H1N1 virus

Gearing up for influenza prevention, care

Years of preparation for an influenza pandemic have paid off. Health care providers and health department planners are implementing those plans to combat a unique influenza.

Contrary to expectations, the 2009 pandemic influenza first broke out not in Asia but in Mexico. The largest number of serious cases have been in the United States. The people suffered the greatest number of serious cases are young people and pregnant women rather than the elderly. And 2009 influenza A (H1N1) virus never did dwindle to the off-season levels typical of the common seasonal influenza.

Fear that H1N1 flu could equal the devastation of the 1918 Spanish flu spurred efforts to prepare. The announcement in mid September that the U.S. Food & Drug Administration approved a vaccine eased the fear. But as the disease reasserts itself this fall, there is still much to be done.

(Review the State of Oregon Pandemic Flu Plan, prepared in 2008, at www.flu.oregon.gov/DHS/ph/acd/flu/panfluplan.pdf.)

Detailed, up-to-date H1N1 information

The Oregon Department of Human Services is closely coordinating all H1N1 efforts. It has launched a web site, www.flu.oregon.gov, to keep the most up-to-date information available. Highlights of this site are posted here.

The department keeps a detailed Q&A page updated regularly. You can reach it at www.oregon.gov/DHS/ph/acd/flu/h1n1flu-subcommittee.shtml.

You can also subscribe to DHS e-mail notices of new H1N1 information, and to the Public Health Director's H1N1 newsletter. The first edition is available here.

FDA approves vaccines for 2009 H1N1 influenza virus

The U.S. Food and Drug Administration announced Sept. 15 that it approved four vaccines against the 2009 H1N1 influenza virus. The vaccines are now arriving in the states.

“Approval is good news for our nation's response to the 2009 H1N1 influenza virus,” said Commissioner of Food and Drugs Margaret A. Hamburg, M.D. “This vaccine will help protect individuals from serious illness and death from influenza.”

The vaccine will be available in two formulations: with the preservative thimerosal and without. The U.S. Food and Drug Administration (FDA) has approved the use of one dose of 2009 H1N1 flu vaccine for persons 10 years of age and older. Children 9 years of age and younger will need two doses to be most effective.

(Read the full FDA press release.)

Early vaccination is recommended

The Centers for Disease Control and Prevention recommends that patients be immunized for seasonal and H1N1 flu as soon as vaccines are available. A 2008 study shows that early vaccination does not lead to early waning of immunity.

(View an abstract of the report, “Rapid Decline of Influenza Vaccine-Induced Antibody in the Elderly: Is It Real, or Is It Relevant?” Published in the Journal of Infectious Diseases 2008.

To be an H1N1 vaccine provider

CareOregon covers vaccination for seasonal and H1N1 influenza for all members.

The state of Oregon is allocating H1N1 vaccine through county health departments. To be an H1N1 vaccine provider, contact the immunization coordinator of your county health department. You must have adequate refrigeration storage, report all doses administered to the Oregon ALERT registry within 14 days of administration, and sign the agreement.

Oregon DHS has a directory of county contacts posted here: www.oregon.gov/DHS/ph/imm/docs/H1N1contacts.pdf

Infection control in health care facilities
(from www.flu.oregon.gov)

To date, the H1N1 virus appears to be behaving similarly to seasonal influenza in terms of the severity of illness and transmission of infection. Minimum levels of infection control precautions and surveillance among hospitalized patients and health care workers are recommended to identify early signals of increasing severity or changing epidemiology.

Review the recommendations at www.oregon.gov/DHS/ph/acd/flu/infection-control.pdf

You may download informational materials to provide your patients here.

Flu advice for CareOregon members

CareOregon’s fall member newsletter, CareLink, is dedicated to just two subjects: the state’s Healthy Kids program and flu information.

We have also posted flu information on our web site, www.careoregon.org. Members can find information on seasonal flu or H1N1 flu by going directly to the site. These pages are available in Spanish, Russian and Vietnamese, in addition to English. The English page has additional links to patient materials in a number of different languages.

• Seasonal flu information for members and families (English)
• H1N1 flu information for members and families (English)
• Seasonal flu information for members and families (Spanish)
• H1N1 flu information for members and families (Spanish)
• Seasonal flu information for members and families (Russian)
• H1N1 flu information for members and families (Russian)
• Seasonal flu information for members and families (Vietnamese)
• H1N1 flu information for members and families (Vietnamese)

Flu education materials are also available on the state’s web site.

DHS changes disease-reporting rules in response to H1N1

The Department of Human Services, Public Health Division is temporarily amending OAR 333-018-0015 related to disease reporting to require reporting of laboratory-confirmed influenza resulting in or associated with hospitalization or death. The division no longer requires reporting of all H1N1 cases, only those more serious cases involving hospitalization or death.

According to the division, accurate reporting is necessary to fully investigate and control the disease. See the full announcement.

Recommendations for antivirals

The use of antiviral medications is secondary to vaccination as a prophylaxis for influenza. The CDC has posted interim recommendations for the use of antivirals this flu season, when both seasonal and H1N1 flus will affect different at-risk groups.

Read these recommendations here.