Influenza Update - Sept 7th

Novel Influenza H1N1 Update  Dr. Stuart B. Weiss   INFLUENZA UPDATE WHO PANDEMIC ALERT LEVEL 6 Sept 7, 2009   SUBSCRIBE: Click button at bottom or send email to alert@MedPrepGroup.com Hang onto your hats....flu is here already! We monitor many information sources across the country and the world and we are getting clear reports that the flu is here and the number of cases is rising.    Current Situation: Since schools and universities have been opening for the school year, there have been many reports of children and young adults with influenza like illnesses. There have been reported cases of outbreaks or clusters over the past two weeks in 11 states. For example, in the State of Washington, reports indicate that as many as 2000 students at a university have reported influenza-like illness. There are also sporadic case reports of outbreaks in K-12 schools, especially in the southeast. Some emergency physicians are reporting seeing cases of flu-like illness in the emergency department. One physician in Texas wrote that a third of the patients he saw in the emergency department a few days ago had flu. Another physician from Massachusetts also is seeing patients already. The vast majority have routine symptoms of flu and do not require hospitalization. The CDC reported on Sept 4th that there is increased flu activity in the nation, especially in the southeastern states where many school districts resumed classes on August 10th. Vaccine for the new flu strain should be approved and available in the US in October. Early data from a study at Novartis showed that 80% of test volunteers had a good immune response after only 1 shot of their Celtura vaccine. China announced that it has approved a single dose vaccine made by Sinovac. The WHO reported that novel H1N1 influenza outbreaks in the southern hemisphere have started to wane. Looking back, most cases were mild but there were cases of severe viral pneumonia in previously healthy young people (similar to what was seen in April/May at the beginning of this pandemic) The WHO published a lessons learned briefing note on August 28th that summarizes the findings from the southern hemisphere (see below) 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:    On August 28th, the WHO published a briefing note that summarized the findings from the experience in the southern hemisphere over the past few months. Here are their findings and our comments on what was observed: Novel H1N1 is the dominant virus strain in most parts of the world overtaking seasonal strains. There was not alot of co-circulation although there was some and we will have to monitor this closely in the northern hemisphere The virus has not mutated to a more lethal form and the overwhelming majority of sick people experience mild illness (that keeps them out of work for an average of 3-5 days -sw) Even if the disease stays mild, such large numbers of people are susceptible to the virus that it could still severely impact society. Healthcare systems may be overwhelmed by people requiring ICU care. For people who develop severe viral pneumonia, prolonged intensive care is required and in the US, we do not have a large reserve of ICU beds. Many hospitals function at close to capacity in their ICU's especially in the winter. In the southern hemisphere, for our healthcare clients, problems included ICU personnel shortages (due to illness), ventilator shortages, ECMO shortage (for treatment of ARDS), ICU capacity shortage. In addition, significant utilization of pediatric emergency departments was seen in April/May and should be anticipated this winter as well. Drug resistance to Tamiflu is not a problem so far. There have been sporadic cases reported but that is completely expected and very rare. Acquisition of Tamiflu resistance by sharing of genetic material between seasonal H1N1 (which is almost 100% Tamiflu resistant) and pandemic H1N1 has been a concern. One study in Ferrets suggested that novel H1N1 doesn't seem to share genetic material well with seasonal H1N1 so perhaps we won't see widespread Tamiflu resistance emerge. Pattern of illness points to a younger population for novel H1N1. Most people who catch this are younger than 50 years old with deaths in elderly rare. Most cases of severe illness are in younger people compared with seasonal influenza. A report in August 2009 analyzed 574 fatal cases worldwide and found the average age was 37 and 51% of the deaths were between 20-49 years old. About half of the deaths were in patients with underlying medical conditions. While obesity and diabetes were the most common conditions identified it is not clear whether these were contributing factors themselves or whether people with diabetes and obesity have more heart disease and lung disease making them more susceptible. Other factors included asthma and heart disease. Pregnancy is a consistent risk factor for severe disease across many countries. HIV and novel H1N1 - studies from two countries seem to indicate that people with HIV who are on HIV medications are not at increased risk for severe or fatal illness.   ADVICE: Schools are reopening and we are seeing a resurgence of flu cases. It is really important for you to have looked at your human resource policies and your supply chain. Since pregnancy is a consistent risk factor, you must plan for protecting your pregnant employees. As I wrote in the last update, 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. TOOLS: Virtual Medical Director - Ensure that you have medical decision support if you do not have an in-house medical director. Look into our Virtual Medical Director program. We have affordable decision support plans that you can enroll in.   DC3 will be available next week. This is the software we have been busily designing over the past two months. It will take the place of the WHO Pandemic Phases and give you intelligent Organizational Levels to link your trigger based action plan to. DC3 incorporates expert medical opinion that is updated regularly into the logic and will advise you on actions you should be taking and help you assess your readiness. Drop me a note if you would like to see it.   Global Disease Surveillance - MedPrep has teamed with a global surveillance company to provide geomapped specific surveillance for corporations who want site specific news and information. Through this system, we monitor over 30,000 information sources and provide you with intelligence and analysis on influenza and 259 other infectious diseases.   If you need last minute pandemic planning help, drop me a note. We have a policy matrix, policy toolkits, FAQ's, posters, employee educational materials, a trigger based action plan template . We can help you jumpstart your planning and initiative or take a look at your current plans 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