Pandemic (H1N1) influenza activity in Middlesex-London:

 

Influenza activity in Middlesex-London continues to increase and is now high and widespread.  Between October 19 and 23, the Health Unit received reports of 9 laboratory-confirmed cases of Pandemic (H1N1) influenza and 33 cases of influenza A, which are quite likely to be the Pandemic (H1N1) strain.  In total, 78 laboratory-confirmed cases of Influenza A or Pandemic (H1N1) have been reported to the Health Unit this fall.  The number of people in the community who have influenza is likely considerably higher than indicated by laboratory-confirmed cases because most people with influenza do not need to see their health care provider, and for most people testing is not recommended. 

 

Across the province, 16% of all nose samples taken in people with respiratory illness came back positive for the Pandemic (H1N1) strain.  In Middlesex-London, the percentage was considerably higher at 52.4%.

Another indicator that provides further insight into the level of influenza activity in the community is the proportion of patients visiting emergency rooms or doctors’ offices due to symptoms of fever and respiratory illness.  These rates have risen dramatically during the past two weeks.  On average, 25.4% of patients visiting London emergency departments during the week of October 18 to 22 had fever and respiratory symptoms.

 

Other indicators also suggest that influenza activity in our community is increasing.  Absenteeism in both child care centres and elementary schools are rising.  As well, the Health Unit was notified about a greater-than-expected number of calls related to respiratory illness to Telehealth Ontario, a free, confidential telephone service that provides health advice and general health information to callers.

 

Appendix A of this update shows all the indicators that the Health Unit is using to monitor influenza activity in Middlesex County and the City of London.

The Pandemic (H1N1) influenza vaccine has arrived:

Approximately 20,000 doses of Pandemic (H1N1) influenza vaccine have arrived in the community. The vaccine is being distributed to the highest risk individuals first. These individuals are: health care providers, children between 6 months of age and less than 5 years of age, household contacts of children less than 6 months of age, and pregnant woman who are over 20 weeks in their pregnancy or pregnant women who have medical conditions. More vaccine is expected this week and it will be targeted to those who are less than 65 years of age with underlying medical conditions. Vaccine for the general public and seniors is expected to be available in about two weeks; however, this may change depending on vaccine availability and the number of people coming to receive the vaccine.

 

Please check our website frequently for dates, times and locations of newly-announced clinics at www.healthunit.com/h1n1info . When attending a clinic, please bring your health card or driver’s license. Do not attend a clinic if you have a new onset of fever and respiratory symptoms.

 

Do not seek medical care unless you need it:

 

As influenza activity continues to increase in our community, only people who need health care should be going to their doctors or walk-in clinics. These are people outlined in Box C in the attached “Caring for People with Symptoms of Influenza” (October 22, 2009). These people can be placed on an antiviral drug to decrease their chances of developing complications of influenza. Only people with signs of severe or worsening illness, as outlined in Box D on the attached sheet, should go to the emergency department or urgent care.

 

It is very important that employers do not request a note from people returning to school, work or child care settings. This will cause unnecessary demands on the health care system. People with symptoms of influenza can return to school, work or child care when their fever is gone for 24 hours and they are feeling better and are fully able to go back to normal activities. It is recognized that a cough may persist for several days to weeks. Health care workers should ensure they are better for at least 24 hours and their cough is only mild.

 

Public information sessions – vaccinations are NOT available at these sessions:

 

There are two public information sessions remaining:

 

·      October 27^th   7 to 9 pm         North London Optimist Community Centre, 1345 Cheapside Street, London

·      October 29^th  7 to 9 pm          Earl Nichols Community Centre, 799 Homeview Road, London

 

The sessions consist of a presentation with ample time for questions.

 

Regular immunization services curtailed:

As of Monday, October 26^th, most of the regular immunization clinic services at the Middlesex-London Health Unit will be suspended due to the Health Unit’s response to the arrival and spread of the Pandemic (H1N1) influenza virus.

As of October 26, 2009, the Health Unit will only offer immunization clinics for children under the age of two (2) on Wednesdays between 9:00 a.m. and noon at its 50 King Street location. The Pandemic (H1N1) influenza vaccine will not be available at these clinics held at the Health Unit. The immunization clinics normally held at the Health Unit’s Kenwick Mall location in Strathroy on the first Tuesday of each month from 3:30 p.m. to 7:30 p.m. will be suspended.

 

Keep checking our website:

 

Information on our website is regularly updated. News on the Pandemic (H1N1) influenza vaccine and

clinic schedules will be posted there when they are available. Visit www.healthunit.com/h1n1info regularly.

 

Appendix A

Summary of Influenza Indicators

October 23, 2009

 

All indicators are showing an increase in influenza activity, which is now high and widespread throughout the community.

 

Indicator	Recent data / trends	Comments
Hospital emergency room reports regarding the percentage of patients with fever and respiratory illness	Increasing and high	·         From October 18 to 22, 25.4% of patients were presented with a fever and respiratory illness.  Values ranged from 11.7% to 60.9%, depending on the site and day. ·         By comparison, during the summer less than 3% of patients presented to London emergency rooms had a fever and respiratory symptoms.
Sentinel physicians reports regarding the percentage of patients with fever and respiratory illness	Comparable to previous week	·         For the week of October 11 to 17, the overall percentage of patients reporting fever and respiratory illness on the surveillance day(s) was 6.4%.  Values ranged from 3.0% to 10.0% depending on the practice and the day. ·         Information is based on reports from 25 physicians screening at 4 medical practices.
Absence reports from child care centres (i.e. absenteeism > 10%)	Increasing	·         Between October 19 and 23, 8.8% (10/114) of child care centres in Middlesex-London reported absenteeism > 10%.
Absence reports from schools (i.e. absenteeism > 10%)	Increasing and high	·         Between October 19 and 23, 23.5% (31/132) of elementary schools in the two English school boards in Middlesex-London had a weekly absenteeism rate exceeding > 10%. ·         The weekly average percentage of student absent ranged from 1.2% to 20.1%, depending on the school. ·         Several reports have been received about individual classes experiencing high absenteeism at some schools. ·         Five other schools reported absenteeism >10%. ·         At the secondary school level, increased absenteeism has also been reported.
Laboratory-confirmed cases	Increasing and high	·         From October 19 to 23, 9 laboratory-confirmed cases of Pandemic (H1N1) influenza A were reported, as well as 33 influenza A cases that are likely to be Pandemic (H1N1). ·         As of October 23, in total, there have been 63 laboratory-confirmed cases of Pandemic (H1N1) and 68 influenza A positive cases that are quite likely to be the Pandemic (H1N1) strain reported by Middlesex-London residents, 78 of whom acquired infection this fall.
Percentage of all laboratory samples that are positive	Increasing and high	·         In Middlesex-London from October 11 to 17, 52.4% of all samples taken to test for influenza were positive for the Pandemic (H1N1) strain. ·         In Ontario from October 11 to 17, approximately 16% of all samples taken to test for influenza were positive for the Pandemic (H1N1) strain.  This compares to approximately 1% at the beginning of September.
Antiviral prescriptions filled by major pharmacies	Increasing	·         From October 11 to October 17 in Middlesex-London, increased antiviral prescriptions were filled by major pharmacies relative to other prescriptions, compared to the previous week.
Calls to Telehealth Ontario related to respiratory and influenza-like illness	Increasing	·         Between October 19 and 23, the Health Unit has been notified of an increased number of calls related to respiratory illness.
Long-term care facility outbreaks	None reported	·         No long-term care facility outbreaks due to the Pandemic (H1N1) 2009 strain have been reported.
Hospitalizations	Increasing	·         Five new admissions were reported this past week. ·         To date, 12 people who had laboratory confirmation of the Pandemic (H1N1) strain or who had influenza A, which is quite likely to be the Pandemic (H1N1) strain, have been hospitalized.
Deaths	None reported	·         No deaths have been reported.

 

 

Caring for People with Symptoms of Influenza

October 22, 2009

 

Symptoms of influenza are listed on the back in Box A

 

Instructions for the person with symptoms of influenza:

·         Stay home until your fever has been gone for 24 hours and you are feeling better and are fully able to go back to your normal activities. You may still have a cough for several days to weeks, but you can return to school or work even if you are still coughing as long as you are otherwise better. Health care workers should ensure they are better for at least 24 hours and their cough is only mild. Medical notes are not needed in order to return to work, school or child care centres.

·         Avoid contact with the rest of the family as much as possible. Ensure you have your own towel in the bathroom. If you need to be close to others, consider wearing a surgical mask.

·         Cough into a tissue or your sleeve. Discard tissue right away and wash your hands.

·         Wash hands frequently using warm water and pump soap or an alcohol-based hand rub.

·         Do not share anything that goes in your mouth.

·         Try to avoid having visitors in the house.

·         See Box B on the back of this sheet for specific instructions to help you feel better.

·         See Boxes C and D on the back of this sheet regarding when to seek medical care.

·         If you need to leave the house for a medical appointment, try to minimize direct contact with others as much as possible and consider wearing a surgical mask.

·         Follow the advice of your health care provider. You can also call Telehealth Ontario for advice (1-866-797-0000).

 

Instructions for caregivers:

• If possible, choose only one family member to care for a sick person. Pregnant women and people with medical problems may want to avoid providing direct care if possible.
• Try to maintain a distance of at least six (6) feet (two metres) between you and the sick person whenever possible.
• When holding a small child who is sick, place their chin on your shoulder so they do not cough in your face.
• Wash your hands frequently with warm water and pump soap or an alcohol-based hand rub before and after caring for the sick person.
• Perform extra cleaning in frequently touched areas of the house (table tops, keyboards, door knobs, remote controls, telephones, light switches, etc). Dishwashing and laundry can be done as usual.

 

Instructions for all household contacts:

• Watch for symptoms that include: fever, cough, sore throat, sore muscles, joint pain, weakness, tiredness, headache and sometimes diarrhea and vomiting.
• Follow the instructions on this sheet if you become ill.

 

Seek health care if the sick person:

• Has underlying medical problems, is pregnant or had a baby in the past month, is very overweight, is under five (5) years of age or is 65 years of age or older.
• See Box C on the back for more details;

 

Seek emergency care if the sick person has symptoms of worsening illness:

• See Box D on the back for details.

 

For additional information, please contact the Middlesex-London Health Unit at 519-663-5317, ext. 2330 or visit our website at www.healthunit.com/h1n1info .

 

BOX A SYMPTOMS OF INFLUENZA   Sudden onset of fever, chills or shakes Sometimes not present, particularly in those less than 5 years of age or 65 years of age and over. Cough Sore throat Headache Sore muscles and joints Tiredness Diarrhea and vomiting may occur, particularly in children

BOX B INSTRUCTIONS TO HELP YOU FEEL BETTER   ·            Rest ·            Drink lots of fluids ·            Treat fever with acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®) ·            Do not give acetylsalicylic acid (ASA or Aspirin®) to children or teenagers under the age of 18 or pregnant women ·            Pregnant women should treat their fever with acetaminophen ·            Gargle with a glass of warm water or suck on hard candy or lozenges ·            Use saline drops or spray for a stuffy nose ·            Avoid alcohol, tobacco and caffeine ·           Stay home until your fever has been gone for 24 hours and you are feeling better. You can return if you are still coughing. Health care workers should ensure they are better for at least 24 hours and their cough is only mild.  Medical notes are not needed in order to return to work, school or child care centres.   Contact Telehealth Ontario at 1-866-797-0000 if you have any questions.

BOX C PEOPLE AT HIGHER RISK FOR COMPLICATIONS   You are at higher risk for complications if you are: ·         less than 5 years of age ·         65 years of age and over ·         pregnant or had a baby in the past 4 weeks ·         very overweight Or, if you have medical conditions including: ·         lung problems, including asthma ·         heart problems ·         diabetes ·         cancer ·         problems with your immune system caused by disease or medications, including HIV ·         kidney disease ·         problems with your blood, such as anemia ·         neurologic problems ·         less than 18 years of age and taking daily aspirin   If you are at higher risk for complications, consult your health care provider as soon as symptoms develop. If you have no health care provider, go to a walk-in clinic.   Your health care provider may recommend an antiviral drug to help you feel better sooner and prevent complications.   Inform your health care provider that you have symptoms of influenza before or as soon as you arrive so that proper precautions can be taken to prevent spread to others.

BOX D WORSENING ILLNESS   Symptoms of worsening illness include: ·         Difficult or fast breathing or feeling short of breath ·         Chest pain ·         Purple or blue discolouration of the lips ·         Vomiting and unable to keep liquids down ·         Signs of dehydration such as dizziness when standing, dry mouth and/or decreased peeing ·         Confusion, disorientation, seizures, difficulty waking ·         Stiff neck or sensitive to light ·         Fever that does not go away or comes back after four (4) to five (5) days   In children also watch for: ·         Any fever in a baby less than 3 months of age ·         Very cranky or irritable     What to do: ·      Go to the nearest emergency department. ·      If symptoms are severe, call 911. ·      Inform the emergency department and/or paramedics that you have symptoms of influenza so that proper precautions can be taken to prevent spread to others.