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Swine flu to boils it is reducing the risk that counts
Prepared by Peter MasseyCNC, Program Manager Health Protection
HNE Population HealthNov 2009
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Swine flu
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"In the absence of a pandemic, almost any preparation will smack of alarmism. If a pandemic does break out, nothing that’s been done will be enough.”
Tony Abbott, Pandemic influenza conference, Ottawa, 25 September 2005
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Influenza pandemics
1918-1919, Spanish Flu, H1N1
1957-1958, Asian Flu, H2N2
1968-1970, Hong Kong Flu, H3N2
2009-????, ‘Swine Flu,’ H1N1
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AHMPPI Pandemic projections
Based on a 1918 scenario:
40% attack rate (AUS 8.5million)
2.4% mortality (AUS 200,000)
Up to 50% absentee rate
Expect several waves
Economical impact lasting two years
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April 09: Mexico City – a state of emergency with 1.1% mortality rate
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AHMPPI Pandemic projections
Based on a 1918 scenario:
40% attack rate (AUS 8.5million)
1.1% mortality (AUS 100,000)
Up to 50% absentee rate
Expect several waves
Economical impact lasting two years
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Novel influenza strains are just one of many emerging diseases that we
face and which have to be addressed through disaster
preparedness and generic business continuity planning
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Hendra, ABL, Nipah….
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Encroachment on wildlife habitat
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Climate change
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Natural disasters
Storms 2007
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The 2009 Influenza Pandemic
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April 2009
Mexican deaths
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Where are the football crazy Mexicans?
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Outside the ground!!
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H1N109 Timelines
3/09 Outbreaks of H1N109 in Mexico
24/4/09 WHO informs Aus of new influenza strain
28/4/09 DELAY Phase implemented
-8/5/09 Activation: Call centre, GPs, Local Governments, national medical stockpile, Ref Labs
19/5/09 First Aus case
22/5/09 CONTAIN Phase implemented
25/5/09 Cases arrive on international flights & cruise ship
3/6/09 State of Origin in Melbourne
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There was a rugby player named KurtPlaying in Melbourne during the swine flu alertAlthough the virus was piddlyIt travelled back with young GiddlyTwas a cert it was the dirt on his shirt
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First confirmed case in Australia
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H1N109 Timelines (cont’d)
11/6/09 WHO declares a pandemic
06/09 Local transmission identified in Vic & NSW
06/09 Flu Clinics set up in many states
06/09 Massive influx of H1N1 lab requests
17/6/09 PROTECT Phase implemented
29/6/09 First H1N1 related death recorded
30/9/09 Vaccination roll out
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H1N1 (October 2009)
343,298 confirmed cases globally (Aus 36,910)
4,108 confirmed deaths globally (Aus 185)
198 countries, uneven impact
In Australia ~ 8-10% attack rate
Risk groups e.g. pregnancy, Indigenous
4,830 hospitalisations, 20% in ICU!
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The surveillance pyramid
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Emergency Department ILI presentations
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H1N1 '09 at 12/8/09 NSW Population(2009) vs HNE Hosp Admission vs ICU Admission (Aus & NZ)
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5
10
15
20
25
30
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0 to 14 years 15 years to24 years
25 years to34 years
35 years to44 years
45 years to54 years
55 years to64 years
65 years to74 years
75 years to84 years
85 years andover
Age Group
%
NSW Pop 2009
NSW Hosp (n=1043)
HNE Hosp (n=154)
ANZIC ICU (n=154)
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So what was different? pH1N1 vs seasonal flu:
– younger hospitalised, ICU & death
– pregnancy
– Indigenous people
– next waves
Did Tamiflu work?
Home isolation & home quarantine?
How would we go if pH1N1 and H5N1 mixed?
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Panvax Myths & facts
30 Sep 09 Myths v Facts presentationFinal.pdf
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Debriefs Between waves of pandemic is a great time to
debrief
What worked well at your Practice, what didn’t work so well and what needs to be changed?
What worked well with HNE services, what didn’t works o well and what needs to be changed?
Also, there is more to life than swine flu……
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Brucellosis Staying on the pig
theme….
Brucella suis in the Moree area
4 cases
All pig hunters
Some delays in diagnosis
Surveillance & testing project
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Q fever – not pigs! Table 1: Ongoing health
conditions in people notified with acute Q fever in the Hunter New England Area, 2007. Issue Number* Percent*
Fatigue 32 94%
Athralgia or
myalgia 20 59%
Fevers & sweats 9 26%
Endocarditis 1 3%
Total with ongoing
issues 34 100%
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HNE Q fever 2007 As a result of their Q fever illness 50/54 (93%)
people had time off work or school, with a median of 21 days off and a range of 2-296 days.
Twenty-nine respondents were hospitalised for a median six days and a range of 1-42 days.
At the time of the structured interviews (conducted 28-93 weeks after illness onset) 34/54 (63%) people reported they had not fully recovered.
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Figure 2: Age distribution of Q fever notifications, NSW, 1993-2007
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50
100
150
200
250
300
350
400
450
0-04yrs
05-09yrs
10-14yrs
15-19yrs
20-24yrs
25-29yrs
30-34yrs
35-39yrs
40-44yrs
45-49yrs
50-54yrs
55-59yrs
60-64yrs
65-69yrs
70-74yrs
75-79yrs
80-84yrs
85+yrs
No
tifi
cati
on
s
Q fever
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Some other issues….. caMRSA: what are the proven methods of
control???.................
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Pertussis Who needs preventative
treatment in a household with a confirmed case?
– Under 2 yr old is the decision point
Swab or serology?
– swab in first 3 weeks
– serology after that if needed
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Some other projects Acute Flacid Paralysis surveillance through ICUs
Polio virus in sewage
Effect of Rotavirus vaccine on gastro admissions for under 2 yr olds
Pneumococcal
Zoonotic potential of crypto on dairy or beef farms
Swine flu & Aboriginal communities (just to complete the circle of these slides…
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Acknowledgements With grateful acknowledgements of:
– David Durrheim & team at Public Health
– Deepal, Louise, Di
– Barwon Div GP
Hunter New England Population Health is a unit of the Hunter New England Area Health Service.
Supported by funding from NSW Health through the Hunter Medical Research Institute.
Developed in partnership with theUniversity of Newcastle.
