RALEIGH  – The year may be coming to an end, but North Carolina leaders caution that the 2009 H1N1 flu pandemic is not over. January typically heralds the start of peak flu season, accompanied by increased hospitalizations and deaths from the virus. Since its arrival in April, the H1N1 flu already has claimed 79 lives in North Carolina.

“I urge all North Carolinians to get vaccinated to protect themselves and others,” said Gov. Bev Perdue.

Unlike seasonal influenza, which can be deadly for elderly adults, H1N1 flu has disproportionately affected children and middle-aged adults.  According to statistics from the N.C. Division of Public Health, this year’s influenza has killed seven children, 29 people between 25 and 49 years old, and another 31 people between the ages of 50 and 64.

“We do not commonly see serious flu cases, much less deaths from flu, in the young and middle-aged adult population,” State Epidemiologist Megan Davies said.  “What we are experiencing in North Carolina is consistent with the rest of the country.”

While hospital emergency department visits related to flu are down from a high in late October, they are still above typical flu season rates.

“If typical seasonal flu trends hold true this year, we can anticipate another increase in flu cases this winter and into the spring,” said Davies.  “H1N1 has been anything but typical, so it is difficult to know how long this pandemic will last.”

Vaccination is the most effective way to prevent influenza.  Limited vaccine supplies forced health care providers to limit it only to high-risk groups when it first became available. After vaccine production increased, North Carolina was one of the first states to expand access to everyone in early December.

H1N1 vaccine is readily available through local health departments, private healthcare providers, and retail and independent pharmacies. For more information on H1N1 flu statistics and a convenient flu vaccine finder, visit flu.nc.gov.

Big Box Retailers Approved For Direct Shipments Of H1N1 Vaccine

RALEIGH — As part of a nationwide initiative to improve vaccination rates against 2009 H1N1 virus, retail pharmacy chains and retail-based medical clinics across North Carolina are now able to get H1N1 vaccine directly from the Centers for Disease Control and Prevention (CDC).

State Health Director Jeffrey Engel said he and health directors from across the country are supporting the supplementary 2009 Influenza (H1N1) vaccine initiative by the CDC as a way to get more vaccine out to the public at a critical time.

“The more people we can get immunized against this virus, the less likely it is to spread in the coming months,” said Engel. “This initiative helps us expand the pool of providers and venues where vaccine is available.”

According to the CDC, retail chains will be allowed to order vaccine directly from the CDC on a weekly basis through the end of January. To participate, chains must be capable of ordering an initial minimum of 100,000 doses of vaccine at one time and delivering all doses of vaccine received to vaccination administration sites within two days after receipt of vaccine.

The supplemental retail initiative will be in addition to the vaccine doses allocated to states based on their population size. North Carolina is expected to receive up to two million more doses of vaccine before the end of January.

Retail pharmacies may opt to continue receiving vaccine through the N.C. Division of Public Health, which is responsible for vaccine distribution to retail and independent pharmacies, local health departments, colleges and universities, private providers and hospitals.

Consumers are advised to check directly with their local pharmacies or health departments for vaccine availability or visit flu.nc.gov for a convenient flu vaccine locator.

The Guilford County Department of Public Health is offering the QuitSmart® smoking cessation class series in both Greensboro and High Point this winter.  The series consists of one class per week for four weeks.  Each class lasts 90 minutes and there is no cost to the participants for the session or materials.  These classes are open to any Guilford County adult resident.  Class size is limited to 12 participants.

In High Point, the first winter daytime series begins January 7 and ends on January 28.  The second series begins February 3 and ends on February 24. Classes will be held from 12 noon until 1:30 p.m.  An evening series will begin January 5 and will end January 26.   This session will begin at 5:30 p.m. and end at 7:00 p.m.  Both sessions will be held at the 501 East Green Drive location.  For more information or to register, please contact Cindy Simpson at 845-7654.

In Greensboro, the winter sessions will begin on January 6 and will end January 27.  Classes will be held from 6:00 until 7:30 p.m. at the 1100 East Wendover Avenue location.  For more information or to register, please contact Kim Herzing at 420-0933 or Catherine Richardson at 641-4718.

The QuitSmart® classes are being funded by the Office of Minority Health and Health Disparities, North Carolina Department of Health and Human Services. QuitSmart® utilizes evidenced-based techniques (cognitive behavioral strategies, brand-fading, self-hypnosis compact disc, patented cigarette substitute) that have proven to be more effective than other stop-smoking programs.  In a study at five U.S. Air Force bases, sixty-six percent of Quit Smart participants were still smoke free six months after quitting, compared to 16-30% in other stop smoking programs (source:  Shipley, et al., Federal Practitioner).

Tobacco use is the number one preventable cause of death in our state and in our nation.  It creates health risks for smokers as well as those around them.  There is no known safe level of exposure to secondhand smoke.  For women, smoking creates some unique health risks.  For example, women over age 35 who smoke and use birth control pills have a higher risk of heart attack, stroke, and blood clots of the legs.   Smoking is a risk factor for having a low birth-weight baby and low birth-weight babies are more likely to die or to have learning and physical problems.

Individuals interested in quitting can also receive free expert support by using QuitLineNC.  For more information or to talk with a Quit Coach, call 1-800-QUIT-NOW (1-800-784-8669)

Sources:  www.tobaccofreeguilford.org
www.cancer.org
www.quitlinenc.com

The news went out last night that the vaccine manufacturer, MedImmune, was recalling millions of doses of their nasal live attenuated influenza vaccine, FluMist.  I just now received the information from the CDC that explains the purpose of the recall.

Imagine that the nasal vaccine is a carton of milk that you bought in October.  In October you poured the milk over your bowl of cereal and enjoyed it immensely. Then you put the milk back in the refrigerator.  Putting the orange juice in front of the milk carton, you forgot it was there…until yesterday.  Now on rediscovering the milk, you notice the carton is past it’s expiration date.  You could drink it and probably nothing will happen.  Or you can toss the milk and buy some that you know will be fresh and good.  Most of us would just toss the milk and go to the store for some fresh milk.

That is kind of what happened with the nasal vaccine.  The company has been monitoring the “potency” of the vaccine and it has been perfectly fine up until just recently.  They found that the potency of the vaccine had dropped below what they wanted it to be, so they asked everyone to return the vaccine (like tossing the carton of milk even when its probably still good) from the questionable lots.

So here’s the important part.  Even if we kept using the vaccine now, it would probably work.  But rather than take any chance that it will lose more of its strength and have to do a “do-over”, they are pulling the lots.

So no one has to fret…except we at the health department who need to find out if we have any of the lots on our shelf.  If we do, we’ll send them back.

No one has to get revaccinated.  No one has to know what lot they received because all the vaccines that were given were potent at the time they were given.

There is a new Harvard survey published today with good news and bad.

The good news is that three quarters of the parents who have wanted the H1N1 vaccine for their children have found it. With millions of doses coming each week now, that percentage should approach 100% soon enough. Any family in Guilford wanting H1N1 vaccine (or seasonal vaccine for that matter) need only ask their own doctor or schedule an appointment with the Guilford County Department of Public Health or come to our open vaccine clinics on 7 January.

The bad news is that 60% of parents who don’t expect to get the vaccine for the their children are holding out because of concerns about the safety of the vaccine.

1. The vaccine is identical to the seasonal influenza vaccines that have been given since World War II. There aren’t any mysteries about it.

2. CDC and FDA have been monitoring adverse events with this vaccine very closely. There aren’t any surprises with the H1N1 vaccine.

3. It is highly protective against the H1N1 virus, that has already killed young healthy children.

But those are just dry facts. My children got vaccinated.

I encourage you to get an H1N1 vaccine as well.

It is indeed inconvenient to get vaccinated. It is even more of a pain to have to do so twice! The current guidelines are for those children 9 or younger to receive two doses of H1N1 vaccine at least 21 days apart. So wouldn’t it be nice if you only had to take your child to the clinic just once?

Today an article from Australia by Terry Nolan and others was published by JAMA. They looked at the immune response in children given big doses of H1N1 in a 2 dose regimen administered 21 days apart. They found that after even one dose of vaccine over ninety percent of children had antibody levels above 1:40. Great news, right? Only need one, right?

Well, yes and no. As the accompanying editorial from Anthony Fiore and Kathleen Neuzil point out there are problems. First the dose was bigger than we usually give in the US. And there isn’t consensus on what a protective antibody level should be with the test Nolan used. And past experience with seasonal flu vaccines indicate that protection really comes from the two doses of vaccine…not just one.

So, what does that mean for Guilford County?
1. We shouldn’t change our strategy of giving two doses of H1N1 to children 9 and younger.
2. But we shouldn’t freak out when our loved ones have only received one vaccine and they have to wait for the second one. There is likely to be some pretty good protection even with one dose.

Remember we will be holding more vaccine clinics for both seasonal and H1N1. Check back to this blog or to guilfordhealth.org for updates.

GCDPH vaccinated 833 persons at the 2 school-sited clinics on 17 December. Between Public Health Department in-house clinics and our school-sited clinics, we vaccinated over 1,000 persons in one day!

We will be providing 3 more school based vaccine clinics on Thursday, 7 January. Clinic locations: Northern High School, Smith High School and Southeast High School. All clinics are 4-7pm.

GCDPH is continuing to make appointments for our in house clinics for both H1N1 and seasonal flu vaccines.  H1N1 is available to anyone age 6 months and older.  Seasonal flu vaccine is available to anyone 4 years of age and older.   There is no out of pocket cost to receive these vaccines.  We do ask that clients bring their health insurance, Medicare or Medicaid card, if they have one.

Sanofi Pasteur recalled some batches of their H1N1 vaccine delivered in single dose syringes for use in children 6 to 35 months of age.

Here is what you need to know:

1. This was a precautionary action taken because the amount of antigen in the vaccine had fallen below the company’s standard.  The problem was discovered in the company’s own monitoring of product after it had been shipped.  There isn’t a problem with the safety of the vaccine.

2. If your child received the vaccine there is every reassurance that they will have received enough antigen to produce an antibody response and therefore be immune.  Remember though that children less than 10 need two doses of vaccine to be protected.  The second dose should be given at a minimum of three weeks after the first.

3. We checked and Guilford County Department of Public Health did not have any of the lots listed in the recall.  So this recall does not affect the vaccine we’ve given…not that it would change things if it did.

Guilford County Department of Public Health will hold two flu vaccination clinics for Guilford County School staff, students and families on Thursday, December 17, 2009.  The clinics will be held at Ragsdale High School from 4:00pm-8:00pm and Northwest High School from 4:15 p.m. to 8:00 p.m.

On Thursday, January 7, 2010, 3 additional flu vaccination clinics will be held at Northern, Smith and Southeast High Schools. The time will be 4:00 p.m. to 8:00 p.m.

Each clinic will offer both the H1N1 and seasonal flu vaccine. The H1N1 flu vaccine will be available for persons 6 months of age and older.  Seasonal flu vaccine will be available for persons 4 years of age and older.

The vaccines will be provided at no cost. No appointment is needed. Vaccines will be available first-come, first-served. Persons under age 18 will be required to have a signed consent from the parent or guardian in order to receive the vaccinations. Consent forms will be available at each clinic.

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 these clinics, call Guilford County Department of Public Health at 641-7777.

Guilford County Department of Public Health now has appointments available for the seasonal flu vaccine. This vaccine is for persons 4 years of age and older. For an appointment in Greensboro, please call 641-5563; for High Point, call 845-7655. Department of Public Health offices are located at 1100 E. Wendover Avenue in Greensboro and 501 E. Green Drive in High Point.

There is no out of pocket expense for the vaccine; however we do ask that you bring your Medicare, Medicaid or insurance card, if you have one.

For more information, contact Guilford County Department of Public Health at 641-7777 or visit our website at www.guilfordhealth.org and click on the Seasonal Flu photo at the bottom of the home page.