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.
Thursday, October 29, 2009
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.
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