Epidemiologic Trends
There have been 323 confirmed and probable cases of H1N1 total to date, with 176 in Maine residents and 147 in out-of-state residents. A total of 14 Maine residents and 5 out-of-state residents have been hospitalized. No deaths have been reported to date. Nearly all (90%) of lab confirmed H1N1 cases in Maine residents and out-of-state visitors are under the age of 50 (range 0-81 years, mean of 22 years).
US CDC has shifted to reporting total hospitalizations and deaths nationally, instead of by state. Maine CDC will no longer be following up on every person who tests positive for H1N1, and instead will focus on those associated with certain settings (day care, health care workers, prisons, schools, shelters, nursing homes, group homes, etc), those who are high risk for complications, and those who are hospitalized.
The Lancet published an article about the increased risk of severe or fatal illness in pregnant women infected with H1N1 (www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61304-0/fulltext). WHO strongly recommends that pregnant women, and the clinicians treating them, be alert to the symptoms of influenza-like illness (http://www.cdc.gov/h1n1flu/sick.htm#2), especially during the second and third trimesters of pregnancy (http://www.who.int/csr/disease/swineflu/notes/h1n1_pregnancy_20090731/en/index.html). US CDC has several guidance documents on its web site related to pregnancy: http://www.cdc.gov/h1n1flu/pregnancy.
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).
Seasonal Influenza Vaccine
US CDC recommends that all children ages 6 months to 18 years be vaccinated against the regular seasonal flu this year, and that vaccination 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)
Maine CDC is working with a number of statewide partners to plan for large scale vaccine campaigns this fall, beginning with a school-located seasonal flu vaccine campaign. The number of schools who have signed up or shown an interest in signing up for the seasonal flu vaccine now represents about half of all school children in Maine – about 95,000.
The seasonal flu vaccine is not expected to specifically protect against the novel H1N1 influenza virus. However, with H1N1 and seasonal influenza viruses both expected to be circulating, getting a seasonal influenza vaccine will help a person’s overall protection against the flu.
H1N1 Vaccine
Maine CDC expects H1N1 vaccine to arrive in the state in mid-October at the earliest, and staff continues to meet frequently to plan for vaccination clinics much like the seasonal flu clinics. Clinical trials for the H1N1 vaccine have recently started (http://www.reuters.com/article/healthNews/idUSTRE5734KX20090804).
For more information about H1N1 vaccine trials: http://www3.niaid.nih.gov/news/QA/vteuH1N1qa.htm.
US CDC released the priority groups for receiving this vaccine, and they are:
Pregnant women, because they are at higher risk of complications 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 immuno-compromised persons. Morbid obesity may also represent an additional risk factor for severe illness. (http://www.cdc.gov/h1n1flu/vaccination/acip.htm)
Once the demand for vaccine for these prioritized groups has been met, CDC recommends that providers offer vaccinations to everyone ages 25 through 64 years. People age 65 or older have shown some immunity to H1N1 and are considered at lower risk than younger age groups. However, as supply and demand for vaccine among younger age groups is met, CDC recommends that providers also offer vaccination to people 65 years and older.
The H1N1 vaccine is not intended to replace the seasonal flu vaccine – it is intended to be used with seasonal flu vaccine to protect people.
At this point in time, there is no evidence that vaccinations will be mandatory.
US CDC expects that H1N1 vaccines will be available in multiple formulations, including some that are preservative (thimerosal) free.
For more information about H1N1 vaccine, visit US CDC’s Q&A: http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm.
CDC has also issued guidance on vaccination clinic planning (http://www.cdc.gov/h1n1flu/vaccination/statelocal).
Testing and Management for H1N1
Maine CDC issued a health advisory July 28 on Testing and Management for Novel Influenza A H1N1 (http://www.maine.gov/tools/whatsnew/attach.php?id=77176&an=1). Maine CDC held a conference call for health care providers on Aug. 3 related to the advisory, which gave an update on surveillance and shifting focus from tracking individual cases to outbreaks in certain settings (schools, jails, shelters, etc).
H1N1 Preparations for Residential Schools
Maine CDC has issued the following health advisory: H1N1 Preparations for Residential Schools (http://www.maine.gov/tools/whatsnew/attach.php?id=77501&an=1). A conference call giving suggestions on how residential schools, such as secondary boarding schools, colleges, and universities, can prepare for H1N1 this fall will be held Aug. 10. See below for more information.
H1N1 Conference Calls
Maine CDC will be holding conference calls on a variety of topics related to H1N1 over the coming weeks. The information for the next two calls is as follows:
Date: Monday, Aug. 10
Time: Noon to 1 p.m.
Topic: Residential Schools and how they can prepare for H1N1 through communication, prevention, early detection, isolation, and treatment
Call-in number: 1-800-914-3396
Pass code: 473623
Date: Monday, Aug. 17
Time: Noon to 1 p.m.
Topic: Update for Health Care Providers on seasonal influenza vaccine and H1N1 vaccine
Call-in number: 1-800-914-3396
Pass code: 473623
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. At least 850 people have already registered to attend the H1N1 Influenza Preparedness Summit co-sponsored by Maine CDC/DHHS, Maine Emergency Management Agency, Maine Department of Education, and Maine EMS. The Summit will be held from 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 special 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
Other New or Recently Updated US CDC H1N1 Guidance or News
Interim Guidance for the Detection of Novel Influenza A Virus Using Rapid Influenza Diagnostic Tests
http://www.cdc.gov/h1n1flu/guidance/rapid_testing.htm
School Dismissal Monitoring System
http://www.cdc.gov/h1n1flu/schools/dismissal_form/index.htm
How to Stay Updated
U.S. CDC H1N1 Recommendations and Guidance
http://www.cdc.gov/h1n1flu/
Maine CDC H1N1 Website and Related Links
http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml
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)
My Space (www.myspace.com/mainepublichealth)
Maine CDC’s Blog (http://mainepublichealth.blogspot.com/)
Maine CDC Clinical Consultation 24x7 line: 1-800-821-5821
H1N1 Conference Calls: Check Wednesday Weekly Updates for schedule of topics. See information above for upcoming calls.
H1N1 Summit: August 20th at the Augusta Civic Center. More information above.
Weekly Updates: Check the Wednesday late afternoon updates on H1N1 in Maine on Maine CDC’s H1N1 website: http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml
Maine CDC Clinical Consultation: 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.
