Influenza Update - December 21

Pandemic H1N1 Update Dr. Stuart B. Weiss INFLUENZA UPDATE Dec 21, 2009 SUBSCRIBE: Click button at bottom or send email to: sbw1@MedPrepGroup.com Influenza activity contines to fade down to seasonal levels in the U.S. Pandemic H1N1 activity in the U.S. and around most of the world continues to decline with some notable exceptions, namely India and parts of the Russian Federation. Current Situation: The CDC confirmed that the number of states reporting widespread influenza activity continues to decrease, from 14 states down to 11. The number of people visiting physicians in the US for influenza-like illness has decreased again this week. The number of pediatric deaths has decreased as well. The WHO reports that influenza activity has decreased or plateaued in much of the world with some exceptions: Europe: Activity is declining across Europe except in parts of southeast Europe and the Russian Federation. Asia: East - transmission remains active but declining. West & Central Asia - Increasing activity in Kazakhstan and Kyrgyzstan. Activity in the Middle East have peaked. Southeast Asia: India, Nepal, Sri Lanka and the Maldives continue to show increasing flu intensity. Africa: Limited data shows continued activity across the continent (except in South Africa where it is summer) Southern Hemisphere: Little to no activity. Vaccine Update: The CDC reported that almost 100 millions doses of vaccine have been released. Approximately half of the states across the U.S. are relaxing their vaccination guidelines to include anyone who wishes to be vaccinated. Several scientists wrote that the U.S. should honor its commitment to donate 10% of its vaccine supply to poor third world countries. Secretary Sebelius said that the U.S. will honor its commitment. The WHO reports that it will donate vaccine to its first three recipients, Afghanistan, Azerbaijan and Mongolia. China's death toll leapt by more than 30% in recent days which is raising alarm with the approaching Lunar New Year or Spring holiday. This is the biggest and most important holiday and millions of people crowd the roadways, trains and airports to return home. 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: Officials in the government continue to encourage everyone to get vaccinated as do I. As I wrote about a few weeks back, activity continues to be a problem in India so if you have business processes outsourced to India, make sure your contingency plans have been updated. We have much experience auditing these types of plans so if you need assistance, give us a call. ADVICE: Get vaccinated. It is a safe vaccine. Keep one eye on the virus looking out for a third wave. It is too early to tell if one will occur. Review your plans for offices in areas with intense or increasing influenza activity. TOOLS: Pandemic and Infectious Disease Plan Audits - Having outside experts review your pandemic plans may bring you new insight into planning areas that need work. Take this opportunity to review your pandemic and other infectious disease plans. Think about inviting us in to bring a new set of expert eyes to take a look at your plans. Corporate Exercises - Validating your plans through the use of well planned exercises remains an important tool in the business continuity toolkit. We are experts in developing and facilitating exercises customized to the needs of our clients. 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 jump start 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 Vaccine Recall - December 15

Pandemic H1N1 Update Dr. Stuart B. Weiss INFLUENZA VACCINE UPDATE Dec 15, 2009 SUBSCRIBE: Click button at bottom or send email to: sbw1@MedPrepGroup.com Non-safety Recall of Pediatric H1N1 (2009) Vaccine Today, the CDC announced a recall of some lots of Sanofi Pasteur H1N1 Pediatric (.025ml for 6-35 month olds) vaccine in pre-filled syringes. Current Situation: The CDC reports that routine testing of the potency (strength) of vaccine in three lots of pre-filled pediatric vaccine fell slightly below the required strength and was being recalled. Vaccine manufacturers routinely test vaccine lots after they are released to make sure that they maintain their potency. According to the CDC, the potency is only slightly below the required potency. This only affects certain lots of pediatric vaccine in pre-filled syringes intended for 6-36 month olds. 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: There is basically nothing to do about this. If your young child received the recommended two doses of vaccine, the CDC says that they are protected since the potency was only slightly below the required level. Since there is no safety issue, there is nothing to worry about. For further information, here is the link to the CDC site: http://www.cdc.gov/h1n1flu/vaccination/syringes_qa.htm 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 - December 14

Pandemic H1N1 Update Dr. Stuart B. Weiss INFLUENZA UPDATE Dec 14, 2009 SUBSCRIBE: Click button at bottom or send email to: sbw1@MedPrepGroup.com Give yourself an early holiday gift, get vaccinated. As influenza activity in the U.S. and much of Europe continues to wane and vaccine stockpiles continue to increase, now is the time to get vaccinated for H1N1 (2009) before the winter wave arrives. Current Situation: The CDC confirmed that the number of states reporting widespread influenza activity has decreased again, from 25 states down to 14. The number of people visiting physicians in the US for influenza-like illness has decreased again this week. the CDC released new projections indicating that approximately 50 million American have gotten pandemic H1N1 or about 15% of the U.S. population. The flu has resulted in about 200,000 hospitalizations so far, a number that equals a usual entire flu season (and we are only in December), and approximately 9820 deaths with 1,090 children, 7450 adults 18-64 and only 1280 people over 65. This is markedly different from the usual flu pattern. The number of new influenza cases on college campuses increased after the Thanksgiving break. It had been dropping for the past several weeks. The WHO reports that while there is slowing of influenza activity in North America and most of Europe, activity continues across the northern hemisphere: Europe: Activity has peaked or is peaking across Europe except in France where activity is still rising. East Asia: Increasing influenza-like illness in Japan and northern China. Hong Kong and Chinese Taipei are showing increasing activity after a previous peak. South and Southeast Asia: India and Sri Lanka continue to show increasing flu intensity. Africa: Limited data shows continued activity across the continent (except in South Africa where it is summer) Southern Hemisphere: Little to no activity. Vaccine Update: The CDC reported that 73 millions doses of vaccine has been released. Many states across the U.S. are relaxing their vaccination guidelines to include anyone who wishes to be vaccinated. CDC reported 16 additional pediatric deaths this week due to flu related complications. Two studies came out showing a disparity in death rates among ethic minorities. A study in Illinois showed the death rate in Blacks and Hispanics to be twice the rate of Caucasians. A second study in New Mexico showed a higher death rate in Native Americans. There are many factors that may have contributed to this and it will take more time to sort this out. A new study looked at the death rates for this pandemic. The death range, depending on how it is calculated, ranges from slightly above a typical flu season to markedly less than a typical flu season. More time will be required to come to more definitive numbers. Another study looked at immunity and suggested that many people many have some partial immunity which explains that large number of cases but the low death rate. There was a report in the British Medical Journal and investigated by a British Television station looking into the usefulness of Tamiflu to prevent serious complications of seasonal flu. After reading the articles and the rebuttals, it seems there is much more being written about access to data than about the usefulness of Tamiflu. this report focused on seasonal flu and did not discuss pandemic flu. the bottom line is that more transparency in study data is necessary in the future. The USDA licensed the first pig H1N1 (2009) vaccine that can be used by pork producers. It is produced by Pfizer Animal Health division. 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: I had the opportunity to speak to a large group of legislators this past weekend about H1N1 (2009). One of their main questions was whether we are done with the flu or will there be a third wave. While it is impossible to know for certain, there are several factors which makes me think we may not be through with this flu. First, if you look back at the 1957 flu, there was a great big peak in early winter which died down nicely and then renewed its attack rate in February/March 1958. Second, if we look at the illness rate on college campuses after Thanksgiving break, when students returned from home, we saw a bump in the number of cases and Christmas break is rapidly approaching. Third, only 15% of American have gotten the illness and have immunity. Even if you add in the immunity that some older American have, and the folks getting vaccinated, we still have a large number of people who are susceptible in this country (probably more than half our population). Taken together, it seems like it is likely that we will have another wave. So although I don't have a crystal ball, I continue to advise clients to keep their eye on this problem and keep their pandemic planning efforts up to date. This is what I told the legislators as well. I also reminded them that influenza viruses are notorious for mutating. This virus has remained stable so far but that is another unknown in the equation and another reason to keep your planning efforts on track at some level. Lastly, if you think this is a mild flu, just look at the pediatric death rate. We have almost 1100 kids that have died already from H1N1 (2009) complications. That is many times the normal number of children that died of flu. So although most people recover uneventfully, this is taking a hard toll on our children. ADVICE: Get vaccinated. It is a safe vaccine and now that there is enough, it should be not problem to get you and your family and co-workers vaccinated. Speak to your doctor or visit a local health clinic. Do it now. Take this opportunity to compile lessons learned over the past 8 months. Look at what worked and what didn't work and revise your plans. This breather we are having is a gift you should take advantage of. If I am correct and we have a third wave, if you have updated your plans, you will be ready. 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 - December 8

Pandemic H1N1 Update Dr. Stuart B. Weiss INFLUENZA UPDATE Dec 8, 2009 SUBSCRIBE: Click button at bottom or send email to: sbw1@MedPrepGroup.com Will pandemic H1N1 continue its downward trend or will it follow the pattern of 1957. Only time will tell. As influenza activity continues to wane and vaccine stockpiles continue to increase, now is the time to encourage people to protect themselves by getting vaccinated. Current Situation: The CDC confirmed that the number of states reporting widespread influenza activity has decreased again, from 32 states down to 25. The number of people visiting physicians in the US for influenza-like illness has decreased for the fifth straight week although the overall number is still high for this time of year. The number of deaths due to flu is still above the epidemic threshold for the United States. 99% of all sub-typed virus in the U.S. is still pandemic H1N1. The number of new influenza cases on college campuses dropped again this week. The WHO reports that while there is slowing of influenza activity in several parts of the world, activity continues across the northern hemisphere: Western and Northern Europe: Activity has peaked or is peaking. Numbers of new cases has plateaued in many parts. Central Europe (from Baltic to Balkan countries, from Germany to Romania): Influenza activity continues to increase Eastern Europe: Activity seems to be peaking and leveling off in most of eastern Europe. In the Russian Federation, activity remains high with an increasing trend. East Asia: Increasing influenza-like illness in Japan and southern China. Decreasing activity in northern China. South and Southeast Asia: India, Nepal and Sri Lanka continue to show increasing flu intensity. Africa: Influenza activity continues across the continent with co-circulation of seasonal H3N2 and pandemic H1N1 Southern Hemisphere: Countries in temperate zones continue to show little to no activity, most countries in tropical zones have decreasing activity. Vaccine Update: The CDC reported that 73 millions doses of vaccine has been released with 10 million more expected this week. Some states are reporting a surplus of vaccine and are relaxing their vaccine criteria to include all citizens. Liquid Tamiflu shortage is easing as Roche reported that more Tamiflu suspension is being shipped. CDC reported 17 additional pediatric deaths this week due to flu related complications. Vietnam reported another H5N1 (Bird flu) case in a 33 year old male who eat duck blood pudding. From Pro-Med: "raw blood soup (tiet canh in Vietnamese) is a dish made with raw blood of ducks or geese (sometimes pigs), with peanuts and herbs on top. This is the typical protein-rich breakfast of the country people in Northern Vietnam, but is dangerous because of the H5N1 bird flu virus. It is made by taking fresh blood and sticking it in the refrigerator to gently congeal. Raw blood soup is a Vietnamese dish that makes very little effort to appeal to the taste buds of the non-Vietnamese diner. Usually you will find a few chopped peanuts scattered on top of your blood dish but that's as far as it goes for fanciness. Blood soup has the oddest texture and tastes strangely metallic." For the curious (& unsqueamish) an image of plates of duck soup is available at www.loupiote.com/photos/87750125.shtml . 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: The number of flu cases continues to trend downward in the U.S. and Canada as well as western and northern Europe. The question is whether this will continue through the remainder of the flu season or will we see a pattern similar to the 1957 pandemic where there was a surge at the beginning of the school year followed by a waning period which ended with a new surge in December. Or will we see seasonal flu begin to circulate as is occurring in parts of Africa. Its too early to know but it is important to keep your eye on this evolving situation. The report of the first new case of H5N1 in Vietnam in the past 6 months reminds us that H5N1 is entrenched in the bird population in southeast Asia and although much of our attention has been on pandemic H1N1, you should not forget to keep some attention of that virus as well. ADVICE: If you live or work in a state that has relaxed its immunization criteria, encourage employees to be vaccinated. Pandemic H1N1 is still causing serious illness across the U.S. and Canada and the vaccine is proving to be extremely safe. Take this opportunity to review your work from home program. There have been several reports released recently about the common pitfalls associated with work from home programs especially as it relates to the "last mile". Review potential problems with your IT staff. Also take a look at which outside critical vendors/contractors need access to your network and make sure that they will be able to get in. 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