H1N1 Influenza A: Preparing Suffolk County s Schools and School Districts

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September 21, 2009. Diagram. Suffolk County Department of Health ServicesDefinitions and a History of PandemicsH1N1 Influenza A VirusSymptoms and Transmission PatternsSuffolk County, New York, World StatisticsSuffolk County Public Health ResponseCDC Guidance for School Officials (K-12)Q

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H1N1 Influenza A: Preparing Suffolk County's Schools and School Districts Humayun J. Chaudhry, DO, MS, SM, FACOI, FACP, FAODME Commissioner, Suffolk County Department of Health Services, NY and Clinical Associate Professor of Preventive Medicine, Stony Brook University School of Medicine, N.Y.

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Outline Suffolk County Department of Health Services Definitions and a History of Pandemics H1N1 Influenza A Virus Symptoms and Transmission Patterns Suffolk County, New York, World Statistics Suffolk County Public Health Response CDC Guidance for School Officials (K-12) Q&A

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Suffolk County , Long Island, New York

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Suffolk County Department of Health Services Senior Leadership

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Endemic, Epidemic, and Pandemic Defined Endemic — A sickness that as of now happens at a high rate in a given populace Epidemic — A flare-up of new instances of an ailment in numbers that surpass what is normal Pandemic — A scourge that spreads overall Malarious Area www.cbsnews.com

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Pandemics Throughout History Plague of Justinian — 541 A.D. The Black Death — 1347-1350 A.D. Typhus or camp fever — 15 th and16 th hundreds of years Smallpox — 16 th to 18 th hundreds of years "Spanish" Flu — 1918 The Roof Rat www.algonet.se

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How Influenza Viruses Change Antigenic Drift: Small changes in infections after some time New strains show up May not be perceived by antibodies Antigenic Shift: Abrupt, real change (reassortment) Results in novel strain or new subtype Can bring about pandemic flu

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Seasonal Influenza, 2009 Annual regular flu pestilences > 36,000 passings in US from occasional flu ( ~ 100-200 passings in Suffolk County every year ) > 200,000 hospitalizations from influenza every year Over 85% mortality in people ≥ 65 yrs Severe illness in newborn children, youthful youngsters, and elderly people Attack rate of 5-15% (Nursing home assault rate of 60% ) Potential for pandemic

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Novel H1N1 Influenza A Virus

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H1N1 Influenza A (Swine Flu), 2009 WHO Phase 6 Pandemic (announced June 11, 2009) > 1 million cases in the U.S. > 40,617 affirmed cases in U.S. > 263 affirmed passings in U.S. > 180 affirmed cases in Suffolk County (6 passings) Imminent Public Threat pronounced by NYSDOH August 6, 2009 A shiny new infection A "fourfold reassortment of 2 swine strains, 1 human strain, and 1 avian strain of flu infection" Mean period of cases in Suffolk County and in U.S.: 12 Severe contamination happens in people who are not at the extremes of age Attack rate of 22-30% at first

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Novel H1N1 Influenza A Symptoms (Fever , hack , as well as sore throat) , disquietude, and cerebral pain Vomiting and loose bowels (abnormal for regular flu) Chills, myalgias, and arthralgias Infants: fever, torpidity, +/ - hack Elderly people and immunocompromised hosts may likewise have atypical introductions

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Risk Factors for Novel H1N1 Influenza A Virus Complications Chronic lung illness (particularly asthma, COPD) Immunocompromised states (counting pregnancy, kidney sickness, growth) Heart malady (other than HTN) Diabetes Mellitus Obesity? * Most Common Reasons for Hospitalization: Pneumonia and Dehydration

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Management of Novel H1N1 Influenza An Infection This infection is delicate to Tamiflu and Relenza, two antiviral solutions (just accessible by medicine) It is impervious to other antiviral pharmaceuticals Treatment is prescribed for All hospitalized patients with affirmed, plausible or suspected cases Patients who are at higher hazard for occasional flu intricacies Tamiflu and Relenza dislike anti-microbials and are best when utilized inside 24-48 hours of a flu sickness

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Testing for H1N1 in Fall, 2009 Not a need of the CDC, NYSDOH, or the Suffolk County Department of Health Services aside from Pediatric hospitalizations for "flu like disease" Any passings credited to, or connected with, a conclusion of pneumonia or other respiratory contamination As controlled by a social insurance supplier in counsel with the NYSDOH

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Transmission of H1N1 Primarily by respiratory beads ( sniffling and hacking ) Incubation Period: 1-4 days Viral shedding (infectiousness) Begins 1 day before side effects Peak shedding is amid initial 3 days of ailment with fever Lasts 7 days in grown-ups or 10+ days in youngsters

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Flu Pandemics: A Comparison YEAR 1918 2009 World Population 1.8 Billion 6.8 Billion Primary Mode of Ships, Jet Aircraft, Transportation Railroad Automobile Time for Virus to 4 months 4 days Circle the Globe Estimated Dead 20+ Million ? Around the world

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Influenza Viral Morphology Influenza Type A, B, C - in view of antigenic properties of nucleoproteins (NP) and network (M) proteins Hemagglutinin – protein that helps the infection append to a sound cell (15 sorts) Neuraminidase – protein that discharges infections into the body (9 sorts)

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How Are We Doing With Seasonal Influenza Vaccination Rates in the U.S.? Solid People 2010 flu immunization targets are 90% among people matured ≥65 years 60% among people matured 18-64 years CDC Data from the 2006-07 Influenza Season show inoculation rates of 72.1% among people matured ≥65 years 35.1% among people matured 18-49 42.0% among people matured 50-64 Source: MMWR, September 26, 2008

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H1N1 in the Fall, 2009 Washington has had the country's most astounding rate of H1N1 amid the pinnacle time frame in the state (2,500 presumed cases) 366.8 instances of this season's cold virus for each 10,000 understudies New York State has had 6.5 instances of this season's cold virus for each 10,000 understudies

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An understudy at Cornell University apportioning cleanser to understudies on Sept. 18 Cornell University in Ithaca, New York, on Sept. 18 revealed more than 700 instances of "ILI" since classes started A 20 year-old understudy at Cornell with a fundamental restorative condition kicked the bucket of entanglements from the H1N1 infection two weeks prior 3 abutting school grounds have had a sum of 100 cases Cornell University "ILI" Outbreak

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Legal Authority Pursuant to the New York Public Health Law, the Suffolk County Commissioner of Health Services has the lawful specialist to arrange the segregation or potentially isolate of any individual or thing "contaminated with or presented to" a transmittable ailment. New York Public Health Law § 2100 (1); 10 N.Y.C.R.R. §§ 2.1, 2.25 & 2.29.

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Personal Hygiene is Best Tool Handwashing with cleanser and water is basic Virus can spread by tainting of hands that is then trailed by hand contact with mucous films Alternatives to cleanser and water exist Alcohol-based hand gels

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Masks May Also Play a Role Use of covers may diminish the spread of infection between individuals Widespread use amid SARS episode May keep youngsters from putting hands/objects into their mouths

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This Might Help… Chicken Soup Orange Juice Vitamin C Multivitamins

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Kobe, Japan May 19, 2009

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Daily Swine Flu Exam: China, May, 2009

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School Closure, Deer Park School District, Suffolk County, N.Y., May, 2009

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CDC Guidance for K-12 School Response Purpose Provide direction on proposed implies for lessening introduction of understudies and staff to H1N1 and occasional flu amid the 2009-2010 school year Goals Decrease spread of influenza among understudies and staff Minimize interruption of everyday social, instructive, and financial exercises

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Recommended School Responses (If comparative seriousness as in Spring 2009) Stay home when wiped out Separate sick understudies and staff Teach hand cleanliness and respiratory behavior! Early distinguishing proof and treatment of high-hazard understudies and staff Routine cleaning Consideration of specific school expulsion

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Recommended School Responses (If expanded seriousness ) "Dynamic" screening High-chance understudies and staff remain home Students with sick family unit individuals remain home for 5 days Increase separate between individuals at schools Extend the period for sick people to remain home Selective, receptive, and pre-emptive school rejections

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"Dynamic" Screening for Illness Ask about fever and different manifestations Send home individuals with side effects of intense respiratory disease Be cautious for the duration of the day Send understudies and staff who seem sick for further screening by school-based medicinal services specialist If conceivable, have sick individual wear a cover until sent home

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If seriousness builds: Increase Distance between People Explore creative strategies Rotate instructors instead of understudies Cancel classes that unite understudies from numerous classrooms Outdoor classes Move work areas more remote separated Move classes to bigger spaces Discourage utilization of school transports and open travel Postpone some class trips

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Suffolk County's H1N1 Plan for Fall 1) Two conceivable situations Moderately extreme sickness Slightly a larger number of cases than in Spring, 2009 Increased seriousness of ailment No sign from CDC or WHO this is going on, or will happen, however we will be readied 2) "Remain Home in the event that You Are Ill" Influenza-like Illness (ILI): Fever, Cough Suffolk County's meaning of fever: >100 ºF or feeling warm/hot in addition to chills/sweats

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Suffolk County's H1N1 Plan for Fall 3) H1N1 inoculation and regular flu immunization will be encouraged for target populaces Hospitals, Private Physician Practices, Pharmacies 10 SCDHS Health Centers and >50 Vaccination Clinic PODs (Points of Dispensing) all through County Schools, on the off chance that they wish to have inoculation facilities Mandatory in NYS for all doctors and staff at doctor's facilities, Article 28 offices, Home Health Care, Hospice (NYSDOH Emergency Regulation) 4) Upon reques

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