Influenza Update - October 8

Novel Influenza H1N1 Update  Dr. Stuart B. Weiss   INFLUENZA UPDATE Oct 8, 2009   SUBSCRIBE: Click button at bottom or send email to: sweiss@MedPrepGroup.com The Official "Flu Season" started on October 4th but tell that to the H1N1 virus  Although the official flu season started 4 days ago, the CDC is reporting that there is widespread flu activity in 27 States. Here is what's happening...    Current Situation: Outbreaks on college and university campuses across the country continue to be widespread but the number of new cases decreased this past week. Most cases continue to be mild, according to the American College Health Association. ABC reported last night that approximately 400 schools have been closed so far related to widespread absenteeism form flu. A quick scan of our global surveillance system also shows schools scattered across the US closing for several days to slow the spread of illness. The CDC reports that twenty-seven states now report widespread flu activity with some activity in all states. The CDC data is usually two weeks old so this reflects that week of September 20-26 The WHO reports that there is widespread disease across the northern hemisphere especially in the US and northwestern Mexico. Vaccine Update: States have begun receiving pandemic flu vaccine. Most are prioritizing health care workers for this first round of doses but it varies State to State. The military will mandate vaccination of all active duty troops and expects to have 1.4 million people vaccinated with the new vaccine. Multiple global experts have weighed in on the Canadian study showing a supposed increased risk of catching pandemic flu if you have a seasonal flu shot. They all think the Canadian results are flawed and should not change vaccine strategies at all. Disease Update: The CDC working with Emory University has designed a good algorithm for quickly sorting patients presenting with influenza-like illness. This could be useful for emergency departments, clinics and corporate health departments. You can find it at: www.cdc.gov/h1n1flu/clinicians/pdf/adultalgorithm.pdf Emory has also worked with Microsoft to launch a public flu screening tool for people to check if they should see a health care provider. It is interesting and can be found at: www.h1n1responsecenter.com A new syndrome called FLAARDS was published by Australian and New Zealand researchers. While FLAARDS sounds like a funny name it stands for Flu-A Associated Acute Respiratory Distress Syndrome. We may hear more about this as more data from the southern hemisphere is published. FLAARDS is associated with inflamed fluid filled lungs requiring ventilation or ECHO and may include multi-organ failure and death. More Mask controversy In the continuing discussion of masks, a new study from Ontario looked at nurses wearing either N-95 masks or surgical masks and found no difference in the prevention of flu between the two. Experts reviewing the study were quick to point out the significant flaws in the study that may have caused erroneous results. These results are directly opposite of the study a few weeks ago from Australian researchers showing N-95 masks to be superior to surgical masks. So the debate continues. EEOC guidance for corporations The EEOC put out some good guidance on the application of the Americans with Disabilities Act (ADA) to pandemic planning. While I am not a lawyer, it has clarifying examples and simple questions and answers. It is certainly worth looking at. you can find it at: http://www.eeoc.gov/facts/pandemic_flu.html You can also find a good CIDRAP article on this at: http://www.cidrap.umn.edu/cidrap/content/influenza/biz-plan/news/oct0709eeoc.html     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 me at sweiss@MedPrepGroup.com       ANALYSIS:    There continues to increasing numbers of cases across the US. Thankfully, the cases remain mild, for the most part. Although the number of cases have diminished a little in college campuses, this should not lull you into thinking that the wave is over or has peaked. That is unlikely.  We still expect that many more people will catch this virus and be out for 3-5 days. So far, we have seen reported that about 400 schools have been closed across the county. That is a small number but may rise as this continues.   I want to take a moment to stress the safety of the new pandemic H1N1 virus vaccine. This vaccine is manufactured in the same way as every other influenza vaccine by the same companies. In fact, if this virus had first emerged a few months earlier, this virus would have been included in the seasonal flu vaccine and we wouldn't be having this conversation. Please encourage your employees to get the vaccine when it is available. The question of when it will be available is a whole other story. Remember, almost all vaccine coming out now is going to the high priority groups. You and your employees will not get access to the vaccine until November or December. That is why it is important to continue your pandemic planning and take appropriate employee protection steps.   The ongoing controversy about masks is unfortunate. Problems with the study methodology continue because it is hard to design a truly clear study because it would require some folks to not wear a mask around sick patients and that is contrary to CDC guidance. So we continue to recommend N-95 masks for emergency responders, security and people at high risk who cannot maintain good social distancing due to job requirements. Everyone else who requires a mask should use surgical masks. This may change as we learn more information.   ADVICE - my advice this week is the same as last week: Keep yourself informed on what is going on. We will help you do that through our Business Alerts but you may want to also subscribe to ProMed and look at the CIDRAP site frequently. This virus is spreading and adapting and you need to anticipate problems. If you have finished writing plans and policies, think about validating those plans or policies with an external audit or small drills and exercises.   Watch out for pandemic fatigue. With all the information flowing out there and the blogs and webinars and seminars and notices its easy to get overloaded and tired. Pick a few trusted sources and stick with them.   TOOLS: Pandemic QuickStart - If you need to quickly bring your company up to speed with its pandemic planing efforts, we can help with our quickstart resources.   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. We have affordable decision support plans that you can enroll in.   DC3 Expert Trigger Assessment and Readiness Analysis tool will be available next week. This software replaces the old non-helpful WHO Pandemic phases and will analyze your current H1N1 situation from several key perspectives 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.    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.   Pandemic Planning Assistance - 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 or take a look at your current plans with a fresh set of eyes.         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

Influenza Update - October 1

Novel Influenza H1N1 Update Dr. Stuart B. Weiss INFLUENZA UPDATE WHO PANDEMIC ALERT LEVEL 6 Oct 1, 2009 SUBSCRIBE: Click button at bottom or send email to: sweiss@MedPrepGroup.com The Influenza virus in on the march and its mutated, a little. The Influenza virus and vaccine have been in the news alot this week for good reasons and bad. Here is what's happening... Current Situation: Outbreaks on college and university campuses across the country continue to be widespread. Most cases continue to be mild. The highest rates of activity are now in the Northeast and while there is still significant activity in the Southeast, things have calmed down a bit. According to the American College Health Association, the campus attack rate is 20.1 cases per 10,000 students for the week ending Sept 25th. Twenty-six states now report widespread flu activity with some activity in all states. Vaccine Update: Many vaccine manufacturers have begun shipping or will begin shipping vaccine soon. States are ramping up to begin widespread vaccination programs. Data from an unpublished study in Canada was reported in the press which reportedly points to an increased risk of catching pandemic H1N1 flu if you received a seasonal flu shot last year. This result has NOT been reproduced anywhere else in the world (see analysis for more discussion on this) Tamiflu: The government warned of a shortage of pediatric Tamiflu suspension and the CDC issued new guidance to pharmacists on how to make suspension from pills. H1N1 Virus mutation Virologists in the Netherlands reported on two cases of H1N1 with a mutation in the PB2 protein which could help the virus better adapt to humans (see analysis section). Influenza viruses are notorious for constantly mutating so changes are to be expected. H5N1 Avian Flu Egypt reported two more cases of H5N1 virus this past week. 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 me at sweiss@MedPrepGroup.com ANALYSIS: There are two items that I want to discuss. First is the study from Canada having to do with increased risk of novel H1N1 if a person received seasonal flu vaccine last year. These were results from an unpublished study reported in the Canadian press. Because the study and journal article are undergoing peer review, the authors can't comment on anything or answer questions. The results reported in the press are that people who received the seasonal flu vaccine last year were twice as likely to catch novel H1N1. As a result of this, several provinces in Canada have postponed their seasonal flu vaccination programs. Let me be very clear about this, this is an unpublished study that has not been peer reviewed. It may have many design flaws in the research. This is especially true since the WHO, CDC, British and Australian investigators have failed to find similar results when those groups looked into this. This lack of independent confirmation is a BIG red flag for studies. We need to watch this and look at the peer review and the actual article when it is published. It may turn out to be true but it is too early to tell. So in my opinion, the Canadian actions are very premature. It is interesting that a week or two ago, I read that they were thinking about postponing their seasonal vaccine programs. Perhaps this provided an easy excuse. We will see. The second item is about a virus mutation that hasn't received much press. Virologists in the Netherlands have reported finding two cases of virus that has a mutation in the Polymerase basic 2 or PB2 protein. Back on May 5th, I wrote about the PB1-F2 protein and how it seems to be important in how lethal the virus is. The PB2 protein change moves that particular protein from a form that is usually seen in non-human influenza viruses to one that is frequently seen in human viruses. This change is usually associated with increased efficiency of virus duplication in humans. While the two people with this changed virus had normal mild flu courses, the fact that the virus has adapted to make it better growing in humans is a bit concerning. This bears close watching and further reinforces that its way too early to declare that this is "just the flu". Finally, Egypt announced two more cases of H5N1 avian flu this past week. That virus continues to slowly spread. While it is easy to focus on the current H1N1 pandemic, we must remember that we have another influenza virus out there infecting humans. This is why you should have a pandemic plan with two sets of assumptions or scenarios, one with the current relatively mild but widespread pattern, and one with a more lethal pattern. Common Questions: If I had the flu last spring, can I get it again? The answer is "it depends". If you really had the novel H1N1 flu and not the seasonal flu then right now, you are unlikely to get it again however, this virus can change or drift while it is spreading making it appear differently to our immune system and then you may be able to get it again. If a Family member is sick, can that employee come to work? The current recommendation is that the employee should monitor their own health looking for signs or symptoms of illness but that they can come to work. Can I get the flu from the flu shot? If you are receiving the injection in your arm, you are getting a killed virus vaccine and there is no way to get the flu from that shot. You may feel a little sore from the shot or achy the next day but it is not the flu. If you get the live weakened nasal spray flu vaccine and you have a problem with your immune system, there is a slight chance of a problem which is why those people should not get the nasal spray vaccine. This is a discussion you should have with your doctor. ADVICE: Keep yourself informed on what is going on. We will help you do that through our Business Alerts but you may want to also subscribe to ProMed and look at the CIDRAP site frequently. This virus is spreading and adapting and you need to anticipate problems. If you have finished writing plans and policies, think about validating those plans or policies with an external audit or small drills and exercises. Watch out for pandemic fatigue. With all the information flowing out there and the blogs and webinars and seminars and notices its easy to get overloaded and tired. Pick a few trusted sources and stick with them. Watch for sensational but unsubstantiated studies or results that are reported in various media outlets. Scientific studies should be peer reviewed and reproducible. TOOLS: Pandemic QuickStart - If you need to quickly bring your company up to speed with its pandemic planing efforts, we can help with our quickstart resources. 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. We have affordable decision support plans that you can enroll in. DC3 Expert Trigger Assessment and Readiness Analysis tool will be available next week. This software replaces the old non-helpful WHO Pandemic phases and will analyze your current H1N1 situation from several key perspectives 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. 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. Pandemic Planning Assistance - 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 or take a look at your current plans with a fresh set of eyes. 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