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:

• 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.

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

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

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 -

• 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/)

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