Mono Health Director Releases Flu Alert Info

Public Health Mono-Gram

Richard O. Johnson, M.D., MPH, Public Health Officer Office: (760) 924-1828 Fax: (760) 924-1831 E-mail: drrickjohn@gmail.com

Lynda Salcido, Public Health Director Office: (760) 924-1842 Fax: (760) 924-1831 E-mail: lsalcido@mono.ca.gov

24/7/365 Emergency Contact: (760) 914-0496 H1N1 influenza update - Thursday, May 7th, 2009 What happened? During the months of March and April, a brand new influenza virus appeared. The outbreak probably started in Mexico, and spread to the southern US. Laboratory confirmed cases have now been reported from 41 states and 23 countries around the world. Most illnesses are mild to moderate, with some hospitalizations, and 2 deaths linked to the virus. A majority of cases have been in youth, with two-thirds of cases being less than 35 years of age. Contrast this to the "seasonal influenza" that we have every winter, which on average causes 200,000 hospitalizations, and 36,000 deaths, mostly in the elderly and very young infants. Declarations of Emergency were declared at both the Federal and State levels. Mono County Health Department opened its Department Operations Center. The focus has been on enhanced surveillance for possible cases in the local area, engagement of all partners in positioning ourselves in case of a medical surge, and education and communication with the public to alleviate fear and prevent panic. We are grateful to all for your support and willingness to work with us to protect individuals and families in our "parish". What will happen? We will continue to "lean forward", and to monitor the situation - locally, regionally, and internationally - as it evolves, for the foreseeable future. This is not a time for us to become complacent, and to let our guard down. Here come the questions - and some educated guesses! 1.We will continue to see quantum leaps in reports of new cases, with some hospitalizations and deaths. However, we expect illnesses to continue to be generally mild. After a few more weeks, I expect cases to rapidly diminish, as the weather gets warmer. There will be evidence of spread to all 50 states, and to many more countries. Question - what will happen in the Southern Hemisphere as they go into winter with their annual flu season arriving in the next few weeks? How will this impact the huge numbers of immunocompromised HIV individuals living in sub-Saharan Africa that do not have adequate treatment? 2.What is the true story in Mexico? Intensive on-the-ground field work is ongoing, and should provide some very interesting theories - if not answers - within the next weeks to a month. Did it really start in Mexico? Why is the reported Mexican experience with severe illness and death so different from the rest of the world? More questions than answers at this point. 3.Most illnesses have been in young people. Why is that? Is it something different about the virus? The 1918 "Spanish flu" virus also attacked primarily the young, but it was a killer. Or, is it that older individuals have some immunity gained from previous exposure that is protecting them from illness this time around. Only time - and lots of ongoing laboratory work - will provide answers. Maybe there is an advantage to being old!! 4.Will the virus mutate? Absolutely - yes - but into what form? Will it become a killer? Will it become resistant to antiviral medication such as Tamiflu? Will it attack different age groups? So far, the 2009 H1N1 virus lacks a gene that is present in highly virulent flu viruses, like the 1918 virus. Hopefully, it stays that way. That is more a hope than a prediction. 5.Will there be a second wave? All of the previous pandemics - 1889, 1918, 1957, and 1968, had more than one wave, and the second wave was the worst. Will the virus just up and burn itself out and go away? I doubt it. When will a second wave occur? Most likely in the fall when the weather gets colder and the next respiratory illness season gets underway. My advice to healthcare workers - take your vacation this summer, and be prepared for a very interesting time next fall and winter. Our surveillance systems will be running at full capacity once school starts in the fall, looking for anything unusual that may be happening. 6.Will there be a vaccine? Contrary to popular opinion, the decision to start full production of a vaccine has not yet been made. One question - why produce millions of doses of vaccine for a disease that appears to be pretty benign? A key meeting will occur on May 14th, with more information after that. Many decisions are still to be made, but some things are clear. The capacity to make vaccine is limited. Therefore, any decision to make a "swine flu" vaccine will need to be balanced with the need for a seasonal flu vaccine. It appears too late to combine the two; therefore, we are looking at 2 different vaccines when available. Safety of the vaccine will be of utmost concern, especially following the experience from 1976. You may or may not remember that President Ford ordered massive production of a vaccine against a "swine flu" that never materialized into an epidemic outside of Fort Dix in New Jersey. The vaccine killed more people than the disease, and caused paralysis in over 1,000 people. Who should get a vaccine? The choice of vaccine strategy will be the subject of intense debate over the next few months. Priority will be given to those most likely to get sick (currently the young), those most likely to get complications from infection (those with chronic medical conditions, and perhaps the very young and very elderly), and essential workers who are exposed (first responders and healthcare workers). When will there be a vaccine? If a decision is made to go ahead with production, and if everything goes like clockwork (unlikely), it will still be months before a vaccine is available. We are probably talking about 4-6 months, which may or may not be before a second wave of infections occurs. Finally, the responsibility for responding to these events is shared - it is not solely a responsibility of public health or government. This is a perfect teaching moment - current events have gotten your attention, but have not caused you major disruption. This is not a time to panic - there are things that you can do to take some control over your destiny! Individuals need to continue to practice (or start!) all the good, common-sense hygiene you learned from your mother that was reinforced in kindergarten. This means: Wash your hands thoroughly and regularly (15-20 seconds) with soap and water, or use a water free, alcohol based hand cleanser. Cover your mouth with your sleeve or elbow when you sneeze or cough. Stay home from work when you are sick. Keep your children home from school when they are sick. Households and families: Have contingency plans in place in case schools and day care are closed Be prepared to be self-sustaining for up to 2 weeks, with food, water, gasoline, propane, wood, etc. Have a communication system in place to stay in touch with family and friends. Know where you are going to get dependable information on the local situation, including resources that you may need, such as medical care, shelters, evacuation routes, etc. Think about how you are going to be emotionally and spiritually resilient, when your workplace and schools are closed, and events seem out of your control. Parents - how will you cope when your teen-aged kids are stuck home with you for weeks? Kids - how will you cope being stuck at home with your parents, especially if your cell phone, Blackberry, etc., does not work, and you can't Tweet! Businesses: Do you have a contingency plan in place that deals with absent or sick employees, so that you can continue to operate? Do you have measures in place to alter the work environment so that people are not as close to each other as usual, have less face-to-face interaction, and have less shared workspace and equipment (working at home, conference calling, etc.) What are your essential services that you must continue to perform, and what can be postponed? What essential supplies do you need that you should now be keeping on hand in case of shortages? I am proud of our government. In the last few weeks, we have seen government at all levels - federal, state, region, local, and tribal - come together with a focus and purpose to confront this potential threat. Communication and cooperation has been good, and much of the planning that has been done over the years has been applied to this threat. Everyone has a role to play - let's continue to move forward! For more information: http://www.cdc.gov/swineflu/ http://ww2.cdph.ca.gov/HEALTHINFO/DISCOND/Pages/SwineInfluenza.aspx http://www.monohealth.com/news/news.html