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Public health officials readying for increase in H1N1 influenza cases.

An expected increase of H1N1 influenza this fall has federal health agencies and health leaders ramping up resources, releasing new guidance and issuing vaccine recommendations.

"Influenza is unpredictable ... we don't know what lies ahead in the coming weeks and months," Jay Butler, director of the Centers for Disease Control and Prevention's H1N1 Vaccine Task Force, said at a news briefing in late August. "It's best that we plan and prepare for lots of flu activity, and that's a good assumption, given that we expect to see both the 2009 H1N1 virus and the seasonal influenza viruses causing illness this fall."

Although CDC officials stopped counting every case of H1N1 as of July, hospitalizations are still being tracked, with more than 9,000 confirmed as of mid-September and almost 600 deaths. As with seasonal flu, federal health officials are stressing immunization as the best way to stem the spread of H1N1 flu, also known as swine flu.

"The big thing we will all be facing in October is whether the virus will get here before the vaccine and cause a lot of illness before we can even start to vaccinate," APHA member William Schaffner, MD, an infectious diseases specialist at Vanderbilt Medical Center in Nashville, told The Nation's Health. "We shall see. We can only do what we can do."

In early September, federal health officials were expecting the first 50 million or so doses of H1N1 vaccine to be available by mid-October, followed by additional weekly shipments of the vaccine, for a total of about 195 million doses by the end of the year. CDC's Advisory Committee on Immunization Practices recommended that pregnant women, who have increased rates of illness and death from influenza but dismally low uptake of seasonal flu vaccine coverage, be among the first in line to get the H1N1 vaccine. CDC offers guidance for treating pregnant women with H1N1 flu at clinician_pregnant.htm.


Other priority groups for the H1N1 vaccine include children and adults ages 6 months through 24 years, health care personnel, people who live with or care for infants younger than 6 months and adults ages 25-64 who have chronic health conditions.

Pending the results of clinical trials, it is likely that certain groups of people will require two doses of H1N1 vaccine for full protection, Schaffner said.

But encouraging Americans to step up and be vaccinated against both seasonal flu and H1N1 influenza will be challenging, health officials say. For example, even in regular flu season, only about 40 percent of U.S. health care workers receive an influenza vaccine each year.

"We have trouble getting people to get vaccinated when we have one vaccine," Aaron Glatt, MD, president and chief executive officer of New Island Hospital in Bethpage, N.Y., told The Nation's Health. "When you multiply that by having two vaccines, it's that much harder."

To encourage more people to get immunized, health officials are urging health workers and the media to educate the public about the risks associated with flu and the benefits of being immunized. CDC offers a full menu of such resources on the issue at h1n1flu/general_info.htm.

As of late August, the largest number of H1N1 flu cases had occurred in people ages 5 to 24. With seasonal flu and H1N1 influenza posing a serious health threat to children and young adults, CDC in August released updated guidance to help state and local health officials and school administrators decrease the spread of flu in day care settings, schools and colleges.

"We think campuses will be the first places that get hit by the disease in a given community, because most campuses have student populations that come from geographically diverse populations," said James Turner, MD, executive director for student health at the University of Virginia and president of the American College Health Association. "Once it starts on a college campus, it bleeds out, if you will, into the community."

To better understand H1N1 outbreaks on college campuses this fall and winter, the American College Health Association planned to launch a surveillance program by mid-September, Turner told The Nation's Health. Under the program, participating college health officials would provide reports every Friday evening on the numbers of H1N1 cases on their campuses that week.

"We are hoping to identify between 50 and 70 schools that geographically represent the nation, so we can get a good handle on the burden of disease and the geographic distribution of the disease," Turner said.

CDC also recently released guidance to help businesses and child care providers prepare for H1N1.

For more information, visit flu/general_info.htm.
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Title Annotation:The NATION: Health news at the national and federal levels
Author:Johnson, Teddi Dineley
Publication:The Nation's Health
Date:Oct 1, 2009
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