WASHTENAW COUNTY PUBLIC HEALTHDIANA TORRES-BURGOS, MEDICAL DIRECTORRICHARD FLEECE, INTERIM HEALTH OFFICER

CINDRA JAMES, EP COORDINATORWISD

8/5/09

H1N1 Influenza A Updates: Schools & Fall Flu Season

Overview

H1N1 Influenza A and Seasonal InfluenzaH1N1 Activity Statistics and UpdatesInfluenza Prevention Strategies

Antivirals Vaccines

Public Health Preparation & PlanningSchool Preparation & PlanningRecommendationsDiscussions/ Q & A

What is Novel Influenza A H1N1?

Pandemic Influenza A H1N1 is a new strain of the flu that contains genetic fragments from birds, pigs, and humans and was first detected in April, 2009.

Signs and Symptoms

Fever CoughSore ThroatVomitingBody acheDiarrheaLethargy

How does it spread?

Thought to be spread in the same way that seasonal flu spreads

Mainly from person to person when an infected person coughs or sneezes and spreads tiny particles into the air

Sometimes by touching contaminated surfaces with flu viruses, and then touching one’s mouth, nose or eyes

How long is a person infectious and can spread to others?

Up to 7 days after they become sickChildren, especially infants, may be

contagious for longer periodsViruses can live 2 - 8 hours on surfaces like

tables, desks, and doorknobsOn hard non porous surfaces may live up to

48-72 hours

Influenza A H1N1 and Seasonal Flu

H1N1 influenza A is different from seasonal flu because: It is a new strain of the virus Most people do not have immunity to it Immunizations received last fall or this

winter do not offer protection against the H1N1 swine flu

Children and young adults at higher risk for disease and complications from H1N1

H1N1 Statistics

Note: before reports changes*

Confirmed and Probable cases

Deaths

International 134,503* 816

United States 43,771* 353

Michigan 3,166* 10

Washtenaw County

94 0

US Hospitalizations and Deaths

As of August 6th , in U.S. - 6,506 hospitalizations and 436 deaths

National Influenza Positive Tests

Respiratory illness in WC schools and Child Care

H1N1: What We Do Know

Novel H1N1 viruses make up 99% of all influenza A viruses currently

We are seeing co-circulation of seasonal H1N1, H3N2 and novel H1N1 virus, though in some places novel H1N1 virus are becoming dominant

No change in virus characteristics or disease patterns

Causes more severe pneumonia than seasonal flu

H1N1:What We Know-Cont’d

Novel H1N1 transmission ongoing

Majority of deaths in individuals with underlying medical conditions

No significant difference in rates between males and females

Most common underlying conditions: Asthma, Diabetes, and immune disorders

Fourfold hospitalization in pregnant women

H1N1: What We Know-Cont’d

Most reported cases: Highest in 5-24 years old, Next highest in the 0-4 year olds Lowest reported cases in 65+ years old

Hospitalization rates: Highest in 0-4 years of age, Next highest 5-24 years, Lowest hospitalizations rates in 65+years old

Death rates: Highest people aged 25-49 years of age (39%) Next highest people aged 50-64 (25%) People aged 5-24 (16%)

Note: Usually 90% of seasonal influenza-related deaths occur in people aged 65 and older

What we don’t know!

Influenza viruses are unpredictable and can change in severity

Anticipate CDC guidelines updates as new information becomes available

Exact date of vaccine availability (mid-October)2 doses (anticipated) vs. 1 doseSupply versus demandAmount and types of vaccine combinations we

will receive Single filled syringe Multi-dose vials Nasal spray Preservative free

Public Health Planning

Meeting weekly with PH Emergency Response Team

Monitoring State and Federal Guidelines

Preparing for delivery of large #s of vaccines

Developing agreements for vaccination centers

Developing Communications Plan

Developing internal policy to require sick employees to stay home

Developing Voluntary Medical Reserve Corps

Communicating with Health Care Providers and Emergency Responders

Seasonal flu vaccines available earlier this year in preparation for H1N1 vaccines

Public Health Authorized Intervention Options

To help contain or limit the spread of infections as effectively as possible The Health Department has the authority to: Treat sick and exposed individuals with

antivirals Isolate sick people in hospitals, homes or other

facilities Identify and quarantine exposed people Close schools and workplaces as needed Cancel public events Restrict Travel

Funding

State and local funding Uncertain Governors Executive OrderBoth House and Senate version increase

fundingGovernors preliminary budget cuts PH funding

by 17%Federal Emergency Preparedness Funding

available for planningFederal funding available for vaccines and

suppliesUncertain if funding will be available to

administer vaccine but assumption is it will be

Communications to Schools

School Web PortalFrequent fax updates (daily if warranted)Nurse of the Day available to answer

questionsPresentations LettersFact SheetsSchool reporting summaries

Strategic National Stockpile

Antivirals

Methods of dispensing

Criteria

PPE –face masks

H1N1 Vaccine

Novel H1N1 vaccine is being purchased by the Federal Government

Allocation to States in proportion to population

States will allocate to LHD for distribution to vaccination partners

Timing of availability – earliest in mid-October

Vaccines remains the single best means for protection

H1N1 Vaccine Priority Groups

On 7/29/09, CDC/ACIP recommendations for equal focus due to at risk conditions and burden of disease:

1. Pregnant women2. People who live with or care for children younger

than 6 months age3. Health care and emergency services personnel4. Persons between the ages of 6 months – 24 years of

age5. People from ages 25 – 64 years who are at higher risk

for H1N1 complications due to chronic health diseases or compromised immune systems

Alternate/Closed PODs

Agreements

School Districts

What we need from schools and what you can expect from us

(PODs – Points of Distribution)

Influenza Prevention Strategies

Personal hygiene

Social Distancing

Antivirals drugs

Vaccines

What Can Schools do to prepare for the Fall Flu Season?

Update Communication Networks

Identify key contacts/authorities responsible for case identification, isolation, quarantine, movement restriction, healthcare services, emergency care, and mutual aid.

Communications and education about influenza and preparation for Staff/ Students/Parents

Keep in contact with us-Your Local Health Department

Diversify Communication Venues

Consider use of social media sites such as ‘Twitter’ and ‘Facebook’ to educate and communicate

Specially appealing to school aged childrenUse of http://twitter.com/cdcemergency

increased from 2500 followers before H1N1 to 370,000 and now up to 624,000

PH/School health portal RSS feed - twitter

Review Emergency Plans and Policies

Review school emergency plans and update contact information

Support a policy that stresses employees and students with flu like illness to stay home

Review capacity for distance educationReview guidelines and consider policies

for exclusion Strongly advise staff and students to get

the seasonal flu when available

Promote Respiratory Hygiene

Allow regular breaks for students and staff to wash hands using soap and water

Waterless hand gels sanitizers may be used in the classroom to minimize disruptions

Check sink locations and restrooms regularly to ensure they are stocked with soap, paper towels or working hand dryers

Cough etiquette education posters throughout school

Disinfecting Facilities

Viruses commonly live on surfaces from 2-8 hours

When schools reopen, Commonly hand touched surfaces such as stairways, railings, elevator buttons should be kept clean by wiping with detergent-based cleaners or EPA registered disinfectants used in the school settings

School Mass Vaccination Clinics

Schools –potential site for mass vaccination clinics –CDC/DOE (further guidance expected by end of week)

School nurses MOU/Agreements with VNA, other nursing associations Need to address spectrum of issues related to school

based vaccinations such as: Logistics Communication with parents Consent forms

Develop relationships with volunteer organizations to get volunteers to assist with mass vaccination

School Closures

CDC/ DOE: New guidelines anticipate not advising school closure unless magnitude of absenteeism interferes with the school function

Decisions will be made at the local level and on a case by case basis

Schools may need to close depending on the severity of the pandemic

Local and state health department will work with schools to make a decision consistent with community health needs. To aid this process: Reporting of respiratory

and GI symptoms to local health department and increased rates of absenteeism to local health department

Please Call Early & Often!

CDC Revised Recommendations for Schools K-12

8/5/09- CDC revises guidelines for the exclusion of persons with influenza-like illness

“CDC recommends that people with influenza-like illness remain at home until at least 24 hours after they are free of fever (100 degrees F), or signs of a fever without the use of fever-reducing medications.”

CDC Recommendations for Schools

Isolate those with flu like symptoms promptly in a room separate from other students while waiting to be sent home

Do Not administer Aspirin or aspirin-containing products to <18 years age

Ill students should not attend alternative child care or congregate in the community

CDC Recommendations for Schools

School administrator’s should communicate regularly with local public health officials to obtain guidance about reporting of influenza-like illnesses in the school

Changes in frequency of IP-10 reporting can be expected

Key messages: Keep ill students and staff at home Wash hands frequently Cover cough and sneezes

Conclusion

Planning and preparing now is important to be ready for the fall flu season

Ongoing communications will be essential

Public Health Contacts

Public Health Communicable Disease Department Office hours: 734 - 544- 6770 After hours: 734 - 891- 4327

Donna Nussdorfer, CD Coordinator 544-6880 Email: nussdorferd@ewashtenaw.org

Laura Bauman, Epidemiologist 544-6763 Email: baumanl@washtenaw.org

Diana Torres-Burgos, Medical Director 544-3058 Email: torresburgosd@ewashtenaw.org

Richard Fleece, Health Officer 544-2959 Email: fleecer@ewashtenaw.org

Cindra James, Emergency Preparedness Coordinator

544- 2979 Email: jamesc@ewashtenaw.org

Resources

The Centers of Disease Control and Prevention www.flu.gov www.cdc.gov/h1n1flu/schools/schoolguidance.htm www.cdc.gov/h1n1flu/schools/toolkit

The Department of Education www.ed.gov

Michigan Department of Community Health www.michigan.gov/h1n1

Washtenaw County Public Health http://publichealth.ewashtenaw.org

Public Health - School Portal

Q & ACommunicationsEducation of

Staff/students/ParentsScreening and

implementation ill staff/students to stay at home

Mass vaccination clinics Best sites, staffing,

logistics Private, Charter, Child

care centers

Schools and Public Health Expectations Challenges Capabilities