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/

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