influenza a h1n1: a pandemic in real time – what’s next? danny chen, md frcpc msc infectious...
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Influenza A H1N1: A Pandemic in Real Time – What’s Next?
Danny Chen, MD FRCPC MScInfectious Disease Specialist
Grand Rounds, York Central HospitalSeptember 9, 2009
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SEX
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PB2PB1PAHANPNAMPNS
PB2PB1PAHANPNAMPNS
PB2PB1PAHANPNAMPNS
Classical swine, N. American lineageAvian, N. American lineageHuman seasonal H3N2Eurasian swine lineage
Eurasian swine H1N1
N. American H1N1(swine/avian/human)
Pandemic (H1N1) 2009, combining
swine, avian and human viral components
Genetic origins of the pandemic (H1N1) 2009
virus: Quadruple viral reassortment
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WHO phases of pandemic alert
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Symptoms
• Definition of Influenza-like Illness (ILI):– Acute onset fever and cough
AND – one or more of:
• Sore throat, arthralgia, myalgia, or prostration,
– In children < 5 years of age, GI symptoms may also be present.
– In patients < 5 years of age or >65 years fever may not be prominent.
Guidance for Management of Patients with Influenza-like Illness(ILI) in Emergency Departments, MOHLTC June 4, 2009
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Prevention
ENHANCED
DROPLET
PRECAUTIONS
– Hand hygiene always– Gown, gloves, eye protection, N95 mask
= droplet + contact + N95
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Treatment Recommendations
• Oseltamivir recommended within 48 hours of the onset of symptoms:– ILI requiring hospitalization
OR– ILI and at risk for
complicated disease
• Other patients with ILI do not require treatment.
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Laboratory confirmed cases of pandemic (H1N1) 2009 in
Ontario by week between April 13 and August 29, 2009
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Hospitalizations among confirmed cases of pandemic
(H1N1) 2009 in Ontario, April 13 – September 3, 2009
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Incidence of hospitalization and death due to
pH1N1 in Ontario, April 13 to September 3, 2009
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Seasonal influenza
• Every year:Every year:
• 5 million Canadians (1 in 6) will be infected5 million Canadians (1 in 6) will be infected– Up to 75,000 hospitalizedUp to 75,000 hospitalized– 2000-4000 people will die 2000-4000 people will die
• 90% are >65 yrs90% are >65 yrs– half of those in LTCHshalf of those in LTCHs
• Bacterial pneumoniaBacterial pneumonia• Cardiac failureCardiac failure
Mortality rate:13/100,000 population0.2% of cases
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PANDEMIC H1N1 2009
CASES AT YCHNumber
Seen in ER and discharged
24
Hospitalized 15
TOTAL 39
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So What Next
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“Potential for catastrophe…”
vs
“…a pandemic dud.”
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Laboratory confirmed cases of pandemic (H1N1) 2009 in Australia, to 28 August 2009 by
jurisdiction
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Rate of ILI reported from GP ILI surveillance systems from 2007 to 23 August 2009 by week
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Rates of absenteeism of greater than 3 days absent, National employer, 1 January 2007 to
19 August 2009, by week
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Hospitalised confirmed cases of pandemic (H1N1) 2009, by length of hospital stay and age
group, to 28 August 2009, Australia
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Age specific rates of hospitalised confirmed cases of pandemic (H1N1) 2009 compared with average annual age specific rates of hospitalisations from seasonal
influenza, Australia
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Hospitalized (n= 1145)
Comorbidity 64% (731)
chronic respiratory 51% (n=379)
diabetes 14% (n=107)
pregnancy 11% (n=77)
chronic cardiac 11% (n=84)
immunocompromised 11% (n=77)
morbid obesity 8% (n=57)
renal 5% (n=35)
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Hospitalised confirmed cases of pandemic (H1N1) 2009 in pregnant women by weeks of
gestation, to 28 August 2009, Australia
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Numbers of deaths among confirmed cases of pandemic (H1N1) 2009, by age group and
sex, compared with total laboratory confirmed pandemic (H1N1) 2009 notifications by age group
Median age = 54 (cf seasonal flu: 83yo)
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Percentage of all deaths classified as influenza and pneumonia, WA Registry of Births,
Deaths and Marriages, 1 January 2008 to 23 August 2009
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Seasonal Flu
Pandemic H1N1 2009
Symptoms Similar Similar
Transmission Same Same
Prevention Same Same
(enhanced droplet)
Severity Similar Similar
Age affected Older (>65) Younger
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But no room for complacency
• Pandemics take some time to get going (1918 and 1968).
• Some pandemic viruses have ‘turned nasty’ (1918 and 1968).
• There will be severely ill people and deaths — in risk groups (young children, pregnant women and especially people with underlying illnesses).
• Health services capacity? • Resistance to antivirals?• Attack rate?• An inappropriate and excessive response to the
pandemic could be worse than the pandemic itself…
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“…the H1N1 influenza and influenza generally is unpredictable...”
Dr. Anne Schuchat, CDC
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Pandemic Model York Region Impact
• 35% of the population, including YCH staff, will be infected during the first wave of pandemic influenza
• Need to MAXIMIZE CAPACITY to manage increased patient volumes in the face of depleted resources
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Summary
• H1N1 now the dominant virus strain
• Large populations susceptible to infection– Vaccine?
• Not the same as seasonal influenza– Age distribution
• Influenza is unpredictable
• Be prepared– Capacity, resources
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Summary
• What next…– Replay the Australian
experience?
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• http://www.sesamestreet.org/video_player?p_p_lifecycle=0&p_p_id=videoPlayer_WAR_sesameportlets4369&p_p_uid=140598a2-90b4-461f-82d4-53011bdf3849
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