R 302034Z JUL 09 ALCOAST 441/09 SUBJ: H1N1 INFLUENZA UPDATE A. COMDT COGARD WASHINGTON 282202Z APR 09/ALCOAST 251/09 B. COMDT COGARD WASHINGTON 051950Z MAY 09/ALCOAST 269/09 1. THE H1N1 INFLUENZA VIRUS PANDEMIC HAS CONTINUED TO SPREAD AND THERE HAVE BEEN SIGNIFICANT H1N1 INFLUENZA OUTBREAKS IN THE UNITED STATES (US). 2. ALTHOUGH 43,000 CASES HAVE BEEN CONFIRMED, THE CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) ESTIMATES OVER 1,000,000 H1N1 INFLUENZA CASES INCLUDING 302 DEATHS HAVE OCCURRED IN THE US. IT IS CERTAIN THAT MORE CASES, MORE HOSPITALIZATIONS AND ADDITIONAL DEATHS ASSOCIATED WITH THIS PANDEMIC WILL OCCUR THIS FALL AND WINTER. 3. THIS MESSAGE SERVES AS AN UPDATE AND A REMINDER THAT COMMANDS SHOULD REMAIN VIGILIANT TO THIS EMERGING VIRAL THREAT TO COAST GUARD FORCES AND MISSIONS. 4. COMMANDING OFFICERS (CO) /OFFICER-IN-CHARGE (OIC) RESPONSIBILITIES: A. CONTINGENCY PLANNING IS A CO/OIC RESPONSIBILITY. THE CO/OIC MUST ENFORCE FORCE HEALTH PROTECTION MEASURES AS ONLY ONE ASPECT OF CONTINUITY OF OPERATIONS PLANS (COOP). B. COOP MUST CONTAIN PLANNING FACTORS THAT ADDRESS IMPACT ON MISSION CAPABILITIES IN THE FACE OF ABSENTEE RATES OF 10, 25 AND 40 PERCENT. C. CONTINUITY OF FOOD SERVICES, SUPPLY LOGISTICS, JANITORIAL SERVICES, SECURITY AND RISK MITIGATION IN HIGH DENSITY BILLETING AREAS SUCH AS BARRACKS OR SHIPS ARE EXAMPLES OF OTHER NON-MEDICAL ESSENTIAL ITEMS OF THE COOP. D. CO/OIC SHOULD ENSURE THEIR MEMBERS HAVE TAKEN THE MANDATORY PANDEMIC INFLUENZA TRAINING COURSES. 5. FORCE HEALTH PROTECTION MEASURES - A. TRANSMISSION - H1N1 INFLUENZA IS SPREAD IN THE SAME WAY THAT REGULAR SEASONAL INFLUENZA VIRUSES SPREAD, MAINLY THROUGH COUGHING AND SNEEZING. IT MAY ALSO BE SPREAD BY TOUCHING CONTAMINATED OBJECTS AND THEN TOUCHING YOUR NOSE OR MOUTH. B. PREVENTION - ALL COAST GUARD MEMBERS SHOULD TAKE EVERYDAY PREVENTIVE ACTIONS TO STOP THE SPREAD OF INFLUENZA, INCLUDING FREQUENT HAND WASHING AND PRACTICING APPROPRIATE COUGH AND SNEEZE HYGIENE (E.G. COUGH OR SNEEZE INTO THE BEND OF YOUR ELBOW OR INTO A DISPOSABLE TISSUE - REUSABLE HANDKERCHIEFS ARE DISCOURAGED). ILL PERSONS SHOULD STAY HOME, NOTIFY SUPERVISOR, AND SEEK MEDICAL CARE FOR WORSENING SYMPTOMS. C. INCUBATION PERIOD -INCUBATION IS USUALLY 1-7 DAYS WITH AN AVERAGE OF 4 DAYS. D. SYMPTOMS - H1N1 INFECTION IS CHARACTERIZED BY FEVER (100.5 DEGREES FAHRENHEIT OR GREATER) AND A RANGE OF INFLUENZA-LIKE SYMPTOMS SUCH AS, COUGH, SORE THROAT, BODY ACHES, HEADACHE, CHILLS, AND FATIGUE AND MAY LAST UP TO 7-10 DAYS. NAUSEA, VOMITING, AND DIARRHEA ARE NOT TYPICAL FLU SYMPTOMS. E. SCREENING - WHEN A COAST GUARD MEMBER HAS INFLUENZA-LIKE SYMPTOMS, COMMANDS SHOULD ENSURE THE MEMBER IS EVALUATED BY MEDICAL (WHETHER COAST GUARD, DOD, OR CIVILIAN). FOR COAST GUARD MEMBERS EVALUATED BY COAST GUARD HEALTH CARE PERSONNEL, AN H1N1 CONFIRMATORY TEST SHOULD BE PERFORMED (E.G. REAL TIME POLYMERASE CHAIN REACTION (RT/PCR) OR VIRAL CULTURE). CONFIRMATORY TESTING MAY OR MAY NOT BE PERFORMED FOR MEMBERS EVALUATED AT DOD OR CIVILIAN FACILITIES. UNIT IDHS SHOULD CONTACT THEIR DMOAS OR SERVICING COAST GUARD CLINIC FOR ASSISTANCE IN OBTAINING CONFIRMATORY TESTING. RAPID INFLUENZA TESTING IS NOT RECOMMENDED BECAUSE OF TESTING LIMITATIONS AND THE VARIABILITY OF INTERPRETING POSITIVE OR NEGATIVE RESULTS. F. TREATMENT - TREATMENT OF INDIVIDUAL CASES IS AT THE DISCRETION OF LOCAL MEDICAL PROVIDERS AND SHOULD BE IN ACCORDANCE WITH CDC GUIDELINES AND STANDARD MEDICAL PRACTICE. G. PROPHYLAXIS - PROPHYLAXIS IS PREVENTIVE MEDICATION TAKEN BY PERSONS WHO ARE NOT YET ILL BUT MAY HAVE BEEN EXPOSED. TO ENSURE CONSISTENCY, COMDT (CG-11) IS THE SOLE APPROVING AUTHORITY FOR PROPHYLAXIS OF ACTIVE DUTY AND SELRES MEMBERS. THE DECISION FOR PROPHYLAXIS IS BASED ON MANY FACTORS INCLUDING SEVERITY OF ILLNESS, BERTHING ARRANGEMENTS, OPERATIONAL CONSIDERATIONS, ETC. INDEPENDENT DUTY HEALTH SERVICES TECHNICIANS (IDHS) MUST CONTACT THEIR COGNIZANT DESIGNATED MEDICAL OFFICER ADVISOR (DMOA), OR IF NOT AVAILABLE, THE HEALTH-SAFETY, AND WORK-LIFE (HSWL) OPERATIONAL MEDICINE (OP-MED) DIVISION, FOR PROPHYLAXIS GUIDANCE. HSWL OP-MED WILL CONTACT THE APPROPRIATE HEADQUARTERS REPRESENTATIVE COMDT (CG-112)/ COMDT (CG-1121) FOR COMDT (CG-11) DECISION REGARDING PROPHYLAXIS. H. REPORTING - ALL CONFIRMED (RT-PCR) CASES MUST BE REPORTED BY THE COGNIZANT HEALTH CARE PERSONNEL IN THE NAVY DISEASE REPORTING SURVEILLANCE INTERNET (NDRSI) DATABASE. IDHS MUST CONTACT THEIR COGNIZANT DMOA OR HSWL OPMED DIVISION FOR ASSISTANCE WITH EVALUATING AND TREATING MEMBERS WHO PRESENT WITH INFLUENZA-LIKE ILLNESS. DMOAS SHOULD INFORM THE HSWL OP-MED CHIEF OF ANY SUSPECTED OR CONFIRMED H1N1 OUTBREAKS. COMDT (CG-112)/ COMDT (CG-1121) MUST BE INFORMED OF ALL SUSPECTED OR CONFIRMED OUTBREAKS. I. VACCINE - THE COAST GUARD WILL PROCURE H1N1 VACCINE FOR COAST GUARD MEMBERS AS SOON AS THE VACCINE BECOMES AVAILABLE. PLANNING FOR VACCINATION OF ALL MEMBERS IS CURRENTLY UNDERWAY. ADDITIONALLY, ALL MEMBERS SHALL BE IMMUNIZED AGAINST SEASONAL INFLUENZA WHEN SUPPLIES ARE AVAILABLE. 6. COMDT (CG-53) WILL RELEASE THE COMMUNICABLE DISEASE STRATEGIC PLAN BY 31 JUL. LANTAREA/OPCOM WILL USE THIS FRAMEWORK TO DEVELOP AN OPLAN FOCUSED ON THREAT OF IMPENDING H1N1 PANDEMIC. THE OPLAN WILL BE RELEASED TO THE FIELD FORAC NLT 01 SEP 09. RATIFICATION OF THE DEPARTMENT OF HOMELAND SECURITY (DHS)/DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS) MEMORANDUM OF UNDERSTANDING (MOU) NEARS COMPLETION. THIS MOU FORMALIZES THE RELATIONSHIP BETWEEN DHS AND HHS TO COORDINATE A PANDEMIC RESPONSE. CONSULTATIONS ARE PLANNED FOR EARLY AUG 09 BETWEEN DHS COMPONENTS AND CDC TO FINALIZE THE DHS/HHS MOU. 7. FOR FORCE HEALTH PROTECTION QUESTIONS, PLEASE CONTACT CDR JEFFREY SALVON-HARMAN, HSWL OP-MED, AT (757) 628-4331 OR HSCM MARTHA UTLEY, HSWL, AT (757) 628-4375. 8. RADM MARK J. TEDESCO, DIRECTOR OF HEALTH, SAFETY AND WORK LIFE AND RADM J.T. RIKER, DIRECTOR OF RESPONSE POLICY SEND. 9. INTERNET RELEASE IS AUTHORIZED