ALERT: What to make of the current regional uptick in H1N1 activity in Southeastern states

(CIDRAP Business Source Osterholm Briefing) – Recent novel H1N1 influenza developments in the Southeastern region of the United States merit your attention. They're prime examples of why we must vigilantly expect the unexpected.

Of particular note are the following:

  • An unusual level of hospitalizations linked to lab-confirmed novel H1N1 influenza in the state of Georgia prompted the US Centers for Disease Control and Prevention (CDC) this week to call a short-notice press briefing and describe the uptick as a "worrisome trend." The state's current level of hospitalizations is comparable to last October when novel H1N1 infections peaked there.
  • Most of the hospitalized patients are adults who have chronic medical conditions and did not get the H1N1 vaccine. Georgia had one of the lowest rates of H1N1 vaccination last fall, and people with chronic medical conditions are among the groups considered at high risk of developing complications if they're infected by the novel H1N1 pandemic virus.
  • Regional-level spread of novel H1N1 influenza in 3 states (Georgia, Alabama, and North Carolina) was reported last week by the CDC. Regional spread is second only to widespread (in epidemiological terms), which is what we experienced in all 50 states during the peak of the second wave of the novel H1N1 pandemic. In addition, local activity is reported in Puerto Rico and eight states, mostly in the Southeast—Arkansas, Louisiana, Mississippi, North Carolina, Tennessee, and Virginia—as well as states farther west like Hawaii and New Mexico. (For more details, see this CIDRAP News article.)

I don't know the last time in April we've seen an increasing number of hospitalizations for influenza. Of note, the number in Georgia is similar to the number of hospitalizations seen at the height of the second pandemic wave last October. In short, the trend is unexpected. Does it portend a third wave of the pandemic? We just don't know. I hope not. But I sure wouldn't rule out the possibility.

On the international side, the most recent update from the World Health Organization (WHO) reported that pandemic influenza remains the most prominent influenza virus circulating worldwide and that the most active areas are in parts of tropical zones of Asia, the Americas, and Africa. Guatemala, Nicaragua, El Salvador, Panama, Brazil, Peru, and Bolivia all reported "an increasing trend in pandemic influenza activity for at least one week during March," according to the WHO.

I think it's safe to say that we can't take our eyes off this virus yet.

So what do these developments mean to your workforce? Two things:

  1. Employees need to seek medical care without delay if they become sick. This is especially critical for people who haven't been vaccinated and who are at high risk of developing complications.
  2. Employees who haven't been vaccinated need to be encouraged to do so. The possibility of a third wave is real. Furthermore, the vaccine is likely to protect against novel H1N1 next winter season.

Encourage employees to get early medical care

The good news is that (except in extremely rare cases), the antiviral medications oseltamivir (Tamiflu) and zanamivir (Relenza) can be used effectively to treat people infected by novel H1N1 influenza—if the drugs are administered early enough. Speedy medical attention is a must during these unprecedented conditions.

The following groups are at high risk of developing flu-related complications, according to the CDC:

  • Pregnant women
  • People with chronic medical conditions, including asthma, diabetes, lung disease, weakened immune systems, heart disease, blood disorders, metabolic disorders, neurological conditions, and liver and kidney disorders
  • Adults 65 years of age or older
  • Children younger than age 5, but especially younger than 2 years of age

Morbid obesity has also been recognized recently as a risk factor for hospitalization and death from novel H1N1 infection. Chances are good you have employees who fall into this category. Among Americans 20 years or older, more than one-fourth are obese and 5% are morbidly obese.

No, you can't legally ask employees to tell you if they fall into a high-risk group. But you can (1) spread the word about who is, (2) encourage employees to seek medical care at the first sign of illness, and (3) encourage them to get vaccinated if they or their family members haven't already done so.

Encourage your employees to get a vaccine

Consider this a window of opportunity. The supply of novel H1N1 vaccine is plentiful, its safety profile is similar to that of seasonal flu shots, and your encouragement might be just what people "on the fence" need to take this important protective measure. Remind employees that immunization doesn't occur as soon as the vaccine enters their body. Building immunity takes time. So the sooner employees and their families get the H1N1 flu shot, the better.

By the way: Have you been vaccinated? I got my shot as soon as restrictions (that prioritized high-risk individuals) were lifted. Some organizations are hosting on-site clinics. Could you do the same? Some other ideas include allowing employees time to get vaccinated at private or public clinics or at locations with a pharmacy that is offering them. At a minimum, provide a list of places where employees can find the vaccine.

Bottom line for organizations

We don't know whether regional flu activity in the southeastern United States means a third wave of the novel H1N1 pandemic is building or whether it's the smoldering vestiges of the second wave. Stayed tuned to CIDRAP Business Source, and we'll do everything we can to keep you informed of the most current status of novel H1N1 virus activity. For now, what we do know is that what's happening in Georgia is unusual for this time of the year and that people who are getting sick enough to need hospital care did not get vaccinated and are among the groups considered to be at high risk of developing complications.

Alert your senior management about these unprecedented developments; keep tabs on novel H1N1 and keep briefing your executives; let employees know that, given what's happening in the Southeast, they should take flu-like symptoms seriously; and by all means encourage vaccinations. Remember how surprised we were last April? Well, we're wiser and more experienced now, and that means we must always expect the unexpected.

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