1. Seasonal & H1N1 Influenza Gail Jackson, RN, BSN, CIC Infection Control Coordinator Newport Hospital

2. What are the differences between Seasonal flu and Pandemic (H1N1) Influenza? Seasonal influenza Occurs every year Occurs every year The type of flu people are accustomed to so they usually have some immunity built up from previous exposures The type of flu people are accustomed to so they usually have some immunity built up from previous exposures Healthy adults usually not at risk for serious complications Healthy adults usually not at risk for serious complications Vaccine available Vaccine available Pandemic influenza Occurs rarely (only 3 in 20th century) Occurs rarely (only 3 in 20th century) Worldwide outbreak of a new human flu virus so people have little or no immunity Worldwide outbreak of a new human flu virus so people have little or no immunity Healthy people may be at increased risk for serious complications Healthy people may be at increased risk for serious complications No Vaccine previously available No Vaccine previously available

3. new A global outbreak of disease that occurs when a new influenza A virus (one that has never circulated among people) appears in the human population, causes serious illness and then spreads easily from person to person worldwide. 1918 - Spanish Flu 1957 - Asian Flu 1968 - Hong Kong Flu H1N1 (Pandemic) Influenza (definition)

4. Seasonal Influenza  36,000 deaths in the U.S. per year.  120,000 hospitalizations per year.  Usually lasts from November-March.  Flu vaccine helps protect against virus.

5. H1N1 Influenza (Background)  The first cases of H1N1 in the US were found in April 2009 in California and Texas.  The virus has spread rapidly and is now is widespread in the US and internationally.  H1N1 flu appears to infect younger people at a higher rate than older people, who may have some existing immunity from previous infections and vaccinations.

15. How does H1N1 Influenza spread?  This virus is thought to spread the same way seasonal flu spreads - primarily through respiratory droplets: Coughing Coughing Sneezing Sneezing Touching respiratory droplets on yourself, another person, or an object, then touching mucus membranes (e.g., mouth, nose, eyes) without washing your hands Touching respiratory droplets on yourself, another person, or an object, then touching mucus membranes (e.g., mouth, nose, eyes) without washing your hands

16. Signs and Symptoms Symptoms of novel H1N1 flu in people are similar to those associated with seasonal flu. Fever (> 100.0) Cough Sore throat Runny or stuffy nose Body aches Headache Chills Fatigue In addition, vomiting (25%) and diarrhea (25%) have been reported. (Higher rate than for seasonal flu.)

17. High Risk Groups  Pregnant women  Persons aged 6 months – 24 years of age  Persons who live with or provide care for infants <6 months of age  Healthcare workers and 1st responders  Persons 25-64 years who have medical conditions that put them at higher risk for influenza-related complications

18. H1N1 Vaccine  The H1N1 vaccine is made using the same manufacturing process used for seasonal flu vaccine.  CDC reports that almost all of the influenza viruses identified so far are 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine viruses  Children younger than 10 will need two doses.

19. H1N1 Vaccine Distribution Plan Children (6 mos–5 yrs) - Pediatric health care providers Children (6 mos–5 yrs) - Pediatric health care providers Children (K-12) - School vaccination clinics Children (K-12) - School vaccination clinics Pregnant Women - Prenatal care providers Pregnant Women - Prenatal care providers Young adults (19-24) - School and public clinics Young adults (19-24) - School and public clinics Caregivers of infants younger than 6 months - Health Caregivers of infants younger than 6 months - Health care provider offices and public clinics care provider offices and public clinics Healthcare workers and 1st responders – POD and Healthcare workers and 1st responders – POD and hospital based clinic hospital based clinic

20. School Vaccination Schedule NEWPORT 11/6 - Sullivan School 11/19- Coggeshall School 11/30 - Thompson Middle School 12/7 - Cranston - Calvert School 12/9 - Underwood School 12/9 - Cluny School 12/10 - Rogers High School 12/10 - St. Michael's School MIDDLETOWN 11/4- Aquidneck School 11/18 - All Saints Academy 11/23- Gaudet Middle School 11/30 - Middletown High School 12/2- Forest Avenue School 12/2 - St. George's School 12/7 - Valley Community School

21. PORTSMOUTH 11/3/2009 - The Pennfield School 11/19/2009 – Melville Elementary School 11/19/2009 - St. Philomena School 12/1/2009 - Portsmouth High School 12/1/2009 - Portsmouth Abbey School 12/1/2009 - Aquidneck Island Christian Academy 12/3/2009 - Howard Hathaway School 12/10/2009 - Elmhurst School 12/15/2009 - Portsmouth Middle School JAMESTOWN 11/3 - Jamestown School - Melrose 11/16 - Jamestown School - Lawn

22. If You Have Influenza-Like-Illness  REST.  Drink plenty of fluids.  “Cover Your Cough”  Stay home from school, work, etc. for at least 24 hours after your fever is gone (without the use of fever reducing medicines).  Read the “When to Call Your Doctor” handout from the RI Department of Health.

23. Watch for Emergency Warning Signs Most people should be able to recover at home, but watch for emergency warning signs that mean you should seek immediate medical care. In adults:   Difficulty breathing or shortness of breath   Pain or pressure in the chest or abdomen   Sudden dizziness   Confusion   Severe or persistent vomiting

24. Emergency Warning Signs in Children Fast breathing or trouble breathing Fast breathing or trouble breathing Bluish color on skin or around mouth and lips Dehydration (no tears, dried lips and mouth, not drinking enough fluids) Not waking up or not interacting Being so irritable that child does not want to be held Flu-like symptoms improve but then return with fever and a worse cough Fever with a rash If a child gets sick and experiences any of these If a child gets sick and experiences any of these warning signs, seek emergency medical care. warning signs, seek emergency medical care.

25. Care of Patients in the Hospital with Influenza-Like-Illness  Mask the Patient in ED/Admitting  Admit on Droplet Precautions (orange sign)  HCWs Wear Mask with Eye Protection  Patient wears mask when out of room  Visitor Restriction  HAND HYGIENE

27. How to Protect Yourself and Your Family  Receive the seasonal influenza vaccine.  Receive the H1N1 vaccine when it is available to you.  Sneeze and cough into your elbow. If you have a tissue available, cover your mouth and nose when you sneeze or cough. Throw the tissue in the trash after you use it.  Wash your hands with soap and water or use a hand sanitizer often, especially after you cough or sneeze.  Avoid touching your eyes, nose, or mouth.  If you are sick, keep away from others as much as possible to keep from making others sick.

28. Questions? www.health.ri.gov www.cdc.gov gjackson@lifespan.org 845-1557