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EMS Update on H1N1 Influenza A and Pan Flu. Kathy Robinson NASEMSO Program Manager. September 23, 2009. EMS & 9-1-1 Critical Components of the National Strategy. EMS and 9-1-1 documents are available for download at www.ems.gov. We All Know…. Public Interest in Context.

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ems update on h1n1 influenza a and pan flu

EMS Update on H1N1 Influenza A and Pan Flu

Kathy Robinson

NASEMSO Program Manager

September 23, 2009

ems 9 1 1 critical components of the national strategy
EMS & 9-1-1Critical Components of the National Strategy

EMS and 9-1-1 documents are available for download at www.ems.gov

public interest in context
Public Interest in Context

 Results 1 - 10 of about 38,400,000 for Swine Flu [definition]. (0.21 seconds) 

Results 1 - 10 of about 49,000,000 for H1N1. (0.05 seconds)  

 Results 1 - 10 of about 186,000,000 for MichaelJackson. (0.08 seconds)   

cdc september 15 2009
CDC—September 15, 2009

“It never went away.”

The virus has not changed to become more deadly. 

Drug-resistant strands emerging.

Child deaths--had at least one severe underlying illness or underlying disability, actually, rather than illness, in most of the cases -- cerebral palsy, muscular dystrophy, long-standing respiratory or cardiac problems. 

cdc september 15 20096
CDC-September 15, 2009

Child deaths--had at least one severe underlying illness or disability-- cerebral palsy, muscular dystrophy, long-standing respiratory or cardiac problems. 

Children who didn't have an underlying condition and who did become severely ill, and they were generally infected also by bacteria. 

cdc september 15 20097
CDC-September 15, 2009

Most people recover from infection without the need for hospitalization or medical care.

Causes more serious lung disease than seasonal flu strains and sheds from the lung and throat tissue where it reproduces at higher rates.**

High fever post viral infection?? Suspect bacterial pneumonia. 

current status
Current Status

Twenty-one states are reporting widespread influenza activity at this time.

Reports of widespread influenza activity in September are very unusual.

Almost all of the influenza viruses identified so far are 2009 H1N1 influenza A viruses.

influenza in schools
Influenza in schools

National Association of State EMS Officials

h1n1 in schools
H1N1 in Schools
  • Some schools in Florida and Canada have banned hand sanitizers because of the high concentration of alcohol.
  • Officials worried about flammability and potential misuse as an intoxicant.
  • Must store larger pump containers and extra bottles in fireproof cabinets or outdoor sheds.
new thinking on school closures
New Thinking on School Closures

“The potential benefits of preemptively dismissing students from school are often outweighed by negative consequences, including students being left home alone, health workers missing shifts when they must stay home with their children, students missing meals, and interruption of students’ education.”

World Health Organization, September 2009

masks and respirators
Masks and Respirators

Estimated Need

US Stockpile

SNS contains 119 million masks

39 million surgical

80 million N-95’s

  • More than 30 billion masks needed in a pandemic
    • 27B surgical masks
    • 5 billion N-95
reality
Reality

One anecdotal report— 7000 masks in caring for ONE H1N1 Influenza A patient in one ICU

n 95 vs surgical mask
N-95 vs Surgical Mask?

CDC – “We want to ensure that health care workers are safe.”

Revised guidance expected this week

iom advisory committee n95
IOM Advisory Committee-N95
  • The committee was not charged with considering implementation issues, which include cost, availability of equipment, and other considerations (such as effective vaccines) in the implementation of such guidance.
iom advisory committee n9518
IOM Advisory Committee- N95

An emphasis is needed on implementing a range of strategies across all levels.

Studies on influenza transmission show that airborne transmission is one of the potential routes of transmission.

iom advisory committee n9519
IOM Advisory Committee-N95

The committee endorses the current CDC guidelines and recommends that these guidelines should be continued until or unless further evidence can be provided to the effect that other forms of protection or other guidelines are equally or more effective.

Employers should ensure that the use and fit testing of N95 respirators be conducted in accordance with OSHA regulations…

key points iom
Key Points-IOM

The use of respirators should be for those in initial contact with individuals presenting with unidentified febrile respiratory illnesses and those healthcare workers in close contact with individuals with confirmed or suspected H1N1.

key points iom21
Key Points-IOM

PPE needs to be viewed asone part of a continuum of controls to ensure worker and patient safety that range from engineering controls and administrative approaches to pharmaceutical measures.

key points iom22
Key Points-IOM
  • Emergency medical responders
  • Fit-tested disposable N-95 respirator if in close contact
    • Aerosol generating activities
    • Interfacility transfers
this just in
This Just In…
  • Last week, American Society for Microbiology Meeting describes first randomized controlled trial comparing N95 to facemasks
  • MacIntyre Study found that surgical masks had no protective effect. In contrast, the N95s, compared with the controls, were linked with
    • 60% reduction in risk for any respiratory illness
    • 75% reduction in flu-like illness
    • 56% decrease in lab-confirmed respiratory illness
    • 75% reduction in confirmed flu
really
Really???

The researchers found that fit-testing of the made no difference in protection.

Published at: http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/sep1709respir-jw.html

fraudulent products
Fraudulent Products
  • 136 entries so far
  • Topics on this Page
  • Air System ProductsBody Wash ProductsDevice ProductsGel ProductsGloves ProductsHand Sanitizer ProductsHerbal Extract ProductsInhaler ProductsKit ProductsMask ProductsShampoo ProductsSpray ProductsSupplement ProductsTea ProductsTest Products
  • http://www.accessdata.fda.gov/scripts/h1n1flu/
medical countermeasures
Medical Countermeasures

National Association of State EMS Officials

cdc media briefing september 18
CDC Media Briefing –September 18
  • FDA has licensed H1N1 vaccine
    • (4 of 5 manufacturers, so far)
  • Good antibody response
  • 90,000 distribution sites
  • Live, attenuated virus (easiest and quickest to make)
  • Triggers immune response, can’t infect individuals
  • 3.4 million (inhalable) doses ready by 1st week of October
    • 195 million doses available by the end of the year
  • Should be available to anyone who wants it
cdc media briefing september 1829
CDC Media Briefing –September 18
  • FluMist is approved for healthy individuals between 2 and 49
    • No kids under 2
    • No pregnant women
    • No immuno-compromised
  • Expect inactivated vaccines to become available early to mid-October
vaccine priority groups
Vaccine Priority Groups

Pregnant women

Health care workers and emergency medical responders

People caring for infants under 6 months of age

Children and young adults from 6 months to 24 years

People aged 25 to 64 years with underlying medical conditions (e.g. asthma, diabetes)

cdc media briefing september 1831
CDC Media Briefing –September 18

Could be minor variations from the federal list in the states

Feds won’t intervene to supersede State priorities

vaccine
Vaccine
  • NEJM Preliminary Report
    • Swiss firm Novartis and the Australian firm CSL report that nearly 300 adults given experimental pandemic vaccines "unexpectedly" developed protective antibodies after just one dose
      • Published at www.nejm.org September 10, 2009 (10.1056/NEJMoa0907413)
influenza and gbs
Influenza and GBS

Influenza virus infection has also been associated with GBS. 

Baseline rates of GBS and miscarriages (1 per 100,000 pop.)

In 1976, there was a small risk of GBS following influenza (swine flu) vaccination (approximately 1 per 100,000 persons vaccinated).  

influenza and gbs34
Influenza and GBS

Numerous studies have been done to evaluate if other flu vaccines were associated with GBS.  In most studies, no association was found.

Two studies suggested that approximately 1 person out of 1 million vaccinated persons may be at risk of GBS associated with seasonal influenza vaccine.   

antivirals
Antivirals
  • H1N1 has high level of susceptibility to antivirals
  • Best outcomes associated in treatment within 48 hours
resuming activities
Resuming Activities

CDC Guidance – can resume activities 24 hours after fever subsides

Two small studies—Canada and Singapore—H1N1 patients may be infectious 10+ days

emtala enforcement during extraordinary surges
EMTALA enforcement during extraordinary surges

National Association of State EMS Officials

emtala and pan flu
EMTALA and Pan Flu

CMS Memorandum to State Agencies August 2009-”Extraordinary surges”

Hospitals can establish alternative screening sites ON CAMPUS to perform MSE’s for persons presenting to the ED with ILI.

Can be redirected after qualified person determines there is no obvious EMC.

emtala and pan flu39
EMTALA and Pan Flu

Off-site ILI screening centers

Can’t refer patients there from ED.

Can’t be used to screen patients for other urgent, unscheduled illnesses or conditions.

influenza in context
Influenza in Context

Seasonal influenza results in 200,000 hospitalizations annually in the United States.

Seasonal influenza causes 36,000 thousand deaths each year in the US, ranking it among the nation’s top 10 causes of death.

Influenza related deaths are usually due to secondary pneumonias, exacerbated cardiopulmonary conditions, or other chronic diseases.

critical strategies
Critical Strategies
  • Respiratory Hygiene
    • Cover your mouth when you sneeze or cough
    • WASH YOUR HANDS FREQUENTLY
    • Avoid touching your face, eyes, nose, mouth
    • If you are sick, STAY HOME
    • Immediately discard used tissues and then WASH YOUR HANDS!
current recommendation
Current Recommendation

Stay home if you are sick for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer.

fall 2009 so far
Fall 2009 so far…
  • The epidemiology of the disease caused by the 2009 H1N1 influenza virus in the Southern Hemisphere is very similar to that described in the United States this past spring.
  • There have been no significant changes detected in the 2009 H1N1 influenza virus isolated from persons in the Southern Hemisphere as compared to viruses isolated from persons in the Northern Hemisphere. 
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