3) Hurricane Wilma:

We tried to get a federal Public Health analysis of the post-Wilma situation. The last Hurricane Katrina post at http://www.cdc.gov/od/katrina/ was a very informative public health analysis for the Gulf Coast as of 2005-10-07 -- but that was the last such document for Katrina, and I haven't found a similar document for Hurricane Wilma. If any E-News reader knows of one, please let me know.

***

AAPHP Vice President Kevin M. Sherin, MD, MPH recently returned to Orlando from service in South Florida, where he helped manage state and federal medical relief efforts for the Florida Department of Health. We hope to report further on Dr. Sherin's observations and after-action review in a future E-News issue.

***

CDC recently released a 45-page report on mold assessment and post-hurricane mold cleanup. This report is at http://www.bt.cdc.gov/disasters/mold/report/pdf/2005_moldreport.pdf. Thanks to CDC's Clinician Outreach and Communications Activity (COCA) team for letting us know about this report!

4) Influenza Update:

Avian influenza was Newsweek's cover story for 2005-10-31, with a well-balanced presentation of what we know and don't know. That issue's lead article has apparently been superseded on the public Web by the
2005-11-07 issue, but the influenza issue of Newsweek should be available in libraries.

For me, the eye-opener in the Newsweek article was the map of bird migration routes. Many of the migration paths for both East Asia and the Americas converge in Alaska. If, as appears likely, highly pathogenic avian influenza
H5N1 (HPAI H5N1) travels via migrating birds, there may be few natural obstacles to the eventual spread of HPAI H5N1 to the Americas. This could entail significant changes -- and/or significant losses -- for U.S.
agriculture.

Fareed Zakaria's 2005-10-31 opinion column, "A Threat Worse Than Terror", contrasted the federal government's flu budget, and flu preparations, with the budget and preparations for other threats. That column is on the public Web at http://msnbc.msn.com/id/9787690/site/newsweek/

CDC's Avian Influenza information sheet for the public, last modified 2005-10-25, is at http://www.cdc.gov/flu/avian/gen-info/facts.htm

The federal Department of Health and Human Services has announced that the latest Pandemic Influenza plan will be released tomorrow, 2005-11-02.
(Please remember that the avian flu is not currently pandemic, and the next pandemic flu may not be an avian strain. These two themes are closely related, but they aren't the same thing.) When released, the pandemic flu plan will be posted at http://www.pandemicflu.gov/.

In response to reports of individuals stockpiling oseltamivir, often on the advice of medical professionals, Public Health physician and Health Officer Diana T. Yu, MD, MSPH sent a letter to health professionals in one of her counties. Selected text of this letter, graciously shared with E-News by Dr. Yu, follows:

*** Oseltamivir Message - Mason County WA, 2005-10-28 ***

Public health officials strongly discourage healthcare providers from prescribing and the public from requesting Tamiflu® (influenza antiviral
medication) for private stockpiling purposes.

PRIORITY USE FOR TAMIFLU®

The highest current priority for use of Tamiflu® is for treatment of people during the upcoming regular flu season who are at highest risk of serious complications from influenza infection (e.g., persons >65 years, young children, and persons with certain chronic diseases).

The next highest priority for use of Tamiflu® and other influenza antiviral medications is for prophylaxis in persons at high risk of serious complications from influenza infection who have been exposed to influenza (e.g., household in which someone has been diagnosed with influenza or hospital or nursing home with an outbreak of influenza) during the regular flu season.

The use of Tamiflu® during a pandemic with avian influenza may be considered, however a community wide planned approach will be necessary.
Encouraging patients to take Tamiflu® during a potential pandemic without a planned approach will not be effective in control of the outbreak, could be wasteful, and may cause drug resistance.

TAMIFLU® SUPPLY

There are limited supplies of Tamiflu® in the US. Some people are advocating for stockpiling of this drug now because of concerns about a future pandemic. National stockpiling for controlled use is not the same as individual hoarding of Tamiflu® for personal use.

The indiscriminate and inappropriate use of Tamiflu® may promote the development and spread of resistance to this important drug among influenza viruses.

PREVENTING INFLUENZA AND OTHER RESPIRATORY ILLNESSES

Health care providers can use a mask when seeing patients with a cough illness.

Steps people can take to keep themselves and others healthy this flu season
include:
Avoiding crowds;
Staying home from work or school when sick with cough illness;
Getting their flu shot;
Covering their cough; and
Washing hands after coughing or touching respiratory secretions.

*** End of oseltamivir message ***

CDC's oseltamivir message for the public, last updated 2005-10-21 and found at http://www.cdc.gov/flu/protect/antiviral/ doesn't address the stockpiling issue as directly as Dr. Yu's 2005-10-28 letter.

[Editor's Note: It will probably take a long time -- far longer than the attention span of the news media and the public -- to fully understand the potential dangers from new influenza strains. Thanks to all the public health leaders who are trying to "do the right thing" and give the public accurate information about what we know and don't know.]