H1N1 Flu Update

Jason Eberhart-Phillips, MD, MPH

Director of Health and

Kansas State Health Officer

CHAC Immunization Advisory Committee

February 19, 2010

A Whole New Kind of Flu• Global emergence of an

entirely new flu virus

• By sheer luck this virus is not usually a killer– 100 times less lethal

than the 1918 flu virus

• Still, by mid-January– >57 million cases in US– 257,000 hospitalizations– About 11,690 deaths

The “Second Wave” is Over

Where We Were at the Peak

Where We Are Now

Nearly Every Place Touched

Schools on the Front Line

Absenteeism in October

Absenteeism Now

What’s Next?• Pandemic behavior is

never predictable– H1N1 is still here, it will

be back, and will be in the 2010-11 flu vaccine

– Up to half of the KS population is still susceptible to H1N1

– Window of opportunity now for vaccine before a possible ‘third wave’

R01.3

R01.8

Proportion with Natural and Vaccine- Induced Immunity, by State

Assuming 60% of ILI is flu and 20% of those infected are asymptomaticas of December 13, 2009

% of immunity in the population necessary to interrupt transmission

Kansas

0

10

20

30

40

50

60

70

80

% im

mu

ne

Verm

on

t

Delaw

are

Illino

is M

aine

Alaska

District

So

uth

Da

Wis

consi

So

uth

Ca

Co

nnect...

Min

neso

ta

Rh

ode Is

Florida

Arizon

a

Pu

erto R

ico

Wa

shing

t

New

Yo

rk

Miss

ouri

Alab

ama

No

rth Da

Mass

achu

Iow

a N

ew H

amp

Ohio

N

YC

Nevad

a

Indiana

Kan

sas

Califo

rn

Marylan

d

Mich

igan

Pen

nsylv

Georgia

Oklah

oma

Mo

ntan

a

Oreg

on

Wy

omin

g

We

st Vir

Neb

raska

Texas

Idah

o

Ten

nesse

No

rth Ca

Miss

issi

Haw

aii

Virgin

ia

Lou

isian

Co

lorado

Arkan

sas

New

Mexi

New

Jers

Ken

tucky

Utah

Acqired Immunity* Acquired plus Vax

% of immunity in the population necessary to interrupt transmissionR01.3

R01.8

Proportion with Natural and Vaccine- Induced Immunity, by State

Assuming 60% of ILI is flu and 50% of those infected are asymptomaticas of December 13, 2009

Kansas

A Lot of Immunity Out There!

Controlling the Pandemic

• A 3-step approach– Vaccination, which is

safe and effective – Non-pharmacologic

measures such as covering coughs, washing hands often, and staying home if ill

– Correct use of antiviral drugs, if prescribed

• Voluntary network of hospitals, pharmacies and clinics making flu-fighting medications available at little or no cost from stockpile

Antivirals for All in Need

Vaccine: A Huge Success

• In just over 3 months >889,000 vaccine doses have been distributed!– An unprecedented

statewide mobilization– Every county health

department in the lead– >1000 private providers– 1000s of volunteers

staffing public clinics

KS Vaccine Uptake So Far

Vaccine Supply and Demand

Some Way Still to Go...

A Communication Challenge• Overcoming obstacles

to flu immunization– Communicating the real

risks from infection– Being clear that the

vaccine is much safer than getting the disease

– Serious harm from the vaccine is extremely rare, if it occurs at all

– Supply is now ample!

Safe? Here’s How Safe It Is

• VAERS Data 01/22/10– After ~122 million doses

shipped out, just 8,755 adverse event reports

– Of these, only 564 (6%) are considered “serious”

– No common cause or pattern to suggest these were caused by vaccine

– Monitoring continues

Pandemic Reflections So far • In the lull, whether or

not a third wave hits,– How did we do?– Did we react too slow,

too aggressively?– Did we provide good

information, dispel false rumors, alert but not alarm the public?

– What would we do differently next time?

Luck Has Been on Our Side…

• Disease virulence is low• Virus is genetically stable• Transmissibility is high, but

could’ve been higher• Vaccine induces a strong,

fast, immune response• Most people require only a

single dose of vaccine• It is as safe as expected

…Most of the Time!

• Predictions of ample vaccine supplies were wildly optimistic– Up to 160 million doses

expected by October 31– Got less than 30 million– One of the poorest

producing vaccine virus strains ever seen

– Just 0.2 - 0.6 doses/egg

Lessons Learned Already• Preparation pays

– Plans, drills, exercises in advance of a crisis really help when the crisis comes

– Politics sometimes trumps good plans, however

• Risk communication is a challenge– Media/public interest is fickle, fades quickly– Vaccine risks are magnified when disease risk is

considered low, when disease is absent or mild– People don’t always act in their own self interest

• State/Local alliance is essential for success

www.kdheks.gov

To Protect the Health and Environment of all Kansans To Protect the Health and Environment of all Kansans by Promoting Responsible Choicesby Promoting Responsible Choices

Thank You For Listening!