As of Monday, December 14, the Whitman County Health Department now has enough H1N1 vaccine to lift any restrictions on who may receive it. Most other health departments in our area have also lifted restrictions now that vaccine supplies are adequate.
In Whitman County, we will be distributing vaccine to physician offices and pharmacies that are interested in giving the vaccine. Special clinics will be conducted at the offices of the Health Department, and, for WSU faculty and staff, immunization clinics will be held at the WSU Health and Wellness Service clinic on Wednesday, Thursday and Friday from 1-5 pm.
H1N1 vaccine is now available to anyone over the age of 6 months. Vaccination is especially encouraged for anyone with a chronic medical condition, pregnant women, children 6 months to 2 years of age, everyone 65 years of age or older, and parents/care givers of children under 6 months of age.
H1N1 vaccine is available in several formulations. Preservative free injectable vaccine is reserved for young children and pregnant women. The nasal spray formulation is for healthy people age 2 to 49. Injectable vaccine with preservative is best for anyone with chronic health problems and folks age 50 and up.
The safety of the H1N1 vaccine has been excellent, with a rate of reactions/complications less than what we typically see with seasonal influenza vaccine. The most common reaction is soreness at the injection site.
If you are interested in getting the vaccine, this would be a good time to receive it. It takes about 10 days after immunization for immunity to build up. People who are traveling over the holidays should get the vaccine now to ensure protection.
Although it appears we are well past the peak of the H1N1 influenza epidemic around the country, there is a possibility of a resurgence or 'third wave' later in the winter. It is impossible to predict. Get the vaccine now and you won't need to worry about it.
Stay tuned for a more complete review of the H1N1 outbreak in a coming blog post.
Call the Whitman County Health Department (Colfax 509-397-6280, Pullman 509-332-6752, or the Flu Line 877-783-0039) or visit our website (www.WhitmanCounty.org/PublicHealth) for more information.
Monday, December 14, 2009
Thursday, October 29, 2009
H1N1 Vaccine Purgatory
Unless you have been living under a rock lately, you know that the flow of vaccine to combat H1N1 Influenza has been slow. Extremely slow. Woefully slow. We need the vaccine; not now, but yesterday.
So what happened? Early predictions from the Centers for Disease Control (CDC) were 45 million doses of vaccine by mid-October with 20 million doses a week after that. It is nearly the first of November and vaccine manufactures have delivered less than 20 million doses. The CDC and vaccine manufacturers offered multiple reasons for the shortfall. Most of these relate to problems at the point of production. However, vaccine manufacturers that are based in foreign countries face domestic pressures that can delay the fulfillment of orders from the United States. We will probably never know the true impact of those pressures.
The most likely explanation for the mismatch, though, was the wildly optimistic projection by the CDC. The US is lucky if we get between 90 and 120 million doses of influenza vaccine in a regular flu season. Production of seasonal flu vaccine was already well under way when manufacturers had to slow the assembly line and begin making H1N1 vaccine. I'm not sure how the CDC thought we might get upwards of 100 million doses of each type of vaccine. Now we are faced with a supply of H1N1 vaccine that was certainly less than hoped for, as well as shortages of seasonal flu vaccine in many areas of the county.
Looking for someone to blame for the shortage or just wishing our doctor or public health department had more H1N1 vaccine won't help to protect a single person from H1N1 influenza. Instead, we need to focus on what we can do right now to protect the ourselves and everyone else from H1N1. Here are a few suggestions.
1) Keep doing those things that prevent the spread of H1N1, including:
- Wash your hands frequently
- Avoid touching your eyes, nose or mouth
- Wash high-tough surfaces frequently
- Don't share with others items you put in your mouth
- Cover your cough or sneezes with your sleeve rather than your hands
- Stay home if you are sick with symptoms of the flu
2) Make sure folks that are on the target list for H1N1 vaccination have access to vaccine first. This includes:
- Pregnant women
- Parents and caregivers of children under 6 months old
- Everyone age 6 months to age 24
- Persons age 25 to 64 chronic health conditions
- Health care and emergency service workers
3) Call your health care provider to inquire about vaccine availability. The Public Health Department will place announcements on the radio, newspaper and on-line when vaccine is in stock.
4) Be patient. Eventually, there will be enough vaccine for everyone who wants it.
So what happened? Early predictions from the Centers for Disease Control (CDC) were 45 million doses of vaccine by mid-October with 20 million doses a week after that. It is nearly the first of November and vaccine manufactures have delivered less than 20 million doses. The CDC and vaccine manufacturers offered multiple reasons for the shortfall. Most of these relate to problems at the point of production. However, vaccine manufacturers that are based in foreign countries face domestic pressures that can delay the fulfillment of orders from the United States. We will probably never know the true impact of those pressures.
The most likely explanation for the mismatch, though, was the wildly optimistic projection by the CDC. The US is lucky if we get between 90 and 120 million doses of influenza vaccine in a regular flu season. Production of seasonal flu vaccine was already well under way when manufacturers had to slow the assembly line and begin making H1N1 vaccine. I'm not sure how the CDC thought we might get upwards of 100 million doses of each type of vaccine. Now we are faced with a supply of H1N1 vaccine that was certainly less than hoped for, as well as shortages of seasonal flu vaccine in many areas of the county.
Looking for someone to blame for the shortage or just wishing our doctor or public health department had more H1N1 vaccine won't help to protect a single person from H1N1 influenza. Instead, we need to focus on what we can do right now to protect the ourselves and everyone else from H1N1. Here are a few suggestions.
1) Keep doing those things that prevent the spread of H1N1, including:
- Wash your hands frequently
- Avoid touching your eyes, nose or mouth
- Wash high-tough surfaces frequently
- Don't share with others items you put in your mouth
- Cover your cough or sneezes with your sleeve rather than your hands
- Stay home if you are sick with symptoms of the flu
2) Make sure folks that are on the target list for H1N1 vaccination have access to vaccine first. This includes:
- Pregnant women
- Parents and caregivers of children under 6 months old
- Everyone age 6 months to age 24
- Persons age 25 to 64 chronic health conditions
- Health care and emergency service workers
3) Call your health care provider to inquire about vaccine availability. The Public Health Department will place announcements on the radio, newspaper and on-line when vaccine is in stock.
4) Be patient. Eventually, there will be enough vaccine for everyone who wants it.
Monday, October 5, 2009
H1N1 Vaccine Arriving Soon
The vaccine for 2009 H1N1 Influenza (“swine flu”) may be arriving this week. Folks have a lot of questions. Fortunately, I have answers.
The first doses of H1N1 vaccine to be delivered will be in a special formulation called Live Attenuated Influenza Virus or LAIV. This vaccine has a form of H1N1 virus that has been weakened so that after it is delivered it causes a sub-clinical form of the flu. It is given in a nasal spray and helps build immunity to the flu in the upper respiratory passages; the same place natural flu viruses gain entry. LAIV has been used for seasonal flu vaccine for several years and is marketed under the trade name FluMist.
LAIV is approved by the FDA for use in healthy, non-pregnant individuals between the ages of 2 and 49. This limits its usefulness in protecting people who are high risk for complications from the flu. However, it is an excellent vaccine to use in healthy children, young adults, and especially in health care workers who could accidentally spread H1N1 influenza to the patients they care for.
Initial shipments of vaccine to Whitman County will be very limited. We are scheduled to receive only 500 doses the first week the vaccine begins shipping. Most public health departments in Washington have decided to use the first allotment of vaccine in health care workers and emergency medical personnel. We have elected to do the same. Vaccine left over after health care workers are inoculated will be distributed to clinics in our area as quickly as possible.
An injectable form of H1N1 vaccine will be available later in October. This vaccine is made from a killed, purified H1N1 virus. It will come in several formulations for both children and adults. We do not know at this time how many doses Whitman County will receive. Much of the injectable vaccine will be sent directly to clinics and physicians offices. Our website will have a list of where and when the vaccine is available.
All H1N1 vaccine is paid for by the federal government. Clinics may charge an administrative fee, which insurance plans will cover, but they cannot charge for the vaccine. Folks without insurance can obtain the vaccine for no cost through the public health department. Although early supplies of vaccine will be limited, there should eventually be enough for anyone who wants it.
Target groups for H1N1 vaccination are pregnant women, parents and caregivers of children under six months old, health care workers, all persons age 6 months to 24 years of age, and persons age 25 to 64 with chronic health problems. People 65 and over are not in the initial target group because H1N1 flu rarely affects this age group. Once the vaccine supply is adequate, H1N1 vaccine will be available to everyone.
Some of the vaccine will be delivered in multi-dose vials and will contain a preservative made from mercury called Thimerosal. Multiple scientific studies have shown no worrisome effects due to thimerosal. Nevertheless, some H1N1 vaccine will be available in single-dose vials without thimerosal. The LAIV form of vaccine (nasal spray) is single-dose only, and does not contain any mercury or preservatives.
H1N1 vaccine is being made in the same manner and by the same companies that make seasonal flu vaccine, and it is expected to have a similar safety profile. The only difference between H1N1 vaccine and seasonal flu vaccine is a change in the strain of the flu virus from which the vaccine is made. Also, just like seasonal flu vaccine, H1N1 vaccine will be free of any immune boosting chemicals or adjuvants.
Finally, check the Whitman County website for details of when H1N1 vaccine will be available. Also call the Flu Line at 509-397 -6FLU.
I welcome your questions and comments.
The first doses of H1N1 vaccine to be delivered will be in a special formulation called Live Attenuated Influenza Virus or LAIV. This vaccine has a form of H1N1 virus that has been weakened so that after it is delivered it causes a sub-clinical form of the flu. It is given in a nasal spray and helps build immunity to the flu in the upper respiratory passages; the same place natural flu viruses gain entry. LAIV has been used for seasonal flu vaccine for several years and is marketed under the trade name FluMist.
LAIV is approved by the FDA for use in healthy, non-pregnant individuals between the ages of 2 and 49. This limits its usefulness in protecting people who are high risk for complications from the flu. However, it is an excellent vaccine to use in healthy children, young adults, and especially in health care workers who could accidentally spread H1N1 influenza to the patients they care for.
Initial shipments of vaccine to Whitman County will be very limited. We are scheduled to receive only 500 doses the first week the vaccine begins shipping. Most public health departments in Washington have decided to use the first allotment of vaccine in health care workers and emergency medical personnel. We have elected to do the same. Vaccine left over after health care workers are inoculated will be distributed to clinics in our area as quickly as possible.
An injectable form of H1N1 vaccine will be available later in October. This vaccine is made from a killed, purified H1N1 virus. It will come in several formulations for both children and adults. We do not know at this time how many doses Whitman County will receive. Much of the injectable vaccine will be sent directly to clinics and physicians offices. Our website will have a list of where and when the vaccine is available.
All H1N1 vaccine is paid for by the federal government. Clinics may charge an administrative fee, which insurance plans will cover, but they cannot charge for the vaccine. Folks without insurance can obtain the vaccine for no cost through the public health department. Although early supplies of vaccine will be limited, there should eventually be enough for anyone who wants it.
Target groups for H1N1 vaccination are pregnant women, parents and caregivers of children under six months old, health care workers, all persons age 6 months to 24 years of age, and persons age 25 to 64 with chronic health problems. People 65 and over are not in the initial target group because H1N1 flu rarely affects this age group. Once the vaccine supply is adequate, H1N1 vaccine will be available to everyone.
Some of the vaccine will be delivered in multi-dose vials and will contain a preservative made from mercury called Thimerosal. Multiple scientific studies have shown no worrisome effects due to thimerosal. Nevertheless, some H1N1 vaccine will be available in single-dose vials without thimerosal. The LAIV form of vaccine (nasal spray) is single-dose only, and does not contain any mercury or preservatives.
H1N1 vaccine is being made in the same manner and by the same companies that make seasonal flu vaccine, and it is expected to have a similar safety profile. The only difference between H1N1 vaccine and seasonal flu vaccine is a change in the strain of the flu virus from which the vaccine is made. Also, just like seasonal flu vaccine, H1N1 vaccine will be free of any immune boosting chemicals or adjuvants.
Finally, check the Whitman County website for details of when H1N1 vaccine will be available. Also call the Flu Line at 509-397 -6FLU.
I welcome your questions and comments.
Thursday, September 24, 2009
Seasonal Flu Vaccine is Here
The vaccine for seasonal flu is now in stock and available most everywhere, from pharmacies to clinics and the local public health office. Seasonal flu is the flu that comes around every winter. The vaccine covers three strains of influenza; two type A flu strains and one type B. It does NOT cover the new H1N1 ('swine flu') strain. The strains of influenza virus that make up this year's seasonal flu vaccine were decided upon and produced well before we even knew about the new H1N1 Influenza.
No one can predict how bad the flu season will be or which flu strains will predominate. The strains included in this year's seasonal flu vaccine were scientist's best guess of what will circulate. The new H1N1 influenza has really upset even the best predictions, and now most folks who are accustomed to getting a flu shot every fall are faced with getting two shots; one for seasonal flu and one for the new H1N1 strain. The H1N1 flu vaccine isn't available yet. We can expect it in a few weeks. Getting vaccinated for both seasonal and H1N1 flu strains will cover all the possible circulating strains and reduce the number people who suffer complications or death from influenza.
Who should get the vaccine for seasonal influenza?
No one can predict how bad the flu season will be or which flu strains will predominate. The strains included in this year's seasonal flu vaccine were scientist's best guess of what will circulate. The new H1N1 influenza has really upset even the best predictions, and now most folks who are accustomed to getting a flu shot every fall are faced with getting two shots; one for seasonal flu and one for the new H1N1 strain. The H1N1 flu vaccine isn't available yet. We can expect it in a few weeks. Getting vaccinated for both seasonal and H1N1 flu strains will cover all the possible circulating strains and reduce the number people who suffer complications or death from influenza.
Who should get the vaccine for seasonal influenza?
People who are at high risk for complications from seasonal flu:
- Children 6 months through 18 years of age,
- Pregnant women,
- People 50 years of age and older,
- People of any age with certain chronic medical conditions, and
- People who live in nursing homes and other long-term care facilities.
People who live with or care for those at high risk for complications:
- Household contacts of persons at high risk for complications from the flu (see above),
- Household contacts and out-of-home caregivers of children less than 6 months of age (these children are too young to be vaccinated), and
- Healthcare workers.
Vaccine for seasonal flu is also available for anyone wishing to reduce their chance of getting influenza.
For more information on seasonal flu vaccine, go here.
Thursday, September 17, 2009
Influenza Update
Influenza continues to extract a toll on Whitman County residents. While the initial tidal wave of influenza-like illness at Washington State University seems to be slowing to an ebb, the ripples of that wave are now being felt in Pullman and surrounding communities. This week and last, the Whitman County Health Department has received reports of student absenteeism rates reaching 20% in some schools.
Exact counts of the number of influenza cases in the county are difficult to determine. Many patients with influenza-like illness (ILI) do not seek or need medical evaluation. We have no way of knowing how many cases of ILI fall in that category. Local medical providers have been seeing increased numbers of patients with ILI in the last few weeks, but there is no requirement they report the numbers of patients they see to the Health Department. And even though schools do report the number of students who are absent, our ability to reliably determine that the absent students actually have influenza is quite limited.
However, we are able to track the number of patients hospitalized with ILI or with complications from ILI. The number of patients hospitalized with ILI provide a good gauge of the amount of influenza activity in a community. The Centers for Disease Control estimates that the rate of hospitalization for H1N1 flu is similar to seasonal flu, or about 1 percent. Since the middle of August, only 10 persons in Whitman County have been hospitalized with ILI. So that would mean we have had approximately 1000 cases of Influenza. If we include the dozen or so WSU students that have required intravenous fluids for their ILI as hospitalized cases, then we are up over 2200 cases.
Two thousand or so cases of flu a year is not abnormal for Whitman County. What is wildly abnormal is that these cases have occurred over just three weeks at a time of year we never see influenza. This is a new flu. This is H1N1 influenza. Our experience here shows how quickly this virus can spread in a non-immune and unprepared population.
A few simple steps might reduce the rapid spread of H1N1 to a slow crawl. These are the best options we have until the H1N1 vaccine arrives:
Exact counts of the number of influenza cases in the county are difficult to determine. Many patients with influenza-like illness (ILI) do not seek or need medical evaluation. We have no way of knowing how many cases of ILI fall in that category. Local medical providers have been seeing increased numbers of patients with ILI in the last few weeks, but there is no requirement they report the numbers of patients they see to the Health Department. And even though schools do report the number of students who are absent, our ability to reliably determine that the absent students actually have influenza is quite limited.
However, we are able to track the number of patients hospitalized with ILI or with complications from ILI. The number of patients hospitalized with ILI provide a good gauge of the amount of influenza activity in a community. The Centers for Disease Control estimates that the rate of hospitalization for H1N1 flu is similar to seasonal flu, or about 1 percent. Since the middle of August, only 10 persons in Whitman County have been hospitalized with ILI. So that would mean we have had approximately 1000 cases of Influenza. If we include the dozen or so WSU students that have required intravenous fluids for their ILI as hospitalized cases, then we are up over 2200 cases.
Two thousand or so cases of flu a year is not abnormal for Whitman County. What is wildly abnormal is that these cases have occurred over just three weeks at a time of year we never see influenza. This is a new flu. This is H1N1 influenza. Our experience here shows how quickly this virus can spread in a non-immune and unprepared population.
A few simple steps might reduce the rapid spread of H1N1 to a slow crawl. These are the best options we have until the H1N1 vaccine arrives:
- Wash your hands frequently
- Don't touch your nose, mouth or eyes
- Wash high-touch surfaces regularly
- Don't share with others items you put in your mouth
- Cover your coughs and sneezes with your sleeve rather than your hands
- Stay home if you are sick with the flu. Don't return to work or school until 24 hours after your fever has resolved without the use of fever reducers.
Tuesday, September 8, 2009
Updated antiviral use recommendations
Monday, September 7, 2009
Certain children at high risk with H1N1 flu
In the most resent version of the Morbidity and Mortality Weekly Report (MMWR), CDC researchers wrote about the first 36 children that died since last spring from the novel H1N1 virus; of those, two-thirds had underlying medical conditions like cerebral palsy, muscular dystrophy, asthma, diabetes or cardiovascular problems. Some of the other children who died had bacterial illnesses in addition to this novel influenza. See the whole article here.
Friday, September 4, 2009
So how many H1N1 cases? 2 or 2000?
WSU reported this week they have had approximately 2000 contacts (visits or consultations) with students who have H1N1 influenza. And the Whitman County Health Department states that only two cases of H1N1 flu have been confirmed. This can't be right, can it?
Actually, both numbers are correct, and I will try to explain why.
Influenza viruses circulate around the Northern Hemisphere every winter. We call that Seasonal Influenza. There are Influenza A viruses and Influenza B viruses. Influenza A viruses have a lot of variation and are identified by a confusing set of letters (H,N) and numbers (1-7).
In April of this year, a new Influenza A virus appeared in Mexico and quickly spread around the world. This is the 2009 H1N1 Influenza A virus (formerly call 'swine flu'). 2009 H1N1 Influenza quickly became THE main influenza virus in circulation. Since May of this year, about 98% of all influenza viruses sampled from flu sufferers in the US and examined in laboratories has been 2009 H1N1 Influenza.
The hallmark symptom of influenza is fever. The fever is usually over 101 degrees and comes with a dry cough or sore throat. Body aches, headaches and a feeling like the roots of your hair are on fire frequently accompany the fever. These symptoms typically last 3-5 days then usually resolve without treatment.
Health care providers see enough patients with influenza every year they rarely need a test to confirm the diagnosis. Early in the regular flu season, doctors may test a few patients to convince themselves that what they are seeing is really influenza. After that, they don't spend money testing for the flu. If it looks like the flu, sounds like the flu, and acts like the flu, it's the flu.
And this is what has happened with the sick students on campus. A few students with typical flu symptoms were tested at the beginning of the outbreak and were found to be positive for Influenza A. We assumed this was 2009 H1N1 Influenza A from the outset. But since assuming anything is usually a bad idea, a few samples from sick patients were sent to the State Public Health Laboratory for further testing. As we suspected, the samples came back showing the infections were due to 2009 H1N1 Influenza.
So both numbers are right. In the past two weeks, up to 2000 students at WSU have complained of, or sought care for, symptoms compatible with influenza. That means a fever with a cough or sore throat. Only a dozen or so had tests showing they had Influenza A. And only two have had more extensive testing confirming the flu outbreak was caused by the H1N1 Influenza A virus - something we knew all along.
Actually, both numbers are correct, and I will try to explain why.
Influenza viruses circulate around the Northern Hemisphere every winter. We call that Seasonal Influenza. There are Influenza A viruses and Influenza B viruses. Influenza A viruses have a lot of variation and are identified by a confusing set of letters (H,N) and numbers (1-7).
In April of this year, a new Influenza A virus appeared in Mexico and quickly spread around the world. This is the 2009 H1N1 Influenza A virus (formerly call 'swine flu'). 2009 H1N1 Influenza quickly became THE main influenza virus in circulation. Since May of this year, about 98% of all influenza viruses sampled from flu sufferers in the US and examined in laboratories has been 2009 H1N1 Influenza.
The hallmark symptom of influenza is fever. The fever is usually over 101 degrees and comes with a dry cough or sore throat. Body aches, headaches and a feeling like the roots of your hair are on fire frequently accompany the fever. These symptoms typically last 3-5 days then usually resolve without treatment.
Health care providers see enough patients with influenza every year they rarely need a test to confirm the diagnosis. Early in the regular flu season, doctors may test a few patients to convince themselves that what they are seeing is really influenza. After that, they don't spend money testing for the flu. If it looks like the flu, sounds like the flu, and acts like the flu, it's the flu.
And this is what has happened with the sick students on campus. A few students with typical flu symptoms were tested at the beginning of the outbreak and were found to be positive for Influenza A. We assumed this was 2009 H1N1 Influenza A from the outset. But since assuming anything is usually a bad idea, a few samples from sick patients were sent to the State Public Health Laboratory for further testing. As we suspected, the samples came back showing the infections were due to 2009 H1N1 Influenza.
So both numbers are right. In the past two weeks, up to 2000 students at WSU have complained of, or sought care for, symptoms compatible with influenza. That means a fever with a cough or sore throat. Only a dozen or so had tests showing they had Influenza A. And only two have had more extensive testing confirming the flu outbreak was caused by the H1N1 Influenza A virus - something we knew all along.
Thursday, September 3, 2009
H1N1 Inflenza Confirmed by State Lab
H1N1 Influenza Confirmed by State Lab
The Washington State Public Health Laboratory today confirmed that the influenza outbreak at Washington State University (WSU) and Pullman is indeed caused by the novel 2009 H1N1 Influenza A strain. The Whitman County Health Department received confirmation this afternoon of H1N1 influenza virus in two samples sent to the State Lab. Samples tested were from a 19 year old male and a 24 year old female.
WSU reports a slight decline in the numbers of students seen with influenza in the past 24 hours. However, WSU officials estimate that nearly 2000 students have sought evaluation or consultation with providers at the Health and Wellness Service over the past 10 days. Local medical providers in the Pullman area report a slight uptick in influenza cases seen, several of whom are grade school age children.
The spectrum of illness caused by H1N1 seems fairly mild so far, with sudden onset of fever and cough or sore throat. Symptoms last for 3-5 days and the fever is usually responsive to acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Several cases have required intravenous fluids for dehydration.
Antiviral medications (Tamiflu or Relenza) are available for treatment of H1N1 influenza, but most patients do not need treatment and will recover without difficulty. Some individuals have medical conditions that make them a high-risk for complications from influenza. This includes pregnant women, children under age 4, adults over age 65, and persons with chronic lung, heart, neurologic or immunologic conditions. Patients who have a high-risk condition and have the flu should consult their medical provider as soon as possible.
A vaccine is being developed for H1N1 influenza but is still in the testing phase. Federal health officials predict the vaccine will be available near the middle of October. Target groups for H1N1 vaccination, at least initially, will include pregnant women, children age 6 months to 4 years old, children age 5-18 with chronic medical conditions like asthma, parents and caregivers of infants under 6 months old, and health care and emergency workers with direct patient contact.
Until a vaccine is available, Public Health officials encourage everyone to follow these simple steps to help prevent transmission of influenza:
The Whitman County Health Department is monitoring the H1N1 situation carefully and is in regular contact with Washington State Department of Health officials as well as local medical providers. Everyone is urged to stay informed on H1N1 influenza and up-to-date on the latest developments regarding the outbreak by following alerts posted on the Whitman County website (http://whitmancounty.org/publichealth) or the Washington State University blog (https://hws.wsu.edu/blog/default.asp).
For more information, please contact Melissa Elkins, RN or Timothy Moody, MD at the Whitman County Health Department (509-397-6280).
The Washington State Public Health Laboratory today confirmed that the influenza outbreak at Washington State University (WSU) and Pullman is indeed caused by the novel 2009 H1N1 Influenza A strain. The Whitman County Health Department received confirmation this afternoon of H1N1 influenza virus in two samples sent to the State Lab. Samples tested were from a 19 year old male and a 24 year old female.
WSU reports a slight decline in the numbers of students seen with influenza in the past 24 hours. However, WSU officials estimate that nearly 2000 students have sought evaluation or consultation with providers at the Health and Wellness Service over the past 10 days. Local medical providers in the Pullman area report a slight uptick in influenza cases seen, several of whom are grade school age children.
The spectrum of illness caused by H1N1 seems fairly mild so far, with sudden onset of fever and cough or sore throat. Symptoms last for 3-5 days and the fever is usually responsive to acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Several cases have required intravenous fluids for dehydration.
Antiviral medications (Tamiflu or Relenza) are available for treatment of H1N1 influenza, but most patients do not need treatment and will recover without difficulty. Some individuals have medical conditions that make them a high-risk for complications from influenza. This includes pregnant women, children under age 4, adults over age 65, and persons with chronic lung, heart, neurologic or immunologic conditions. Patients who have a high-risk condition and have the flu should consult their medical provider as soon as possible.
A vaccine is being developed for H1N1 influenza but is still in the testing phase. Federal health officials predict the vaccine will be available near the middle of October. Target groups for H1N1 vaccination, at least initially, will include pregnant women, children age 6 months to 4 years old, children age 5-18 with chronic medical conditions like asthma, parents and caregivers of infants under 6 months old, and health care and emergency workers with direct patient contact.
Until a vaccine is available, Public Health officials encourage everyone to follow these simple steps to help prevent transmission of influenza:
- Wash your hands frequently. When soap and water are not available use an alcohol based hand sanitizer
- Avoid touching your nose, mouth and eyes. This is how germs spread.
- Clean high-touch surfaces on a regular basis. Normal household cleansers are adequate.
- Do not share with others things you put in your mouth, like eating and drinking utensils, smoking materials or lip gloss.
- Cover your coughs and sneezes with a tissue and dispose of the tissue immediately. When tissues are not available, cough in to the bend of your arm.
- Stay home if you are sick with symptoms of the flu. Do not return to work or school until 24 hours after complete resolution of fever without the use of fever reducers.
The Whitman County Health Department is monitoring the H1N1 situation carefully and is in regular contact with Washington State Department of Health officials as well as local medical providers. Everyone is urged to stay informed on H1N1 influenza and up-to-date on the latest developments regarding the outbreak by following alerts posted on the Whitman County website (http://whitmancounty.org/publichealth) or the Washington State University blog (https://hws.wsu.edu/blog/default.asp).
For more information, please contact Melissa Elkins, RN or Timothy Moody, MD at the Whitman County Health Department (509-397-6280).
Wednesday, September 2, 2009
New H1N1 Blog at WSU
The Washington State University Health and Wellness Service has started a new blog related to the H1N1 Influenza outbreak on campus. Daily updates are posted there. Check it out here:
http://hws.wsu.edu/blog/default.asp
http://hws.wsu.edu/blog/default.asp
Tuesday, September 1, 2009
Whitman County Influenza Update 8/31/09
Over the last weekend (8/28-8/30), over 200 persons with influenza-like illness (ILI) were seen in area clinics, urgent care centers and hospital emergency rooms. Most persons presenting for care were WSU students. Some community members were also seen. Two patients were hospitalized overnight for treatment. Several students have been treated for influenza symptoms associated with dehydration. No deaths or serious complications have been reported at this time.
WSU has an update on their situation here: http://h1n1flu.wsu.edu/utils/File.aspx?fileid=5504.
Although no patient samples have been confirmed in the State Public Health Laboratory, we believe the present outbreak is caused by the 2009 H1N1 Influenza A sub-type since this is the predominant strain or sub-type of Influenza A in circulation since late last Spring.
Follow-up on local patients identified with Influenza A has shown this illness to be mild to moderate in severity and to have a duration of 4-5 days, at the most. Most cases respond very well to acetaminophen (Tylenol) and ibuprofen (Advil, Motrin). Patients with mild and un-complicated infections do not require treatment with anti-viral medication.
Health officials at the Whitman County Health Department expect to see more cases of influenza occurring in the Pullman area in the coming days and weeks. Working parents of school aged children should make a plan now for keeping children home and away from school in the event they become sick. . A vaccine for H1N1 Influenza A is currently undergoing clinical trials but is not expected to be available until the middle of October.
Influenza transmission can be prevented by following some simple hygienic measures:
WSU has an update on their situation here: http://h1n1flu.wsu.edu/utils/File.aspx?fileid=5504.
Although no patient samples have been confirmed in the State Public Health Laboratory, we believe the present outbreak is caused by the 2009 H1N1 Influenza A sub-type since this is the predominant strain or sub-type of Influenza A in circulation since late last Spring.
Follow-up on local patients identified with Influenza A has shown this illness to be mild to moderate in severity and to have a duration of 4-5 days, at the most. Most cases respond very well to acetaminophen (Tylenol) and ibuprofen (Advil, Motrin). Patients with mild and un-complicated infections do not require treatment with anti-viral medication.
Health officials at the Whitman County Health Department expect to see more cases of influenza occurring in the Pullman area in the coming days and weeks. Working parents of school aged children should make a plan now for keeping children home and away from school in the event they become sick. . A vaccine for H1N1 Influenza A is currently undergoing clinical trials but is not expected to be available until the middle of October.
Influenza transmission can be prevented by following some simple hygienic measures:
- Wash your hands frequently with soap and water. Use an alcohol-base hand sanitizer when soap and water are not available
- Avoid touching your hands to your nose, mouth or eyes
- Do not share with others things you put in your mouth such as eating or drinking utensils
- Cover your cough or sneezes with a tissue or your sleeve
- Clean surfaces and objects that are touched frequently by other people (door knobs, railings, etc) on a regular basis
- Stay home if you are sick with a flu-like illness (fever, cough, sore throat, head ache, body aches). Do not return to work or school until 24 hours after your fever has resolved.
Friday, August 28, 2009
WSU H1N1 Update
WSU is stepping up it's response to an outbreak of Influenza A (probably H1N1) on campus. The Health and Wellness Service there is providing daily updates on the situation. Below is the update from today.
Health & Wellness Services Flu update - 08.28.09 - 9:30 a.m.
HWS staff has seen 179 patients with influenza-like illness since Monday. Of those 179 patients, 32 were tested for type A influenza and 7 of those tests were positive. These numbers were gathered from our database and are more accurate than previous estimates. Health care providers in the local community have also seen WSU students with influenza-like illnesses, but we do not have numbers available for those patients.
Following Centers for Disease Control guidelines, Health & Wellness Services is encouraging all influenza patients who are not severely ill and at low risk for complications from influenza to self care at home and to isolate themselves as much as possible in an effort to reduce the spread of the virus. Self isolation should continue until the patient has been fever free for 24 hours without the use of fever reducing medication.
HWS has distributed self care and self assessment information to WSU students through multiple communication channels. The vast majority of the patients we’ve been seeing have had relatively mild symptoms. The patients have been responding well to acetaminophen and feel better within days.
If a patient has severe symptoms or is considered high risk for complications from influenza, they should call or come in. Patients who are at all unsure about their symptom status or whether or not they should seek medical attention are strongly encouraged to call Health and Wellness Services at 509-335-3575 or come in to be seen.
Seek emergency medical care if you or someone you know is having any of following warning signs:
In adults, emergency warning signs that need urgent medical attention include:
Seek emergency medical care if you or someone you know is experiencing any of the signs above.
In accordance with guidelines from the Whitman County Health Department and the CDC, HWS is no longer testing patients to confirm H1N1 infection, and we are only testing high risk patients for type A influenza . If a patient tests positive for type A influenza, it is assumed they have H1N1 and are treated accordingly. It is also possible to have H1N1 and not test positive for type A influenza. We are treating all patients with influenza-like symptoms as if they have H1N1.
People at high risk of serious flu complications are young children, pregnant women, people with chronic health conditions like asthma, diabetes or heart and lung disease and people 65 years and older.
People at greatest risk for novel H1N1 infection include children, pregnant women, and people with chronic health conditions like asthma, diabetes or heart and lung disease.
Seasonal flu vaccine is available at HWS for WSU students who are at high risk for complications from influenza. We anticipate that seasonal flu vaccine will be available for non-high risk WSU students no later than October. At this time we are focusing on our student patients and are not providing flu vaccine for WSU employees. High-risk students are encouraged to come to HWS during morning hours, when there are usually fewer sick patients in the clinic, to get vaccinated.
Health & Wellness Services Flu update - 08.28.09 - 9:30 a.m.
HWS staff has seen 179 patients with influenza-like illness since Monday. Of those 179 patients, 32 were tested for type A influenza and 7 of those tests were positive. These numbers were gathered from our database and are more accurate than previous estimates. Health care providers in the local community have also seen WSU students with influenza-like illnesses, but we do not have numbers available for those patients.
Following Centers for Disease Control guidelines, Health & Wellness Services is encouraging all influenza patients who are not severely ill and at low risk for complications from influenza to self care at home and to isolate themselves as much as possible in an effort to reduce the spread of the virus. Self isolation should continue until the patient has been fever free for 24 hours without the use of fever reducing medication.
HWS has distributed self care and self assessment information to WSU students through multiple communication channels. The vast majority of the patients we’ve been seeing have had relatively mild symptoms. The patients have been responding well to acetaminophen and feel better within days.
If a patient has severe symptoms or is considered high risk for complications from influenza, they should call or come in. Patients who are at all unsure about their symptom status or whether or not they should seek medical attention are strongly encouraged to call Health and Wellness Services at 509-335-3575 or come in to be seen.
Seek emergency medical care if you or someone you know is having any of following warning signs:
In adults, emergency warning signs that need urgent medical attention include:
- Difficulty breathing or shortness of breath
- Pain or pressure in the chest or abdomen
- Sudden dizziness
- Confusion
- Severe or persistent vomiting
Seek emergency medical care if you or someone you know is experiencing any of the signs above.
In accordance with guidelines from the Whitman County Health Department and the CDC, HWS is no longer testing patients to confirm H1N1 infection, and we are only testing high risk patients for type A influenza . If a patient tests positive for type A influenza, it is assumed they have H1N1 and are treated accordingly. It is also possible to have H1N1 and not test positive for type A influenza. We are treating all patients with influenza-like symptoms as if they have H1N1.
People at high risk of serious flu complications are young children, pregnant women, people with chronic health conditions like asthma, diabetes or heart and lung disease and people 65 years and older.
People at greatest risk for novel H1N1 infection include children, pregnant women, and people with chronic health conditions like asthma, diabetes or heart and lung disease.
Seasonal flu vaccine is available at HWS for WSU students who are at high risk for complications from influenza. We anticipate that seasonal flu vaccine will be available for non-high risk WSU students no later than October. At this time we are focusing on our student patients and are not providing flu vaccine for WSU employees. High-risk students are encouraged to come to HWS during morning hours, when there are usually fewer sick patients in the clinic, to get vaccinated.
Wednesday, August 26, 2009
H1N1 Antiviral Resistance
Two more oseltamivir (Tamiflu)-resistant cases of novel H1N1 flu have been identified in the United States, bringing the US total to four, Dr. Scott Epperson of the CDC reported today during a teleconference sponsored by the National Influenza Vaccine Summit. "These two new cases as well as the first two reported 2 weeks ago were associated with treatment or prophylaxis with Tamiflu," Epperson said. The two latest cases were included in the CDC's weekly surveillance update issued Aug 21.
See the full CDC Flu Surveillance summary here: http://www.cdc.gov/flu/weekly/?date=082609
See the full CDC Flu Surveillance summary here: http://www.cdc.gov/flu/weekly/?date=082609
H1N1 Flu Outbreaks on Other Campuses Too
Officials at Carnegie Mellon University in Pittsburgh have confirmed novel H1N1 in 24 students, many of whom are being treated in isolation units, the Pittsburgh Post-Gazette reported today. Penn State has also confirmed several cases. Meanwhile, schools near Lee County, Alabama, including the cities of Opelika and Auburn, are reporting hundreds of students sick with flu-like illnesses, and dozens of illnesses have been reported in Los Alamos, NM, schools, according to other reports.
See the full story here: http://www.post-gazette.com/pg/09238/993217-455.stm
See the full story here: http://www.post-gazette.com/pg/09238/993217-455.stm
Tuesday, August 25, 2009
The Flu is Here
Two days into the beginning of the semester and the Whitman County Health Department is already receiving reports of positive Influenza A cases occurring among students at Washington State University. Over a dozen cases of Influenza A have been diagnosed in local provider offices, urgent care clinics and the Pullman Regional Hospital emergency department. No hospitalizations or serious complications have been reported at this time.
Since May of this year, over 95% of Influenza A cases in the United States have been the Novel H1N1 (“Swine Flu”) sub-type. It is likely these recent Influenza A cases locally are the Novel H1N1 sub-type as well.
Symptoms of Novel H1N1 flu include the sudden onset of a fever, usually over 102 degrees, and a cough or sore throat. These symptoms occur in over 95% of cases. Headaches, body aches and muscle pain also occur. Very young children may also have vomiting and diarrhea with H1N1.
Several groups of people are at especially high risk for complications from H1N1 flu. These include pregnant women, people with asthma and chronic lung disease, those with cardiovascular disease, and folks with conditions that impair the immune system. Young children, under the age of two, and older adults, over the age of 65, may also be considered high risk.
A vaccine for the Novel H1N1 Influenza is currently undergoing clinical trials. It won’t be available until the middle of October at the earliest. Efforts to limit the impact of H1N1 must focus on preventing further spread. Here is a list of what you can do now to prevent the spread of H1N1:
If you are well and do not have the flu -
If you are sick with symptoms of H1N1 flu -
Seek medical care for yourself if you have flu symptoms and any of the following –
Seek medical care for your child if they have flu symptoms and any of the following –
Stay up to date on the latest regarding Novel H1N1 by visiting these web sites:
Centers for Disease Control and Prevention H1N1 page (http://www.cdc.gov/h1n1flu/)
Washington State Department of Health H1N1 page (http://www.doh.wa.gov/swineflu/default.htm)
Whitman County Public Health (http://www.whitmancounty.org/publichealth/)
Since May of this year, over 95% of Influenza A cases in the United States have been the Novel H1N1 (“Swine Flu”) sub-type. It is likely these recent Influenza A cases locally are the Novel H1N1 sub-type as well.
Symptoms of Novel H1N1 flu include the sudden onset of a fever, usually over 102 degrees, and a cough or sore throat. These symptoms occur in over 95% of cases. Headaches, body aches and muscle pain also occur. Very young children may also have vomiting and diarrhea with H1N1.
Several groups of people are at especially high risk for complications from H1N1 flu. These include pregnant women, people with asthma and chronic lung disease, those with cardiovascular disease, and folks with conditions that impair the immune system. Young children, under the age of two, and older adults, over the age of 65, may also be considered high risk.
A vaccine for the Novel H1N1 Influenza is currently undergoing clinical trials. It won’t be available until the middle of October at the earliest. Efforts to limit the impact of H1N1 must focus on preventing further spread. Here is a list of what you can do now to prevent the spread of H1N1:
If you are well and do not have the flu -
- Wash your hands frequently with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer.
- Avoid touching your fingers to your eyes, nose or mouth.
- Don’t share with others things you put in your mouth. This includes drinking and eating utensils as well as smoking materials.
- Wash surfaces that are touched by other people, such as door handles, railings, etc, on a regular basis. No special cleanser is required.
- Cover your coughs and sneezes with a tissue or your sleeve rather than your hands. Dispose of used tissues immediately and wash your hands.
- Consider limiting your exposure to large groups of people if you are pregnant, have a chronic medical condition or immune system impairment.
- Make a plan now for work or school absence if you or your child were to catch H1N1 flu.
- Surgical masks are not useful as a protective measure for well persons and are not recommended.
If you are sick with symptoms of H1N1 flu -
- Stay home. Minimize the number of people with which you have contact.
- Rest and drink lots of fluids.
- Use acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce fevers and help with body aches. Do not use aspirin due to the possibility of Reye Syndrome.
- Wear a surgical mask to protect others from your coughs and sneezes if you must be out or if seeking medical evaluation.
- Cover your coughs and sneezes with a tissue or your sleeve rather than your hands.
- Wash your hands frequently.
- Do not return to school or work until 24 hours beyond complete resolution of your fever without the use of fever reducing medicines (acetaminophen or ibuprofen).
Seek medical care for yourself if you have flu symptoms and any of the following –
- Difficulty breathing or severe shortness of breath
- Sudden chest pain
- Signs of dehydration such as lightheadedness or near fainting when standing
- Persistent vomiting and inability to keep fluids down
- Confusion
- Flu-like symptoms improve but then return with fever and worse cough
- CALL BEFORE YOU GO – please call your provider prior to presenting at the office or emergency room for evaluation
Seek medical care for your child if they have flu symptoms and any of the following –
- Fast breathing or trouble breathing
- Bluish or gray skin color
- Not drinking enough fluids
- Severe or persistent vomiting
- Not waking up or not interacting
- Being so irritable that the child does not want to be held
- Flu-like symptoms improve but then return with fever and worse cough
- CALL BEFORE YOU GO – please call your provider prior to presenting at the office or emergency room for evaluation
Stay up to date on the latest regarding Novel H1N1 by visiting these web sites:
Centers for Disease Control and Prevention H1N1 page (http://www.cdc.gov/h1n1flu/)
Washington State Department of Health H1N1 page (http://www.doh.wa.gov/swineflu/default.htm)
Whitman County Public Health (http://www.whitmancounty.org/publichealth/)
Thursday, August 20, 2009
H1N1 Vaccine Availability
The Centers for Disease Control and Prevention just revised their projections for the amount of H1N1 vaccine that will be available for delivery by the middle of October. Initial estimates were that 120 million doses would be available mid-October, with about 20 million doses each week after. That estimate has been adjusted to only 45 million doses by mid-October with 20 million doses a week after that.
Limited vaccine availability will severely narrow the risk groups eligible for initial immunization efforts. The US Advisory Committee on Immunization Practices will undoubtedly meet again and revise their previously published priority groups, which included nearly 159 million Americans. I would guess the new priority list for vaccination would include pregnant women, children 6 months to 4 years of age, children 5-18 with chronic health conditions that place them at risk of complications from the flu, parents and care-givers of children under 6 months of age, and health care and emergency workers with direct patient contact. We will have to wait and see what they recommend.
The reasons for the lower estimate for vaccine production are outlined in this article:
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/aug1409vaccine.html
Limited vaccine availability will severely narrow the risk groups eligible for initial immunization efforts. The US Advisory Committee on Immunization Practices will undoubtedly meet again and revise their previously published priority groups, which included nearly 159 million Americans. I would guess the new priority list for vaccination would include pregnant women, children 6 months to 4 years of age, children 5-18 with chronic health conditions that place them at risk of complications from the flu, parents and care-givers of children under 6 months of age, and health care and emergency workers with direct patient contact. We will have to wait and see what they recommend.
The reasons for the lower estimate for vaccine production are outlined in this article:
http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/aug1409vaccine.html
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