Preparedness and Prevention for a Influenza Pandemic Hello, I am Katrina Rice a doctorate student with Walden University. Today, I would like to discuss how to prepare and prevent the spread of influenza within educational settings. Katrina Rice Doctorate Student Walden University PUBH-8165 Environmental Health

Target Audiences School Nurses Educators (e.g. teachers, child care takers) The targeted audiences of this presentations are school nurses, educators or anyone who provide child care support and guidance

Objectives What is an influenza pandemic? Ways to Significance of the pandemic Ways to Prepare for an influenza pandemic Prevent the spread of an influenza pandemic Above are the key objectives of the presentation. (Read objectives) Before we discuss how to prepare for and prevent the spread of an influenza pandemic within educational setting, it is important for us to understand what influenza is and why it is considered a pandemic.

What is influenza? Also called the “flu” Viral infection which affects the respiratory tract Symptoms can be mild to severe and can lead to death According to the CDC, within the United States yearly: 5% to 20% of the population gets the flu More than 200,000 people are hospitalized from flu-related complications Approximately 36,000 people die from flu-related causes Influenza or seasonal flu is a viral infection which affects the upper respiratory tract such as the nose, throat, and lungs. It is contagious and is caused by influenza viruses. Symptoms such as fever (often high), headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose can cause mild to severe illness, and at times can lead to death. Since January 2009, the "normal" seasonal flu has already killed 13,000. According to the CDC, the worldwide annual death from seasonal flu is estimated between 250,000 and 500,000. Center for Disease Control and Prevention (CDC). (2009). Seasonal Flu. Retrieved October 23, 2009, from http://www.cdc.gov/flu/keyfacts.htm

What is influenza? (cont’d) Three types of influenza viruses which infect humans: A, B, and C Influenza A viruses are further classified by subtype Influenza A subtypes and B viruses are further classified by strains. Subtypes of influenza A currently circulating worldwide include H1N1, H1N2, and H3N2 viruses H1N1 (Swine) flu is a new virus first seen in the US There are 3 types of influenza viruses which can be contracted by humans. These are A, B and C. Influenza A viruses are further classified by subtypes glycoproteins hemagglutinin (HA) and neuraminidase (NA). Further subtypes of A which are circulating are listed above. This year, the 2009 H1N1 flu virus is expected to cause more illness or more severe illness than usual. H1N1 is a new virus first seen in the United States and just as the seasonal flu it is contagious and spreads from person to person. Symptoms are similar to those of the seasonal flu. Center for Disease Control and Prevention (CDC). (2009). Avian Influenza (Flu) – Influenza Viruses. Retrieved October 23, 2009, from http://www.cdc.gov/flu/avian/gen-info/flu-viruses.htm FLU.gov (2009). About the Flu. Retrieved October 27, 2009, from http://www.flu.gov/individualfamily/about/index.html

What is a pandemic? Pandemic is defined as a worldwide epidemic of a disease An influenza pandemic may occur when a new influenza virus appears against which the human population has no immunity Such as in the case of the H1N1 As of June 11, 2009 the World Health Organization (WHO) declared a global pandemic of the H1N1 flu As of October 17, 2009 worldwide more than 414,000 laboratory cases of H1N1 have been confirmed Typically, a disease epidemic occurs when there are more cases of a disease than normal. A pandemic is a worldwide epidemic of a disease. A new influenza A(H1N1) virus has never before circulated among humans. This virus is not related to previous or current human seasonal influenza viruses. Because of this and the potential severity of the virus, the WHO declared a global pandemic of the H1N1 flu. As of October 17, 2009, worldwide there have been more than 414,000 laboratory confirmed cases of pandemic influenza H1N1 and nearly 5000 deaths reported to WHO. Since these are just laboratory cases, the number could be much higher. World Health Organization (WHO). (2009). Global Alert and Response (GAR) – Pandemic preparedness. Retrieved October 27, 2009, from http://www.who.int/csr/disease/influenza/pandemic/en/ World Health Organization (WHO). (2009). Global Alert and Response (GAR) – Pandemic (H1N1) 2009 update 71. Retrieved October 27, 2009, from http://www.who.int/csr/don/2009_10_23/en/index.html

Influenza pandemic preparation Know the facts Understand the difference between seasonal flu and H1N1 Develop communication tools Develop ways to increase social distances (space between students) Have PPE (personal protective equipment) such as masks and alcohol-based hand cleaners on hand Have cleaning supplies on hand Keep surfaces and class room items clean In order to effectively prepare for an influenza pandemic, above are a few key items to keep in mind. First and foremost is to know the facts, stay abreast of updated facts and statistics on the topic. Understand the difference between, for example the seasonal flu and H1N1. The seasonal flu is usually predictable, occurs at the same time of the year, therefore people are becoming immune to it. For H1N1,since new strains are occurring, people haven’t developed a natural immunity. Also, for the seasonal flu, vaccines are developed before the flu season, unlike the H1N1. Develop communications tools, letters to parents, website, recorded messages, etc. that can quickly be used to update parents and staff on new findings on the pandemic. Collaborate with other local and state educational authorities, if required to rearrange activities and events to increase social distances between students. Ensure teachers and school custodians keep surface areas which children are in constant contact thoroughly cleaned. Center for Disease Control and Prevention (CDC). (2009). Preparing for the Flu (Including the 2009 H1N1 Flu). [Electronic version]. Retrieved October 27, 2009, from http://www.cdc.gov/h1n1flu/schools/toolkit/pdf/schoolflutoolkit.pdf

Prevent the spread of influenza Advocate for the flu vaccine Educate students on proper hygiene Educate other teachers and staff to stay home when sick Be a good role model Collaborate with local public health officials There are many ways to help reduce the spread of influenza, which you as school nurses, educators and staff can assist with. A few points are listed above: The first is advocating for children and families to get the flu vaccine. According to the CDC, vaccination is the best method for preventing flu and its potentially severe complications in children. Be sure you get the flu vaccine as well. Remind children and the staff to cover their noses and mouths when coughing or sneezing and to wash their hands often or use alcohol-based hand cleaners. Also encourage students to attempt to apply social distances with other students, since close contact with others helps to continue the spread. Educate parents of sick children to keep the children home and away from the child care setting until the children have been without fever for at least 24 hours. Ensure parents check in with their personal health care provider since this time could be longer depending on the severity of the virus. Similarly, encourage sick care providers to stay home. Be a good role model. As discussed previous, get the flu vaccine. Stay home when sick, ensure children observe you using proper hygiene (e.g. washing your hands often, covering your nose and mouth when coughing and sneezing). Consult your local health department when increases in respiratory illness occur in the child care setting. Get recommendation and guidance from them on other ways to prevent the spread of influenza. Center for Disease Control and Prevention (CDC). (2009). Preventing the Spread of Influenza (the Flu) in Child Care Settings: Guidance for Administrators, Care Providers, and Other Staff. Retrieved October 27, 2009, from http://www.cdc.gov/flu/professionals/infectioncontrol/childcaresettings.htm

Summary An influenza pandemic is an epidemic of influenza virus, such as H1N1, that spreads on a worldwide scale The WHO declared H1N1 to be a global pandemic after significant evidence that is has affected over 414,000 people across 74 countries In summary, An influenza pandemic is an epidemic of influenza virus that spreads on a worldwide scale and infects a large proportion of the human population. Because of the worldwide impact of the H1N1, the WHO has declared this a global pandemic. Wikipedia , the free encyclopedia (2009). Influenza pandemic. Retrieved October 27, 2009, from http://en.wikipedia.org/wiki/Influenza_pandemic

Summary, cont. As school nurses and educators there are many ways you can help to prepare and prevent the continuous spread of the influenza pandemic. Some key ways include: Know the facts Advocate for children and families to get the flu vaccines Educate on proper hygiene Be a good role model As presented previous, as school nurses and educators you have an obligation to ensure the safety and well being of the children in your care.

Additional Resources Institute of Medicine (IOM). (2009). Pandemic Influenza – A Guide to Recent Institute Medicine Studies and Workshops Santa Clara Valley Health & Hospital System. (nd). Preparing for Pandemic Flu. Public Health Department. http://www.sccgov.org/SCC/docs%2FPublic%20Health%20Department%20(DEP)/attachments/PHPandemicEng.pdf Connecticut Department of Health. (2002-2009). CT Flu Watch. http://www.ct.gov/ctfluwatch/site/default.asp National Institute of Allergy and Infectious Diseases (NIAID). (2009). Flu Viruses Notoriously Unpredictable; Robust Pandemic Preparedness Efforts Critical. http://www.niaid.nih.gov In additional to the references provided on the following slides, above is a list of additional resources which can be beneficial in your understanding of this pandemic.

References Center for Disease Control and Prevention (CDC). (2009). Preventing the Spread of Influenza (the Flu) in Child Care Settings: Guidance for Administrators, Care Providers, and Other Staff. Retrieved October 27, 2009, from http://www.cdc.gov/flu/professionals/infectioncontrol/childcaresettings.htm Center for Disease Control and Prevention (CDC). (2009). Seasonal Flu. Retrieved October 23, 2009, from http://www.cdc.gov/flu/keyfacts.htm Center for Disease Control and Prevention (CDC). (2009). Avian Influenza (Flu) – Influenza Viruses. Retrieved October 23, 2009, from http://www.cdc.gov/flu/avian/gen-info/flu-viruses.htm FLU.gov (2009). About the Flu. Retrieved October 27, 2009, from http://www.flu.gov/individualfamily/about/index.html Wikipedia , the free encyclopedia (2009). Influenza pandemic. Retrieved October 27, 2009, from http://en.wikipedia.org/wiki/Influenza_pandemic World Health Organization (WHO). (2009). Global Alert and Response (GAR) – Pandemic preparedness. Retrieved October 27, 2009, from http://www.who.int/csr/disease/influenza/pandemic/en/