Influenza Update 12/18/09

Supply of vaccine continues to improve. From the Massachusetts Department of Public Health on 12/17/09:

To date, DPH has distributed over two million doses of the H1N1 vaccine -- enough to protect the vast majority of our highest risk residents against the H1N1 flu. Recently, we have received several large shipments of vaccine, and we expect to continue to receive additional large amounts in the near future. As a result, we will begin to offer the vaccine to all residents who wish to receive it, although our focus will remain on vaccinating members of the priority groups.

Currently, we are booking appointments for:

H1N1 injectable (no preservative-free injectable available)
H1N1 Flumist (nasal)

Seasonal Flumist (nasal)
Seasonal injectable preservative-free (only for infants and toddlers)
Seasonal injectable

We will continue to update this blog as the vaccine supply changes.

Influenza Practical Advice from the CDC

At the Center for Disease Control website, there is a great deal of information for parents who are caring for sick children at home. Is it the flu? How do I know? How do I care for my child?

What To Do If You Get Sick

http://www.cdc.gov/h1n1flu/sick.htm

Taking Care of a Sick Person in Your Home

http://www.cdc.gov/h1n1flu/guidance_homecare.htm

Holliston Guidelines for Flu Vaccination

Holliston Pediatrics will be following the Center for Disease Control (CDC) recommendations for Seasonal Flu and H1N1 Flu vaccination. Because the supply of the vaccines cannot yet meet demands, children with certain medical issues will be offered earlier supply of vaccine. Currently, the populations to be vaccinated first are:

*6 months to 4 year olds.

*siblings of babies under 6 mos.

*patients with certain chronic conditions that make them more at risk for flu complications.

Once these targeted patient populations are vaccinated, we will try to provide vaccine to all who desire it. We recommend that everyone be vaccinated for both Seasonal Flu and H1N1 Flu.

The American Academy of Pediatrics (AAP) has outlined conditions which put patients at risk for complications from the flu:

*Neurological disorders - epilepsy, cerebral palsy, neurodevelopmental disabilities.

*Neuromuscular disorders with impaired respiratory function.

*Chronic respiratory diseases with impaired pulmonary function and/or difficulty

handling secretions - moderate/severe asthmatics, cystic fibrosis, patients requiring

oxygen/ventilators/tracheostomy.

*Immunodeficiency states.

*Congenital heart disease.

*Mitochondrial disease with respiratory impairment.

The CDC has added additional conditions that put patients at higher risk for flu complications. These include renal disease, liver disease, hematologic disease (sickle cell), metabolic disease (diabetes), and patients on high-dose aspirin therapy (risk of Reye syndrome).

Vaccines

Seasonal Flu There are two vaccines available:

Nasal spray(3 strains of attenuated live virus) is approved for 2 yr to 49 yr.

Injectable(3 strains of killed virus) is approved for 6 mos and up.

*A patient under 9 yr will require 2 vaccine doses the first year that they are vaccinated (2 doses of the same vaccine 1 month apart).

H1N1 Flu There are two vaccines available: nasal spray and injectable

Nasal spray(1 strain of attenuated live virus) is approved for 2 yr to 49 yr.

Injectable(1 strain of killed virus) is approved for 6 mos and up.

*A patient under 10yo will require 2 vaccine doses this year (2 doses of the same vaccine 1 month apart).

Your child may get the injectable seasonal flu vaccine, or the injectable H1N1 flu vaccine, with any other live or killed vaccine on the same day, and with each other on the same day.

Your child may get the nasal spray seasonal flu vaccine, or the nasal spray H1N1 flu vaccine, with any other live vaccine or killed vaccine on the same day. One cannot administer the nasal spray seasonal flu vaccine and the nasal spray H1N1 flu vaccine on the same day, and one must wait at least 1 month before administering another live vaccine of any type.

Contraindications to the nasal spray

Nasal seasonal flu vaccine and the nasal spray H1N1 vaccine:

*Under 2 yr, or over 50 yr.

*Pregnant women.

*Allergy to egg or any of the other vaccine components (gelatin, gentamicin, arginine).

*Patients who have had Guillain-Barre syndrome.

*Patients who have had a life-threatening reaction to any previous flu vaccination.

*Acute febrile illness or severe nasal congestion.

*Household member who is severely immunocompromised. One must wait 7 days

after receiving nasal vaccine to visit immunocompromised people.

Contraindications to the injectable Seasonal Flu vaccine and the injectable H1N1 vaccine:

*Under 6 mos.

*Allergy to egg or any of the other vaccine components (gelatin, gentamicin,arginine).

*Patients who have had Guillan-Barre syndrome.

*Patients who have had a life-threatening reaction to any previous flu vaccination.

*Acute febrile illness.

If a patient is on anti-viral therapy, they should wait 48 hours to receive any flu vaccine. If a patient takes anti-viral therapy within 2 weeks of being vaccinated for any flu, they need to repeat their vaccination 48 hours after the anti-viral medication is complete.

Women who are breast feeding may have the nasal or injectable vaccines and continue to breast feed.

A patient who has had a flu-like illness during 2009 should probably still receive the H1N1 Flu vaccine, and certainly should receive the seasonal flu vaccine.

School systems are expecting to get H1N1 vaccine to administer, and our patients should be encouraged to get vaccinated through their schools if/when available. We should encourage these patients to call us with the date and type of vaccine that is received so that we can update their vaccination record.

Influenza Prevention

With the anticipation of a serious influenza season upon us, the medical staff of Holliston Pediatrics is available to offer assistance and answer questions. The prevention of influenza is part of assuring the health and well-being of your child. We fully support the use of the influenza vaccine as an important tool in this prevention. As stated by the Center for Disease Control:

“Vaccines are the most powerful public health tool for control of influenza.”

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. Alcohol-based hands cleaners are also effective.
• 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.

Who is recommended to receive the 2009 H1N1 flu vaccine?

• 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

Influenza - General Information

For general information about influenza, try these websites:

Center for Disease Control
http://www.cdc.gov/h1n1flu/

Dept of Health and Human Services
http://www.flu.gov/

American Academy of Pediatrics
http://www.aap.org/advocacy/releases/swineflu.htm