MEDDESKTOP: May 2009

Monday, May 11, 2009

Be Safe, Wash Your Hands, Avoid Swine Influenza And Other Virus Infections.

WHO has published the following poster instructing the correct procedure to wash hands and be safe. Click on the diagram to download a full size PDF file that you could print and distribute.

The H1N1 Influenza Pandemic

The major determinant of the severity of an influenza pandemic, as measured by the number of cases of severe illness and deaths it causes, is the inherent virulence of the virus. However, many other factors influence the overall severity of a pandemic’s impact.

Even a pandemic virus that initially causes mild symptoms in otherwise healthy people can be disruptive, especially under the conditions of today’s highly mobile and closely interdependent societies. Moreover, the same virus that causes mild illness in one country can result in much higher morbidity and mortality in another. In addition, the inherent virulence of the virus can change over time as the pandemic goes through subsequent waves of national and international spread.

Properties of the virus

An influenza pandemic is caused by a virus that is either entirely new or has not circulated recently and widely in the human population. This creates an almost universal vulnerability to infection. While not all people ever become infected during a pandemic, nearly all people are susceptible to infection.

The occurrence of large numbers of people falling ill at or around the same time is one reason why pandemics are socially and economically disruptive, with a potential to temporarily overburden health services.

The contagiousness of the virus also influences the severity of a pandemic’s impact, as it can increase the number of people falling ill and needing care within a short timeframe in a given geographical area. On the positive side, not all parts of the world, or all parts of a country, are affected at the same time.

The contagiousness of the virus will influence the speed of spread, both within countries and internationally. This, too, can influence severity, as very rapid spread can undermine the capacity of governments and health services to cope.

Pandemics usually have a concentrated adverse impact in specific age groups. Concentrated illnesses and deaths in a young, economically productive age group will be more disruptive to societies and economies than when the very young or very old are most severely affected, as seen during epidemics of seasonal influenza.

Population vulnerability

The overall vulnerability of the population can play a major role. For example, people with underlying chronic conditions, such as cardiovascular disease, hypertension, asthma, diabetes, rheumatoid arthritis, and several others, are more likely to experience severe or lethal infections. The prevalence of these conditions, combined with other factors such as nutritional status, can influence the severity of a pandemic in a significant way.

Subsequent waves of spread

The overall severity of a pandemic is further influenced by the tendency of pandemics to encircle the globe in at least two, sometimes three, waves. For many reasons, the severity of subsequent waves can differ dramatically in some or even most countries.

A distinctive feature of influenza viruses is that mutations occur frequently and unpredictably in the eight gene segments, and especially in the haemagglutinin gene. The emergence of an inherently more virulent virus during the course of a pandemic can never be ruled out.

Different patterns of spread can also influence the severity of subsequent waves. For example, if schoolchildren are mainly affected in the first wave, the elderly can bear the brunt of illness during the second wave, with higher mortality seen because of the greater vulnerability of elderly people.

During the previous century, the 1918 pandemic began mild and returned, within six months, in a much more lethal form. The pandemic that began in 1957 started mild, and returned in a somewhat more severe form, though significantly less devastating than seen in 1918. The 1968 pandemic began relatively mild, with sporadic cases prior to the first wave, and remained mild in its second wave in most, but not all, countries.

Capacity to respond

Finally, the quality of health services influences the impact of any pandemic. The same virus that causes only mild symptoms in countries with strong health systems can be devastating in other countries where health systems are weak, supplies of medicines, including antibiotics, are limited or frequently interrupted, and hospitals are crowded, poorly equipped, and under-staffed.

Assessment of the current situation

To date, the following observations can be made, specifically about the H1N1 virus, and more generally about the vulnerability of the world population. Observations specific to H1N1 are preliminary, based on limited data in only a few countries.

The H1N1 virus strain causing the current outbreaks is a new virus that has not been seen previously in either humans or animals. Although firm conclusions cannot be reached at present, scientists anticipate that pre-existing immunity to the virus will be low or non-existent, or largely confined to older population groups.

H1N1 appears to be more contagious than seasonal influenza. The secondary attack rate of seasonal influenza ranges from 5% to 15%. Current estimates of the secondary attack rate of H1N1 range from 22% to 33%.

With the exception of the outbreak in Mexico, which is still not fully understood, the H1N1 virus tends to cause very mild illness in otherwise healthy people. Outside Mexico, nearly all cases of illness, and all deaths, have been detected in people with underlying chronic conditions.

In the two largest and best documented outbreaks to date, in Mexico and the United States of America, a younger age group has been affected than seen during seasonal epidemics of influenza. Though cases have been confirmed in all age groups, from infants to the elderly, the youth of patients with severe or lethal infections is a striking feature of these early outbreaks.

In terms of population vulnerability, the tendency of the H1N1 virus to cause more severe and lethal infections in people with underlying conditions is of particular concern.

For several reasons, the prevalence of chronic diseases has risen dramatically since 1968, when the last pandemic of the previous century occurred. The geographical distribution of these diseases, once considered the close companions of affluent societies, has likewise shifted dramatically. Today, WHO estimates that 85% of the burden of chronic diseases is now concentrated in low- and middle-income countries. In these countries, chronic diseases show an earlier average age of onset than seen in more affluent parts of the world.

In these early days of the outbreaks, some scientists speculate that the full clinical spectrum of disease caused by H1N1 will not become apparent until the virus is more widespread. This, too, could alter the current disease picture, which is overwhelmingly mild outside Mexico.

Apart from the intrinsic mutability of influenza viruses, other factors could alter the severity of current disease patterns, though in completely unknowable ways, if the virus continues to spread.

Scientists are concerned about possible changes that could take place as the virus spreads to the southern hemisphere and encounters currently circulating human viruses as the normal influenza season in that hemisphere begins.

The fact that the H5N1 avian influenza virus is firmly established in poultry in some parts of the world is another cause for concern. No one can predict how the H5N1 virus will behave under the pressure of a pandemic. At present, H5N1 is an animal virus that does not spread easily to humans and only very rarely transmits directly from one person to another.

WHO World Health Organization

Taking Care Of H1N1 Swine Influenza Patient At Home

Swine influenza A virus infection (swine flu) can cause a wide range of symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu.

People with swine flu also can have vomiting and diarrhea. Like seasonal flu, swine flu in humans can vary in severity from mild to severe. Severe disease with pneumonia, respiratory failure and even death is possible with swine flu infection. Certain groups might be more likely to develop a severe illness from swine flu infection, such as persons with chronic medical conditions. Sometimes bacterial infections may occur at the same time as or after infection with influenza viruses and lead to pneumonias, ear infections, or sinus infections.

CDC, the U.S. Centers for Disease Control and Prevention has pulished a dynamic document tha procides interim guidance that will get updated as needed. So if you are sick or taking care of H1N1 patient, bookmark the taking care of a sick person at home document.

People with swine flu who are cared for at home should:

check with their health care provider about any special care they might need if they are pregnant or have a health condition such as diabetes, heart disease, asthma, or emphysema
check with their health care provider about whether they should take antiviral medications
stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer
get plenty of rest
drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants) to keep from being dehydrated
cover coughs and sneezes. Clean hands with soap and water or an alcohol-based hand rub often and especially after using tissues and after coughing or sneezing into hands.
avoid close contact with others – do not go to work or school while ill
be watchful for emergency warning signs (see below) that might indicate you need to seek medical attention

Follow this link for the CDC Publication. The Centers for Disease Control and Prevention (CDC) Hotline (1-800-CDC-INFO) is available in English and Spanish, 24 hours a day, 7 days a week.

H1N1 Swine Influenza Guidance For The Public And Clinicians

The United States has 2,618 cases of the H1N1 swine influenza in 44 states (click on the map above to see a large version), and three deaths, CDC, the U.S. Centers for Disease Control and Prevention reported on Monday.

CDC anticipates that there will be more cases, more hospitalizations and more deaths associated with this new virus in the coming days and weeks because the population has little to no immunity against it. Novel influenza A (H1N1) activity is now being detected in two of CDC’s routine influenza surveillance systems as reported in the May 8, 2009 FluView. FluView is a weekly report that tracks U.S. influenza activity through multiple systems across five categories.

The H1N1 swine influenza has moved into the southern hemisphere of the world, where anual influenza season is just beginning, and could mix with circulating seasonal flu viruses or the H5N1 avian influenza virus to create new strains, according to health officials.

Clinician Guidance

CDC has issued interim guidance for clinicians on identifying and caring for patients with novel H1N1, in addition to providing interim guidance on the use of antiviral drugs. Influenza antiviral drugs are prescription medicines (pills, liquid or an inhaler) with activity against influenza viruses, including novel influenza H1N1 viruses. The priority use for influenza antiviral drugs during this outbreak is to treat severe influenza illness, including people who are hospitalized or sick people who are considered at high risk of serious influenza-related complications.

Public Guidance

In addition, CDC has provided guidance for the public on what to do if they become sick with flu-like symptoms, including infection with novel H1N1. CDC also has issued instructions on taking care of a sick person at home. Novel H1N1 infection has been reported to cause a wide range of symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. In addition, a significant number of people also have reported nausea, vomiting or diarrhea. Everyone should take everyday preventive actions to stop the spread of germs, including frequent hand washing and people who are sick should stay home and avoid contact with others in order to limit further spread of the disease.

Friday, May 08, 2009

UNIVERSAL ADOPTION OF ELECTRONIC HEALTH RECORDS

Washington, D.C. *---*Senator John D. (Jay) Rockefeller IV today introduced legislation that will facilitate nationwide adoption of electronic health records, particularly among small, rural providers. The Health Information Technology Public Utility Act of 2009 will build upon the successful use of "open source" electronic health records by the Department of Veterans Affairs as well as the "open source exchange model," which was recently expanded among federal agencies through the Nationwide Health Information Network-Connect initiative.

"We need advancements in health information technology across the board to improve the quality of care Americans receive," said Senator Rockefeller, Chairman of the Senate Finance Subcommittee on Health Care. "To make this happen, we need universal access to affordable and interoperable health information technology - from small, rural health clinics to large, urban hospitals."

Open source software refers to a computer program with unrestricted source code that does not limit the use or distribution by any organization or user.

Senator Rockefeller continued, "Open source software is a cost-effective, proven way to advance health information technology - particularly among small, rural providers. This legislation does not replace commercial software; instead, it complements the private industry in this field - by making health information technology a realistic option for all providers."

Background

Senator Rockefeller's Health Information Technology Public Utility Act of 2009 would:

Create a new federal Public Utility Board within the Office of the National Coordinator for Health IT to direct and oversee formation of this HIT Public Utility Model, its implementation, and its ongoing operation.

Implement and administer a new 21^st Century Health IT Grant program for safety-net providers to cover the full cost of open source software implementation and maintenance for up to five years, with the possibility of renewal for up to five years if required benchmarks are met.

Facilitate ongoing communication with open source user groups to incorporate improvements and innovations from them into the core programs.

Ensure interoperability between these programs, including as innovations are incorporated, and develop mechanisms to integrate open source software with Medicaid and CHIP billing.

Create a child-specific Electronic Health Record (EHR) to be used in Medicaid, CHIP, and other federal children's health programs.

Develop and integrate quality and performance measurement into open source software modules.

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