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:
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:

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

US CDC has issued guidance for schools ( and child care programs ( 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:

The FDA has issued guidance on compounding an oral suspension of Tamiflu® to provide multiple prescriptions:

US CDC has also posted information about the safety of antivirals (

To read the full update:

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