Our vision: Healthier communities, Excellence in healthcare Our values: Teamwork, Honesty, Respect, Ethical, Excellence, Caring, Commitment, Courage Swine flu to boils it is reducing the risk that counts Prepared by Peter Massey CNC, Program Manager Health Protection HNE Population Health Nov 2009
3 "In the absence of a pandemic, almost any preparation will smack of alarmism. If a pandemic does break out, nothing thats been done will be enough. Tony Abbott, Pandemic influenza conference, Ottawa, 25 September 2005
4 Influenza pandemics 1918-1919, Spanish Flu, H1N1 1957-1958, Asian Flu, H2N2 1968-1970, Hong Kong Flu, H3N2 2009-????, Swine Flu, H1N1
5 AHMPPI Pandemic projections Based on a 1918 scenario: 40% attack rate (AUS 8.5million) 2.4% mortality (AUS 200,000) Up to 50% absentee rate Expect several waves Economical impact lasting two years
6 April 09: Mexico City – a state of emergency with 1.1% mortality rate
7 AHMPPI Pandemic projections Based on a 1918 scenario: 40% attack rate (AUS 8.5million) 1.1% mortality (AUS 100,000) Up to 50% absentee rate Expect several waves Economical impact lasting two years
18 H1N109 Timelines 3/09Outbreaks of H1N109 in Mexico 24/4/09WHO informs Aus of new influenza strain 28/4/09DELAY Phase implemented -8/5/09Activation: Call centre, GPs, Local Governments, national medical stockpile, Ref Labs 19/5/09First Aus case 22/5/09CONTAIN Phase implemented 25/5/09Cases arrive on international flights & cruise ship 3/6/09State of Origin in Melbourne
19 There was a rugby player named Kurt Playing in Melbourne during the swine flu alert Although the virus was piddly It travelled back with young Giddly Twas a cert it was the dirt on his shirt
21 H1N109 Timelines (contd) 11/6/09WHO declares a pandemic 06/09Local transmission identified in Vic & NSW 06/09Flu Clinics set up in many states 06/09Massive influx of H1N1 lab requests 17/6/09PROTECT Phase implemented 29/6/09First H1N1 related death recorded 30/9/09Vaccination roll out
22 H1N1 (October 2009) 343,298 confirmed cases globally (Aus 36,910) 4,108 confirmed deaths globally (Aus 185) 198 countries, uneven impact In Australia ~ 8-10% attack rate Risk groups e.g. pregnancy, Indigenous 4,830 hospitalisations, 20% in ICU!
27 So what was different? pH1N1 vs seasonal flu: –younger hospitalised, ICU & death –pregnancy –Indigenous people –next waves Did Tamiflu work? Home isolation & home quarantine? How would we go if pH1N1 and H5N1 mixed?
29 Debriefs Between waves of pandemic is a great time to debrief What worked well at your Practice, what didnt work so well and what needs to be changed? What worked well with HNE services, what didnt works o well and what needs to be changed? Also, there is more to life than swine flu……
30 Brucellosis Staying on the pig theme…. Brucella suis in the Moree area 4 cases All pig hunters Some delays in diagnosis Surveillance & testing project
31 Q fever – not pigs! Table 1: Ongoing health conditions in people notified with acute Q fever in the Hunter New England Area, 2007.
32 HNE Q fever 2007 As a result of their Q fever illness 50/54 (93%) people had time off work or school, with a median of 21 days off and a range of 2-296 days. Twenty-nine respondents were hospitalised for a median six days and a range of 1-42 days. At the time of the structured interviews (conducted 28-93 weeks after illness onset) 34/54 (63%) people reported they had not fully recovered.
34 Some other issues….. caMRSA: what are the proven methods of control???.................
35 Pertussis Who needs preventative treatment in a household with a confirmed case? –Under 2 yr old is the decision point Swab or serology? –swab in first 3 weeks –serology after that if needed
36 Some other projects Acute Flacid Paralysis surveillance through ICUs Polio virus in sewage Effect of Rotavirus vaccine on gastro admissions for under 2 yr olds Pneumococcal Zoonotic potential of crypto on dairy or beef farms Swine flu & Aboriginal communities (just to complete the circle of these slides…
37 Acknowledgements With grateful acknowledgements of: –David Durrheim & team at Public Health –Deepal, Louise, Di –Barwon Div GP Hunter New England Population Health is a unit of the Hunter New England Area Health Service. Supported by funding from NSW Health through the Hunter Medical Research Institute. Developed in partnership with the University of Newcastle.