Guilford County Department of Public Health will hold two special flu vaccination clinics Wednesday, November 25.  The H1N1 flu vaccine will be available by appointment for all 5 CDC priority groups (pregnant women; children ages 6 months to 24 years of age; health care workers and emergency medical services personnel; adults ages 25-64 with underlying health conditions; and household contacts and caregivers of children 6 months of age and younger).  Seasonal flu vaccine will be available by appointment for children ages 4-18 years of age.  The clinics will be held at two public health locations:  501 E. Green Drive in High Point and 1100 E. Wendover Avenue in Greensboro between the hours of 8:00 a.m. and 2:30 p.m. The Department of Public Health has nearly 350 appointments available at this time for this effort. These appointments are available first-come, first-served. For an appointment at the Greensboro location, call 641-5563. For an appointment at the High Point location, call 845-7655.There will be no out of pocket expense to individuals.  Individuals should bring their insurance or Medicaid card if they have one.

Individuals who are moderately to severely ill are advised to wait until they recover to get the vaccines. Those with a mild cold or other illness should be able to get the vaccines. No one should get the vaccines if allergic to eggs or to any other substance in the vaccines, have had Guillain Barré Syndrome or a life-threatening reaction following a flu vaccine.

For more information about this event, call 641-7777 or visit www.guilfordhealth.org and click on the H1N1 flu vaccine availability link.

Many of us are getting ready for Thanksgiving and for some, Thanksgiving entails driving to Piedmont Triad International and getting on a plane to visit family.

You shouldn’t be surprised if the passenger sitting next to you is in what I scientifically call “Full Snot Mode”. In such a confined setting it is likely that you will be receiving a full dose of swine flu regardless of what you do. Although commercial passenger jets have cabins with airflow confined to a few rows, that helps passengers at considerable distance.  The air within a row is pretty much close circuited.

Influenza is transmitted through large droplets which fall out within 3 feet of the person generating them. It also is spread through hand-to-hand contact. If you are sitting next to the guy sneezing, coughing and blowing into the paper napkin that came on the inedible dinner tray, you may well find yourself symptomatic in a day or two.

So do everyone a favor and if you’re sick, don’t get on a plane. It’s not fair to your fellow passengers who only want a helping of tofurky for the holidays with family. Air carriers should not allow sick passengers on board; but many will probably get on board anyway.

A news release arrived in our e-mail boxes Friday afternoon. The report detailed the discovery of tamiflu resistant swine flu at Duke University Medical Center. Several patients were found to have viable influenza virus while on antibiotics.  The viruses were confirmed to be resistant to tamiflu. Since the patients had been ill weeks ago the urgency of the message was lost on me. Indeed we had heard of this before.

Early this fall we heard of two kids in a summer camp around Asheville who had been taking tamiflu prophylactically but came down with symptoms of influenza anyway. Their viruses were found to be tamiflu resistant also.

So we shouldn’t be surprised if we hear of more cases of resistant influenza. Doctors have already been instructed by CDC to be frugal in our prescriptions of antibiotics. We should remind ourselves of this.

In the event doctors are caring for someone with influenza that is not responding to tamiflu, then antibiotic resistance should be suspected and tests for that should be requested from the state lab. There is another antibiotic that can be used when tamiflu isn’t working.

For the rest of us antibiotic resistance clearly is another reason to get our children and pregnant loved ones vaccine. With vaccine induced immunity, you are protected from antibiotic resistant influenza too.

There have been a few articles in the newspaper recently about how the Santa Union members want to be placed at the front of the line for swine flu vaccines. In a similar vein we have been receiving a few disgruntled calls from people over the age of 65 who want their swine flu vaccine and want to know when they can get it.

It is ironic that the people wanting the vaccine the most need it the least.

It is clear from the demographics of this epidemic that children of school age are contracting the infection and spreading it to others. Unlike seasonal influenza, this shift virus has taken hold of young people. It is for this reason that the CDC has been very forceful in asking health departments to focus attention on school-aged children. There are four other categories of people who should be in the front of the line for vaccine. These categories are pregnant women, family members who have children less than six months of age at home, adults less than 64 years of age who have medical conditions that place them at increase risk of complications and healthcare workers/first responders. Until our open clinics and clinic appointments show us that there are no more children to vaccinate, we will continue to focus our efforts on them.

Eventually and soon enough we will come to the point where vaccine supply has met the childhood demand and we will be instructed to open clinics for all who want the vaccine.n

When it comes to swine flu, people who were alive in 1976 have acquired reasonable immunity from previous vaccinations and influenza illnesses. We seem to be least affected by swine flu. Although we should all accept swine flu vaccination when offered, there are more vulnerable individuals in our community who should go first. Santa Claus should let the children go first.

The argument that Santa comes in contact with children and therefore needs to be vaccinated to prevent spreading the infection is weak. Santa can avoid spreading influenza by staying at the North Pole should he get sick. Furthermore there is every likelihood that should Santa get the vaccine he would not develop an adequate protective response. Although some immunity is better than no immunity, children and young adults are much more likely to respond to a vaccine with brisk and protective antibodies. We’re learning again in this epidemic season that vaccinating the children prevents other members of the family from being exposed. With any tipping point you don’t have to apply the remedy to everyone, just at the focal points.

So in my opinion we need to continue to promote the vaccine for the target groups. We will certainly announce the time for everyone who wants one to get the vaccine when that time is ripe.  At this moment, women and children first.

Guilford County Department of Public Health will hold two flu vaccination clinics Saturday, December 5, 2009.  The H1N1 flu vaccine will be available for all 5 CDC priority groups (pregnant women; children ages 6 months to 24 years of age; health care workers and emergency medical services personnel; adults ages 25-64 with underlying health conditions; and household contacts and caregivers of children 6 months of age and younger).  Seasonal flu vaccine will be available for children ages 4-18 years of age.  The clinics will be held at the Department’s High Point location at 501 E. Green Drive from 8:00 a.m. to 12:00 noon and from 12 noon to 4:00 p.m. at the Department’s 1203 Maple Street, Greensboro site.

The vaccines will be given to these individuals on a first-come, first-served basis. No appointment is needed. There will be no out of pocket expense to individuals.  Individuals should bring their insurance or Medicaid card if they have one.

Individuals who are moderately to severely ill are advised to wait until they recover to get the vaccines. Those with a mild cold or other illness should be able to get the vaccines. No one should get the vaccines if allergic to eggs or to any other substance in the vaccines, have had Guillain Barré Syndrome or a life-threatening reaction following a flu vaccine.

For more information about this event, call 641-7777 or visit www.guilfordhealth.org and click on the H1N1 flu vaccine availability link.

I listened to the CDC’s press conference this afternoon.  There were three items that Dr. Anne Schuchat (Rear Admiral of Public Health Uniformed Services) reported.

She confirmed what we already know…that vaccine supply is less than anticipated, but that each week there are deliveries.  (In a separate communication we learned that they project vaccine shipments out into January.)  So demands will be met…eventually.

She highlighted that diabetes is a condition that is associated with a higher complication rate and higher hospitalizations.  Since obesity has also been seen to be a complicating factor, and since diabetes is a comorbid condition of obesity, teasing out the difference and the underlying reason for complications may take some time.

Most importantly and what I presume will make headlines tomorrow is that the CDC has estimated the number of cases of H1N1 so far (in six months) in the US.  The numbers are phenomenal. 22 million cases of H1N1 with 98,000 hospitalizations and 3,900 deaths.  The estimates of pediatric deaths is three fold previous numbers (540).

We can all grieve the loss of the ones who have died from this infection.

But the epidemic will end when the proportion of immune individuals reaches a point in which the virus no longer has a susceptible host on which to land.  Immunity can occur either with immunization or survival of actual infection.  With tens of millions of vaccines already given, more on the way and 22 million immune from infection, the epidemic appears to already be slowing.  We can give it a huge shove by continuing our efforts to get everyone covered with vaccine.  Indeed, active infection is NOT the preferred way to gain immunity.

Any comments?

Dr. Jeffrey Engel, the State Health Director of Public Health at the North Carolina Department of Health and Human Services, just sent out the surveillance statistics for North Carolina.  For the second week in a row the numbers of influenza cases across NC appear to be falling.  Furthermore, Mose Cone Hospital is also seeing a decrease in their emergency room visits for influenza.  They are still swamped, but the trend is in the right direction.

We are not out of the woods yet and GCDPH will continue our efforts to get vaccine out to the community.  But I much prefer intervening on the down slope of the epidemic curve.

Carl Williams of the NC Department of Health and Human Services was kind to send an email out to public health alerting us to two web sites relating to pets and influenza.

I’m copying his message and the links here.  If you have questions about what is posted please let me hear from you:

“Hi everyone,

I have heard from some of you that you are receiving calls about Influenza virus infection and pets and I wanted to make you aware of a couple of resources that can be very helpful. The first is the AVMA website about influenza:http://www.avma.org/public_health/influenza/default.asp.

Another good resource is the WHO website “infection of farmed animals with the pandemic virus”http://www.who.int/csr/disease/swineflu/notes/briefing_20091105/en/index.html“

The CDC has a brief video they’ve produced showing the way the H1N1 vaccine is produced.   It only takes 2 minutes to watch, but is informative nonetheless.

Take a look if you have 2 minutes to spare:

http://www.youtube.com/watch?v=Hmjmze-4kRg

Guilford County Department of Public Health will hold a H1N1 flu vaccination clinic this Saturday, November 7 from 9:00 a.m. to 4:00 p.m. for children age 6 months to 18 years of age, college students, and pregnant women only.

The clinic will be held in the Medlin Center at GTCC at 601 High Point Road in Jamestown.  The Department of Public Health has nearly 6,000 doses of the H1N1 flu vaccine to administer.  The vaccine will be given to these individuals on a first-come, first-served basis. No appointment is needed. There will be no out of pocket expense to individuals.  Individuals should bring their insurance or Medicaid card if they have one.  In addition, college students should bring their college identification cards.

The GTCC campus will be open at 8:00 a.m.; there will be no access to campus prior to 8:00 a.m.  The Medlin Center and parking is accessible from High Point Road, across the street from Ragsdale High School.  Upon arrival, individuals will be assessed to make sure they are in the priority groups. Interested individuals should be aware of traffic detours in the area; these are clearly marked.  Individuals coming from the High Point area may want to travel Kivett Drive, turn left on Harvey Road, turn left on Vickery Chapel Road and then right on East Main Street.  The entrance to GTCC will be off East Main Street, on the left.

Individuals who are moderately to severely ill are advised to wait until they recover to get the vaccine. Those with a mild cold or other illness should be able to get the vaccine. No one should get the vaccine if allergic to eggs or to any other substance in the vaccine, have had Guillain Barré Syndrome or a life-threatening reaction following a flu vaccine.

“We are excited to be able to offer this much vaccine to our community at one time,” states Merle Green, Health Director.  “We are anxious to continue our vaccination efforts for children, college students and pregnant women since we know these three groups are most adversely affected by this virus. If we can help keep these folks healthy, all of us benefit.”

For more information about this event, call 641-7777 or visit www.guilfordhealth.org and click on the H1N1 flu vaccine availability link.