Maine Public Health Update 01/28/10

Maine CDC/DHHS Public Health Update
January 28, 2010

Keep ME Well
Governor Baldacci, in his State of the State Speech and in a January 27th press conference, launched the Keep ME Well initiative. This novel tool helps people to assess their health risks, to obtain a report that helps them take action and find local resources and support in their own communities, and to find low-cost health care services. This will be a very useful web site for health care providers and their patients. Check it out at http://bit.ly/bJRAHK

2010 District Health Indicator Tables are posted!
In 2008, Maine CDC published tables comparing major health indicators for each of the 8 public health districts, Maine, and the U.S. These tables have just been updated and include additional indicators such as some on preventable hospitalizations by district and cost data associated with them. District data that are significantly different than the state data are yellow highlighted. Both the 2008 and 2010 tables along with the data resources used can be found under “Health Indicator Comparison Tables” on the upper left hand side of our homepage (http://bit.ly/ciXQkx) or directly at http://bit.ly/9d2FJj. We hope you find these tables useful.

Group A Strep
Maine CDC issued a health advisory last week to health care providers on an increase in the number and severity of invasive Group A Streptococcal (GAS) infections seen in January in Maine. Since then, additional cases have been identified, bringing the total thus far this month to ten, with an age range of 15 – 90 years-old. Four of these have resulted in Streptococcal Toxic Shock Syndrome (STSS), of which three have died. Although GAS is a common bacteria in the throat and skin, often causing strep throat or impetigo, invasive GAS disease is rare, with the five-year median in Maine being 19 cases per year. More information, including recommendations, can be found in last week’s health advisory at: http://bit.ly/bswpU2 or visit this US CDC web site: http://bit.ly/cP0vIl.

Earthquakes and Public Health
There are many public health concerns as a result from earthquakes, including those related to victims of the disaster and those related to people traveling to post earthquake zones such as Haiti to assist in recovery efforts. The US CDC’s earthquake website has helpful information for those who may be involved with the Haiti relief efforts or who are interested in improving their preparations here at home.
http://www.bt.cdc.gov/disasters/earthquakes/

Influenza Activity in Maine and the US
There were no new confirmed cases of H1N1 influenza reported in Maine last week. However, 10 people in Maine have been hospitalized due to H1N1 since the beginning of this month, including four children. Of those hospitalized, three required admission to an intensive care unit, including one child and one young adult. Only one of those hospitalized was fully vaccinated and only two had received early antiviral medicines, despite risk factors for severe disease. These hospitalizations are reminders of the importance of health care providers offering H1N1 flu vaccine to every patient at every encounter. Vaccination against influenza and early detection with prompt treatment are still very important, especially for those at risk for complications. We expect to see the pandemic form of H1N1 to circulate for months to come. We have not yet detected any seasonal influenza virus in samples submitted for testing this winter, and there have been no outbreaks of seasonal flu reported in other parts of the country. Vaccine can still be found in a number of public clinics, including many that are offering it for free. These can be located by calling 211 or by visiting http://bit.ly/5xdkVe. The free clinics are in bold font.

H1N1 Vaccine Supply
There is now plenty of H1N1 vaccine in Maine, with over 900,000 doses of H1N1 vaccine available statewide since October to about 500 health care providers. The Maine CDC is able to process orders with about a 4-day business day turnaround between order and receipt of vaccine. More than half of the doses of vaccine distributed have not been reported as administered. Vaccine administrators are required to report doses administered weekly. 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.

Messages to the Public
• Many people are still susceptible to this virus and would benefit from vaccination. Being vaccinated not only protects you, but it helps protect the people around you who are more likely to suffer serious complications from the flu.
• To find a vaccine, call your health care provider, or get the list of public vaccine clinics by calling 211 from 8 a.m. to 8 p.m. or visiting www.maineflu.gov (all clinics posted in bold are free).
• If you think you have the flu, cannot reach your doctor, and/or your health plan does not have a nurse call line available, you may call 2-1-1 from 8 a.m. to 8 p.m. to be connected with a health professional who can assess your symptoms.

Check Out Our Partners on Facebook
Maine CDC: http://bit.ly/cBNhXp
Maine HIV, STD, Viral Hepatitis Program: http://bit.ly/aphqWA
Maine WIC Nutrition Program: http://bit.ly/bDFndk
Portland Public Health: http://bit.ly/5bh6wj


View the full update here: http://bit.ly/cZKqbK

Weekly update on H1N1 in Maine 1/21/10

Maine CDC/DHHS Public Health Update
January 21, 2010

Flu Activity in Maine and the US
We continue to see H1N1 circulate in Maine, though at declining levels from a month ago. This last week there were two new hospitalizations, one of whom required intensive care. Since the beginning of January, 10 Mainers have been hospitalized for H1N1, including four children. Of those hospitalized, three required admission to an intensive care unit, including one child and one young adult. We are finding an increasing number of hospitalized patients who have neither been vaccinated nor received early treatment with antiviral medicines. Vaccination against influenza and early detection of infection with prompt treatment are still important, especially for people at risk of complications. These cases are also a reminder that we expect to see the pandemic form of H1N1 influenza virus to continue to circulate for months to come, so it is important to keep H1N1 in the differential for people presenting with symptoms.

We have not yet detected any seasonal influenza virus in samples submitted for testing this winter, and there have been no reported outbreaks of seasonal influenza in other parts of the country as well.

H1N1 Vaccine Supply
There is now plenty of vaccine in Maine, with about 800,000 doses of H1N1 vaccine distributed statewide since October. Maine CDC is now processing orders for H1N1 vaccine the same day the request comes in from a health care provider, with about a four-day turnaround between order and receipt of vaccine.

About 500 health care providers in the state have received H1N1 vaccine. We strongly urge health care providers to offer the H1N1 flu vaccine to every patient at every encounter.

Public clinics can be located by calling 211 or visiting www.maineflu.gov. There are many clinics that are offering free vaccine, identified by the bold font on the website.

December 2009 National Survey of H1N1 and Seasonal Flu Vaccine Coverage
US CDC has released data from a national survey conducted through much of December on H1N1 and seasonal flu vaccine coverage. Maine stood out as having an H1N1 vaccine rate among children that is more than twice the national average – 60% versus 28%. Although we do not know our formal ranking, we know only 4 states had pediatric coverage rates of over 40%.

Maine also had higher rates of H1N1 vaccine in health care personnel working with high-risk patients (46% vs. 27% nationally) and of seasonal flu vaccine coverage among children (52% vs. 34% nationally).

Additional information on vaccine coverage can be found in this MMWR: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm59e0115a1.htm

Main Messages to the Public
Many people are still susceptible to this virus and would benefit from vaccination. Being vaccinated not only protects you, but it helps protect the people around you who are more likely to suffer serious complications from the flu.
To find a vaccine, call your health care provider, or get the list of public vaccine clinics by calling 211 from 8 a.m. to 8 p.m. or visiting www.maineflu.gov (all clinics posted in bold are free).
If you think you have the flu, cannot reach your doctor, and/or your health plan does not have a nurse call line available, you may call 2-1-1 from 8 a.m. to 8 p.m. to be connected with a health professional who can assess your symptoms.

To view the full update: http://bit.ly/5X7I9G

Dr. Martin Luther King, Jr. and Health Care

Below is a wonderful tribute to Dr. Martin Luther King, Jr., written 10 years ago by the then head of US DHHS' AHRQ. About a year after this was published, Dr. John Eisenberg was diagnosed with an aggressive brain cancer, and died in 2002. I think this piece is a wonderful tribute to both men we were so fortunate to have on this planet, though for too short a time. Dora



Birthday Observance of Dr. Martin Luther King, Jr.
Remember! Celebrate! Act! A Day On, Not a Day Off!
John M. Eisenberg, MD, Director, Agency for Healthcare Research and Quality, January 14, 2000

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When I was invited to welcome you to the Department of Health and Human Service's 26th observance of Martin Luther King, Jr.'s birthday, my first thought was about how honored I was to be asked. My second thought was about what Martin Luther King's birth could mean to a rebirth of health care in this country. Few have had as much impact upon the American consciousness.

But what did Martin Luther King, Jr. think about health care?

My colleagues and I searched through his writings and his speeches, and realized that he didn't give speeches about health care. Martin Luther King, Jr. was confronting the basic nature of American society. He had mountains to move—and mountaintops to climb—for this country so that today we can address the issues of high quality health care for all Americans.

If Dr. King were alive today he'd be 71 years old. He'd be eligible for Medicare. Like many 71-year-olds, he might be dealing with a chronic medical condition—maybe arthritis, or hypertension, or diabetes. What would he think of the health care system we have today? What would he think of the medical care he might receive? And what advice would he be giving the Department of Health and Human Services?

No, Dr. King didn't give many speeches about health care. But like the rest of society, health care had to change too.

When I was a teenager in Memphis, before the Medicare program was passed, the Baptist Hospital was the biggest in town, and the proudest of the care it gave. But if you were African-American in Memphis and you went to the Baptist Hospital, you'd go in through a back entrance. And you'd go to a segregated ward, where you would be in a big room with about 15 or 20 other people. And your doctor, if he was black, would not have privileges on staff. And the same would have been true for Dr. King in Montgomery or in Atlanta.

Dr. Vanessa Gamble, who is the new director of minority affairs at the Association of American Medical Colleges here in Washington, has documented the incredibly important role that Medicare and Medicaid played in helping to desegregate hospitals. Medicare was a lever that lifted equity and equality in hospitals. In 1965, our Department issued regulations mandating that hospitals had to be in compliance with Civil Rights Act—which had been passed just the year before—in order to be eligible for Federal assistance or to participate in any federally assisted program. The passage of Medicare and Medicaid legislation that year made every hospital a potential recipient of federal funds, and therefore obligated every hospital to comply with civil rights legislation if they wanted to get paid.

The law changed, but practice was slower.

When I was a medical student in St. Louis, at Barnes Hospital around 1970, researchers asked why the hospital still seemed to be segregated. Why? Because clerks in the admissions office—both black and white—were so accustomed to the old ways that they continued to admit the races to their old units. The law had changed, but racial stereotypes had remained. Racist practices were illegal, but racism was institutionalized, and the seeds of racism grew into practices that amounted to discrimination.

I ask you, is it any different today, 31 years after Dr. King was shot in my hometown, and we grieved over the loss of a great American? Is it different 31 years after I was ashamed of the symbol that my hometown had become, when all that Dr. King wanted was to put into practice the placards that the Memphis sanitation workers wore, that read, "I am a man"?

Today, research shows that African-Americans are one-third less likely to have coronary bypass surgery than whites with the same conditions. Why? And today, African-Americans with HIV are less likely to receive antiviral treatment. Why do these disparities occur?

The easy answer is that it is because African-Americans are more often uninsured. And that is true. But even with the same insurance, African-Americans don't have the same access to primary care doctors, specialists and hospitals. And most distressing, even with the same insurance and being cared for at the same hospitals, African-Americans get different care. In one study I did, if you were a black woman you were much less likely to get referred for cardiac catheterization.

The reason—I fear—is that, despite Dr. King's advances, and despite civil rights laws, and despite Medicare, racism is a part of the institution of American life, and the seeds of racism still grow into discriminatory practices.

So, now 31 years after Dr. King's death and 35 years after Medicare broke down segregated wards in the nation's hospitals, the question for us is: What can we do today in our Department to eliminate these disparities, whether they grow out of lack of insurance, lack of access, or lack of quality care for those who get access?

No matter where we work in this Department—

At the Health Care Financing Administration, where care is funded.

At the Health Resources and Services Administration, where programs are supported to help access.

At the Food and Drug Administration, where safe drugs are assured.

At the National Institutes of Health, where research can identify the causes of disease.

At the Agency for Healthcare Research and Quality, where we find out why the quality of care isn't what it can be, and where our name itself speaks of an arc, of closing gaps.

In every operating and staff division—

We can use the levers that we are so lucky to have, and so privileged to use, to eliminate the barriers to high quality health care.

Because we shall overcome.

We shall overcome the disparities in health care, whether they are due to economic barriers, or institutionalized racism, or even unconscious discrimination. We—as public servants—can build on Dr. King's contribution to the moral health of our country to make our own contributions to the physical and mental health of all of its people.

Let's make that commitment today.

Current as of January 2000


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Internet Citation:

Birthday Observance of Dr. Martin Luther King, Jr.: Remember! Celebrate! Act! A Day On, Not a Day Off! Opening Remarks by John M. Eisenberg, M.D., Director, Agency for Healthcare Research and Quality, January 14, 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/mlkspch.htm


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Haiti Earthquake

This US CDC website is very useful for earthquake preparedness. Believe it or not, we have them in Maine on occasion, and certainly many Mainers frequently travel to zones of higher earthquake activity. It also has good information for those who may be traveling to Haiti to assist in the recovery efforts there, including which vaccines to obtain and what other health issues to be concerned about.

Weekly update on H1N1 in Maine 1/14/10

Flu Activity in Maine and the US
We continue to see H1N1 in Maine, including three new hospitalizations this week – one in a child younger than 5, another child younger than 18, and an adult in the 50-64 age range. There was also an outbreak of H1N1 at a long term care facility. Although H1N1 flu activity has decreased in Maine in recent weeks, there have been increases in H1N1 illness in other areas of the U.S.

Many people are still susceptible to this virus and would benefit from vaccination. Being vaccinated not only protects you, but it helps protect the people around you who are more likely to suffer serious complications from the flu.

Flu is unpredictable, but it often comes in waves. There was a mild surge in the spring of 1957, followed by a large surge in the fall, another large one in the winter of 1958, and others following that with the virus circulating for several years. All pandemics are different, but most have multiple waves of illness and death.


H1N1 Vaccine Supply
There is now plenty of vaccine in Maine, so it’s an excellent time for people who have not been vaccinated against H1N1 and seasonal flu to do so before the next wave of disease. Nearly 800,000 doses of H1N1 vaccine have been distributed statewide since October. Close to 500 health care providers in the state have received H1N1 vaccine. Call your health care provider, or get the list of public vaccine clinics by calling 211 from 8 a.m. to 8 p.m. or visiting www.maineflu.gov (all clinics posted in bold are free).

Maine CDC recommends that health care providers offer H1N1 vaccine to every patient at every visit, every hospitalization, or other health care encounter, assuming contraindications do not exist.

Treatment Recommendations
Maine CDC issued a health alert on Jan. 11 to reinforce recommendations for early treatment of patients with increased risk of complications from influenza. Early treatment for influenza may prevent secondary bacterial infections. This alert can be viewed here: http://www.maine.gov/tools/whatsnew/index.php?topic=DHHS-HAN&id=88550&v=alert

If you think you have the flu, cannot reach your doctor, and your health plan does not have a nurse call line available, you may call 2-1-1 from 8 a.m. to 8 p.m. to be connected with a health professional who can assess your symptoms.

Information for People with Chronic Underlying Health Conditions
Pneumonia, bronchitis, acute respiratory distress syndrome, sinus infections and ear infections are examples of flu-related complications. The flu can also make chronic health problems worse. H1N1 has caused more deaths among adults with chronic medical conditions than in any other group. All 18 H1N1-related deaths in Maine have been in adults with chronic underlying conditions.

If you have a high-risk condition, getting vaccinated is the single best action you can take to protect yourself from the flu. Still, most adults with high-risk conditions have not been vaccinated yet. Many people in these groups do not realize that their medical conditions increase their risk. The following conditions put people are risk for flu-related complications:
· asthma;
· heart disease
· chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis);
· diabetes and other endocrine disorders;
· neurological or neurodevelopmental disorders, and especially those that affect lung capacity (muscular dystrophy, cerebral palsy, strokes, etc);
· blood disorders, such as sickle cell disease;
· kidney and liver disorders;
· weakened immune system due to disease or medication, such HIV/AIDS, cancer, or steroids;
· long-term aspirin therapy in people younger than 19.

If you have a chronic health condition and have not yet received your vaccine against H1N1, get one now. Contact your health care provider, specialist, call 2-1-1 from 8 a.m. to 8 p.m. for a list of public clinics, or check www.maineflu.gov (clinics listed in bold are free).

If you have an underlying health condition and experience flu-like symptoms, contact your health care provider immediately to receive a prescription for antiviral medications (such as Tamiflu®).

To read the full update: bit.ly/8CFsPI

People with chronic health conditions should be vaccinated against the flu

It’s National Influenza Vaccination Week, and although H1N1 flu activity has decreased in recent weeks, people in Maine and across the country are still being hospitalized and dying from influenza.

All 18 deaths due to H1N1 flu in Maine since August have been among people with underlying health conditions. If you have a high-risk condition, getting vaccinated is the single best action you can take to protect yourself from the flu.

Flu is unpredictable, but it often comes in waves. Now is an excellent time for people who have not been vaccinated against H1N1 and seasonal flu to do so before the next wave of disease. Vaccine is widely available in Maine now. Call your health care provider, or get the list of public clinics by calling 211 from 8 a.m. to 8 p.m. or visiting www.maineflu.gov (all clinics posted in bold are free).

If you have an underlying health condition and experience flu-like symptoms, contact your health care provider immediately to receive a prescription for antiviral medications (such as Tamiflu®).





A schedule of events for National Influenza Vaccination Week is available on US CDC’s web site at: http://www.cdc.gov/flu/NIVW/activities.htm?s_cid=cs_000&s_cid=cs_000

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

Three simple steps to a healthy new year

1. Add Vaccination to Your List of Resolutions – Getting vaccinated is the best way to protect yourself and your loved ones from the flu. To find the H1N1 and seasonal flu vaccine clinics nearest you, visit www.maineflu.gov or call 211 for Maine-based clinics, or visit www.flu.gov for clinics elsewhere. There are more clinics being added every day, so check it out!

2. Be a Germ Stopper – Cover your nose and mouth when you cough or sneeze, wash your hands often, and avoid touching your eyes, nose and mouth. Germs spread this way. Also, stay home if you are sick and avoid close contact with people who are sick. For additional information, see how to prevent and treat the flu.

3. Check the Facts and Stay Informed – Visit www.maineflu.gov or www.flu.gov regularly for the latest information. Heard a rumor? Visit Myths & Facts to run a fact check. Have a question? Email us at flu.questions@maine.gov or call 211. Want to stay informed? Sign up for the RSS feed or Maine CDC on Facebook or Maine CDC on Twitter for our weekly updates, health advisories, and/or press releases.


If you’ve been vaccinated already, please share this message with friends and family and let them know why the H1N1 vaccine is safe and recommended by health experts. The 2009 H1N1 flu vaccine is made the same way as the seasonal flu vaccine. Millions of people have safely received the H1N1 vaccine, including the President, First Lady and their children.

Also, consider posting a flyer at your work, school and local community centers. www.maineflu.gov and flu.gov offers free outreach materials available in multiple languages.

Important updates for Vaccine Administrators

Maine CDC/DHHS Update on 2009 H1N1 Influenza Virus
December 30, 2009

H1N1 Vaccine Supply and Prioritization
We expect to have close to 700,000 cumulative doses of H1N1 vaccine in the state by January 4th – enough for more than half of the state’s population.

The nasal spray vaccine is generally more available than injectable vaccine. 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.

We have and expect sufficient supplies to meet the demand for vaccine on a weekly basis, but it often takes 7-10 days to replenish a health care provider’s vaccine supply. Additionally, we have experienced delays in distributing vaccine the past two weeks primarily due to federal CDC holiday shipping schedules and to some degree the state shutdown day. We expect these delays to dissipate the first week of January, though snowstorms in Maine or on the East Coast can also cause some delays.

We are extremely grateful for the thousands of Maine health care providers who have been offering vaccine to their patients and volunteering with many vaccination efforts. We hope to continue and even increase these efforts now that more vaccine is flowing into the state, since this is our window of opportunity to protect people before the next wave of H1N1 infection and as H1N1 continues to circulate. Our first priority is to make sure traditional health care providers (hospitals, private practices, health centers, home health agencies, municipal health departments) have sufficient vaccine. We are also increasingly distributing vaccine to other health care providers, such as those in employment and in retail settings. Offering vaccine in these other settings will help serve many people who may have difficulty seeking vaccine in traditional health care settings and will help reduce the burden on traditional health care providers.

Important Information for Vaccine Administrators
Vaccination is the best way to protect patients and to slow down the circulation of the virus, which will also help to prevent 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:
1. Register for a PIN: http://www.maine.gov/dhhs/boh/maineflu/h1n1/provider-agreement-2009-2010.shtml.
2. 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 www.maineflu.gov.

When a health care provider’s vaccine supply is sufficient, we recommend offering vaccine to every patient at every visit, so long as there are no contraindications for receiving vaccine. It is important to take advantage of this window of opportunity (declining disease burden and expanded vaccine supply) to encourage vaccine. Health care providers who have sufficient supplies and no longer need vaccine that is being shipped to them 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.

Vaccinating Small Children:
Due to national production delays and the recent recall of 0.25 mL pre-filled syringes, 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

Vaccine Dose Spacing and Administration:
Those who have questions about H1N1 vaccine dose spacing and administration with seasonal flu or other vaccines should consult this table from US CDC: http://www.cdc.gov/H1N1flu/vaccination/dosespacing_admin.html.

Additional vaccine-related information for health care providers, including information on billing and consent forms can be found on our web site at: www.maineflu.gov or specifically on: http://www.maine.gov/DHHS/boh/maineflu/h1n1/health-care-providers.shtml.


To read the full weekly update: http://www.maine.gov/tools/whatsnew/attach.php?id=87323&an=2

Why this Maine CDC staffer got a nasal spray vaccine

I am a healthy 30-year-old, and I’ve never had a flu shot in my life. (Although I’ve complained to almost anyone who will listen that I had the flu for my seventh and eighteenth birthdays – which made both birthdays completely miserable.)

I normally work in the HIV, STD, and Viral Hepatitis program at Maine CDC, but I’ve been reassigned to help with H1N1 communications since late July. I’ve been combing through scientific jargon, trying to boil it down for people like me who don’t have medical or public health degrees. I’ve been updating our web site, this blog, Facebook, Twitter, and Myspace. I’ve sat through meetings with people who DO have medical and public health degrees and can explain some of the scientific jargon in common sense terms.

I’ve learned a couple of very simple things these last few months: Vaccination is the single most effective way of avoiding the flu, and the benefits of getting the H1N1 vaccine far outweigh the very small risk of serious complications from vaccination.

So, yesterday, I got my very first flu vaccine. I opted for the nasal spray, because I know that it is safe and effective. I’m healthy, not pregnant, well over two years-old and under 49. There was no reason for me NOT to get the nasal spray vaccine (also a first for me). If I had gotten an injected vaccine, it’s possible that I would have deprived someone at high risk from the shot that could save them from getting very sick.

I took pictures of Dr. Mills getting her nasal spray vaccine as well. (If it looks like she’s grimacing, it’s more about the flash from my camera than anything else.)

- Tara Thomas
H1N1 Communications Coordinator, Maine CDC













For more information on nasal spray vaccine:
Our Fact Sheet: http://www.maine.gov/dhhs/boh/maineflu/LAIV_factsheet.pdf
Vaccine Information Statement: http://www.maine.gov/dhhs/boh/maineflu/h1n1/H1N1-nasal%20-spray.pdf
US CDC Q&A: http://www.cdc.gov/h1n1flu/vaccination/nasalspray_qa.htm



Note:
Maine CDC is encouraging health care providers with sufficient supplies to provide vaccine to all who want it, and those without sufficient vaccine to focus their supply on those in the high priority groups: pregnant and recently pregnant women; household members and caregivers of infants younger than six months old; all people ages 6 months through 24 years; people ages 25 through 64 with underlying health conditions; and health care and EMS workers.

Over the coming days and weeks, vaccine will become more available in a variety of settings, including health care provider offices, public clinics, retail locations, large employer settings, nursing homes, etc. People have three easy options in seeking vaccine: check the clinic locator at http://www.maineflu.gov/, call 211, or call their health care providers.

For now, we request that nasal spray vaccine be given to anyone who is eligible to receive it. Nasal spray flu vaccine is not new. It has been used successfully in many settings for seasonal flu vaccination since 2003. Even if you come into regular contact with people who cannot receive the nasal spray vaccine themselves you may still be able to receive the nasal spray vaccine as long as you are healthy, not pregnant, and age 2 through 49. The nasal spray vaccine is safe for breastfeeding mothers. Health care workers who cannot receive the vaccine themselves (due to pregnancy, health condition, or age) may still administer the vaccine.

Important updates on vaccine prioritization and recall

Maine CDC/DHHS Update on 2009 H1N1 Influenza Virus
December 17, 2009

Highlights
Four deaths due to H1N1 have been reported, bringing the total to 17 since August. Please note that an estimated 150 people die in a normal flu season in Maine.
We are now recommending H1N1 vaccine be made available to anyone who wants it, as local supply allows and with an emphasis on prioritizing injectable vaccine for those at highest risk for complications.
A non-safety recall has been issued for about 800,000 doses of H1N1 vaccine nationwide.
We expect the H1N1 flu virus to continue to circulate and additional surges are also possible. We expect to experience a seasonal flu surge as well, as we normally do sometime in the winter. There is still more influenza across the country than is usually seen this time of year, and vaccination remains the best protection against the flu.
Now is an excellent time to get vaccinated, so you will be protected during the next wave of flu.

Flu Activity in Maine and the US
Data indicate that H1N1 flu has been relatively mild in Maine compared with other states, and continues to decline. Nationally, data indicate that H1N1 is striking young people the hardest. However, there were four deaths among people older than 64 since last week’s update. Those individuals lived in Androscoggin, Kennebec, Knox, and Oxford counties. Note: Three deaths were 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.

All 17 deaths since August have occurred in people with underlying health conditions. People with underlying health conditions should seek vaccine at their specialty providers, primary care providers, or at public clinics listed at www.maineflu.gov. Anyone with underlying health conditions who experiences flu-like symptoms should contact his or her health care providers immediately to receive a prescription for antiviral medications (such as Tamiflu®).

There were 11 new hospitalizations due to H1N1 in the last week, down from 31 the week before, all ages 25 and older. One individual older than 64 required intensive care. Counties of those hospitalized this past week are: York, 3; Franklin, Penobscot, and Somerset with two each; and one each in Hancock and Knox counties.

Outbreaks were reported in one long term care facility, one acute care facility, one K-12 school, and two other institutions. The outbreaks occurred in Androscoggin, Cumberland, Oxford, and Penobscot counties.

Flu is unpredictable. Although it appears that flu activity may have peaked during the current wave, other waves of seasonal and/or H1N1 flu may occur. We expect H1N1 to continue to circulate for months, if not years, to come. Take precautions to prevent serious illness: stay home when sick, cover coughs and sneezes, wash hands frequently, and get vaccinated against both seasonal and H1N1 flu when vaccine is available to you.

To remind people of the importance of taking these precautions, order flu posters and magnets for your organization, workplace, or health care practice: http://www.maine.gov/dhhs/boh/flu-poster-orders.shtml

H1N1 Vaccine Supply and Prioritization
Since October, we have received more than 500,000 doses of H1N1 vaccine in Maine. Based on recent demand, Maine CDC is now recommending that H1N1 vaccine be offered to anyone who wishes to receive it when local supplies allow. The focus for vaccine will still be the five high priority groups as defined by US CDC, but in many places public clinics will not need to turn others away. We are encouraging health care providers with sufficient supplies to provide vaccine to all who want it, and those without sufficient vaccine to focus their vaccine supply to those in the high priority groups: pregnant and recently pregnant women; household members and caregivers of infants younger than six months old; all people ages 6 months through 24 years; people ages 25 through 64 with underlying health conditions; and health care and EMS workers.

The nasal spray vaccine is available in slightly greater quantities than injectable vaccine. If healthy people who qualify for the nasal spray are given injectable vaccine, this can easily deplete the injectable vaccine supply for those who are most vulnerable to being hospitalized or dying from H1N1. Therefore, 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 who are not pregnant.

Nasal spray flu vaccine is not new. It has been used successfully in many settings for seasonal flu vaccination since 2003. Even if you come into regular contact with people who cannot receive the nasal spray vaccine themselves you may still be able to receive the nasal spray vaccine as long as you are healthy, not pregnant, and age 2 through 49. The nasal spray vaccine is safe for breastfeeding mothers. Health care workers who cannot receive the vaccine themselves (due to pregnancy, health condition, or age) may still administer the vaccine.

For more information on nasal spray vaccine, please see our Fact Sheet at: http://www.maine.gov/dhhs/boh/maineflu/LAIV_factsheet.pdf

The benefits of getting the H1N1 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 carefully monitor vaccine reports. After millions of doses of H1N1 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 nationwide have been classified as not serious.

Over the coming days and weeks, vaccine will become more available in a variety of settings, including health care provider offices, public clinics, retail locations, large employer settings, nursing homes, etc. People have three easy options in seeking vaccine: check the clinic locator at www.maineflu.gov, call 211, or call their health care providers.

Vaccine Recall
About 800,000 doses of H1N1 vaccine in the .25 mL pre-filled syringe presentation manufactured by Sanofi Pasteur and approved for children ages 6-35 months have been recalled due to questions of potency. This is not a safety recall.

Maine CDC notified 25 practices on Wednesday that they had received some of the recalled lots of H1N1 vaccine. The remaining vaccine from these lots was pulled from their shelves. About 4,500 doses of the recalled lots had been recently shipped to Maine, and reportedly many of those had not been administered yet. Because there were no safety concerns and the vaccine was slightly weaker than the license standards called for, there are no recommendations for the children who received the vaccine except to proceed with their second dose as would normally occur.

All children less than 10 years old should get the recommended two doses of H1N1 vaccine approximately a month apart for the optimal immune response. Therefore, children less than 10 years old who have only received one dose of vaccine thus far should still receive a second dose of 2009 H1N1 vaccine. Parents of children who received vaccine from the recalled lots do not need to take any action, other than to complete the two-dose immunization series if not already completed.

For more information http://www.maine.gov/tools/whatsnew/index.php?topic=Portal+News&id=86326&v=article-2008


To read the complete update: http://www.maine.gov/tools/whatsnew/attach.php?id=86508&an=2

Increased H1N1 vaccine in Maine; now is an excellent time to get vaccinated

Maine CDC/DHHS Update on 2009 H1N1 Influenza Virus
December 10, 2009

Highlights
The H1N1 total vaccine supply in the state has doubled in just over two weeks. Many people in priority groups who have waited for H1N1 vaccine should now be able to more easily access it.

Although we are seeing some decrease in flu activity, we expect the H1N1 flu virus to continue to circulate and additional surges are also possible. We expect to experience a seasonal flu surge as well, as we normally do sometime in the winter. There is still more influenza across the country than is usually seen this time of year, and vaccination remains the best protection against the flu.

Now is an excellent time to get vaccinated if you can, so you will be protected during the next wave of flu.

Flu Activity in Maine and the US
There were three deaths due to H1N1 last week, one of which was included in the weekly report on Dec. 4 and two others reported in a press release Dec. 9. All three were age 50 or older.

All 13 deaths since August occurred in people with multiple underlying health conditions. People with underlying health conditions should seek vaccine at their specialty providers, primary care providers, or at public clinics listed at www.maineflu.gov. Anyone with underlying health conditions who experiences flu-like symptoms should contact his or her health care providers immediately to receive a prescription for antiviral medications (such as Tamiflu®).

There were 31 new hospitalizations due to H1N1 in the last week, up from 25 the week before, and across all age ranges. Although children made up half of all hospitalizations due to H1N1 at one time, only two were hospitalized this past week. Six people required intensive care, all of whom were age 50 or older. Counties of those hospitalized this past week are: Penobscot, 9; Androscoggin, 4; three each in Cumberland, Franklin, and York counties; two each in Knox and Oxford counties; and one each in Aroostook, Hancock, Kennebec, Piscataquis, and Somerset counties.

Of the 175 schools with high absentee rates the past few weeks, only one has reported a high rate this past week (down from 17 the previous week). Outbreaks were also reported in an acute care facility and a long-term care facility. The three outbreaks occurred in Aroostook, Hancock, and York counties.

Flu is unpredictable. Although it appears that flu activity may have peaked during the current wave, other waves of seasonal and/or H1N1 flu may occur. We expect H1N1 to continue to circulate for months, if not years, to come. Take precautions to prevent serious illness: stay home when sick, cover coughs and sneezes, wash hands frequently, and get vaccinated against both seasonal and H1N1 flu when vaccine is available to you.

E-mail Hoax
CDC has not implemented a state vaccination program requiring registration on www.cdc.gov. Users who click on e-mails directing people to create a personal H1N1 vaccination profile 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 benefits of getting the H1N1 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 nationwide have been classified as "not serious" and are things often seen after vaccinations, such as soreness at the vaccination site. This MMWR features information on H1N1 vaccine safety: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58e1204a1.htm.

Nasal Spray Vaccine:
The injectable type of H1N1 vaccine is found in relatively smaller quantities than the nasal spray vaccine in Maine right now. The nasal spray vaccine is a safe and effective vaccine option for healthy people ages 2 through 49 who are not pregnant.

Nasal spray flu vaccine is not new. It has been used successfully in many settings for seasonal flu vaccination since 2003. Questions often arise about nasal spray vaccine because it contains live viruses. The viruses in the nasal spray vaccine are weakened and cannot cause the flu. Side effects, such as runny nose or sore throat, are usually mild and short-lasting, especially compared to getting the flu itself.

Even if you come into regular contact with people who cannot receive the nasal spray vaccine themselves you may still be able to receive the nasal spray vaccine as long as you are healthy, not pregnant, and age 2 through 49. The nasal spray vaccine is safe for breastfeeding mothers. Health care workers who cannot receive the vaccine themselves (due to pregnancy, health condition, or age) may still administer the vaccine.

People who should not receive the H1N1 nasal spray vaccine include:
Children younger than 2 years-old;
Pregnant women;
People age 50 and older;
People with a medical condition that places them at higher risk for complications from flu, including those with chronic heart or lung disease, such as asthma or reactive airways disease; people with medical conditions such as diabetes or kidney failure; or people with illnesses that weaken the immune system, or who take medications that can weaken the immune system;
Children younger than 5 years-old with one or more episodes of wheezing in the last year;
Children or adolescents receiving aspirin therapy;
People who have had Guillain-Barré syndrome (GBS), a rare disorder of the nervous system, within 6 weeks of getting a flu vaccine;
People who have a severe allergy to chicken eggs or who are allergic to any of the nasal spray vaccine components;
Health care workers who are providing medical care for patients who require special environments in the hospital because they are profoundly immunocompromised (i.e., patients undergoing bone marrow or stem cell transplantation).

H1N1 Vaccine Supply and Prioritization
Since October, we have received about 455,300 doses of H1N1 vaccine in Maine. Although this is a significant increase from last week, it is still only about 65% of what is needed for priority populations in the state.

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;

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);

and the following health care workers: 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. Any other health care worker who falls into one or more of the other priority groups above should also be vaccinated.

In general, the reasons for health care workers to be vaccinated are because they can transmit flu to their patients, who generally are more vulnerable to flu. Therefore, the category of health care workers who should receive vaccine at this time is those who work closely with the other high priority populations such as pregnant women and children. However, the best way to provide protection to these other priority populations is to provide them vaccine.

Maine CDC asks that the nasal spray vaccine be used for all healthy, non-pregnant health care workers younger than 50, unless they care for patients undergoing bone marrow or stem cell transplantation (i.e., patients who require a protected environment) or have another contraindication (see above list). The reason is that at this point in time there are not sufficient supplies of injectable vaccine for those with underlying conditions who can only be given the injectable vaccine. If healthy health care workers who qualify for the nasal spray are given injectable vaccine, this can easily deplete the injectable vaccine supply for those who are most vulnerable to being hospitalized or dying from H1N1.

Nearly all K-12 schools in the state have offered initial doses of vaccine to their students; some schools are beginning to hold second dose clinics for children ages nine and younger who need a booster dose 28 days after the initial dose and for students who were unable to receive vaccine during initial clinics.

Vaccine has been distributed to over 360 health care providers in the state, including specialty providers who serve people with high risk health conditions, family practices, obstetric and pediatric providers, and hospitals for distribution within their health networks.

Several residential colleges have also received vaccine for their highest risk students and are now beginning to receive nasal spray vaccine for additional students who are prioritized due to their age and the fact that they often live, work, and study in close proximity.

Public clinics are being organized for those in the current priority groups listed above. All public clinics are required to be listed at www.maineflu.gov. Please check this list frequently as it is updated regularly.

Once all of the prioritized groups have been vaccinated, we anticipate that there will be enough vaccine for anyone who wants it.

Read the full update here: http://www.maine.gov/tools/whatsnew/attach.php?id=86033&an=2

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

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

Weekly Update on H1N1 in Maine 11/12/2009

Maine CDC/DHHS Update on 2009 H1N1 Influenza Virus
November 12, 2009
Highlights
As expected, H1N1 continues to expand and worsen – 65 school outbreaks, ER visits for flu accounting for 1 in 6 ER patients, 19 hospitalizations, and 2 deaths (for a total of 3 since August).
Antiviral medicines are under-utilized.
Vaccine efforts continue – about 95% of schools are expected to complete their vaccinations by the end of next week, for a total of about 400 schools in 4 weeks’ time.

Increased Flu Activity in Maine and the US

The 2009 H1N1 flu continues to be widespread in Maine. Statewide, schools are reporting increased absenteeism due to influenza-like illness (ILI), with rates ranging from 15% to almost 50%. Schools in two communities have closed, and this is an administrative decision based on operational challenges associated with absenteeism among students as well as staff.

There were 65 new outbreaks reported this week (up from 24 last week), all in school settings. Outbreaks in schools occurred in the following counties: Androscoggin (10), Aroostook (2), Cumberland (5), Hancock (3), Kennebec (7), Oxford (3), Penobscot (18), Piscataquis (1), Sagadahoc (1), Somerset (3), Waldo (3), and York (9).

A total of 19 people were hospitalized due to H1N1 (up from 10 last week). Of those hospitalized, 5 were children; 3 were young adults ages 18-24; 10 were adults younger than 65; and one was an adult 65 or older. Two of the adults were in intensive care. Hospitalizations occurred in Androscoggin, Cumberland, Kennebec, Oxford, Penobscot, Washington, and York counties.

There were two deaths – one in a young adult reported in a press release late last week, and another in an adult in the 50-64 age group. Both deaths were in Penobscot County and both people had severe underlying conditions.

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 only enough vaccine for 1 in 8 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 spread this way.
Avoid contact with sick people. If you are at very high risk for complications, you may want to avoid large crowds.
When vaccine is available, get both the 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. The state’s stockpile of these medicines is also available to those who do not have adequate insurance and cannot afford the costs.
Although most people can stay home to recover without seeing a health care provider, anyone with the flu should seek medical attention for:
Dehydration
Trouble breathing
Getting better, then suddenly getting a lot worse
Any major change in one’s condition

H1N1 Vaccine Supply and Prioritization

Another 41,800 doses of H1N1 vaccine were distributed in Maine this week, bringing the total vaccine in the state to 180,400 doses.

US CDC released a list of recommended priority groups to receive the initial doses of H1N1 vaccine last summer. These groups were chosen because they were at high risk for complications from H1N1 or because they could pass H1N1 on to someone at high risk for complications.

Currently, we have received enough vaccine for about 1 in 4 people in priority populations in Maine. For this reason, Maine CDC has had to prioritize within the priority groups, based on trends in infections, the type and amount of vaccine available, and readiness of partners to administer vaccine.

The first groups targeted were children and pregnant women, because they are most disproportionately affected by H1N1 infection and because the types of vaccine available were most appropriate for them. Certain health care workers – for example, those who work in hospital maternity wards, pediatric units, ICU, and emergency departments – were also prioritized initially.

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 inpatients who are at high risk (pregnant women, children, and high-risk adults older than 65)

**Chronic medical conditions that confer a higher risk for influenza-related complications include chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematologic, or metabolic disorders (including diabetes mellitus) or immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus).

We are currently distributing vaccine for use in the following settings:
K-12 schools
Health care providers who care for children, pregnant women and/or very high-risk adults
Colleges and universities for their high-risk students
Some pre-school settings such as preschool programs for high-risk children and Head Starts

By the end of next 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, but not until sometime in December.
All health care providers that ordered H1N1 vaccine for pregnant women will have received sufficient 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 http://www.maineflu.gov/.
We hope to provide more vaccine for health care workers by the end of this month 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.

Reporting Vaccine Administration

Maine CDC asks that all H1N1 vaccine providers and/or administrators are submitting the vaccine administration data into the 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. The vaccine reporting periods on the form are the same timeframe as the dates for the vaccine clinics. This form is then compiled by us and submitted, as required, to US CDC.

We have many thousands fewer doses of vaccine being reported as being administered than we believe have actually been administered. This will start impacting the flow of vaccine, since the flow of vaccine is expected to slow to those states that are not showing evidence of using it.

Maine CDC’s Immunization Program is compiling a database that matches the vaccine distribution database with the vaccine administration database by provider so we can tell which providers are not reporting on vaccine administration (or not using their vaccine). We will then use this to guide our vaccine distribution decision-making.

H1N1 Vaccination Distribution as of November 12:

STATE

180,400 doses
14% of the state population

These numbers mean there is 1 dose for every 4 people in a high priority group, and 1 for every 8 people in the state.

Adverse Events

US CDC's Vaccine Adverse Event Reporting System (VAERS) for years has recorded any adverse events following vaccination. This week Maine CDC compiled the data from the first month of H1N1 vaccine being administered in Maine. We found a total of 5 adverse events reported, all of them minor with none requiring hospitalization or evidence of long term problems. The events included: congestion and a sore throat following a nasal spray vaccine, and tingling and numbness following an injectable vaccine that resolved.


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). These medicines can significantly reduce severity (including hospitalization and death) as well as duration of illness.

State 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: http://www.maine.gov/tools/whatsnew/index.php?topic=DHHS-HAN&id=84066&v=alert

Pediatric Suspension:
The FDA has issued guidance on compounding an oral suspension of Tamiflu® to provide multiple prescriptions: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm188629.htm/ohttp:/www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm188629.htmblocked::http:/www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm188629.htm

MaineCare is promulgating emergency rules increasing the reimbursement for compounding pediatric suspension from $4.35 to $10. The full stockpile of pre-prepared pediatric suspension in the stockpile has been fully deployed to hospitals, health centers, and Hannaford’s pharmacies and other willing pharmacies.

Additional Federal Guidance on Antivirals:
US CDC has posted information about the safety of antivirals: http://www.cdc.gov/H1N1flu/antivirals/safety_info.htm
US CDC Health Alert: Key Issues for Clinicians Concerning Antiviral Treatments for 2009 H1N1: The 2009 H1N1 virus continues to be the dominant influenza virus in circulation in the United States. The benefit of antiviral treatment is greatest when it is initiated as early as possible in the clinical course. http://www.cdc.gov/H1N1flu/HAN/110609.htm


Clinical Testing, Reporting, and Management of H1N1

Health care providers and other public health partners are asked to report to Maine CDC influenza infection among patients who:
· Are hospitalized;
· Have died; and/or
· Are associated with a suspected outbreak.
Health care providers with questions on influenza can contact the Maine CDC at 1-800-821-5821 24 hours a day, 7 days a week.

Testing:
§ Submit a specimen for influenza testing for patients with ILI who are hospitalized, who have died, or for whom a diagnosis of influenza would affect clinical care, infection control, or management of contacts.
§ When testing is indicated, rapid diagnostic tests that are negative should be followed by PCR testing.
§ For outbreaks in institutional settings, submit 3-4 specimens to confirm the cause of the outbreak. Once infection has been confirmed as influenza, further testing is not usually indicated.
§ Information on testing at the Health and Environmental Testing Laboratory is available at: http://www.maine.gov/dhhs/etl/micro/submitting_samples.htm

Algorithm for Testing and Management of H1N1 can be found at: http://www.maine.gov/tools/whatsnew/attach.php?id=82597&an=1
Additional Information for Health Care Providers on testing, reporting and management of H1N1, including patient handouts can be found at:
http://www.maine.gov/dhhs/boh/maineflu/h1n1/health-care-providers.shtml and
http://www.maineflu.gov/


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: http://www.maine.gov/dhhs/boh/maineflu/h1n1/educators.shtml#forms

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 disease.reporting@maine.gov.

US CDC has issued guidance for schools (http://www.cdc.gov/h1n1flu/schools/schoolguidance.htm) and child care programs (http://www.cdc.gov/h1n1flu/childcare/guidance.htm) 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.

New Videos, posters, and related materials from US CDC
Influenza Round Table: Warning Signs Video
Don't Get, Don't Spread Video
H1N1 Flu Vaccine -- Why the Delay? Watch a new CDC video to find out how flu vaccines are made: http://is.gd/4OVFq
"Seasonal and 2009 H1N1 Flu: For Parents Who Have Children or Adolescents with High-Risk Medical Conditions" brochure. New brochure for parents of high-risk children. http://www.cdc.gov/h1n1flu/childcare/toolkit/pdf/H1N1Seasonal_HiRiskChildren_Final.pdf
Updated: H1N1 Flu and You Brochure
Update: Poster-Disposable Respirators: General Donning InstructionsThese posters describe general procedures for properly putting on and taking off a disposable respirator. http://www.cdc.gov/h1n1flu/eua/pdf/n95instructions.pdf

Other Updates from Federal Partners
The World Organization for Animal Health issues this report that the recent identification of H1N1 in a house cat in Iowa is no additional cause for alarm (http://www.oie.int/eng/press/en_091104.htm) and CDC updated this Q&A about H1N1 in pets (http://www.cdc.gov/h1n1flu/qa.htm).

The commissioner of the US Food and Drug Administration (FDA) sent a letter to America’s healthcare professionals thanking them for their efforts during the 2009 H1N1 influenza outbreak and providing information on the safety of the 2009 H1N1 vaccines. The letter can be viewed at http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm189691.htm


Maine CDC H1N1 Activities This Past Week

Calls received by the phone bank: 708
Questions coming into flu.questions@maine.gov: 227
Hits on the webpages associated with http://www.maineflu.gov/: 71,425
Lab tests we (HETL at Maine CDC) conducted: 451
Lab tests we (HETL) conducted total since April: 6,134
Calls coming into the clinical consultation line: 202
Maine CDC employees whose jobs do not normally involve anything related to H1N1 who have volunteered with the phone bank and other related efforts: 124
Maine CDC employees who have been redeployed from other activities to focus on H1N1: 97

Many Maine CDC posters and magnets are now available for order online: http://www.maine.gov/dhhs/boh/flu-poster-orders.shtml

How to Stay Updated

· Flu News: View current Maine CDC press releases, Thursday morning weekly updates, and urgent updates from our Health Alert Network (HAN) by visiting: http://www.maine.gov/dhhs/boh/maineflu/flu-news.shtml. RSS feeds are available for the weekly updates and HAN. Starting this week, Maine CDC is posting the top Q&A from Maine at the beginning of each week, which can be accessed the same way as these Weekly Updates.
· Follow Maine CDC’s Social Media Updates:
o Facebook (search for “Maine CDC”)
o Twitter (http://twitter.com/MEPublicHealth)
o MySpace (www.myspace.com/mainepublichealth)
o Maine CDC’s Blog (http://mainepublichealth.blogspot.com/)
· H1N1 Conference Calls: Maine CDC will be holding conference calls to provide updates and take questions on H1N1. The next call will be held Monday, November 16, from noon to 1 pm. To participate, call 1-800-914-3396 and enter pass code 473623#. During calls, please press *6 to mute your line and #6 to un-mute when you are actively participating.

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: 1-888-257-0990
Deaf and Hard of Hearing phone number: 1-800-606-0215
Phone lines are open Monday - Friday 9 a.m. – 5 p.m.
· Email your questions to: flu.questions@maine.gov