Influenza Update - January 28

Pandemic H1N1 Update Dr. Stuart B. Weiss INFLUENZA UPDATE Jan 28, 2010 SUBSCRIBE: Click button at bottom or send email to: sbw1@MedPrepGroup.com We seem to have dodged the pandemic bullet for now so what should you be doing? Pandemic H1N1 activity in the U.S. and around most of the world continues to decline. There are still areas with widespread influenza activity (North Africa and South Asia) but activity in the U.S. is LESS than a normal seasonal year. Current Situation: In the CDC briefing last week, it was reported that most signs of flu activity in the U.S. are declining with no states reporting widespread activity and only 7 reporting regional flu activity. Current rates of outpatient visits for flu are at 1.8%. There were nine pediatric influenza deaths that week and seven the week before. The WHO reports that influenza activity is decreasing in much of the world with intense activity remaining in South Asia and North Africa. The inevitable finger pointing has begun with various groups accusing the WHO of being influenced by vaccine manufacturers and for instigating a "fake" pandemic. The WHO has vigorously denied any wrongdoing (see below for comments). Vaccine: Several countries are either reducing their vaccine orders or trying to get out of existing vaccine purchase contracts as unused amounts of vaccine pile up. Governments around the world are trying to encourage people to get vaccinated. In Mexico City, they began to offer vaccination in the 26 busiest subway stations. College and Universities in the U.S. have vaccine but its been an uphill battle getting students to come in to be vaccinated. A study published last week in the British medical journal Lancet found that 10 times more young people had been infected with the H1N1 pandemic virus during the first wave than had been picked up by traditional surveillance. The researchers also found the many more older people had pre-existing antibodies. The may explain the mild pandemic experience we are having. The CDC warned people not to be fooled like they were in the 1957 pandemic when it was declared over in Dec-Jan 1957 only to return a few months later with increased numbers of deaths. ANALYSIS: Its been an interesting few weeks. It seems that we are not only having mild pandemic flu season but actually this flu season is turning out to be more mild than even a normal flu season. The CDC reported the usual outpatient visits to a doctor for ILI (Influenza-like Illness) during a flu season is 2.3% and we are experiencing only 1.8%. Who could have predicted that. Its no wonder that we don't hear about H1N1 anymore and that the finger pointing has begun. I have to say that the accusations of a "false" or "fake" pandemic are completely incorrect. This was and is a pandemic and we have luckily dodged the pandemic bullet probably having to do with what the British study found. Looking back at the WHO's behavior, I have to say that if anything, they delayed announcing a pandemic in order to be absolutely certain. If you think back to my Pandemic Alerts from the spring, I was saying the new disease had reached pandemic status weeks before the official WHO announcement. Its also important to remember that there are significant lead times on vaccine development and actions governments can take so public health officials are constantly looking to be proactive. I am not sure where all this finger pointing will go but it seems completely unjustified. The British study is interesting and may be the reason that we are seeing such a mild January. When they looked at the number of people who had antibodies to H1N1 (2009) they found ten times as many as were reported by surveillance. Surveillance only picks up people who seek medical care so there must have been a huge population of people who had mild or minimal symptoms and never sought medical care. This huge population of people is now immune. In addition, they found that more older people than previously thought had pre-existing antibodies. Since the virus has not mutated significantly, the combination of the two factors has led to a large number of people who can not catch this disease and has caused it to wane. The bottom line here is that we have been lucky so far. Influenza viruses are notorious for mutating and this one has not. Influenza viruses don't usually cause large numbers of people to have minimal or no symptoms of infection, this one apparently has. But, the winter flu season is not over. Folks in 1957 were fooled by a mild December-January and the virus came back with an increased mortality. Many of our clients are taking this opportunity to ask us to help them review their infectious disease plans to incorporate lessons learned and look for gaps. They realize that although we may have dodged the bullet this time, something else will pop-up. We also continue to help clients develop new and more useful triggers for their corporate response. On the other hand, a few of our clients have disbanded their pandemic teams and have taken their eye completely off this ball. That is a mistake that I hope you will not make. ADVICE: So here is my advice to you at this point: Make sure that someone keeps watching this situation. It is too soon to declare this over. De-escalate your response for the moment. You may want to decrease the frequency of conference calls or meetings but do not disband your pandemic team. Keep them in the loop until the Spring when we can say with certainty that flu is over for the time being. Use this opportunity to learn from what you have done and augment your current infectious disease plans and update your triggers, if need be, Develop an after action report reviewing actions taken since last April to help you with future infectious disease outbreaks. Keep your eye on H5N1 as it continue to be a problem in parts of the world. TOOLS: We are infectious disease planning experts and can assist you with your infectious disease / pandemic flu plan development and analysis. We are one of the few physician led firms that bridge the gap between business continuity and disaster medicine. I am proud to have both an MD and CBCP after my name. So send me an email or call if you think we can assist you. My team would be happy to develop a very reasonable proposal for a plan review and after action report. I can be reached at sweiss@MedPrepGroup.com or call us at 212-875-8888. 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 for companies without in-house medical direction. Stuart Weiss, MD, CBCP is the CEO of MedPrep Consulting Group. For more information, visit http://rs6.net/tn.jsp?t=6oilehdab.0.k8wpj8cab.ksb4ircab.0&ts=S0452&p=http%3A%2F%2Fwww.medprepgroup.com%2F Stuart Weiss, MD, CBCP MedPrep Consulting Group LLC