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Monday, August 17, 2015

HHS Establishes Pandemic Flu Countermeasure Injury Table

Pandemic flu countermeasures cause injury? Apparently they do and we have a compensation table to prove it.

The Countermeasure Injury Compensation Program(CICP)/Pandemic Influenza Countermeasure Injury Table has been published in the Code of Federal Register (CFR) and goes into effect on September 9, 2015. The CICP is established by the Department of Health and Human Services under the Public Readiness and Emergency Preparation Act of 2005 (PREP Act).

The CICP defines liability protection and compensation from a covered injury, defined as death or serious injury, that is

  1. presumed to be a direct result of use or administration of a covered countermeasure (full text link
  2. an injury or or health implication that is a direct result of an included countermeasure. This includes causing serious aggravation of a preexisting condition. (full text link)
Components of the pandemic CICP include
Anaphylaxis 
Pandemic Intranasal Vaccine
Antiviral use in children less than 2 years of age
Overal Children and Infants
Gillain-Barre` Syndrome
National Vaccine Injury Program
West Nile Virus

The Injury Table lists the covered countermeasures, covered serious injury (illness), and time interval from countermeasure use to symptom onset. 

Saturday, August 15, 2015

MMWR: Prevention and Control of Influenza with Vaccines 2015/2016

Vaccine Recommendations from CDC Advisory Committee on Immunization Practices

The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) have released guidelines for 2015/2016 seasonal influenza vaccination.

As expected, the recommendations call for vaccination against seasonal influenza for anyone greater than six months old. Live Attenuated Influenza Vaccine (LAIV) and Inactivated Influenza Vaccine (IIV) are available. Both vaccine types are recommended for adults with a few exceptions, while LAIV may be better for children, according to the recommendations.

ACIP calls for vaccination to occur as soon as possible and before flu activity in your area. The recommendations also mentions the possibility of that antibody decline (vaccinating too early) may be more rapid in older adults and should be balanced with risks of vaccinating too late. (related Influenza vaccine overrated?)

The recommendations further state that vaccination of children six months or older "should occur before onset of influenza activity in the community." Children six months to 8 years old will require two doses of vaccine this season; the first dose given as soon as possible - "before onset of flu activity  in the community" - and the second dose after four weeks. The recommendations state that health children ages of 2-8 who have no contraindications, may revive LAIV or IIV.  Please note that LAIV is not recommended for ages less than 2 years or children between 2-7 years who are receiving aspirin or aspirin-containig products. LAIV is not recommended for ages greater than 49 years. 

There is a lot of discussion related to LAIV and asthma/wheezing. The "warnings and precautions" statement for LAIV also states that anyone with asthma, of any age, may be at greater risk for wheezing after receiving LAIV. While kids (ages 2-4 years) with asthma or a wheezing episode within the last 12 months prior to vaccination should not receive LAIV. 

Vaccine or not, its important to remember the non-pharmacolgical interventions for preventing spread of influenza. 

The issue of a two-dose vaccine season for children is worth additional consideration when planning for community events such as Points of Distribution (POD) activity and health care system utilization for routine vaccination. (Related Nurse Triage Line and Improving Service

LAIV is not recommended for those who have sever allergic reaction in the past, those who are pregnant, and people with who are immunocompromised. Further, caregivers of immunocompromised patients should avoid contact for 7 days due to a "theoretical risk of infection" after LAIV.  Anyone who has revived antiviral medications should delay vaccination for 48 hours. 

Please read the full report from CDC/ACIP for detailed information. Visit the CDC flu page and the ACIP page for additional updates. This summary is not intended as sole source of information or vaccination guidelines. 

Related: Three things to know about seasonal flu

Sunday, August 09, 2015

2015/2016 Flu: Forward Thinking for the next Epidemic

Its difficult to think about seasonal influenza and the potential of a seasonal epidemic when you're bathed in summer weather. Its difficult to research and write about it at this time of year, too. Believe me. Still, after last flu season, if we learned nothing (and maybe we did learn nothing) we learned to get prepared early.


The 2014/2015 flu season was particularly difficult. The vaccine was poorly matched and resulted in ~23% vaccine effectiveness (VE) overall with a ~18% VE for the (drifted) H3N2 strain. And it was worse for children. Add to that the particularly long season of 20 weeks as compared to the usual 13 week flu season and it becomes easy to see why we had such a difficult time last flu season. Thats why we need to get into gear now.

Epidemic on the horizon

We don't often get a lot of warning before a natural disaster strikes. Seasonal influenza gives us a bit of a break on that fact. We know seasonal influenza is coming every year. We know what it did last year, and the year before that and the year before that. We know what it can do to our emergency response systems, our emergency departments, intensive care units, walk-in clinics, and doctors offices. There remains a lot to learn and apply from Dark Winter and Atlantic Storm.

We have an awful lot of data and we need to use it, along with this time of relative quiet, to ramp up for the coming epidemic.

Plan for it

Drag out your biologic plans and review them with all members of your staff. Anyone who works in your facility (medical providers, secretarial support, food service, and environmental service) should be made aware of their responsibilities (and they all have them) during a biologic event. Remember, seasonal influenza is a naturally occurring biologic event. Treat it like one. Surge capacity and mass fatality plans are two additional plans you should be looking at.

Take a hard look at your staffing patterns 

Influenza-like illness (ILI) can result in an absentee rate greater than 20%. Now is a good time to review your call back procedures and evaluate who will be available/willing to come back to work. Keep in mind that the best way to keep people coming back to work is to keep them safe. Medical staff who feel they (and their families) are protected are more likely to report to work during a biologic event. The flip side of this is, of course, reminding sick staff to stay home.

Review triage 

In this case, triage of specialty medical resources such as ventilators and intensive care unit bed. At the height of a biologic event is not the time to decide who does or does not get the last bed or ventilator.

Points of Distribution

Points of distribution (POD) planning is critical to any successful pharmaceutical countermeasure program. Public (open POD) and closed POD plans need to be reviewed, updated and practiced. They will not run themselves and your organizations health, safety, and public image may hang in the balance. Make sure you POD system works!

Practice the non-pharmaceutical countermeasures

Hand washing, respiratory etiquette, and appropriate social distancing (staying home if you're ill) will go a long way towards keeping your staff and facility safe and functional. Endorse it, live it, practice it.

Forward thinking: Whats in store for the 2015/2016 flu season? 

The predicted strains included in this season are A H1N1, A H3N2, and two strains of B influenza. Go here for additional details on flu strains. Estimates are that between 164 million and 175 million doses of flu vaccine will be available between August and October, 2015. Sanofi Pasteur released their first flu vaccine shipment of the season in July, 2015.

A trivalent and quadrivalent vaccine will again be available for the 2015/2016 season. Intramuscular, nasal spray will be available. New this season is the Jet Injector that delivers vaccine by a high pressure stream rather than a needle.

Wednesday, March 12, 2014

NYC Explosion/Collapse - Terrorism, Gas Leak, or Souvenir Ordnance?

"Terrorism, Gas Leak, or Souvenir Ordnance?" was the first question asked when an explosion destroyed an apartment building in Harlem, New York City, 1992.

In 1992 a natural gas leak originating in an eleventh floor apartment caused an explosion that killed three and injured 34. Nineteen police officers and six firefighters were among the injured.

More than twenty years later, as the Vulcan Blizzard dominates media coverage, emergency management and traditional responders are asking that same question as five-alarms respond to a deadly explosion and building collapse in East Harlem.

The 1992 Harlem event was publicized in the U.S Fire Administration Technical Report Series (see Fire, Police, and EMS Coordination at Apartment Building Explosion). In an era before September 11 and before the National Incident Management System, the traditional responders of the City of New York are noted by this report to have effected a remarkable response to the situation.

According to the USFA report:
"The efforts of the three lead response agencies, fire, police, and emergency medical services (EMS), were coordinated within the structure of an Incident Command System (ICS). Integrated and coop- erative command, linked with the implementation of a Collapse Rescue Plan; prudent triage and effective use of available resources for medical treatment; and rapid perimeter control to prevent fur- ther injuries demonstrated that seemingly overwhelming emergencies can be managed by applying good standard operating procedures. The lessons learned/reinforced by each agency at this incident can serve as a model to assist other emergency responders in planning for similar situations."
 I encourage everyone to review this report from 1992 with special attention to the Lessons Learned and Reinforced. The recommendations made and findings of this report are as important today as they were back in 1992. Solid emergency management and response does not mean re-inventing tactics and policy. Rather, better to remember your experiences and build on them. 

Friday, February 28, 2014

The Week in Preparedness February 28, 2014

A brief of emergency preparedness from social media.





Tuesday, February 25, 2014

2013/2014 Flu Update #6


Update #6 for February 25, 2014

A long, slow march into the sunset 

This weeks Mitigation Journal Flu Update includes publicly available data from the CDC FluView, Google Flu Trends and other media sources.

This report contains data from the Centers for Disease Control and Prevention 2013/2014 Influenza season for week #7 for the period ending February 15, 2014.

In the News

CDC: Flu Vaccine 61% Effective
The CDC issued a report on February 20, 2014 claiming the current influenza vaccine to be sixty-one percent effective so far this season. The report notes those vaccinated have a lowered need to be seen by their doctor. CDC also notes that the 2014 influenza season has been, as in years past, particularly difficult for some age groups. We typically focus on extremes of age and those with comorbid conditions as being at risk for influenza related illness (ILI) or death. The trend over several years indicates hospitalizations and deaths attributed to ILI is growing in the "young and middle-age populations. The vaccination rate for these age groups has been estimated at 34%.

California Influenza ICU Admissions and Deaths
California is reporting the highest number of severe and fatal cases of seasonal influenza since the 2009 H1N1 pandemic, according to Morbidity and Mortality Weekly Report (MMWR). The report states that there have been 94 deaths and 311 ICU admissions due to flu from September, 2013 to January, 2014.

WHO: No Changes to Vaccine for 2014-2015 Flu Season
The World Health Organization (WHO) announced in a press release that it is keeping essentially the same vaccine profile for next year. The current vaccine is touted by CDC as being 61% effective and will keep the same influenza virus strains for next season. These strains include  - A/California/7/2009 (H1H1) pdm09, A/Texas/50/2012 (H3N2), and B/Massachusetts/2/2012 in the trivalent vaccine. 

Social Media

 Flu by the CDC numbers

According to the CDC Flu View site:
During week 7 (February 9-15, 2014), influenza activity decreased, but remained elevated in the United States.
  • Viral Surveillance: Of 6,887 specimens tested and reported during week 7 by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories, 958 (13.9%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
  • Influenza-Associated Pediatric Deaths: Two influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations: A season-cumulative rate of 26.1 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 2.5%, above the national baseline of 2.0%. Nine of 10 regions reported ILI at or above region-specific baseline levels. Seven states experienced moderate ILI activity; 16 states and New York City experienced low ILI activity; 27 states experienced minimal ILI activity, and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in 17 states was reported as widespread; 22 states reported regional influenza activity; the District of Columbia, Guam, and nine states reported local influenza activity; Puerto Rico and two states reported sporadic influenza activity, and the U.S. Virgin Islands reported no influenza activity.

Timeline Comparison

Below are CDC FluView maps that compare ILI Activity between corresponding weeks of 2012/2013 influenza season against the 2013/2014 season. The 2014 week 4 CDC map demonstrates considerably lower level of activity as compared to 2012/2013 map at this time.

2013/2014 CDC Flu Interactive Map for week 7, 2014


2012/2013 CDC Flu Interactive Map for week 7, 2013


Google Flu Trends

Google Flu Trends remains a trusted source for ILI activity and comparison data. According to Google Flu Trends ILI activity has progressed from moderate to high  overall with plateaus noted in other areas.

Monday, February 03, 2014

2013/2014 Flu Update #5


Update #5 for February 3, 2014

ILI activity continues, progressing 

This weeks Mitigation Journal Flu Update includes publicly available data from the CDC FluView, Google Flu Trends and other media sources.

This report contains data from the Centers for Disease Control and Prevention 2013/2014 Influenza season for week #5 for the period ending January 25, 2014.

In the News

WHO issues A(H7N9) Global Alert and Response Update
January 31, 2014. The World Health Organization (WHO) issued a Global Alert and Response (GAR) Update based on reports from the National Health and Family Planning Commission of China and the Center for Health Protection (CHP) of China regarding six more cases of human infection with H7N9 avian influenza.

Numerous commonalities exist among the cases, according to the report.
All of the six cases are males. The age range is 2 to 63 years old. The cases are reported from Fujian (1), Guangdong (1), Hong Kong SAR (1), and Zhejiang (3). Four of the cases are currently in critical or serious condition. Four of the cases are reported to have had exposure to poultry or a live poultry market. Source: WHO/GAR
Follow up story from Center for Infectious Disease Research and Policy (CIDRAP)
"...new cases lift the number reported in the second wave to 137, topping the 136 cases reported during the first wave last spring." CIDRAP

Social Media

A nice approach by NBC#3 in Syracuse, NY. Key message: 
  • Not too  late to get flu vaccine
  • Have symptoms, call you doctor (that's call your doctor...NOT go to the ED)
  • If your sick, stay home...appropriate social distancing
  • Flu cases (in this area) are lower
And then there's this short, self-limiting flu going around:

Biologic event "serious" threat in London, 2012...not so much in Sochi, 2014

 Flu by the CDC numbers

According to the CDC Flu View site:
During week 4 (January 19 - 25, 2014), shows a high rate of influenza activity in the United States.
  • Viral Surveillance: Of 9,514 specimens tested and reported during week 4 by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories, 2,006 (21.1%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold.
  • Influenza-Associated Pediatric Deaths: Nine influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations: A season-cumulative rate of 20.3 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 3.3%, above the national baseline of 2.0%. All 10 regions reported ILI above region-specific baseline levels. Ten states experienced high ILI activity; 12 states and New York City experienced moderate ILI activity; 14 states experienced low ILI activity; 14 states experienced minimal ILI activity, and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in 38 states was reported as widespread; 10 states reported regional influenza activity; the District of Columbia and one state reported local influenza activity; Guam, Puerto Rico, and one state reported sporadic influenza activity, and the U.S. Virgin Islands did not report.

Timeline Comparison

Below are CDC FluView maps that compare ILI Activity between corresponding weeks of 2012/2013 influenza season against the 2013/2014 season. The 2014 week 4 CDC map demonstrates considerably lower level of activity as compared to 2012/2013 map at this time.

2013/2014 CDC Flu Interactive Map for week 4, 2014

2012/2013 CDC Flu Interactive Map for week 4, 2013



Google Flu Trends

Google Flu Trends remains a trusted source for ILI activity and comparison data. According to Google Flu Trends ILI activity has progressed from moderate to high  overall with plateaus noted in other areas.

Tuesday, January 28, 2014

This Week in Preparedness 1.24.14

TWiP: Top trending preparedness topics of the week


Hospital preparedness for natural disasters has come into question more than ever since Hurricane Katrina. Despite preparedness efforts on the part of healthcare institutions they remain vulnerable to natural disasters because much of the preparedness and training that's going on in healthcare has failed to touch on the real issues.

Should you have to dial a"9" to get an outside line when you're staying in a hotel? That's the question being asked after a series of events highlighting the fact that you just can't pick up the phone in a hotel or some businesses and dial 911. The need to dial an extra digit to obtain an outside line has been questioned by many fire and emergency service personnel over the years. With modern technology that includes the ability to text message many 911 systems are adding enhanced features that allow them to receive emergency calls via text messaging. It seems intuitive that the need to dial a "9" to get an outside line has certainly outgrown its usefulness… if it ever served a purpose.

An article I wrote back in 2010 highlighting the details in planning that went into the failed Times Square bombing event has received a  fair amount of attention this week. This article highlights the fact that explosive events are real threat it's civilian soft targets in at those who would carry out such an event have the ability to plan and conduct surveillance on their intended targets.

Saturday, January 18, 2014

This Week in Preparedness

Topping the Twitter Feeder  - A week in review

We continue to expect that hospitals Will be prepared to handle anything that we bring to them. Unfortunately the level of preparedness for most hospitals and emergency departments in United States is lacking. If hospitals are truly part of critical infrastructure and emergency departments part of the initial response to disaster they must be prepared, protected, trained, and supported. In 2014 Will have to answer the question" hospitals: are they public-health for public safety?"

This was an interesting piece that caught my eye because it encouraged us to shelter in place in event of a nuclear blast. It was also interesting because the peace encouraged us to calculate how long or how far would take us to get to the next place of shelter from where we currently are. The interesting bias in the story was the assumption that you would know where to go for shelter, have an idea of how to get there, and what the road conditions and travel time would be like during times of crisis. Most interestingly you'd make these decisions after a new player detonation…
The story boasts about the precautions taken to prevent and Deter active shooter an explosive events that mass gatherings. High profile event such as the Olympics, The World Series, and the Super Bowl, have all undergone tremendous scrutiny for their security efforts. But when it comes to truly being prepared training for explosive events and active shooters is child's play compared to planning and preventing a biologic event.

Monday, January 13, 2014

2013/2014 Flu Update #4


Update #4 for January 13, 2014

ILI activity continues, increased in some areas plateaus in others

This weeks Mitigation Journal Flu Update includes publicly available data from the CDC FluView, Google Flu Trends and other media sources.

This report contains data from the Centers for Disease Control and Prevention 2013/2014 Influenza season for week #1for the period ending January 4, 2014.

In the News

CIDRAP is reporting on the first Canadian death from H5N1. Death of an Alberta resident with travel history to Beijing is the first fatal case of H5N1 in North America.
PhillyDOTcom: bioterror limits efforts needed to fight viruses. 

Rochester media beginning to notice flu season

According to the CDC Flu View site:
During week 1 (December 29, 2013-January 4, 2014), shows continued increase of influenza activity in the United States.
  • Viral Surveillance: Of 9,482 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 1, 2,486 (26.2%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
  • Influenza-Associated Pediatric Deaths: Four influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations: A cumulative rate for the season of 9.7 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 4.4%, above the national baseline of 2.0%. All 10 regions reported ILI above region-specific baseline levels. Twenty states experienced high ILI activity; seven states and New York City experienced moderate ILI activity; 11 states experienced low ILI activity; 12 states experienced minimal ILI activity, and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: : The geographic spread of influenza in 35 states was reported as widespread; 12 states and Guam reported regional influenza activity; the District of Columbia, Puerto Rico, and two states reported local influenza activity; and one state reported sporadic influenza activity, and the U.S. Virgin Islands did not report.
Timeline Comparison
Below are CDC FluView maps that compare the prior two reporting periods against the corresponding weeks of 2012/2013 influenza season. The 2014 week 1 CDC map demonstrates a clustered geographical impact of High ILI activity compared to 2012/2013 map at this time.

2013/2014 CDC Flu Interactive Map for week 1, 2014


2012/2013 CDC Flu Interactive Map for week 1, 2013


Google Flu Trends

Google Flu Trends remains a trusted source for ILI activity and comparison data. According to Google Flu Trends ILI activity has progressed from moderate to high  overall with plateaus noted in other areas.

Top MJ Podcasts of 2013 + One More

2013 Top of the Charts includes a podcast from 2012!











Friday, January 10, 2014

Top MJ Reads of 2013

MJ readers select Top Blog Topics of 2013

Mitigation Journal blog readers have voted and the results are in on the top topics of 2013. The top 3 blog pieces were selected based on site statistics, number of article views, and reader interaction, we've come up with our best articles of 2013.

#3 From May, 2013. Biological effects of radiation are dependent upon the type of exposure a person has with the duration of the exposure and intensity of the material playing a key role. We also have to include the role of personal protection such as time, distance and shielding. In this piece, we discussed, Hematopoietic Syndrome, Gastrointestinal syndrome, Cardiovascular syndrome, and central nervous system syndrome


#2 JAMA Flu Myth Busters appeared on MJ in March, 2013 creating substantial debate on social media about the flu vaccine. We also enjoyed an unprecedented volume of email conversations behind the scenes. The big vaccine debate was at the heart of most of our conversations. We also noted a substantial increase in request for biologic planning, plan writing and plan review. Our most popular live talk during this period (Understanding Flu and Biological Events) was presented seven times in and around New York. Fueling the fire on this topic was the political climate surrounding flu related public health emergencies, mandated vaccination for health care workers, and an intense flu season.
 #1 Our top rated posting comes from January, 2013. No Shelter for You was a unique post because it tied together the Tenent Health Care ruling with subtle emergency management changes that were brought to our attention by MJ readers. We had the good fortune of first-hand reporting by Michael Ehrman, a retired emergency manager and long time MJ follower.  Mr. Ehrman continued his reporting on the changes in shelters by joining us on the podcast as well. 

Sunday, December 29, 2013

2013/2014 Flu Update #3


Update #3 for December 28, 2013

ILI activity climbing fast, HAN Alert Issued

This weeks Mitigation Journal Flu Update includes publicly available data from the CDC FluView, Google Flu Trends and other media sources.

This report contains data from the Centers for Disease Control and Prevention 2013/2014 Influenza season for week 51 for the period ending December 21, 2013. In this period flu cases are described as "widespread" and Health Alert Network advisory published.

The  CDC's Heath Alert Network (HAN) has published an official CDC Health Advisory alerting clinicians to reports of severe respiratory illness/infection with influenza A (H1N1). According to the HAN Advisory, the H1N1 pdm09 virus has resulted in numbers pH1N1 hospitalizations and ICU admissions. Some fatalities have bee reported. The alert also notes "While it is not possible to predict which influenza viruses will predominate during the entire 2013-14 influenza season, pH1N1 has been the predominant circulating virus so far.

According to the CDC Flu View site:
During week 51 (December 15-21, 2013), shows continued increase of influenza activity in the United States.
  • Viral Surveillance: Of 6,813 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 51, 1,639 (24.1%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
  • Influenza-Associated Pediatric Deaths: One influenza-associated pediatric death that occurred during the 2012-2013 season was reported.
  • Influenza-associated Hospitalizations: A cumulative rate for the season of 4.3 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 3.0%, above the national baseline of 2.0%. Eight regions reported ILI at or above region-specific baseline levels. Six states experienced high ILI activity; eight states experienced moderate ILI activity; six states experienced low ILI activity; 28 states experienced minimal ILI activity, and the District of Columbia, New York City, and two states had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in 10 states was reported as widespread; Guam and 23 states reported regional influenza activity; 12 states reported local influenza activity; the District of Columbia, Puerto Rico, and four states reported sporadic influenza activity, and the U.S. Virgin Islands and one state did not report.
Timeline Comparison
Below are CDC FluView maps that compare the prior two reporting periods against the corresponding weeks of 2012/2013 influenza season. They indicate ILI activity increasing steadily through weeks 48 to week 51, 2013. There is a noticeable difference in ILI activity between week 51 2013 when compared to week 51 2012. The 2013 CDC map demonstrates a much lower geographical impact of High ILI activity compared to the current year at this time.

2013/2014 CDC Flu Interactive Map for week 51 2013


2013/2014 CDC Flu Interactive Map for week 50 2013


Comparison: 2012/2014 CDC Interactive Map for week 51, 2012 

Google Flu Trends

Google Flu Trends remains a trusted source for ILI activity and comparison data. According to Google Flu Trends ILI activity has progressed from moderate to high between December 15 to December 22, 2013. 

Monday, December 16, 2013

Scheduling Your Mandated Vaccines

 When is voluntary compliance not enough?

Joint Policy Statement endorses mandated vaccine schedule.

The Infectious Disease Society of America, the Society of Heatlhcare Epidemiology of America, and the Pediatric Infectious Diseases Society have collectively endorsed recommendations made by the Advisory Committee on Immunization Practices (ACIP) concerning universal immunization of health care workers.

The joint statement issued December, 2013, called for voluntary immunization programs to be discontinued in favor of mandates when compliance falls below 90%. ACIP further recommends that healthcare workers provide "documentation of receipt of ACIP-recomended vaccinations as a condition of employment, unpaid service, or receipt of professional privileges." Full text of the joint statement can be found with the link below.

Mandated vaccine against seasonal influenza has been hotly debated for several years (see Mandate the Shot or Not). While this debate continues to grind on there has been little attention given to the non-pharmacologic strategies that go hand-in-hand with vaccinations.

Pharmaceutical shortages have occurred and are certain to play a role in vaccine production in the future. Requirement or not, if vaccine is not available, you won't get it. What about when no vaccine has been created to fight a given pathogen? To both situations healthcare workers should turn to personal protective equipment to help prevent the spread of disease (see Best Disease Prevention is Action).

Saturday, December 14, 2013

2013/2014 Flu Update #2


Update #2 for December 14, 2013

Modest increases in ILI activity 

This weeks Mitigation Journal Flu Update includes publicly available data from the CDC FluView, Google Flu Trends and other media sources.

This report contains data from the Centers for Disease Control and Prevention 2013/2014 Influenza season for week 49 for the period ending December 7, 2013. In this reporting period flu cases are continuing to increase but remain behind last year at this time.

According to the CDC Flu View site:
During week 49 (December 1-7, 2013), shows continued increase of influenza activity in the United States.
  • Viral Surveillance: Of 6,219 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 49, 830 (13.3%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
  • Influenza-Associated Pediatric Deaths: No influenza-associated pediatric deaths were reported.
  • Influenza-associated Hospitalizations: A cumulative rate for the season of 2.0 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 2.1%, above the national baseline of 2.0%. Three regions reported ILI above region-specific baseline levels. Four states experienced high ILI activity, five states and New York City experienced low ILI activity, 41 states experienced minimal ILI activity and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in 14 states was reported as regional; 18 states reported local influenza activity; the District of Columbia, Guam, Puerto Rico, and 16 states reported sporadic influenza activity; the U.S. Virgin Islands and two states reported no influenza activity.

Timeline Comparison

Below are CDC FluView maps that compare the last two reporting weeks and 2012/2013 week 49 to this year at week 49. They indicate a modest increase in ILI activity from the week 48 to week 49, 2013. There is a noticeable difference in ILI activity between week 49 this year versus week 49 2012.

2013/2014 CDC Flu Interactive Map for week 49 2013

2013/2014 CDC Flu Interactive Map for week 48 2013

Comparison: 2012/2014 CDC Interactive Map for week 49, 2012 

Google Flu Trends

Google Flu Trends remains a trusted source for ILI activity and comparison data.

Monday, December 09, 2013

2013/2014 Flu Update #1


Update #1 for the week ending December 9, 2013

Flu activity increases slightly, but will we follow the 2012/13 pattern?

This weeks Mitigation Journal Flu Update includes publicly available data from the CDC FluView, Google Flu Trends and other media sources.

This report contains data from the Centers for Disease Control and Prevention 2013/2014 Influenza season for week 48 for the period ending November 30, 2013. In this reporting period flu cases are starting to increase most notably in the south and south east.

According to the CDC Flu View site:

During week 48 (November 24-30, 2013), influenza activity increased slightly in the United States.
  • Viral Surveillance: Of 5,306 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 48, 536 (10.1%) were positive for influenza.
  • Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.
  • Influenza-Associated Pediatric Deaths: One influenza-associated pediatric death was reported.
  • Influenza-associated Hospitalizations: A cumulative rate for the season of 1.2 laboratory-confirmed influenza-associated hospitalizations per 100,000 population was reported.
  • Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) was 1.9%, below the national baseline of 2.0%. Two regions reported ILI above region-specific baseline levels. Two states experienced high ILI activity, two states experienced moderate ILI activity, two states and New York City experienced low ILI activity, 44 states experienced minimal ILI activity and the District of Columbia had insufficient data.
  • Geographic Spread of Influenza: The geographic spread of influenza in nine states was reported as regional; 13 states reported local influenza activity; the District of Columbia, Guam, Puerto Rico, and 27 states reported sporadic influenza activity, and the U.S. Virgin Islands and one state reported no influenza activity.

Comparison to last year at this time.

In the 2012/2014 flu season public health emergencies were not declared in New York and Boston until well after high numbers of ILI cases and intensity had been experienced. By looking at the  trends displayed between these two maps, can we predict and prepare for increased flu numbers in the coming weeks? The following images compare the Influenza Like Illness (ILI) activity for week 48 of 2012 and 2014. Both maps indicate ILI concentrations in the South and Southeastern United States. By reviewing last years data we know that with in four-weeks high ILI activity had progressed to the Northeast. Can we predict the same for 2013?  

2013/2014 CDC Flu Interactive Map for week 48 2013




Comparison: 2012/2014 CDC Interactive Map for week 48, 2012 


Google Flu Trends

Google Flu Trends remains a trusted source for ILI activity and comparison data.

Friday, November 29, 2013

This Week in Preparedness 11.29.13

Mitigation Journal TWiP week ending 11.29.13

CDC buys into Social Media to Predict Flu - sponsors "Predict the Influenza Season Challenge" Enter for a chance to will $75,000 and CDC recognition. (CDC.gov)

Department of Health and Human Services balk at H7N9 Vaccine. Is HHS holding back on a vaccine that could dampen the threat of pandemic from H7N9? If so, why? Read Politix Why Won't HHS Approve Crucial Flu Vaccine? (politic.topix.com)

Always worth following - Google Flu Trends indicates low level of seasonal flu activity in the United States as of this posting. Current numbers reflect flu cases on par with average for this time of year.  (google.org)

New Guidelines on Managing Obesity Crisis - The American College of Cardiology and the American Heart Association along with The Obesity Society and National Heart Lung and Blood Institute have issued a updated set of guidelines to battle what is believed to be one of the largest threats to national security and public health...Obesity. (medscape.com)

H7N9 Has Virulence and Transmissibility - It's stupid and contagious! But then, these are the qualities of most viruses. Novel Flu Virulence and Transmissibility. (thealmagest.com)

Nurses have a role in creating new IT? Really, what the heck for? Read: Why nurses must be involved in developing new health IT (fiercehealthit.com)

Preventing Opimism Bias is cornerstone of MJ's Culture of Preparedness. We've talked about preventing the "it can't happen to me" mentality since day one. Mainstream media is starting to listen according to this piece from The Journal Gazette (Fort Wayne IN) Be Wary of 'it can't happen here' attitude. (journal gazette.net)

The Many Faces of H7N9. Indications are that H7N9 has as many as six different clinical presentations according to data gathered and presented in the Avian Flu Diary. Bookmark and check Avian Flu Diary often. (afludiary.blogspot.com)

Monday, November 25, 2013

Preparedness by Popular Demand

MJ Readers Suggest Topics for 2014


What preparedness topics are important to you as we move dangerously close to 2014? I asked that question on my Facebook page (rickrussotti) and was impressed by the depth of topics our readers and listeners came back with.

Steve Erb (Rochester, NY) suggested crowd/spectator control planning for events at malls, schools, sports ensues and outdoor events (civilian soft targets). Steve writes "we might learn some things regarding planning, communication and response from the Aurora, Colorado theater shooting as a case study." 

The Aurora situation is another tragic milestone with enduring lessons.  The rescue efforts have been questioned during that event and we've seen how politics can bog down readiness. In the end, what have we learned since Columbine? 

Michael Coffin (California) suggested a continued look at active shooter events along with a session on Zombie Apocalypse. Both are right up our alley. The zombie theme was mentioned by Lisamarie Pocza (Massachusetts), too. 

John Spaulding (Rochester, NY)suggested credentialing for volunteer fire officers, pre incident planning, and  social media in public safety. Johns topic about social media is exemplified by this post - all this subject matter came from one Facebook post!

Micheal F. Staley (Georgia) brought up an often overlooked topic - the importance of taking care of our family. 

Jim O'Kelly (Rochester) hit on another under-addressed topic - life in the post antibiotic world. 

You can follow me on Facebook and Twitter (@rickrussotti)