Pandemic?

[imsayin]

9 cases confirmed in Illinois.

 

[mommy*RN]

I didn't catch he interview, but was it said that the resistant strain had achieved human-to-human transition? Most swine flus don't, so perhaps that is why the resistant ttrain isn't being talked about. If it were spreading, I'm sure our fear-mongering media would be all over that angle!

Really all she said was in a seperate incidence (then folded her hands in a praying motion and said something like, we're praying it's seperate) there has shown a strain of the swine flu that is resistant to Tamiflu but so far the cases in Mexico have shown no resistance to Tamiflu and they hope that continues to be the case. This isn't verbatium, just from my memory. Please correct me if I am wrong...it was a short little blurb but really caught my attention because she did the praying thing.

I agree if the resistant strain were out there infecting people and the media caught one tiny wiff of it...it would be ALL over the news. I watched this lady 3 times in the interview and she didn't really make any reference to how or where this resistant strain was found. Maybe they were testing the pigs??

 

[S. C.]

One case confirmed in livingston county Michigan (next county over from me)

One probable case in Ottawa county on the west side of the state.

Five Suspected cases in Ingham county. (same county I live in)

http://www.wlns.com/Global/story.asp?S=10264929&nav=menu25_2

 

[mommy*RN]

No confirmed cases here in Wisconsin...yet.

This was published by one of our local news channels and I thought it was interesting. The study from the University peaked my interested (I bolded that part).

Probable Cases Of Swine Flu Hit Midwest, But Not Wisconsin
91 Confirmed Cases In United States

As of 8:30 am. Wednesday, there were still no confirmed cases of the swine flu in Wisconsin.

State health officials are awaiting test results on 22 specimens.

Chicago school officials shut down an elementary school on Wednesday after one child contracted a probable case of swine flu. A probable case has also showed up in Minnesota.

In the meantime, University of Wisconsin-Madison has done a study looking at the effects of a pandemic on schools, businesses and the working poor in Wisconsin.

Professor Vicki Bier said she and others tried to stay away from recommendations in the study. But, for example, it says if local health departments close schools, they should do it early to be effective.

The study was published on a state Web site in June.

The U.S. now has 91 confirmed cases of the swine flu in 10 states, not including Wisconsin.

The current pandemic alert level now stands at phase 4, two levels below the threshold for a full pandemic. The World Health Organization plans to convene an emergency committee to discuss the alert level.

Copyright 2009 by WISN.com. The Associated Press contributed to this report. All rights reserved.

http://www.wisn.com/health/19324081/detail.html

 

[pansmermaidzlagoon]

first case in our county - not sure if it is confirmed or not, but they are closing that school district down.

level has been raised to 5.

 

[LuvOrlando]

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[mommy*RN]

first case in our county - not sure if it is confirmed or not, but they are closing that school district down.

level has been raised to 5.

Closing the school district down just makes sense to me. Why wait for confirmation on that one case...or for more suspect cases to crop up. If they are going to try and "beat" it (and yes I know they will never beat it) being proactive just makes sense to me.

 

[wvjules]

We just got a powerpoint presentation on this. I'll copy and past what I can.

What is this outbreak?
Basic virus type is “H1N1”
This is a common type of flu, but…
Immunity is based on the individual strain, not major type
Being called “Swine Flu” as shorthand
Actually a combination (“reassortment”) virus
At least 2 swine virus components
1 avian virus component (This is NOT “Avian Flu”)
Human virus components
Most cases have had no contact with swine
Implies that there is human to human transmission

Cases as of April 28, 2009
US Confirmed: 65 (median age 16 yrs)
California 10 (3 hospitalized)
Kansas 2
New York City 45
Ohio 1
Texas 6
Indiana 1 (not in total as not yet CDC confirmed)
Mexico Confirmed: 26
Suspect cases variously reported over 2000 in 19 of Mexico’s 32 states
Other Confirmed: Canada (6), New Zealand (3),  Israel (2), UK (2), Spain (2), Costa Rica (1)
Official Status
WHO (Pandemic Phase) updated 4/27
Phase 4: “Small clusters with human to human transmission, but spread is highly localized suggesting that the virus is not well adapted to humans”
WHO has declared a “Public Health Emergency of International Concern (4/26)
U.S. Government
Pandemic Response Stage 0
HHS declared “Public Health Emergency” (4/26)
CDC Interim Director noted that U.S. Response Staging is based on virulence (and other factors) and not only the geographic spread.

How is this “Flu” different?
Little immunity in the general population
Increased attack rates
Flu rates 3 to 4 times the normal in Mexico (various cities)
Underreporting may be a big issue…but flu always underreported
Possibly increased severity
Hospitalization and mortality rates reported as high in Mexico
US cases have been mild to moderate with no deaths
This is Flu, not SARS
A person does not have to have symptoms to be infectious
This flu, like most flu, is infectious 24+ hours before symptoms
There may be asymptomatic or very mildly symptomatic cases who are infectious nonetheless
So far, this does not appear to have as high a mortality rate
How is this flu similar to usual flu?
Transmission:
Respiratory secretions: surfaces/airborne droplets
Incubation period / Infectivity period:
Incubation 1 to 4 days, very rarely up to 7 days or longer
People are infectious from 24+ hours before symptoms start and up to 7 days after onset of symptoms
Symptoms
Fever/chill, cough, sore throat, body aches, headache, fatigue
Effects can be much worse in those with other diseases
Treatment
Antivirals (oseltamivir or zanamivir only) appear effective
Is this THE “Pandemic Flu” we all fear?
Maybe…
Swine Flu is very contagious (as are most new flu strains)
Populations are not immune to this strain
Has already demonstrated international spread
Some, very preliminary, evidence of high virulence (relatively high death rate in Mexican cases)
Large numbers of cases being diagnosed in Mexico
Maybe not…
The season is not conducive to sustained transmission
Cases in US have had low to moderate virulence
“Epidemic” may have been smoldering for several weeks in locations outside Mexico without explosive growth rates
What should our organization do?
Prior “Pandemic Flu” preparation is valuable… …even if this is not pandemic flu
Refresh training on controlling secretions
Cover mouth when coughing/sneezing
Use paper tissues and throw them away when done
Wash hands frequently and/or use a hand sanitizer
Always wash hands immediately before and after touching eyes, nose, or mouth
Tell employees not to come to work sick!
But don’t go to a clinic/hospital without contacting the facility first…you don’t want to transmit to/from others
If an employee has close contact with someone meeting criteria for suspected, probable, or confirmed illness, ideally they should not return to work for 7 days after last contact or after contact’s symptoms have cleared (added 4/28)
Should we change travel/meeting plans?
In general:
Not yet, but prudent to develop contingency plans
Emphasize basic infection control for air travel
Use hand sanitizers frequently
Avoid shared magazines / blankets / pillows / etc.
Don’t travel if you have respiratory illness symptoms
International Travel (updated 4/28)
CDC has advised delay of nonessential travel to Mexico
Many nations are screening travelers to/from North America; some screening all travelers
Screening, when used, is usually a temperature screen
Elevated temp can result in further eval or quarantine/isolation

Should we change general operations?
For everyone:
Review and update pandemic plan
For sites not in proximity to known cases
No change in operations
Reassure staff that management is monitoring closely
Encourage review of respiratory secretion precautions


Should we change general operations?
For sites in proximity to known cases
No change in operations
Minimize large gatherings or even small meetings in enclosed locations
Ensure all personnel review respiratory precautions
Have plans for handling ill employees:
Do not to come to work with respiratory symptoms or if closely exposed to someone with a respiratory illness at home (unless medically cleared)
Institute specific plans for handling personnel developing symptoms while at work
Follow local public health guidelines, including having plans to screen employees if directed by local public health



Additional Information



Additional Information for Medical Professionals
Interim Case Definition – Suspected (4/28)
a person with acute febrile respiratory illness
With onset within 7 days of close contact with a person who is a confirmed case of swine influenza A (H1N1) virus infection, or
With onset within 7 days of travel to community either within the United States or internationally where there are one or more confirmed swine influenza A(H1N1) cases, or
resides in a community where there are one or more confirmed swine influenza cases.
*Acute febrile respiratory illness is defined as recent onset of a fever with at least two of the following: Rhinorrhea or nasal congestion, sore throat, cough.
**Close contact is defined as: within about 6 feet of an ill person who is a confirmed or suspected case of swine influenza A (H1N1) virus infection during the case’s infectious period.


Interim Case Definition – Probable (4/28)
A person with an acute febrile respiratory illness who is:
positive for influenza A, but negative for H1 and H3 by influenza RT-PCR, or
positive for influenza A by an influenza rapid test or an influenza immunofluorescence assay (IFA) plus meets criteria for a suspected case




*Acute febrile respiratory illness is defined as recent onset of a fever with at least two of the following: Rhinorrhea or nasal congestion, sore throat, cough.



Interim Case Definition – Confirmed (4/28)
A person with an acute respiratory illness* with laboratory confirmed swine influenza A (H1N1) virus infection at CDC by one or more of the following tests:
real-time RT-PCR
viral culture




*Acute febrile respiratory illness is defined as recent onset of a fever with at least two of the following: Rhinorrhea or nasal congestion, sore throat, cough.

Utility of Screening Tests
Most screens are A+B tests
If positive:
Treat with anti-virals
Send to State Lab
Routine hospital/commercial labs have little to offer
If Screen can type as B (not common):
Positive B and negative A rules out current swine flu strain
Positive A must be handled as above
State labs can rule out H1N1-swine
…but cannot further type
Sample must be sent to CDC for swine flu confirmation
CDC may distribute PCR primers to states in near future
Severity Discrepancy
CDC very clear that nothing should be made of apparent discrepancy in severity between Mexico and US.
May simply be a “denominator issue” (Mexico has had many, many more cases than US)
CDC said (4/26 press briefing) that US should be prepared to expect Swine-flu related deaths in the near future
Vaccine Issues
CDC has found little antigenic cross-protection from current flu vaccine
Vaccine programs are not indicated to prevent this flu
Being vaccinated however, can help rule out seasonal flu if ill
Degree of natural immunity not well characterized
CDC actively investigating Swine Flu vaccine
Referring to problems with 1976 Swine Flu issues:
Much has changed in vaccine science since 1976
US has much more experience with vaccine production / QC
If a vaccine is determined to be advisable:
Difficult to determine duration for preparation as much is determined by how fast virus grows
New technologies, such as cell-based vaccine production, might be available, but none are FDA approved

 

[mommy*RN]

Okay fellow healthcare people...or anyone...Can a pregnant woman take anti-virals. I'm guessing yes as she can take antibiotics, but I'm curious. I worked in peds for 5 yrs and there weren't many preggo 6 yr olds. Now I work with new mom's and babys so I'm still out of the loop.

 

[amarberry]

9 cases confirmed in Illinois.

They are not actually confirmed, but rather, probable at this point.

http://www.chicagobreakingnews.com/2009/04/more-probable-swine-flu-cases-in-illinois.html

 

[pansmermaidzlagoon]

Closing the school district down just makes sense to me. Why wait for confirmation on that one case...or for more suspect cases to crop up. If they are going to try and "beat" it (and yes I know they will never beat it) being proactive just makes sense to me.

exactly! I am glad they are being pro-active.

(DD goes to dance class with a student from there. I purposely enroll her in activities so she can meet kids outside the district. Hopefully her mom will keep her home)

 

[LuvOrlando]

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[Poppinsme]

Okay fellow healthcare people...or anyone...Can a pregnant woman take anti-virals. I'm guessing yes as she can take antibiotics, but I'm curious. I worked in peds for 5 yrs and there weren't many preggo 6 yr olds. Now I work with new mom's and babys so I'm still out of the loop.

I work at Children's Hospital New Orleans. NICU/PICU/CICU. Yes you can get vaccinated and should if need be. With many anti-virals it can protect your baby for 6 months after birth.

 

[LuvOrlando]

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[DawnCt1]

Okay fellow healthcare people...or anyone...Can a pregnant woman take anti-virals. I'm guessing yes as she can take antibiotics, but I'm curious. I worked in peds for 5 yrs and there weren't many preggo 6 yr olds. Now I work with new mom's and babys so I'm still out of the loop.

DH just came home and this is what he said, "Tamiflu is a class C drug. It hasn't been studied well in pregnant women, but that said, influenza hits pregnant women particularly hard, so yes, they would be candidates for Tamilfu."

 

[mommy*RN]

So the new news made me call Continental to see if they have any intentions of lessening the penalties against families like mine who have a member in a high risk category.
The answer was a No Change, still $150 per ticket to make any changes. EVEN with a Dr's note.

To those of you who may be new, both of my kids are Asthmatic. My DS11 is an extremely hard to control Asthmatic and that means any sort of upper Respiratory infection is extremely dangerous for him (even the old fashioned kinds). Due to this situation and my scheduled trip next week I have been glued to the news since this broke. I am not being overly dramatic or paranoid, this is a very real threat to some people (my kids are only two of many) and I really hope the Travel Industry will show all us some kindness when handling situations such as mine. Still, with them or without them I'm probably going to cancel next week. How could I possibly have any fun at all worrying about every sniffle

I'm sorry you have to cancel your trip.

 

[DawnCt1]

I work at Children's Hospital New Orleans. NICU/PICU/CICU. Yes you can get vaccinated and should if need be. With many anti-virals it can protect your baby for 6 months after birth.

I think she was referring to the anti viral drugs like Tamiflu and not immunizations. But yes, pregnant women should get the flu shot, when its available.

 

[mommy*RN]

DH just came home and this is what he said, "Tamiflu is a class C drug. It hasn't been studied well in pregnant women, but that said, influenza hits pregnant women particularly hard, so yes, they would be candidates for Tamilfu."

Thank you! I couldn't find my drug book...which is probably severely outdated.

I did mean the oral meds and not the flu shot, but I appreciate all the responses!

ETA: I'm not preggers, but people I know are.

 

[LuvOrlando]

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[D L and K's Mom]

I know how hard it will be to go. I feel for you as a parent of a special needs child who has respitory problems. On a "Good" note. We have been to Celebration Hospital on 2 occasions. They are wonderful! We were treated wonderfully and they were fast, and very efficient. They called my Dr here in NY and compared notes. WDW was wonderful. They sent a van to pick up DS and DD when they were released from the hospital. We also had to use one of the Drs who came to the hotel. DD got the flu (two years ago). He had a high fever, would not eat and had some respitory problems. We had the Dr come to the hospital room. He even brought the medication with him. The only problem is you pay upfront and insurance pays you back. We used charge card. I know it is a terrible decision to make but if you do go and for some reason you need medical assistance it is there!! I hope all works out for you!