World Health Organization Pandemic H1N1 Update from the USPACOM/COE Pandemic Influenza Workshop, February 2010.

1. Current stocks of disposable N-95 respirators will not be sufficient to meet demands within the health care community.

a. Increased number of sick individuals;

b. Decreased stores and available stock-on-hand;

c. Limited production with dependence on international production facilities;

d. Production and delivery may be impacted by staff and employee absenteeism;

e. The pandemic may result in the prolonged requirement for respiratory protection.

A DEADLY plague could sweep across Europe, doctors fear, after an outbreak of a virus in Ukraine plunged the country and its neighbours into a state of panic. A cocktail of three flu viruses are reported to have mutated into a single pneumonic plague, which it is believed may be far more dangerous than swine flu. The death toll has reached 189 and more than 1 million people have been infected, most of them in the nine regions of Western Ukraine. President of Ukraine Viktor Yushchenko has called in the World Health Organisation and a team of nine specialists are carrying out tests in Kiev and Lviv to identify the virus. Samples have been sent to London for analysis.

The number of those estimated to perish during another pandemic influenza (PI) event in the United States (US) may be between 5%- 7% of the infected population (infected population est. to be 25%) or 3,612,500 – 5,057,500 respectively1. Governmental authorities, primarily the medical examiner/coroner (ME/C), law enforcement, public health, and associated death care professionals, will not only need to manage these fatalities but also the 2.4 million deaths that occur annually.

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• As of 16 October, the number of Influenza-Like Illness (ILI) deaths in the U.S. was 537 this week compared to 405 deaths reported last week. (Source: HHS/CDC)
• As of 16 October, the most significant impacts of A(H1N1) remain increased ILI outpatient visits and influenza associated pediatric deaths. (Source: HHS/CDC)
• CDC provided updated interim guidance on the use of face masks and N95 respirators for decreasing exposure to A(H1N1). (Source: HHS/CDC)

2009 H1N1 Influenza

As of October 2, 2009:
–World Health Organization (WHO) regions have reported over 343,298 laboratory-confirmed cases
–At least 4,108 deaths
–The laboratory-confirmed cases represent a substantial underestimation of total cases

So far this year, there have been nine deaths related to H1N1 influenza in the state. The other H1N1-related deaths are as follows: A 45-year-old female from Sierra County with end stage liver disease, a 52-year-old female from Bernalillo County with chronic pulmonary disease, a 48-year-old female from McKinley County with asthma and diabetes, a 21-year-old female from Los Alamos County without chronic medical conditions, a 58-year-old male from Bernalillo County with chronic conditions that put him at risk for serious complications from the flu, a 28-year-old male from Lea County died Sept. 23 after being hospitalized in El Paso, Texas.

Critics are calling it a two-tier health system — one for the politically well-connected, another for the hoi polloi. As Germany launched its mass vaccination program against the H1N1 flu virus on Monday, the government found itself fending off accusations of favoritism by offering one vaccine believed to have fewer side effects to civil servants, politicians and soldiers, and another potentially riskier vaccine to everyone else.

This exercise is designed to create an opportunity for the participants to experience a series of possible pandemic influenza environments. These scenarios are not necessarily predictive, nor do they represent the official viewpoint of any organization, group, or entity. The exercise is intended to allow the participants and their organizations to explore possible situations and to consider their options for responses and mitigation approaches. The sponsors understand that no scenario can present all aspects of a possible situation, and that there is no way to know definitively the actual circumstances that might be present during a pandemic.

The Los Angeles County Department of Public Health (LACPDH) encourages schools, residents, community organizations and businesses to develop plans and policies in the event of a public health emergency, such as a pandemic or other large-scale disease outbreak. Preparedness is one of the best prevention techniques available. Many of the planning procedures and precautionary measures suggested are important to practice in everyday life—not only in the event of a public health emergency.

Influenza A (H1N1) 2009 Monovalent Vaccine Live, Intranasal is not approved for use in children <24 months of age. In a clinical trial with FluMist, among children 6-23 months of age, wheezing requiring bronchodilator therapy or with significant respiratory symptoms occurred in 5.9% of FluMist recipients compared to 3.8% of active control (injectable influenza vaccine made by Sanofi Pasteur Inc.) recipients (Relative Risk 1.5, 95% CI: 1.2, 2.1). Wheezing was not increased in children ≥24 months of age. Hypersensitivity, including anaphylactic reaction, has been reported during post-marketing experience with FluMist.

Anaphylaxis has been reported after administration of FLUVIRIN. Although FLUVIRIN and Influenza A (H1N1) 2009 Monovalent Vaccine contain only a limited quantity of egg protein, this protein can induce immediate hypersensitivity reactions among persons who have severe egg allergy. Allergic reactions include hives, angioedema, allergic asthma, and systemic anaphylaxis. The 1976 swine influenza vaccine was associated with an increased frequency of Guillain-Barré syndrome (GBS). Evidence for a causal relation of GBS with subsequent vaccines prepared from other influenza viruses is unclear. If influenza vaccine does pose a risk, it is probably slightly more than 1 additional case/1 million persons vaccinated.

Anaphylaxis has been reported after administration of influenza vaccines. Although Influenza A (H1N1) 2009 Monovalent Vaccine contains only a limited quantity of egg protein, this protein can induce immediate hypersensitivity reactions among persons who have severe egg allergy. Allergic reactions include hives, angioedema, allergic asthma, and systemic anaphylaxis. The 1976 swine influenza vaccine was associated with an increased frequency of Guillain-Barré syndrome (GBS). Evidence for a causal relation of GBS with subsequent vaccines prepared from other influenza viruses is unclear. If influenza vaccine does pose a risk, it is probably slightly more than 1 additional case/1 million persons vaccinated. Neurological disorders temporally associated with influenza vaccination such as encephalopathy, optic neuritis/neuropathy, partial facial paralysis, and brachial plexus neuropathy have been reported.

The Capital Area Public Health Network is planning for the immunization or prophylaxis of the entire population in the region. This plan will serve a guide for a regional response to a local or regional event in the Capital Area. The plan is flexible to adjust to the scope of the event. POD response time and target numbers are specific to the particular event. These variables will dictate how many POD sites will be activated. This plan prepares for the worst-case scenario by identifying five POD sites located throughout the region to be used in large-scale emergencies. In order to balance clinic load, reduce congestion, and maximize facility operations, residents have been assigned to a specific POD by municipality.

Control Measures to Limit Dissemination of Influenza
•Covering mouth/nose with a tissue when coughing
•Post signs that promote respiratory/cough hygiene in common areas
•Hand hygiene after contact with respiratory secretions
•Make hand sanitizers available to your staff
•If feasible, screen personnel for cough or fever before they come on duty
•Ill workers should be advised to stay home

The attack rate is the proportion of the population who become infected with a disease during a defined period of time. In the Fear-40 and Antiviral scenarios, greater than 20 percent of the U.S. population becomes symptomatic, leading to approximately 1.2 to 1.5 million deaths.

* Disease likely persists through summer in US, possible surge in late August when school returns
* Monitor closely for genetic and antigenic virus changes
* Expected higher attack rate (20-30%) than in spring (6-15%), notably affecting younger individuals
* Vaccine availability possibly mid October, Federal funds for distribution and administration are available
* Healthcare facility support in part from HPP grants
* SNS Antiviral stocks likely to be distributed
* Drifted H3N2 may co-circulate with novel H1N1

• Oseltamivir (Tamiflu) and Zanamivir (Relenza)
• Randomized clinical trials (RCT): Reduced duration of influenza by 1-1.5 days when administered in 48 hours
• Pooled RCT analysis: Reduced lower respiratory tract complications, pneumonia, and hospitalization
• Observational studies*: Oseltamivir reduced mortality among hospitalized adults with lab-confirmed seasonal influenza A virus infections

A pandemic will severely stress and overwhelm the capacity of our current health care system to provide and sustain care for those who need it. This includes those inside the health care system, such as: hospital and health clinic employees, home health agencies, private physician groups and other medical facilities. Fire, EMS and other responding agencies, local and state health department personnel will also be affected.

This Pandemic Influenza Preparedness and Response Plan is a guide on how to prepare, detect, and respond to an influenza pandemic in the state of Nevada. This plan is written in accordance with guidelines set forth by the Centers for Disease Control and Prevention (CDC) and describes the emergency management concepts and structure under which the Nevada State Health Division (NSHD) may operate.

In a contest that pits human against virus, the U.S. government is evaluating the safety and effectiveness of swine flu vaccine in hopes of having millions of doses ready for use before the next wave of the pandemic H1N1 sweeps across the nation. This week the virus struck first, infecting a handful of students at the University of Wisconsin-Madison; an additional 25 to 30 are awaiting results of a swine flu test.

* WHO: Pandemic Phase 6 (11 JUN 2009 1600 EDT)
* Outbreaks in at least one country in > two WHO regions
* USG: Public Health Emergency declared (26 Apr 2009)
* Renewed by HHS Secretary Kathleen Sebelius
* HHS: Downgraded to Phase 1 – Awareness (9 May 2009)

One of the main battlegrounds in the fight against an expected resurgence of swine flu this fall will be the schoolyard, a place where the disease could, well, go viral. People between 6 months and 24 years old appear to be particularly vulnerable to the swine flu virus, known as H1N1.

The Situation Manual (SITMAN) with Facilitator notes provides guidance in conducting the Determined Accord influenza pandemic tabletop exercise (TTX). This guide is for “Facilitator Use Only” and provides more detailed information on the guidelines for conduct of the TTX, as well as the exercise objectives, scenario, and discussion topics.