Update on Novel H1N1 Influenza Kimberly Handel, MSN,CRNP PSU Occupational Medicine

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Update on Novel H1N1 Influenza
Kimberly Handel, MSN,CRNP
PSU Occupational Medicine
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What is Swine Flu?

• A new (novel) form of influenza virus (not
  bacterial)
• Originally spread from pigs to humans
• Similar in symptoms to the seasonal flu
• Has reached pandemic status
• Expected to affect 40 of population within 2
  years
• Vaccine has been developed (different from
  yearly)
• Not yet more lethal than seasonal flu 36,000
  deaths/ 226,000 hosp yearly w/seasonal (see
  chart)
• Has not yet occurred along with US flu
  season-cause for concern

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U.S. Human Cases of H1N1 Flu Infection As of
1100 AM ET on July 24, 2009, CDC is reporting
43,701 confirmed and probable cases and 302 deaths

• Alabama 477 cases 0 deaths
• Alaska 272 cases 0 deaths
• Arizona 947 cases 15 deaths
• Arkansas 131 cases 0 deaths
• California 3161 cases 52 deaths
• Colorado 171 cases 0 deaths
• Conn 1713 cases 8 deaths
• Delaware 381 cases 0 deaths
• Florida 2915 cases 23 deaths
• Georgia 222 cases 1 death
• Hawaii 1424 cases 3 deaths
• Idaho 166 cases 0 deaths
• Illinois 3404 cases 17 deaths
• Indiana 291 cases 1 death
• Iowa 165 cases 0 deaths
• Kansas 204 cases 0 deaths
• Kentucky 143 cases 0 deaths

• Nebraska 313 cases 1 deaths
• Nevada 467 cases 0 deaths
• New Ham 247 cases 0 deaths
• New Jersey 1414 cases 15 deaths
• New Mexico 232 cases 0 deaths
• New York 2738 cases 63 deaths
• N Carolina 483 cases 5 deaths
• N Dakota 63 cases 0 deaths
• Ohio 188 cases 1 death
• Oklahoma 189 cases 1 death
• Oregon 524 cases 5 deaths
• PA 1960 cases 8 deaths
• Rh Island 192 cases 2 deaths
• S Carolina 244 cases 0 deaths
• S Dakota 45 cases 0 deaths
• Tennessee 283 cases 1 deaths
• Texas 5151 cases 27 deaths
• Utah 988 cases 16 deaths
• Vermont 59 cases 0 deaths

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Basic Principles of Influenza Viruses

• Human influenza viruses are transmitted
  person-to-person breaking this chain can limit
  additional cases. (ex.school closings)
• Influenza viruses are primarily transmitted by
  respiratory droplets from a cough or sneeze. (
  6ft/ 2-8 hrs)
• Influenza viruses prefer cool, dry air.
  Influenza is a highly seasonal virus (fall/
  winter)
• Novel viruses can occur at unusual times because
  of the absence of immunity
• Influenza viruses target respiratory mucosa
  including the nasal passages, eyes, throat, and
  lungs. Contaminated hands can provide direct
  contact.

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• Incubation period is 24 to 72 hours after
  exposure.
• Potentially infectious 1 day before symptoms
  occur and up to 6 days after. Advise staying
  home from work for 24hr after they are free of
  fever (100), or symptoms of a fever while not on
  fever reducing meds.
• Infection and recovery produces lasting immunity
• Those who avoid H1N1 influenza will be
  susceptible in the future and should be
  vaccinated once a vaccine is available and
  recommended.
• Mortality is highest in very young, very old, and
  in the most immunocompromised persons.
• As late fall and winter return, H1N1 influenza
  may become significantly worse.
• Influenza viruses have a high potential for
  mutation. Need to keep abreast of changing
  information.
• Temte JL. Basic rules of influenza how to combat
  the H1N1 influenza (swine flu) virus. Am Fam
  Physician. 2009

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Symptoms of Swine Flu

• Fever (usually gt102)
• Headache
• Cough
• Sore Throat
• Nasal discharge
• Muscle aches
• Fatigue
• Vomiting or diarrhea (more likely in children)
• Secondary bacterial infections can occur

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Who is at Highest Risk of Complications?

• Children under 5 years old, especially under 2
• Adults 65 and older
• Persons with chronic diseases including those
  with lung or heart disease or diabetes
• Immunosuppressed individuals
• Pregnant women
• Nursing home residents

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The first groups recommended to receive the novel
H1N1 influenza vaccine include

• Pregnant women
• Household contacts and caregivers for children
  younger than 6 months of age
• Healthcare and emergency medical services
  personnel
• All people from 6 months through 24 years of age
• Persons aged 25 through 64 years who have health
  conditions associated with higher risk of medical
  complications from influenza.

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Treatment of Swine Flu

• Antiviral medications TamifluRelenza
• Amantidine/ rimantidine resistant
• Slow replication of virus
• Most treatment is supportive
• Rest, hydrate, treat symptoms
• Monitor for signs of secondary infection

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Education and Prevention is Key

• Stay home if sick (24hr after fever resolves)
• Send sick employees home (consider mask while
  exiting)
• Handwashing! (Soap/ water or alcohol based)
• Clean common surfaces
• Avoid touching hands to mouth or nose
• Cover your mouth or cough and sneeze into tissue
• Social distancing when possible (6ft)
• Consider Seasonal flu shot this fall
• Consider Swine flu vaccine when available (may be
  limited)
• Stay informed of changes/ recommendations

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Questions ????