Swine flu to boils it is reducing the risk that counts

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Swine flu to boils it is reducing the risk that
counts

• Prepared by Peter Massey
• CNC, Program Manager Health Protection
• HNE Population Health
• Nov 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 thats 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 (contd)
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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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 didnt
  work so well and what needs to be changed?
• What worked well with HNE services, what didnt
  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.

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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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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 the University of
Newcastle.