CGA Alert is a publication of the California Grocers Association
April 30, 2009

H1N1 INFLUENZA UPDATE

The World Health Organization announced on April 30 that it will refer to the new influenza virus as influenza A(H1N1).

CURRENT SITUATION

CDC's Division of the Strategic National Stockpile (SNS) continues to send antiviral drugs, personal protective equipment, and respiratory protection devices to all 50 states and U.S. territories to help them respond to the outbreak. The A(H1N1) virus is susceptible to Tamiflu and Relenza. In addition, the Federal Government and manufacturers have begun the process of developing a vaccine against this new virus.

RESOURCES

The California Grocers Association has created a member-only webpage for CGA and its members to exchange H1N1 (swine flu) information and resources. It includes a "Forum" allowing users to exchange and discuss information and ask operational questions regarding H1N1 (swine flu) with grocery industry peers and CGA staff. Local county information is also available under the Groups section. Specific information regarding the webpage is located on the site's Main page.

To join this website, log on to: www.cgadisasterpreparedness.ning.com. On the Main page, click on "Sign Up or Sign In" and register. You must sign-in to utilize the website. CGA recommends any individual with responsibilities impacted by the H1N1 virus sign up. Please forward the website address to appropriate staff.

Click here for a resource paper entitled "The Microbiological Threat to Food and Agricultural Institutions: Advanced Pandemic Planning for Executives" prepared in 2008 for the grocery and food service industry by Regina Phelps and Joseph McMenamin. It provides a very good overview exploring several areas such as communication, cleaning, social distancing, human resources as well as a great deal of information on legal issues all geared toward the food industry.

The Food Marketing Institute has a guide available from 2006, "Avian Influenza and Pandemic Preparedness A Planning Resource for the Grocery Industry" that may be helpful in your current response efforts. Click here for a copy.

EMPLOYEE/CUSTOMER ILLNESS

If a customer appears ill in a store, in addition to standard company procedures, it is recommended that store employees provide literature on the current flu virus. Click here for the updated consumer brochure from the Food Marketing Institute.

If an employee becomes ill at work there are procedures that must be followed. 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. It is important to note this requirement is in effect at all times, not just in pandemic flu situations. For more specific information click here for a copy of California's Retail Food Code Requirements.

If an employee calls in sick but does not share information regarding the nature of the illness, you may not know if he/she has H1N1. Employees are not required to inform employers and healthcare providers are not allowed to inform employers. In this scenario, you may not find out about the exposure in your store until the health department calls.

If an employee is suspected or confirmed as having H1N1 and worked in the store during the contagious period, your local health department may have additional requirements to the standard Food Code. Most likely a health department will consider three areas when assessing the situation including the employee's contact with exposed food products, exposure to other employees and exposure to customers. For example, the health department may require the store be completely disinfected, or that all exposed food in the department where the employee worked be disposed.

By the time the illness is confirmed, most likely the virus from that employee will no longer be active on any surface, however other employees may have been infected and still working with no outward symptoms. The department may take measures to inform the public of businesses or locations where the infected person visited. There are many considerations and actions that a local health department could take. There is no state or federal guidance on this issue. Decisions of this nature are made by each individual local health department.

Remember, this is a community-based outbreak and is being handled individually and sometimes differently within each locality. The local health departments control how the situation is handled. It is important for companies to make contact and work with their local health departments as the situation evolves.

CLEANING PRODUCTS

According to Federal authorities the influenza virus remains active on hard surfaces for up to seven hours and on course surfaces like upholstery for up to 30 minutes. Standard household and commercial disinfectants are effective in terminating the virus. If these cleaning products are unavailable, a solution of 5% bleach/95% water can be utilized.

SCHOOL CLOSURES

Currently multiple temporary school closings are peppered throughout the nation. A few reported districts in other states have considered closing schools early for summer break. It should be noted that no official guidance has been issued from any Federal authorities making this recommendation.

TAMIFLU AVAILABILITY

On a national level, Roche Laboratories Inc. is reporting that the availability of Tamiflu is plentiful however the distribution system has been a bit delayed. The situation is being corrected and any delays your pharmacy may be experiencing in obtaining Tamiflu should be expedited soon. Roche has a program, the Roche Antiviral Protection Program (RAPP), which enables organizations to reserve Tamiflu for pandemic plans. If you are interested, contact Alejandra Beall, Corporate Development Manager, Roche Laboratories Inc., VM: (888) 233-4802 Ext. 8583, Fax: (925) 837-8746.

PANDEMIC INFLUENZA PATTERNS

According to Dr. Stuart Weiss, MD, CBCP, MedPrep Consulting Group LLC, an outbreak of an infectious disease usually follows a bell-shaped curve in which the number of cases start off slow and then build to a peak and then fall off. It's not certain whether this disease will follow this pattern but it's probable. That pattern together with the increased amount of surveillance will lead to more cases detected in the U.S. As we have more cases, the probability of fatalities increases so it is not unexpected that we would have fatalities in the U.S. The CDC has been reporting this for several days.

It will be important to watch what happens with the number of cases over the next few weeks. Influenza spread typically slows and then stops in the Northern Hemisphere each May only to increawe in the fall. This flu virus is an influenza virus so it may follow that pattern. If we look back at the 1918 pandemic which killed millions of people, that virus followed this seasonal pattern. It was very mild in the spring and then came back in a much more serious form in September.

CGA CONTACT INFORMATION

The California Grocers Association is monitoring the current swine flu situation and will continue to provide daily updates. For further information, please visit www.cagrocers.com. If you have questions, email Jill Rulon, CGA, or call (916) 448-3545.