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Influenza A (H1N1) Waikato updateJUNE 5, 2009 Background and global information On 24 April 2009, an outbreak of Influenza A (H1N1), previously known as Swine Flu, was reported by the USA and Mexico. This outbreak is continuing to spread globally, and the situation is evolving rapidly. Although the virus is tending to act more like a typical seasonal influenza virus, this could mean larger impacts for countries in the Southern Hemisphere as winter is upon us. "Non-seasonal influenza (capable of being transmitted between humans)" was made a notifiable and quarantinable disease under the Health Act 1956 on 29 April, 2009. Sixty two countries have reported more than 17,000 cases with more than 115 deaths. New Zealand situation New Zealand is currently in Code Yellow alert. Code yellow = standby phase, used to alert the health sector when there has been a significant development in the virus overseas, or single isolated cases in New Zealand. It is warned this may escalate to Code Red. Code Red = response phase, used to alert the health sector that they should activate their response plans. New Zealand has reported ten confirmed cases of the illness, although all of these have been imported from a country of concern. Waikato situation The Waikato Public Health Unit is currently dealing with management of the local situation, and has a Coordinated Incident Management Structure (CIMS) in place. The Waikato region is currently reporting two possible cases. Possible cases have been swabbed, given tamiflu and are in self isolation until their test results are returned as negative or seven days from onset of symptoms. Waikato DHB and primary care met on the 2nd June to discuss current situation and planning for possible move to 'Code Red'. As a result two groups were formed; Health Waikato planning group and primary care and community based assessment centre (CBAC) planning group. These groups will meet regularly of the next few weeks to review and finalise planning. All patients presenting at Health Waikato emergency departments at Waikato, Taumarunui, Te Kuiti, Tokoroa and Thames hospitals, who have influenza-like illness and have travelled overseas within 14 days, are being asked to wear masks in waiting rooms as a precaution. Australian situation As at 5am 2nd June, Australia were reporting 501 laboratory confirmed cases of Influenza A (H1N1). More than 75 per cent of these were in Victoria. Health advice and information Medical officers of health still ask that people be aware of the dangers of seasonal influenza and practice good cough and sneeze etiquette, social distancing when unwell and good hand hygiene. Precautions remain: anyone with an influenza-like illness, who developed symptoms within seven days of travel to a country of concern, should call their general practitioner or the medical officers of health immediately. On-call health protection officer (021 999 521), on-call medical officer of health (021 359 650), or Healthline 0800 611 116. For up-to-date information, visit www.moh.govt.nz or www.who.govt.nz Preparedness for your organisation Please ensure you have a pandemic plan in place in your business/organisations. Travel Advice The WHO currently is not advising any travel restrictions or border closures. International travellers are encouraged to register with "Safe Travel" which provides information and advice. New Zealand travel advisory information is posted on the Ministry of Foreign Affairs and Trade safe travel website: www.safetravel.govt.nz. At this time all tourist and non-essential travel to Mexico is being advised against as it is classified as being high risk. Any changes to this advice will be updated immediately on the website link provided. Media are currently reporting in the South Island that Canterbury DHB have advised staff who have travelled overseas to remain off work for a further 3 – 7 days once they have returned home. NOTE this is not national policy or advice. School information Below is a letter sent to all schools and early childhood centres by the Ministry of Health this week: Influenza A (H1N1) Swine Flu The focus of the Ministry of Health and the efforts of the Public Health authorities are very much on containing any suspected or actual cases of this influenza. To date, there is no evidence of community spread of the virus here and numbers remain stable. All of our cases had recently returned from travel in affected areas including the original cluster from Rangitoto College. The stability of these figures has seen the issue slip largely from public consciousness and a sense that it will soon be all over. The reality is likely the opposite. There are clear signs of the early stages of a pandemic, namely significant increase in the number and spread of infection outside Mexico and North America. The overseas experience of the virus shows schools seem to be particularly susceptible to the virus as evidenced in the US, Europe, Japan and also Australia. It is worth noting that had the Rangitoto College party had a chance to return to school prior to identification, then the College would have been closed. The health sector's response in New Zealand will be informed by what happens abroad, and at this stage all evidence suggests it will be a matter of when, rather than if, the virus appears in our community. Schools and early childhood services by their nature are susceptible to many viruses and influenza in particular is readily spread by children. As a result it is likely that schools and early childhood services would be amongst the first affected when the swine flu virus starts to spread here, both by cases and the need to contain them. For instance, any cases in a school with students recently returned from anywhere overseas might see that school closed. Any community spread in one area could see all schools or early childhood services in that area closed. The length of closure would depend on circumstances, but it would be initially for at least seven days, which is the time an infected person would be infectious. The Ministry of Health suggests that the families of students who have travelled to countries with considerable spread of Influenza A (H1N1) should keep them home for a week upon their return, even if they have no symptoms. Australia is already requiring students who have travelled to countries with considerable local spread of Influenza A (H1N1) to stay home for a week even if they have no symptoms. Dealing with any health issue like this is problematic for schools and early childhood services, although there is evidence that suggests that some basic measures will slow down the spread of viruses like influenza. In addition to potential school closure, these include basic but effective initiatives include promoting basic hygiene measures like very regular hand washing (before anyone puts anything in their mouths), students and staff covering their coughs and sneezes, and any staff or students with symptoms of possible influenza should stay home until they are well. In the event that a large number of students or a group of students and staff become unwell with flu like symptoms, schools and early childhood services should contact their public health unit. The Ministry of Health is preparing for the possibility of escalation and I strongly advise all schools and early childhood services to do the same. If a school or early childhood service was directed to close it could happen very fast – students would be sent home at the end of the day and told not to return. Your communication with parents needs to be thought through and prepared. Consideration also needs to be given to remote learning and lessons by schools, not just for a week, but potentially several weeks. There is material on both the moh.govt.nz/influenza-a-h1n1 and Pandemic Planning (www.mindedu.govt.nz) websites and any questions should be directed to your local Ministry of Education office, or Healthline 0800 611 116. Thank you for helping us deal with this very real threat to public health. Dr Mark Jacobs, Director of Public Health |