Wednesday, August 12, 2009

Weekly Update on H1N1 in Maine 8/12/09

Tracking Updates

Maine CDC reported on Aug. 11 that a York County man in his 50s was the first death linked to H1N1 flu in the state. The man died last week. His name and the date of his death are not being released to protect the privacy of the family.

While most people with H1N1 in Maine and the nation have had a relatively mild infection, this news demonstrates how serious influenza can be, especially in those with underlying medical conditions, pregnant women, and very young children.

Maine has identified 335 cases of H1N1, which include 19 individuals requiring hospitalization. Of Maine residents with H1N1, 60 percent have been under 25 years of age.

How Influenza Tracking (Surveillance) Works

Maine CDC’s influenza surveillance program tracks the spread of influenza in Maine. Surveillance information is used to determine where and when influenza transmission is occurring, who is most at risk for contracting influenza and experiencing severe illness, and to track the current severity of influenza in Maine.

Surveillance data is collected through hospitals, private labs, physician offices, and Maine CDC’s Health and Environmental Testing Laboratory (HETL). Maine CDC is currently recruiting outpatient health care providers to report the total number of patients seen in their practices and the number of those patients seen for influenza-like illness (ILI) by age group on a weekly basis for the 2009-2010 season. This information is one of several strategies that help measure the extent of illness in the state.

Maine CDC and other public health authorities use surveillance information to direct influenza response activities – such as communicating information to the public, targeting prevention and treatment messages to specific populations, and directing community mitigation efforts. Surveillance information also informs public policy, such as guidelines on the use of vaccines and antiviral medications. Maine surveillance information contributes to a standardized national surveillance system.

Special Populations
Health care Workers – Maine CDC monitors confirmed cases of H1N1 Influenza in health care workers to determine the impact on the health care system and to intervene when possible to prevent transmission in the health care setting.

Pregnant Women - Because pregnant women have been severely impacted by H1N1 influenza, Maine CDC follows up on cases confirmed by the HETL in pregnant women to monitor the impact of the disease on this population and to help health care providers and their patients understand the CDC recommendations.

Outbreaks
Monitoring outbreaks provides information on the intensity and impact of influenza transmission in communities throughout the state. Outbreak surveillance provides the opportunity to inform and assist facilities experiencing outbreaks and to lessen the transmission and impact of influenza where possible.

Outbreaks of influenza or influenza-like illness are reportable by law in Maine. The definition used to recognize outbreaks of influenza-like illness varies by setting.

In a typical influenza season, most outbreaks affect persons greater than 65 years of age. However, current surveillance data suggest that H1N1 is affecting younger people more than seasonal influenza typically does, so outbreaks are expected to occur in more diverse settings.

Outbreaks will be detected and monitored in two ways. First, institutional outbreaks are reportable to Maine CDC by law. Institutions experiencing an outbreak should report to Maine CDC (through the toll free 24 hour disease reporting and clinical consultation line, 1-800-821-5821), and we will initiate an investigation to characterize the outbreak. Secondly, laboratory submission of specimens to HETL now requires completion of a form that describes potential exposure settings. Laboratory confirmed results that have significant institutional exposures will be evaluated to measure the extent of outbreak activity in Maine.

School Reporting
Maine schools report absenteeism greater than 15% or sudden increases in reported illness to Maine CDC. School nurses should also make direct reports to the Maine CDC if they see a sudden increase in influenza-like illness. Should school closures become necessary at any point, Maine CDC will be monitoring school closures in cooperation with the US CDC.

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 sleeve or tissue, 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).

Health Advisory

Maine CDC issued an advisory through the Health Alert Network today that provides information on four important novel H1N1 updates recently issued by US CDC. These federal updates include: changes to the recommended isolation period for people recovering from an influenza-like illness; updated guidance for K-12 schools to respond to H1N1 influenza; H1N1 vaccine recommendations; and informational resources for those planning vaccination clinics.

To view/subscribe to Health Alerts, visit: http://www.maine.gov/dhhs/boh/newhan.shtml.

Staying Home When Ill

US CDC now recommends that people with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F [37.8°C]), or signs of a fever, without using fever-reducing medications (http://www.cdc.gov/h1n1flu/guidance/exclusion.htm). For additional information, including exceptions to this recommendation for the health care setting, see today’s health advisory mentioned above.

Updated Guidance and Information for Schools

US CDC issued new guidance to help decrease the spread of flu among K-12 students and school staff during the 2009-2010 school year: http://www.flu.gov/plan/school/schoolguidance.html. The guidance includes recommendations for conditions with similar severity to spring 2009, and recommendations for more severe conditions. A report detailing the reasons behind these strategies and suggestions on how to use them is available at http://www.flu.gov/plan/school/k12techreport.html.

With these guidance documents, CDC also issued a tool kit to provide basic information and communication resources to help school administrators implement its recommendations (http://www.flu.gov/plan/school/toolkit.html).

H1N1 Preparations for Residential Schools

On August 10, Maine CDC hosted a conference call for residential schools – including K-12 boarding schools, colleges, and universities – which discussed the health advisory issued last week: H1N1 Preparations for Residential Schools (http://www.maine.gov/tools/whatsnew/attach.php?id=77501&an=1). Following are the questions and answers from that call:

Q: Will test kits for H1N1 be provided? What’s the turnaround time?
A: Test kits may be ordered through the Health and Environmental Testing Lab (HETL) by physicians or schools. Turnaround is about 48 hours.

Q: Should students wear masks?
A: People who are ill should be isolated according to current US CDC guidelines (http://www.cdc.gov/h1n1flu/guidance/exclusion.htm), to prevent the spread of disease. Putting a mask on an ill person can be effective in limiting transmission of infection if the person needs to leave isolation (e.g., for a doctor's visit). http://www.cdc.gov/h1n1flu/masks.htm

Q: Should residential schools have a supply of antivirals on hand?
A: This is an individual decision to be made in consultation with a physician. Antivirals are prescription medications. For some schools, having a supply of antivirals would be appropriate.

Q: Can students get the seasonal flu and H1N1 vaccine at the same time?
A: This will depend on the results of the clinical trials currently being conducted. US CDC recommends people get the seasonal flu vaccine as soon as it is available, preferably in September, rather than waiting until the H1N1 vaccine is available (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0724a1.htm?s_cid=rr58e0724a1_e).

Q: Can residential schools get free flu vaccine through the state?
A: For seasonal flu vaccine, the state will be offering free vaccine to all K-12 schools (including residential K-12 schools). In the unlikely event that there is excess vaccine available, the state may offer vaccine to the state colleges.

For H1N1 vaccine, we expect that eventually there will be enough vaccine for everyone in the state, free of charge.

Q: Will the H1N1 vaccine require two shots?
A: Clinical trials will determine the number of doses necessary for H1N1 vaccine. Trials are currently ongoing. At this time, it appears likely that H1N1 vaccine will require two doses, about 3 – 4 weeks apart.

Q: Is there any guidance about setting up dining hall procedures to minimize the spread of flu?
A: Maine CDC is not aware of specific guidance on this subject. The recommendation is for ill individuals to avoid public areas (http://www.cdc.gov/h1n1flu/guidance/exclusion.htm). Schools should consider having plans in place to ensure that ill individuals receive their meals without entering the public dining space, and that hand sanitizer is readily available.

Q: Do ill individuals have to be isolated from each other?
A: No, but schools might consider separating the acutely ill from those who are nearing the end of their isolation.

Q: Should day students be isolated the same as residential students?
A: All individuals with influenza-like illness should be isolated according to current US CDC guidelines (http://www.cdc.gov/h1n1flu/guidance/exclusion.htm).

H1N1 Summit 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. More than 1,100 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 by Monday, Aug. 17.

Vaccination

Maine CDC continues to work with a number of statewide partners to plan for large scale vaccine campaigns this fall. A conference call for health care providers related to both seasonal flu vaccine and H1N1 vaccine will be held from noon to 1 p.m. Monday, Aug. 17. The call-in number is 1-800-914-3396 and the pass code is 473623.

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)

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 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.

Clinical trials for H1N1 vaccine have begun. The World Health Organization has issued briefing notes on the H1N1 vaccine manufacturing process and timeline (http://www.who.int/csr/disease/swineflu/notes/h1n1_vaccine_20090806/en/index.html) as well as safety (http://www.who.int/csr/disease/swineflu/notes/h1n1_safety_vaccines_20090805/en/index.html).

The federal government has contracted with five vaccine manufacturers to produce H1N1 vaccine. This vaccine production is being funded by the federal government and will be provided to state health departments as a free federal resource. The goal of the vaccine production effort is to provide enough vaccine to be available for everyone in the United States. Vaccine will only be available through state health departments (Maine CDC/DHHS in Maine), and will not be available for private purchase from manufacturers.

The actual number of doses of vaccine to be distributed to Maine CDC is not currently known, but is expected to number upward of several hundred thousand within the first month. A supply of vaccine sufficient to vaccinate the entire population in Maine will not be available all at once. Therefore, CDC has made recommendations about the groups that should be considered the highest priority to receive 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 immuno-compromised persons. Morbid obesity may also represent an additional risk factor for severe illness.

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. For more information about H1N1 vaccine, visit US CDC’s Q&A: http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm.

Vaccine Distribution:
The large volume of H1N1 vaccine to be distributed and the newly established priority populations require a new approach to vaccine distribution for the H1N1 vaccination effort. This approach will be built on extensive vaccine distribution experience within Maine CDC, established emergency preparedness infrastructure and partnerships and a spirit of shared responsibility between public health, health care providers, and the private sector.

H1N1 vaccine will be distributed to states through a nationwide distributor that now handles the distribution of pediatric vaccine for Maine CDC’s Vaccines For Children Program. This company will directly ship vaccine and associated supplies as designated by Maine CDC to sites in Maine. Some of these sites will include public health sites throughout Maine (including Public Health Nursing sites and city health departments) and through the private sector routes that are traditional providers of seasonal flu vaccine. It is a goal of Maine CDC pandemic response activities to minimize the impact on the health care system. Therefore, there will be a strong need for vaccination in non-traditional settings to reach the defined priority populations.

Vaccine Distribution and Administration Planning:
Maine CDC field staff located in each DHHS District will serve as District Vaccine Coordinators, who will identify those populations prioritized to receive H1N1 Influenza vaccine who often do not have easy access to vaccine through the health care system. They will work with district and local partners to determine the most efficient and effective means for offering the vaccine to these priority groups.

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.

Vaccine Coordinators will be participating in the afternoon planning sessions at the Statewide H1N1 Summit on Aug. 20, and will begin their work after the Summit. They are:

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, 592-5644
(Somerset and Kennebec counties)

District 6 – Penquis: Debra Roy, 592-5633
(Penobscot and Piscataquis counties)

District 7 – Downeast: Jen Gunderman-King/Cindy Look, 596-4278
(Washington and Hancock counties)

District 8 – Aroostook: Sharon Ramey, 592-5632

Tribal Vaccine Coordinator: Jerolyn Ireland, 532-2240, Ext. 15

Other New or Recently Updated US CDC H1N1 Guidance or News

This MMWR evaluates three commercially available rapid influenza diagnostic tests (RIDTs) for their ability to detect novel H1N1: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5830a2.htm.

How to Stay Updated

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

H1N1 Summit:
August 20th at the Augusta Civic Center. More information above.

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/)

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 from noon to 1 p.m. Monday, Aug. 17, and will be an update for health care providers on seasonal influenza vaccine and H1N1 vaccine. The call-in number is 1-800-914-3396 and the pass code is 473623. Check Wednesday Weekly Updates for schedule of topics.

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 9am - 5pm
Email Us Your Questions at: Sue.Dowdy@maine.gov

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

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