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H1N1 Pandemic - As of November 1, 2009
CGA CONTACT INFORMATION The California Grocers Association is monitoring the current H1N1 (swine flu) situation and will continue to provide periodic updates. If you have questions, email Dave Heylen, CGA, or call (916) 448-3545. LATEST H1N1 INFORMATION (November 16, 2009) The Centers for Disease Control and Prevention (CDC) reports that although H1N1 flu activity is still widespread, the number of people visiting physicians in the US for influenza-like illness has decreased for the second straight week in the U.S. and in California. However, visits to doctors for influenza-like illness remain higher than what is seen during the peak of many regular flu seasons. The number of cases seems to be slowing in the U.S. while activity is increasing in other countries. CDC estimates that there have been approximately 22 million cases of H1N1 illness in the U.S. resulting in approximately 98,000 hospitalizations with 3,900 deaths (including 540 pediatric deaths). Hospitalizations and deaths continue to climb and remain higher than expected for this time of year. Rates are highest in the younger population with the highest being 0-4 years old. To date there have been 5,380 hospitalizations (13.9 per 100,000 population) resulting in 297 pandemic H1N1 deaths in California. Influenza circulating in the State continues to be predominantly H1N1. Twenty-five local health departments and five Operational Areas have activated their Emergency Operations Centers. Some counties have declared a Proclamation of Local Emergency including most recently San Bernardino and Ventura. Supply of H1N1 vaccine continues to be problematic with significant delays in shipping delivering only about two-thirds of the originally promised doses in the U.S. California has received 4,389,700 doses (12% of U.S. shipments). The California Department of Public Health anticipates receiving an increase of vaccine culminating in 20 million doses by the end of January. Typically 13 million doses of seasonal flu vaccine are administered via 40,000 vaccinators each year in the State. CDPH anticipates providing 33 million seasonal and H1N1 vaccinations this flu season. The vaccination is still only available to targeted groups and it is unknown when it will be made available to the general public. Companies interested in becoming a vaccinator can find further information at www.calpanflu.org. Immunization training and resources can be found at www.eziz.org. Individuals may find local vaccination sites through www.flu.gov or www.cdph.ca.gov. State and Federal stockpiles of N95 masks, antivirals and personal protective equipment continued to be shipped to local health authorities. A very worthwhile document created for businesses of all size was just released. The Minnesota Center for Infectious Disease Research and Policy (CIDRAP) in conjunction with the Society for Human Resource Management (SHRM) has produced “Doing Business During an Influenza Pandemic: Human Resource Policies, Protocols, Templates, Tools & Tips.” This free reference is available here. LATEST H1N1 INFORMATION (November 1, 2009) While most people who have been sick with H1N1 influenza have recovered without needing medical treatment, as of mid-October more than 3,000 people have been hospitalized and 219 deaths have occurred in the state of California. The number of flu cases, 95 percent confirmed H1N1, is very high for this time of year and continues to increase. The illness is statewide with over half of the state's jurisdictions reporting active outbreaks, although most likely there are many more cases than reported due to the fact that surveillance and laboratory testing continues to be focused only on severe cases. Although the most severe cases have been linked to people with pre-existing health conditions, 30-40 percent of those hospitalized nationwide have had no underlying health conditions. Necessary precautions should be taken to avoid becoming infected. H1N1 Compared to Seasonal Flu Although the symptoms and overall mortality rate of H1N1 are similar to seasonal flu there are several key differences. More people will become ill from H1N1 due to the lack of immunity. Second, seasonal flu typically impacts those over the age of 65 with pre-existing health conditions. This pandemic strikes those between 6 months and 50 years of age with the average age of 17 for all cases. Twenty-eight is the average age of people hospitalized and 45 is the average age of death due to H1N1 in California. 2009-2010 Flu Season Challenges Everyone will be affected by this prolonged illness. Workforce disruption is expected. State officials recommend that businesses prepare for as much as 30 percent absenteeism during the peak of the season. The Southern Hemisphere experienced 30-40 percent absenteeism due to the illness. Many sectors of the healthcare system are already becoming over loaded. Some hospitals have deployed external triage tents for patients with influenza-like symptoms. A scarcity of medical and other related supplies including antivirals and masks is an ongoing challenge. The California Department of Public Health requests that companies provide information to their employees and the public on how to reduce the risk of illness including vaccinations, antivirals, social distancing and personal health and hygiene. See the resources section below for information and materials available for employers. Grocery Industry Recommendations The grocery industry is a medium-risk industry due to necessary and unavoidable contact with the public. In addition, the industry is one of 13 identified critical infrastructures in the United States. As a result, federal, state and local government expect that every business involved in the production and delivery of food be as prepared as possible for disasters including public health emergencies such as pandemic influenza. Every grocery business should consider the following: H1N1 Vaccine in California There have been a total of 750,000 doses of vaccine shipped to California; 200,000 of which are the injectable vaccine. The majority of the vaccine has been distributed via private practice office with a small portion going through the state health department to local health departments. The state expects 20 million doses to be shipped to California by the end of the year. Over the past two years, the California Grocers Association has participated in the State’s process to establish a distribution priority system whereby critical infrastructure (including the grocery industry) was placed in the second highest category to receive any type of medications, antivirals, vaccines, etc. in the event of a health emergency. Due to the nature of how this virus has unfolded, the State believes it is necessary to follow the CDC's recommendation focusing on individuals as opposed to occupational groups. Therefore distribution efforts continue to target the following individuals although the vaccine will be available to everyone at some point. That time has not yet been determined. At this time, companies should provide vaccination information to employees to encourage those who fit the above criteria be vaccinated. In addition to health providers and local health departments there are several large chain drug stores, mass merchants and grocery stores that are already approved to distribute the vaccine. Log on to www.calpanflu.org to determine eligibility requirements and apply to serve as a distribution center. Community-Based Interventions The California Department of Public Health has provided the following information outlining their current position on various community-based interventions surrounding H1N1.
Virus Adaptation Virologists in the Netherlands reported finding two cases of the virus with a mutation within one of the proteins (PB2) of H1N1. This type of change is usually associated with increased efficiency of virus duplication in humans. It indicates that most likely the virus may be changing. Lab testing has shown that the H1N1 virus and H5N1 (Avian) virus do not appear to mix well. However, these diseases will continue to evolve through constant random mutation which is the survival mechanism of the microbial world. In early September, there was a report that three individuals in Egypt tested positive for both H1N1 and H5N1. In late August officials in Chile reported an outbreak of H1N1 in turkeys. It is the first known case of H1N1 in a species besides humans and pigs. It is believed that, as with swine, the turkeys were infected by a human source. As with pork, turkey meat is completely safe for consumption. This confirmation raises two concerns: 1) other poultry and birds may be at risk for the disease and 2) it could combine with H5N1 (Avian) flu virus. The bottom line is that all companies should prepare for a very bad flu season with possible high absenteeism rates. For questions or further information, please visit www.cagrocers.com or call Dave Heylen, CGA, at (916) 448-3545. Resources California Department of Public Health (CDPH): www.cdph.ca.gov Hotline: (888) 865-0564 from 8:00 a.m. - 5:00 p.m. daily Includes California specific employer and employee guidance, CalOSHA policies, HIPAA rules, personal protective equipment suggestions, links to local health departments and general information for the public. Federal Government Sponsored Flu Website: www.flu.gov A comprehensive repository for all types of flu information including a flu clinic locator and federal employment laws. Centers for Disease Control (CDC): www.cdc.gov Includes national-level employer and employee guidance, Federal OSHA policies, and general information for the public. Vaccine Distribution Website: www.calpanflu.org State of California -sponsored website where you can apply to become a vaccine distributor. Consumer and Food Industry Information: www.fmi.org In addition to the resources listed above, the Food Marketing Institute has produced an informational brochure geared toward consumers. Also on FMI's website is a Q/A piece developed by the Food and Agriculture Sector Coordinating Council entitled, "Food Handlers-Frequently Asked Questions about 2009 H1N1 Flu." Equal Employment Opportunity Commission (EEOC): www.eoc.gov/facts/pandemic_flu.html The Equal Employment Opportunity Commission (EEOC) provides guidance for corporations on the application of the Americans with Disabilities Act (ADA) to pandemic planning. Online Flu Screening Tools CDC and Emory University developed an algorithm for quickly sorting patients presenting flu-like symptoms click here. Emory has also worked with Microsoft to launch a public flu screening tool for people to check if they should see a health care provider: www.h1n1responsecenter.com. Consulting Services MedPrep Consulting Group: www.MedPrepGroup.com Emergency Management and Safety Solutions: www.ems-solutionsinc.com CONSIDERATIONS FOR RETAIL GROCERS Click here for a list of items grocers should consider in responding to the H1N1 pandemic. If you have been considering utilizing anti-viral medications as part of your pandemic response, it is recommended that you pursue that course of action now. The process of obtaining antiviral medications requires a medical screening exam, employee education and a prescription for each employee. ANTI-VIRAL USE AND INFECTION CONTROL The CDC has posted recommendations on anti-viral use, safety, infection control and non-pharmacological community mitigation strategies on their website. They will be issuing interim recommendations as the situation evolves. Go to www.cdc.gov/swineflu for more information. If you have been considering utilizing anti-viral medications as part of your pandemic response, it is recommended that you pursue that course of action now. The process of obtaining antiviral medications requires a medical screening exam, employee education and a prescription for each employee. H1N1 AND PORK PRODUCTS The CDC has stated that H1N1 (swine flu) viruses are not transmitted by food. You can not get H1N1 from eating pork or pork products. Eating properly handled and cooked pork and pork products is safe. Cooking pork to an internal temperature of 160 degrees kills the H1N1 virus as it does other bacteria and viruses. CALIFORNIA FOOD CODE REQUIREMENTS California Retail Food Code (Cal Code) requires that food employees who work in food facilities not work with food or utensils if they are sick with gastrointestinal illnesses, including diarrhea and/or abdominal cramps, fever, and vomiting. Food employees experiencing persistent sneezing, coughing, or runny nose that is associated with discharges from the eyes, nose, or mouth, and that cannot be controlled by medication, shall not work with exposed food; clean equipment, utensils, or lines; or unwrapped single-use utensils. It is important to note this requirement is in effect at all times, not just in pandemic flu situations. The Person in Charge (PIC) must report to the local Department of Environmental Health if an employee is diagnosed with Salmonella, Hepatitis A, Shigella, Enterohemorrhagic or shiga toxin producing E. coli, Norovirus or Entamoeba histolytica. In addition, the PIC must report to the local Department of Environmental Health if two or more people are sick with acute gastrointestinal illness. Acute gastrointestinal illness is diarrhea, either alone or with vomiting, fever, or abdominal cramps. It can also include vomiting with diarrhea or two other gastrointestinal symptoms such as fever or abdominal cramps. Exclude a food employee from the food facility if diagnosed with Salmonella, Hepatitis A, Shigella, Enterohemorrhagic or shiga toxin producing E. coli, Norovirus or Entamoeba histolytica. Only local departments can clear an excluded employee to go back to work. Restrict a food employee from working with exposed food, clean equipment, clean linens, clean utensils, and unwrapped single-service articles if the food employee is suffering from symptoms of acute gastrointestinal illness or if he/she is experiencing persistent coughing, sneezing, or nasal discharges. Restrictions can be removed by the PIC. Full California Retail Food Code Article 3 Employee Health language RECOMMENDATIONS TO BUSINESSES FROM EMS SOLUTIONS What Should Companies Be Doing Now? Here are eight things you should be doing now to prepare for a possible global pandemic.
2009 EMS Solutions 260 Whitney Street SF CA 94131 415-643-4300 www.ems-solutionsinc.com LINKS National
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