Tuesday, September 29, 2009

The Flu 101

Having received a number of calls and emails about the flu season and H1N1 from people that have been driven to either hysterics or simple confusion, MedFN is dedicating this newsletter to providing you with a simpler, un-hyped list of important tips and facts from the Center for Disease Control (CDC).

Know the differences between seasonal flu and the H1N1 flu, their respective vaccinations and treatments. Here are some of the latest helpful postings from the CDC.

http://www.cdc.gov/FLU/protect/keyfacts.htm - SEE BELOW

Key Facts About Seasonal Flu Vaccine

The single best way to protect against the flu is to get vaccinated each year.

Important – A seasonal vaccine will not protect you against 2009 H1N1 flu.This year there also is a 2009 H1N1 flu vaccine. http://www.cdc.gov/h1n1flu/vaccination/

There are two types of vaccines:

The "flu shot" — an inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm. The flu shot is approved for use in people older than 6 months, including healthy people and people with chronic medical conditions.

The nasal-spray flu vaccine — a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for "live attenuated influenza vaccine" or FluMist®). LAIV (FluMist®) is approved for use in healthy* people 2-49 years of age who are not pregnant.

Each seasonal influenza vaccine contains three influenza viruses-one A (H3N2) virus, one regular seasonal A (H1N1) virus (not the 2009 H1N1 virus), and one B virus. The viruses in the vaccine change each year based on international surveillance and scientists' estimations about which types and strains of viruses will circulate in a given year. About 2 weeks after vaccination, antibodies that provide protection against influenza virus infection develop in the body.

The seasonal flu vaccine will not provide protection against 2009 H1N1 flu.

When to Get Vaccinated

Yearly flu vaccination should begin in September or as soon as vaccine is available and continue throughout the influenza season, into December, January, and beyond. This is because the timing and duration of influenza seasons vary. While influenza outbreaks can happen as early as October, most of the time influenza activity peaks in January or later.

Who Should Get Vaccinated

In general, anyone who wants to reduce their chances of getting seasonal flu can get a seasonal influenza vaccine. However, it is recommended by ACIP that certain people should get vaccinated each year. They are either people who are at high risk of having serious seasonal flu-related complications or people who live with or care for those at high risk for serious seasonal flu-related complications. During flu seasons when vaccine supplies are limited or delayed, ACIP makes recommendations regarding priority groups for vaccination.

People who should get the seasonal vaccine each year are:
  1. Children aged 6 months up to their 19th birthday
  2. Pregnant women
  3. People 50 years of age and older
  4. People of any age with certain chronic medical conditions
  5. People who live in nursing homes and other long-term care facilities
  6. People who live with or care for those at high risk for complications from flu, including:
    a. Health care workers
    b. Household contacts of persons at high risk for complications from the flu
    c. Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)

Use of the Nasal Spray Flu Vaccine

It should be noted that vaccination with the nasal-spray flu vaccine is always an option for healthy* people 2-49 years of age who are not pregnant.

The ACIP has issued separate recommendations on
who should get the 2009 H1N1 vaccine.

Who Should Not Be Vaccinated

There are some people who should not get a flu vaccine without first consulting a physician.

These include:

  • People who have a severe allergy to chicken eggs.
  • People who have had a severe reaction to an influenza vaccination.
  • People who developedGuillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine.
  • Children less than 6 months of age (influenza vaccine is not approved for this age group), and
  • People who have a moderate-to-severe illness with a fever (they should wait until they recover to get vaccinated.)

Vaccine Effectiveness

The ability of a flu vaccine to protect a person depends on the age and health status of the person getting the vaccine, and the similarity or "match" between the viruses or virus in the vaccine and those in circulation.

Vaccine Side Effects (What to Expect)

Different side effects can be associated with the flu shot and LAIV.

The flu shot: The viruses in the flu shot are killed (inactivated), so you cannot get the flu from a flu shot. Some minor side effects that could occur are:

  • Soreness, redness, or swelling where the shot was given
  • Fever (low grade)
  • Aches

If these problems occur, they begin soon after the shot and usually last 1 to 2 days. Almost all people who receive influenza vaccine have no serious problems from it. However, on rare occasions, flu vaccination can cause serious problems, such as severe allergic reactions. As of July 1, 2005, people who think that they have been injured by the flu shot can file a claim for compensation from the National Vaccine Injury Compensation Program (VICP) .

The nasal spray (also called LAIV or FluMist®): The viruses in the nasal-spray vaccine are weakened and do not cause severe symptoms often associated with influenza illness. (In clinical studies, transmission of vaccine viruses to close contacts has occurred only rarely.)

In children, side effects from LAIV (FluMist®) can include:

  • runny nose
  • wheezing
  • headache
  • vomiting
  • muscle aches
  • fever

In adults, side effects from LAIV (FluMist®) can include:

  • runny nose
  • headache
  • sore throat cough

More Information

For information about the 2009 H1N1 flu vaccine, see http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm.

* "Healthy" indicates persons who do not have an underlying medical condition that predisposes them to influenza complications.

2009 H1N1 Influenza Vaccine:
Questions and AnswersSept 24, 2009, 10:30 AMET

What are the plans for developing 2009 H1N1 vaccine?

Vaccines are the most powerful public health tool for control of influenza, and the U.S. government is working closely with manufacturers to take steps in the process to manufacture a 2009 H1N1 vaccine. Working together with scientists in the public and private sector, CDC has isolated the new H1N1 virus and modified the virus so that it can be used to make hundreds of millions of doses of vaccine. Vaccine manufacturers are now using these materials to begin vaccine production. Making vaccine is a multi-step process which takes several months to complete. Candidate vaccines will be tested in clinical trials over the few months.

When is it expected that the 2009 H1N1 vaccine will be available?

The 2009 H1N1 vaccine is expected to be available in the fall. More specific dates cannot be provided at this time as vaccine availability depends on several factors including manufacturing time and time needed to conduct clinical trials.

Will the seasonal flu vaccine also protect against the 2009 H1N1 flu?

The seasonal flu vaccine is not expected to protect against the 2009 H1N1 flu.

Can the seasonal vaccine and the 2009 H1N1 vaccine be given at the same time?

It is anticipated that seasonal flu and 2009 H1N1 vaccines may be administered on the same day. However, we expect the seasonal vaccine to be available earlier than the H1N1 vaccine. The usual seasonal influenza viruses are still expected to cause illness this fall and winter. Individuals are encouraged to get their seasonal flu vaccine as soon as it is available.

Who will be recommended to receive the 2009 H1N1 vaccine?

CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended that certain groups of the population receive the 2009 H1N1 vaccine when it first becomes available. These target groups include pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months and 24 years old, and people ages of 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems.

We do not expect that there will be a shortage of 2009 H1N1 vaccine, but availability and demand can be unpredictable. There is some possibility that initially the vaccine will be available in limited quantities. In this setting, the committee recommended that the following groups receive the vaccine before others: pregnant women, people who live with or care for children younger than 6 months of age, health care and emergency medical services personnel with direct patient contact, children 6 months through 4 years of age, and children 5 through 18 years of age who have chronic medical conditions.

The committee recognized the need to assess supply and demand issues at the local level. The committee further recommended that once the demand for vaccine for these target groups has been met at the local level, programs and providers should begin vaccinating everyone from ages 25 through 64 years. Current studies indicate the risk for infection among persons age 65 or older is less than the risk for younger age groups. Therefore, as vaccine supply and demand for vaccine among younger age groups is being met, programs and providers should offer vaccination to people over the age of 65.

Do those that have been previously vaccinated against the 1976 Swine Influenzaneed to get vaccinated against the 2009 H1N1 influenza?

The 1976 swine flu virus and the 2009 H1N1 virus are different enough that it’s unlikely a person vaccinated in 1976 will have full protection from the 2009 H1N1. People vaccinated in 1976 should still be given the 2009 H1N1 vaccine.

Where will the vaccine be available?

Every state is developing a vaccine delivery plan. Vaccine will be available in a combination of settings such as vaccination clinics organized by local health departments, healthcare provider offices, schools, and other private settings, such as pharmacies and workplaces. For more information, see
State/Jurisdiction Contact Information for Health Care Providers Interested in Providing H1N1 Vaccine.

Will this vaccine be made differently than the seasonal influenza vaccine?

No. This vaccine will be made using the same processes and facilities that are used to make the currently licensed seasonal influenza vaccines.

Are there other ways to prevent the spread of illness?

Take everyday actions to stay healthy.

Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

Wash your hands often with soap and water, especially after you cough or sneeze. If soap and water are not available, use an alcohol-based hand rub.

Avoid touching your eyes, nose or mouth. Germs spread that way.

Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

Follow public health advice regarding school closures, avoiding crowds and other social distancing measures. These measures will continue to be important after a 2009 H1N1 vaccine is available because they can prevent the spread of other viruses that cause respiratory infections.

What about the use of antiviral to treat 2009 H1N1 infection?

CDC has issued
interim guidance for the use of antiviral drugs for this season. CDC also has published Questions & Answers related to the use of antiviral drugs for this season.

Will two doses of vaccine be required?

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. Data from trials among children are not available at this time, so dosing schedules for children are not yet known. Data from trials among children will be available soon. At this time, FDA has approved two doses for children 6 months through 9 years of age. Immunogenicity data for the 2009 flu H1N1 vaccine among adults is similar to that for seasonal influenza vaccines. If this is also the case among children, then it is likely that younger children will require two doses and older children will require one dose. As with seasonal vaccine, children 6 months through 35 months of age should get two doses of 2009 H1N1 flu vaccine, which contains one-half of the dose used for older children and adults.

What will be the recommended interval between the first and second dose for children 9 years of age and under?

This will not be known until clinical trials are complete. For planning purposes, planners should assume 21-28 days between the first and second vaccination.

Can seasonal vaccine and novel H1N1 vaccine be administered at the same time?

Inactivated 2009 H1N1 vaccine can be administered at the same visit as any other vaccine, including pneumococcal polysaccharide vaccine. Live 2009 H1N1 vaccine can be administered at the same visit as any other live or inactivated vaccine EXCEPT seasonal live attenuated influenza vaccine.