OMSI Science Pub - H1N1 Flu

35
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

description

"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

Page 1: OMSI Science Pub - H1N1 Flu

Spread the Word-Not the fluNovember 2nd 2009OMSI Science Pub

Gary Oxman, MD, MPH

Paul Lewis, MDTri-county Health Officer Group

Clackamas, Multnomah, Washington Counties

Page 2: OMSI Science Pub - H1N1 Flu

Desired Outcomes for SessionParticipants will…

1. Be introduced to a framework for thinking about emergencies

2. Understand the basic science behind Influenza

3. Understand the current pandemic influenza situation

4. Become familiar with the Public Health response to H1N1

5. Have questions answered or acknowledged

Page 3: OMSI Science Pub - H1N1 Flu

H1N1 Preparedness & Response

A Framework for Action

Read this book!*

* Available in Paperback

Page 4: OMSI Science Pub - H1N1 Flu

The Unthinkable - Basics

• 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

Page 5: OMSI Science Pub - H1N1 Flu

The Unthinkable - Basics

• Three stages of human response to disaster

1. Denial – not understanding the new realities

2. Deliberation – considering possible actions

3. Decisive moment – taking action

• Dysfunctional responses do occur– Inaction/paralysis – very common– Poor choices of action– Panic – rare

Page 6: OMSI Science Pub - H1N1 Flu

The UnthinkableTake away points

• People are built to cope with disaster

• Understand that the response is in ordinary people’s 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 don’t wait.

Page 7: OMSI Science Pub - H1N1 Flu

Influenza Basics

Page 8: OMSI Science Pub - H1N1 Flu

Influenza

Page 9: OMSI Science Pub - H1N1 Flu

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

Page 10: OMSI Science Pub - H1N1 Flu

Influenza Types & DefinitionsSeasonal 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

Page 11: OMSI Science Pub - H1N1 Flu

Biology of Pandemics

Page 12: OMSI Science Pub - H1N1 Flu

Influenza Virus

Page 13: OMSI Science Pub - H1N1 Flu

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

Page 14: OMSI Science Pub - H1N1 Flu

• 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 ZeelandHealth Emergency Management, NZ

Changes in the Virus

Page 15: OMSI Science Pub - H1N1 Flu

Genesis of New Influenza A Virus Subtypes with Pandemic Potential

Gerberding, J. L. et al. N Engl J Med 2004;350:1236-1247

Page 16: OMSI Science Pub - H1N1 Flu

NIH Web conf

Page 17: OMSI Science Pub - H1N1 Flu

Pandemic H1N1 Genetic History

www.sciencexpress.org / 22 May 2009 / Page 4/ 10.1126/science.1176225

Page 18: OMSI Science Pub - H1N1 Flu

Current Situation

Page 19: OMSI Science Pub - H1N1 Flu

LikelyOriginWinter2009

•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

Page 20: OMSI Science Pub - H1N1 Flu

Metro Area H1N1 Hospitalization and Vaccine Supply

0

10

20

30

40

50

60

70

80

90

100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Week Since Sept 1

Cas

es

0

10

20

30

40

50

60

70

80

90

100

Per

cen

t N

eed

ed V

acci

ne

Page 21: OMSI Science Pub - H1N1 Flu

0.00

10.00

20.00

30.00

40.00

50.00

0–4 5–24 25–49 50–64 65+

Age (Years)

Ho

spit

aliz

atio

ns

per

100

,000

Oregon H1N1April 2009-present

Portland tri-county 2005-2008

Hospitalizations by Age Group, Oregon*

*data as of 10/09/09*data as of 10/09/09

Page 22: OMSI Science Pub - H1N1 Flu

US Pandemic Severity Scale

Anticipated rangeof H1N1 severity during 2009-2010

Page 23: OMSI Science Pub - H1N1 Flu

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

Page 24: OMSI Science Pub - H1N1 Flu

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:

Page 25: OMSI Science Pub - H1N1 Flu

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

Page 26: OMSI Science Pub - H1N1 Flu

Public Health & Medical Response

Page 27: OMSI Science Pub - H1N1 Flu

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

Page 28: OMSI Science Pub - H1N1 Flu

Public Health Response Strategies

1. Prevention through appropriate individual and institutional behaviors to protect self and others

2. Vaccination

3. Medical care to treat illness and prevent complications

Page 29: OMSI Science Pub - H1N1 Flu

Preventing Illness Through Appropriate Behavior

• The mantra– Wash you hands– Cover your cough– Stay home when you’re sick

• Sounds simple, but…”The 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)

Page 30: OMSI Science Pub - H1N1 Flu

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

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5810a1.htm

~50%Of USA

Page 31: OMSI Science Pub - H1N1 Flu
Page 32: OMSI Science Pub - H1N1 Flu

PH Strategy: Access to Medical Care

• Goals: – Treat illness– Prevent complications

• Two Approaches1. Providers continue to care for their

established patients– Anticipate surge in demand – visits calls– Plan ahead – office protocols, methods

for testing, prescribing antivirals2. Regional Access to Care initiative for those

without a medical home

Page 33: OMSI Science Pub - H1N1 Flu

Temporary healthcare reformAccess to care during a pandemic

Page 34: OMSI Science Pub - H1N1 Flu

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

Page 35: OMSI Science Pub - H1N1 Flu

Questions and Dialogue