This material is not to be reproduced without the permission of Exxon Mobil Corporation. H1N Influenza NOBODY GETS HURT EVERYBODY STAYS HEALTHY Objectives: Review H1N Influenza issues Discuss specific actions needed to protect worker health Richard O. Dockins, MD, MPH

2 Carrat, F. et al. Am. J. Epidemiol : Summary curves of viral shedding in experimental influenza virus infection, according to the virus type or subtype Peak infectivity is hours after infection and lasts ~ 8 days Obviously “sick” persons are more infectious than those mildly ill or those with no symptoms Close contact (living together) increases the risk of person to person transmission So... Don’t send obviously sick people offshore to live and work

3 Background EXXONMOBIL PROPRIETARY H1N The “spectrum of disease” Proportion of people affected Severity of illness mild Severe No or very mild symptoms Typical “cold” The “flu” At work Sick-unable to work Very ill, Hospitalized Some cases can be preventedfrom progressing to this stagewith early antiviral treatment - High risk people - Those with chest involvement So... Ensure workers have reliable access to early medical support - including anti-viral treatment if indicated.

4 What’s this all mean? Most infected people will stay well enough to come to work Infected people will show up at work not knowing they are infected but still able to spread the virus. Obviously “sick” people can clearly spread their infection to others Workers quartered offshore are at higher risk of person to person transmission due to close working and living conditions Some people that develop influenza like illnesses are at high risk of severe illness and may need to promptly start anti-viral treatment (no later than 48 hours after symptom onset).

5 Actions Advise everyone to try and get an H1N1 flu shot – only available through local health departments Implement improved hygiene measures to reduce the risk of person to person transmission on offshore facilities (hand washing, sanitizers, not sharing common utensils, cough precautions, etc.) Ensure obviously “sick” workers are not sent offshore to live and work. Implement procedures to isolate persons that develop influenza like illnesses while offshore to limit spread of the virus. Ensure people that develop influenza like illnesses while offshore promptly report and have access to medical support including anti- viral medications when indicated. NOBODY GETS HURT - EVERYBODY STAYS HEALTHY