response to pandemic influenza during the 2009–2010 school year jeffrey engel, md state health...
TRANSCRIPT
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Response to Pandemic Influenza during the 2009–2010 School Year
Jeffrey Engel, MD
State Health Director
North Carolina Division of Public Health
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Outline
I. Influenza overview
II. Pandemic H1N1: The current situation
III. Mitigation strategies/control measures
IV. Pandemic influenza vaccination
V. Specific guidance for school settings
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The Enemy
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How Flu Spreads
• Most spread through coughing and sneezing• Contact transmission also important
– Hand to hand, contaminated surfaces
• Airborne transmission possible
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www.cdc.gov/h1n1flu/surveillanceqa.htm
Pandemic H1N1 Case Rates by Age Group
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Cleveland
Buncombe
Anson
Ashe
Beaufort
Bertie
Bladen
Brunswick
Burke
Caldwell
Carteret
Caswell
CatawbaChatham
Cherokee Clay
Columbus
Dare
Davie
Duplin
Forsyth Franklin
Gaston
Gates
Graham
Greene
Guilford
Halifax
Harnett
Hertford
Hoke
Hyde
Iredell
Jackson
Johnston
Jones
Lee
Lenoir
McDowell
Macon
MadisonMartin
Moore
Nash
Onslow
Orange
Pamlico
Pender
Person
Pitt
Polk
Randolph
Robeson
Rockingham
Rowan
Rutherford
Sampson
Scotland
Stanly
Stokes
Surry
Swain
Transylvania
Tyrrell
Union
Wake
Warren
Washington
Watauga
Wayne
Wilkes
Wilson
Yadkin
Yancey
Chowan
PasquotankPerquimans
CamdenCurrituck
MontgomeryHenderson
GranvilleVance
Durham
Mecklenburg
LincolnCabarrus
RichmondCumberland
Alexander
Craven
Haywood
Alleghany
Mitchell AveryAlamance
Davidson Edgecombe
New Hanover
Confirmed NC Cases by County of Residence — August 12, 2009
Confirmed Cases, N=687 (75 counties)
Northampton
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Percent of Visits due to Influenza-Like Illness -- North Carolina, 2008-2009: Sentinel provider Network (SPN) and Hospital Emergency Department (ED)
0
1
2
3
4
5
6
7
8
9
10
40 41 42 43 44 45 46 47 48 49 50 51 52 53 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
WEEK#
%IL
I
ED SPN
Emergency Departments
Doctors’ Offices
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NC State Lab Influenza Virus Testing Results by MMWR Week, 2008–2009
Influenza Positive Tests Reported by the N.C. State Laboratory of Public Health by Week
0
10
20
30
40
50
60
70
80
40 41 42 43 44 45 46 47 48 49 50 51 52 53 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
MMWR Week
#Pos
itive
Spe
cimen
s
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
% P
ositi
ve†
Seasonal A (H1) Seasonal A (H3) A unsubtypable* Seasonal B Novel A (H1N1) Percent Positive†
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Pandemic Mitigation Strategies
1. Vaccination
2. Antiviral treatment and prophylaxis
3. Non-pharmaceutical interventions• Respiratory hygiene • Isolation and quarantine• Social distancing (school closures, cancellation
of large gatherings, teleworking, etc.)
Strategies are guided by severity of illness
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Pandemic H1N1 Vaccine
• Separate from seasonal flu vaccine– Both vaccines important for protection
• Pandemic vaccine will probably require two doses
• Clinical trials in progress, evaluating– Safety / adverse events– Interval between doses– Administration with seasonal vaccine
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Pandemic Vaccine Availability
• Considering “early roll out” in late September – 20 million doses
• First large bolus expected mid-October– 40 million doses
• Monthly shipments of 40 million doses – Total amount dependent on uptake
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Pandemic Vaccine Distribution
• Centralized distribution– Supplies shipped with vaccine – needles,
syringes, etc.
• List of pandemic vaccine providers compiled by Local Health Departments– 100 dose minimum shipments
• Need for state and local coordination on school vaccination programs
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Vaccination in Schools
Benefits:• Brings vaccine to target population• Many districts experienced with seasonal flu
and hepatitis B campaigns
Obstacles:• Issues with parental consent• Potential disruption
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Pandemic Vaccine: Priority Groups
1. Pregnant women
2. People who live with or care for children younger than 6 months of age
3. Health care and emergency services workers
4. People 6 months through 24 years of age
5. People 25 through 64 years of age at high risk for complications of influenza
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* If supply is limited
Priority Groups: Smaller *
1. Pregnant women
2. People who live with or care for children younger than 6 months of age
3. Health care and emergency services workers with direct patient contact
4. Children 6 months through 4 years of age
5. Children 5 through 18 years of age who have chronic medical conditions
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School Guidance: Goals
• Decrease risk of hospitalization and death• Minimize disruption of day-to-day social,
educational, and economic activities
• Goal is NOT to eliminate all transmission of influenza in schools– Might change if severity increases
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School Guidance: “Similar Severity”
• Stay home when sick– At least 24 hours after fever resolves without use of
fever-reducing medicines
• Separate ill students/staff• Emphasize hand hygiene• Routine environmental cleaning• Early treatment of high-risk students and staff• Consideration of selective dismissal
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*Recently revised by CDC
Current Isolation Recommendations*
• Home until at least 24 hours after fever resolves (without fever-reducing medications)– 3–5 days in most cases– Duration NOT influenced by use of antivirals
• Longer isolation period for health care settings, other settings with many high-risk persons
• Practice good respiratory hygiene after return– Might still be shedding virus
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School Dismissal Considerations
• Number and severity of cases– Local, state, and national levels
• Balance between risk of infection and problems that school dismissal can cause
• Different types of dismissal (selective, reactive, and preemptive).
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Categories of Dismissal
• Selective– Most students in the school are high risk – May close while other schools in the community
are open
• Reactive– Used when many students and staff are sick
• Preemptive – Used early during a flu response to decrease
spread before many students and staff get sick– Only considered if severity increases– Probable declared state of emergency
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School Guidance: “Increased Severity”
• Active screening for illness• High risk students/staff stay home• Students with ill household members stay
home• Increase social distancing• Extend exclusion period to at least 7 days• Consider preemptive dismissals
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Roles and Responsibilities
• State and local health agencies– Collect and share relevant epidemiological data– Have regular channels of communication to share
information– Jointly make decisions with school officials
• State and local education agencies– Work with public health and social service
counterparts to ensure health and safety for students and staff
– Disseminate emerging guidance– Promote teaching and learning – even if school is
dismissed
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ABCD of School GuidanceDo this now…
• Respiratory hygiene• Hand hygiene• Exclusion of ill students• Routine cleaning
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School Dismissal Reporting
• Reporting of all flu-related school dismissals requested by CDC
• Report via www.cdc.gov/FluSchoolDismissal
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Public Health Resources
• www.flu.nc.com
• www.cdc.gov/h1n1flu