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H1N1 A Discussion For Primary Care Physicians

H1N1 A Discussion For Primary Care Physicians. Bonita J. Sorensen, M.D., MBA Director Volusia County Health Department. H1N1 Points of Discussion. Why is this issue an important public health issue Current epidemiological information and the national, state and local level

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H1N1 A Discussion For Primary Care Physicians

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  1. H1N1A Discussion For Primary Care Physicians Bonita J. Sorensen, M.D., MBA Director Volusia County Health Department

  2. H1N1Points of Discussion • Why is this issue an important public health issue • Current epidemiological information and the national, state and local level • Important CDC guidance you should be aware of • Priority groups for vaccination • Plans for vaccine safety monitoring • Who should be tested and who should be treated • Return to work guidance • Federal, state and local planning for vaccine distribution • When will vaccine be available locally • Payment Issues • Plans for mass vaccination • How you can help

  3. Influenza… is an old disease... it’s been with us for sometime…

  4. What are the consequences of yearly epidemics in U.S.A? > 36,000 die and 200,000 are hospitalized 5 to 20% of general population infected Nursing home attack rates of up to 60% 85% of flu-related deaths in ages > 65 Over $10 billion lost

  5. This rate of human and economic loss is our regular (normal) rate of loss due to minor changes in the viral protein structure (antigenic drift) What are the loss estimates when there are larger changes in the circulating viral structure (antigenic shift)?

  6. Our Historical ExperiencePast Flu Pandemics Credit: US National Museum of Health and Medicine 1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu” A(H1N1) A(H2N2) A(H3N2) 20-40 m deaths 675,000 US deaths 1-4 m deaths 70,000 US deaths 1-4 m deaths 34,000 US deaths

  7. What might happen if we have a pandemic now? Mortality (death) rate of the new H1N1 virus not currently known. The following are estimates (depending on severity): Infected: 90 million US Based on 30% attack rate Hospitalized: 865,000 to 9.9 million US Deaths 209,000 to 1.9 million US $71-166 billion would be lost http://pandemicflu.gov/plan/pandplan.html, Accessed 24 August 2009

  8. How do pandemics happen?

  9. Current Epidemiological InformationH1N1 Swine Flu in US • More than 1 million cases occurred in U.S. between April and June. • See CDC website for the most up-to-date information on cases: http://www.cdc.gov/h1n1flu/

  10. H1N1 Swine Flu in Florida • Florida (as of 8/26/09) • 605 known hospital admissions • 66 deaths • Florida H1N1 info: www.myflusafety.com • Call 877 FLAFLU1 • The Bureau of EPI Weekly Surveillance Report:http://www.doh.state.fl.us/Disease_ctrl/epi/swineflu/index.html

  11. Local Epidemiological Surveillance

  12. Priority groups for vaccination • Advisory Committee on Immunization Practices (ACIP) recommended that novel H1N1 flu vaccine be made available first to the following five groups: • Pregnant women • People caring for infants under 6 months of age • Health care workers and emergency medical responders • Children and young adults from 6 months to 24 years • People aged 25 to 64 years with underlying medical conditions (e.g. asthma, diabetes) • Combined, these groups would equal approximately 159 million individuals http://www.flu.gov/faq/vaccines/2004.html, Accessed 24 August 2009

  13. ACIP Recommendations: Influenza A (H1N1) 2009 monovalent vaccine use • Prioritization within these 5 target groups might be necessary if initial vaccine availability is insufficient to meet demand (~42 mil) • Pregnant women • Household and caregiver contacts of children younger than 6 months of age • Health-care and emergency medical services personnel with direct patient contact • Children from 6 months through 4 years of age • Children and adolescents aged 5 through 18 years who have medical conditions associated with a higher risk of influenza complications

  14. ACIP Recommendations: Influenza A (H1N1) 2009 monovalent vaccine use • Vaccine should not be held in reserve for patients who already have received 1 dose but might require a second dose. • Simultaneous administration of inactivated vaccines against seasonal influenza viruses and pandemic (H1N1) 2009 virus IS PERMISSIBLE if different anatomic sites are used. • Simultaneous administration of live, attenuated vaccines against seasonal viruses and pandemic (H1N1) 2009 virus is NOT RECOMMENED. • All persons currently recommended for seasonal influenza vaccine, including those aged ≥65 years, should receive the seasonal vaccine as soon as it is available.

  15. Influenza A (H1N1) 2009 monovalent vaccine - safety monitoring Objectives of the safety monitoring response: • Identify clinically significant adverse events following receipt of vaccine in a timely manner • Rapidly evaluate serious adverse events following receipt of vaccine and determine public health importance • Evaluate if there is a risk of Guillain-Barré syndrome (GBS) associated with receipt of vaccine • Communicate vaccine safety information in a clear and transparent manner to all community stakeholders

  16. Influenza A (H1N1) 2009 monovalent vaccine - safety monitoring Methods: • Vaccine Adverse Event Reporting System (VAERS) will be the front-line monitoring system for collecting and analyzing voluntary reports of adverse events following receipt of vaccine

  17. Influenza A (H1N1) 2009 monovalent vaccine - safety monitoring Methods (continued): • Vaccine Safety Datalink • Collaborative effort between CDC and eight large managed care organizations • Vaccine Analytic Unit • Collaboration among the Department of Defense, CDC and the FDA • Emerging Infections Programs • A population-based network of CDC and 10 state health departments (CA, CO, CT, GA, MD, MN, NM, NY, OR, TN) • American Academy of Neurologists and CDC • Collaboration to enhance VAERS reporting of neurological events, including GBS • Clinical Immunization Safety Assessment (CISA) • Collaboration between CDC and 6 academic centers

  18. Who should be tested and who should be treated • Testing: • Recommended only for seriously ill (ICU) patients and those part of an epidemiological cluster: • A school, church, camp, day care, etc • No need to test everyone in a cluster, one or two will do • Treatment: • Tamiflu and Relenza are effective for H1N1 • These treatments are most effective if given within 24 hours of symptoms, but should be considered regardless of duration of illness in someone seriously ill http://www.cdc.gov/H1N1flu/antiviral.htm, Accessed 24 August 2009

  19. Who should be treated • The CDC has identified the same high risk groups for treatment of H1N1 that are recommended for treatment with seasonal flu. • Children younger than 5 years old. The risk for severe complications from seasonal influenza is highest among children younger than 2 years old. • Adults 65 years of age and older. • Persons with the following conditions: • Chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological (including sickle cell disease), neurologic, neuromuscular, or metabolic disorders (including diabetes mellitus); • Immunosuppression, including that caused by medications or by HIV; • Pregnant women; • Persons younger than 19 years of age who are receiving long-term aspirin therapy; • Residents of nursing homes and other chronic-care facilities. http://www.cdc.gov/h1n1flu/recommendations.htm, Accessed 24 August 2009

  20. Return to work • Health care worker recommendations: • Healthcare personnel should not report to work if they have a febrile respiratory illness.In communities where swine influenza virus transmission is occurring, healthcare personnel who develop a febrile respiratory illness should be excluded from work for 7 days or until symptoms have resolved, whichever is longer. http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm, Accessed 24 August 2009

  21. Return to work recommendations for your patients and the general public • CDC recommends that people with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F [37.8°C]), or signs of a fever without the use of fever-reducing medications. http://www.cdc.gov/h1n1flu/guidance/exclusion.htm, Accessed 26 Augsut 2009

  22. Federal, state and local planning for vaccine distribution • CDC is contracting with the McKesson Corporation, a national vaccine distributor for pediatric vaccines, to drop ship vaccine to 90,000 sites. • Florida Shots, an state-wide immunization registry will be used to coordinate with McKesson on the shipment/dosage allocation at each site, with assistance from the Department of Health central office (Tallahassee) and our local office

  23. Local vaccine availability • Vaccine will be provided in pre-filled syringes, multi-dose vials, and intranasal sprayers. • Projections are vaccine will be available starting last week of September 2009 and will be shipped weekly as available from manufacturer. • Nationally, the number of doses available in October 2009 are anticipated to be: • Total of 63.8M doses by end of October 2009 • Florida fair share based on population is 5.9% of total available, about 3.4M doses • Volusia County’s fair share based on population is 2.7% of Florida’s share, about 102,400 doses by end of October 2009 • Starting Mid-October, anticipate available vaccine is estimated to be 20M doses (nationally) or 32K for Volusia County per week to and continue to be shipped through December 2009 Vaccine Estimates from CDC as of 8/21/09

  24. Influenza A (H1N1) 2009 monovalent vaccine financing • Providers CANNOT charge a fee for the vaccine, syringes or needles since they are being provided at no cost to the provider • Providers may charge a fee for the administration of the vaccine to the patient, their health insurance plan, or other third party payer • Providers are encouraged to vaccinate under- or uninsured patients; however, if unable, providers should refer these patients to us

  25. Influenza A (H1N1) 2009 monovalent vaccine financing Association of Health Insurance Plans (AHIP), on behalf of its members: "Every year health plans contribute to the seasonal flu vaccination campaign in several ways: a) Health plans communicate directly with plan sponsors and members on the current ACIP recommendations and encourage immunization; they also provide information on where to get vaccinations, and who to contact with any questions. b) Just as health plans have provided extensive coverage for the administration of seasonal flu vaccines in the past, public health planners can make the assumption that health plans will provide reimbursement for the administration of a novel (A) H1N1 vaccine to their members by private sector providers in both traditional settings e.g., doctor’s office, ambulatory clinics, health care facilities, and in non-traditional settings, where contracts with insurers have been established"

  26. Plans for mass vaccination • Points of distribution (PODs) • Working with local schools of nursing, school officials, and other community partners, plans are being developed for three PODs in strategically locally schools throughout the county to administer swine flu vaccines on weekends

  27. How you can help • Vaccinate your patients and help to vaccinate the under or uninsured. • Sign up in Florida Shots to receive vaccine • http://www.flshots.org/. • Volunteer to serve in our Medical Reserve Corps (MRC) • Please call 386-274-0500 ext 0691for more information

  28. How you can help • Become a sentinel physician • Sentinel physicians send cultures to the state laboratory weekly and as needed, so we can accurately identify the prevalent viral strains in our community • Benefits include: Free monthly educational material from CDC Priority, in terms of processing your culture results • Please contact Michelle Nash at 386-274-0500 ext 0618 for more information or visit: http://www.doh.state.fl.us/disease_ctrl/epi/htopics/flu/FSPISN/influenza_sentinels.html

  29. How you can help • Keep yourselves informed: • Monitor the CDC web site for the latest information • The Volusia County Health Department will also provide frequent updates as the situation dictates

  30. Thank you for your kind attention. Questions?

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