omsi science pub - h1n1 flu
DESCRIPTION
"Spread the Word, Not the Flu: H1N1 and You" This Science Pub took place on Monday, November 2, 2009, at the Bagdad Theater in Portland, Oregon. It was presented by Gary Oxman, MD, MPH, and by Paul Lewis, MD, both from the Tri-county Health Officer Group of Clackamas, Multnomah, and Washington Counties. (There were some sound issues at the venue but this recording is clear.)TRANSCRIPT
Spread the Word-Not the fluNovember 2nd 2009OMSI Science Pub
Gary Oxman, MD, MPH
Paul Lewis, MDTri-county Health Officer Group
Clackamas, Multnomah, Washington Counties
Desired Outcomes for SessionParticipants will…
1. Be introduced to a framework for thinking about emergencies
2. Understand the basic science behind Influenza
3. Understand the current pandemic influenza situation
4. Become familiar with the Public Health response to H1N1
5. Have questions answered or acknowledged
H1N1 Preparedness & Response
A Framework for Action
Read this book!*
* Available in Paperback
The Unthinkable - Basics
• Through evolution, people are built to cope with disasters
• Individual capacity– We all can cope, but some cope better
than others– All of us can improve our coping capacity
• Group capacity– People naturally support each other to
cope with disaster
The Unthinkable - Basics
• Three stages of human response to disaster
1. Denial – not understanding the new realities
2. Deliberation – considering possible actions
3. Decisive moment – taking action
• Dysfunctional responses do occur– Inaction/paralysis – very common– Poor choices of action– Panic – rare
The UnthinkableTake away points
• People are built to cope with disaster
• Understand that the response is in ordinary people’s hands – your hands
• Be prepared; rehearse– Understand the situation– Have a focused, realistic plan
• When disaster happens, act on your plan! Listen to authorities, but don’t wait.
Influenza Basics
Influenza
Influenza Symptoms
• It's NOT the common cold– Fever, body aches, cough, sore throat– Notably ill for 3-5 days
• Diagnosis – by health care provider (lab tests usually not necessary)
• Great majority recover without treatment
Influenza Types & DefinitionsSeasonal Influenza• Occurs every year• Affects ~10-15% of population yearly • Kills ~36,000 people in the US every year
– mostly elderly• There is a vaccine every year
Pandemic Influenza• A world-wide outbreak of influenza• Occurs a few times per century• Caused by a new influenza virus strain• Illness can be mild to severe• Can affect ~20-35% of the population
Biology of Pandemics
Influenza Virus
Changes in the Flu Virus
• Drift: continuous small RNA mutations– H and N evolve during
and between seasons– Vaccine requires
frequent modification to be effective
– Over many years a specific H or N-type can become much different from its origin
• Drift: continuous small RNA mutations
• Shift: major changes – Non-human virus
infects humans– Combining of genes
between human and animal strains
– Shift required to produce a Pandemic
Earthquake fault, New ZeelandHealth Emergency Management, NZ
Changes in the Virus
Genesis of New Influenza A Virus Subtypes with Pandemic Potential
Gerberding, J. L. et al. N Engl J Med 2004;350:1236-1247
NIH Web conf
Pandemic H1N1 Genetic History
www.sciencexpress.org / 22 May 2009 / Page 4/ 10.1126/science.1176225
Current Situation
LikelyOriginWinter2009
•Rapid, global, spread April-June 2009•WHO declared pandemic in June •Overall severity mild•Shift in severe disease away from elderly•48 states in US reporting widespread flu activity at this time-very early
Current Flu Situation
Metro Area H1N1 Hospitalization and Vaccine Supply
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10
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50
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90
100
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Week Since Sept 1
Cas
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Per
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0–4 5–24 25–49 50–64 65+
Age (Years)
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Oregon H1N1April 2009-present
Portland tri-county 2005-2008
Hospitalizations by Age Group, Oregon*
*data as of 10/09/09*data as of 10/09/09
US Pandemic Severity Scale
Anticipated rangeof H1N1 severity during 2009-2010
How bad is it ?Assumptions:• 20 to 30% of the population will get influenza• Death rate is same as seasonal flu (0.05% or 1 in 2,000)• Metro area population is 2 million people
400,000- 600,000
Sick
1,400,000- 1,600,000
Well
200 - 300 Severely ill
or dead
Risk Factors
• Pregnancy• Heart disease• Kidney disease• Immune system
problems
• Diabetes • Obesity• Cancer• Asthma & other
lung diseases
About 2/3 of severe H1N1 illness and hospitalization impacts people with risk factors:
H1N1: Some Take-home Points
• Typical influenza virus with typical symptoms, complications – a “mild” influenza
• Can be treated with antiviral drugs• Most cases recover uneventfully• Compared with seasonal flu, shift to younger
ages for hospitalization and death
Public Health & Medical Response
Goals of Pandemic Response
• Minimizing death and disability as much as practical given available resources, and
• Maintaining an intact community – one that is poised to resume normal life physically, socially, economically, emotionally and spiritually following the pandemic
Public Health Response Strategies
1. Prevention through appropriate individual and institutional behaviors to protect self and others
2. Vaccination
3. Medical care to treat illness and prevent complications
Preventing Illness Through Appropriate Behavior
• The mantra– Wash you hands– Cover your cough– Stay home when you’re sick
• Sounds simple, but…”The choices people make are driven by the choices they have”
• Choice requires– Information for people (and their friends, family and
coworkers) – Supportive policies (e.g., sick time policies)– Absence of disincentives (e.g., losing pay or job)
ACIP H1N1 2009 Vaccine Recommendations
(not in order of priority)
• Pregnant women
• Live with or care for infants < 6 mo old
• Healthcare/EMS workers with direct contact with patients or infectious material
• People 6 months – 24 years old
• People 25 - 64 years old with high-risk medical conditions
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5810a1.htm
~50%Of USA
PH Strategy: Access to Medical Care
• Goals: – Treat illness– Prevent complications
• Two Approaches1. Providers continue to care for their
established patients– Anticipate surge in demand – visits calls– Plan ahead – office protocols, methods
for testing, prescribing antivirals2. Regional Access to Care initiative for those
without a medical home
Temporary healthcare reformAccess to care during a pandemic
Supporting PH Strategies
• Communication– Information for the public– Partner and Clinician outreach and
communication – e.g., detailed clinical practice guidelines
• PH surveillance and investigation– Tracking hospitalized cases, deaths –
now reportable– Tracking hospital/health care utilization– Outbreak investigation – selected
situations only
Questions and Dialogue