H1N1 Update: A Guide to Recommendations and Resources  H1N1 Update 10/25/09

JeanAnne Ware, NP

Nurse Practitioner

Clinical Monitoring Research Program

Support to Laboratory of Clinical Infectious Diseases SAIC-Frederick Inc.

National Cancer Institute at Frederic

Information current as of 10/25/09; as information is updated frequently, please check the listed resource links for most current information, and consult with state health authorities for guidance as needed.

CDC H1N1 home page: http://www.cdc.gov/h1n1flu/

http://www.cdc.gov/h1n1flu/clinicians/

Maryland DHMH http://www.marylandfluwatch.org/

http://dhmh.maryland.gov/swineflu/index.html

Vaccine information: http://www.fda.gov/

http://www.flu.gov.

Flu activity continues to be widespread throughout most of the United States, with H1N1 the predominant strain.  Per the CDC, national visits for influenza-like illnesses (ILI) are higher than what is seen at peak of many flu seasons.  Outpatient visits for ILI increased steeply last week, and hospitalizations and deaths are also increasing and are above expected levels at this time of year.  For the week ending 10/23/09, there were 11 influenza-associated pediatric deaths reported.  Weekly flu updates are available on the CDC website.

On October 25, President Obama declared H1N1 flu a national emergency, allowing the Secretary of the Department of Health and Human Services the power to lift some federal regulations for medical providers, in order to allow more flexibility in procedures to respond to high volumes of patients. The action was described as a precautionary measure, not a response to any new development.

In Maryland, there have been 3 reported flu deaths since 8/30/09, the onset of the 2009-2010 flu season (10 deaths since the onset of 2009 H1N1 infection in 4/09) and flu activity is widespread throughout the state.  Surveillance shows that H1N1 continues to be the predominant strain in Maryland.

 H1N1 vaccine, predominantly the intranasal spray, is available in smaller quantities than previously predicted, due to factors related to manufacturing processes.  More vaccine is expected later this month and later in the season. Vaccination efforts in Maryland are directed to target groups (pregnant women, household contacts and caregivers for children younger than 6 months of age, healthcare and emergency medical services personnel, all people from 6 months through 24 years of age, persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza).  Local vaccination program schedules may be found on the Maryland website.

Recent updates of interest on the CDC website include:

Antiviral recommendations (10/16/09): http://www.cdc.gov/h1n1flu/recommendations.htm

Recommendations for Healthcare Settings and Personnel (10/14/09)

Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel

http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm

Frequently asked Vaccine Questions

For clinicians:

http://www.cdc.gov/H1N1flu/vaccination/top10_faq.htm (10/21/09)

General public:

http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm (10/16/09)

Should I get vaccinated against the 2009 H1N1 if I have had flu-like illness since the Spring of 2009?

The symptoms of influenza (flu-like illnesses) are similar to those caused by many other viruses. Even when influenza viruses are causing large numbers of people to get sick, other viruses are also causing illnesses. Specific testing, called “RT-PCR test,” is needed in order to tell if an illness is caused by a specific influenza strain or by some other virus. This test is different from rapid flu tests that doctors can do in their offices. Since most people with flu-like illnesses will not be tested with RT-PCR this season, the majority will not know whether they have been infected with 2009 H1N1 flu or a different virus.

Therefore, if you were ill but do not know if you had 2009 H1N1 infection, you should get vaccinated, if your doctor recommends it. So, most people recommended for 2009 H1N1 vaccination should be vaccinated with the 2009 H1N1 vaccine regardless of whether they had a flu-like illness earlier in the year.

-JeanAnne Ware, NP

 Additional Useful links

Global status and travel notices: http://wwwn.cdc.gov/travel/content/novel-h1n1-flu.aspx

CDC Brochure available for download: Seasonal and novel H1N1 flu: A guide for parents:  http://www.cdc.gov/flu/professionals/flugallery/2009-10/pdf/pan_flu_brochure.pdf

DHHS website: http://www.flu.gov.

Additional resource for immunization information: www.immunize.org

http://www.cdc.gov/h1n1flu/vaccination/vaccine_safety_qa.htm