Breastfeeding can protect your baby during an emergency

CDPHE News Release by Lori Maldonado


Be Prepared – Breastfeed: A Shield That Protects Infants in an Emergency

DENVER—Breastfeeding is not the first thing that comes to mind when thinking about how to prepare for an emergency. However, state nutritionists say breastfeeding is just the shield moms need to protect their infants in a crisis.

“Being prepared for natural or manmade emergencies is not just a global concern, it also is a Colorado concern,” said Jennifer Dellaport, nutritionist and breastfeeding coordinator at the Colorado Department of Public Health and Environment, “Colorado is prone to incidents that can bring a family’s daily routine and a small town or large city to a halt for long periods of time, such as blizzards, wildfires, snowstorms and tornadoes. Breastfeeding requires no running water and protects babies from contamination or limited water resources,” said Dellaport, referencing isolated incidents of contaminated water and formula recalls that have limited access to a safe food and water supply.

Despite the situation or surroundings, breastfeeding is safe, free, readily available and designed to nourish and hydrate infants.

Breast milk provides optimal nutrition to support an infant’s growth and development and provides protection against respiratory illness and diarrhea, diseases that can be fatal in groups displaced by disasters. “Plus, in a disaster, breastfeeding is calming to both the mother and baby,” said Dellaport.

These messages are part of a national effort to promote World Breastfeeding Week, August 1-7, 2009. This year’s theme, “Be Prepared – Breastfeed: A shield that protects infants in an emergency,” reflects the vital role that breastfeeding plays during emergencies.

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She cited events in Colorado as an example of emergencies where breastfeeding would be helpful:
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In January 2009, wildfires in the Boulder area forced thousands to evacuate their homes.
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In March 2009, a blizzard left more than 400 airline passengers stranded at Denver International Airport.
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A flash flood in Fort Collins displaced families from their homes in August 2007.
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A tornado touched down in Windsor in May 2008, killing one and leaving hundreds without food and shelter.
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In Alamosa, water contaminated by salmonella sickened over 275 people and thousands were without safe water for several weeks.
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H1N1 season has become a pandemic, sickening many Coloradans.

Dellaport provided the following additional facts on breastfeeding:

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Breastfeeding infants for more than six months provides long-term protection against illness and disease.
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Infants who are breastfed always have a source of food.
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Mothers under stress still will produce milk. During emergencies, responding relief organizations are encouraged to support breastfeeding by providing a dedicated space with privacy and knowledgeable counselors to encourage continued breastfeeding.

Even Glamour magazine is focusing on H1N1...

"Are You Starting to Worry About Swine Flu? (There's H1N1 Hysteria Going on in England)"

That's the headline for an article and poll on Glamour magazine's blog at http://www.glamour.com/health-fitness/blogs/vitamin-g/2009/07/poll-are-you-starting-to-worry.html. Take the poll yourself.

(Do review the comments, too. That's the best part of reading on the web.)

For those who don't know, Glamour is a women's magazine, with a median age of 33. They claim a circulation of 2.29 million but a total audience of 12.2 million. Pretty big rag. And interesting that they are interested in flu in addition to fashion.

We are seeing H1N1 slowly creep back into the headlines, with summer camps and the Air Force Academy reporting outbreaks.

My daughter starts school in exactly three weeks. All those little (and not-so-little) germ carriers together could be a mighty force.

What's ahead for flu? Don't let anyone tell you they know!

Every public health agency and hospital in the U.S. is planning for many unknowns this fall.

Influenza experts are watching the spread of H1N1 (the novel influenza A that emerged in April of this year) in the Southern Hemisphere very closely. At this point, they still don't know how the virus will behave here come October or November.

So far, the virus has been stable and two antiviral medications have been pretty effective in reducing the severity of illness for most people, if they take them soon enough.

But one thing is certain: flu viruses are notorious for being unpredictable.

Our job now -- for all of us, not just public health and hospitals -- is to be prepared for anything.

What are you doing now to be ready for the possibility of a highly contagious flu virus this fall?

Please use the "comments" to let us know now!

H1N1 confusing to most people - no surprise here!

As COHealth posted today, most people remain confused about the term H1N1. (Source: public poll conducted by the Harvard School of Public Health)

Just yesterday I contacted CDC about wanting a consistent way of referring to the virus, since a lot of CDC's stuff has different names. I said, "I thought I might suggest one convention among Colorado PIOs so we try to avoid confusing people. What do you think of 'new H1N1 flu virus' to keep it simple and appropriate for all literacy levels?" (After all, I am the co-chair of a national health literacy committee....)

CDC's response: the different names are on older web pages and all will be converted to the official and correct name:

"I think your suggest for Colorado is fine, but be advised that novel influenza A (H1N1) is the correct nomenclature for the new flu virus and will continued to be used by CDC and others. The reason for the variation in CDC documents is that the name change occurred midway through the event...."

So, what do you think, public health people? (And should we use this forum to discuss the pros and cons of each of these options?) Please respond by commenting!!

1. Should we use the official name of novel influenza A (H1N1)?

2. Should we adopt our own convention for Colorado and what should it be?

3. Should we let everyone call it whatever they want? (Most people would call it swine flu, including the media.)

Please respond here (using the comments feature) and ask others to read and respond as well!

What should everyone do to prepare for severe flu?

OK, so we know that public health agencies will be very busy this summer, to be ready in case the new H1N1 flu comes back and is more severe.

We all should be busy, too.

For individuals, this gives you a window of time to prepare yourselves and your families. Parents, teach your children how to cover their coughs and sneezes and wash their hands thoroughly - and do these things yourselves, too (those kids notice EVERYthing!).

If the virus returns and public health officials recommend staying at home, will your family be able to follow the recommendations? Can you stay at home, all of you, for two weeks?

We suggest a two-week period as this would be two cycles of flu, since it averages about a week. (So you would know if you were exposed within that two-week period, and if you were fine, you probably were not, or you have some immunity.)

Staying home for two weeks is a little more complicated than it might sound at first. It means that you can't go to the mall if school is closed or work shuts down, you can't go to a movie, and you shouldn't go to the grocery store. You only should leave if you need to seek medical care.

So what does it take? You'll need a two-week food supply - can you cope when you run out of fresh fruit and vegetables? Stock up on foods your family will eat. It's no fun to be home for two weeks with people who are unhappy with what there is to eat. It's true about chicken soup being helpful for flu (I've heard it's the thyme in the broth), so put some in your freezer or stock up on some cans of soup.

You need your prescription medicines that you take routinely and perhaps some over- the-counter remedies to help you get through the flu - acetaminophen (Tylenol), ibuprofen (Advil and Motrin), something like Gatorade or Pedialyte, and maybe some anti-nausea medication for the kids. And don't forget the thermometer (and batteries?), tissues, toilet paper, paper towels, sanitary needs, hand, laundry and dish soap, and disinfectant.

Do you have pets? Make sure you have at least two weeks of extra food and other needed supplies for these loved ones, too. If you live alone, is there someone you can call for help if you get the flu and can't walk your dog?

How about cash - do you have enough on hand if you need to order groceries or medications, or hire some help?

Contact information - if you get sick, it would be great to have your contact information all in one place to share with your caretakers, whether at home or at an urgent care site.

Finally, how about recreation? How will your family stay occupied during a two-week period at home? Store some new games for the family, new books for each family member, and maybe some puzzles, movies, and toys. (Maybe it would be a good time to work on cleaning out some closets!)

Pandemonium about pandemic?

You probably heard that today the World Health Organization raised the level of pandemic alert to full pandemic. No pandemonium is needed.

What is important to remember is that this is a geographic designation, acknowledging the widespread illness resulting from the H1N1 virus. It does not mean that the virus is causing more severe illness.

When I look back on my post from May 22, what is most remarkable is that our information and messages have not changed. The good news about that is the virus is still stable, which makes efforts to create an effective vaccine possible.

So what should we do now?

In public health, we need to use this time to prepare for the fall in case the virus re-emerges. We don't know if it will; we don't know if it will be more severe; we don't know if we will have a vaccine. Regardless, there are many things we can do in the meantime. We have immunization and stockpile people thinking ahead; communicators can prepare information, too.

Tomorrow, look for a post on what individuals can do to prepare for the fall, in case we see the return of H1N1 in a more severe form.

Making a vaccine, and would you want to get it?

CDC has been talking about the steps they are taking that would make it possible to manufacture an effective vaccine for H1N1 flu. They just released some research yesterday that makes them pretty sure that the seasonal flu vaccine won't help at all for this novel (new) H1N1 virus.

It's quite a process to develop vaccine, not to mention the FDA approval process, called clinical trials, that would be necessary to get it into the arms of people.

First, they have to isolate the virus. The good news about is that this particular H1N1 flu virus (and there are many other H1N1s) has remained pretty stable over this last month, so it's not like they are chasing something that is changing every time they look at it.

Then, they have to try to grow the virus to see if it will replicate so they can make anything out of it. If so, this "candidate" virus is shared with manufacturers.

The production people do testing to see if they will be able to make enough vaccine and what dose will generate the immune response that they want. They can add stuff to the vaccine to improve the immune response -- stuff called adjuvants -- which might help reduce how much antigen is needed to get the desired immune response.

OK, so if you are following so far, they are saying it looks promising for a vaccine and the feds have dedicated $1 billion (!) to the clinical studies needed to get it approved and the commercial production.

All this is to be ready if this virus reemerges with some fury in the future, maybe even this fall. Pretty interesting.

So, what do you think? Do you get a seasonal flu shot? If this flu comes back with a vengeance, would you want to be vaccinated?

Is H1N1 still a threat?

This from Jackie Zheleznyak, Colorado's pandemic flu planner:


Every day a plethora of articles are released about every aspect of H1N1. This morning a CIDRAP article caught my eye, entitled “WHO: H1N1 flu more contagious than seasonal virus”.

The reason this cause my eye is because for the past 2+weeks most non-governmental organizations and various federal agencies have been telling us that H1N1 isn’t as ‘bad’ as once thought. H1N1 in the U.S. appears to have lost some of its severity. I have seen the reported U.S. cases, I have seen the news that the death rate in the U.S. is low, and while people are still getting sick, sometimes very sick, they just seem to have the flu.

So why do I need to care that this H1N1 virus may be more contagious than a seasonal flu? Why do I need to pay attention to the WHO talking about the severity of this virus?

I am not a clinician or an epidemiologist. I am a planner. Being a planner I analyze everything about twice as much as actually needed. This is why this particular article on H1N1 being more contagious, and WHO’s statement on how to assess severity is causing my mind to spin today. The question remains ‘Why do I need to be paying this much attention to something that hasn’t even been placed on the Pandemic Severity Index and hasn’t cause an increase in the HHS Pandemic Alert Periods?’

In an article titled, "Assessing the severity of an influenza pandemic," released on May 11, 2009, by the WHO, it states: “H1N1 appears to be more contagious than seasonal influenza. The secondary attack rate of seasonal influenza ranges from 5% to 15%. Current estimate of the secondary attack rate of H1N1 range from 22% to 33%.” \

Reading this statement, the question for me becomes ‘why do I care if its really just like the seasonal flu?’

As a planner, I care because if a virus is truly more than twice as contagious as previously thought, I will have that many more people becoming ill, and I will have that many more people using assets from our public health and medical system. As a planner, I need to be able to support the ‘boots on the ground’ in their extraordinary efforts to respond to their new challenge, and this is why I care.

Nevertheless, I struggle with the abrupt changes from U.S. Health and Human Services in its response to this H1N1 flu virus by making a decision not to follow the pandemic alert levels (which they created their own planning around, and encouraged us to also plan around). I struggle with the fact scientists and the WHO have not yet determined a way to grade this virus’ severity. Both of these facts leave me with a place for doubt to grow. I wonder if I, who am very familiar with the topic of influenza, have doubts, then what is the average Coloradan thinking about all of the variety of information out there? This is the other reason I care.

I want to be able to cast away the misconceptions and doubts surrounding H1N1. My colleagues and I strive to provide accurate and appropriate information to Colorado. While some may think that we never provide enough information, others may have already tuned us out.

Public Health is paying so much attention to H1N1 to be able to provide you, Colorado, with the answers you are looking for to the best of our ability. Some days we will have more answers than others, and some days we will not have any answers, only more questions. We pay attention to H1N1 to keep Colorado informed.

I keep reminding myself that science is full of unknowns and that’s what makes it science. We can only work with what we know, and what we know today is that this seems to be a new virus. We know that washing your hands helps prevent H1N1. And we know that staying home when you’re sick not only is good for you, but everyone in your community.

So, the question never was ‘why do I care about H1N1?’ The question has always been ‘why do we care about H1N1?” Surprisingly the answer is very simple: we care because public health is not just something I do for a living; public health is something that we all do, even if it's just by washing your hands.

Do Everybody a Favor: Take a Sick Day

Great little opinion piece from the New York Times:

http://www.nytimes.com/2009/05/12/health/12case.html?_r=1

Swine flu parties(!)??

What is CDC’s recommendation regarding "swine flu parties"?
"Swine flu parties" are gatherings during which people have close contact with a person who has novel H1N1 flu in order to become infected with the virus. The intent of these parties is to become infected with what for many people has been a mild disease, in the hope of having natural immunity to the novel H1N1 flu virus that might circulate later and cause more severe disease.

CDC does not recommend "swine flu parties" as a way to protect against novel H1N1 flu in the future. While the disease seen in the current novel H1N1 flu outbreak has been mild for many people, it has been severe and even fatal for others. There is no way to predict with certainty what the outcome will be for an individual or, equally important, for others to whom the intentionally infected person may spread the virus.

CDC recommends that people with novel H1N1 flu avoid contact with others as much as possible. They should stay home from work or school for 7 days after the onset of illness or until at least 24 hours after symptoms have resolved, whichever is longer.

More on the role of social media in crises

What an interesting blog-posting here:
http://crisisblogger.wordpress.com/2009/05/07/leaving-heads-in-the-dust-one-impact-of-twitter-and-social-media-on-public-information/

We are really trying to keep up, but it is challenging.

Antiviral Stockpile Deployed Quickly in Time of Need

Federal antiviral medication and medical protective supplies from the Strategic National Stockpile were distributed throughout Colorado during the ongoing H1N1 virus outbreak. This is the first time the stockpile was requested and deployed during a declared emergency in Colorado.

The supplies help local public health agencies throughout Colorado ensure that the people who need medication will be able to receive it. The medication primarily is intended for those who are hospitalized or seriously ill.

Swift Transportation Company quickly and successfully worked through the day and night last week to distribute the medication and medical supplies to 13 locations throughout the state. The company is one of many partners that have signed agreements with the Colorado Department of Public Health and Environment’s Emergency Preparedness and Response Division to assist in emergencies or other crisis.

The Emergency Preparedness and Response Division always is looking for community partners to provide volunteers, warehouse space or a variety of necessary services. Interested parties should contact Patrick Barnett at the Colorado Department of Public Health and Environment, 303-692-2648, for information on becoming involved with public health emergency preparedness activities in Colorado.

Are we ready?

From Chris Lindley, Colorado's director of public health preparedness and response:

When people ask if we are ready or prepared the answer should be “we are better prepared than we were yesterday.” The last two weeks have reinforced this statement. The rapid coordinated response by local, state and federal public health officials clearly demonstrated that we are better prepared as a nation than we would have been just a few years ago. The investment in public health infrastructure post 9/11 clearly has paid off, and it has paid off big. Systems and processes have been developed and tested to coordinate a national response to any emerging disease or crisis. While there were certainly mishaps, overall we all had the same message, and resources to share that message with health care providers, partners and the general public real-time.

While it appears that this first wave of the H1N1 virus is mild and will likely die down within the U.S. this summer, we all need to remember history. The 1918 pandemic followed a similar path, with a mild presentation in the spring and summer followed by a explosion in the fall and winter, killing an estimated 100 million people worldwide.

Hopefully history will not repeat itself here. However, hope is not part of the preparedness equation. What is needed now is a personal, neighborhood, community, state and national effort to further prepare the country for a severe flu season next year. The challenge is making this a priority for all, at all levels, as we struggle to maintain current responsibilities in a fiscal crisis. Unfortunately we will need to prioritize and something that also needs to be done will be put off until a later date. This is the challenge we face in public health -- an aging workforce, plus limited local, state and federal investment with the responsibility to protect the population. Hopefully the events of the past two weeks will remind elected officials what public health is, and its value.

Thank an epidemiologist today...

Especially Nancy Cox from CDC, who home burned to the ground while she was trying to find out what was happening with an emerging virus from Mexico.
http://www.washingtonpost.com/wp-dyn/content/article/2009/05/02/AR2009050202353.html

Expect a surge of confirmed cases nationwide...

CDC reminded us today that the numbers of confirmed cases of H1N1 Influenza A will climb dramatically over the next few days as the backlog of samples at the CDC lab is reduced and as states start doing their own testing.

No cause for alarm - still the same messages: wash your hands! cover your cough! stay home if you are sick!

Also: new school guidance from CDC today.
http://www.cdc.gov/h1n1flu/K12_dismissal.htm

Additional two cases of H1N1 confirmed in Colorado

The state health department announced that two cases of influenza were confirmed to be H1N1.

The first is a male in his 20s from Jefferson County.

The other is a middle-school aged male from Jefferson County who had recently traveled to an affected area in the U.S. The student's school, Excel Academy, is a Jefferson County charter school with 450 students. The superintendent of schools in Jefferson County told reporters today that the school will be closed this week as a precaution.

Maybe it's time to question CDC's guidance...

More from Chris Lindley, Colorado's director of public health emergency preparedness and response:


We can no longer say that this new H1NI influenza strain appears to be mild like the 1957 and 1968 pandemics, which were both similar to seasonal influenza.

At the national level, politicians and the CDC are recommending containment strategies for a new much more deadly influenza strain, along the lines of the 1918 pandemic strain. All of pubic health can either fall in line like sheep, or stand up and issue their own guidance, only suggesting containment strategies we would employ during any seasonal influenza epidemic. If things changed and we saw more severe illness, we could immediately use more aggressive containment strategies. Now is not the time to play the Ace.

1.) The current mixed message will ultimately hurt the creditability of public health at all levels. It is either one or the other. We cannot say it is mild ("relax, everything will be ok"), but you need to act as if this is the 1918 pandemic otherwise you might risk your and our families' lives. If, as we are told at the national level. it is presenting as a new but mild influenza strain, as it appears to be in Colorado, we should apply containment strategies at a similar level. Doing otherwise will later be considered an abuse of our powers, and credibility will be lost. After 7 years of preparedness funding, this would be a poor demonstration of measured improvement. If the epidemiology and surveillance later presents a different picture, we can always increase containment measures.

2.) CDC has just thrown a grenade to the local and state public health and school districts with the release of its updated "School (K-12) and Childcare Facilities Closure Guidance." The latest recommendations encourage the closure of all schools (K-12) and childcare facilities (as well as all feeder schools and childcare facilities in the network or a geographic area) for 14 days, for those schools/facilities with one or more laboratory-confirmed or non-subtypable influenza A cases among students, faculty or staff. To put this simply, as long as there is a confirmed or probable case “in the same area” in a school-aged kid, all surrounding schools (K-12) and childcare facilities are encouraged to close as well, even if they have no cases according to CDC guidance. Come Monday, schools and childcare facilities that don’t meet some aspect of this description might be few and far between.

3.) We now also have a critical shortage of N-95 masks across the country. Being into this less than one week it is clear that everyone, including the medical community, has responded to the media pandemic with the utmost of caution. In many ways that is good; however, it is time now to be honest about how this disease is presenting itself and how measures can and should be in line with what we are seeing. Again, if this is a mild influenza strain like seasonal influenza, our guidance to healthcare providers and the general public around the use of PPE should be just as it is with seasonal flu.

Let's not pull the trigger too soon.

H1N1 Flu in Perspective

This is important:

http://www.webmd.com/cold-and-flu/news/20090501/putting-swine-flu-in-perspective

H1N1 Flu Information for Spanish speakers, in easy-to-read format!

Thank you, Rachel, for getting these brochures together so quickly.

See http://www.cdphe.state.co.us/epr/Public/H1N1/Languages/Spanish/info.html.

My advice: use legal size paper and look for the tiny marks to show where to fold them.

We also have a poster on this page - we think that can be printed on either 8.5x11 or 11x17 paper, but I had no luck on 8.5 x 11. Maybe it depends on your printer.

Hurray, Rachel!

WOW - good work!

Lots of public health folks were really busy last night -- and even overnight.

Colorado has moved 167,000 courses of antiviral medications to sites all over the state. You should thank your local public health department!