CDC links:
http://www.cdc.gov/flu/swine/investigation.htm
http://www.cdc.gov/flu/swine/recommendations.htm
http://www.cdc.gov/flu/swine/key_facts.htm

California Dept. of Public Health (CDPH): http://www.cdph.ca.gov

County public health departments:
Santa Clara County - http://swineflu.sccgov.org/
San Francisco City/County - www.sfcdcp.org/swineflu.html
Alameda County - www.acphd.org
Marin County - www.marinflu.org
Contra Costa County - http://cchealth.org/topics/swine_flu/
San Mateo County - www.smhealth.org/swineflu
CalEMA list of county swine flu websites

Other useful sites:
CIDRAP (Dr. Michael Osterholm): www.cidrap.umn.edu
Regina Phelps: http://emssolutionsinc.wordpress.com/
www.promedmail.org
http://healthmap.org/en
National Swine Flu Situation Page (VueTOO)
http://www.vuetoo.com/vue1/Situationpagenews.asp?af=&sit=4540&a...

Please see pandemic flu preparedness files available on the Public Health Group main page:
http://calpartnership.ning.com/group/publichealth

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Santa Clara County swine flu information in English, Spanish and Vietnamese.
Attachments:
DHS Private Sector Office Conference Call Recap - Swine Flu
Time of Conference: May 1 Noon to 1300

Three principal facilitators on the conference call
· Damion Higbie Deputy Director, Partnership and Outreach Division Office of Infrastructure Protection, U.S. Department of Homeland Security
· Bridger McGaw, Acting Assistant Secretary, Office of Policy, Private Sector Office, U.S. Department of Homeland Security
· Jim Snyder, DHS Deputy Secretary

Conference began with a brief history of the U.S. detecting the emergence of the H1N1 Type A flu strain
· CDC first reported two mild flu cases in Southern CA on 17 Apr 09
· Virus was not seasonal flu when tested – evidence led to the appearance of a novel virus
· No exposure to pigs by sick children evident upon investigation
· CDC surveillance mechanisms immediately set up

CDC has reported 109 confirmed cases in 11 different states as of today
· One toddler death reported in Texas (Traveled from Mexico)
· CDC deploying field teams to states with outbreaks
· Illness changing to a more serve form

o Six hospitalizations
· Short incubation period – 1 to 4 days
· The infection period lasts two to seven days
· Virus sensitive to most commonly used anti-virus medications
o SNS mobilized and U.S. HHS is pushing out 25% of 50 million antiviral does should supplies be needed
o Publishing guidance for healthcare community and private sector
· Nation not in a Pandemic stage at this point

Within days of recognizing the existence of a novel virus, steps undertaken to develop a vaccine
· The process is underway

o Vaccine takes approximately 16 weeks to develop with mini doses a bit longer
· Vaccine production not an overnight process
· Possibly available in late summer or early fall

Best Guidance - sick individual should stay home
· Businesses need to align Human Resource policies to accommodate the developing situation
· Concern about workers who have traveled to Mexico
o Monitor own health and call health provider first if ill
· Virus is capable of being spread person-to-person

Speakers stressed the CDC and U.S. HHS are best and most credible primary sources of information and guidance at this time
· CDC Website is critical source of information for health care workers and general public
· Federal government and agencies will provide guidance but state/local governments may altered or totally accept the guidance issued
· Very important for Private Sector to maintain public health touch-points at local and state levels
· Keep news reporting in perspective and comments made by VP Biden about avoiding mass transportation to avoid infection
· Vital for Public-Private engagement and communications include credible information sources along with plans

Private sector should brush off pandemic plans and ensure planning efforts are synchronized with local and state health plans

EPA Website has a list of disinfectants for use in cleaning workplaces, homes and surface areas

Questions
When is there going to be an aggressive education campaign about preventing the flu and spread of germs through touching?
· CDC is rolling out guidance and instructions in English and Spanish
· Other languages forthcoming

Where should worker health be monitored if travel to Mexico occurred? Concern exists about fears arising among coworkers and the workforce in general.
· Monitor temperature and other symptoms
· If sick, don’t go to work or becoming ill, leave the workplace

CDC Scale removed from its Website
· U.S. stages have not been updated recently
· Relying temporarily on WHO Phase Alert
o WHO pandemic alert stages differ from US alerting system

How long will it take to recover from flu and is re-infection possible?
· Limited experience with current virus
· Duration 2-5 days
· Fever will shed virus
· Learning curve will improve with increases in cases leading to knowledge of the current flu
· Travelers from Mexico are being given a card to monitor physiological signs
· Current strain will “drift” and change genetically
o Re-infection is possible when flu re-emerges during the next season
o A probable scenario since this a novel virus

Will virus persistent in deceased and pose risk to funeral directors?
· Viruses generally “die” when host deceases
· Follow protective procedures as a precaution anyway
· Monitor personal health

Jim Caverly, DHS CIP Directorate – Decisions about assembly, schools, business operations, and other mitigation measures will be made at local level by public health agencies and governors at state level
· No Federal intervention planned

David Pagan – Custom Border Protection
· Precautionary measures implemented with state and Federal partners
o Monitoring persons entering the country
o Protocols in place for persons displaying symptoms
· No plans to close the nation’s borders or crossing in Southern Texas

Guidance relevant to VP Biden’s comments made this morning is forthcoming and will be posted on the CDC Website
· Controversial Comments: Neither he nor his family should be traveling in “confined spaces” like airplanes or subways where a cough or a sneeze by a person infected with swine flu could spread the illness. Asked whether he’d advise his family against a trip to Mexico, the vice president said: “It’s not just going to Mexico, if you’re any place in a confined aircraft and one person sneezes it goes all the way through the aircraft. That’s me. I would not be at this point, if they had another way of transportation, suggesting they ride the subway.”
· If sick stay home is the best rule of thumb presently

Speakers recommended businesses stay in touch with local health authorities as to planned actions and don’t get ahead of them especially in regard to medications – coordination is important

Emphasize individual measures
· Begin and end day by wiping down common and exposed surfaces like keyboards, telephones, desktops, etc with disinfectant
· Practice proper hygiene

CI/KR can contact National Infrastructure Coordination Center 24/7 at NICC@dhs.gov for questions or by telephone - (202) 282-9201

E-mail box for Private Sector lessons learned, success stories and requests for additional information -private.sector@dhs.gov

DHS Deputy Secretary Jim Snyder provided closing comments
· Another conference call scheduled for next Monday, May 4, 2009
· The Department (DHS) wants to maintain a policy of open and wide communication
· Posting of individual U.S. actions will continue separate from World Health Organization (WHO)

Next call with Private Sector is Monday, May 4, 2009

Lauren B. Armistead
Executive Director

Homeland Security Advisory Council (HSAC)
Business Executives for National Security (BENS)
Los Angeles, California 90071
Larmistead[at sign]hsac.bens.org
www.hsac.bens.org
From: Olivia Bruch [mailto:Olivia.Bruch@sfdph.org]
Sent: Mon 5/4/2009 11:42 AM
Subject: Updated H1N1 webpage with San Francisco-specific updates, twitter, and more

San Francisco has revamped it's H1N1 (Swine) Flu Website!

There's now more information:

San Francisco-specific updates
More FAQs
Guidance on what to do if you think you are ill
Real time updates
and more....

We're also now on twitter and facebook. Sign-up through the website!

http://www.sfcdcp.org/H1N1flu.html
MedPrep Consulting Group LLC
Dr. Stuart B. Weiss

IMPORTANT INFLUENZA UPDATE #15
WHO PANDEMIC ALERT LEVEL 5

MAY 6, 2009

Daily Brief Call Today at 1:00PM call-in: 866-369-8761
(we will modify Daily Brief call schedule based on the need. We will post future call schedule here)

SUBSCRIBE: Click button at bottom or send email to alert@MedPrepGroup.com

CDC expects a big bump in U.S. cases in the next few days but it will be hard to find it in the media

On the CDC media briefing call yesterday, Dr. Besser, the acting head of the CDC said that they expect a big bump in reported U.S. cases as states work through the backlog of specimens. The CDC also posted relaxed school guidance reflecting the new understanding of the H1N1 (swine) virus.

CURRENT SITUATION:
• The WHO is reporting that since yesterday, the number of confirmed cases increased from 1124 people in 21 countries to 1516 people in 22 countries around the world. The WHO kept the Pandemic Phase at 5 and will only raise it to 6 if there is sustained community level outbreaks in other parts of the world (note: Spain already is reporting 57 cases)
• In the U.S. there are 403 confirmed cases and about 700 probable cases in 44 states (as per media briefing yesterday). Texas reported the second U.S. death related to H1N1 (swine) in a 33 year old pregnant woman. Apparently she had underlying medical problems and died earlier in the week.
• Mexico continues to report a marked drop in the number of people presenting to hospitals with flu-like illness. Mexico is reopening government offices and restaurants today and will reopen museums, libraries and churches tomorrow
• The vast majority of cases outside of Mexico continue to be mild influenza illness which people recover from uneventfully
• China continues to brace itself against a repeat of the 2003 SARS outbreak situation. China has now changed the Visa requirements for U.S. citizens traveling to China. All Visas will now require 6 business days to process. Express and rush services for U.S. citizens have been cancelled. U.S. citizens also must declare what countries and what U.S. states they have visited within the past two weeks
• The CDC posted new relaxed guidance on school closures which now emphasizes keeping children and staff home if they are sick but removes the recommendation to close schools if they have a confirmed case of H1N1 (swine). This reflects the new understanding of the disease caused by the H1N1 (swine) virus. You can find the new guidance at: http://www.cdc.gov/h1n1flu/K12_dismissal.htm
• The CDC reported on the media briefing call yesterday that there are 86 CDC personnel working on tracking the outbreak with 16 deployed to help in Mexico.
• The CDC also reported that states are gaining the ability to test for H1N1 (swine) themselves (previously only the CDC could confirm H1N1 (swine)) and will be working through all the specimens they have. This could cause a bump in the reported number of cases and does not mean that there has been a huge resurgence of new cases.

HOUSEKEEPING ITEM:
If you receive this alert indirectly through a mailing list or from a friend or colleague please take a moment and sign up to receive it directly from us by clicking on the button at the bottom of this alert or by sending an email to alert@MedPrepGroup.com with the word signup in the subject.


ANALYSIS:

Its going to get harder and harder to find stories about H1N1 (swine) as the days move forward. I was at a gathering of news media here in New York City last evening and every time I mentioned H1N1 (swine) people rolled their eyes and told me that this was now old news. In fact, we get RSS feeds from most of the major news services and this morning the number of stories is greatly reduced. With all the good news about the mildness of the viral disease, you may lose your sense of urgency about this problem if you don't have offices in the Southern Hemisphere (where the flu season is just getting into full swing). My recommendation to you continues to be to not lose sight of the fact that we are not out of the woods yet. We won't know until the fall how this new virus will behave. One of the reporters last night said he wasn't worried because if it does come back, we will have a vaccine by then. That is partially true. Vaccine development is actively occurring but safe effective vaccine may not be available until the middle of the fall flu season. So don't take this opportunity to relax your efforts to mature your pandemic plan. Now is the time to work out all the kinks.

ADVICE:
• Uncouple your plan from the WHO Phases. One of the lessons we have learned from this outbreak is linking pandemic plans to WHO Phases may not be the best approach. For example, one client called us because the plan they developed required all employees to wear N-95 masks at WHO Phase 5. It also required the closing of cafeterias, shutting of non-essential services, etc. Obviously, that was not called for with this outbreak. WHO Phases and CDC Stages should be part of the criteria you use to activate parts of your plan. With our clients, we have worked out a set of criteria that triggers parts of their plan that includes CDC, WHO and other factors. You should develop these same criteria.
• Follow activities in the Southern Hemisphere. If you have meetings scheduled in the Southern Hemisphere in the next few months, it will be important to continue to follow the evolution of this outbreak.
• Emphasis good public health practices with your traveling employees. Encourage your employees who are traveling to not board trains or planes if they are sick. Create a culture that allows employees to follow good public health practices.


MedPrep Consulting Group is internationally recognized as a leader in pandemic, disaster and business continuity planning, training and exercising. Let us know if you need help reviewing your plans, designing educational posters, writing FAQ's (frequently asked questions) or policies, etc.. We have resources and expertise that you can count on.

Not preparing now would be a serious mistake should things worsen quickly.

If you have any questions or concerns that we can help you with, please feel free to reach out to me. My email is: sweiss@MedPrepGroup.com

SUBSCRIBE TO ALERTS by clicking the button below.

Dr. Stuart Weiss is a nationally recognized pandemic planning expert and CEO of MedPrep Consulting Group. MedPrep can assist you with your pandemic, disaster and business continuity planning, training and exercising needs. Drop me a note if you want more information about us.


Stuart Weiss, MD, CBCP
MedPrep Consulting Group LLC
State of California
California Emergency Management Agency (Cal EMA)
H1N1 Influenza 2009

Statewide Situation Report
May 6, 2009 - Morning Report


Please note: The following information is a comprehensive snapshot of Cal EMA efforts in support of the H1N1 Influenza activity throughout California. Every effort is taken to ensure the accuracy of the information, however due to changing conditions this data may become outdated relatively quickly. For the most accurate and up to date information please refer to the California Department of Public Health website at www.cdph.ca.gov or the Centers for Disease Control and Prevention at www.cdc.gov.

I. CURRENT SITUATION
The California Emergency Management Agency, State Operations Center (SOC) focus is to assist CDPH as needed and to develop advance plans for potential emergency operations.

II. AFFECTED AREAS
Statewide: 23 Operational Areas are reporting confirmed and probable cases of H1N1 Influenza as of 5/05/09.

A. Inland Region
1. Sacramento Operational Area
2. San Joaquin Operational Area
3. El Dorado Operational Area
4. Tulare Operational Area
5. Amador Operational Area

B. Coastal Region
1. Alameda Operational Area
2. Marin Operational Area
3. Monterey Operational Area
4. Santa Clara Operational Area
5. Solano Operational Area
6. San Francisco Operantional Area
7. San Mateo Operational Area
8. Santa Clara Operational Area
9. Sonoma Costa Operational Area

C. Southern Region
1. Los Angeles Operational Area
2. San Bernardino Operational Area
3. Riverside Operational Area
4. Imperial Operational Area
5. San Diego Operational Area
6. San Luis Obispo Operational Area
7. Orange Operational Area
8. Ventura Operational Area

III. HAZARD SPECIFIC INFORMATION
Contamination and control guidelines can be found at the California Department of Public Health website at: http://ww2.cdph.ca.gov/healthinfo/discond/pages/swineinfluenza.aspx

IV. INITIAL NEEDS
The State Operations Center is supporting the CDPH – EMSA Joint Emergency Operations Center during this event. Support has included:
A. Assist in establishing an information hotline.

B. Clarifying the resource ordering process

C. Information coordination among the affected agencies.

D. Cal EMA staff assisting CDPH Emergency Preparedness Office with Advance Planning

V. ESSENTIAL FACILITIES ACTIVATED (As of 5/05/09)
Statewide: 29 Operational Area Emergency Operations Centers (EOC) and 41 Public Health Department Operations Centers (DOC) are activated as of 5/05/09.

A. State Operations Center (0700-1900)

B. Department of Corrections DOC

C. Joint Emergency Operation Center staffed by representatives from the California Department of Public Health (CDPH), Emergency Medical Services Authority (EMSA) & the Department of Health Care Services (DHCS).
1. CDPH Richmond Campus Coordination Center (RCCC)
2. Joint Information Center

D. Inland Region Emergency Operations Center (0800-1700)
Operational Areas with local Emergency Operations Centers (EOC)
1. Butte EOC
2. Colusa EOC
3. Lassen EOC
4. Modoc EOC
5. Plumas EOC
6. Sierra EOC
7. Sutter EOC
8. Amador EOC
9. El Dorado EOC
10. Nevada EOC
11. Kern EOC
12. Kings EOC
13. Mariposa EOC
14. Merced EOC
15. Tulare EOC

Operational Areas with Local Department Operations Centers (DOC)

1. Amador County Public Health DOC
2. Butte County Public Health DOC
3. Colusa County Public Health DOC
4. El Dorado County Public Health DOC
5. Fresno County Public Health DOC
6. Glenn County Public Health DOC
7. Kern County Public Health DOC
8. Kings County Public Health DOC
9. Lassen County Public Health DOC
10. Mariposa County Public Health DOC
11. Merced County Public Health DOC
12. Modoc County Public Health DOC
13. Nevada County Public Health DOC
14. Placer County Public Health DOC
15. Plumas County Public Health DOC
16. Sacramento County Public Health DOC
17. San Joaquin County Public Health DOC
18. Shasta County Public Health DOC
19. Sierra County Public Health DOC
20. Sutter County Public Health DOC
21. Tuolumne County Public Health DOC
22. Tulare County Public Health DOC

D. Coastal Region Emergency Operations Center (0700-1900)
Operational Areas with local Emergency Operations Centers (EOC)
1. Alameda EOC
2. Napa EOC
3. San Mateo EOC
4. San Benito EOC
5. Santa Clara EOC

Operational Areas with Local Department Operations Centers (DOC)
1. Alameda County Public Health DOC
a. City of Berkeley Public Health DOC
2. Contra Costa County Public Health DOC
3. Marin County Public Health DOC
4. San Mateo County Public Health DOC
5. San Benito County Public Health DOC
6. San Francisco County Public Health DOC
7. Santa Clara County Public Health DOC
8. Santa Cruz Public Health DOC
9. Sonoma County Public Health DOC

E. Southern Region Emergency Operations Center (0800-1700)
Operational Areas with local Emergency Operations Centers (EOC)
1. Los Angeles EOC
2. Orange EOC
3. Santa Barbara EOC
4. Ventura EOC
5. San Luis Obispo EOC
6. Imperial EOC
7. Riverside EOC
8. San Bernardino EOC
9. San Diego EOC

Operational Areas with Local Department Operations Centers
1. Imperial County Public Health DOC
2. Los Angeles County Public Health DOC
i. City of Pasadena Public Health DOC
ii. City of Long Beach Public Health DOC
3. Orange County Public Health DOC
4. Riverside County Public Health DOC
5. San Bernardino County Public Health DOC
6. San Diego County Public Health DOC
7. San Luis Obispo County Public Health DOC
8. Santa Barbara County Public Health DOC
9. Ventura County Public Health DOC

VI. CRITICAL FACILITIES STATUS
A. Statewide: 35 schools have been closed due to confirmed and probable cases of H1N1 Influenza as of 5/1/09. View details below or go to CA Department of Education website at http://www.cde.ca.gov/nr/re/ht/schcloselist.asp
1. Inland Region
a. Mountain View School, Community of Visalia
b. Linden Elementary School, Community of Linden
c. Camino School, City of Camino
d. Woodville Elementary School, City of Porterville

2. Coastal Region
a. Bahia Vista Elementary School, City of San Rafael
b. Branham High School, City of San Jose
c. Brentwood Elementary School, City of Brentwood
d. Challenger School, Strawberry Park, City of San Jose
e. Coyote Creek Elementary School, City of San Ramon
f. Delphi Academy & Elan Sprit, City of Santa Clara
g. Highlands Elementary School, City of Pittsburgh
h. Lone Tree Elementary School, City of Antioch
i. Malcolm X Elementary School, City of Berkeley
j. Shores Acres Elementary School, City of Baypoint
k. Tamalpais High School, City of Mill Valley

3. Southern Region
a. Art Haycox Elementary, Oxnard
b. Barton Elementary School, City of San Bernardino
c. Charles Blackstock Junior High School, Oxnard
d. Clement Middle School, City of Redlands
e. Cole Elementary School, City of Highland
f. Indio High School, City of Indio
g. Della S. Lindley Elementary, Thousand Palms
h. Fred Moila Elementary School, City of Fountain Valley
i. Kearney High School, City of San Diego
j. Kennedy Gardens Elementary School, City of Calexico
k. Lee V. Pollard Continuation School, City of Corona
l. Lytle Creek, City of San Bernardino
m. McKinley School, City of El Centro
n. Mission Bell Elementary School, City of Riverside
o. Mission Hills High School, City of San Marcos
p. Newbury Park High School, City of Newbury
q. San Diego School of Creative and Performing Arts, San Diego
r. Sunflower Elementary School, City of El Centro
s. Washington Elementary School, City of El Centro
t. Ruth Harris Middle School, City of Bloomington
u. Shandin Hills, City of San Bernardino

VII. OPERATIONAL PRIORITIES
A. Public Health and Safety: Take action to protect public health and safety.

B. Advanced Planning: To stay focused on the current and projected emergency management needs.

C. Adequate Staffing: To ensure that staffing assignments are adequate to deal with emergency.

D. Validate Information: To confirm the accuracy of information based on the best information available.

E. Keep Information in Channels: To direct inquires and requests to the most appropriate agency or government level.

VIII. DECLARATIONS/PROCLAMATIONS (As of 5/05/09)
Statewide: 12 counties have proclaimed a Local Emergency in response to H1N1 influenza situation as of 5/05/09.

Local
A. Sonoma County proclaimed a Local Emergency on 5/04/09.
B. City of Corona proclaimed a Local Emergency on 4/30/09
C. San Francisco County proclaimed a Local Emergency on 4/30/09.
D. San Mateo County proclaimed a Local Emergency on 4/30/09.
E. Orange County proclaimed a Local Emergency on 4/30/09.
F. Tulare County proclaimed a Local Emergency on 4/30/09.
G. Santa Clara County proclaimed a Local Emergency on 4/29/09.
H. Kings County proclaimed a Local Emergency on 4/29/09.
I. Los Angeles County proclaimed a Local Emergency on 4/28/09.
J. Riverside County proclaimed a Local Emergency on 4/29/09.
K. San Diego County proclaimed a Local Emergency on 4/29/09.
L. Imperial County proclaimed a Local Emergency on 4/29/09.
M. San Bernardino County proclaimed a Local Emergency on 4/29/09.

State
The Governor proclaimed a State of Emergency on 4/28/09 to support and coordinate the State Health Department’s response. The entire proclamation can be viewed at the following link: http://gov.ca.gov/proclamation/12148/

Federal
A public health emergency was declared by the US Department of Health and Human Services on Sunday, April 26, 2009.

IX. OPEN ISSUES/UNMET NEEDS
None identified.

X. STATE AGENCY UPDATES

The CDPH/EMSA JEOC and CDPH’s Richmond Campus Coordinating Center (RCCC) remain activated at 12 hour shifts. CDPH, EMSA, the California Emergency Management Agency (Cal EMA), and the California Department of Corrections and Rehabilitation (CDCR) are staffing the JEOC. The Receipt, Storage and Staging (RSS) Warehouse is a perimeter secured Incident Post. The RSS Incident Post receives the Federal Stockpile of “Anti-Virals” and also stores the State National Stockpile of “Anti-Virals”. Currently, the supply of N95 face masks is also stored at this secured location. The RSS is monitored and secured by CHP Officers and remains activated 24/7.

The CalEMA State Operations Center (SOC) continues to assist CDPH as needed, and continues to develop advance plans for potential emergency operations in response to H1N1 outbreak. SOC is activated at 'Level 1' status until further notice. The Southern, Inland and Coastal REOC's remain activated and will be staffed daily until further notice.


Resources
--------------------------------------------------------------------------------
California Department of Public Health (CDPH) H1N1 Hotline: (888) 865-0564
Statistics | Map

04/29/2009 - Gov. Schwarzenegger Issues Proclamation to Confront Swine Flu Outbreak
04/27/2009 - Governor Holds Press Conference Regarding State Response to Swine Flu (Video)
04/24/2009 - Governor Schwarzenegger Directs State Swine Flu Response

What You Can Do To Stay Healthy
--------------------------------------------------------------------------------
There are everyday actions people can take to stay healthy.

Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
Avoid touching your eyes, nose or mouth. Germs spread that way.

Try to avoid close contact with sick people.
Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.
If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

Links to More Information
--------------------------------------------------------------------------------
Latest News from the CDC:

Center for Disease Control Website
Updates on Swine Flu Investigation (CDC)
Swine Flu and You - Questions and Answers (CDC)
Interim Guidance for Swine influenza A (H1N1): Taking Care of a Sick Person in Your Home (CDC)
Swine Influenza Key Facts (CDC)
Swine Flu Video Podcast (CDC)
Swine Influenza in Pigs and People Brochure (CDC, U.S. Department of Agriculture)
Risk of Swine Flu Associated with Travel to Affected Areas (CDC)
Datos Importantes Sobre la Influenza Porcina (Gripe Porcina) - Espanol (CDC)
PandemicFlu.gov

Swine Influenza (Flu) Clinical Guidelines

--------------------------------------------------------------------------------
California Department of Public Health:
CDPH Website
Interim Guidance for Swine influenza A (H1N1): Taking Care of a Sick Person in Your Home Apr 25, 2009
Interim Guidance on Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection and Close Contacts Apr 25, 2009
Interim Recommendations for Facemask and Respirator Use in Certain Community Settings Where Swine Influenza A (H1N1) Virus Transmission Has Been Detected Apr 26, 2009
Swine Influenza A (H1N1) Virus Biosafety Guidelines for Laboratory Workers Apr 24, 2009
This guidance is for laboratory workers who may be processing or performing diagnostic testing on clinical specimens from patients with suspected swine influenza A (H1N1) virus infection, or performing viral isolation.
Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare Setting Apr 24, 2009
Interim Guidance on Case Definitions to be Used For Investigations of Swine Influenza A (H1N1) Cases Apr 26, 2009
This document provides interim guidance for state and local health departments conducting investigations of human cases of swine influenza A (H1N1) virus. The following case definitions are for the purpose of investigations of suspected, probable, and confirmed cases of swine influenza A (H1N1) virus infection.
Nasopharyngeal Swab Collection Instructions (PDF)
Santa Clara County Public Health New Flu Virus (H1N1) Update – May 6, 2009 at 5:00 pm
A new “probable” case of H1N1 flu has been reported in a 41 year old male from Santa Clara. As with previous cases, this “probable” case will be treated as a confirmed case of this new flu. Currently there are 18 cases of the new flu (H1N1) in Santa Clara County, seven confirmed cases and 11 probable cases.

As this new flu (H1N1) outbreak unfolded over the last two weeks, the Santa Clara County Public Health Department took a cautious approach to ensure the public’s health. Information gathered over the last week in Santa Clara County and elsewhere in the country shows that most U.S. cases have been mild and very much like seasonal influenza.

Dr. Marty Fenstersheib, Health Officer for Santa Clara County, has been pleased with the County’s response. “Two weeks ago, we didn’t know how quickly or easily this virus would spread, nor how severe it could become”, said Dr. Fenstersheib. “In our exercises and planning for pandemic flu, we always envisioned a ‘worse case scenario’ with a much more severe virus. Luckily, this has not occurred. While this is still a mild flu, it is still a new flu, to which people do not have immunity and there is no vaccine. Our community needs to continue to take common sense actions to protect their own health.”

Dr. Marty Fenstersheib has re-issued guidance to school district superintendents based on the CDC’s recommendations. The Public Health Department will no longer routinely close schools and childcare centers if a case of the new flu virus is identified. Instead, the focus will be on keeping INDIVIDUAL students and staff, with flu symptoms, out of school.

Additional cases of the new flu continue to be identified and Dr. Fenstersheib is reminding the public to remain vigilant in monitoring and protecting their health:

- If sick persons exhibit a fever and any of the following: stuffy nose, sore throat, and/or coughing they should stay at home and limit contact with healthy persons.
- Sick persons should stay home for at least 7 days after they first show flu symptoms or until they stop having any symptoms, whichever is longer.
- Sick person(s) should try to stay away from people who are well. It is especially important to stay away from those who may be more likely to get very sick, like infants and young children, the elderly, pregnant women, or those with chronic diseases.
- If you are sick, think about wearing a surgical mask so that you don’t spread the virus to others. And wash your hands frequently for the same reason – so that you don’t spread the flu to others.
- Change and throw away masks when they become moist.
- If the sick person is not wearing a mask, they should cover their mouth and nose with tissues when coughing or sneezing.
- Limit the number of people taking care of the sick family member.
- Caregivers should wash their hands after they have contact with the sick person.
- Keep windows open to circulate air.
- Keep common area surfaces clean.
- Do not have visitors in your home while the person is sick.

For information about the new flu virus, H1N1, please call the California Department of Public Health toll-free hotline at 1-888-865-0564 (Monday – Friday from 7 a.m. to 6 p.m. and Saturday/Sunday from 8 a.m. to 4 p.m.).

On the web, for more information about the new flu virus (H1N1), visit www.cdc.gov/h1n1flu or for Spanish, visit www.cdc.gov/swineflu/espanol/
City/County of San Francisco Situation Briefing

Date: May 6, 2009
Time: 1540 hrs
Subject/Event: H1N1 Influenza 2009
Prepared By: David Ebarle
Please Respond to: DEM Duty Officer

Orientation & Situation: EOC remains in standby mode (potential demob to occur Friday 5/8/09 if situation warrants); DPH DOC preparing to relocate out of 1011 Turk, and to begin de-mob process)

For brevity sake, please see the CDC for a state-by-state breakdown of confirmed cases: http://www.cdc.gov/h1n1flu/

TOTAL Nationwide count as of 1100 hours EST is 642 cases, with 2 deaths (2nd reported in Texas)

**San Francisco** total is 4 confirmed, 2 probable, none are school aged. (no change from yesterday's sit rep)


Mission: Cointue to monitor situation and provide timely and accurate information to the public and stakeholders. Take appropriate action as warranted by the situation.

Execution: DPH will continue to staff DOC until such time it is determined to de-mob and return to normal/routine operations. LEO Virtual Command Center is still active.

Administration & Logistics: REOC advises of one more conference call tomorrow, at which time they will confirm shifting to an "as needed" basis. All Operational Areas continue to work on Continuity of Operation planning and staffing models; most are either starting or have de-mob plans imminent.

A reminder to those who received the email requesting cost analysis to DES Xushie Brue by COB today.

Coordination & Communication: DPH remains lead agency, with support from DEM. DEM Duty Officer remains point-of-contact at (415) 327-0543. DEM will issue another sit rep tomorrow following the REOC call.

Outlook & Contingencies: This event remains active; an assessment will be made on Friday May 8th of the status of this event, and to determine near future action/situation reports.

Attachments:

Sent by CCSF Alert to Situation Briefing (E-mail accounts) through CCSF Alert
Sent: Wednesday, May 06, 2009 4:01 PM

U.S. DEPARTMENT OF HOMELAND SECURITY
PRIVATE SECTOR OFFICE
H1N1 FLU OUTBREAK UPDATE #10

MAY 6, 2009 –5:00PM

TODAY’S NEWS
• (5/05) Remarks by Secretary Napolitano at Today’s Media Briefing on the H1N1 Flu Outbreak
o http://www.dhs.gov/ynews/releases/pr_1241615110532.shtm
• (5/05) Statement by Health and Human Services (HHS) Secretary Kathleen Sebelius and by Acting CDC Director Dr. Richard Besser Regarding the Change in CDC’s School and Child Care Closure Guidance
o http://www.hhs.gov/news/press/2009pres/05/20090505a.html
• (5/06) World Health Organization (WHO) Influenza A(H1N1) - update 17
o http://www.who.int/csr/don/2009_05_06/en/index.html

PRIVATE SECTOR CONFERENCE CALL TOMORROW POSTPONED TO MONDAY 5/11
• The conference call previously scheduled for tomorrow, 5/7 has been postponed to Monday, 11 MAY from 12:00 PM – 1:00 PM EDT. The call will include an update on the Influenza A (H1N1) situation and an opportunity for Q&A.

KEY LINKS
• (5/05) 2009 H1N1 Flu Virus and Food http://www.fda.gov/oc/opacom/hottopics/H1N1Flu/faq_food.html
• U.S. Information: http://www.cdc.gov/swineflu/?s_cid=swineFlu_outbreak_001
• Preventing the Flu: http://www.cdc.gov/flu/protect/habits.htm?s_cid=swineFlu_outbreak_003
• Plan and Prepare: http://www.pandemicflu.gov/
• International Information: http://www.who.int/csr/disease/swineflu/en/index.html
• Federal Response Stages: http://www.pandemicflu.gov/plan/federal/fedresponsestages.html
• Key Web Sites
o www.cdc.gov
o www.hhs.gov
o www.pandemicflu.gov
• H1N1 Flu Web Widget and Public Service Advertisements
o Post the H1N1 Flu Outbreak Web Widget (both English and Spanish) to your web site: http://www.hhs.gov/web/library/index.html#HHSWidgets
o (5/05) CDC Novel H1N1 Flu Public Service Announcements: http://www.cdc.gov/h1n1flu/psa/

KEY RESOURCES
• Q&A - Key Facts on H1N1 Flu: http://www.cdc.gov/swineflu/key_facts.htm
• CDC H1N1 Flu Guidance: http://www.cdc.gov/swineflu/guidance/
• H1N1 Flu (Swine Flu) and YouAnd You: http://www.cdc.gov/h1n1flu/qa.htm
• Taking Care of a Sick Person in Your Home: http://www.cdc.gov/h1n1flu/guidance_homecare.htm

PREPAREDNESS AND PREVENTION
• Good Health Habits Guidance: http://www.cdc.gov/flu/protect/habits.htm
• Control of Pandemic Flu Virus on Environmental Surfaces in Homes and Public Places: http://www.pandemicflu.gov/plan/individual/panfacts.html
• Interim Guidance on Environmental Management of Pandemic Influenza Virus: http://www.pandemicflu.gov/plan/healthcare/influenzaguidance.html
• Workplace Frequently Asked Questions: http://www.pandemicflu.gov/faq/workplace_questions/
• Pandemic Preparedness in the Workplace: http://www.pandemicflu.gov/plan/workplaceplanning/index.html
• Critical Infrastructure Guide: http://www.pandemicflu.gov/plan/pdf/cikrpandemicinfluenzaguide.pdf
• Health and Safety Information: http://www.pandemicflu.gov/health/index.html

TRAVEL AND TOURISM
• CDC H1N1 Flu and Travel: http://wwwn.cdc.gov/travel/

For Travelers
• Travel Warning: H1N1 Flu and Severe Cases of Respiratory Illness in Mexico — Avoid Nonessential Travel to Mexico: http://wwwn.cdc.gov/travel/contentSwineFluMexico.aspx
• U.S. Department of State Travel Alert for Mexico: http://travel.state.gov/travel/cis_pa_tw/pa/pa_3028.html
• Travel Questions: http://www.pandemicflu.gov/faq/travel/index.html
• Travelers Health: http://wwwn.cdc.gov/travel/contentSwineFluTravel.aspx
• Travelers Health (Spanish): http://wwwn.cdc.gov/travel/contentSwineFluTravelSpanish.aspx

For Industry:
• Travel Industry Pandemic Flu Checklist: http://www.pandemicflu.gov/plan/workplaceplanning/travelchecklist.html
• Information for Airline Passengers Exposed to H1N1 Flu: http://wwwn.cdc.gov/travel/contentSwineFluPassengers.aspx
• (5/04) Interim Novel Influenza A (H1N1) Guidance for Cruise Ships: http://www.cdc.gov/h1n1flu/guidance/cruiseships.htm
• Flight Crews Arriving from Affected Areas: http://www.cdc.gov/h1n1flu/guidance/air-crew-dom-intl.htm
• Identifying Passengers Who May Have Swine Influenza:
http://www.cdc.gov/h1n1flu/aircrew.htm


LINKS AROUND THE UNITED STATES GOVERNMENT

U.S. Department of Homeland Security
• (5/05) Remarks by Secretary Napolitano at Today’s Media Briefing on the H1N1 Flu Outbreak: http://www.dhs.gov/ynews/releases/pr_1241615110532.shtm

Centers for Disease Control

Main Web Site: http://www.cdc.gov/h1n1flu/
• (5/05) Statement by HHS Secretary Kathleen Sebelius and by Acting CDC Director Dr. Richard Besser Regarding the Change in CDC’s School and Child Care Closure Guidance: http://www.hhs.gov/news/press/2009pres/05/20090505a.html
• (5/05) CDC Update on School (K – 12) Dismissal and Childcare Facilities: Interim CDC Guidance in Response to Human Infections with the 2009 Influenza A H1N1 Virus: http://www.cdc.gov/h1n1flu/K12_dismissal.htm
• (5/05) Flyer for Print – Clean Hands Save Lives: http://www.cdc.gov/h1n1flu/pdf/handwashing.pdf
• (5/05) Transcript and Audio for May 1 CDC Clinician Conference Call on Maternal and Child Health Issues Related to the Current Outbreak of the New Influenza Virus of Swine Origin: http://emergency.cdc.gov/coca/confcall_archive.asp
• (5/05) What Adults with HIV Infection Should Know About the Novel H1N1 Flu (formerly called swine flu): http://www.cdc.gov/h1n1flu/hiv_flu.htm
• (5/05) CDC Briefing on Public Health Investigation of Human Cases of H1N1 Flu (Swine Flu): http://www.cdc.gov/media/transcripts/2009/t090505.htm
• (5/05) Key Mental and Behavioral Health Issues Related to Social Distancing For State, Local, And Tribal Health Departments And Community Based Organizations: http://www.cdc.gov/h1n1flu/guidance/mental-social.htm
• (5/05) Interim Guidance for Employers for Protection of Migrant and Seasonal Farmworkers from the Novel H1N1 Flu Virus: http://www.cdc.gov/h1n1flu/guidance/migrant_farmworkers.htm
• What to Do If You Get Flu-Like Symptoms: http://www.cdc.gov/h1n1flu/sick.htm
• FDA and CDC Information on Potential “Spot Shortages” of Supplies for Treating and Preventing Novel Influenza A (H1N1): http://www.fda.gov/oc/opacom/hottopics/H1N1flu/shortages.html
• What Pregnant Women Should Know About H1N1 (formerly called swine flu) Virus: http://www.cdc.gov/h1n1flu/guidance/pregnant.htm
• H1N1 Flu: Interim Guidance for People With Heart Disease, Stroke, or Cardiovascular Disease: http://www.cdc.gov/h1n1flu/heart.htm
• H1N1 Flu (Swine Flu) Infections Alert for Institutions of Higher Education: http://www.cdc.gov/h1n1flu/college-alert.htm

U.S. Department of Agriculture
• (5/05) Frequently Asked Questions about H1N1: http://www.usda.gov/wps/portal/?contentidonly=true&contentid=20...
• Statement from Secretary Vilsack on Canada’s Detection of H1N1 in Alberta: http://www.usda.gov/wps/portal/!ut/p/_s.7_0_A/7_0_1OB?contentidonly=true&contentid=2009/05/0142.xml
• Updated Statement by Agriculture Secretary Vilsack Regarding USDA Efforts Regarding H1N1 Flu Outbreak: http://www.usda.gov/wps/portal/!ut/p/_s.7_0_A/7_0_1OB?contentidonly=true&contentid=2009/04/0137.xml
• USDA Food Safety Inspection Service (FSIS) Food Safety Education Page: http://www.askkaren.gov
• USDA Meat & Poultry Hotline: 1-888-674-6854 (both English and in Spanish)

U.S. Department of Education
• H1N1 Flu & U.S. Schools: Frequently Asked Questions: http://www.ed.gov/admins/lead/safety/emergencyplan/pandemic/guidanc...

U.S. Department of Health and Human Services: PandemicFlu.gov
• (5/05) Statement by HHS Secretary Kathleen Sebelius and by Acting CDC Director Dr. Richard Besser Regarding the Change in CDC’s School and Child Care Closure Guidance: http://www.hhs.gov/news/press/2009pres/05/20090505a.html
• Frequently Asked Questions on H1N1 Flu Outbreak: http://pandemicflu.gov/faq/swineflu/
• Guidance for individuals and families preparing for pandemic: http://www.pandemicflu.gov/plan/individual/index.html.
• Planning information for community organizations: http://www.pandemicflu.gov/plan/community/index.html

U.S. Department of Labor/Office of Safety and Health Administration
• Preparing Workplaces for an Influenza Pandemic: http://www.osha.gov/Publications/influenza_pandemic.html
• Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers: www.osha.gov/Publications/OSHA_pandemic_health.pdf
• Proposed Guidance on Stockpiling of Respirators and Facemasks in Occupational Settings: http://www.osha.gov/dsg/guidance/stockpiling-facemasks-respirators....

U.S. Food and Drug Administration
• (5/05) Frequently Asked Questions on 2009 H1N1 Flu Virus and Food: http://www.fda.gov/oc/opacom/hottopics/H1N1Flu/faq_food.html
• FDA information on 2009 H1N1 Flu Virus: http://www.fda.gov/oc/opacom/hottopics/H1N1Flu/
• Fraudulent 2009 H1N1 Influenza Products List: http://www.accessdata.fda.gov/scripts/h1n1flu/
• FDA, FTC Warn Public of Fraudulent 2009 H1N1 Influenza Products: http://www.fda.gov/bbs/topics/NEWS/2009/NEW02007.html

• FDA Authorizes Emergency Use of Influenza Medicines, Diagnostic Test in Response to Swine Flu Outbreak in Humans:
http://www.fda.gov/bbs/topics/NEWS/2009/NEW02002.html

Office of Personal and Management
• Director Barry’s Memo – Flexibilities for Agencies: http://www.chcoc.gov/Transmittals/TransmittalDetails.aspx?Transmitt...
• Pandemic Influenza Information: http://www.opm.gov/pandemic/index.asp

U.S. Department of Homeland Security
Private Sector Office
Contact: private.sector@dhs.gov
(202) 282-8484
Update from San Mateo County Department of Public Health

H1N1 (swine flu) Update - May 5, 2009
It is important to remember that healthy people, with no flu symptoms, or minor flu symptoms, and not in need of medical care, should stay away from the emergency rooms, clinics and hospitals. Please take common sense precautions just as you would for seasonal flu prevention like staying home if you're sick, covering your cough and washing your hands.

Local Situation
As of May 5, 2009, there is one confirmed case and one probable case reported in San Mateo County. Surveillance and testing for H1N1 (swine flu) is focused on those with severe flu-like illness requiring hospitalization.

The San Mateo County Health System continues to work closely with state, federal, and neighboring local health authorities in monitoring and response activities. Our collective goal is to reduce the spread and illness severity of flu. There have been many cases of swine flu in California. All of those cases have been mild to moderate and those infected have recovered or are being treated. For more information, you may check www.cdph.ca.gov ( http://www.cdph.ca.gov/ ).

The San Mateo County Health System is also working closely with many local partners in this response, including school officials. No students at San Mateo County schools are known to be infected.

What You Can Do to Stay Healthy
If you work directly with the public, you do not need to change how you do work. Take the following common precautions to prevent the spread of flu:

* Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
* Cough or sneeze into your elbow instead of your hands.
* Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
* Avoid touching your eyes, nose, or mouth. Germs spread that way.
*Try to avoid close contact with sick people.
*If you are sick, stay at home from work or school and avoid social gatherings.
*If you are very sick, (high fever, dehydration, shortness of breath) talk to your healthcare provider.

In addition, please:
*Do not request H1N1 (swine flu) testing. The results will not affect what your doctor does for you.
*Do not go to the emergency department unless you are very sick.
*Do not request antiviral medications from your provider. Antivirals are to be reserved for hospitalized patients.

Additional Information
For tips on how to care for someone who is sick with the flu, download a copy of "What you can do to stop the flu: A guide to home care and prevention" from the Public Health Web site at http://www.smhealth.org/vgn/images/portal/cit_609/23/19/799377077hm...

For regular updates about the swine flu situation please visit the San Mateo County Health System website at www.smhealth.org/swineflu or call the flu hotline at (650) 573-3927.

For more information, visit the CDC's Web site http://www.cdc.gov/h1n1flu/qa.htm (http://www.cdc.gov/swineflu/swineflu_you.htm)
If you provide direct care to patients in the hospital, clinics or long term care, you should take extra precautions. See www.smhealth.org/swineflu for details.

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