Influenza Update - November 30

Pandemic H1N1 Update  Dr. Stuart B. Weiss   INFLUENZA UPDATE Nov 30, 2009   SUBSCRIBE: Click button at bottom or send email to: sbw1@MedPrepGroup.com We've had a relatively quiet holiday week as pandemic flu activity continues to decrease across the U.S. but the kids keep taking a heavy hit. While we sit back and relax a bit in the U.S., other countries are not so fortunate. This could be a nice break for us before seasonal flu arrives.  Current Situation: The CDC confirmed that the number of states reporting widespread influenza activity has decreased again, from 43 states down to 32. The number of people visiting physicians in the US for influenza-like illness has decreased for the fourth straight week although the overall number is still very high. 99% of all sub-typed virus is still pandemic H1N1. The number of new influenza cases on college campuses dropped again this week. The number of new cases was down 37% from last week. The WHO reports that while there is slowing of new cases in North America, activity continues in other areas of the world: Europe: The pandemic death toll in Europe has nearly doubled every two weeks over the past 6 weeks. Three countries report very high flu intensity: Italy, Norway and Sweden. Nine countries report high flu intensity: Bulgaria, Denmark, Germany, Iceland, Ireland, Lithuania, Luxembourg, Poland and Portugal. East Asia: Japan's number of new cases is stable with a slight decrease in activity in urban areas. Mongolia continues to show intense flu activity although the number of new cases seems to have peaked. India, Nepal and Sri Lanka continue to show increasing flu intensity. Southern Hemisphere: Countries in temperate zones continue to show little to no activity, most countries in tropical zones have decreasing activity (except Ecuador and Venezuela). Vaccine Update: Novartis unveiled its cell-based vaccine production facility last week. It is the first such facility in the U.S. and will be running by 2011 with full production capability in 2013. It is located in Holly Springs, N.C.  CDC reported 27 additional pediatric deaths this week due to flu related complications.  The CDC confirmed that a West Virginia physician was sick with pandemic H1N1 twice, once in April and once in October. The CDC estimates that the current case fatality rate for the pandemic H1N1 virus is 0.018% which is about 100 times less lethal than the 1918 pandemic flu virus China reported two confirmed cases of pandemic H1N1 in dogs adding that species to the list of susceptible species which includes Birds, Cats, Ferrets, Pigs and Humans.  Egypt reported another H5N1 (Bird flu) case in a 3 year old male.   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 sbw1@MedPrepGroup.com       ANALYSIS:    Clearly we have decreasing pandemic activity in the U.S. although the increasing number of pediatric deaths is quite concerning. I still strongly recommend that eligible children receive the extremely safe pandemic flu vaccine.   For those of you that have outsourced business processes to India, I want to spend a moment discussing that. Many of our clients have partnered with Indian firms or have offices in Chennai, Bangalore, Hyderabad, Mumbai, etc. to perform important business functions. Based on the rising flu intensity in that region (India, Nepal, Sri Lanka) and the weak public health system throughout India, we would strongly suggest that you develop business continuity plans around losing some or all of those assets for a period of time. You must answer the question of how you will maintain those outsourced business processes should there be a prolonged and widespread disease outbreak.   Lastly, there was an interesting article published in Virology that speaks to the origin of the pandemic virus. The virologist who wrote the article analyzed the virus and claims that there is a suggestion that this wasn't a naturally occurring virus but was instead created in a lab. This same virologist made this assertion earlier but it was dismissed and he has made it again. This will be interesting to follow.     ADVICE: If you have overseas offices or use overseas companies for important business processes, it is important to develop contingency plans for how you will take over critical outsourced functions if overseas offices are closed due to flu. We are seeing a decrease of flu cases in the U.S. but that is not true in other countries. This is especially important in India. We have experience in this area if you need assistance. Take this opportunity to remind employees about proper hand hygiene. If you put up posters last April about hand hygiene, change them or move them. People do not pay attention to something that has been hanging on a wall for months. Lastly, don't take your eye completely off H5N1 as Egypt reported yet another case this week.   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.   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 - November 22

Novel Influenza H1N1 Update Dr. Stuart B. Weiss INFLUENZA UPDATE Nov 22, 2009 SUBSCRIBE: Click button at bottom or send email to: sweiss@MedPrepGroup.com Okay, it seems official. The U.S. novel H1N1 has peaked for the moment but all the news is still not rosey. While the situations seems to be improving in the U.S., the number of influenza cases is still way up and in other parts of the world, there is no sign of a peak yet. Current Situation: The CDC reports that 43 states now report widespread flu activity, this is down from 46 states last week. The number of people visiting physicians in the US for influenza-like illness has decreased for the third straight week although the overall number is still very high. The WHO reports that while there is some slowing of new cases in the U.S., Canada continue to show intensifying disease. In other areas of the world: Europe: Transmission is widespread and increasing across Europe especially in north, east and southeast Europe with some dramatic recent spikes in eastern Europe. A peak seems to have occurred in some western Europe countries especially Iceland, Ireland, UK and Belgium. Central/Western Asia: Increased disease in Kazakhstan, Uzbekistan and parts of Afghanistan. this is affecting troops and Afghan security forces. East Asia: Japan's numbers of new cases is slightly decreased. Some experts suspect large numbers of cases in China. There is also seasonal H1N1 and H3N2 circulating in China Southern Hemisphere: Temperate zones showing little to no activity, tropical zones have variable activity Vaccine Update: Supply shortages of H1N1 vaccine continue as 11 million doses of vaccine were released last week. This brings the total to 54.1 million doses. CDC reported 21 additional pediatric deaths this week due to flu related complications. 2/3 of the children had underlying medical problems such as asthma, cerebral palsy or muscular dystrophy. There were two clusters of patients in hospitals with Tamiflu resistant novel H1N1 viral infections. One cluster was in the UK and another was in the U.S.. At a news conference late last week, the CDC mentioned a mutation in the novel H1N1 virus was found in Norway. This mutation may make the virus live easier deep in lung tissue. Researchers at the USDA found that the novel H1N1 virus has changed enough that it doesn't infect birds well or spread between them easily. Egypt reported another H5N1 (Bird flu) case in a 21 year old male who was involved with slaughtering chickens. 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: Its now been three weeks in a row that the number of cases of people visiting their physicians for influenza like illness has decreased and in fact, several television network news stories last week interviewed hospital folks who reported less emergency department and clinic visits. It does indeed appear that we have peaked and are on the downswing of this wave. I say wave because there are some reports of a second wave starting in some countries already. As indicated by the virus mutation, the clusters of resistance and the virus's adaptation to humans, this is far from over. In fact, in many parts of the world, the numbers are still markedly increasing. This decrease in the U.S. gives us a chance to take a deep breath but I can't stress strongly enough that planning efforts should continue. It is not time to let down your guard as there is no evidence to support that position this early in the flu season. The highest travel time of the year is approaching and people from different parts of our country and the world will be coming together. We will have to watch to see if this changes the viral patterns. I have done several webinars and talks this past week in different parts of the country and had many questions about the novel H1N1 vaccine. My advice remains the same. It is an extremely safe vaccine and I recommend it to everyone who is eligible. Use this lull in public attention to have eligible people vaccinated. Go on the Goggle flu site and find where vaccine is available. ADVICE: In the U.S. this past week, there were congressional hearings on making sick time mandatory as a way to fight H1N1. Don't wait for congress to act, review your H.R. plans and make some decisions on how you will handle employees who are out sick with the flu or those that stay home with sick family members. Review the American With Disabilities act and decide what screening questions you can ask. It may be challenging to keep interest in this topic as your C-suite executives have seen the news stories about flu having peaked. Remind them that even though we have peaked, this is one of three expected waves and we still have markedly increase flu cases across the U.S. even thought the numbers of new cases seem to have peaked three weeks ago. Lastly, don't take your eye completely off H5N1 as Egypt reported yet another case this week. 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. 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 - November 15

Novel Influenza H1N1 Update  Dr. Stuart B. Weiss   INFLUENZA UPDATE Nov 15, 2009   SUBSCRIBE: Click button at bottom or send email to: sweiss@MedPrepGroup.com Perhaps there is a small light at the end of the tunnel Its way too early to say for sure but there are some early signs that flu activity may have peaked in the US and is slightly declining.   Current Situation: The CDC reports that 46 states now report widespread flu activity, this is down from 48 states last week. The number of people visiting physicians in the US for influenza-like illness has decreased for the second straight week although the overall number is still very high. The WHO reports that while there is some slowing of new cases in the US, Canada has reported sharp increases over the past three weeks and there is increasing activity in several European countries as well as some regions in eastern Asia. The huge outbreak in the Ukraine continues to be a big problem for that country. They are estimating that there have been over 1 million cases there (the country only has 48 million people). There have been sharp increases in flu activity in some Middle Eastern counties including Israel and Afghanistan as well as increases in eastern Asia including China and Japan. See the WHO update at: http://www.who.int/csr/don/2009_11_13/en/index.html for more details. Vaccine Update: Supply of H1N1 vaccine continues to be a problem in the US. As we wrote about earlier, there are significant delays in shipment of vaccine from manufacturers. Several manufacturers this week stated that they will be shipping much more vaccine shortly and will meet their US government commitments. Although the US Government had originally predicted that we would have 60-80 million doses by this point, only 41.6 million have been shipped. Around the world, millions of people have received the vaccine and it continues to be a very safe vaccine. CDC changed the way it tracks and counts pandemic H1N1 cases increasing the numbers included in the case counts. The new, more inclusive counts are: There have probably been around 22 million cases of pandemic H1N1 illness in the US Approximately 98,000 people have been hospitalized for flu related illnesses There have been 3900 deaths with 540 pediatric deaths The breakdowns are as follows: Cases: 0-17 = 8 million cases, 18-64 = 12 million, 65+ = 2 million Hospitalizations: 0-17 = 36,000, 18-64 = 53,000, 65+ = 9000 Deaths: 0-17 = 540, 18-64 = 2920, 65+ = 440 The new CDC counts do not indicate any change in the disease, just a more accurate counting of the cases.     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:    Although it is way to early to make any predictions, the fact that visits to physicians for influenza-like illness has dropped for the second week in a row and the number of states with widespread flu illness has dropped by two may be pointing to the US having peaked a few weeks ago with this wave of the influenza pandemic. Remember that cases are still markedly rising in some parts of the world and we may still see significant supply chain interruptions around the world. But before you start thinking that the worst has passed us, it is important to understand that it is way too early to decide that. We will need to continue to watch this disease carefully as it unfolds in the coming weeks to know if we have peaked in the US.   As you continue your pandemic planning efforts, you should take a look at a good document that the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP) put out last week. Based in large part on the September summit, CIDRAP, in collaboration with the Society for Human Resource Management (SHRM) released a new toolkit: Doing Business During an Influenza Pandemic: Human Resource Policies, Protocols, Templates, Tools, & Tips. It is definitely worth a read. The toolkit is available free of charge as a PDF document: http://www.cidrapsource.com/hrtoolkit   ADVICE (we continue to recommend the following): 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.   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 - November 8

Novel Influenza H1N1 Update Dr. Stuart B. Weiss INFLUENZA UPDATE Nov 8, 2009 SUBSCRIBE: Click button at bottom or send email to: sweiss@MedPrepGroup.com After a few weeks we are back, and boy has alot happened during that time! I want to apologize to our loyal readers for no newsletter over the past few weeks. So let's review what has been happening and make sure you are up to date. Current Situation: Outbreaks on college and university campuses across the country have surged again after declining. Most cases continue to be mild, according to the American College Health Association. The number of school closings across the country continues to rise, as reported by the US Department of Education. The CDC reports that 48 states now report widespread flu activity. Although we haven't reached the peak yet, flu activity has already exceeded what we have seen in some of the worst flu seasons. Pneumonia and influenza rates continue to rise. The WHO reports that there is widespread disease across the northern hemisphere. Mexico is seeing more flu cases now than they saw in the initial outbreak in April/May. Europe is experiencing an unusually early flu season with wide spread cases. A huge outbreak in the Ukraine is causing a big problem for that country. They are estimating that there have been 500,000 cases since mid-October with 24,000 people hospitalized (the country only has 48 million people). Vaccine Update: Supply of H1N1 vaccine continue to be a problem in the US. As we wrote about earlier, there are significant delays in shipment of vaccine from manufacturers. This is due to the difficulties in growing the virus in eggs, which is part of the manufacturing process. Although the US Government had originally predicted that we would have 60-80 million doses by this point, only 38 million have been shipped. Vaccine delay has impacted vaccination programs in states across the US and has eroded the confidence in public health initiatives, according to several state health representatives. The Alabama Health Department testified to congress that they don't expect to receive adequate vaccine to immunize their high priority groups until the end of December or January. Around the world, millions of people have received the vaccine and it is proving to be a very safe vaccine. Since vaccine campaigns started in October, only 1/3 of parents who tried to get their children vaccinated have been successful. Disease Update: 99 % of the subtyped flu that is tested is the new novel H1N1. Those areas that had seen some early seasonal flu strains circulating, have seen that drop off significantly. More Mask controversy In the continuing discussion of masks, the original study done in China and reported here last month showing that N-95 masks were much more protective than surgical masks has been "re-analyzed" and now is much less conclusive. Due to some changes in the statistical analysis done, N-95's still show some benefit but the study numbers make the difference not statistically significant. President Obama declares a National Emergency (on October 26th) This was not unexpected and it allows HHS Secretary Sebelius to waive or modify certain provisions in Medicare, Medicaid, Child Health Insurance Program (CHIP), EMTALA and HIPAA programs. It also allows hospitals to respond to this crisis easier. Medications There has been a shortage of liquid Tamiflu and the government has released about 300,000 bottles of liquid Tamiflu from the National Strategic Stockpile. There are also directions for compounding liquid Tamiflu on the CDC website that pharmacists can use. The government issues emergency use authorization for IV Perimivir and Zanamivir for critically ill patients that don't respond to Tamiflu. A few cases were recently presented on a conference call and they had good results. First cat to catch H1N1 Iowa has reported that a house cat has been documented with the novel H1N1 infection after two of its three owners were sick with flu. This is the first time a cat has been documented to have the disease. Prior to this, infections were only documented in humans, pigs, birds and ferrets. No more kissing in Turkey Last week, the health minister in Turkey advised all Turks to avoid kissing anyone for the next 5 months. 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: Since this is a long newsletter, I will keep the analysis short this week. There continues to increasing numbers of cases across the US. We are seeing case numbers that are higher than some of the worst past flu seasons. Luckily, most cases are mild but we have not reached our peak yet. Young people are still being affected. There were 18 pediatric deaths reported last week and the vast majority of deaths are in people younger than 65 years old. People have been asking me if they should get their children vaccinated. The answer is yes, if they are in the high risk group and they do not have anything that would prevent them from safely receiving the vaccine (speak to your pediatrician about this). I want to take a moment to stress the safety of the new pandemic H1N1 virus vaccine. Millions of people have already been vaccinated around the world and the vaccine is proving to be very safe. This vaccine is manufactured in the same way as every other influenza vaccine by the same companies. Remember, all vaccine coming out now is going to the high priority groups. You and your employees will not get access to the vaccine until next year. In fact, one government official testified that the current flu outbreak may be over before adequate vaccine is available for the general population. 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: 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. 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