| Novel Influenza H1N1 (2009) Update MedPrep Consulting Group LLC Dr. Stuart B. Weiss | | INFLUENZA UPDATE WHO PANDEMIC ALERT LEVEL 6 | | Uh-oh, are we seeing a drift in circulating flu virus, and what happened to the summer influenza hiatus? | | | This year, the flu season has continued in the Northern Hemisphere over the summer, a time when flu is typically non-existent. In the Southern Hemisphere, some concerning changes have occurred in the circulating H3N2 virus. Current Situation: - Although cases continue to rise in the Southern Hemisphere, case counts will no longer be reported as they are not very meaningful.
- In some countries in the Southern Hemisphere, the novel H1N1 virus is the dominant strain and in others, there is concomitant spread of both seasonal influenza and novel H1N1.
- On Friday, a news story out of Canada reported that Canadian employers are seeing huge increases in H1N1 related employee absenteeism as well as confusion on sick time policies.
- The CDC released a report about 4 children with novel H1N1 virus infections that developed neurological complications such as seizures or confusion/lethargy.
- Reports from the Southern Hemisphere suggest the presence of a new H3N2 flu variant that has drifted. This could lead to a vaccine mismatch for the fall seasonal influenza vaccine in the Northern Hemisphere is this new H3N2 becomes dominant (see analysis below).
- Samples of the novel H1N1 virus continue to show no genetic changes in the virus.
- Several clinical trials are beginning to test new H1N1 vaccines. These trials are testing single and two dose regimens and different amounts of administered vaccine. These studies should take about 3 months to complete.
- There was much news about "worst case scenarios" from the CDC this past week. Although the worst case scenario is scary, it is worst case, not most likely case. As planners, worst case scenarios are useful in planning but too much emphasis should not be given to the worst case.
- MIT has a wonderful paper on novel H1N1 which summarizes what is currently occurring and reviews past pandemics. It is well worth the read. You can find it at: http://esd.mit.edu/WPS/2009/esd-wp-2009-07.pdf
- The Advisory Committee on Immunization Practices (ACIP) will meet in Atlanta on July 29th and is expected to develop guidance for who should be prioritized for the new H1N1 vaccine when it is available.
| | | HOUSEKEEPING ITEM: If you get this Alert through a mailing list and not directly from us, subscribe by clicking the button at the bottom or send an email to alert@MedPrepGroup.com ANALYSIS: In the United States over the summer, we really haven't had the usual flu hiatus. In both summer camps and military bases, there have been continued outbreaks of this new virus. Twenty states are still showing widespread influenza activity, all of it related to the new H1N1 virus. This is leading many to predict that once schools reopen in a little over a month, we may see a real spike in the number of novel H1N1 cases. This spike in new cases in young people is a real possibility and would occur in late August or September, a full month or two before we have vaccine available. This spike would lead to employee absenteeism as parents are forced to stay home with sick children. The fact that the CDC reported finding neurological complications in children with the new H1N1 virus infection is concerning. Although all 4 children fully recovered, having large numbers of children develop seizures or confusion will stress our medical care system significantly. In the United States, Federal officials are moving towards a voluntary mass flu vaccination program for the fall. That is a massive undertaking with many logistical nightmares, not the least of which is that the vaccine may come out two months after the number of flu cases begins to spike. The Federal government is ramping up for a bad flu season this year and so should you. Lastly, the development of a new drifted H3N2 seasonal flu strain is concerning. As I have written about before, influenza viruses are very prone to genetic changes as they spread. Small genetic changes result from a drift while large genetic changes result from a shift. These small genetic drifts can sometimes make a virus different enough that the vaccine for it doesn't work. If this new drifted H3N2 becomes the dominant strain this coming fall/winter and we end up with an ineffective vaccine, then we will have a particularly bad seasonal flu season regardless of what the new H1N1 does. This will need to be watched as the Souther Hemisphere flu season continues. ADVICE: - Plan for supply chain interruptions. It is very important for you to plan for supply chain interruptions this fall. With just-in-time delivery of much of the inventory in the U.S., there is no extra inventory to carry us through supply chain interruptions. Review how you will keep your company going if deliveries slow or stop for a period of time.
- Look at your sick time policies. When reviewing these policies, look closely at your requirement for physician notes if your employees are out for a certain number of days. Many companies require such notes after 3 or 4 days of illness. You can expect that during a bad flu season, public health authorities will be recommending that people only seek medical care when they have severe illness so getting return to work notes will be problematic. At a recent exercise we ran in New York, we heard from many health care providers that they were inundated with people wanting a return to work notes.
- Turn up the heat on your planning efforts. You only have a month or two before we will see the spike in cases from schools reopening. You must review your pandemic policies and trigger based action plan.
- Develop a trusted source for important medical information and analysis. If you have a corporate medical director, include them in the planning process. If you do not have this resource in-house, hire us to serve as your Virtual Medical Director if you wish. See below for information.
Virtual Medical Director If you don't have a corporate medical director, we'll be your medical director. Our Virtual Medical Director service provides you with 24 hour access to physicians and experts trained in emergency medicine, disaster medicine, business continuity, occupational health and mental health crisis management to give you situation updates, analysis and advice. Contact us for further information. Pandemic Planning Services If you need assistance with pandemic planning, we offer a full range of materials and services including policy templates, FAQ's, development of trigger based actin plans, refinement of plan triggers, plan audits, employee educational programs, exercises, etc. Give us a call or send me an email if you want more information. Not preparing now would be a serious mistake. If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com
MedPrep Consulting Group is internationally recognized as a leader in pandemic, disaster and business continuity planning, training and exercising. We have resources and expertise that you can count on. Ask us about our Virtual Medical Director Program. Dr. Stuart Weiss is the CEO of MedPrep Consulting Group. For more information, visit www.MedPrepGroup.com |
Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC | | | | |
