Don’t Let Influenza Spoil Your Plans for Spring Break

Frequestly asked questions about the Flu and the Vaccine:

This is the time to prevent further illness, hospitalizations and death.  Did you know: Roughly 1 in 75 who had symptomatic H1N1 flu end up hospitalized.  Roughly one in 500 needed to be on a ventilator and one in 2000 died from the flu. (source information:  Presanis AM, De Angelis D, Hagy A, Reed C, Riley S, et al. 2009 The Severity of Pandemic H1N1 Influenza in the United States, from April to July 2009: A Bayesian Analysis. PLoS Med 6(12): e1000207. doi:10.1371/journal.pmed.1000207)

GET VACCINATED NOW!

These are the most common concerns and excuses for NOT getting the flu shot:

1. Risks from the H1N1 vaccine?  Approximately 8 in 100,000 had an adverse event to the H1N1 (swine) flu vaccine.  Serious adverse events were reported in 4.4 per million vaccinations and was similar to event rates to seasonal flu shots.  There are no deaths reported that are attributable to the H1N1 vaccine.  There are no increase in any neuromuscular diseases like Guillain-Barre syndrome after monitoring over 47 million dosed given.  An increase of these conditions should be detected after giving <1 million doses of the vaccine. (source information: Safety of Influenza A (H1N1) 2009 Monovalent Vaccines --- United States, October 1--November 24, 2009 (MMWR)
   Fri, 04 Dec 2009 13:30:00 -0600)
2. Guillain-Barre (GB) syndrome -since the 1976 swine flu shot which had a risk of 1 in 100,000 for GB syndrome.  Since then, the seasonal flu shot (which is exactly the same way the H1N1 vaccine is made) is associated with a decreased risk of suffering from GB syndrome.
3. Thimerosol and Autism-Since 2001, most pediatric vaccines no longer contain thimerosol.  There has been a reported increase in autism since thimerosol has been removed, indicating no association between thimerosol and autism. Three leading federal agencies (CDC, FDA, and NIH) have reviewed the published research on thimerosal and found it to be a safe product to use in vaccines. Three independent organizations [The National Academy of Sciences’ Institute of Medicine, Advisory Committee on Immunization Practices (ACIP), and the American Academy of Pediatrics (AAP)] reviewed the published research and also found thimerosal to be a safe product to use in vaccines. The scientific community supports the use of thimerosal in influenza vaccines.  There is no rational association of thimerosol with autism.
4. Adjuvants-  these are added to some vaccines to increase the effectiveness of vaccines for over 70 years and have reviewed for safety.  They are NOT present or needed in either the seasonal or H1N1 flu vaccines.
5. Pregnancy risks-current data shows that women who receive flu vaccinations have a DECREASED risk of miscarriage and low birth weight babies.  In addition, pregnant women are at high risk of having severe symptoms and hospitalization from the seasonal and H1N1 flu.
6. Animal Cancer Cells, green monkey cells, other viruses are in nutrient solution used to make or in the H1N1 vaccine- NOT TRUE-the vaccine is made with chicken eggs in the same manner as the seasonal flu shot.

Please regularly check your EVMS email for updates from EVMS Emergency Management and Occupational Health. Also, look for updates on the situation on the EVMS web site. For highly important information sign up for e2Campus at: http://www.evms.edu/about-eastern-virginia-medical-school/e2campus-homepage.html

7. How do I keep up with further guidance from CDC and the State regarding the 2009 H1N1 (Swine) influenza?

• http://www.cdc.gov/h1n1flu/
• http://www.vdh.state.va.us/

Medication Update:

The FDA reports marketing on the internet and other sites of fraudulent medications for treating influenza. To keep up to date or report fraudulent medications:

• http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm186340.htm

As of October 26, the FDA has approved under emergency use authorization (EUA), Peramivir, an intravenous medication for severely ill hospitalized patients who have failed oral/inhaled antivirals. For more information:

• http://www.cdc.gov/H1N1flu/EUA/peramivir_recommendations.htm

Flu questionnaire:

Emory University has created a web-based questionnaire for patients and health care providers to use to assess flu symptoms.

www.h1n1responsecenter.com

Provider algorithms for assessment and treatment of adults and children are available to help clinicians at:

http://www.cdc.gov/h1n1flu/clinicians/pdf/adultalgorithm.pdf

http://www.cdc.gov/h1n1flu/clinicians/pdf/childalgorithm.pdf

Guidance for EVMS Faculty and Employees

• http://www.cdc.gov/h1n1flu/general_info.htm

Clinician resources:

2. Identification of high-risk groups:

• Age 65 or older

OR

• Pregnant (up to 2 weeks post delivery)

• Chronic pulmonary (including asthma), cardiovascular (except isolated hypertension), renal, hepatic, hematological (including sickle cell disease), or metabolic disorders (including diabetes mellitus).
• Disorders that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders).
• Immunosuppression, including that caused by medications, rheumatologic disorders or by HIV.

NOTE: Obese patients and morbidly obese patients should be carefully evaluated for the presence of underlying medical conditions that are known to increase the risk for influenza complications, and receive empiric treatment when these conditions are present, or if signs of lower respiratory tract infection are present.

3. Assessment Algorithm for ILI: if the patient is in the high risk groups, AND the onset of symptoms has been <48 hours, consideration of antivirals is strongly recommended. Please see the following assessment recommendations updated October 16 and November 4 from the CDC when making recommendations for treating adults and children:

• http://www.cdc.gov/h1n1flu/clinicians/pdf/adultalgorithm.pdf
• http://www.cdc.gov/h1n1flu/clinicians/pdf/childalgorithm.pdf
• http://www.cdc.gov/H1N1flu/antivirals/facts_clinicians.htm

4. Recommendations for adults and children from the CDC Medications for ILI: if the patient is at risk, antiviral medications may be helpful in reducing morbidity and duration of illness. If >48 hours and/or severely ill (even in those without risk factors), antivirals can also be considered. Oseltamivir (tamiflu) and zanamivir (relenza) are the recommended agents for treatment and chemoprophylaxis. Chemoprophylaxis can be considered in:

• Persons who are at higher risk for complications of influenza and are a close contact of a person with confirmed, probable, or suspected 2009 H1N1 or seasonal influenza during that person's infectious period. The infectious period for influenza is defined as one day before until 24 hours after fever ends.
• Antiviral agents should not be used for post exposure chemoprophylaxis in healthy children or adults based on potential exposures in the community, school, camp or other settings.
• Chemoprophylaxis generally is not recommended if more than 48 hours have elapsed since the last contact with an infectious person.

Patients given post-exposure chemoprophylaxis should be informed that the chemoprophylaxis lowers but does not eliminate the risk of influenza and that protection stops when the medication course is stopped. Patients receiving chemoprophylaxis should be encouraged to seek medical evaluation as soon as they develop a febrile respiratory illness that might indicate influenza. A history of receipt of 2009 H1N1 or seasonal influenza vaccine does not rule out influenza infection. Early empiric treatment should be initiated for vaccinated persons with suspected influenza infection when indicated (e.g. persons requiring hospitalization, with severe infection, or at higher risk for influenza-related complications).

For more information on treatment recommendations for adults and children, please see:

• http://www.cdc.gov/h1n1flu/recommendations.htm
• http://www.cdc.gov/h1n1flu/recommendations_pediatric_supplement.htm

For a podcast for clinicians regarding 2009 H1N1 and antiviral medications, go to:

• http://www2c.cdc.gov/podcasts/player.asp?f=175219

5. Vaccination Guidance:

When vaccine is available, the CDC has recommended the 2009 H1N1 vaccine for the following 5 target groups (approximately 159 million persons nationally):

• Pregnant women
• Household and caregiver contacts of children younger than 6 months of age (e.g. parents, siblings, and daycare providers)
• Health care and emergency medical services personnel
• Persons from 6 months through 24 years of age
• Persons aged 25 through 64 years who have medical conditions associated with a higher risk of influenza complications

Once providers meet the demand for vaccine among persons in these initial target groups, vaccination is recommended for all persons 25 through 64 years of age. Current studies indicate that the risk for infection among persons age 65 or older is less than the risk for younger age groups. However, once vaccine demand among younger age groups has been met, programs and providers should offer vaccination to people 65 or older.

A single dose is recommended for children and adults age 10 or older. Children from ages 6 months through 9 years should receive 2 shots at least 21 days apart.

The Live Attenuated Influenza Vaccine (LAIV) should be reserved for healthy people between the ages of 2 to 9 years of age as a two time dose 4 weeks apart and a one time dose for ages 10 through 49. Those who should not receive the LAIV include: pregnant women, those with immune suppression, those with chronic cardiopulmonary diseases or those in close contact with severely immunosuppressed (e.g. bone marrow transplants).

Please remember, many patients who qualify for influenza vaccines also should receive the Pneumococcal polysaccharide vaccine (PPSV or Pneumovax), including 19-64 year olds with asthma or who smoke.

For more information and answers to FAQs:

• http://www.cdc.gov/h1n1flu/vaccination/
• http://www.flu.gov/professional/hospital/10vaccinefaqs.html
• http://www.cdc.gov/h1n1flu/vaccination/provider/provider_pneumococcal.htm