Transcript 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 and 9-1-1 documents are available for download at
www.ems.gov
9/23/2009
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We All Know…
9/23/2009
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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 Michael Jackson.
(0.08 seconds)
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9/23/2009
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CDC—September 15, 2009
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9/23/2009
“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.
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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.
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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.
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9/23/2009
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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.
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9/23/2009
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INFLUENZA IN SCHOOLS
6/12/2009
National Association of State EMS
Officials
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Population
Density and
Mitigation
9/23/2009
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H1N1 in Schools
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9/23/2009
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.
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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
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RESPIRATORY PROTECTION
FOR HEALTH CARE WORKERS
9/23/2009
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Masks and Respirators
Estimated Need
 More than 30 billion
masks needed in a
pandemic
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27B surgical masks
5 billion N-95
9/23/2009
US Stockpile
 SNS contains 119 million
masks
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39 million surgical
80 million N-95’s
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Reality
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9/23/2009
One anecdotal report— 7000 masks
in caring for ONE H1N1 Influenza A
patient in one ICU
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N-95 vs Surgical Mask?
CDC – “We want to ensure that
health care workers are safe.”
 Revised guidance expected this week
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9/23/2009
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IOM Advisory CommitteeN95
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9/23/2009
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.
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IOM Advisory CommitteeN95
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.
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IOM Advisory CommitteeN95
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9/23/2009
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…
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Key Points-IOM
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9/23/2009
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.
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Key Points-IOM
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9/23/2009
PPE needs to be viewed as one part
of a continuum of controls to ensure
worker and patient safety that range
from engineering controls and
administrative approaches to
pharmaceutical measures.
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Key Points-IOM
Emergency medical responders
 Fit-tested disposable N-95 respirator
if in close contact
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Aerosol generating activities
 Interfacility transfers
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This Just In…
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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
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60%
75%
56%
75%
reduction in risk for any respiratory illness
reduction in flu-like illness
decrease in lab-confirmed respiratory illness
reduction in confirmed flu
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Really???
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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/sep1709resp
ir-jw.html
9/23/2009
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Fraudulent Products
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136 entries so far
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Topics on this Page
Air System Products
Body Wash Products
Device Products
Gel Products
Gloves Products
Hand Sanitizer Products
Herbal Extract Products
Inhaler Products
Kit Products
Mask Products
Shampoo Products
Spray Products
Supplement Products
Tea Products
Test Products
http://www.accessdata.fda.gov/scripts/h1n1flu/
9/23/2009
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9/23/2009
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MEDICAL
COUNTERMEASURES
6/12/2009
National Association of State EMS
Officials
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CDC Media Briefing –
September 18
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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
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9/23/2009
195 million doses available by the end of the year
Should be available to anyone who wants it
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CDC Media Briefing –
September 18
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FluMist is approved for healthy individuals
between 2 and 49
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9/23/2009
No kids under 2
No pregnant women
No immuno-compromised
Expect inactivated vaccines to become
available early to mid-October
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Vaccine Priority Groups
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9/23/2009
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)
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CDC Media Briefing –
September 18
Could be minor variations from the
federal list in the states
 Feds won’t intervene to supersede
State priorities
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Vaccine
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NEJM Preliminary Report
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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
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9/23/2009
Published at www.nejm.org September 10, 2009
(10.1056/NEJMoa0907413)
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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).
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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.
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Antivirals
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9/23/2009
H1N1 has high
level of
susceptibility to
antivirals
Best outcomes
associated in
treatment within
48 hours
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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
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9/23/2009
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EMTALA ENFORCEMENT DURING
EXTRAORDINARY SURGES
6/12/2009
National Association of State EMS
Officials
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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.
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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.
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Drive-through Triage
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Influenza in Context
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9/23/2009
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.
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Critical Strategies
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Respiratory Hygiene
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9/23/2009
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!
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Current Recommendation
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9/23/2009
Stay home if you are sick for 7
days after your symptoms begin
or until you have been symptomfree for 24 hours, whichever is
longer.
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Fall 2009 so far…
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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.
9/23/2009
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Email: [email protected]
9/23/2009
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