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Wednesday

SAMHSA: Synthetic Marijuana linked to thousands of Emergency Department Visits

First report on Synthetic Marijuana use highlights dangers, healthcare impact


The Substance Abuse and mental Health Services Administration (SAMHSA) has released a study highlighting the impact of synthetic marijuana use. Drug Related Emergency Department Visits Involving Synthetic Cannabinoids appears in the December, 2012 issue of The Drug Awareness Warning Network (DAWN) Report.

Synthetic drugs are generally considered to include synthetic Bath Salts (sBS) and synthetic marijuana (sM). Both sBS and sM are sold under a variety of names and are made up of any number of chemical compositions. Both classifications of drugs have been linked to thousands of emergency department visits and hospital admissions as well as a variety of medical and psychiatric outcomes. The exact composition of synthetic cannabis and bath salts may change with manufacturer. For more on chemical composition and effects on the body, see Bath Salts: Stronger than dirt!.

According to the DAWN report, 11,406 emergency department visits involved a synthetic cannabiod product. Ages 12 to 29 years made up three quarters of those visits with an overwhelming majority of users being male.

The DAWN report also notes that:
"They [synthetic marijuana] have been reported to cause agitation, anxiety, nausea, vomiting, tachycardia, elevated blood pressure, tremor, seizures, hallucinations, paranoid behavior, and nonresponsiveness."
Polypharmacy use is often seen with synthetic bath salts, it may not be a large issue among synthetic marijuana usesers. Fifty-nine percent of those reporting to ED after synthetic marijuana use (12 to 29 age group) had no other substances involved. When polypharmacy was present, alcohol was found in 13% of cases and other pharmaceuticals used in 17%.

Synthetic drugs including bath salts and synthetic marijuana have captured the attention of public health officials, hospital staff and the media. The use of these materials continues to climb as does the awareness to the consequences. The CDC published its first article on the subject of bath salts in the May, 2011 edition of Morbidity and Mortality Weekly Report (MMWR) [Emergency Department Visits After Use of a Drug Sold as "Bath Salts"]. Since that report nearly two years ago, the use of synthetic drugs continues to rise.

A recent high profile case involving a young woman from Texas and a new CDC finding have added to the list of dangers from synthetic drugs use. A CNN news story indicates that a teenage girl from Cypress, Texas had been diagnosed with vasculitis after smoking synthetic marijuana that may have contributed to a stroke and resulting in two weeks ICU care. The CDC is reporting in its February 15, 2013 MMWR cases of unexplained acute kidney injury associatied with synthetic cannabinoid use. MMWR report indicates:
"AKI has not been reported previously in users of SCs and might be associated with 1) a previously unrecognized toxicity, 2) a contaminant or a known nephrotoxin present in a single batch of drug, or 3) a new SC compound entering the market."
Also, according to the CDC; "Synthetic cannabinoids (SCs) are psychoactive chemicals dissolved in solvent, applied to plant material, and smoked as a drug of abuse. They are sold in "head shops" and tobacco and convenience stores under labels such as "synthetic marijuana," "herbal incense," "potpourri," and "spice." Most reports of adverse events related to SCs have been neurologic, cardiovascular, or sympathomimetic."

 References.
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (December 4, 2012). The DAWN Report: Drug-Related Emergency Department Visits Involving Synthetic Cannabinoids. Rockville, MD.

Acute Kidney Injury Associated with Synthetic Cannabinoid Use - Multiple States, 2012. Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report. February 15, 2013 / 62 (06); 93-98

Teen narrowly escapes death after smoking synthetic marijuana CNN and affiliate news reporting.

Synthetic cannabis, Wikipedia

Tuesday

CDC Defines the Biological Threat

CDC Categorizes Bioterrorism Agents and Diseases

Events involving naturally occurring  pathogens and weaponized biological agents share many features.  The intentional release of smallpox would make world-wide front page news and would be a devastating global public health crisis. Naturally occurring biological events are no different, albeit much less glamorous. Naturally occurring biological events can be as devastating as any intentional biological event, but we rarely consider seasonal flu as a "major event". The fact is that any biologic event can have a profound physical and psychological impact on society and culture. The 2012/2013 Influenza season is a good example of how a naturally occurring event can impact public health. Solid biologic event planning is the key to successful operation during a natural or intentional event. You need know how to write your biologic plan and should avoid common pitfalls in bio-event planning.

The Centers for Disease Control and Prevention list biological agents into categories according to potential harm and ability to be manipulated. Category A biologic agents are those pathogen (bacteria, toxins, and virus) that are rarely seen in the United States and have potential to be enhanced or engineered in order to increase the likelihood of harm. Pathogens in Category A include:
  • Anthrax
  • Botulism
  • Plague
  • Smallpox
  • Tularemia
  • Viral  hemorrhagic fevers

According to the CDC Bioterrorism Agents/Diseases page, Category A biologic agents  pose a risk to national security because they can be easily transmitted person to person, have high mortality rates/major public health impact, could cause panic and social disruption, and require special public health preparedness.

Category B pathogens are defined as those that are moderately easy to disseminate, result in moderate mobility rates and low mortality rates, and need specific enhancements of CDC diagnostic capacity and surveillance. 

Visit the CDC Bioterrorism agents/diseases page for further details on category B pathogens.

Category C pathogens are defined by the Centers for Disease Control and Prevention as those emerging pathogens that could be engineered for mass dissemination in the future. Factors in this making this determination include availability, ease of production and dissemination, and potential for high morbidity/mortality rates with major public health impact.

 Visit the CDC Bioterrorism agents/diseases page for further details on category C pathogens.

What could we do to a virus, toxin, or bacteria to enhance its effects? The first step in answering that question is to understand the target potential (hard or soft) and dissemination. Understand also that intentional biological events may utilize indirect means of dissemination. Person to person spread of disease is possible in both natural and intentional events.

Additional Media
How to write your biologic plan

Four pitfalls to avoid in biologic planning

What good plans have that bad ones don't

The Bioterrorist Next Door

Clinton Warns of Bioweapon threat

Black Death DNA

Alarm Dutch lab creates killer flu

Monday

2012/2013 Flu Update #9

Update #9 for the week of February 24, 2013

State/Territorial Influenza Estimates (CDC)
This weeks Mitigation Journal Flu Update includes publicly available data from the CDC FluView, Google Flu Trends, Sickweather and other media sources.

This report contains data from the Centers for Disease Control and Prevention 2012/2013 Influenza season week 7 for the period ending February 16, 2013. In this reporting period (February 10-16, 2013)  CDC flu data report ILI activity elevated in the United States. Indications continue to point to declining ILI in most areas.

The number of hospitalizations remained elevated at 34.2 per 100,000 population during this reporting period. Those greater than 65 years of age continue to account for greater than 50% of those hospitalized. Influenza and pneumonia related deaths are reported to be above the epidemic threshold.

Twenty-two states reported widespread ILI activity during this reporting period, down from twenty-four states reported high level of ILI activity in week four and from twenty-six states in  week3.

Viral surveillance results for week 9, 2013 shows 16.8%  of 8,144 samples tested positive for influenza. This is down from week 4 where 25.5% of 10,581 samples were positive.

Outpatient ILI surveillance (those seen at clinics and doctors offices for ILI complaints) was 2.8% for week 7, down from 4.2% for week 4 and 4.3% for week 3,  but  remaining above the national base line of 2.2%.

Antiviral resistance is a non-issue at this point. None of the circulating strains (H1N1, H3N2 or Influenza B) are resistant to Oseltamivir or Zanamivir.

State-by-State week 7 reporting (from CDC website)
  • Widespread influenza activity was reported by 22 states (Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Idaho, Indiana, Iowa, Kansas, Massachusetts, Michigan, New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Virginia, Washington, and Wyoming).
  • Puerto Rico and 21 states reported regional influenza activity (Florida, Kentucky, Illinois, Louisiana, Maine, Maryland, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, North Dakota, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, West Virginia, and Wisconsin).
  • The District of Columbia and 6 states (Alabama, Georgia, Hawaii, Mississippi, North Carolina, and Rhode Island) reported local influenza activity.
  • One state (Delaware) reported sporadic influenza activity.
  • Guam reported no influenza activity.
  • The U.S. Virgin Islands did not report.


CDC Flu Interactive Map

Google Flu Trends

Sickweather Data
Sickweather video no longer available


Friday

Biologic Exercises provide valuable information


Recommendations show promise for future biological event success


Terrorist attacks using biological agents are potentially deadly beyond imagination. In 2001, the dissemination of engineered Anthrax struck panic with American civilians and emergency service responders resulting in exaggerated responses and near-ridiculous actions. Inhalation anthrax is fatal if not treated appropriately, but there is treatment. How would be as population fair if the biological agent was something more devastating than anthrax; an agent with no cure or treatment? Let’s use smallpox as an example.

In June of 2001, the Johns Hopkins Center for Civilian Biodefense Strategies along with the Center for Strategic and International Studies, the Analytic Services Institute for Homeland Defense held a senior-level tabletop exercise that simulated the effects of a covert biological attack on the United States. The dissemination of highly contagious smallpox as an act of terrorism became know as the “Dark Winter” scenario. This one-of-a-kind TTx examined the ability of senior-level policy makers to face the challenges of a bio terrorist attack with outbreaks of highly contagious diseases.

A similar event took place in January, 2005, this time among the international leadership community. Known as Atlantic Storm, this TTx continued on a larger scale from Dark Winter. Atlantic Storm simulated the heads of state and senior international governmental leaders attempting to manage a simultaneous smallpox bio terror attack on Istanbul, Frankfurt, Warsaw, Rotterdam, New York, and Los Angeles.

Both Dark Winter and Atlantic Storm focused on government leadership and ability to manage issues in public health, medical services, diplomacy, domestic response, and critical infrastructure. Both exercises were well developed and planned...they did, however, reached differing results. What follows is a comparison of the tabletop exercises Dark Winter (2001) and Atlantic Storm (2005). Despite commonalities in scenario and biological agent, glaring differences have emerged that leave those studying such material wondering and concerned. The opinions and concerns addressed herein are based upon study of documents, video where available, objective analysis of the scenarios themselves, of course, smallpox.

Comparison of Assumptions
 Dark Winter focused on the United States as the only target in a “worst-case” scenario; Atlantic Storm targeted the international community with “best-case” circumstances. This primary difference may prove to be a single most perturbing factor when comparing the two exercises.

Although both scenarios simulated the use of smallpox as the agent with similar methods of dissemination, there were concerning differences in the projected infection rates, death rates, and person-to-person transmission potential. Dark Winter assumed a thirty percent fatality rate while deaths from smallpox were projected at twenty-five percent in Atlantic Storm. Atlantic Storm also assumed that there was residual immunity among the affected population with 300 million doses of vaccine available. Dark Winter was somewhat less optimistic; simulating a CDC stockpile of 15.4 million doses of vaccine and allowing for up to twenty percent of stockpile loss due to contamination or improper use.

Dark Winter hypothesized that 1g of smallpox could generate 100 infections when aerosolized resulting in 3000 first generation cases from 30gms of virus. There is no mention of virus quantity in Atlantic Storm; however, both scenarios disseminate the virus via an aerosolizing device under similar conditions. Dark Winter used 1:10 transmission rate (every one person with smallpox could infect ten others) as compared to Atlantic Storms rate of 1:3. Atlantic Storm also anticipated 1: 0.25 for second to third generation while no mention was made in the Dark Winter scenario of second to third generation transmission. Dark Winter planners integrated herd immunity of twenty percent into the scenario which was not accounted for in Atlantic Storm. I found the following excerpt from the Dark Winter scenario an interesting commentary on person-to-person transmission rate. A sidebar reads:

“…Given the low level of herd immunity to smallpox and the high likelihood of delayed diagnosis and public health intervention, the authors of this exercise used a 1:10 transmission rate for Dark Winter and judged that an exercise that used a lower rate of transmission would be unreasonably optimistic, might result in false planning assumptions, and, therefore, would be irresponsible. The authors of this exercise believe that a 1:10 transmission rate for a smallpox outbreak prior to public-health intervention may, in fact, be a conservative estimate, given that factors that continue to precipitate the emergence and reemergence of naturally occurring infectious diseases (e.g., the globalization of travel and trade, urban crowding, and deteriorating public health infrastructure) [26, 27] can be expected to exacerbate the transmission rate for smallpox in a bioterrorism event…”

In contrast, the Atlantic Storm best-case scenario planned for adequate disease control, compliance with public health “social distancing” (a.k.a. quarantine), available vaccine, higher herd immunity, residual protection granted by prior vaccination, and lower transmission rates. The wide range of transmission rates between the two exercises may account for the differences in total number of smallpox cases and deaths. Dark Winters worst-case predicted 1,000,000 deaths with 3,000,000 infections while the Atlantic Storm exercise predicted 660,000 cases and approximately 495,000 deaths.

Summary: Lessons/RecommendationsDark Winter summarized the exercise with a list of lessons and Atlantic Storm used the term recommendations to summarize. Below is a list of lessons from Dark Winter or recommendations from Atlantic Storm that seem to be common to both events despite being conducted years apart. Various excerpts from the text have been added to aid explanation.
  • Leaders are unfamiliar with the character of bioterrorist attacks, available policy options, and their consequences.
  • After a bioterrorist attack, leaders’ decisions would depend on data and expertise from the medical and public health sectors.
  • …they were given more information on locations and numbers of infected people than would likely be available in reality.” Statement concerning the amount of infromation given out in both TTx's.
  • …lack of information, critical for leaders’ situational awareness in Dark Winter, reflects the fact that few systems exist that can provide a rapid flow of the medical and public health information needed in a public health emergency.”
  • …it was difficult to quickly identify the locations of the original attacks…”
  • The lack of sufficient vaccine or drugs to prevent the spread of disease severely limited management options.
  • After a bioterrorist attack, leaders’ decisions would depend on data and expertise from the medical and public health sectors.

    … [This] reflects the fact that few systems exist that can provide a rapid flow of the medical and public health information needed in a public health emergency.”
    “What’s the worst case? To make decisions on how much risk to take…whether to use vaccines, whether to isolate people, whether to quarantine people…I’ve got to know what the worst case is” (Sam Nunn).
  • The lack of sufficient vaccine or drugs to prevent the spread of disease severely limited management options.
  • The US health care system lacks the surge capacity to deal with mass casualties.
  • The numbers of people flooding into hospitals across the country included people with common illnesses who feared they had smallpox and people who were well but worried.”
“…[the challenges]of distinguishing the sick from the well and rationing scarce resources, combined with shortages of health care staff, who were themselves worried about becoming infected or bringing infection home to their families, imposed a huge burden on the health care system.”
  • To end a disease outbreak after a bioterrorist attack, decision makers will require ongoing expert advice from senior public health and medical leaders. 
  • “…the imposition of geographic quarantines around affected areas, but the implications of these measures (e.g., interruption of the normal flow of medicines, food and energy supplies, and other critical needs) were not clearly understood at first. In the end, it is not clear whether such draconian measures would have led to a more effective interruption of disease spread.”
    “A complete quarantine would isolate people so that they would not be able to be fed, and they would not have medical [care].…So we can’t have a complete quarantine. We are, in effect, asking the governors to restrict travel from their states that would be nonessential. We can’t slam down the entire society” (Sam Nunn).
  • Federal and state priorities may be unclear, differ, or conflict; authorities may be uncertain; and constitutional issues may arise.

    “My fellow governors are not going to permit you to make our states leper colonies. We’ll determine the nature and extent of the isolation of our citizens…You’re going to say that people can’t gather. That’s not your [the federal government’s] function. (Frank Keating).

    “…worried that it would not be possible to forcibly impose vaccination or travel restrictions on large groups of the population without their general cooperation."

    “The federal government has to have the cooperation from the American people. There is no federal force out there that can require 300,000,000 people to take steps they don’t want to take” (Sam Nunn).

    “…Atlantic Storm showed that even experienced politicians have unrealistic notions of what WHO would be able to deliver in a crisis, given its current budgetary, political, and organizational limits.”

    “In Atlantic Storm, leaders viewed border closings and travel bans as an unattractive option for controlling the spread of disease, but, given the lack of vaccine or any other mechanism to control disease, they were forced to consider these measures.

“…leaders were provided with far more situational awareness than they would have had in a real crisis. They were given the locations and numbers of reported smallpox cases in almost real time, and they were constantly updated as information changed. If this had been a real bioattack or epidemic affecting cities in multiple countries, leaders would have had a great deal of trouble getting even this level of basic information.”

Questions:In the end it would appear that we are not much closer to answering (or instituting) the questions posed by these two exercises. The results of the two events, despite being years apart, have come to similar end points…without resolution. Since Dark Winter, we have seen the 9-11 attacks, dealt with WNV, witnessed SARS, and begun preparing for H5N1. Yet, these questions continue to be re-invented.

Given the time frame of the two exercises, one being pre-9-11 and the other post-9-11, is there any expectation change in the “post-9-11 mindset”?

Can any correlation be drawn between the expectations of national leaders towards international cooperation and state/local leaders towards cooperation with the Federal government?

Will the American public respond differently to a biological attack that threatens only the United States in contrast to an attack threatening the U.S. as well as other nations?

How will we approach issues of evacuation, quarantine, mandatory vaccination, and loss of freedoms? Will compliance be better or worse based on the events of Katrina?

Can we compare the expectations of FEMA during Katrina to the expectations of the CDC during a biological terrorist attack?

Why are we not closer to resolving the issues mentioned in these exercises?

So many of the Atlantic Storm recommendations are strikingly similar to the lessons of Dark Winter that one has to ask if the organizers have even read the Dark Winter scenario!

Wednesday

Lessons from Dark Winter and Atlantic Storm applied to seasonal Influenza

Biologic Tabletop Exercises can help Influenza preparedness

Everyone remembers Hurricane Katrina. Did you know that about a year before Katrina there was another devastating hurricane? Just about a year before Katrina hit the Gulf Coast, Hurricane Pam ripped through causing the levee system to fail, flooding New Orleans, and causing destruction on nearly a life for life, dollar for dollar par with Katrina. The storm was Hurricane Pam and you didn’t read about this storm in the paper or see it on television. Why doesn't anyone remember Hurricane Pam? You don’t remember Pam because it never actually happened...Hurricane Pam was a tabletop exercise (TTX) that predicted with eerie accuracy what would happen if a major hurricane scored a direct hit on the Gulf Coast. The point is that we can learn a lot from our own exercises if we listen. In this post I’m suggesting we learn the lessons from two biologic event tabletop exercises...

In the setting of a naturally occurring or intentional biologic attack how will countries manage shortages of medicine, vaccines, and medical supplies? What mechanisms will be used to control or halt the spread of disease? How will local and national leaders balance their responsibilities to their own citizens with their responsibilities to the international community?

These are the questions we should be asking ourselves and these are the issues addressed by two tabletop exercises Dark Winter and Atlantic Storm.

Click the player below for staged media footage used in Dark Winter.

Watch Dark Winter Pretext for TOPOFF/CCMRF/CBRNE Martial Law Drills in Educational & How-To | View More Free Videos Online at Veoh.com

In June of 2001, the Johns Hopkins Center for Civilian Biodefense Strategies along with the Center for Strategic and International Studies, the Analytic Services Institute for Homeland Defense held a senior-level tabletop exercise that simulated the effects of a covert biological attack on the United States. The dissemination of highly contagious smallpox as an act of terrorism became known as the “Dark Winter” scenario. This one-of-a-kind TTx examined the ability of senior-level policy makers to face the challenges of a bioterrorist attack with outbreaks of highly contagious diseases.



A few years later, in January, 2005, a similar exercise took place. This time among the international leadership community, known as Atlantic Storm, this TTx continued on a larger scale from the Dark Winter exercise. Atlantic Storm simulated the heads of state and senior international governmental leaders attempting to manage a simultaneous bioterror attack. The attack was centered on Istanbul, Frankfurt, Warsaw, Rotterdam, New York, and Los Angeles with Smallpox as the weapon.

Already know it all? Think again. Atlantic Storm verbalizes many of the issues discussed in recent studies as well as historic preparedness problems. An excellent real-life example, Atlantic Storm is also a high quality tabletop exercise, complete with PDF user guides and downloadable documents, Atlantic Storm provides an outstanding example of power a tabletop exercise (TTX) can bring to the planning and training process.

A review of Dark Winter and Atlantic Storm is a useful tool for traditional and non-traditional responders. Take an hour and view the presentation, review the documentation. To view Atlantic Storm; go to: http://www.atlantic-storm.org/flash/index-b.html and turn up you speakers!

Monday

Will your POD work when you need it?

Planning essential for Points of Distribution success

Points of Distribution, or POD, is a site designated for the distribution of medications or supplies in the event of a crisis or emergency. The pubic gathers at a give location or locations and materials are handed out.are the hub of pandemic planning in some communities. The POD system can be a viable option for medication distribution but is dependent on a number of factors for success.

The current points of distribution model is based on an earlier process used to receive, break down, repackage, and distribute materials/supplies from the National Pharmaceutical Stockpile (NPS). The idea was further refined for the use after experiences with SARS, H5N1 Highly Pathological Avian Flu and 2009 H1N1.

There are four basic assumptions to be considered in points of distribution planning. We assume that:
  • the pathogen will be known 
  • the appropriate medication/vaccine will be available
  • staffing will be adequate
  • civil order will be maintained
The assumption that the pathogen will be known or reliably predictable is key. Without this vital information there is little benefit to mass vaccination or prophylactic medication. We may also have to predict when a given pathogen is threatening and plan time to medicate/vaccinate our public. Many assumptions were based on a disease coming from a certain known area and estimating how long it may take for that disease to reach a given population. Many so called pandemic plans assume a disease like SARS or Avian Influenza will take weeks or months to reach us and we'll have sufficient time to put plans into action. Our experience with SARS and predictions of H5N1 and is rendered totally dysfunctional after experience with 2009 Swine Flu. To assume there will be a "lead-time" when we know a pathogen is coming is a mistake. As we have seen with H1N1 in 2009, the disease was present in various states with little or no lead-in. In that situation, we have to plan for the disease spreading beyond any given boundary by virtue of our modes of modern travel and limited surveillance ability. Without clear definition of the pathogen in question, bringing otherwise healthy people together into a central location for medication distribution may actually increase exposure. The key to success is to provide as much information as possible to the public and institute non pharmacological interventions to prevent disease spread during your distribution.  

Points of distribution planning must consider vaccine or medication availability. Vaccine or medication may not be available in quantities needed to meed the demand at a given POD site while others may be overstocked. One of the worst possible situations would be to run out of medication. Running out of medication leaves people standing in line and not getting protected, perhaps being exposed and certainly not meeting expectations. In the extreme situation, there is a risk of civil unrest (imagine being next in line and told "sorry, we just ran out) and certainly a blow to your public image.

Adequate staffing is major planning point. Staffing must be able to meet demand for service. Conducting you point of distribution under the NIMS model will be helpful. Incident Action Planning and Operation Period Planning are vital to determine staffing requirements. Managing the que and providing sanitation services, shelter from the environment, food, and medical care at POD locations are additional logistics that must be considered but may not be part of your points of distribution planning.  The people in line are y our concern and their needs must be addressed. Utilization of Federal Medical Stations as a model may be beneficial for points of distribution planning. Federal Medical Stations are part of the Centers for Disease Control and Preventions Strategic National Stockpile program and is designed to fill a gap that exists between disaster shelters and temporary hospitals. According to the CDC Works For You 24/7 Blog, Federal Medical Stations are non-emergency medical installations used during disaster situations to care for people with special medical needs and  chronic health conditions. They also include services for those with mental health issues. The CDC notes that FMS can be operational within 48 hours. See Federal Medical Stations, Mitigation Journal (December, 2012)

 Civil unrest and disobedience is a real problem that could threaten all aspects of points of distribution operation. Dealing with uncooperative persons, people with special needs, and those intent on causing problems is often beyond the scope of those working in a POD. Understand that the unrest can turn into a riot and become violent quickly especially if you run out of medication and needs are not met. Sufficient law enforcement resources must be in place to prevent or counter any disruptive situation. Law enforcement must also be able to manage traffic flow and parking.

In isolated situation  points of distribution were overwhelmed with people and had delays of several hours while other locations remained nearly silent. This may be due, in part, because  people did not know where to go, under what conditions to go, or did not understand direction. Plan for people not following direction. We can expect that once the media announces that site "A" is running with a ten-hour delay, many people will flood site "B".

Points of Distribution sites are difficult to manage and plan for. They are a part of pandemic planning, but only a part.

Additional resources:
Four pitfalls to avoid in biologic planning Mitigation Journal July, 2012
How to write you biologic plan Mitigation Journal October, 2010

Thursday

2012/2013 Flu Update #8

Update #8 for the week of February 4, 2013

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

This report contains data from the Centers for Disease Control and Prevention 2012/2013 Influenza season week 4 for the period ending January 26, 2013. In this reporting period (January 20-26, 2013) CDC flu data report ILI activity declining in some areas of the United States while high rates of activity persists. Indications point to declining ILI activity in the East and increasing in the West. The number of hospitalizations and deaths remain significantly elevated during this reporting period. Twenty-four states reported high level of ILI activity, down from twenty-six states in the prior week. Thirteen states report moderate ILI activity. Forty-two states reported widespread geographic influenza, down from forty-seven in last weeks report.

Viral surveillance results for week 4, 2013 shows 25.5% of 10,581 samples tested positive for influenza. This is down slightly from week 7 at 26.1%. The proportion of deaths related to influenza and pneumonia remain  above epidemic threshold for week 4. The elderly continue to make up the majority of people hospitalized with ILI as 50% of hospitalizations were those aged 65 or older.

Outpatient ILI surveillance (those seen at clinics and doctors offices for ILI complaints) was 4.2% for week 4 (4.3% for week 3) and remained above the national base line of 2.2%.

Antiviral resistance is a non-issue at this point. None of the circulating strains (H1N1, H3N2 or Influenza B) are resistant to Oseltamivir or Zanamivir.

CDC Flu Interactive Map


Google Flu Trends


Sickweather Data



Friday

2012/2013 Flu Update #7

Update #7 for the week of January 28, 2013

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

This report contains data from the Centers for Disease Control and Prevention 2012/2013 Influenza season week 3 for the period ending January 119, 2013. In this reporting period (January 13-19, 2013) CDC flu data sources report high rates of ILI activity in twenty-six states, moderate activity in fourteen states, and nine states defined as low ILI activity. In contrast, there were forty-eight states demonstrating widespread activity in week 2 (see Flu Update #6) and forty-seven states reporting widespread flu in week 1 (see Flu Update #5). Many healthcare facilities have implemented some form of visitation limits in effort to reduce the spread of influenza within the patient population.

Viral surveillance results for week 3, 2013 shows 26.1% (3,129) of the 11,948 samples tested positive for flu, down slightly from week 2 where 29.4% (3,638) of the 12,360 samples tested positive for flu. The proportion of deaths related to influenza and pneumonia remain  above epidemic threshold for week 3. The elderly continue to make up the majority of people hospitalized with ILI as 50% of hospitalizations were those aged 65 or older.

Outpatient ILI surveillance (those seen at clinics and doctors offices for ILI complaints) was 4.3% for week 3 and remained above the national base line of 2.2%.

Antiviral resistance is a non-issue at this point. None of the circulating strains (H1N1, H3N2 or Influenza B) are resistant to Oseltamivir or Zanamivir.

CDC Flu Interactive Map



Google Flu Trends Data

Sickweather Data

In the news
Minnesota Department of Health: Flu remains widespread but may be past peak
Can you emit influenza during routine care? A new study suggests that patients with influenza can emit small virus-containing particles into the surrounding air during routine patient care, potentially exposing health care providers to influenza.