symptoms of H1N1
Table: Symptoms of hospitalized novel H1N1 patients
Symptom                                               Number (%)

Fever*                                                249 (93%)
Cough                                                 223 (83%)
Shortness of breath                                   145 (54%)
Fatigue/Weakness                                      108 (40%)
Chills                                                99 (37%)
Body aches                                            96 (36%)
Runny nose                                            96 (36%)
Sore Throat                                           84 (31%)
Headache                                              83(31%)
Vomiting                                              78 (29%)
Wheezing                                              64 (24%)
Diarrhea                                              64 (24%)
Age groups affected by death
    CDC studied the hospital records of 268 patients
    hospitalized with novel H1N1 flu early on during
    the outbreak.
•   The number of deaths was highest among
    people 25-49 years of age (39%), followed by
    people 50-64 years of age (25%), and people 5
    to 24 years of age (16%).
•   This is very different from seasonal
    influenza, where an estimated 90% of
    deaths occur in people 65 years of age and
Graph C: Novel H1N1 U.S. Deaths, By
            Age Group
Reducing the risk of infection:
• Wash hands frequently with soap and water
• Alcohol based hand cleaner use when soap and
    water is not available.
•   Cover mouth and nose with a tissue when
    coughing or sneezing.
•   Avoid touching eyes, nose and mouth.
•   Avoid close contact (within 6 feet) with those
    who are ill.
•   Keep surfaces clean with disinfectant cleaners.
What people should do if they get
sick with influenza-like symptoms:
• Stay home and keep away from others as much as possible.
• Contact your family doctor for treatment recommendations.
    Antiviral medications are being reserved for high risk populations
    and those people hospitalized at this time.
•   Notify Dr. office of symptoms before arrival so isolation from others
    can be planned.
•   Practice good cough etiquette and hand hygiene.
•   A face mask may be worn if available and able.
•   Remain isolated from others until fever free for 24 hours before
    resuming normal activities.
•   Keep in contact with physician for any symptoms not resolving or
              Recommended school responses for the 2009-2010 school year
              Under conditions with similar severity as in spring 2009

Stay home when sick: Those with flu-like illness should stay home 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 home even if they are using antiviral drugs.
(For more information, visit

Separate ill students and staff: Students and staff who appear to have flu-like
illness should be sent to a room separate from others until they can be sent home.
CDC recommends that they wear a surgical mask, if possible, and that those who
care for ill students and staff wear protective gear such as a mask.

Hand hygiene and respiratory etiquette: The new recommendations emphasize
the importance of the basic foundations of influenza prevention: stay home when
sick, wash hands frequently with soap and water when possible, and cover noses
and mouths with a tissue when coughing or sneezing (or a shirt sleeve or elbow if no
tissue is available).
            More for schools…
Routine cleaning: School staff should routinely clean areas that students and
staff touch often with the cleaners they typically use. Special cleaning with bleach
and other non-detergent-based cleaners is not necessary.

Early treatment of high-risk students and staff: People at high risk for
influenza complications who become ill with influenza-like illness should speak
with their health care provider as soon as possible. Early treatment with antiviral
medications is very important for people at high risk because it can prevent
hospitalizations and deaths. People at high risk include those who are pregnant,
have asthma or diabetes, have compromised immune systems, or have
neuromuscular diseases.

Consideration of selective school dismissal: Although there are not many
schools where all or most students are at high risk (for example, schools for
medically fragile children or for pregnant students) a community might decide to
dismiss such a school to better protect these high-risk students.
Pandemic Viruses

   Are unpredictable.
   Based on experience in other regions, an
    escalation in cases will occur in the coming
   As many as 20-40% of the population in
    Kansas (between 550,000 and 1.1 million
    individuals) can expect to be infected in the
    next two years.
   Waves of infection lasting several weeks
    may be seen.
High Risk Groups

People who:
• Are pregnant
• Have asthma
• Have diabetes
• Have a compromised immune system
• Have a neuromuscular disease
Monovalent H1N1 Vaccine is in
• Expected to be available as early as September.
• Advisory Committee on Immunization Practices has
  recommended initial vaccination efforts for five key
  populations (details of vaccination order, etc. are
   – All people 6 months through 24 years of age.
   – People who live with or care for children younger than 6 months of age.
   – All pregnant women.
   – Healthcare and emergency medical services personnel
   – People aged 25 through 64 years who have health conditions
     associated with higher risk of medical complications from influenza.
   – As supply increases further, immunization can be extended to others.
Seasonal Flu Vaccine:

• Will be available in Kansas soon.
• KDHE strongly encourages all Kansans,
  particularly those at high risk, to get
• Vaccines given in August or September
  will cover the flu season.
We will do all we can at PV to
          be safe…
          Thank you,
        Pam Johnson, RN

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