H1N1 Update 9/29/09

 

I am posting a new update even though there is very little news to report.  I continue to monitor the CDC website for changes to the guidance for schools.  This guidance has not changed since August 31, 2009.   In general, the severity of the H1N1 flu has not changed this year.  I also continue to monitor student and staff attendance at school.  The first week of September we had a few schools with student absences exceeding 10% by a little bit.  This has come down in the last couple of weeks.  I have posted student attendance data to the Barrow County Schools H1N1 Information page.  I will try to update this report every few days and at least once per week.  That is all the news that I have at the moment.    

Seasonal Flu Vaccination

 

This morning I received my seasonal flu vaccination.  I encourage anyone reading this blog to get your seasonal flu vaccination as soon as possible.  In a few weeks, we will have the opportunity to get the H1N1 vaccination.  I plan to get mine as soon as I can. 

H1N1 Update 9/16/09

 

A few minutes ago, I participated in a statewide conference call sponsored by the Georgia Department of Education to provide H1N1 updates to educators.   The speakers were Dr. Patrick O’Neal, Division Chief for Emergency Preparedness and Response, Georgia Department of Community Health, and Dr. Michelle Conner, Program Director of Infectious Disease and Immunization, Georgia Department of Community Health.  I will provide my summary of the information presented in this conference call below:

 

Dr. O’Neal described Four Pillars of Attention being addressed by public health.  The first pillar is the need to continue to monitor the situation with H1N1 paying particular attention to any increases in severity or evidence that the virus is mutating.  So far, there has been no evidence of either of these occurring.  The CDC is working on a process to more accurately count the number of H1N1 cases in order to be able to put the number of deaths associated with it into some context for comparison.  Currently the CDC has characterized the severity of H1N1 as low to moderate.  CDC is also monitoring for any evidence that the virus has become resistant to antiviral medications.   Less than thirty cases have been reported to have demonstrated some resistance to the antiviral medications but this is extremely minimal.   

 

The second pillar addressed by Dr. O’Neal was the mass vaccination campaign.  This campaign is two pronged and includes seasonal flu vaccinations and H1N1 vaccinations.  The reason that this is important is because there is a need to not overwhelm the healthcare system’s capacity to help patients who need medical care.  Vaccinations should prevent some people from catching the flu or needing healthcare and thus freeing up capacity of health care facilities to serve patients that really need care.  The vaccinations campaign is also designed to reduce the potential of people catching both strains of the flu at once.  This would be really bad for people with other health complicating conditions.  There is an increased chance that the virus may mutate if a person is infested with both seasonal flu and H1N1 at the same time.

 

The third pillar is community mitigation.  Currently the CDC and Georgia Department of Community Health are not recommending the closing of schools to decrease the spread of the flu.  Decisions to close schools at this point should remain a local decision based on significantly higher rates of absenteeism or concentrations of high risk medically fragile students.  The fourth pillar is communication.  It is very important that the message get out that the degree of sickness from H1N1 at this time is generally milder than seasonal flu.  The duration is typically 2-3 days for otherwise healthy people.  He emphasized the importance of continuing careful hand washing of 20 seconds or more with soap and warm water, covering coughs and sneezes, and staying home when sick.  All three of these recommendations should be followed for the best outcome.    

 

Dr.  Conner discussed recent news regarding the H1N1 vaccination.  The FDA has approved the H1N1 vaccination.  It should be available as early as October 5^th.  It has been researched and created through the same process as regular flu.  This process has a very good safety profile.  To date, over 2700 have registered to administer the vaccine in Georgia.  This should be more than an adequate network of providers.  There are no plans for public health to provide immunizations in schools.  However, local communities may choose to develop plans to offer voluntary school-based vaccinations on their own.  (In Barrow County, we have no current plans to offer voluntary school-based H1N1 vaccinations but we are willing to have a discussion about it).  There has not been a final decision made about the number of doses that will be required.  It is expected that adults will need 1 dose and children will need 2 doses.

 

Questions and answers:

1.        Recently we have heard reports in the media that people who are sick should remain at home for longer (up to 7 days) before returning to work and school.  What is the current recommendation from CDC?  Some health care providers  believe that a longer time out of work and school is needed.  However, Dr. O’Neal recommends sticking to the CDC guidelines of 24 hours after the person has no fever without the use of fever reducing medications.

2.       How close together can a person have the seasonal flu  vaccine and H1N1 vaccine?  If the person receives the injectable (shot form of the vaccine there are no spacing issues.  The only recommendation so far is that a person cannot get both vaccinations in the intranasal form on the same day.

3.       Can a person get the vaccine while taking antiviral medications?  This is not recommended because the antiviral medications will prevent the body from benefitting from the vaccine.  It is best to wait a few days after completing an antiviral medication before getting the vaccination.

4.       Are vaccinations mandatory?  The vaccinations are definitely not mandatory. 

H1N1 Pandemic Influenza Update 9/15/09

This morning I had the opportunity to attend another H1N1 Information session. The main speaker was Dr. David Suarez from the Southeast Poultry Research Lab in Athens. Dr. Suarez went into a little more depth about H1N1 than other presenters that I have heard. Below is my summary of the key points of Dr. Suarez’s presentation.

There are three types of flu. Type A affects humans, swine, horses, dogs, birds and other animals. It has two common subtypes. These are H3N2 which has been present in humans since 1968 and H1N1 which has been present in humans since 1918 with a 20 year absence. All Type A influenzas come originally from wild birds. Type B and Type C influenza only affect humans. Seasonal flu in humans is most often comprised of H1N1, H3N2 and Type B. The seasonal flu vaccine is prepared to address these three strains of the flu. The flu virus is susceptible to detergent and easy to kill with soap and water due to the fat layer that provides a protective layer for the virus. The fat layer can be destroyed with common cleaning fluids and soap and water. Influenza viruses can easily mix and match and produce new offspring with characteristics that may be different from the original virus. The current Novel H1N1 virus has 8 genes. Six of these genes are ones with which researchers are familiar. Two of these genes have not been recognized before and this makes the Novel H1N1 a new virus. Although it was first recognized in Mexico no one knows where it originated. The terms Pandemic H1N1, Novel H1N1 and swine flu all refer to the same illness and can be used interchangeably.

The CDC routinely tracks a group of illnesses that have similar symptoms. These are called Influenza Like Illness (ILI). These illnesses have common symptoms such as fever, cough, nasal congestion, body aches, headaches, sore throat and possibly vomiting and diarrhea. A person does not have to have all these symptoms to have the flu. The flu itself is rarely severe or fatal. The primary cause of death in these situation is bacterial infections that are secondary to the flu or pneumonia.

The word pandemic is a misunderstood term. Pandemic refers to a worldwide epidemic of a new virus. It is not an indicator of severity. The current Pandemic Flu is not more severe than seasonal flu. The concern is that since it is new everyone is susceptible to it. Some predictions are that as many as 30% of the population with get Pandemic H1N1 flu. More than 98% of flu cases at the present time are Pandemic H1N1 flu. There have been 4 human pandemics, including the current one, in the last 110 years each about 30-40 years apart.

The flu is transmitted from person to person in two main ways. One way is through person to person contact. To transmit the flu in this way one person would come into contact with infected droplets from a person’s cough or sneeze. This can only happen if someone is within a few feet of the person who coughs or sneezes. The most likely way to transmit the virus is indirect contact. This is where the virus is picked up from surfaces than contain the virus and then the person touches his/her eyes, nose or mouth. In the summer the virus can only live on surfaces for a short period of time. The best way to avoid becoming infected with the virus from indirect contact is to thoroughly wash your hands before eating or touching your face.

Dr. Suarez mentioned a few websites with good information about preventing the spread of the flu virus. I will try to locate these resources and provide links in the next few days. He also answered a few questions from the audience.
1. Should I get the seasonal flu vaccine? Yes
2. Should I get the H1N1 flu vaccine? Yes!!! It is not yet available but when it is he would recommend everyone who has not already had Novel H1N1 get it.
3. Can I get sick from the vaccine? Not likely. In the mid 70s there were about 500 cases out of millions of vaccines given in which children developed Guillain-Barre Syndrome. The rate was about 1 in a million and would be less likely today because the vaccines are more pure.
4. Is it safe to eat pork? Yes, the virus is a respiratory virus and never gets in the meat.
5. Is H1N1 hard to kill? No – It is the same as seasonal flu and easy to kill with common cleaning materials and techniques. Do not use high levels of bleach where kids are present.
6. What do I do if I think I have H1N1? Call your doctor for guidance.
7. Is the virus likely to mutate? We can’t predict. The severity does not seem to be increasing.
8. Can you get both seasonal flu and H1N1 flu? It is possible but unlikely.
9. Is a fever always present with the flu? No
10. What advice do you have for pregnant women? Get the vaccine to prevent illness. If you get sick first then sick treatment immediately.
11. How long does the virus live on surfaces? It is very variable. Indoors it lives for only a few days. Outdoors in the winter it can live for months. Heat and sunlight tend to deactivate the virus.
12. Have there been enough time to test the H1N1 vaccine? The H1N1 vaccine will receive the same amount of testing that other flu vaccines receive before being approved.

Steven Dumpert from the Northeast Georgia Health District was also present to explain current plans in the district to disperse H1N1 vaccinations. All potential providers including local health departments must register to provide H1N1 flu shots. The local health district does not currently plan to distribute the H1N1 vaccine through schools. However, in some cases schools may be used as a distribution site but not during normal school hours. The flu vaccine will be free but providers may charge up to $14.75 as an administration fee.

This is all for today. I will participate in a conference call tomorrow and will provide a summary as soon as possible.

Update for 9/13/09

In this update I will attempt to clarify some misinformation that has been circulating in Barrow County and provide a brief summary of some information from the CDC website.
In the party game "telephone" a group sits in a story and shares a short story around the circle. The object of the game is to start a story, whisper it from one person to another around the circle as accurately as possible and compare the version of the story that the last person heard to the one that the first person heard. Most of the time, the final version is very different from the original. This game illustrates the importance of getting information from the source because the further away from the source one chooses to get information the more likely that the information will be distorted.
This week, I heard on more than one occasion a "story" that was inaccurate. The "story" claims that Barrow County Schools will be closed if we reach a specified attendance threshold. Most versions of the story claim the attendance threshold is 10%. This is not true. There are no plans to close schools when absences reach a pre-specified threshold. We are monitoring student and staff attendance on a daily basis. We are reporting to the local health department any time a school reaches or exceeds 10% in absences. Starting this week we will begin reporting this information to the Georgia Division of Public Health. Within the last 7-8 days we have had several schools that have exceeded 10% absences and each time we have reported this data as we said we would. At this time there are no plans to close school. We are working very hard to keep schools open. If the situation changes we are prepared to rethink this position.
On Tuesday, September 8th, the Northeast Georgia Health District issued a press release to summarize the current with the flu in the health district. This is an excellent summary that I have posted to the Barrow County Schools H1N1 Information page (see link). I recommend that everyone read it.
Below is a summary of the most recent key indicators as described on the CDC website:
• Visits to doctors for influenza-like illness have been increasing over the past four weeks and are higher than expected this time of year.
• Hospitalization rates are similar to or lower than hospitalization rates for seasonal flu but are higher than expected in the summer.
• The proportion of deaths for pneumonia and influenza has been low and within the normal range for the summer months.
• Eleven states, including Georgia and most other states in the south east, are reporting widespread flu activity which is very unusual for August and September.
I will be participating in two H1N1 information opportunities this week and will update the blog with the information gained in these sessions as soon as I can.

CDC H1N1 Update for 9/3/09

This afternoon, I listened in on a press conference from the CDC regarding H1N1 updates.  The conference speaker was Dr. Thomas Frieden, Director of the CDC.  This is my summary of the information presented in the press conference.  You can see a video of the press conference by following the link to flu.gov. 

 

H1N1 is here and spreading in the southeast.  In fact, it never actually left the United States over the summer.  The good news is that so far, both here and abroad, it has not changed since it arrived on the scene in spring 2009.  The vast majority of people with the flu have not been severely ill.  However, H1N1, and Influenza in general, is very unpredictable and the CDC is vigorously monitoring its spread and severity.  Dr. Frieden advises that we should all be prepared to change course quickly if the situation changes.  A report was recently posted to flu.gov that describes the experiences of 5 countries in the Southern Hemisphere.  These countries have experienced some challenges but overall no changes in the severity of the illness.

 

In reviewing information on pediatric deaths from H1N1 in the spring of 2009, Dr. Frieden noted that in a normal flu season the US will have between 50 and 100 flu related deaths among children.  Of the 36 pediatric deaths this spring, 2/3 of the children also had severe underlying conditions which contributed to their death.  Most of the remaining young people became infected with bacteria due to their immune systems being weakened by the flu.  The flu can be severe especially among high risk groups  which includes children with other medical needs.  These children are a priority for getting the flu vaccine.  The H1N1 vaccine is still on track for release in mid-October.  The vaccine itself will be free but physicians may charge a small administration fee.  At the current time, it will likely still be two doses especially for younger children.  The priority groups for getting this vaccine first are school-age children, people with underlying health conditions and pregnant women.  The vaccine programs will be run by state and local health agencies in partnership with local physicians.  As the program rolls out, the CDC will be closely monitoring adverse effects after the vaccine has been given and comparing to the normal rate of occurrence of these adverse conditions in the general population. 

 

Dr. Frieden stressed that we can expect to see more cases now that schools are opening.  In fact, the increased spread of H1N1 in the southeast may be attributed in part to the opening of schools for a new school year and the fact that schools in the southeast open sooner in the year than schools in other parts of the country.  Dr. Frieden also stated that the vast majority of flu cases are mild and there is no need to see a doctor unless the sick person begins to develop signs of distress such as difficulty breathing or trouble keeping fluids down.  Others who should seek prompt medical attention are people with underlying health conditions that may be complicated by the flu.  Two examples given by Dr. Frieden were people with muscular dystrophy and cerebral palsy.   The H1N1 flu has proven to be no more virulent or drug resistant than when it first appeared in the spring.  He advises that we continue with basic flu prevention procedures such as staying home when sick, covering coughs and sneezes and frequent hand washing.  He discouraged schools from requiring parents or staff to get a note from the doctor to return to school after having the flu.  This will prevent doctor’s offices from being inundated with people who are not currently sick.  He further noted that he hopes that schools will continue to open and remain open and follow common sense practices to prevent the need for school closings.  The common sense measures include staying home when sick, separating sick children from nonstick children and sending sick children home.  So far H1N1 is no more severe than seasonal flu.  It may not be less severe but it is not more severe.

 

I have posted a few new links for more information.  These new links include links to the Flu.gov website, the Georgia Emergency Management Agency’s Ready  Georgia and Preparedness H1N1 website and both the US Department of Education and Georgia Department of Education H1N1 information websites.  Shortly I will be posting a link to H1N1 information on the Barrow County Schools Website.  I hope that you find these links helpful.  The best information can be found by going directly to the source of the information.  My primary sources of information are the CDC, Georgia Public Health and local health officials, Georgia Emergency Management Agency (GEMA), Georgia Department of Education and the US Department of Education.  I consider these agencies and their representatives to be the experts in the field of H1N1 planning and mitigation in the school setting.