Lots of things have been happening since last week not the least of which is the Yankees winning the pennant.  Quel dommage!

Nevertheless, we all have to move on.  Sigh…

So, in the world of H1N1, what has been particularly relevant to UT is the arrival and distribution of the vaccine on both campuses as well as an increase in ILI cases on campus and in the region.   That’s not unexpected.  Ms. Krystalyn Weaver has written an excellent piece not only about her personal feelings about the vaccine and her decision to get it, but she has also posted sites where the H1N1 vaccine will be given.  Remember, the vaccine is free here.

Ms. Weaver is right that the amount of the vaccine is not what was hoped for.  There are a number of reasons for that and this NY Times link presents the whys and wherefores (http://www.nytimes.com/2009/10/26/health/26flu.html?_r=1&th&emc=th).  Nothing really nefarious.  Even D-Day had its glitches.

However, whether or not you choose to receive the vaccine, don’t forget that this is not the time to let down your guard.  Especially now.  Maintain your own respiratory/hand hygiene and all those social distancing measures that we’ve been promulgating.  Eat well, exercise, and rest appropriately.  And should you come down with the “flu,” remember that for the vast majority of cases, the disease remains relatively benign.  Resting at home, drinking plenty of fluids, taking ibuprofen will be all that’s needed for most of us.  Remember to contact your healthcare provider anyway, especially if you’re in a high-risk category.  Meanwhile, keep in mind the following CDC advice (http://www.cdc.gov/h1n1flu/guidance_homecare.htm):

“…Get medical care right away if you or the sick person you are attending:

• has difficulty breathing or chest pain
• has purple or blue discoloration of the lips
• is vomiting and unable to keep liquids down
• has signs of dehydration such as dizziness when standing, absence of urination, or in infants, a lack of tears when they cry
• has seizures (for example, uncontrolled convulsions)
• is less responsive than normal or becomes confused…”

Next up is President Obama declaring a national emergency (http://edition.cnn.com/2009/HEALTH/10/24/h1n1.obama/index.html).  Oh my God!  “National emergency!”  Is it time to get in the old pontoon and hide out in some glacial fjord on the Greenlandic coast?  Not at all.  This declaration isn’t an admission that the system is falling apart or that the disease has suddenly shifted into a more lethal state.  What he’s done is proactively to allow the hospitals to initiate their own disaster protocols as efficiently and expeditiously as possible without incurring unnecessary financial or legal hardships.  This next link looks at this topic more intensely (http://www.flu.gov/professional/federal/h1n1emergency10242009.html).

All patients will still be cared for.  We are not at a point of the greatest good for the greatest number and there is no indication that we will ever get to that point, at least as far as H1N1 is concerned.

Meanwhile, here is what the latest US Flu Map looks like.  Note how its grayish hue has spread farther than the previous map:

Finally, this is a series of statements, hopefully reassuring, from the CDC as of October 23.  It tries to resolve the question about the ingredients contained in the vaccine.  It also attempts to put Guillain-Barre’ syndrome (GBS) in perspective:

“Key Points – 2009 H1N1 & Seasonal Influenza - Oct 23

- None of the seasonal or 2009 H1N1 influenza vaccines currently licensed and distributed by the U.S. government contains adjuvants. This means that none of these influenza vaccines contains squalene or aluminum.

- The currently licensed seasonal and 2009 H1N1 influenza vaccines do not contain latex.  If healthcare providers do not use the vaccine administration products provided by the vaccine manufacturers which do not contain latex, there may be a risk of latex allergy.

- Each year, approximately 6,000 to 9,100 people in the United States get GBS whether or not they receive a vaccination. This means that about 140 people get GBS every week.�
During the 2009-2010 influenza season, CDC and FDA will be closely monitoring reports of serious problems following the 2009 H1N1 influenza vaccines and the regular seasonal influenza vaccines including GBS.

- Since GBS is a serious disorder that people do get every year, CDC has developed several GBS surveillance systems. These are tracking systems to identify whether some GBS cases are linked to influenza vaccinations. �
These surveillance systems include some existing vaccination safety systems, such as the Vaccine Adverse Event Reporting System (VAERS), and new systems, such as the CDC Emerging Infections Program and a partnership with the American Academy of Neurology, which includes doctors (neurologists) who are most likely to see persons with GBS. None of these systems existed in 1976.
Through these systems, CDC and FDA will be able to find any possible link between GBS and seasonal or 2009 H1N1 flu vaccines early in the vaccination campaign if it occurs and take appropriate action.”

That’s about it for now and know that there are a lot of people here on campus, expert in who they are and what they do, constantly assessing and re-assessing the situation and responding to the events as they develop for the betterment of each of us and the University.  It sounds hokey, but it’s true.

Well, the vaccine is here.  In small quantities, but it’s here.  Right now, most of it is the inhaled, attenuated variety and some is the injectable, dead virus kind.  The vaccination process is already under way.

Here is a snippet from today’s NY Times that gives a snapshot of what’s happening around the country:

“Flu caused by the H1N1 virus is now widespread in 41 states, and flulike illnesses account for 6.1 percent of all doctor visits. (Link:  http://www.nytimes.com/2009/10/17/health/17flu.html?_r=1&th&emc=th)… Forty-three children have died from swine flu since Aug. 30 — about the same number that usually die in an entire flu season. Nineteen of the 43 who died were teenagers, and 16 were ages 5 to 11 years old; the rest were under 5…..Fifteen percent to 20 percent of the patients who were hospitalized for the flu wound up in the intensive care unit, a rate comparable with that for seasonal flu. Although the disease continues to spread, its severity is not increasing……”

Now, the administration of the vaccine will be dependent upon an individual’s risk based upon CDC criteria and the type of vaccine available.  In order for you to get the vaccine, it is really important for you to pre-register.  The following explains why and how:

‘To receive a vaccination, employees must pre-register at the link below, and bring their resulting paperwork and UT identification to University Health Services.
�
Pre-register at this time by visiting https://h1n1vaccine.odh.ohio.gov.
�
The pre-registration process requires a printer and the printed form should be presented when you receive your vaccine.

Pre-registration benefits include:

- Reduced amount of time spent at the facility where you receive your vaccine.

- Improved accuracy.

- Enables you to be notified when your facility has vaccines available.

- Enables you to be notified when to receive your 2nd dose, if one is necessary.

- Enables you to retrieve your record on the system.

- Enables public health to plan for how much product is necessary for each facility.’

Even if you are not considering the vaccine at the present time, pre-register anyway.  It doesn’t obligate you and it’ll speed things up if you change your mind.

Meanwhile, I’ve been asked about whether it is wise for a pregnant woman to receive the injectable vaccine.  Since I am not the lady’s private physician or her obstetrician, I feel it would be wrong to give advice.  It’s a question of a number of factors such as the medical condition of the lady, her environmental factors, and an assessment of risk versus benefit.  These can only be intelligently decided with the healthcare professionals who know her best.  However, is it true that there is a disproportionate number of H1N1 complications and death due to H1N1?  Unfortunately, the literature substantiates that (http://www.cdc.gov/h1n1flu/guidance/pregnant.htm) & (http://www.cdc.gov/h1n1flu/vaccination/pregnant_qa.htm).

There is also a concern that people might be still reveling in the mysteries of beer pongs during this time of disease transmission. So, a cautionary note:  Beer pongs can spread H1N1 (http://www.syracuse.com/news/index.ssf/2009/10/flu_fears_prompt_troy_college.html).  Play chess instead, but sanitize the pieces before and after!

There was a also a question of caches of seasonal flu vaccine.  UT has a number that is less than expected.  Why, you ask?  There were contracts for the delivery of more seasonal flu vaccines for us, but those agreements were cancelled by the pharmaceutical companies when they directed their efforts to development of the H1N1 vaccine.  What is available will be prioritized for patients first.

Finally, there is a concern about thimerosal.  There are H1N1 vaccines that are free of the preservative, but, after checking with pharmacy it is unclear as to what is available for us.  It’s best to check for yourself as the vaccination revs up this coming week.

You think you’ve got problems.  I’m stuck here watching the Yankees beat the Twins 7-2.  And there’s still two more innings to go….

Anyway, let me get to the point of writing this blog.  We may be seeing the arrival of the H1N1 vaccine by next week.  More than likely, what we’ll be getting is the live, attenuated intranasal vaccine (LAIV).  Exactly, what does that mean?  It’s the H1N1 virus, but it has been cultivated to be weak enough not to cause disease, but strong enough to generate antibodies against the H1N1 virus. 

Think of H1N1 as Superman and LAIV as Superman with a pound of Kryptonite in his shorts.

So, while it is safe, because it still is a live virus, we must exercise caution about who should receive it.  Right now, it’s recommended for:

1)      Healthy people from 2-24 years of age;

2)      Healthy people from 25-49 years of age and who live with or care for kids under 6 months old or who are health care providers (this might have to be determined on a case-by-case basis depending upon the types of patients that are being cared for).

LAIV should NOT be given to you if you have a severe egg allergy.  Make sure you list all your allergies.  Tell your healthcare provider if you ever had a life-threatening reaction to seasonal flu vaccine or if you ever had Guillain-Barré or if you are feeling acutely ill at the time you are receiving the vaccine.  These may be reasons not to receive the live virus vaccine and to wait for the inactive variety.  Also tell your care provider what, if any, vaccines you’ve received or plan to receive in that two-month period of time.

LAIV should not be given for the following groups:

1)      Children under 2 years of age

2)      Adults 50 years of age or older

3)      Pregnant women

4)      Those with a weakened immune system

5)      Those with chronic health problems like

1. Heart disease
2. Lung disease
3. Asthma
4. Kidney disease
5. Liver disease
6. Metabolic dysfunction (e.g. diabetes)
7. Blood disorders (e.g. anemia)

6)      Children under 5 years of age with asthma or with 1 or more wheezing episodes during the past year

7)      Anyone with muscle/nerve disorders (e.g. cerebral palsy) that can lead to breathing or swallowing problems

8)      Anyone in CLOSE contact with someone who is severely immunocompromised

9)      Kids and adolescents on long-term aspirin therapy.

If you have questions, you have a number of options:

1)       Your regular healthcare provider

2)      The Lucas County health department (419) 213-4100

3)      CDC

1. 1-800-232-4636
2. www.cdc.gov/h1n1
3. www.cdc.gov/flu

4)      www.flu.gov

Source:  CDC (http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-laiv-h1n1.pdf)

Well, the Yanks won.  And so it goes…

Now that we’re gearing up for the arrival of the live, inhaled version of the H1N1 vaccine, reports are coming out that the inactivated, injectable vaccine will be delivered to the states maybe as early as next week.   We’ll let you know when both versions hit town.

Meanwhile, there are many of you with kids.  My condolences.  Anyway, CDC just yesterday came out with a little blurb on how to protect your kids from H1N1 and what to do and what to look for should they become ill.

It wouldn’t be a bad idea for you to go to the link that’s located at the bottom of this posting and print out the complete copy and keep it handy.  Give it to your relatives and to your kid’s teachers.

How can I protect my child against flu?

Get a seasonal flu vaccine for yourself and your child to protect against seasonal flu viruses.

Get a 2009 H1N1 vaccine for your child. Ask your doctor about whether you should get one too.

Take – and encourage your child to take – everyday steps that can help prevent the spread of germs. This includes:

Cover coughs and sneezes with a tissue. Throw the tissue in the trash after you use it.

Stay away from people who are sick.

Wash hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.

Avoid touching your eyes, nose and mouth. Germs spread this way.

If someone in the household is sick, try to keep the sick person in a separate room from others in the household, if possible.

Keep surfaces like bedside tables, surfaces in the bathroom, kitchen counters and toys for children clean by wiping them down with a household disinfectant according to directions on the product label.

Throw away tissues and other disposable items used by sick persons in your household in the trash.

Source:  CDC, (Cade Martin)

What can I do if my child gets sick?

If your child is 5 years or older and otherwise healthy and gets flu-like symptoms, including a fever and/orcough, consult your doctor as needed and make sure your child gets plenty of rest and drinks enough fluids.

If your child is younger than 5 (and especially younger than 2) or of any age and has a medical condition like asthma, diabetes, or a neurologic problem and develops flu-like symptoms, ask a doctor if your child should be examined. This is because younger children (especially children younger than 2) and children who have chronic medical conditions may be at higher risk of serious complications from flu infection, including 2009 H1N1 flu. Talk to your doctor early if you are worried about your child’s illness.

What if my child seems very sick?

Even children who have always been healthy before or had the flu before can get a severe case of flu. Call or take your child to a doctor right away if your child of any age has:

Fast breathing or trouble breathing •

Bluish or gray skin color •

Not drinking enough fluids •

Severe or persistent vomiting •

Not waking up or not interacting •

Being so irritable that the child does not want to • be held

Flu-like symptoms improve but then return with • fever and worse cough

Has other conditions (like heart or lung disease, • diabetes, or asthma) and develops flu symptoms, including a fever and/or cough.

Source:  CDC (http://www.cdc.gov/flu/freeresources/2009-10/pdf/pan_flu_flier.pdf )

While we’re waiting for the H1N1 vaccine like Republicans waiting for the next election, let’s get a handle on what’s happening here and abroad.  As of October 2, 2009, the World Health Organization (WHO) regions have reported over 343,298 laboratory-confirmed cases of 2009 H1N1 with at least 4,108 deaths.  This is an increase of at least 24,373 cases and 191 deaths since September 20. Meanwhile in the United States, CDC has released a report stating that H1N1 is “widespread in 27 states, and outpatient visits for influenza symptoms are above normal everywhere but New England.”  During September, there were 16,174 hospitalizations for swine flu across the US with 1,379 flu-related deaths.  Eleven of the deaths were in the pediatric population.  Bottom line?  Don’t get complacent.

Now, it’s not impossible that during this season, you’ll have to care for friends and family members who have been stricken by either seasonal flu or H1N1.  How do you care for them without getting infected?   CDC and local public health have discussed measures like masks, gloves, hand hygiene, etc, but are these means really effective or is it all smoke and mirrors?  Research has indicated that  we have been on the right track all along. 

There is a new study conducted in Hong Kong that concluded that hand hygiene and facemasks seemed to prevent household transmission of influenza virus when implemented within 36 hours of index patient symptom onset.   So, this study reinforces what has been promulgated in the past.  So, plan ahead.  Get a supply of surgical masks and hand cleansers ahead of time.

  This is a tad extreme, no?

Source:  Facemasks and Hand Hygiene to Prevent Influenza Transmission in Households:
A Cluster Randomized Trial
Benjamin J. Cowling, Kwok-Hung Chan, Vicky J. Fang, et al.

Ann Intern Med 2009;151 437-446
http://www.annals.org/cgi/content/abstract/151/7/437?etoc

A couple of things have been happening with regard to H1N1 lately.  Number 1, it looks like we’ll be getting the vaccine this coming week.  At least, as far as I can tell, it’ll be in Ohio. Exactly when it gets to UT, I’m not sure, but you’ll be the first to know.  UT and the responsible agencies in Northwest Ohio are all over this, I assure you.  Number 2, a recent poll conducted by Harvard School of Public Health  suggests that the public is more accepting of the H1N1 vaccine now.  More than half of U.S. adults said in the poll that they will get the vaccine for themselves and 75 percent will get it for their children, according to a survey released last Friday (http://www.reuters.com/article/healthNews/idUSTRE5916FO20091002).  The results are an improvement over an earlier poll conducted by Consumer Reports.

It also occurred to me that there may be some among us who really don’t understand what “H” and “N” in H1N1 signify.  So here it goes.

H1N1 is an Influenza A virus.  These are RNA viruses belonging to the family Orthomyxoviridae and the genus Influenzavirus A.  Whew!  Each of these viruses (or virions) is encased in an envelope.  This envelope consists of spike-shaped glycoproteins.  There are 2 basic glycoproteins: Hemagglutinin [HA] and Neuramidase [NA].  Of the HA glycoproteins or antigens, there are 16 subtypes (H1 to H16).  Of the NA glycoproteins or antigens, there are nine (N1 to N9).  Most of the flu outbreaks we’ve had in history have come from the H1, H2, and H3 subtypes.  It’s only lately that we’ve fallen victim to the H5, H7, and H9 subtypes.  The 1918 Pandemic Flu was an H1 subtype.

So, there you have it.  H1N1 is an Influenza A virus that has Hemagglutinin 1 antigens and Neuramidase 1 antigens protruding from its protective wall.

There’ll be a test on this next week.

Source:  Center for Infectious Disease Research & Policy, University of Minnesota

Not unsurprisingly, we’ve had a couple of more H1N1 cases in our school systems. One student from Highland Elementary in Sylvania and one from Christ the King School in Toledo have been diagnosed with it (http://www.wtol.com/Global/story.asp?S=11245124). There’ll be more, but with careful attention to ourselves and our environment, those numbers, hopefully, will be manageable. Don’t get caught up in the hype. Keep the following tenets in mind:

Cover your nose and mouth with a tissue when coughing or sneezing, or coughing or sneezing into your elbow.

Wash hands thoroughly and frequently or use of alcohol‐based hand sanitizers if soap and water are unavailable.

Don’t touch your eyes, nose and mouth – germs are spread that way.

Stay home when sick and keep sick children home from school and/or day care.

Meanwhile, agencies in Northwest Ohio have received word that the first H1N1 vaccines will be arriving next week. However, for one reason or another, polls are showing the public’s disinterest in getting the vaccine (http://www.hsph.harvard.edu/news/press-releases/2009-releases/survey-40-adults-absolutely-certain-h1n1-vaccine.html). Is it complacency? Is it ignorance? Is it fear? Below, is a CDC explanation, published by ODH (Ohio Department of Health), as to why certain groups should be prioritized to receive the vaccine first. To attempt to receive the limited vaccine when you are not one of these high-risk groups could deprive the vaccine from those who are at greatest risk.

The Centers for Disease Control and Prevention (CDC) recommends certain priority groups receive the H1N1 vaccine as soon as it becomes available. The number 1 priority group is:

Pregnant women because they are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated.

‘The CDC is aware of about 700 cases of 2009 H1N1 in pregnant women since late April or early May,” Tom Skinner, a spokesman for the Centers for Disease and Control and Prevention [said]. “There have been about 100 pregnant women admitted to intensive care units and there have been 28 pregnant women who have died from 2009 H1N1.’” Source: CDC (http://www.cdc.gov/flu/weekly/?date=100209)

“Nationwide during week 38, 4.2% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is above the national baseline of 2.4%.”

Source link: http://www.cdc.gov/flu/weekly/?date=100209