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Thursday, February 13, 2014

H1N1, H5N1, H10N8, H7N9, H5N8 - What Influenza strain will we see next?

It may seem odd, at this stage in the Flu season to write yet another blog on Influenza, particularly when reports in Flu activity in North America are starting to decline. Rest assured, this blog is not going to focus on how to prevent transmission of the flu through cleaning and disinfection, what the symptoms of flu are or a reminder that it's not too late to get vaccinated.

Instead I want to focus on the question that inevitably comes up when a new strain of influenza comes knocking on our door. That question is:
"Do you have efficacy against the H(insert number)N(insert number) strain of Influenza?"
As most would attest, in accordance to EPA criteria, if you do not see the "bug" you are concerned with on the label then the disinfectant cannot makes claims against it. To some aspects I can agree, however, if we look at the plethora of data investigating disinfectant efficacy we know that from an efficacy perspective there are not any differences in a disinfectant product's ability to kill K. pneumonia, K. pneumonia ESBL, K. pneumonia MDRO or K. pneumonia CRE. From a purely scientific perspective, if a disinfectant can kill K. pneumonia for example, it does not matter whether you are dealing with the ESBL, the MDRO or the CRE strain. Unfortunately, the EPA has been slow to adopt this stance which has lead disinfectant manufacturers into the "claims race" for bragging rights on who has the greatest number of claims on their label. The truth is when it comes to efficacy claims, strength is not always found in numbers.

For Influenza however; for once, I can say the EPA has finally got it right!  In 2009, when the Pandemic H1N1 strain hit and panic over how facilities were to develop cleaning and disinfection protocols when disinfectant products available on the market did not have efficacy testing against the specific H1N1 strain, the EPA determined that since there were over 500 disinfectant products registered for use on hard, non-porous surfaces against influenza A viruses that based on available scientific information, the currently registered influenza A virus products will be effective against the 2009-H1N1 flu strain and other influenza A virus strains on hard, non-porous surfaces. Of course, for safe and effective use of these products, the EPA reminded users to always follow label instructions and to pay special attention to the product’s dilution rate (if applicable) and contact time. Fancy that, if you kill 1 strain you kill them all. 

In health care, where we talk about evidence based practices, why then do we not use the science, the evidence and the experts who generate the science and evidence to develop evidence based practices around efficacy claims? The EPA has shown it can work for Influenza perhaps we should consider using the same rational for antibiotic resistant bacteria? 

In the meantime, the rates of H7N9 cases and deaths continue to increase and a new strain, H10N8 has caused the death of two people with genetic testing showing it appears to be more virulent to mammals. Is this concerning from an infection prevention perspective?  Yes. Are we concerned from an environmental hygiene perspective? NO. If you kill 1 strain you kill them all.

Bugging Off!



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