Thursday, April 30, 2009

Don't believe everything you hear ...

This from Chris Lindley, the director of public health preparedness and response in Colorado:

I heard an anchor on a major network expressed her fear after hearing that a soldier had been diagnosed with H1N1. Then, I hear from my colleagues about talk radio shows pushing ridiculous commentary about closing borders, even criticizing particular groups of people of color as having been responsible for the origin of this flu. Wow, I guess they missed high school biology.

A pandemic, or even just a new disease with no known immunization yet available, leaves people feeling powerless, so the weak-minded try to blame someone. They strive to overcome their feelings of impotence and create the illusion of power by finding scapegoats to blame and even ostracize. Data and science do not always play much of a role in their thinking processes.

Give your mind a break. Limit 24/7 news. Instead, refer to your local, state, and federal public health officials for information, not a talk show host who clearly failed high school biology. The media needs to fill the time they have and whether there is big news or no news, they will fill it with whatever talking head they can find. Instead of that extra news show, try watching a funny movie, play a game of cards with your family or better yet get some exercise (you know you need it!). Keep balance in your life and you will weather the current storm or any storm.

Today's news release about H1N1

For Immediate Release Wednesday, April 30, 2009

Colorado Reports First Confirmed Cases of Swine Flu in State
DENVER – Today the Colorado Department of Public Health and
Environment reported the first two confirmed cases of swine flu in the
state. One case is a female in her 30s from Arapahoe county who
returned from a Mexico cruise a several day stay in San Diego. She
was not hospitalized and is recovering. The other case is a male in
his 40s from Douglas county who works as a baggage handler at DIA. He
was hospitalized for three days and will be released today to recover
at home.
“As I said on Sunday and Monday, we fully expected to identify
Colorado cases of swine flu,” said Ned Calonge, the state’s Chief
Medical Officer at the department. “This doesn’t change the state’s
approach to the swine flu outbreak.
“It’s important to understand that at this time, in the United States,
the swine flu is acting just like seasonal flu. It is a relatively
mild disease. We continue to ask all individuals with mild flu-like
illness to stay home. This is regardless of travel history. Children
and adolescents with fever should not go to day care or school.
Adults with fever should not go to work until their symptoms resolve.
Individuals with severe illness, such as difficulty breathing, should
contact their health care provider.”
The symptoms of swine flu in people are similar to the symptoms of
seasonal flu in humans and may include: Fever greater than 100°F, sore
throat, cough, stuffy nose, chills, headache and body aches, and
fatigue. Some people have reported diarrhea and vomiting associated
with swine flu.
The department advises those who experience influenza symptoms need to
stay home for seven days after onset of symptoms, or at least 24 hours
after the symptoms have resolved, whichever is longer.
The state health department also encourages people to take these
personal precautions to decrease their chances of getting the flu:
· Wash hands frequently
· Cover your sneezes and coughs
· Avoid others with respiratory illnesses
The case from DIA reminds us that there are potential exposures in
public places, and here, frequent hand washing or the use of hand
sanitizers can protect people and prevent the spread of illness.
“There are other lab specimens from patients in the pipeline that may
confirm additional cases of swine flu in the days and weeks to come,”
added Calonge. “If there is evidence of a cluster of swine flu cases
that would warrant protective public health measures, we are prepared
to employ social distancing measures that would help protect people
from coming in contact with individuals who may be contagious.”
Again, this is a rapidly evolving situation and the state health
department is asking people to be alert for changes in our guidance,
available on our web site,, as we learn


Public Health Heroes

HEROES from Chris Lindley on Wednesday

Today as I walked from the Department's Operations Center to my car, I couldn’t help but smile. After three full days of intense activities, decision-making and coordination with 64 counties, I still wanted more. Why, it’s the people I get to work with! If only the general public realized the dedicated work that your local, state and federal public health officials where doing right now. While the general population is somewhere between “freaked” and “who cares,” the public health workforce across the country is taking every action possible to educate the public, track the disease, and prevent the spread in every community. We all hope that the case fatality rate will be low, and that much of this work will have been an excellent exercise. However, if it is not and we are at the seeding stage of a severe pandemic, it is the actions of these unknown, under-funded, heroes that might save your life.

I wanted to highlight one of these heroes, one of MY heroes! Tomorrow we are deploying medical assets for the first time statewide. While this is something we have prepared for and practiced on multiple occasions, we have never actually moved product, nor has anyone on this scale in any state. The individual leading and coordinating this effort is 8 months pregnant, and as she likes to say “only has 7cm to go.” This is just one example of the quality of individuals currently working 12 to 15 hours a day to protect your health.

Wednesday, April 29, 2009

Pandemic Level Raised to 5

The secretary of the WHO just announced that we are now in Level 5, where a pandemic is imminent.

News release: CDPHE activated

Good site for information at CIDRAP

See especially this great section on Community Mitigation:

Community Mitigation Measures

According to the CDC, "It is prudent for communities to act in the absence of sufficient data to protect their citizens and take advantage of a narrow window of opportunity for intervention." Therefore, the CDC recommends that affected states with at least one laboratory-confirmed case of swine influenza A H1N1 virus infection consider activating community mitigation interventions for affected communities, at least until more information is known. Key recommendations from the CDC as of April 27, 2009, for affected communities include the following (see References: CDC 2009: Interim CDC guidance for nonpharmaceutical community mitigation in response to human infections with swine influenza [H1N1] virus; CDC 2009: Interim guidance for swine influenza A [H1N1]: taking care of a sick person in your home):
Home Isolation of Cases

* Persons who develop influenza-like-illness (ILI) (fever with either cough or sore throat) should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved, whichever is longer.
* Persons who experience ILI and wish to seek medical care should contact their healthcare providers to report illness (by telephone or other remote means) before seeking care at a clinic, physician's office, or hospital. Persons who have difficulty breathing or shortness of breath or are believed to be severely ill should seek immediate medical attention.
* If ill persons must go into the community (eg, to seek medical care), they should wear a face mask to reduce the risk of spreading the virus when they cough, sneeze, talk, or breathe. If a face mask is unavailable, ill persons needing to go into the community should use a handkerchief or tissues to cover any coughing.
* Household contacts of home-isolated patients who are well should remain home at the earliest sign of illness and minimize contact in the community to the extent possible.

Care of a Person with Swine Influenza in the Home

* The ill person should be kept away from others in the home as much as possible (for example, in a separate bedroom with a separate bathroom). In addition, if possible, only one adult in the home should take care of the ill person (pregnant women should not care for ill persons).
* Caregivers who must have close contact with a person who has swine influenza should spend the least amount of time possible in close contact and try to wear a face mask (for example, surgical mask) or N-95 disposable respirator during close contact.
* If possible, consideration should be given to maintaining good ventilation in shared household areas.

* Persons in home isolation and their household members should be given infection control instructions, including practicing frequent hand washing with soap and water (or use alcohol-based hand gels containing at least 60% alcohol when soap and water are not available and hands are not visibly dirty).
* When the ill person is within 6 feet of others at home, the ill person should wear a face mask if one is available and the ill person is able to tolerate wearing it.
* Consideration should be given to providing antiviral medications (ie, oseltemivir [Tamiflu] or zanamivir [Relenza]) to prevent infection household contacts, particularly those contacts who may have chronic health conditions.
* The ill person should not have visitors other than caregivers.

School Dismissal and Childcare Facility Closure

* Dismissal of students should be strongly considered in schools with a confirmed or a suspected case epidemiologically linked to a confirmed case.
* Decisions regarding broader school dismissal within these communities should be left to local authorities, taking into account the extent of ILI in the community.
* If the school dismisses students or if a childcare facility closes, they should also cancel all school- or childcare-related gatherings and encourage parents and students to avoid congregating outside of the school. (Note: The CDC defines "childcare facilities" as centers and facilities that provide care to children in a nonresidential setting or family childcare homes that provide care for children in the home of the provider.)
* Schools and childcare facilities should dismiss students for a time to be evaluated on an ongoing basis, depending upon epidemiological findings.
* Schools and childcare facilities should consult with their local or state health departments for guidance on reopening. If no additional confirmed or suspected cases are identified among students (or school-based personnel) for 7 days, schools may consider reopening.
* Schools and childcare facilities in unaffected areas should begin to prepare for the possibility of school dismissal or childcare facility closure. This includes asking teachers, parents, and officials in charge of critical school-associated programs (such as meal services) to make contingency plans.

Other Social Distancing Interventions

* Large gatherings linked to settings or institutions with laboratory-confirmed cases should be cancelled, for example, a school event linked to a school with cases; other large gatherings in the community may not need to be cancelled at this time.
* Additional social distancing measures currently are not recommended.
* Persons with underlying medical conditions who are at high risk for complications of influenza may wish to consider avoiding large gatherings.

Use of Face Masks and Respirators

Use of face masks and respirators may help reduce the risk of acquiring influenza in crowded settings where there is potential for exposure to infectious persons. The CDC currently recommends that, whenever possible, rather than relying on the use of face masks or respirators, people should avoid close contact with people who might be ill and avoid being in crowded settings. However, the CDC also recommends that the use of face masks or respirators in areas where transmission of swine influenza A H1N1 virus has been confirmed should be considered as follows:

* Face masks should be considered for use by individuals who enter crowded settings, both to protect their nose and mouth from other people's coughs and to reduce the wearers' likelihood of coughing on others; the time spent in crowded settings should be as short as possible.
* Respirators should be considered for use by individuals for whom close contact with an infectious person is unavoidable. This can include selected individuals who must care for a sick person (eg, family member with a respiratory infection) at home.

CDC Interim Guidance—Children and Pregnant Women: Considerations for Clinicians

Interim Guidance—Children and Pregnant Women who may be Infected with
Swine-Origin Influenza Virus: Considerations for Clinicians

Today CDC issued new interim guidance for clinicians on how to care for
children and pregnant women who may be infected with a new influenza
virus of swine origin that is spreading in the U.S. and internationally.
Children and pregnant women are two groups of people who are at high
risk of serious complications from seasonal influenza.

New Interim Clinical Guidance for the Treatment of Children
Little is currently known about how swine-origin influenza viruses
(S-OIV) may affect children. However, we know from seasonal influenza
and past pandemics that young children, especially those younger than 5
years of age and children who have high risk medical conditions, are at
increased risk of influenza-related complications.
Illnesses caused by influenza virus infection are difficult to
distinguish from illnesses caused by other respiratory pathogens based
on symptoms alone. Young children are less likely to have typical
influenza symptoms (e.g., fever and cough) and infants may present to
medical care with fever and lethargy, and may not have cough or other
respiratory symptoms or signs.
The new interim guidance for clinicians on the prevention and treatment
of swine influenza in young children is available at

New Interim Clinical Guidance for the Treatment of Pregnant Women
Evidence that influenza can be more severe in pregnant women comes from
observations during previous pandemics and from studies among pregnant
women who had seasonal influenza. An excess of influenza-associated
deaths among pregnant women were reported during the pandemics of
1918–1919 and 1957–1958. Adverse pregnancy outcomes have been
reported following previous influenza pandemics, with increased rates of
spontaneous abortion and preterm birth reported, especially among women
with pneumonia. Case reports and several epidemiologic studies conducted
during interpandemic periods also indicate that pregnancy increases the
risk for influenza complications for the mother and might increase the
risk for adverse perinatal outcomes or delivery complications.
The new interim guidance for clinicians for the treatment of influenza
in pregnant women is available at

Human infections with the newly identified S-OIV that is spreading among
humans were first identified in April 2009 with cases in the United
States and Mexico. The epidemiology and clinical presentations of these
infections are currently under investigation. There are insufficient
data available at this point to determine who is at higher risk for
complications of S-OIV infection. However because pregnant women and
children are known to be at higher risk for complications during
seasonal influenza complications and during prior pandemics, it is
reasonable to assume that these groups of people may be at higher risk
for complications from infection with this new virus.

Additional Information
For additional information about the current influenza outbreak, see:
For additional information about CDC’s investigation of the current H1N1
outbreak, see

This information is also available by calling 1-800-CDC-INFO.

For more information about swine flu:
Additional information is also available by calling 1-800-CDC-INFO.

Tuesday, April 28, 2009

Cleaning EMS Vehicles

Interim Guidance for Cleaning Emergency Medical Service (EMS)
Transport Vehicles during an Influenza Pandemic

Handwashing video - Spanish

Handwashing videos ( good video for

Media Advisory, 042809

Local public health agencies and directors around the state should continue to take the lead for local communications in their communities. To facilitate timely communications to the public, local communications do not need to be reviewed by the state’s joint information system.

Reporters and news outlets seeking state information should continue to contact the Colorado Department of Public Health and Environment for state information about swine flu in Colorado.

We will begin to send out a daily update between 2 and 3 p.m. each day for developments in Colorado. This will serve as the update for today.

As of today, the state still has no confirmed cases of swine flu.

* General information line for the public 1-877-462-2911
* Website to stay updated


Mark W. Salley, director of communications, Colorado Department of Public Health, 303-692-2021

Video about managing stress

This from Dr. Curt Drennan, Colorado's Disaster Behavioral Health Coordinator:

Many folks are concerned and anxious about the current flu breakout;
in an attempt to address their anxiety, here is a video which talks
about anxiety and some things which folks can do. We are going to
follow this with daily videos on frequently asked questions and
a "mental health" tip of the day.

Please share!

CDC's "What You Can Do to Stay Healthy"

What You Can Do to Stay Healthy

There are everyday actions people can take to stay healthy.

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

Try to avoid close contact with sick people.

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

New swine flu website available

ASTHO has started a swine flu website which includes a page tracking
state response information:

Travel recommendations from Denver Health in English and Spanish

From: Chris Urbina, MD, MPH

Subject: traveler information

Based on current CDC guidance, Denver Public Health has not recommended that non-healthcare (e.g., airline, environmental services, TSA or other DIA) employees use any protective mask to prevent contracting swine flu. To date, there are no cases of swine flu identified within Colorado. The situation may change in the near future as new cases are identified daily across the United States. Even in places where the disease has been detected, there are no current mask recommendations. Virtually all cases of swine flu have been mild or similar to the seasonal flu we experience yearly.

Just as will seasonal flu, the most important things you can do to prevent transmission of infection are: 1) avoid close (within 6 feet) contact with ill people, 2) stay home when you are sick, 3) cover your mouth and nose when coughing or sneezing, 4) wash your hands, 5) avoid touching your eyes, nose or mouth, and 6) practice other good health habits

If there are any changes to these recommendations, Denver Public Health will issue an update through DIA Operations Center. Attached is our recommendations for travelers.


Chris Urbina

Colorado Department of Public Health and Environment and Denver Public Health
Interim Guidelines for Travelers and Swine Influenza A (H1N1), April 27, 2009

To date, several human swine influenza (flu) cases have been identified in California, Texas, Kansas, New York, and Ohio. More states are reporting cases daily. Several cases have a history of travel to Mexico. As yet, the Centers for Disease Control and Prevention ( has not issued any specific travel advisory. The most important things you can do to prevent transmission of infection are: 1) avoid close contact with ill people, 2) stay home when you are sick, 3) cover your mouth and nose when coughing or sneezing, 4) wash your hands, 5) avoid touching your eyes, nose or mouth, and 6) practice other good health habits.

If you recently visited Mexico or other parts of the U.S. reporting cases of swine influenza and become ill with influenza-like symptoms, including fever, body aches, cough, runny nose, sore throat, nausea, or vomiting or diarrhea, you should contact your health care provider if your symptoms are severe or if you have other medical problems such as heart or lung problems. If you are sick and have mild symptoms, stay at home, and avoid contact with other people to keep from spreading illness. If you become ill and experience any of the following warning signs, seek emergency medical care and share travel history.

In children, emergency warning signs:
· Fast breathing or trouble breathing
· Bluish skin color
· Not drinking enough fluids
· Not waking up or not interacting
· Being so irritable that the child does not want to be held
· Flu-like symptoms improve but then return with fever and worse cough
· Fever with a rash

In adults, emergency warning signs:
· Difficulty breathing or shortness of breath
· Pain or pressure in the chest or abdomen
· Sudden dizziness
· Confusion
· Severe or persistent vomiting

As more information becomes available, the Colorado Department of Public Health and Environment (303-692-2700 /after-hours: 303-370-9395) and Denver Public Health 24-Hour Emergency Number: 303-602-3700 will work to ensure updates through the media and website (

Colorado Department of Public Health and Environment and Denver Public Health
Directrices provisionales para viajeros y la gripe A (H1N1) de los cerdos, 27 de abril 2009

Hasta hoy, se han identificado brotes por el virus de la influenza porcina tipo A (H1N1) en California, Texas, Kansas, Nueva York, y Ohio. Más estados identifican casos cada día. Además, brotes o casos humanos de la influenza porcina se ha identificado asociado a viajes a México. Hasta ahora, el Centro para el Control y la Prevención de Enfermedades ( ) no ha provenido ninguna recomendación o aviso especifico sobre viajar. Las cosas mas importantes que usted puede hacer para prevenir transmitir la infección son: 1) evite el contacto con personas enfermas, 2) si esta enfermo, quédese en casa, 3) cúbrase la nariz y la boca cuando tosa o estornude, 4) lávese las manos con agua y jabón, y 5) trate de no tocarse los ojos, la nariz ni la boca, y 6) practique buenos hábitos de salud para la prevención.

Si recientemente usted ha visitado a México o otros partes de los EEUU reportando casos humanos de influenza porcina y siente enfermo con síntomas de influenza, incluyendo: fiebre, dolores musculares, tos, congestión nasal, dolor de garganta, escalofríos, nausea o vómitos o diarrea debe hacer contacto con su proveedor de atención médica si sus síntomas son severos o si tiene otros problemas médicos como de corazón o pulmones. Si siente enfermo y los síntomas son livianos, manténgase en casa y evite el contacto con otras personas para prevenir la propagación de la influenza porcina. Si empeora y siente algunas de los siguientes síntomas, vaya de inmediato a buscar un proveedor de atención médica e informarle de su reciente viaje.

En niños, signos de emergencia:
· Respirar rápido o con dificultad
· Color azul el la piel
· No tomar suficiente líquidos
· No despertar o poca actividad
· Siendo tan irritado que el niño no quiere ser abrazado
· Síntomas de influenza que mejoran pero vuelvan con fiebre y tos peor
· Fiebre con una erupción

En adultos, signos de emergencia:
· Dificultad con respirar o falta de aire
· Dolor o presión en el pecho o el abdomen
· Vértigos repentinos
· Confusión
· El vomitar severo o persistente

Como más información llega a estar disponible, el Departamento de Colorado de la Salud Pública y del Ambiente (303-692-2700 /después de horas: 303-370-9395) y número de 24 horas de la emergencia de la Salud Pública de Denver: 303-602-3700 trabajará para asegurar actualizaciones através de las noticias y el sitio Internet (

Monday, April 27, 2009

Pandemic Level Raised to 4

27 April 2009 -- The Emergency Committee, established in compliance
with the International Health Regulations (2005), held its second
meeting on 27 April 2009. The Committee considered available data on
confirmed outbreaks of A/H1N1 swine influenza in the United States of
America, Mexico, and Canada. The Committee also considered reports of
possible spread to additional countries. On the advice of the
Committee, the WHO Director-General has raised the level of influenza
pandemic alert from the current phase 3 to phase 4.

US Confirmed Cases as of today

U.S. Human Cases of Swine Flu Infection
(As of April 27, 2009 1:00 PM ET)

STATE Number of Laboratory Confirmed Cases
California 7 cases
Kansas 2 cases
New York City 28 cases
Ohio 1 case
Texas 2 cases
TOTAL COUNT 40 cases

For International Human Cases of Swine Flu Infection see: World Health Organization

Immune-compromised people - question from a reader and answer from an epidemiologist

I'm a resident of Telluride and have a question that I'd like to see addressed on your blog:

"My 85 year old mother has lupus and nearly died in the 1968 pandemic when flu triggered her lupus and I have a good friend who is HIV positive. Should folks like this take extra precautions such as wearing N95 masks when in public or avoid public gatherings until more is known?"

I've seen that the one hospitalized case in US was immune compromised and reading between the lines sounds like she had something like lupus.

Thanks for any info that could be posted on this.

Answer from Nicole Comstock of the Colorado Department of Public Health and Environment:

"Based on CDC guidance, at this point, we are not recommending that anyone wear N-95 masks (or other masks) when going out in public unless they are experiencing symptoms consistent with influenza. If they are symptomatic and are going out in public (like to go see a doctor), wearing a face mask would be prudent.

"When swine influenza is confirmed in a community, persons with underlying medical conditions who are at high risk for influenza-related complications may want to consider avoiding large gatherings. At this point, we don't have any swine flu in Colorado, so we have no reason to push this recommendation."

Guidance documents from CDC

Guidance Documents - available at

* Interim Guidance for Swine influenza A (H1N1): Taking Care of a Sick Person in Your Home Apr 25, 2009
* Interim Guidance on Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection and Close Contacts Apr 25, 2009
* Interim CDC Guidance for Nonpharmaceutical Community Mitigation in Response to Human Infections with Swine Influenza (H1N1) Virus Apr 26, 2009, 11:45 PM ET
* Interim Recommendations for Facemask and Respirator Use in Certain Community Settings Where Swine Influenza A (H1N1) Virus Transmission Has Been Detected Apr 27, 2009
* Swine Influenza A (H1N1) Virus Biosafety Guidelines for Laboratory Workers Apr 24, 2009
* Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare Setting Apr 24, 2009
* Interim Guidance on Case Definitions to be Used For Investigations of Swine Influenza A (H1N1) Cases Apr 26, 2009

CDC's latest travel precaution

Travel Health Precaution
Swine Influenza and Severe Cases of Respiratory Illness in Mexico
This information is current as of today, April 27, 2009 at 13:43

Updated: April 26, 2009

Revised April 26 9 a.m. to reflect updated guidance on antiviral use in travelers.
Current Situation

Since March 18, 2009, the Government of Mexico has reported an increase in the number of cases of influenza-like-illness. occurring in several areas of Mexico. Please visit the website of the World Health Organization, for further details about these cases.

CDC has confirmed that seven of 14 respiratory specimens from patients sent to the CDC by the Mexican National Influenza Center are positive for swine influenza virus and are similar to the swine influenza viruses recently identified in the US.

CDC and state public and animal health authorities are currently investigating 20 cases of swine flu in humans in California, Texas, Kansas, Ohio, and New York City. Some of the US cases have been linked to travel to Mexico. At this time only two of the 20 cases in the US have been hospitalized and all have recovered.

This investigation is still in the early stages. Further updates to this investigation and any related travel recommendations will be posted on when available.
CDC Recommendations

CDC has NOT recommended that people avoid travel to Mexico at this time. If you are planning travel to Mexico, follow these recommendations to reduce your risk of infection and help you stay healthy.
Monitor the International Situation

Check updates from the:

* Centers for Disease Control and Prevention
* Secretaria de Salud
* World Health Organization

Prepare for your trip before you leave

* Visit CDC's Travelers’ Health Website to learn about any disease risks and CDC health recommendations for areas you plan to visit.
* See a travel medicine specialist or a doctor familiar with travel medicine at least 4–6 weeks before you leave to answer your questions and make specific recommendations for you.
* Antiviral Medications: Travelers from the US going to Mexico that are at high risk of severe illness from influenza (for example persons with chronic conditions such as diabetes, lung disease, heart disease, and the elderly) are recommended to take antiviral medications for prevention of swine influenza during travel. The recommended antiviral drugs for swine influenza are oseltamivir (brand name Tamiflu®) and zanamivir (brand name Relenza®). Both are prescription drugs that fight against swine flu by keeping flu viruses from reproducing in your body. These drugs can prevent infection if taken as a preventative. Talk to your doctor about correct indications for using influenza antiviral medications. Always seek medical care if you are severely ill.
* Antiviral chemoprophylaxis (pre-exposure or post-exposure) is recommended for the following individuals:
1. Household close contacts who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly) of a confirmed or suspected case.
2. School children who are at high-risk for complications of influenza (persons with certain chronic medical conditions) who had close contact (face-to-face) with a confirmed or suspected case.
3. Travelers to Mexico who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly).
4. Border workers (Mexico) who are at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly).
5. Health care workers or public health workers who had unprotected close contact with an ill confirmed case of swine influenza A (H1N1) virus infection during the case’s infectious period.
* Antiviral chemoprophylaxis can be considered for the following:
1. Any health care worker who is at high-risk for complications of influenza (persons with certain chronic medical conditions, elderly) who is working in an area with confirmed swine influenza A (H1N1) cases, and who is caring for patients with any acute febrile respiratory illness.
2. Non-high risk persons who are travelers to Mexico, first responders, or border workers who are working in areas with confirmed cases of swine influenza A (H1N1) virus infection.
For more information on CDC's recommendations for antiviral use during the swine flu outbreak, please visit
* Be sure you are up-to-date with all your routine vaccinations, including seasonal influenza vaccine if available.
* Pack a travel health kit that contains basic first aid and medical supplies. See Pack Smart in Your Survival Guide to Safe and Healthy Travel for a list of what to include in your travel health kit.
* Identify the health-care resources in the area(s) you will be visiting.
* Check if your health insurance plan will cover you abroad. Consider purchasing additional insurance that covers medical evacuation in case you become sick. For more information, see Medical Information for Americans Traveling Abroad from the U.S. Department of State.
* Remember that U.S. embassies, consulates and military facilities do not have the legal authority, capability, and resources to give medications, vaccines or medical care to private U.S. citizens overseas.

During your visit to an area affected by swine flu
Monitor the local situation

* Pay attention to announcements from the local government.
* Follow local public health guidelines, including any movement restrictions and prevention recommendations.

Practice healthy habits to help stop the spread of germs

* Wash your hands often with soap and water. This removes germs from your skin and helps prevent diseases from spreading.
o Use waterless alcohol-based hand gels (containing at least 60% alcohol) when soap is not available and hands are not visibly dirty.
* Cover your mouth and nose with a tissue when you cough or sneeze and put your used tissue in a wastebasket.
* If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands.
* Wash your hands after coughing or sneezing, using soap and water or an alcohol-based hand gel.
* Follow all local health recommendations. For example, you may be asked to put on a surgical mask to protect others.

Seek medical care if you feel sick

* If you are ill with fever and other symptoms of swine flu like cough and sore throat, see a doctor, especially if you think you may have had contact with someone with swine flu or severe respiratory illness in the past 7 days before becoming ill.
* If you need to find local medical care while in Mexico, a U.S. consular officer can help you locate medical services and will inform your family or friends in the United States of your illness. To contact the U.S. Embassy or consulate in Mexico, call the Overseas Citizens Services at:
o 1-888-407-4747 if calling from the U.S. or Canada
o 00 1 202-501-4444 if calling from overseas
o US Embassy in Mexico

* See the information on the page “Know What To Do if You Become Sick or Injured on Your Trip" to help you.
* You should avoid further travel until you are free of symptoms, unless traveling locally for medical care.

After you return from Mexico

* Closely monitor your health for 7 days
* If you become ill with fever and other symptoms of swine flu like cough and sore throat and possibly vomiting and diarrhea during this period, call your doctor or clinic for an appointment right away. Your doctor may test you for influenza and decide whether influenza antiviral treatment is indicated.
* When you make the appointment, tell the doctor the following:
o Your symptoms,
o Where you traveled, and
o If you have had close contact with a person infected with swine flu.
* Avoid leaving your home while sick except to get local medical care, or as instructed by your doctor. Do not go to work or school while ill. If you must leave your home (for example, to seek medical care) wear a surgical mask to keep from spreading your illness to others.
* Always cover your nose and mouth with a tissue when you cough or sneeze. Throw away used tissues in a trash can.
* Wash your hands with soap and water often and especially after you cough or sneeze. If soap and water are not available, use an alcohol-based hand gel containing at least 60% alcohol.
* Avoid close contact with other people as much as possible.
* Wear a surgical mask if you are in contact with other people.

Additional Information

If you have specific questions about the swine influenza cases see or call 1-800-232-4636, which is 1-800-CDC-INFO.

To learn more about travel health, visit

For the swine Influenza situation in Mexico, visit:

* Secretaria de Salud: Secretary of Health, Mexico [Web page in Spanish]
* World Health Organization: Influenza-Like Illness in the United States and Mexico
* Pan American Health Organization

For all Colorado preparedness partners

To COlorado preparedness partners from CDPHE EPRD Director Chris Lindley:

The current concern about swine flu and its possibly becoming a
problem of major proportions gives us an unprecedented opportunity to
demonstrate that the confidence and dollars given to preparedness have
been well placed. The hard work and great energy spent over the past
few years can now bear fruit. Together we can make a significant
difference in the lives of the citizens of Colorado.

Here are a few possibilities:
1. Share your best practices...whether related to pan flu or other
kinds of community emergencies.
2, Share your prepared communications...put them out there and let
other local health departments adapt them as they need to. CDPHE will
not be able to develop all communication messages, we will need your
3. Prepare your own staffs - so they they and their families are ready
for whatever might lie ahead in the next few weeks.
4. Review (and update if necessary) your own agency emergency plans.
5. Be proactive - discuss with your staff and your communication's
person or persons especially, ways to get out messages which are
encouraging and which can alleviate the fear and anxiety which people
might be feeling right now. ...and share those positive messages
which the rest of us...we might be able to use them as well.

This is the time to demonstrate that the collaborative relationships
we have developed and the energy we have spent will work for the good
of everyone. As preparedness workers we are all in this together.

Thanks for all you are doing....

Sunday, April 26, 2009

Swine Flu and Colorado Businesses

These wise words from Colorado's pandemic influenza planning coordinator Jacqueline Zheleznyak:

As we approach the beginning of the work week, we walk towards it with a new challenge: will the swine flu affect my business, my employees, and me? In reality, the answer is yes. The swine flu epidemic has already affected our lives. It’s on every TV station, website and newspaper.

So what do we do now? As a business owner or manager, let’s look at these steps you can take today to help protect your business, your customers, yourself and your employees.

Be Ready
· Get your plan in place: As the owner or manager, you are viewed as an example. Review your personal and family plans. As in any emergency or potential threat, be it a flood, hurricane or earthquake, make sure you have your 72-hour kit or ‘emergency kit’ stocked and ready. If you don’t have one, take this opportunity to get one started. For more information on what you may want in the kit, please go to or Some extra items you may want to add to your kit for flu are a small amount of cold or flu medicine, tissues and non-aspirin pain reliever such as ibuprofen (Motrin, Advil) or acetaminophen (Tylenol), which also help reduce fever. Help your employees or co-workers out by bringing in your kit as an example and encourage everyone to make one of their own. One way to ensure that it is done is to give everyone an hour or so to get their supplies and make one. Everyone is busy, but allowing your employees time to prepare themselves not only helps them but shows them that you, and your business, value them as business assets and individuals.
· Continuity: If you don’t have a business continuity plan, this is the perfect opportunity to start one. For detailed information on continuity planning for large and small business, go to If you have a continuity plan, review it and update all contact and other important information. Contact your business partners to learn how their continuity plans may affect your business. Remember that continuity planning for a potential pandemic may focus more on human capital than on physical or structural issues.
· Telework: For businesses that frequently meet with clients must start thinking about how to do this virtually. You might be surprised at how many free or low-cost teleconference services exist. Search out services that will meet your needs as an organization.

Be Healthy
· Stay home if you are sick or think you are sick: If you are sick, or not feeling well, stay home. Take care of yourself. Encourage your employees to do the same. This is one of the best ways to do your part to help your community respond to any public health event. It seems small but can be invaluable to your community and business. This will also help your co-workers, employees and customers stay well.
· Leave or sick time: Your business may want to consider a change to its sick time and leave polices. Encourage your employees to stay home when sick and to use their sick time or leave they may be saving. Allow employees to donate extra leave to a leave bank that can be used by employees that may need it. If your business does not provide leave to employees, be as flexible as possible if your employees need to stay home because they are sick or caring for someone that is ill.

Be Informed
· Educate yourself: Learn about the flu and swine flu. Take the time to learn about flu and how it can be spread. Go to or and read for yourself what the current situation is and how to get the latest information. To see more of what Colorado has specifically done on business planning, look at the guidelines posted at
· Educate your employees: No matter how big or small your business may be, this will benefit everyone involved. Smaller businesses may want to hold a mandatory staff meeting where everyone is gathered and accurate information about the flu is presented. Larger businesses may decide to send an email or memo to all staff that includes basic information about the flu. Do something that will benefit your employees and your company, but don’t forget to have a way for your staff to ‘educate’ you as well. That may be an anonymous question box, or an email address to which they may direct questions. Taking time for you to understand what your employees concerns are will help you and your business navigate a successful path through this event.
· Educate your customers: No matter what type of business you have, there is a way to do this and it is important. Communicate with your customers about what your business is doing to protect customers and your staff from the flu. For example, you may want to print and have flyers or fact sheets available about the flu. Many examples can be found at Or, you may want to communicate to your customers that business hours or specific operations may be altered slightly as we learn more about the effect of swine flu on our community. Ask for patience and understanding as your business navigates its way through this challenge. In reality, no matter what the changes are, they will almost always be temporary or short-term.

All of these suggestions are general and may not work for all businesses. Do what will work for your business and your customers. For more detailed information on continuity planning and pandemic flu planning, visit the following websites:

Saturday, April 25, 2009

Preparing for a Public Health Event—Swine Flu 2009

This just shared by Chris Lindley, director of Emergency Preparedness and Response for the Colorado Department of Public Health and Environment:

Preparing for a Public Health Event—Swine Flu 2009

Pandemics by definition are scary and something award winning movies are created about. A pandemic is a global disease outbreak. However, pandemics are not new and the US Government and all states have spent years working to create response plans. We work with the CDC and our local governments daily to plan for a public health emergency, like a pandemic.

In any type of public health response, we rely on you, the public, to help us to mitigate the effects of and respond to the event. What does that mean? That means three things:

1) Education & Awareness
2) Personal Preparedness
3) Be a good neighbor

Education & Awareness
· Remember the saying “knowledge is power.” Well it is. One of the best ways to gain understanding on something that is unknown to you is to educate yourself on what it is. Educate yourself on what the flu is and how it spreads by doing simple research. If you have Internet access go to or and read about influenza.

· Know who your local health department is and learn what they have been doing to prepare for public health events. Also, do your best to learn how their response may affect you and what actions you can do to assist in that response if necessary.

· Ask Questions. Ask as many as you need to gain understanding of the situation. Remember there is never a dumb question.

Personal Preparedness
· As in any emergency or potential threat, be it a flood, hurricane, or earthquake, make sure you have your 72-hour kit or ‘emergency kit’ stocked and ready. And don’t feel bad if you don’t have one, this is a great opportunity to get one started! For more information on what you may want in the kit please go to: Some extra items you may want to add to deal with flu is a small amount of cold or flu medicine, Kleenex, and pain reliever.

· If you are sick, or ‘not feeling well’ stay home. Take care of yourself. This is one of the best ways to ensure that you are doing your part to help your community respond to any public health event. This is something that seems small but can be invaluable to your community.

Be a Good Neighbor
· While it's always nice to visit your neighbors and make sure they are doing okay, for a public health event we want to modify that. Lets pass on the door-to-door visits and pick up the phone instead. Or, for your more technology, savvy folks make friends on Twitter or another social networking site. Text messaging and social networking tools are great informational tools. We all want to ensure that our friends, colleagues and neighbor are safe and healthy and we should continue to do that, we just need to be more aware that we are dealing with an influenza virus that is transmissible from person to person.

· If one of your friends or neighbors are sick offer to go to the store for them if they need something, or run that errand. Be a good neighbor by letting them rest and recuperate. Drop off the items at their doorstep.

By doing, these three things you are helping yourself, your community, and your state to successfully work through our current situation.

Friday, April 24, 2009

Why we don't know more

CDC is, if nothing else, very thorough and cautious.

When an outbreak is first identified, there are enormous amounts of information that must be gathered and analyzed in order for the epidemiologists to draw rational conclusions. It is easy to jump ahead before we have all the information, but they are scientists - the best in the world.

That is why acting director Richard Besser prefaced his comments with a few important points:

First, CDC is concerned, very concerned, as the information becomes available. However, uncertainty at beginning of an outbreak is normal and to be expected. This is a fluid situation, and they are working with international partners to gather data and issue information.

Second, CDC's guidance is likely to change as we learn more. While this may be confusing or appear to be conflicting with older information, it is the reality of an ongoing epidemiological investigation. And this is just the beginning.

CDC really wants to get into Mexico and start its investigation so it can get firsthand information. So, more will be revealed...

The latest from CDC

The acting director of CDC updated state and local health departments nationwide on the "swine" flu outbreak.

Yesterday, CDC reported seven confirmed cases; today there are eight. The last case was from San Diego and has recovered.

CDC has tested only 14 samples from Mexico and seven were the strain that is causing this illness. With only seven samples from Mexico and eight US cases, it is hard to draw conclusions. CDC expects to provide epidemiological and laboratory support to Mexico. Once CDC has more information about the nature of the cases in Mexico, the US will know more. They need detailed analysis of the virus' genome, Dr. Besser said.

Neither the CDC nor the WHO have elevated their threat levels to a pandemic. No travel restrictions have been issued but CDC is issuing an outbreak notice today for travelers to central Mexico and Mexico City. An outbreak notice provides information on what is known and allows travelers to take precautions.

Dr. Besser repeatedly talked of the cooperation among all the partners involved and CDC's commitment to open communication as information becomes available. CDC is taking these steps already:
  1. working with state and local officials in California, Texas, WHO, and Mexico
  2. sending teams to CA and TX to help identify infections, helping with lab
  3. expect to send people to Mexico also
  4. no travel restrictions at this time; an outbreak notice will be issued today for central Mexico and Mexico City
  5. CDC will issue a MMWR health dispatch with recommendations
  6. for labs - all unidentified strains should be sent to CDC
  7. activated web page with info and updates (on home page)
  8. activated hotline at 1-800-CDC-INFO

You'll know more when we get it. Stay tuned this weekend.

Sources of information and lots of interesting surveillance...

One of Colorado public health's friends:

"James M. Wilson V, M.D., Chief Technical Officer and Chief Scientist of the Veratect Corporation: "We operate two operations centres based in the United States (one in the Washington, DC area and one in Seattle, WA) that provide animal and human infectious disease event detection and tracking globally. Both operations centres are organizationally modelled after our National Weather Service using a distinct methodology inspired by the natural disaster and meteorology communities. Our analysts handle information in the native vernacular language and have been thoroughly trained in their discipline, which include cultural-specific interpretation of the information. We are currently partnered with 14 organizations that provide us with direct ground observations in 238 countries. We are a multi-source, near-real time event detection and tracking organization.

We have been tracking the situation in Mexico since April 4."

So here is what Jim has to say:

Mexico City: WHO Expresses "Concern" Over "Influenza-Like" Illness; Classes Canceled for "Millions" of Children
Multiple national and international media sources report the World Health Organization (WHO) has expressed "concern" regarding an outbreak of "influenza-like" illness in Mexico that resulted in more than 800 cases nationwide, including at least five health care workers, and 57 deaths in Mexico City alone. The WHO is cited indicating symptoms are similar to swine influenza. However, the Centers for Disease Control and Prevention (CDC) noted that there is no confirmation of swine influenza in Mexico at this time. The Mexican Minister of Health stated that the outbreak is related to a "new" influenza virus, and classes have been canceled for "millions" of children do to the outbreak. The Ottawa Citizen, a Canadian News Source, described the outbreak as a "mysterious, SARS-like illness."


The illness is described as initially presenting with influenza-like symptoms, but rapidly progresses to respiratory distress, followed by death in some instances. Sources indicated that the majority of deaths occurred in otherwise healthy adults ranging in age from 25 - 44 years old. WHO noted two unusual characteristics about the outbreak; the cases have not occurred in very young or elderly segments of the population and have occurred much later in the influenza season than normal. The WHO characterized both of these abnormalities as cause for "heightened concern." The CDC also stated that it was "very concerned" about the outbreak.


Mexican health authorities have been working in conjunction with international health authorities to respond to the outbreak. WHO has activated its Strategic Health Operations Center (SHOC), but did not specify whether it was planning to send advisors to Mexico or issue a travel advisory for the country. The Pan American Health Organization (PAHO) stated that it was working with Mexican health officials to monitor the situation. The CDC has set up emergency operations centers in response to the outbreak in Mexico and the detection of swine influenza in the US. While some media sources have reported the US swine influenza cases in conjunction with the situation in Mexico, no confirmation of association between the two events has been declared by officials at this time.


On 23 April, Veratect reported that the CDC confirmed seven cases of novel swine influenza A (H1N1) in California (5) and Texas (2). CDC states that the "new" virus has genes typically found in strains from North American, European, and Asian swine influenza; human influenza; and avian influenza. Additionally, the fact that none of the cases had any direct contact with pigs, as is usually noted in human cases of swine influenza, indicates there is potential for human-to-human transmission. CDC officials are preparing a vaccine against the new strain, which they cite is "standard operating procedure."

Moreover, Veratect reported on 21 April that national health officials issued a health alert due to a significant increase in influenza cases during the spring season in Mexico. The most heavily affected states were Baja California, Chihuahua, Distrito Federal (Mexico City), Hidalgo, Tlaxcala, and Veracruz. Health officials deny that these events constitute an epidemic, but characterize the situation as "unprecedented" due to the fact that it was occurring outside Mexico’s normal influenza season (October – February/March).

Keeping you informed about "swine" flu...

Situation discussed about Mexico. 1 - There is a report of severe respiratory illness in Mexico involving three human clusters. 2 - With samples sent from Mexico to CDC and Canadian labs, there are a total of 22 lab confirmed cases of the H1N1 strain found so far; 3 - Report at the time was approximately 120 severe respiratory illness cases and 20 deaths, but BBC reports "dozens" of deaths.

"Swine" flu - epidemic or pandemic? Lots of info!

With Mexico City closing schools and the alarm bells ringing in public health agencies all over North America, the media is starting to report extensively.

Here's one example from the New York Times:

And one from Google:

CDC news conference has been moved to 12:30 pm Mountain time. We'll know more then.

"Swine" flu - epidemic or pandemic?

We expect more information from CDC today. Here is where they are posting the latest:

Thursday, April 23, 2009

Swine flu in TX and CA, and an unidentified virus in Canada

A total of seven cases of a previously undetected strain of swine flu have been confirmed in humans in the United States, the Centers for Disease Control and Prevention said. None of the patients has had direct contact with pigs.

While this has no impact on Colorado at this time, it is a concern - especially in light of the news of an unusual virus observed in Canadians who traveled to Mexico:
What is really ringing the bells for me is how they say in this article that, "The flu-like condition has so far affected healthy young adults between the ages 25 and 44. The victims showed influenza-like symptoms that progressed to "severe respiratory distress" within five days."

Sound familiar?

While this will likely NOT result in a pandemic of any sort, or a turn into a significant threat to the US, it does demonstrates just how poor our national surveillance and communication systems are in the current US public heath system.

The Canadians for the past two days have been issuing public warnings about a mysterious respiratory flu-like illness in Mexico, while we here in the US have not heard a word about it, not even on the governmental public health side (including EpiX, HAN etc....).

We have still have lot of work to do. Please read.

Friday, April 10, 2009

No matter what you do to prevent it.....

.... you could get sick.

OK, so here is the background. I was really diligent all winter about washing my hands, covering my cough, avoiding people who were sick, taking vitamins, cleaning the handle of the grocery cart, etc.

Here it is, April, and I managed to stay well all winter (one close call - a little extra sleep and extra Vitamin C staved it off).

Well, in spite of my efforts, the common cold caught up with me. I guess I was overdue, but I was feeling pretty invincible for a while there!

I might have caught the bug from a household member - that does make it pretty tough to avoid. I also haven't been getting enough sleep.

But the point here is that no matter what you do to stay well, in a community-wide communicable disease situation -- say, a pandemic influenza, for example -- you might not be able to avoid getting sick.

1. Be prepared to keep your distance from others, if it becomes necessary.
:: That means that you might have to miss out on some events if it means being around others who might be sick -- even church, work or school.
:: That means that you might need to avoid the grocery store, so keep non-perishable food on hand.

2. Do what you can to stay well, especially if there is something going around.
:: Wash your hands - a LOT!
:: Keep your immune system strong. Eat healthy. Get enough sleep.

3. Stay informed.
:: Know where to get good info about diseases and prevention. We like CDC and we will do our best to pass on the best info at !
:: Use your resources, whether it is your doctor, the web, or your local public health agency.

Thursday, April 9, 2009

How Government Works

I can't take credit for this one:

How Government Works
Once upon a time the government had a vast scrap yard in the middle of a desert. Congress
said "someone may steal from it at night."

So they created a night watchman position and hired a person for the job.

Then Congress said, "How does the watchman do his job without instruction?"

So they created a planning department and hired two people, one person to write the instructions, and one person to do time studies.

Then Congress said, "How will we know the night watchman is doing the tasks correctly?"

So they created a Quality Control department and hired two people. One to do the studies and one to write the reports.

Then Congress said, "How are these people going to get paid?"

So they created the following positions, a time keeper, and a payroll officer, then hired two people.

Then Congress said, "Who will be accountable for all of these people?" So they created an
administrative section and hired three people, an Administrative Officer, Assistant Administrative Officer, and a Legal Secretary.

Then Congress said, "We have had this command in operation for one year and we are $18,000 over budget, we must cut back overall costs."

So they laid off the night watchman.