Twin epidemics of obesity and type 2 diabetes continue unabated in the US, while we search for causes and solutions. The abundance of low cost, high calorie, low nutrient food has certainly been a contributor. But so too has been our lack of physical activity. Our automobile-centric society has all but done away with an activity that only one century ago we did without a second thought: walking.
Dependence and preference for personal vehicle transportation co-evolved with the way we design our cities and towns. A priority consideration behind most housing and commercial developments is car accessibility. Typically, all other modes of transport and movement are clearly subordinate. Or they are completely ignored. Getting a new street put in for driving convenience is relatively easy. A pedestrian or bicycle path takes years of effort and countless fund raisers on the part of motivated citizens.
Automobile usage also tends to be self reinforcing. Take the relatively recent phenomenon of most children being driven to school by their parents. For a number of arguable reasons, parents perceive an increased safety hazard for their children as they walk to school. School buses, once the preferred conveyance for children, are now considered by many parents to be less than what their child deserves socially and some erroneously think buses are risky transportation. So more kids than ever get a ride to school.
The result is more traffic, more congestion, and increased risk to walking children. In some cities, studies show that 20 percent or more of the morning rush hour traffic is due to parents driving children to school.
It doesn’t need to be this way. What if we considered making community development “health promoting,” instead of “car convenient?” Many U.S cities have demonstrated that active living principals can be easily incorporated in community planning and design. Examples include Portland, Omaha, Buffalo and Orlando, to name just a few. They have implemented programs that provide safe routes for children to walk to school, paths for pedestrians and bicyclists to commute to work, and easily accessible parks. Additionally, they have created comprehensive plans that emphasize the importance of active living design in future development so that physical activity can become a part of our everyday routine, not just an add-on bit of exercise.
In the last 20 years, Pullman has come a long way toward creating a more active living environment. The Pullman trail system, the Chipman Trail, and the continuing work of the Pullman Civic Trust are a testament to that. But much more needs to be done to make Pullman a place where the environment actually encourages human powered transportation and makes physical activity more convenient than car use.
The current development on Bishop Boulevard demonstrates how little we currently plan for pedestrian or bicycle access in Pullman. There is not a single pedestrian crosswalk or stoplight on Bishop between south Grand Avenue and the bridge near the Professional Mall, even though multiple businesses are located on both sides of the street. There are no real bike lanes. And folks in the Bishop Place area need to take a car to reach the Pullman Care Community, which is directly across the street! This situation will only get worse with the arrival of further commercial development along Bishop Blvd.
To be fair, the Pullman’s Comprehensive Plan recognizes the importance of pedestrian and bicycle paths, but only in the context of alternate transportation: not in promoting health or livability. This should change. The livability of our community will only be enhanced by planning for, and designing in, those features that make an active lifestyle possible and even convenient. In fact, Pullman should and can become a model city for these values. Such a choice is marketable to more like-minded citizens settling here and could be a model for small town sustainable planning.
Wednesday, January 20, 2010
Tuesday, January 5, 2010
H1N1: A Pandemic in Review
Some folks say the recent pandemic of H1N1 (“Swine Flu”) influenza was no big deal; just a product of media hype and overzealous public health officials. Others think we dodged a bullet because the H1N1 pandemic was not as bad as it could have been. And others say the H1N1 pandemic was an unmitigated disaster due to pointless school closings, poor governmental communication, overstressed medical care facilities, inexplicable delays in vaccine production and delivery, and many lives lost.
Actually, everybody’s right.
H1N1 arrived in the US in April amidst considerable alarm and panic. A new influenza virus prompted swift action by public health and governmental officials. Schools were closed, travel warnings were issued and flu-fighting medicines were shipped from the federal stockpile to the nation’s public health departments. In Mexico, initial mortality rates from this new flu looked high. Worldwide media went into overdrive covering every flu-related topic they could find.
The pork industry lost hundreds of millions of dollars because the new flu was thoughtlessly called the “Swine Flu.” Personal and business travel to Mexico was eliminated or put on hold. Surgical masks were sold out. Calls were made for quarantines and fever scanners at airports. After a month or so, coinciding with the public school summer recess, the first wave of H1N1 flu ended.
But H1N1 did not go away. It continued along during the summer months at a slow rate, giving CDC epidemiologists time to produce a vaccine and refine H1N1 prevention and treatment guidelines. Review of the first several thousand cases of H1N1 showed it to be no more life-threatening than regular seasonal flu. This was good news. H1N1 was not the “killer” pandemic many scientists had been expecting. But in contrast to seasonal flu, which causes the highest mortality in people over 65, H1N1 was disproportionately affecting children, pregnant women, and adults under 60 with chronic diseases.
Knowing H1N1 flu activity would increase again later in the fall, officials from public health, public schools and hospitals got busy making preparations for flu prevention and treatment, as well as planning for an H1N1 vaccine arriving by mid-October.
What we overlooked is pathogens like H1N1 are on their own time schedule and don’t wait for a vaccine. Universities with late August starts found that school convened with an unwelcome visitor.
Washington State University was one of the hardest hit by H1N1 with the first case identified three days before classes started. By the end of the second week of classes, more than 2000 students had flu-like symptoms.
Thankfully, most people infected with H1N1 had a fairly mild disease. Nevertheless, health care providers were inundated with flu sufferers. Hospitals resorted to triaging patients with mild illness and no risk factors away from their Emergency Rooms so staff could cope, resources could be reserved for those who really needed them, and the spread of infection reduced. Many clinics and urgent care facilities were seriously stressed for several weeks. One wonders what would have happened had H1N1 been a more severe illness.
The speed at which H1N1 spread was truly impressive. WSU's experience demonstrated how explosive a new flu could be in a population where 100 percent were susceptible. Many public schools were caught off guard as H1N1 caused absenteeism rates up to 40 percent, canceling classes as well as athletic contests. In Whitman County, Washington, even rural school districts were impacted following a “Teen Mixer” dance at the County Fair.
By the end of September and into early October, the H1N1 epidemic was on the wane locally. The rest of the state was at least a month behind as H1N1 reached a peak toward the end of October, gradually subsiding to rates similar to what was seen over the summer by the end of November. Since September, 1357 hospitalizations and 71 deaths attributed to H1N1 have been reported in Washington. The hospitalization rate was highest among children 0-4 years of age while the death rate was highest among adults 50-64 years old.
By the time vaccine arrived in any useful quantity, the second wave of H1N1 was nearly over. The delay caused extreme frustration to providers and patients alike. Despite this fact, nearly a million doses of vaccine were distributed statewide. In Whitman County, about 1,000 doses were given at the Public Health Department while an additional 6,000 doses were distributed to hospitals, clinics and pharmacies. Further public interest in receiving the vaccine has essentially evaporated even though we are unsure if H1N1 has a third act waiting for us later this winter.
In retrospect, we were very fortunate. Believe it or not, H1N1 spread much faster and with greater fury than the 1918 influenza pandemic. But H1N1 influenza was a much milder disease than the flu in 1918, at least to those of us who survived it. As such, it served well as a sort of “training pandemic” for public health and other governmental officials. We now know what parts of our influenza pandemic plan work well, which don’t, and what needs improvement. We found out that, even under ideal circumstances (instant recognition, immediate vaccine production, and ideal distribution), we lack the technology to crank out vaccine soon enough and in sufficient quantities to avert a disaster if we truly face a deadly flu.
Beefing up our response plans for the next influenza pandemic is reasonable. However, it is foolish to assume we can prepare for a flu pandemic like the historic 1918 outbreak. Our health care system was taken to the breaking point with H1N1; a relatively mild flu . We don’t have enough beds, enough ventilators, enough anti-viral medicines, or enough doctors and nurses to handle anything like the Great Influenza of 1918. More importantly our society can’t afford to have massive surpluses of highly trained people and materiel on hand “just in case.”
The only way to rationally respond to the next “killer” flu pandemic is to prevent it entirely. Current flu vaccines are produced with the new flu virus strain after it has been identified. We then grow the virus in chicken eggs for vaccine production. As H1N1 showed us, the 1950s era technology is ineffective. Our strain specific vaccines also become less effective if the virus mutates much. Constant genetic changes are the reason we need to get a seasonal flu shot annually to maintain effective immunity.
What if we could develop an effective vaccine that acted on the parts of the flu virus that don’t change or mutate? This could result in a “universal” flu vaccine that prevents illness from strains of influenza circulating now, and new ones that may emerge in the future; even “killer” strains.
The idea of a universal flu vaccine is doable. Some researchers are already testing candidate vaccines and other diseases are being eliminated using the same strategies. Influenza vaccine researchers should be supported, encouraged, and most of all funded with the lion’s share of influenza pandemic planning resources. We can prepare for managing and surviving the next flu pandemic all we want. But a much better strategy is to prevent it from happening so that, in the future, we will ask, what was the flu like back when you were young and we still got it?
Actually, everybody’s right.
H1N1 arrived in the US in April amidst considerable alarm and panic. A new influenza virus prompted swift action by public health and governmental officials. Schools were closed, travel warnings were issued and flu-fighting medicines were shipped from the federal stockpile to the nation’s public health departments. In Mexico, initial mortality rates from this new flu looked high. Worldwide media went into overdrive covering every flu-related topic they could find.
The pork industry lost hundreds of millions of dollars because the new flu was thoughtlessly called the “Swine Flu.” Personal and business travel to Mexico was eliminated or put on hold. Surgical masks were sold out. Calls were made for quarantines and fever scanners at airports. After a month or so, coinciding with the public school summer recess, the first wave of H1N1 flu ended.
But H1N1 did not go away. It continued along during the summer months at a slow rate, giving CDC epidemiologists time to produce a vaccine and refine H1N1 prevention and treatment guidelines. Review of the first several thousand cases of H1N1 showed it to be no more life-threatening than regular seasonal flu. This was good news. H1N1 was not the “killer” pandemic many scientists had been expecting. But in contrast to seasonal flu, which causes the highest mortality in people over 65, H1N1 was disproportionately affecting children, pregnant women, and adults under 60 with chronic diseases.
Knowing H1N1 flu activity would increase again later in the fall, officials from public health, public schools and hospitals got busy making preparations for flu prevention and treatment, as well as planning for an H1N1 vaccine arriving by mid-October.
What we overlooked is pathogens like H1N1 are on their own time schedule and don’t wait for a vaccine. Universities with late August starts found that school convened with an unwelcome visitor.
Washington State University was one of the hardest hit by H1N1 with the first case identified three days before classes started. By the end of the second week of classes, more than 2000 students had flu-like symptoms.
Thankfully, most people infected with H1N1 had a fairly mild disease. Nevertheless, health care providers were inundated with flu sufferers. Hospitals resorted to triaging patients with mild illness and no risk factors away from their Emergency Rooms so staff could cope, resources could be reserved for those who really needed them, and the spread of infection reduced. Many clinics and urgent care facilities were seriously stressed for several weeks. One wonders what would have happened had H1N1 been a more severe illness.
The speed at which H1N1 spread was truly impressive. WSU's experience demonstrated how explosive a new flu could be in a population where 100 percent were susceptible. Many public schools were caught off guard as H1N1 caused absenteeism rates up to 40 percent, canceling classes as well as athletic contests. In Whitman County, Washington, even rural school districts were impacted following a “Teen Mixer” dance at the County Fair.
By the end of September and into early October, the H1N1 epidemic was on the wane locally. The rest of the state was at least a month behind as H1N1 reached a peak toward the end of October, gradually subsiding to rates similar to what was seen over the summer by the end of November. Since September, 1357 hospitalizations and 71 deaths attributed to H1N1 have been reported in Washington. The hospitalization rate was highest among children 0-4 years of age while the death rate was highest among adults 50-64 years old.
By the time vaccine arrived in any useful quantity, the second wave of H1N1 was nearly over. The delay caused extreme frustration to providers and patients alike. Despite this fact, nearly a million doses of vaccine were distributed statewide. In Whitman County, about 1,000 doses were given at the Public Health Department while an additional 6,000 doses were distributed to hospitals, clinics and pharmacies. Further public interest in receiving the vaccine has essentially evaporated even though we are unsure if H1N1 has a third act waiting for us later this winter.
In retrospect, we were very fortunate. Believe it or not, H1N1 spread much faster and with greater fury than the 1918 influenza pandemic. But H1N1 influenza was a much milder disease than the flu in 1918, at least to those of us who survived it. As such, it served well as a sort of “training pandemic” for public health and other governmental officials. We now know what parts of our influenza pandemic plan work well, which don’t, and what needs improvement. We found out that, even under ideal circumstances (instant recognition, immediate vaccine production, and ideal distribution), we lack the technology to crank out vaccine soon enough and in sufficient quantities to avert a disaster if we truly face a deadly flu.
Beefing up our response plans for the next influenza pandemic is reasonable. However, it is foolish to assume we can prepare for a flu pandemic like the historic 1918 outbreak. Our health care system was taken to the breaking point with H1N1; a relatively mild flu . We don’t have enough beds, enough ventilators, enough anti-viral medicines, or enough doctors and nurses to handle anything like the Great Influenza of 1918. More importantly our society can’t afford to have massive surpluses of highly trained people and materiel on hand “just in case.”
The only way to rationally respond to the next “killer” flu pandemic is to prevent it entirely. Current flu vaccines are produced with the new flu virus strain after it has been identified. We then grow the virus in chicken eggs for vaccine production. As H1N1 showed us, the 1950s era technology is ineffective. Our strain specific vaccines also become less effective if the virus mutates much. Constant genetic changes are the reason we need to get a seasonal flu shot annually to maintain effective immunity.
What if we could develop an effective vaccine that acted on the parts of the flu virus that don’t change or mutate? This could result in a “universal” flu vaccine that prevents illness from strains of influenza circulating now, and new ones that may emerge in the future; even “killer” strains.
The idea of a universal flu vaccine is doable. Some researchers are already testing candidate vaccines and other diseases are being eliminated using the same strategies. Influenza vaccine researchers should be supported, encouraged, and most of all funded with the lion’s share of influenza pandemic planning resources. We can prepare for managing and surviving the next flu pandemic all we want. But a much better strategy is to prevent it from happening so that, in the future, we will ask, what was the flu like back when you were young and we still got it?
Monday, December 14, 2009
The Wait is Over
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.
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.
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.
Subscribe to:
Posts (Atom)
