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H1N1 Preparations Continue as 'Flu Fatigue' Sets in

Despite the fact that children appear to be at higher risk for H1N1 complication, only 40% of parents intend to have their children vaccinated against the flu strain, according to a new national poll from C.S. Mott Children's Hospital at the University of Michigan. The poll, published Sept. 24, echoes other recent reports from college campuses suggesting 'flu fatigue' may be setting in.

Apathy, while troublesome, shouldn't come as a surprise. Widespread avian flu coverage eventually elicited a similar response. Unfortunately, health-care providers may be growing weary of H1N1 as well. EMS officials at the state and national levels, however, continue to drive home vital messages regarding prevention and PPE.

The National Association of State EMS Officials (NASEMSO) met for its annual meeting last week in Little Rock, Ark., to discuss -- among other pressing issues -- continuing preparations for H1N1 influenza. On Wednesday, Sept. 23, NASEMSO Program Advisor Kathy Robinson presented an "EMS Update on H1N1 Influenza A and Pan Flu."„

Robinson briefed NASEMSO conference attendees on current H1N1 information. In a nutshell:„

„„„„ Î The virus that emerged in the spring never went away;

„„„„ Î It's not, at present, mutating into a deadlier strain;

„„„„ Î Drug-resistant strands are emerging;

„„„„ Î Deaths in children are typically associated with at least one severe underlying illness or disability;

„„„„ Î Bacterial infections often occur in children with H1N1;

„„„„ Î Most H1N1 sufferers recover without hospitalization or medical care;

„„„„ Î H1N1 can cause serious disease in the lower lung tissues, resulting in more ICU admissions;„

„„„„ Î A high-fever post-viral infection along with bacterial infection are not unusual;

„„„„ Î A new study shows a single dose of the vaccine appears to be effective for people 10 or older;

„„„„ Î Twenty-one states are experiencing widespread infection atypical for September; and

„„„„ Î Almost all diagnosed cases are H1N1, not seasonal flu.

Given the close quarters, flu is spreading widely in schools, Robinson said. However, most campuses remain open -- good news for health-care workers who might otherwise skip work to care for their children.„

The widespread use of alcohol-based hand sanitizers in schools may be hitting a snag, she said. Some schools in Florida and Canada have banned their use due to the high alcohol content. Large containers must be stored outside in locked fireproof sheds or cabinets, preventing easy access. In addition, some children have misused the alcohol-based gels as an intoxicant, forcing districts to ban its use on campuses.

Latest News From CDC

On Sept. 24, the CDC updated its "Interim Recommendations for Facemask and Respirator Use to Reduce 2009 Influenza A (H1N1) Virus Transmission."No changes were made with regard to the recommended use of facemasks and respirators (N95) in health-care settings.The CDC continues to advise that health-care workers caring for a patient with known or suspected H1N1 or influenza-like illness wear a respirator. Those at increased risk for illness from influenza should also wear a respirator as well as "consider temporary reassignment."

In an H1N1 press briefing on Friday, CDC Director Thomas Frieden, MD, MPH, said the vaccine will be available shortly. When asked about how distribution of the H1N1 vaccine will differ from that of the seasonal flu, Frieden said, "This is a very different distribution system from what we do with seasonal flu. In normal flu season and for seasonal flu vaccine this year, doctors, clinics, health centers and hospitals, employers place orders with the companies directly, and whoever orders first, gets the most."

This year, he said because the government is paying for the H1N1 vaccine and they want to ensure equitable and rapid distribution throughout the country and throughout the flu season, they "will be using a central distributor system and working through state health departments." Only state health departments will be able to order the vaccine, so EMS agencies need to be in touch with their local public health department. "At the end of September we will begin taking orders, and by the first week in October, a vaccine will begin arriving in doctors' offices," Frieden said. "The first vaccine you would expect to see around the 6th of October." He expects there will be about 90,000 vaccine distribution sites throughout the country.

Frieden said initial vaccine distribution is going to be "bumpy because in different states there will be different levels of preparedness, readiness and planning." In addition, much of the initial vaccine will be the flu spray and that is "unfortunately something that is indicated only for people who do not have underlying health conditions and are under the age of 50."

One reporter asked Frieden to address the "so-called Canadian problem" regarding reports that people who received the seasonal flu vaccine were more susceptible to getting an H1N1 infection. "We have looked at our data at the CDC nationally. I have looked carefully at the data from New York City where we had a very large outbreak and lots of information about what vaccine was received. The Australians have looked at it and published their information. In none of those data is there any suggestion that the seasonal flu vaccine has any impact on your likelihood of getting H1N1."

Finally, those who experienced flu symptoms in the spring and plan to skip the vaccine should reconsider. "Many people had H1N1; many people had colds or different viruses," Frieden said. The safety would suggest to get vaccinated, even in places where there was lots of H1N1 in the spring, like New York City, where as much as 10% of people may have had it. That means 90% of people didn't, and in the small studies we did, even at the height of H1N1 in the spring and the fall, most people with flu-like symptoms didn't have H1N1; they had something else."

Jennifer Doyleis the editor ofEMS Insider.She invites readers to join and post information on the newEMS Insidergroup onJEMS Connect.For more information on the NASEMSO annual conference, visitwww.nasemsd.org.„

An H1N1 Reading List

Click hereto read a "groundbreaking" study conducted in China comparing N95s to facemasks.

Click herefor a list of fraudulent products, such as masks, sanitizers and body washes, associated with H1N1.„

NASEMSO maintains a comprehensive list of H1N1 resources, including interim guidance on cleaning EMS vehicles during a flu pandemic and guidance for EMS systems and 9-1-1 call centers on managing patients with confirmed or suspected infection. Find ithere.„

Access the New England Journal of Medicine article, "Response after One Dose of a Monovalent Influenza A (H1N1) 2009 Vaccine -- Preliminary Report"here.„

Access the C.S. Mott Children's Hospital National Poll on Children's Healthhere.


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