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

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