Health Alerts > 9/11/09 H1N1 Weekly Update

Date:  September 11, 2009

While the summer has demonstrated relatively low levels of flu activity, virtually all of the circulating flu virus is the 2009 Influenza A H1N1 virus.  In anticipation of a potential surge of flu activity this fall, we will begin to provide a weekly H1N1 update.  We will include current statistics, relevant articles, and important local issues. 

Over the past several months (years, really) local public health, healthcare, emergency, law enforcement, and academic organizations have been planning within and among their organizations on how to handle a potential H1N1 outbreak.  We will share this information with you as it is finalized.  This includes potential vaccination sites, triage policies, communication and education strategies, etc.  Our goal is to ensure that we are all “on the same page” and are using our community resources in the most effective way to minimize the negative impact the H1N1 virus could have on our county. 

We hope that you find this helpful and you can go on our website www.allencountyhealth.com to sign up for automatic emails if you like. 

Current Viral Activity:

During week 34 (August 23-29, 2009), influenza activity increased in the United States, with 97% of all subtyped influenza A viruses being reported to CDC this week being 2009 influenza A (H1N1) viruses.  Indiana remains at sporadic activity.

The percentage of 2009 influenza A (H1N1) viruses that are resistant to Tamiflu is 0.6%.  Eight of the nine patients had documented exposure to Oseltamivir through either treatment or chemoprophylaxis, and the remaining patient is currently under investigation to determine exposure to Oseltamivir.

As of September 4, 2009, 9,079 hospitalizations and 593 deaths due to 2009 influenza A H1N1 have occurred

Deaths by Age

New Recommendations

New Guidelines for Antiviral Use

• Treatment with oseltamivir or zanamivir is recommended for all persons with suspected or confirmed influenza requiring hospitalization.
• Treatment with oseltamivir or zanamivir generally is recommended for persons with suspected or confirmed  influenza who are at higher risk for complications (children younger than 5 years old, adults 65 years and older, pregnant women, persons with certain chronic medical or immunosuppressive conditions, and persons younger than 19 years of age who are receiving long-term aspirin therapy.
• Any suspected influenza patient presenting with warning symptoms (e.g., dyspnea) or signs (e.g., tachypnea, unexplained oxygen desaturation) for lower respiratory tract illness should promptly receive empiric antiviral therapy.
• Consider empiric treatment of patients at higher risk for influenza complications based on telephone contact if hospitalization is not indicated and if this will substantially reduce delay before treatment is initiated.
• In selected circumstances, providers might also choose to provide selected patients at higher risk for influenza-related complications (e.g., patients with neuromuscular disease) with prescriptions that can be filled at the onset of symptoms after telephone consultation with the provider.

Persons who are not at higher risk for complications or do not have severe influenza requiring hospitalization generally do not require antiviral medications for treatment or prophylaxis. However, clinical judgment is an important factor in antiviral treatment decisions for all patients presenting for medical care who have illnesses consistent with influenza.

New Articles/Studies on H1N1

A good review of 2009 Influenza A H1N1 activity in Chicago can be found at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5833a1.htm

The highlights are that the overall attack rate was highest among children aged 5--14 years (147 per 100,000 population), which was 14 times higher than for adults aged ≥60 years. A total of 205 (13%) patients were hospitalized, with the highest rate observed among children aged 0--4 years (25 per 100,000), followed by children aged 5--14 years (11 per 100,000). These findings affirm prevention strategies that target children and young adults, who are at a disproportionate risk for infection and hospitalization. The Advisory Committee on Immunization Practices (ACIP) recommends that these populations should be among the first groups targeted for vaccination with influenza A (H1N1) 2009 monovalent vaccine.

A good review of pediatric deaths due to H1N1 can be found at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5834a1.htm

Highlights include:

As of August 8, 2009, CDC had received reports of 477 deaths associated with 2009 pandemic influenza A (H1N1) in the United States, including 36 deaths among children aged <18 years.

The results of that analysis indicated that, of 36 children who died, seven (19%) were aged <5 years, and 24 (67%) had one or more of the high-risk medical conditions.  Among the 24 children with high-risk medical conditions, 22 (92%) had neurodevelopmental conditions (e.g., developmental delay or cerebral palsy). Of these 22 children, 13 (59%) had more than one neurodevelopmental diagnosis, and nine (41%) had neurodevelopmental and chronic pulmonary conditions. Eight (22%) of the 36 children were aged ≥5 years with no reported high-risk conditions. Two of these eight children were reported as obese; however, height and weight measurements were not reported.

Local H1N1 Information

Again, if you are interested in providing H1N1 vaccine to your patients (following the CDC priority groups) please call Candy Staadt at 449-3514 and/or plan to attend one of the following planning/information sessions:

9/22/09             Lutheran Hospital (Kachman Auditorium)

                        Set up time – 10:00 a.m.

                        Meeting   10:30 – 11:30 a.m.

9/22/09             Parkview Corporate Office   (large conference area)

                        Set Up time – 2:30 p.m.

                        Meeting    3:00 – 4:00 p.m.

9/24/09             Dupont Hospital   (Resource Center – 2^nd Floor Classrooms 2&4

                        Set Up time – 9:30 a.m.

                        Meeting   10:00 – 11:00 a.m.

9/24/09             St. Joseph Hospital (Assembly Room, Lower Level by cafeteria)

                        Set Up time:     1 p.m.

                        Meeting  1:30 – 2:30 p.m.

Please RSVP your attendance to Joanna at 449-4371

Please feel free to call with any questions.          
Deb McMahan, MD