1. Pandemic (H1N1) Preparedness: Medical Aspects Dr. Esther Tan Medical Services Division 1

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3. What is the Pandemic H1N1 Virus? 3 H1N1 is a completely new strain of influenza virus Genetic material from pig, bird and human combined to form this unique strain Is very contagious, spreads from person-to- person through coughing or sneezing of ill persons Despite term “swine flu”: Infections not associated with contact with pigs or pork meat

4. So What? 4 This new influenza virus has already sparked a pandemic A pandemic is world-wide epidemic Results from emergence of a new virus in which overall population has that no immunity Severity can vary

5. Past Influenza Pandemics 1900 1850 1950 2000 1847 1889 1918 1957 1968 42 yrs 29 yrs 39 yrs 11 yrs Pandemic usually occur every 30 – 40 years Last Pandemic was ≈ 40 yrs ago, in 1968....

6. “2009 Flu Pandemic” Declared As of 25 Oct: >440,000 lab-confirmed cases 5700 deaths

7. What We Know About Pandemics More than one pandemic wave likely Can be weeks or months between waves Severity of waves unpredictable: subsequent wave could be worse than first Typically affects young, healthy adults (unlike regular seasonal flu) Severe wave Mild wave

8. Why Must the UN Prepare? A severe pandemic can have great impact on organization’s operations Social disruption due to fear and panic Routine life could be affected High absenteeism everywhere – staff focus on own families’ health 8 In March 2006, the Secretary-General directed all UN offices to prepare for a pandemic

9. Situation in the US April – July 2009: Est. 1.8-5.7 million cases 9000-21000 hospitalizations

10. 10 2006-07 2007-08 2008-09

11. 11 Spring outbreak: Est 750,000 to 1 mil cases Identified 930 hospitalized, 54 deaths ? Situation in NYC

12. H1N1 Compared With Seasonal Flu Cases So Far? Consistent with a pandemic, most cases identified are young, between 5 to 24 yrs, > 65 yrs not at risk 12

13. What To Expect For Upcoming Fall/Winter Season? Both seasonal influenza and pandemic H1N1 viruses will circulate H1N1 not likely to cause high rates of severe illness –Virus appears stable Number of people ill cannot be predicted 13

14. Some Facts About the Flu Virus 14

15. Common Flu Signs & Symptoms? Fever, chills, dry cough, sore throat Extreme fatigue Muscle/body aches, headache Stuffed/runny nose No appetite or desire to drink Nausea, vomiting and diarrhea especially in children Not every case will have fever 15 May need 1-2 weeks to recover 1-4 days incubation

16. Anyone who: –Has difficulty breathing or chest pain –Sudden dizziness –Is less responsive than normal or becomes confused –Severe or persistent vomiting and unable to keep liquids down –Has uncontrolled fits –Has signs of dehydration: dizziness when standing, absence of urination, or in infants a lack of tears when crying Warning Signs of Severe Disease?

17. Most cases recover without any treatment; if healthy with no underlying condition: “Rest it out” Staff at higher risk of severe disease: –Those > 65 years, or < 5 years of age –Anyone with lung, heart, kidney, liver or blood disorders, or diabetes –Anyone with a weak immune system –Pregnant women –Those <19 yrs on long-term aspirin therapy What Should I Do If I have Mild Flu? Contact your doctor as soon as possible!

18. Antiviral Medication (e.g. oseltamivir) 18 Reduces duration and severity of flu symptoms Currently not recommended for healthy persons with uncomplicated flu; only recommended for persons with flu and who are at at “higher risk” of severe symptoms NYC DOH and UNMS have enough stockpiles to treat all expected to be ill Consults with your family doctor for first line health services

19. Search for a local doctor and nearest hospital to where you live Use network of participating physicians under your health insurance plan to identify your doctor (http://www.un.org/Depts/oppba/accounts/insurance/heal thPlans.htm ).http://www.un.org/Depts/oppba/accounts/insurance/heal thPlans.htm Staff with no health insurance can look up the New York City Health and Hospitals Corporation (HHC) directory (http://www.nyc.gov/html/hhc/html/facilities/directory.sht mlhttp://www.nyc.gov/html/hhc/html/facilities/directory.sht ml Getting Prepared: Choosing A Local Health Care Provider

20. How Does the Flu Virus Spread? 1.Droplet transmission 2.Contact transmission 3.Airborne transmission 20

21. Droplet Transmission When ill person cough or sneezes, heavy droplets land on the mouth, eyes, nose of others Virus then enter the other person 21 3 feet

22. Contact Transmission Direct: Virus directly transferred from ill person to another person Indirect: Virus is on a surface, and person touches that surface 22

23. Be “Touch Aware” 23

24. Airborne Transmission Limited to healthcare or clinical laboratory settings Specific procedures can generate tiny “aerosols” that float in air and can be inhaled deep into lungs 24

25. Action Steps to Limit Influenza Exposure 25

26. Stay Home If Ill Stay home and do not come to work if you are ill Stay home until fever-free for 24 hrs, without use of fever medications 26 If staff is exposed to ill person, but is well with no flu symptoms, can still come to work

27. Cover When Cough/Sneeze Don’t use bare hands! Use disposable tissue or your sleeve 27

28. Wash Your Hands Frequently

29. Get Vaccinated – The Most Effective Strategy! 29

30. Influenza Vaccines This Season 30 Two types available this season: seasonal & pandemic (H1N1) flu Seasonal flu vaccine recommended for specific risk groups (elderly, very young, pregnant women) In initial period, due to limited supply, pandemic flu vaccine recommended only for specific groups (medical staff, pregnant women, those caring for children < 6 months..etc) [See 9 October iSeek post by MSD]

31. Pandemic H1N1 Vaccine 31 Two types – Flu shot (killed/inactivated virus) and Flu Mist/Nasal Spray (weakened virus) Persons with severe allergy to chicken eggs should not be vaccinated

32. Is the Pandemic H1N1 Vaccine Safe? 32 Manufactured in the same way, expected to have similar safety profile to seasonal flu vaccine; Side effects rare. If occurs, similar to seasonal flu vaccine: Soreness/redness/swelling, Headache, muscle aches Fever Nausea Life-threatening allergic reactions to vaccines very rare

33. Thimerasol in Vaccines Mercury-based preservative used in multi-dose vials to prevent contamination No scientific evidence of harm caused by the low doses of thimerosal in vaccines No conclusive scientific evidence that any vaccine or vaccine additive increases the risk of developing autism or any other behavior disorder Single-dose shots and nasal spray of the H1N1 vaccine does not contain thimerasol 33

34. Pandemic H1N1 Vaccine is Initially Recommended For: Pregnant women People 6 mths to 24 yrs People 25 to 64 yrs with chronic conditions –Asthma, diabetes, heart, kidney, neurologic, and immune system disorders People who live with or care for children less than 6 mths Healthcare workers and emergency medical responders 34

35. Where to Get Vaccinated? Your personal / family doctor, pediatrician, obstetrician UN Medical Services for seasonal flu vaccine NYC “Flu locator” (www.nyc.gov/flu) and other health departmentswww.nyc.gov/flu Pharmacies School-based vaccination 35

36. See ISeek Announcements on MSD Webpage 36

37. Use of Masks 37

38. Types of Masks Two Types: –Surgical masks or Respirators/N95 38

39. When To Use A Surgical Mask? 39 WHO: No scientific evidence that wearing surgical masks in community setting is effective Currently recommended only for ill persons and in health care settings and medical staff caring for suspected patients May still wish to wear it – but must remember it should be combined with other public health measures

40. Stockpile Supplies, including Surgical Masks 40

41. In Severe Flu Scenario 41

42. Possible Additional Actions by UN Implement social distancing in the workplace Enhanced workplace cleaning Active screening of staff before coming into workplace Establish separate “flu” clinic for symptomatic staff 42

43. In Case of Medical Emergencies No different from routine Follow instructions available on iSeek

44. Medical Emergency Protocol 1.Call 9-911 2.Render first aid assistance if you are trained 3.Call 3-5555 or 212-963-5555 (UN Fire & Safety Unit)

45. UN Pandemic Booklet http://www.un.org/staff/pandemic/

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