OMSI Science Pub - H1N1 Flu

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"Spread the Word, Not the Flu: H1N1 and You" This Science Pub took place on Monday, November 2, 2009, at the Bagdad Theater in Portland, Oregon. It was presented by Gary Oxman, MD, MPH, and by Paul Lewis, MD, both from the Tri-county Health Officer Group of Clackamas, Multnomah, and Washington Counties. (There were some sound issues at the venue but this recording is clear.)

Transcript of OMSI Science Pub - H1N1 Flu

  • 1.Spread the Word-Not the flu November 2nd 2009 OMSI Science Pub Gary Oxman, MD, MPH Paul Lewis, MD Tri-county Health Officer Group Clackamas, Multnomah, Washington Counties

2. Desired Outcomes for Session Participants will

  • Be introduced to a framework for thinking about emergencies
  • Understand the basic science behind Influenza
  • Understand the current pandemic influenza situation
  • Become familiar with the Public Health response to H1N1
  • Have questions answered or acknowledged

3. H1N1 Preparedness & Response A Framework for Action Read this book!* * Available in Paperback 4. The Unthinkable- B asics

  • Through evolution, people are built to cope with disasters
  • Individual capacity
    • We all can cope, but some cope better than others
    • All of us can improve our coping capacity
  • Group capacity
    • People naturally support each other to cope with disaster

5. The Unthinkable -Basics

  • Three stages of human response to disaster
    • Denial not understanding the new realities
    • Deliberation considering possible actions
    • Decisive moment taking action
  • Dysfunctional responses do occur
    • Inaction/paralysis very common
    • Poor choices of action
    • Panic rare

6. The Unthinkable Take away points

  • People are built to cope with disaster
  • Understand that the response is in ordinary peoples hands your hands
  • Be prepared; rehearse
    • Understand the situation
    • Have a focused, realistic plan
  • When disaster happens, act on your plan!Listen to authorities, but dont wait.

7. Influenza Basics 8. Influenza 9. Influenza Symptoms

  • It's NOT the common cold
    • Fever, body aches, cough, sore throat
    • Notably ill for 3-5 days
  • Diagnosis by health care provider (lab tests usually not necessary)
  • Great majority recover without treatment

10. Influenza Types & Definitions

  • Seasonal Influenza
  • Occurs every year
  • Affects ~10-15% of population yearly
  • Kills ~36,000 people in the US every year mostly elderly
  • There is a vaccine every year
  • Pandemic Influenza
  • A world-wide outbreak of influenza
  • Occurs a few times per century
  • Caused by a new influenza virus strain
  • Illness can be mild to severe
  • Can affect ~20-35% of the population

11. Biology of Pandemics 12. Influenza Virus 13. Changes in the Flu Virus

  • Drift: continuous small RNA mutations
    • H and N evolve during and between seasons
    • Vaccine requires frequent modification to be effective
    • Over many years a specific H or N-type can become much different from its origin


  • Drift: continuous small RNA mutations
  • Shift: major changes
    • Non-human virus infects humans
    • Combining of genes between human and animal strains
    • Shift required to produce a Pandemic

Earthquake fault, New Zeeland Health Emergency Management, NZ Changes in the Virus 15. Genesis of New Influenza A Virus Subtypes with Pandemic Potential Gerberding, J. L. et al. N Engl J Med 2004;350:1236-1247 16. NIH Web conf 17. Pandemic H1N1 Genetic History / 22 May 2009 / Page 4/ 10.1126/science.1176225 18. Current Situation 19. Likely Origin Winter 2009

  • Rapid, global, spread April-June 2009
  • WHO declared pandemic in June
  • Overall severity mild
  • Shift in severe disease away from elderly
  • 48 states in US reporting widespread flu activity at this time-very early

Current Flu Situation 20. 21. Hospitalizations byAge Group, Oregon* *data as of 10/09/09 22. US Pandemic Severity Scale Anticipated range of H1N1 severity during 2009-2010 23. How bad is it ?

  • Assumptions:
  • 20 to 30% of the population will get influenza
  • Death rate is same as seasonal flu (0.05% or 1 in 2,000)
  • Metro area population is 2 million people

400,000- 600,000 Sick 1,400,000- 1,600,000 Well 200 - 300 Severely ill or dead 24. Risk Factors

    • Pregnancy
    • Heart disease
    • Kidney disease
    • Immune system problems
    • Diabetes
    • Obesity
    • Cancer
    • Asthma & other lung diseases

About 2/3 of severe H1N1 illness and hospitalization impacts people with risk factors: 25. H1N1: Some Take-home Points

  • Typical influenza virus with typical symptoms, complications a mild influenza
  • Can be treated with antiviral drugs
  • Most cases recover uneventfully
  • Compared with seasonal flu, shift to younger ages for hospitalization and death

26. Public Health & Medical Response 27. Goals of Pandemic Response

  • Minimizing death and disability as much as practical given available resources, and
  • Maintaining an intact community one that is poised to resume normal life physically, socially, economically, emotionally and spiritually following the pandemic

28. Public Health Response Strategies

  • Prevention through appropriate individual and institutional behaviors to protect self andothers
  • Vaccination
  • Medical care to treat illness and prevent complications

29. Preventing Illness Through Appropriate Behavior

  • The mantra
    • Wash you hands
    • Cover your cough
    • Stay home when youre sick
  • Sounds simple, butThe choices people make are driven by the choices they have
  • Choice requires
    • Information for people (and their friends, family and coworkers)
    • Supportive policies (e.g., sick time policies)
    • Absence of disincentives (e.g., losing pay or job)

30. ACIP H1N1 2009 Vaccine Recommendations (not in order of priority)

  • Pregnant women
  • Live with or care for infants < 6 mo old
  • Healthcare/EMS workers with direct contact with patients or infectious material
  • People 6 months 24 years old
  • People 25 - 64 years old with high-risk medical conditions ~ 50% Of USA 31. 32. PH Strategy: Access toMedical Care

  • Goals:
    • Treat illness
    • Prevent complications
  • Two Approaches
    • Providers continue to care for their established patients
      • Anticipate surge in demand visits calls
      • Plan ahead office protocols, methods for testing, prescribing antivirals
    • Regional Access to Care initiative for those without a medical home

33. Temporary healthcare reform Access to care during a pandemic 34. Supporting PH Strategies

  • Communication
    • Information for the public
    • Partner and Clinician outreach and communication e.g., detailed clinical practice guidelines
  • PH surveillance and investigation
    • Tracking hospitalized cases, deaths now reportable
    • Tracking hospital/health care utilization
    • Outbreak investigation selected situations only

35. Questions and Dialogue