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/
Thursday, September 24, 2009
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/
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