December 01, 2018

Why should employers be informed about the next possible pandemic?

A pandemic has far-reaching personal and business impacts on an organization. Why?

A Global Society

People- and illnesses- travel easily and quickly all over the world. This is especially true in global companies where business travelers and international assignees are common, and people often work together in close quarters.

Business Travel and Expatriates

Organizations have to make decisions about whether and where to send business travelers or assignees when there are outbreaks of various diseases around the world. The more informed they are, the better.

Employees look to their employer guidance

This is particularly true in organizations that offer well- being programs, on-site health services or clinics. This need for health guidance and communication is heightened in times of crisis or fear.

How can employers prepare?

Employers can and should play an important role in pandemic preparedness by:

• Developing business continuity plans.
• Assessing business risks (e.g., impact of worker absenteeism, quarantine, supply chain delays, etc).
• Establishing policies to guide the company through a pandemic (e.g., determine critical workers, plan for emergency operations, establish lines of communication).
• Developing basic prevention measures (e.g., employee illness surveillance system, employee education for hand and cough hygiene).

What do experts think the next pandemic(s) will be?

2015: The World Health Organization convened experts to develop a list of the top 5-10 “emerging pathogens likely to cause severe outbreaks in the near future, and for which few or no medical countermeasure

This list becomes the WHO Blue print for R&D Preparedness. Focuses on developing diagnostics, vaccines and therapeutics, as well as filling critical gaps in scientific knowledge.

2017-2018: The list was fine-tuned. A summary of the listed diseases follows .

Crimean-Congo haemorrhagic fever (CCHF)

Where is it?

Africa, the Balkans, the Middle East and Asian countries south of the 50th parallel north

What is it?

• Spread by ticks and livestock; human-to-human transmission can occur with close contact
• Causes severe hemorrhagic fever
• Fatality rate of 10-40%

Prevention

• Wear protective clothing and use repellants/aracides to reduce the risk of tick to human transmission
• Wear gloves and protective clothing while handling animals; quarantine animals before they enter slaughterhouses or treat with pesticides two weeks before
• Wear gloves and protective clothing when taking care of ill people. Avoid close contact with persons who have CCHF and wash hands frequently.
• Health care workers caring for patient in outbreak areas should implement standard infection control precautions; when caring for those with hemorrhagic fever, follow WHO infection control guidelines for Ebola and Marburg hemorrhagic fevers.

Treatment

• General supportive care and treatment of symptoms
• Oral and IV ribavirin ( may show some benefit

Source: World Health Organization

Ebola virus disease and Marburg virus disease

Where is it?

Outbreaks have taken place in Central and West Africa.

What is it?

• Spread to people by contact with wild animals and then human-to-human transmission through bodily fluids
• Symptoms typically begin with fever, severe headache and malaise and progress to nausea, vomiting and diarrhea. Many patients have internal and external bleeding in late phases of the illness .
• Causes severe illnesses with average fatality rate of 50%.

Prevention

• Animals should be handled with gloves and other appropriate protective clothing. Animal products should be thoroughly cooked before consumption.
• Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing is required.
• Male survivors of Ebola virus dis ease should practice safe s ex and hygiene for 12 months from onset of symptoms or until their semen tests negative twice for Ebola virus .
• Deceased bodies should be buried promptly and safely, and when possible the healthy should be separated from the s ick.

Treatment

• Supportive care, particularly fluid replacements , increases the odds of survival. Other treatments may include dialysis , blood transfusions and plasma replacement therapy.
• A vaccine is in development to prevent Ebola virus disease. As of yet, no treatment exists for Marburg virus , but a number of treatments are being evaluated.

Source: World Health Organization Marburg virus disease, Ebola virus disease, FAQs on Ebola virus disease

Lassa Fever

Where is it?

Endemic in Benin, Ghana, Guinea, Liberia, Mali, Sierra Leone, and Nigeria. Probably exists in other West African countries as well.

What is it?

• People become infected through contact with infected animals (Mastomys rats) that shed the virus in their urine and feces. Human to human transmission can happen through direct contact with the blood, urine, faeces, or other bodily secretions of a person infected with Lassa fever.
• About 80% of infected humans show no symptoms. Those that do typically have headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhea, cough and abdominal pain. More severe symptoms and disease occur among 20% of patients.

Prevention

• Community prevention efforts generally focus on good hygiene to keep rodents out of homes, such as storing grain and other food in rodent-proof containers, disposing of garbage far from the home, maintaining clean households and keeping cats.
• Family members should avoid contact with blood and bodily fluids when caring for sick persons.
• Health care workers should apply extra infection control measures when caring for patients with suspected or confirmed Lassa fever, including face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).

Treatment

The antiviral drug ribavirin may be an effective treatment for Lassa fever if given early in the course of illness.

Source: World Health Organization

Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS)

Where is it?

• SARS began in Asia in February 2003 before spreading to more than 2 dozen countries. No human cases have been reported since 2004.
• 80% of MERS cases are in the Kingdom of Saudi Arabia. Cases that have been reported outside the Middle East are among people who were infected there and then traveled elsewhere.

What is it?

• MERS and SARS are more severe examples of illnesses caused by a family of viruses called coronaviruses. Coronaviruses cause symptoms that typically affect the upper respiratory tract and can be as mild as the common cold.
• SARS typically causes fever, headache, and pneumonia. It is spread through human-to-human contact, specifically droplet spread. It may be airborne
• MERS typically causes fever, cough, shortness of breath and pneumonia. Some people are asymptomatic. Mortality rate is estimated at 35%; however, it may actually be lower as mild cases are not reported. MERS is spread through contact with animals (dromedary camels); however, the majority of human infections have taken place in health care settings.

Prevention

• People coming in contact with wild or farmed animals should practice general hygiene measures, including hand washing, and avoid contact with sick animals. Animal products should be cooked or pasteurized before consumption.
• Health care workers should be trained in infection control in order to limit the spread of coronaviruses in health care settings.

Treatment

Treatment is supportive and based on clinical condition.

Source: CDC Coronavirus Symptoms and Diagnosis, SARS Basics Fact Sheet; WHO MERS-CoV, MERS-CoV FAQs

Nipah and henipaviral diseases

Where is it?

Nipah was first recognized in 1999 among pig farmers in Malaysia. Since, there have been several outbreaks in Asia.

What is it?

• Nipah virus can cause a range of symptoms, from asymptomatic infection (subclinical) to acute respiratory infection and fatal encephalitis. The fatality rate ranges from 40%-75%.
• The incubation period is likely 4 to 14 days, but may be as long as 45 days,
• The virus can be transmitted to humans from animals (such as bats or pigs), from humans to humans or through contaminated foods.
• Fruit bats are the natural hosts for Nipah virus. Consumption of infected fruit products may spread the virus.

Prevention

• Decrease or limit bat access to fruit and Discard fruits with signs of bat bites and wash all fruits.
• Avoid contact with infected pigs. When it’s necessary to handle sick animals, use gloves and other protective clothing, as well as during slaughtering.
• Avoid close contact with people who are infected with Nipah virus. Regular hand washing is recommended.
• Contact and droplet precautions should be used in health care settings.

Treatment

There is no treatment or vaccine available, only supportive care

Source: World Health Organization

 

Rift Valley fever (RVF)

Where is it?

Outbreaks have occurred in Sub-Saharan Africa and Saudi Arabia and Yemen.

What is it?

• RVF is a zoonotic disease, meaning spread by animals. The majority of infections have been a result of human contact with the blood or organs of infected animals. This typically happens during slaughtering, veterinary procedures or the disposal of carcasses or fetuses.
• Infection may occur through consumption of unpasteurized or uncooked milk. Infection has occurred through bites by infected mosquitoes. No cases of human-to-human infection have been reported.
• Most cases are mild but a small minority are severe, causing loss of vision, neurological deficits or hemorrhaging. The fatality rate varies but is typically less than 1%.

Prevention

Outbreaks can be prevented by regular animal vaccination programs.

Treatment

• No treatment is required for mild cases. For severe cases, supportive therapy is recommended.
• A vaccine has been developed but is not available for general use. It has been used experimentally for veterinary and lab personnel

Source: World Health Organization

 

Zika Virus

Where is it?

There have been Zika outbreaks in Africa, the Americas, Asia and the Pacific. Most recently, in 2015, there was a large outbreak of the virus in Brazil.

What is it?

• Zika is a mosquito-borne virus that causes rash, fever, conjunctivitis, muscle/joint pain, malaise and headache.
• Zika infection during pregnancy may cause microcephaly and other congenital abnormalities or may cause pregnancy loss and/or preterm birth.
• In adults and older children, Zika virus infection may cause Guillain-Barré syndrome, neuropathy and myelitis

Prevention

• Protect against mosquito bites during the day and early evening. This is particularly important for young children and women of child-bearing age.
• “Personal protection measures include wearing clothing (preferably light-coloured) that covers as much of the body as possible; using physical barriers such as window screens and closed doors and windows; and applying insect repellent to skin or clothing that contains DEET, IR3535 or icaridin according to the product label instructions.”
• Young children and pregnant women should sleep under mosquito nets during the day and early evening.
• Communities should cover water storage containers, remove standing water in flower pots, and clean up trash and used tires to eliminate mosquito breeding sites.
• Travelers returning from regions with active Zika should practice safe sex for 2 months (women) and 6 months (men). Individuals living in Zika-affected areas should practice safer sex or abstain for the duration of pregnancy.

Treatment

There is no treatment yet available. Symptoms are typically mild. Pregnant women should seek medical attention.

Source: World Health Organization

 

Disease X

Disease X represents the knowledge that a serious international epidemic could be caused by a pathogen currently unknown to cause human disease.

World Health Organization

What can employers do in the event of a pandemic?

• Educate employees on how to prevent the spread of disease.
• Ensure on-site and occupational health providers are appropriately trained in infection control measures.
• Have adequate supplies for isolation and decontamination ready in affected areas if needed.
• Educate business travelers on risk and make recommendations as appropriate.
• Coordinate with local health system(s) and make sure employees have access to screening and treatment resources.
• Coordinate with public health agencies for tracking of cases as appropriate.
• See additional guidance in following resource list.

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