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Influenza A H1N1: A Pandemic in Real Time Whats Next

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In children 5 years of age, GI symptoms may also be present. ... Symptoms. Pandemic H1N1 2009. Seasonal Flu. But no room for complacency ... – PowerPoint PPT presentation

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Title: Influenza A H1N1: A Pandemic in Real Time Whats Next


1
Influenza A H1N1 A Pandemic in Real Time
Whats Next?
  • Danny Chen, MD FRCPC MSc
  • Infectious Disease Specialist
  • Grand Rounds, York Central Hospital
  • September 9, 2009

2
SEX
3
Genetic origins of the pandemic (H1N1) 2009
virus Quadruple viral reassortment
N. American H1N1 (swine/avian/human)
Eurasian swine H1N1
Pandemic (H1N1) 2009, combining swine, avian
and human viral components
Classical swine, N. American lineage Avian, N.
American lineage Human seasonal H3N2 Eurasian
swine lineage
4
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5
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6
WHO phases of pandemic alert
7
Symptoms
  • Definition of Influenza-like Illness (ILI)
  • Acute onset fever and cough
  • AND
  • one or more of
  • Sore throat, arthralgia, myalgia, or prostration,
  • In children lt 5 years of age, GI symptoms may
    also be present.
  • In patients lt 5 years of age or gt65 years fever
    may not be prominent.

Guidance for Management of Patients with
Influenza-like Illness (ILI) in Emergency
Departments, MOHLTC June 4, 2009
8
Transmission
9
Prevention
  • ENHANCED
  • DROPLET
  • PRECAUTIONS
  • Hand hygiene always
  • Gown, gloves, eye protection, N95 mask
  • droplet contact N95

10
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11
Treatment Recommendations
  • Oseltamivir recommended within 48 hours of the
    onset of symptoms
  • ILI requiring hospitalization OR
  • ILI and at risk for complicated disease
  • Other patients with ILI do not require treatment.

12
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13
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15
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16
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17
Laboratory confirmed cases of pandemic (H1N1)
2009 in Ontario by week between April 13 and
August 29, 2009
18
Hospitalizations among confirmed cases of
pandemic (H1N1) 2009 in Ontario, April 13
September 3, 2009
19
Incidence of hospitalization and death due to
pH1N1 in Ontario, April 13 to September 3, 2009
20
Seasonal influenza
  • Every year
  • 5 million Canadians (1 in 6) will be infected
  • Up to 75,000 hospitalized
  • 2000-4000 people will die
  • 90 are gt65 yrs
  • half of those in LTCHs
  • Bacterial pneumonia
  • Cardiac failure

Mortality rate 13/100,000 population 0.2 of
cases
21
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22
So What Next
23
  • Potential for catastrophe…
  • vs
  • …a pandemic dud.

24
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25
Laboratory confirmed cases of pandemic (H1N1)
2009 in Australia, to 28 August 2009
by jurisdiction
26
Rate of ILI reported from GP ILI surveillance
systems from 2007 to 23 August 2009 by week
27
Rates of absenteeism of greater than 3 days
absent, National employer, 1 January 2007 to 19
August 2009, by week
28
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29
Hospitalised confirmed cases of pandemic (H1N1)
2009, by length of hospital stay and age group,
to 28 August 2009, Australia
30
Age specific rates of hospitalised confirmed
cases of pandemic (H1N1) 2009 compared with
average annual age specific rates of
hospitalisations from seasonal influenza,
Australia
31
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32
Hospitalised confirmed cases of pandemic (H1N1)
2009 in pregnant women by weeks of gestation, to
28 August 2009, Australia
33
Numbers of deaths among confirmed cases of
pandemic (H1N1) 2009, by age group and sex,
compared with total laboratory confirmed pandemic
(H1N1) 2009 notifications by age group
Median age 54 (cf seasonal flu 83yo)
34
Percentage of all deaths classified as influenza
and pneumonia, WA Registry of Births, Deaths and
Marriages, 1 January 2008 to 23 August 2009
35
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36
But no room for complacency
  • Pandemics take some time to get going (1918 and
    1968).
  • Some pandemic viruses have turned nasty (1918
    and 1968).
  • There will be severely ill people and deaths in
    risk groups (young children, pregnant women and
    especially people with underlying illnesses).
  • Health services capacity?
  • Resistance to antivirals?
  • Attack rate?
  • An inappropriate and excessive response to the
    pandemic could be worse than the pandemic itself…

37
  • …the H1N1 influenza and influenza generally is
    unpredictable...

Dr. Anne Schuchat, CDC
38
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39
Pandemic Model York Region Impact
  • 35 of the population, including YCH staff, will
    be infected during the first wave of pandemic
    influenza
  • Need to MAXIMIZE CAPACITY to manage increased
    patient volumes in the face of depleted resources

40
Summary
  • H1N1 now the dominant virus strain
  • Large populations susceptible to infection
  • Vaccine?
  • Not the same as seasonal influenza
  • Age distribution
  • Influenza is unpredictable
  • Be prepared
  • Capacity, resources

41
Summary
  • What next…
  • Replay the Australian experience?

42
  • http//www.sesamestreet.org/video_player?p_p_lifec
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    _p_uid140598a2-90b4-461f-82d4-53011bdf3849

43
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