Judith A. Monroe, M.D.State Health Commissioner

28 April 2009

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What Is A Pandemic?Pandemic = worldwide epidemic

Three factors must happenNovel (new) disease agent --> yesMust cause severe disease in humans yes and noMust be easily transmitted person-to-person likely

Pandemic has not been officially declared

National public health emergency has been declared

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BackgroundOn 23 April, CDC described 5 cases of novel influenza virus

(A/H1N1/North America/Human)3 from San Diego area2 from San Antonio, TX

Other surveillance information indicated a respiratory outbreak in Central Mexico, including Mexico City, for previous three weeksHundreds of casesSome deaths, mostly in young adults (20-45 years old)As of 24 April, 7 of these cases matched same H1N1 strain as US cases

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Viral Reassortment

(2) Reassortment in swine Pandemic virus

Reassortment in humans

Pandemic virus

Reassortment/mutations in birds

Human virus

A/H1N1/North America/HumanNorth American swine strain

European swine strain

Avian strain

Human strain

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Current Outbreak Virus

A/H1N1/North America/HumanIncubation: 2-7 daysSymptoms: fever, cough, sore throat, headache, body aches,

some vomiting/diarrheaTransmission: person-to-person

respiratory droplet or hand contact to eyes/nose/mouth not transmitted by contact with pigs or eating pork

Communicability: usually 1-2 days prior to symptoms until symptoms cease

Vaccine availability: noneAntivirals

Susceptible to Tamiflu, RelenzaResistant to amantidanes

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Global StatusMexico

1000+ cases reported as of 27 April, 16:00Over 100 deaths23 confirmed positive for A/H1N1/North America/Human

Other countries: Canada, Spain, Britain, France, New Zealand, Israel

World Health Organization (WHO)No travel or trade restrictions issued; those ill advised to avoid

international travelPandemic level raised to 4 (sustained person-to-person

transmission in clusters)8

National Status40 confirmed cases as of 27 April, 16:00

California: 7Kansas: 2New York City: 28Ohio: 1Texas: 2

US Department of Homeland Security has assumed lead role for response

Strategic National Stockpile (SNS) being deployed for states: antivirals, respiratory equipment

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Indiana’s StatusOne confirmed case as of 27 April, more expected

Specimens collected on suspect cases and sent to ISDH Laboratory

Specimens sent to CDC if test positive for influenza A but cannot be subtyped with seasonal flu reagents

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Current Case DefinitionA person with compatible symptoms of influenza

Fever ≥ 100°FCoughSore throatHeadache and body aches

ANDTravel to a state or country with confirmed cases within

7 days of illness OR contact with someone ill who has traveled to a state or country with confirmed cases within 7 days of illness

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ISDH RoleConduct case investigation, surveillance, contact tracingProvide laboratory testing and specimen collection kitsTrack national and international disease trendsDevelop educational messages and press releasesProvide subject matter expertiseCommunicate with health care providers, local health

departments, governmental agencies, and other partnersCall center and dedicated ISDH web site link under

development

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Practice Good HygieneWash hands well and often, especially after

Contact with other people and common surfacesHelping someone who is illUsing facial tissues

Use respiratory etiquetteCough or sneeze into your elbow/upper sleeveDiscard used tissues promptlyAvoid using handkerchiefs

Avoid touch eyes, nose, mouthStay home if you are sick and encourage others to do so

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Get Credible InformationLocal health departmentsISDH

www.in.gov/isdhCall center to be established 28 April

CDC: www.cdc.gov/swinefluWHO: www.who.org

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Very simple measures that everyone can do will make a big, positive difference

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