2016 Flu Workshop

Fun with Flu

• TRUE or FALSEo the word “virus/viral” in Latin means “strong, quickly

spreading”

o FALSE: “virus” Latin for “poison, slimy liquid”

Fun with Flu

• 2. The Spanish Flu pandemic of 1918 killed millions. It originated in:oA. Etaples, FranceoB. Spittal, AustriaoC. Baoji, ChinaoD. Haskell, Kansas

Fun with Flu

• 3. Annual US Flu deaths:

oA. up to 50,000

oB. 6,900-12,200

oC. 11,200-16,121

Fun with Flu

# HIV deaths in US 2013

# Firearm related deaths US 2013

• TRUE or FALSEo20 years ago the CDC recommendations for flu

immunization was limited to those over age 65.

o TRUE: current recommendations are for all ages >6 months.

Fun with Flu

2016-2017 Influenza Season

2016-2017 Influenza UpdateWHO Influenza Update #271, Sep 5, 2016

2016-2017 Influenza UpdateWHO Influenza Update #271, Sep 5, 2016

• Decreasing activity in S. America, except in Chile• Continued rise in S. Africa• High rates in Australia• Increase rates in SE Asia• Low levels in N. Africa, N. America and Europe

2016-2017 Influenza UpdateWHO Influenza Update #271, Sep 5, 2016

• Data as of Sep 2, 2016:o70% Influenza A 31% A(H1N1)pdm09 69% A(H3N2)

o30% Influenza B 23% B-Yamagata 77% B-Victoria

2016-2017 Influenza UpdateNational Influenza Centers (FluNet)

2016-2017 Influenza Update

2016-2017 Influenza UpdateImmunization Updates

Grohskopf LA, Sokolow LZ, Broder KR, et al. Prevention and Control of Seasonal Influenza with Vaccines. MMWR Recomm Rep 2016;65(No. RR-5):1–54. DOI: http://dx.doi.org/10.15585/mmwr.rr6505a1.

• IIV3 (SD, 2) • IIV4 (4)• ccIIV4 (1)• aIIV3 (HD, 1)• RIV3 (1)• LAIV4 (1)

oNot recommended 2016-2017

2016-2017 Influenza UpdateImmunization Updates

• ACIP: 2015-16 immunization rateso45% immunization rateo33%: 18-49o44%: 50-64 (decrease 3.4%)o63%: >65 (decrease 3.3%)

• “Immunizing on 5% more Americans…would cut cases by 800,000 and hospitalizations by 10,000” Tom Frieden, Director CDC

2016-2017 Influenza UpdateImmunization Update

• Treatment Options oNeuroaminidase Inhibitors

Oseltamivir (Tamiflu) – Oral (bid for 5 days) Zanamivir (Relenza) – Inhaled (bid for 5 days) Peramivir (Rapivab) – Intravenous (one dose)

oAdamantanes Amantadine Rimantadine

• Resistance

2016-2017 Influenza UpdateTreatment

• Potential demand in Pandemic. oAssumption: 20-30% infection rateoAssumption:

16 N95/day/ICU patient 8 N95/day/ward patient Outpatient and EMS 4 N95/day

oModel: 4 separate pandemic scenarios 3 respirator distribution scenarios 3 separate demand reduction strategies

o1.7-7.3 billion N95o .1-.4 billion SM’s

Potential Demand for Respirators and Surgical Masks During a Hypothetical Influenza Pandemic in the United States.

Caries, et al; Clinical Infectious Diseases 2015:60

• Transmission uncertainties• Droplet vs Airborne precautions.

o Inadequate data: do droplets actually contain live infectious particles able to produce disease?

o N95 <5micrometers = aerosols, longer distances for longer periods of time

o Droplets: >5micrometers, transmitted <1m do not remain suspended.

• Objective evidenceo Intuitively N95’s should be better, but is there a clinical

difference?o Gap: Science and Behavior

25% non-wear time negative and significant difference in protection

N95 vs Surgical Mask

• Prospective comparison, in clinical outpatient settings, US, multi-site

• Sites are randomized to N95 vs SMo Infection rates, both lab and symptomatico Exposure diaries

• Data gathering: 2010-2016• Publish date: 2017

The Respiratory Protection Effectiveness Clinical TrialResPECT

Radonovich, et al; U.S. Department of Veterans Affairs, National Center for Occupational Health and Infection Control

1. CSmith JD1, MacDougall CC1, Johnstone J1, Copes RA1, Schwartz B1, Garber GE2; CMAJ. 2016 May 17;188(8):567-74. doi: 10.1503/cmaj.150835. Epub 2016 Mar 7. “Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis.”

2. Harnish DA1, Heimbuch BK, Husband M, Lumley AE, Kinney K, Shaffer RE, Wander JD.; Infect Control Hosp Epidemiol. 2013 May;34(5):494-9. doi: 10.1086/670225.;“Challenge of N95 filtering facepiece respirators with viable H1N1 influenza aerosols.”

3. CAtrie D1, Worster A.; JEM. 2012 Jan;14(1):50-2.“Surgical mask versus N95 respirator for preventing influenza among health care workers: a randomized trial.”

4. Seto WH; J Hosp Infect. 2015 Apr;89(4):225-8. doi: 10.1016/j.jhin.2014.11.005. Epub 2014 Dec 13; “Airborne transmission and precautions: facts and myths.”

5. Carias C1, Rainisch G2, Shankar M2, Adhikari BB2, Swerdlow DL3, Bower WA4, Pillai SK2, Meltzer MI2, Koonin LM5; “Potential demand for respirators and surgical masks during a hypothetical influenza pandemic in the United States.” Clin Infect Dis. 2015 May 1;60 Suppl 1:S42-51. doi: 10.1093/cid/civ141;

6. Radonovich LJ Jr1, Bessesen MT2,3, Cummings DA4,5, Eagan A6, Gaydos C7, Gibert C8, Gorse GJ9, Nyquist AC10,3, Reich NG11, Rodrigues-Barradas M12, Savor-Price C13,3, Shaffer RE14, Simberkoff MS15, Perl TM7; “The Respiratory Protection Effectiveness Clinical Trial (ResPECT): a cluster-randomized comparison of respirator and medical mask effectiveness against respiratory infections in healthcare personnel.” BMC Infect Dis. 2016 Jun 2;16:243. doi: 10.1186/s12879-016-1494-2.

7. http://www.forbes.com/sites/ritarubin/2016/09/29/cdcs-frieden-flu-vaccine-isnt-perfect-but-its-the-best-tool-we-have-to-protect-ourselves/?sf37525741=1#6d31ad0e252f

8. Grohskopf, Lisa A, et al; “Prevention and Control of Seasonal Influenza with Vaccine Recommnedation of the Advisory Committee on Immunization Practics, US 2016-17 Influenza Season; MMWR:65 (5); Aug 2016

References

2016-2017 Flu Update

www.facebook.com/nwhrn@TheNetworkNWHRN

www.nwhrn.org

CONTACT US:

PREPARE. RESPOND. RECOVER.

Vicki L. Sakata, MDSr. Medical Advisor, NWHRNvicki.sakata@nwhrn.org

Thank YouQuestions?