1. H1N1 Flu Update Jason Eberhart-Phillips, MD, MPH Director of Health and Kansas State Health Officer CHAC Immunization Advisory Committee February 19, 2010

2. A Whole New Kind of Flu Global emergence of an entirely new flu virus By sheer luck this virus is not usually a killer –100 times less lethal than the 1918 flu virus Still, by mid-January –>57 million cases in US –257,000 hospitalizations –About 11,690 deaths

3. The “Second Wave” is Over

4. Where We Were at the Peak

5. Where We Are Now

6. Nearly Every Place Touched

7. Schools on the Front Line

8. Absenteeism in October

9. Absenteeism Now

10. What’s Next? Pandemic behavior is never predictable –H1N1 is still here, it will be back, and will be in the 2010-11 flu vaccine –Up to half of the KS population is still susceptible to H1N1 –Window of opportunity now for vaccine before a possible ‘third wave’

11. R 0 1.3 R 0 1.8 Proportion with Natural and Vaccine- Induced Immunity, by State Assuming 60% of ILI is flu and 20% of those infected are asymptomatic as of December 13, 2009 % of immunity in the population necessary to interrupt transmission Kansas

12. % of immunity in the population necessary to interrupt transmission R 0 1.3 R 0 1.8 Proportion with Natural and Vaccine- Induced Immunity, by State Assuming 60% of ILI is flu and 50% of those infected are asymptomatic as of December 13, 2009 Kansas

13. A Lot of Immunity Out There!

14. Controlling the Pandemic A 3-step approach –Vaccination, which is safe and effective –Non-pharmacologic measures such as covering coughs, washing hands often, and staying home if ill –Correct use of antiviral drugs, if prescribed

15. Voluntary network of hospitals, pharmacies and clinics making flu-fighting medications available at little or no cost from stockpile Antivirals for All in Need

16. Vaccine: A Huge Success In just over 3 months >889,000 vaccine doses have been distributed! –An unprecedented statewide mobilization –Every county health department in the lead –>1000 private providers –1000s of volunteers staffing public clinics

17. KS Vaccine Uptake So Far

18. Vaccine Supply and Demand

19. Some Way Still to Go...

20. A Communication Challenge Overcoming obstacles to flu immunization –Communicating the real risks from infection –Being clear that the vaccine is much safer than getting the disease –Serious harm from the vaccine is extremely rare, if it occurs at all –Supply is now ample!

21. Safe? Here’s How Safe It Is VAERS Data 01/22/10 –After ~122 million doses shipped out, just 8,755 adverse event reports –Of these, only 564 (6%) are considered “serious” –No common cause or pattern to suggest these were caused by vaccine –Monitoring continues

22. Pandemic Reflections So far In the lull, whether or not a third wave hits, –How did we do? –Did we react too slow, too aggressively? –Did we provide good information, dispel false rumors, alert but not alarm the public? –What would we do differently next time?

23. Luck Has Been on Our Side… Disease virulence is low Virus is genetically stable Transmissibility is high, but could’ve been higher Vaccine induces a strong, fast, immune response Most people require only a single dose of vaccine It is as safe as expected

24. …Most of the Time! Predictions of ample vaccine supplies were wildly optimistic –Up to 160 million doses expected by October 31 –Got less than 30 million –One of the poorest producing vaccine virus strains ever seen –Just 0.2 - 0.6 doses/egg

25. Lessons Learned Already Preparation pays –Plans, drills, exercises in advance of a crisis really help when the crisis comes –Politics sometimes trumps good plans, however Risk communication is a challenge –Media/public interest is fickle, fades quickly –Vaccine risks are magnified when disease risk is considered low, when disease is absent or mild –People don’t always act in their own self interest State/Local alliance is essential for success

26. www.kdheks.gov To Protect the Health and Environment of all Kansans by Promoting Responsible Choices Thank You For Listening!