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

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