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H1N1 Pandemic

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... curve for hospitalized cases and deaths. 10. 11. Canadian Situation ... H1N1 Vaccine ... population differences in protection from the pandemic vaccine? ... – PowerPoint PPT presentation

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Title: H1N1 Pandemic


1
H1N1 Pandemic
  • Andre Lalonde, MD
  • EVP, SOGC

2
Objectives
  • Review epidemiology of H1N1 infection
  • Prepare Obstetricians and Gynaecologists in the
    counseling of pregnant woman on
  • Measures of preventions
  • Treatment of H1N1 suspect in infant
  • Immunization against H1N1
  • Up to date information on H1N1 available on SOGC
    website

3
Disease Characteristics and Burden
  • How severe is the pandemic?
  • Who is the most affected in terms of illness,
    complications and death?
  • Who are the persons most likely to spread
    infection?

4
Ethical Considerations
  • What ethical principles and values should be
    applied?
  • How do they inform the decision?
  • Are the recommendations fair and equitable?

5
Data source Health Canada
6
Epidemic Curve No Vaccination
7
Cumulative Attack Rates No Vaccination
8
Hospitalization Rate per 100 000 person years in
healthy individuals
9
Hospitalization Rate per 100 000 person years in
individuals with underlying conditions
10
Epidemiological curve for hospitalized cases and
deaths
11
(No Transcript)
12
Canadian Situation
  • Total of 7,276 laboratory confirmed cases
  • 1,315 cases were hospitalized (line-list info on
    1282 (97))
  • 239 (18.1) of those hospitalized admitted to ICU
  • 66 (5.0) of those hospitalized died

13
(No Transcript)
14
Data Highlights - I
  • Population incidence rates are highest for those
    5-19 years and infants
  • Hospitalization rates are highest in the under 15
    years, pregnant women, those with underlying
    conditions and Aboriginal populations
  • Presence of underlying condition is the greatest
    risk factor of admission to ICU or death
  • Female gender is associated with higher risk of
    ICU admission and death

15
Data Highlights - II
  • Rates in healthy individuals,
  • Incidence highest in 0-24 years
  • Hospitalization highest in 0-24 years
  • ICU Similar between 1 and 64 y
  • Death Similar between 1 and 64 y
  • ICUdeath Similar between 1 and 64 y
  • Vaccinating 2-24 year olds would have a greater
    epidemiological impact compared to older age
    groups

16
Data Highlights - III
  • H1N1 Vaccine characteristics
  • Many unknowns remain first clinical trial
    results in mid-late September (CSL product)
    initial GSK results late Oct./early Nov.
  • Unknowns
  • Need for second dose
  • Vaccine safety increased reactogenicity if
    adjuvanted, otherwise unknown
  • Effect of adjuvant for dose-sparing,
    immunogenicity, cross-reactive immunity

17
Data Highlights - IV
  • Vaccine logistical assumptions
  • 3.5 million doses per week capacity minimum
    level
  • Production limited by fill line capacity
  • First lots filled mid to late October probably
    including an unadjuvanted lot.
  • HC authorization mid November (up to 17.5 m
    doses available)
  • Projected 49 million doses produced by first week
    of February

18
Whos at Risk for a Severe Outcome? Analysis
based on cases who were hospitalized or died
19
Hospitalized cases by PTs
20
Overall Hospitalization Rates by Age Group
Assumes rate of hospitalization will remain
constant
21
Hospitalized cases by gender and pregnancy
status
Assumes rate of hospitalization will remain
constant Depending on estimations of total
number of pregnant women per year between 330,000
and 475, 000
22
Pregnant Women
  • 48 women hospitalized were pregnant
  • 11 Admitted to ICU of which 2 died
  • 4 of all hospitalized cases were pregnant
  • Information about trimester was available for 26
    pregnant women
  • 1st Trimester 3 women
  • 2nd Trimester 4 women
  • 3rd Trimester 19 women
  • Of the 7 women in their 1st or 2nd trimester all
    had non-severe hospitalizations
  • 4 (21) out of 19 women in their 3rd trimester
    were admitted to ICU or Died

23
Hospitalized Women and Pregnancy
Risk of ICU Admission or Death for Pregnant Women
relative to Non-pregnant women OR 0.72
(0.34-1.52)
24
Signs Symptoms of H1N1 Infection
  • fever
  • cough
  • runny nose
  • sore throat
  • body aches
  • fatigue
  • lack of appetite

25
Prevention
  • Stay away from people infected or suspected of
    Flu like disease
  • Ask people around you at home or work to wear
    protection mask if they have the flu
  • Use antiseptic soaps in your home or office in
    case of flu epidemic
  • In case large number of people at work are
    infected, stay home
  • Do not shake hands
  • Avoid crowded public areas

26
Treatment of H1N1
  • All Health Care Professionals should provide
    their pregnant patien with a Tamiflu prescription
    in readiness, in case symptoms develop.
  • Pregnant women with onset of flu like symptoms
  • Send someone immediately to get the prescription
    filled
  • Take medication immediately
  • Do not go to the emergency room or your doctors -
    start taking medication ASAP
  • Go to the hospital if you have breathing
    difficulties with or without medication

27
Vaccination 2 types
  • Unadjavent vaccine
  • Adjavent vaccine (ASO3) available in mid november

28
Vaccine Characteristics
  • Any expected population differences in protection
    from the pandemic vaccine?
  • Any people who do not need the vaccine?
  • Need for a second dose?
  • Are dose-sparing strategies possible, e.g.
    intradermal administration?
  • Are there any vaccine safety concerns?
  • What is the proposed indication for use and what
    indication/market authorization has been granted
    by the Health Canada regulator?
  • What pre-market assessment has been performed,
    and what post-market surveillance requirements
    are imposed?

29
H1N1 and the Aboriginal Population
30
Access to Care
  • Nursing stations, health stations, health centres
    , health offices-heavy orientation to nursing
    provided care and a lot of community health
    representatives
  • More limited scope of services than urban health
    services

31
Population Rates by Aboriginal Status
Assumes rates will remain constant
32
Risk of ICU Admission or Death by Aboriginal or
First-Nations Status amongst those hospitalized

33
H1N1 Aboriginal Population on Reserves
  • Risk factors for severe H1N1 younger population,
    higher rates of underlying disease that are
    associated with higher risk, more pregnancies
    among younger mothers.
  • Difficulties access to appropriate medical care
    for early treatment given geographic isolation
    and lack of health human resources
  • Operational factors make rapid spread and
    infection control difficult higher housing
    density and lack of running water in several
    communities
  • All of these issues relate to equity, which is
    also an ethical consideration.

34
PRIORITY SEQUENCE FOR IMMUNIZATION FOR CANADA
35
Primary Targets Canada
  • Persons with chronic conditions (NACI list) under
    the age of 65 - at higher risk of complications
    65 less affected to date
  • Pregnant women - at higher risk of complications
    and to potentially protect their infants
  • Healthy Children 6 to 23 months of age - at
    higher risk of severe disease children
    identified as a priority by the public

36
Primary Targets (cont.)
  • Remote and isolated communities (First Nations,
    Inuit and other communities)
  • - limited access to medical care, potential for
    development of herd immunity and prevention of
    infection, logistically easier to target whole
    community equity, high concentration of persons
    with chronic conditions, observed
    morbidity/mortality

37
Summary of findings
  • Population incidence rates are highest for those
    5-19 years and infants
  • Hospitalization rates are highest in the under 15
    years, pregnant women, those with some underlying
    conditions and Aboriginal populations
  • Increasing age, presence of underlying condition,
    female gender are associated with higher risk of
    admission to ICU or death
  • Presence of an underlying condition and
    increasing age have the greatest impact on risk
    of ICU admission or death

38
What is SOGC Doing
  • Guidelines
  • Update website regularly (www.sogc.org)
  • Patient information tear out pad
  • Posters

39
What you should do
  • Advise all patients about H1N1 and their risk
  • Give each pregnant woman a prescription
  • Keep checking SOGC website and provincial health
    announcements
  • Protect yourself and your staff
  • - medication to treat H1N1 information
  • - immunization of you, your family and staff
  • Consider providing immunization to your patients.
    If you want to do so make yourself aware of how
    to immunize and register with Public health to
    receive vaccine.

40
The Executive Committee of the SOGC adopted the
following motions regarding H1N1 and pregnancy
during the September 4th, 2009 meeting held in
Ottawa. SOGC Members should
  • Promote the yearly influenza vaccine to all
    pregnant women.
  • Inform, counsel, and promote to all pregnant
    women the availability and benefits of H1N1
    vaccination.
  • Inform pregnant women of the risks, signs,
    symptoms, severity and management of a possible
    H1N1 infection.

41
SOGC Members should
  • Provide pregnant women with a prescription for
    Tamiflu (75mg bid for 5 days) during their
    antenatal visit, to be used when a suspected H1N1
    infection occurs.
  • Inform all pregnant women of the benefits and
    risks associated with the use of Tamiflu, and
    its follow-up, such as the side effects, when to
    use the medication, and in case of serious
    respiratory difficulties to report to the nearest
    hospital.
  • Be aware that Tamiflu should NOT be used as a
    prophylaxis drug.
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