The U.S. declared a public health emergency on Sunday, April 26th to deal with the emerging new swine flu. Officials reported 100 U.S. cases of swine flu in ten states so far, with one death in Texas. "As we continue to look for cases, we are going to see a broader spectrum of disease," predicted Dr. Richard Besser, acting chief of the Centers for Disease Control and Prevention. "We're going to see more severe disease in this country."
As of July 17th, health officials have reported 2,188 confirmed and probable cases of swine flu and 14 deaths in Florida. There were three confirmed cases in Pinellas County.
The first 20 cases had mild influenza-like illness with only one requiring brief hospitalization. All 20 viruses have the same genetic pattern based on preliminary testing. The virus is being described as a new subtype of A/H1N1 not previously detected in swine or humans.
CDC officials described the virus as having a unique combination of gene segments not seen before in people or pigs. The bug contains human virus, avian virus from North America and pig viruses from North America, Europe and Asia. One unnamed cell biologist and medical doctor working at Johns Hopkins stated anonymously that this 4-part flu combination is highly unusual and looks like it could be man-made, especially because it has an avian strain. He explained that in Asia, it's common for a avian-swine-human flu to happen naturally, but this virus first showed up in Mexico, where pigs and ducks are not usually raised together. Also, recombination of more than 2-different flu viruses is extremely rare.
The Florida Department of Health is proactively responding to this event by enhancing surveillance and monitoring efforts for influenza across the state. The Florida Department of Health, in partnership with the Centers for Disease Control and Prevention, has the capability needed to detect novel influenza viruses.
“This is a situation where we must all be on the alert,” said Dr. Ana Viamonte Ros, Florida’s State Surgeon General. “We have increased our surveillance and we’re telling doctors that with flu season waning, if they see patients with sudden onset of high fever and a cough or sore throat, they should collect a specimen for testing.”
Dr. Viamonte Ros said the Florida Department of Health (DOH) and county health department have response plans and have put them into play. “Our state laboratories have the equipment necessary and our personnel are trained in identifying influenza samples. We have increased surveillance, alerted doctors and are working with our local county health departments,” she said.
Florida has prepared for influenza events:
- All state laboratories have the facilities to safely identify influenza samples;
- The state has almost 100 sentinel physicians who report any unusual influenza-like activity to DOH and the CDC.; and
- We have the ability to monitor the sale of over the counter drugs, as an early warning sign for increased influenza activity.
The Pinellas County Health Department is working closely with the Florida Dept of Health and the Centers for Diseases Control with this rapidly evolving situation. Local plans fall in line with State and Federal plans, and the County's health officials are actively monitoring for cases.
Sarah Snyder, executive director of the Pinellas County Coalition for the Homeless, has asked all homeless service providers to take the following measures:
1. Make sure that you and your staff keep up to date on the latest information. I have attached some materials from 2-1-1 Tampa Bay, and urge you to look at them and to also check out the continually updating ‘H1N1 Influenza Quick Guide’ on www.211tampabay.org website in the ‘Guides’ section; it has all the numbers and information resources.
2. Please copy and post the attached ‘Fact Sheet Flyer’ that was created from Health Department and other information: put it up in your shelters, or transitional or permanent living quarters, lobbies, and anywhere else people will see them.
3. For those of you that operate day centers, soup kitchens, food banks, one-stops, or are close to places where the street homeless gather: please make as many copies as you want and post them or hand them out wherever you can, so more homeless persons will see them.
4. For all of you: please make soap and water and a place to wash hands available as much as possible. If you can, please expand your supply of hand sanitizer bottles that can be given out to the street homeless, so they have some way of keeping as healthy as possible.
The CDC reports Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza that regularly cause outbreaks of influenza among pigs. Swine flu viruses do not normally infect humans, however, human infections with swine flu do occur, and cases of human-to-human spread of swine flu viruses has been documented.
Homeless men, women, and children make up a growing population that is vulnerable to preventable disease, progressive morbidity, and premature death. Providing effective primary care for homeless persons is a formidable task because of many internal and external barriers to care. Chronic disease is seen more frequently in homeless persons, 40% of whom report at least one chronic health problem. These chronic illnesses may be silent until late in their course and, because of limited medical attention, often go unrecognized and untreated. Even if the condition is detected and treated, lack of compliance and consistent follow-up often results in disease progression, disability, morbidity, and premature death.
Premature death is the ultimate consequence of the increased vulnerability of homeless persons. However, the likelihood of the spread of transmissable disease to the general population makes this a problem that we can ill afford to overlook. The lack of prevention, intervention and treatment may have consequences beyond the homeless community. The progressive morbidity and mortality from infection, cancer, and heart disease in homeless persons could be reduced by developing primary care systems that include a common medical record across homeless shelter sites and that offer targeted case management that focuses on influenza and pneumococcal immunization, cancer detection, and reduction of risk factors for premature heart disease.
According to M.A. Rogers of the Boston Health Care for the Homeless Program, little is understood regarding the prevalence and transmission of influenza among the homeless. Further inquiry on this topic is timely because of concern over the current possibility of a swine flu pandemic. Additionally, US officials are concerned about increasing vaccination rates among homeless persons, and reducing the potential threat to persons who live and work in homeless shelters, which as congregate settings are likely sites for transmission of airborne pathogens such as influenza viruses and tubercle bacilli, shown in part by numerous tuberculosis outbreaks among the homeless. The Journal of the American Medical Association (JAMA) reported that homeless persons experience high rates of pneumonia and related death. This outcome indicates that the homeless also have high rates of influenza because pneumonia is a common complication of influenza.
So what can homeless shelters and day centers do to help prevent the spread of influenza among their consumers? Controlling influenza transmission within shelters may benefit the broader public in the same way that reducing the rates of tuberculosis among homeless persons is regarded as essential in preventing transmission to the general population. Here are some suggested steps:
- Clean surfaces regularly, like cafeteria tables, door knobs, telephones and desks;
- Make sure there is sufficient ventillation and sunlight;
- Conduct shelter-based interventions such as the "Snapshot Intervention" model developed in Marseilles;
- Educate shelter residents on proper personal hygiene;
- Maintain a health log, noting persons with persistent coughs, placing them in a quarantined area and reporting these conditions to the appropriate health officials;
Florida health officials stress the importance of good personal hygiene among all residents. These disease prevention habits include:
More Information:
"Swine Flu FAQs": http://www.pinellashomeless.org/Page__1/ArticleID__337/News-and-Events/Articles-and-Features.html
Swine flu information line set up by FLORIDA DEPT. OF HEALTH (DOH): 1-800-775-8039
For more information please visit the CDC’s Web site at: http://www.cdc.gov/flu/swine/index.htm or call 1-800-CDC-INFO.
For further information on Pinellas County's proactive plans or to report cases, contact: Jeannine Mallory, Public Information Officer, Pinellas County at 727-824-6908, and the Disease Control Division at 727-824-6932.
Resource Link:
National Health Care for the Homeless Council, resources about communicable diseases: http://www.nhchc.org/CommunicableDiseases.html
