H1N1 Influenza Update
(formerly known as Swine Flu)
11/10/09 Stephen Motzko, CSP
H1N1– What Is The Big Deal?
Novel H1N1 (referred to as swine flu early on) is a new
influenza virus that is spreading from person-to-person.
Media Attention Varies
Novel H1N1 Influenza
• Influenza is always serious – each year in the United
States, seasonal influenza results, on average, in an
estimated 36,000 deaths and more than 200,000
hospitalizations from flu-related causes.
• This outbreak certainly poses the potential to be at
least as serious as seasonal flu, if not more so.
• CDC expects that more cases, more hospitalizations,
and more deaths (up to 90K) from this outbreak will
occur this year.
• While past diseases of SARS (2003) and Bird Flu
H5N1 (2005+) have had little impact on most of us,
there can be significant impacts.
Lessons from SARS (2003)
• Economic disruption led to loss of 2% of East
Asian GDP in the second quarter of 2003
• In the US, SARS blamed for losses of 15% of
sales in tech sector
• SARS outbreak in Toronto led to sharp drop
in tourist visits, costing US $850 million in
GDP
• During SARS outbreak, Cathay Pacific
carried only 30% of its usual passengers –
stock price decreased nearly 20%
Source/Footnote: Maplecroft Website
H1N1 & Pandemic Planning
Let’s Talk H1N1
• Issues, Issues, Issues –Why We Care
– Productivity
– Human Resources Issues
– Supply Chain
– Travel
• Background Information
– Where To Find Information
– Avoiding Information Overload
Business Issue - Employees
• Employee Health & Absence
– Telecommuting Options/Feasibility
• Business Travel
– Exposure While Traveling
– Contributing to Spread
– Quarantines
– Evacuation from Infected Areas
• Visitor Exposures (incl. Vendors and Contractors)
Business Issue - Logistics
• Transfer of Operations/Business
– Avoid Restricted/Quarantined Areas
– Avoid Bottlenecks
– Leverage Existing Plans/Capabilities
• Supply Chain Management
• Outsourcing of Operations/Services
• Integration with Existing Disaster Response
& Recovery Planning Procedures/Programs
H1N1 Influenza – Travel Alerts
•
Due to the outbreak of novel H1N1 flu occurring in the United
States and many other countries, airport staff in some
countries may check the health of arriving passengers.
•
If you are sick with symptoms of influenza-like illness, you
should not travel.
H1N1 Influenza – Travel Alerts
•
Travel Alert: China - H1N1 Quarantine Measures
http://travel.state.gov/travel/cis_pa_tw/pa/pa_4238.html
•
Due to the outbreak of novel H1N1 flu occurring in the United States and many
other countries, airport staff in some countries may check the health of arriving
passengers. Many countries, including Japan and China, are screening arriving
passengers for illness due to novel H1N1 flu. These health screenings are being
used to reduce the spread of novel H1N1 flu.
•
If you are sick with symptoms of influenza-like illness, you should not travel.
These symptoms include fever, cough, sore throat, runny or stuffy nose, body
aches, headache, chills, and fatigue. A significant number of people who have
been infected with this virus also have reported diarrhea and vomiting.
•
Since the novel H1N1 flu outbreak is occurring in the United States, flights from
the United States arriving in other countries may be specifically targeted for
screening. Travelers coming from the United States may be checked for fever
and other symptoms of novel H1N1 flu, and their travel may be delayed.
•
Consult the embassy of the country, or countries, in your travel itinerary for
information about entry screening procedures (see Websites of U.S. Embassies,
Consulates, and Diplomatic Missions for contact information).
Source / CDC Traveler’s Health (Updated – 9/11/09)
H1N1 Influenza – What Is Simpson
Strong-Tie Doing?
• We are following the precautions and guidelines set by the
World Health Organization (WHO) and the U.S. Centers for
Disease Control (CDC)
– Recognized, credible sources for current information about the
situation
– Continuously updating the status of known facts
• News headlines can sometimes be premature or
misinterpreted, and although they can provide some
highlights, we defer to the international health agencies for
reference guidance
H1N1 Influenza – Our Response
• Information is kept current on our Intranet (Jobsite) in the form
of a PowerPoint presentation, updated regularly
• Resources (posters, flyers, etc.) are also available
• Flu vaccines are provided (Seasonal Flu)
• Branches/locations have contingency plans
– for absences; especially smaller Branches with few
employees
– Branch/site plans include keeping soap and towels in
bathrooms in adequate supply, available for employees
– Encourage sick employees to stay home! Adjust policies
Jobsite PowerPoint Guidance
• Hygiene precautions (hand washing,
cough and sneeze etiquette
• Guidance on staying home when sick
• Current status and news about H1N1
• Travel Precautions
(Before-During-After)
• Where to go for more information
Sample from Presentation
H1N1 Influenza (Swine Flu) – What Is It?
Novel H1N1 (referred to a swine flu early on) is a
new influenza virus that is spreading from personto-person.
The United States government has declared a
public health emergency in the U.S. in response to
the H1N1 outbreak.
CDC’s response goals are to:
• reduce transmission and illness severity
• provide information to help health care providers, public
health officials, and the public address the challenges
posed by this emergency.
Source / CDC (5/11/09)
Sample from Presentation
Novel H1N1 Influenza
• The first cases of human infection with
novel H1N1 influenza virus were detected
in April 2009 in San Diego and Imperial
County, California and in Guadalupe
County, Texas.
• The virus has spread rapidly.
• The virus is widespread in the United
States at this time and has been detected
internationally as well.
Source / CDC (5/11/09)
Sample from Presentation
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
– Fatigue
– In addition, vomiting (25%) and diarrhea (25%) have
been reported. (Higher rate than for seasonal flu.)
Source / CDC (5/11/09)
Sample from Presentation
How does novel H1N1 Influenza spread?
• This virus is thought to
spread the same way
seasonal flu spreads
• Primarily through respiratory
droplets
– Coughing
– Sneezing
– Touching respiratory droplets on
yourself, another person, or an
object, then touching mucus
membranes (e.g., mouth, nose,
eyes) without washing hands
Source / CDC (5/11/09)
Sample from Presentation
Can you get H1N1 from eating pork?
No. The novel H1N1 influenza virus
(formerly referred to as swine flu) virus is
not spread by food.
You cannot get novel H1N1 flu from eating
pork or pork products. Eating properly
handled and cooked pork products is safe.
Source / CDC (5/11/09)
Take these everyday steps to protect
Sample from Presentation
your health
• Wash your hands often with soap and
warm water, especially after you cough
or sneeze. Wash for 15 to 20 seconds.
• Alcohol-based hand wipes or gel sanitizers are
also effective.
• Cover your nose and mouth with a tissue when
you cough or sneeze. Throw the tissue in the
trash after you use it.
• Avoid touching your eyes, nose or mouth. Germs
spread this way.
• Avoid contact with sick people.
Source / CDC (5/11/09)
Sample from Presentation
If you get sick…
• Stay home if you’re sick
for 7 days after your symptoms
begin or until you’ve been
symptom-free for 24 hours,
whichever is longer.
• If you are sick, limit your contact
with other people as much as possible.
Source / CDC (5/11/09)
Sample from Presentation
Watch for emergency warning signs
Most 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
– Severe or persistent vomiting
– Flu-like symptoms improve but then return with fever and
worse cough
Source / CDC (5/11/09)
Sample from Presentation
Emergency warning signs in children
If a child gets sick and experiences any of
these warning signs, seek emergency
medical care.
In children:
– Fast breathing or trouble breathing
– Bluish or gray skin color
– Not drinking enough fluids
– Severe or persistent vomiting
– Not waking up or not interacting
– Irritable, the child does not want to be held
– Flu-like symptoms improve but then return
with fever and worse cough
Source / CDC (5/11/09)
Sample from Presentation
International Travel
If you travel internationally from the United States, you may be asked to:
•
Pass through a scanning device that checks your temperature. (The device may look like an airport
metal detector, a camera, or a handheld device.)
•
Have your temperature taken with an oral or ear thermometer
•
Fill out a sheet of questions about your health
•
Review information about the symptoms of novel H1N1 flu
•
Give your address, phone number, and other contact information
•
Be quarantined for a period of time if a passenger on your flight is found to have symptoms of novel
H1N1 flu
•
Contact health authorities in the country you are visiting to let them know if you become ill
•
If you have a fever or respiratory symptoms or are suspected to have novel H1N1 flu based on
screening, you may be asked to:
•
Be isolated from other people until you are well
•
Have a medical examination
•
Take a rapid flu test (which consists of a nasal swab sample)
•
Be hospitalized and given medical treatment, if you test positive for novel H1N1 flu
•
Please note that the U.S. Department of State usually cannot interfere with the rights of other
countries to screen airline passengers entering or exiting their countries, nor can it influence
the number of days in quarantine.
•
Because these outbreak-related delays, which could include several days of quarantine, may affect
planned activities and lead to unexpected costs, CDC strongly recommends that travelers consider
purchasing travel insurance. To find a list of possible travel health and medical evacuation insurance
companies, visit Medical Information for Americans Abroad (U.S. Department of State).
Source / CDC Traveler’s Health (Updated – 9/11/09)
H1N1 Influenza – Travel Precautions Sample from Presentation
Before
• Prepare for your trip before you leave
• Visit CDC's Travelers’ Health Website to learn
about any disease risks and CDC health
recommendations for areas you plan to visit.
• Be sure you are up-to-date with all your routine
vaccinations, including seasonal influenza vaccine
if available.
• Identify the health-care resources in the area(s)
you will be visiting.
Source / CDC Traveler’s Health (4/27/09)
H1N1 Influenza – Travel Precautions Sample from Presentation
During
•
Monitor the local situation
•
Pay attention to announcements from the local government.
•
Follow local public health guidelines, including any movement restrictions and
prevention recommendations.
•
Practice healthy habits to help stop the spread of influenza
•
Wash your hands often with soap and water. This removes germs from your skin and
helps prevent diseases from spreading.
–
Use waterless alcohol-based hand gels (containing at least 60% alcohol) when soap is not
available and hands are not visibly dirty.
•
Cover your mouth and nose with a tissue when you cough or sneeze and put your used
tissue in a wastebasket.
•
If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands.
•
Wash your hands after coughing or sneezing, using soap and water or an alcoholbased hand gel.
•
Follow all local health recommendations. For example, you may be asked to put on a
surgical mask to protect others.
•
Seek medical care if you feel sick
Source / CDC Traveler’s Health (4/27/09)
H1N1 Influenza – Travel Precautions Sample from Presentation
After
•
Closely monitor your health for 7 days
•
If you become ill with fever and other symptoms of swine flu like cough and sore throat and possibly
vomiting and diarrhea during this period, call your doctor or clinic for an appointment right away. Your
doctor may test you for influenza and decide whether influenza antiviral treatment is indicated.
•
When you make the appointment, tell the doctor the following:
–
Your symptoms,
–
Where you traveled, and
–
If you have had close contact with a person infected with swine flu.
•
Avoid leaving your home while sick except to get local medical care, or as instructed by your doctor.
Do not go to work or school while ill. If you must leave your home (for example, to seek medical care)
wear a surgical mask to keep from spreading your illness to others.
•
Always cover your nose and mouth with a tissue when you cough or sneeze. Throw away used
tissues in a trash can.
•
Wash your hands with soap and water often and especially after you cough or sneeze. If soap and
water are not available, use an alcohol-based hand gel containing at least 60% alcohol.
•
Avoid close contact with other people as much as possible.
•
Wear a surgical mask if you are in contact with other people.
Source / CDC Traveler’s Health (4/27/09)
Sample from Presentation
Weekly Updates of WHO & CDC
The following slides summarize the weekly updates from the World
Health Organization (WHO) and the Center for Disease Control
(CDC).
•
On the basis of available evidence and expert assessments of the
evidence, the scientific criteria for an influenza pandemic have been
met.
•
The Director-General of WHO raised the level of influenza
pandemic alert from phase 5 to phase 6. "The world is now at the
start of the 2009 influenza pandemic," she said at a press
conference 6/11.
•
On present evidence, the overwhelming majority of patients
experience mild symptoms and make a rapid and full recovery,
often in the absence of any form of medical treatment.
•
Worldwide, the number of deaths is small. Each and every one of
these deaths is tragic, and we have to brace ourselves to see more.
However, we do not expect to see a sudden and dramatic jump in
the number of severe or fatal infections.
Source / WHO (6/11/09)
Sample from Presentation
H1N1 Flu – Present Situation - WHO
Pandemic (H1N1) 2009 - update 73
•
As of 1 November 2009, worldwide more than 199 countries and overseas territories/communities have
reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 6000 deaths.
•
As many countries have stopped counting individual cases, particularly of milder illness, the case
count is likely to be significantly lower than the actual number of cases that have occurred. WHO is
actively monitoring the progress of the pandemic through frequent consultations with the WHO
Regional Offices and member states and through monitoring of multiple sources of data.
•
Intense and persistent influenza transmission continues to be reported in North America without
evidence of a peak in activity. The proportion of sentinel physician visits due to influenza-like-illness
(ILI)(8%) has exceeded levels seen over the past 6 influenza seasons; 42% of respiratory samples
tested were positive for influenza and 100% of subtyped influenza A viruses were pandemic H1N1
2009. Rates of ILI, proportions of respiratory samples testing positive for influenza, and numbers of
outbreaks in educational settings continues to increase sharply in Canada as activity spreads
eastward. Significantly more cases of pandemic H1N1 have been recorded in Mexico since September
than were observed during the initial springtime epidemic.
•
In Europe and Central and Western Asia, pandemic influenza activity continues to increase across
many countries, signaling an unusually early start to the winter influenza season. Active circulation of
virus marked by high proportions of sentinel respiratory samples testing positive for influenza has
been reported in Belgium (69%), Ireland (55%), Netherlands (51%), Norway (66%), Spain (46%), Sweden
(33%), the United Kingdom (Northern Ireland:81%), and Germany (27%). In addition, there is evidence
of increasing and active transmission of pandemic influenza virus across Northern and Eastern
Europe (including Ukraine and Belarus), and eastern Russia. For details on the situation in Ukraine
please refer to the Disease Outbreak News update below. In Western Asia and the Eastern
Mediterranean Region, increasing activity has been reported in Oman and Afghanistan.
•
Link to WHO Update 73 http://www.who.int/csr/don/2009_11_06/en/index.html
Source / WHO (11/6/09)
Sample from Presentation
Spread of Influenza A(H1N1)
Sample from Presentation
H1N1 Flu – Key Flu Indicators 11/6/09
During week 43 (October 25-31, 2009), influenza activity remained elevated in the U.S.
•
5,258 (37.2%) specimens tested by U.S. World Health Organization (WHO) and
National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating
laboratories and reported to CDC/Influenza Division were positive for influenza.
•
Over 99% of all sub typed influenza A viruses being reported to CDC were 2009
influenza A (H1N1) viruses.
•
The proportion of deaths attributed to pneumonia and influenza (P&I) was above the
epidemic threshold.
•
Eighteen influenza-associated pediatric deaths were reported. Fifteen of these deaths
were associated with 2009 influenza A (H1N1) virus infection and three were
associated with an influenza A virus for which the subtype was undetermined.
•
The proportion of outpatient visits for influenza-like illness (ILI) was above the
national baseline. All 10 regions reported ILI above region-specific baseline levels.
•
Forty-eight states reported geographically widespread influenza activity, two states
reported regional influenza activity, the District of Columbia reported local influenza
activity; Puerto Rico and Guam reported sporadic influenza activity, and the U.S.
Virgin Islands did not report.
Source / CDC (11/6/09)
Sample from Presentation
H1N1 Flu – Present Situation - CDC
Source / CDC (11/6/09)
Who
will
be
recommended
to
receive
Sample from Presentation
the 2009 H1N1 vaccine?
•
CDC’s Advisory Committee on Immunization Practices (ACIP) recommends that certain
groups of the population receive the 2009 H1N1 vaccine first. These target groups include
pregnant women, people who live with or care for children younger than 6 months of age,
healthcare and emergency medical services personnel, persons between the ages of 6
months and 24 years old, and people ages of 25 through 64 years of age who are at higher
risk for 2009 H1N1 because of chronic health disorders or compromised immune systems.
•
Vaccine to protect against the 2009 H1N1 flu virus is available; however, initial supplies are
limited. The Advisory Committee on Immunization Practices (ACIP) has recommended that
the following groups receive the vaccine before others: pregnant women, people who live
with or care for children younger than 6 months of age, health care and emergency medical
services personnel with direct patient contact, children 6 months through 4 years of age,
and children, especially those younger than 5 years of age and those who have high risk
medical conditions are at increased risk of influenza-related complications. For a more
detailed description of children at highest risk, read Children with Developmental Disabilities
and Chronic Medical Conditions
•
The committee recognized the need to assess supply and demand issues at the local level.
The committee further recommended that once the demand for vaccine for these target
groups has been met at the local level, programs and providers should begin vaccinating
everyone from ages 25 through 64 years. Current studies indicate the risk for infection
among persons age 65 or older is less than the risk for younger age groups. Therefore, as
vaccine supply and demand for vaccine among younger age groups is being met, programs
and providers should offer vaccination to people over the age of 65.
Source / CDC (11/5/09)
Follow Reputable
Information/Sources
•
What is CDC’s recommendation regarding "swine flu parties"?
"Swine flu parties" are gatherings during which people have close contact
with a person who has 2009 H1N1 flu in order to become infected with the
virus. The intent of these parties is for a person to become infected with
what for many people has been a mild disease, in the hope of having
natural immunity 2009 H1N1 flu virus that might circulate later and cause
more severe disease.
•
CDC does not recommend "swine flu parties" as a way to protect against
2009 H1N1 flu in the future. While the disease seen in the current 2009
H1N1 flu outbreak has been mild for many people, it has been severe and
even fatal for others. There is no way to predict with certainty what the
outcome will be for an individual or, equally important, for others to whom
the intentionally infected person may spread the virus.
•
CDC recommends that people with 2009 H1N1 flu avoid contact with others
as much as possible. If you are sick with flu-like illness, CDC recommends
that you stay home for at least 24 hours after your fever is gone except to
get medical care or for other necessities. (Your fever should be gone without
the use of a fever-reducing medicine.) Stay away from others as much as
possible to keep from making others sick.
Commercial Tracking Available – E.G. iJet
Source/Footnote: CDC Website - http://www.ijet.com/swinefluresources/images/WW-human-cases-LATEST.gif
CDC Business Pandemic Influenza
Planning Checklist
Source/Footnote: CDC Website - http://www.pandemicflu.gov/professional/pdf/businesschecklist.pdf
H1N1 Influenza
For additional Information
• H1N1 Influenza resources:
– World Health Organization:
http://www.who.int/csr/disease/swineflu/en/index.html
– Centers for Disease Control:
http://www.cdc.gov/h1n1flu/
1-800-CDC-INFO (1-800-232-4636)
– CDC Travel Advisories & Alerts:
http://wwwn.cdc.gov/travel/notices.aspx
– U.S. State Department Travel Alerts:
http://travel.state.gov/travel/cis_pa_tw/pa/pa_1766.html
– U.S. state Department Travel Warnings:
http://travel.state.gov/travel/cis_pa_tw/tw/tw_1764.html
MORE…H1N1 Influenza Information
• More H1N1 Influenza resources:
– Flu.gov Communication Toolkit for Businesses and
Employers:
http://www.pandemicflu.gov/professional/business/toolkit.html
– SHRM - Human Resources H1N1 Page:
http://www.shrm.org/hrdisciplines/safetysecurity/articles/pages
/swineflunewsresources.aspx
– CNN H1N1: Fighting the Flu :
http://www.cnn.com/SPECIALS/2009/h1n1/
– International SOS – Pandemic Preparedness:
http://www.internationalsos.com/pandemicpreparedness/
– Marsh Flu Pandemic Page:
http://global.marsh.com/risk/pandemic/index.php
?’s
H1N1 Influenza Update
(Swine Flu)
Thank You
11/10/09 Stephen Motzko, CSP