Guillain-Barre Syndrome is a paralysis that starts in the lower extremities and works upward.  No one knows what causes it, but it has been found to occur after infections and vaccines.  It is rare.  Since there was a cluster of cases following the original 1976 swine influenza vaccine campaign, there was great concern that the 2009 H1N1 influenza vaccine campaign might cause a similar increase in Guillain-Barre Syndrome cases.

The CDC just reported that while there were more cases of GBS than expected without the vaccine, it was still a rare event.  They calculate that it occurred in 0.8 cases per million; the risk associated with seasonal influenza.  That might even be an overestimate in that many of the cases of GBS occurred after another illness (cold or GI illness) that might have been responsible (rather than the vaccine).

So that is great news.  Even though the risk isn’t zero…it is still very very very very…very small.

The CDC sends out periodic reports of H1N1 activity in the US.  One arrived in my inbox this afternoon.

Flu activity persists across the US with much of it in the Southeast.  But overall, including here in North Carolina, activity has declined tremendously.

All the influenza circulating is H1N1.

As of mid February, 86 million people have received the 2009 H1N1 vaccine.  When that number is added to the folks who have been infected with H1N1, a good portion (about a third) of us have immunity.  Not bad.  Could be much better though, as it probably takes about 80% of us to have strong “herd” immunity.

No one knows if the transmission is over.  With continued circulating virus, less than perfect global immunization and a majority of us still susceptible, we continue to encourage vaccination.

We have both seasonal and H1N1 vaccines left.  If you haven’t taken advantage of our previous offers, please do so now by calling 336-641-7777 and request an appointment in our immunization clinic.

The CDC announced two major changes for next season’s influenza vaccination campaign.

First, EVERYONE is now in the “eligible and should get vaccinated” group.  Recognizing that the population outside of the recommended lists was growing smaller and smaller with each added risk group, CDC decided to encourage everyone to get one next year.  For those of us in public health, this is great news and will make decisions very quick.  ”Are you alive and older than 6 months? Then, yes…you get the vaccine.”

Second, they decided on the composition of next season’s trivalent vaccine.  To no surprise, the H1N1 component will be the currently circulating “swine flu” strain.  The components will be an A/California/7/2009 (H1N1)-like virus, an A/Perth/16/2009 (H3N2)-like virus, and a B/Brisbane/60/2008-like virus.

One vaccine and everyone gets it! Sounds like a breeze, doesn’t it?

H1N1 Immunization Campaign Targets College Students

RALEIGH — In response to continued cases of H1N1 on college campuses across the state, the N.C. Division of Public Health is sponsoring a college immunization campaign during the month of February to protect young people against the flu. “While flu cases are not at the level they were back in the fall, we are seeing clear evidence that H1N1 is still striking young people,” said Zack Moore, M.D., public health epidemiologist.

From late January through early February, student health centers outpaced other providers in cases of influenza-like illness. A similar trend was evident during the fall wave of H1N1, with student health centers consistently seeing higher-than-average rates of flu. However, statistics from the state’s Immunization Branch show college-age individuals remain the least immunized overall in the state. As of Jan. 30, only 5 percent of 19- to 24-year-olds had received vaccine distributed to colleges through the N.C. Division of Public Health.

“Students appear to be less interested now because H1N1 is not getting the publicity it did in the fall,” said Katrin Wesner, director of Abrons Student Health Center at the University of North Carolina at Wilmington. “This campaign will help us re-energize our efforts and remind people that it is not too late to be vaccinated.”

College mascots are joining the campaign to encourage students to get immunized. Mascots from eight colleges and universities will be sporting bandages with the message “The Flu Stops With Me” at selected basketball games during February. In addition to their campus efforts, student health services personnel will offer immunization clinics at games to reach students and others who have not yet been vaccinated.

“This is a great opportunity for us to reach one of our most at-risk populations,” said State Health Director Jeffrey Engel, M.D. “We appreciate the support of our colleges and universities in helping us get the message out about the importance of immunization.”

Colleges involved in the campaign include N.C. State University, Fayetteville State University, UNC-Chapel Hill, UNC-Charlotte, North Carolina A&T, UNC-Wilmington, East Carolina University and Winston-Salem State University.

For information about H1N1 and immunization clinics, see flu.nc.gov. Students may also check with the student health center at their college or university.

The Center for Disease Control and Prevention has a new media campaign to encourage people to get the H1N1 vaccine.  A sample of the social media efforts can be viewed online.

I also saw a state sponsored public service announcement last night on television.  It showed a lineup of very pretty and happy people after they had supposedly received their influenza vaccine.  Each has a bandaid on their arm which they proudly show to camera.  There is only a small problem:  The bandaid is over their biceps…that’s not where you get the vaccine.  The deltoid muscle (upper arm) is where the injection is placed…so the bandaids are in the wrong spot.  Nice try though.

Guilford County Department of Public Health will hold two more flu vaccination clinics for the general public on Wednesday, January 27, 2010 at Christ United Methodist Church, 1300 N. College Drive in High Point and Moses Cone MedCenter, 2630 Willard Dairy Road, also in High Point.  The time will be 4:00 p.m. to 7:00 p.m.

Each clinic will offer both the H1N1 and seasonal flu vaccines. 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.   Spanish interpreters will be on site to assist.

For more information about these clinics, call Guilford County Department of Public Health at 641-7777. For more information about the flu or flu vaccines, visit www.guilfordhealth.org.

The national medical journals have been busy since Christmas.  Just looking at the major ones, JAMA and the New England Journal of Medicine, there are very important articles about the influenza disease and the vaccine.

From our CDC and England’s MRC, there is an article that describes the “household transmission of 2009 pandemic influenza A (H1N1) virus in the United States”.  So if one family member gets the flu, how many other family members get sick?  Well it appears that the transmission is lower than seen in past influenza seasons.  In three quarters of households, no one else got sick.  As we’ve seen here in Greensboro, the incubation time (from the sick family member to other sick family members) is about three days.  (Cauchemez and others, NEJM 2009;361:2619)

Remember back to April, there was that high school in New York City where students went to Mexico for spring break and came back with H1N1.  The same issue of the New England Journal describes some of the details about the spread of the virus at that point in time. (Lessler and others. NEJM 2009:361:2628)

Of equal interest are a report from Australia and an accompanying editorial by Tony Fiore and Kathleen Neuzil in JAMA, that explores the response of infants and children to the H1N1 vaccine.  The conclusions are that the vaccine is highly potent, even after one shot, and there are no unexpected side effects (it is safe).  Although we might be able to get by with only one shot for children, it is better to get two, as we currently provide.

The most interesting article was actually a comment by Dr. Ofri in NEJM, entitled “The Emotional Epidemiology of H1N1 Influenza vaccine”.  Simply put, when we wanted the vaccine we didn’t have it.  Now that we have it in great supply, we don’t want it.

My take on Dr. Ofri’s comments is that… I agree.  There is this great science fiction movie, Serenity, I’ve enjoyed watching many times.  The premise is that there is a federation plot to eliminate violence on a distant planet.  But rather than making people peaceful, instead it makes 90% of people so peaceful they stop eating and they die… and it makes 10% of people so violent that they become monsters.  We all tend to react that way to issues…going to extremes.  Either we are frantic to get the vaccine or we’re totally indifferent.  A middle ground would definitely be nice….we recognize the potency of the vaccine, the safety of the vaccine, the availability of the vaccine.  AND we start thinking collectively.  Even if you don’t get influenza each year, even if you do only get a mild “flu” when you do, your loved ones aren’t so lucky.  The people most vulnerable to influenza are also the least likely to get protection from a vaccine.  So by providing ring immunity, by vaccinating the strong, you protect the weak.

That’s loving kindness.

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.

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.