Thursday, November 19, 2009

H1N1 Expands and Worsens in Maine, Vaccine Continues to Trickle into the State, Pneumococcal Infections, and Other Important Updates

Maine CDC/DHHS Update on 2009 H1N1 Influenza Virus
November 19, 2009

Highlights

H1N1 continues to expand and worsen amid continuing vaccination efforts and some utilization of antiviral medicines.

There were 44 new school outbreaks, ER visits for flu accounting for 1 in 6 ER patients, 50 hospitalizations, and 2 deaths (for a total of 5 since August).

Underreporting of vaccine administration could impact the flow of vaccine into the state, and the supply to providers who are not reporting the doses they administer in a timely fashion.

Flu infections can make people more likely to develop pneumococcal infections, which can cause serious complications, including death. All children younger than 5, all people between ages 5 and 64 with high risk conditions, and all people age 65 and older should receive a pneumococcal vaccine.

Continued Surge of Flu Activity in Maine and the US

Two deaths this week were reported publicly over the weekend, bringing the total deaths due to H1N1 in the state since August to five. Four of these have been in the past two weeks. The average age among those who have died is 47; by comparison, 90% of deaths related to seasonal flu are among those older than 64.

There were 50 hospitalizations this week, accounting for more than half of the hospitalizations due to H1N1 since April. Half of the new hospitalizations were children, two of whom have been or currently are in intensive care; 23 were adults ages 19-65, seven of whom were or are in intensive care; 2 people were older than 65, neither of whom needed intensive care.

One in every six visits to an emergency department this week was flu-related, and rates of visits to other outpatient settings continue to be elevated.

There were 44 new outbreaks in school settings this week. A school in Kennebec County and another in Washington County chose to close as a result of absenteeism. An outbreak of H1N1 in a long-term care facility was reported over the weekend. There were five other institutional outbreaks this week.

The timing, spread, and severity of flu viruses is uncertain with outbreaks often occurring in waves. In past pandemics, the first wave is usually a smaller wave followed by a larger peak wave, which can be followed by subsequent smaller waves. Even after flu activity peaks during the current wave, it is possible that other waves of activity may occur – caused by either H1N1 or regular seasonal flu viruses.

There have been confirmed cases of H1N1 in every county in Maine. People should assume that they will be exposed to the flu at some point, and with vaccine for less than one-third of those most prioritized to receive it in the state, we should all take precautions to prevent serious illness by staying home when sick, covering coughs and sneezes, washing hands frequently, and getting vaccinated against both seasonal and H1N1 flu when vaccine is available.

Pneumococcal Illness and Vaccine

Increases in pneumococcal disease were seen during all three of the flu pandemics that occurred in the twentieth century. A report released in September showed that bacterial pneumonia is contributing to fatalities in people with H1N1 flu, similar to previous pandemics (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58e0929a1.htm?s_cid=rr58e0929a1_e).

All children less than 5 years of age should receive the pneumococcal conjugate vaccine. The polysaccharide vaccine should be administered to all persons 2-64 years of age with high risk conditions and everyone 65 years and older.

Although there is no evidence that this vaccine is harmful to either a pregnant woman or to her fetus, it is not recommended during pregnancy. Women who have underlying conditions known to put them at risk of pneumococcal disease should be vaccinated before becoming pregnant, if possible.

US CDC issued a letter to health care providers urging them to make sure all their adult patients with indications have received the pneumococcal polysaccharide vaccine. (http://www.cdc.gov/h1n1flu/vaccination/provider/lettertoprovider.htm)

CDC has also issued a Q&A on influenza and invasive pneumococcal disease (http://www.cdc.gov/h1n1flu/vaccination/qa_pneumococcal_disease.htm).

H1N1 Vaccine Supply and Prioritization

The US Food and Drug Administration (FDA) this week approved an additional vaccine for H1N1 flu (http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm190783.htm). We do not yet know how this will impact our vaccine supply in the state.

The FDA also approved the use of another vaccine already in use for those 18 and older to be administered to infants and children (http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm190359.htm) – vaccine administrators should note that this new approval is not reflected on the vaccine’s package inserts as of yet.

We have 210,500 doses of vaccine in Maine – which is about 30% of what is needed for priority populations in the state. For this reason, Maine CDC has had to prioritize within US CDC’s priority groups for vaccine, based on trends in infections, the type and amount of vaccine available, and readiness of partners to administer vaccine.

Currently, Maine CDC priority groups for vaccination are:
All children 6 months – 18 years of age
Pregnant women
Caregivers and household members of infants younger than 6 months old
Adults 18 – 64 years of age with chronic medical conditions**
Health care personnel with frequent direct contact with infectious materials and hospital inpatients who are at high risk (pregnant women, children, and high-risk adults older than 65)

We continue to distribute vaccine in K-12 schools; among health care providers who care for children, pregnant women and/or very high-risk adults; colleges and universities for their high-risk students; and some pre-school settings such as preschool programs for high-risk children and Head Starts.

By the end of the week, we expect:
About 95% of all K-12 schools, which is all schools that signed up to provide H1N1 vaccines, will have administered their first doses to children. The second doses for children ages nine and younger we anticipate will begin to be distributed in the next several weeks. US CDC recommends that the two doses of H1N1 vaccine for children 9 years of age and younger be separated by 4 weeks, but there is no maximum number of days between doses.
All health care providers that ordered H1N1 vaccine for pregnant women will have received some supply for their pregnant patients.

Over the next several weeks, we expect that it will be easier for household members of infants younger than six months old, pre-school aged children, and people younger than 65 at high risk due to underlying medical conditions to access vaccine through several channels:
Vaccine has been shipped to pediatric health care providers that placed orders for H1N1 vaccine. Public Health Nurses are conducting vaccine clinics in preschool settings for high-risk children and will soon be conducting vaccine clinics in Head Start locations. Other organizations are also starting to organize clinics for preschool aged children.
The limited amount of vaccine formulation that is ideal for adults is being distributed to specialists serving those adults who are at the highest risk – pulmonologists, cardiologists, oncologists, neurologists, rheumatologists, infectious disease physicians, and dialysis centers. We hope in the next week to be able to distribute increasing amounts of vaccine to other adult practices, such as internal medicine physicians. In addition, clinics for high risk groups will be starting in the coming weeks, and will be posted on the flu clinic locator at www.maineflu.gov.
We hope to provide more vaccine for health care workers in the next several weeks as the vaccine formulations for adults become more available. Any health care worker who fits into another high-risk group (pregnant, household member of an infant younger than six months, younger than 65 with an underlying health condition) should try to access vaccine now.

Once all of the prioritized groups have been vaccinated, we anticipate that there will be enough vaccine for anyone who wants it. However, vaccine may not be available to those not included in the priority groups until early in 2010.

To read the complete update: http://www.maine.gov/tools/whatsnew/attach.php?id=84993&an=2

Thursday, November 12, 2009

Weekly Update on H1N1 in Maine 11/12/2009

Maine CDC/DHHS Update on 2009 H1N1 Influenza Virus
November 12, 2009
Highlights
As expected, H1N1 continues to expand and worsen – 65 school outbreaks, ER visits for flu accounting for 1 in 6 ER patients, 19 hospitalizations, and 2 deaths (for a total of 3 since August).
Antiviral medicines are under-utilized.
Vaccine efforts continue – about 95% of schools are expected to complete their vaccinations by the end of next week, for a total of about 400 schools in 4 weeks’ time.

Increased Flu Activity in Maine and the US

The 2009 H1N1 flu continues to be widespread in Maine. Statewide, schools are reporting increased absenteeism due to influenza-like illness (ILI), with rates ranging from 15% to almost 50%. Schools in two communities have closed, and this is an administrative decision based on operational challenges associated with absenteeism among students as well as staff.

There were 65 new outbreaks reported this week (up from 24 last week), all in school settings. Outbreaks in schools occurred in the following counties: Androscoggin (10), Aroostook (2), Cumberland (5), Hancock (3), Kennebec (7), Oxford (3), Penobscot (18), Piscataquis (1), Sagadahoc (1), Somerset (3), Waldo (3), and York (9).

A total of 19 people were hospitalized due to H1N1 (up from 10 last week). Of those hospitalized, 5 were children; 3 were young adults ages 18-24; 10 were adults younger than 65; and one was an adult 65 or older. Two of the adults were in intensive care. Hospitalizations occurred in Androscoggin, Cumberland, Kennebec, Oxford, Penobscot, Washington, and York counties.

There were two deaths – one in a young adult reported in a press release late last week, and another in an adult in the 50-64 age group. Both deaths were in Penobscot County and both people had severe underlying conditions.

There have been confirmed cases of H1N1 in every county in Maine. People should assume that they will be exposed to the flu at some point, and with only enough vaccine for 1 in 8 people in Maine right now, we should all take precautions to prevent serious illness:
Stay home if you are sick, until you are fever-free for a full 24 hours without taking fever-reducing medicine.
Cough and sneeze into your elbow, or into a tissue. Throw this tissue away.
Wash your hands frequently with soap and water, but especially after coughing and sneezing. Alcohol-based hand gels can also be used.
Avoid touching your nose, mouth, and eyes. Germs can spread this way.
Avoid contact with sick people. If you are at very high risk for complications, you may want to avoid large crowds.
When vaccine is available, get both the seasonal and H1N1 flu vaccines.
Contact your health care provider if there are flu-like symptoms in a household where anyone is younger than 2 years old, 65 years or older, pregnant, and/or has an underlying medical condition. There are prescription medicines (antivirals such as Tamiflu®) that may help. The state’s stockpile of these medicines is also available to those who do not have adequate insurance and cannot afford the costs.
Although most people can stay home to recover without seeing a health care provider, anyone with the flu should seek medical attention for:
Dehydration
Trouble breathing
Getting better, then suddenly getting a lot worse
Any major change in one’s condition

H1N1 Vaccine Supply and Prioritization

Another 41,800 doses of H1N1 vaccine were distributed in Maine this week, bringing the total vaccine in the state to 180,400 doses.

US CDC released a list of recommended priority groups to receive the initial doses of H1N1 vaccine last summer. These groups were chosen because they were at high risk for complications from H1N1 or because they could pass H1N1 on to someone at high risk for complications.

Currently, we have received enough vaccine for about 1 in 4 people in priority populations in Maine. For this reason, Maine CDC has had to prioritize within the priority groups, based on trends in infections, the type and amount of vaccine available, and readiness of partners to administer vaccine.

The first groups targeted were children and pregnant women, because they are most disproportionately affected by H1N1 infection and because the types of vaccine available were most appropriate for them. Certain health care workers – for example, those who work in hospital maternity wards, pediatric units, ICU, and emergency departments – were also prioritized initially.

Currently, Maine CDC priority groups for vaccination are:
All children 6 months – 18 years of age
Pregnant women
Caregivers and household members of infants younger than 6 months old
Adults 18 – 64 years of age with chronic medical conditions**
Health care personnel with frequent direct contact with infectious materials and inpatients who are at high risk (pregnant women, children, and high-risk adults older than 65)

**Chronic medical conditions that confer a higher risk for influenza-related complications include chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematologic, or metabolic disorders (including diabetes mellitus) or immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus).

We are currently distributing vaccine for use in the following settings:
K-12 schools
Health care providers who care for children, pregnant women and/or very high-risk adults
Colleges and universities for their high-risk students
Some pre-school settings such as preschool programs for high-risk children and Head Starts

By the end of next week, we expect:
About 95% of all K-12 schools, which is all schools that signed up to provide H1N1 vaccines, will have administered their first doses to children. The second doses for children ages nine and younger we anticipate will begin to be distributed in the next several weeks, but not until sometime in December.
All health care providers that ordered H1N1 vaccine for pregnant women will have received sufficient supply for their pregnant patients.

Over the next several weeks, we expect that it will be easier for household members of infants younger than six months old, pre-school aged children, and people younger than 65 at high risk due to underlying medical conditions to access vaccine through several channels:
Vaccine has been shipped to pediatric health care providers that placed orders for H1N1 vaccine. Public Health Nurses are conducting vaccine clinics in preschool settings for high-risk children and will soon be conducting vaccine clinics in Head Start locations. Other organizations are also starting to organize clinics for preschool aged children.
The limited amount of vaccine formulation that is ideal for adults is being distributed to specialists serving those adults who are at the highest risk – pulmonologists, cardiologists, oncologists, neurologists, rheumatologists, infectious disease physicians, and dialysis centers. We hope in the next week to be able to distribute increasing amounts of vaccine to other adult practices, such as internal medicine physicians. In addition, clinics for high risk groups will be starting in the coming weeks, and will be posted on the flu clinic locator at http://www.maineflu.gov/.
We hope to provide more vaccine for health care workers by the end of this month as the vaccine formulations for adults become more available. Any health care worker who fits into another high-risk group (pregnant, household member of an infant younger than six months, younger than 65 with an underlying health condition) should try to access vaccine now.

Once all of the prioritized groups have been vaccinated, we anticipate that there will be enough vaccine for anyone who wants it. However, vaccine may not be available to those not included in the priority groups until early in 2010.

Reporting Vaccine Administration

Maine CDC asks that all H1N1 vaccine providers and/or administrators are submitting the vaccine administration data into the Maine CDC’s weekly vaccine reporting system.

The weekly vaccine reporting form can be found at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/health-care-providers.shtml. The vaccine reporting periods on the form are the same timeframe as the dates for the vaccine clinics. This form is then compiled by us and submitted, as required, to US CDC.

We have many thousands fewer doses of vaccine being reported as being administered than we believe have actually been administered. This will start impacting the flow of vaccine, since the flow of vaccine is expected to slow to those states that are not showing evidence of using it.

Maine CDC’s Immunization Program is compiling a database that matches the vaccine distribution database with the vaccine administration database by provider so we can tell which providers are not reporting on vaccine administration (or not using their vaccine). We will then use this to guide our vaccine distribution decision-making.

H1N1 Vaccination Distribution as of November 12:

STATE

180,400 doses
14% of the state population

These numbers mean there is 1 dose for every 4 people in a high priority group, and 1 for every 8 people in the state.

Adverse Events

US CDC's Vaccine Adverse Event Reporting System (VAERS) for years has recorded any adverse events following vaccination. This week Maine CDC compiled the data from the first month of H1N1 vaccine being administered in Maine. We found a total of 5 adverse events reported, all of them minor with none requiring hospitalization or evidence of long term problems. The events included: congestion and a sore throat following a nasal spray vaccine, and tingling and numbness following an injectable vaccine that resolved.


Antiviral Treatment


Anyone who is in a high risk category for flu complications – those younger than 2 years old, 65 years or older, pregnant, and/or those with an underlying medical condition – should be started on prescription antiviral medicines such as Tamiflu® if they have flu symptoms (or if anyone in their household has symptoms). These medicines can significantly reduce severity (including hospitalization and death) as well as duration of illness.

State Stockpile:
Maine CDC encourages physicians to prescribe antiviral medications as appropriate. In an effort to minimize financial barriers, Maine CDC has mobilized a significant portion of the state-purchased stockpile of antiviral medications for use by patients who do not have adequate insurance coverage (no insurance, high deductibles, high co-pays). Read the full Health Alert issued on this topic here: http://www.maine.gov/tools/whatsnew/index.php?topic=DHHS-HAN&id=84066&v=alert

Pediatric Suspension:
The FDA has issued guidance on compounding an oral suspension of Tamiflu® to provide multiple prescriptions: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm188629.htm/ohttp:/www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm188629.htmblocked::http:/www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm188629.htm

MaineCare is promulgating emergency rules increasing the reimbursement for compounding pediatric suspension from $4.35 to $10. The full stockpile of pre-prepared pediatric suspension in the stockpile has been fully deployed to hospitals, health centers, and Hannaford’s pharmacies and other willing pharmacies.

Additional Federal Guidance on Antivirals:
US CDC has posted information about the safety of antivirals: http://www.cdc.gov/H1N1flu/antivirals/safety_info.htm
US CDC Health Alert: Key Issues for Clinicians Concerning Antiviral Treatments for 2009 H1N1: The 2009 H1N1 virus continues to be the dominant influenza virus in circulation in the United States. The benefit of antiviral treatment is greatest when it is initiated as early as possible in the clinical course. http://www.cdc.gov/H1N1flu/HAN/110609.htm


Clinical Testing, Reporting, and Management of H1N1

Health care providers and other public health partners are asked to report to Maine CDC influenza infection among patients who:
· Are hospitalized;
· Have died; and/or
· Are associated with a suspected outbreak.
Health care providers with questions on influenza can contact the Maine CDC at 1-800-821-5821 24 hours a day, 7 days a week.

Testing:
§ Submit a specimen for influenza testing for patients with ILI who are hospitalized, who have died, or for whom a diagnosis of influenza would affect clinical care, infection control, or management of contacts.
§ When testing is indicated, rapid diagnostic tests that are negative should be followed by PCR testing.
§ For outbreaks in institutional settings, submit 3-4 specimens to confirm the cause of the outbreak. Once infection has been confirmed as influenza, further testing is not usually indicated.
§ Information on testing at the Health and Environmental Testing Laboratory is available at: http://www.maine.gov/dhhs/etl/micro/submitting_samples.htm

Algorithm for Testing and Management of H1N1 can be found at: http://www.maine.gov/tools/whatsnew/attach.php?id=82597&an=1
Additional Information for Health Care Providers on testing, reporting and management of H1N1, including patient handouts can be found at:
http://www.maine.gov/dhhs/boh/maineflu/h1n1/health-care-providers.shtml and
http://www.maineflu.gov/


Guidance for Schools and Day Cares
In light of recent school outbreaks, we expect that most schools in the state will eventually have some cases of the flu. Schools and day cares do not need to notify parents of each individual case of the flu. However, parental notification may be helpful in some situations.

If you have cases of flu in your school and are unsure whether you should notify parents, you may contact Maine CDC for guidance. There are specific reporting guidelines and forms related to increased absenteeism, available at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/educators.shtml#forms

If you are a school or day care administrator and have questions about reporting increased absenteeism, precautions to take, or the ways in which to notify parents, please contact our Clinical Consultation line at 1-800-821-5821 or e-mail disease.reporting@maine.gov.

US CDC has issued guidance for schools (http://www.cdc.gov/h1n1flu/schools/schoolguidance.htm) and child care programs (http://www.cdc.gov/h1n1flu/childcare/guidance.htm) designed to decrease exposure to the flu while limiting the disruption of day-to-day activities and learning.

Maine CDC is not issuing directives to close schools or day cares at this time. These are administrative decisions, largely based on staffing capacity.

New Videos, posters, and related materials from US CDC
Influenza Round Table: Warning Signs Video
Don't Get, Don't Spread Video
H1N1 Flu Vaccine -- Why the Delay? Watch a new CDC video to find out how flu vaccines are made: http://is.gd/4OVFq
"Seasonal and 2009 H1N1 Flu: For Parents Who Have Children or Adolescents with High-Risk Medical Conditions" brochure. New brochure for parents of high-risk children. http://www.cdc.gov/h1n1flu/childcare/toolkit/pdf/H1N1Seasonal_HiRiskChildren_Final.pdf
Updated: H1N1 Flu and You Brochure
Update: Poster-Disposable Respirators: General Donning InstructionsThese posters describe general procedures for properly putting on and taking off a disposable respirator. http://www.cdc.gov/h1n1flu/eua/pdf/n95instructions.pdf

Other Updates from Federal Partners
The World Organization for Animal Health issues this report that the recent identification of H1N1 in a house cat in Iowa is no additional cause for alarm (http://www.oie.int/eng/press/en_091104.htm) and CDC updated this Q&A about H1N1 in pets (http://www.cdc.gov/h1n1flu/qa.htm).

The commissioner of the US Food and Drug Administration (FDA) sent a letter to America’s healthcare professionals thanking them for their efforts during the 2009 H1N1 influenza outbreak and providing information on the safety of the 2009 H1N1 vaccines. The letter can be viewed at http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm189691.htm


Maine CDC H1N1 Activities This Past Week

Calls received by the phone bank: 708
Questions coming into flu.questions@maine.gov: 227
Hits on the webpages associated with http://www.maineflu.gov/: 71,425
Lab tests we (HETL at Maine CDC) conducted: 451
Lab tests we (HETL) conducted total since April: 6,134
Calls coming into the clinical consultation line: 202
Maine CDC employees whose jobs do not normally involve anything related to H1N1 who have volunteered with the phone bank and other related efforts: 124
Maine CDC employees who have been redeployed from other activities to focus on H1N1: 97

Many Maine CDC posters and magnets are now available for order online: http://www.maine.gov/dhhs/boh/flu-poster-orders.shtml

How to Stay Updated

· Flu News: View current Maine CDC press releases, Thursday morning weekly updates, and urgent updates from our Health Alert Network (HAN) by visiting: http://www.maine.gov/dhhs/boh/maineflu/flu-news.shtml. RSS feeds are available for the weekly updates and HAN. Starting this week, Maine CDC is posting the top Q&A from Maine at the beginning of each week, which can be accessed the same way as these Weekly Updates.
· Follow Maine CDC’s Social Media Updates:
o Facebook (search for “Maine CDC”)
o Twitter (http://twitter.com/MEPublicHealth)
o MySpace (www.myspace.com/mainepublichealth)
o Maine CDC’s Blog (http://mainepublichealth.blogspot.com/)
· H1N1 Conference Calls: Maine CDC will be holding conference calls to provide updates and take questions on H1N1. The next call will be held Monday, November 16, from noon to 1 pm. To participate, call 1-800-914-3396 and enter pass code 473623#. During calls, please press *6 to mute your line and #6 to un-mute when you are actively participating.

Call or Email 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
Deaf and Hard of Hearing phone number: 1-800-606-0215
Phone lines are open Monday - Friday 9 a.m. – 5 p.m.
· Email your questions to: flu.questions@maine.gov

Monday, November 9, 2009

Questions about second dose of H1N1 flu vaccine for children under 10

Q. My child is under 10 and has received his first dose of H1N1 vaccine. Will there be enough vaccine to get the second dose 28 days later? The first dose was a nasal spray, what if nasal spray is unavailable later?

A. US CDC recommends that the two doses of H1N1 vaccine for children 9 years of age and younger be separated by 4 weeks. There is no maximum number of days between doses.

Ideally the same type of vaccine – nasal spray or injection – should be used for both doses. If different types of vaccine are used for the first and second doses, however, there is no need to revaccinate a child.

Thursday, November 5, 2009

Increased flu activity in Maine, guidance for schools, treatment, vaccine prioritization, and more

From this week's update:

Increased Flu Activity in Maine and the US

The 2009 H1N1 flu continues to be widespread in Maine, more widespread than we have seen in years, as it is in nearly all other states. This was anticipated, and Maine CDC has been working for months to make sure we have resources in place to prevent and treat the flu.

In the past week, there have been increases in visits to health care providers for influenza-like illness (ILI) and increases in school absences. There have been 24 new outbreaks of ILI in K-12 schools and one in a university. Although the majority of outbreaks occurred in Kennebec and Penobscot counties, there were also outbreaks in Androscoggin, Aroostook, Franklin, Lincoln, Oxford, Somerset, Washington, and York counties.

There were 10 people hospitalized due to H1N1, nearly all of whom have been discharged. Four of the hospitalized patients were otherwise healthy children; one was a young adult; and five were middle-aged adults.

The first cases of H1N1 in Franklin County were reported this week. There have now been confirmed cases of H1N1 in every county in Maine. Although the vast majority of people are not getting tested and do not need to, almost 300 people were tested and confirmed as having H1N1. Most of these were children.

People should assume that they will be exposed to the flu at some point, and with only enough vaccine for 1 in 10 people in Maine right now, we should all take precautions to prevent serious illness:
* Stay home if you are sick, until you are fever-free for a full 24 hours without taking fever-reducing medicine.
* Cough and sneeze into your elbow, or into a tissue. Throw this tissue away.
* Wash your hands frequently with soap and water, but especially after coughing and sneezing. Alcohol-based hand gels can also be used.
* Avoid touching your nose, mouth, and eyes. Germs can be spread by touching contaminated surfaces and then touching your eyes, nose, and mouth.
* Avoid contact with sick people. If you are at very high risk for complication, you may want to avoid large crowds.
* If and when vaccine is available, consider getting both seasonal and H1N1 flu vaccines.
* Contact your health care provider if there are flu-like symptoms in a household where anyone is younger than 2 years old, 65 years or older, pregnant, and/or has an underlying medical condition. There are prescription medicines (antivirals such as Tamiflu®) that may help.
* Although most people can stay home without seeing a health care provider, anyone with the flu should seek medical attention for:
Dehydration
Trouble breathing
Getting better, then suddenly getting a lot worse
Any major change in one’s condition

Guidance for Schools and Day Cares

In light of recent school outbreaks, we expect that most schools in the state will eventually have some cases of the flu. Schools and day cares do not need to notify parents of each individual case of the flu. However, parental notification may be helpful in some situations.

If you have cases of flu in your school and are unsure whether you should notify parents, you may contact Maine CDC for guidance. There are specific reporting guidelines and forms related to increased absenteeism, available at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/educators.shtml#forms

If you are a school or day care administrator and have questions about reporting increased absenteeism, precautions to take, or the ways in which to notify parents, please contact our Clinical Consultation line at 1-800-821-5821 or e-mail disease.reporting@maine.gov.

US CDC has issued guidance for schools (http://www.cdc.gov/h1n1flu/schools/schoolguidance.htm) and child care programs (http://www.cdc.gov/h1n1flu/childcare/guidance.htm) designed to decrease exposure to the flu while limiting the disruption of day-to-day activities and learning.

Maine CDC is not issuing directives to close schools or day cares at this time. These are administrative decisions, largely based on staffing capacity.

H1N1 Vaccine Supply and Prioritization

Vaccine is being distributed at an unprecedented speed. Almost 40,000 doses of vaccine are arriving this week, bringing the total as of Nov. 5, to 138,600 doses. This is about 20% of the total amount of vaccine needed for prioritized populations in the state. Vaccine is continuing to be shipped as soon as it is allocated. However, it is possible that there will not be sufficient supplies of vaccine for some of the highest priority people until next month.

Vaccine is being sent out in response to several factors, including current trends in infections, prioritized populations, and the supply available.

We are asking that health care providers receiving shipments of H1N1 vaccine make sure it is immediately available to schools if they are serving as a distribution site for schools, and that in general, pregnant women and children be prioritized.

There are many reasons Maine CDC has been working with the Department of Education and other partners for months on the school-located vaccine clinic project:
* All school children are at risk for H1N1 because of their age.
* K-12 school children account for about a third of the of the estimated 575,000 non-health care workers in high priority groups in Maine. Schools are therefore an extremely efficient way to vaccinate a very large portion of the high-priority population.
* Studies show that school children as the major transmitters of flu in communities.
* By vaccinating children in school, we help ease the burden on the health care system, which would be overrun by many more additional parents and children seeking vaccine.
* Schools have most of the infrastructure needed to host vaccine clinics (nurses, refrigerators, space).
* Much of the vaccine formulation available to us first was the nasal spray, which is only licensed for otherwise healthy young people – the largest high priority group fitting the restrictions for that vaccine formulation is school children.

The school-located vaccine clinics have been successful in vaccinating thousands of Maine children with little disruption for students or parents in most cases. Nearly 100 schools have already conducted clinics, and more than 200 are scheduled for this week and next. However, this does not mean that pre-school aged children are not also a focus for vaccine.

The specific formulation of H1N1 vaccine for children ages 6 months – 3 years-old just became available to Maine CDC to order for the first time late last week. Since then, we have distributed about 6,600 doses to pediatric and family practices across the state. We anticipate being able to distribute another 11,000 doses of this formulation this week and next, and will continue to distribute to these practices across the state. If the national vaccine estimates continue as anticipated, there should be about 20,000 doses of this vaccine distributed in Maine before Thanksgiving. This should provide strong coverage for these infants and toddlers, who number about 35,000 in Maine.

There are other formulations of vaccine that can be administered to pre-school aged children, which are also slowly increasing in Maine. We are distributing those formulations to hospitals (who are mainly redistributing to their associated practices), pediatric and family practices, as well as home health agencies. There have been some clinics for young children, especially in rural areas and along the Midcoast.

As the appropriate formulations become available, about 1,100 doses of vaccine has been distributed to specialty practices (pulmonologists, asthma specialists, etc.) for people with underlying health conditions who are at risk for complications from the flu. We have contracted with home health agencies, health centers, city health departments, and hospitals to put on H1N1 vaccine clinics to be focused on high-risk populations. They should be underway as soon as there is sufficient vaccine.

As more vaccine arrives, we will broaden our distribution to other high risk groups, including young adults, additional people with health conditions, and health care and emergency services personnel. Once the full supply of vaccine has arrived, we plan to offer it to anyone who wants it.

Antiviral Treatment

Anyone who is in a high risk category for flu complications – those younger than 2 years old, 65 years or older, pregnant, and/or those with an underlying medical condition – should be started on prescription antiviral medicines such as Tamiflu® if they have flu symptoms or if anyone in their household has symptoms.

Maine CDC’s Stockpile: Maine CDC encourages physicians to prescribe antiviral medications as appropriate. In an effort to minimize financial barriers, Maine CDC has mobilized a significant portion of the state-purchased stockpile of antiviral medications for use by patients who do not have adequate insurance coverage (no insurance, high deductibles, high co-pays). Read the full Health Alert issued on this topic here: http://www.maine.gov/tools/whatsnew/index.php?topic=DHHS-HAN&id=84066&v=alert

The FDA has issued guidance on compounding an oral suspension of Tamiflu® to provide multiple prescriptions: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm188629.htm

US CDC has also posted information about the safety of antivirals (http://www.cdc.gov/H1N1flu/antivirals/safety_info.htm).



To read the full update: http://www.maine.gov/tools/whatsnew/attach.php?id=84420&an=2

Wednesday, November 4, 2009

I have the flu. Why won’t my doctor test me for H1N1?

In many cases, it is unlikely that your doctor will test you for H1N1 flu. There are several reasons:

We are monitoring the progress of H1N1 in the state through a number of different data sources, rather than counting individual lab reports. Now that we know that there have been cases of H1N1 in every county in Maine, we no longer need to test every case.

Testing everyone with flu-like symptoms would overwhelm our laboratories, so we need to save those resources for those who are most severely ill, where a confirmed diagnosis might influence treatment.

Testing will usually not change either treatment or the steps you should take if you are sick. The treatments for both seasonal and H1N1 flu are the same.

If you are not in a group of people at high risk for complications and do not have severe symptoms, you may recover on your own.

If you are in a high risk group, your health care provider will know if you need to be tested for H1N1, based on current guidance from the US CDC.

Tuesday, November 3, 2009

Top H1N1 Questions in Maine Week of Oct. 26

Maine CDC/DHHS Top Questions on 2009 H1N1 Flu
November 3, 2009


Note: Maine CDC will now post the answers to the top questions related to 2009 H1N1 flu received by our public phone bank, e-mail, and disease reporting and consultation line at the beginning of each week. Our weekly updates on H1N1 flu in Maine will continue to be posted on Thursdays. For more information on how to stay updated, see the end of this document.


Top Questions from the week of October 26:

Q. Where can I get a flu shot?

A. The short answer is if you’re in a high priority group and cannot find it, keep trying with your health care provider. The vaccine supply is increasing every week.

Right now there are few, if any, public clinics since there is not a sufficient supply of vaccine. This is the case in many other states as well. Eventually, there will be enough vaccine for anyone who wants it. In the meantime, we are distributing vaccine to those who are in the high priority groups. Right now there is a focus on pregnant women and children. So, the vast majority of vaccine is currently being distributed to schools, pediatric, and obstetrical health care providers. Early on, some vaccine went to hospitals for health care workers with frequent direct contact with patients and infectious material, especially to those with contact with pediatric and obstetrical patients. Over the past few days, we also received a very tiny amount of some adult-only vaccine formulations for the first time, so we distributed that to some specialty practices (pulmonary, cardiac, dialysis, etc) and large internal medicine/family practices.


Q. Why are healthy school children getting vaccine and I cannot find any?

A. The answer is threefold. First, all children are disproportionately affected by H1N1 and are at risk. Second, we provide protection to the entire community by vaccinating school children, since they are the major transmitters of flu. Third, we could not offer the nasal spray vaccine – which accounts for about a third of all vaccine received so far and the majority of the initial doses to arrive in the state – to many high priority categories of people, because it is only licensed for otherwise healthy non-pregnant people ages 2 – 49, and most priority categories of people have underlying conditions. It therefore seemed most effective to use this vaccine with our healthy school and pre-school aged children, although we are also distributing some injectable vaccine into schools and pediatric practices for their children with underlying conditions.



Q. How are you deciding which schools are getting vaccine?


A. The first few schools that held clinics this past week were simply those that had ordered early and were ready to vaccinate right away. Since then, we have received a surge of orders from schools across the state and not enough vaccine to fulfill these orders. We are distributing vaccine to those schools indicating readiness to vaccinate and we are also assuring an even distribution across the state and within counties in proportion to the population.


Q. Who are the overall priority groups for vaccine?

A. They are:

Pregnant women
All people ages 6 months – 25 years-old
People with underlying conditions who are 25 – 64 years-old
Caregivers and household members of those younger than 6 months old
Health care workers

Please note that these priority groups add up to about 700,000 in Maine, and we have only received about 99,000 doses of vaccine in the state right now. This is why Maine CDC is asking that vaccine in state and not administered yet be prioritized for pregnant women and children.


Q. Who are the priority groups for receiving antiviral medications (Tamiflu® or Relenza®) if they have symptoms of H1N1 or are heavily exposed to someone with H1N1 (for example, live in the same household)?

A. They are:

Pregnant women
Children younger than 2 years-old
People older than 64 years of age
People with underlying medical conditions, including children on chronic aspirin therapy
Anyone with more severe H1N1 disease such as that involving a pneumonia or a hospitalization (which children at any age are more likely to encounter)
People in certain outbreak situations involving many at high risk – prisons outbreaks, for instance


Q. Why are these two priority groups not the same, for instance, seniors?

A. The data so far indicates that seniors are at low risk for contracting H1N1 since they seem to have some underlying immunity. However, if they do contract H1N1, they are at risk for complications and should receive antiviral medications.



How to Stay Updated

· Flu News: View current Maine CDC press releases, Thursday morning weekly updates, and urgent updates from our Health Alert Network (HAN) by visiting: http://www.maine.gov/dhhs/boh/maineflu/flu-news.shtml. RSS feeds are available for the weekly updates and HAN.
· Follow Maine CDC’s Social Media Updates:
o Facebook (search for “Maine CDC”)
o Twitter (http://twitter.com/MEPublicHealth)
o MySpace (www.myspace.com/mainepublichealth)
o Maine CDC’s Blog (http://mainepublichealth.blogspot.com)
· H1N1 Conference Calls: Maine CDC will be holding conference calls to provide updates and take questions on H1N1. The next call will be held Monday, November 9, from noon to 1 pm. To participate, call 1-800-914-3396 and enter pass code 473623#. During calls, please press *6 to mute your line and #6 to un-mute when you are actively participating.

Call or Email 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
Deaf and Hard of Hearing phone number: 1-800-606-0215
Phone lines are open Monday - Friday 9 a.m. – 5 p.m.
· Email your questions to: flu.questions@maine.gov