Stay Healthy This Flu Season Public Health Preparedness & Planning October 12th, 2009 Nina M. Oliver, MS Rowan County Health Dept.

Overview: Define “the flu.” Describe the illness caused by influenza Explain how influenza spreads Discuss medications used to prevent the flu Discuss how to protect yourself

What is ‘the flu’? An illness caused by the influenza virus. Affects nose, throat, air passages, and lung Abrupt onset of fever, cough, sore throat, chills, and body aches Not typically associated with vomiting or diarrhea Yearly epidemics In the U.S each year: -36,000 deaths -200,000 hospitalizations 3 3

What are the symptoms of influenza? Sudden fever, muscle aches, headache, lack of energy, dry cough, sore throat, runny nose Supportive care: Rest, fluids, anti-cough, anti-fever meds Antivirals if you have had symptoms less then 48 hours Source: Centers for Disease Control and Prevention www.cdc.gov/flu/ Source: CDC Flu Factsheet http://www.cdc.gov/flu/ 4 4

Are there different types of flu? Answer: Yes! Type A– moderate to severe illness All age groups Humans and other animals Type B– milder epidemics Humans only Primarily affects children Type C– rarely reported in humans No epidemics ABC's

How Flu Spreads Large droplet mostly Generated by coughing, sneezing, talking “spitting distance” Rarely ‘airborne’ Contact with contaminated hands or surfaces Examples: Contaminated hands, toys, doorknobs, keyboards Source: U.S. Department of Health & Human Services www.hhs.gov/pandemicflu 6 6

What is the difference between an epidemic and pandemic? Epidemics occur every year due to minor changes in influenza A viruses that circulate; it is wide- spread, but not worldwide. Pandemics happen only occasionally when a completely new influenza A virus circulates. It is worldwide/ global Influenza epidemics and pandemics differ primarily in scope and the mechanisms by which they occur. Epidemics occur every year due to minor changes (AKA mutations) in the influenza viruses that circulate. This results in an upswing of cases over about 6 weeks in a given community with an associated increase in hospitalizations and deaths. By contrast, pandemics happen only occasionally when a completely new influenza virus starts to circulate resulting in a really large worldwide epidemic often with multiple waves of illness. Pandemics result in more severe illnesses and more deaths than usual…especially if both the H and N components are novel. There were 3 pandemics in the last century. 7

What is required for a pandemic to occur? Answer: A new virus with person-to-person spread. Novel virus to which population has little or no immunity Virus that spreads quickly and widely Virus must be capable of sustained person-to-person transmission The H1N1 virus has a high likelihood of becoming the next pandemic strain of influenza. 8

Influenza Pandemics 20th Century Credit: US National Museum of Health and Medicine 1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu” A(H1N1) A(H2N2) A(H3N2) 20-40 m deaths 675,000 US deaths 1-4 m deaths 70,000 US deaths 1-4 m deaths 34,000 US deaths

Who is Most Affected?

Vaccine and Antivirals Can not make vaccine until viral strain is identified Vaccine grown in eggs Very long process (3-9 Months) An injectable vaccine and nasal spray is available to prevent H1N1 flu Flu vaccine is made in hen's egg. image: CDC

Antivirals Concerns: Anti-virals help to: Prevent the flu Treat the flu Eases Flu Symptoms Concerns: Have to take it within 48-hours of symptom onset Will need MASSIVE amounts (10 pills per person for treatment and 40 for prevention) Expensive

Who should get the H1N1 vaccine? Target groups have been identified by the Center for Disease Control and Prevention (CDC): Pregnant women Household contacts and caregivers for children younger than 6 months of age Healthcare and emergency medical services personnel Persons 6 months through 24 years of age Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza. Everyone should get the seasonal vaccine!

If I get sick with the flu, when should I call my provider? If you have difficulty breathing If unable to drink fluids, have dark urine, or feel dizzy when standing (signs of dehydration) If you have a fever for more than 3 to 5 days If you start to recover from the flu symptoms and you get fever again. Dizziness or confusion

Influenza. Don't let it catch you! Flu Prevention: Influenza. Don't let it catch you! 

Prevention: What Can You Do? 16

Prevention Step #1 Maintain a healthy lifestyle through rest, diet, exercise, and relaxation. 17

Prevention Step #2 Wash your hands frequently with soap and warm water for 20 seconds. 18

Alcohol-based hand sanitizers An excellent alternative to hand washing - when soap and water aren't available. Apply about 1/2 teaspoon of the product to the palm of your hand. Rub your hands together, covering all surfaces of your hands, until they're dry. Bottle must contain at least 60% alcohol. 19

Help children wash their hands for about 15 seconds or long enough to sing the ‘Happy Birthday’ song twice. A Must: Warm water and soap 20

Prevention Step #3 Avoid touching your nose, mouth, and eyes. Germs spread this way. 21

Prevention Step #4 Cover your coughs and sneezes with a tissue, or cough and sneeze into your elbow. 22

What's wrong with this picture? 23

Prevention Step #5 Keep frequently touched common surfaces clean, such as telephones, computer keyboards, doorknobs, etc. 24

Where Do Germs Live? Germs can stay alive for hours, even days, on … Door knobs Chairs Light switches Bathroom Eating tables Sinks Soft and hard toys Faucets Floors Changing tables Tables Telephones Keyboards, etc. 25

Stay home at least 24 hours after you are free of fever and cough Prevention Step #6 Don't spread the flu! If you are sick with flu-like illness, stay home. Symptoms include: Fever (100 degrees Fahrenheit or 38 degrees Celsius) Chills and cough or sore throat. Stay home at least 24 hours after you are free of fever and cough 26

Prevention Step #7 Get vaccinated against seasonal flu and H1N1 when a vaccine is available (if you fall into the priority groups). 27

Prevention Step #8 Create a Preparedness Kit/Plan: Identification; Medication that you are taking or need Health conditions; Allergies, etc. Next of kin contact information 28 28

Preparedness and Partners: Rowan County Telecommunications Rowan County Emergency Services Rowan County Sheriff Salisbury Police Dept Rowan Rescue Squad American Red Cross Rowan-Salisbury School System Rowan Cabarrus Community College Rowan County IT NC Highway Patrol Dept. of Social Services Daymark Recovery Health City of Salisbury Food Lion LLC Spencer Police China Grove Police Livingstone College VA Hospital Rowan Regional Medical Center

Questions? Nina Oliver, MS Preparedness Coordinator 704-216-8811 Nina.oliver@rowancountync.gov www.rowancountync.gov/healthdepartment