General Information

Pandemic H1N1 Update
Planning & Response Expectations

H1N1 Planning and Response Expectations

The President of the United States has increased the focus on H1N1 as a significant public health concern. The novel status of H1N1 influenza points to the unknown ability of the virus to mutate and cause significant illness or death. California’s Governor has declared a public state of emergency. Hospitals will be under increasing scrutiny by the public and media regarding their preparedness for a more virulent form of H1N1. Hospitals should work directly with their local public health authorities regarding preparedness in the event of a mutated, more dangerous virus, as the current H1N1 pandemic shows no sign of slowing its spread.

It should also be noted that the state has already begun to see an increase in H1N1 cases with schools back in session.

CDPH Updated Recommendations

The California Department of Public Health (CDPH) issued new infection-prevention and -control recommendations Aug. 20 for known or suspected pandemic (H1N1) 2009 influenza patients in inpatient, outpatient and long-term-care settings. The last updated guidelines were issued May 19. The new guidance includes the definition of suspect pandemic (H1N1) 2009 influenza for infection-control purposes; admission and transfer of patients to long-term-care facilities; duration of exclusion for health care workers; antiviral post-exposure prophylaxis for health care workers; and relationship to the CAL/OSHA Aerosol Transmissible Disease (ATD) Standard. The new CDPH guidance is posted on the CHA Emergency Preparedness website at

Definition of suspect pandemic (H1N1) 2009 influenza for infection-control purposes: any patient younger than 60 years of age with a fever (>37.8°C of 100°F) and new onset of cough OR any patient whom a health care provider believes, based on the patient’s history and illness, to have a high likelihood of being infected with pandemic (H1N1) 2009 influenza virus.

Cal/OSHA ATD Standard

Cal/OSHA recognizes the challenges hospitals face with being compliant with the new ATD standard. As such, it has been working collaboratively with CHA and a taskforce, as well as CDPH, to develop an enforcement policy. The policy will include an acceptable approach for hospitals to conserve surgical N95 respirators; utilize alternate N95s or personal protective equipment (PPE); reuse and re-don PPE, etc. However, hospitals will be expected to make every effort to acquire the necessary PPE, and to adhere to the new standard to protect their employees and patients. An enforcement policy is expected to be released next week.

CDPH’s narrowing of the definition for suspect cases is expected to reduce the use of N95 respirators in the hospital setting.

Hospital Reporting of H1N1 Cases to Local Health Departments

Hospitals are required to report all hospitalized H1N1 cases to their local health department, not directly to the state. Each local health jurisdiction should provide facilities the information necessary to adhere to this requirement. Please contact your local health department if you have questions regarding this requirement and the process.

H1N1 Vaccine Update

CDPH currently anticipates receiving its first doses of H1N1 vaccine by late September to mid-October. It estimates California will receive approximately 10 million plus doses initially. McKesson has been selected as the nation’s vaccine distributor. It will distribute the vaccine to up to 90,000 sites nationally. An ordering system is being defined for California. More information is expected to be available on or before Sept. 1. The state will recruit vaccine providers (hospitals, clinics, local health departments, public sites, private sites). A website will be established for registering; however, it will not be a guarantee of vaccine. Early vaccine supplies will be directed to providers serving targeted populations, and local health departments will have priority status. CHA will provide more information on this program as it becomes available. Local health departments will also provide information to providers within their jurisdictions.

Health Care Worker Vaccine ‘Requirement’

CDPH and Cal/OSHA are working on developing a policy around health care worker and H1N1 vaccine requirements. CHA is seeking clarification on the interpretation of the new ATD standard and the language stating the influenza vaccine is mandatory for health care workers. CHA is hopeful that more information will be available soon.

State and Local Health Alerts (CAHAN)

As a significant part of planning, hospitals should ensure that facilities are enrolled in both the local health alert system and state alert system, CAHAN. At a minimum, CHA recommends that hospitals have two individuals established to receive alerts. However, additional alert recipients such as the infection-control practitioner, pharmacy director and laboratory director should be considered. The decisions to add additional recipients should be internal to business processes and emergency operations plans.

New and Updated CDC Interim Guidance and Links to Resources for Clinicians

All H1N1 Flu guidance documents:
Novel H1N1 Influenza — Resources for Clinicians:

HHS/ASPR Situational Awareness Tools

The Office of the Assistant Secretary for Preparedness and Response (ASPR) — under the U.S. Department of Health & Human Services — is working to improve its situational awareness of the health care system. A current proposal for updates to the HavBED system includes existing elements, proposed additions and the purpose of the information. Since system upgrades will be needed, ASPR proposes more changes than would be required for H1N1 (so all upgrades can be done at the same time). ASPR will request only data elements that are relevant to the event. In the existing system, 20 states provide the office with individual hospital-level data, and some states provide aggregate data. ASPR prefers individual-level data to provide a national picture of facility stress that may not be visible with aggregate data. However, the office is not requiring states that report aggregate data to change their systems. ASPR has no intention of reaching directly to individual hospitals, but will follow the ICS chain of command and engage with states when areas of stress are identified. Identified “hot spots” would trigger contact between regional coordinators and state emergency management to gather additional specific information. ASPR is finalizing a concept of operations that will be circulated as well. The goal is to have upgrades completed by the beginning of September, so the office is requesting any final comments on the proposed data elements by August 24. ASPR will begin to engage with vendors immediately to alert them to the proposed changes. The draft document can be viewed on the CHA Emergency Preparedness website at CHA will submit comments August 24.