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EMS Update on H1N1 Influenza A and Pan Flu

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EMS Update on H1N1 Influenza A and Pan Flu. Kathy Robinson. NASEMSO ... Results 1 - 10 of about 49,000,000 for H1N1. ... Drive-through Triage. 9/23/2009. 40 ... – PowerPoint PPT presentation

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Title: EMS Update on H1N1 Influenza A and Pan Flu


1
EMS Update on H1N1 Influenza A and Pan Flu
  • Kathy Robinson
  • NASEMSO Program Manager

September 23, 2009
2
EMS 9-1-1 Critical Components of the National
Strategy
EMS and 9-1-1 documents are available for
download at www.ems.gov
3
We All Know…
4
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)   

5
CDCSeptember 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. 

6
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. 

7
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. 

8
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.

9
Influenza in schools
10
Population Density and Mitigation
11
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.

12
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

13
Respiratory Protection for Health care workers
14
Masks and Respirators
  • Estimated Need
  • US Stockpile
  • More than 30 billion masks needed in a pandemic
  • 27B surgical masks
  • 5 billion N-95
  • SNS contains 119 million masks
  • 39 million surgical
  • 80 million N-95s

15
Reality
  • One anecdotal report 7000 masks in caring for
    ONE H1N1 Influenza A patient in one ICU

16
N-95 vs Surgical Mask?
  • CDC We want to ensure that health care workers
    are safe.
  • Revised guidance expected this week

17
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.

18
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.

19
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…

20
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.

21
Key Points-IOM
  • 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.

22
Key Points-IOM
  • Emergency medical responders
  • Fit-tested disposable N-95 respirator if in close
    contact
  • Aerosol generating activities
  • Interfacility transfers

23
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

24
Really???
  • The researchers found that fit-testing of the
    made no difference in protection.
  • Published at http//www.cidrap.umn.edu/cidrap/co
    ntent/influenza/swineflu/news/sep1709respir-jw.htm
    l

25
Fraudulent Products
  • 136 entries so far
  • 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/
26
(No Transcript)
27
Medical Countermeasures
28
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, cant 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

29
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

30
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)

31
CDC Media Briefing September 18
  • Could be minor variations from the federal list
    in the states
  • Feds wont intervene to supersede State
    priorities

32
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)

33
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).  

34
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.   

35
Antivirals
  • H1N1 has high level of susceptibility to
    antivirals
  • Best outcomes associated in treatment within 48
    hours

36
Resuming Activities
  • CDC Guidance can resume activities 24 hours
    after fever subsides
  • Two small studiesCanada and SingaporeH1N1
    patients may be infectious 10 days

37
EMTALA enforcement during extraordinary surges
38
EMTALA and Pan Flu
  • CMS Memorandum to State Agencies August
    2009-Extraordinary surges
  • Hospitals can establish alternative screening
    sites ON CAMPUS to perform MSEs for persons
    presenting to the ED with ILI.
  • Can be redirected after qualified person
    determines there is no obvious EMC.

39
EMTALA and Pan Flu
  • Off-site ILI screening centers
  • Cant refer patients there from ED.
  • Cant be used to screen patients for other
    urgent, unscheduled illnesses or conditions.

40
Drive-through Triage
41
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
    nations top 10 causes of death.
  • Influenza related deaths are usually due to
    secondary pneumonias, exacerbated cardiopulmonary
    conditions, or other chronic diseases.

42
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!

43
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.

44
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. 

45
201 Park Washington Court Falls Church, VA
22046 Phone 703.538.1799 Email info_at_nasemso.org
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