Call for Abstracts

 

19^th Annual Western Migrant Stream Forum

 

February 12-14, 2010

 

Seattle, WA

 

The Northwest Regional Primary Care Association invites you to submit an abstract proposal for consideration to present at the 19^th Annual Western Migrant Stream Forum.  Click here to download the abstract proposal form.  The deadline for submission is September 18, 2009.   

 

The Western Migrant Stream Forum brings together a broad representation of migrant health professionals for three days of education and training, information and resource sharing, coalition building, and policy development.  Join us as we learn about current issues, policy, and programs related to the health of migrant and seasonal farmworkers.

 

 

Please contact Seth Doyle, sdoyle@...; (206) 783-3004 ext.16, with any questions.  

 

 

Seth Doyle, MA

Migrant Health Coordinator

Northwest Regional Primary Care Association

sdoyle@..., (206) 783-3004 ext 16

 

Dear Colleagues,

 

Below please find  a recent notice from CDC on advice regarding separation of persons with H1N1 from work and school environments, in anticipation of an upsurge of the influenza in the fall cold and flu season.

 

As critical providers of primary healthcare you may find this to be helpful information as you plan your policies and response to the probability that your centers will encounter the influenza among either or both your patient and employee populations.

 

Bobbi Ryder

 

 

 

DEPARTMENT OF HEALTH & HUMAN SERVICES                                                                                                   Public Health Service

 

Centers for Disease Control

And Prevention (CDC)

Atlanta, GA 30333

 

This notice is about the exclusion period, or the amount of time persons should be away from others if they have Novel H1N1 Influenza.

 

You are signed up to receive American Red Cross updates from CDC's Community Health Outreach & Education Team (CHET).   CHET is part of CDC’s Emergency Communication System – an all-hazards response unit with resources and structures to provide emergency information through appropriate channels to multiple audiences across the country.

 

 

Please read the important public health information below and send to your constituency as you see fit.

 

 

 

 

This is an official

CDC Health Advisory

 

Distributed via Health Alert Network

Month dd, 20yy, 13:51 EDT (01:51 PM EDT)

CDCHAN-00XXX-yy-mm-dd-ADV-N

 

CDC Updates Recommendations for the Amount of Time Persons with Influenza-Like Illness should be Away from Others

 

On August 5, 2009, CDC changed its recommendation related to the amount of time people with influenza-like illness should stay away from others (the exclusion period). New guidance indicates that people with influenza-like illness should stay home for at least 24 hours after their fever is gone (without the use of fever-reducing medicine). A fever is defined as having a temperature of 100° Fahrenheit or 37.8° Celsius or greater.

 

This is a change from the previous recommendation that ill persons stay home for 7 days after illness onset or until 24 hours after the resolution of symptoms, whichever was longer. 

 

The new recommendation applies to camps, schools, businesses, mass gatherings, and other community settings where the majority of people are not at increased risk for influenza complications.  CDC recommends this exclusion period regardless of whether or not antiviral medications are used. This guidance does not apply to health care settings where the exclusion period continues to be for 7 days from symptom onset or until 24 hours after the resolution of symptoms, whichever is longer. (See http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm for guidance on infection control in health care settings.) 

 

Decisions about extending the exclusion period should be made at the community level, in conjunction with local and state health officials. More stringent guidelines and longer periods of exclusion – for example, until complete resolution of all symptoms – may be considered for people returning to a setting where high numbers of high-risk people may be exposed.

 

This exclusion period guidance for the community setting is based on epidemiologic data about the overall risk of severe illness and death. The new recommendation attempts to balance the risks of acquiring illness from influenza and the potential benefits of decreasing transmission through the exclusion of ill persons with the goal of minimizing social disruption.  This guidance will continue to be updated as more information becomes available. 

 

To read the complete revised guidance see:    http://www.cdc.gov/h1n1flu/guidance/exclusion.htm

 

This change in our recommendation has affected content on a number of other pages, including the following:

 

Visit http://www.cdc.gov/h1n1flu/guidance_homecare.htm for more information on caring for sick persons in the home.

Visit http://www.cdc.gov/h1n1flu/qa.htm questions and answers about H1N1 influenza.

For more general information on H1N1, go to http://www.cdc.gov/h1n1flu/.

 

____________________________________________________________________________________

Categories of Health Alert messages:

Health Alert           conveys the highest level of importance; warrants immediate action or attention.

Health Advisory    provides important information for a specific incident or situation; may not require immediate action.

Health Update       provides updated information regarding an incident or situation; unlikely to require immediate action.

 

##This Message was distributed to State and Local Health Officers, Public Information Officers, Epidemiologists and HAN Coordinators as well as Clinician organizations##

 

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Questions or problems?  Please contact support@....

 

Centers for Disease Control and Prevention (CDC) · 1600 Clifton Rd · Atlanta GA 30333 · 800-CDC-INFO (800-232-4636)

Located approximately 45 minutes from Philadelphia, PA, Southern Jersey Family Medical Center has 8 community and/or migrant health center.  The Migrant Outreach Coordinator is responsible for planning, developing, and implementing the provision of health education, outreach, transportation, interpretation and social services to migrant and seasonal farmworkers in the South Jersey area during the harvest

season (approx. April – October), as well as to the community at large.  The Outreach Coordinator will work with a team of 3-15 outreach specialist drivers. Openings at our Hammonton and Pemberton offices in New Jersey.  

 

Job Category: Full time

 

Salary: $32,000+ (depending on experience) with  benefits

 

Requirements: Graduation from a 4 year institution with a major in nursing, health education, public health or related field.  Bi-lingual Spanish and/or Haitian Creole or Portuguese. Must have a valid driver’s license. Must have basic computer skills and experience with MS Windows. Must be willing to work evenings Monday-Thurs and some weekends.

 

Preferred: 1 to 2 years of managerial experience, Community Health education or social service experience with farmworkers, CHES, LPN or RN. Community needs assessment, focus group facilitation and program evaluation experience.  Knowledge of the South Jersey area, organizations and needs is a plus. At least 26 years old in order to drive a company vehicle.

 

Please email carias@... by 8/21/09.

 

 

Cherie S. Arias, MPH, CHES

Health Education and Migrant Outreach Manager

Southern Jersey Family Medical Centers, Inc.

860 S. White Horse Pike, Hammonton, NJ 08037

phone: 609-567-0434 x. 4275

fax: 609-567-8632

carias@...

 

Dear Colleagues,

 

I would like to share with you the attached article on an Intern with the National Rural Health Association, Fiorella Horna Guerra.  It is always great to see positive press on the farmworker population….and Fiorella is clearly an outstanding advocate.

 

Enjoy! One page long only.

 

(www.RuralHealthWeb.org)

 

This article has been re-printed with permission from the National Rural Health Association.

 

Bobbi Ryder

 

 

 

Bobbi,

PDF version of article attached for distribution to e-groups.  Permission to share below.  Please include the full organization name (National Rural Health Association) and website (www.RuralHealthWeb.org) in the postings, as

 

We are pleased to announce the publication of an article in the Journal of Family Violence about our Familas con Voz program (see attached).

 

Familias con Voz: Community Survey Results from an Intimate

Partner Violence (IPV) Prevention Project

with Migrant Workers

Candace Kugel & Carmen Retzlaff & Suellen Hopfer &

David M. Lawson & Erin Daley & Carmel Drewes &

Stephanie Freedman

 

 

 

Candace Kugel, CRNP, CNM, MS

Migrant Clinicians Network

ckugel@...

 

 

The Migrant Clinicians Network is a force for justice in health care for the mobile poor. http://www.migrantclinician.org/donate.html

 

Your everyday outreach activities could be somebody else's solutions! Share the creative ways you're serving farmworkers with your peers in migrant health by submitting an Innovative Outreach Practice. Your submission will be considered for inclusion in FHSI's 2010 Innovative Outreach Practices Report and M/CHCs and Voucher Programs will be nominated for the Sister Cecilia B. Abhold Award--which includes a cash prize!

 

To submit an Innovative Outreach Practice, visit http://www.farmworkerhealth.org/nominate.html today. The deadline is September 18, 2009.

 

For more information on guidelines, benefits of the Sister Cecilia B. Abhold award, and previous practices submitted, visit http://farmworkerhealth.org.

 

Thank you,

 

Cassie Caravello

Project Coordinator

Farmworker Health Services, Inc.

405 14th Street Suite 909*

Oakland, CA 94612

(510) 268-0091

www.farmworkerhealth.org

 

*Please note: We have moved and are now located in Suite 909 (formerly 809).

 

Erin- while it is not an optimal option, there is also the possibility of helping the person get back to their home country. In speaking to several Mexican Consulates they have indicated that helping co-nationals return home is a major element of their work portfolio. This may be the case with other countries. If Gail is interested in having our Health Network staff work on helping people get back to their country- with the person’s consent- this is something we could do. It is a terrible circumstance and as I said not a great option but one to consider. Best, Del

 

 

 

Hi Everyone,

 

I am writing to get ideas on a heartbreaking matter. I spoke to Gail Maurer today. She is the Psychosocial/ Bereavement Director at HPC Healthcare Inc., a hospice organization that serves Hillsborough, Highlands, Polk and Hardee Counties in Florida. She called to discuss the situation with undocumented immigrants in her community. With some frequency undocumented patients are discharged from the hospital or other inpatient facilities and have absolutely no place to stay, no family, no home, nowhere. In many of these cases HPC has cared for the patients at their facility until they made their transition. Of course, all hospice patients are terminally ill. However, HPC is not really equipped to do this on a regular basis and is looking for viable alternatives. With patients who have Medicaid or other forms of insurance, they are able to place them in nursing homes or other facilities, which will not accept undocumented immigrants without insurance. County programs for the indigent also exclude undocumented immigrants.

 

We discussed the situation and came up with a few ideas, including getting the word out to the community, where compassionate individuals might be willing to let these people stay with them until they die. Another idea but longer term is to write a grant to fund some of their care. I told her I would send an email to my contacts and see if others have had experience with this or have ideas about possible solutions. It is so sad to think of someone being so alone at the end of their life. Please let us know if you have experience with this, or other ideas about how to address the situation. Gail’s contact info is below and I have copied her on this email. I would appreciate being kept in the loop so I can learn more about this.

 

Thank you.

 

Gail Maurer

Gail Maurer, LCSW, PhD

Corporate Psychosocial/Bereavement Director

HPC Healthcare, Inc.

12973 N. Telecom Pkwy., Suite 100

Temple Terrace, FL 33637

Direct: (813) 871-8017

Fax: (813) 871-8470

E-mail: maurerg@...

 

 

 

Erin Kay Sologaistoa

Florida Association of Community Health Centers

2340 Hansen Lane

Tallahassee, Florida 32301

Phone: (850) 942-1822 (ext 208)

Fax: (850) 942-9902

erin@...

www.fachc.org

 

 

Ron, its usually minimum wage with no benefits.  Depending on state they live in.

 

Mr. Rene Quintana

 

 

Dear Colleagues,

 

It’s not too late to join us for tomorrow’s webcast on Maximizing Farmworker Involvement in Board Governance.   We look forward to seeing you there tomorrow!

 

Bobbi Ryder ryder@...  and Del Garcia dgarcia@...

 

 

 

 

 

Dear Colleagues,

 

Last week I sent you an introductory email about Consumer Reports’ Best Buy Drug program.   I hope that you found the time to look it over and determine if it might be of use to you and your staff.

 

Here is a second email  which will direct you to their web site for general information on the program and to sign up for their monthly newsletter. 

 

 

• Sign up for Best Buy Drug free newsletter http://www.consumerreports.org/cro/customer-service/email-service/e-mail-newsletters/index.htm) so that you can stay informed about all of the updates.

 

• Click here (http://www.consumerreport.org/health/about/best-buy-drugs.htm#abtproject) to learn more about Consumers Reports Best Buy Drugs program.

 

 

As always we welcome your feedback on the usefulness of this information.  Ryder@...

 

 

Bobbi

 

 

Bobbi Ryder

President & CEO

National Center for Farmworker Health, Inc.

1770 FM 967

Buda, TX

(512) 312-5453 direct line

(512) 312-5451 Lisa Mendoza Miller, Assistant

(512) 312-2600

www.ncfh.org

 

Here is the latest from CDC on the H1N1Influenza.  FYI¡Ä.

 

 

FluView Influenza Activity Update

 

·         Influenza illness, including illness associated with the pandemic influenza A (H1N1) virus, is ongoing in the United States.

·         As of June 19, 2009, 21,449 confirmed and probable infections with pandemic influenza A (H1N1) virus have been identified by CDC and state and local public health departments with 87 deaths.

·         During week 23 (June 7 – 13, 2009), the June 19 FluView Report shows that influenza activity overall decreased in the United States; however, there are still higher levels of influenza-like illness than is normal for this time of year and pandemic H1N1 outbreaks are ongoing in parts of the United States, in some cases with intense activity.

·         11 states in the U.S. are reporting widespread influenza activity (Arizona, Connecticut, Delaware, Hawaii, Maine, New Jersey, New York, Pennsylvania, Rhode Island, Utah, and Virginia); 6 states and Puerto Rico are reporting regional influenza activity; 13 states and the District of Columbia are reporting local influenza activity; and 20 states are reporting sporadic activity.

·         It is very unusual for this time of year to still be having so many states reporting regional and widespread activity.

·         Pandemic H1N1 viruses now make up approximately 98% of all subtyped influenza A viruses analyzed by the U.S. WHO/NREVSS collaborating laboratories.

·         Overall, the nationwide level of outpatient visits to providers for influenza-like-illness is below the national baseline, but one of the 10 surveillance regions reported an influenza-like illness percentage above its region-specific baseline (Region II). 

o        This was in Region II, which includes New Jersey, New York, Puerto Rico, and the U.S. Virgin Islands.

o        Increases in ILI in region II likely represent an increase in influenza activity in large cities in that region, such as New York City, which is experiencing community outbreaks of pandemic H1N1.

·         Influenza-like illness decreased during week 23 in six of 10 regions compared to week 22. 

·         The proportion of deaths attributed to pneumonia and influenza (P&I) was slightly above the epidemic threshold.

·         One influenza-associated pediatric death was reported and was associated with pandemic influenza A (H1N1) virus infection during Week 23.

·         Since September 28, 2008, CDC has received 71 reports of laboratory confirmed influenza-associated pediatric deaths that occurred during the 2008-09 influenza season, six of which were due to pandemic influenza A (H1N1) virus infections.

·         It¡Çs uncertain at this time how severe this H1N1 pandemic will be in terms of how many people infected will have severe complications or death from pandemic H1N1-related illness.

·         It is likely that localized outbreaks will continue to occur over the summer and that we will see pandemic H1N1 virus, illness and death during the upcoming U.S. flu season in the fall and winter.

·         The real uncertainty is how widespread and severe the pandemic H1N1 virus will be during the 2009-2010 influenza season in the United States.

·         We are still learning about the severity and other epidemiological characteristics of the pandemic H1N1 virus and are watching the Southern Hemisphere very carefully to see how pandemic H1N1 affects their influenza season, which is just beginning.

·         This information is important and will be taken into account when making recommendations with regard to vaccine and other preventive measures in the fall.

Enhanced Influenza Surveillance in the Southern Hemisphere

 

·         The Centers for Disease Control and Prevention (CDC) is working closely with countries in the Southern Hemisphere to enhance surveillance for influenza viruses circulating in the Southern Hemisphere, including pandemic H1N1 flu.

 

• The Southern Hemisphere is just going into its flu season now and how this virus behaves will give us some clues about what we can expect for the Northern Hemisphere.

·         CDC is providing real-time, reverse transcriptase polymerase chain reaction (rRTPCR) reagents to all national influenza centers (NICs) in the Southern Hemisphere region and is working with the Pan American Health Organization (PAHO)* to increase laboratory testing capacities in South/Central America by supplying resources and training.

 

* PAHO is a regional office of the World Health Organization (WHO).

 

·         In addition, CDC is providing to all NICs in the PAHO region a supplemental WHO Influenza kit containing reagents for identification of pandemic H1N1 influenza virus in the Hemagglutination Inhibition (HI) assay.

 

·         CDC's Influenza Division has provided the necessary documents and forms with instructions for sending influenza virus isolates and specimens to CDC to 28 NICs in PAHO.

 

·         As part of CDC¡Çs efforts to enhance surveillance in the Southern Hemisphere, CDC has developed guidance for national laboratories within PAHO to send their most recent and representative influenza virus isolates to CDC more frequently: as often as every two weeks, if possible.

 

·         The World Health Organization has offered to help countries ship influenza virus isolates and specimens to CDC for testing by supplying financial and logistical support.

 

·          In addition to laboratory assistance, CDC has deployed two epidemiologists, one to Peru and one to Chile, to assist with planning enhanced surveillance activities.

 

·          A recent mission to Chile, Argentina, and Bolivia has met with the ministries of health in each of those countries to map out a strategy for enhancing surveillance.

 

·          CDC has provided $200,000 (U.S. Dollars) to the Central America Project in Guatemala to enhance surveillance for severe acute respiratory illness in five countries of Central America.

 

Summer Camp Guidance

·         CDC has heard reports of pandemic H1N1 outbreaks in summer camps in the U.S.

 

·         This is not surprising given the fact that children and young adults have been the most affected by the outbreak of pandemic H1N1 flu so far.

 

·         CDC has developed guidance for day and residential camps in response to human infections with pandemic H1N1 influenza and posted this information on our website. 

 

·         It is important that camp staff members, parents and others are aware of, and use measures to protect themselves and also the public¡Çs health by making plans for how to prevent and control outbreaks in camps and other places that children and young adults gather. 

 

·         CDC is recommending that the primary way to reduce spread of influenza in camps is to focus on identifying ill campers and staff as soon as possible, moving ill persons away from well campers, treating ill campers, educating campers and staff about good cough and hand hygiene etiquette, and educating camp facilitators and administrators about environmental controls that should be in place to encourage use of these practices.

 

·         CDC is recommending that people who currently have or have had influenza-like symptoms in the previous seven days should not attend, work or volunteer in a camp until at least seven days AFTER their symptoms began or until they have been symptom-free for 24 hours, whichever is longer. 

 

·         Camp staff, volunteers, and campers should be aware of the symptoms of pandemic H1N1 flu and rapidly report to camp staff if they recognize any of them in campers or themselves.

 

·         CDC is encouraging camp administrators and facilitators to work with parents to plan ahead for what to do in the event that their child becomes ill while at camp. 

 

·         Camps should work with local public health authorities to develop plans for addressing potential camp outbreaks and establish an open line of communication. 

 

·         Hand washing facilities, including running water and soap, should be available to all campers and staff.  Everyone should be reminded to use good hand hygiene (hand washing and appropriate use of alcohol-based gels) and good cough etiquette (covering coughs and sneezes).

 

·         Aspirin or aspirin-containing products should not be given to any person 18 years old or younger with a confirmed or suspected case of influenza, due to the risk of Reye¡Çs syndrome. 

 

 

MMWR: Novel H1N1 virus infections among healthcare personnel

 

• On June 19, 2009 the Morbidity and Mortality Weekly Report (MMWR) published a report entitled ¡ÈNovel Influenza A (H1N1) Virus Infections Among Healthcare Personnel ¨¡ United States, April – May 2009¡É

 

• As of May 13, 2009, CDC had received information on 48 confirmed or probable pandemic H1N1 infections reported to have occurred in people who worked in the healthcare profession; 26 with detailed information.

 

• Of the 26 cases, CDC found that:

 

o        13 healthcare personnel (HCP) (50%) were deemed to have acquired infection in a healthcare setting which could have been from provider-to-provider (1) contact or patient-to-provider (12) contact. 

 

o        11 healthcare workers (42%) were deemed to have been infected in the community.

 

o        2 HCP (8%) had no reported exposures in either healthcare or community settings.

 

• Two infected HCP were hospitalized, one of whom reported underlying medical conditions. Neither hospitalized HCP was admitted to the intensive care unit; neither died.

 

• None of the HCP with potential patient-to-provider transmission of pandemic H1N1 influenza reported adhering to all recommended infection control practices for all contacts with possible source patients. 

 

• These findings cannot definitely establish whether these instances of patient-to-provider transmission were related to non-adherence to certain parts of personal protection equipment.

 

• Whatever the risk of infection to HCP, this report suggests that much of it exists in the outpatient setting, such as outpatient clinics and emergency rooms.

 

• Current CDC infection control recommendations for the care of patients with pandemic H1N1 infections include:

 

o        Administrative actions such as exclusion of ill HCP from work

o        The use of fit-tested N-95 respirators

o        Eye protection

o        Use of gloves and gowns

o        Aerosol-generating procedures should be performed in an airborne infection isolation room with negative pressure air handling

 

• HCP were defined as employees, students, contractors, clinicians or volunteers whose activities involved contact with patients in a healthcare or laboratory setting.

 

• These case reports do not contain enough information to determine effectiveness of specific types of personal protection equipment to protect against infection of pandemic H1N1 infection.

 

WHO Declaration Phase 6

·         On June 11, 2009, the World Health Organization (WHO) raised the worldwide pandemic alert level to Phase 6.

• Designation of this phase indicates that a global pandemic is underway.

·         There are now community level outbreaks ongoing in other parts of the world.

·         While U.S. influenza surveillance systems indicate that overall flu activity is decreasing in the United States, pandemic H1N1 outbreaks are ongoing in different parts of the U.S., in some cases with intense activity.

·         In the United States, this virus has been spreading efficiently from person-to-person since April and, as we have been saying for some time, we do expect that we will see more cases, more hospitalizations and more deaths from this virus.

·         Because there is already widespread pandemic H1N1 disease in the United States, the WHO Phase 6 declaration does not change what the United States is currently doing to keep people healthy and protected from the virus.

·         Thus, there is no change to CDC¡Çs recommendations for individuals and communities.

·         WHO¡Çs decision to raise the pandemic alert level to Phase 6 is a reflection of epidemiological changes in other parts of the world and not a reflection of any change in the pandemic H1N1 virus or associated illness.

·         At this time, most of the people who have become ill with pandemic H1N1 in the United States have not become seriously ill and have recovered without hospitalization.

·         In the United States, we have been preparing for this for some time.

·         And we are actively and aggressively implementing our pandemic response plan.

• Phase 6 is an indicator of spread and not of severity.

·         It¡Çs uncertain at this time how serious or severe this pandemic H1N1 pandemic will be in terms of how many people infected have severe complications or death related to pandemic H1N1 infection.

• There were three influenza pandemics in the last century and they varied widely in severity.
• The 1918 pandemic killed tens of millions of people.
• The 1957 pandemic is thought to have resulted in at least 70,000 deaths in the United States.
• Deaths from the 1968-69 pandemic were about the same as for seasonal influenza.
• This pandemic certainly poses the potential to be at least as serious as seasonal flu, if not more so.
• Because this is a new virus, many people will not have immunity to it and illness may be more severe and widespread as a result.
• We are still learning about this virus and expect that, like all influenza viruses, it will continue to change.

We are taking action:

• The Federal Government is mounting an aggressive response to this newly declared pandemic.
• CDC¡Çs goals during this public health emergency are to reduce transmission and illness severity, and provide information to assist health care providers, public health officials and the public in addressing the challenges posed by this newly identified influenza virus.
• To this end, CDC continues to update guidance.
• Visit the CDC website at http://www.cdc.gov/h1n1flu/ for more information or call 1-800-CDC-INFO.

·         Everyday, we learn more about this virus and what we learn will continue to inform the actions that we take in response.

·         We are aggressively taking early steps in the vaccine manufacturing process, working closely with manufacturing and the rest of the government.

·         Vaccines are a very important part of a response to pandemic influenza.

·         CDC isolated the pandemic H1N1 virus, made a candidate vaccine

·         virus, and has provided this virus to industry so they can begin scaling up for production of a vaccine, if necessary.

·         There are many steps involved with producing a vaccine and we are committed to going forward with the NIH, and FDA, BARDA, and the manufacturers of influenza vaccines, to see about developing full scale vaccine production.

·         Where possible, we are taking parallel steps to speed up the vaccine process.

• If things go well, and we develop a full scale production, it would be several months until the vaccine were available.
• So vaccine is an important tool for the future.

Pandemic Severity

·         Influenza pandemics can range in severity, mainly in terms of the number of people that have severe illness and die.

·         Pandemic severity may also change over time and will differ across regions of the world, in different countries and even within different communities within a country.

·         Pandemic disease severity will vary depending on several factors: a nation¡Çs ability to provide health care to their people, the availability of antiviral medications to treat those who are sick, differences in how the disease affects people in different age groups, and the effectiveness of efforts to reduce person-to-person transmission of influenza.

·         An evaluation of pandemic severity should be based on local circumstances for this reason.

·         A pandemic severity index helps pubic health officials to match the timing of the spread and severity of the outbreak with the appropriate use of public health and community resources to minimize the number of people who get sick and the number of people who die. 

• WHO has a three point scale to determine pandemic severity: mild, moderate and severe.
• At this time, WHO has indicated this seems to be a moderately severe pandemic.

U.S. Pandemic Severity Index (PSI)

• CDC developed the U.S. Pandemic Severity Index (PSI) to describe the severity of a pandemic in terms of illness and death.
• The U.S. PSI scale is based on the case-fatality ratio; the likelihood of people dying from the disease.
• The PSI scale ranges from Category 1 to Category 5 and is comparable to the U.S. hurricane severity index.
• Category 1 is the least severe and Category 5 is the most severe.

·         At the current time, CDC estimates that the pandemic situation in the U.S. would be equivalent to a pandemic severity index of 2. (This would be most similar to the 1957 influenza pandemic, however, it¡Çs uncertain how the current situation will evolve over the coming months so it¡Çs not possible to make a predication about deaths at this time.)

• CDC will re-evaluate the classification of the Pandemic Severity Index should there be evidence that the pandemic has become more severe.
• The PSI will be adjusted based on that evaluation and appropriate guidelines and recommendations provided.
• CDC emphasizes that unnecessary weight not be given to the numeric categorization of the pandemic.

• According to the U.S. PSI:

• A category 1 pandemic has the following:
• Case fatality ratio of less than 0.1 percent
• Excess death rate of less than 30 per 100,000 people
• Illness rate of 20-40% of the population
• Less than 90,000 potential deaths (based on 2006 U.S. population)
• Similar to a more severe seasonal flu year in the United States
• A category 2 pandemic has the following:

¡ø         Case fatality ratio of 0.1 percent to less than 0.5 percent.

¡ø         Between 90,000 and 450,000 deaths in the U.S. (based on 2006 U.S. population)

¡ø         Excess death rate of between 30 to less than 150 per 100,000 people

¡ø         Illness rate of between 20 and 40 percent.

¡ø         Similar to 1957 pandemic.

• A category 5 pandemic has the following:
• Case fatality ratio of greater or equal to 2 percent
• Excess death rate of more than 600 per 100,000 people
• Illness rate of 20-40% of the population
• Greater than or equal to 1.8 million potential deaths (based on 2006 U.S. population)

• Similar to the 1918 pandemic
• The importance of identifying a category of severity is only to help guide the public health interventions recommended for individuals and communities.
• The PSI scale helps public health officials match the range of public health intervention efforts to the severity of a pandemic.

For a Category 1 to 3 pandemic:

• Ill adults and children are asked to stay home voluntarily.
• If someone in the household is sick, well adults and children do not need to stay at home.
• School and child care dismissal is not generally recommended, but may be considered depending on the local impact of the disease.
• Workplace and Community adult social distancing efforts (e.g., encouraging teleconferences instead of meetings, reducing density, meaning the number of people crowded into an enclosed space, in public transit and the workplace, postponing or canceling selected public gatherings, encouraging people to telework, or take staggered shifts) are generally not recommended.
• For a Category 4 to 5 pandemic
• Ill adults and children are asked to stay home voluntarily.
• If someone in the household is sick, well adults and children should stay at home too.
• School and child care dismissal is recommended for up to 12 weeks.
• Workplace and Community adult social distancing efforts (e.g., encouraging teleconferences instead of meetings, reducing density, meaning the number of people crowded into an enclosed space, in public transit and the workplace, postponing or canceling selected public gatherings, encouraging people to telework, or take staggered shifts) are recommended

Declaration of Phase 6 and Travel

 

• At this time, CDC does not recommend against travel to any country.
• CDC will continue to monitor the pandemic H1N1 situation around the world and will provide recommendations to U.S. travelers based on the changing situation.
• Travelers should check the CDC travelers¡Ç health website (www.cdc.gov/travel) for information related to this outbreak, as well as for health information on the prevention and management of flu.
• Travelers should also check the website of the embassy of the country to which they are traveling for the latest updates on entry or exit screening procedures which may impact their travel.
• CDC recommends that ill persons postpone travel both for their protection and that of other travelers.

Public:

• So far, most people who have been ill with this virus have recovered.
• We are monitoring hospitalization and death rates.
• At this point, whether you are tested and actually diagnosed with pandemic H1N1 is less important than what you do if you become sick.
• It¡Çs possible that this summer, people around you may get sick and you may get sick.
• Certainly in the fall, with our flu season, people around you will be getting sick and you may get sick.

• Be prepared to stay home for a week or so if you are ill.
• Most people infected with this virus so far have experienced the regular symptoms of flu (fever, cough, body aches, and a significant number of people have reported vomiting and diarrhea).
• For people who are critically ill, we do have antiviral medications in our arsenal against flu.
• The priority use for influenza antiviral drugs at this time is to treat severe influenza illness.

·         Influenza antiviral drugs are prescription medicines (pills, liquid or an inhaler) with activity against influenza viruses, including swine influenza viruses.

·         There are two influenza antiviral medications that are recommended for use against swine influenza. These are oseltamivir (trade name Tamiflu ®) and zanamivir (Relenza ®).

·         Influenza antiviral drugs work best when stated soon after illness onset (within two 2 days), but treatment with antiviral drugs should still be considered after 48 hours of symptom onset, particularly for hospitalized patients or people at high risk for influenza-related complications.

·         You have a role in protecting yourself and your family.

• Stay informed. Health officials will provide additional information as it becomes available. Visit www.cdc.gov
• Everyone should take these everyday steps to protect your health and lessen the spread of this new virus:

• 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 hand cleaners are also effective.
• Avoid touching your eyes, nose or mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• If you are sick with a flu-like illness, stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further.
• Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
• If you don¡Çt have one yet, consider developing a family emergency plan as a precaution.

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Centers for Disease Control and Prevention (CDC) · 1600 Clifton Rd · Atlanta GA 30333 · 800-CDC-INFO (800-232-4636)

Dear Colleagues,

 

Here are a series of links that might be of interest and assistance to you in your work with health center patients.  This information is brought to you as a result of a new partnership between the National Center for Farmworker Health and Consumer Reports Best Buy Drugs.

 

Consumer Reports has developed a significant presence related to consumer education in their choices related to prescription drugs.  This is the first of  a series of email messages that we will be sending to you on a periodic basis in hope that this information will be helpful to you, your staff, and your patients. 

 

Our assessment of this information is that the literacy level is quite high and only a limited number of the documents are currently available in Spanish as well as English.  We have already provided CBB with this feedback and they are working on literacy level adjustment, and translation.  So with that caveat, you may find that this information is most helpful to your staff for their utilization with patients as a tool in their health education endeavors.

 

 

 

Consumer Reports  Best Buy Drugs

A trusted source for providing independent analysis on the products you buy and use

every day

is now offering a new public education service.

 

Consumer Reports Best Buy Drugs works to empower consumers to make informed choices on prescription drugs based on effectiveness, safety and price.

 

Here are just a few reasons to check out Consumers Reports Best Buy Drugs online:

 

• Save Money Link to http://www.consumerreports.org/health/best-buy-drugs/money-saving-guides.htm

 

• Learn about high-quality, low-cost medicines that will save you thousands of dollars.

 

• Free, unbiased analysis of drug effectiveness
• Best Buy Drugs provides free reviews conducted by physicians and researchers offering advice for over 20 drug categories, including our best buy pick for each.

 

• Be informed. Be empowered.
• Print free downloadable guides you can use to talk to your doctor about the most effective and affordable medicines.

 

• Reports address Link to prescription and generic medicines http://www.consumerreports.org/health/resources/pdf/best-buy-drugs/money-saving-guides/english/GenericDrugs-FINAL.pdf

 

 

We welcome your input in regard to this and all other emails sent to you via this e-group.  For individual response please direct your message to me at Ryder@...

 

 

Bobbi Ryder

 

Bobbi Ryder

President & CEO

National Center for Farmworker Health, Inc.

1770 FM 967

Buda, TX

(512) 312-5453 direct line

(512) 312-5451 Lisa Mendoza Miller, Assistant

(512) 312-2600

www.ncfh.org

 

Here is an email for you from Henry Lopez at  the Office of Migrant and Special Populations, regarding availability of funding for individuals who might be interested in serving as consultants in evaluation with the RWJ Foundation.

 

Bobbi

 

 

 

FYI see below....

 

Henry Lopez, Jr., CAPT, USPHS

Director, Office of Minority & Special Populations

Bureau of Primary Health Care

Health Resources and Service Administration

Health and Human Services

 

5600 Fishers Lane

Parklawn 16-105

Rockville, Maryland 20857

(301) 594-4303

hlopez@...

 

 

 

 

Dear Colleague,

 

I am pleased to announce a new grant opportunity with the New Connections program at Robert Wood Johnson Foundation (see below and attached). We recently released the New Connections Call For Proposals (CFP) for Senior Consultants in Evaluation. We would welcome your assistance in distributing this CFP to eligible individuals who may be interested in the opportunity.

 

An applicant web conference is scheduled for Wednesday, June 17, 2009 from 3-4:30pm ET- for those interested in getting more information.

 

 

New Connections is a program designed to expand the diversity of perspectives that inform RWJF programming and introduce new researchers and scholars to the Foundation.  We work with junior investigators (those who are no more than 7 years from receipt of the doctorate) and senior consultants (individuals who do not need to have a doctorate but have at least 10 years of experience) who have been historically underrepresented in research and evaluation activities supported by RWJF (in the areas of health and health care). This includes people from ethnic or racial minority groups, first-generation college graduates and people from low-income communities.

 

The 4^th round of New Connections for Senior Consultants is focused on evaluation. Applicants to the New Connections Senior Consultant CFP must: have at least ten years of evaluation experience; be a member of a historically underrepresented group (as detailed in the CFP) in research and evaluation; be a first-time grantee to RWJF; and propose an evaluation plan for a program related to RWJF team portfolios as listed in the CFP. Brief proposals are due July 1, 2009.

 

I have copied our letter of invitation below, for your information and for you to forward to those individuals who may be interested in and eligible to apply for the New Connections Senior Consultant CFP. If you think there is a list serve where this opportunity may be of interest, please let me know (using the contact information in my signature below) and I will make contact with the list serve host.

 

If you have any questions or comments, please do not hesitate to contact Edith Arrington at earrington@... or 609) 627-6305.

 

Thank you.

Debra Joy

 

 

Debra Joy Pérez, PhD

Senior Program Officer

 

Robert Wood Johnson Foundation

Route 1 and College Road East  Princeton, NJ 08543

Tel. 609 627-5966  Fax. 609 627-5966

dperez@...

 

If you have any questions or need to set up an appointment, please contact Karen Reuter at kreuter@... or call 609 627-5954.  If you are interested in learning more about funding opportunities at RWJF please sign up for funding alerts at http://www.rwjf.org/global/signin.jsp

 

 

 

NEW CONNECTIONS: INCREASING DIVERSITY OF RWJF PROGRAMMING

 

Are you a diverse researcher or evaluator interested in funding, mentoring and training opportunities?

 

Do you have at least ten years experience in evaluation?

 

If so, the Robert Wood Johnson Foundation’s New Connections: Increasing Diversity of RWJF Programming is a wonderful opportunity.

 

Our program offers early-mid career researchers from historically underrepresented backgrounds funding opportunities, as well as a community of support, advice, and collaboration. We aim to give diverse researchers the necessary opportunities to impact change.

 

Launched in 2005 New Connections is more than a grant opportunity. It is a life-long professional network for diverse researchers. To date, New Connections: Increasing Diversity of RWJF Programming has awarded over $2 million in grants.

 

We are pleased to announce our Round 4 Call for Proposals for Senior Consultants.

  

In this fourth round of call for proposals, New Connections seeks Senior Consultants who have been underrepresented in research and evaluation activities and would be first-time grantees to RWJF. This includes researchers and evaluators who are historically underrepresented ethnic or racial minorities, first-generation college graduates, and individuals from low-income communities. Senior Consultants are those who have at least ten years of experience in research and/or evaluation.

 

Senior Consultants must propose an evaluation plan for a project connected to the Building Human Capital and Vulnerable Population portfolios. Senior Consultants are eligible for a one-year grant of up to $75,000.

 

Key Dates:

* Thursday, May 28, 2009 - CFP is released

* Wednesday, June 17, 2009 from 3-4:30pm ET- Optional applicant web conference

This is an opportunity to answer applicant questions, and is highly encouraged.

* Wednesday, July 1, 2009 by 3pm ET- Brief Proposal (8-page concept paper) is due

 

For more information and to apply, please visit the New Connections website at www.rwjf-newconnections.org 

 

Please do NOT post this on any list serve. If you have a colleague that you think would be interested in and eligible for this opportunity, please forward this email to them. If you think there is a list serve where this opportunity may be of interest please email us at rwjf-newconnections@... and New Connections will make contact with the host(s) of the list serve.

 

Thank you.

 

 

 

 

 

Q&As on the WHO Declaration of Pandemic Phase 6 for Novel H1N1 Flu as of 11:07am

 

 

PHASE 6

 

What do the WHO phases mean?

 

The WHO phases are based on the geographical spread of a novel influenza virus.  As “pandemic” means worldwide epidemic, a WHO Phase 6 means that the virus is spreading across the globe.  What the WHO phases do NOT do is predict the severity of the virus.

 

Using a hurricane analogy, the WHO phase system simply tells us that a hurricane is imminent, but it DOES NOT tell us how big or how strong the storm might be.   It is the strength of a hurricane that dictates which pre-landfall actions are needed, such as just boarding up windows versus a full evacuation.   While weather forecasters can fly an airplane into the eye of a hurricane to measure a storm’s strength and predict its ultimate severity, there is no such forecasting tool for flu viruses. 

 

Does WHO’s change to Phase 6 mean the virus is more severe?

 

No.  It is important to understand that this change is based on the geographic spread of the virus to other parts of the world and does not necessarily reflect any change in the severity of the virus or associated illness. 

 

So why did WHO move to Phase 6 if the virus severity is unchanged?

 

The move to Phase 6 is really an alert that the spread of the H1N1 virus is now expected to traverse the globe and those nations where the virus has yet to arrive should expect to eventually see cases and be prepared to respond. 

 

What does the phase change mean for the United States?  What will the U.S. do differently?

 

Here in the United States, the virus has been spreading steadily from person-to-person since April, so today’s announcement by WHO does not really change what we are already doing here at home to respond. 

 

In response to an influenza pandemic, governments, communities, workplaces and individuals will base the intensity of their efforts to reduce spread of the virus on the severity of the disease, as reflected by the number of deaths and hospitalizations from the virus.

 

The United States has been responding to the H1N1 flu in a way that balances the health of our residents while minimizing disruption to society.  We will continue to provide guidance using the most current scientific data available about the H1N1 flu.

 

Regardless of what WHO calls or labels this, we are taking necessary and aggressive measures to protect the health of our residents out of an abundance of caution. 

 

 

What actions has the U.S. taken already?

 

Since the first reports of the appearance of novel H1N1 flu in the U.S., we have been actively and aggressively implementing our pandemic response plan.  We have distributed 11 million courses of antiviral drugs nationwide, we have begun the process of procuring  a vaccine should it be needed, and we have been routinely providing the latest information to assist health care providers, public health officials and the public in addressing the challenges posed by this newly-identified influenza virus.

 

Is the outbreak over in the U.S.?

 

The  only thing certain about flu viruses is uncertainty.  As we have been saying for some time, we do expect that we will see more cases, more hospitalizations and more deaths from this virus.   However, to date most people who have become ill with novel H1N1 in the United States have not become seriously ill and have recovered without hospitalization.

 

While the number of cases in the U.S. may be waning, we are continuing to prepare for the possibility that the virus may return in the fall.   We will continue to watch this virus carefully, especially in the Southern Hemisphere.  Every day we learn more about this virus and its impact on human health.  As  we learn new information, we will adjust our responses and planning, and inform the public and continue to do all we can to make this outbreak less severe.

 

Is there anything individuals can do?

 

There are everyday common sense things that people must do to protect their health and lessen the spread of the novel H1N1 virus as well as seasonal flu viruses.  Wash your hands and cover your mouth when you cough or sneeze.  If you are sick,  stay home, recover, and keep others well. Avoid going to work or school. Delay travel plans/. Limit your contact with others . And stay informed—be sure to visit www.hhs.gov, www.cdc.gov, and www.pandemicflu.gov to get the latest information as it becomes available. You can also call 1-800 CDC INFO.

 

What does Phase 6 mean for vaccine development and production?

 

First, it is important to recognize that developing a vaccine for use, in case it is needed, is different from recommending individuals be immunized.  There is a great deal still unknown, including the severity of illness caused by the virus, how the virus will evolve, how the outbreak plays out in the coming weeks to months, and what populations may be most (or least) at risk.

 

The process of vaccine preparation is already underway and decisions regarding production will be informed by what we learn about the need for such a vaccine and what we learn about the vaccine itself as it is developed and is used in clinical studies. The goal is to have vaccine(s) ready, if needed, but this is a multi-step process and the decisions to have a vaccine ready, if needed, including, potentially, to produce such vaccines on a large-scale level, is distinct from any decision to recommend its use.

 

 

 

Are you planning an H1N1 immunization program?

 

While we are all working as fast as possible to develop the vaccine in the event that we need it, please understand that this is separate from a decision to use it, or not. Any decisions on immunization programs must be made on the best scientific and public health evidence available at the time. That said, it is very important that we prepare expeditiously and thoroughly for all potential scenarios.

 

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Centers for Disease Control and Prevention (CDC) · 1600 Clifton Rd · Atlanta GA 30333 · 800-CDC-INFO (800-232-4636)

FYI . . . this maybe of interest to those following the H1N1 situation. 

 

Best regards,

Heather

***********************

Heather Gardner, MPH

Senior Project Manager

Farmworker Health Services, Inc.

Oakland, CA

510-268-0091

heather@...

www.farmworkerhealth.org

 

 

Dear Colleagues

 

While it might feel that the issues related to H1 N1 are subsiding…this email from CDC raises the current level to 6 and declares that a global pandemic is underway.  Please see below.

 

Any feedback that you would like to send to me individually should be directed to me at Ryder@....

 

 

Bobbi

 

 

 

 

Attached are updated notes from CDC related to the WHO Declaration of Pandemic Influenza Phase 6.

• On June 11, 2009, the World Health Organization (WHO) raised the worldwide pandemic alert level to Phase 6.
• Designation of this phase indicates that a global pandemic is underway.

·         There are now community level outbreaks ongoing in other parts of the world.

·         State and international borders don’t matter at this point. The bottom line is that this new virus is among us all.

·         While U.S. influenza surveillance systems indicate that overall flu activity is decreasing in the United States, novel H1N1 outbreaks are ongoing in different parts of the U.S., in some cases with intense activity.

·         In the United States, this virus has been spreading efficiently from person-to-person since April and, as we have been saying for some time, we do expect that we will see more cases, more hospitalizations and more deaths from this virus.

·         Because there is already widespread novel H1N1 disease in the United States, the WHO Phase 6 declaration does not change what the United States is currently doing to keep people healthy and protected from the virus.

·         Thus there is no change to CDC’s recommendations for individuals and communities.

·         WHO’s decision to raise the pandemic alert level to Phase 6 is a reflection of epidemiological changes in other parts of the world and not a reflection of any change in the novel H1N1 virus or associated illness.

·         At this time, most of the people who have become ill with novel H1N1 in the United States have not become seriously ill and have recovered without hospitalization.

·         In the United States, we have been preparing for this for some time.

·         And we are actively and aggressively implementing our pandemic response plan.

• Phase 6 is an indicator of spread and not of severity.

·         It’s uncertain at this time how serious or severe this novel H1N1 pandemic will be in terms of how many people infected have severe complications or death related to novel H1N1 infection.

• There were three influenza pandemics in the last century and they varied widely in severity.
• The 1918 pandemic killed tens of millions of people.
• The 1957 pandemic is thought to have resulted in at least 70,000 deaths in the United States.
• Deaths from the 1968-69 pandemic were about the same as for seasonal influenza.
• This pandemic certainly poses the potential to be at least as serious as seasonal flu, if not more so.
• Because this is a new virus, many people will not have immunity to it and illness may be more severe and widespread as a result.
• We are still learning about this virus and expect that, like all influenza viruses, it will continue to change.
• There are some encouraging signs:

o              So far we have not seen an extensive pattern of very severe illness related to this virus.

o              Results of a serology study conducted by CDC suggest that some adults may have some degree of preexisting cross-reactive antibody to the novel H1N1 flu virus, especially adults older than 60.

o              And, this virus does not have the genetic markers for virulence that we saw in the 1918 pandemic virus, or that we see today in the H5N1 virus in Asia that has been lethal among people.

·         But it’s early days and too soon to predict what will happen.

·         It is important to remember that the potential remains for the virus to change and cause more severe disease.

·         The real uncertainty is the fall and how the novel H1N1 virus will affect the 2009-2010 influenza season in the United States.

·         We are still learning about the severity and other epidemiological characteristics of the novel H1N1 virus.

·         This information is important and will be taken into account when making recommendations with regard to vaccine and other preventive measures in the fall.

·         CDC will update its guidance and recommendations as more information about the novel H1N1 flu virus becomes available.

·         It will be important that we continue to watch this virus carefully.

·         The Southern Hemisphere is just going into their flu season and how this virus behaves will give us some clues about what we can expect for the Northern Hemisphere.

·         The situation is indeed sobering, but it’s important to keep in mind that we are not helpless.

We are taking action:

• The Federal Government is mounting an aggressive response to this newly declared pandemic.
• CDC’s goals during this public health emergency are to reduce transmission and illness severity, and provide information to assist health care providers, public health officials and the public in addressing the challenges posed by this newly identified influenza virus.
• To this end, CDC continues to update guidance.
• Visit the CDC website at http://www.cdc.gov/h1n1flu/ for more information or call 1-800-CDC-INFO.

·         Everyday, we learn more about this virus and what we learn will continue to inform the actions that we take in response.

·         We are aggressively taking early steps in the vaccine manufacturing process, working closely with manufacturing and the rest of the government.

·         Vaccines are a very important part of a response to pandemic influenza.

·         CDC isolated the new H1N1 virus, made a candidate vaccine virus, and has provided this virus to industry so they can begin scaling up for production of a vaccine, if necessary.

·         There are many steps involved with producing a vaccine and we are committed to going forward with the NIH, and FDA, BARDA, and the manufacturers of influenza vaccines, to see about developing full scale vaccine production.

·         Where possible, we are taking parallel steps to speed up the vaccine process.

• If things go well, and we develop a full scale production, it would be several months until the vaccine were available.
• So vaccine is an important tool for the future.

Public:

• So far, most people who have been ill with this virus have recovered.
• We are monitoring hospitalization and death rates.
• At this point, whether you are tested and actually diagnosed with novel H1N1 is less important than what you do if you become sick.
• It’s possible that this summer, people around you may get sick and you may get sick.
• Certainly in the fall, with our flu season, people around you will be getting sick and you may get sick.

• Be prepared to stay home for a week or so if you are ill.
• Most people infected with this virus so far have experienced the regular symptoms of flu (fever, cough, body aches + a significant number of people have reported vomiting and diarrhea).
• For people who are critically ill, we do have antiviral medications in our arsenal against flu.
• The priority use for influenza antiviral drugs at this time is to treat severe influenza illness.

·         Influenza antiviral drugs are prescription medicines (pills, liquid or an inhaler) with activity against influenza viruses, including swine influenza viruses.

·         There are two influenza antiviral medications that are recommended for use against swine influenza. These are oseltamivir (trade name Tamiflu ® and zanamivir (Relenza ®).

·         Influenza antiviral drugs work best when stated soon after illness onset (within two 2 days), but treatment with antiviral drugs should still be considered after 48 hours of symptom onset, particularly for hospitalized patients or people at high risk for influenza-related complications.

·         You have a role in protecting yourself and your family.

• Stay informed. Health officials will provide additional information as it becomes available. Visit www.cdc.gov
• Everyone should take these everyday steps to protect your health and lessen the spread of this new virus:

• 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 hand cleaners are also effective.
• Avoid touching your eyes, nose or mouth. Germs spread this way.
• Try to avoid close contact with sick people.
• If you are sick with a flu-like illness, stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further.
• Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
• If you don’t have one yet, consider developing a family emergency plan as a precaution.

Pandemic Severity, General

·         Influenza pandemics can range in severity, mainly in terms of the number of people that have severe illness and die.

·         Pandemic severity may also change over time and will differ across regions of the world, in different countries and even within different communities within a country.

·         Pandemic disease severity will vary depending on several factors: a nation’s ability to provide health care to their people, the availability of antiviral medications to treat those who are sick, differences in how the disease affects people in different age groups, and the effectiveness of efforts to reduce person-to-person transmission of influenza.

·         An evaluation of pandemic severity should be based on local circumstances for this reason.

·         A pandemic severity index helps pubic health officials to match the timing of the spread and severity of the outbreak with the appropriate use of public health and community resources to minimize the number of people who get sick and the number of people who die. 

U.S. Pandemic Severity Index (PSI)

• CDC developed the U.S. Pandemic Severity Index (PSI) to describe the severity of a pandemic in terms of illness and death.
• The U.S. PSI scale is based on the case-fatality ratio; the likelihood of people dying from the disease.
• The PSI scale ranges from Category 1 to Category 5 and is comparable to the U.S. hurricane severity index.
• Category 1 is the least severe and Category 5 is the most severe.

·         At the current time, CDC estimates that the pandemic situation in the U.S. would be equivalent to a pandemic severity index of 2. (This would be most similar to the 1957 influenza pandemic, however, it’s uncertain how the current situation will evolve over the coming months so it’s not possible to make a predication about deaths at this time.)

• CDC will re-evaluate the classification of the Pandemic Severity Index should there be evidence that the pandemic has become more severe.
• The PSI will be adjusted based on that evaluation and appropriate guidelines and recommendations provided.
• CDC emphasizes that unnecessary weight not be given to the numeric categorization of the pandemic.

• According to the U.S. PSI:

• A category 1 pandemic has the following:
• Case fatality ratio of less than 0.1 percent
• Excess death rate of less than 30 per 100,000 people
• Illness rate of 20-40% of the population
• Less than 90,000 potential deaths (based on 2006 U.S. population)
• Similar to a more severe seasonal flu year in the United States
• A category 2 pandemic has the following:

§         Case fatality ratio of 0.1 percent to less than 0.5 percent.

§         Between 90,000 and 450,000 deaths in the U.S. (based on 2006 U.S. population)

§         Excess death rate of between 30 to less than 150 per 100,000 people

§         Illness rate of between 20 and 40 percent.

§         Similar to 1957 pandemic.

• A category 5 pandemic has the following:
• Case fatality ratio of greater or equal to 2 percent
• Excess death rate of more than 600 per 100,000 people
• Illness rate of 20-40% of the population
• Greater than or equal to 1.8 million potential deaths (based on 2006 U.S. population)

• Similar to the 1918 pandemic
• The importance of identifying a category of severity is only to help guide the public health interventions recommended for individuals and communities.
• The PSI scale helps public health officials match the range of public health intervention efforts to the severity of a pandemic.

For a Category 1 to 3 pandemic:

• Ill adults and children are asked to stay home voluntarily.
• If someone in the household is sick, well adults and children do not need to stay at home.
• School and child care dismissal is not generally recommended, but may be considered depending on the local impact of the disease.
• Workplace and Community adult social distancing efforts (e.g., encouraging teleconferences instead of meetings, reducing density, meaning the number of people crowded into an enclosed space, in public transit and the workplace, postponing or canceling selected public gatherings, encouraging people to telework, or take staggered shifts) are generally not recommended.
• For a Category 4 to 5 pandemic
• Ill adults and children are asked to stay home voluntarily.
• If someone in the household is sick, well adults and children should stay at home too.
• School and child care dismissal is recommended for up to 12 weeks.
• Workplace and Community adult social distancing efforts (e.g., encouraging teleconferences instead of meetings, reducing density, meaning the number of people crowded into an enclosed space, in public transit and the workplace, postponing or canceling selected public gatherings, encouraging people to telework, or take staggered shifts) are recommended

Declaration of Phase 6 and Travel

 

• At this time, CDC does not recommend against travel to any country.
• CDC will continue to monitor the H1N1 situation around the world and will provide recommendations to U.S. travelers based on the changing situation.
• Travelers should check the CDC travelers’ health website (www.cdc.gov/travel) for information related to this outbreak, as well as for health information on the prevention and management of flu.
• Travelers should also check the website of the embassy of the country to which they are traveling for the latest updates on entry or exit screening procedures which may impact their travel.
• CDC recommends that ill persons postpone travel both for their protection and that of other travelers.

WHO Phases

 

·         The World Health Organization (WHO) has developed a plan to be prepared for a global outbreak of influenza to help countries to protect the public’s health before and during a pandemic. 

·         This plan defines the “phases” of a pandemic which describe the global risk for a pandemic and the extent of global spread.

·         The WHO phases provide a benchmark to guide national preparedness and planning for a pandemic, and helps to indicate when countries should shift to response and mitigation efforts.

·         The WHO phases are:

o        Phase 1: No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals. If present in animals, the risk of human infection or disease is considered to be low.

o        Phase 2: No new influenza virus subtypes have been detected in humans. However, an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans and poses a substantial risk of human disease.

o        Phase 3: An animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Human infection(s) that occur with this new subtype occur with at most rare inst ances of human-to-human spread, or spread to a close contact.

o        Phase 4: Small cluster(s) of human infections with limited but verified human-to-human transmission. The spread is highly localized, suggesting that the virus is not well adapted to humans. However, the virus has the potential to cause “community-level outbreaks.

o        Phase 5: There is human-to-human spread of the virus into at least two countries in one WHO region. Most countries are not affected but there are larger though localized cluster(s) of human infections due to human-to-human spread. These changes  suggest that the vir us is becoming increasingly better adapted to humans. There is a substantial pandemic risk.

o        Phase 6: The pandemic phase. There is increased and sustained transmission with community level outbreaks in at least one other country in a second WHO region. This phase indicates that a global pandemic is under way.

WHO Phase 6 Declaration 

•   The World Health Organization (WHO) has declared Pandemic Phase 6; that this outbreak of influenza is a pandemic, which means that the current novel H1N1 flu which is spreading involves sustained human-to-human transmission in two or more regions of the world.

•   Because there is already widespread novel H1N1 flu virus disease in the United States, the WHO Phase 6 declaration does not change what the United States is currently doing to keep people healthy and protected from the virus.

·         Thus there is no change to CDC’s recommendations for individuals and communities.

•   CDC’s initial recommendations were aimed at preventing and minimizing illness and death in light of uncertainty about the how severe novel H1N1 flu would be.

•   It is important to remember that the potential remains for the virus to change and cause more severe disease.

• CDC will update its guidance and recommendations as more information about the novel H1N1 flu virus becomes available.

Significance of WHO Phase 6 Declaration – [Moderate] Severity Index

• WHO has a three point scale to determine pandemic severity – mild, moderate and severe.
• At this time, WHO has indicated this seems to be a moderately severe pandemic.
• The WHO severity index advises countries about the possible impact on health and other related issues as a result of the current novel H1N1 flu outbreak.   
• Similar to how on any given day the weather pattern and the severity of weather will differ from country to country around the world and even within a country, the novel H1N1 flu pandemic will affect countries and communities in different ways.

•   The effects of the novel H1N1 flu pandemic will not be the same for all countries, and countries may not experience effects at the same time. 

• Transmission of the novel H1N1 virus from person to person will affect countries at different times of the year but also in different locations within these countries.
• The potential health effects of the influenza pandemic will differ depending on several factors: a nation’s ability to provide health care to their people, the availability of antiviral medications to treat those who are sick, differences in how the disease affects people in different age groups, and the effectiveness of efforts to reduce person-to-person transmission of influenza.
• As understanding of the novel H1N1 virus becomes clearer over time, the WHO recommendations may change.  CDC will remain flexible in order to respond in the best way possible to the changing situation and provide updated guidance as more information becomes available.

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Colleagues,

Below is a link to an article that I believe would be of interest to many of you -- it discusses “La Hora Mixteca” a program of RadioBilingue. 

Voice That Sounds Like Home Welcomes Mexico’s Outsiders

Of particular interest is the model of telemedicine mentioned here:

The Oaxacan Indians, mistrustful of doctors, rely heavily on home remedies and refrain from seeking treatment of serious illness or injury.

That problem has led Mr. López to spearhead a project in which Oaxacan doctors give medical advice in Mixteco by videoconference to immigrants at clinics in the Central Valley. The Oaxacan government is collaborating on the project, and the Center for Reducing Health Disparities at the University of California, Davis, Health System is the lead organizer.

Is anyone familiar with this project or involved in it?  I’d be very interested in learning more.

 

Thanks,

Seth

 

 

 

Seth Doyle, MA

Migrant Health Coordinator

Northwest Regional Primary Care Association

sdoyle@..., (206) 783-3004 ext 16

 

Please check the web site of:

 

School of Rural Public Health, Texas A&M University System Health Science Center