France prepares for another H1N1 outbreak

Annick Chapoy reports from Paris

Experts predict that 25-50% of the French population could be affected by the H1N1 flu this autumn. According to Patrick Berche, head of the microbiology department at the Necker Hospital in Paris, the likely second wave of the epidemic would produce a great number of cases due to the highly contagious nature of the virus.

In such a scenario, the epidemic could be difficult to handle for 8 to 10 weeks, when quarantine measures would have to be taken. Of course, flu viruses are unpredictable and other scenarios are possible, ranging from the mere end of the epidemic to a very serious pandemic, with a much more virulent virus. But the most likely situation could be an epidemic explosion when schools re-open after the summer. Despite summers being unfavourable for flu, H1N1 has flourished in just a few days in three schools in the heart of Paris, and many cases have erupted in the city’s vicinity. In all, over 900 cases have been registered in France.
Even though H1N1 appears to be more benign than expected (2-3 deaths per 1,000 cases compared with 1 in 1,000 for seasonal flu) some of its characteristics are worrisome. The potential number of affected people is one concern, because this virus is new, so the population is unprotected. In addition, although the mortality ratio is quite low, the number of deaths could be quite high if applied to a large population: On the basis of two deaths per 1,000 infected, the result would be a death toll of 40,000 if 20 million become infected! Flu also primarily strikes the elderly whereas, in the current situation, doctors tend to think those who have died from swine flu are mostly in their 20s or 30s, albeit formal statistics are lacking.
Health Minister Roselyne Bachelot has announced a flu pandemic plan that places general practitioners (GPs) in a central role, i.e. people should not go directly to a hospital, but first see their GPs.
France has ordered more than 90 million vaccines – estimated cost: ?800 million, to be shared equally by the state and the health insurance system. Some members of parliament have criticised this high cost, as well as the management of health resources in general. One noted that the vaccination for one person costs three or four times more than the one used for seasonal flu. Even in the case of a health emergency, public authorities should negotiate properly with industry, he added.
These 90 million doses would vaccinate 45 million people (two doses are necessary for each). Negotiations are underway with the French firm Sanofi-Aventis and GlaxoSmithKline from Britain.
In early August the government began to supply information leaflets to small-size businesses (under 50 employees). Major firms, which are better prepared for health crises, have already planned strategies, most designing a PCA (plan for continuation of activities). However, smaller businesses appear to have a hard time mobilising, despite numerous internet campaigns from employer’s organisations, which include explanations about the virus, questions and answers, advice about devising a PCA etc.
Many firms that had prepared avian flu strategies in 2006 simply updated them. The first cases of swine flu reported in France immediately revived the wish to protect employees – buying masks and tele-working, among their plans.
Auchan, a major food distribution group aims to deliver goods to the biggest number of stores despite a flu pandemic. Employees were invited for seasonal flu vaccinations to lower their ‘chances’ of infection. This, the group said, would also make it easier to determine whether the new virus is responsible, if a worker becomes infected despite vaccination.
Fearing a high rate of cashiers’ absenteeism, an accelerated training programme has been set up. Meanwhile, to prevent the spread of the flu in supermarkets, Auchan plans to extend opening hours till as late as possible, to prevent crowding. In case of a very severe epidemic, a one-way system for customers might further ease infection.
Mask distribution and enhanced cleaning procedures are planned by the BNP Paribas banking group, which also plans to promote tele-working. Meetings in closed offices and handshakes would be banned and, should an infection occur in one location, staff would be moved to another.
The Paris airports authority stocks 400,000 masks for 10,000 employees. Posters and tannoy messages are in place in all Paris airports, but closure has never been considered. If/when necessary, employees with close passenger contact will be vaccinated first.
The RATP (Paris public transport authority) aims to guarantee the most extensive service possible. A census of workers able to perform additional duties has been organised. The public authorities would decide on ‘temporary closure of subway service’, e.g. closing a particular subway station in the case of localised infections. The government’s emergency team would also demand greater hygiene measures during cleaning of stations and carriages. Firms in the Paris area would be asked to adjust employees’ work schedules to relieve heavy crowding on public transport.

01.09.2009

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