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Novel Influenza A (H1N1) Pandemic
Information UWSP Safety Loss 2009 Content
Source U. S. Centers for Disease Control and
Prevention
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Influenza

• Influenza is a viral infection that attacks the
  respiratory system, including your nose, throat,
  lungs. Influenza, commonly called the flu, is not
  the same as the stomach viruses.
• Flu viruses travel through the air in droplets
  when someone with the infection coughs, sneezes
  or talks. You can inhale the droplets directly
  (most likely exposure route), or you can pick up
  the germs from an object, such as a telephone or
  computer keyboard, and then transfer them to your
  eyes, nose or mouth.
• The flu is caused by three types (strains) of
  viruses influenza A, B and C. Type A can be
  responsible for the deadly influenza pandemics
  (worldwide epidemics) that strike every 10 to 40
  years. Type B can lead to smaller, more localized
  outbreaks. Either types A or B can cause the flu
  that circulates almost every winter. Type C is
  fairly stable has never been connected with a
  large epidemic. Types A and B are constantly
  changing, with new strains appearing regularly.
  Once you've had the flu, you develop antibodies
  to the strain that caused it, but those
  antibodies won't protect you from new strains.
  That's why annual flu shot is recommended.

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Influenza Virus Types

• There are many terms used to describe various
  influenzas (Bird Flu, Swine, Avian, Seasonal,
  etc.).
• Influenza A viruses are found in many different
  animals, including ducks, chickens, pigs, whales,
  horses, and seals.
• Influenza A has many subtypes, classified
  according to 16 H and 9 N proteins
• There are and can be various combinations of the
  H N proteins.
• The current novel influenza A (H1N1) is a
  heightened concern due to the fact humans have
  little or no immunity to this novel (new) virus.
  
• Note Another influenza virus, the H5N1 (Avian
  Influenza), found in birds in Asia and Europe is
  an extremely severe virus (60 fatality rate in
  those infected). But has not be able to transmit
  from person to person well at this time. H5N1 is
  not in North America at this time.

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Influenza Virus Example
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Influenza viruses can change in two different
ways.

• Antigenic drift
• Changes in proteins by genetic point mutation
  selection
• Ongoing and basis for change in vaccine each year
• Antigenic shift
• Changes in proteins through genetic reassortment
• Produces different viruses not covered by annual
  vaccine
• Reassortment, or Viral Subunit Reassortment, is
  the exchange of DNA between viruses inside a host
  cell. Two or more viruses of different strains
  (but usually the same species) infect a single
  cell and pool their genetic material creating
  numerous genetically diverse progeny viruses.
• It is a type of genetic recombination.
• Reassortment can lead to a viral shifts under
  some conditions.
• When shift happens, most people have little or no
  protection against the new virus.

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Seasonal Influenza

• Seasonal Influenza - A respiratory illness that
  can be transmitted person to person. Most people
  have some immunity, and a vaccine is available.
  This is also known as the common flu or winter
  flu. (H3N2 is one example of seasonal influenza
  strain).
• In the US each year 35,000 deaths are attributed
  to seasonal influenza resulting in gt200,000
  hospitalizations.
• Seasonal Influenza verses Pandemic Influenza -
  for more info on this see http//www.flu.gov/gen
  eral/season_or_pandemic.html

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Novel Influenza A (H1N1) Cause of Current 2009
Pandemic

• Novel Influenza A (H1N1) (referred to a swine flu
  early on) is a new influenza virus that is
  currently spreading from person-to-person. Spread
  can be very rapid.
• The 2009 flu outbreak in humans that is widely
  known as "swine flu" is due to an apparently
  virulent new strain of influenza A virus subtype
  H1N1 that was produced by reassortment from one
  strain of human influenza virus, one strain of
  avian influenza virus, and two separate strains
  of swine influenza.
• CDC declared public health emergency and WHO
  declared global pandemic for this virus last
  spring. The virus is widespread in the United
  States internationally.

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Pandemic

• Epidemic A disease occurring suddenly in humans
  in a community, region or country in numbers
  clearly in excess of normal.
• Pandemic The worldwide outbreak of a disease in
  humans in numbers clearly in excess of normal.
• Pandemic Phases 1 6.
• Currently (08/09) at Phase 6 increased and
  sustained transmission in general public.
• See WHO for more details.

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WHO Pandemic Phases
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Pandemic Influenza Information

• Occur rarely (three times in 20th century - last
  in 1968)
• No previous exposure little or no pre-existing
  immunity. Likely a NEW influenza strain.
• Healthy people may be at increased risk for
  serious complications. Capacity to cause severe
  disease in nontraditional groups.
• Health systems may be overwhelmed. Sharp increase
  in demand.
• Vaccine probably would not be available in the
  early stages of a pandemic
• Effective antivirals may be in limited supply
• Number of deaths can be quite high
• Symptoms may be more severe and complications
  more frequent
• Major impact on society and economy.

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Past Pandemics

• Pandemics Death Toll Since 1900
• 1918-1919
• U.S.... 675,000
• Worldwide50,000,000
• 1957-1958
• U.S....70,000
• Worldwide1-2,000,000
• 1968-1969
• U.S.... 34,000
• Worldwide700,000
• 2009 Thousands so far - plus ?

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Pandemics

• Pandemics are unpredictable
• Mortality, severity of illness, pattern of spread
• Waves of infection
• Ages/areas not initially infected likely
  vulnerable in future waves
• Subsequent waves may be more severe
• 1918- virus mutated into more virulent form
• 1957 schoolchildren spread initial wave, elderly
  died in second wave
• Public health interventions delay, but do not
  stop pandemic spread
• Quarantine, closings, travel restriction show
  little effect
• Does not change population susceptibility
• However, forced restrictions may occur if deemed
  necessary (i.e. extremely high rates of
  infection). Would be by order of Public Health
  Department.
• Delaying spread is desirable
• Fewer people ill at one time improve capacity to
  cope with sharp increase in need for medical
  care.

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CDC Pandemic Severity Levels(Currently at Level
1)
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Novel Influenza A (H1N1)

• Though severity still relatively low, need to
  take seriously.
• Virus - very rapid spread.
• Higher rates of adverse affects (including death)
  on certain age groups (under age 50, young
  adults, teens and children) compared to seasonal
  influenza affects.
• New virus full picture still unclear.

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Signs and symptoms

• Symptoms of novel H1N1 flu in people are similar
  to those associated with seasonal flu.
• Fever
• Cough
• Sore throat
• Runny or stuffy nose
• Body aches
• Headache
• Chills/Shivering
• Fatigue
• In addition, vomiting (25) and diarrhea (25)
  have been reported. (Higher rate than for
  seasonal flu.)

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How does Novel Influenza A (H1N1) spread?

• This virus is thought to spread the same way
  seasonal flu spreads
• Primarily through respiratory droplets
• Coughing
• Sneezing
• Close contact (about 3 ft or less) necessary for
  above.
• Also may be spread by touching respiratory
  droplets on yourself, another person, or an
  object, then touching mucus membranes (e.g.,
  mouth, nose, eyes) without washing hands.
• One study showed that influenza virus can survive
  on environmental surfaces and can infect a person
  for up to 2-8 hours after being deposited on the
  surface.  

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Can you get Novel Influenza A (H1N1) from eating
pork?

• No.
• You cannot get novel H1N1 flu from eating pork
  or pork products. Eating properly handled and
  prepared pork products is safe.

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What can you do to protect yourself from
getting sick?

• Vaccine is currently being developed. When and if
  available to you obtain vaccine ASAP. Oct./Nov.
  timeline. Availability will be determined.
  Priority will likely be established. UWSP will
  work to have vaccination clinic available if
  necessary.
• Also, everyday actions can help prevent spread
  of germs that cause respiratory illnesses like
  influenza. See following slides.

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Take these everyday steps to protect your health

• Wash your hands often with
• soap and warm water,
• especially after you cough
• or sneeze. Wash for 15 20
• seconds. Watch http//www.youtube.com/watch?vXH
  ISh559ohofeaturechannel_page
• Alcohol-based hand
• wipes or gel sanitizers are also
• effective. Use those that contain at least 60
  alcohol.

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Take these everyday steps to protect your health

• Cover your nose and mouth with a tissue when you
  cough or sneeze. Throw the tissue in the trash
  after you use it. Or sneeze cough into elbow.
• Watch Why Dont We Do It In Our Sleeves
  Watch http//coughsafe.com/media.html
• Wash hands after sneezing and coughing.
• Avoid touching your eyes, nose or mouth. Germs
  spread this way.
• Avoid contact with sick people. Social
  Distancing. Stay home (see later slide)
• See CDC poster Cover you Cough

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Infectious Period

• How long can an infected person spread this virus
  to others?People infected with seasonal and
  novel H1N1 flu shed virus and may be able to
  infect others from 1 day before getting sick to 5
  to 7 days after. This can be longer in some
  people, especially children and people with
  weakened immune systems and in people infected
  with the new H1N1 virus.
• How long can influenza virus remain viable on
  objects (such as books and doorknobs)?Studies
  have shown that influenza virus can survive on
  environmental surfaces and can infect a person
  for up to 2-8 hours after being deposited on the
  surface.

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Cleaning Surfaces

• UWSP Custodial Services have implement plans for
  stepped up cleaning of Academic Buildings,
  Administrative Buildings, following the CDCs
  Interim Guidance on Environmental Management of
  Pandemic Influenza Virus.
• Have disposable disinfectant wipes, and Kleenex
  available in your areas. UWSP Departments should
  purchase these for their areas.
• Disinfectant wipes and cleaners can be used by
  employees and students to routinely wipe down
  frequently touched surfaces (doorknobs, elevator
  buttons, rails, shared computers, remote
  controls, table tops, other work surfaces, etc).
  Ensure items are dispose of properly in garbage
  containers.
• Hand Sanitizer, disposable sanitizing wipes,
  gloves and Kleenex all available to order through
  UWSP Central Stores (x3897).
• Most household disinfectant cleaners and
  detergents are effective for influenza. Any
  cleaner questions contact UWSP EHS Department at
  2320.
• Gloves would be prudent or wash hands afterward.
  Respirator or mask not needed for cleaning
  regular surfaces.
• Haz Com. Review MSDS for cleaner and safety
  measures with employees.

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Masks/Respirators/Gloves

• N95 vs. Basic Masks. See http//www.cdc.gov/h1n1fl
  u/masks.htm.
• Use of mask for all in normal every-day
  situations not recommended. Individuals that are
  ill should be asked to go home and seek
  appropriate treatment. If persons with (ILI) must
  leave their home or dorm room (i.e., to seek
  medical care or other necessities) they should
  cover their nose and mouth when coughing or
  sneezing. A basic nuisance or surgical
  loose-fitting mask can be helpful for persons who
  have access to these. A tissue or other covering
  would be appropriate as well.
• N95 Respirators recommended for health care
  providers and those caring for ill in certain
  situations. Patients may need to wear surgical
  masks while being cared for.
• Contact EHS (x2320) for guidance on selection of
  proper respirators and masks. N95 use by
  employees has requirements.
• Gloves (basic exam gloves such as nitrile) worn
  by health care providers or when cleaning or
  garbage disposal operations. Wash hands after
  using gloves.
• Follow regular laundry procedures. Wash hands
  after putting into washer.

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Respirator vs. Masks

• N95 Respirator (NIOSH certified)

• Basic Mask

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UWSP Employee Wellness Group

• Take advantage of improving your wellness through
  UWSP Employee Wellness programs.
• See http//www.uwsp.edu/hphd/empwell/

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If you get sick

• Those with influenza like illness (ILI) should
  stay away from work and classes and limit
  interactions with other people (called voluntary
  self-isolation), except to seek medical care,
  for at least 24 hours after they no longer have a
  fever, or signs of a fever, without the use of
  fever-reducing medicines. They should stay away
  from others during this time period even if they
  are taking antiviral drugs for treatment of the
  flu. (For more information, visit
  http//www.cdc.gov/h1n1flu/guidance/exclusion.htm.
  ). This includes all students, employees, student
  employees, and other campus visitors. See UWSP
  Residential Halls letter.
• If you are sick, limit your contact with other
  people as much as possible.
• See CDC site Taking Care of a Sick Person in Your
  Home
• Seek medical attention as necessary.
• However be prepared for limited healthcare
  availability during major events.
• See http//www.flu.gov/individual/index.html for
  home/personal preparedness.

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Watch for emergency warning signs

• According to the CDC many people should be
  able to recover at home, but watch for emergency
  warning signs that mean you should seek immediate
  medical care.

• In adults
• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion / Not waking up and interacting.
• Severe or persistent vomiting
• Flu-like symptoms improve but then return with
• fever and worse cough
• Have pre-existing conditions that may
  compromise response to the virus.

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Higher Risk Groups

• The information analyzed by CDC supports the
  conclusion that novel H1N1 flu has caused greater
  disease burden in people younger than 25 years of
  age than older people. At this time, there are
  few cases and few deaths reported in people older
  than 64 years old, which is unusual when compared
  with seasonal flu.  However, pregnancy and other
  previously recognized high risk medical
  conditions from seasonal influenza appear to be
  associated with increased risk of complications
  from this novel H1N1. These underlying conditions
  include asthma, diabetes, suppressed immune
  systems, heart disease, kidney disease,
  neurocognitive and neuromuscular disorders and
  pregnancy.
• Other areas of concern that are being reviewed
  include smoking obesity.
• Remember the disease is new and being studied.
  All individuals should be prepared for prevention
  and response to the virus.
• See CDCs site at http//www.cdc.gov/h1n1flu/guid
  ance/exclusion.htm for further discussion on high
  risk groups.

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What is CDC doing?

• CDC has implemented its emergency response.
• CDC continues to issue new interim guidance for
  clinicians and public health professionals.
• CDCs Division of the Strategic National
  Stockpile (SNS) has sent 25 of the SNS stockpile
  of antiviral drugs, personal protective
  equipment, and respiratory protection devices to
  all 50 states and U.S. territories to help them
  respond to the outbreak.
• CDC is working closely with state and local
  officials nationwide.
• CDC also is coordinating closely with the World
  Health Organization and other international
  partners.
• Monitoring potential changes in virus.

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UWSP

• Following CDC, State of WI Dept. of Health
  Services, Portage County guidance.
• Developed Pandemic Plan. Individual department
  responsibilities. MOD updates.
• Work with Portage County and Providers to offer
  vaccination clinics when they are available.
• UWSP Health Services efforts for students.
• Recommendations within this presentation.
• Continue to monitor and respond. See
  http//www.uwsp.edu/ehs/emp/pandemic.html Also
  MOD.

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Summary

• Influenza should always be taken seriously. This
  Novel H1N1 outbreak certainly poses the potential
  to be at least as serious as seasonal flu, if not
  more so, especially given the fact that there
  very limited immunity which can make the illness
  more severe and widespread. Also adversely
  affecting different age groups vs. seasonal
  influenza.
• CDC anticipates that there will be more cases,
  more hospitalizations and more deaths associated
  with this new virus in the coming months because
  the population has little to no immunity against
  it.
• Follow all recommendations for preventing the
  spread of influenza. Proper hygiene and staying
  home when you are seek are the two key measures.
• We must all work together to limit and control
  the transmission of novel H1N1 influenza. Help
  spread the word and use proper measures.

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Resources

• US Centers for Disease Control (CDC)
  http//www.cdc.gov/h1n1flu/
• Flu.gov - Contains good home preparedness
  information.
• WI Pandemic Flu Resource at http//pandemic.wisco
  nsin.gov/
• Info line - 1-800-CDC-INFO (1-800-232-4636)
• World Health Organization (WHO)
  http//www.who.int/csr/disease/swineflu/en/index.h
  tml
• UWSP Pandemic Page at http//www.uwsp.edu/ehs/emp/
  pandemic.html
• Grainger.com Many Supplies available at
  discount. See MDS system.
• Do I have the flu? - take this quick
  self-assessment
• CDCStreamingHealth on YouTube at
  http//www.youtube.com/user/CDCStreamingHealth
• Note recommendations from CDC are dynamic.
  Various changes occur based on studies and other
  analysis.

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Questions?

• May contact Jeff Karcher x3901 or email at
  jkarcher_at_uwsp.edu
• Thank you.