Two Aircraft Carriers’ Perspectives: A Comparative of Control Measures in Shipboard H1N1 Outbreaks

2013 ◽  
Vol 7 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Jared L. Harwood ◽  
Joseph T. LaVan ◽  
George J. Brand
Keyword(s):  
Influenza A ◽  
Survival Curve ◽  
Treatment Protocol ◽  
Ronald Reagan ◽  
H1n1 Influenza ◽  
Case Definition ◽  
Lessons Learned ◽  
Control Measures ◽  
H1n1 Strain ◽  
Novel H1n1 Influenza

AbstractBackgroundThe USS George Washington (GW) and the USS Ronald Reagan (RR), 2 US Navy aircraft carriers, experienced almost simultaneous outbreaks of novel H1N1 influenza A in the summer of 2009. We compared the respective epidemic control measures taken and subsequent lessons learned.MethodsData were collated from both outbreaks to assess various elements including attack rate, isolation/quarantine protocols, and treatment methods. The respective duration of each outbreak was compared with survival curve analysis. The number of personnel affected in each outbreak was compared using χ2 analysis.ResultsDifferences were found in the protocols used on the 2 ships. The GW treated about two-thirds of the patients with oseltamivir through day 14 and quarantined all patients meeting case definition throughout the outbreak. Face masks were used throughout. The RR used oseltamivir and quarantined many fewer patients (through days 5 and 3, respectively). No face masks were used after day 5. The outbreaks were similar in duration (GW = 25 days, RR = 27 days, P = .38), but the RR had significantly more cases (n = 253 vs 142, P < .0001). A portion of each group had samples that were confirmed H1N1 by polymerase chain reaction.ConclusionsGW's protocol, including aggressive oseltamivir treatment of two-thirds of the cases and quarantine throughout the duration decreased the overall number of personnel affected, likely reducing the overall control reproduction number. Both outbreaks were similar in duration. Even though the GW expended significantly more resources than the RR, if the 2009 pandemic H1N1 strain had been as clinically severe as the 1918 pandemic, a more stringent treatment protocol may have been the only way to prevent significant operational impact.(Disaster Med Public Health Preparedness. 2013;7:29-35)

scholarly journals The novel H1N1 Influenza A global airline transmission and early warning without travel containments

2010 ◽  
Vol 55 (26) ◽  
pp. 3030-3036 ◽  
Author(s):  
ChaoYi Chang ◽  
ChunXiang Cao ◽  
Qiao Wang ◽  
Yu Chen ◽  
ZhiDong Cao ◽  
...  
Keyword(s):  
Early Warning ◽  
Influenza A ◽  
H1n1 Influenza ◽  
The Novel ◽  
Novel H1n1 Influenza

Fulminant myocarditis associated with novel H1N1 influenza A

Heart & Lung ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 566-568 ◽  
Author(s):  
Rami N. Khouzam ◽  
Constantin Parizianu ◽  
Abdul Moiz Hafiz ◽  
Shalinee Chawla ◽  
Richard Schwartz
Keyword(s):  
Influenza A ◽  
H1n1 Influenza ◽  
Fulminant Myocarditis ◽  
Novel H1n1 Influenza

scholarly journals Asthma and severity of 2009 novel H1N1 influenza: a population-based case–control study

2013 ◽  
Vol 50 (10) ◽  
pp. 1069-1076 ◽  
Author(s):  
Carlos F. Santillan Salas ◽  
Sonia Mehra ◽  
Maria R. Pardo Crespo ◽  
Young J. Juhn
Keyword(s):  
Influenza A ◽  
Case Control Study ◽  
H1n1 Influenza ◽  
Population Based ◽  
Case Control ◽  
Novel H1n1 Influenza ◽  
Control Study

scholarly journals Assessment of secondary attack rate and effectiveness of antiviral prophylaxis among household contacts in an influenza A(H1N1)v outbreak in Kobe, Japan, May–June 2009

2009 ◽  
Vol 14 (35) ◽  
Author(s):  
F Odaira ◽  
H Takahashi ◽  
T Toyokawa ◽  
Y Tsuchihashi ◽  
T Kodama ◽  
...  
Keyword(s):  
Attack Rate ◽  
Influenza A ◽  
Underlying Disease ◽  
Severe Form ◽  
Case Definition ◽  
Control Measures ◽  
Onset Date ◽  
Antiviral Prophylaxis ◽  
Household Contacts ◽  
Influenza A H1n1

This report describes the assessment of the secondary attack rate (SAR) and the effectiveness of post-exposure antiviral prophylaxis among household contacts in the first domestic outbreak of a novel influenza A(H1N1)v between mid-May and early June 2009 in Kobe city, Japan. Of the 293 subjects, 14 (4.8%) household contacts met the case definition and most secondary cases were probably infected around the time of symptom onset date of the respective index case. The SAR among household contacts who did not receive prophylaxis was 7.6%, similar to the rate of seasonal influenza, and the attack rate in siblings was significantly higher than that in parents. We conclude that it is important to establish routine infection control measures for households in order to prevent the spread of the virus among household contacts and, possibly, to the community. We could not conclude whether antiviral prophylaxis was effective or not. However, among close contacts with underlying disease who received prophylaxis, nobody developed a severe form of the disease.

Utility of Influenza Vaccination for Oncology Patients

2010 ◽  
Vol 28 (14) ◽  
pp. 2481-2490 ◽  
Author(s):  
Daniel A. Pollyea ◽  
Janice M.Y. Brown ◽  
Sandra J. Horning
Keyword(s):  
Influenza Vaccination ◽  
Seasonal Influenza ◽  
Hematologic Malignancies ◽  
H1n1 Influenza ◽  
The Novel ◽  
H1n1 Influenza Virus ◽  
Immunological Responses ◽  
Patients With Cancer ◽  
H1n1 Strain ◽  
Novel H1n1 Influenza

Every fall and winter, patients with cancer and their families ask oncologists whether they should be vaccinated for influenza. This season, with escalating concerns regarding the novel H1N1 influenza virus and its recently approved vaccine, this question has become more frequent and increasingly urgent. The purpose of this article is to review evidence related to the ability of patients with cancer to mount protective immunological responses to influenza vaccination. The literature on immunogenicity in pediatric and adult patients, those with solid tumors and hematologic malignancies, untreated and actively treated patients, and patients receiving biologic agents is summarized and reviewed. In addition, we report on potential strategies to improve the efficacy of influenza vaccination in patients with cancer, such as the timing of vaccination, use of more than a one-shot series, increasing the antigen dose, and the use of adjuvant therapies. We conclude that there is evidence that patients with cancer receiving chemotherapy are able to respond to influenza vaccination, and because this intervention is safe, inexpensive, and widely available, vaccination for seasonal influenza and the novel H1N1 strain is indicated.

Rationing of Resources: Ethical Issues in Disasters and Epidemic Situations

2009 ◽  
Vol 24 (3) ◽  
pp. 215-221 ◽  
Author(s):  
Janet Y. Lin ◽  
Lisa Anderson-Shaw
Keyword(s):  
Influenza A ◽  
Large Scale ◽  
Ethical Issues ◽  
H1n1 Influenza ◽  
Care Providers ◽  
Mechanical Ventilators ◽  
Ethical Decisions ◽  
Successful Recovery ◽  
1918 Influenza ◽  
Novel H1n1 Influenza

AbstractIn an epidemic situation or large-scale disaster, medical and human resources may be stretched to the point of exhaustion. Appropriate planning must incorporate plans of action that minimize public health morbidity and mortality while maximizing the appropriate use of medical and human healthcare resources. While the current novel H1N1 influenza has spread throughout the world, the severity of this strain of influenza appears to be relatively less virulent and lethal compared to the 1918 influenza pandemic.However, the presence of this new influenza strain has reignited interest in pandemic planning.Amongst other necessary resources needed to combat pandemic influenza, a major medical resource concern is the limited number of mechanical ventilators that would be available to be used to treat ill patients. Recent reported cases of avian influenza suggest that mechanical ventilation will be required for the successful recovery of many individuals ill with this strain of virus. However, should the need for ventilators exceed the number of available machines, how will care providers make the difficult ethical decisions as to who should be placed or who should remain on these machines as more influenza patients arrive in need of care?This paper presents a decision-making model for clinicians that is based upon the bioethical principles of beneficence and justice. The model begins with the basic assumptions of triage and progresses into a useful algorithm based upon utilitarian principles. The model is intended to be used as a guide for clinicians in making decisions about the allocation of scarce resources in a just manner and to serve as an impetus for institutions to create or adapt plans to address resource allocation issues should the need arise.

Time-series model to predict impact of H1N1 influenza on a children's hospital

2011 ◽  
Vol 140 (5) ◽  
pp. 798-802 ◽  
Author(s):  
M. C. SPAEDER ◽  
J. R. STROUD ◽  
X. SONG
Keyword(s):  
Time Series ◽  
Influenza A ◽  
Burden Of Illness ◽  
Influenza Pandemic ◽  
Model Performance ◽  
H1n1 Influenza ◽  
Influenza A H1n1 ◽  
Distribution Of Resources ◽  
Novel H1n1 Influenza ◽  
Novel Influenza A

SUMMARYThe spring of 2009 witnessed the emergence of a novel influenza A(H1N1) virus resulting in the first influenza pandemic since 1968. In autumn of 2010, the 2009 novel H1N1 influenza strain re-emerged. We performed a retrospective time-series analysis of all patients with laboratory-confirmed H1N1 influenza who presented to our institution during 2009. Cases of influenza were assembled into 3-day aggregates and forecasting models of H1N1 influenza incidence were created. Forecasting estimates of H1N1 incidence for the 2010–2011 season were compared to actual values for our institution to assess model performance. Ninety-five percent confidence intervals calculated around our model's forecasts were accurate to ±3·6 cases per 3-day period for our institution. Our results suggest that time-series models may be useful tools in forecasting the incidence of H1N1 influenza, helping institutions to optimize distribution of resources based on the changing burden of illness.

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