4. Clinical Presentation of Initial US H1N1 Cases
fever
cough
sore throat
diarrhea
vomit
0 20 40 60 80 100
percent of cases
5. Influenza Like Illness Clinical
Case Definition
• Fever(*) AND Cough
• AND at least one of:
– Sore throat
– coryza
– Myalgia
– Arthralgia
– Diarrhea/vomiting
*Fever may be absent in young children and seniors
6. Surveillance Plan for H1N1
• Detailed data collection from all hospitalized cases
• Lab based surveillance of all submitted specimens
• Sentinel physicians
• MSP data monitoring
• Reporting of high absenteeism in schools/daycares
• Active follow up with remote First Nations
communities
7.
8.
9. H1N1 Vaccine
• Produced by GlaxoSmithKline
• Adjuvanted (AS03) single Ag, split virus
• Initial trials safe and immunogenic after
single dose (similar vaccines from other
manufactures showing similar results)
• Initial shipments expected in mid-
November; then weekly for about 2 months
10. H1N1 Vaccine Priority Groups
– persons with chronic medical conditions
– pregnant women
– children 6 months to less than 5 years of age
– persons residing in remote and isolated settings or
communities
– health care workers involved in pandemic response or
who deliver essential health services
– household contacts or caregivers of those at high risk
who cannot be immunized
– populations otherwise identified as high risk
• There will be sufficient H1N1 vaccine available in Canada
for everyone that needs and wants to be immunized. No
one will be left out.
11. H1N1 Vaccine Delivery
• Expected to start in mid-November
• Physician and public health delivered
– Physicians will have a critical role in providing
to their patients in a timely way
• 10 dose vials
– e.g. could plan for 10 patients in ½ hour block
• IM injection (likely single dose)
• Further information including ordering
forms will be sent by mail in October.
12. Tamiflu
• Commercial supply currently available
through community pharmacies
• Provincial stockpile to be released to
community pharmacies Oct 1.
• Available with physician prescription
– Consider providing high risk patients a
prescription in advance that could be filled
during fall if they develop influenza
13. Tamiflu Indictions
• Early treatment of influenza in:
– patients with underlying conditions: Pregnancy,
respiratory, cardiovascular disease, diabetes,
obesity, immunocompromised
– Children 2 years and under
– *Aboriginal people living on reserve
• Treatment of severe influenza cases
– (severity may be indicated by deterioration in
condition with dyspnea, tacchypnea, reduced
oxygen sats, hypotension)
15. H1N1 and Schools
• Schools can facilitate virus amplification
• However, based on mild virus profile,
closures of schools are not warranted.
• Instead, approach is:
– Attempt to exclude those with influenza until
recovered
– Strong emphasis on hygeine and cough
etiquette
– Emphasis on cleaning common surfaces