Friday, December 4, 2009

Additional waves of H1N1 expected; increased vaccine availability; other updates

Maine CDC/DHHS Update on 2009 H1N1 Influenza Virus
December 4, 2009


Highlights
Nationally and in Maine we are seeing gradual declines in flu activity; however, there is still a lot of influenza everywhere.

It is possible that other waves of activity may occur – caused by either H1N1 or regular seasonal flu – and people should continue to take precautions, including seeking vaccine when it is available.

Maine CDC is partnering with 211 Maine to provide confidential information and referrals related to the flu to the general public from 8 a.m. to 8 p.m. seven days a week.

To date, more than 300,000 doses of H1N1 vaccine have arrived in the state, but this is still less than half of what will be needed for all prioritized groups in Maine.


Flu Activity in Maine and the US
Since the last update, there have been six additional deaths due to H1N1, bringing the total to 11 reported since August. All of the recent deaths have occurred in people over the age of 25 with one each in Androscoggin, Franklin, and Washington counties and three in Penobscot County. All deaths related to H1N1 in Maine have occurred among people with underlying health conditions. People with underlying health conditions who experience flu-like symptoms should contact their health care providers immediately to receive a prescription for antiviral medications (such as Tamiflu®). Please note that one of these recent deaths was reported after the surveillance report at the end of this update was finalized.

There were 25 new hospitalizations due to H1N1 in the last week (down from 50 two weeks ago). Of those hospitalized, all were adults and five were admitted to intensive care units. Counties of those hospitalized this past week are: York, 5; Cumberland, 4; Androscoggin, 3; two each in Franklin, Kennebec, Penobscot, Piscataquis, and Washington counties; and one each in Knox, Oxford, and Waldo counties.

Seventeen schools reported absenteeism greater than or equal to 15% due to influenza-like illness in the past week. In a normal flu season in Maine, fewer than half a dozen schools usually report high absentee rates. High absenteeism was reported in Androscoggin, Aroostook, Cumberland, Kennebec, Knox, Oxford, Somerset, Waldo, and Washington counties.

The timing, spread, and severity of flu viruses is unpredictable with outbreaks often occurring in 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. It is also fully expected that H1N1 virus will continue to circulate for months if not years to come. People should continue to 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
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. For more information, see this US CDC Q&A on pneumococcal disease: http://www.cdc.gov/h1n1flu/vaccination/qa_pneumococcal_disease.htm.

Public Information
Maine CDC has contracted with 211 Maine to provide confidential information and referrals to the general public related to H1N1 and seasonal flu. Since August, staffing of Maine CDC’s information line has been limited to business hours. The partnership with 211 Maine will allow people to dial 2-1-1 to obtain information and referrals from trained 211 staff from 8 a.m. to 8 p.m. 7 days a week.

E-mail Hoax
US CDC has received reports of fraudulent emails referencing a CDC-sponsored State Vaccination Program. The messages tell people to create a personal H1N1 Vaccination Profile on the cdc.gov website. The message then states that anyone that has reached the age of 18 has to have his/her personal Vaccination Profile on the cdc.gov site. CDC has not implemented a state vaccination program requiring registration on www.cdc.gov. Users that click on the e-mail are at risk of having a computer virus installed on their system. To prevent computer viruses:
Do not follow unsolicited links and do not open or respond to unsolicited email messages.
Use caution when visiting untrusted websites.
Use caution when entering personal information online.
For more information: http://www.cdc.gov/hoaxes_rumors.html

H1N1 Vaccine Safety

The H1N1 vaccine is made the same way as seasonal flu vaccines. Although GlaxoSmithKline asked the Canadian government to stop using vaccine doses from one particular lot shipment, none of that vaccine had even been available in the United States.

The benefits of getting the 2009 H1N1 influenza vaccine far outweigh the very small risk of serious complications from vaccination. Some people getting vaccinated will have mild side effects such as pain, redness or swelling in the arm where the shot was given or a runny nose and headache after the nasal spray vaccine.

US CDC and FDA are carefully monitoring the H1N1 vaccine reports and after millions of doses of vaccine being administered in the U.S., the number, pattern and types of adverse event reports are similar to what we see for seasonal influenza vaccine. More than 90% of adverse event reports have been classified as "not serious" and are things often seen after vaccinations, such as soreness at the vaccination site.

H1N1 Vaccine Supply and Prioritization
We currently have 301,900 doses of vaccine in Maine – which is about 43% 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.

Nearly all K-12 schools have offered vaccine to their students. We continue to distribute vaccine to K-12 schools to complete all first doses and offer second doses to children ages nine and younger. We have been distributing increasing amounts of vaccine to larger numbers of health care providers, primarily for pregnant women, young children, and people with health conditions.

Vaccine supply has gradually increased and we expect it to increase substantially this week and into next week. Our current priorities for vaccine are:
Pregnant women and recently pregnant women;
Caregivers and household members of infants younger than 6 months old;
All people 6 months through 24 years of age; and
People ages 25 through 64 with underlying medical conditions, including COPD, asthma, chronic heart disease (except hypertension), kidney disease, liver disease, cognitive disability, neurologic/neuromuscular, blood disorder, metabolic disorders (including diabetes) or compromised immune systems (including HIV, organ transplant, people undergoing chemotherapy).

The following healthy health care providers are also prioritized: inpatient and outpatient health care workers with frequent direct contact with high priority patients and infectious materials, including all EMS as well as nurses and doctors working in outpatient primary care practices, specialty practices, and schools. The main reason health care workers should be vaccinated is to protect the patients they serve, who more likely fall into high-risk categories. The best way to protect these patients is to vaccinate them when the appropriate formulation is available. We ask that healthy health care workers be offered nasal spray vaccine whenever possible, which is only licensed for otherwise healthy and non-pregnant 2- to 49-year-olds.

Vaccine supply should be able to support more public clinics for high priority populations by the end of this month. We also plan to distribute some nasal spray to residential college campuses in order to offer vaccine to this group before the winter holidays.

Once all of the prioritized groups have been vaccinated, we anticipate that there will be enough vaccine for anyone who wants it. We hope that is soon, and it is our strong desire that everyone in Maine be offered this vaccine as soon as possible.

Second Doses:
Children nine and younger require a second dose of vaccine at least 21 days after the initial dose for full immunity; US CDC recommends a period of 28 days between doses. There is no maximum number of days between doses. Although it is preferable to receive the same type of vaccine (nasal spray or injection) for both doses, it is not required.

Due to the formulation of vaccine currently coming into the state, we are now able to begin offering second doses for children nine and younger in some areas. Vaccinators should follow the vaccine screening form to determine if sufficient time has passed between doses. Documentation of the first dose should not be required before administering a second dose. If a second dose is inadvertently administered early, it will not cause harm. In settings where supply is limited, first doses should still be prioritized.

The full weekly update can be viewed here: http://www.maine.gov/tools/whatsnew/attach.php?id=85718&an=2

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