Epidemiologic Trends
A total of 20 cases have been identified since the last update, for a total of 302 confirmed and probable cases to date. Most of the cases continue to be in the southern half of the state. The number of cases is only a barometer of community transmission, not of actual case counts. US CDC and WHO are no longer providing case numbers, since increasingly the numbers of those tested are a significant underestimate of those with the infection.
Three summer camps have reported at least one confirmed case of H1N1 in the last week. All camps reporting outbreaks have been able to remain open and isolate ill children following US CDC recommendations (http://www.cdc.gov/h1n1flu/sick.htm). Many camps are starting their second sessions and having visiting days, so prevention and screening efforts have increased.
Massachusetts, which has had more cases of H1N1 than Maine and therefore more data, has a hospitalization rate of about 12%, which is close to the national rate for H1N1 of 11%. This is significantly higher than the hospitalization rate for seasonal influenza, which is about 1%. Seasonal influenza is most serious in those 65 and older, while the average age for those most seriously ill with H1N1 in MA is 14. Out of the 5 deaths in MA, 3 had underlying conditions and 2 did not.
Since the southern hemisphere is in its seasonal influenza (winter) season, with both H1N1 and seasonal influenza strains circulating, the situation there is being monitored carefully as a barometer of our upcoming fall/winter seasonal influenza season. Viral isolates from the southern hemisphere have not indicated any significant genetic changes thus far in H1N1, and the profile of those encountering serious illness with H1N1 there is the same as is seen in the U.S. Some countries are seeing strains on the health care systems and some have closed schools, providing strong evidence that the U.S. should move forward with H1N1 vaccine.
Respiratory Etiquette
Prevention of H1N1 is most important, especially now that the virus is becoming more widespread in Maine. Respiratory etiquette (covering coughs and sneezes with a sleeve or tissue, washing hands frequently, and staying home if ill with a fever) is a shared responsibility of everyone in Maine, especially to protect people who are at higher risk for complications from H1N1. Those at higher risk for complications from H1N1 should take extra precautions (see CDC Information for Specific Groups: http://www.cdc.gov/h1n1flu/groups.htm
and Maine CDC’s H1N1 website at http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml).
Vaccination
Maine CDC is working with a number of statewide partners to plan for large scale vaccine campaigns this fall. The first is a school-located seasonal influenza vaccine campaign. The FDA has approved the vaccine for 2009-2010 seasonal influenza (http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm172772.htm).
The Advisory Committee on Immunization Practices (ACIP) has released recommendations for seasonal influenza vaccine, including that all children ages 6 months to 18 years be vaccinated against seasonal influenza, and that vaccination efforts should begin as soon as vaccine is available and continue through the influenza season. (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0724a1.htm?s_cid=rr58e0724a1_e)
Maine CDC staff continues to meet weekly to plan for the possible arrival of H1N1 vaccine later in the fall, which may be a two-dose vaccine a month apart. US CDC has updated its Q&A on H1N1 vaccine (http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm). Clinical trials for the H1N1 vaccine are starting soon (http://www.nih.gov/news/health/jul2009/niaid-22.htm).
H1N1 Summit planned for August 20
Maine CDC continues to work closely with high-risk settings and organizations on preparing for a possible escalation of H1N1 in the fall, especially as schools reconvene and transmission is then expected to pick up. Maine CDC/DHHS, Maine Emergency Management Agency, and Maine Department of Education are co-sponsoring an H1N1 Influenza Preparedness Summit 8 a.m. to 4 p.m. Aug. 20 at the Augusta Civic Center, 76 Community Drive.
A $15 registration fee is required, with scholarships by request. For more information, contact MCD Meeting Services at conferences@mcd.org or 207-622-7566, ext 232. To register online: http://www.mcdregistration.org/signup.asp?ID=172
H1N1 Vaccine Q&A (source: US CDC)
Q. What are the plans for developing novel H1N1 vaccine?
A. Vaccines are the most powerful public health tool for control of influenza, and the U.S. government is working closely with manufacturers to take steps in the process to manufacture a novel H1N1 vaccine. Working together with scientists in the public and private sector, CDC has isolated the new H1N1 virus and modified the virus so that it can be used to make hundreds of millions of doses of vaccine. Vaccine manufacturers are now using these materials to begin vaccine production. Making vaccine is a multi-step process which takes several months to complete. Candidate vaccines will be tested in clinical trials over the few months.
Q. When is it expected that the novel H1N1 vaccine will be available?
A. The novel H1N1 vaccine is expected to be available in the fall. More specific dates cannot be provided at this time as vaccine availability depends on several factors including manufacturing time and time needed to conduct clinical trials
Q. Will the seasonal flu vaccine also protect against the novel H1N1 flu?
A. The seasonal flu vaccine is not expected to protect against the novel H1N1 flu.
Q. Can the seasonal vaccine and the novel H1N1 vaccine be given at the same time?
A. Clinical trial results will be necessary to confirm that novel H1N1 and seasonal vaccine will be safe and effective if given at the same time. We expect the seasonal vaccine to be available earlier than the H1N1 vaccine. The usual seasonal influenza viruses are still expected to cause illness this fall and winter. Individuals are encouraged to get their seasonal flu vaccine as soon as it is available.
Q. Who will be recommended as priority groups to receive the novel H1N1 vaccine?
A. Based on what we're currently seeing with respect to the virus and epidemiologic data, states, communities, and health care providers should begin planning strategies for how they will vaccinate younger people (children and younger adults), pregnant women, healthcare personnel, and people who have underlying health conditions. The Advisory Committee on Immunization Practices (ACIP) and other federal advisory bodies will continue to monitor the virus and review epidemiologic data over the summer. We'll be looking to the ACIP and other stakeholders, as well as the public, as we move forward in our planning. It is possible that vaccine priority groups will differ from earlier guidance as more data becomes available however it's very important for planning to continue based on information currently available.
Q. Where will the vaccine be available?
A. Every state is developing a vaccine delivery plan. Vaccine will be available in a combination of settings such as vaccination clinics organized by local health departments, healthcare provider offices, schools, and other private settings, such as pharmacies and workplaces.
Q. Are there other ways to prevent the spread of illness?
A. Take everyday actions to stay healthy.
· Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
· Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
· Avoid touching your eyes, nose or mouth. Germs spread that way.
· Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.
Follow public health advice regarding school closures, avoiding crowds and other social distancing measures. These measures will continue to be important after a novel H1N1 vaccine is available because they can prevent the spread of other viruses that cause respiratory infections.
Q. What about the use of antivirals to treat novel H1N1 infection?
A. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. This fall, antivirals may be prioritized for persons with severe illness or those at higher risk for flu complications.
Neurologic Complications Associated with H1N1 Infection in Children
This US CDC MMWR report describes the clinical findings related to four children in Dallas, Texas, who experienced neurological complications associated with influenza A (H1N1) virus infection in May. All four patients recovered fully. These findings indicate that, as with seasonal influenza, neurologic complications can occur after respiratory tract infection with novel influenza A (H1N1) virus.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5828a2.htm?s_cid=mm5828a2_e
Other New or Recently Updated US CDC H1N1 Guidance or News
Interim Guidance for People who have Close Contact with Pigs in Non-commercial Settings
http://www.cdc.gov/h1n1flu/guidelines_pig_workers.htm
H1N1 Monitoring Questions and Answers
http://www.cdc.gov/h1n1flu/reportingqa.htm
For more information
U.S. CDC H1N1 Recommendations and Guidance
http://www.cdc.gov/h1n1flu/recommendations.htm
http://www.cdc.gov/h1n1flu/guidance/
Maine CDC H1N1 Website
http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml
Maine CDC Clinical Consultation 24x7 line: 1-800-821-5821
To view surveillance data and other updates: http://www.maine.gov/dhhs/boh/swine-flu-update-archives.shtml
