Pandemic Influenza Pandemic Influenza

Community Education, Prevention, Community Education, Prevention, and Planningand Planning

What is public health?What is public health?

•• As define by the Associated Schools of Public As define by the Associated Schools of Public Health:Health:–– Public health is the science and art of protecting and Public health is the science and art of protecting and

improving the health of communities improving the health of communities –– Helps improved the health and well being of allHelps improved the health and well being of all–– Aims to help people achieve a healthier lifestyleAims to help people achieve a healthier lifestyle

Who is public health?Who is public health?

–– Environmental HealthEnvironmental Health–– Disease ControlDisease Control–– Health Education and PromotionHealth Education and Promotion–– Epidemiology and BiostatisticsEpidemiology and Biostatistics–– Clinical CareClinical Care–– Maternal, Child & Adolescent Maternal, Child & Adolescent

HealthHealth

–– Injury PreventionInjury Prevention–– NutritionNutrition–– Emergency Preparedness and Emergency Preparedness and

ResponseResponse–– Emergency Medical ServicesEmergency Medical Services–– LaboratoryLaboratory–– And many other divisionsAnd many other divisions

A department and team of staff with diverse training and A department and team of staff with diverse training and backgrounds to monitor the health of the community.backgrounds to monitor the health of the community.

This includes practitioners in:This includes practitioners in:

Influenza Influenza

• Highly contagious, acute febrile respiratory illness

• Yearly seasonal occurrence (November-March)

• Passes from person to person• Infects all age groups• Considerable public health impact

Seasonal vs. Pandemic InfluenzaSeasonal vs. Pandemic Influenza

• Seasonal influenza: a respiratory illness that can be transmitted person to person. Most people have some immunity, and a vaccine is available.

• Pandemic Influenza: a virulent human flu that causes a global outbreak, or pandemic. Because there is little or no natural immunity, the disease can spread easily from person to person..

Average Annual Impact of Seasonal Average Annual Impact of Seasonal Influenza in US and CaliforniaInfluenza in US and California

• 5 – 20 percent of the population become infected• Over 200,000 hospitalized from flu complications

(California: 25,000)• Est. 36,000 Influenza related deaths

(California: 4,500)• Individual cases of influenza are not reportable but

outbreaks are reportable to Public Health• Individual influenza like illnesses are reported by

hospitals and various medical clinics using Reddinet

Prevention of InfluenzaPrevention of Influenza

•• Frequent hand washingFrequent hand washing•• Covering coughs and sneezesCovering coughs and sneezes•• Proper disposal of tissuesProper disposal of tissues•• Staying home from work/school if illStaying home from work/school if ill•• Utilization of appropriate personal Utilization of appropriate personal

protective equipment.protective equipment.

InterventionsInterventions

• Vaccination• Isolation • Quarantine • School Closures• Prohibit Mass Gatherings• Social Distancing • Proper hand hygiene and respiratory etiquette

Pandemic H1N1Pandemic H1N1

General InformationGeneral Information

• Influenza spreads from person to person• H1N1 virus is a type A influenza virus that

contains genes from pigs, birds, and humans• Over 70 countries have reported cases•• A person can be infectious 1 day before and up A person can be infectious 1 day before and up

to 7 days after onset of symptomsto 7 days after onset of symptoms•• Case definition: Person under 60 years of age Case definition: Person under 60 years of age

with fever with fever >> 100 F and cough100 F and cough

General InformationGeneral Information(continued)(continued)

•• Signs and SymptomsSigns and Symptoms–– Fever, sore throat, cough, runny or stuffy nose, body Fever, sore throat, cough, runny or stuffy nose, body

aches, headaches, chills, and fatigue.aches, headaches, chills, and fatigue.–– Diarrhea and vomiting may also be experienced.Diarrhea and vomiting may also be experienced.–– Severity of illness can range from mild to severe.Severity of illness can range from mild to severe.–– Severe disease with pneumonia, respiratory failure, Severe disease with pneumonia, respiratory failure,

and even death is possible and even death is possible

Riverside CountyRiverside CountySituational Status UpdateSituational Status Update

(As of (As of 09/30/200909/30/2009))

•• Probable Cases: Probable Cases: 7878Meets case definition and NP swab positive for Meets case definition and NP swab positive for Influenza A and nonInfluenza A and non--subtypeablesubtypeable

•• Confirmed Cases: Confirmed Cases: 403403Meets case definition and laboratoryMeets case definition and laboratory--confirmed H1N1 confirmed H1N1 Influenza Influenza

•• Deaths: Deaths: 77

For PerspectiveFor Perspective

•• On an annual basis in Riverside County there On an annual basis in Riverside County there are on average:are on average:–– 375 Influenza375 Influenza--related deathsrelated deaths–– 19,000 Emergency room visits for influenza19,000 Emergency room visits for influenza--likelike--

illness (ILI)illness (ILI)

Priority Groups for H1N1 VaccinePriority Groups for H1N1 Vaccine

•• Pregnant WomenPregnant Women•• Caretakers of children younger than 6 months of Caretakers of children younger than 6 months of

ageage•• Healthcare and emergency medical services Healthcare and emergency medical services

personnelpersonnel•• Persons between the age of 6 months and 24 years Persons between the age of 6 months and 24 years

oldold•• Persons ages of 25 through 64 years of age who are Persons ages of 25 through 64 years of age who are

at high risk (chronic health disorders or at high risk (chronic health disorders or compromised immune systems)compromised immune systems)

AntiviralsAntivirals

•• Not everyone with H1N1 Influenza Not everyone with H1N1 Influenza requires antiviralsrequires antivirals

•• Clinician evaluates for treatment based Clinician evaluates for treatment based on the patients severity of illnesson the patients severity of illness

Community MitigationCommunity Mitigation

•• Community EventsCommunity Events–– Request individuals with influenzaRequest individuals with influenza--likelike-- illness (ILI) not illness (ILI) not

attend community eventsattend community events–– Discourage going to emergency departmentDiscourage going to emergency department--unless very illunless very ill–– Take precautions to avoid exposure of othersTake precautions to avoid exposure of others

•• SchoolsSchools–– School dismissals will be evaluated on a caseSchool dismissals will be evaluated on a case--byby--case case

basisbasis–– Students and staff with influenzaStudents and staff with influenza--likelike--illness (ILI) illness (ILI)

should stay home until 24 hours after symptoms should stay home until 24 hours after symptoms have resolvedhave resolved

Community MitigationCommunity Mitigation

•• Isolation in Health Care SettingsIsolation in Health Care Settings–– Probable and confirmed cases must be isolated for 7 days Probable and confirmed cases must be isolated for 7 days

after onset of illness or 24 hours after symptoms resolved, after onset of illness or 24 hours after symptoms resolved, which ever is longerwhich ever is longer

•• QuarantineQuarantine–– Exposed individuals are asked to monitor for development of Exposed individuals are asked to monitor for development of

cough and fever for 7 days after last contact with probable or cough and fever for 7 days after last contact with probable or confirmed case.confirmed case.

–– Should stay home from work/school if symptoms developShould stay home from work/school if symptoms develop

Providing Care for the IllProviding Care for the Ill

•• Keep sick person away from othersKeep sick person away from others•• Sick should keep coughs covered and hands Sick should keep coughs covered and hands

cleanedcleaned•• No visitors for ill personsNo visitors for ill persons•• Avoid having pregnant women care for illAvoid having pregnant women care for ill•• Avoid close contact with ill, use face masks if Avoid close contact with ill, use face masks if

contact is necessarycontact is necessary•• Dispose of waste and keep the household and Dispose of waste and keep the household and

laundry cleanlaundry clean

Planning and PreparednessPlanning and Preparedness

Impact of Pandemic Influenza on Impact of Pandemic Influenza on SocietySociety

• Health Services• Businesses• Schools• Essential Services • Community Services• Community Activities • Transportation

Riverside County RolesRiverside County Roles

• Response to pandemic at local level• Pandemic emergency command and management• Emergency medical response• Pandemic flu surveillance• Maintenance of essential services• Communications• Antiviral and vaccine distribution• Response to healthcare surge capacity • Maintain essential health and medical services• Prepare and respond to possible second wave

Preparation for a PandemicPreparation for a Pandemic

• Seasonal flu precautions• Educate yourself and those around you• Personal preparedness • Community preparedness• Create flexible plans• Coordinate with other agencies

Community and Community and FaithFaith--Based OrganizationsBased Organizations

•• Guidance has been developed and Recommendations Guidance has been developed and Recommendations include:include:–– Spread the word about importance of vaccinationSpread the word about importance of vaccination–– Sponsor community forum to discuss and provided Sponsor community forum to discuss and provided

information about the fluinformation about the flu–– Encourage families to be prepared for the flu and have plans Encourage families to be prepared for the flu and have plans

in placein place–– Work with state, local, tribal, or territorial governments to Work with state, local, tribal, or territorial governments to

coordinate response efforts.coordinate response efforts.•• Further information may be obtained at:Further information may be obtained at:http://www.pandemicflu.gov/professional/community/cfboguidance.hhttp://www.pandemicflu.gov/professional/community/cfboguidance.html#Atml#A

Health Care WorkersHealth Care Workers•• Guidance for Health Care Workers in outpatient Guidance for Health Care Workers in outpatient

settings has been developed.settings has been developed.•• Recommendations include:Recommendations include:

–– The use of personal protective equipment (PPE)The use of personal protective equipment (PPE)•• Wearing of gloves, masks, goggles or face shields, gowns, and Wearing of gloves, masks, goggles or face shields, gowns, and

respiratorsrespirators–– Proper hand washing proceduresProper hand washing procedures–– Workers with febrile respiratory illness should be excluded Workers with febrile respiratory illness should be excluded

from work based upon facility guidelines. If H1N1 exposure from work based upon facility guidelines. If H1N1 exposure is suspected, personnel should not report to work for 7 days is suspected, personnel should not report to work for 7 days or until the resolution of symptoms, whichever is longer.or until the resolution of symptoms, whichever is longer.

•• Further information may be obtained at:Further information may be obtained at:http://www.cdc.gov/h1n1flu/guidelines_infection_control.htmhttp://www.cdc.gov/h1n1flu/guidelines_infection_control.htm

SchoolsSchools•• Guidance exists for child care centers, KGuidance exists for child care centers, K--12, and 12, and

college campuses.college campuses.•• Recommendations include:Recommendations include:

–– Vaccinations for those that can receive themVaccinations for those that can receive them–– Students must stay home when sickStudents must stay home when sick–– Conduct daily health checks on younger studentsConduct daily health checks on younger students–– Keep facilities cleanKeep facilities clean–– Consider school, program, and event closuresConsider school, program, and event closures

•• Further information may be obtained at:Further information may be obtained at:http://www.pandemicflu.gov/professional/school/childguidance.htmhttp://www.pandemicflu.gov/professional/school/childguidance.htmllhttp://www.pandemicflu.gov/professional/school/higheredguidance.http://www.pandemicflu.gov/professional/school/higheredguidance.htmlhtml

Medical Providers Medical Providers •• Develop a business continuity planDevelop a business continuity plan•• Communicate with employeesCommunicate with employees•• Ask sick employees to remain homeAsk sick employees to remain home•• Prepare to provide care to patients with H1N1, as well Prepare to provide care to patients with H1N1, as well

as surge in of patients and increased demand for care.as surge in of patients and increased demand for care.•• Provide seasonal and H1N1 vaccine to staffProvide seasonal and H1N1 vaccine to staff

–– Register for H1N1 VaccineRegister for H1N1 Vaccine–– CalPanFlu.orgCalPanFlu.org–– All providers must register on this siteAll providers must register on this site–– Requires M.D. licenseRequires M.D. license

•• Further information may be obtained at:Further information may be obtained at:http://www.cdc.gov/h1n1flu/10steps.htmhttp://www.cdc.gov/h1n1flu/10steps.htm

TravelersTravelers

•• Prepare for trip: Get vaccinated and consult with your Prepare for trip: Get vaccinated and consult with your provider.provider.

•• Check your own health: Do not travel if you are illCheck your own health: Do not travel if you are ill•• During your trip, follow local guidelinesDuring your trip, follow local guidelines•• Practice healthy habits to stop the spreadPractice healthy habits to stop the spread•• If you become ill with severe symptoms contact the US If you become ill with severe symptoms contact the US

embassy or consulate to identify local medical careembassy or consulate to identify local medical care•• When you return, monitor you health for 7 daysWhen you return, monitor you health for 7 days•• Further information may be obtained at:Further information may be obtained at:http://wwwnc.cdc.gov/travel/content/outbreakhttp://wwwnc.cdc.gov/travel/content/outbreak--notice/novelnotice/novel--h1n1h1n1--fluflu--globalglobal--

situation.aspxsituation.aspx

LetLet’’s prevent the flus prevent the flu

•• Public health is dedicated to serving the Public health is dedicated to serving the communitycommunity

•• By working together, we can prevent the spread By working together, we can prevent the spread of fluof flu–– Support vaccination effortsSupport vaccination efforts–– Create and foster community partnershipsCreate and foster community partnerships–– Ensure dissemination of information and Ensure dissemination of information and

recommendations to schools, health care providers, recommendations to schools, health care providers, media, and the communitymedia, and the community

Resources Resources

• www.cdc.gov/h1n1flu• www.who.int• www.pandemicflu.gov•• www.cdph.ca.govwww.cdph.ca.gov•• www.rivcoph.org/h1n1www.rivcoph.org/h1n1• Planning Tools: International, Federal, State and Local

pandemic flu plans• Individual, Business, School, Healthcare and

Community pandemic flu plans

Riverside County ProgramsRiverside County ProgramsContact InformationContact Information

helptalk@co.riverside.ca.ushelptalk@co.riverside.ca.us

Epidemiology Branch: Epidemiology Branch: (951) 358(951) 358--55575557www.rivcohealthdata.orgwww.rivcohealthdata.org

Public Health Emergency Preparedness and Response Public Health Emergency Preparedness and Response Branch:Branch: (951) 358(951) 358--7100 7100

www.rivcophepr.orgwww.rivcophepr.org

Disease Control Branch:Disease Control Branch: (951) 358(951) 358--51075107www.rivcowww.rivco--diseasecontrol.orgdiseasecontrol.org