Disease Outbreak: Pandemic Influenza H1N1

***ASSIGNMENT: Discuss a disease outbreak you've had to deal with in your professional role. Discuss what went well, what you would do differently if a similar situation occurred in the future, and how you dealt (or would deal) with the media. (Please answer all the questions)—Below I summarized some of the more important information that should be included. Please do not write personal pronouns (I would), instead use (This nurse practitioner would do…)

*Most articles are in the website links provided below… I took minimal information (Just the information I needed) from other articles more updated and wrote the citation after the information.

One disease outbreak that affected the state where this nurse lives was the pandemic Influenza (pH1N1) in 2009.

- Please paraphrase and ADD “Georgia reported its first case of 2009 H1N1 influenza in April and its first outbreak shortly after in May. Case counts and public concern seemed to only increase from there. Georgia outbreaks of 2009 H1N1 occurred in a variety of venues, but were predominantly reported in schools and summer camps. Nineteen outbreaks of 2009 H1N1 were reported in summer camps in Georgia in 2009”. Citation: Georgia Department of Community Health. (2009). Georgia infectious disease outbreak: annual summary 2009. Retrieved from: https://dph.georgia.gov/sites/dph.georgia.gov/files/related_files/document/ADES_Summary_2009.pdf

“Influenza is primarily transmitted from person to person via large virus-laden droplets that are generated when infected persons cough or sneeze. Transmission may also occur through direct contact or indirect contact with respiratory secretions such as when touching surfaces contaminated with influenza virus and then touching the eyes, nose or mouth. Clinical presentation usually includes abrupt onset of fever, myalgia, sore throat, nonproductive cough, eye pain, sensitivity to light, rhinitis, myalgias, and headache”. Reference: Centers for Disease Control and Prevention. (2018). Influenza. Retrieved from: https://www.cdc.gov/vaccines/pubs/pinkbook/flu.html#flu

- Discuss about the pandemic Influenza H1N1 in the United states:

“In April 2009, a novel influenza A (H1N1) virus emerged in the United States with the key characteristics of a pandemic virus, and within weeks it had spread to every region in the country.¹ Ultimately, the rate of death was lower than was initially predicted, but the numbers of H1N1 cases, hospitalizations, and deaths were nonetheless substantial”. SEE ARTICLE https://www.nejm.org/doi/full/10.1056/NEJMp1005102

“To calculate the burden of 2009 pandemic influenza A (pH1N1) in the United States: From 12 April 2009 to 10 April 2010, we estimate that approximately 60.8 million cases (range: 43.3–89.3 million), 274 304 hospitalizations (195 086–402 719), and 12 469 deaths (8868–18 306) occurred in the United States due to pH1N1. Eighty-seven percent of deaths occurred in those under 65 years of age with children and working adults having risks of hospitalization and death. These results confirm the necessity of a concerted public health response to pH1N1”.

Sundar S. Shrestha, David L. Swerdlow, Rebekah H. Borse, Vimalanand S. Prabhu, Lyn Finelli, Charisma Y. Atkins., … Martin I. Meltzer. (2011). Estimating the Burden of 2009 Pandemic Influenza A (H1N1) in the United States (April 2009–April 2010). Clinical Infectious Diseases, 52(1), s75-S82. Retrieved from: https://doi.org/10.1093/cid/ciq012

**What went well? I’m not really sure what to add here about what went well… I think we can add something like this…the good response of public health surveillance… see below information and article

“The U.S. public health surveillance response to pH1N1 offers much to admire. Together with surveillance activities in Mexico, and benefiting from advances in laboratory capacity and notification systems introduced in the previous decade, epidemiologists relatively quickly identified and characterized a new pathogen, allowing the CDC and shortly afterwards the WHO to issue alerts about the emergence of a new pandemic strain, triggering a rapid global public health response to H1N1 [8]. These alerts triggered pandemic influenza plans that had been prepared in recent years, which focused initially on surveillance activities, including the development of a case definition and testing procedures, and non-pharmaceutical control measures”. (Stoto, M. A. (2012). The effectiveness of U.S. public health surveillance systems for situational awareness during the 2009 H1N1 pandemic: A retrospective analysis. PLoS One, 7(8), 1-13. DOI:10.1371/journal.pone.0040984)

***What you would do differently if a similar situation occurred in the future. How would you dealt with media? SEE ARTICLE HERE: https://www.nejm.org/doi/full/10.1056/NEJMp1005102

Increase education and awareness of the disease in my clinical practice, public locations and throughout the media (FB, Instagram, etc..)

1. Immunization educational community campaigns

- The public was divided on whether to have the vaccine or not. The public was divided over whether they would get vaccinated. Roughly half (46 to 57%) of the public said they expected to receive the vaccine.

In making their decision, some people appeared to think there was a trade-off between accepting the perceived risk associated with the illness and accepting any perceived risk associated with the vaccine.

There were two major reasons why people said they would not or might not get the H1N1 vaccine, one of which was concern about its safety. Among adults overall, this concern was present but not dominant: most (87%) believed the H1N1 influenza vaccine was “very safe” or “somewhat safe.” However, only 33% believed it was “very safe,” as compared with 57% who said the same of the seasonal influenza vaccine (HSPH, September 2009). Among adults who said they would not or might not get the H1N1 vaccine, concerns about getting H1N1 influenza, another serious illness, or other side effects from it were top “major reasons” for their decision (cited by 21%, 20%, and 30%, respectively).

The other major reason for avoiding the H1N1 vaccine was the belief that it was not needed. Among adults overall, 47 to 50% said they were not concerned that they or their family members would get sick with H1N1 in the next 12 months (HSPH, August–September and September 2009). Among adults who said they would not or might not get the vaccine, the second and third most commonly reported reasons were a belief that they were not at risk for getting a serious case of H1N1 infection (28%) and the idea that if they did acquire H1N1, they could get medication to treat it (26%). A similar fraction (27%) of parents who said they would not or might not have their child vaccinated said that they did not think their child was at risk for getting a serious case

*Reasons why the public said they would not or might not get the vaccine: concern about side effects form the vaccine, doubt about the risk of getting a serious case, belief that is possible to get medication to treat H1N1, concern about getting H1N1 from vaccine, concern about getting another illness from the vaccine, doubt about vaccine effectiveness, concerns about safety risk from the vaccine (Information taken from tables in the article). See Article and citation: https://www.nejm.org/doi/full/10.1056/NEJMp1005102

Evidently many of these concerns can be addressed by health care provider by educating their patients and the public about Influenza H1N1n and the vaccine, and the importance of vaccination.

Public misconceptions were apparent regarding modes of transmission and preventive measures. To prevent misconceptions during future outbreaks, it is important that health care providers and authorities provide up-to-date information about H1N1 influenza, importance of vaccination, and other preventive measures. (Bults, M., Beaujean, D. J. M. A., Richardus, J. H., & Voeten, H. (2015). Perceptions and behavioral responses of the general public during the 2009 influenza A (H1N1) pandemic: A systematic review. Disaster Medicine and Public Health Preparedness, 9(2), 207-219. DOI:10.1017/dmp.2014.160)

Increase education in clinical practice and public setting about behavioral preventive measures: wash hands and use sanitizers more frequently, make plans to stay home if you or your family member are sick, avoid being near someone with flulike symptoms, avoid places where many people are gathered together(Malls, public transportations, sport events), avoid air travels, stop shaking hands with people, wear face mask, contact your doctor if you are having flu-like symptoms for education and possible antiviral drugs. (Information taken from tables in the article)

SEE ARTICLE: https://www.nejm.org/doi/full/10.1056/NEJMp1005102

will follow CDC recommendations to use early antiviral drugs if suspected influenza

“The CDC strongly recommends that patients hospitalized with suspected influenza should be treated with oseltamivir (Tamiflu®) or zanamivir (Relenza®) as quickly as possible; this is especially important for those at risk of serious complications. Treatment with Tamiflu® and Relenza® has been associated with improved survival, especially when initiated early.⁸ CDC is emphasizing that laboratory confirmation of influenza is not necessary to initiate treatment”.

*Centers for Disease Control and Prevention. Recommendations for early empiric antiviral treatment in persons with suspected influenza who are at increased risk of developing severe disease. http://www.cdc.gov/H1N1flu/HAN/101909.htm.

“Pandemic influenza is different from other outbreaks we have faced because the characteristics of influenza viruses – their propensity to change, the ability to spread easily among people, and the routes of transmission – make the disease challenging to contain. Throughout history, influenza pandemics have led to widespread illness and death. Pandemic influenza is not a theoretical threat; rather, it is a recurring threat. Even so, we don’t know when the next pandemic will occur, or how severe it will be”.

**ADD this information:

The CDC identified a flu pandemic implementation plan. Some of the strategies of this plan include:

Production and Stockpiling of Vaccine and Antiviral Medications
Research to develop an effective universal flu vaccine
Prioritizing and Distributing Limited Supplies of Vaccine and Antiviral Medications
stockpiling anti-viral medications
Supporting Local Law Enforcement Activities
Enhancing epidemiological tracking and enforcement of strategies to reduce transmission.
Online Training for Public Health Response
Establishing Real-Time Clinical Surveillance
Modeling to Inform Decision Making and Public Health Interventions

Centers for Disease Control and Prevention. (2006). National strategy for pandemic influenza implementation plan. Retrieved from: https://www.cdc.gov/flu/pandemic-resources/pdf/pandemic-influenza-implementation.pdf

“From an epidemiological perspective, Influenza outbreaks should be managed with vaccination, however, one of the biggest challenges of pandemic preparedness is rapid formulation and manufacture of a strain-specific vaccine” (Nguyen, A. M., & Noymer, A. (2013). Influenza mortality in the united states, 2009 pandemic: Burden, timing and age distribution. PLoS One, 8(5). 1-10. DOI: 10.1371/journal.pone.0064198)

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