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Any anthrax detection by an automated system should be confirmed by a Laboratory Response Network (LRN) laboratory with polymerase chain reaction assay and culturing, the CDC says. Environmental sampling may be necessary both to find the source of contamination and to determine which employees need post-exposure prophylaxis (PEP), the guidelines state. However, the CDC does not recommend nasal swabs of potentially exposed workers to test for Bacillus anthracis. Employers should designate evacuation routes and places where workers can go for decontamination in the event of an anthrax finding, the report says. If possible, a separate exit route and decontamination area should be provided for workers with the greatest exposure to anthrax, such as operators of postal canceling machines. Decontamination plans will require agreements with outside partners, such as emergency medical services or public health agencies. Because incubation periods for inhalational anthrax have ranged anywhere from 1 to 43 days, PEP should include both prolonged antibiotic treatment and vaccination, the CDC advises. When an LRN lab has confirmed the presence of anthrax, potentially exposed people should receive 60 days of antibiotic treatment and three doses of anthrax vaccine. Other recommended precautions include a plan for providing accurate information to employees and the media. “A positive signal indicating possible presence of a biologic agent requires a coordinated, swift, and effective response,” the CDC document says. A detection system should be installed only in businesses where, if anthrax spores were introduced, machines or production steps might disperse them as an aerosol, the report says. Further, such detection systems should be used only in combination with comprehensive response planning and where laboratory confirmation of anthrax findings is available. May 12, 2004 (CIDRAP News) Businesses that install systems to detect airborne anthrax should have detailed plans to follow in case the pathogen turns up, the Centers for Disease Control and Prevention (CDC) said recently. Since PEP should begin within 15 hours of a preliminary anthrax finding, employers will need agreements with public health agencies or other collaborators for fast access to antibiotics, the CDS says. This could necessitate keeping a supply of antibiotics on the site or making arrangements with local pharmacies or hospitals to keep a supply for the employer. The report, published Apr 30, notes that the US Postal Service plans to install an automatic monitoring system called the Biohazard Detection System (BDS) in about 300 mail processing centers around the country. The step is a response to the mail-borne anthrax attacks of 2001, which killed five people and made another 17 sick. CDC. Responding to detection of aerosolized Bacillus anthracis by autonomous detection systems in the workplace. MMWR 2004;53(early release):1-11 [Full text] To encourage such planning, the CDC has published a 16-page set of guidelines. The guidelines cover evacuation of buildings, decontamination and medical treatment for potentially exposed workers, laboratory confirmation of anthrax findings, and evaluation of potentially contaminated environments.
Nov 22, 2005 (CIDRAP News) – Federal health officials today proposed rule changes to make it easier for public health authorities to keep travelers from bringing infectious diseases into the United States or spreading them between states.The changes would require airlines and ship operators to report passengers who have certain signs of illness and to keep lists of passengers for at least 60 days after arrival, the Centers for Disease Control and Prevention (CDC) announced. The proposed rules also expand the definition of ill travelers to include those with influenza-like illness, and they provide more specific legal protections for people placed in quarantine.The Department of Health and Human Services has authority to use isolation and quarantine to keep people with any of nine infectious diseases out of the country. Pandemic influenza was added to the list of diseases this year; the others are cholera, diphtheria, tuberculosis, plague, SARS (severe acute respiratory syndrome), smallpox, yellow fever, and viral hemorrhagic fevers.The proposed rule changes are largely a result of the SARS experience in 2003, when the CDC had a lot of trouble tracking down and alerting passengers who had been on flights with suspected SARS case-patients, officials said.”The absence of rapid electronic passenger manifests completely paralyzed our ability to notify people who were on board with suspected SARS cases,” Dr. Marty Cetron, director of the CDC Division of Global Migration and Quarantine, said in a teleconference today.After the SARS outbreak subsided, the CDC analyzed what changes were needed in the disease-control regulations incoming concerning travelers. “Existing communicable disease regulations are outdated, have not kept up with advances in disease control measures, and have not been substantially updated for over 25 years,” the agency said in a news release.Cetron said the proposed regulations would require airlines and passenger ship lines to keep an electronic list of passengers for 60 days after arrival and be prepared to provide it to the CDC in a day or less. The rule also would apply to interstate airline flights between large and medium-sized cities, he said.In the past, passenger lists often have been purged within 48 hours, and if a disease threat emerged after the fact, it became very difficult to recover passenger names and contact information and seating charts, Cetron explained. Health officials sometimes had to go through customs forms to get the information, “an extremely time-consuming process even for a single flight,” he said.The proposal also calls for airlines to ask passengers to provide post-arrival contact information for potential use by public health officials, though this would be voluntary, Cetron said. “We’re asking airlines to come up with a proposal for how they would accomplish this,” he said.The CDC is “hopeful and optimistic” that most people would accept assurances that the information would not be used for other than public health purposes, Cetron added.The updated regulations also require “the captain of a conveyance” (pilot or ship captain) to report to the CDC any passenger who has certain signs and symptoms suggesting one of the nine diseases of concern, Cetron said. “It’s best if they do this before landing, to allow for pre-positioning of medical personnel,” he said.The definition of ill passengers who must be reported has been expanded to include those with influenza-like illness, meaning those with fever, cough, and sore throat, Cetron told reporters.As things stand now, he explained, sick travelers are not usually reported until well after their trip and generally are identified through traditional public health surveillance. “What we have now is a very passive system that we can occasionally enhance with awareness and education,” such as giving lists of illness signs to airline personnel, he said.He was unable to say how many reports of ill passengers the CDC has received in a typical year.The new regulations also include more detailed due-process rules for people placed in quarantine because of exposure to a disease, Cetron said. The existing rules have “largely been silent on the specifics” of legal protections for people subject to quarantine.The proposed rules empower authorities to hold a person for 3 days, after which a formal decision must be made whether to quarantine or not, he said. In addition, there must be an opportunity for a hearing before an independent arbiter.Also included in the proposed changes is “explicit authority to offer vaccination, prophylaxis, and other appropriate medical interventions on a voluntary basis” to people in quarantine, according to a CDC fact sheet.The proposed rules are to be published in the Federal Register, and the CDC will accept comments on them for 60 days. (See links below for the regulations and information on submitting comments.)See also:CDC page for proposed regulationshttp://www.cdc.gov/ncidod/dq/nprm/index.htmCDC fact sheet, including addresses for comments on the regulationshttp://www.cdc.gov/ncidod/dq/nprm/docs/ControlofCommunicableDiseasesfactsheetfinal.pdf
Mar 6, 2006 (CIDRAP News) – The European expansion of H5N1 avian influenza continued with discovery of the virus in two swans in Poland, while three cats in an Austrian animal shelter tested positive for the virus as well, according to reports today.A Polish laboratory identified the virus in two swans found dead in the northern city of Torun, news services reported. The cases were the first ones reported in Poland.A veterinary official, Jan Zmudzinski, told Agence France-Presse (AFP), “Yes, we have confirmed that it is definitely H5N1.” He said samples would be sent to the European Union reference laboratory in Weybridge, England, for confirmatory testing.Polish authorities began taking precautions yesterday, after experts announced that the swans were probably infected, according to AFP. A 3-kilometer hygiene-security zone was set up around where the birds were found on the banks of the Vistula River.Zmudzinski said several other dead birds found in the Torun area had been tested, but no other cases were found, according to the story.In Austria, three live cats from the Noah’s Ark animal shelter in the southern town of Graz tested positive, according to another AFP report. A chicken in the same shelter had been found infected with the virus about 2 weeks ago, marking the first known case in a domestic bird in Europe, the story said.The shelter had placed infected chickens in cages next to pens holding cats and dogs in the belief that the virus could not spread from birds to mammals, according to AFP.Testing of cats in the shelter began last week, after German officials announced the discovery of a dead cat infected with H5N1 on the Baltic Sea island of Ruegen, the report said. All 170 cats in the shelter were to be tested. An Associated Press (AP) report described the three infected cats as sick.All the cats from the shelter have been moved to another site where they were to be monitored, the AP quoted Austrian Health Minister Maria Rauch-Kallat as saying.In Serbia, authorities confirmed H5N1 infection in two swans found dead in northern and western regions, according to another AFP report today. Last week officials had reported finding an H5 virus in one swan.One of the infected swans was found Mar 2 at Backi Monostor near the Danube River, less than 6 miles from the border with Croatia and Hungary, AFP reported. The other swan was discovered over the weekend near Bacevci village on the Drina River, which forms the border with Bosnia.In southern France, the virus turned up in a wild swan found dead about 31 miles east of Camargue, marking the first case outside an area near the Swiss border, according to a Bloomberg News report published yesterday. Camargue is a nesting area for thousands of flamingos and is also home to a third of France’s ducks from September to March, the story said.In Uganda, the newspaper the Daily Monitor reported yesterday that the unexplained deaths of thousands of poultry on farms in several districts had triggered an avian flu scare. Today, a report from the Ugandan Web site The New Vision said a Ugandan official had reported that tests at a lab in Nairobi, Kenya, had found no avian flu in samples from the birds.
Jun 21, 2007 (CIDRAP News) – A study from the University of Iowa suggests that veterinarians who work with poultry have a significantly higher risk of infection with avian influenza, compared with nonveterinarians.The researchers studied blood samples from 42 veterinarians and 66 healthy nonveterinarians and found that the vets were significantly more likely to have antibodies to avian flu subtypes H5, H6, and H7, indicating previous infection with the viruses. The scientists did not ascertain whether the vets had had any clinical illness caused by their infections.”These data suggest that occupational exposure to avian species may increase veterinarians’ risk of avian influenza virus infection,” says the report by Kendall P. Myers and colleagues in the Jul 1 issue of Clinical Infectious Diseases. “Veterinarians should be considered for priority access to vaccines and antiviral drugs in pandemic planning.”They say their study appears to be the first search for serologic signs of a wide variety of avian flu subtypes in US veterinarians.The scientists enrolled vets who attended a conference in 2004 and recruited control volunteers in the spring of 2006. Vets who had no exposure to birds and controls who reported such exposure were excluded, leaving 42 vets and 66 controls. Varying numbers of the vets had worked with chickens, turkeys, ducks, geese, and quail. Bloods samples were taken from both groups and analyzed for antibodies to avian flu virus subtypes H4 through H12 and human flu subtypes H1N1 and H3N2.Compared with the controls, some of the vets were found to have increased levels of antibodies to subtypes H5, H6, H7, and H9. Further analysis of the data revealed no evidence that the elevated avian flu antibodies were accidental results of seasonal flu infection or vaccination (cross-reactions).After adjusting for possible confounding variables and doing further statistical analysis, the researchers determined that the vets had significantly higher odds of having increased antibodies to three avian flu subtypes: H5 (adjusted odds ratio [OR], 16.7; 95% confidence interval [CI], 2.1 to infinity), H6 (OR 12.2; 95% CI, 2.0 to 138.2), and H7 (OR, 17.7; 95% CI, 2.3 to infinity).”Veterinarians who reported having examined birds known to be infected with avian influenza presented an increasing trend of being seropositive, compared with veterinarians without this exposure and with control subjects,” the report adds.Acknowledging limitations of the study, the authors said their sample was too small to allow an assessment of whether any of the avian flu subtype findings were a result of cross-reactions against other avian subtypes.They also said the study design didn’t allow them to assess whether seropositivity was linked with any clinical signs of illness. “The nature, frequency, and severity of clinical illness caused by infection due to avian influenza remains unknown,” they write.The researchers note that when different flu virus subtypes infect the same host, there is a risk they will trade genetic material and give rise to a dangerous new virus. The authors say that increasing vets’ rate of immunization against seasonal flu would limit the chances of such reassortment events and should be considered. Thirty-six of 75 vets (48%) in the study reported having had a flu shot in the preceding year, lead author Myers told CIDRAP News.The researchers also say their findings suggest that vets who work with birds have an increased risk of zoonotic flu infection. “We posit that they should be considered for inclusion on priority access lists for pandemic vaccines and antiviral drugs,” they conclude.David A. Halvorson, DVM, a veterinary pathologist and avian flu expert at the University of Minnesota in St. Paul, said the study suggests that humans may be infected with avian flu viruses more commonly than was previously thought. It seems that, as has happened in Asia with the deadly H5N1 virus, “Humans intimately exposed to birds may get infected,” he said.He added that the findings reinforce doubts about the older view that pigs were the “mixing vessel” for new flu strains because they could be simultaneously infected with avian and human strains. “Rather, an avian virus may infect people directly and result in a recombinant with no other mixing vessel involved,” he said.However, Halvorson expressed doubt about the authors’ idea that, in view of their findings, vets should have priority access to pandemic flu vaccines”The only way that I see a need to rank veterinarians high for pandemic flu vaccines would be to possibly prevent them from infecting poultry,” he said. “Once a virus is a human pandemic strain, it is difficult to imagine that poultry will play a significant role in transmission to people.”However, Myers asserted that the H5N1 strain could reach birds in the United States, putting those who work with poultry at risk. “The geographic range of the virus is rapidly expanding and efforts to contain it have been unsuccessful. Many feel that the spread of H5N1 into birds in this country is inevitable,” she told CIDRAP News by e-mail.She pointed to a recent commentary in Vaccine by her colleague Gregory C. Gray, the senior author of the veterinarian study, and two other authors. They make a case for promoting annual flu shots for those who work with swine and poultry and including those workers in the priority groups for pandemic flu vaccines and antiviral drugs. Among other reasons, they suggest that H5N1 infections in domestic ducks, geese, or pigs might not be readily identified, posing a threat to humans who work with them.Myers KP, Setterquist SF, Capuano AW, et al. Infection due to 3 avian influenza subtypes in United States veterinarians. Clin Infect Dis 2007 Jul 1;45(1):4-9 [Full text]See also:Gray GC, Trampel DW, Roth JA. Pandemic influenza planning: Shouldn’t swine and poultry workers be included? Vaccine 2007 May 30;25(22):4376-81 [Abstract]
Jul 24, 2009Canadian employers see high H1N1-related absenteeismCanadian employers are reporting “huge increases” in absenteeism tied to concerns about the H1N1 virus, according to Karen Seward of Shepell-fgi, a Canadian firm that provides health and productivity services to businesses. Seward said her company is getting many questions from employers about handling absences, according to a story in the Hamilton, Ont., Spectator. She said employers and public health officials are giving conflicting advice about when sick workers should see a doctor. Britain’s H1N1 cases soared last weekThe United Kingdom’s Health Protection Agency (HPA) estimated yesterday that the nation had 100,000 new cases of H1N1 flu in the past week, up from 55,000 the week before. The estimate is based on medical-visit rates for flu-like illness. Children up to age 14 were the age-group most affected, with people older than 65 showing much lower rates, the HPA said. Most cases continued to be mild.[HPA pandemic flu update] UK flu line hits glitch on first dayThe Web component of Britain’s national flu line, which launched yesterday alongside a telephone service, crashed yesterday after receiving about 9.3 million hits per hour, the London Telegraph reported today. The system was reportedly back online a short time later. The system is designed to relieve pressure on doctors’ offices by diagnosing novel flu cases over the phone and issuing patients code numbers that allow them to obtain oseltamivir (Tamiflu).[Jul 24 Telegraph story] Canada clears Tamiflu use for infantsCanada’s health ministry yesterday approved an interim order authorizing the use of oseltamivir (Tamiflu) in children younger than 1 year, despite limited safety data, Canwest News Service reported yesterday. As in the United States, the drug previously had been approved only for use in patients older than 1. The Public Health Agency of Canada requested the action because infants seem to be at higher risk for novel H1N1 flu complications.[Jul 23 Canwest News Service story]FDA issues emergency authorization for H1N1 diagnostic testThe Food and Drug Administration (FDA) today issued an emergency use authorization (EUA) for another unlicensed diagnostic test for novel H1N1 flu. The test, made by Focus Diagnostics of Cypress, Calif., is the third H1N1 test to receive an EUA. The EUA allows the company to distribute the test to labs certified under the Clinical Laboratory Improvement Amendments to run highly complex tests. The test amplifies viral genetic material from nose or throat swabs or nasal discharges.[Jul 24 FDA news release]Kazakhstan reports first H1N1 casesKazakhstan yesterday reported its first three novel H1N1 cases, involving three students who were diagnosed after returning from London, according to a Reuters report based on an Interfax news service story.[Jul 23 Reuters report]
In 2018, Valamar Riviera will increase salaries by 11,5% with a focus on increasing salaries of basic occupations, which has been agreed with the Croatian Tourism and Services Union (STUH) and the Istria, Kvarner and Dalmatia Trade Union (SIKD).According to the agreement with the social partners, the basic salary will increase by a total of 4% while 7,5% of the total salary will be additionally invested in increasing the salaries of basic occupations such as chefs, waiters, cleaners, receptionists, maids and many others. The increase of coefficients for almost 50 key jobs in operating operations and the increase of the base by 2% will start on June 1, 2018, while the salary of all employees will increase by 2% from December 1, 2018, Valamar pointed out. and added that this adjustment of salaries for basic occupations will cover about 4.000 employees, which will guarantee Valamar for 2018 a net income of at least 5.000 to 7.500 kuna per month for employees in the facilities.Valamar Riviera will thus invest over HRK 20 million in increasing the salaries of all employees with a focus on basic occupations in business, of which about 30% of investments are tax relief, and the rest are direct investments in increasing the material rights of workers.Photo: Valamar”In recent years, in accordance with its development strategy, Valamar has progressively increased the basic salary of its employees, so the average salary at Valamar in 2017 was 20% higher than the average for the tourism sector in Croatia. With progressive salary growth and other investments in human resources development, Valamar puts employees first because of their key role in achieving excellent service, innovation and long-term success in tourism. ” stand out from Valamar.New hotel for employeesIn addition to a significant increase in net income, seasonal workers who come to work in Valamar’s destinations from all over Croatia are provided with quality accommodation and three meals a day at the expense of the employer. This season, Valamar is opening a fourth hotel for employees called Valamar House. The company has invested over HRK 60 million in the Valamar House project in the last two years. In the Valamar House, seasonal workers are waiting for newly renovated rooms and apartments with private bathrooms, common areas for rest and socializing, as well as many other benefits.In 2018, Valamar Riviera will employ 6.600 employees from Istria and Kvarner to Dubrovnik. In 2018, Valamar will offer 1.200 permanent season contracts within the Valamar +3 program and 400 new permanent employment contracts. “All these initiatives have contributed to the fact that Valamar Riviera has been awarded the Employer Partner certificate for the eleventh year in a row, and further confirm Valamar’s leading role as a leading employer in tourism. ” conclude from Valamar.
“At the moment in our city we have a permanent offer of 23 specialties with beer, both sweet and sweet dishes. In addition to 9 restaurants, we also have 15 cafes that have joined us. They offer about 30 different entertainment and music programs in the next two weeks as long as this promotional action “For a beer in Karlovac” will last. For the second year in a row, the exhibition on the topic of beer will be in the TIC space on Korzo, the second will be in the Katzler Pavilion. And the third, new, virtual exhibition organized by Aquatika and KaFotka” she stated the director of the Tourist Board of the city of Karlovac, Marina Burić, stated on this occasion. The invitation to cooperate was accepted by 15 catering facilities that are prominent in this promotional action. The caterers have prepared a rich offer of beer, musical performances, quizzes, discounts, and the action lasts from August 21 to September 8, 4. The Karlovac Tourist Board presented today at a press conference in Karlovac the activity it is carrying out together with Karlovac caterers called “For a beer in Karlovac”, which we talked about recently писали. Find out the list of all cafes and restaurants participating in this project HERE The offer of beer menus in restaurants was well received and the promotional campaign “For beer in Karlovac” was a logical continuation of cooperation with caterers. Karlovac is a traditional beer destination, and this beer event is a continuation of the branding of Karlovac as a quality gastronomic destination that began in June with the presentation of the offer of Karlovac restaurants.