Quick Survey. What are employers doing to respond to the emerging H1N1 Flu threat? This survey addresses travel policy, social distancing and personal protection strategy, and pay leave policies. To date, the Business Group has conducted two different surveys:
Background Information:
In the weeks and months since H1N1 Flu was first identified as a problem, the scientific community has learned more about this offending virus and what works well government response to threat of a pandemic.
- Virus Information -- A comprehensive analysis of the novel H1N1 influenza virus has shed light on the original source of the H1N1 A virus. Genetic components of the new virus closely resemble influenza viruses found in pigs. This suggests novel H1N1 likely originated in pigs, although researchers don't know if humans contracted the virus directly from swine or if there was an intermediary host. In the US there are significant gaps in surveillance of disease in pigs. Formal surveillance for swine influenza isn't conducted because of a lack of coordinated funding and effort.
- Global Flu Response -- Many countries have complained that the WHO's original 6 point pandemic warning system is invalid because it does not address severity of illness. In declaring Phase 6, the WHO is saying that countries around the world are experiencing the same kind of community transmission as in the United States. As such, countries need to dust off their pandemic plans and be sure they know how to react as illness increases in their own communities.
Incidence of Disease
Influenza is unpredictable. As of July 20th, there were over 40,500 confirmed cases of H1N1 Flu reported in the U.S. The number of related deaths in the United States is 263. These numbers are assumed to underestimate the true impact of H1N1 Flu in the US.
For up to date information about the number of confirmed and probable cases of disease in the United States, please click here.
For up to date information about confirmed cases of disease worldwide, please click here.
Government Response Efforts
Although H1N1 Flu has faded from front page news coverage, CDC continues to actively investigate the disease. CDC is monitoring how the virus evolves and behaves during the Southern Hemisphere's flu season. This should provide clues about what the Northern Hemisphere can expect during its next flu season.
| Please remember, influenza is always serious. Every year in the US, seasonal
influenza (flu) results in an estimated 36,000 deaths and more than 200,000 hospitalizations. Employers have a role to play in seasonal flu prevention. For more information, click here
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The HIN1 Flu virus spreads from person-to-person without regard for borders, race or ethnicity. To date, related illness in the US has been mild. Most sick people recovered with limited confirmed deaths from infection. The following groups are at increased risk of serious flu-related complications: children younger than 5 years old, pregnant women, people with chronic medical conditions, and people 65 years and older. H1N1 is most common among teenagers and young adults. The disease has an incubation period in the US of 1 to 5 days.
Public health response occurs primarily at the local level. As such, response may vary across states and communities depending on local circumstances. Communities, businesses, places of worship, schools and individuals can all take action to slow the spread of this outbreak. People who are sick are urged to stay home from work or school and to avoid contact with others, except to seek medical care. This action can avoid spreading illness further. Additionally, healthy people are advised to wash hands thoroughly with soap and water on a regular basis and should seek medical attention if they develop any symptoms of influenza-like illness.
Antivirals
According to laboratory testing, the H1N1 Flu is susceptible to the prescription antiviral drugs oseltamivir and zanamivir (tamiflu and relenza).
CDC recommends that testing and antiviral treatment be prioritized for those with severe respiratory illness and those at highest risk of complications from seasonal influenza. This includes children younger than 5 years old, pregnant women, people with chronic medical conditions and weakened immune systems, and people 65 years and older. Influenza antiviral drugs work best when started soon after illness onset (within two 2 days), but treatment with antiviral drugs should still be considered after 48 hours of symptom onset, particularly for hospitalized patients or people at high risk for influenza-related complications.
In light of a few recent instances of H1N1 resistance to Tamiflu, HHS wants to increase the proportion of zanamivir (Relenza) in the national stockpile relative to oseltamivir (Tamiflu). The current split is 80% oseltamivir and 20% zanamivir. The agency would like to move to a 50-50 split, although that will take time.
HHS is considering issuing an emergency use authorization for peramivir, an antiviral drug that is in phase 3 clinical trials but not yet licensed. According to Dr. Robin Robinson, director of HHS's Biomedical Advanced Research and Development Authority (BARDA), "It's under consideration whether we should have some of that drug available for individuals in desperate need".
Employers should be aware of UPDATED Interim Guidance on Antiviral Recommendations for Patients with Novel Influenza A (H1N1) Virus Infection and Their Close Contacts from CDC. Pre-exposure antiviral chemoprophylaxis should only be used in limited circumstances and in consultation with local medical or public health authorities. Certain persons at ongoing occupational risk for exposure who are also at higher risk for complications of influenza (e.g., health care personnel, public health workers, or first responders who are working in communities with influenza A H1N1 outbreaks) should carefully follow guidelines for appropriate personal protective equipment or consider temporary reassignment. (May 6)
Vaccines
The CDC, National Institutes on Health (NIH) and Food and Drug Administration (FDA) have begun the process of developing an H1N1 Flu vaccine. The Department of Health and Human Services (HHS) placed orders with manufacturers (both Sanofi Pasteur and GlaxoSmithKline) for a vaccine to fight influenza A (H1N1) infection. Manufacturers have already received virus samples from which to develop this vaccine. According to the WHO, the virus sample being distributed is an isolate from California to which most other isolated H1N1 viruses are similar.
Health officials estimate that from point of receiving a vaccine sample, it should take 4 to 6 months to start producing a vaccine en masse. According to reports from HHS and the WHO, the first H1N1 doses should be ready for distribution in mid-October. HHS has not yet made a formal decision about whether to go ahead with a formal, national vaccination campaign.
HHS has contracted for a total of 193 million doses of vaccine from five different manufacturers. Vaccine totals are based on the assumption that each dose is 15 mcg. HHS has also ordered 119 million doses of two different adjuvants, MF59 and ASO3. It isn't yet known which (if any) adjuvant will be used and in what quantity.
After 2.5 weeks of production, manufacturers have made 18 million doses worth of bulk vaccine. Production yields are in line with expectations given experience with H5N1 vaccines. The H1N1 vaccine virus apparently contains less hemagglutinin (the antigen) than seasonal strains and is therefore a little harder to purify. The story is the different for production of live attenuated H1N1 vaccine. Instead of low yields, the company is getting surprisingly high yields.
The federal government is till determining how vaccine will be distributed once it becomes available. It is safe to assume that vaccine will be distributed evenly by population density for distribution by local public health. Decisions have not yet been reached about vaccine dosage and frequency or the population groups that should be prioritized. Employers should contact their local public health departments for more information about accessing vaccine supply for prioritized employees.
Side note: The WHO has expressed concern about the ability of poor countries to purchase H1N1 flu vaccine. In response:
- GlaxoSmithKline has agreed to donate 50 million doses of vaccine to the WHO.
- Sanofi-Aventis SA plans to donate 100 million doses of vaccine to the WHO. Sanofi said it will also consider a tiered-pricing policy for developing countries should its vaccine plants become fully committed to the producing the swine-flu vaccine.
- Novartis AG will not donate vaccine, but is examining pricing and other ways to assure access.
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Travel Warnings
At this time, CDC has removed its recommendation that U.S. travelers avoid travel to Mexico. CDC continues to recommend that travelers to Mexico take steps to protect themselves from getting novel H1N1 flu. Travelers at high risk for complications from any form of influenza should talk to their doctor about the risks of travel and may want to consider postponing travel. Travelers at high risk for complications include:
- Children less than 5 years old
- Persons aged 65 years or older
- Children and adolescents (less than 18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza virus infection
- Pregnant women
- Adults and children who have chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders
- Adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV)
- Residents of nursing homes and other chronic-care facilities
WHO does not recommend countries implement travel restrictions. Global travel is commonplace; large numbers of people move around the world for business and leisure. Limiting travel and imposing travel restrictions would have very little effect on stopping the virus from spreading. It would also be highly disruptive to the global community.
CDC Resources
For a breakdown of all CDC-developed resources for individual and organizational pandemic response, click here.
The Centers for Disease Control and Prevention (CDC) has released General Business and Workplace Guidance for the Prevention of Novel Influenza A (H1N1) Flu in Workers. This guidance is designed to help employers with employees in Occupational Safety and Health Administration's (OSHA) Lower Risk (Caution) Zone: those employees who have minimal occupational contact with the general public and other coworkers (for example, office employees). This interim guidance is meant to inform and educate management, unions, and employees about appropriate precautions and work practices to minimize the risk of potential employee exposure, illness, and the spread of H1N1 flu in the workplace through general prevention and preparedness strategies and in the event that a worker becomes ill.
The following CDC guidance documents may also be particularly relevant to large employers:
The CDC released (5/5/09) guidance on school H1N1 response. School closure is not advised for a suspected or confirmed case of novel influenza A (H1N1) and, in general, is not advised unless there is a magnitude of faculty or student absenteeism that interferes with the school's ability to function. Schools that were closed based on previous interim CDC guidance related to this outbreak may reopen. At this time, CDC believes that the primary means to reducing the spread of influenza in schools should be early identification of ill students and staff, staying home when ill, and good cough and hand hygiene etiquette. Ultimately, decisions about school closure should be at the discretion of local authorities based on local considerations, including public concern and the impact of school absenteeism and staffing shortages.
The U.S. Equal Employment Opportunity Commission (EEOC) issued technical assistance for employers who want to prepare for the H1N1 virus without violating the Americans with Disabilities Act (ADA). ADA limits when and how employers can ask disability-related questions or ask employees to undergo medical exams. The technical assistance provides frequently asked questions on planning for absenteeism and infection control. It includes a sample prepandemic employee survey. The EEOC also reminds employers against discrimination on the basis of national origin.
For employers concerned about stigmatization arising in their workplaces, CDC developed a podcast addressing the issue. In this podcast, CDC's Dr. Barbara Reynolds defines stigmatization, describes how stigmatization can occur in a community, and discusses activities that response officials and communication professionals can do to prevent or confront stigmatization. Barbara spoke to the Business Group community in June 2007. Her slides are available on the Business Group's website.
Other Resources
American Psychological Association (APA)
APA has released tips for managing anxiety about H1N1 Flu. Companies should consider sharing these tips with onsite occupational health professionals or managers. http://www.apahelpcenter.org/articles/article.php?id=194
Association of State and Territorial Health Officers (ASTHO)
ASTHO's website has useful information and resources for states on H1N1 Flu.
http://www.astho.org/index.php?template=swine_flu_response.html
As large employers may operate in many public health jurisdictions, it is difficult to establish who to contact to understand local H1N1 Flu responses. ASTHO has developed a State and Territorial Health Official Directory to support better information sharing with local public health.
National Resource Center on Advancing Emergency Preparedness for Culturally Diverse Communities
The mission of the National Resource Center is to serve as a central clearinghouse of resources and an information exchange portal to facilitate communication, networking and collaboration to improve preparedness, build resilience and eliminate disparities for culturally diverse communities across all phases of an emergency.
http://www.diversitypreparedness.org/Search-Results/46/search__influenza/
National Institutes of Health
The following website provides Spanish-language resources about H1N1 Flu.
http://www.nlm.nih.gov/medlineplus/spanish/swineflu.html
New England Journal of Medicine
The New England Journal of Medicine has developed an online catalogue of its H1N1 Flu and related pandemic materials. Its H1N1 Influenza Center provides scientific and medical information about the current circulating H1N1 Influenza A virus, viruses resulting in past pandemics, and a variety of response strategies. Much of this information is available without a subscription.
Updated: November 12th 2009, 2:30pm
Employer Resources