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| Maine CDC's November 20 Update on H1N1 | | 11/20/2009 3:19:00 PM | Email this article • Print this article | H1N1 continues to expand and worsen amid increasing vaccine shortages relative to demand for it as well as under-utilization of antiviral medicines.
There have been a total of 143 schools with reported high absentee rates, including 44 this past week; ER visits for flu account for about 1 in 6 ER patients; there have been 50 hospitalizations this week, with half of them among children; and there have been 2 deaths (both previously reported), for a total of 5 since August.
Vaccine administered appears to be very under-reported by health care providers, with only about 45% of doses distributed having been reported as administered.
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 certain high risk conditions, and all people age 65 and older should receive a pneumococcal vaccine. Information on treatment with intravenous antiviral medicines is available.
Continued Surge of Flu Activity in Maine and the US
Two deaths were reported publicly over the past 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; and 2 people were older than 65, neither of whom needed intensive care. Counties of those hospitalized this past week are: Androscoggin and Penobscot both 11; Cumberland 9; York 8; Hancock 3; Kennebec, Oxford, Piscataquis all 2 each; Aroostook and Washington 1 each.
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.
A total of 143 schools have reported high absenteeism (greater than 15%) due to flu, and 44 of them were from this past 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 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.
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. 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. Maine CDC expects this vaccine to arrive sometime in mid-late December.
The FDA also approved the use of an additional vaccine already in use for those 18 and older to be administered to infants and children. It is produced by the company CSL.
Maine has received 210,500 doses of vaccine - which is about 30% of what is needed for priority populations in the state. Therefore, 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 the most severe chronic medical conditions. (As of now vaccine for this category is only being distributed to some specialists who care for adults with the most severe 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)
Maine CDC continues 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.
As of the end of this week:
• 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. It's expected that the second doses for children ages nine and younger will begin to be distributed in the next several weeks, beginning sometime in December. 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, it is expected 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. Maine CDC hopes that in the next week it will 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.
• Maine CDC hopes 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.
Vaccine may not be available to those not included in the priority groups until early in 2010.
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