Flu Assessment Clinics

Someone in Ottawa, Canada had a simple idea to lessen the overcrowding at the hospital emergency wards with influenza cases.

They established influenza assessment, treatment and referral centres.

The sites were set up to accommodate anyone who had influenza-like symptoms and needed medical attention quickly and possible treatment with antiviral medication.

The centres were open to all members of the public.

Anyone who had influenza-like symptoms and was in a high risk group were advised to call their own health care provider quickly to ask for an appointment or to receive instructions as to where to go for assessment and treatment.

The high risk groups included:
• people with underlying medical conditions such as cardiac disease, lung diseases, diabetes, cancer, renal disease
• people over the age of 65
• children under age 5
• pregnant women
• children under 18 years of age on long-term acetylsalicylic acid therapy

Anyone who had severe or worsening illness were advised to go to the nearest hospital emergency department Severe or worsening illness included:
• difficulty breathing
• shortness of breath
• chest pain
• continuous vomiting or severe diarrhea with signs of dehydration
• confusion
• seizures
• extreme lack of energy

The clinics quickly relieved the pressure on the hospitals and on the flu shot clinics. A simple idea that really paid off.

Q&A with Dr. Anne Schuchat, CDC Nov 23,2009

Adjuvants vs Preservatives

Adjuvants and preservatives are two different things.

Adjuvant:
An adjuvant is a substance that is added to the vaccine to increase the body's immune response to the vaccine.

“According to current federal plans, only unadjuvanted vaccines will be used in the United States during the 2009 flu season. This includes all of the 2009 H1N1 and seasonal influenza vaccines that will be available for children and adults in both the injectable and nasal spray formulations. None of these influenza vaccines will contain adjuvants. 2009 H1N1 vaccines with adjuvants are being studied to determine if they are safe and effective. Experts will review these data when they are available. There is no plan at this time to recommend a 2009 H1N1 influenza vaccine with an adjuvant.” (CDC)

More information on adjuvants can be found here: http://www.cdc.gov/vaccinesafety/Concerns/adjuvants.html
More information on adjuvants and the H1N1 vaccine can be found here: http://www.cdc.gov/h1n1flu/vaccination/vaccine_safety_qa.htm

Preservative:
A preservative is something used to prevent contamination in multi-dose vials that are used to administer vaccines. Thimerosal is a very effective preservative that contains a small amount of mercury. Influenza vaccines in multidose vials contain 12.5 to 25 micrograms of mercury per influenza vaccine dose. It is used in some of the influenza vaccines (those in multi-dose vials).

If you are concerned about preservatives such as thimerosal, preservative-free inactivated (Flu Shot) H1N1 vaccines are available. The live attenuated vaccine (LAIV or FluMist) does not contain a preservative.

“The 2009 H1N1 influenza vaccines that FDA is licensing (approving) will be manufactured in several formulations. Some will come in multi-dose vials and will contain thimerosal as a preservative. Multi-dose vials of seasonal influenza vaccine also contain thimerosal to prevent potential contamination after the vial is opened.” (CDC)

More information on Thimerosal (preservative) can be found here: http://www.cdc.gov/vaccinesafety/Concerns/thimerosal/index.html
More information on Thimerosal (preservative) and the H1N1 vaccine can be found here:
http://www.cdc.gov/h1n1flu/vaccination/vaccine_safety_qa.htm

H1N1 STATISTICS: How Bad is It ?

This is an Amalga-created graph of flu seasons in Washington, D.C. from 2002 to 2009.

ILI stands for “Influenza-Like-Illness,” meaning that this includes everybody who shows up at the hospital primarily for symptoms of flu.

For each year, January 1 is at the left side of the screen and December 31 is at the right. Historically, the “flu season” has a small bump in the fall, with the serious spike usually beginning early in January and extending into the beginning of March.

It’s instantly apparent that this year is unprecedented in recent history. Long before the typical spike season we are already seeing more cases than we’ve ever seen — and presumably the worst is yet to come. Although the graph is a bit difficult to see, that line shooting up is the number of ILI-related hospital visits right now.

This material is from the Freakonomics blog ( http://freakonomics.blogs.nytimes.com/2009/11/10/on-the-prevalance-of-h1n1/ ) by Stephen Dubner, who can be contacted at levittdubner@freakonomics.com .

This is well worth reading.

U.S. Influenza Statistics and What to Expect

Almost all the influenza currently circulating is the new pandemic strain and, as a result, the seasonal influenza vaccine has so far had little use. The pandemic vaccine has just now begun to be distributed and given to patients. We are still in the heart of the flu season. It is too early to tell from the data if the country itself has peaked in terms of the number of cases. There are also regional and local differences – some areas have already been hit hard, as evidenced by school closures. Other areas have not yet peaked. It is also too early to tell if the pandemic vaccine has made any difference in the overall numbers.

In usual influenza seasons, an estimated 36,000 deaths occur directly or indirectly from influenza in the U.S., with 90% of these in the elderly or in those with weakened immune systems. The good news this season is that the elderly seem to have some immunity to the pandemic H1N1 strain, probably due to different H1N1 strains that were in circulation until the 1957 H2N2 pandemic, at which time H2N2 replaced H1N1 as the seasonal strain. So, we are seeing far fewer total deaths, just over 1,000 (but perhaps as high as 3,000, according to other CDC data not currently publicized) since the pandemic started.

The bad news is that we are seeing more than the usual number of deaths in younger people (under age 65). People with weakened immune systems are still dying disproportionately, and we are seeing more than the usual number of deaths in previously healthy individuals including children and pregnant women.

Between vaccine being distributed / administered and the pandemic running its course through communities, one would hope to see a downward trend in hospitalizations and deaths. The vast majority of unvaccinated patients who get pandemic influenza will be fine after a few days of misery. Similarly, patients who get the vaccine prior to getting sick from pandemic influenza will not have a serious reaction to the vaccine and also will not get ill or die from the virus.

Next year’s seasonal influenza vaccine will include the current pandemic H1N1 strain (or a mutated version), and influenza B. It can be expected that subsequent seasons will be mild because so many will have already gotten ill and developed immunity to the novel H1N1. The elderly will continue to have some natural immunity, and the vaccine and herd immunity will protect most of the rest of the population.
(from Extreme Thinkover by Dr. John Bogen, MD November 8, 2009)