Thursday, January 7, 2010

Weekly update on H1N1 in Maine 1/7/10

Maine CDC/DHHS Update on 2009 H1N1 Influenza Virus
January 7, 2010


Flu Activity in Maine and the US
Flu activity in Maine has decreased enough to be classified as “regional” instead of “widespread.” However, people are still being hospitalized due to H1N1, and it is important to be aware that flu comes in waves. Vaccination is the best protection for yourself and the people you care about.

An Aroostook County resident in the 50 to 64 age group died earlier this week in part due to complications related to H1N1. The deceased was diagnosed with H1N1 in mid-December and had multiple serious underlying conditions. (This death was reported to Maine CDC after the surveillance information at the end of this report was compiled, and therefore will not be reflected in that data at the end of this update.)

All 18 deaths due to H1N1 since August have been among people with underlying health conditions, which emphasizes the importance of getting vaccinated if you have a high-risk condition, including asthma, emphysema, diabetes, heart disease, kidney and liver disorders, neurological disorders, blood disorders, cancer, HIV or AIDS, and others.

There were 5 new hospitalizations due to H1N1 last week, up from 3 the week before. Two children under age 18 were hospitalized, with one in intensive care; one young adult under age 24 was hospitalized and in intensive care; and two adults under age 65 were hospitalized. Hospitalizations occurred in Aroostook, Hancock, and Penobscot counties.

Vaccine is widely available, and we encourage everyone to be vaccinated. Information on flu vaccine clinics, including many free ones, is available by calling 211, checking www.maineflu.gov (free ones in bold font) or by contacting one’s health care provider.

H1N1 Vaccine Supply and Prioritization
Nearly 800,000 cumulative doses of H1N1 vaccine have arrived in Maine since October, which is an increase of 300,000 in just the last 2 ½ weeks. Maine CDC is able to meet the demand for vaccine, so if a health care provider needs more vaccine, they should order additional doses, as per the instructions below. We recommend health care providers offer H1N1 vaccine to every patient at every visit, every hospitalization, or other health care encounter, assuming contraindications do not exist. Such strategies as standing orders and adding H1N1 vaccine status to intake and discharge questions are appropriate to consider. It is important to take advantage of this window of opportunity (declining disease burden and expanded vaccine supply) to encourage vaccine.

There is an abundant supply of nasal spray vaccine in the state. We request that nasal spray vaccine be given to anyone who is eligible to receive it. The nasal spray vaccine is a safe and effective vaccine option for healthy people ages 2 through 49 years old who are not pregnant. For more information on nasal spray vaccine, please see our Fact Sheet at: http://www.maine.gov/dhhs/boh/maineflu/LAIV_factsheet.pdf.

Important Information for Vaccine Administrators
Vaccination is the best way to protect patients and to slow down the circulation of the virus, which may also help to prevent unwanted changes in the virus. Maine CDC encourages all appropriately licensed health care providers to register for, order, and offer H1N1 vaccine to their patients, including those health care providers in non-traditional settings for vaccine, such as specialists and those providing care for populations who may not seek vaccine, such as those with serious mental illness.

For health care providers to receive vaccine for the first time to administer to patients there is a simple two-step process:
Register for a PIN: http://www.maine.gov/dhhs/boh/maineflu/h1n1/provider-agreement-2009-2010.shtml.
Once the PIN is received, place an order for vaccine:http://www.maine.gov/DHHS/boh/maineflu/h1n1/health-care-providers.shtml.

Please note that all H1N1 vaccine providers and/or administrators must submit the vaccine administration data into 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. Detailed instructions are also available at: http://www.maine.gov/dhhs/boh/maineflu/h1n1/H1N1-Weekly-Reporting-Form-instructions.pdf.

If a health care provider is already registered but is running low on H1N1 vaccine, the provider should:
Confirm that you have placed orders for all the vaccine you need. You may order more by completing this form: http://www.maine.gov/dhhs/boh/maineflu/h1n1/hc-providers/h1n1-vaccine-orderform.shtml.
It often takes 7-10 days to replenish a health care provider’s vaccine supply. If you have acute vaccine needs or other related concerns or questions, email flu.questions@maine.gov or call the Immunization Program at: 287-3746 or toll free at 1-800-867-4775 Monday – Friday 8 am – 5 pm.

If local vaccine supplies are not sufficient while awaiting more vaccine, Maine CDC recommends focusing the limited supply on those patients in the five high priority groups (pregnant women, people ages 6 months through 24 years-old, people 25 through 64 years-old with an underlying medical condition, caregivers and household contacts of infants younger than 6 months, and health care workers). Patients can also be referred to public clinics which can be found by calling 211 or checking http://www.maineflu.gov/.

Health care providers who have too much vaccine should contact their local Vaccine Coordinator to arrange for redistribution.

Vaccine Coordinators:
District 1 – York: Sharon Leahy-Lind, 490-4625, sharon.leahy-lind@maine.gov
District 2 – Cumberland: Becca Matusovich, 797-3424, becca.matusovich@maine.gov
District 3 – Western Maine: MaryAnn Amrich, 753-9103, maryann.amrich@maine.gov
(Franklin, Oxford, and Androscoggin counties)
District 4 – Mid Coast: Jen Gunderman-King, 596-4278, jennifer.gunderman-king@maine.gov
(Waldo, Knox, Lincoln, and Sagadahoc counties)
District 5 – Central Maine: Sue Lee, 592-5634, susan.j.lee@maine.gov
(Somerset and Kennebec counties)
District 6 – Penquis: Jessica Fogg, 592-5633, jessica.fogg@maine.gov
(Penobscot and Piscataquis counties)
District 7 – Downeast: Al May, 263-4975, alfred.may@maine.gov
(Washington and Hancock counties)
District 8 – Aroostook: Stacy Boucher, 592-5632, stacy.boucher@maine.gov
Tribal Vaccine Coordinator: Jerolyn Ireland, 532-2240, Ext. 15, jireland@maliseets.com

Vaccine Return:
The only vaccines that should be returned are those that arrive non-viable or appear to be damaged during transit. Providers with concerns about vaccine viability during transit from the McKesson Distributor should call 877-836-7123 immediately upon receipt of the package.

Once a provider takes receipt of the vaccine as a usable product, it is that provider’s responsibility to ensure proper disposal of any damaged, expired, or un-used vaccine unless it has been recalled. Health care providers who have sufficient supplies and no longer need vaccine they receive should contact their local vaccine coordinator (listed above) to arrange for redistribution.

Changes in Ancillary Supply Kits:
As supplies of Influenza Vaccination Record cards are exhausted, US CDC will no longer be including these cards in shipments of H1N1 vaccine. Within a single shipment, cards could be included with one type of vaccine and not others.

Vaccinating Small Children
The 0.25 mL pre-filled syringe presentation of vaccine for children ages 6-36 months will no longer be available for order. Maine CDC makes the following recommendations for vaccinating small children:
Use the Sanofi or CSL multidose vial for all children ages 6 months to two years of age
Use the nasal spray vaccine for healthy children ages two years and older, when available and appropriate
Use the Sanofi or CSL multidose vial for children ages two and older who are not eligible to receive nasal spray vaccine, or when nasal spray is unavailable

People with concerns about thimerosal in multidose vial presentations of vaccine should see US CDC’s new fact sheet on thimerosal at: http://www.cdc.gov/h1n1flu/vaccination/vaccine_factsheet.htm

Seasonal Flu Vaccine
Maine CDC’s Immunization Program has filled all of its orders for seasonal flu vaccine, and is unable to place additional orders for vaccine. Most seasonal flu vaccine in the state is ordered privately and is not under the control of Maine CDC.

There have been several national delays in privately supplied seasonal flu vaccine, and more demand for this vaccine than usual. Limited amounts of seasonal flu vaccine remain. Providers who are seeking more information about seasonal flu vaccine availability and ordering may check these web sites: http://www.preventinfluenza.org/ivats/ and http://www.cdc.gov/flu/professionals/vaccination/#supply

US CDC continues to encourage those at highest risk from flu complications to seek seasonal flu vaccine and receive H1N1 vaccine, as recommended. People ages 65 and older at highest risk for complications from seasonal flu. Others are high risk for complications from seasonal flu include pregnant women, children younger than 2 years-old, and people with underlying health conditions. If you fall into one of these groups and have not been able to locate vaccine, check with your health care provider or look for seasonal flu clinics listed at http://www.maineflu.gov/ and with 211.

Conference Call for Partners Holding Public Vaccine Clinics
A conference call to address questions regarding expectations of partners who have agreed to host H1N1 vaccine clinics and receive funding from Maine CDC to support those efforts will be held at noon on Monday, Jan. 11. The call-in number is 1-800-244-5901 with the pass code 749239. This call will focus on the development of some concrete ideas for how to meet the objectives of funding provided to partners, and approaches to develop and implement plans for administration of vaccine to broad populations statewide. Representatives of hospitals, health centers and schools will be invited to join this discussion. During calls, please press *6 to mute your line un-mute when you are actively participating.

View the full weekly update here: http://bit.ly/6I8oDA

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