Maine CDC/DHHS Update on 2009 H1N1 Influenza Virus
November 19, 2009
Highlights
H1N1 continues to expand and worsen amid continuing vaccination efforts and some utilization of antiviral medicines.
There were 44 new school outbreaks, ER visits for flu accounting for 1 in 6 ER patients, 50 hospitalizations, and 2 deaths (for a total of 5 since August).
Underreporting of vaccine administration could impact the flow of vaccine into the state, and the supply to providers who are not reporting the doses they administer in a timely fashion.
Flu infections can make people more likely to develop pneumococcal infections, which can cause serious complications, including death. All children younger than 5, all people between ages 5 and 64 with high risk conditions, and all people age 65 and older should receive a pneumococcal vaccine.
Continued Surge of Flu Activity in Maine and the US
Two deaths this week were reported publicly over the weekend, bringing the total deaths due to H1N1 in the state since August to five. Four of these have been in the past two weeks. The average age among those who have died is 47; by comparison, 90% of deaths related to seasonal flu are among those older than 64.
There were 50 hospitalizations this week, accounting for more than half of the hospitalizations due to H1N1 since April. Half of the new hospitalizations were children, two of whom have been or currently are in intensive care; 23 were adults ages 19-65, seven of whom were or are in intensive care; 2 people were older than 65, neither of whom needed intensive care.
One in every six visits to an emergency department this week was flu-related, and rates of visits to other outpatient settings continue to be elevated.
There were 44 new outbreaks in school settings this week. A school in Kennebec County and another in Washington County chose to close as a result of absenteeism. An outbreak of H1N1 in a long-term care facility was reported over the weekend. There were five other institutional outbreaks this week.
The timing, spread, and severity of flu viruses is uncertain with outbreaks often occurring in waves. In past pandemics, the first wave is usually a smaller wave followed by a larger peak wave, which can be followed by subsequent smaller waves. Even after flu activity peaks during the current wave, it is possible that other waves of activity may occur – caused by either H1N1 or regular seasonal flu viruses.
There have been confirmed cases of H1N1 in every county in Maine. People should assume that they will be exposed to the flu at some point, and with vaccine for less than one-third of those most prioritized to receive it in the state, we should all take precautions to prevent serious illness by staying home when sick, covering coughs and sneezes, washing hands frequently, and getting vaccinated against both seasonal and H1N1 flu when vaccine is available.
Pneumococcal Illness and Vaccine
Increases in pneumococcal disease were seen during all three of the flu pandemics that occurred in the twentieth century. A report released in September showed that bacterial pneumonia is contributing to fatalities in people with H1N1 flu, similar to previous pandemics (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58e0929a1.htm?s_cid=rr58e0929a1_e).
All children less than 5 years of age should receive the pneumococcal conjugate vaccine. The polysaccharide vaccine should be administered to all persons 2-64 years of age with high risk conditions and everyone 65 years and older.
Although there is no evidence that this vaccine is harmful to either a pregnant woman or to her fetus, it is not recommended during pregnancy. Women who have underlying conditions known to put them at risk of pneumococcal disease should be vaccinated before becoming pregnant, if possible.
US CDC issued a letter to health care providers urging them to make sure all their adult patients with indications have received the pneumococcal polysaccharide vaccine. (http://www.cdc.gov/h1n1flu/vaccination/provider/lettertoprovider.htm)
CDC has also issued a Q&A on influenza and invasive pneumococcal disease (http://www.cdc.gov/h1n1flu/vaccination/qa_pneumococcal_disease.htm).
H1N1 Vaccine Supply and Prioritization
The US Food and Drug Administration (FDA) this week approved an additional vaccine for H1N1 flu (http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm190783.htm). We do not yet know how this will impact our vaccine supply in the state.
The FDA also approved the use of another vaccine already in use for those 18 and older to be administered to infants and children (http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm190359.htm) – vaccine administrators should note that this new approval is not reflected on the vaccine’s package inserts as of yet.
We have 210,500 doses of vaccine in Maine – which is about 30% of what is needed for priority populations in the state. For this reason, Maine CDC has had to prioritize within US CDC’s priority groups for vaccine, based on trends in infections, the type and amount of vaccine available, and readiness of partners to administer vaccine.
Currently, Maine CDC priority groups for vaccination are:
All children 6 months – 18 years of age
Pregnant women
Caregivers and household members of infants younger than 6 months old
Adults 18 – 64 years of age with chronic medical conditions**
Health care personnel with frequent direct contact with infectious materials and hospital inpatients who are at high risk (pregnant women, children, and high-risk adults older than 65)
We continue to distribute vaccine in K-12 schools; among health care providers who care for children, pregnant women and/or very high-risk adults; colleges and universities for their high-risk students; and some pre-school settings such as preschool programs for high-risk children and Head Starts.
By the end of the week, we expect:
About 95% of all K-12 schools, which is all schools that signed up to provide H1N1 vaccines, will have administered their first doses to children. The second doses for children ages nine and younger we anticipate will begin to be distributed in the next several weeks. US CDC recommends that the two doses of H1N1 vaccine for children 9 years of age and younger be separated by 4 weeks, but there is no maximum number of days between doses.
All health care providers that ordered H1N1 vaccine for pregnant women will have received some supply for their pregnant patients.
Over the next several weeks, we expect that it will be easier for household members of infants younger than six months old, pre-school aged children, and people younger than 65 at high risk due to underlying medical conditions to access vaccine through several channels:
Vaccine has been shipped to pediatric health care providers that placed orders for H1N1 vaccine. Public Health Nurses are conducting vaccine clinics in preschool settings for high-risk children and will soon be conducting vaccine clinics in Head Start locations. Other organizations are also starting to organize clinics for preschool aged children.
The limited amount of vaccine formulation that is ideal for adults is being distributed to specialists serving those adults who are at the highest risk – pulmonologists, cardiologists, oncologists, neurologists, rheumatologists, infectious disease physicians, and dialysis centers. We hope in the next week to be able to distribute increasing amounts of vaccine to other adult practices, such as internal medicine physicians. In addition, clinics for high risk groups will be starting in the coming weeks, and will be posted on the flu clinic locator at www.maineflu.gov.
We hope to provide more vaccine for health care workers in the next several weeks as the vaccine formulations for adults become more available. Any health care worker who fits into another high-risk group (pregnant, household member of an infant younger than six months, younger than 65 with an underlying health condition) should try to access vaccine now.
Once all of the prioritized groups have been vaccinated, we anticipate that there will be enough vaccine for anyone who wants it. However, vaccine may not be available to those not included in the priority groups until early in 2010.
To read the complete update: http://www.maine.gov/tools/whatsnew/attach.php?id=84993&an=2
Thursday, November 19, 2009
H1N1 Expands and Worsens in Maine, Vaccine Continues to Trickle into the State, Pneumococcal Infections, and Other Important Updates
Thursday, November 12, 2009
Weekly Update on H1N1 in Maine 11/12/2009
Maine CDC/DHHS Update on 2009 H1N1 Influenza Virus
November 12, 2009
Highlights
As expected, H1N1 continues to expand and worsen – 65 school outbreaks, ER visits for flu accounting for 1 in 6 ER patients, 19 hospitalizations, and 2 deaths (for a total of 3 since August).
Antiviral medicines are under-utilized.
Vaccine efforts continue – about 95% of schools are expected to complete their vaccinations by the end of next week, for a total of about 400 schools in 4 weeks’ time.
Increased Flu Activity in Maine and the US
The 2009 H1N1 flu continues to be widespread in Maine. Statewide, schools are reporting increased absenteeism due to influenza-like illness (ILI), with rates ranging from 15% to almost 50%. Schools in two communities have closed, and this is an administrative decision based on operational challenges associated with absenteeism among students as well as staff.
There were 65 new outbreaks reported this week (up from 24 last week), all in school settings. Outbreaks in schools occurred in the following counties: Androscoggin (10), Aroostook (2), Cumberland (5), Hancock (3), Kennebec (7), Oxford (3), Penobscot (18), Piscataquis (1), Sagadahoc (1), Somerset (3), Waldo (3), and York (9).
A total of 19 people were hospitalized due to H1N1 (up from 10 last week). Of those hospitalized, 5 were children; 3 were young adults ages 18-24; 10 were adults younger than 65; and one was an adult 65 or older. Two of the adults were in intensive care. Hospitalizations occurred in Androscoggin, Cumberland, Kennebec, Oxford, Penobscot, Washington, and York counties.
There were two deaths – one in a young adult reported in a press release late last week, and another in an adult in the 50-64 age group. Both deaths were in Penobscot County and both people had severe underlying conditions.
There have been confirmed cases of H1N1 in every county in Maine. People should assume that they will be exposed to the flu at some point, and with only enough vaccine for 1 in 8 people in Maine right now, we should all take precautions to prevent serious illness:
Stay home if you are sick, until you are fever-free for a full 24 hours without taking fever-reducing medicine.
Cough and sneeze into your elbow, or into a tissue. Throw this tissue away.
Wash your hands frequently with soap and water, but especially after coughing and sneezing. Alcohol-based hand gels can also be used.
Avoid touching your nose, mouth, and eyes. Germs can spread this way.
Avoid contact with sick people. If you are at very high risk for complications, you may want to avoid large crowds.
When vaccine is available, get both the seasonal and H1N1 flu vaccines.
Contact your health care provider if there are flu-like symptoms in a household where anyone is younger than 2 years old, 65 years or older, pregnant, and/or has an underlying medical condition. There are prescription medicines (antivirals such as Tamiflu®) that may help. The state’s stockpile of these medicines is also available to those who do not have adequate insurance and cannot afford the costs.
Although most people can stay home to recover without seeing a health care provider, anyone with the flu should seek medical attention for:
Dehydration
Trouble breathing
Getting better, then suddenly getting a lot worse
Any major change in one’s condition
H1N1 Vaccine Supply and Prioritization
Another 41,800 doses of H1N1 vaccine were distributed in Maine this week, bringing the total vaccine in the state to 180,400 doses.
US CDC released a list of recommended priority groups to receive the initial doses of H1N1 vaccine last summer. These groups were chosen because they were at high risk for complications from H1N1 or because they could pass H1N1 on to someone at high risk for complications.
Currently, we have received enough vaccine for about 1 in 4 people in priority populations in Maine. For this reason, Maine CDC has had to prioritize within the priority groups, based on trends in infections, the type and amount of vaccine available, and readiness of partners to administer vaccine.
The first groups targeted were children and pregnant women, because they are most disproportionately affected by H1N1 infection and because the types of vaccine available were most appropriate for them. Certain health care workers – for example, those who work in hospital maternity wards, pediatric units, ICU, and emergency departments – were also prioritized initially.
Currently, Maine CDC priority groups for vaccination are:
All children 6 months – 18 years of age
Pregnant women
Caregivers and household members of infants younger than 6 months old
Adults 18 – 64 years of age with chronic medical conditions**
Health care personnel with frequent direct contact with infectious materials and inpatients who are at high risk (pregnant women, children, and high-risk adults older than 65)
**Chronic medical conditions that confer a higher risk for influenza-related complications include chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematologic, or metabolic disorders (including diabetes mellitus) or immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus).
We are currently distributing vaccine for use in the following settings:
K-12 schools
Health care providers who care for children, pregnant women and/or very high-risk adults
Colleges and universities for their high-risk students
Some pre-school settings such as preschool programs for high-risk children and Head Starts
By the end of next week, we expect:
About 95% of all K-12 schools, which is all schools that signed up to provide H1N1 vaccines, will have administered their first doses to children. The second doses for children ages nine and younger we anticipate will begin to be distributed in the next several weeks, but not until sometime in December.
All health care providers that ordered H1N1 vaccine for pregnant women will have received sufficient supply for their pregnant patients.
Over the next several weeks, we expect that it will be easier for household members of infants younger than six months old, pre-school aged children, and people younger than 65 at high risk due to underlying medical conditions to access vaccine through several channels:
Vaccine has been shipped to pediatric health care providers that placed orders for H1N1 vaccine. Public Health Nurses are conducting vaccine clinics in preschool settings for high-risk children and will soon be conducting vaccine clinics in Head Start locations. Other organizations are also starting to organize clinics for preschool aged children.
The limited amount of vaccine formulation that is ideal for adults is being distributed to specialists serving those adults who are at the highest risk – pulmonologists, cardiologists, oncologists, neurologists, rheumatologists, infectious disease physicians, and dialysis centers. We hope in the next week to be able to distribute increasing amounts of vaccine to other adult practices, such as internal medicine physicians. In addition, clinics for high risk groups will be starting in the coming weeks, and will be posted on the flu clinic locator at http://www.maineflu.gov/.
We hope to provide more vaccine for health care workers by the end of this month as the vaccine formulations for adults become more available. Any health care worker who fits into another high-risk group (pregnant, household member of an infant younger than six months, younger than 65 with an underlying health condition) should try to access vaccine now.
Once all of the prioritized groups have been vaccinated, we anticipate that there will be enough vaccine for anyone who wants it. However, vaccine may not be available to those not included in the priority groups until early in 2010.
Reporting Vaccine Administration
Maine CDC asks that all H1N1 vaccine providers and/or administrators are submitting the vaccine administration data into the Maine CDC’s weekly vaccine reporting system.
The weekly vaccine reporting form can be found at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/health-care-providers.shtml. The vaccine reporting periods on the form are the same timeframe as the dates for the vaccine clinics. This form is then compiled by us and submitted, as required, to US CDC.
We have many thousands fewer doses of vaccine being reported as being administered than we believe have actually been administered. This will start impacting the flow of vaccine, since the flow of vaccine is expected to slow to those states that are not showing evidence of using it.
Maine CDC’s Immunization Program is compiling a database that matches the vaccine distribution database with the vaccine administration database by provider so we can tell which providers are not reporting on vaccine administration (or not using their vaccine). We will then use this to guide our vaccine distribution decision-making.
H1N1 Vaccination Distribution as of November 12:
STATE
180,400 doses
14% of the state population
These numbers mean there is 1 dose for every 4 people in a high priority group, and 1 for every 8 people in the state.
Adverse Events
US CDC's Vaccine Adverse Event Reporting System (VAERS) for years has recorded any adverse events following vaccination. This week Maine CDC compiled the data from the first month of H1N1 vaccine being administered in Maine. We found a total of 5 adverse events reported, all of them minor with none requiring hospitalization or evidence of long term problems. The events included: congestion and a sore throat following a nasal spray vaccine, and tingling and numbness following an injectable vaccine that resolved.
Antiviral Treatment
Anyone who is in a high risk category for flu complications – those younger than 2 years old, 65 years or older, pregnant, and/or those with an underlying medical condition – should be started on prescription antiviral medicines such as Tamiflu® if they have flu symptoms (or if anyone in their household has symptoms). These medicines can significantly reduce severity (including hospitalization and death) as well as duration of illness.
State Stockpile:
Maine CDC encourages physicians to prescribe antiviral medications as appropriate. In an effort to minimize financial barriers, Maine CDC has mobilized a significant portion of the state-purchased stockpile of antiviral medications for use by patients who do not have adequate insurance coverage (no insurance, high deductibles, high co-pays). Read the full Health Alert issued on this topic here: http://www.maine.gov/tools/whatsnew/index.php?topic=DHHS-HAN&id=84066&v=alert
Pediatric Suspension:
The FDA has issued guidance on compounding an oral suspension of Tamiflu® to provide multiple prescriptions: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm188629.htm/ohttp:/www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm188629.htmblocked::http:/www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm188629.htm
MaineCare is promulgating emergency rules increasing the reimbursement for compounding pediatric suspension from $4.35 to $10. The full stockpile of pre-prepared pediatric suspension in the stockpile has been fully deployed to hospitals, health centers, and Hannaford’s pharmacies and other willing pharmacies.
Additional Federal Guidance on Antivirals:
US CDC has posted information about the safety of antivirals: http://www.cdc.gov/H1N1flu/antivirals/safety_info.htm
US CDC Health Alert: Key Issues for Clinicians Concerning Antiviral Treatments for 2009 H1N1: The 2009 H1N1 virus continues to be the dominant influenza virus in circulation in the United States. The benefit of antiviral treatment is greatest when it is initiated as early as possible in the clinical course. http://www.cdc.gov/H1N1flu/HAN/110609.htm
Clinical Testing, Reporting, and Management of H1N1
Health care providers and other public health partners are asked to report to Maine CDC influenza infection among patients who:
· Are hospitalized;
· Have died; and/or
· Are associated with a suspected outbreak.
Health care providers with questions on influenza can contact the Maine CDC at 1-800-821-5821 24 hours a day, 7 days a week.
Testing:
§ Submit a specimen for influenza testing for patients with ILI who are hospitalized, who have died, or for whom a diagnosis of influenza would affect clinical care, infection control, or management of contacts.
§ When testing is indicated, rapid diagnostic tests that are negative should be followed by PCR testing.
§ For outbreaks in institutional settings, submit 3-4 specimens to confirm the cause of the outbreak. Once infection has been confirmed as influenza, further testing is not usually indicated.
§ Information on testing at the Health and Environmental Testing Laboratory is available at: http://www.maine.gov/dhhs/etl/micro/submitting_samples.htm
Algorithm for Testing and Management of H1N1 can be found at: http://www.maine.gov/tools/whatsnew/attach.php?id=82597&an=1
Additional Information for Health Care Providers on testing, reporting and management of H1N1, including patient handouts can be found at:
http://www.maine.gov/dhhs/boh/maineflu/h1n1/health-care-providers.shtml and
http://www.maineflu.gov/
Guidance for Schools and Day Cares
In light of recent school outbreaks, we expect that most schools in the state will eventually have some cases of the flu. Schools and day cares do not need to notify parents of each individual case of the flu. However, parental notification may be helpful in some situations.
If you have cases of flu in your school and are unsure whether you should notify parents, you may contact Maine CDC for guidance. There are specific reporting guidelines and forms related to increased absenteeism, available at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/educators.shtml#forms
If you are a school or day care administrator and have questions about reporting increased absenteeism, precautions to take, or the ways in which to notify parents, please contact our Clinical Consultation line at 1-800-821-5821 or e-mail disease.reporting@maine.gov.
US CDC has issued guidance for schools (http://www.cdc.gov/h1n1flu/schools/schoolguidance.htm) and child care programs (http://www.cdc.gov/h1n1flu/childcare/guidance.htm) designed to decrease exposure to the flu while limiting the disruption of day-to-day activities and learning.
Maine CDC is not issuing directives to close schools or day cares at this time. These are administrative decisions, largely based on staffing capacity.
New Videos, posters, and related materials from US CDC
Influenza Round Table: Warning Signs Video
Don't Get, Don't Spread Video
H1N1 Flu Vaccine -- Why the Delay? Watch a new CDC video to find out how flu vaccines are made: http://is.gd/4OVFq
"Seasonal and 2009 H1N1 Flu: For Parents Who Have Children or Adolescents with High-Risk Medical Conditions" brochure. New brochure for parents of high-risk children. http://www.cdc.gov/h1n1flu/childcare/toolkit/pdf/H1N1Seasonal_HiRiskChildren_Final.pdf
Updated: H1N1 Flu and You Brochure
Update: Poster-Disposable Respirators: General Donning InstructionsThese posters describe general procedures for properly putting on and taking off a disposable respirator. http://www.cdc.gov/h1n1flu/eua/pdf/n95instructions.pdf
Other Updates from Federal Partners
The World Organization for Animal Health issues this report that the recent identification of H1N1 in a house cat in Iowa is no additional cause for alarm (http://www.oie.int/eng/press/en_091104.htm) and CDC updated this Q&A about H1N1 in pets (http://www.cdc.gov/h1n1flu/qa.htm).
The commissioner of the US Food and Drug Administration (FDA) sent a letter to America’s healthcare professionals thanking them for their efforts during the 2009 H1N1 influenza outbreak and providing information on the safety of the 2009 H1N1 vaccines. The letter can be viewed at http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm189691.htm
Maine CDC H1N1 Activities This Past Week
Calls received by the phone bank: 708
Questions coming into flu.questions@maine.gov: 227
Hits on the webpages associated with http://www.maineflu.gov/: 71,425
Lab tests we (HETL at Maine CDC) conducted: 451
Lab tests we (HETL) conducted total since April: 6,134
Calls coming into the clinical consultation line: 202
Maine CDC employees whose jobs do not normally involve anything related to H1N1 who have volunteered with the phone bank and other related efforts: 124
Maine CDC employees who have been redeployed from other activities to focus on H1N1: 97
Many Maine CDC posters and magnets are now available for order online: http://www.maine.gov/dhhs/boh/flu-poster-orders.shtml
How to Stay Updated
· Flu News: View current Maine CDC press releases, Thursday morning weekly updates, and urgent updates from our Health Alert Network (HAN) by visiting: http://www.maine.gov/dhhs/boh/maineflu/flu-news.shtml. RSS feeds are available for the weekly updates and HAN. Starting this week, Maine CDC is posting the top Q&A from Maine at the beginning of each week, which can be accessed the same way as these Weekly Updates.
· Follow Maine CDC’s Social Media Updates:
o Facebook (search for “Maine CDC”)
o Twitter (http://twitter.com/MEPublicHealth)
o MySpace (www.myspace.com/mainepublichealth)
o Maine CDC’s Blog (http://mainepublichealth.blogspot.com/)
· H1N1 Conference Calls: Maine CDC will be holding conference calls to provide updates and take questions on H1N1. The next call will be held Monday, November 16, from noon to 1 pm. To participate, call 1-800-914-3396 and enter pass code 473623#. During calls, please press *6 to mute your line and #6 to un-mute when you are actively participating.
Call or Email Us
· For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
· General Public Call-in Number for Questions: 1-888-257-0990
Deaf and Hard of Hearing phone number: 1-800-606-0215
Phone lines are open Monday - Friday 9 a.m. – 5 p.m.
· Email your questions to: flu.questions@maine.gov
November 12, 2009
Highlights
As expected, H1N1 continues to expand and worsen – 65 school outbreaks, ER visits for flu accounting for 1 in 6 ER patients, 19 hospitalizations, and 2 deaths (for a total of 3 since August).
Antiviral medicines are under-utilized.
Vaccine efforts continue – about 95% of schools are expected to complete their vaccinations by the end of next week, for a total of about 400 schools in 4 weeks’ time.
Increased Flu Activity in Maine and the US
The 2009 H1N1 flu continues to be widespread in Maine. Statewide, schools are reporting increased absenteeism due to influenza-like illness (ILI), with rates ranging from 15% to almost 50%. Schools in two communities have closed, and this is an administrative decision based on operational challenges associated with absenteeism among students as well as staff.
There were 65 new outbreaks reported this week (up from 24 last week), all in school settings. Outbreaks in schools occurred in the following counties: Androscoggin (10), Aroostook (2), Cumberland (5), Hancock (3), Kennebec (7), Oxford (3), Penobscot (18), Piscataquis (1), Sagadahoc (1), Somerset (3), Waldo (3), and York (9).
A total of 19 people were hospitalized due to H1N1 (up from 10 last week). Of those hospitalized, 5 were children; 3 were young adults ages 18-24; 10 were adults younger than 65; and one was an adult 65 or older. Two of the adults were in intensive care. Hospitalizations occurred in Androscoggin, Cumberland, Kennebec, Oxford, Penobscot, Washington, and York counties.
There were two deaths – one in a young adult reported in a press release late last week, and another in an adult in the 50-64 age group. Both deaths were in Penobscot County and both people had severe underlying conditions.
There have been confirmed cases of H1N1 in every county in Maine. People should assume that they will be exposed to the flu at some point, and with only enough vaccine for 1 in 8 people in Maine right now, we should all take precautions to prevent serious illness:
Stay home if you are sick, until you are fever-free for a full 24 hours without taking fever-reducing medicine.
Cough and sneeze into your elbow, or into a tissue. Throw this tissue away.
Wash your hands frequently with soap and water, but especially after coughing and sneezing. Alcohol-based hand gels can also be used.
Avoid touching your nose, mouth, and eyes. Germs can spread this way.
Avoid contact with sick people. If you are at very high risk for complications, you may want to avoid large crowds.
When vaccine is available, get both the seasonal and H1N1 flu vaccines.
Contact your health care provider if there are flu-like symptoms in a household where anyone is younger than 2 years old, 65 years or older, pregnant, and/or has an underlying medical condition. There are prescription medicines (antivirals such as Tamiflu®) that may help. The state’s stockpile of these medicines is also available to those who do not have adequate insurance and cannot afford the costs.
Although most people can stay home to recover without seeing a health care provider, anyone with the flu should seek medical attention for:
Dehydration
Trouble breathing
Getting better, then suddenly getting a lot worse
Any major change in one’s condition
H1N1 Vaccine Supply and Prioritization
Another 41,800 doses of H1N1 vaccine were distributed in Maine this week, bringing the total vaccine in the state to 180,400 doses.
US CDC released a list of recommended priority groups to receive the initial doses of H1N1 vaccine last summer. These groups were chosen because they were at high risk for complications from H1N1 or because they could pass H1N1 on to someone at high risk for complications.
Currently, we have received enough vaccine for about 1 in 4 people in priority populations in Maine. For this reason, Maine CDC has had to prioritize within the priority groups, based on trends in infections, the type and amount of vaccine available, and readiness of partners to administer vaccine.
The first groups targeted were children and pregnant women, because they are most disproportionately affected by H1N1 infection and because the types of vaccine available were most appropriate for them. Certain health care workers – for example, those who work in hospital maternity wards, pediatric units, ICU, and emergency departments – were also prioritized initially.
Currently, Maine CDC priority groups for vaccination are:
All children 6 months – 18 years of age
Pregnant women
Caregivers and household members of infants younger than 6 months old
Adults 18 – 64 years of age with chronic medical conditions**
Health care personnel with frequent direct contact with infectious materials and inpatients who are at high risk (pregnant women, children, and high-risk adults older than 65)
**Chronic medical conditions that confer a higher risk for influenza-related complications include chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematologic, or metabolic disorders (including diabetes mellitus) or immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus).
We are currently distributing vaccine for use in the following settings:
K-12 schools
Health care providers who care for children, pregnant women and/or very high-risk adults
Colleges and universities for their high-risk students
Some pre-school settings such as preschool programs for high-risk children and Head Starts
By the end of next week, we expect:
About 95% of all K-12 schools, which is all schools that signed up to provide H1N1 vaccines, will have administered their first doses to children. The second doses for children ages nine and younger we anticipate will begin to be distributed in the next several weeks, but not until sometime in December.
All health care providers that ordered H1N1 vaccine for pregnant women will have received sufficient supply for their pregnant patients.
Over the next several weeks, we expect that it will be easier for household members of infants younger than six months old, pre-school aged children, and people younger than 65 at high risk due to underlying medical conditions to access vaccine through several channels:
Vaccine has been shipped to pediatric health care providers that placed orders for H1N1 vaccine. Public Health Nurses are conducting vaccine clinics in preschool settings for high-risk children and will soon be conducting vaccine clinics in Head Start locations. Other organizations are also starting to organize clinics for preschool aged children.
The limited amount of vaccine formulation that is ideal for adults is being distributed to specialists serving those adults who are at the highest risk – pulmonologists, cardiologists, oncologists, neurologists, rheumatologists, infectious disease physicians, and dialysis centers. We hope in the next week to be able to distribute increasing amounts of vaccine to other adult practices, such as internal medicine physicians. In addition, clinics for high risk groups will be starting in the coming weeks, and will be posted on the flu clinic locator at http://www.maineflu.gov/.
We hope to provide more vaccine for health care workers by the end of this month as the vaccine formulations for adults become more available. Any health care worker who fits into another high-risk group (pregnant, household member of an infant younger than six months, younger than 65 with an underlying health condition) should try to access vaccine now.
Once all of the prioritized groups have been vaccinated, we anticipate that there will be enough vaccine for anyone who wants it. However, vaccine may not be available to those not included in the priority groups until early in 2010.
Reporting Vaccine Administration
Maine CDC asks that all H1N1 vaccine providers and/or administrators are submitting the vaccine administration data into the Maine CDC’s weekly vaccine reporting system.
The weekly vaccine reporting form can be found at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/health-care-providers.shtml. The vaccine reporting periods on the form are the same timeframe as the dates for the vaccine clinics. This form is then compiled by us and submitted, as required, to US CDC.
We have many thousands fewer doses of vaccine being reported as being administered than we believe have actually been administered. This will start impacting the flow of vaccine, since the flow of vaccine is expected to slow to those states that are not showing evidence of using it.
Maine CDC’s Immunization Program is compiling a database that matches the vaccine distribution database with the vaccine administration database by provider so we can tell which providers are not reporting on vaccine administration (or not using their vaccine). We will then use this to guide our vaccine distribution decision-making.
H1N1 Vaccination Distribution as of November 12:
STATE
180,400 doses
14% of the state population
These numbers mean there is 1 dose for every 4 people in a high priority group, and 1 for every 8 people in the state.
Adverse Events
US CDC's Vaccine Adverse Event Reporting System (VAERS) for years has recorded any adverse events following vaccination. This week Maine CDC compiled the data from the first month of H1N1 vaccine being administered in Maine. We found a total of 5 adverse events reported, all of them minor with none requiring hospitalization or evidence of long term problems. The events included: congestion and a sore throat following a nasal spray vaccine, and tingling and numbness following an injectable vaccine that resolved.
Antiviral Treatment
Anyone who is in a high risk category for flu complications – those younger than 2 years old, 65 years or older, pregnant, and/or those with an underlying medical condition – should be started on prescription antiviral medicines such as Tamiflu® if they have flu symptoms (or if anyone in their household has symptoms). These medicines can significantly reduce severity (including hospitalization and death) as well as duration of illness.
State Stockpile:
Maine CDC encourages physicians to prescribe antiviral medications as appropriate. In an effort to minimize financial barriers, Maine CDC has mobilized a significant portion of the state-purchased stockpile of antiviral medications for use by patients who do not have adequate insurance coverage (no insurance, high deductibles, high co-pays). Read the full Health Alert issued on this topic here: http://www.maine.gov/tools/whatsnew/index.php?topic=DHHS-HAN&id=84066&v=alert
Pediatric Suspension:
The FDA has issued guidance on compounding an oral suspension of Tamiflu® to provide multiple prescriptions: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm188629.htm/ohttp:/www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm188629.htmblocked::http:/www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm188629.htm
MaineCare is promulgating emergency rules increasing the reimbursement for compounding pediatric suspension from $4.35 to $10. The full stockpile of pre-prepared pediatric suspension in the stockpile has been fully deployed to hospitals, health centers, and Hannaford’s pharmacies and other willing pharmacies.
Additional Federal Guidance on Antivirals:
US CDC has posted information about the safety of antivirals: http://www.cdc.gov/H1N1flu/antivirals/safety_info.htm
US CDC Health Alert: Key Issues for Clinicians Concerning Antiviral Treatments for 2009 H1N1: The 2009 H1N1 virus continues to be the dominant influenza virus in circulation in the United States. The benefit of antiviral treatment is greatest when it is initiated as early as possible in the clinical course. http://www.cdc.gov/H1N1flu/HAN/110609.htm
Clinical Testing, Reporting, and Management of H1N1
Health care providers and other public health partners are asked to report to Maine CDC influenza infection among patients who:
· Are hospitalized;
· Have died; and/or
· Are associated with a suspected outbreak.
Health care providers with questions on influenza can contact the Maine CDC at 1-800-821-5821 24 hours a day, 7 days a week.
Testing:
§ Submit a specimen for influenza testing for patients with ILI who are hospitalized, who have died, or for whom a diagnosis of influenza would affect clinical care, infection control, or management of contacts.
§ When testing is indicated, rapid diagnostic tests that are negative should be followed by PCR testing.
§ For outbreaks in institutional settings, submit 3-4 specimens to confirm the cause of the outbreak. Once infection has been confirmed as influenza, further testing is not usually indicated.
§ Information on testing at the Health and Environmental Testing Laboratory is available at: http://www.maine.gov/dhhs/etl/micro/submitting_samples.htm
Algorithm for Testing and Management of H1N1 can be found at: http://www.maine.gov/tools/whatsnew/attach.php?id=82597&an=1
Additional Information for Health Care Providers on testing, reporting and management of H1N1, including patient handouts can be found at:
http://www.maine.gov/dhhs/boh/maineflu/h1n1/health-care-providers.shtml and
http://www.maineflu.gov/
Guidance for Schools and Day Cares
In light of recent school outbreaks, we expect that most schools in the state will eventually have some cases of the flu. Schools and day cares do not need to notify parents of each individual case of the flu. However, parental notification may be helpful in some situations.
If you have cases of flu in your school and are unsure whether you should notify parents, you may contact Maine CDC for guidance. There are specific reporting guidelines and forms related to increased absenteeism, available at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/educators.shtml#forms
If you are a school or day care administrator and have questions about reporting increased absenteeism, precautions to take, or the ways in which to notify parents, please contact our Clinical Consultation line at 1-800-821-5821 or e-mail disease.reporting@maine.gov.
US CDC has issued guidance for schools (http://www.cdc.gov/h1n1flu/schools/schoolguidance.htm) and child care programs (http://www.cdc.gov/h1n1flu/childcare/guidance.htm) designed to decrease exposure to the flu while limiting the disruption of day-to-day activities and learning.
Maine CDC is not issuing directives to close schools or day cares at this time. These are administrative decisions, largely based on staffing capacity.
New Videos, posters, and related materials from US CDC
Influenza Round Table: Warning Signs Video
Don't Get, Don't Spread Video
H1N1 Flu Vaccine -- Why the Delay? Watch a new CDC video to find out how flu vaccines are made: http://is.gd/4OVFq
"Seasonal and 2009 H1N1 Flu: For Parents Who Have Children or Adolescents with High-Risk Medical Conditions" brochure. New brochure for parents of high-risk children. http://www.cdc.gov/h1n1flu/childcare/toolkit/pdf/H1N1Seasonal_HiRiskChildren_Final.pdf
Updated: H1N1 Flu and You Brochure
Update: Poster-Disposable Respirators: General Donning InstructionsThese posters describe general procedures for properly putting on and taking off a disposable respirator. http://www.cdc.gov/h1n1flu/eua/pdf/n95instructions.pdf
Other Updates from Federal Partners
The World Organization for Animal Health issues this report that the recent identification of H1N1 in a house cat in Iowa is no additional cause for alarm (http://www.oie.int/eng/press/en_091104.htm) and CDC updated this Q&A about H1N1 in pets (http://www.cdc.gov/h1n1flu/qa.htm).
The commissioner of the US Food and Drug Administration (FDA) sent a letter to America’s healthcare professionals thanking them for their efforts during the 2009 H1N1 influenza outbreak and providing information on the safety of the 2009 H1N1 vaccines. The letter can be viewed at http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm189691.htm
Maine CDC H1N1 Activities This Past Week
Calls received by the phone bank: 708
Questions coming into flu.questions@maine.gov: 227
Hits on the webpages associated with http://www.maineflu.gov/: 71,425
Lab tests we (HETL at Maine CDC) conducted: 451
Lab tests we (HETL) conducted total since April: 6,134
Calls coming into the clinical consultation line: 202
Maine CDC employees whose jobs do not normally involve anything related to H1N1 who have volunteered with the phone bank and other related efforts: 124
Maine CDC employees who have been redeployed from other activities to focus on H1N1: 97
Many Maine CDC posters and magnets are now available for order online: http://www.maine.gov/dhhs/boh/flu-poster-orders.shtml
How to Stay Updated
· Flu News: View current Maine CDC press releases, Thursday morning weekly updates, and urgent updates from our Health Alert Network (HAN) by visiting: http://www.maine.gov/dhhs/boh/maineflu/flu-news.shtml. RSS feeds are available for the weekly updates and HAN. Starting this week, Maine CDC is posting the top Q&A from Maine at the beginning of each week, which can be accessed the same way as these Weekly Updates.
· Follow Maine CDC’s Social Media Updates:
o Facebook (search for “Maine CDC”)
o Twitter (http://twitter.com/MEPublicHealth)
o MySpace (www.myspace.com/mainepublichealth)
o Maine CDC’s Blog (http://mainepublichealth.blogspot.com/)
· H1N1 Conference Calls: Maine CDC will be holding conference calls to provide updates and take questions on H1N1. The next call will be held Monday, November 16, from noon to 1 pm. To participate, call 1-800-914-3396 and enter pass code 473623#. During calls, please press *6 to mute your line and #6 to un-mute when you are actively participating.
Call or Email Us
· For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
· General Public Call-in Number for Questions: 1-888-257-0990
Deaf and Hard of Hearing phone number: 1-800-606-0215
Phone lines are open Monday - Friday 9 a.m. – 5 p.m.
· Email your questions to: flu.questions@maine.gov
Monday, November 9, 2009
Questions about second dose of H1N1 flu vaccine for children under 10
Q. My child is under 10 and has received his first dose of H1N1 vaccine. Will there be enough vaccine to get the second dose 28 days later? The first dose was a nasal spray, what if nasal spray is unavailable later?
A. US CDC recommends that the two doses of H1N1 vaccine for children 9 years of age and younger be separated by 4 weeks. There is no maximum number of days between doses.
Ideally the same type of vaccine – nasal spray or injection – should be used for both doses. If different types of vaccine are used for the first and second doses, however, there is no need to revaccinate a child.
A. US CDC recommends that the two doses of H1N1 vaccine for children 9 years of age and younger be separated by 4 weeks. There is no maximum number of days between doses.
Ideally the same type of vaccine – nasal spray or injection – should be used for both doses. If different types of vaccine are used for the first and second doses, however, there is no need to revaccinate a child.
Thursday, November 5, 2009
Increased flu activity in Maine, guidance for schools, treatment, vaccine prioritization, and more
From this week's update:
Increased Flu Activity in Maine and the US
The 2009 H1N1 flu continues to be widespread in Maine, more widespread than we have seen in years, as it is in nearly all other states. This was anticipated, and Maine CDC has been working for months to make sure we have resources in place to prevent and treat the flu.
In the past week, there have been increases in visits to health care providers for influenza-like illness (ILI) and increases in school absences. There have been 24 new outbreaks of ILI in K-12 schools and one in a university. Although the majority of outbreaks occurred in Kennebec and Penobscot counties, there were also outbreaks in Androscoggin, Aroostook, Franklin, Lincoln, Oxford, Somerset, Washington, and York counties.
There were 10 people hospitalized due to H1N1, nearly all of whom have been discharged. Four of the hospitalized patients were otherwise healthy children; one was a young adult; and five were middle-aged adults.
The first cases of H1N1 in Franklin County were reported this week. There have now been confirmed cases of H1N1 in every county in Maine. Although the vast majority of people are not getting tested and do not need to, almost 300 people were tested and confirmed as having H1N1. Most of these were children.
People should assume that they will be exposed to the flu at some point, and with only enough vaccine for 1 in 10 people in Maine right now, we should all take precautions to prevent serious illness:
* Stay home if you are sick, until you are fever-free for a full 24 hours without taking fever-reducing medicine.
* Cough and sneeze into your elbow, or into a tissue. Throw this tissue away.
* Wash your hands frequently with soap and water, but especially after coughing and sneezing. Alcohol-based hand gels can also be used.
* Avoid touching your nose, mouth, and eyes. Germs can be spread by touching contaminated surfaces and then touching your eyes, nose, and mouth.
* Avoid contact with sick people. If you are at very high risk for complication, you may want to avoid large crowds.
* If and when vaccine is available, consider getting both seasonal and H1N1 flu vaccines.
* Contact your health care provider if there are flu-like symptoms in a household where anyone is younger than 2 years old, 65 years or older, pregnant, and/or has an underlying medical condition. There are prescription medicines (antivirals such as Tamiflu®) that may help.
* Although most people can stay home without seeing a health care provider, anyone with the flu should seek medical attention for:
Dehydration
Trouble breathing
Getting better, then suddenly getting a lot worse
Any major change in one’s condition
Guidance for Schools and Day Cares
In light of recent school outbreaks, we expect that most schools in the state will eventually have some cases of the flu. Schools and day cares do not need to notify parents of each individual case of the flu. However, parental notification may be helpful in some situations.
If you have cases of flu in your school and are unsure whether you should notify parents, you may contact Maine CDC for guidance. There are specific reporting guidelines and forms related to increased absenteeism, available at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/educators.shtml#forms
If you are a school or day care administrator and have questions about reporting increased absenteeism, precautions to take, or the ways in which to notify parents, please contact our Clinical Consultation line at 1-800-821-5821 or e-mail disease.reporting@maine.gov.
US CDC has issued guidance for schools (http://www.cdc.gov/h1n1flu/schools/schoolguidance.htm) and child care programs (http://www.cdc.gov/h1n1flu/childcare/guidance.htm) designed to decrease exposure to the flu while limiting the disruption of day-to-day activities and learning.
Maine CDC is not issuing directives to close schools or day cares at this time. These are administrative decisions, largely based on staffing capacity.
H1N1 Vaccine Supply and Prioritization
Vaccine is being distributed at an unprecedented speed. Almost 40,000 doses of vaccine are arriving this week, bringing the total as of Nov. 5, to 138,600 doses. This is about 20% of the total amount of vaccine needed for prioritized populations in the state. Vaccine is continuing to be shipped as soon as it is allocated. However, it is possible that there will not be sufficient supplies of vaccine for some of the highest priority people until next month.
Vaccine is being sent out in response to several factors, including current trends in infections, prioritized populations, and the supply available.
We are asking that health care providers receiving shipments of H1N1 vaccine make sure it is immediately available to schools if they are serving as a distribution site for schools, and that in general, pregnant women and children be prioritized.
There are many reasons Maine CDC has been working with the Department of Education and other partners for months on the school-located vaccine clinic project:
* All school children are at risk for H1N1 because of their age.
* K-12 school children account for about a third of the of the estimated 575,000 non-health care workers in high priority groups in Maine. Schools are therefore an extremely efficient way to vaccinate a very large portion of the high-priority population.
* Studies show that school children as the major transmitters of flu in communities.
* By vaccinating children in school, we help ease the burden on the health care system, which would be overrun by many more additional parents and children seeking vaccine.
* Schools have most of the infrastructure needed to host vaccine clinics (nurses, refrigerators, space).
* Much of the vaccine formulation available to us first was the nasal spray, which is only licensed for otherwise healthy young people – the largest high priority group fitting the restrictions for that vaccine formulation is school children.
The school-located vaccine clinics have been successful in vaccinating thousands of Maine children with little disruption for students or parents in most cases. Nearly 100 schools have already conducted clinics, and more than 200 are scheduled for this week and next. However, this does not mean that pre-school aged children are not also a focus for vaccine.
The specific formulation of H1N1 vaccine for children ages 6 months – 3 years-old just became available to Maine CDC to order for the first time late last week. Since then, we have distributed about 6,600 doses to pediatric and family practices across the state. We anticipate being able to distribute another 11,000 doses of this formulation this week and next, and will continue to distribute to these practices across the state. If the national vaccine estimates continue as anticipated, there should be about 20,000 doses of this vaccine distributed in Maine before Thanksgiving. This should provide strong coverage for these infants and toddlers, who number about 35,000 in Maine.
There are other formulations of vaccine that can be administered to pre-school aged children, which are also slowly increasing in Maine. We are distributing those formulations to hospitals (who are mainly redistributing to their associated practices), pediatric and family practices, as well as home health agencies. There have been some clinics for young children, especially in rural areas and along the Midcoast.
As the appropriate formulations become available, about 1,100 doses of vaccine has been distributed to specialty practices (pulmonologists, asthma specialists, etc.) for people with underlying health conditions who are at risk for complications from the flu. We have contracted with home health agencies, health centers, city health departments, and hospitals to put on H1N1 vaccine clinics to be focused on high-risk populations. They should be underway as soon as there is sufficient vaccine.
As more vaccine arrives, we will broaden our distribution to other high risk groups, including young adults, additional people with health conditions, and health care and emergency services personnel. Once the full supply of vaccine has arrived, we plan to offer it to anyone who wants it.
Antiviral Treatment
Anyone who is in a high risk category for flu complications – those younger than 2 years old, 65 years or older, pregnant, and/or those with an underlying medical condition – should be started on prescription antiviral medicines such as Tamiflu® if they have flu symptoms or if anyone in their household has symptoms.
Maine CDC’s Stockpile: Maine CDC encourages physicians to prescribe antiviral medications as appropriate. In an effort to minimize financial barriers, Maine CDC has mobilized a significant portion of the state-purchased stockpile of antiviral medications for use by patients who do not have adequate insurance coverage (no insurance, high deductibles, high co-pays). Read the full Health Alert issued on this topic here: http://www.maine.gov/tools/whatsnew/index.php?topic=DHHS-HAN&id=84066&v=alert
The FDA has issued guidance on compounding an oral suspension of Tamiflu® to provide multiple prescriptions: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm188629.htm
US CDC has also posted information about the safety of antivirals (http://www.cdc.gov/H1N1flu/antivirals/safety_info.htm).
To read the full update: http://www.maine.gov/tools/whatsnew/attach.php?id=84420&an=2
Increased Flu Activity in Maine and the US
The 2009 H1N1 flu continues to be widespread in Maine, more widespread than we have seen in years, as it is in nearly all other states. This was anticipated, and Maine CDC has been working for months to make sure we have resources in place to prevent and treat the flu.
In the past week, there have been increases in visits to health care providers for influenza-like illness (ILI) and increases in school absences. There have been 24 new outbreaks of ILI in K-12 schools and one in a university. Although the majority of outbreaks occurred in Kennebec and Penobscot counties, there were also outbreaks in Androscoggin, Aroostook, Franklin, Lincoln, Oxford, Somerset, Washington, and York counties.
There were 10 people hospitalized due to H1N1, nearly all of whom have been discharged. Four of the hospitalized patients were otherwise healthy children; one was a young adult; and five were middle-aged adults.
The first cases of H1N1 in Franklin County were reported this week. There have now been confirmed cases of H1N1 in every county in Maine. Although the vast majority of people are not getting tested and do not need to, almost 300 people were tested and confirmed as having H1N1. Most of these were children.
People should assume that they will be exposed to the flu at some point, and with only enough vaccine for 1 in 10 people in Maine right now, we should all take precautions to prevent serious illness:
* Stay home if you are sick, until you are fever-free for a full 24 hours without taking fever-reducing medicine.
* Cough and sneeze into your elbow, or into a tissue. Throw this tissue away.
* Wash your hands frequently with soap and water, but especially after coughing and sneezing. Alcohol-based hand gels can also be used.
* Avoid touching your nose, mouth, and eyes. Germs can be spread by touching contaminated surfaces and then touching your eyes, nose, and mouth.
* Avoid contact with sick people. If you are at very high risk for complication, you may want to avoid large crowds.
* If and when vaccine is available, consider getting both seasonal and H1N1 flu vaccines.
* Contact your health care provider if there are flu-like symptoms in a household where anyone is younger than 2 years old, 65 years or older, pregnant, and/or has an underlying medical condition. There are prescription medicines (antivirals such as Tamiflu®) that may help.
* Although most people can stay home without seeing a health care provider, anyone with the flu should seek medical attention for:
Dehydration
Trouble breathing
Getting better, then suddenly getting a lot worse
Any major change in one’s condition
Guidance for Schools and Day Cares
In light of recent school outbreaks, we expect that most schools in the state will eventually have some cases of the flu. Schools and day cares do not need to notify parents of each individual case of the flu. However, parental notification may be helpful in some situations.
If you have cases of flu in your school and are unsure whether you should notify parents, you may contact Maine CDC for guidance. There are specific reporting guidelines and forms related to increased absenteeism, available at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/educators.shtml#forms
If you are a school or day care administrator and have questions about reporting increased absenteeism, precautions to take, or the ways in which to notify parents, please contact our Clinical Consultation line at 1-800-821-5821 or e-mail disease.reporting@maine.gov.
US CDC has issued guidance for schools (http://www.cdc.gov/h1n1flu/schools/schoolguidance.htm) and child care programs (http://www.cdc.gov/h1n1flu/childcare/guidance.htm) designed to decrease exposure to the flu while limiting the disruption of day-to-day activities and learning.
Maine CDC is not issuing directives to close schools or day cares at this time. These are administrative decisions, largely based on staffing capacity.
H1N1 Vaccine Supply and Prioritization
Vaccine is being distributed at an unprecedented speed. Almost 40,000 doses of vaccine are arriving this week, bringing the total as of Nov. 5, to 138,600 doses. This is about 20% of the total amount of vaccine needed for prioritized populations in the state. Vaccine is continuing to be shipped as soon as it is allocated. However, it is possible that there will not be sufficient supplies of vaccine for some of the highest priority people until next month.
Vaccine is being sent out in response to several factors, including current trends in infections, prioritized populations, and the supply available.
We are asking that health care providers receiving shipments of H1N1 vaccine make sure it is immediately available to schools if they are serving as a distribution site for schools, and that in general, pregnant women and children be prioritized.
There are many reasons Maine CDC has been working with the Department of Education and other partners for months on the school-located vaccine clinic project:
* All school children are at risk for H1N1 because of their age.
* K-12 school children account for about a third of the of the estimated 575,000 non-health care workers in high priority groups in Maine. Schools are therefore an extremely efficient way to vaccinate a very large portion of the high-priority population.
* Studies show that school children as the major transmitters of flu in communities.
* By vaccinating children in school, we help ease the burden on the health care system, which would be overrun by many more additional parents and children seeking vaccine.
* Schools have most of the infrastructure needed to host vaccine clinics (nurses, refrigerators, space).
* Much of the vaccine formulation available to us first was the nasal spray, which is only licensed for otherwise healthy young people – the largest high priority group fitting the restrictions for that vaccine formulation is school children.
The school-located vaccine clinics have been successful in vaccinating thousands of Maine children with little disruption for students or parents in most cases. Nearly 100 schools have already conducted clinics, and more than 200 are scheduled for this week and next. However, this does not mean that pre-school aged children are not also a focus for vaccine.
The specific formulation of H1N1 vaccine for children ages 6 months – 3 years-old just became available to Maine CDC to order for the first time late last week. Since then, we have distributed about 6,600 doses to pediatric and family practices across the state. We anticipate being able to distribute another 11,000 doses of this formulation this week and next, and will continue to distribute to these practices across the state. If the national vaccine estimates continue as anticipated, there should be about 20,000 doses of this vaccine distributed in Maine before Thanksgiving. This should provide strong coverage for these infants and toddlers, who number about 35,000 in Maine.
There are other formulations of vaccine that can be administered to pre-school aged children, which are also slowly increasing in Maine. We are distributing those formulations to hospitals (who are mainly redistributing to their associated practices), pediatric and family practices, as well as home health agencies. There have been some clinics for young children, especially in rural areas and along the Midcoast.
As the appropriate formulations become available, about 1,100 doses of vaccine has been distributed to specialty practices (pulmonologists, asthma specialists, etc.) for people with underlying health conditions who are at risk for complications from the flu. We have contracted with home health agencies, health centers, city health departments, and hospitals to put on H1N1 vaccine clinics to be focused on high-risk populations. They should be underway as soon as there is sufficient vaccine.
As more vaccine arrives, we will broaden our distribution to other high risk groups, including young adults, additional people with health conditions, and health care and emergency services personnel. Once the full supply of vaccine has arrived, we plan to offer it to anyone who wants it.
Antiviral Treatment
Anyone who is in a high risk category for flu complications – those younger than 2 years old, 65 years or older, pregnant, and/or those with an underlying medical condition – should be started on prescription antiviral medicines such as Tamiflu® if they have flu symptoms or if anyone in their household has symptoms.
Maine CDC’s Stockpile: Maine CDC encourages physicians to prescribe antiviral medications as appropriate. In an effort to minimize financial barriers, Maine CDC has mobilized a significant portion of the state-purchased stockpile of antiviral medications for use by patients who do not have adequate insurance coverage (no insurance, high deductibles, high co-pays). Read the full Health Alert issued on this topic here: http://www.maine.gov/tools/whatsnew/index.php?topic=DHHS-HAN&id=84066&v=alert
The FDA has issued guidance on compounding an oral suspension of Tamiflu® to provide multiple prescriptions: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm188629.htm
US CDC has also posted information about the safety of antivirals (http://www.cdc.gov/H1N1flu/antivirals/safety_info.htm).
To read the full update: http://www.maine.gov/tools/whatsnew/attach.php?id=84420&an=2
Wednesday, November 4, 2009
I have the flu. Why won’t my doctor test me for H1N1?
In many cases, it is unlikely that your doctor will test you for H1N1 flu. There are several reasons:
We are monitoring the progress of H1N1 in the state through a number of different data sources, rather than counting individual lab reports. Now that we know that there have been cases of H1N1 in every county in Maine, we no longer need to test every case.
Testing everyone with flu-like symptoms would overwhelm our laboratories, so we need to save those resources for those who are most severely ill, where a confirmed diagnosis might influence treatment.
Testing will usually not change either treatment or the steps you should take if you are sick. The treatments for both seasonal and H1N1 flu are the same.
If you are not in a group of people at high risk for complications and do not have severe symptoms, you may recover on your own.
If you are in a high risk group, your health care provider will know if you need to be tested for H1N1, based on current guidance from the US CDC.
We are monitoring the progress of H1N1 in the state through a number of different data sources, rather than counting individual lab reports. Now that we know that there have been cases of H1N1 in every county in Maine, we no longer need to test every case.
Testing everyone with flu-like symptoms would overwhelm our laboratories, so we need to save those resources for those who are most severely ill, where a confirmed diagnosis might influence treatment.
Testing will usually not change either treatment or the steps you should take if you are sick. The treatments for both seasonal and H1N1 flu are the same.
If you are not in a group of people at high risk for complications and do not have severe symptoms, you may recover on your own.
If you are in a high risk group, your health care provider will know if you need to be tested for H1N1, based on current guidance from the US CDC.
Tuesday, November 3, 2009
Top H1N1 Questions in Maine Week of Oct. 26
Maine CDC/DHHS Top Questions on 2009 H1N1 Flu
November 3, 2009
Note: Maine CDC will now post the answers to the top questions related to 2009 H1N1 flu received by our public phone bank, e-mail, and disease reporting and consultation line at the beginning of each week. Our weekly updates on H1N1 flu in Maine will continue to be posted on Thursdays. For more information on how to stay updated, see the end of this document.
Top Questions from the week of October 26:
Q. Where can I get a flu shot?
A. The short answer is if you’re in a high priority group and cannot find it, keep trying with your health care provider. The vaccine supply is increasing every week.
Right now there are few, if any, public clinics since there is not a sufficient supply of vaccine. This is the case in many other states as well. Eventually, there will be enough vaccine for anyone who wants it. In the meantime, we are distributing vaccine to those who are in the high priority groups. Right now there is a focus on pregnant women and children. So, the vast majority of vaccine is currently being distributed to schools, pediatric, and obstetrical health care providers. Early on, some vaccine went to hospitals for health care workers with frequent direct contact with patients and infectious material, especially to those with contact with pediatric and obstetrical patients. Over the past few days, we also received a very tiny amount of some adult-only vaccine formulations for the first time, so we distributed that to some specialty practices (pulmonary, cardiac, dialysis, etc) and large internal medicine/family practices.
Q. Why are healthy school children getting vaccine and I cannot find any?
A. The answer is threefold. First, all children are disproportionately affected by H1N1 and are at risk. Second, we provide protection to the entire community by vaccinating school children, since they are the major transmitters of flu. Third, we could not offer the nasal spray vaccine – which accounts for about a third of all vaccine received so far and the majority of the initial doses to arrive in the state – to many high priority categories of people, because it is only licensed for otherwise healthy non-pregnant people ages 2 – 49, and most priority categories of people have underlying conditions. It therefore seemed most effective to use this vaccine with our healthy school and pre-school aged children, although we are also distributing some injectable vaccine into schools and pediatric practices for their children with underlying conditions.
Q. How are you deciding which schools are getting vaccine?
A. The first few schools that held clinics this past week were simply those that had ordered early and were ready to vaccinate right away. Since then, we have received a surge of orders from schools across the state and not enough vaccine to fulfill these orders. We are distributing vaccine to those schools indicating readiness to vaccinate and we are also assuring an even distribution across the state and within counties in proportion to the population.
Q. Who are the overall priority groups for vaccine?
A. They are:
Pregnant women
All people ages 6 months – 25 years-old
People with underlying conditions who are 25 – 64 years-old
Caregivers and household members of those younger than 6 months old
Health care workers
Please note that these priority groups add up to about 700,000 in Maine, and we have only received about 99,000 doses of vaccine in the state right now. This is why Maine CDC is asking that vaccine in state and not administered yet be prioritized for pregnant women and children.
Q. Who are the priority groups for receiving antiviral medications (Tamiflu® or Relenza®) if they have symptoms of H1N1 or are heavily exposed to someone with H1N1 (for example, live in the same household)?
A. They are:
Pregnant women
Children younger than 2 years-old
People older than 64 years of age
People with underlying medical conditions, including children on chronic aspirin therapy
Anyone with more severe H1N1 disease such as that involving a pneumonia or a hospitalization (which children at any age are more likely to encounter)
People in certain outbreak situations involving many at high risk – prisons outbreaks, for instance
Q. Why are these two priority groups not the same, for instance, seniors?
A. The data so far indicates that seniors are at low risk for contracting H1N1 since they seem to have some underlying immunity. However, if they do contract H1N1, they are at risk for complications and should receive antiviral medications.
How to Stay Updated
· Flu News: View current Maine CDC press releases, Thursday morning weekly updates, and urgent updates from our Health Alert Network (HAN) by visiting: http://www.maine.gov/dhhs/boh/maineflu/flu-news.shtml. RSS feeds are available for the weekly updates and HAN.
· Follow Maine CDC’s Social Media Updates:
o Facebook (search for “Maine CDC”)
o Twitter (http://twitter.com/MEPublicHealth)
o MySpace (www.myspace.com/mainepublichealth)
o Maine CDC’s Blog (http://mainepublichealth.blogspot.com)
· H1N1 Conference Calls: Maine CDC will be holding conference calls to provide updates and take questions on H1N1. The next call will be held Monday, November 9, from noon to 1 pm. To participate, call 1-800-914-3396 and enter pass code 473623#. During calls, please press *6 to mute your line and #6 to un-mute when you are actively participating.
Call or Email Us
· For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
· General Public Call-in Number for Questions: 1-888-257-0990
Deaf and Hard of Hearing phone number: 1-800-606-0215
Phone lines are open Monday - Friday 9 a.m. – 5 p.m.
· Email your questions to: flu.questions@maine.gov
November 3, 2009
Note: Maine CDC will now post the answers to the top questions related to 2009 H1N1 flu received by our public phone bank, e-mail, and disease reporting and consultation line at the beginning of each week. Our weekly updates on H1N1 flu in Maine will continue to be posted on Thursdays. For more information on how to stay updated, see the end of this document.
Top Questions from the week of October 26:
Q. Where can I get a flu shot?
A. The short answer is if you’re in a high priority group and cannot find it, keep trying with your health care provider. The vaccine supply is increasing every week.
Right now there are few, if any, public clinics since there is not a sufficient supply of vaccine. This is the case in many other states as well. Eventually, there will be enough vaccine for anyone who wants it. In the meantime, we are distributing vaccine to those who are in the high priority groups. Right now there is a focus on pregnant women and children. So, the vast majority of vaccine is currently being distributed to schools, pediatric, and obstetrical health care providers. Early on, some vaccine went to hospitals for health care workers with frequent direct contact with patients and infectious material, especially to those with contact with pediatric and obstetrical patients. Over the past few days, we also received a very tiny amount of some adult-only vaccine formulations for the first time, so we distributed that to some specialty practices (pulmonary, cardiac, dialysis, etc) and large internal medicine/family practices.
Q. Why are healthy school children getting vaccine and I cannot find any?
A. The answer is threefold. First, all children are disproportionately affected by H1N1 and are at risk. Second, we provide protection to the entire community by vaccinating school children, since they are the major transmitters of flu. Third, we could not offer the nasal spray vaccine – which accounts for about a third of all vaccine received so far and the majority of the initial doses to arrive in the state – to many high priority categories of people, because it is only licensed for otherwise healthy non-pregnant people ages 2 – 49, and most priority categories of people have underlying conditions. It therefore seemed most effective to use this vaccine with our healthy school and pre-school aged children, although we are also distributing some injectable vaccine into schools and pediatric practices for their children with underlying conditions.
Q. How are you deciding which schools are getting vaccine?
A. The first few schools that held clinics this past week were simply those that had ordered early and were ready to vaccinate right away. Since then, we have received a surge of orders from schools across the state and not enough vaccine to fulfill these orders. We are distributing vaccine to those schools indicating readiness to vaccinate and we are also assuring an even distribution across the state and within counties in proportion to the population.
Q. Who are the overall priority groups for vaccine?
A. They are:
Pregnant women
All people ages 6 months – 25 years-old
People with underlying conditions who are 25 – 64 years-old
Caregivers and household members of those younger than 6 months old
Health care workers
Please note that these priority groups add up to about 700,000 in Maine, and we have only received about 99,000 doses of vaccine in the state right now. This is why Maine CDC is asking that vaccine in state and not administered yet be prioritized for pregnant women and children.
Q. Who are the priority groups for receiving antiviral medications (Tamiflu® or Relenza®) if they have symptoms of H1N1 or are heavily exposed to someone with H1N1 (for example, live in the same household)?
A. They are:
Pregnant women
Children younger than 2 years-old
People older than 64 years of age
People with underlying medical conditions, including children on chronic aspirin therapy
Anyone with more severe H1N1 disease such as that involving a pneumonia or a hospitalization (which children at any age are more likely to encounter)
People in certain outbreak situations involving many at high risk – prisons outbreaks, for instance
Q. Why are these two priority groups not the same, for instance, seniors?
A. The data so far indicates that seniors are at low risk for contracting H1N1 since they seem to have some underlying immunity. However, if they do contract H1N1, they are at risk for complications and should receive antiviral medications.
How to Stay Updated
· Flu News: View current Maine CDC press releases, Thursday morning weekly updates, and urgent updates from our Health Alert Network (HAN) by visiting: http://www.maine.gov/dhhs/boh/maineflu/flu-news.shtml. RSS feeds are available for the weekly updates and HAN.
· Follow Maine CDC’s Social Media Updates:
o Facebook (search for “Maine CDC”)
o Twitter (http://twitter.com/MEPublicHealth)
o MySpace (www.myspace.com/mainepublichealth)
o Maine CDC’s Blog (http://mainepublichealth.blogspot.com)
· H1N1 Conference Calls: Maine CDC will be holding conference calls to provide updates and take questions on H1N1. The next call will be held Monday, November 9, from noon to 1 pm. To participate, call 1-800-914-3396 and enter pass code 473623#. During calls, please press *6 to mute your line and #6 to un-mute when you are actively participating.
Call or Email Us
· For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
· General Public Call-in Number for Questions: 1-888-257-0990
Deaf and Hard of Hearing phone number: 1-800-606-0215
Phone lines are open Monday - Friday 9 a.m. – 5 p.m.
· Email your questions to: flu.questions@maine.gov
Friday, October 30, 2009
Are you in a priority group and worried because you can't get vaccine?
from this week's update on H1N1 in Maine:
H1N1 Vaccine Supply and Prioritization
As of October 28, a total of 99,000 doses of vaccine had been allocated to the state, which is about 14% of the total amount of vaccine needed for prioritized populations in the state. Vaccine is continuing to be shipped as soon as it is allocated. However, it is possible that there will not be sufficient supplies of vaccine for some of the highest priority people until December.
Maine CDC is developing short-term plans, which are constantly being reevaluated, based on the supply of vaccine being allocated to us from the federal government. Vaccine is being sent out in response to several factors, including current trends in infections, prioritized populations, and the supply available. Every county in the state has received some vaccine, and will continue to receive it as it is available.
Less than 2% of the vaccine that has arrived to date is in the formulation most frequently requested for children under age three. About a third of the vaccine that has arrived is in the nasal spray form, which cannot be given to many people in the priority populations, but can be administered to healthy children over the age of two.
We are focusing our first doses on children and pregnant women, because they are the most disproportionately affected by H1N1. We are providing some vaccine to pediatric providers for very young children, household members of children under six months old, and some high-risk children. Most of our vaccine is going to schools.
Vaccine clinics for school children have been held in the Sanford/Springvale, greater Portland, Lewiston, Augusta, and Bangor areas, as well as in Passamaquoddy Indian Township in the past week. Vaccinating children, who are the major transmitters of flu, provides some protection to the entire community.
As more vaccine arrives, we will broaden our distribution to other high risk groups, including young adults, people with health conditions, and health care and emergency services personnel. Once the full supply of vaccine has arrived, we plan to offer it to anyone who wants it.
In the mean time, people in priority groups who do not have access to vaccine yet can take some steps to protect themselves:
* If vaccine is appropriately available to other members of the household (for instance, children who can be vaccinated in their school), then this is one way to provide some protection to a high-risk individual.
* If you can get a seasonal flu vaccine (which is also in short supply in many areas), do so. The seasonal flu vaccine will not protect you from H1N1, but by protecting you from seasonal flu, it will keep you from getting run down and therefore being more likely to get H1N1.
* Avoid close contact with people who are sick. Wash or sanitize your hands often.
* Keep checking the clinic locator on our web site: http://www.maine.gov/dhhs/boh/maineflu/fluclinics/index.shtml
* Your health care provider may prescribe antiviral medicine if someone in the household is sick with a fever plus cough and/or sore throat and the sick person, or a household member, meets one or more of these criteria:
* Younger than 2 years-old
* Older than 64 years-old
* Pregnant
* Has an underlying medical condition
These antiviral prescription medicines (Tamiflu or Relenza) may help reduce the severity of the flu.
To read the full update: http://www.maine.gov/tools/whatsnew/attach.php?id=83965&an=2
H1N1 Vaccine Supply and Prioritization
As of October 28, a total of 99,000 doses of vaccine had been allocated to the state, which is about 14% of the total amount of vaccine needed for prioritized populations in the state. Vaccine is continuing to be shipped as soon as it is allocated. However, it is possible that there will not be sufficient supplies of vaccine for some of the highest priority people until December.
Maine CDC is developing short-term plans, which are constantly being reevaluated, based on the supply of vaccine being allocated to us from the federal government. Vaccine is being sent out in response to several factors, including current trends in infections, prioritized populations, and the supply available. Every county in the state has received some vaccine, and will continue to receive it as it is available.
Less than 2% of the vaccine that has arrived to date is in the formulation most frequently requested for children under age three. About a third of the vaccine that has arrived is in the nasal spray form, which cannot be given to many people in the priority populations, but can be administered to healthy children over the age of two.
We are focusing our first doses on children and pregnant women, because they are the most disproportionately affected by H1N1. We are providing some vaccine to pediatric providers for very young children, household members of children under six months old, and some high-risk children. Most of our vaccine is going to schools.
Vaccine clinics for school children have been held in the Sanford/Springvale, greater Portland, Lewiston, Augusta, and Bangor areas, as well as in Passamaquoddy Indian Township in the past week. Vaccinating children, who are the major transmitters of flu, provides some protection to the entire community.
As more vaccine arrives, we will broaden our distribution to other high risk groups, including young adults, people with health conditions, and health care and emergency services personnel. Once the full supply of vaccine has arrived, we plan to offer it to anyone who wants it.
In the mean time, people in priority groups who do not have access to vaccine yet can take some steps to protect themselves:
* If vaccine is appropriately available to other members of the household (for instance, children who can be vaccinated in their school), then this is one way to provide some protection to a high-risk individual.
* If you can get a seasonal flu vaccine (which is also in short supply in many areas), do so. The seasonal flu vaccine will not protect you from H1N1, but by protecting you from seasonal flu, it will keep you from getting run down and therefore being more likely to get H1N1.
* Avoid close contact with people who are sick. Wash or sanitize your hands often.
* Keep checking the clinic locator on our web site: http://www.maine.gov/dhhs/boh/maineflu/fluclinics/index.shtml
* Your health care provider may prescribe antiviral medicine if someone in the household is sick with a fever plus cough and/or sore throat and the sick person, or a household member, meets one or more of these criteria:
* Younger than 2 years-old
* Older than 64 years-old
* Pregnant
* Has an underlying medical condition
These antiviral prescription medicines (Tamiflu or Relenza) may help reduce the severity of the flu.
To read the full update: http://www.maine.gov/tools/whatsnew/attach.php?id=83965&an=2
Saturday, October 3, 2009
H1N1 Clinician Update
Below this blog post are some important recent (this last 2 days) updated documents from US CDC. The Treatment Algorithm for Adults, the H1N1 Vaccine Information Statements (which must be given to patients receiving the vaccine), updated information for seniors, pregnant women, other patients, and clinicians all may be of interest.
Maine CDC was one of few states that ordered its entire allotment of H1N1 vaccine this week. Our Immunization Program staff along with redeployed Maine CDC staff worked many hours to accomplish this. Over 300 health care providers were registered as H1N1 distribution sites. 8,700 doses of LAIV (Live Attenuated Influenza Vaccine), also known as nasal spray vaccine (analogous to the seasonal flu vaccine FluMist), will be arriving and distributed to about 70 clinical sites this coming week – most likely arriving at clinical sites Tuesday or Wednesday. We ask that these first few doses of vaccine be focused on healthy children, especially young children ages 2 – 5 years of age, and household contacts and caregivers of young infants under 6 months old. This LAIV is licensed for healthy non-pregnant 2 – 49 year olds, and as more vaccine arrives, this formulation should be expanded to include other high priority populations that fit the licensure parameters.
We expect to be able to order other formulations plus additional LAIV this coming week. As we are able to order and distribute more vaccine, the high priority populations it will be focused on will be expanded. For the next few weeks we anticipate focusing vaccine on the 5 high priority populations of:
· pregnant women;
· people ages 6 months – 25 years of age;
· household contacts and caregivers of young infants under 6 months old;
· people 25 – 65 years of age with underlying conditions; and
· health care workers including EMS.
Within the latter category of health care workers, we anticipate that this next several weeks the vaccine will most likely be focused on hospital-based health care workers with direct patient contact who work in emergency departments, intensive care units, labor and delivery units, and inpatient pediatric wards. As vaccine becomes more available, the priority groups it can reach can expand.
Our vaccine distribution and administration plans focus on settings where these high priority populations are in highest numbers and proportion. For instance, we are currently focused on distributing H1N1 vaccine to pediatric and obstetrical health care providers, hospitals, schools, and city health departments. This means that health care providers who have not been accepted by the end of this coming week as a distribution site most likely do not fit into these priority settings. If we are allowed more distribution sites, we may be able to expand to include these other health care providers. If not, H1N1 vaccine can easily be redistributed to these other health care providers from a distribution site. However, we ask that it still remain focused on high priority populations for now. Highlights from information sent to all current H1N1 vaccine distribution sites are below this email and the CDC documents.
Thank you for all the work you and many others are doing! It is exciting to think the vaccine is almost here, though I know these next few weeks will be quite busy for anyone involved with health care and public health.
Dora
2009-2010 Influenza Season Triage Algorithm for Adults (>18 Years) With Influenza-Like Illness
This algorithm is designed to assist physicians and those under their supervision in identifying indicators of and responses to symptoms of flu-like illness (i.e., fever with cough or sore throat). (NOTE: this guidance is not intended for use by the general public and is not a substitute for sound clinical judgment.)
Download and print the algorithm (PDF) >>
H1N1 Flu Vaccine Information Statements (VISs)
Vaccine Information Statements (VISs) are information sheets produced by CDC that explain to vaccine recipients, their parents, or their legal representatives both the benefits and risks of a vaccine.
Inactivated 2009 H1N1 Influenza Vaccine
(the flu shot)
Live, Intranasal 2009 H1N1 Influenza Vaccine
(the nasal spray vaccine)
Pregnancy and H1N1
Update: 2009 H1N1 Influenza Shots and Pregnant Women: Questions and Answers for Patients
Why does CDC advise pregnant women to receive the 2009 H1N1 influenza (flu) vaccine (shot)? Will the seasonal flu shot also protect against the 2009 H1N1 flu? Are there flu vaccines that pregnant women should not get? More...
2009 H1N1 Influenza Vaccine and Pregnant Women: Information for Healthcare Providers
Where can healthcare providers obtain 2009 H1N1 flu vaccine? How should healthcare providers organize their clinics for vaccination? How many vaccine doses will a pregnant woman need to get? More...
H1N1 Clinician Information
Update: H1N1 Clinicians Questions and Answers
The age for two doses is different for seasonal (6 months through 8 years) and 2009 H1N1 monovalent vaccine (6 months through 9 years) in the package inserts. Does CDC recommend that clinicians follow the recommendation in the package inserts? Can a person who has received LAIV test positive on a rapid influenza diagnostic test? And more...
Questions and Answers on 2009 H1N1 Vaccine Financing
Considerations of financing distinguish between those related to the vaccine itself, the ancillary supplies needed to administer the vaccine, and the actual administration of the vaccine.
Questions & Answers: Interim Recommendations for Clinical Use of Influenza Diagnostic Testing During the 2009-2010 Influenza Season - For Health Care Providers
What does CDC recommend this season regarding testing for influenza? What is the reason for these recommendations? Does CDC recommend diagnostic testing for patients with uncomplicated illness from suspected influenza infection? More...
Interim Recommendations for Clinical Use of Influenza Diagnostic Tests During the 2009-10 Influenza Season
To provide updated interim recommendations on influenza diagnostic testing for clinicians treating patients with suspected 2009 H1N1 influenza virus infection and to assist clinicians with testing decisions for the 2009-10 influenza season.
H1N1 Information for Patients
Preparing for the Flu: A Communication Toolkit for the Federal Workforce
The purpose of Preparing for the Flu: A Communication Toolkit for the Federal Workforce is to provide information and communication resources to help federal agencies and employees implement recommendations from CDC in planning and responding to the 2009–2010 Influenza Season.
2009 H1N1 Influenza Vaccine and Seniors
Questions and Answers about 2009 H1N1 Influenza Vaccine and Seniors
Questions & Answers: Influenza Diagnostic Testing During the 2009-2010 Flu Season - For the Public
How will I know if I have the flu this season? How can I know for certain if I have the flu this season? What kinds of flu tests are there? More...
HIGLIGHTS OF INFORMATION SENT BY MAINE CDC TO H1N1 VACCINE DISTRIBUTION SITES FRIDAY:
Distribution:
· We expect approximately 800,00 doses of vaccine to be available in Maine by early January 2010.
· H1N1 vaccine will be offered in four different presentations: 7.5mg prefilled syringes, 15mg prefilled syringes, multi-dose vials and intranasal sprayers (LAIV).
· Approximately 40% of the vaccine will be in thimerosal free presentations (prefilled syringes and LAIV intranasal sprayers).
· Approximately 20% of the H1N1 vaccine that will be available over the course of this vaccine campaign will be in the form of the LAIV intranasal sprayer.
· The first vaccine available is in the form of LAIV intranasal sprayers.
· The first 7.5mg prefilled syringes (for children 6 months through 35 months old) are expected to be available in early November and should be available in sufficient quantity for this age group in late November.
Administration:
· Vaccine distributed at this time is intended to be used as soon as possible. Please start using this vaccine in your practice right away and consider holding clinics in your practice, especially for young children.
· Please offer H1N1 LAIV to any healthly non-pregnant patient from 2 years of age through 49 years of age.
o At this point in time, primary foci should be on 2-5 year olds that do not have any other avenue for vaccination, and caregivers and household contacts (including sibilings) of paitents younder than 6 months of age.
o It is anticipated that the focus of this H1N1 LAIV will expand soon (in ~2 weeks) to all healthy children 6 months – 18 years of age (since this is thimerasol-free vaccine).
· School vaccination clinics will be starting as soon as mid-October. Please consider requests to partner with schools to vaccinate school children.
· WEEKLY reporting of doses adimintered is due by close of business every Saturday.
o Either fax report to 207-287-8127 or submit online at http://www.maine.gov/dhhs/boh/maineflu/h1n1/hc-providers/h1n1-vaccine-weeklyreport.shtml
· Order vaccine frequently.
Maine CDC was one of few states that ordered its entire allotment of H1N1 vaccine this week. Our Immunization Program staff along with redeployed Maine CDC staff worked many hours to accomplish this. Over 300 health care providers were registered as H1N1 distribution sites. 8,700 doses of LAIV (Live Attenuated Influenza Vaccine), also known as nasal spray vaccine (analogous to the seasonal flu vaccine FluMist), will be arriving and distributed to about 70 clinical sites this coming week – most likely arriving at clinical sites Tuesday or Wednesday. We ask that these first few doses of vaccine be focused on healthy children, especially young children ages 2 – 5 years of age, and household contacts and caregivers of young infants under 6 months old. This LAIV is licensed for healthy non-pregnant 2 – 49 year olds, and as more vaccine arrives, this formulation should be expanded to include other high priority populations that fit the licensure parameters.
We expect to be able to order other formulations plus additional LAIV this coming week. As we are able to order and distribute more vaccine, the high priority populations it will be focused on will be expanded. For the next few weeks we anticipate focusing vaccine on the 5 high priority populations of:
· pregnant women;
· people ages 6 months – 25 years of age;
· household contacts and caregivers of young infants under 6 months old;
· people 25 – 65 years of age with underlying conditions; and
· health care workers including EMS.
Within the latter category of health care workers, we anticipate that this next several weeks the vaccine will most likely be focused on hospital-based health care workers with direct patient contact who work in emergency departments, intensive care units, labor and delivery units, and inpatient pediatric wards. As vaccine becomes more available, the priority groups it can reach can expand.
Our vaccine distribution and administration plans focus on settings where these high priority populations are in highest numbers and proportion. For instance, we are currently focused on distributing H1N1 vaccine to pediatric and obstetrical health care providers, hospitals, schools, and city health departments. This means that health care providers who have not been accepted by the end of this coming week as a distribution site most likely do not fit into these priority settings. If we are allowed more distribution sites, we may be able to expand to include these other health care providers. If not, H1N1 vaccine can easily be redistributed to these other health care providers from a distribution site. However, we ask that it still remain focused on high priority populations for now. Highlights from information sent to all current H1N1 vaccine distribution sites are below this email and the CDC documents.
Thank you for all the work you and many others are doing! It is exciting to think the vaccine is almost here, though I know these next few weeks will be quite busy for anyone involved with health care and public health.
Dora
2009-2010 Influenza Season Triage Algorithm for Adults (>18 Years) With Influenza-Like Illness
This algorithm is designed to assist physicians and those under their supervision in identifying indicators of and responses to symptoms of flu-like illness (i.e., fever with cough or sore throat). (NOTE: this guidance is not intended for use by the general public and is not a substitute for sound clinical judgment.)
Download and print the algorithm (PDF) >>
H1N1 Flu Vaccine Information Statements (VISs)
Vaccine Information Statements (VISs) are information sheets produced by CDC that explain to vaccine recipients, their parents, or their legal representatives both the benefits and risks of a vaccine.
Inactivated 2009 H1N1 Influenza Vaccine
(the flu shot)
Live, Intranasal 2009 H1N1 Influenza Vaccine
(the nasal spray vaccine)
Pregnancy and H1N1
Update: 2009 H1N1 Influenza Shots and Pregnant Women: Questions and Answers for Patients
Why does CDC advise pregnant women to receive the 2009 H1N1 influenza (flu) vaccine (shot)? Will the seasonal flu shot also protect against the 2009 H1N1 flu? Are there flu vaccines that pregnant women should not get? More...
2009 H1N1 Influenza Vaccine and Pregnant Women: Information for Healthcare Providers
Where can healthcare providers obtain 2009 H1N1 flu vaccine? How should healthcare providers organize their clinics for vaccination? How many vaccine doses will a pregnant woman need to get? More...
H1N1 Clinician Information
Update: H1N1 Clinicians Questions and Answers
The age for two doses is different for seasonal (6 months through 8 years) and 2009 H1N1 monovalent vaccine (6 months through 9 years) in the package inserts. Does CDC recommend that clinicians follow the recommendation in the package inserts? Can a person who has received LAIV test positive on a rapid influenza diagnostic test? And more...
Questions and Answers on 2009 H1N1 Vaccine Financing
Considerations of financing distinguish between those related to the vaccine itself, the ancillary supplies needed to administer the vaccine, and the actual administration of the vaccine.
Questions & Answers: Interim Recommendations for Clinical Use of Influenza Diagnostic Testing During the 2009-2010 Influenza Season - For Health Care Providers
What does CDC recommend this season regarding testing for influenza? What is the reason for these recommendations? Does CDC recommend diagnostic testing for patients with uncomplicated illness from suspected influenza infection? More...
Interim Recommendations for Clinical Use of Influenza Diagnostic Tests During the 2009-10 Influenza Season
To provide updated interim recommendations on influenza diagnostic testing for clinicians treating patients with suspected 2009 H1N1 influenza virus infection and to assist clinicians with testing decisions for the 2009-10 influenza season.
H1N1 Information for Patients
Preparing for the Flu: A Communication Toolkit for the Federal Workforce
The purpose of Preparing for the Flu: A Communication Toolkit for the Federal Workforce is to provide information and communication resources to help federal agencies and employees implement recommendations from CDC in planning and responding to the 2009–2010 Influenza Season.
2009 H1N1 Influenza Vaccine and Seniors
Questions and Answers about 2009 H1N1 Influenza Vaccine and Seniors
Questions & Answers: Influenza Diagnostic Testing During the 2009-2010 Flu Season - For the Public
How will I know if I have the flu this season? How can I know for certain if I have the flu this season? What kinds of flu tests are there? More...
HIGLIGHTS OF INFORMATION SENT BY MAINE CDC TO H1N1 VACCINE DISTRIBUTION SITES FRIDAY:
Distribution:
· We expect approximately 800,00 doses of vaccine to be available in Maine by early January 2010.
· H1N1 vaccine will be offered in four different presentations: 7.5mg prefilled syringes, 15mg prefilled syringes, multi-dose vials and intranasal sprayers (LAIV).
· Approximately 40% of the vaccine will be in thimerosal free presentations (prefilled syringes and LAIV intranasal sprayers).
· Approximately 20% of the H1N1 vaccine that will be available over the course of this vaccine campaign will be in the form of the LAIV intranasal sprayer.
· The first vaccine available is in the form of LAIV intranasal sprayers.
· The first 7.5mg prefilled syringes (for children 6 months through 35 months old) are expected to be available in early November and should be available in sufficient quantity for this age group in late November.
Administration:
· Vaccine distributed at this time is intended to be used as soon as possible. Please start using this vaccine in your practice right away and consider holding clinics in your practice, especially for young children.
· Please offer H1N1 LAIV to any healthly non-pregnant patient from 2 years of age through 49 years of age.
o At this point in time, primary foci should be on 2-5 year olds that do not have any other avenue for vaccination, and caregivers and household contacts (including sibilings) of paitents younder than 6 months of age.
o It is anticipated that the focus of this H1N1 LAIV will expand soon (in ~2 weeks) to all healthy children 6 months – 18 years of age (since this is thimerasol-free vaccine).
· School vaccination clinics will be starting as soon as mid-October. Please consider requests to partner with schools to vaccinate school children.
· WEEKLY reporting of doses adimintered is due by close of business every Saturday.
o Either fax report to 207-287-8127 or submit online at http://www.maine.gov/dhhs/boh/maineflu/h1n1/hc-providers/h1n1-vaccine-weeklyreport.shtml
· Order vaccine frequently.
Friday, October 2, 2009
Weekly Update on H1N1 in Maine October 1, 2009
Overview
US CDC reports that flu activity continued to increase in the US during the week of Sept. 13-19. Widespread influenza activity continues in much of the southern parts of the country, including higher than expected hospitalizations for this time of year. Outpatient visits for influenza like illness (ILI) increased in much of New England.
In Maine, visits to outpatient office settings and hospital emergency departments for influenza like illness increased this past week. There have been some occasional cases of H1N1 detected in students, but no new distinct outbreaks have been identified this past week.
However, the increases in outpatient visits and students indicate that this is the time to be extra vigilant in respiratory precautions, especially staying away from work and school when one has a fever, properly covering coughs and sneezes, and washing hands frequently. Recommendations for schools can be found in the “Quick Reference Guide” at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/educators.shtml. Guidance for other settings (child care, businesses, etc) can be found at www.maineflu.gov.
There continue to be delays in Maine receiving seasonal influenza vaccine, especially pediatric influenza vaccine for large scale clinics. We expect this vaccine to arrive in late October. Schools and other settings that have planned large scale clinics with this vaccine should postpone these clinics until early November if they have not yet received vaccine. They should be able to offer H1N1 vaccine concurrently at these clinics.
Maine CDC placed the first orders for H1N1 vaccine on Wednesday September 30th. The first orders should arrive next week and are for a small amount of live attenuated intranasal vaccine (LAIV) shipped primarily to pediatric health care providers for healthy toddlers and household contacts and caregivers of young infants. We are placing additional orders for this vaccine this week, and anticipate being able to place orders for other formulations of the H1N1 vaccine next week. It is important that health care providers who want to have H1N1 vaccine shipped directly to them register as an H1N1 provider and place orders as soon as possible. For more information see the section for health care providers at: www.maineflu.gov.
Seasonal influenza vaccine
Maine CDC has distributed about than 121,000 doses of seasonal flu vaccine, with most of this (80,000) going to pediatric providers and schools. Approximately 15 schools or school districts have held vaccine clinics. Due to nationwide delays in distribution of seasonal flu vaccine, Maine CDC recommended last week that large public clinics and school-located clinics be rescheduled if vaccine for those clinics had not already arrived. Clinic planners are advised to reschedule to early November, and to consider offering both seasonal flu vaccine and H1N1 flu vaccine at the same time.
H1N1 influenza vaccine
Maine CDC has placed its first orders with U.S. CDC for the first shipments of H1N1 vaccine this week, starting Wednesday, September 30th. The first shipments are not expected to arrive until the week of October 5th and will consist of only a limited number (~7,700) of one type of H1N1 vaccine, the H1N1 LAIV (Live Attenuated Intranasal Vaccine). This nasal formulation’s license is limited to healthy non-pregnant 2 – 49 year olds. In terms of the high-risk populations for H1N1, this vaccine is most appropriate for healthy children (especially those under 5 since they are at higher risk for H1N1 complications than older children) and household contacts of young infants. Maine CDC urges pediatric and obstetrical health care providers to register and submit orders for H1N1 vaccine as soon as possible.
If you are a licensed health care provider for children or their families, and have not registered as an H1N1 Provider, then please do so now. You must register even if you already receive vaccine from Maine CDC. To register, fill out and submit the H1N1 Provider Agreement for H1N1 Vaccine, which can be found at www.maineflu.gov.
If you have registered and have received ordering information, please submit your order as soon as possible to Maine CDC. We cannot ship vaccine to you unless you have submitted an order.
· For questions regarding H1N1 influenza vaccine ordering see the FAQ from the September 17th health advisory (http://www.maine.gov/tools/whatsnew/attach.php?id=79438&an=2)
· For other questions:
Contact the Maine CDC’s Immunization Program at 287-3746 or the public information line at 1-888-257-0990.
Email us questions at: flu.questions@maine.gov
More information, including consent forms and billing information, will be found at www.maineflu.gov
Updated CDC guidance on H1N1 influenza vaccine including vaccine handling can be found at: http://www.cdc.gov/h1n1flu/vaccination
FAQ on H1N1 vaccine safety can be found at: http://www.cdc.gov/h1n1flu/vaccination/vaccine_safety_qa.htm
FAQs Related to H1N1 Vaccine (more detailed answers can be found at www.maineflu.gov):
Can seasonal influenza vaccine and H1N1 vaccine be given at the same visit?
Yes. However, both the nasal forms of the vaccine cannot be given at the same time. If both the nasal forms are to be given, then they should be separate by a minimum of 4 weeks. The injectable forms of the seasonal and H1N1 vaccine can be given at the same time (different anatomical locations), and a nasal vaccine of one and an injectable vaccine of the other can be given at the same time.
Can H1N1 vaccine be administered at the same visit as other vaccines?
Inactivated H1N1 vaccine can be administered at the same visit as any other vaccine, including pneumococcal polysaccharide vaccine. Live H1N1 vaccine can be administered at the same visit as any other live or inactivated vaccine EXCEPT seasonal live attenuated influenza vaccine.
Will the H1N1 vaccine be recommended for patients who had influenza-like illness since spring 2009?
Yes.
Does the H1N1 vaccine contain adjuvants such as squalene or aluminum?
No.
Is the H1N1 vaccine mandatory?
No.
Does the H1N1 vaccine contain thimerosal?
The multi-dose vials of H1N1 vaccine contain a very small amount of thimerosal in order to prevent bacterial contamination. The single-dose syringes and nasal spray do not contain thimerosal. These thimerosal-free formulations are expected to represent about one-third of the H1N1 vaccine supply distributed in the next 3 months. This thimerosal-free vaccine is primarily being distributed to settings where pregnant women and young children are offered vaccine.
Who are the priority populations for H1N1 vaccine these first few weeks?
Pregnant women, all children and young adults ages 6 months to 25 years old, caregivers and household contacts of infants under 6 months, 25 – 65 year olds with underlying conditions, and health care workers including EMS.
Why does the seasonal flu vaccine list “H1N1” on it but does not protect against the H1N1 pandemic?
The seasonal flu vaccine protects against three major strains of influenza virus, including a seasonal (“regular”) strain of H1N1 influenza. However, protection against this seasonal strain of H1N1 does not protect you against the 2009 pandemic strain of H1N1.
Other New or Recently Updated H1N1 Guidance or News
US CDC posted the following materials on its web site:
· CDC announced the approval this week of H1N1 Vaccines. An FDA press release may be viewed at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm182399.htm
· Updated Questions & Answers: Antiviral Drugs, 2009-2010 Flu Season is available at http://www.cdc.gov/h1n1flu/antiviral.htm.
· Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season was issued earlier this week and can be found at http://www.cdc.gov/h1n1flu/recommendations.htm.
· 2009-2010 Influenza Season: Information for Pharmacists is available at http://www.cdc.gov/H1N1flu/pharmacist/pharmacist_info.htm. This document provides 1.) background information on influenza activity to date and how pharmacists may be affected this season, 2.) an update on antiviral drug supplies, 3.) information about compounding an oral suspension from Tamiflu® 75mg capsules and 4.) information about the oral dosing dispenser provided with certain formulations of Tamiflu® oral suspension.
· Updated Interim Recommendations for Obstetric Health Care Providers Related to Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season is now posted at http://www.cdc.gov/H1N1flu/pregnancy/antiviral_messages.htm.
· Asthma Information for Patients and Parents of Patients is now posted at http://www.cdc.gov/H1N1flu/asthma.htm.
· Brochure 2009 H1N1 and You is posted at http://www.cdc.gov/h1n1flu/flyers.htm.
How to Stay Updated
Weekly Updates: Check the Thursday morning updates on H1N1 in Maine on Maine CDC’s H1N1 website. Now available as an RSS feed (midway down the center of the homepage): http://www.maineflu.gov/
Health Alert Network: Sign up to receive urgent updates from Maine CDC’s Health Alert Network (HAN). The easiest and quickest way is to sign up is through the HAN Alert RSS feed at www.mainepublichealth.gov (midway down the center of the homepage).
Follow Maine CDC’s Updates:
Facebook (search for “Maine CDC”)
Twitter (http://twitter.com/MEPublicHealth)
MySpace (www.myspace.com/mainepublichealth)
Maine CDC’s Blog (http://mainepublichealth.blogspot.com)
H1N1 Conference Calls: Maine CDC will be holding conference calls on a variety of topics related to H1N1 over the coming weeks. The next call will be held Monday, October 5, from noon to 1pm, to update interested stakeholders on H1N1 vaccine efforts. To participate, call 1-800-914-3396 and enter pass code 473623#.
Call or Email Us:
For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
General Public Call-in Number for Questions: 1-888-257-0990NextTalk (deaf/hard of hearing) - (207) 629-5751Monday - Friday 9 a.m. – 5 p.m.
Email your questions to: flu.questions@maine.gov
U.S. CDC H1N1 Recommendations and Guidance: http://www.cdc.gov/h1n1flu/ and http://www.flu.gov/
US CDC reports that flu activity continued to increase in the US during the week of Sept. 13-19. Widespread influenza activity continues in much of the southern parts of the country, including higher than expected hospitalizations for this time of year. Outpatient visits for influenza like illness (ILI) increased in much of New England.
In Maine, visits to outpatient office settings and hospital emergency departments for influenza like illness increased this past week. There have been some occasional cases of H1N1 detected in students, but no new distinct outbreaks have been identified this past week.
However, the increases in outpatient visits and students indicate that this is the time to be extra vigilant in respiratory precautions, especially staying away from work and school when one has a fever, properly covering coughs and sneezes, and washing hands frequently. Recommendations for schools can be found in the “Quick Reference Guide” at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/educators.shtml. Guidance for other settings (child care, businesses, etc) can be found at www.maineflu.gov.
There continue to be delays in Maine receiving seasonal influenza vaccine, especially pediatric influenza vaccine for large scale clinics. We expect this vaccine to arrive in late October. Schools and other settings that have planned large scale clinics with this vaccine should postpone these clinics until early November if they have not yet received vaccine. They should be able to offer H1N1 vaccine concurrently at these clinics.
Maine CDC placed the first orders for H1N1 vaccine on Wednesday September 30th. The first orders should arrive next week and are for a small amount of live attenuated intranasal vaccine (LAIV) shipped primarily to pediatric health care providers for healthy toddlers and household contacts and caregivers of young infants. We are placing additional orders for this vaccine this week, and anticipate being able to place orders for other formulations of the H1N1 vaccine next week. It is important that health care providers who want to have H1N1 vaccine shipped directly to them register as an H1N1 provider and place orders as soon as possible. For more information see the section for health care providers at: www.maineflu.gov.
Seasonal influenza vaccine
Maine CDC has distributed about than 121,000 doses of seasonal flu vaccine, with most of this (80,000) going to pediatric providers and schools. Approximately 15 schools or school districts have held vaccine clinics. Due to nationwide delays in distribution of seasonal flu vaccine, Maine CDC recommended last week that large public clinics and school-located clinics be rescheduled if vaccine for those clinics had not already arrived. Clinic planners are advised to reschedule to early November, and to consider offering both seasonal flu vaccine and H1N1 flu vaccine at the same time.
H1N1 influenza vaccine
Maine CDC has placed its first orders with U.S. CDC for the first shipments of H1N1 vaccine this week, starting Wednesday, September 30th. The first shipments are not expected to arrive until the week of October 5th and will consist of only a limited number (~7,700) of one type of H1N1 vaccine, the H1N1 LAIV (Live Attenuated Intranasal Vaccine). This nasal formulation’s license is limited to healthy non-pregnant 2 – 49 year olds. In terms of the high-risk populations for H1N1, this vaccine is most appropriate for healthy children (especially those under 5 since they are at higher risk for H1N1 complications than older children) and household contacts of young infants. Maine CDC urges pediatric and obstetrical health care providers to register and submit orders for H1N1 vaccine as soon as possible.
If you are a licensed health care provider for children or their families, and have not registered as an H1N1 Provider, then please do so now. You must register even if you already receive vaccine from Maine CDC. To register, fill out and submit the H1N1 Provider Agreement for H1N1 Vaccine, which can be found at www.maineflu.gov.
If you have registered and have received ordering information, please submit your order as soon as possible to Maine CDC. We cannot ship vaccine to you unless you have submitted an order.
· For questions regarding H1N1 influenza vaccine ordering see the FAQ from the September 17th health advisory (http://www.maine.gov/tools/whatsnew/attach.php?id=79438&an=2)
· For other questions:
Contact the Maine CDC’s Immunization Program at 287-3746 or the public information line at 1-888-257-0990.
Email us questions at: flu.questions@maine.gov
More information, including consent forms and billing information, will be found at www.maineflu.gov
Updated CDC guidance on H1N1 influenza vaccine including vaccine handling can be found at: http://www.cdc.gov/h1n1flu/vaccination
FAQ on H1N1 vaccine safety can be found at: http://www.cdc.gov/h1n1flu/vaccination/vaccine_safety_qa.htm
FAQs Related to H1N1 Vaccine (more detailed answers can be found at www.maineflu.gov):
Can seasonal influenza vaccine and H1N1 vaccine be given at the same visit?
Yes. However, both the nasal forms of the vaccine cannot be given at the same time. If both the nasal forms are to be given, then they should be separate by a minimum of 4 weeks. The injectable forms of the seasonal and H1N1 vaccine can be given at the same time (different anatomical locations), and a nasal vaccine of one and an injectable vaccine of the other can be given at the same time.
Can H1N1 vaccine be administered at the same visit as other vaccines?
Inactivated H1N1 vaccine can be administered at the same visit as any other vaccine, including pneumococcal polysaccharide vaccine. Live H1N1 vaccine can be administered at the same visit as any other live or inactivated vaccine EXCEPT seasonal live attenuated influenza vaccine.
Will the H1N1 vaccine be recommended for patients who had influenza-like illness since spring 2009?
Yes.
Does the H1N1 vaccine contain adjuvants such as squalene or aluminum?
No.
Is the H1N1 vaccine mandatory?
No.
Does the H1N1 vaccine contain thimerosal?
The multi-dose vials of H1N1 vaccine contain a very small amount of thimerosal in order to prevent bacterial contamination. The single-dose syringes and nasal spray do not contain thimerosal. These thimerosal-free formulations are expected to represent about one-third of the H1N1 vaccine supply distributed in the next 3 months. This thimerosal-free vaccine is primarily being distributed to settings where pregnant women and young children are offered vaccine.
Who are the priority populations for H1N1 vaccine these first few weeks?
Pregnant women, all children and young adults ages 6 months to 25 years old, caregivers and household contacts of infants under 6 months, 25 – 65 year olds with underlying conditions, and health care workers including EMS.
Why does the seasonal flu vaccine list “H1N1” on it but does not protect against the H1N1 pandemic?
The seasonal flu vaccine protects against three major strains of influenza virus, including a seasonal (“regular”) strain of H1N1 influenza. However, protection against this seasonal strain of H1N1 does not protect you against the 2009 pandemic strain of H1N1.
Other New or Recently Updated H1N1 Guidance or News
US CDC posted the following materials on its web site:
· CDC announced the approval this week of H1N1 Vaccines. An FDA press release may be viewed at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm182399.htm
· Updated Questions & Answers: Antiviral Drugs, 2009-2010 Flu Season is available at http://www.cdc.gov/h1n1flu/antiviral.htm.
· Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season was issued earlier this week and can be found at http://www.cdc.gov/h1n1flu/recommendations.htm.
· 2009-2010 Influenza Season: Information for Pharmacists is available at http://www.cdc.gov/H1N1flu/pharmacist/pharmacist_info.htm. This document provides 1.) background information on influenza activity to date and how pharmacists may be affected this season, 2.) an update on antiviral drug supplies, 3.) information about compounding an oral suspension from Tamiflu® 75mg capsules and 4.) information about the oral dosing dispenser provided with certain formulations of Tamiflu® oral suspension.
· Updated Interim Recommendations for Obstetric Health Care Providers Related to Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season is now posted at http://www.cdc.gov/H1N1flu/pregnancy/antiviral_messages.htm.
· Asthma Information for Patients and Parents of Patients is now posted at http://www.cdc.gov/H1N1flu/asthma.htm.
· Brochure 2009 H1N1 and You is posted at http://www.cdc.gov/h1n1flu/flyers.htm.
How to Stay Updated
Weekly Updates: Check the Thursday morning updates on H1N1 in Maine on Maine CDC’s H1N1 website. Now available as an RSS feed (midway down the center of the homepage): http://www.maineflu.gov/
Health Alert Network: Sign up to receive urgent updates from Maine CDC’s Health Alert Network (HAN). The easiest and quickest way is to sign up is through the HAN Alert RSS feed at www.mainepublichealth.gov (midway down the center of the homepage).
Follow Maine CDC’s Updates:
Facebook (search for “Maine CDC”)
Twitter (http://twitter.com/MEPublicHealth)
MySpace (www.myspace.com/mainepublichealth)
Maine CDC’s Blog (http://mainepublichealth.blogspot.com)
H1N1 Conference Calls: Maine CDC will be holding conference calls on a variety of topics related to H1N1 over the coming weeks. The next call will be held Monday, October 5, from noon to 1pm, to update interested stakeholders on H1N1 vaccine efforts. To participate, call 1-800-914-3396 and enter pass code 473623#.
Call or Email Us:
For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
General Public Call-in Number for Questions: 1-888-257-0990NextTalk (deaf/hard of hearing) - (207) 629-5751Monday - Friday 9 a.m. – 5 p.m.
Email your questions to: flu.questions@maine.gov
U.S. CDC H1N1 Recommendations and Guidance: http://www.cdc.gov/h1n1flu/ and http://www.flu.gov/
Thursday, September 24, 2009
Weekly Update on H1N1 in Maine 9/24/09
Maine CDC/DHHS Update on Novel Influenza A (H1N1) Virus
September 24, 2009
Overview
US CDC reports that key indicators show that flu activity continued to increase in the US during the week of Sept. 6-12. Visits to doctors for influenza-like illness are higher than what is expected during this time of year and have increased for five consecutive weeks. Total flu hospitalization rates are higher than expected for this time of year. As of Sept. 13, the World Health Organization reported at least 3,486 deaths from H1N1.
Maine has identified 388 cases of H1N1, which include 19 individuals requiring hospitalization and one individual who has died. The number of cases is only a barometer of community transmission, not of actual case counts, because not all people with infection are tested. Of Maine residents with confirmed H1N1, 64 percent have been under 25 years of age.
The outbreak at Bowdoin College appears to be subsiding. In addition, Maine saw two apparent outbreaks of influenza-like illness in Central Maine schools seeing absentee rates above 15%.
Seasonal influenza vaccine:
Maine CDC has distributed about 114,000 doses of seasonal flu vaccine, with most of this being distributed to schools or pediatric providers. About 14 schools or school districts have held vaccine clinics. Due to nationwide delays in shipping of seasonal flu vaccine, Maine CDC recommended this week that large public clinics and school-located clinics be rescheduled if vaccine for those clinics had not already arrived. Clinic planners were advised to reschedule for mid- to late-October or into November, and to consider offering both seasonal flu vaccine and H1N1 flu vaccine at the same time.
H1N1 influenza vaccine:
It appears from preliminary clinical studies that children 10 – 18 may only need one dose of the H1N1 vaccine. Previous results in adults ages 18 – 65 indicate this population will also only need one dose. Dosage results for younger children are pending. (http://www.nih.gov/news/health/sep2009/niaid-21.htm)
US CDC issued a Q&A for clinicians related to H1N1 vaccination: http://www.cdc.gov/h1n1flu/vaccination/clinicians_qa.htm
Updates by Priority Population
The following groups are prioritized to be offered the first available doses of H1N1 vaccine, because they are at higher risk of complications from H1N1 infection or are more likely to pass the flu on to others who may be at higher risk of complications:
Pregnant women;
Household members and caregivers for children under 6 months old;
Health care and emergency medical services personnel;
All people ages 6 months through 24 years of age;
People ages 25 through 64 who have health conditions.
Minority Populations:
Maine CDC’s Office of Minority Health, under the leadership of Lisa Sockabasin, has been working since April on outreach and communications with Maine’s minority populations related to H1N1, making sure appropriate materials are translated and communities are engaged. This office is working now on assuring such efforts are in place to address the H1N1 influenza vaccine. They can be reached at 287-4844 for further questions or concerns.
Pregnant Women:
US CDC updated its Interim Recommendations for Obstetric Health Care Providers: http://www.cdc.gov/H1N1flu/pregnancy/antiviral_messages.htm
A conference call for clinicians who care for pregnant women was held Sept. 17. Following are the questions and answers from the call:
Q. Is it safe to get the vaccine during the first trimester?
A. Yes.
Q. Will the screening questions be the same for seasonal and H1N1?
A. The Vaccine Information Statement (VIS) will determine that. CDC will be releasing the VIS for the licensed H1N1 vaccine soon.
Q. If a patient already has had H1N1 should they be vaccinated?
A. Generally yes, since the very vast majority of those with H1N1 never got tested, and there is no increased risk of getting the vaccine if you had the disease.
Q. How many shots are needed for H1N1?
A. Preliminary results of clinical studies show that people 10 and older only need one dose of H1N1 vaccine. Clinical studies in pregnant women are underway and results should be available soon.
Q. Is the vaccine diminished by antivirals?
A. Intranasal vaccine should not be administered until 48 hours after cessation of antiviral therapy, and influenza antiviral medications should not be administered for two weeks after receipt of intranasal vaccine.
Q. When will medical practices receive H1N1 vaccine if schools are a priority?
A. We have not yet received specific dates from US CDC for vaccine shipment. We anticipate that the first doses to arrive will be prioritized to medical providers for pregnant women and high-risk children, especially pre-school aged children.
Q. What are the storage and handling requirements for H1N1 vaccine?
A. Please see http://www.maine.gov/dhhs/boh/maineflu/h1n1-vaccine.shtml for information. H1N1 vaccine must be handled in accordance with the package insert, in a vaccine refrigerator.
Health Care and Emergency Medical Services Personnel:
Maine CDC is working with the Regional Resource Centers at Eastern Maine Medical Center, Central Maine Medical Center, and Maine Medical Center, to assure that all health care providers and Emergency Medical Services personnel (EMS) are offered H1N1 vaccine during the first few weeks of its arrival.
A health care provider tool kit for H1N1 vaccine clinics has been posted at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/hc-providers/index.shtml
Health care workers and EMS who would like to volunteer to vaccinate children as part of the school-based clinic initiative should register at www.maineresponds.org. Maine Responds will verify the credentials of volunteers, and they will be added to a list at http://www.maine.gov/mema/mema_news_display.shtml?id=79232.
Child Care Providers:
A conference call for child care providers was held Sept. 21. Following are the questions and answers from the call:
Q. Will the 2009 H1N1 influenza vaccines be safe?A. We expect the 2009 H1N1 influenza vaccine to have a similar safety profile as seasonal flu vaccines, which have a very good safety track record. Over the years, hundreds of millions of Americans have received seasonal flu vaccines. The most common side effects following flu vaccinations are mild, such as soreness, redness, tenderness or swelling where the shot was given. The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) will be closely monitoring for any signs that the vaccine is causing unexpected adverse events and we will work with state and local health officials to investigate any unusual events.
Q. Will there be a possibility of Guillain-Barré Syndrome (GBS) cases following the 2009 H1N1 vaccine?A. Guillain-Barré syndrome (GBS) is a rare disease in which the body damages its own nerve cells, causing muscle weakness and sometimes paralysis. It is not fully understood why some people develop GBS, but it is believed that stimulation of the body’s immune system may play a role in its development. People can also develop GBS after having the flu or other infections (such as cytomegalovirus and Epstein Barr virus). On very rare occasions, they may develop GBS in the days or weeks following receiving a vaccination.
Q. Should someone with Guillain-Barré Syndrome get vaccinated against the flu?
A. If you have Guillain-Barré Syndrome, you should contact your health care provider to find out if you should receive the flu vaccine or not.
Q. If you have an autoimmune disorder, asthma, or other chronic illness, should you avoid getting vaccinated?
A. People who have a severe (life-threatening) allergy to chicken eggs or to any other substance in the vaccine should not be vaccinated. People with asthma, chronic respiratory illnesses, or neurodevelopmental disorders or delays are prioritized to be vaccinated early due to their risk of complications from the flu.
Q. If you get H1N1, can you get it again?
A. We do not know yet. H1N1 is a new flu virus, and it is possible that it will evolve.
Q. Can you get seasonal and H1N1 vaccinations at the same time?
A. It is anticipated that seasonal flu vaccine and H1N1 vaccine may be administered on the same day. However, if you receive the intranasal (“FluMist”) form of vaccine, these should be separated by 1 month. You can get an intranasal vaccine and an injectable vaccine at the same time.
Q. Will the H1N1 vaccine have thimerosal?
A. As with the seasonal influenza vaccines, the 2009 H1N1 vaccines are being produced in formulations that contain thimerosal, a mercury-containing preservative, and in formulations that do not contain thimerosal. We expect to have some thimerosal-free H1N1 vaccine available for pregnant women and very young children.
For more facts about thimerosal see our Fact Sheet (http://www.maine.gov/dhhs/boh/Thimerosal%20Fact%20Sheet%20Final%20Version10%200521.pdf) and Dr. Mills’s presentation: (http://www.maine.gov/dhhs/boh/thimerosal_presentation.pdf).
Q. Will schools have the intranasal vaccine, or will it be available in pediatrician offices only?
A. Distribution plans are currently being determined.
Q. Are there advantages of the intranasal vaccine instead of the injectable?
A. The intranasal vaccine does not require a needle stick; however, it is only recommended for healthy people ages 2-49 who are not pregnant. The intranasal vaccine is as effective as the injected vaccine.
Q. How many shots are required for H1N1?
A. The US Food and Drug Administration (FDA) has approved the use of one dose of 2009 H1N1 flu vaccine for people 10 to 65 years of age. Data from trials among children indicate those 6 months to 10 years of age will need 2 doses, a month apart.
Q. What will be the recommended interval between the first and second dose for children 9 years of age and under?
A. This will not be known until clinical trials are complete. For planning purposes, planners should assume 21-28 days between the first and second vaccination.
Q. What kind of thermometer is best for monitoring fevers?
A. This web site has additional information about fevers: http://www.mayoclinic.com/health/first-aid-fever/FA00063
This Consumer Reports article may give you helpful information in determining what type of thermometer to use:
http://www.consumerreports.org/cro/babies-kids/childrens-health/health-issues/thermometers/thermometers-4-07/overview/thermometers-ov.htm?loginMethod=auto
Q. If the severity increases and day care are asked to close, is there funding available to help make up for lost business?
A. In cases of increased severity, current guidance is to close for 10 days and reassess. Maine CDC would close a business as a last resort. We are unaware of funds to help businesses that have to close due to a disease outbreak.
Q. What precautions should be taken for infants under six months?
A. Infants younger than six months cannot be vaccinated against influenza. Household members and caregivers of these infants are prioritized to receive vaccine in an effort to protect these infants. Other general hygiene protection measures, such as frequent washing of toys, especially during a flu outbreak, are warranted.
Other New or Recently Updated H1N1 Guidance or News
US CDC posted the following materials on its web site:
Preparedness tools for professionals: http://www.cdc.gov/h1n1flu/tools/
Q&A about antiviral drugs: http://www.cdc.gov/h1n1flu/antiviral.htm
Brochure, “H1N1 Flu and You”: http://www.cdc.gov/h1n1flu/flyers.htm
Information for pharmacists: http://www.cdc.gov/H1N1flu/pharmacist/pharmacist_info.htm
How to Stay Updated
Weekly Updates: Check the Thursday morning updates on H1N1 in Maine on Maine CDC’s H1N1 website. Now available as an RSS feed (midway down the center of the homepage): http://www.maineflu.gov/
Health Alert Network: Sign up to receive urgent updates from Maine CDC’s Health Alert Network (HAN). The easiest and quickest way is to sign up is through the HAN Alert RSS feed at www.mainepublichealth.gov (midway down the center of the homepage).
Follow Maine CDC’s Updates:
Facebook (search for “Maine CDC”)
Twitter (http://twitter.com/MEPublicHealth)
MySpace (www.myspace.com/mainepublichealth)
Maine CDC’s Blog (http://mainepublichealth.blogspot.com)
H1N1 Conference Calls: Maine CDC will be holding conference calls on a variety of topics related to H1N1 over the coming weeks. Upcoming calls:
Monday, Sept. 28
Noon to 1 p.m.
conference call for interested stakeholders on H1N1 vaccine efforts and update
1-800-914-3396
pass code: 473623
Monday, Oct. 5
Noon to 1 p.m.
conference call for interested stakeholders on H1N1 vaccine efforts and update
1-800-914-3396
pass code: 473623
Consider Calling or Emailing Us:
For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
General Public Call-in Number for Questions: 1-888-257-0990NextTalk (deaf/hard of hearing) - (207) 629-5751Monday - Friday 9 a.m. – 5 p.m.
Email your questions to: flu.questions@maine.gov
U.S. CDC H1N1 Recommendations and Guidance:
http://www.cdc.gov/h1n1flu/ and http://www.flu.gov/
September 24, 2009
Overview
US CDC reports that key indicators show that flu activity continued to increase in the US during the week of Sept. 6-12. Visits to doctors for influenza-like illness are higher than what is expected during this time of year and have increased for five consecutive weeks. Total flu hospitalization rates are higher than expected for this time of year. As of Sept. 13, the World Health Organization reported at least 3,486 deaths from H1N1.
Maine has identified 388 cases of H1N1, which include 19 individuals requiring hospitalization and one individual who has died. The number of cases is only a barometer of community transmission, not of actual case counts, because not all people with infection are tested. Of Maine residents with confirmed H1N1, 64 percent have been under 25 years of age.
The outbreak at Bowdoin College appears to be subsiding. In addition, Maine saw two apparent outbreaks of influenza-like illness in Central Maine schools seeing absentee rates above 15%.
Seasonal influenza vaccine:
Maine CDC has distributed about 114,000 doses of seasonal flu vaccine, with most of this being distributed to schools or pediatric providers. About 14 schools or school districts have held vaccine clinics. Due to nationwide delays in shipping of seasonal flu vaccine, Maine CDC recommended this week that large public clinics and school-located clinics be rescheduled if vaccine for those clinics had not already arrived. Clinic planners were advised to reschedule for mid- to late-October or into November, and to consider offering both seasonal flu vaccine and H1N1 flu vaccine at the same time.
H1N1 influenza vaccine:
It appears from preliminary clinical studies that children 10 – 18 may only need one dose of the H1N1 vaccine. Previous results in adults ages 18 – 65 indicate this population will also only need one dose. Dosage results for younger children are pending. (http://www.nih.gov/news/health/sep2009/niaid-21.htm)
US CDC issued a Q&A for clinicians related to H1N1 vaccination: http://www.cdc.gov/h1n1flu/vaccination/clinicians_qa.htm
Updates by Priority Population
The following groups are prioritized to be offered the first available doses of H1N1 vaccine, because they are at higher risk of complications from H1N1 infection or are more likely to pass the flu on to others who may be at higher risk of complications:
Pregnant women;
Household members and caregivers for children under 6 months old;
Health care and emergency medical services personnel;
All people ages 6 months through 24 years of age;
People ages 25 through 64 who have health conditions.
Minority Populations:
Maine CDC’s Office of Minority Health, under the leadership of Lisa Sockabasin, has been working since April on outreach and communications with Maine’s minority populations related to H1N1, making sure appropriate materials are translated and communities are engaged. This office is working now on assuring such efforts are in place to address the H1N1 influenza vaccine. They can be reached at 287-4844 for further questions or concerns.
Pregnant Women:
US CDC updated its Interim Recommendations for Obstetric Health Care Providers: http://www.cdc.gov/H1N1flu/pregnancy/antiviral_messages.htm
A conference call for clinicians who care for pregnant women was held Sept. 17. Following are the questions and answers from the call:
Q. Is it safe to get the vaccine during the first trimester?
A. Yes.
Q. Will the screening questions be the same for seasonal and H1N1?
A. The Vaccine Information Statement (VIS) will determine that. CDC will be releasing the VIS for the licensed H1N1 vaccine soon.
Q. If a patient already has had H1N1 should they be vaccinated?
A. Generally yes, since the very vast majority of those with H1N1 never got tested, and there is no increased risk of getting the vaccine if you had the disease.
Q. How many shots are needed for H1N1?
A. Preliminary results of clinical studies show that people 10 and older only need one dose of H1N1 vaccine. Clinical studies in pregnant women are underway and results should be available soon.
Q. Is the vaccine diminished by antivirals?
A. Intranasal vaccine should not be administered until 48 hours after cessation of antiviral therapy, and influenza antiviral medications should not be administered for two weeks after receipt of intranasal vaccine.
Q. When will medical practices receive H1N1 vaccine if schools are a priority?
A. We have not yet received specific dates from US CDC for vaccine shipment. We anticipate that the first doses to arrive will be prioritized to medical providers for pregnant women and high-risk children, especially pre-school aged children.
Q. What are the storage and handling requirements for H1N1 vaccine?
A. Please see http://www.maine.gov/dhhs/boh/maineflu/h1n1-vaccine.shtml for information. H1N1 vaccine must be handled in accordance with the package insert, in a vaccine refrigerator.
Health Care and Emergency Medical Services Personnel:
Maine CDC is working with the Regional Resource Centers at Eastern Maine Medical Center, Central Maine Medical Center, and Maine Medical Center, to assure that all health care providers and Emergency Medical Services personnel (EMS) are offered H1N1 vaccine during the first few weeks of its arrival.
A health care provider tool kit for H1N1 vaccine clinics has been posted at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/hc-providers/index.shtml
Health care workers and EMS who would like to volunteer to vaccinate children as part of the school-based clinic initiative should register at www.maineresponds.org. Maine Responds will verify the credentials of volunteers, and they will be added to a list at http://www.maine.gov/mema/mema_news_display.shtml?id=79232.
Child Care Providers:
A conference call for child care providers was held Sept. 21. Following are the questions and answers from the call:
Q. Will the 2009 H1N1 influenza vaccines be safe?A. We expect the 2009 H1N1 influenza vaccine to have a similar safety profile as seasonal flu vaccines, which have a very good safety track record. Over the years, hundreds of millions of Americans have received seasonal flu vaccines. The most common side effects following flu vaccinations are mild, such as soreness, redness, tenderness or swelling where the shot was given. The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) will be closely monitoring for any signs that the vaccine is causing unexpected adverse events and we will work with state and local health officials to investigate any unusual events.
Q. Will there be a possibility of Guillain-Barré Syndrome (GBS) cases following the 2009 H1N1 vaccine?A. Guillain-Barré syndrome (GBS) is a rare disease in which the body damages its own nerve cells, causing muscle weakness and sometimes paralysis. It is not fully understood why some people develop GBS, but it is believed that stimulation of the body’s immune system may play a role in its development. People can also develop GBS after having the flu or other infections (such as cytomegalovirus and Epstein Barr virus). On very rare occasions, they may develop GBS in the days or weeks following receiving a vaccination.
Q. Should someone with Guillain-Barré Syndrome get vaccinated against the flu?
A. If you have Guillain-Barré Syndrome, you should contact your health care provider to find out if you should receive the flu vaccine or not.
Q. If you have an autoimmune disorder, asthma, or other chronic illness, should you avoid getting vaccinated?
A. People who have a severe (life-threatening) allergy to chicken eggs or to any other substance in the vaccine should not be vaccinated. People with asthma, chronic respiratory illnesses, or neurodevelopmental disorders or delays are prioritized to be vaccinated early due to their risk of complications from the flu.
Q. If you get H1N1, can you get it again?
A. We do not know yet. H1N1 is a new flu virus, and it is possible that it will evolve.
Q. Can you get seasonal and H1N1 vaccinations at the same time?
A. It is anticipated that seasonal flu vaccine and H1N1 vaccine may be administered on the same day. However, if you receive the intranasal (“FluMist”) form of vaccine, these should be separated by 1 month. You can get an intranasal vaccine and an injectable vaccine at the same time.
Q. Will the H1N1 vaccine have thimerosal?
A. As with the seasonal influenza vaccines, the 2009 H1N1 vaccines are being produced in formulations that contain thimerosal, a mercury-containing preservative, and in formulations that do not contain thimerosal. We expect to have some thimerosal-free H1N1 vaccine available for pregnant women and very young children.
For more facts about thimerosal see our Fact Sheet (http://www.maine.gov/dhhs/boh/Thimerosal%20Fact%20Sheet%20Final%20Version10%200521.pdf) and Dr. Mills’s presentation: (http://www.maine.gov/dhhs/boh/thimerosal_presentation.pdf).
Q. Will schools have the intranasal vaccine, or will it be available in pediatrician offices only?
A. Distribution plans are currently being determined.
Q. Are there advantages of the intranasal vaccine instead of the injectable?
A. The intranasal vaccine does not require a needle stick; however, it is only recommended for healthy people ages 2-49 who are not pregnant. The intranasal vaccine is as effective as the injected vaccine.
Q. How many shots are required for H1N1?
A. The US Food and Drug Administration (FDA) has approved the use of one dose of 2009 H1N1 flu vaccine for people 10 to 65 years of age. Data from trials among children indicate those 6 months to 10 years of age will need 2 doses, a month apart.
Q. What will be the recommended interval between the first and second dose for children 9 years of age and under?
A. This will not be known until clinical trials are complete. For planning purposes, planners should assume 21-28 days between the first and second vaccination.
Q. What kind of thermometer is best for monitoring fevers?
A. This web site has additional information about fevers: http://www.mayoclinic.com/health/first-aid-fever/FA00063
This Consumer Reports article may give you helpful information in determining what type of thermometer to use:
http://www.consumerreports.org/cro/babies-kids/childrens-health/health-issues/thermometers/thermometers-4-07/overview/thermometers-ov.htm?loginMethod=auto
Q. If the severity increases and day care are asked to close, is there funding available to help make up for lost business?
A. In cases of increased severity, current guidance is to close for 10 days and reassess. Maine CDC would close a business as a last resort. We are unaware of funds to help businesses that have to close due to a disease outbreak.
Q. What precautions should be taken for infants under six months?
A. Infants younger than six months cannot be vaccinated against influenza. Household members and caregivers of these infants are prioritized to receive vaccine in an effort to protect these infants. Other general hygiene protection measures, such as frequent washing of toys, especially during a flu outbreak, are warranted.
Other New or Recently Updated H1N1 Guidance or News
US CDC posted the following materials on its web site:
Preparedness tools for professionals: http://www.cdc.gov/h1n1flu/tools/
Q&A about antiviral drugs: http://www.cdc.gov/h1n1flu/antiviral.htm
Brochure, “H1N1 Flu and You”: http://www.cdc.gov/h1n1flu/flyers.htm
Information for pharmacists: http://www.cdc.gov/H1N1flu/pharmacist/pharmacist_info.htm
How to Stay Updated
Weekly Updates: Check the Thursday morning updates on H1N1 in Maine on Maine CDC’s H1N1 website. Now available as an RSS feed (midway down the center of the homepage): http://www.maineflu.gov/
Health Alert Network: Sign up to receive urgent updates from Maine CDC’s Health Alert Network (HAN). The easiest and quickest way is to sign up is through the HAN Alert RSS feed at www.mainepublichealth.gov (midway down the center of the homepage).
Follow Maine CDC’s Updates:
Facebook (search for “Maine CDC”)
Twitter (http://twitter.com/MEPublicHealth)
MySpace (www.myspace.com/mainepublichealth)
Maine CDC’s Blog (http://mainepublichealth.blogspot.com)
H1N1 Conference Calls: Maine CDC will be holding conference calls on a variety of topics related to H1N1 over the coming weeks. Upcoming calls:
Monday, Sept. 28
Noon to 1 p.m.
conference call for interested stakeholders on H1N1 vaccine efforts and update
1-800-914-3396
pass code: 473623
Monday, Oct. 5
Noon to 1 p.m.
conference call for interested stakeholders on H1N1 vaccine efforts and update
1-800-914-3396
pass code: 473623
Consider Calling or Emailing Us:
For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
General Public Call-in Number for Questions: 1-888-257-0990NextTalk (deaf/hard of hearing) - (207) 629-5751Monday - Friday 9 a.m. – 5 p.m.
Email your questions to: flu.questions@maine.gov
U.S. CDC H1N1 Recommendations and Guidance:
http://www.cdc.gov/h1n1flu/ and http://www.flu.gov/
Friday, September 18, 2009
Weekly Update on H1N1 in Maine 9/17/09
Overview
US CDC reported 1,380 hospitalizations and 196 deaths nationwide between August 30, and September 5, 2009. As of Sept. 6, the World Health Organization reported at least 3,205 deaths from H1N1 and reports of H1N1 from more than 200 countries.
Maine has identified 381 cases of H1N1, which include 19 individuals requiring hospitalization and one individual who has died. There have been no new outbreaks or institutions since the last update. The outbreak at Bowdoin College is ongoing. Of Maine residents with H1N1, 63 percent have been under 25 years of age. The number of cases is only a barometer of community transmission, not of actual case counts, because not all people with infection are tested.
H1N1 influenza vaccine: Licensed health care providers may now register to receive H1N1 vaccine. Information can be found at http://www.maineflu.gov/. H1N1 vaccine is expected to arrive in Maine in mid-October, with a possible small shipment in early October. The distribution of the first few shipments of H1N1 vaccine will be focused on settings where pregnant women are cared for, schools, and hospitals. Eventually sufficient vaccine is expected for everyone.
Seasonal influenza vaccine: Maine CDC has distributed about 49,000 seasonal flu vaccine for children and 55,000 for adults. 11 schools have conducted seasonal flu vaccine clinics this week, and about 116 school districts or schools have registered to offer seasonal flu vaccine clinics.
Maine CDC has posted an updated FAQ for the general public at http://www.maine.gov/dhhs/boh/maineflu/swine-flu-public-faq.shtml.
US CDC released several question and answer documents, including the following topics:
Guillain-Barré syndrome: http://www.cdc.gov/h1n1flu/vaccination/gbs_qa.htm
H1N1 vaccine safety: http://www.cdc.gov/h1n1flu/vaccination/vaccine_safety_qa.htm
Thimerosal: http://www.cdc.gov/h1n1flu/vaccination/thimerosal_qa.htm
Updates by Priority Population
The following groups are prioritized to be offered the first available doses of H1N1 vaccine, because they are at higher risk of complications from H1N1 infection or are more likely to pass the flu on to others who may be at higher risk of complications:
Pregnant women;
Household members and caregivers for children under 6 months old;
Health care and emergency medical services personnel;
All people ages 6 months through 24 years of age;
People ages 25 through 64 who have health conditions.
Pregnant Women:
An increased risk during pregnancy – especially in the second and third trimesters – has been consistently well-documented across several countries. Pregnant women are prioritized for H1N1 vaccine because of this risk, and because they can potentially provide protection to infants who cannot be vaccinated.
Maine CDC is working with clinicians who provide health care for pregnant women to assure they have H1N1 vaccine for their patients and themselves as soon as it arrives in Maine. A conference call for clinicians who care for pregnant women washeld from noon to 1 p.m. Thursday, Sept. 17. Q&As from the call will be posted at http://www.maineflu.gov/ soon.
The National Institute of Allergy and Infectious Diseases (NIAID) has begun H1N1 vaccine trials in pregnant women: http://www.nih.gov/news/health/sep2009/niaid-09.htm
Health Care and Emergency Medical Services Personnel:
Maine CDC is working with the Regional Resource Centers at Eastern Maine Medical Center, Central Maine Medical Center, and Maine Medical Center, to assure that all health care providers and Emergency Medical Services personnel (EMS) are offered H1N1 vaccine during the first few weeks of its arrival.
Updated frequently asked questions for health care providers, clinicians, and EMS have been posted at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/provider-faq.shtml
Health care workers and EMS who would like to volunteer to vaccinate children as part of the school-based clinic initiative should register at http://www.maineresponds.org/. Maine Responds will verify the credentials of volunteers, and they will be added to a list at http://www.maine.gov/mema/mema_news_display.shtml?id=79232.
The Institute of Medicine issued its report to US CDC and OSHA with their recommendations for the use of protective personal equipment (PPE) in clinical settings. Their recommendations confirmed the current US CDC guidance issued in May (http://www.cdc.gov/h1n1flu/guidance/) that N95 respirators be used in clinical settings by health care workers in close contact with those with H1N1 or influenza-like illness. (http://www.iom.edu/CMS/3740/71769/72967.aspx) CDC anticipates that their updated recommendations should be available by or in October. Maine CDC is not planning to issue guidance until after US CDC issues their updated recommendations.
Child Care Providers:
Maine CDC will be holding a conference call for child care providers from noon to 1 p.m., Monday, Sept. 21. The call-in number is 1-800-914-3396, pass code is 473623. Maine CDC has mailed information on H1N1 to all 3,000 licensed early childhood programs in Maine.
School-age Children:
Maine CDC is working with Maine Department of Education (DOE) to assure that all Maine children are offered seasonal (regular) and H1N1 vaccine in local schools.
US CDC released school-located vaccination planning materials and templates (http://www.cdc.gov/h1n1flu/vaccination/slv/). Maine-specific information can be found in our school-based vaccine clinic tool kit: http://www.maine.gov/dhhs/boh/maineflu/schools/index.shtml
A conference call for school personnel and health care providers working on this initiative was held Monday, Sept. 14. The questions and answers from this call, as well as other frequently asked questions, can be found at: http://www.maine.gov/dhhs/boh/maineflu/schools/index.shtml#faq
A list of schools and schools units that have signed up with the Maine Immunization Program to offer vaccine to their students (as of Monday, Sept. 14) is posted at http://www.maine.gov/dhhs/boh/maineflu/schools/index.shtml.
People with Health Conditions:
Anyone with asthma is at higher risk for flu-related complications, such as pneumonia. US CDC created a web site with information for people with asthma: http://www.cdc.gov/h1n1flu/asthma.htm?s_tw_flu44
Vaccination
Seasonal Flu Vaccine:
H1N1 has been the focus of attention since the spring, but it is important that we do not forget the risks of the regular seasonal flu. Seasonal flu vaccine has begun to arrive in Maine; US CDC recommends that people at risk for the seasonal flu get vaccinated as soon as it is available:
Children ages 6 months to 18 years
Pregnant women
People 50 years of age and older
People of any age with certain chronic medical conditions
People who live in nursing homes and other long-term care facilities
People who live with or care for those at high risk for complications from flu, including:
Health care workers
Household contacts of persons at high risk for complications from the flu
Household contacts and out of home caregivers of children younger than 6 months old
H1N1 Vaccine:
The FDA has approved the H1N1 vaccine. The vaccines will be distributed nationally after the initial lots become available, which is expected within the next four weeks. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm182399.htm.
Early results from clinical trials indicate that adults age 18 and older may need only one dose of H1N1 vaccine. http://www.hhs.gov/news/press/2009pres/09/20090911a.html
Vaccine planning with communities and schools is well underway to ensure that all Maine children, all health care providers and Emergency Medical Services personnel, pregnant women, and others in high-risk groups for H1N1 are offered H1N1 vaccine as soon as it arrives in Maine.
US CDC reported 1,380 hospitalizations and 196 deaths nationwide between August 30, and September 5, 2009. As of Sept. 6, the World Health Organization reported at least 3,205 deaths from H1N1 and reports of H1N1 from more than 200 countries.
Maine has identified 381 cases of H1N1, which include 19 individuals requiring hospitalization and one individual who has died. There have been no new outbreaks or institutions since the last update. The outbreak at Bowdoin College is ongoing. Of Maine residents with H1N1, 63 percent have been under 25 years of age. The number of cases is only a barometer of community transmission, not of actual case counts, because not all people with infection are tested.
H1N1 influenza vaccine: Licensed health care providers may now register to receive H1N1 vaccine. Information can be found at http://www.maineflu.gov/. H1N1 vaccine is expected to arrive in Maine in mid-October, with a possible small shipment in early October. The distribution of the first few shipments of H1N1 vaccine will be focused on settings where pregnant women are cared for, schools, and hospitals. Eventually sufficient vaccine is expected for everyone.
Seasonal influenza vaccine: Maine CDC has distributed about 49,000 seasonal flu vaccine for children and 55,000 for adults. 11 schools have conducted seasonal flu vaccine clinics this week, and about 116 school districts or schools have registered to offer seasonal flu vaccine clinics.
Maine CDC has posted an updated FAQ for the general public at http://www.maine.gov/dhhs/boh/maineflu/swine-flu-public-faq.shtml.
US CDC released several question and answer documents, including the following topics:
Guillain-Barré syndrome: http://www.cdc.gov/h1n1flu/vaccination/gbs_qa.htm
H1N1 vaccine safety: http://www.cdc.gov/h1n1flu/vaccination/vaccine_safety_qa.htm
Thimerosal: http://www.cdc.gov/h1n1flu/vaccination/thimerosal_qa.htm
Updates by Priority Population
The following groups are prioritized to be offered the first available doses of H1N1 vaccine, because they are at higher risk of complications from H1N1 infection or are more likely to pass the flu on to others who may be at higher risk of complications:
Pregnant women;
Household members and caregivers for children under 6 months old;
Health care and emergency medical services personnel;
All people ages 6 months through 24 years of age;
People ages 25 through 64 who have health conditions.
Pregnant Women:
An increased risk during pregnancy – especially in the second and third trimesters – has been consistently well-documented across several countries. Pregnant women are prioritized for H1N1 vaccine because of this risk, and because they can potentially provide protection to infants who cannot be vaccinated.
Maine CDC is working with clinicians who provide health care for pregnant women to assure they have H1N1 vaccine for their patients and themselves as soon as it arrives in Maine. A conference call for clinicians who care for pregnant women washeld from noon to 1 p.m. Thursday, Sept. 17. Q&As from the call will be posted at http://www.maineflu.gov/ soon.
The National Institute of Allergy and Infectious Diseases (NIAID) has begun H1N1 vaccine trials in pregnant women: http://www.nih.gov/news/health/sep2009/niaid-09.htm
Health Care and Emergency Medical Services Personnel:
Maine CDC is working with the Regional Resource Centers at Eastern Maine Medical Center, Central Maine Medical Center, and Maine Medical Center, to assure that all health care providers and Emergency Medical Services personnel (EMS) are offered H1N1 vaccine during the first few weeks of its arrival.
Updated frequently asked questions for health care providers, clinicians, and EMS have been posted at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/provider-faq.shtml
Health care workers and EMS who would like to volunteer to vaccinate children as part of the school-based clinic initiative should register at http://www.maineresponds.org/. Maine Responds will verify the credentials of volunteers, and they will be added to a list at http://www.maine.gov/mema/mema_news_display.shtml?id=79232.
The Institute of Medicine issued its report to US CDC and OSHA with their recommendations for the use of protective personal equipment (PPE) in clinical settings. Their recommendations confirmed the current US CDC guidance issued in May (http://www.cdc.gov/h1n1flu/guidance/) that N95 respirators be used in clinical settings by health care workers in close contact with those with H1N1 or influenza-like illness. (http://www.iom.edu/CMS/3740/71769/72967.aspx) CDC anticipates that their updated recommendations should be available by or in October. Maine CDC is not planning to issue guidance until after US CDC issues their updated recommendations.
Child Care Providers:
Maine CDC will be holding a conference call for child care providers from noon to 1 p.m., Monday, Sept. 21. The call-in number is 1-800-914-3396, pass code is 473623. Maine CDC has mailed information on H1N1 to all 3,000 licensed early childhood programs in Maine.
School-age Children:
Maine CDC is working with Maine Department of Education (DOE) to assure that all Maine children are offered seasonal (regular) and H1N1 vaccine in local schools.
US CDC released school-located vaccination planning materials and templates (http://www.cdc.gov/h1n1flu/vaccination/slv/). Maine-specific information can be found in our school-based vaccine clinic tool kit: http://www.maine.gov/dhhs/boh/maineflu/schools/index.shtml
A conference call for school personnel and health care providers working on this initiative was held Monday, Sept. 14. The questions and answers from this call, as well as other frequently asked questions, can be found at: http://www.maine.gov/dhhs/boh/maineflu/schools/index.shtml#faq
A list of schools and schools units that have signed up with the Maine Immunization Program to offer vaccine to their students (as of Monday, Sept. 14) is posted at http://www.maine.gov/dhhs/boh/maineflu/schools/index.shtml.
People with Health Conditions:
Anyone with asthma is at higher risk for flu-related complications, such as pneumonia. US CDC created a web site with information for people with asthma: http://www.cdc.gov/h1n1flu/asthma.htm?s_tw_flu44
Vaccination
Seasonal Flu Vaccine:
H1N1 has been the focus of attention since the spring, but it is important that we do not forget the risks of the regular seasonal flu. Seasonal flu vaccine has begun to arrive in Maine; US CDC recommends that people at risk for the seasonal flu get vaccinated as soon as it is available:
Children ages 6 months to 18 years
Pregnant women
People 50 years of age and older
People of any age with certain chronic medical conditions
People who live in nursing homes and other long-term care facilities
People who live with or care for those at high risk for complications from flu, including:
Health care workers
Household contacts of persons at high risk for complications from the flu
Household contacts and out of home caregivers of children younger than 6 months old
H1N1 Vaccine:
The FDA has approved the H1N1 vaccine. The vaccines will be distributed nationally after the initial lots become available, which is expected within the next four weeks. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm182399.htm.
Early results from clinical trials indicate that adults age 18 and older may need only one dose of H1N1 vaccine. http://www.hhs.gov/news/press/2009pres/09/20090911a.html
Vaccine planning with communities and schools is well underway to ensure that all Maine children, all health care providers and Emergency Medical Services personnel, pregnant women, and others in high-risk groups for H1N1 are offered H1N1 vaccine as soon as it arrives in Maine.
Saturday, September 12, 2009
H1N1 Infection Control in Health Care Settings
We are increasingly receiving questions on the use of masks vs N95 respirators in health care settings. Below is a review of some major health organizations’ recommendations for infection control in health care settings that you may find helpful. Dora
All recommendations generally agree on the following:
Use of standard and droplet precautions for suspected or confirmed cases of novel H1N1 influenza;
Placing surgical masks on patients with suspected or confirmed novel H1N1 infection at the point of contact with the health care facility;
Placing such patients in a single room, if available, or cohorting them with other infected patients;
Strict adherence to hand hygiene, respiratory hygiene and cough etiquette;
Early recognition and identification of suspected novel H1N1-infected patients upon presentation to a health care facility;
Restriction of visitors and health care workers with febrile respiratory illnesses.
Status of infection control guidance for novel influenza A H1N1
Background: Numerous state and local health agencies previously endorsed the April 29, 2009, World Health Organization (WHO) recommendations (see below) on infection control measures. Subsequently, recommendations by the CDC’s Hospital Infection Control Practices Advisory Committee (HICPAC), the Society for Healthcare Epidemiology (SHEA), the Infectious Diseases Society of America (IDSA) and the Association for Professionals in Infection Control and Epidemiology (APIC), endorsed this approach. Recently, the Institute of Medicine (IOM) issued a report supporting the CDC’s current recommendations, however, the IOM report is only one component of CDC’s current review of their guidance. CDC anticipates that their updated recommendations should be available by or in October.
Since the spring 2009 outbreak of novel influenza A H1N1, infection control recommendations for novel influenza 2009 H1N1 in health care settings have been issued by multiple agencies, expert advisory groups and professional societies. The issue of respiratory precautions has generated controversy largely because of the absence of controlled scientific studies in the clinical setting to guide definitive policy. Consequently, some of the recommendations from different organizations vary with respect to respiratory protection guidance (primarily mask vs. respirator use).
We understand the challenges that variation in recommendations from authoritative organizations may pose for health care system policy makers. Below are excerpts of salient recommendations that may be of use to you in reviewing your infection control policies for the upcoming influenza season. The majority of expert recommendations support the use of standard and droplet precautions, with respirators reserved for high-risk aerosol generating procedures. Maine CDC is not planning to issue guidance until after US CDC issues their updated recommendations in October.
Centers for Disease Control and Prevention (CDC), issued May 13th, 2009 (currently under review), available at, http://www.cdc.gov/h1n1flu/guidance/
May 13, 2009, guidance states that in addition to standard and contact precautions, “All health care personnel who enter the rooms of patients in isolation with confirmed, suspected, or probable novel H1N1 influenza should wear a fit-tested disposable N95 respirator or better.”
World Health Organization (WHO): Issued 29 April, updated July 10, 2009, available at http://www.who.int/csr/resources/publications/swineflu/swineinfinfcont/en/index.html
April 29 guidance and July 10 revision recommend standard and droplet precautions except for aerosol generating procedures where N95 respirator is recommended. July 10 revision recommends N95 protection as for aerosol generating procedures including obtaining specimens by nasopharyngeal aspirate, nasopharyngeal swab, throat swab or bronchial aspirate.
Society for Healthcare Epidemiology (SHEA) issued June 12, 2009, Infectious Diseases Society of America (IDSA) and the Association for Professionals in Infection Control and Epidemiology (APIC), available at http://www.shea-online.org/news/publicpolicy.cfm.
Recommend implementing the same practices recommended to prevent the transmission of seasonal influenza for the novel H1N1 virus: standard and droplet precautions. Recommends enhanced respiratory protection (I.e., N95 respirator) when performing certain aerosol-generating procedures, specifically: bronchoscopy, open suctioning of airway secretions,
resuscitation involving emergency intubation or cardiac pulmonary resuscitation, and endotracheal intubation.
Collection of nasopharyngeal specimens from patients with suspected or confirmed novel H1N1, closed suctioning of airway secretions and administration of nebulized medications should not be considered aerosol-generating and, therefore, do not require enhanced respiratory protection.
CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) Recommendations for Care of Patients with Confirmed or Suspected 2009 H1N1 Influenza Infection in Healthcare Settings - July 23, 2009, available at: http://www.cdc.gov/ncidod/dhqp/hicpac_h1n1.html
Use standard and droplet precautions for care of patients with suspected or confirmed 2009 H1N1 influenza infection.
Use fit tested N95 respirator or higher and consider airborne infection isolation room for aerosol-generating procedures (e.g., bronchoscopy, intubation under controlled or emergent situations, cardiopulmonary resuscitation, open airway suctioning and airway induction).
Public Health Agency of Canada, issued July 28th, 2009, available at http://www.phac-aspc.gc.ca/alert-alerte/h1n1/hp-ps/ig_acf-ld_esa-eng.php Recommend contact and droplet precautions when within 2 meters of a case
Recommend respiratory precautions (N95 respirator or higher) when conducting an aerosol-generating medical procedure.
Institute of Medicine report, September 3, 2009, available at http://www.iom.edu/CMS/3740/71769/72967.aspx
Recommended continuing CDC’s current guidance for respirator use, but notes the limitations on clinical studies and their lack of a charge to consider practical implementation issues.
All recommendations generally agree on the following:
Use of standard and droplet precautions for suspected or confirmed cases of novel H1N1 influenza;
Placing surgical masks on patients with suspected or confirmed novel H1N1 infection at the point of contact with the health care facility;
Placing such patients in a single room, if available, or cohorting them with other infected patients;
Strict adherence to hand hygiene, respiratory hygiene and cough etiquette;
Early recognition and identification of suspected novel H1N1-infected patients upon presentation to a health care facility;
Restriction of visitors and health care workers with febrile respiratory illnesses.
Status of infection control guidance for novel influenza A H1N1
Background: Numerous state and local health agencies previously endorsed the April 29, 2009, World Health Organization (WHO) recommendations (see below) on infection control measures. Subsequently, recommendations by the CDC’s Hospital Infection Control Practices Advisory Committee (HICPAC), the Society for Healthcare Epidemiology (SHEA), the Infectious Diseases Society of America (IDSA) and the Association for Professionals in Infection Control and Epidemiology (APIC), endorsed this approach. Recently, the Institute of Medicine (IOM) issued a report supporting the CDC’s current recommendations, however, the IOM report is only one component of CDC’s current review of their guidance. CDC anticipates that their updated recommendations should be available by or in October.
Since the spring 2009 outbreak of novel influenza A H1N1, infection control recommendations for novel influenza 2009 H1N1 in health care settings have been issued by multiple agencies, expert advisory groups and professional societies. The issue of respiratory precautions has generated controversy largely because of the absence of controlled scientific studies in the clinical setting to guide definitive policy. Consequently, some of the recommendations from different organizations vary with respect to respiratory protection guidance (primarily mask vs. respirator use).
We understand the challenges that variation in recommendations from authoritative organizations may pose for health care system policy makers. Below are excerpts of salient recommendations that may be of use to you in reviewing your infection control policies for the upcoming influenza season. The majority of expert recommendations support the use of standard and droplet precautions, with respirators reserved for high-risk aerosol generating procedures. Maine CDC is not planning to issue guidance until after US CDC issues their updated recommendations in October.
Centers for Disease Control and Prevention (CDC), issued May 13th, 2009 (currently under review), available at, http://www.cdc.gov/h1n1flu/guidance/
May 13, 2009, guidance states that in addition to standard and contact precautions, “All health care personnel who enter the rooms of patients in isolation with confirmed, suspected, or probable novel H1N1 influenza should wear a fit-tested disposable N95 respirator or better.”
World Health Organization (WHO): Issued 29 April, updated July 10, 2009, available at http://www.who.int/csr/resources/publications/swineflu/swineinfinfcont/en/index.html
April 29 guidance and July 10 revision recommend standard and droplet precautions except for aerosol generating procedures where N95 respirator is recommended. July 10 revision recommends N95 protection as for aerosol generating procedures including obtaining specimens by nasopharyngeal aspirate, nasopharyngeal swab, throat swab or bronchial aspirate.
Society for Healthcare Epidemiology (SHEA) issued June 12, 2009, Infectious Diseases Society of America (IDSA) and the Association for Professionals in Infection Control and Epidemiology (APIC), available at http://www.shea-online.org/news/publicpolicy.cfm.
Recommend implementing the same practices recommended to prevent the transmission of seasonal influenza for the novel H1N1 virus: standard and droplet precautions. Recommends enhanced respiratory protection (I.e., N95 respirator) when performing certain aerosol-generating procedures, specifically: bronchoscopy, open suctioning of airway secretions,
resuscitation involving emergency intubation or cardiac pulmonary resuscitation, and endotracheal intubation.
Collection of nasopharyngeal specimens from patients with suspected or confirmed novel H1N1, closed suctioning of airway secretions and administration of nebulized medications should not be considered aerosol-generating and, therefore, do not require enhanced respiratory protection.
CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) Recommendations for Care of Patients with Confirmed or Suspected 2009 H1N1 Influenza Infection in Healthcare Settings - July 23, 2009, available at: http://www.cdc.gov/ncidod/dhqp/hicpac_h1n1.html
Use standard and droplet precautions for care of patients with suspected or confirmed 2009 H1N1 influenza infection.
Use fit tested N95 respirator or higher and consider airborne infection isolation room for aerosol-generating procedures (e.g., bronchoscopy, intubation under controlled or emergent situations, cardiopulmonary resuscitation, open airway suctioning and airway induction).
Public Health Agency of Canada, issued July 28th, 2009, available at http://www.phac-aspc.gc.ca/alert-alerte/h1n1/hp-ps/ig_acf-ld_esa-eng.php Recommend contact and droplet precautions when within 2 meters of a case
Recommend respiratory precautions (N95 respirator or higher) when conducting an aerosol-generating medical procedure.
Institute of Medicine report, September 3, 2009, available at http://www.iom.edu/CMS/3740/71769/72967.aspx
Recommended continuing CDC’s current guidance for respirator use, but notes the limitations on clinical studies and their lack of a charge to consider practical implementation issues.
Friday, September 11, 2009
H1N1 Vaccine Study
The New England Journal of Medicine late yesterday published reports showing that inactivated 2009 H1N1 influenza vaccines appear to produce immunity in adults after a single dose. Preliminary analysis of early data from NIH trials appears to align with other findings that a single dose of H1N1 vaccine induces a strong and prompt immune response in most healthy adults. This is good news because, if confirmed and FDA-approved, we will be able to protect a much larger proportion of the population more quickly and conviently, as adult patients may not need a second dose. Similar findings are expected in young adults age 18 and older.
Results in children are not yet available; though vaccine-induced immunity after a single dose of seasonal flu vaccine is limited for children under the age of 9, making it more likely that children may need two doses of H1N1 vaccine. Data from adults was unexpectedly positive; we cannot predict with confidence what the pediatric data will show about the necessity of one vs. two doses.
Basically, this past year we have had two flu seasons – first the usual 2008-9 season, then the 2009 novel H1N1 influenza season, which started in April and has, essentially, continued until now. It appears likely that we will have two vaccines to address this – one, the seasonal vaccine, which is already available, and the second, the 2009 H1N1 vaccine.
Dora
Results in children are not yet available; though vaccine-induced immunity after a single dose of seasonal flu vaccine is limited for children under the age of 9, making it more likely that children may need two doses of H1N1 vaccine. Data from adults was unexpectedly positive; we cannot predict with confidence what the pediatric data will show about the necessity of one vs. two doses.
Basically, this past year we have had two flu seasons – first the usual 2008-9 season, then the 2009 novel H1N1 influenza season, which started in April and has, essentially, continued until now. It appears likely that we will have two vaccines to address this – one, the seasonal vaccine, which is already available, and the second, the 2009 H1N1 vaccine.
Dora
Thursday, September 10, 2009
Weekly Update on H1N1 in Maine 9/10/09
Maine CDC/DHHS Update on Novel Influenza A (H1N1) Virus
September 10, 2009
Weekly H1N1 updates from Maine CDC will now be issued Thursday mornings. Subscribe to the RSS feed here: http://www.maine.gov/tools/whatsnew/rss.php?tid=900
Tracking Updates
On Friday, Sept. 4, US CDC reported 9,079 hospitalizations and 593 deaths nationwide from H1N1. As of Aug. 30, the World Health Organization reported at least 2,837 deaths from H1N1 and reports of H1N1 from more than 200 countries.
Maine has identified 370 cases of H1N1, which include 19 individuals requiring hospitalization and one individual who has died. Of Maine residents with H1N1, 62 percent have been under 25 years of age. The number of cases is only a barometer of community transmission, not of actual case counts, because not all people with infection are tested.
Updates by Priority Population
The following groups are prioritized to be offered the first available doses of H1N1 vaccine, because they are at higher risk of complications from H1N1 infection or are more likely to pass the flu on to others who may be at higher risk of complications:
Pregnant women;
Household members and caregivers for children under 6 months old;
Health care and emergency medical services personnel;
All people ages 6 months through 24 years of age;
People ages 25 through 64 who have health conditions.
Pregnant Women:
An increased risk during pregnancy – especially in the second and third trimesters – has been consistently well-documented across several countries. Pregnant women are prioritized for H1N1 vaccine because of this risk, and because they can potentially provide protection to infants who cannot be vaccinated.
Maine CDC is working with clinicians who provide health care for pregnant women to assure they have H1N1 vaccine for their patients and themselves as soon as it arrives in Maine. A conference call for clinicians who care for pregnant women will be held from noon to 1 p.m. Thursday, Sept. 17. The call-in number is 1-800-914-3396, pass code is 473623. A letter was sent this past week by Maine CDC to 1,100 clinicians who provide some health care for pregnant women to update them on H1N1 issues and to send them the H1N1 and seasonal vaccine provider ordering forms.
US CDC’s Q&A for pregnant women: http://www.cdc.gov/H1N1flu/vaccination/pregnant_qa.htm
Health Care and Emergency Medical Services Personnel:
Maine CDC is working with the Regional Resource Centers at Eastern Maine Medical Center, Central Maine Medical Center, and Maine Medical Center, to assure that all health care providers and Emergency Medical Services personnel (EMS) are offered H1N1 vaccine during the first few weeks of its arrival.
This week the Institute of Medicine issued its report to US CDC and OSHA with their recommendations for the use of protective personal equipment (PPE) in clinical settings. Their recommendations confirmed the current US CDC guidance that N95 respirators be used in clinical settings by health care workers in close contact with those with H1N1 or influenza-like illness. (http://www.iom.edu/CMS/3740/71769/72967.aspx)
US CDC defines health care personnel (HCP) as “all paid and unpaid persons working in health-care settings who have the potential for exposure to patients with influenza, infectious materials, including body substances, contaminated medical supplies and equipment, or contaminated environmental surfaces. HCP might include (but are not limited to) physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff not employed by the health-care facility, and persons (e.g., clerical, dietary, housekeeping, maintenance, and volunteers) not directly involved in patient care but potentially exposed to infectious agents that can be transmitted to and from HCP. The recommendations in this report apply to HCP in acute-care hospitals, nursing homes, skilled nursing facilities, physicians’ offices, urgent care centers, and outpatient clinics, and to persons who provide home health care and emergency medical services. Emergency medical services personnel might include persons in an occupation (e.g., emergency medical technicians and fire fighters) who provide emergency medical care as part of their normal job duties.” (http://www.cdc.gov/mmwr/PDF/rr/rr5810.pdf)
Child Care Providers:
Maine CDC will be holding a conference call for child care providers from noon to 1 p.m., Monday, Sept. 21. The call-in number is 1-800-914-3396, pass code is 473623. Maine CDC is mailing information on H1N1 to all 3,000 licensed early childhood programs in Maine this week.
US CDC has released new guidance to help decrease the spread of flu among children in early childhood programs, including center-based and home-based early childhood programs, Head Start programs, and other early childhood programs providing care for children in group settings. The guidance recommends actions to take now and provides a checklist for decision-making at the local level. The guidance applies to all early childhood programs, even if they provide services for older children. (http://www.cdc.gov/h1n1flu/childcare/guidance.htm)
This technical report (http://www.cdc.gov/h1n1flu/childcare/technical.htm) explains the strategies presented in the new guidance and suggestions for using the strategies.
US CDC has also issued a communication toolkit for child care providers, including Fact Sheets, Q&As, and posters: http://www.cdc.gov/h1n1flu/childcare/toolkit/
School-age Children:
Maine CDC is working with Maine Department of Education (DOE) to assure that all Maine children are offered seasonal (regular) and H1N1 vaccine in local schools.
Maine CDC has posted a school-based vaccine clinic toolkit to provide information related to influenza and conducting immunization clinics at: http://www.maine.gov/dhhs/boh/maineflu/schools/index.shtml
A conference call for school personnel and health care providers working on this initiative will be held from noon to 1 p.m. Monday, Sept. 14. The call-in number is 1-800-914-3396, pass code is 473623.
People with Health Conditions:
Chronic medical conditions increase the risk for complications from the flu, including severe or fatal illness. These include chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematologic, or metabolic disorders (including diabetes) or immunosuppression caused by medications or by human immunodeficiency virus.
CDC has posted a podcast about H1N1 and HIV, which explains that while HIV-infected individuals may experience more severe complications of the H1N1 virus, the information available so far doesn't indicate that people living with HIV are at greater risk of getting H1N1: http://www2a.cdc.gov/podcasts/player.asp?f=14199
Vaccination
Seasonal Flu Vaccine:
H1N1 has been the focus of attention since the spring, but it is important that we do not forget the risks of the regular seasonal flu. Seasonal flu vaccine has begun to arrive in Maine; US CDC recommends that people at risk for the seasonal flu get vaccinated as soon as it is available:
Children ages 6 months to 18 years
Pregnant women
People 50 years of age and older
People of any age with certain chronic medical conditions
People who live in nursing homes and other long-term care facilities
People who live with or care for those at high risk for complications from flu, including:
Health care workers
Household contacts of persons at high risk for complications from the flu
Household contacts and out of home caregivers of children younger than 6 months old
H1N1 Vaccine:
Vaccine planning with communities and schools is well underway to ensure that all Maine children, all health care providers and Emergency Medical Services personnel, pregnant women, and others in high-risk groups for H1N1 are offered H1N1 vaccine as soon as it arrives in Maine.
This podcast (http://www2a.cdc.gov/podcasts/player.asp?f=14197) from US CDC describes the priority groups for H1N1 vaccination, and how these groups differ from those recommended for seasonal flu vaccination.
Vaccine Coordinators:
Vaccine Coordinators have been appointed for each Public Health District in Maine. Vaccine Coordinators will be one component of district leadership teams, which also include staff from the three Regional Resource Centers for Public Health Emergency Preparedness and Emergency Management Agencies.
An Updated Contact List of Vaccine Coordinators:
District 1 – York: Sharon Leahy-Lind, 490-4625
District 2 – Cumberland: Meredith Tipton, 592-5631
District 3 – Western Maine: MaryAnn Amrich, 753-9103
(Franklin, Oxford, and Androscoggin counties)
District 4 – Mid Coast: Jen Gunderman-King, 596-4278
(Waldo, Knox, Lincoln, and Sagadahoc counties)
District 5 – Central Maine: Sue Lee, 592-5634
(Somerset and Kennebec counties)
District 6 – Penquis: Jessica Fogg, 592-5633
(Penobscot and Piscataquis counties)
District 7 – Downeast: Al May, 263-4975
(Washington and Hancock counties)
District 8 – Aroostook: Stacy Boucher, starting Sept. 21, Sharon Ramey in the interim, 592-5632
Tribal Vaccine Coordinator: Jerolyn Ireland, 532-2240, Ext. 15
US CDC has issued a vaccination campaign planning checklist: http://www.cdc.gov/H1N1flu/vaccination/statelocal/planning_checklist.htm
Good Health Habits Can Help Stop Germs
Prevention of H1N1 is most important, especially now that the virus is widespread in many parts of Maine. Covering coughs and sneezes with a tissue or sleeve, washing hands frequently, and staying home if ill with a fever are shared responsibilities of everyone in Maine, especially to protect people who are at higher risk for complications from H1N1.
Other New or Recently Updated H1N1 Guidance or News
US CDC has updated its interim recommendations for the use of antiviral medications to treat and prevent flu in the 2009-2010 season: http://www.cdc.gov/h1n1flu/recommendations.htm
Q&As about the interim recommendations can be found here: http://www.cdc.gov/h1n1flu/antiviral.htm
US CDC has also issued interim guidance for state and local health departments for reporting influenza-associated hospitalization and deaths in the 2009-2010 season: http://www.cdc.gov/H1N1flu/hospitalreporting.htm
This MMWR presents the analysis of data related to 36 children who died from H1N1 flu from April to August 2009: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5834a1.htm
How to Stay Updated
Weekly Updates: Check the Thursday morning updates on H1N1 in Maine on Maine CDC’s H1N1 website. Now available as an RSS feed (midway down the center of the homepage): http://www.maineflu.gov/
Health Alert Network: Sign up to receive urgent updates from Maine CDC’s Health Alert Network (HAN). The easiest and quickest way is to sign up is through the HAN Alert RSS feed at www.mainepublichealth.gov (midway down the center of the homepage).
Follow Maine CDC’s Updates:
Facebook (search for “Maine CDC”)
Twitter (http://twitter.com/MEPublicHealth)
MySpace (www.myspace.com/mainepublichealth)
Maine CDC’s Blog (http://mainepublichealth.blogspot.com)
H1N1 Conference Calls: Maine CDC will be holding conference calls on a variety of topics related to H1N1 over the coming weeks.
Upcoming calls:
Monday, Sept. 14
Noon to 1 p.m.
Topic: School-Located Seasonal and H1N1 Vaccine Initiative - for school personnel and health care providers working on this initiative
1-800-914-3396
pass code: 473623
Thursday, Sept. 17
Noon to 1 p.m.
Topic: Clinicians Who Care for Pregnant Women
1-800-914-3396
pass code: 473623
Monday, Sept. 21
Noon to 1 p.m.
Topic: Child Care Providers
1-800-914-3396
pass code: 473623
Consider Calling or Emailing Us:
For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
General Public Call-in Number for Questions: 1-888-257-0990
NextTalk (deaf/hard of hearing) - (207) 629-5751
Monday - Friday 9 a.m. – 5 p.m.
Email your questions to: flu.questions@maine.gov
U.S. CDC H1N1 Recommendations and Guidance:
http://www.cdc.gov/h1n1flu/ and http://www.flu.gov/
September 10, 2009
Weekly H1N1 updates from Maine CDC will now be issued Thursday mornings. Subscribe to the RSS feed here: http://www.maine.gov/tools/whatsnew/rss.php?tid=900
Tracking Updates
On Friday, Sept. 4, US CDC reported 9,079 hospitalizations and 593 deaths nationwide from H1N1. As of Aug. 30, the World Health Organization reported at least 2,837 deaths from H1N1 and reports of H1N1 from more than 200 countries.
Maine has identified 370 cases of H1N1, which include 19 individuals requiring hospitalization and one individual who has died. Of Maine residents with H1N1, 62 percent have been under 25 years of age. The number of cases is only a barometer of community transmission, not of actual case counts, because not all people with infection are tested.
Updates by Priority Population
The following groups are prioritized to be offered the first available doses of H1N1 vaccine, because they are at higher risk of complications from H1N1 infection or are more likely to pass the flu on to others who may be at higher risk of complications:
Pregnant women;
Household members and caregivers for children under 6 months old;
Health care and emergency medical services personnel;
All people ages 6 months through 24 years of age;
People ages 25 through 64 who have health conditions.
Pregnant Women:
An increased risk during pregnancy – especially in the second and third trimesters – has been consistently well-documented across several countries. Pregnant women are prioritized for H1N1 vaccine because of this risk, and because they can potentially provide protection to infants who cannot be vaccinated.
Maine CDC is working with clinicians who provide health care for pregnant women to assure they have H1N1 vaccine for their patients and themselves as soon as it arrives in Maine. A conference call for clinicians who care for pregnant women will be held from noon to 1 p.m. Thursday, Sept. 17. The call-in number is 1-800-914-3396, pass code is 473623. A letter was sent this past week by Maine CDC to 1,100 clinicians who provide some health care for pregnant women to update them on H1N1 issues and to send them the H1N1 and seasonal vaccine provider ordering forms.
US CDC’s Q&A for pregnant women: http://www.cdc.gov/H1N1flu/vaccination/pregnant_qa.htm
Health Care and Emergency Medical Services Personnel:
Maine CDC is working with the Regional Resource Centers at Eastern Maine Medical Center, Central Maine Medical Center, and Maine Medical Center, to assure that all health care providers and Emergency Medical Services personnel (EMS) are offered H1N1 vaccine during the first few weeks of its arrival.
This week the Institute of Medicine issued its report to US CDC and OSHA with their recommendations for the use of protective personal equipment (PPE) in clinical settings. Their recommendations confirmed the current US CDC guidance that N95 respirators be used in clinical settings by health care workers in close contact with those with H1N1 or influenza-like illness. (http://www.iom.edu/CMS/3740/71769/72967.aspx)
US CDC defines health care personnel (HCP) as “all paid and unpaid persons working in health-care settings who have the potential for exposure to patients with influenza, infectious materials, including body substances, contaminated medical supplies and equipment, or contaminated environmental surfaces. HCP might include (but are not limited to) physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff not employed by the health-care facility, and persons (e.g., clerical, dietary, housekeeping, maintenance, and volunteers) not directly involved in patient care but potentially exposed to infectious agents that can be transmitted to and from HCP. The recommendations in this report apply to HCP in acute-care hospitals, nursing homes, skilled nursing facilities, physicians’ offices, urgent care centers, and outpatient clinics, and to persons who provide home health care and emergency medical services. Emergency medical services personnel might include persons in an occupation (e.g., emergency medical technicians and fire fighters) who provide emergency medical care as part of their normal job duties.” (http://www.cdc.gov/mmwr/PDF/rr/rr5810.pdf)
Child Care Providers:
Maine CDC will be holding a conference call for child care providers from noon to 1 p.m., Monday, Sept. 21. The call-in number is 1-800-914-3396, pass code is 473623. Maine CDC is mailing information on H1N1 to all 3,000 licensed early childhood programs in Maine this week.
US CDC has released new guidance to help decrease the spread of flu among children in early childhood programs, including center-based and home-based early childhood programs, Head Start programs, and other early childhood programs providing care for children in group settings. The guidance recommends actions to take now and provides a checklist for decision-making at the local level. The guidance applies to all early childhood programs, even if they provide services for older children. (http://www.cdc.gov/h1n1flu/childcare/guidance.htm)
This technical report (http://www.cdc.gov/h1n1flu/childcare/technical.htm) explains the strategies presented in the new guidance and suggestions for using the strategies.
US CDC has also issued a communication toolkit for child care providers, including Fact Sheets, Q&As, and posters: http://www.cdc.gov/h1n1flu/childcare/toolkit/
School-age Children:
Maine CDC is working with Maine Department of Education (DOE) to assure that all Maine children are offered seasonal (regular) and H1N1 vaccine in local schools.
Maine CDC has posted a school-based vaccine clinic toolkit to provide information related to influenza and conducting immunization clinics at: http://www.maine.gov/dhhs/boh/maineflu/schools/index.shtml
A conference call for school personnel and health care providers working on this initiative will be held from noon to 1 p.m. Monday, Sept. 14. The call-in number is 1-800-914-3396, pass code is 473623.
People with Health Conditions:
Chronic medical conditions increase the risk for complications from the flu, including severe or fatal illness. These include chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematologic, or metabolic disorders (including diabetes) or immunosuppression caused by medications or by human immunodeficiency virus.
CDC has posted a podcast about H1N1 and HIV, which explains that while HIV-infected individuals may experience more severe complications of the H1N1 virus, the information available so far doesn't indicate that people living with HIV are at greater risk of getting H1N1: http://www2a.cdc.gov/podcasts/player.asp?f=14199
Vaccination
Seasonal Flu Vaccine:
H1N1 has been the focus of attention since the spring, but it is important that we do not forget the risks of the regular seasonal flu. Seasonal flu vaccine has begun to arrive in Maine; US CDC recommends that people at risk for the seasonal flu get vaccinated as soon as it is available:
Children ages 6 months to 18 years
Pregnant women
People 50 years of age and older
People of any age with certain chronic medical conditions
People who live in nursing homes and other long-term care facilities
People who live with or care for those at high risk for complications from flu, including:
Health care workers
Household contacts of persons at high risk for complications from the flu
Household contacts and out of home caregivers of children younger than 6 months old
H1N1 Vaccine:
Vaccine planning with communities and schools is well underway to ensure that all Maine children, all health care providers and Emergency Medical Services personnel, pregnant women, and others in high-risk groups for H1N1 are offered H1N1 vaccine as soon as it arrives in Maine.
This podcast (http://www2a.cdc.gov/podcasts/player.asp?f=14197) from US CDC describes the priority groups for H1N1 vaccination, and how these groups differ from those recommended for seasonal flu vaccination.
Vaccine Coordinators:
Vaccine Coordinators have been appointed for each Public Health District in Maine. Vaccine Coordinators will be one component of district leadership teams, which also include staff from the three Regional Resource Centers for Public Health Emergency Preparedness and Emergency Management Agencies.
An Updated Contact List of Vaccine Coordinators:
District 1 – York: Sharon Leahy-Lind, 490-4625
District 2 – Cumberland: Meredith Tipton, 592-5631
District 3 – Western Maine: MaryAnn Amrich, 753-9103
(Franklin, Oxford, and Androscoggin counties)
District 4 – Mid Coast: Jen Gunderman-King, 596-4278
(Waldo, Knox, Lincoln, and Sagadahoc counties)
District 5 – Central Maine: Sue Lee, 592-5634
(Somerset and Kennebec counties)
District 6 – Penquis: Jessica Fogg, 592-5633
(Penobscot and Piscataquis counties)
District 7 – Downeast: Al May, 263-4975
(Washington and Hancock counties)
District 8 – Aroostook: Stacy Boucher, starting Sept. 21, Sharon Ramey in the interim, 592-5632
Tribal Vaccine Coordinator: Jerolyn Ireland, 532-2240, Ext. 15
US CDC has issued a vaccination campaign planning checklist: http://www.cdc.gov/H1N1flu/vaccination/statelocal/planning_checklist.htm
Good Health Habits Can Help Stop Germs
Prevention of H1N1 is most important, especially now that the virus is widespread in many parts of Maine. Covering coughs and sneezes with a tissue or sleeve, washing hands frequently, and staying home if ill with a fever are shared responsibilities of everyone in Maine, especially to protect people who are at higher risk for complications from H1N1.
Other New or Recently Updated H1N1 Guidance or News
US CDC has updated its interim recommendations for the use of antiviral medications to treat and prevent flu in the 2009-2010 season: http://www.cdc.gov/h1n1flu/recommendations.htm
Q&As about the interim recommendations can be found here: http://www.cdc.gov/h1n1flu/antiviral.htm
US CDC has also issued interim guidance for state and local health departments for reporting influenza-associated hospitalization and deaths in the 2009-2010 season: http://www.cdc.gov/H1N1flu/hospitalreporting.htm
This MMWR presents the analysis of data related to 36 children who died from H1N1 flu from April to August 2009: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5834a1.htm
How to Stay Updated
Weekly Updates: Check the Thursday morning updates on H1N1 in Maine on Maine CDC’s H1N1 website. Now available as an RSS feed (midway down the center of the homepage): http://www.maineflu.gov/
Health Alert Network: Sign up to receive urgent updates from Maine CDC’s Health Alert Network (HAN). The easiest and quickest way is to sign up is through the HAN Alert RSS feed at www.mainepublichealth.gov (midway down the center of the homepage).
Follow Maine CDC’s Updates:
Facebook (search for “Maine CDC”)
Twitter (http://twitter.com/MEPublicHealth)
MySpace (www.myspace.com/mainepublichealth)
Maine CDC’s Blog (http://mainepublichealth.blogspot.com)
H1N1 Conference Calls: Maine CDC will be holding conference calls on a variety of topics related to H1N1 over the coming weeks.
Upcoming calls:
Monday, Sept. 14
Noon to 1 p.m.
Topic: School-Located Seasonal and H1N1 Vaccine Initiative - for school personnel and health care providers working on this initiative
1-800-914-3396
pass code: 473623
Thursday, Sept. 17
Noon to 1 p.m.
Topic: Clinicians Who Care for Pregnant Women
1-800-914-3396
pass code: 473623
Monday, Sept. 21
Noon to 1 p.m.
Topic: Child Care Providers
1-800-914-3396
pass code: 473623
Consider Calling or Emailing Us:
For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
General Public Call-in Number for Questions: 1-888-257-0990
NextTalk (deaf/hard of hearing) - (207) 629-5751
Monday - Friday 9 a.m. – 5 p.m.
Email your questions to: flu.questions@maine.gov
U.S. CDC H1N1 Recommendations and Guidance:
http://www.cdc.gov/h1n1flu/ and http://www.flu.gov/
Saturday, September 5, 2009
Definition of Health Care Personnel for H1N1 Vaccine Purposes
One question we are getting quite often is, "what is the definition of health care personnel for the purposes of identifying those who are high priority for receiving the H1N1 vaccine when it arrives later this fall?" The answer is below, from the
August 28, 2009 MMWR, Vol/ 58 / Ro. RR-10, page 5:
“§ Health-care personnel (HCP) include all paid and unpaid persons working in health-care settings who have the potential for exposure to patients with influenza, infectious materials, including body substances, contaminated medical supplies and equipment, or contaminated environmental surfaces. HCP might include (but are not limited to) physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff not employed by the health-care facility, and persons (e.g., clerical, dietary, housekeeping, maintenance, and volunteers) not directly involved in patient care but potentially exposed to infectious agents that can be transmitted to and from HCP. The recommendations in this report apply to HCP in acute-care hospitals, nursing homes, skilled nursing facilities, physicians’ offices, urgent care centers, and outpatient clinics, and to persons who provide home health care and emergency medical services (27). Emergency medical services personnel might include persons in an occupation (e.g., emergency medical technicians and fire fighters) who provide emergency medical care as part of their normal job duties.”
August 28, 2009 MMWR, Vol/ 58 / Ro. RR-10, page 5:
“§ Health-care personnel (HCP) include all paid and unpaid persons working in health-care settings who have the potential for exposure to patients with influenza, infectious materials, including body substances, contaminated medical supplies and equipment, or contaminated environmental surfaces. HCP might include (but are not limited to) physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff not employed by the health-care facility, and persons (e.g., clerical, dietary, housekeeping, maintenance, and volunteers) not directly involved in patient care but potentially exposed to infectious agents that can be transmitted to and from HCP. The recommendations in this report apply to HCP in acute-care hospitals, nursing homes, skilled nursing facilities, physicians’ offices, urgent care centers, and outpatient clinics, and to persons who provide home health care and emergency medical services (27). Emergency medical services personnel might include persons in an occupation (e.g., emergency medical technicians and fire fighters) who provide emergency medical care as part of their normal job duties.”
Thursday, September 3, 2009
Weekly Update on H1N1 in Maine 9/2/09
Tracking Updates
On Friday, Aug. 28, US CDC reported 8,843 hospitalizations and 556 deaths nationwide from H1N1. As of Aug. 23, the World Health Organization reported 2,185 deaths from H1N1 and reports of H1N1 from over 200 countries.
Maine has identified 360 cases of H1N1, which include 19 individuals requiring hospitalization and one individual who has died. Of Maine residents with H1N1, 60 percent have been under 25 years of age. The number of cases is only a barometer of community transmission, not of actual case counts, because not all people with infection are tested.
Vaccination
Maine CDC vaccine planning with communities and schools is well underway. There are several areas we are focused on right now:
1. Maine CDC is working with Maine Department of Education (DOE) to assure that all Maine children are offered seasonal (regular) and H1N1 vaccine in local schools. As of Monday August 31st, our toll free H1N1 number (1-888-257-0990) is staffed 9 am – 5 pm with professionals from Maine CDC and DOE to assist schools and partnering health care providers in this effort. We will refer a District Vaccine Coordinator to those schools and/or health care providers who need more direct assistance in this effort.
2. Maine CDC is working with the Regional Resource Centers at Eastern Maine Medical Center, Central Maine Medical Center, and Maine Medical Center, to assure that all health care providers and Emergency Medical Services personnel (EMS) are offered H1N1 vaccine during the first few weeks of its arrival.
3. Maine CDC is working with clinicians who provide health care for pregnant women to assure they have H1N1 vaccine for their patients and themselves as soon as it arrives in Maine.
4. Maine CDC will also be working with residential schools, employers, and health care providers to assure all others in the high-risk groups for H1N1 are offered vaccine.
Governor’s Declaration:
Governor John E. Baldacci on September 1, 2009 signed a Proclamation of Civil Emergency Due to a Highly Infectious Agent to allow the State to better respond to the potential dangers of H1N1 flu and to facilitate a statewide vaccination campaign.
Many school districts reported that a concern about potential liability was putting at risk their ability to participate in vaccination clinics. The proclamation protects school districts and other vaccination clinic participants from liability. The proclamation also will provide immunity from tort liability for approved health care workers who administer the flu vaccines. The Maine CDC, DOE, and MEMA will coordinate and facilitate the implementation of school supported vaccine clinics for both the seasonal flu and H1N1.
The press release and the declaration itself can be found at:
http://www.maine.gov/tools/whatsnew/index.php?topic=Portal+News&id=78666&v=article-2008
Maine CDC Conference Calls:
School-Located Seasonal and H1N1 Vaccine Initiative for school personnel and health care providers working on this initiative - Monday September 14th 12 noon – 1 pm
Clinicians Who Care for Pregnant Women: Thursday September 17th, 12 noon – 1 pm
Phone Number for Both Calls: 1-800-914-3396 and passcode 473623
Vaccine Coordinators – An Update
Vaccine Coordinators have been appointed for each Public Health District in Maine. Vaccine Coordinators will be one component of district leadership teams, which also include staff from the three Regional Resource Centers for Public Health Emergency Preparedness, and Emergency Management Agencies. These Vaccine Coordinators will be following up on discussions had at the Summit to plan for local vaccine distribution, and ensuring that people in the groups prioritized by US CDC (see below) are offered vaccine.
An Updated Contact List of Vaccine Coordinators:
District 1 – York: Sharon Leahy-Lind, 490-4625
District 2 – Cumberland: Meredith Tipton, 592-5631
District 3 – Western Maine: MaryAnn Amrich, 753-9103
(Franklin, Oxford, and Androscoggin counties)
District 4 – Mid Coast: Jen Gunderman-King, 596-4278
(Waldo, Knox, Lincoln, and Sagadahoc counties)
District 5 – Central Maine: Sue Lee, 592-5634
(Somerset and Kennebec counties)
District 6 – Penquis: Jessica Fogg starting September 8 (and Debra Roy in the interim) 592-5633 (phone for either)
(Penobscot and Piscataquis counties)
District 7 – Downeast: Al May starting September 8, 263-4975 (and Mary Jude in the interim, 287-5182)
(Washington and Hancock counties)
District 8 – Aroostook: Sharon Ramey (Interim until September 21), 592-5632
Tribal Vaccine Coordinator: Jerolyn Ireland, 532-2240, Ext. 15
Many resources for vaccination clinics have been posted on our Summit web site (http://www.maine.gov/dhhs/boh/maineflu/h1n1-summit.shtml) under the morning breakout for Organizers of Large-Scale Vaccine Clinics.
CDC has issued a vaccination campaign planning checklist: http://www.cdc.gov/H1N1flu/vaccination/statelocal/planning_checklist.htm
Seasonal Flu Vaccine:
H1N1 has been the focus of attention since the spring, but it is important that we do not forget the risks of seasonal flu. US CDC recommends that people at risk for the seasonal flu get vaccinated as soon as it is available. The protection you get from the vaccine will not wear off before the flu season is over.
The following groups are prioritized for seasonal flu vaccination:
Children ages 6 months to 18 years
Pregnant women
People 50 years of age and older
People of any age with certain chronic medical conditions
People who live in nursing homes and other long-term care facilities
People who live with or care for those at high risk for complications from flu, including:
Health care workers
Household contacts of persons at high risk for complications from the flu
Household contacts and out of home caregivers of children younger than 6 months old
The seasonal flu vaccine is not expected to specifically protect against H1N1. However, with H1N1 and seasonal flu viruses both expected to be circulating, getting a seasonal flu vaccine early will help a person’s overall protection against the flu. We anticipate that season flu and H1N1 vaccines may be administered on the same day. However, we expect seasonal flu vaccine to be available sooner than H1N1 vaccine, which we expect to arrive in the state in mid-October at the earliest. CDC recommends that people get vaccinated against seasonal flu as early as possible.
H1N1 Vaccine:
US CDC updated its Q&A on H1N1 vaccine to include guidance for those who were vaccinated against swine flu in 1976. The 1976 swine flu virus and the current H1N1 virus are different enough that it’s unlikely that a person vaccinated in 1976 will have full protection against H1N1, and therefore should still be given the H1N1 vaccine. (http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm)
This US CDC podcast discusses H1N1 flu vaccine and how to protect your family: http://www2a.cdc.gov/podcasts/player.asp?f=13958.
For most people, two doses of the H1N1 vaccine may be necessary for full protection against the virus. The exact timing between doses will not be known until further clinical trial data are available; however, US CDC anticipates that 21-28 days will be needed between the first and second doses.
The H1N1 vaccine is not intended to replace the seasonal flu vaccine – it is intended to be used in addition to seasonal flu vaccine to protect people. At this point in time, there is no evidence that vaccinations will be mandatory. US CDC recommends (http://www.cdc.gov/mmwr/pdf/rr/rr58e0821.pdf) that the following groups should be considered the highest priority to be offered the first available doses of vaccine:
Pregnant women, because they are at higher risk of complications – especially in the second and third trimesters – and can potentially provide protection to infants who cannot be vaccinated;
Household members and caregivers for children under 6 months old, because younger infants are at higher risk of complications and cannot be vaccinated;
Health care and emergency medical services personnel, because infections among health care workers have been reported and this can be a potential source of infection for patients;
All people ages 6 months through 24 years of age:
Children ages 6 months to 18 years, because there have been many cases of H1N1 in children and they are in close contact with each other in school and day care settings, which increases the chances of spreading disease;
Young adults ages 19 through 24, because there have been many cases of H1N1 in healthy young adults, and they often live, work, and study in close proximity, and they are a frequently mobile population;
People ages 25 through 64 who have health conditions associated with a higher risk of medical complications from the flu, including those with asthma, COPD, diabetes, chronic cardiovascular disease, and people with compromised immune systems.
CDC also issued a Q&A on H1N1 vaccine distribution: http://www.cdc.gov/H1N1flu/vaccination/statelocal/centralized_distribution_qa.htm
Good Health Habits Can Help Stop Germs
Prevention of H1N1 is most important, especially now that the virus is widespread in many parts of Maine. Covering coughs and sneezes with a tissue or sleeve, washing hands frequently, and staying home if ill with a fever are shared responsibilities of everyone in Maine, especially to protect people who are at higher risk for complications from H1N1 (http://www.cdc.gov/h1n1flu/vaccination/acip.htm).
Important Differences Between H1N1 and Seasonal Flu
The age groups affected by H1N1 are generally younger than those affected by the regular seasonal flu. This is true for those most frequently infected, and especially for those experiencing severe or fatal illness.
To date, most severe cases and deaths have occurred in adults younger than 50, with deaths in the elderly comparatively rare. In seasonal flu, around 90% of severe and fatal cases occur in people age 65 years or older.
Perhaps most significantly, clinicians from around the world are reporting a very severe form of disease, also in young and otherwise healthy people, which is rarely seen in seasonal flu infections. In these patients, the virus directly infects the lung, causing severe respiratory failure. Saving these lives depends on highly specialized and demanding care in intensive care units, usually with long and costly stays.
Advice from the World Health Organization
WHO has monitored outbreaks of H1N1 from different parts of the world to get a sense of how the flu pandemic will evolve in the next several months. WHO advises us to be prepared for a second wave of flu. (http://www.who.int/csr/disease/swineflu/notes/h1n1_second_wave_20090828/en/index.html)
H1N1 has quickly become the dominant type of flu in most parts of the world. Close monitoring by WHO has shown no signs that the virus has mutated, and the overwhelming majority of people with H1N1 continue to experience mild illness.
While these trends are encouraging, large numbers of people are still susceptible to infection.
Larger numbers of severely ill patients requiring intensive care are likely to be a burden on health services, possibly disrupting care for other diseases.
Only a handful of H1N1 viruses have been resistant to Tamiflu® worldwide, despite the administration of many millions of treatments with this drug. Intense monitoring of treatment-resistant flu continues.
H1N1 and Pregnant Women
An increased risk during pregnancy – especially in the second and third trimesters – has been consistently well-documented across countries. Pregnant women are prioritized for H1N1 vaccine because of this risk, and because they can potentially provide protection to infants who cannot be vaccinated.
H1N1 Vaccine Q&A for Pregnant Women (source: US CDC):
Q: Why does CDC recommend that pregnant women receive the 2009 H1N1 influenza vaccine?
A. It is important for a pregnant woman to receive the 2009 H1N1 influenza vaccine as well as a seasonal influenza vaccine. A pregnant woman who gets any type of flu is at risk for serious complications and hospitalization. Pregnant women who are otherwise healthy have been severely impacted by the 2009 H1N1 influenza virus (formerly called “novel H1N1 flu” or “swine flu”). In comparison to the general population, a greater proportion of pregnant women infected with the 2009 H1N1 influenza virus have been hospitalized. In addition, severe illness and death has occurred in pregnant women. Six percent of confirmed fatal 2009 H1N1 flu cases thus far have been in pregnant women while only about 1% of the general population is pregnant. While hand washing, staying away from ill people, and other steps can help to protect pregnant women from influenza, vaccination is the single best way to protect against the flu.
Q: Is there a particular kind of flu vaccine that pregnant women should get? Are there flu vaccines that pregnant women should not get?
A. There are two type of flu vaccine. Pregnant women should get the "flu shot"— an inactivated vaccine (containing fragments of killed influenza virus) that is given with a needle, usually in the arm. The flu shot is approved for use in pregnant women.
The other type of flu vaccine — nasal-spray flu vaccine (sometimes called LAIV for “live attenuated influenza vaccine)—is not currently approved for use in pregnant women. This vaccine is made with live, weakened flu viruses that do not cause the flu). LAIV (FluMist®) is approved for use in healthy* people 2-49 years of age who are not pregnant.
Q. Will the seasonal flu vaccine also protect against the 2009 H1N1 flu?
A. The seasonal flu vaccine is not expected to protect against the 2009 H1N1 flu. Similarly, the 2009 H1N1 influenza vaccine will not protect against seasonal influenza.
Q. Can the seasonal influenza vaccine and the 2009 H1N1 influenza vaccine be given at the same time?
A. It is anticipated that seasonal flu and 2009 H1N1 vaccines may be administered on the same day but given at different sites (e.g. one shot in the left arm and the other shot in the right arm). However, we expect the seasonal vaccine to be available earlier than the 2009 H1N1 influenza vaccine. The usual seasonal influenza viruses are still expected to cause illness this fall and winter. Pregnant women and others at increased risk of complications of influenza are encouraged to get their seasonal flu vaccine as soon as it is available.
Q: Is the 2009 H1N1 influenza vaccine safe for pregnant women?
A: Influenza vaccines have not been shown to cause harm to a pregnant women or her baby. The seasonal flu shot (injection) is proven as safe and already recommended for pregnant women. The 2009 H1N1 influenza vaccine will be made using the same processes and facilities that are used to make seasonal influenza vaccines.
Q: What safety studies have been done on the 2009 H1N1 influenza vaccine and have any been done in pregnant women?
A: A number of clinical trials which test 2009 H1N1 influenza vaccine in healthy children and adults are underway. These studies are being conducted by the National Institutes of Allergies and Infectious Diseases (NIAID). Studies of 2009 H1N1 influenza vaccine in pregnant women are expected to begin in September.
Q: Does the 2009 H1N1 influenza vaccine have preservative in it?
A: There is no evidence that thimerosal (used as a preservative in vaccine packaged in multi-dose vials) is harmful to a pregnant woman or a fetus. However, because some women are concerned about exposure to preservatives during pregnancy, manufacturers will produce preservative-free seasonal and 2009 H1N1 influenza vaccines in single dose syringes for pregnant women and small children. CDC recommends that pregnant women may receive influenza vaccine with or without thimerosal.
Q: Can the 2009 H1N1 influenza vaccine be given at any time during pregnancy?
A: Yes.
Q: How many 2009 H1N1 influenza vaccine shots will be needed?
A: Some people, including pregnant women, may need two doses. We will know more about the number of doses once data from the clinical trials are available.
Q. What will be the recommended interval between the first and second dose if two doses are needed?
A. This will not be known until clinical trial data are available. We anticipate that 21-28 days will be needed between the first and second doses.
Q: Should the 2009 H1N1 influenza vaccine be given to someone who has had an influenza- like illness since between April and now? Do I need a test to know if I need the vaccine or not?
A. There is no test that can show whether a person had 2009 H1N1 influenza in the past. Many different infections, including influenza, can cause influenza-like symptoms such as cough, sore throat and fever. In addition, infection with one strain of influenza virus will not provide protection against other strains. People for whom influenza vaccine is recommended should receive the 2009 H1N1 vaccine, even if they had an influenza-like illness previously. It is not necessary to test a person who previously had an influenza-like illness. People for whom the 2009 H1N1 influenza vaccine is recommended should receive it, even if they have had an influenza-like illness previously, unless they can be certain they had 2009 H1N1 influenza based on a laboratory test that can specifically detect 2009 H1N1 viruses. CDC recommends that persons who were tested for 2009 H1N1 influenza discuss this issue with a healthcare provider to see if the test they had was either an RT-PCR or a viral culture that showed 2009 H1N1 influenza. There is no harm in being vaccinated if you had 2009 H1N1 influenza in the past.
Q: What are the possible side effects of the 2009 H1N1 influenza vaccine?
A. The side effects from 2009 H1N1 influenza vaccine are expected to be similar to those from seasonal flu vaccines. The most common side effects following vaccination are expected to be mild, such as soreness, redness, tenderness or swelling where the shot was given. Some people might experience headache, muscle aches, fever, nausea and fainting. If these problems occur, they usually begin soon after the shot and may last as long as 1-2 days. Like any medicines, vaccines can cause serious problems like severe allergic reactions. However life-threatening allergic reactions to vaccines are very rare. In 1976, an earlier type of swine flu vaccine was associated with cases of a severe paralytic illness called Guillain-Barre Syndrome (GBS) at a rate of approximately 1 case of GBS per 100,000 persons vaccinated. Some studies done since 1976 have shown a small risk of GBS in persons who received the seasonal influenza vaccine. This risk is estimated to be no more than 1 case of GBS per 1 million persons vaccinated. Since then, flu vaccines have not been clearly linked to GBS. GBS has a number of different causes, and GBS can occur in a person who has never received an influenza vaccine. The potential benefits of influenza vaccination in preventing serious illness, hospitalization, and death substantially outweigh these estimates of risk for vaccine-associated GBS.
Anyone who has a severe (life-threatening) allergy to eggs or to any other substance in the vaccine should not get the vaccine. People should always inform their immunization provider if they have any severe allergies, if they’ve ever had a severe allergic reaction following flu vaccination, or if they have ever had GBS.
Q. Can the family members of a pregnant woman receive the nasal spray vaccine?
A. Pregnant women should not receive the live nasal spray influenza vaccine but family and household members and other close contacts of pregnant women (including healthcare personnel) who are 2 through 49 years old, healthy* and not pregnant may receive live nasal spray vaccine.
Q. Can a pregnant healthcare worker administer the live nasal influenza vaccine?
A. Yes. No special precautions are (such as gloves) are necessary. Hands should be washed or cleaned with waterless hand sanitizer before and after administering the vaccine or having any direct contact with patients in a health care setting.
H1N1 Vaccine Q&A for Health Care Providers Who Treat Pregnant Women:
Q. Where can healthcare providers obtain 2009 H1N1 influenza vaccine?
A. Please visit our H1N1 vaccination web site for more information: http://www.maine.gov/dhhs/boh/maineflu/h1n1-vaccine.shtml
Q. How will healthcare providers obtain other supplies necessary for vaccination?
A. The vaccine will be distributed with a kit which will contain needles, syringes, sharps containers and alcohol swabs.
Q. How much does the vaccine cost?
A. The vaccine will be provided free; however, healthcare providers may bill for vaccine administration.
Q. If a pregnant woman delivers before receiving her second dose of vaccine, should she still receive the second dose?
A. Yes. In addition to protecting her from infection, infants less than 6 months old will not be able to be vaccinated so it is recommended that everyone who lives with or provides care for infants less than 6 months of age receive both the seasonal influenza vaccine and 2009 H1N1 influenza monovalent vaccine to provide protection for the infant. One recent study conducted in Bangladesh, assessed the effectiveness of influenza immunization for mothers and their young infants. Inactivated influenza vaccine reduced proven influenza illness by 63% in infants up to 6 months of age. This study confirmed that maternal influenza immunization is a strategy with substantial benefits for both mothers and infants.
Q. Where can healthcare providers get more information about the 2009 H1N1 influenza vaccine?
A. Information is continually updated at http://www.cdc.gov/h1n1flu/vaccination/
Vulnerable Groups
Data continue to show that certain medical conditions increase the risk of severe and fatal illness (http://www.cdc.gov/h1n1flu/vaccination/acip.htm). These include respiratory disease, notably asthma, cardiovascular disease, diabetes and immunosuppression.
Several early studies show a higher risk of hospitalization and death among certain subgroups, including minority groups and indigenous populations. In some studies, the risk in these groups is four to five times higher than in the general population. (http://www.who.int/csr/disease/swineflu/notes/h1n1_second_wave_20090828/en/index.html)
Early data from two countries suggest that people co-infected with H1N1 and HIV are not at increased risk of severe or fatal illness, provided these patients are receiving antiretroviral therapy. In most of these patients, illness caused by H1N1 has been mild, with full recovery. (http://www.who.int/csr/disease/swineflu/notes/h1n1_second_wave_20090828/en/index.html)
Other New or Recently Updated H1N1 Guidance or News
This MMWR report (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5833a1.htm) summarizes laboratory-confirmed cases of H1N1 identified between April and July in Chicago, Illinois, and provides clinical and epidemiologic data for a subset of those cases. The study found that the attack rate was highest among children ages 5-14, and 14 times higher than for adults 60 and older. The highest hospitalization rates were among children up to age 4, followed by children 5- to 14-years-old.
This MMWR report (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5833a2.htm) describes a study of seasonal flu and H1N1 in New Zealand, which determined that H1N1 quickly took over the number of cases identified as seasonal flu. Similarly, early results from a study of flu in ferrets (http://www.nih.gov/news/health/aug2009/niaid-31.htm) indicates that H1N1 probably will dominate over seasonal flu in the coming flu season, and that H1N1 caused more severe disease.
Community Flu 1.0 software to calculate the cost, in terms of workdays lost, of influenza and the associated interventions: http://www.cdc.gov/flu/tools/communityflu/
FluLabSurge1.0 software to assist lab directors forecast the demand for testing: http://www.cdc.gov/flu/tools/flulabsurge/
US CDC listed its public health emergency response projects related to H1N1: http://www.cdc.gov/h1n1flu/responseprojects.htm.
The US Department of Health and Human Services, Department of Homeland Security, Department of Education, and Sesame Workshop have launched a new advertising campaign designed to encourage children and families to practice healthy habits and to take steps to prevent the spread of the 2009 H1N1 flu virus. The PSAs featured in this campaign can be viewed on http://www.flu.gov/.
How to Stay Updated
Weekly Updates: Check the Wednesday late afternoon updates on H1N1 in Maine on Maine CDC’s H1N1 website. Now available as an RSS feed (midway down the center of the homepage): http://www.maineflu.gov/
Health Alert Network: Sign up to receive urgent updates from Maine CDC’s Health Alert Network (HAN). The easiest and quickest way is to sign up is through the HAN Alert RSS feed at http://www.mainepublichealth.gov/ (midway down the center of the homepage).
Follow Maine CDC’s Updates:
Facebook (search for “Maine CDC”)
Twitter (http://twitter.com/MEPublicHealth)
MySpace (www.myspace.com/mainepublichealth)
Maine CDC’s Blog (http://mainepublichealth.blogspot.com/)
H1N1 Conference Calls: September 14th for schools and health care providers involved with the school-located seasonal and H1N1 vaccine efforts and September 17th for clinicians who care for pregnant women. Calls are 12 noon – 1 pm. Phone Number for Both Calls: 1-800-914-3396 and passcode 473623.
Consider Calling or Emailing Us:
For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
General Public Call-in Number for Questions: 1-888-257-0990NextTalk (deaf/hard of hearing) - (207) 629-5751Monday - Friday 9 a.m. – 5 p.m.
Email your questions to: Sue.Dowdy@maine.gov
U.S. CDC H1N1 Recommendations and Guidance:
http://www.cdc.gov/h1n1flu/ and http://www.flu.gov/
On Friday, Aug. 28, US CDC reported 8,843 hospitalizations and 556 deaths nationwide from H1N1. As of Aug. 23, the World Health Organization reported 2,185 deaths from H1N1 and reports of H1N1 from over 200 countries.
Maine has identified 360 cases of H1N1, which include 19 individuals requiring hospitalization and one individual who has died. Of Maine residents with H1N1, 60 percent have been under 25 years of age. The number of cases is only a barometer of community transmission, not of actual case counts, because not all people with infection are tested.
Vaccination
Maine CDC vaccine planning with communities and schools is well underway. There are several areas we are focused on right now:
1. Maine CDC is working with Maine Department of Education (DOE) to assure that all Maine children are offered seasonal (regular) and H1N1 vaccine in local schools. As of Monday August 31st, our toll free H1N1 number (1-888-257-0990) is staffed 9 am – 5 pm with professionals from Maine CDC and DOE to assist schools and partnering health care providers in this effort. We will refer a District Vaccine Coordinator to those schools and/or health care providers who need more direct assistance in this effort.
2. Maine CDC is working with the Regional Resource Centers at Eastern Maine Medical Center, Central Maine Medical Center, and Maine Medical Center, to assure that all health care providers and Emergency Medical Services personnel (EMS) are offered H1N1 vaccine during the first few weeks of its arrival.
3. Maine CDC is working with clinicians who provide health care for pregnant women to assure they have H1N1 vaccine for their patients and themselves as soon as it arrives in Maine.
4. Maine CDC will also be working with residential schools, employers, and health care providers to assure all others in the high-risk groups for H1N1 are offered vaccine.
Governor’s Declaration:
Governor John E. Baldacci on September 1, 2009 signed a Proclamation of Civil Emergency Due to a Highly Infectious Agent to allow the State to better respond to the potential dangers of H1N1 flu and to facilitate a statewide vaccination campaign.
Many school districts reported that a concern about potential liability was putting at risk their ability to participate in vaccination clinics. The proclamation protects school districts and other vaccination clinic participants from liability. The proclamation also will provide immunity from tort liability for approved health care workers who administer the flu vaccines. The Maine CDC, DOE, and MEMA will coordinate and facilitate the implementation of school supported vaccine clinics for both the seasonal flu and H1N1.
The press release and the declaration itself can be found at:
http://www.maine.gov/tools/whatsnew/index.php?topic=Portal+News&id=78666&v=article-2008
Maine CDC Conference Calls:
School-Located Seasonal and H1N1 Vaccine Initiative for school personnel and health care providers working on this initiative - Monday September 14th 12 noon – 1 pm
Clinicians Who Care for Pregnant Women: Thursday September 17th, 12 noon – 1 pm
Phone Number for Both Calls: 1-800-914-3396 and passcode 473623
Vaccine Coordinators – An Update
Vaccine Coordinators have been appointed for each Public Health District in Maine. Vaccine Coordinators will be one component of district leadership teams, which also include staff from the three Regional Resource Centers for Public Health Emergency Preparedness, and Emergency Management Agencies. These Vaccine Coordinators will be following up on discussions had at the Summit to plan for local vaccine distribution, and ensuring that people in the groups prioritized by US CDC (see below) are offered vaccine.
An Updated Contact List of Vaccine Coordinators:
District 1 – York: Sharon Leahy-Lind, 490-4625
District 2 – Cumberland: Meredith Tipton, 592-5631
District 3 – Western Maine: MaryAnn Amrich, 753-9103
(Franklin, Oxford, and Androscoggin counties)
District 4 – Mid Coast: Jen Gunderman-King, 596-4278
(Waldo, Knox, Lincoln, and Sagadahoc counties)
District 5 – Central Maine: Sue Lee, 592-5634
(Somerset and Kennebec counties)
District 6 – Penquis: Jessica Fogg starting September 8 (and Debra Roy in the interim) 592-5633 (phone for either)
(Penobscot and Piscataquis counties)
District 7 – Downeast: Al May starting September 8, 263-4975 (and Mary Jude in the interim, 287-5182)
(Washington and Hancock counties)
District 8 – Aroostook: Sharon Ramey (Interim until September 21), 592-5632
Tribal Vaccine Coordinator: Jerolyn Ireland, 532-2240, Ext. 15
Many resources for vaccination clinics have been posted on our Summit web site (http://www.maine.gov/dhhs/boh/maineflu/h1n1-summit.shtml) under the morning breakout for Organizers of Large-Scale Vaccine Clinics.
CDC has issued a vaccination campaign planning checklist: http://www.cdc.gov/H1N1flu/vaccination/statelocal/planning_checklist.htm
Seasonal Flu Vaccine:
H1N1 has been the focus of attention since the spring, but it is important that we do not forget the risks of seasonal flu. US CDC recommends that people at risk for the seasonal flu get vaccinated as soon as it is available. The protection you get from the vaccine will not wear off before the flu season is over.
The following groups are prioritized for seasonal flu vaccination:
Children ages 6 months to 18 years
Pregnant women
People 50 years of age and older
People of any age with certain chronic medical conditions
People who live in nursing homes and other long-term care facilities
People who live with or care for those at high risk for complications from flu, including:
Health care workers
Household contacts of persons at high risk for complications from the flu
Household contacts and out of home caregivers of children younger than 6 months old
The seasonal flu vaccine is not expected to specifically protect against H1N1. However, with H1N1 and seasonal flu viruses both expected to be circulating, getting a seasonal flu vaccine early will help a person’s overall protection against the flu. We anticipate that season flu and H1N1 vaccines may be administered on the same day. However, we expect seasonal flu vaccine to be available sooner than H1N1 vaccine, which we expect to arrive in the state in mid-October at the earliest. CDC recommends that people get vaccinated against seasonal flu as early as possible.
H1N1 Vaccine:
US CDC updated its Q&A on H1N1 vaccine to include guidance for those who were vaccinated against swine flu in 1976. The 1976 swine flu virus and the current H1N1 virus are different enough that it’s unlikely that a person vaccinated in 1976 will have full protection against H1N1, and therefore should still be given the H1N1 vaccine. (http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm)
This US CDC podcast discusses H1N1 flu vaccine and how to protect your family: http://www2a.cdc.gov/podcasts/player.asp?f=13958.
For most people, two doses of the H1N1 vaccine may be necessary for full protection against the virus. The exact timing between doses will not be known until further clinical trial data are available; however, US CDC anticipates that 21-28 days will be needed between the first and second doses.
The H1N1 vaccine is not intended to replace the seasonal flu vaccine – it is intended to be used in addition to seasonal flu vaccine to protect people. At this point in time, there is no evidence that vaccinations will be mandatory. US CDC recommends (http://www.cdc.gov/mmwr/pdf/rr/rr58e0821.pdf) that the following groups should be considered the highest priority to be offered the first available doses of vaccine:
Pregnant women, because they are at higher risk of complications – especially in the second and third trimesters – and can potentially provide protection to infants who cannot be vaccinated;
Household members and caregivers for children under 6 months old, because younger infants are at higher risk of complications and cannot be vaccinated;
Health care and emergency medical services personnel, because infections among health care workers have been reported and this can be a potential source of infection for patients;
All people ages 6 months through 24 years of age:
Children ages 6 months to 18 years, because there have been many cases of H1N1 in children and they are in close contact with each other in school and day care settings, which increases the chances of spreading disease;
Young adults ages 19 through 24, because there have been many cases of H1N1 in healthy young adults, and they often live, work, and study in close proximity, and they are a frequently mobile population;
People ages 25 through 64 who have health conditions associated with a higher risk of medical complications from the flu, including those with asthma, COPD, diabetes, chronic cardiovascular disease, and people with compromised immune systems.
CDC also issued a Q&A on H1N1 vaccine distribution: http://www.cdc.gov/H1N1flu/vaccination/statelocal/centralized_distribution_qa.htm
Good Health Habits Can Help Stop Germs
Prevention of H1N1 is most important, especially now that the virus is widespread in many parts of Maine. Covering coughs and sneezes with a tissue or sleeve, washing hands frequently, and staying home if ill with a fever are shared responsibilities of everyone in Maine, especially to protect people who are at higher risk for complications from H1N1 (http://www.cdc.gov/h1n1flu/vaccination/acip.htm).
Important Differences Between H1N1 and Seasonal Flu
The age groups affected by H1N1 are generally younger than those affected by the regular seasonal flu. This is true for those most frequently infected, and especially for those experiencing severe or fatal illness.
To date, most severe cases and deaths have occurred in adults younger than 50, with deaths in the elderly comparatively rare. In seasonal flu, around 90% of severe and fatal cases occur in people age 65 years or older.
Perhaps most significantly, clinicians from around the world are reporting a very severe form of disease, also in young and otherwise healthy people, which is rarely seen in seasonal flu infections. In these patients, the virus directly infects the lung, causing severe respiratory failure. Saving these lives depends on highly specialized and demanding care in intensive care units, usually with long and costly stays.
Advice from the World Health Organization
WHO has monitored outbreaks of H1N1 from different parts of the world to get a sense of how the flu pandemic will evolve in the next several months. WHO advises us to be prepared for a second wave of flu. (http://www.who.int/csr/disease/swineflu/notes/h1n1_second_wave_20090828/en/index.html)
H1N1 has quickly become the dominant type of flu in most parts of the world. Close monitoring by WHO has shown no signs that the virus has mutated, and the overwhelming majority of people with H1N1 continue to experience mild illness.
While these trends are encouraging, large numbers of people are still susceptible to infection.
Larger numbers of severely ill patients requiring intensive care are likely to be a burden on health services, possibly disrupting care for other diseases.
Only a handful of H1N1 viruses have been resistant to Tamiflu® worldwide, despite the administration of many millions of treatments with this drug. Intense monitoring of treatment-resistant flu continues.
H1N1 and Pregnant Women
An increased risk during pregnancy – especially in the second and third trimesters – has been consistently well-documented across countries. Pregnant women are prioritized for H1N1 vaccine because of this risk, and because they can potentially provide protection to infants who cannot be vaccinated.
H1N1 Vaccine Q&A for Pregnant Women (source: US CDC):
Q: Why does CDC recommend that pregnant women receive the 2009 H1N1 influenza vaccine?
A. It is important for a pregnant woman to receive the 2009 H1N1 influenza vaccine as well as a seasonal influenza vaccine. A pregnant woman who gets any type of flu is at risk for serious complications and hospitalization. Pregnant women who are otherwise healthy have been severely impacted by the 2009 H1N1 influenza virus (formerly called “novel H1N1 flu” or “swine flu”). In comparison to the general population, a greater proportion of pregnant women infected with the 2009 H1N1 influenza virus have been hospitalized. In addition, severe illness and death has occurred in pregnant women. Six percent of confirmed fatal 2009 H1N1 flu cases thus far have been in pregnant women while only about 1% of the general population is pregnant. While hand washing, staying away from ill people, and other steps can help to protect pregnant women from influenza, vaccination is the single best way to protect against the flu.
Q: Is there a particular kind of flu vaccine that pregnant women should get? Are there flu vaccines that pregnant women should not get?
A. There are two type of flu vaccine. Pregnant women should get the "flu shot"— an inactivated vaccine (containing fragments of killed influenza virus) that is given with a needle, usually in the arm. The flu shot is approved for use in pregnant women.
The other type of flu vaccine — nasal-spray flu vaccine (sometimes called LAIV for “live attenuated influenza vaccine)—is not currently approved for use in pregnant women. This vaccine is made with live, weakened flu viruses that do not cause the flu). LAIV (FluMist®) is approved for use in healthy* people 2-49 years of age who are not pregnant.
Q. Will the seasonal flu vaccine also protect against the 2009 H1N1 flu?
A. The seasonal flu vaccine is not expected to protect against the 2009 H1N1 flu. Similarly, the 2009 H1N1 influenza vaccine will not protect against seasonal influenza.
Q. Can the seasonal influenza vaccine and the 2009 H1N1 influenza vaccine be given at the same time?
A. It is anticipated that seasonal flu and 2009 H1N1 vaccines may be administered on the same day but given at different sites (e.g. one shot in the left arm and the other shot in the right arm). However, we expect the seasonal vaccine to be available earlier than the 2009 H1N1 influenza vaccine. The usual seasonal influenza viruses are still expected to cause illness this fall and winter. Pregnant women and others at increased risk of complications of influenza are encouraged to get their seasonal flu vaccine as soon as it is available.
Q: Is the 2009 H1N1 influenza vaccine safe for pregnant women?
A: Influenza vaccines have not been shown to cause harm to a pregnant women or her baby. The seasonal flu shot (injection) is proven as safe and already recommended for pregnant women. The 2009 H1N1 influenza vaccine will be made using the same processes and facilities that are used to make seasonal influenza vaccines.
Q: What safety studies have been done on the 2009 H1N1 influenza vaccine and have any been done in pregnant women?
A: A number of clinical trials which test 2009 H1N1 influenza vaccine in healthy children and adults are underway. These studies are being conducted by the National Institutes of Allergies and Infectious Diseases (NIAID). Studies of 2009 H1N1 influenza vaccine in pregnant women are expected to begin in September.
Q: Does the 2009 H1N1 influenza vaccine have preservative in it?
A: There is no evidence that thimerosal (used as a preservative in vaccine packaged in multi-dose vials) is harmful to a pregnant woman or a fetus. However, because some women are concerned about exposure to preservatives during pregnancy, manufacturers will produce preservative-free seasonal and 2009 H1N1 influenza vaccines in single dose syringes for pregnant women and small children. CDC recommends that pregnant women may receive influenza vaccine with or without thimerosal.
Q: Can the 2009 H1N1 influenza vaccine be given at any time during pregnancy?
A: Yes.
Q: How many 2009 H1N1 influenza vaccine shots will be needed?
A: Some people, including pregnant women, may need two doses. We will know more about the number of doses once data from the clinical trials are available.
Q. What will be the recommended interval between the first and second dose if two doses are needed?
A. This will not be known until clinical trial data are available. We anticipate that 21-28 days will be needed between the first and second doses.
Q: Should the 2009 H1N1 influenza vaccine be given to someone who has had an influenza- like illness since between April and now? Do I need a test to know if I need the vaccine or not?
A. There is no test that can show whether a person had 2009 H1N1 influenza in the past. Many different infections, including influenza, can cause influenza-like symptoms such as cough, sore throat and fever. In addition, infection with one strain of influenza virus will not provide protection against other strains. People for whom influenza vaccine is recommended should receive the 2009 H1N1 vaccine, even if they had an influenza-like illness previously. It is not necessary to test a person who previously had an influenza-like illness. People for whom the 2009 H1N1 influenza vaccine is recommended should receive it, even if they have had an influenza-like illness previously, unless they can be certain they had 2009 H1N1 influenza based on a laboratory test that can specifically detect 2009 H1N1 viruses. CDC recommends that persons who were tested for 2009 H1N1 influenza discuss this issue with a healthcare provider to see if the test they had was either an RT-PCR or a viral culture that showed 2009 H1N1 influenza. There is no harm in being vaccinated if you had 2009 H1N1 influenza in the past.
Q: What are the possible side effects of the 2009 H1N1 influenza vaccine?
A. The side effects from 2009 H1N1 influenza vaccine are expected to be similar to those from seasonal flu vaccines. The most common side effects following vaccination are expected to be mild, such as soreness, redness, tenderness or swelling where the shot was given. Some people might experience headache, muscle aches, fever, nausea and fainting. If these problems occur, they usually begin soon after the shot and may last as long as 1-2 days. Like any medicines, vaccines can cause serious problems like severe allergic reactions. However life-threatening allergic reactions to vaccines are very rare. In 1976, an earlier type of swine flu vaccine was associated with cases of a severe paralytic illness called Guillain-Barre Syndrome (GBS) at a rate of approximately 1 case of GBS per 100,000 persons vaccinated. Some studies done since 1976 have shown a small risk of GBS in persons who received the seasonal influenza vaccine. This risk is estimated to be no more than 1 case of GBS per 1 million persons vaccinated. Since then, flu vaccines have not been clearly linked to GBS. GBS has a number of different causes, and GBS can occur in a person who has never received an influenza vaccine. The potential benefits of influenza vaccination in preventing serious illness, hospitalization, and death substantially outweigh these estimates of risk for vaccine-associated GBS.
Anyone who has a severe (life-threatening) allergy to eggs or to any other substance in the vaccine should not get the vaccine. People should always inform their immunization provider if they have any severe allergies, if they’ve ever had a severe allergic reaction following flu vaccination, or if they have ever had GBS.
Q. Can the family members of a pregnant woman receive the nasal spray vaccine?
A. Pregnant women should not receive the live nasal spray influenza vaccine but family and household members and other close contacts of pregnant women (including healthcare personnel) who are 2 through 49 years old, healthy* and not pregnant may receive live nasal spray vaccine.
Q. Can a pregnant healthcare worker administer the live nasal influenza vaccine?
A. Yes. No special precautions are (such as gloves) are necessary. Hands should be washed or cleaned with waterless hand sanitizer before and after administering the vaccine or having any direct contact with patients in a health care setting.
H1N1 Vaccine Q&A for Health Care Providers Who Treat Pregnant Women:
Q. Where can healthcare providers obtain 2009 H1N1 influenza vaccine?
A. Please visit our H1N1 vaccination web site for more information: http://www.maine.gov/dhhs/boh/maineflu/h1n1-vaccine.shtml
Q. How will healthcare providers obtain other supplies necessary for vaccination?
A. The vaccine will be distributed with a kit which will contain needles, syringes, sharps containers and alcohol swabs.
Q. How much does the vaccine cost?
A. The vaccine will be provided free; however, healthcare providers may bill for vaccine administration.
Q. If a pregnant woman delivers before receiving her second dose of vaccine, should she still receive the second dose?
A. Yes. In addition to protecting her from infection, infants less than 6 months old will not be able to be vaccinated so it is recommended that everyone who lives with or provides care for infants less than 6 months of age receive both the seasonal influenza vaccine and 2009 H1N1 influenza monovalent vaccine to provide protection for the infant. One recent study conducted in Bangladesh, assessed the effectiveness of influenza immunization for mothers and their young infants. Inactivated influenza vaccine reduced proven influenza illness by 63% in infants up to 6 months of age. This study confirmed that maternal influenza immunization is a strategy with substantial benefits for both mothers and infants.
Q. Where can healthcare providers get more information about the 2009 H1N1 influenza vaccine?
A. Information is continually updated at http://www.cdc.gov/h1n1flu/vaccination/
Vulnerable Groups
Data continue to show that certain medical conditions increase the risk of severe and fatal illness (http://www.cdc.gov/h1n1flu/vaccination/acip.htm). These include respiratory disease, notably asthma, cardiovascular disease, diabetes and immunosuppression.
Several early studies show a higher risk of hospitalization and death among certain subgroups, including minority groups and indigenous populations. In some studies, the risk in these groups is four to five times higher than in the general population. (http://www.who.int/csr/disease/swineflu/notes/h1n1_second_wave_20090828/en/index.html)
Early data from two countries suggest that people co-infected with H1N1 and HIV are not at increased risk of severe or fatal illness, provided these patients are receiving antiretroviral therapy. In most of these patients, illness caused by H1N1 has been mild, with full recovery. (http://www.who.int/csr/disease/swineflu/notes/h1n1_second_wave_20090828/en/index.html)
Other New or Recently Updated H1N1 Guidance or News
This MMWR report (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5833a1.htm) summarizes laboratory-confirmed cases of H1N1 identified between April and July in Chicago, Illinois, and provides clinical and epidemiologic data for a subset of those cases. The study found that the attack rate was highest among children ages 5-14, and 14 times higher than for adults 60 and older. The highest hospitalization rates were among children up to age 4, followed by children 5- to 14-years-old.
This MMWR report (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5833a2.htm) describes a study of seasonal flu and H1N1 in New Zealand, which determined that H1N1 quickly took over the number of cases identified as seasonal flu. Similarly, early results from a study of flu in ferrets (http://www.nih.gov/news/health/aug2009/niaid-31.htm) indicates that H1N1 probably will dominate over seasonal flu in the coming flu season, and that H1N1 caused more severe disease.
Community Flu 1.0 software to calculate the cost, in terms of workdays lost, of influenza and the associated interventions: http://www.cdc.gov/flu/tools/communityflu/
FluLabSurge1.0 software to assist lab directors forecast the demand for testing: http://www.cdc.gov/flu/tools/flulabsurge/
US CDC listed its public health emergency response projects related to H1N1: http://www.cdc.gov/h1n1flu/responseprojects.htm.
The US Department of Health and Human Services, Department of Homeland Security, Department of Education, and Sesame Workshop have launched a new advertising campaign designed to encourage children and families to practice healthy habits and to take steps to prevent the spread of the 2009 H1N1 flu virus. The PSAs featured in this campaign can be viewed on http://www.flu.gov/.
How to Stay Updated
Weekly Updates: Check the Wednesday late afternoon updates on H1N1 in Maine on Maine CDC’s H1N1 website. Now available as an RSS feed (midway down the center of the homepage): http://www.maineflu.gov/
Health Alert Network: Sign up to receive urgent updates from Maine CDC’s Health Alert Network (HAN). The easiest and quickest way is to sign up is through the HAN Alert RSS feed at http://www.mainepublichealth.gov/ (midway down the center of the homepage).
Follow Maine CDC’s Updates:
Facebook (search for “Maine CDC”)
Twitter (http://twitter.com/MEPublicHealth)
MySpace (www.myspace.com/mainepublichealth)
Maine CDC’s Blog (http://mainepublichealth.blogspot.com/)
H1N1 Conference Calls: September 14th for schools and health care providers involved with the school-located seasonal and H1N1 vaccine efforts and September 17th for clinicians who care for pregnant women. Calls are 12 noon – 1 pm. Phone Number for Both Calls: 1-800-914-3396 and passcode 473623.
Consider Calling or Emailing Us:
For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
General Public Call-in Number for Questions: 1-888-257-0990NextTalk (deaf/hard of hearing) - (207) 629-5751Monday - Friday 9 a.m. – 5 p.m.
Email your questions to: Sue.Dowdy@maine.gov
U.S. CDC H1N1 Recommendations and Guidance:
http://www.cdc.gov/h1n1flu/ and http://www.flu.gov/
Saturday, August 29, 2009
Why Are Non-EMS First Responders Not On the H1N1 Vaccine High Priority List - From Dora
Another common question we're getting is why non-EMS first responders are not on the list of high priority populations for the H1N1 vaccine when it first arrives.
The list of high priority groups for H1N1 vaccine when it first arrives was developed based on the epidemiology of H1N1 in the United States, and is a list of those who have been shown to be at highest risk for complications from H1N1 or transmitting it to those at high risk. Health care workers, especially those with direct patient contact in hospitals, as well as EMS personnel, have been shown to be contracting H1N1 from patients as well as, most importantly, transmitting it to their patients who are at high risk for complications. For these reasons, they are on the list, along with pregnant women, everyone 6 months to 25 years of age, caregivers of those under 6 months of age, and those 25 – 65 years of age with underlying conditions.
Certainly, if non-EMS first responders fit into one of these other categories (such as being pregnant or having an underlying condition and being 25 – 65, etc), then we want them to be vaccinated in the first round.
We fully expect the H1N1 vaccine to be offered to everyone eventually. However, since it will be coming into the state in shipments, the US CDC has asked that we prioritize the vaccine during the first few weeks in those first shipments to those whom they define, through the epidemiology, as being at highest risk for complications and/or transmitting it to others.
I realize this prioritization will also result in some predicaments. For instance, I am not in a high-risk category, yet my children are. So, while I hope my children will be vaccinated in school during those first few weeks of the vaccine being available, I do not plan on getting the H1N1 vaccine until a few weeks later, when we expect there to be sufficient supplies for everyone. Likewise, a number of teachers will not be offered the vaccine for a few weeks, but the students they teach will.
Meanwhile, the seasonal (regular) flu vaccine will be available very shortly, and all first responders and others can obtain that vaccine, and we recommend they do so in September.
I hope this explanation helps. Dora
The list of high priority groups for H1N1 vaccine when it first arrives was developed based on the epidemiology of H1N1 in the United States, and is a list of those who have been shown to be at highest risk for complications from H1N1 or transmitting it to those at high risk. Health care workers, especially those with direct patient contact in hospitals, as well as EMS personnel, have been shown to be contracting H1N1 from patients as well as, most importantly, transmitting it to their patients who are at high risk for complications. For these reasons, they are on the list, along with pregnant women, everyone 6 months to 25 years of age, caregivers of those under 6 months of age, and those 25 – 65 years of age with underlying conditions.
Certainly, if non-EMS first responders fit into one of these other categories (such as being pregnant or having an underlying condition and being 25 – 65, etc), then we want them to be vaccinated in the first round.
We fully expect the H1N1 vaccine to be offered to everyone eventually. However, since it will be coming into the state in shipments, the US CDC has asked that we prioritize the vaccine during the first few weeks in those first shipments to those whom they define, through the epidemiology, as being at highest risk for complications and/or transmitting it to others.
I realize this prioritization will also result in some predicaments. For instance, I am not in a high-risk category, yet my children are. So, while I hope my children will be vaccinated in school during those first few weeks of the vaccine being available, I do not plan on getting the H1N1 vaccine until a few weeks later, when we expect there to be sufficient supplies for everyone. Likewise, a number of teachers will not be offered the vaccine for a few weeks, but the students they teach will.
Meanwhile, the seasonal (regular) flu vaccine will be available very shortly, and all first responders and others can obtain that vaccine, and we recommend they do so in September.
I hope this explanation helps. Dora
H1N1 Vaccine For Seniors? From Dora
One of the most common question we're getting right now on H1N1 is from seniors who are concerned that they are not seeing themselves in the US CDC's high priority list for H1N1 vaccine. Here is how I've been answering this:
Most importantly, seniors (those over 64) are at risk for complications from seasonal influenza, and the vaccine for that is expected very soon. Seniors should arrange to have their regular (seasonal) flu shot very soon - preferably in September.
The H1N1 vaccine is expected to start arriving in mid-October. We anticipate that it will become available for everyone. However, since it will be arriving in shipments, US CDC has asked that the first few shipments be prioritized to those who are most commonly being severely affected by H1N1 infection such as pregnant women, children, nurses who work in hospitals, and EMS. Studies indicate that those over 64 seem to have some immunity to H1N1, which is probably why they are not being as commonly severely affected by the infection as young people are.
In Maine, we are planning a major focus on getting the first few shipments of vaccine to clinicians who care for pregnant women, schools, and hospitals. It is a Herculian effort to assure that those at high risk have access to the vaccine as well as to assure that everyone does eventually, but by working with many partners across the state - schools, home health organizations, health care systems and providers, emergency management, community organizations - I believe we can do this and do it well.
Thank you to all those who are assisting in this effort across the state! Dora
Dora Anne Mills, MD, MPH, FAAP
Most importantly, seniors (those over 64) are at risk for complications from seasonal influenza, and the vaccine for that is expected very soon. Seniors should arrange to have their regular (seasonal) flu shot very soon - preferably in September.
The H1N1 vaccine is expected to start arriving in mid-October. We anticipate that it will become available for everyone. However, since it will be arriving in shipments, US CDC has asked that the first few shipments be prioritized to those who are most commonly being severely affected by H1N1 infection such as pregnant women, children, nurses who work in hospitals, and EMS. Studies indicate that those over 64 seem to have some immunity to H1N1, which is probably why they are not being as commonly severely affected by the infection as young people are.
In Maine, we are planning a major focus on getting the first few shipments of vaccine to clinicians who care for pregnant women, schools, and hospitals. It is a Herculian effort to assure that those at high risk have access to the vaccine as well as to assure that everyone does eventually, but by working with many partners across the state - schools, home health organizations, health care systems and providers, emergency management, community organizations - I believe we can do this and do it well.
Thank you to all those who are assisting in this effort across the state! Dora
Dora Anne Mills, MD, MPH, FAAP
Wednesday, August 26, 2009
Weekly Update on H1N1 in Maine 08/26/09
Tracking Updates
On Friday, Aug. 21, US CDC reported 7,983 hospitalizations and 522 deaths nationwide from H1N1. As of Aug. 13, the World Health Organization reported 1,799 deaths from H1N1.
Maine has identified 360 cases of H1N1, which include 19 individuals requiring hospitalization and one individual who has died. Of Maine residents with H1N1, 60 percent have been under 25 years of age. The number of cases is only a barometer of community transmission, not of actual case counts, because not all people with infection are tested.
Good Health Habits Can Help Stop Germs
Prevention of H1N1 is most important, especially now that the virus is widespread in many parts of Maine. Covering coughs and sneezes with a tissue or sleeve, washing hands frequently, and staying home if ill with a fever are shared responsibilities of everyone in Maine, especially to protect people who are at higher risk for complications from H1N1 (http://www.cdc.gov/h1n1flu/vaccination/acip.htm).
H1N1 Preparedness Summit
Maine CDC/DHHS, Maine Emergency Management Agency, Maine Department of Education, and Maine EMS co-sponsored an H1N1 Preparedness Summit Aug. 20 at the Augusta Civic Center. With more than 1,400 in attendance, we believe this was the largest public health conference in Maine. Several presentations and handouts from the Summit are posted online, with additional materials coming soon. To access these materials, visit: http://www.maine.gov/dhhs/boh/maineflu/h1n1-summit.shtml.
Boston held an H1N1 Preparedness Summit on Aug. 21. Their materials can be found at: www.bphc.org/programs/infectiousdisease/infectiousdiseasesatoz/influenza/flusummit/Pages/Home.aspx
Vaccination
Seasonal Flu Vaccine:
US CDC recommends that all children ages 6 months to 18 years, as well as others in high-risk groups for seasonal flu, be vaccinated against this year. Vaccination for seasonal flu should begin in September, or as soon as seasonal flu vaccine is available, and continue through the flu season. (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0724a1.htm?s_cid=rr58e0724a1_e)
The seasonal flu vaccine is not expected to specifically protect against H1N1. However, with H1N1 and seasonal flu viruses both expected to be circulating, getting a seasonal flu vaccine early will help a person’s overall protection against the flu. Maine CDC expects H1N1 vaccine to arrive in the state in mid-October at the earliest.
H1N1 Vaccine:
The H1N1 vaccine is not intended to replace the seasonal flu vaccine – it is intended to be used in addition to seasonal flu vaccine to protect people. At this point in time, there is no evidence that vaccinations will be mandatory. US CDC issued its recommendations regarding the use of H1N1 vaccine (http://www.cdc.gov/mmwr/pdf/rr/rr58e0821.pdf), which reiterates the groups that should be considered the highest priority to be offered the first available doses of vaccine. They are:
Pregnant women, because they are at higher risk of complications – especially in the second and third trimesters – and can potentially provide protection to infants who cannot be vaccinated;
Household members and caregivers for children under 6 months old, because younger infants are at higher risk of complications and cannot be vaccinated;
Health care and emergency medical services personnel, because infections among health care workers have been reported and this can be a potential source of infection for patients;
All people ages 6 months through 24 years of age:
Children ages 6 months to 18 years, because there have been many cases of H1N1 in children and they are in close contact with each other in school and day care settings, which increases the chances of spreading disease;
Young adults ages 19 through 24, because there have been many cases of H1N1 in healthy young adults, and they often live, work, and study in close proximity, and they are a frequently mobile population;
People ages 25 through 64 who have health conditions associated with a higher risk of medical complications from the flu, including those with asthma, COPD, diabetes, chronic cardiovascular disease, and people with compromised immune systems.
Vaccine Coordinators have been appointed for each Public Health District in Maine. Vaccine Coordinators will be one component of district leadership teams, which also include staff from the three Regional Resource Centers for Public Health Emergency Preparedness, and Emergency Management Agencies. These Vaccine Coordinators will be following up on discussions had at the Summit to plan for local vaccine distribution, and ensuring that people in the groups prioritized by US CDC (see below) are offered vaccine.
These Vaccine Coordinators are:
District 1 – York: Sharon Leahy-Lind, 490-4625
District 2 – Cumberland: Meredith Tipton (Interim), 592-5631
District 3 – Western Maine: MaryAnn Amrich, 753-9103
(Franklin, Oxford, and Androscoggin counties)
District 4 – Mid Coast: Jen Gunderman-King, 596-4278
(Waldo, Knox, Lincoln, and Sagadahoc counties)
District 5 – Central Maine: Sue Lee, 592-5634
(Somerset and Kennebec counties)
District 6 – Penquis: Debra Roy (Interim), 592-5633
(Penobscot and Piscataquis counties)
District 7 – Downeast: Mary Jude (Interim), 287-5182
(Washington and Hancock counties)
District 8 – Aroostook: Sharon Ramey (Interim), 592-5632
Tribal Vaccine Coordinator: Jerolyn Ireland, 532-2240, Ext. 15
Many resources for vaccination clinics have been posted on our Summit web site (http://www.maine.gov/dhhs/boh/maineflu/h1n1-summit.shtml) under the morning breakout for Organizers of Large-Scale Vaccine Clinics.
Guidance for Educators and Educational Settings
Continuity of Learning:
Recommendations for the continuity of learning during school dismissals were issued by the Department of Education in collaboration with US CDC. These recommendations can be found at: http://www.ed.gov/admins/lead/safety/emergencyplan/pandemic/index.html
Institutions of Higher Education:
US CDC issued new guidance (http://www.flu.gov/plan/school/higheredguidance.html) that recommends actions that Institutions of Higher Education during the 2009-2010 academic year to decrease the spread of flu. The guidance includes additional strategies to use if flu conditions become more severe. The guidance in this document may change as additional information about the severity of the flu season and the impact of H1N1 become known. Detailed information on the reasons for these strategies and suggestions on how to use them is included in this report: http://www.flu.gov/plan/school/higheredtechreport.html.
A communications tool kit, including fact sheets, Q&As, sample letters, and posters is available at: http://www.flu.gov/plan/school/higheredtoolkit.html
All Residential Schools:
Updated guidance for Maine Residential Schools was issued Aug. 24 and can be found at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/H1N1-Maine-Residential-School-Guidance-08-24-09.doc
Information and resources for Maine educators and school administrators is posted at: http://www.maine.gov/dhhs/boh/maineflu/swine-flu-2009-provider.shtml
Other New or Recently Updated H1N1 Guidance or News
The World Health Organization issued guidance for medical providers regarding the prescribing of anti-virals to treat H1N1:
http://www.who.int/csr/resources/publications/swineflu/h1n1_use_antivirals_20090820/en/index.html
How to Stay Updated
Weekly Updates: Check the Wednesday late afternoon updates on H1N1 in Maine on Maine CDC’s H1N1 website: http://www.maineflu.gov//
Health Alert Network: Sign up to receive urgent updates from Maine CDC’s Health Alert Network (HAN). The easiest and quickest way is to sign up is through the HAN Alert RSS feed at http://www.mainepublichealth.gov/ (midway down the center of the homepage).
Follow Maine CDC’s Updates:
Facebook (search for “Maine CDC”)
Twitter (http://twitter.com/MEPublicHealth)
MySpace (www.myspace.com/mainepublichealth)
Maine CDC’s Blog (http://mainepublichealth.blogspot.com/)
H1N1 Conference Calls: Maine CDC will be holding conference calls on a variety of topics related to H1N1 over the coming weeks. Conference calls will resume after Labor Day. Check Wednesday Weekly Updates for schedule of topics and call-in information.
Consider Calling or Emailing Us:
For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
General Public Call-in Number for Questions: 1-888-257-0990NextTalk (deaf/hard of hearing) - (207) 629-5751Monday - Friday 9 a.m. – 5 p.m.
Email your questions to: Sue.Dowdy@maine.gov
U.S. CDC H1N1 Recommendations and Guidance:
http://www.cdc.gov/h1n1flu/ and http://www.flu.gov/
Maine CDC H1N1 Website and Related Links:
http://www.maineflu.gov/
On Friday, Aug. 21, US CDC reported 7,983 hospitalizations and 522 deaths nationwide from H1N1. As of Aug. 13, the World Health Organization reported 1,799 deaths from H1N1.
Maine has identified 360 cases of H1N1, which include 19 individuals requiring hospitalization and one individual who has died. Of Maine residents with H1N1, 60 percent have been under 25 years of age. The number of cases is only a barometer of community transmission, not of actual case counts, because not all people with infection are tested.
Good Health Habits Can Help Stop Germs
Prevention of H1N1 is most important, especially now that the virus is widespread in many parts of Maine. Covering coughs and sneezes with a tissue or sleeve, washing hands frequently, and staying home if ill with a fever are shared responsibilities of everyone in Maine, especially to protect people who are at higher risk for complications from H1N1 (http://www.cdc.gov/h1n1flu/vaccination/acip.htm).
H1N1 Preparedness Summit
Maine CDC/DHHS, Maine Emergency Management Agency, Maine Department of Education, and Maine EMS co-sponsored an H1N1 Preparedness Summit Aug. 20 at the Augusta Civic Center. With more than 1,400 in attendance, we believe this was the largest public health conference in Maine. Several presentations and handouts from the Summit are posted online, with additional materials coming soon. To access these materials, visit: http://www.maine.gov/dhhs/boh/maineflu/h1n1-summit.shtml.
Boston held an H1N1 Preparedness Summit on Aug. 21. Their materials can be found at: www.bphc.org/programs/infectiousdisease/infectiousdiseasesatoz/influenza/flusummit/Pages/Home.aspx
Vaccination
Seasonal Flu Vaccine:
US CDC recommends that all children ages 6 months to 18 years, as well as others in high-risk groups for seasonal flu, be vaccinated against this year. Vaccination for seasonal flu should begin in September, or as soon as seasonal flu vaccine is available, and continue through the flu season. (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0724a1.htm?s_cid=rr58e0724a1_e)
The seasonal flu vaccine is not expected to specifically protect against H1N1. However, with H1N1 and seasonal flu viruses both expected to be circulating, getting a seasonal flu vaccine early will help a person’s overall protection against the flu. Maine CDC expects H1N1 vaccine to arrive in the state in mid-October at the earliest.
H1N1 Vaccine:
The H1N1 vaccine is not intended to replace the seasonal flu vaccine – it is intended to be used in addition to seasonal flu vaccine to protect people. At this point in time, there is no evidence that vaccinations will be mandatory. US CDC issued its recommendations regarding the use of H1N1 vaccine (http://www.cdc.gov/mmwr/pdf/rr/rr58e0821.pdf), which reiterates the groups that should be considered the highest priority to be offered the first available doses of vaccine. They are:
Pregnant women, because they are at higher risk of complications – especially in the second and third trimesters – and can potentially provide protection to infants who cannot be vaccinated;
Household members and caregivers for children under 6 months old, because younger infants are at higher risk of complications and cannot be vaccinated;
Health care and emergency medical services personnel, because infections among health care workers have been reported and this can be a potential source of infection for patients;
All people ages 6 months through 24 years of age:
Children ages 6 months to 18 years, because there have been many cases of H1N1 in children and they are in close contact with each other in school and day care settings, which increases the chances of spreading disease;
Young adults ages 19 through 24, because there have been many cases of H1N1 in healthy young adults, and they often live, work, and study in close proximity, and they are a frequently mobile population;
People ages 25 through 64 who have health conditions associated with a higher risk of medical complications from the flu, including those with asthma, COPD, diabetes, chronic cardiovascular disease, and people with compromised immune systems.
Vaccine Coordinators have been appointed for each Public Health District in Maine. Vaccine Coordinators will be one component of district leadership teams, which also include staff from the three Regional Resource Centers for Public Health Emergency Preparedness, and Emergency Management Agencies. These Vaccine Coordinators will be following up on discussions had at the Summit to plan for local vaccine distribution, and ensuring that people in the groups prioritized by US CDC (see below) are offered vaccine.
These Vaccine Coordinators are:
District 1 – York: Sharon Leahy-Lind, 490-4625
District 2 – Cumberland: Meredith Tipton (Interim), 592-5631
District 3 – Western Maine: MaryAnn Amrich, 753-9103
(Franklin, Oxford, and Androscoggin counties)
District 4 – Mid Coast: Jen Gunderman-King, 596-4278
(Waldo, Knox, Lincoln, and Sagadahoc counties)
District 5 – Central Maine: Sue Lee, 592-5634
(Somerset and Kennebec counties)
District 6 – Penquis: Debra Roy (Interim), 592-5633
(Penobscot and Piscataquis counties)
District 7 – Downeast: Mary Jude (Interim), 287-5182
(Washington and Hancock counties)
District 8 – Aroostook: Sharon Ramey (Interim), 592-5632
Tribal Vaccine Coordinator: Jerolyn Ireland, 532-2240, Ext. 15
Many resources for vaccination clinics have been posted on our Summit web site (http://www.maine.gov/dhhs/boh/maineflu/h1n1-summit.shtml) under the morning breakout for Organizers of Large-Scale Vaccine Clinics.
Guidance for Educators and Educational Settings
Continuity of Learning:
Recommendations for the continuity of learning during school dismissals were issued by the Department of Education in collaboration with US CDC. These recommendations can be found at: http://www.ed.gov/admins/lead/safety/emergencyplan/pandemic/index.html
Institutions of Higher Education:
US CDC issued new guidance (http://www.flu.gov/plan/school/higheredguidance.html) that recommends actions that Institutions of Higher Education during the 2009-2010 academic year to decrease the spread of flu. The guidance includes additional strategies to use if flu conditions become more severe. The guidance in this document may change as additional information about the severity of the flu season and the impact of H1N1 become known. Detailed information on the reasons for these strategies and suggestions on how to use them is included in this report: http://www.flu.gov/plan/school/higheredtechreport.html.
A communications tool kit, including fact sheets, Q&As, sample letters, and posters is available at: http://www.flu.gov/plan/school/higheredtoolkit.html
All Residential Schools:
Updated guidance for Maine Residential Schools was issued Aug. 24 and can be found at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/H1N1-Maine-Residential-School-Guidance-08-24-09.doc
Information and resources for Maine educators and school administrators is posted at: http://www.maine.gov/dhhs/boh/maineflu/swine-flu-2009-provider.shtml
Other New or Recently Updated H1N1 Guidance or News
The World Health Organization issued guidance for medical providers regarding the prescribing of anti-virals to treat H1N1:
http://www.who.int/csr/resources/publications/swineflu/h1n1_use_antivirals_20090820/en/index.html
How to Stay Updated
Weekly Updates: Check the Wednesday late afternoon updates on H1N1 in Maine on Maine CDC’s H1N1 website: http://www.maineflu.gov//
Health Alert Network: Sign up to receive urgent updates from Maine CDC’s Health Alert Network (HAN). The easiest and quickest way is to sign up is through the HAN Alert RSS feed at http://www.mainepublichealth.gov/ (midway down the center of the homepage).
Follow Maine CDC’s Updates:
Facebook (search for “Maine CDC”)
Twitter (http://twitter.com/MEPublicHealth)
MySpace (www.myspace.com/mainepublichealth)
Maine CDC’s Blog (http://mainepublichealth.blogspot.com/)
H1N1 Conference Calls: Maine CDC will be holding conference calls on a variety of topics related to H1N1 over the coming weeks. Conference calls will resume after Labor Day. Check Wednesday Weekly Updates for schedule of topics and call-in information.
Consider Calling or Emailing Us:
For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
General Public Call-in Number for Questions: 1-888-257-0990NextTalk (deaf/hard of hearing) - (207) 629-5751Monday - Friday 9 a.m. – 5 p.m.
Email your questions to: Sue.Dowdy@maine.gov
U.S. CDC H1N1 Recommendations and Guidance:
http://www.cdc.gov/h1n1flu/ and http://www.flu.gov/
Maine CDC H1N1 Website and Related Links:
http://www.maineflu.gov/
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