Friday, October 2, 2009

Weekly Update on H1N1 in Maine October 1, 2009


US CDC reports that flu activity continued to increase in the US during the week of Sept. 13-19. Widespread influenza activity continues in much of the southern parts of the country, including higher than expected hospitalizations for this time of year. Outpatient visits for influenza like illness (ILI) increased in much of New England.

In Maine, visits to outpatient office settings and hospital emergency departments for influenza like illness increased this past week. There have been some occasional cases of H1N1 detected in students, but no new distinct outbreaks have been identified this past week.

However, the increases in outpatient visits and students indicate that this is the time to be extra vigilant in respiratory precautions, especially staying away from work and school when one has a fever, properly covering coughs and sneezes, and washing hands frequently. Recommendations for schools can be found in the “Quick Reference Guide” at: Guidance for other settings (child care, businesses, etc) can be found at

There continue to be delays in Maine receiving seasonal influenza vaccine, especially pediatric influenza vaccine for large scale clinics. We expect this vaccine to arrive in late October. Schools and other settings that have planned large scale clinics with this vaccine should postpone these clinics until early November if they have not yet received vaccine. They should be able to offer H1N1 vaccine concurrently at these clinics.

Maine CDC placed the first orders for H1N1 vaccine on Wednesday September 30th. The first orders should arrive next week and are for a small amount of live attenuated intranasal vaccine (LAIV) shipped primarily to pediatric health care providers for healthy toddlers and household contacts and caregivers of young infants. We are placing additional orders for this vaccine this week, and anticipate being able to place orders for other formulations of the H1N1 vaccine next week. It is important that health care providers who want to have H1N1 vaccine shipped directly to them register as an H1N1 provider and place orders as soon as possible. For more information see the section for health care providers at:

Seasonal influenza vaccine

Maine CDC has distributed about than 121,000 doses of seasonal flu vaccine, with most of this (80,000) going to pediatric providers and schools. Approximately 15 schools or school districts have held vaccine clinics. Due to nationwide delays in distribution of seasonal flu vaccine, Maine CDC recommended last week that large public clinics and school-located clinics be rescheduled if vaccine for those clinics had not already arrived. Clinic planners are advised to reschedule to early November, and to consider offering both seasonal flu vaccine and H1N1 flu vaccine at the same time.

H1N1 influenza vaccine

Maine CDC has placed its first orders with U.S. CDC for the first shipments of H1N1 vaccine this week, starting Wednesday, September 30th. The first shipments are not expected to arrive until the week of October 5th and will consist of only a limited number (~7,700) of one type of H1N1 vaccine, the H1N1 LAIV (Live Attenuated Intranasal Vaccine). This nasal formulation’s license is limited to healthy non-pregnant 2 – 49 year olds. In terms of the high-risk populations for H1N1, this vaccine is most appropriate for healthy children (especially those under 5 since they are at higher risk for H1N1 complications than older children) and household contacts of young infants. Maine CDC urges pediatric and obstetrical health care providers to register and submit orders for H1N1 vaccine as soon as possible.

If you are a licensed health care provider for children or their families, and have not registered as an H1N1 Provider, then please do so now. You must register even if you already receive vaccine from Maine CDC. To register, fill out and submit the H1N1 Provider Agreement for H1N1 Vaccine, which can be found at

If you have registered and have received ordering information, please submit your order as soon as possible to Maine CDC. We cannot ship vaccine to you unless you have submitted an order.

· For questions regarding H1N1 influenza vaccine ordering see the FAQ from the September 17th health advisory (

· For other questions:
Contact the Maine CDC’s Immunization Program at 287-3746 or the public information line at 1-888-257-0990.
Email us questions at:
More information, including consent forms and billing information, will be found at
Updated CDC guidance on H1N1 influenza vaccine including vaccine handling can be found at:
FAQ on H1N1 vaccine safety can be found at:

FAQs Related to H1N1 Vaccine (more detailed answers can be found at

Can seasonal influenza vaccine and H1N1 vaccine be given at the same visit?
Yes. However, both the nasal forms of the vaccine cannot be given at the same time. If both the nasal forms are to be given, then they should be separate by a minimum of 4 weeks. The injectable forms of the seasonal and H1N1 vaccine can be given at the same time (different anatomical locations), and a nasal vaccine of one and an injectable vaccine of the other can be given at the same time.

Can H1N1 vaccine be administered at the same visit as other vaccines?
Inactivated H1N1 vaccine can be administered at the same visit as any other vaccine, including pneumococcal polysaccharide vaccine. Live H1N1 vaccine can be administered at the same visit as any other live or inactivated vaccine EXCEPT seasonal live attenuated influenza vaccine.

Will the H1N1 vaccine be recommended for patients who had influenza-like illness since spring 2009?

Does the H1N1 vaccine contain adjuvants such as squalene or aluminum?

Is the H1N1 vaccine mandatory?

Does the H1N1 vaccine contain thimerosal?
The multi-dose vials of H1N1 vaccine contain a very small amount of thimerosal in order to prevent bacterial contamination. The single-dose syringes and nasal spray do not contain thimerosal. These thimerosal-free formulations are expected to represent about one-third of the H1N1 vaccine supply distributed in the next 3 months. This thimerosal-free vaccine is primarily being distributed to settings where pregnant women and young children are offered vaccine.

Who are the priority populations for H1N1 vaccine these first few weeks?
Pregnant women, all children and young adults ages 6 months to 25 years old, caregivers and household contacts of infants under 6 months, 25 – 65 year olds with underlying conditions, and health care workers including EMS.

Why does the seasonal flu vaccine list “H1N1” on it but does not protect against the H1N1 pandemic?
The seasonal flu vaccine protects against three major strains of influenza virus, including a seasonal (“regular”) strain of H1N1 influenza. However, protection against this seasonal strain of H1N1 does not protect you against the 2009 pandemic strain of H1N1.

Other New or Recently Updated H1N1 Guidance or News

US CDC posted the following materials on its web site:
· CDC announced the approval this week of H1N1 Vaccines. An FDA press release may be viewed at
· Updated Questions & Answers: Antiviral Drugs, 2009-2010 Flu Season is available at
· Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season was issued earlier this week and can be found at
· 2009-2010 Influenza Season: Information for Pharmacists is available at This document provides 1.) background information on influenza activity to date and how pharmacists may be affected this season, 2.) an update on antiviral drug supplies, 3.) information about compounding an oral suspension from Tamiflu® 75mg capsules and 4.) information about the oral dosing dispenser provided with certain formulations of Tamiflu® oral suspension.
· Updated Interim Recommendations for Obstetric Health Care Providers Related to Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season is now posted at
· Asthma Information for Patients and Parents of Patients is now posted at
· Brochure 2009 H1N1 and You is posted at

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):

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 (midway down the center of the homepage).

Follow Maine CDC’s Updates:
Facebook (search for “Maine CDC”)
Twitter (
MySpace (
Maine CDC’s Blog (

H1N1 Conference Calls: Maine CDC will be holding conference calls on a variety of topics related to H1N1 over the coming weeks. The next call will be held Monday, October 5, from noon to 1pm, to update interested stakeholders on H1N1 vaccine efforts. To participate, call 1-800-914-3396 and enter pass code 473623#.

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: 1-888-257-0990NextTalk (deaf/hard of hearing) - (207) 629-5751Monday - Friday 9 a.m. – 5 p.m.
Email your questions to:

U.S. CDC H1N1 Recommendations and Guidance: and

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