Weekly Flu Surveillance Reports
North Carolina
The N.C. Division of Public Health's Communicable Disease Control Branch posts an online North Carolinaís Weekly Influenza Summary at http://www.epi.state.nc.us/epi/gcdc/flu2009.htmlUnited States
For U.S.-wide data on flu activity, go to the CDC web site at http://www.cdc.gov/flu/weekly
CMS to host call on H1N1 waivers Nov. 10
11/06/09 - The Centers for Medicare & Medicaid Services will host a Nov. 10 conference call on Section 1135 waivers, which hospitals can request to help meet patient needs during the H1N1 flu pandemic. Health and Human Services Secretary Kathleen Sebelius has temporarily waived or modified certain Medicare, Medicaid and Children's Health Insurance Program requirements during the pandemic. Hospitals can petition their CMS regional office or state survey agency for any of the waivers. Experts will be available to answer questions during the call. In addition, questions may be emailed to CMS in advance at Pandemic@cms.hhs.gov. For more information, go online at:
http://www.cms.hhs.gov/OpenDoorForums/18_ODF_Hospitals.asp
FDA authorizes use of certain expired flu antivirals
11/06/09 - The Food and Drug Administration has issued emergency use authorizations to allow certain Tamiflu and Relenza products to be used beyond their expiration dates during the H1N1 flu pandemic. The action authorizes 18 lots of Tamiflu and three lots of Relenza to be used until April 26, 2010.
http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm154962.htm
N95 respirators and product re-marketing/replacement
11/06/09 - Due to shortages of N-95 respirators, hospitals may have to purchase or have received different make, model, or styles of respirators from what your workers are currently fit tested for. The respiratory protection standard 29 CFR 1910.134 states that:
"Fit testing. This paragraph requires that, before an employee may be required to use any respirator with a negative or positive pressure tight-fitting facepiece, the employee must be fit tested with the same make, model, style, and size of respirator that will be used."Respirators can be remarketed under different names, but retain the same fit characteristics. The CDC has provided additional guidance:
Q: How can I determine if a specific N95 respirator has been remarketed by a different company under another model number?
A: In some cases, the same product is marketed by separate companies under different model numbers. You can determine if N95 respirators are remarketed under other companies and associated model numbers by visiting http://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/default.html
If your new respirator retains the same fit characteristics, then you will not have to fit test your employees again.
To determine if the new model retains the same characteristics, contact NC Department of Labor. North Carolina administers its own labor program under the NC Department of Labor, instead of OSHA, please contact health standards officers Susan Harritos, 919-807-2879, or Dr. Ed Geddie, 919-807-2880, or email ask.osh@nc.labor.gov to determine if a new respirator that you have purchased or received is acceptable.
Influenza A (H1N1) 2009 Monovalent Vaccine and Reimbursement Guidelines for 2009/2010
11/02/09 - Information from the November 2009 Medicaid Bulletin. Medicaid billing information for administration of H1N1 vaccine.
MedicaidbillingH1N1vaccine.pdf
1135 Waiver Information
10/28/09 - Official 1135 Waiver signed by DHHS Secretary Sebelius
Requesting an 1135 Waiver
10/28/09 - The Centers for Medicare and Medicaid Services has online information on requesting an 1135 Waivers to handle the surge of patients due to H1N1.
http://www.cms.hhs.gov/H1N1/Downloads/RequestingAWaiver101.pdf
CMS Fact Sheet: Hospital Alternative Care Sites during H1N1 Public Health Emergency
10/28/09 - Guidance related to payment, conditions of participation and standards of care related to alternative care sites.
http://www.cms.hhs.gov/H1N1/Downloads/AlternativeCareSiteFactSheet.pdf
Medicare Fee-For-Service
10/28/09 - Emergency and Disaster-Related Policies and Procedures That May Be Implemented Without 1135 Waivers
http://www.cms.hhs.gov/H1N1/Downloads/RequestingAWaiver101.pdf
FDA authorizes use of antiviral drug for certain H1N1 patients
10/28/09 - The Food and Drug Administration Friday issued an emergency use authorization allowing certain patients hospitalized with confirmed or suspected H1N1 flu to receive an investigational antiviral drug. The drug, Peramivir IV, is authorized only for hospitalized adults and children for whom therapy with an intravenous drug is clinically appropriate. For details, see the FDA announcement.
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm187813.htm
Severe Influenza in Pregnancy: Consultation and Reporting memo
10/28/09 - The Attached memo from N.C. Division of Public Health Addresses Severe influenza in Pregnancy including consultation and reporting.
H1N1_pregnancy_provider_letter.pdf
Update on H1N1 Hospital Preparedness Grant Funding
The North Carolina Office of Emergency Medical Services (OEMS) is providing an opportunity for all hospitals in North Carolina to apply for grants to assist in their preparedness planning efforts as it relates to the H1N1 Pandemic Influenza. The total amount available to North Carolina hospitals for this purpose is $1.5 million dollars and is funded by the US Department of Health and Human Services, Assistant Secretary for Preparedness and Response (ASPR). Please see the attached pdf file for the grant's three areas of focus regarding H1N1 Hospital Preparedness Planning and the amounts awarded for each category.
OEMS is currently in the process of setting up an online grant application tool that will be utilized for grant submission. The plan is to have this in place and accepting online applications beginning the first week in November. Please contact Brad Thompson in the Office of Emergency Medical Services should you have questions or need additional information. Brad can be reached at 919-855-3947 or by email at brad.thompson@dhhs.nc.gov.
H1N1_Announcement_10-15-09.pdf
Obama declares flu emergency to ease restrictions for hospitals
10/24/09 - President Obama has declared H1N1 swine flu a national emergency, clearing the way for his health chief to give hospitals wider leeway in how they handle a possible surge of new patients.ÀThe president granted Health and Human Services Secretary Kathleen Sebelius the power to lift some federal regulations for medical providers, including allowing hospitals to set up off-site facilities to increase the number of available beds and protect patients who are not infected. The declaration allows Sebelius to waive certain requirements under Medicaire and Medicaid, privacy rules and other regulations.
Click on the link below to learn more about 1135 waivers and what they can do for health care facilities.
http://www.flu.gov/professional/federal/h1n1emergency10242009.html
Click on the link below for the White House information on the President's declaration of an emergency under the National Emergencies Act.
http://www.whitehouse.gov/blog/2009/10/25/president-obama-signs-emergency-declaration-h1n1-flu
Finally a copy of the actual proclamation from the President can be found at the following link.
http://www.politico.com/static/PPM145_memo_one.html
OSHA issues statement on H1N1 inspections
10/16/09 - The Occupational Safety and Health Administration yesterday confirmed plans to issue a compliance directive to ensure uniform procedures when conducting inspections to identify and minimize high-risk occupational exposures to 2009 H1N1 flu. In a statement, the agency said the directive will closely follow the Centers for Disease Control and Prevention's new H1N1 infection control guidance for health care settings. In response to complaints, OSHA said its inspectors will ensure that health care employers implement a hierarchy of controls, and encourage vaccination and other work practices recommended by the CDC. Where N95 respirators are not commercially available, the agency emphasized that an employer will be considered to be in compliance if the employer can show that a good faith effort has been made to acquire respirators. ”Where respirators are required to be used, the OSHA Respiratory Protection standard must be followed, including worker training and fit testing,’ the agency said. When OSHA inspectors determine that a facility has not violated any OSHA requirements but that additional measures could enhance the protection of employees, the agency said it may provide the employer with a Hazard Alert Letter outlining suggested measures to further protect workers.
http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=NEWS_RELEASES&p_id=16602
http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm
CDC updates H1N1 infection control guidance for health care settings
10/14/09 - The Centers for Disease Control and Prevention today updated its H1N1 infection control guidance for health care settings, including use of N95 respirators. The agency continues to recommend that health care workers who are in close contact with patients having suspected or confirmed H1N1 flu use N95s, but acknowledged supply concerns. Where a shortage of respirators exists despite reasonable efforts to obtain them, hospitals may prioritize use of the N95 respirators, especially for aerosol-generating procedures and for health care workers who are at higher risk for H1N1. Hospitals with insufficient supplies of N95 respirators that demonstrate "good faith" efforts to acquire N95s and follow the agency's hierarchy of control recommendations may use surgical masks. During a CDC call with hospitals about the guidance, a representative from the Occupational Safety and Health Administration said OSHA will not deem these hospitals to be out of compliance with its standards, and is preparing a detailed compliance directive outlining how OSHA will enforce the CDC guidance. The CDC also released a document to help health care facilities optimize the implementation of H1N1-related infection control recommendations within the context of equipment shortages. Today's guidance also updates how long health care workers should stay away from work if they develop a fever and respiratory symptoms. Under the new recommendation, these workers should be excluded from work for at least 24 hours after they no longer have a fever without the use of fever-reducing medicines.
http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm
http://www.cdc.gov/h1n1flu/guidelines_infection_control_qa.htm
Temporary Order Issued For N.C. Docs To Report Flu Deaths In People 18 Or Older
9/25/09 - The State Health Director has issued a temporary order requiring North Carolina physicians to report all influenza-associated deaths in persons 18 years of age or older. Influenza deaths in children less than 18 years of age have been legally reportable since 2004. This order is necessary to enhance influenza surveillance during the current pandemic. For surveillance purposes, an influenza-associated death is defined as a death resulting from a clinically compatible illness that was confirmed to be influenza (either seasonal or pandemic) by an appropriate laboratory or rapid diagnostic test. Physicians should report all influenza-associated deaths to their local health department within 24 hours after death occurs.
http://www.epi.state.nc.us/epi/gcdc/pdf/TempOrderAdultFluDeathReporting.pdf
Waiver of Rules for Hospitals that Provide Temporary Shelter or Temporary Services During a Disaster or Emergency, Temporary Changes in Bed Capacity and H1N1 Virus, EMTALA, and Medicare Fee for Service
9/25/09 - See attached pdf
AHA urges changes to H1N1 infection control guidance
9/17/09 - The AHA yesterday urged the Centers for Disease Control and Prevention to revise its hospital infection control guidelines for H1N1 flu to reflect the most recent data on how the virus is transmitted and the limited supply of N-95 respirators. In a letter to the CDC÷s National Institute for Occupational Safety and Health, the AHA said it supports using a hierarchy of controls to prevent H1N1 infection, and recommends using surgical or procedure masks for most patient contact and N-95 respirators primarily for aerosol-generating procedures. ”Current CDC guidance, issued this past Spring before the severity or mechanism of transmission was fully understood, conservatively recommends the use of N-95 (or higher) respirators for routine patient care,’ the AHA wrote. ”However, more recent data suggests that the virus has not changed to become more severe and studies suggest that it transmits much the same way as seasonal flu.’ The AHA also urged the Department of Health and Human Services to increase funding for research on flu transmission and personal respiratory protection, and for development of a better respirator for health care workers.
http://www.aha.org/aha/letter/2009/090915-let-bentley-howard.pdf
FDA approves H1N1 vaccines from four manufacturers
9/17/09 - The Food and Drug Administration has approved four H1N1 flu vaccines for national distribution. The vaccines are made by CSL Ltd., Diagnostics Ltd., Novartis Vaccines and MedImmune LLC. Three are injectable vaccines and one is a nasal spray. The FDA expects initial lots to be available in the next four weeks, with 40-45 million doses available by mid-October. Based on preliminary data from clinical studies, a single dose of the vaccines induces a robust immune response within 8-10 days in most healthy adults. Studies are still underway to determine optimal dosing for children. The H1N1 vaccines will not protect against seasonal flu, which is a separate vaccine, FDA noted.
http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm181950.htm
NC Flu Preparedness Resources
http://www.flu.nc.gov http://www.flu.gov/professional/hospital/index.html http://www.epi.state.nc.us/epi/gcdc/H1N1flu.html http://www.immunizenc.com/Providers.htm http://www.immunizenc.com/FluSeason.htm http://www.dhhs.state.nc.us
Flu Clinic Finder
The North Carolina Immunization Branch and The Carolinas Center for Medical Excellence team up each year to bring you the North Carolina Flu Clinic Finder. This database contains a listing of all of the flu clinics being offered across North Carolina. All you have to do is enter your zip code and click 'submit'; it will provide a list of clinics within 30 miles of your home.
http://www2.thecarolinascenter.org/fcf/
CDC Resources
2009 H1N1 Flu: Situation Update
http://www.cdc.gov/h1n1flu/update.htm
US Department of Health and Human Services
http://www.hhs.gov/ophs/programs/initiatives/vacctoolkit/index.html
N.C. Communicable Disease Branch
This document from the N.C. Communicable Disease Branch contains revised guidance for control of influenza in healthcare settings. This revision contains the following changes/additions:
Guidance regarding respiratory hygiene/cough etiquette in healthcare settings; Guidance for exclusion of health care workers with flu-like illness; Revised definition of "aerosol-generating procedures".
Interim Infection Control Guidance for Healthcare Workers
CDC updates guidance on flu antiviral use
Hospitals and physicians should consider prescribing antiviral medications to patients at high risk for complications from seasonal or H1N1 flu, according to updated guidelines released today by the Centers for Disease Control and Prevention. However, patients should not use them unless they develop symptoms, the guidance adds. The CDC recommends that all patients hospitalized with flu-like symptoms receive both rapid flu tests and anti-viral medications, since a negative test does not rule out flu and preventive treatment is most effective within 48 hours of flu symptoms.
http://www.flu.gov/vaccine/antiviralfaq.html
Recent State Emergency Response Team H1N1 Operation Briefing
The State Emergency Response Team held a H1N1 webinar on September 1. Information presented is on the Emergency Management’s Documents page:
http://www.nccrimecontrol.org/index2.cfm?a=000003,000010,000024
CMS issues EMTALA guidance for H1N1 flu
The Centers for Medicare & Medicaid Services recently issued a memo and fact sheet clarifying permissible options under the Emergency Medical Treatment and Labor Act for hospitals handling a surge in patients with H1N1 flu. For example, hospitals may set up alternative screening sites on campus or at off-campus, hospital-controlled sites, and communities may set up screening clinics at sites not under the control of a hospital. Further, the law provides for waivers of certain EMTALA requirements in a declared public health emergency, the memo notes.
http://www.cms.hhs.gov/SurveyCertificationGenInfo/downloads/SCLetter09_52.pdf
Medicare Coverage & Reimbursement Rules For H1N1 Seasonal Flu
A special edition MLN Matters article regarding the billing for the administration of the Influenza A vaccine has been published. The document addresses Medicare coverage and reimbursement rules for the H1N1 vaccine and addresses seasonal flu coverage. Medicare will pay for seasonal flu vaccinations even if the vaccinations are rendered earlier in the year than normal. CMS understands that preparations are critical for the upcoming flu season, especially in planning for the H1N1 vaccine. Because of the different situations regarding the number of doses needed in the vaccine area this year, claims processing contractors have been given instructions to allow for earlier payment of claims and to pay multiple administration charges. Please read the entire document at http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0920.pdf
CDC issues H1N1 flu vaccine planning guides
The Centers for Disease Control and Prevention has released several documents to help health care providers and others plan H1N1 flu vaccination campaigns. The resources include a planning checklist, answers to common questions about vaccine planning and distribution, and vaccination guidelines for pregnant women.
http://www.cdc.gov/h1n1flu/vaccination/statelocal/qa.htm
http://www.cdc.gov/H1N1flu/vaccination/statelocal/centralized_distribution_qa.htm
http://www.cdc.gov/H1N1flu/vaccination/pregnant_qa.htm
CMS Releases Questions/Answers -- H1N1 Pandemic Preparedness
The Centers for Medicare and Medicaid Services issued information on Medicare fee-for-service policies and procedures in an H1N1 flu pandemic or other public health emergency or disaster. The document addresses issues related to H1N1 vaccination, flexibilities available in an emergency or disaster, waivers of certain Medicare requirements in a declared emergency or disaster, and payment polices and billing procedures for various types of health care services and providers. To review the information: H1N1_Medicare_FFS_Emergency_QsAs_091109.pdf
IOM: Health workers should wear respirators for H1N1 patients
The Institute of Medicine today recommended that health care workers exposed to patients with suspected or confirmed H1N1 flu wear N95 respirators that have been tested to fit the wearer. The IOM report endorses current Centers for Disease Control and Prevention guidelines for respiratory protection against the H1N1 virus, but cautions against relying on any single strategy to control infection. For example, it also recommends vaccinating health care workers against the virus, considering separate waiting areas and rooms for H1N1 patients, and encouraging workers to use protective gloves and good hand-washing and respiratory hygiene. Requested by the CDC and Occupational Safety and Health Administration, the report examines the efficacy of various types of personal respiratory protection, not implementation factors such as the cost or supply of respirators, masks or other protection.
http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm
http://www.iom.edu/CMS/3740/71769/72967.aspx
Hospitals urged to complete important HHS survey
The American Association for Respiratory Care is surveying all U.S. hospitals to obtain an accurate count of mechanical ventilators available as the nation braces for the H1N1 flu virus this fall. Launched on Aug. 17, the survey is being conducted for the Department of Health and Human Services' Office of Preparedness and Response for completion by Sept. 10. Information on the survey was sent to hospital executives yesterday and to their respiratory care/critical care service managers last month. HHS officials are hoping for a 90% response rate from the nation’s hospitals. For more information or to complete the survey, visit www.aarc.org.
APIC: Providers should require flu vaccine for certain employees
The Association for Professionals in Infection Control and Epidemiology yesterday reinforced its 2008 position paper recommending that health care facilities require annual seasonal flu vaccination for all employees with direct patient contact. APIC said health care facilities should implement a comprehensive strategy for immunizing employees based on guidelines from the Center for Disease Control and Prevention’s Healthcare Infection Control Practices Advisory Committee and the Advisory Committee on Immunization Practices. In addition, APIC recommends that health care facilities “obtain informed statements acknowledging the risk to patients from employees who decline the vaccine for reasons other than medical.” Linda Greene, RN, lead author on the APIC position paper and director of infection prevention and control at Rochester (NY) General Health System, said, “We want to be certain that health care personnel are protected against both seasonal flu and the 2009 H1N1 virus. Otherwise, facilities could face a double problem of increased illness and absenteeism among staff coupled with overcrowded emergency departments.”