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August 9, 2015

2015/2016 Flu: Forward Thinking for the next Epidemic

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

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

Epidemic on the horizon

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

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

Plan for it

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

Take a hard look at your staffing patterns 

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

Review triage 

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

Points of Distribution

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

Practice the non-pharmaceutical countermeasures

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

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

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

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

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