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?

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.

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:

• 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.

Updated antiviral use recommendations

The CDC has updated their recommendations for the use of antiviral medications for the 2009-2010 influenza season. This includes the 2009 H1N1 Influenza. Both treatment and preventive therapy are discussed. See the full report here. A Question and Answer document about the recommendations is here.

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.

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.

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:

• 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).

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

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:

• 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.

Please call the Whitman County Health Department at 509-397-6280 for more information. Or check our website at www.whitmancounty.org/publichealth/