1. George A. Ralls M.D. Dave Freeman Health Services Department September 1st, 2009 INFLUENZA UPDATE

2. Brief History Current Situation Disease Projections Mitigation Efforts CDC Guidelines H1N1 INFLUENZA

3. PRESENTATION OUTLINE H1N1 INFLUENZA Brief History Current Situation Disease Projections Mitigation Efforts CDC Guidelines

4. March & April of 2009 –New form (Novel) of Influenza found to cause disease in Mexico and Southern US –Spread rapidly across North America By May 2009 “Swine Flu” identified in many areas of the world H1N1 INFLUENZA

5. Symptoms of H1N1 are similar to those of seasonal flu: Fever Cough Sore throat Runny or stuffy nose Body aches Headache Chills Fatigue H1N1 INFLUENZA

7. On June 11 th, 2009 the WHO declared a worldwide pandemic (pandemic level 6) –Uncontained community level transmission in many areas of the world H1N1 INFLUENZA

8. Symptoms no worse than seasonal flu Most patients recovered with no treatment Case mortality rate low Deaths in predisposed patients Reassuring early trends H1N1 INFLUENZA

9. PRESENTATION OUTLINE Brief History Current Situation Disease Projections Mitigation Efforts CDC Guidelines

10. 2185 Deaths Worldwide

12. Estimated over 1 Million infected in US since outbreak –8843 Hospital Admissions –556 deaths H1N1 INFLUENZA

14. 605 Hospital Admissions 66 Deaths Florida H1N1 INFLUENZA

15. % of Florida ED Visits for ILI

16. Seasonal Flu –vs- H1N1 Positive Tests

18. Florida H1N1 Deaths (N=66) H1N1 INFLUENZA

19. H1N1 Related Deaths (US) H1N1 INFLUENZA

20. PRESENTATION OUTLINE Brief History Current Situation Disease Projections Mitigation Efforts CDC Guidelines

22. 87.7% of US population is less than 65 years old H1N1 INFLUENZA Second Emergence

23. Deaths attributed to pneumonia and influenza are low and within bounds for what is expected in the summer

24. PRESENTATION OUTLINE Brief History Current Situation Disease Projections Mitigation Efforts CDC Guidelines

25. MITIGATION

28. Delivered in October or earlier? Distributed from FDOH Central Pharmacy Coordinated through CHDs Requires 2 shots – 28 days apart Priority groups for vaccinations H1N1 Vaccine

29. Pregnant women People who live with or care for children younger than 6 months of age Healthcare and emergency medical services personnel Persons between the ages of 6 months and 24 years old People ages of 25 through 64 years of age who are at higher risk because of chronic health disorders or impaired immune systems H1N1 Vaccine Priority Groups

30. Brief History Current Situation Disease Projections Mitigation Efforts CDC Guidelines H1N1 INFLUENZA

32. www.cdc.gov www.flu.gov

33. H1N1 INFLUENZA CDC Guidelines Parents & caregivers Pregnant women Clinicians Businesses & employers Schools, colleges & universities Persons with chronic conditions Travelers & travel industry

34. Sick persons should stay home Expect sick employees to be out for about 3 to 5 days in most cases Ensure that your sick leave policies are flexible Do not require a doctor’s note for workers who are ill with ILI to validate their illness or to return to work Employer Guidelines H1N1 INFLUENZA

35. Employees who are well but who have an ill family member at home with influenza can go to work Should monitor their health status closely & stay home if they become ill H1N1 INFLUENZA Employer Guidelines

36. H1N1 INFLUENZA Employer Guidelines Influenza widgets and /or links on Intranet

37. CDC recommends people with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F), or signs of a fever without the use of fever- reducing medications Persons NOT working in a Healthcare Setting Exclusion Period H1N1 INFLUENZA

38. Review and revise COOP Mass Vaccination for Priority Employees Employee Workplace Policies –Hygiene –Social Distancing –Don’t come to work when sick Personal Protection Equipment Work Force Protection H1N1 INFLUENZA

39. Cough or sneeze into tissue and throw it in trash or use upper arm if no tissue available Wash hands for 15-20 seconds or use alcohol- based hand gel often Keep hands away from eyes and mouth unless hands were washed Get a pneumonia shot if in high risk group: prevents secondary infections after the flu Avoid others if you are sick or if they are sick Develop an Individual/family plan What Can You Do Now?

40. Monitoring CDC and WHO influenza response recommendations and activities 25% of the SNS stockpile of antiviral drugs, personal protective equipment, and respiratory protection devices has been recieved –25% additional coming soon State and local public health agencies have been developing, exercising, and revising their mass vaccination plans since 2001 What is Florida Doing?

41. Orange County is reviewing and updating its response plan Surveillance for influenza is ongoing Currently working with local public health and hospital partners to identify gaps in preparedness and response Incident Management Team is organized and overseeing planning process What is Orange County ESF8 Doing?

42. SUMMARY Rapidly developing situation Develop good habits now Cover your cough Wash your hands Avoid touching your face Follow advice of public health officials Talk to a healthcare provider about “Flu” shots Stay informed www.cdc.gov www.flu.gov

43. Questions? H1N1 INFLUENZA