Influenza Update - novel H1N1 (2009)

Novel Influenza H1N1 (2009) Update  MedPrep Consulting Group LLC Dr. Stuart B. Weiss   INFLUENZA UPDATE WHO PANDEMIC ALERT LEVEL 6 August 9, 2009   SUBSCRIBE: Click button at bottom or send email to alert@MedPrepGroup.com CDC changes its guidance on how long to stay home, Federal officials issues new guidance on school closures and vaccine clinical studies begin.....boy its been a busy week. Governments in North America have really turned up the heat on pandemic flu preparedness. President Obama is in Mexico for talks with the President of Mexico and the Prime Minister of Canada. A big topic on their agenda is mutual cooperation in responding to the resurgence of H1N1 expected in the next 6-8 weeks.    Current Situation: The CDC issued new guidance regarding how long sick individuals should stay home from work. The CDC issued new guidance based on the epidemiological data from the spring outbreak of novel H1N1 (2009). The new recommendations for non healthcare settings recommends that sick individuals stay home until they are free from fever (without fever reducing medicine) for 24 hours. This is a change from previous recommendations that they stay home for 7 days or fever-free for 24 hours, whichever was longer. Based on data from the spring, the average length of time people had fever was 2 -4 days so this new recommendation would result in 3-5 days of absenteeism in most cases. The new guidance can be found at: http://www.cdc.gov/h1n1flu/guidance/exclusion.htm Federal officials issued new guidance for school closure. It can be found at: http://www.cdc.gov/h1n1flu/schools/schoolguidance.htm The new guidance discusses that if the H1N1 comes back with the same illness pattern and is not causing worse disease, the benefits of closing schools may not outweigh the negative aspects of children left home alone, parents missing work to watch the children, students missing meals and interruptions in education. If the flu comes back worse, there is a stronger case for closures. There is much more guidance in the document. There was much discussion about vaccines and vaccine safety in the media this past week. The WHO held a press conference on this topic this past Thursday. The reported that there are 7 manufacturers with clinical trials in progress in 5 countries (China, Australia, UK, Germany and U.S.). They should have study results in September. That should lead to vaccine being licensed for use by late September / early October. WHO information on vaccines can be found at: http://www.who.int/csr/disease/swineflu/notes/h1n1_safety_vaccines_20090805/en/index.html Health Experts are predicting that up to 1/3 of the world's population (2 billion people) may contract this new flu.   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:    The updated guidance from the CDC on how long to stay home makes sense based on the data from the Spring outbreak. While this is based on the data showing that the maximal amount of viral shedding occurred when people had fever, there still was lower levels of viral shedding for up to ten days after people were symptom free. Therefore, workers who return to work must be counseled to practice good cough/sneeze etiquette, hand hygiene and to avoid close contact with people with known increased risk (pregnant workers, workers with underlying medical cardiac or respiratory conditions, workers living or caring for others at increased risk). We have sent updated policy recommendations to our clients to bring their policies into alignment with this new information. You should make certain that you have looked at your policies as well.   There continues to be concern over vaccine safety. We will know much more as clinical trials continue but I want to stress that there are many years worth of experience with influenza vaccines and much is known about their safety. Some of the vaccine being produced uses the same production methods as seasonal flu vaccine and should have the same excellent safety profile. There are some new techniques being used that includes adding a component to improve immune response with less vaccine (called adjuvanted vaccine). These are newer techniques that need more study. In general, these vaccines should be very safe. I want to caution however, in any large scale, mass vaccination program, even extremely rare side effects may be present due to the large number of people being vaccinated. When we look back at the swine flu vaccination program in 1976, there were 30 people that got a severe neurological complication called Guillain-Barre syndrome. While this was a tragedy for those people, it was only 30 out of 40 million. So while those cases received alot of press, they were extremely rare events. In addition, vaccine production has gotten much better in the past 30 years and you can be certain that there will be close surveillance of this new H1N1 vaccine when it is given to large numbers of people.   While we are talking about rare side effects, there will be another type of adverse event that will be reported and that is something that is temporally associated to the vaccine even though it doesn't actually have anything to do with the vaccine. This means that a person may develop a medical condition by chance close to the time when they received a vaccine. People may then make the assumption that the vaccine caused the problem when that was not the case.   Finally, take a look at the new school guidance. It encourages school officials to carefully weigh the benefits of closing schools before doing so. Since the virus is so wide spread, at this point, it may not be very useful to close schools unless the virus starts causing more severe disease.     ADVICE: I have been advising you to take action in planning for quite some time now. Schools will reopen soon and we will see a resurgence of flu cases once that happens. By this time, you should have at least looked at your human resource policies and your supply chain. There are nine areas that we advise our clients to look at: HR, Corporate Governance, Incident Management, Security, Communications, Finance, Operations, Corporate Services and Information System. For each of these areas, take a look at your policies and procedures from the point of view of worker absenteeism. How will these areas function if large numbers of people are out for 3-5 days during October through February/March. Look upstream at your suppliers and downstream at your distributors to develop work-around solutions should they experience interruptions from absenteeism. Now is the time to be preparing. Don't wait until September or October to review your plans.   If you need help, drop me a note. We have a policy matrix, policy toolkits, FAQ's, posters, employee educational materials, a trigger based action plan template and shortly, we will be releasing our new trigger decision model to replace the WHO Pandemic Phases. We can help you jumpstart your planning initiative or take a look at your plan with a fresh set of eyes.     Virtual Medical Director If you don't have a corporate medical director, our Virtual Medical Director program may be a good solution for you. 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.     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