August 28, 2009

“The beginning of the school year with kids congregating in large numbers may bring about a resurgence of the H1N1 flu,” said Kacey Ernst, PhD, MPH, an assistant professor and epidemiology researcher at The University of Arizona Mel and Enid Zuckerman College of Public Health (MEZCOPH).  Parents of children in preschool through high school, and college students should be on the alert for signs and symptoms, as well as the general public.  In the Tucson Unified School District (TUSD), school began on Monday, August 17, 2009 while The University of Arizona’s classes began on Monday, August 24 for the fall semester.

Mutations May Make H1N1 More Deadly

Besides a surge in numbers of H1N1 flu sufferers, MEZCOPH researchers and international public health officials are watching this strain for mutations, or changes as the virus evolves.  So far H1N1 has been about as deadly as the regular seasonal flu, but if it were to mutate, that could change. Flu is very unpredictable and it could mutate into something more deadly or something milder than what is already being transmitted.  Dr. Ernst says “if that {more severe} happens we could be looking at whole new situation.  It’s probably going to be a severe and early flu season. How severe depends on how much the virus shifts and mutates before it takes off this fall. .” As H1N1 is still being transmitted and the specific vaccine for it will not likely be available before October (though regular seasonal flu vaccine is currently available) it is likely that we will have an early flu season.

H1N1 Surveillance By State and County Health Departments

The state’s county health departments and the Arizona State Health Department are both monitoring the H1N1 virus closely.   Dr. Kacey Ernst served as the pandemic influenza epidemiologist  in the Office of Infectious Diseases in the Arizona Department of Health Services before coming to MEZCOPH.   When asked what a state flu epidemiologist does on a day-to-day basis, she said it involved “mostly writing emergency plans and working on preparation” and conducting flu surveillance during the flu season.  Strategic hospitals act as sentinel sites “which best represent the population as a whole around the state” are chosen to report cases of influenza like illness (ILI) . As these hospitals reported cases of ILI, specimens were sent to the state lab to verify and genetically identify the cases and strains circulating.

“It’s incredibly important to have good surveillance now,” said Dr. Ernst.  “We already know that the flu is widespread, and all geographic areas have had H1N1 exposure now” so it is most important for hospitals that have severe cases of the flu to test suspected cases and verify what type of flu it is.  One problem is that medical providers overall are not consistent with their testing: some never test suspected flu cases, while some do a lot of testing.  If a person goes to the hospital and is suspected of having the flu, a test kit is used to take a sample from the person, and the kit is sent to the laboratory.  Coordinators interact with the counties to provide enough kits.  Public health nurses can also collect samples for testing in the field. 

Making Arizona SAFER – MEZCOPH Epidemiology Graduate Students

One potential problem is Arizona’s county health departments do not have enough personnel to do the amount of follow-up and testing needed.  Counties are receiving much-needed assistance from the Student Aid for Field Epidemiology Response (SAFER) Team from The University of Arizona.  The founder and supervisor of the program is Kristen Pogreba-Brown, MPH, a graduate of MEZCOPH, who started SAFER as her internship project for her Master of Public Health degree.  Graduate epidemiology student volunteers do the “leg work” of interviewing people by telephone who may have the H1N1 virus.  They then forward a test kit to the possible H1N1 patient, and it is picked up by a laboratory courier or mailed in, and the results are reported to county and the state health departments.  Their work has helped greatly in the effort to track the H1N1 flu and other diseases throughout Arizona.

Besides doing telephone-based work, SAFER has done disease surveillance at events such as the May 2009 commencement at Arizona State University, where President Barack Obama was the main speaker, and also at SuperBowl XLII in Glendale several years ago.  At major events, they use syndromic surveillance, tracking the symptoms of people who check in at first aid stations to determine if they are suffering from the H1N1 flu or other illnesses.  At the ASU commencement, however, it turned out that H1N1 was not the main problem.  Visitors from other parts of the country were fainting due to the 102-degree heat and flooded the first-aid stations, a story which made national news.

The Big Question - How Deadly Will H1N1 Become?

The biggest question with the H1N1 flu is how deadly it will become.  In the beginning of an illness outbreak, public health professionals track the disease’s progression geographically until people in all areas of a county, state, or country have been exposed for the first time.  Once the disease has spread, such as now with H1N1, health officials “monitor for change in severity,” Dr. Ernst pointed out.  It’s especially important to examine people who are hospitalized for flu and to determine the most severe cases in Arizona, the U.S., and as H1N1 moves through the southern hemisphere and circles the globe.

By observing how severe the cases of flu are, scientists figure out how virulent, or deadly, the virus is. Right now, H1N1 is as virulent as the regular seasonal flu.  During its mutation changes, the H1N1 virus may become more deadly, or it may become less severe – these changes are unpredictable. 

Taxpayers may wonder that if money is spent to track the flu and it doesn’t get worse, are these dollars wasted?  “Absolutely not.  Planning for the worst-case scenario is the best way to go at this point because we don’t want to be caught unaware.  Money to curb transmission will not go to waste, since it goes into a public health infrastructure essential for any type of emergency situation.  In disease outbreaks and pandemics, it is always better to be over-prepared than under-prepared,” warns Dr. Ernst.

What can you do?

Dr. Ernst gives the following tips to help with the H1N1 flu:

• Stay home if you are sick so you don’t give the flu to your coworkers.  Anyone running a fever should not be at work!

• Keep your children at home if they are sick to keep transmission down, or with a relative or other caregiver.

• If you’re a parent, be sure to line up alternate care in advance for a possible sick child if you can’t afford to take off of work.   Some employers will provide special care for sick children.

• Teach your kids proper hand washing.  Sing the “happy birthday” song or “Twinkle,  twinkle, Little Star” all the way through while kids wash hands in warm water with soap.  (Antibacterial soaps are not necessary.)

• Use an alcohol-based hand sanitizer when hand washing is not available for you and your children.

• Parents can be advocates with teachers.  “Please make sure my kids wash their hands.”

• Tell your child’s school, “If my child gets sick, call me.”

• If you have a sick child at home, make sure that other kids are not around them.  Isolate them from the rest of the family. It’s especially important to keep the sick away from infants, toddlers, and kids who have other diseases or health problems, such as asthma or an immune system disorder.

• Vaccinate your kids unless contraindicated.  Get vaccinated yourself.

• Sneeze or cough into your arm or sleeve.

• If you or a family member have a runny nose, throw tissues away and wash hands thoroughly afterwards.

• Increase circulation in your home – bring in fresh air. Open windows if possible, since continuous fresh air flowing through your home is best.

News media - for more information and interviews, please contact:

Kacey Ernst, PhD, MPH

Assistant Professor

Mel and Enid Zuckerman College of Public Health

The University of Arizona

Drachman Hall, Room A246

1295 N. Martin

Tucson, Arizona 85724

(520) 626-7374

High-resolution photos of the SAFER team doing surveillance work at the ASU Commencement (where President Obama was the speaker) and SuperBowl in Glendale are available. 

Useful Links:

Memo from University of Arizona President Robert Shelton regarding status and preparedness activities related to H1N1: 

http://www.president.arizona.edu/prescomm_more.cfm?f_ID=116

Mel and Enid Zuckerman College of Public Health: 

www.publichealth.arizona.edu

SAFER Home Page:

http://azcphp.publichealth.arizona.edu/TE/safer.aspx

Centers for Disease Control’s H1N1 Flu Information Page:

http://www.cdc.gov/h1n1flu/

This helpful web site offers information on vaccinations, the H1N1 flu virus, updates on the numbers of cases around the U.S., and other useful information.

This article written by Loretta McKibben. 

First posted on August 28, 2009.  Last updated on August 28, 2009.

Please send comments to mckibben@email.arizona.edu.