h1n1 influenza (swine flu): what employers and employees need to know

OSHA Hawai`i Workshop 05/20/2009 1


H1N1 Influenza is the new name for the 2009 Swine Flu.

Started in Mexico, and now is worldwide – 40 countries 9,830 cases 79 deaths

As of May 19, 2009


U.S. 48 states, including Hawai`i 5,469 cases 6 deaths

HAWAI`I 26 cases


Phases of Pandemic Alert - WHO

Phase 1 No flu viruses of concern

Phase 2 Animal virus capable of causing human infection

Phase 3 Animal virus has caused some infection, but does not spread easily

Phase 4 Virus can cause sustained outbreaks and is adapting itself to human spread

Phase 5 The virus has spread to two (2) countries and is causing even bigger outbreaks.

Phase 6 Full-blown pandemic – outbreaks in at least two (2) regions of the world.

Bird Flu

H1N1 Flu

WHO declared Phase 5 status on 4/29/09


H1N1 does not appear to be as virulent as Avian Flu (H5N1)

Similar to Spanish Influenza of 1918 – affected healthy young adults

SARS – Toronto – affected healthy health care workers

As of 5/19/09, with 5,469 confirmed & probable cases in the U.S., only 6 deaths


As of May 19, 2009

U.S. Mexico Worldwide

Confirmed Cases 5,469 3,648 9,830

Fatalities 6 72 79

Fatality Rate 0.11% 2.0% 0.8%

On May 1, Mexico’s fatality rate was 6-7%


Kills ~ 36,000 Hospitalizations ~ 200,000 Infection Rate: 5 – 20% of population

(15 – 61 million people each year) Fatality Rate: ~ 0.09% on average Severity Rate: ~ 0.5% on average


Severe Acute Respiratory Syndrome November 2002 – July 2003 8,096 cases worldwide 774 deaths In Canada – mostly healthcare workers

(healthy young adults) Fatality rate: 9.6% More than 100x more fatal than Seasonal

Flu


H5N1 2005 – 2006 mostly Similar to Spanish Influenza of 1918 –

healthy young adults Confirmed cases: 208 No. of Deaths: 115 Fatality Rate: 55% More than 5x more virulent than SARS,

500x more virulent than seasonal flu


H5N1 Avian Influenza Situation Update Humans

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHOCumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO

12-May-0612-May-06

CountryCountry

20032003 20042004 20052005 20062006 TotalTotal

casescases deathsdeaths casescases deathsdeaths casescases deathsdeaths casescases deathsdeaths casescases deathsdeaths

AzerbaijanAzerbaijan 00 00 00 00 00 00 88 55 88 55

CambodiaCambodia 00 00 00 00 44 44 22 22 66 66

ChinaChina 00 00 00 00 88 55 1010 77 1818 1212

DjiboutiDjibouti 11 00 11 00

EgyptEgypt 00 00 00 00 00 00 1313 55 1313 55

IndonesiaIndonesia 00 00 00 00 1717 1111 1616 1414 3333 2525

IraqIraq 00 00 00 00 00 00 22 22 22 22

ThailandThailand 00 00 1717 1212 55 22 00 00 2222 1414

TurkeyTurkey 00 00 00 00 00 00 1212 44 1212 44

Viet NamViet Nam 33 33 2929 2020 6161 1919 00 00 9393 4242

TotalTotal 33 33 4646 3232 9595 4141 6464 3939 208208 115115

WHO reports only laboratory-confirmed cases.WHO reports only laboratory-confirmed cases.55%!


H1N1 Flu2009 – (US)

Seasonal Flu (US)

SARS(2003)

H5N1(Avian) (2006)

No. of Confirmed Cases

5,123 40,000,000 8,096 208

No. of Fatalities 5 36,000 744 115

Fatality Rate .10% .09% 9.6% 55.0%

In U.S. appears to be similar in severity to seasonal flu

But it’s not the same as seasonal flu!


Never-before seen combination of human, swine, and avian influenza viruses.

Most affected are healthy, young adults More contagious than seasonal flu

22-33% versus 5-15% for seasonal Virus may continue to evolve

No human immunity May become more virulent Major impact on society


Viruses mutate quickly The 1918 Spanish

influenza was originally a mild flu in the spring

Came back in November as a killer

Different from seasonal flu in viral composition

Leads to uncertainty

OSHA Hawai`i Workshop 05/20/2009 15OSHA Hawai`i Workshop 05/20/2009 15


Credit: US National Museum of Health and Medicine

A(H1N1) A(H2N2) A(H3N2)1918: “Spanish Influenza” 1957: “Asian Flu” 1968: “Hong Kong Flu”

20-40 m deaths

675,000 US deaths

1-4 m deaths

70,000 US deaths

1-4 m deaths

34,000 US deaths


1889, 1918, 1957, 1968

First wave in spring was mild

Second wave in fall – much more virulent.

Time to Prepare -- 3 months!


This is a MUST for all businesses!!!!


Continuity of Operations (COOP) Worker Protection - OSHA/HIOSH Law“Every employer shall furnish to each of the

employer’s employees employment and a place of employment which are safe as well as free from recognized hazards.”

Section 6(a) of the Hawai`i Occupational Safety and Health Law, Chapter 396, Hawai`i Revised Statutes


Common knowledge to the industry Employer genuinely desirous of

protecting workers.


Risk Level depends on whether or not jobs require: Close Proximity Repeated or Extended

Contact

To people: Potentially infected, or Known or suspected sources

http://www.osha.gov/Publications/influenza_pandemic.html


Healthcare workers performing aerosol generating procedures on known or suspected patients Cough Induction

procedures Bronchoscopies Some Dental

procedures Invasive specimen

collection


Healthcare and delivery support staff Doctors, nurses,

others that must enter patients rooms

Medical Transport EMTs

Autopsy Morgue and mortuary

employees


High frequency contact with general population Schools High population

density work High volume retail


Employees with minimal contact with the general public and other coworkers Office employees


For workers exposed to hazards for which respiratory protection is required Only NIOSH approved N95 or higher Full program – no waivers for medical

evaluations or fit testing. Where hazard assessments have

determined that respirators are NOT required - Voluntary filtering face-pieces – Training as

per Appendix D.


Guidance on Preparing Workplaces for an Influenza Pandemic (OSHA Publication 3327-02N)(2007) (http://www.osha.gov/Publications/influenza_pandemic.html)

Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers. (OSHA Publication 3328-05 (2007). (http://www.osha.gov/Publications/3328-05-2007-English.html)


Frequently Asked Questions on Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers. OSHA, Office of Occupational Health Nursing (OOHN). (http://www.osha.gov/SLTC/pandemicinfluenza/pandemic_health.html)

Proposed Guidance on Workplace Stockpiling of Respirators and Facemasks for Pandemic Influenza. OSHA. (http://www.osha.gov/dsg/guidance/stockpiling-facemasks-respirators.html)

Workplace Preparation. PandemicFlu.gov. (http://pandemicflu.gov/news/panflu_webinar4.html)


Lead State Agency is the Hawai`i State Department of Health (HDOH) Issue advisories, warnings to public Recommends actions Can require quarantine and isolation

Governor can issue Emergency Declarations


Training – Cough Etiquette Hand Washing

Posters in Public Areas Hand Sanitizers Sick leave policy


Tiny droplets from coughing or sneezing

Spreads 3 – 6 feet Can survive on

surfaces up to 1-2 days

Transferred from hands to mouth, nose, eyes.


Cover your cough/sneeze

Wash hands (Use waterless/ alcohol-based hand cleaners if water/soap not available)


Stay Home When Sick

Keep Self and Family Healthy

Sanitize Work Stations of Co-Workers Who Become Ill


NO H1N1 (Swine Flu) is not spread by food.

You cannot get H1N1 by eating pork or pork products. Eating properly handled and cooked pork products is safe.

Reason for change in name is to separate pigs from the human H1N1 flu.


Hygiene and Distancing are more effective Purpose is to prevent the transmission of

droplets and fomites from the ill person. Limited protection for the non-ill person

trying to avoid getting sick In the workplace, when respirators are

necessary for the type of work, only NIOSH approved N95 respirators are allowed.


There is NO vaccine for H1N1 yet. Earliest would be fall of 2009.

CDC has NOT recommended that the general public take anti-viral drugs such as Tamiflu or A viruses.

They are most effective if taken 48 hours after exposure.


Hawai`i State Department of Health website:

http://hawaii.gov/health H1N1 Flu Information Hot Line (Hawai`i

State Department of Health) (866) 767-5044


Centers for Disease Control:http://www.pandemicflu.gov/

World Health Organization (WHO)http://www.who.int/csr/disease/swineflu/en/

index.html OSHA

www.osha.gov


Implement good hygiene and infection control practices.

Stay healthy (Keep your family healthy)

Wash your hands frequently – soap and water or alcohol based hand sanitizer

Cover your mouth and nose when coughing or sneezing

Go to your doctor if you suspect you have the flu! (Don’t wait)

Don’t Panic!

h1n1 influenza (swine flu): what employers and employees need to know

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