2009 Nove! H1N1 Influenza Public Engagement Project Pre-Meeting Questions Today’s meeting is one of several public engagement activities on pandemic flu planning taking place in several states around the country (a flu pandemic is a global outbreak of the flu). Please take a few minutes to answer the following questions. Directions: Please fill out this survey and a similar one at the end of the day. In order to compare answers between the two surveys, please use the sane ID number each time. ‘Your name will never be connected with your ID number, so no one will know your answers to the survey, Your number will be used only for these surveys. Your ID number for the surveys is the year you were born, followed by the last four digits of your home phone number. For example, if you were born in 1961, and your phone number is 123-4567, your ID number will be 19614567. Please write your ED number in the box below: 1D Number Last Four Digits of Your Home Phone Number Go On >Section I: Knowledge about Pandemic Flu Please answer the following questions based on what you know right now about the flu. Itis OK if you do not know the answers to any of the questions. 1. How soon after someone is infected with a flu virus can they get sick? Almost immediately ‘One day later Afew weeks later About a month later don't know oO oo00 2. About how many people die in a typical year from flu in the United States? 6,000 36,000 156,000 256,000 I don’t know Oo oo000 3. Whois at risk when a new flu virus appears that has never been seen before? Only children Only people in the country the virus is first discovered in Only people who have never receivad a flu shot The entire population of the world I don't know Oo 0000 4, How many flu pandemics have occurred over the last 100 years? 9 (rone} 3 (three) 20 (twenty) 365 (thitly-five) ‘don't know Oo poo0 5. What causes flu pandemics? Poor hand washing ‘The fiu virus changes so much that nobody has immunity to it People don't get annual flu shots No onereally knows. I don't know Oo oooo Go On >6. Where did the 2009 novel H1N1 flu virus start? Spain 1D Mexico 1 United States O China 1 I don't know 7. Inthe United States, which group has been most likely to be hospitalized after getting the novel H1N1 flu? Children younger than 4 years of age Adults age 25-64 Persons 65 years of age and older Persons with Guillane-Barre’ Syndrome I don't know Oo oo00 Section i: Opinions about Flu Planning The following questions are about your personal opinions relating to how you might make decisions in the event of a flu pandemic. 8. Please indicate your level of agreement with the following statements: Disagree Disagree Agree Agree Strongly Somewhat Somewhat Strongly Even if flu caused by the novel H1N1 virus is as severe as predicted, i won't get sick. a eI il ci Flu caused by the novel H1N1 virus won't be as severe as a H o o Oo Oo The U.S. should provide surplus flu vaccines to poor countries that don't have enough vaccine eI EI Ei Go On>