Did You Get It?

CDC published “Update: Influenza Activity–United States,  September 28, 2008-April 4, 2009, and Composition of the 2009-10 Influenza Vaccine” in the April 17 issue of MMWR. Portions of the article are reprinted below.
 
  ***********************
 
  This report summarizes U.S. influenza activity from September
  28, 2008, the start of the 2008-09 influenza season, through
  April 4, 2009, and reports on the 2009-10 influenza vaccine
  strain selection. Low levels of influenza activity were reported
  from October through early January. Activity increased from mid-
  January and peaked in mid-February. Influenza A (H1N1) viruses
  have predominated overall this season, but influenza B viruses
  have been isolated more frequently than influenza A viruses
  since mid-March. Widespread oseltamivir resistance was detected
  among circulating influenza A (H1N1) viruses and a high level of
  adamantane resistance was identified among influenza A (H3N2)
  viruses. . . .
 
  Composition of the 2009-10 Influenza Vaccine
  WHO recommended that the 2009-10 Northern Hemisphere trivalent
  influenza vaccine contain A/Brisbane/59/2007-like (H1N1),
  A/Brisbane/10/2007-like (H3N2), and B/Brisbane/60/2008-like
  (B/Victoria lineage) viruses. The Food and Drug Administration’s
  Vaccines and Related Biological Products Advisory Committee
  recommended these same vaccine strains be included in the 2009-
  10 influenza vaccine for the United States. Only the influenza B
  component represents a change from the 2008-09 vaccine
  formulation. These recommendations were based on antigenic and
  genetic analyses of recently isolated influenza viruses,
  epidemiologic data, post-vaccination serologic studies in
  humans, and the availability of candidate vaccine strains and
  reagents. . . .
 
  Pneumonia- and Influenza-Related Mortality
  For the week ending April 4, 2009, pneumonia and influenza was
  reported as an underlying or contributing cause of death for
  7.4% of all deaths reported through the 122 Cities Mortality
  Reporting System. This is below the epidemic threshold of 7.8%
  for that week. Since September 28, 2008, the weekly percentage
  of deaths attributed to pneumonia and influenza ranged from 6.1%
  to 7.6%, and remained below the epidemic threshold. . . .
 
  Influenza-Associated Pediatric Mortality
  Since September 28, 2008, CDC has received 45 reports of
  influenza-associated pediatric deaths that occurred during the
  current season. Of the 27 decedents who had specimens collected
  for bacterial culture from normally sterile sites, 12 (44.4%)
  were positive; Staphylococcus aureus was identified in eight of
  the 12 children. Three of the S. aureus isolates were sensitive
  to methicillin, and five were methicillin resistant. Among the
  12 children with bacterial coinfections, all were aged >=5
  years, and 10 (83.3%) were aged >=12 years. An increase in the
  number of influenza-associated pediatric deaths with S. aureus
  coinfections was first recognized during the 2006-07 influenza
  season.
 
  Of the 36 decedents aged >6 months for whom patient vaccination
  status was known, five (13.9%) had been vaccinated against
  influenza according to 2008 Advisory Committee on Immunization
  Practices recommendations. These data are provisional and
  subject to change as more information becomes available. . . .
 
  Vaccination remains the best method for preventing influenza
  virus infection and its complications. Influenza vaccination can
  prevent influenza infections from strains that are sensitive or
  resistant to antiviral medications. Thus far this season, all
  the influenza A viruses that have been characterized, including
  oseltamivir-resistant (H1N1) viruses, are antigenically related
  to the components in the vaccine. However, approximately 80% of
  influenza B viruses tested are from a distinct lineage that is
  not related to the vaccine strain. Limited or no protection is
  expected when the vaccine and circulating virus strains are from
  different lineages. The composition of the 2009-10 influenza
  vaccine includes the same influenza A (H1N1 and H3N2)
  components, and a change in the influenza B component from the
  Yamagata to the Victoria lineage. . . .
 
  ***********************
 
  To access a web-text (HTML) version of the complete article, go
  to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5814a4.htm
 
  To access a ready-to-print (PDF) version of this issue of MMWR,
  go to: http://www.cdc.gov/mmwr/PDF/wk/mm5814.pdf

U.S. Influenza activity is really on the move. In the week of
  March 1-7, CDC received reports of four more U.S. children
  killed by complications from influenza; the total of reported
  pediatric influenza deaths this influenza season now stands at
  26. Thirty-five states have reported widespread influenza
  activity, up from 31 reported during the week of February 22-28.
 
  Yearly vaccination is the first and most important step in
  protecting against influenza and its complications. It is
  important to continue vaccinating into the spring months. The
  supply of influenza vaccine is robust; if you run out of vaccine
  in your work setting, please place another order.
 
  Many resources regarding influenza disease and vaccination are
  available to healthcare professionals and the public. Following
  is a list of some of them.
 
  To access the National Influenza Vaccine Summit website, go to:
  http://www.preventinfluenza.org
 
  To access CDC’s Seasonal Flu web section, go to:
  http://www.cdc.gov/flu
 
  To access a CDC web page of information for the public titled
  “Taking Care of Yourself: What to Do if You Get Sick with Flu,”
  go to: http://www.cdc.gov/flu/takingcare.htm
 
  To access a CDC resource for clinicians titled “Talking Points:
  Deaths in Children from Influenza Complications,” go to:
  http://www.preventinfluenza.org/media/Pediatric_Deaths_209.pdf
 
  To access the VIS for trivalent inactivated influenza vaccine
  (TIV; injectable), go to: http://www.immunize.org/vis/2flu.pdf
 
  To access the VIS for live attenuated influenza vaccine (LAIV;
  nasal spray), go to: http://www.immunize.org/vis/liveflu.pdf 
 
  To access IAC’s print piece titled “Don’t take chances with your
  family’s health–make sure you all get vaccinated against
  influenza every year!” go to:
  http://www.immunize.org/catg.d/p4069.pdf
 
  To access IAC’s print piece titled “Give these people influenza
  vaccine!” go to: http://www.immunize.org/catg.d/p2013.pdf
 
  To access IAC’s print piece titled “Screening questionnaire for
  injectable influenza vaccination,” go to:
  http://www.immunize.org/catg.d/p4066.pdf
 
  To access IAC’s print piece titled “Screening questionnaire for
  intranasal influenza vaccination,” go to:
  http://www.immunize.org/catg.d/p4067.pdf

From Immunization Action Coalition (www.immunize.org): Influenza activity now widespread in 27 states; CDC tells those who are sick how to take care of themselves

It was slow to put in an appearance, but influenza is definitely here. In the week ending February 21, 27 states reported having widespread influenza activity, which means that at least half of the regions within each state reported having recent laboratory-confirmed influenza AND an influenza outbreak or an increase in cases of influenza-like illness.

Given the increase in influenza activity, CDC’s web page of information for the public is timely and welcome. Titled “Taking Care of Yourself: What to Do if You Get Sick with Flu,” the web page offers the public information on flu symptoms, antiviral drugs, what to do if you get sick, and emergency warning signs. The sections If You Get Sick and Emergency Warning Signs are reprinted below.

As the video “Why Flu Vaccination Matters: Personal Stories from Families Affected by Flu” graphically shows, healthy children can become fatally ill from influenza very quickly. It is important that providers, parents, and caregivers know the emergency warning signs that indicate that a child needs immediate medical attention. (A link to the six-minute video is given at the end of this IAC Express article.)

IF YOU GET SICK

Most healthy people recover from the flu without complications. If you get the flu:

• Stay home from work or school.
• Get lots of rest, drink plenty of liquids, and avoid using alcohol and tobacco.
• There are over-the-counter (OTC) medications to relieve the symptoms of the flu (but never give aspirin to children or teenagers who have flu-like symptoms, particularly fever).
• Remember that serious illness from the flu is more likely in certain groups of people including people 65 and older, pregnant women, people with certain chronic medical conditions, and young children.
• Consult your doctor early on for the best treatment, but also be aware of emergency warning signs that require urgent medical attention.

EMERGENCY WARNING SIGNS
Seek emergency medical care if you or someone you know is having any of following warning signs discussed below.

In children, emergency warning signs that need urgent medical attention include

• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• 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
• Fever with a rash

In adults, emergency warning signs that need urgent medical attention include

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Seek emergency medical care if you or someone you know is experiencing any of the signs above.

To access “Taking Care of Yourself: What to Do if You Get Sick with Flu,” go to: http://www.cdc.gov/flu/takingcare.htm

To access the video “Why Flu Vaccination Matters: Personal Stories from Families Affected by Flu,” go to:
http://www.youtube.com/cdcflu

From Immunization Action Coalition: Influenza activity is increasing, and yearly vaccination is the first and most important step in protecting against influenza and its complications. It is important to continue vaccinating into the spring months. The supply of influenza vaccine is robust; if you run out of vaccine in your work setting, please place another order.

For abundant information about influenza vaccination, visit the following two websites often. They are continually updated with the latest resources:

The National Influenza Vaccine Summit website at
http://www.preventinfluenza.org

CDC’s Seasonal Flu web section at http://www.cdc.gov/flu

The American Nurses Association (ANA) strongly recommends that registered nurses and all other HCP who have direct patient contact be vaccinated against the influenza virus. 

The Centers for Disease Control and Prevention (CDC) has announced the week of December 8-14, 2008, as National Influenza Vaccination Week. This event is designed to highlight the importance of continuing influenza (flu) vaccination, as well as foster greater use of flu vaccine through the months of November, December and beyond, to avoid getting the flu when influenza season actually peaks.

This year, Tuesday, December 9th, is designated as Children’s Vaccination Day. Each year in the U.S., 20,000 children under the age of 5 are hospitalized due to influenza, and children between the ages of 2 and 5 are more likely to be taken to a doctor, urgent care center, or the emergency room because of flu. There are new tools on the CDC flu Web site (www.cdc.gov.flu) to promote children’s vaccination.

Seniors remain another group at risk of serious complications from influenza; Thursday, December 11th, is designated as Seniors’ Vaccination Day. African-American and Hispanic seniors have lower reported rates of vaccination than their Caucasian peers.

Friday, December 12th, will be Health Care Worker Vaccination Day. Many hospitals, clinics, and nursing homes are taking vigorous steps to prioritize vaccination of health care workers, as emphasized by CDC and HHS.

Because the influenza virus has the potential to greatly affect nurses and their patients, ANA is especially adamant about nurses receiving an annual influenza vaccination. ANA further maintains that nurses involved in direct patient care – and particularly nurses working with persons who have HIV/AIDS, are immunocompromised or in other high-risk groups – get vaccinated against the flu in order to prevent any outbreaks of the virus.

ANA is encouraging nurses to get vaccinated in part because, according to the CDC, only 42% of health care professionals received immunizations against the flu virus last year. ANA believes this is an alarmingly low percentage and one that is totally unacceptable, especially given health care professionals’ categorization as an influenza high-risk group, their access to the vaccine and their daily contact with vulnerable patients, many of whom also are in high-risk influenza categories. Because influenza annually leads to 200,000 hospitalizations, resulting from complications, and 36,000 deaths each year, nurses who are vaccinated against the virus not only safeguard themselves, but they also help protect their patients, their families and their communities. For more information, please visit http://www.nursingworld.org/MainMenuCategories/OccupationalandEnvironmental/occupationalhealth/Influenza.aspx.

FDA recently posted a statement and a video on its website that urge healthcare organizations to make sure influenza vaccination programs are available to healthcare personnel (HCP). A portion of the statement is printed below. Links to English- and Spanish-language versions of the complete statement are given at the end of this IAC Express article, as are links to the video and a related toolkit.
  
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  Despite the benefits of immunization, CDC estimates that only 40
  percent of the nation’s HCP are vaccinated each year. Studies
  have shown that low vaccination rates among HCP contribute to
  influenza outbreaks in hospitals and other healthcare settings,
  needlessly putting patients at an increased risk of contracting
  influenza and suffering from its potential major complications.
  Annual immunization of caregivers protects employees, their
  families and patients, and may reduce influenza-related deaths
  among persons at high risk for complications from influenza.
 
  HCP refers to all paid and unpaid persons working in healthcare
  settings who have the potential for exposure to patients and/or
  to infectious materials, including body substances, contaminated
  medical supplies and equipment, contaminated environmental
  surfaces, or contaminated air. . . .
 
  One hospital evaluated the impact of vaccination on HCP and
  hospitalized patients and saw an increase in immunization
  coverage from 4 percent to 67 percent over 12 flu seasons.
  During that timeframe, laboratory-confirmed influenza cases
  among HCP decreased from 42 percent to 9 percent. In addition,
  nosocomial (hospital-acquired) influenza cases among patients
  decreased from 32 percent to 0 percent.
 
  *******************
 
  To access the statement in English, go to:
  http://www.fda.gov/cber/flu/fluhealthcare.htm
 
  To access the statement in Spanish, go to:
  http://www.fda.gov/cber/flu/fluhealthcareesp.htm
 
  To access the video, go to:
  http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/psn/transcript.cfm?show=81#4
 
  To access a related resource from the Department of Health and
  Human Resources titled Health Care Personnel Initiative to
  Improve Influenza Vaccination Toolkit, go to:
  http://www.hhs.gov/ophs/programs/initiatives/vacctoolkit/index.html

Influenza vaccine for the 2008-09 influenza season is available.

Vaccination should continue through the spring months of 2009.

Visit the following websites often to find the information you need to keep vaccinating. Both are continually updated with the latest resources.
 
The National Influenza Vaccine Summit website at http://www.preventinfluenza.org
 
CDC’s Seasonal Flu web section at http://www.cdc.gov/flu

The next “Current Issues in Immunization” net conference will be held on December 12 from 2PM to 3PM ET. This coincides with the 2008 observation of National Influenza Vaccination Week, which is scheduled for December 8-14.

Andrew T. Kroger, MD, MPH, will speak on influenza vaccination of healthcare personnel, and Alan Janssen, MSPH, will present case studies about influenza vaccination of healthcare personnel.
 
Registration is limited and will close on December 10 or when the course is full. To register, go to: http://www2.cdc.gov/vaccines/ed/ciinc

Scheduled for December 8-14, this year’s National Influenza Vaccination Week (NIVW) emphasizes the importance of vaccinating children, seniors, and healthcare personnel by setting aside a day for each group. Friday, December 12, is Healthcare Worker Vaccination Day. Links to materials for NIVW in general and to materials pertinent to children, seniors, and healthcare personnel are listed below.
 
  NATIONAL INFLUENZA VACCINATION WEEK
  To access resources pertinent to NIVW, go to:
  http://www.cdc.gov/flu/nivw
 
  CHILDREN’S VACCINATION DAY
  To access an English-language poster, go to: 
  http://www.cdc.gov/flu/professionals/flugallery/2008-09/fluvac_kids.htm
 
  To access a Spanish-language poster, go to:
  http://www.cdc.gov/flu/professionals/flugallery/2008-09/fluvac_kids_sp.htm
 
  To access a video narrated by parents who have lost a child to
  influenza, go to:
  http://www.cdc.gov/flu/professionals/flugallery/2008-09/vaccination_video.htm
 
  SENIORS’ VACCINATION DAY
  To access posters intended for African-American and Hispanic
  seniors, who have lower reported influenza vaccination rates
  than their Caucasian peers, go to:
  http://www.cdc.gov/flu/professionals/flugallery
 
  HEALTHCARE WORKER VACCINATION DAY
  To access a poster that focuses on nurses and allied healthcare
  personnel, go to:
  http://www.cdc.gov/flu/professionals/flugallery/2008-09/p_healthcare_provide.htm
 
  To access numerous print materials, public service
  announcements, e-cards, web badges and buttons, and ready-to-use
  articles for the media, go to:
  http://www.cdc.gov/flu/professionals/flugallery

With annual influenza vaccination recommended for about 85 percent of the U.S. population, chances are every patient a clinician sees has at least one family member for whom influenza vaccination is recommended. With that in mind, IAC has developed a new one-page print resource titled “Don’t take chances with your family’s health–make sure you all get vaccinated against influenza every year!”

The piece explains how easy it is to become infected with and to transmit influenza and outlines the range of health consequences the disease can have on the individual and family. The intention is to influence at least one person in each family to see to it that all family members–children, parents, and grandparents– get vaccinated every year.

To access the new piece, go to: 

http://www.immunize.org/catg.d/p4069.pdf