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NEWS: AMERICAS

1103 H1N1-related death reported [Nebraska]--Douglas County reported a H1N1 death to the Nebraska Department of Health and Human Services. The man was in his 50s and had a health condition. He tested positive for H1N1 early last week.

Because of state statutes, the name and other details about the person can’t be released.

“As always, I am deeply saddened by the loss of another Nebraskan and my thoughts go out to his family,” said Dr. Joann Schaefer, Chief Medical Officer for the Nebraska Department of Health and Human Services. “H1N1 activity is widespread across the state and unfortunately, we will see more illness.”

So far, there have been a total of eight H1N1 flu deaths reported in Nebraska. DHHS will continue to track deaths from H1N1.

1103 First H1N1-related death announced [North Dakota]--The North Dakota Department of Health announced today the state’s first H1N1 influenza-related death, according to State Health Officer Terry Dwelle, M.D.

The individual was a resident of northwestern North Dakota. According to Dwelle, the man was older than 60 and had underlying medical conditions.

“We extend our sympathy to the family and loved ones of the gentleman who died,” Dwelle said. “This loss should remind all of us that influenza, whether seasonal or H1N1, can be a serious illness for some people.”

As of Wednesday, Oct. 21, 2009, a total of 1,216 cases of influenza had been reported to the Department of Health. It is estimated that about 92 percent of the influenza circulating in North Dakota is H1N1.

“It’s so very important that we all do our part to help stop the spread of influenza,” Dwelle said. “That’s why we keep urging people to wash their hands often throughout the day, cover their coughs and sneezes, and stay home when they are sick. These simple steps can make a huge difference in stopping the spread of flu.”

Late this week, 21,000 doses of H1N1 influenza vaccine will be allocated to the state. This allocation will consist of both the nasal spray FluMist and the injectable flu shot. The allocated doses will be shipped to various providers throughout North Dakota next week.

The North Dakota Department of Health has activated a toll-free public health hotline for people to call if they have questions about influenza. (The hotline cannot provide medical advice to callers. For that information, people should call their physicians.) The number to call is 866.207.2880. The hotline is available Monday through Friday from 8 a.m. to 5 p.m. Central Standard Time. Information about influenza also is available on the Department of Health’s influenza website at www.ndflu.com.

1103 Families asked to be patient while waiting for H1N1 vax [Louisiana]--The Louisiana Department of Health and Hospitals updated the status of the state’s Fight the Flu campaign today. As the H1N1 vaccination campaign moves forward, it is important for Louisiana families to be patient if their provider has not yet received the H1N1 vaccine, as more vaccine is arriving every week. Residents should stay in contact with their provider as to the vaccine’s availability and to make an appointment when the time comes.

State Health Officer Jimmy Guidry, M.D., also announced that the Governor has proclaimed this week Pneumonia Awareness Week in Louisiana. Approximately 50,000 Louisianians contract pneumonia annually. In 2006, the latest year for which numbers are available, 1.2 million people in the U.S. were hospitalized with pneumonia and 55,477 people died from the disease. These numbers are despite the fact that a vaccine is available to combat many forms of bacterial pneumonia, and the vaccine is widely available throughout the country.

"Pneumonia is one of the most common causes of death in America from a vaccine-preventable disease, and is a common complication associated with severe cases of both seasonal and H1N1 flu," said Dr. Guidry. "According to the CDC, about 20 percent of fatalities nationwide from H1N1 have been influenza leading to a bacterial pneumonia. This underscores the importance for those in pneumonia target groups to receive the pneumonia vaccine. It can save lives."

The pneumococcal conjugate vaccine, PCV7, can be used in children under the age of 2 years. This age group is also a high-risk group for H1N1. This is especially important when considering that children under six months cannot receive any sort of flu vaccine, but those between two and six months can get the PCV7 vaccination.

The pneumococcal polysaccharide vaccine (PPSV) is currently recommended for use in all adults who are older than 65 years of age and for people who are two years and older and at high risk for disease. The CDC also recommends it for any adult 19 through 64 years of age who is a smoker or has asthma. People over two years old with pre-existing conditions are also one of the high-risk groups for H1N1.

Louisianians are encouraged to contact their health care provider as to whether or not they should receive the pneumonia vaccine. According to the National Foundation for Infectious Diseases, the pneumococcal vaccine has been available for more than 20 years in the United States, yet more than one-third of people 65 years of age and older reported that they have not received the pneumococcal vaccine, and fewer than 20 percent of adults in other high-risk groups who should get the pneumococcal vaccine have received it.

1103 Pregnant women targeted for H1N1 vax [Iowa]--Three weeks after the 2009 H1N1 influenza vaccine began arriving in Iowa, the supply continues to be allocated to counties on a staggered basis. Until the vaccine is widely available, vaccination priority groups have been established to target those individuals known to be at highest risk for complications from H1N1.

For more information on pregnancy and H1N1, visit www.cdc.gov/Features/PregnantH1N1Flu.

Additional information about H1N1 influenza can be found at www.idph.state.ia.us/h1n1/default.asp.

1103 Statewide H1N1 vax blitz planned [Oklahoma]--State Health officials are planning a statewide H1N1 influenza vaccination effort Saturday November 7^th for Oklahomans who fall into one of the priority groups targeted to receive this vaccine.

For more information about the availability of H1N1 influenza vaccine in your area, call your local county health department or visit www.health.ok.gov, or call the Oklahoma State Department of Health toll-free H1N1 hotline at: 1-866-278-7134. Phones are answered Monday through Friday from 8 am to 5 pm.

1103 If the Green River floods, follow the signs [King County, Washington]--If the Green River Valley is threatened with major flooding this season, will you know the quickest way to higher ground? 
 
In an effort to speed evacuation when floodwaters rise, King County began installing evacuation signs on key roads in unincorporated areas Monday.
 
Many homes and businesses in the Green River Valley that don’t typically see floodwater - including parts of Auburn, Kent, Renton, Tukwila and unincorporated King County - should be prepared to evacuate this winter. Seepage from an earthen bank next to the Howard Hanson Dam has reduced capacity to hold back water during periods of prolonged heavy rain - and that has increased the risk of serious flooding.
 
If evacuations do become necessary, residents should know the quickest and safest passage away from areas considered vulnerable to flooding. In the coming days, King County Road Services Division crews will install 27 blue and white signs with directional arrows along 11 roads in unincorporated areas.
 
King County and other government service providers in the valley have been working together for several months to identify the least flood-prone routes providing the quickest routes to higher ground. The coordinated effort will also ensure that there is a common understanding among agencies of roads considered priorities before and after the flood.
 
A map of roads that have been identified as evacuation routes in the Green River Valley will be posted online beginning Monday, Nov. 2.
 
Once the evacuation signs are in place, residents should take the time to familiarize themselves with posted routes near their home that will safely take them out of harm’s way. The idea is to have more than one way out when flooding begins to occur.
 
Of course, no road is safe when it is overtaken by floodwater. Motorists should never drive around barricades or road closure signs – this is the leading cause of drowning during floods. Roads and bridges are closed when crews determine they are no longer safe for travel.
 
In addition to identifying evacuation routes, contingency planning has also been underway to identify impacts from flooding to Metro Transit service in the Green River Valley.
 
Metro has identified a revised bus service plan for about 30 regular routes when service can no longer be operated due to flooding. However, service on some existing routes may be suspended until roadways can be reopened. That’s why transit customers are being encouraged to identify backup travel plans as part of their pre-flood planning. They can learn more about these transit service alternatives by visiting Metro Online.

1103 Pediatric H1N1-related death in Bernalillo County [New Mexico]--The New Mexico Department of Health announced today that an 11-year-old male with H1N1 influenza from Bernalillo County died Nov. 1st. The boy had a chronic medical condition that put him at higher risk for serious complications and was hospitalized at the University of New Mexico Hospital in Albuquerque since Oct. 11.

"We express our deepest sympathies to the family who is dealing with the heartbreaking loss of their child," said Health Secretary Alfredo Vigil, MD. "This tragedy should remind every New Mexican that influenza can cause serious complications and even death, so it is important for everyone to follow the prevention guidelines to minimize the spread of the disease."

So far in 2009, there have been 22 deaths related to H1N1 influenza in New Mexico. A complete listing of all H1N1-related deaths can be found on the Department of Health’s H1N1 website at www.nmhealth.org/H1N1.

1030 NSTU wants H1N1 vaccine clinics in schools [Nova Scotia]--The Nova Scotia Teachers Union is urging the Nova Scotia Department of Health Promotion and Protection to administer the H1N1 vaccine to students and teachers while they are at school.

"Students and teachers are on the front line of this pandemic, and yet schools seem to have been left out of the H1N1 vaccination planning," says Alexis Allen, NSTU President. "Schools are an ideal venue for vaccinating our children and their teachers, instead of having them line up for hours before and after school at public arenas and community centres."

Many schools across the province are already seeing increased rates of absenteeism since the second wave of the H1N1 virus hit Nova Scotia this fall. With the first public vaccination sites already swamped and turning people away, Allen says vaccinating children and teachers at school is the logical next step.

"One of our main roles as teachers is to advocate on behalf of our students, and right now the best way to do that is to ensure they receive the H1N1 vaccine," says Allen. "Giving them the vaccine at school would not only ensure that they receive it; it would also cut down on lineups at the public vaccination sites and eliminate the need for parents to take their children out of school to get the vaccine."

1030 Province evaluating vax plans as supplies significantly less than expected [Saskatchewan]--Saskatchewan's H1N1 immunization roll-out will continue as planned next week, but future plans are being re-evaluated in light of news that all provinces will receive significantly fewer doses than expected of H1N1 vaccine.

"While this is disappointing and frustrating news, we do have enough vaccine to immunize young children and pregnant and post-partum women as planned next week," Chief Medical Health Officer Dr. Moira McKinnon said. "We will continue to open up vaccine clinics to other high-risk groups based on available vaccine and the most current information we have about H1N1's tendencies and patterns."

Due to the manufacturer's difficulties in producing enough vaccine to meet demand, Saskatchewan will be receiving 13,000 doses in its next shipment, rather than the 60,000 expected. As a result, the province's supply will need to be carefully managed until more vaccines arrive.

Other provinces are now moving away from open clinics and are instead having to re-evaluate how to target those higher risk groups like Saskatchewan's roll-out plan.

As H1N1's second wave continues throughout the province, Saskatchewan's toll-free health information line is hiring additional registered nurses and opening more phone lines to field inquiries about the virus and vaccination program.

HealthLine, which is available 24 hours a day, seven days a week at 1-877-800-0002, provides guidance on such topics as how to address flu symptoms, when to call their physician or visit an emergency room, and the locations and times for local H1N1 vaccination clinics.

To date, most people in Saskatchewan who have contracted H1N1 have experienced only mild illness.

Healthy individuals experiencing milder symptoms such as cough, fever, or muscle aches, are advised to rest and care for themselves at home.

For individuals experiencing more severe illness, antiviral medications are available to ease symptoms.

"We're suggesting that people with underlying medical conditions who are experiencing flu-like symptoms should call their doctors right away," McKinnon said. "At the physician's discretion, the patient can be prescribed medication to address the symptoms."

In the meantime, all Saskatchewan residents are urged to continue with infection prevention measures such as frequent washing of hands and staying home if unwell.

Up-to-date vaccine clinic information will continue to be posted at www.health.gov.sk.ca. 

1030 Province extends palliative home care drug pilot project [Prince Edward Island]--The Province is extending the Palliative Home Care Drug Pilot Project, which provides drug coverage for pain and symptom management to those who wish to spend their last days in the location of their choice, including at home, says Premier Robert Ghiz.

“This project gives individuals the resources and medications they need to receive end-of-life care where they are most comfortable,” said Premier Ghiz. “That is why I am pleased to announce that my government is extending this project. We will continue to cover the cost of medications that qualified patients need to keep them comfortable and symptom free, in the place of their choice, during the last days of their lives.”

The Palliative Home Care Drug Pilot Project is an extension of the Integrated Palliative Care Program, which aims to enhance client and family options for palliative care through access to trained, qualified health care teams in the most appropriate setting.

“This project is designed to give people choices and to compassionately provide respect and dignity to individuals in the final stages of life,” said Health Minister Doug Currie. “Giving individuals the option to remain at home helps strengthen communities and reduces the emotional and financial burden on families. This project is a solid example of how improvements to services for Islanders are being achieved through integrated health system change.”

The province is investing an additional $750,000 to continue covering the cost and delivery of the project.

Eligibility for the project is based on a number of criteria that define the patient’s need for end-of-life care. Staff who are trained in palliative care work closely with family and caregivers to ensure the patient is a good fit. Once it is determined that a patient qualifies, and is registered with Pharmacy Services, clients are able to obtain palliative specific medications from their own local pharmacist.

QUESTION & ANSWERS

Palliative Home Care Drug Pilot Project Extended

What is the Palliative Home Care Drug Pilot Project?

The Palliative Home Care Drug Pilot Project is an extension of the existing Integrated Palliative Care Program. It provides coverage for end-of-life medications for patients who prefer to receive palliative treatment at home.

For the purposes of this project, home is defined as wherever the person is living, whether in their own home, living with family or friends, or living in a supportive living residence. It does not include a hospital setting, a palliative care unit, or a provincially operated long term care facility.

How long has the project been operating?

It officially began operating October 2008 as a 12 month pilot.

How long is the project being extended?

The provincial government is investing an additional $750,000 to continue covering the cost and delivery of the project for another 18 months. The province previously invested $547,500.

What is required to make this project a provincial program?

The program needs to be developed in phases based on recommendations that will be determined by the upcoming results of an on going evaluation process. This process is being carried out by the pilot project manager and staff of the current Integrated Palliative Care Program.

Additional resources will also be required.

What information is available on the project based on the ongoing evaluation process?

Since the implementation of the project:

• 81 patients have been registered, ranging in age from 18 months to 96 years

• average number of days per patient in program is 61 days

• total number of program days is 5789 - out of this, total number of days patients have been able to remain at home is 4626 (79 percent) - average number prior to project was 55 percent

• total number of days in hospital is 378

• total number of days in designated palliative care bed is 785

• total number of hospital days reduced by this project is 1110

• patients have spent 24 percent more time at home during illness than prior to project

• additionally, this has resulted in estimated savings to the health care system of more than $1 million (estimated hospital/institutional care rate is $1000 per patient, per day)

• 41 patients have died, of those, 12 died at home - 18 died in designated palliative care beds, 11 died in hospital

Who is eligible for the project?

A patient must first be eligible for the Integrated Palliative Care Program. A patient who is diagnosed with a life threatening disease can be referred to the Integrated Palliative Care Program for assessment. Following assessment, a home care nurse, trained in palliative care, and other resources are assigned as needed. Then a Palliative Performance Scale (PPS) assessment is performed. This scale measures the functional status of an individual. In order for a patient to qualify for the project, the family, care givers, and patient must agree that the treatment protocol is of a palliative nature.

How does a patient apply?

A patient who has been diagnosed with a life threatening disease can be referred to the Integrated Palliative Care Program for assessment. Home care palliative care nurses will assess the needs of the patient to determine the level of care and medication requirements.

If a patient is eligible, the palliative care nurse registers the patient with Pharmacy Servies. Once registration is complete the patient can obtain palliative medications through their local pharmacy. The patient will be required to pay a small co-payment of two dollars per prescription.

Is there a time limit for coverage?

No, there is no time limit of coverage for end-of-life medications in the Palliative Home Care Drug Pilot Project.

Will a patient need to reapply if hospitalization is required?

No, if the client is hospitalized, coverage through the project is suspended. Once the client returns home, coverage resumes. Coverage continues while the client is receiving home based palliative care.

What does the project cover?

It covers most end-of-life medications. These are medications that are used for pain and symptom management, ranging from anti-depressants and laxatives to pain relieving medications, such as morphine.

This project supplements the care that is already provided by the Integrated Palliative Care Program, which may include a Nurse, Occupational Therapist, Home Support Worker, Social Worker, Physiotherapist, Dietician, Community Support Worker, Pharmacist, and Hospice volunteers.

What is not covered by the project?

Medications that are considered active life-prolonging drugs, such as chemotherapy drugs, Total Parenteral Nutrition (TPN), and nutritional supplements, are not covered. This is a drug pilot project, therefore, most palliative equipment is not covered. There is a minimal amount of palliative care equipment provided by the Integrated Palliative Care Program that will still be provided to patients depending on availability.

1030 Temporary changes to visitor guidelines at QE and Prince County Hospitals [Prince Edward Island]--Staff and administration at the Queen Elizabeth Hospital (QEH) and Prince County Hospital (PCH) would like to advise the public of changes to visitor guidelines that come into effect tomorrow – Saturday, October 31 – at both facilities.

“Our patients are our top priority and these temporary changes to visitor guidelines are reflective of the impacts of the H1N1 influenza in the community,” said Rick Adams, Executive Director of the Queen Elizabeth Hospital. “We need to ensure that we take the appropriate precautionary steps to protect our patients, staff, physicians and volunteers from the H1N1 virus while they are at the hospital.”

Temporary changes to visitor guidelines include:

• No visitors under the age of 18 years.

• No more than 2 designated visitors per patient may visit during that patient’s stay in hospital.

Patients will be asked to identify two persons to designate as visitors during their stay in hospital. Reducing hospital visits will reduce the risk of influenza-like illness coming into the facilities. Designated visitors who are experiencing influenza-like illness – cough with or without fever, accompanied by either a sore throat, sore muscles, achy joints or extreme fatigue – are asked to refrain from visiting patients at the hospital until they are symptom-free.

Compassionate exceptions will be made to the temporary visitor guidelines on an individual patient basis and will be done in consultation with the patient and their health care team.

“The incidents of individuals under the age of 18 infected with influenza-like illness in our communities is increasing across the province,” said Prince County Hospital Executive Director, Arlene Gallant-Bernard. “A collaborative effort is needed to ensure that these temporary guidelines are followed as a measure to protect the health and safety of patients and visitors, as well as to prevent the spread of influenza.”

In addition to the temporary changes to visitor guidelines, the Queen Elizabeth and Prince County Hospitals are asking individuals who are experiencing influenza-like illness and have scheduled appointments at either hospital to please contact the facility in advance of their appointment to advise them of their symptoms. In an ongoing effort to reduce the spread of influenza, staff will then make the appropriate arrangements with the individual to either reschedule their appointment to a later date or make alternative arrangements for care delivery. Individuals with scheduled hospital appointments are also reminded that, where possible, they may only bring one other person with them to the appointment. The accompanying individual must be 18 years or older as per the new temporary guidelines.

In order to relieve pressures at emergency rooms, the public is reminded that influenza assessment sites have been set up across the province to provide health services to Islanders with influenza-like illness. Persons with influenza-like illness that are also experiencing chest pains and shortness of breath should continue to seek medical attention at an emergency department. Islanders should also continue to seek immediate medical attention at an emergency department for a child if he/she has very fast breathing or trouble breathing, bluish skin colour, is not drinking enough fluids, not waking up or not interacting; or has increased irritability, fever with a rash, or flu-like symptoms that improve and then return with fever and worse cough.

It is extremely important that anyone visiting the hospitals clean their hands before and after visiting a patient’s room, unit, and upon entering and leaving the facilities. Alcohol hand rinse stations are available throughout the hospitals for this purpose.

1030 Limited vax requires important changes to H1N1 vax criteria for coming week [Newfoundland and Labrador]--The Department of Health and Community Services is advising the public that due to a reduced amount of vaccine available to the province by the Federal Government in the coming week, H1N1 vaccinations will be limited to the following high-risk groups:

• Children six months up to 59 months (up to fifth birthday)

• People five years of age up to and including 24 years of age with chronic conditions

• Pregnant women in the second half of their pregnancy (20 to 40 weeks)

“We received information late today from the Federal Government advising that our vaccine allocation for the coming week would be much less than anticipated,” said the Honourable Jerome Kennedy, Minister of Health and Community Services. “Based on this, we have had to reduce the high-risk groups targeted for clinics for the coming week to ensure that the limited amount of vaccine we have available to the province is offered to those who need it most. Ethically, this is the right thing for us to do.”

The restricted criteria apply to clinics in all regions of the province and will be strictly enforced.

1030 Significant increase in H1N1 flu activity [New Brunswick]--The following update on the H1N1 flu virus was issued by the Office of the Chief Medical Officer of Health for New Brunswick on Friday, Oct. 30.

We encourage New Brunswick residents to read clinic information and more information about the H1N1 flu virus and its symptoms by vising the flu website, www.gnb.ca/flu, or by calling toll-free, 1-800-580-0038, which is available 24/7.

More information on the H1N1 flu virus may be found online, or by calling the 24-hour H1N1 line, 1-800-580-0038.

1030 Four confirmed cases of E.coli believed to be linked to Wendy's restaurant [Fredericton NB]--The Fredericton office of Public Health Services is following four confirmed cases of E. coli believed to be linked to persons who ate at Wendy's Restaurant, 967 Prospect St., Fredericton.

"Public Health advises those who ate at the restaurant before Tuesday, Oct. 27, seek medical attention if they experience symptoms of gastro-intestinal illness, such as severe cramps, diarrhea (may be bloody and watery), abdominal pain and vomiting," said Dr. Cristin Muecke, regional medical officer of health for the Fredericton area.

The cases of E. coli 0157:H7 are believed to be linked to salads prepared and served at the Prospect Street restaurant location. There is no evidence to suggest a public health concern at other restaurant locations. Public Health Services is continuing its investigation into the matter.

The restaurant has implemented control measures to help minimize any risks and has been fully inspected. The restaurant is fully co-operating with Public Health Services and, at this time, Public Health officials do not have any concerns with the restaurant remaining open.

Muecke said anyone experiencing symptoms should follow good hygiene practices, such as washing their hands thoroughly. They should avoid contact with persons who may be particularly susceptible, including the very young, very old and those with weakened immune systems.

1030 Due to H1N1 vax shortages mass clinics may be postponed [Manitoba]--Manitoba has been advised the province will receive 15,500 doses of vaccine next week, well below the expected 72,000 doses.

As a result, each region will be adjusting their plans according to their population and geographic realities. Mass immunization clinics may be postponed in some regions.

Many regions will continue to provide vaccine to people in the first priority group with a particular emphasis for people most at risk of severe illness. This includes targeting these individuals on the priority list:
· children aged six months to under five years old;
· anyone of Aboriginal ancestry (First Nations, Métis or Inuit);
· people under 55 with a severe chronic medical or other risk condition; and
· pregnant women.

This focuses on the key populations in Manitoba’s priority list who are most at risk of severe illness or death. For more details on how to access vaccine, please contact your local regional health authority.

The initial delivery from the federal government of 134,000 doses and a second delivery of 72,000 doses have already been distributed for use in clinics around the province. As of the end of day Oct. 29, there had been 92,901 flu shots administered in Manitoba.

Next week, Manitoba will take delivery of vaccine that does not have an adjuvant. This vaccine is for pregnant women. Manitoba expects to receive approximately 9,200 doses of the Australia-based vaccine obtained by the federal government.

Additional measures to help prevent flu infections include:
· Cover your cough by coughing into your elbow or sleeve or use a tissue to cover your nose and mouth when coughing or sneezing. Place the tissue in the garbage.
· Wash your hands often with soap and water, especially after coughing or sneezing. Hand sanitizers may also be effective.
· Reduce the spread of germs. Limit touching your eyes, nose or mouth.
· Maintain your health by making healthy food choices, being physically active and getting enough sleep.

For more information on H1N1 flu, visit www.manitoba.ca/flu or call Health Links-Info Santé at 788-8200 or 1-888-315-9257.

1030 H1N1 flu vax update - further distribution will include phased approach [British Columbia]--Despite unexpected delays in the manufacture of pandemic H1N1 influenza vaccine in Canada, all British Columbians who need or want the vaccine will be able to receive it before the end of the year as has been said previously, Minister of Healthy Living and Sport Ida Chong and Provincial Health Officer Dr. Perry Kendall reiterated today.  

The federal government has advised all provinces, including B.C. that they won't be receiving as many doses of pandemic vaccine in the next few weeks as anticipated. Nevertheless, the provincial rollout will continue with a significant number of doses over the next week, and B.C. has ordered more than four million doses of the vaccine, more than enough to cover the province.

“Based on the information the federal government has conveyed, every British Columbian who needs and wants the vaccine will be able to receive it before the end of this year,” said Chong. “The Province has a plan in place to first deliver the vaccine to those most at risk from serious consequences of H1N1 infection, and we will continue to implement that plan.”

B.C. began the largest immunization campaign in its history earlier this week with the vaccine made available to the first groups of high-risk residents – people under 65 years of age with chronic health conditions, pregnant women and individuals, including First Nations living on reserves, who reside in remote or isolated areas.

Beginning next week, eligibility to receive the vaccine will be extended to include front-line health care workers, children between six months and five years of age, and household contacts of babies less than six months old and of immunocompromised people. Not everyone in these groups will be immunized in the second week of the program.  Each region will need to gauge supply and demand, and there may be some differences in timing because of these variables.

As a result of smaller than expected shipments of the vaccine, further distribution will include a phased approach. Vaccination of health care workers will be prioritized to first cover those deemed to require it most in order for critical health care services in B.C. to be maintained. Not all health care workers will be able to receive the vaccine immediately but, as supplies increase, all health care workers who want the vaccine will get it.

In addition, health authorities that had been running seasonal influenza clinics for seniors may temporarily be suspending those clinics, depending on local logistics, in order to focus on delivering the H1N1 vaccine to those most at risk. Seniors’ influenza clinics will resume later in November, the time of year that they are normally held. This change isn’t expected to have any impact on the rate of seasonal influenza among seniors this winter.

To date, B.C. has received nearly a half-million doses of the adjuvanted H1N1 vaccine and is expecting a shipment of another 350,000 doses for distribution next week. In addition, the province is scheduled to receive 58,000 doses of adjuvanted and 25,000 of unadjuvanted vaccine from Canada’s pandemic H1N1 vaccine manufacturer GlaxoSmithKline – the latter specifically for pregnant women – late next week.

Health authorities in B.C. are receiving vaccine shipments based on their respective populations. Each health authority has implemented a vaccination plan which best suits its geographical area and population densities.

“We acknowledge that there may be concern among the public that the H1N1 vaccine is not getting to B.C. and other provinces as quickly as it should,” noted Dr. Kendall, “but I am confident that the federal government and GlaxoSmithKline are doing their best to ensure that the vaccine is manufactured and distributed as quickly as possible. There have been similar challenges in the United States and other countries as well. In the meantime, our provincial health authorities will tailor their delivery plans to ensure that the vaccine we do have is used in the best possible way.”

“Members of the general population who don’t fall into the high-risk categories identified in the phased implementation approach will be able to receive the H1N1 vaccine as soon as supply is sufficient but not at this time,” said Dr. Monika Naus, medical director of immunization programs at the B.C. Centre for Disease Control, an agency of the Provincial Health Services Authority. 

“We ask that healthy individuals allow those who need the vaccine most at this time to get it first. In the meantime, we remind everybody that basic infection control measures remain a powerful weapon against influenza infection and spread. Wash your hands properly and often, cough or sneeze into your sleeve or a disposable tissue, and remain at home if you are sick.”

1030 H1N1 flu public clinics set to begin Nov 3 [Vermont]--The Vermont Department of Health and the state’s home health agencies and Visiting Nurse Associations are offering H1N1 flu vaccine. A total of 37 clinics are currently scheduled for locations around the state starting Nov. 3 and continuing into January.

To locate a vaccination clinic, got to the Health Department’s website at www.healthvermont.gov, then select H1N1 Vaccine Clinics at the top of the home page. Clinics next week are being held in Middlebury, Manchester Center and Colchester.

Extensive information, tools and resources about seasonal and pandemic flu, healthy habits and preparedness are available at the Health Department’s website: healthvermont.gov or dial 2-1-1. You can also follow us on Twitter at twitter.com/healthvermont.

1030 Vax efforts unprecedented as H1N1 flu becomes widespread [Maine]--The Maine Center for Disease Control and Prevention/Maine DHHS has determined H1N1 influenza (swine flu) to be widespread in the state. However, the H1N1 vaccine is also being administered at unprecedented speed.

Many are listed on the clinic locator at http://www.maineflu.gov

1030 H1N1 flu shots to be offered at City colleges [Chicago IL]--After successfully vaccinating a total of more than 12,000 people across the city on Saturday and Tuesday, Chicago Department of Public Health (CDPH) officials are looking forward to protecting thousands more Chicagoans from the H1N1 flu on Thursday.

“We continue to say that the best place to get an H1N1 flu vaccination is your own family doctor or other regular medical provider,” stated Chicago Department of Public Health Commissioner Terry Mason, M.D. “Many thousands of doses of vaccine have already been distributed to hospitals, clinics, family practitioners, pediatricians, obstetricians, and college/university health services. But for those Chicago residents who do not have a doctor or whose doctor does not plan to give H1N1 vaccinations, we are offering H1N1 flu vaccinations at six locations across the city.”

The vaccinations are intended for people at increased risk for flu and flu complications:

• pregnant women
• all children and young adults ages 6 months to 24 years
• people who live with and/or care for infants younger than 6 months of age
• people age 25-64 with chronic health conditions (like asthma or diabetes).
• health care workers

The six locations are:

• Kennedy King College, 6301 S. Halsted
• Olive Harvey College, 10001 S. Woodlawn
• Richard J. Daley College, 7500 S. Pulaski
• Truman College, 1145 W. Wilson
• Arturo Velasquez Institute, 2800 S. Western
• Wright College, 4300 N. Narragansett

The locations will be open to serve Chicago residents at increased risk on Tuesdays, Thursdays and Saturdays.

Hours of operation are 3:00 to 8:00 p.m. Tuesdays and Thursdays, 9:00 a.m. to 2:00 p.m. Saturdays.

No appointments are necessary, and all vaccinations will be delivered free of charge, on a first come/first served basis.

People who are allergic to eggs should not receive the vaccination.

In addition to doctors’ offices and public health vaccination sites, H1N1 vaccine is expected to be available at retail pharmacies in the weeks ahead----giving Chicagoans ample opportunities to get vaccinated.

College students in the city are advised to check in with their campus health service to see if and when H1N1 vaccinations will be offered.

"Vaccination is a smart, safe and effective public health intervention,” added CDPH Immunization Program Medical Director Julie Morita, M.D. “Every week, thousands of doses of H1N1 vaccine are arriving in the city and suburbs. Assuming that vaccine production continues as anticipated, it is fair to say that every Chicagoan who wants an H1N1 vaccination will be able to get one in the weeks and months to come.”

In addition to getting a flu vaccination, CDPH officials advise all Chicagoans to:

• make an extra effort to cover coughs and sneezes, and wash hands regularly with soap and water.
• stay home from work and/or school if you have influenza-like symptoms (coughing, sore throat and a fever).
• remind parents of young children to teach these good health habits to their sons and daughters---and to plan ahead and make home-care arrangements for their children on days when they are ill and should be kept home from school or day care.

For local information on flu prevention, go online to www.cityofchicago.org/swineflu.

1030 H1N1 flu vax available at County Health depts next week [Mississippi]--The Mississippi State Department of Health (MSDH) announces the limited availability of the 2009 H1N1 (swine flu) vaccine at all county health department clinics beginning Monday.  So far, 223,800 doses have been allocated to Mississippi. Of those doses, 146,000 are injectable vaccine and 77,800 are nasal mist vaccine.

The first injectable vaccine doses at the county clinics will be available for those in the following priority groups: pregnant women; children six months through four years of age; and parents, siblings, caregivers and anyone else living in the house with an infant under six months of age. These groups are at the highest risk for complications from influenza. The vaccine is free at all county health departments.

For more information on swine flu, visit the MSDH website at www.HealthyMS.com  or call the toll-free MSDH flu hotline at 1-877-222-9FLU. The hotline hours are 8 a.m. – 5 p.m. Monday through Friday, except state holidays.To receive updates on Twitter, visit the MSDH H1N1 swine flu page to sign up as a follower.

1030 Three more H1N1 flu-related deaths confirmed [Kansas]--The Kansas Department of Health and Environment (KDHE) today confirmed the deaths of three people who were infected with the pandemic H1N1 influenza virus.  None of the cases announced today had any underlying health conditions that placed them at greater risk of complications from H1N1 flu. Twelve people in Kansas have now reportedly died after being infected with H1N1.

The deaths occurred in the following individuals:

The H1N1 vaccine has started to arrive in Kansas, but at this time in very limited quantities. Certain individuals are recommended to receive the vaccine earlier.  For more information on vaccine prioritization, please visit www.kdheks.gov/H1N1/H1N1_Vaccine.htm.

Up-to-date information on H1N1 vaccination clinics being held across the state can be found by going to www.kdheks.gov and clicking on “Where can I receive the H1N1vaccine?”

Kansans with questions about the virus can email H1N1fluinfo@kdheks.gov.  Information is also available from KDHE at www.kdheks.gov.

1030 Death of elderly female linked to H1N1 flu [Wyoming]--According to the Wyoming Department of Health, swine (novel H1N1) flu was linked to the death last week of an elderly female Laramie County resident with underlying health conditions associated with higher risk of severe illness.

More information about flu in Wyoming is available online at www.health.wyo.gov

1029 ERs at Montreal's childrens' hospitals seeing a significant increase in number of children seeking care [Quebec]--The CHU Sainte-Justine and The Montreal Children's Hospital of the McGill University Health Centre are currently seeing a significant increase in patients in their Emergency Departments.

Children are arriving with mild flu-like symptoms and fever. The hospitals wish to remind parents that their Emergency Rooms are reserved for urgent care. Mild flu-like symptoms should be treated at home. Also, due to the increased demand for care, the hospitals are NOT testing children to determine if they have H1N1.

"The Emergency is unusually busy for this time of year," says Dr. Harley Eisman, Medical Director, Emergency Department at The Montreal Children's Hospital. "The increase is attributable to children coming in with mild flu-like symptoms and fever. This increase is resulting in extra pressures on the Emergency Department, and therefore, an increase in wait times."

Dr. Eisman reminds parents that the H1N1 influenza is a relatively mild form of the flu and is very similar in severity to the annual flu virus. The only difference is that flu season has started earlier and more people are being infected.

Even though the second wave of the H1N1 virus has only just started, both ERs are already at 180% capacity. The Montreal Children's Hospital Emergency Room is staffed and equipped to treat approximately 180 children per day. The current daily average is 300. CHU Sainte-Justine is staffed and equipped to treat 180 per day and is currently seeing 250 children.

"Children in need of urgent care are our number one priority. There is absolutely no wait for emergency care. However, any patient arriving with mild flu-like symptoms can expect to wait before seeing a health professional. It is important, that parents prepare for the flu season by educating themselves on ways to keep their children healthy, to manage minor illness and injury at home, to know when they should see a doctor and when they should visit the Emergency Department," says Dr. Michael Arsenault, Medical Manager of Emergency Services at the CHU Sainte-Justine.

Dr. Arsenault points out that emergency rooms must be reserved for children who are seriously ill or injured. He says, if everyone runs to the ER when their child has a low-grade fever it will impinge on the staff's ability to treat children whose lives are in danger.

Both physicians recommend parents refer to the Self-Care Guide distributed by the Québec Government. However, they want to point out a small error in the guide. The guide says that parents should consult a doctor as soon as possible if their child aged two or younger has a fever. This is not accurate. Parents need only consult a doctor urgently if their newborn (three months and younger) has a fever of more than 38.3 degrees C (100.9 degrees F). For all other children, a doctor should only be consulted if the child has a fever and other complications associated with the flu as described in the guide.

They also recommend you take your child or teenager to the emergency department if your child has:

- Difficulty breathing (for example: breathing faster than normal; and
look paler than usual or have whitish or bluish lips; are coughing
excessively, choking or breathing irregularly).
- An injury where it is suspected that a bone may be broken or stitches
required.
- Vomiting following an injury.
- A fever over 38 degrees C or 100.4 degrees F and are under three months
of age.
- A fever and is difficult to wake up or is very sleepy.
- A rash that does not turn white when you push on it.
- Diarrhea, vomiting and have no tears, a very dry mouth, and have not
urinated at least two to three times over the last 24 hours.

Both doctors ask families to visit their pediatrician or family doctor, unless they are dealing with a true emergency, as described above. If there is no community physician, or the physician is unavailable, families should go to their local CLSC or walk in clinic. You should be using the health care services available in your neighbourhood. To learn where these services are located please call Info-Santé by dialing 8-1-1.

Not a Vaccination Centre

A reminder: neither the CHU Sainte-Justine nor The Montreal Children's Hospital are H1N1 vaccination centres. To find the vaccination centre nearest your home call Info-Santé at 8-1-1 or go to: www.pandemiequebec.gouv.qc.ca.

1029 Statement from Ontario Medical Association on H1N1 vax delays [Toronto ON]--"Patient concern has grown across the province about the pending wave of the H1N1 virus in Ontario. As expected, community doctors' offices have been inundated with calls from patients wishing to get themselves and their families vaccinated in order to protect themselves.

Over the last few days there have been suggestions in the media and some in public health that Ontario doctors are not interested in participating in the H1N1 vaccination program. I want to assure the public that Ontario doctors are ready, willing and wanting to provide the vaccine to patients. The problem is that many doctors can't get the vaccine to give to our patients yet.

Unfortunately, it appears that some local health units have made the decision to limit the distribution of the vaccine to mass vaccination centres, rather than the traditional community physician office for the time being. We understand that this decision has been made due to a limited supply of the vaccine. Some doctors who have ordered the vaccine have been told that they won't be receiving it right away. To date, we have not received confirmation as to when these current supply issues will allow for wide distribution of the vaccine to community physicians.

We need manufacturers and government officials to expedite the distribution of the vaccine as quickly as possible.

Doctors are frustrated by the mixed information they have been receiving. We're also frustrated by our inability to provide for the patients who have been asking to get vaccinated. However, all of us are committed to working together with our health care partners to provide whatever care we can in this challenging time for Ontario families.

Ontario's doctors understand the concerns of parents given recent unfortunate events. We encourage families to try to be patient over the next few weeks. There is no doubt that government officials, public health units, doctors and all health care providers are all working towards the same goal - providing the best care possible to our patients - despite some of these challenges."

Suzanne Strasberg, MD

President, Ontario Medical Association

Dr. Strasberg is also a family doctor who practices at a clinic in Toronto's Jane and Finch corridor.

1029 New advice on H1N1 care [Nova Scotia]--Nova Scotians now have more detailed advice on what to do if they have flu-like symptoms, which include fever and/or cough, sore throat and extreme tiredness.

"Up to this point in time, we have been telling people that if they are sick, they should stay home. Now, as we have learned more about the H1N1 virus, we have new guidelines that offer much better clarity and direction on what to do if you have influenza symptoms," said Dr. Ken Buchholz, senior physician advisor, Department of Health.

People with symptoms in risk groups -- those younger than five, pregnant women and people younger than 65 with a chronic medical condition for which they receive regular medical care -- should be assessed and receive early treatment as soon as possible. They should visit family doctors, nurse practitioners or family health nurses, go to a walk-in clinic, or visit a primary assessment centre, if one is available in their area.

People with severe flu-like symptoms, which may include shortness of breath, chest pain, dizziness, severe vomiting, high fever and confusion, should call 911, or immediately go to the local emergency room.
"As we are starting to see an increase in cases of flu throughout the province, it is important that Nova Scotians know how to recognize flu-like symptoms, and when and where to seek medical care," said Dr. Buchholz.

Like other provinces and territories, Nova Scotia has a stockpile of antiviral drugs. It is being distributed to district health authorities and pharmacies and supplies should be in stock everywhere by early next week. Antivirals will be available, at no cost, to Nova Scotians who are in the risk groups and have a prescription.

People with flu-like symptoms who are otherwise healthy should stay home until they are feeling well. If their condition worsens, they should seek medical care.

Effective today, lab tests will be done only on people admitted to hospital with flu symptoms so labs are focused on testing those who need it most.

For information and advice on H1N1, people can contact Healthlink 811 to speak with a registered nurse. For more information on H1N1, including who is at risk, flu symptoms and primary assessment centres, visit www.gov.ns.ca/h1n1

1029 Significantly less H1N1 vax available than had been anticipated [Manitoba]--The federal government is advising all provinces, including Manitoba, that there will be significantly less vaccine delivered than had been anticipated in the weeks ahead.
 

The initial delivery from the federal government of 134,000 doses and a second delivery of 72,000 doses have already been distributed for use in clinics around the province. As of the end of day Oct. 28, there had been 67,078flu shots administered in Manitoba.
 

As a result, Manitobans who are not in the first priority group are asked to wait to get their flu shots. Manitoba’s priority groups include those who are most at risk and would benefit the most from getting the shot. All Manitobans will have access the shot as soon as enough supply of the vaccine arrives. The first group of Manitobans who should get the H1N1 flu shot now include:
- children aged six months to under five years old;
- anyone of Aboriginal ancestry (First Nations, Métis or Inuit);
- disadvantaged individuals (for example, the homeless);
- people living in remote or isolated areas;
- people under 65 with a chronic medical condition or other risk including severe obesity, substance abuse or alcoholism;
- anyone with a weakened immune system or those who live with or care for them;
- those who live with or care for infants under six months old;
- single parents or anyone solely responsible for a dependent;
- health-care workers and medical first responders; and
- pregnant women who should consult with their doctor about the right type of vaccine to receive.
 

Regional health authorities (RHAs) may have to adjust their clinic schedules including postponing clinic dates until there is sufficient vaccine supply. RHAs will issue updates as their plans are adapted.
 

Next week, Manitoba will take delivery of vaccine that does not have an adjuvant. This vaccine is for pregnant women. Manitoba expects to receive approximately 8,200 doses of the Australia-based vaccine obtained by the federal government.

1029 Flu Assessment Centre opening Oct 30 [Edmonton, Alberta]--Alberta Health Services will open an Influenza Assessment Centre (IAC) in Edmonton on Friday, October 30 at 8 a.m. 

• visit www.albertahealthservices.ca for Self-Care information and local Influenza Assessment Centre details;
• call Health Link Alberta for further advice on managing symptoms & accessing additional services; or
• call their family physician

For more Influenza information, visit www.albertahealthservices.ca or call Health Link Alberta toll-free at 1-866-408-5465; in the Edmonton-area at 780-408-5465; in the Calgary-area at 403-943-5465.

1029 H1N1 vax rollout continues [Alberta]--In the first three days of Alberta’s pandemic H1N1 2009 influenza immunization campaign, the vaccine has been administered to well over 150,000 people provincewide. This exceeds the start of any other immunization program in Alberta history.

Alberta Health and Wellness and Alberta Health Services are working to address the challenges of delivering a public health initiative of this scale - the largest of its kind ever seen in the province or in Canada.

Immunization wait times continue to be a concern. Albertans who are not among those at greatest risk for severe illness related to H1N1 influenza are reminded to delay their immunization to ensure those with the greatest need are protected.

As announced by public health officials on October 22, in order to make the best use of the vaccine supply on hand in the province, Alberta aims to protect those most at risk for severe illness due to H1N1 influenza first. The following groups are encouraged to be immunized as soon as possible:

• pregnant women;
• children six months to less than five years of age;
• people under 65 with chronic health conditions;
• people living in remote and isolated settings or communities;
• health care workers involved in pandemic response or the delivery of essential health care services; and
• household contacts and care providers of people at high risk but who cannot be immunized or may not respond to vaccines.

There are constraints to how quickly the campaign can proceed, including vaccine supply. Alberta and other provinces are receiving regular shipments from the manufacturer. Alberta will have received roughly 600,000 doses of vaccine by October 30. Starting the week of November 2, deliveries of adjuvanted vaccine to provinces will slow down while the vaccine manufacturer temporarily shifts its focus to producing enough non-adjuvanted vaccine to meet Canadian demand. Non-adjuvanted vaccine is provided to accommodate personal choice for pregnant women.

For more information on H1N1, visit www.health.alberta.ca.

1029 More details about the H1N1 vax distribution program [Massachusetts]--As of today, more than 480,000 doses of H1N1 vaccine have been distributed to providers in Massachusetts –- just the tip of the iceberg of the total 3.5 million doses of vaccine that we expect to receive this flu season. This is not where we expected to be at this point based on what we were initially told by the federal government, and it creates a difficult and frustrating situation for everyone, especially those people at greatest risk of complications from the H1N1 flu.

These initial limited supplies have been prioritized for distribution to the health care providers who serve populations at the highest risk of H1N1 flu –- children and pregnant women. It has also been prioritized for health care workers with direct patient contact in light of their vital role in ensuring a functioning health care system. DPH believes this targeted distribution approach, using health care providers who serve these high risk groups every day, is the most effective way to ensure the vaccine gets to those who need it most as quickly as possible.

As vaccine supplies arrive in larger quantities, more and more providers will receive vaccine for their patients. Vaccine will then be targeted to young adults up to 24 years old and people 25-64 with chronic health problems. Eventually, flu clinics for the general public will begin. However, they won’t be scheduled until there are large enough quantities of vaccine available to support them. Based on current projections from the Centers for Disease Control and Prevention, these flu clinics will not likely be feasible until December. When they have been scheduled, you can find one near you at http://flu.masspro.org. It is important to note that no H1N1 vaccination clinics are listed at this time.

This vaccine supply situation is complex and confusing. We continue to receive requests for further details on how vaccine arrives in the state, the role of DPH in that process, and how providers receive word on upcoming vaccine availability. Here’s how the system works:

Major vaccine manufacturers are producing H1N1 vaccine in addition to the seasonal flu vaccine they produce every year. There are nine different H1N1 vaccine formulations approved for various age groups. Vaccine comes as thimerisol-free prefilled syringes, multidose vials with thimerisol, and live, attenuated virus nasal spray (Flumist). More detailed information is available on this chart.

When a provider first registers with DPH to receive H1N1 vaccine, they include key details about their practice, including:

* Type of practice and target patient population served
* Capacity to vaccinate (how many people could they vaccinate in a month with sufficient vaccine supplies)
* Whether they consent to receive live attenuated vaccine formulations (e.g., Flumist vaccine)
* How much vaccine and which formulations they would like to order

Several times each week, DPH receives notice about how much newly available vaccine, and in which formulations, the state can expect to receive. We use the details provided to our vaccine registration system to figure out where that vaccine can and should be shipped. For instance, pregnant women can’t take Flumist, so if a manufacturer tells us there is a new batch of Flumist coming, we cannot send that new quantity to OB/GYNs. It can however, be administered to healthy children, and would therefore be sent to pediatricians.

DPH does not play any role in physically receiving and redistributing H1N1 vaccines, which are shipped directly to providers in the community. However DPH does play a vital role in matching up available formulations to appropriate providers as vaccine comes off the production line.

There are more than 4,000 health care providers in Massachusetts that have signed up with DPH to receive H1N1 vaccine this year. (The actual number of vaccination sites is higher, because some of the larger providers will further distribute their allocations of vaccine to their affiliated provider locations.) Virtually all of the providers that serve the priority groups have received some amount of vaccine and will receive more in the coming weeks.

Unfortunately, the vaccine supply is unpredictable during these early days of distribution even to the point of not having enough for the highest priority groups. Thus, it is possible that a pregnant woman with an underlying health condition may not be able to get vaccinated right away. As more vaccine becomes available in all of the various formulations, these allocations will even out, and all pregnant women who wish to be vaccinated can be.

Understandably, given the delays in receiving large quantities of vaccine, people want to know exactly where the vaccine has been shipped. We have received requests for specific information on which providers have which quantities of which formulations at any given time. This information is difficult to accurately convey as the situation is constantly evolving. Furthermore, releasing that level of information would likely result in an overwhelming surge of calls and visits to providers, preventing them from quickly and efficiently dispensing the vaccine that they have available to their most at-risk patients. These disruptions may also discourage providers from participating in the H1N1 vaccination program, contributing to further delays in getting vaccine to individuals in the community.

DPH is as frustrated as you are about the current situation. Regrettably, neither the states nor the federal government have the ability to speed production. What we can do is pledge to distribute the vaccine to the appropriate providers as soon as it becomes available and to continue providing the most up to date information on the situation.

1029 National delays in H1N1 vax distribution highlight need for continued prevention efforts [Pennsylvania]--Responding to delays in the nationwide distribution H1N1 flu vaccine, Department of Health officials today urged Pennsylvanians to continue to take steps to prevent the spread of illness.

1029 While we wait for the H1N1 vax: taking charge of your health [by Jason Eberhart-Phillips MD, Kansas State Health Officer and Director of Health, KDHE]--Many Kansas families have been anxiously waiting this month to have their children and themselves vaccinated against the pandemic H1N1 flu virus. Regrettably, makers of the new H1N1 vaccine have found that production of the vaccine’s active ingredient in their laboratories is occurring much slower than anyone expected.

Until there is enough vaccine to put an end to this pandemic once and for all in Kansas, please join me in doing what we can to reduce the spread of H1N1 flu,  protecting our families and ourselves.  For more information on reducing the spread of H1N1 flu, go to http://kdheks.gov/H1N1.

1029 King County Flood Warning Center opens as Snoqualmie, Tolt rivers rise on heavy rains [Washington]--Following intense rainfall across much of eastern King County, the King County Flood Warning Center opened at 8:30 a.m. Monday to monitor rising flows on the Snoqualmie and Tolt rivers.

As of 9 a.m., the sum of the forks of the Snoqualmie River was 13,428 cubic feet per second (cfs), which is above the threshold for a Phase II flood alert level. At these flows, minor flooding could be expected in agricultural areas in the Snoqualmie Valley.

Meanwhile, the Tolt River was flowing at 2,920 cfs at 9 a.m., which is a Phase II flood alert level. At this level, very minor flooding could be expected in low-lying areas along the Tolt River.

The current rainfall is not expected to lead to any flooding in the Green River Valley, where the reduced flood-storage capacity at Howard Hanson Dam has led to numerous flood-preparation activities.

A Phase II warning on any major King County river is the level of the county's four-phase warning system at which the Flood Warning Center is activated to monitor lowland flooding. The center will remain open and continue to monitor the river flooding until conditions improve.

Flood Warning Center staff are monitoring stream gages and weather reports, and will provide updated information on river conditions as necessary.

Flood Warning Center staff will continue to monitor stream gages and weather reports and provide updated information on river conditions as necessary. Real-time river level information is available online at www.kingcounty.gov/flood

Updated information on flooding will also be posted on the King County Web site at www.kingcounty.gov, or via RPIN, the area's regional Web site at http://www.rpin.org. A recorded flood-information hotline is also updated each hour for citizens wanting information in flood areas. The number is 206-296-8200 or 1-800-945-9263.

Citizens who need help interpreting flood information should call 206-296-4535 or 1-800-768-7932. Problems on county maintained roads can be reported by calling 206-296-8100 or 1-800-KC-ROADS.

1028 The CHU Saint-Justine and the Montreal Children's Hospital reminds parents that ERs are for urgent care [Quebec]--The two pediatric ERs are being flooded with children with only mild flu-like symptoms and fever as parents ask that their child be tested for H1N1.

As per the Ministry of Health and Social Services recommendations, Pediatric Emergency Staff will only do testing on patients who are sick enough to be admited or those with risk factors (e.g. cystic fibrosis, immunosuppressed state) that may put them at risk for complications.

Staff will not routinely test for A(H1N1) influenza even if they present from an outside health care provider. Critically ill patients with febrile respiratory illness will be their priority.

1028 More than 38,000 vaccinated against H1N1 this week [Manitoba]--As of Oct. 27, approximately 38,476 Manitobans had received the H1N1 flu shot. Flu clinics organized by the province’s 11 regional health authorities and Health Canada’s First Nations and Inuit Health Branch are being held across the province this week.

· To date, Manitoba has received 134,000 doses of H1N1 vaccine from the national allocation. It is anticipated that an additional 72,000 doses of vaccine will arrive late this week and the same amount will be shipped next week. The exact amounts may change depending on manufacturing capacity and federal distribution plans.
 

· Manitobans who should get the shot first should attend the clinics in their area now. Once these Manitobans are immunized over the next few weeks, the H1N1 flu shot will be made available to every Manitoban who needs or wants to be vaccinated or is expected to benefit from the shot.

Manitobans who should get the H1N1 flu shot now include:
- children aged six months to under five years old;
- anyone of Aboriginal ancestry (First Nations, Métis or Inuit);
- disadvantaged individuals (for example, the homeless);
- people living in remote or isolated areas;
- people under 65 with a chronic medical condition or other risk including severe obesity, substance abuse or alcoholism;
- anyone with a weakened immune system or those who live with or care for them;
- those who live with or care for infants under six months old;
- single parents or anyone solely responsible for a dependent;
- health-care workers and medical first responders; and
- pregnant women who should consult with their doctor about the right type of vaccine to receive.

Flu Update

· Manitoba is now at the beginning of the second wave of the pandemic. As of Oct. 26, there were 19 new cases of laboratory-confirmed cases of H1N1 flu bringing the lab-confirmed case count since Oct. 1 to 32. The best way to protect against the flu is to get immunized.
· In addition to getting the flu shot, there are other steps to take to prevent spreading or getting the flu and to prevent severe illness and death:
- Cover your cough, wash your hands regularly and limit touching your eyes, nose and mouth.
- Stay home when you are sick and don’t return to work or school until you feel well enough to do so.
- See a doctor or nurse within 24 hours of getting even mild symptoms of the flu if you have risk conditions for severe illness (e.g. under five years of age, chronic medical condition, Aboriginal ancestry, pregnant). You need to be assessed and you could be offered antiviral medication that should be given within two days of the onset of symptoms.
- Get emergency medical care if you develop severe symptoms or if your symptoms get worse, especially shortness of breath or severe or worsening weakness.
· If you have mild flu symptoms, you should:
- Stay home from school or work until you feel well enough to return and limit unnecessary contact with others.
- Contact you nearest health-care provider or visit your nearest health-care centre if you have risks for severe illness or you are concerned that you may need care, especially if your symptoms are severe or worsening. Early treatment (within 24 to 48 hours) may be very important.
· Go for emergency medical help or call 911 if you or a family member:
- experience shortness of breath or have difficulty breathing;
- experience severe or worsening symptoms such as increased thirst, or decreased urination and strength;
- are dehydrated or have not urinated for 12 hours;
- are drowsy or confused; or
- have an infant under three months old with a fever.

For more information on H1N1 flu, visit www.manitoba.ca/flu or call Health Links-Info Santé at 788-8200 or 1-888-315-9257.

1028 Flu assessment clinic opening in Charlottetown [Prince Edward Island]--An Influenza Assessment Site, opening in Charlottetown tomorrow, will provide health services to Islanders with influenza-like illness, says Dr. Heather Morrison, Chief Health Officer for Prince Edward Island.

H1N1 Vaccine Clinics are continuing to operate throughout the province. This week vaccinations are offered to those who would benefit most from the vaccine as well as those who care for them. For a complete schedule, and list of the times and locations of clinics across the province each week, visit www.gov.pe.ca/flu or see the ads in local newspapers.

For more information on how to look after someone who is ill at home, visit the Public Health Agency website at www.fightflu.ca.

1028 First H1N1 flu-related hospitalization confirmed [Yukon]--Yukon’s medical officer of health, Dr. Brendan Hanley, today confirmed that Yukon has had its first hospitalization linked to pandemic H1N1 (pH1N1).

“The first patient was a child, with an underlying chronic condition who was hospitalized last week, and has now been released,” Hanley said. The lab has confirmed that the patient had H1N1.

“We are seeing more flu activity right now and it was to be expected that some of our cases would be hospitalized,” Hanley added. “We are very fortunate that until now, most cases have been mild.”

Hanley said he will not be reporting numbers of lab confirmed cases because numbers do not truly reflect the actual situation. Physicians and community nurses are being asked to test only those individuals who have influenza-like illness with either risk factors or severe illness.

1028 Statement from chief medical officer of health: H1N1 flu clinics update [New Brunswick]--The following statement was issued today by Dr. Eilish Cleary, chief medical officer of health:

The clinics listed on www.gnb.ca/flu, or through the toll-free flu information telephone number, are for priority groups. If you are not a member of a priority group, we ask that you wait until clinics open for the public. It is important that we all work together to protect those most vulnerable, and we appreciate your co-operation.

The information, including dates, times, locations, and eligible groups for H1N1 clinics is available by region at www.gnb.ca/flu . This site will be updated continually to include clinics scheduled throughout the months of November and December. These clinic listings will be clearly labelled as the vaccine is extended to other groups, as well as to the general public.

Please continue to check our website or call 1-800-580-0038 for weekly H1N1 vaccine clinic listings.

1028 Govt of Canada providing H1N1 travel guidance [Ottawa ON]--The Government of Canada today provided important guidance on how to reduce the spread of the H1N1 flu virus on planes, trains, ferries and inter-city buses. 

The guidance document also provides advice on how to deal with sick passengers on board planes, trains, ferries and buses, and outlines the responsibilities of conveyance operators for notifying public health or other appropriate authorities about sick passengers (see backgrounder).  The first priority is to arrange for immediate medical attention of a passenger, if required.

The guidance document has been distributed to all conveyance operators, and is available on the website of the Public Heath Agency of Canada.

1028 First death linked to H1N1 reported as flu is widespread [Vermont]--The Vermont Department of Health is reporting a significant increase in influenza illness around the state over the past week. Cases of 2009 H1N1 have been confirmed by the Health Department Laboratory in all areas of the state, and hospitals are reporting a sharp increase in the number of visits related to respiratory or viral illness.

Extensive information, tools and resources about seasonal and pandemic flu, healthy habits and preparedness are available at the Health Department’s website: healthvermont.gov or dial 2-1-1. You can also follow us on Twitter at twitter.com/healthvermont.

1028 City officials launch school-based H1N1 vax program [New York City]--

1028 Flu activity widespread as H1N1 vax delays continue [New Jersey]--Statement from Dept of Health and Human Services Commissioner Heather Howard: New Jersey continues to maintain open lines of communication with the public to ensure they have access to the most recent information on H1N1 influenza. There are a number of tools that New Jerseyans can use to stay informed, and simple everyday actions we can take to stay healthy.

New Jersey opened an H1N1 Information Hotline - 1-866-321-9571 earlier this month. Because of increased interest, call center hours will be extended to weekends. This toll-free public hotline will now be accessible seven days a week from 9 a.m. to 5 p.m. Call center operators will be able to provide general information about H1N1, vaccine safety and availability information, symptoms of H1N1 and flu preventive measures. Since opening the hotline, the Department has answered more than 7,730 calls from the public.

New Jersey’s flu activity has moved from regional to widespread. This means that H1N1 flu is present in a majority of counties throughout the state. While any type of flu is cause for concern, it is not cause for alarm. I urge all residents to stay informed and take simple preventive measures to stay healthy.

I also want to take this opportunity to provide an update on vaccine production and availability, vaccine safety, and H1N1 target populations.

New Jersey’s H1N1 Public Information Initiative

In an effort to provide critical information to the public, New Jersey created a Find a Flu Shot Locator, an H1N1 Resource Center website, and a toll-free hotline. These resources will help ensure residents and health care providers have access to information and can obtain accurate responses to their questions.

The State established an H1N1 Resource Center website that includes important information and timely updates on H1N1 flu in New Jersey. The website can be found at www.nj.gov/health. Additional information on H1N1 flu is available at the federal website, www.flu.gov.

The Find a Flu Shot Locator can be accessed at www.nj.gov/health. Residents can find where H1N1 flu clinics are being held throughout the State. Not all clinics are included on this list because some are being offered to very specific target populations, such as school-based efforts and private doctors’ offices. Public flu clinics will be posted on this site as soon as they are scheduled. Additional public health clinics will be scheduled as more vaccine arrives.

H1N1 Vaccine Production and Availability

Many residents are concerned with the slower than expected arrival of H1N1 vaccine. Please understand that the H1N1 vaccine, like other vaccines, is produced by manufacturers and distributed by the federal government. We will do all that we can to ensure orders are placed in a timely manner and that the vaccine is getting to the target populations.

As of October 28, 2009, New Jersey ordered approximately 1.3 million doses of vaccine and more than 567,000 doses have been distributed to nearly 891 providers statewide. Shipments of the H1N1 vaccine will continue to arrive throughout this month and into the winter.

The federal government has assured us that ultimately there will be enough vaccine for everyone who wants it. However, with only limited vaccine available at this time, it is important to first target the individuals most susceptible to H1N1 flu.

H1N1 Target Populations

It is recommended that certain target groups be among the first to receive the H1N1 vaccine as it becomes available. These groups include:

* Pregnant women
* Household contacts and caregivers for children younger than 6 months of age
* Healthcare and emergency medical services personnel
* All people from 6 months through 24 years of age
* Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza

H1N1 Vaccine is Safe

Many parents have raised concerns about the safety of the new H1N1 vaccine. All vaccines, including the H1N1 vaccine, are held to the highest standard of safety and are continually monitored. Each year, millions of Americans safely receive seasonal flu vaccines. The H1N1 vaccine is made the same way as seasonal flu vaccine by the same manufacturers that make seasonal flu vaccine. In addition, the National Institute of Health (NIH) has conducted clinical trials for the H1N1 vaccine. The vaccine has been tested and safely used in children, pregnant woman, and adults.

What You Can Do to Stay Healthy

* Cover your nose and mouth with a tissue when you cough or sneeze.
* Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
* Avoid touching your eyes, nose or mouth. Germs spread that way.
* Stay home if you are sick.

Symptoms of H1N1

The symptoms of H1N1 flu include fever, cough, sore throat, body aches, headaches, chills and fatigue. Some people have reported diarrhea and vomiting. You should immediately call your physician if your child is exhibiting the above symptoms.
 

1028 H1N1-related death in an 80-year-old woman [Delaware]--Delaware’s Division of Public Health (DPH) has learned of another H1N1-related death, this time in an 80-year-old Sussex County woman. She passed away Saturday, October 24, in a Delaware hospital. Because she doesn't fit the typical age profile, additional H1N1 investigation was conducted to confirm her status.

"Our hearts go out to her loved ones," said Dr. Karyl Rattay, DPH director. "As with most H1N1-related deaths, this individual had multiple other existing medical conditions."

While people 65 years and older are much less likely to become ill with novel H1N1 flu, when people in this age group get the infection, especially those who are immuno-compromised, their risk of poorer outcomes is increased. This is not surprising given that people 65 and older are generally considered at higher risk of serious flu-related complications, including those requiring hospitalization, from seasonal flu illness.

Certain groups of people are at higher risk of complications from the H1N1 flu, including people with chronic underlying health conditions such as asthma, diabetes, heart disease, obesity, and those who are immuno-suppressed. For most healthy people this has been a mild infection.

Precautions to help stop the spread of flu include:

* Get vaccinated against both H1N1 and seasonal flu.
* Wash your hands frequently with soap and warm water or use an alcohol-based hand sanitizer.
* Cover your cough/sneeze with a tissue, or cough/sneeze into your inner elbow and not into your hands.
* If you are sick, stay home for at least 24 hours after your fever goes away. This means no fever for at least 24 hours after you have stopped taking any fever-reducing medication. Employers are encouraged to be flexible with their employees on the issue of staying home when ill.
 

1028 Rumor control: H1N1 vax and prisons [Texas]--Texas has not allocated any H1N1 vaccine to prisons at this time. Prisoners are not a priority group to receive the vaccine and will not be vaccinated ahead of the general public.

Given the limited national supply, Texas is initially targeting priority groups most at risk. Pregnant women are one of those groups. There are pregnant women who are incarcerated who need the vaccine to help protect their unborn children.

Health care providers who serve pregnant women in prisons have requested vaccine from the Texas Department of State Health Services. It is unclear when the state will be able to fill those orders given the limited national supply of the vaccine.

Texas has been providing vaccine since the state first received allocations from the U.S. Centers for Disease Control and Prevention earlier this month. A limited supply will be going to the prison system to vaccinate those most at risk.

Texas continues to order its full allocation of H1N1 vaccine, but the national supply still isn't adequate to meet demand. Texas plans to allocate more vaccine to other groups as it becomes more widely available.

Texas had expected to receive 3.4 million doses of the vaccine by mid-October, according to the initial projections from the CDC. However, the state has been allocated less than 1.7 million doses so far.

1028 Two more H1N1 deaths confirmed [Minnesota]--Two more deaths from 2009 H1N1 influenza have been confirmed by the Minnesota Department of Health, bringing the total number of H1N1 deaths to 12 since April. The additional deaths were confirmed in:

* An adult in the 50-59 age range from south central Minnesota with no underlying health conditions.
* An adolescent in the 10-19 age range from the Twin Cities metro area who did have underlying health conditions.

MDH continues to investigate possible H1N1-related deaths on an ongoing basis.

1028 H1N1 mass vax clinics update [Arkansas]---The Arkansas Department of Health (ADH) will hold mass vaccination clinics throughout the state on Thursday, Friday and Saturday, October 29-31. CHECK YOUR LOCAL AREA FOR EXACT TIMES.

* Supplies of H1N1 vaccine are arriving in the state in very limited quantities. This is happening in states nationwide.
* We have more seasonal vaccine available this year than in past years, but we expect the demand to be high.
* We would like to be able to vaccinate everyone who wants to get the H1N1 vaccine during the Mass Flu Clinics scheduled for October 29-30, but there is not enough vaccine at this time.
* Our supply of H1N1 vaccine is so small that we are currently vaccinating only priority groups at most risk for serious complications from H1N1 flu:

1. pregnant women, because they suffer the most complications from flu infection;

2. children 6 months through 4 years of age, and children 5 through 18 years of age with underlying medical conditions. These include: chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematological or metabolic disorders (including diabetes mellitus); children that are immunosuppressed (including immunosuppression caused by medications or by human immunodeficiency virus); are receiving long-term aspirin therapy and therefore might be at risk for experiencing Reye syndrome after influenza virus infection; are residents of long-term care facilities.

3. We will vaccinate persons in these two priority groups until our supply of H1N1 vaccine runs out.

* We ask for the public’s patience at the mass flu clinics. Many of the staff at the clinics are community volunteers. They and ADH staff are doing the best they can to vaccinate as many people as possible given limited vaccine supplies and adverse weather conditions. Local ADH staff and volunteers did not set the priorities for who would receive vaccine. These are national recommendations based on people most at risk for serious complication from flu.
* There are positive indications that the supplies of H1N1 will increase substantially over the next 3-4 weeks and additional mass flu clinics will be scheduled at later dates. Also, as supplies increase, we will be providing vaccine to the roughly 900 private providers that have pre-registered to distribute vaccine.
* As we get more H1N1 vaccine, those doses will continue to be given to priority groups first. These include pregnant women, children ages 6 months through 24 years, health care workers and emergency medical responders, people living with and caring for infants under 6 months of age, and people ages 25-64 years with underlying health conditions (like asthma and diabetes).
* All vaccines are FREE at the mass vaccination clinics, but we ask that if you have insurance, Medicare, Medicaid or ARKids First, bring your cards with you so that we can file with your insurance.
 

1028 Child death linked to pertussis [Iowa]--The Iowa Department of Public Health (IDPH) has confirmed the pertussis (whooping cough)-associated death of a young child in southeast Iowa. “This tragic death serves as a reminder that vaccine-preventable diseases can cause complications and death among infants and young children who are too young to be fully vaccinated,” said IDPH Medical Director, Dr. Patricia Quinlisk.

“It’s important for all adults, especially those around children less than 5 years of age, to be fully vaccinated to prevent the spread of infectious diseases like pertussis.”

Pertussis is a disease caused by bacteria. It causes coughing spells so severe that it is difficult for infants to eat, drink or breathe. Whooping cough is spread when someone who is sick with pertussis coughs and spreads the bacteria to others. Coughing spells can last for weeks; pertussis can lead to pneumonia, seizures, brain damage and death.

Adults may not realize they have whooping cough because the symptoms of pertussis can begin like the common cold. Young children get whooping cough from infected people around them. This is why it’s critical for everyone around infants and young children to be up-to-date on their tetanus, diphtheria, and pertussis vaccines.

Until recently there was no pertussis vaccine for adults, but today the tetanus booster vaccine, Tdap, contains pertussis and provides the immunity needed to ensure they do not pass pertussis to vulnerable people. Even if you had a tetanus booster less than 10 years ago, you can receive the pertussis-containing vaccine.

IDPH recommends all adults receive the Tdap booster vaccine and all children receive their recommended vaccines on time, including the pertussis vaccination.

For more information about pertussis, visit www.idph.state.ia.us/adper/pertussis.asp.

1028 State recommends prioritization of H1N1 vax [Wisconsin]--The Department of Health Services (DHS) is recommending that local health departments and health professionals target H1N1 vaccine for those individuals most-at-risk during the next several weeks as the vaccine supply continues to fluctuate.

DHS has also requested that, beginning next week, public and private health care providers refrain from mass public vaccination clinics, unless they are targeted at those most at risk. As of today, Wisconsin has been allocated a total of 407,000 doses of H1N1 vaccine.

“As we have seen in every state in the nation, the supply of H1N1 vaccine is unpredictable. Therefore, the safest course of action is to target the vaccine we do have for those who are most-at-risk of becoming seriously ill from this virus,” says Secretary Karen Timberlake. “While we do not anticipate this will need to be a long-term strategy, we’ve issued guidance to help our health professionals make the largest impact with the vaccine that is available.”

DHS is now recommending that the public health and health care community focus vaccination efforts on the following subset of CDC’s target groups:

• Pregnant women

• Persons who live with or provide care for infants age 6 months or younger (examples: parents, siblings, daycare providers)

• Health care and emergency medical services personnel who have direct contact with patients or infectious material

• Children age 6 months - 4 years

• Children and adolescents age 5-18 years who have chronic medical conditions that put them at higher risk for influenza-related complications (see attached letter for list of chronic medical conditions)

These recommendations are consistent with the Advisory Committee on Immunization Practices guidelines when vaccine supply is limited. The Advisory Committee on Immunization Practices advises the CDC.

“The CDC had to choose between waiting to distribute vaccine until it had large quantities ready to be shipped or distributing limited quantities of the vaccine sooner,” says Secretary Timberlake. “The CDC chose the latter knowing it would create some challenges and frustrations for health care providers and the public, but also realizing it would allow us to start protecting people against this virus as soon as possible.”

Community vaccination clinics will resume as H1N1 vaccine becomes more readily available. People may call 2-1-1 to find out an H1N1 or seasonal influenza vaccine clinic nearest them. A “clinic finder” is also available online at http://pandemic.wisconsin.gov or www.wisconsinfluclinic.info.

1028 Strategy for H1N1 vax response [Oklahoma]--Vaccine News: OSDH will receive considerably less vaccine next week than expected. The CDC has announced that these reductions are a result of manufacturing delays. Next week’s shipment to Oklahoma will be around 37,000 doses.

OSDH Vaccine Response:
 

Due to the low vaccine doses expected for next week, the vaccination strategy will be primarily focused on:
o Pregnant women
o School-aged children
o Parents and custodial parents of children less than 6 months old.
o Healthcare workers providing direct patient care to acutely ill patients.
 

Local County Health Departments will need to review provider registrations and identify any physician offices in their counties that will receive vaccine shipments next week.
 

OSDH has developed a strategy to increase vaccination rates amount pregnant women but the low amount of available vaccine has made it difficult to implement.
As vaccine shipments increase, OSDH will be implementing a plan for “fast-passes” for OB-GYN physicians to give to their patients that will allow pregnant women a quick move to the front of lines at public health clinics. Pregnant women have had the highest complication rates from the flu this season.

OSDH Operations:

Hospital visits continue to increase statewide but medical systems are still reporting that they are capable of handling the current volume. OSDH continues to follow-up with any hospital that identifies signs of stress.

Tamiflu suspension is available in the counties for patients who cannot afford costs of compounded Tamiflu suspension. The FDA has also posted instructions for parents who receive Tamiflu capsule prescriptions for children that have difficulty
swallowing. This information may be found at:
http://www.cdc.gov/H1N1flu/antivirals/mixing_tamiflu_qa.htm

1028 Indications flu activity has peaked in Denver-Boulder metro area [Colorado]--While officials at the Colorado Department of Public Health and Environment expect the total number of H1N1 hospitalized cases and deaths to increase, there are indications that influenza activity has peaked in the Denver-Boulder metropolitan area.

The department has added an online link to a free and secure interactive Web site that walks patients through a series of questions to determine the severity of their flu symptoms based on the latest Centers for Disease Control and Prevention guidelines. The link can be found at https://www.amafluhelp.org/Public/Consumer/Home.aspx

Individuals with questions about H1N1 are encouraged to call CO HELP at 1-877-462-2911. The hotline has been established to respond to questions about H1N1 and seasonal influenza.

1027 Fifth Calgary H1N1 vaccination clinic opens Wednesday, October 28 [Alberta]--Alberta Health Services is opening a fifth H1N1 vaccination clinic in Calgary, October 28 at 8:30 a.m.  This fifth clinic - located on the 2nd floor of the Olympic Oval at the University of Calgary - will deliver H1N1 Vaccine specifically to pregnant women, children aged six months to less than 10 years, seniors, and family members accompanying the above groups.  The clinic will be open from 8:30 a.m. to 8 p.m. Mondays to Thursdays, and 8:30 a.m. to 3:30 p.m. Fridays, Saturdays and Sundays.

For detailed clinic information, including dates, times and locations, visit www.albertahealthservices.ca or call HEALTHLink Alberta toll-free at 1-866-408.LINK (5465), in Edmonton-area at 780-408-LINK (5465) or in Calgary-area at 403-943-LINK (5465).

1027 Adjuvanted H1N1 vax now available for some pregnant women [Prince Edward Island]--The province is now recommending that pregnant women who are in the second half of their pregnancy (20 weeks and over) receive the adjuvanted vaccine at this time. In addition, those pregnant women who are under 20 weeks and have serious underlying health conditions should also receive the adjuvanted vaccine at this time. This recommendation is supported by the Public Health Agency of Canada and the National Society of Obstetricians and Gynaecologists of Canada.

Pregnant women can also receive the vaccine at any public health clinic across the province. For a complete list of the times and locations of upcoming clinics, watch the newspaper, visit www.gov.pe.ca/flu or call 1-888-748-5454 for further information.

1027 Province has 80 new cases of H1N1 flu [Nova Scotia]--Canada is experiencing the second wave of the H1N1 virus. This means that increased flu activity is being witnessed across the country, including Nova Scotia.

Nova Scotia has seen 80 new lab-confirmed cases of H1N1, and one hospitalization, since influenza re-emerged this fall.

There has been one H1N1-related death in Nova Scotia, in July.

H1N1 activity has been highest in the Guysborough-Antigonish Strait Health Authority and Capital Health.

"An increase in H1N1 activity was fully expected in our province with the start of the fall flu season," said Dr. Robert Strang, chief public health officer for the province. "That's why I strongly encourage Nova Scotians to get the vaccine as soon as it is made available in their area. Getting vaccinated is the best way to protect yourself, your family and your community.

"H1N1 is a community virus. We can expect to see it everywhere in our communities -- schools, grocery stores, day cares, libraries and more."

Women in the second half of their pregnancy, and women at any stage of pregnancy with chronic health conditions, are most at risk of complications from H1N1 and seasonal flu.

Because of increased H1N1 activity in Nova Scotia, Dr. Strang recommends pregnant women, at 20 weeks gestation or less, who have pre-existing health conditions, consider receiving adjuvanted vaccine. It is also recommended that all pregnant women in the second half of their pregnancy (more than 20 weeks gestation) receive adjuvanted vaccine.

Healthy pregnant women in the first half of their pregnancy are at less risk of complications, and can wait to receive the unadjuvanted vaccine. Unadjuvanted vaccine will start to be available in Nova Scotia next week.

H1N1 vaccine will be available, free of charge, to all Nova Scotians who want it. H1N1 clinic dates and times from across the province are available at www.gov.ns.ca/H1N1 or through HealthLink 811.

This is the largest immunization campaign in the province's history. Dr. Strang urged Nova Scotians to be patient and to get the vaccine when it becomes available at a clinic in their community.

In addition to getting vaccinated, Dr. Strang said Nova Scotians should continue to take other precautions to avoid illness:

-- Most importantly, stay home if sick with flu-like symptoms, which are fever and/or cough with unusual tiredness, head/muscle/joint aches or sore throat.
-- Wash hands often with soap and water, especially after a sneeze or cough. When soap and water are not handy, alcohol-based hand sanitizers are an acceptable alternative.
-- Cough and sneeze into elbow or sleeve.
-- If using tissues, dispose of them appropriately and wash hands.
-- Limit touching eyes, nose and mouth.
-- Do not share drinking glasses, water bottles, mouth guards, cosmetics or eating utensils.
-- If concerned that medical advice or care is needed, contact HealthLink 811. Like any illness, should symptoms worsen, visit a doctor or walk-in clinic.

As of Oct. 27, Nova Scotia is experiencing increased flu activity. As a result, women in the second half of their pregnancy (more than 20 weeks gestation), and women at any stage of pregnancy with chronic health conditions, should consider receiving the adjuvanted H1N1 vaccine. These women are most at risk of complications from H1N1 and seasonal flu.

Healthy pregnant women in the first half of their pregnancy are at less risk of complications, and can wait to receive the unadjuvanted H1N1 vaccine. Unadjuvanted vaccine will start to be available in Nova Scotia the first week in November.
 

1027 Almost 90 new severe cases of H1N1 flu since Oct 20 [British Columbia]--British Columbia continues to monitor and respond to the spread of the pandemic H1N1 flu virus. Since Oct. 20, there have been 88 new severe cases of H1N1 identified in B.C. – 43 in Fraser Health, 29 in Vancouver Coastal Health, 11 in Interior Health, four on Vancouver Island and one in Northern Health – with three new deaths, two in Fraser Health and one in Interior Health.

The majority of lab-confirmed cases in B.C. have been mild or moderate in severity, with the patients either having already recovered or currently recovering.

While the Province continues to monitor all laboratory-confirmed cases, the weekly report now includes only severe confirmed H1N1 cases (hospitalizations and deaths).

Since Oct. 20, there have been 88 new severe cases of H1N1 identified in B.C., with three new deaths.

In total, BC Centre for Disease Control (BCCDC) has confirmed 199 severe H1N1 cases in British Columbia since April 2009, including:

Eighty-seven in Fraser Health, including seven deaths.

Thirty-one in Interior Health, including three deaths.

Six in Northern Health.

Sixty in Vancouver Coastal Health, including one death.

Fifteen on Vancouver Island, including one death.

Of these 199 lab-confirmed cases admitted to hospital, 51 have been admitted to the ICU. Twenty-one new cases have been admitted to the ICU in the last week.

To date, twelve laboratory-confirmed H1N1 cases in B.C. are reported to have died. In eleven of those cases, there were underlying medical conditions.

British Columbians can use the Flu Clinic Locator at www.immunizebc.ca to find out where to get the H1N1 vaccine. If there are no clinics posted in a particular area, people can call their public health unit or family physician to find out where and when they can get vaccinated.

Starting the week of Oct. 26, the people who will benefit most from pandemic H1N1 immunization, and who need and want to get vaccinated, will be able to receive that vaccine should they choose to do so.

These groups include:
· Persons under the age of 65 with chronic conditions.
· Pregnant women.
· Persons – including First Nations – living in remote and isolated settings or communities.

People who fall into these groups AND for whom the seasonal flu vaccine is normally recommended will be able to receive both shots at the same time. People who do not fall into these groups are asked to put off receiving the H1N1 vaccine for a few weeks to allow those at most risk to get their vaccine first.

Starting the week of Nov. 2, the people eligible to receive the H1N1 vaccine will expand to include the following groups:
· All initial groups.
· Children 6 months to less than 5 years of age.
· Healthcare workers (including all health-care system workers involved with the pandemic response or delivery of essential health services).
· Household contacts and care providers of infants less than 6 months of age, and persons who are immunocompromised.

People who fall into these groups AND for whom the seasonal flu vaccine is normally recommended will be able to receive both shots at the same time.

Beginning in mid-November, everyone else who needs and wants the H1N1 vaccine will be recommended to receive it. Public notification will happen at this time so that everyone is aware the vaccine is available to them.

1027 DHS proposes guidance for anthrax responders [Washington DC]--In conjunction with an interagency task force, Department of Homeland Security (DHS) Secretary Janet Napolitano today announced new proposed guidance for protecting the health of emergency responders during an anthrax attack on a major U.S. city.

Interested stakeholders are encouraged to comment through www.regulations.gov.

1027 Clarification on H1N1 priority groups - in English and Spanish [Massachusetts]--We want to provide some clarification on how the H1N1 vaccine is being distributed amongst priority groups across the state.

When the CDC originally outlined these groups, they also recommended that if the vaccine was initially only available in limited qualities that these groups would need to be sub-prioritized. Unfortunately, due to an unprecedented flu season involving the need to produce 2 different types of vaccines, there have been interruptions in the production and distribution of the H1N1 vaccine and we have only received a small percentage of our total allocation from the federal government.

Based on the CDC recommendations, this limited supply is reserved for people at especially high risk for flu, which includes pregnant women, children, caregivers of infants and healthcare workers with direct patient contact. As supplies grow, this will expand to include the additional priority groups of young adults up to the age of 24, and people between the ages of 25 and 64 with underlying health conditions like asthma and diabetes.

We expect the number of doses of H1N1 vaccine in the state to exceed 1 million by the end of November. As it arrives, we will continue to work to ensure that the vaccine that is available goes to these high priority groups. We thank you for your patience and understanding.

Gostaríamos de esclarecer algumas coisas sobre a distribuição da vacina contra a gripe A H1N1 entre os grupos prioritários do Estado.

Quando o CDC inicialmente determinou os grupos prioritários, eles também recomendaram que caso houvesse falta de vacina uma nova ordem de prioridade deveria ser estabelecida. Lamentavelmente, devido a uma temporada anual de gripe sem precedentes – e a necessidade de fabricar dois tipos diferentes da vacina – houve interrupções na fabricação e distribuição da vacina contra a gripe A H1N1. Somente recebemos uma pequena percentagem do número total de doses que o governo federal tinha inicialmente destinado para Massachusetts.

Segundo recomendações do CDC, esse pequeno número de vacinas está reservado para pessoas consideradas dentro do principal grupo prioritário na vacinação. Isto é, mulheres grávidas, crianças, pessoas que cuidam de crianças pequenas e profissionais da área da saúde que têm contato direto com doentes. Na medida em que os carregamentos da vacina forem chegando, a vacinação irá abranger o resto do grupo de prioridade, que inclui jovens até a idade de 24 anos e pessoas entre os 25 e 64 anos de idade que tiverem condições de saúde debilitantes, como asma e diabete.

Esperamos receber mais de um milhão de doses da vacina contra a gripe A H1N1 até o final de novembro. Conforme a vacina chegar, continuaremos trabalhando para que a vacina que estiver disponível chegue a todos aqueles dentro desses grupos prioritários. Agradecemos sua paciência e compreensão.
 

1027 DHHS announces activation of H1N1 flu public inquiry line [New Hampshire]--The New Hampshire Department of Health and Human Services is announcing the activation of New Hampshire’s H1N1 Flu Public Inquiry Line. DHHS is urging residents with questions about the H1N1 influenza virus, the H1N1 vaccine, and any other questions related to H1N1 to contact 2-1-1 NH by dialing 2-1-1.

“People have questions about the H1N1 virus and the status of the supply of H1N1 vaccine. We are activating the public inquiry line because we want to be sure people have access to good information are getting answers to their questions and are taking the proper steps to prevent the spread of the virus,” which is why we are activating the public inquiry line,” said Gov. John Lynch.

“We understand that people are concerned about H1N1, particularly with the delay in vaccines being made and shipped from private manufacturers. But we want to assure the public that the vaccine will be coming,” said DHHS Public Health Director Dr. José Montero. “We want to encourage everyone, in the absence of the vaccine, to take common sense preventative measures to avoid becoming sick with H1N1 or any other illness. This includes washing your hands frequently, covering your mouth when you cough or sneeze, and staying home from work or school if you are sick.”

DHHS has been working with 2-1-1 NH, (a program of United Ways of NH in partnership with Public Service of NH, The State of NH and Exeter Hospital) to be ready to respond as the State’s public inquiry line for all questions regarding H1N1 influenza. Initially the public inquiry line will be open for H1N1 related questions from 8 am – 5 pm Monday through Friday.

For more information on H1N1 flu, visit www.dhhs.nh.gov or the Centers for Disease Control and Prevention (CDC) at www.cdc.gov/h1n1flu.

1027 E.coli 0157:H7 found in beef patties after more than 20 children became ill [Massachusetts]--South Shore Meat Company in Brockton, Mass. has initiated a voluntary recall on certain ground beef and other beef products based on confirmed laboratory evidence of the presence of E. coli O157:H7 in leftover ground beef samples obtained from a nature camp in Plymouth, Mass.

Suspect ground beef patties were collected and tested by the Mass. Department of Public Health (DPH) after more than 20 school children and adults from Rhode Island, who had visited Camp Bournedale in Plymouth, Mass., the week of October 13th became ill with gastrointestinal symptoms.

DPH is continuing to investigate the outbreak in cooperation with the Rhode Island Health Department and the Centers for Disease Control and Prevention.

There is now laboratory evidence that the ground beef collected at the camp is the same strain of E. coli O157:H7 confirmed in two of the children. No other camp attendees have reported any illnesses to date.

DPH is continuing to work with United States Department of Agriculture to identify all affected beef products that will need to be recalled. Additional information on recalled products will be posted at www.fsis.usda.gov/FSIS_Recalls/Open_Federal_Cases/index.asp as it becomes available.

Anyone with signs or symptoms of foodborne illness should consult their health care provider, local board of health, the DPH Epidemiology Program at 617-983-6800 or the Food Protection Program at 617-983-6712.

1027 DoH expands list of priority groups served at free H1N1 vax clinics [Washington DC]--The DC Department of Health (DOH) announced today that the free H1N1 vaccine clinics for District residents will expand the priority groups served. Since October 19 the Department of Health has hosted clinics for pregnant women and youth ages 6 months to 24 years. The clinics will now also serve adults with underlying health conditions such as asthma and diabetes, and caregivers of children under 6 months. The clinics will continue to be in every ward once a week for the next three weeks.

DOH also announced that vaccine is now expected to arrive at pharmacies the week of November 2. The vaccine is also still available at pediatricians, family physicians and community health centers who have registered to distribute the vaccine. As DOH continues to receive updates from the federal government on vaccine supply and availability it will update the vaccine distribution schedule to reflect those updates.  Residents can find regular updates and additional information on H1N1 at flu.dc.gov or by calling the Mayor’s Citywide Call Center at 311.

Select  H1N1 Vaccine Clinic Schedule for Priority Groups to see the list of clinics.

Select H1N1 Vaccination Information Availability to see the expected vaccine availability for different priority groups.

1027 High-risk individuals offered H1N1 influenza vaccine [Alabama]--County health departments will start administering a limited number of doses of H1N1 influenza vaccine to individuals in targeted high-risk groups beginning Wednesday at locations throughout the state. Statewide the health department has 55,000 doses available at this time.

Vaccine in injectable form will be offered only to pregnant women; children 6 months though 4 years old; parents, siblings and caregivers of children less than 6 months old; children and adolescents 5 through 18 years old who have underlying medical conditions; and health care workers.

“We must target our limited amounts of vaccine to individuals at the highest risk because of the uncertainties in supply we face,” Dr. Donald Williamson, state health officer, said. “We ask for your support and understanding at this time. As more vaccine becomes available, our department and other health care providers will begin vaccinating school children and others outside of these target groups.”

Alabama and the nation are experiencing significant delays in the amount of H1N1 influenza vaccine received. Vaccine supply is short for both private providers and health departments. The number of vaccine doses sent to each county health department has been allocated based on population.

The public can find clinic dates, times and locations at www.adph.org. Information is also available by calling the health department’s toll-free hotline at 877-377-7285 between 7 a.m. and 7 p.m. Monday through Friday.

1027 Flu helpline surpasses 5,000 calls [Marion County, Indiana]--The Marion County Health Department Flu Helpline has received more than 5,000 calls since opening September 21.

As of October 27, the Flu Helpline has received 5,558 calls.

The 221-3366 helpline allows the public to ask general flu related questions.

"We are pleased with the response. People are concerned and it's appropriate we provide this resource," said Pam Thevenow, Flu Helpline Coordinator and administrator of the health department's water quality and hazardous materials management program.

A majority of calls are from those wanting to know where they can get the H1N1 vaccine. Other callers want information on the seasonal flu vaccine.

"By and large callers are interested in getting the latest information. Most understand that we don't have a lot of vaccine to distribute and that those in the at-risk groups are getting the initial doses of vaccine," said Thevenow.

The Flu Helpline was established to provide current flu information and take calls that might otherwise go to 911, 211 or the Mayor's Action Center.

Health educators are available to take calls in English and Spanish, Monday to Friday from 8 a.m. - 5 p.m. Those calling at other times can leave a message and have their call returned.

1027 State Public Health director urges patience as H1N1 vax supply limited [Illinois]--Dr. Damon T. Arnold, Director of the Illinois Department of Public Health, is urging Illinoisans to be patient in getting the H1N1 vaccine. Due to slower than anticipated production, there is currently a limited supply of the H1N1 vaccine nationwide. However, manufacturers continue to produce the vaccine as quickly as possible and supplies are expected to increase throughout November and December.

• Pregnant women
• Household contacts and caregivers for children younger than six-months of age
• Healthcare and emergency medical services personnel
• All people from six-months through 24-years of age
• Persons aged 25-64 years who have health conditions associated with higher risk of medical complications from influenza

Both the nasal spray and injectable form of the vaccine are available. For a list of public H1N1 vaccination sites and clinic times, as well as additional information on the 2009 H1N1 flu, log onto www.ready.illinois.gov.

• CLEAN – wash your hands frequently to prevent the spread of germs.
   
• COVER – your cough and sneeze with a tissue or sleeve, not your hand.
   
• CONTAIN – contain your germs. Stay home if you are sick.

1027 H1N1 vax continues to trickle into state [Oregon]--The H1N1 vaccine continues to trickle into the state. So far, Oregon has received about 6 percent of the vaccine necessary for the people in priority groups, which accounts for about half of Oregon’s population.

1027 Two more flu-related deaths reported [Wyoming]--Two more flu-related deaths of state residents have been reported to the Wyoming Department of Health.

Flu contributed to the deaths earlier in October of both an adult male (Influenza A, further subtype not confirmed) and elderly male (Influenza B, not H1N1). Both were Laramie County residents and had underlying health conditions linked with higher risk of severe illness.

Flu activity continues to climb in Wyoming, is widespread across the state and is mostly due to the H1N1 flu strain. More influenza cases have been reported to the department since May than the total in any flu season over the past ten years. Influenza symptoms include fever, cough, sore throat, body aches, headaches and fatigue. Some patients also report diarrhea and vomiting.

Of the total 2,522 reported flu cases in Wyoming since late May, 587 have been confirmed as swine flu cases. Most other cases were not subtyped. Over the same timeframe, the department has received reports of 77 Wyoming hospitalizations in connection with the virus.

The department expects the number of actual flu infections around the state to be much higher, because most ill persons do not seek medical care or are not tested. Specific swine (novel H1N1) flu counts only reflect cases confirmed by specialized lab testing as the H1N1 strain as part of the department’s ongoing surveillance activities.

Actions recommended to slow the spread of illness include:

· When available, get immunized with both a swine flu and a seasonal flu vaccine.
· In general, people who develop influenza-like illness should stay home from work, school or travel until at least 24 hours after they are free of fever. Those who are severely ill (such as having trouble breathing) should seek medical care.
· Avoid contact with ill persons.
· Covering noses and mouths with a tissue or sleeve when coughing or sneezing, and throwing used tissues in a trash can.
· Frequent hand washing with soap and water or the use of an alcohol-based hand gel.

More information about flu in Wyoming is available online at www.health.wyo.gov .

1026 Estimates indicate 115,000 residents have or have had H1N1 flu [Louisiana]--The Department of Health and Hospitals today updated the status of the state’s Fight the Flu campaign. As the H1N1 vaccination campaign moves forward, it is important for Louisiana families to be patient if their provider has not yet received the H1N1 vaccine, as more vaccine is arriving every week. Residents should stay in contact with their provider as to the vaccine’s availability and to make an appointment when the time comes.

• LAIV nasal spray vaccine continues to be available through registered providers, including pediatric providers.  Most of these doses have been slated for use in young children.
• Additional shipments of H1N1 vaccine are expected every 5-10 days for the next 2-3 months, with pregnant women, front line health care workers, and adults with pre-existing medical conditions as the next target groups for vaccination.
• Every Louisianian who wants the vaccine should have access by the end of January.
• Residents should check with their providers regarding the availability of H1N1 vaccine.
• DHH will post a flu shot locator on www.FightTheFluLA.com, showing locations where vaccine will be available across the state.
• DHH has launched a Twitter feed (FightTheFluLA) and a Facebook page to help ensure teenagers and young adults, both of which fall into high-risk groups for H1N1, have easy access to up to date information regarding the H1N1 virus and vaccine.

DHH’s Fight the Flu campaign aims to keep Louisianians healthy by promoting immunizations and good hygiene to prevent the spread of the seasonal flu and the H1N1 virus. For more information on flu activity in Louisiana, including guidance for families and medical professionals, visit www.FightTheFluLA.com or follow the campaign at www.twitter.com/FightTheFluLA.

1026 State announces toll-free H1N1 flu vax hotline [South Dakota]--South Dakotans looking for information about H1N1 vaccine opportunities can call a new toll-free state hotline, 1-866-320-2740. The line is available from 8:30 a.m. to 5 p.m., central time, Monday through Friday.

“Vaccine is still limited in South Dakota but supplies are slowly increasing. Right now, most vaccinations are being given in doctors' offices and clinics to high risk patients but by mid-November we hope to begin offering public clinics,” said Doneen Hollingsworth, Secretary of Health.

“This hotline will give South Dakotans one more resource to find out about those vaccination opportunities.”

Hollingsworth said South Dakotans can also check the web at http://h1n1.sd.gov  for information about H1N1 flu and vaccination. As clinics are scheduled they will be posted at that site.

In addition to vaccination, personal precautions should be taken to help stop the spread of influenza and other illnesses:
· Wash hands often with soap and water or use alcohol-based hand gel.
· Cough and sneeze into a tissue or your sleeve, not into your hands.
· Stay home when you’re sick. – until 24 hours after symptoms are gone – without fever-reducing medicine.

1026 H1N1 update - activity in province beginning to increase [New Brunswick]--The following update on the H1N1 flu virus was issued by the Office of the Chief Medical Officer of Health for New Brunswick on Monday, Oct. 26:

• Canada is experiencing a second wave of pandemic influenza activity;
• there is significant variation in numbers of cases across the country. In New Brunswick, activity is still low, but we are starting to see it pick up. This means we are on the cusp of a second wave of pandemic H1N1 activity in New Brunswick;
• fortunately, we have access to a good, safe and effective vaccine;
• our H1N1 flu vaccine clinics have started today across the province;
• the province will receive a third shipment of vaccine this week. This will allow us to continue to expand our clinic coverage;
• we encourage New Brunswick residents to access clinic information and more information about the H1N1 flu virus and its symptoms by using the flu website www.gnb.ca/flu or the toll-free telephone number, available 24/7, set up for New Brunswickers seeking information about H1N1 flu virus, 1-800-580-0038;
• the information including dates, times, locations, and eligible groups for H1N1 clinics is available by region through the web or the toll-free number. The clinic listings were significantly updated over the weekend and will be continuously updated over the course of the H1N1 vaccination program;
• New Brunswickers are reminded that there will be sufficient vaccine for all who want or need to be immunized against the H1N1 flu. If you do not see your community or target group listed, please recognize that these listings are frequently updated and know that it will be coming. The absence of your community or target group just means that it has not been added to the website yet. No one will be forgotten or overlooked. This website will be continuously updated as more clinics are scheduled and the vaccine is extended to other groups as well as the public;
• we are aware that heavy demand for information may occasionally cause longer wait times than usual on the toll-free line. Extensive improvements were made over the weekend and continue to be made;
• we know that pregnant women, especially in the second half of pregnancy, are at highest risk for severe disease if they contract the virus. Additionally, maternal immunization while pregnant may help to protect the infant after birth;
• in view of the likelihood of increased circulation of virus, as of today we are recommending that women in the second half of their pregnancy (more than 20 weeks), and those less than 20 weeks with a pre-existing condition, should be offered the H1N1 vaccine at the earliest clinics;
• in Canada, original plans were to offer pregnant women a more traditional unboosted vaccine as there was a lack of data in pregnancy with boosted vaccines. However the adjuvanted vaccine is authorized for use in pregnancy and the World Health Organization (WHO) has indicated that it does not have any special concerns about the safety of adjuvanted H1N1 flu vaccines in general;
• the WHO has recommended that pregnant women be immunized against the H1N1 flu virus, even if no non-adjuvanted vaccine is available;
• this recommendation is a recognition that waiting for the future delivery of unadjuvanted vaccine is a greater risk than having them vaccinated now. We also know that the adjuvanted vaccine will give better protection;
• however, it is still a personal choice. If a pregnant woman chooses to wait, then she will still be offered the unadjuvanted vaccine when it becomes available. If she should become ill with influenza-like symptoms in the meantime, she should seek medical attention as soon as possible;
• we have just become aware that the Government of Canada has procured an additional supply of unadjuvanted vaccine, which may be available in the provinces as early as mid-next week;
• New Brunswickers should continue to protect themselves and those around them by washing hands thoroughly and often, coughing or sneezing into sleeves, staying home if sick, and keeping common surfaces clean;
• persons at high risk of complications from influenza-like illness should seek medical attention promptly. Those at risk include pregnant women, people with underlying medical conditions such as diabetes, chronic lung conditions or those with compromised immune systems;
• persons with influenza-like symptoms should stay home and minimize contact with family members as much as possible. If symptoms worsen, they should visit their physician or nurse-practitioner, a walk-in clinic or the nearest hospital emergency department;
• it is recommended that sick people limit contact with other people until they are free of symptoms; and they are feeling well;
• it is important for New Brunswickers to understand that if they do not have influenza-like symptoms, they can continue to go to work and school as normal, to participate in activities and to socialize; and
• more information on the H1N1 flu virus may be found online or by calling the 24-hour H1N1 line, 1-800-580-0038.

1026 Overall flu activity increased for fifth consecutive week [Canada]--Summary of FluWatch Findings for the Week ending October 17, 2009

* The overall influenza activity has increased for a fifth consecutive week. All indicators (proportion of positive influenza tests, national ILI consultation rate, number of regions reporting widespread and localized activity and number of influenza outbreaks) were higher this week compared to the previous weeks. There is increased influenza activity across the country, particularly in the West (BC, AB, SK, NT).
* This week, 99.9% of the positive influenza A subtyped specimens were Pandemic (H1N1) 2009.
* The intensity of Pandemic (H1N1) 2009 in the population was moderate with sixty-four hospitalizations and three deaths reported this week. Hospitalized cases were reported from BC, AB, MB, ON and NT while the deaths were from BC and SK. As of October 17, 2009, a total of 1,604 hospitalized cases including 312 cases admitted to an intensive care unit (ICU) and 164 cases required ventilation as well as 83 deaths had been reported since the beginning of the pandemic.
* The Minister of Health announced on October 21, 2009, that Health Canada has approved AREPANRIX, a vaccine against the Pandemic (H1N1) 2009 virus.

Pandemic (H1N1) 2009 virus Surveillance and Epidemiology

A total of 1,604 hospitalized cases including 312 (19.5%) cases admitted to ICU and 164 (10.2%) cases required ventilation as well as 83 deaths of Pandemic (H1N1) 2009 were reported to PHAC as of October 17, 2009. The proportion of females affected, the median age and the proportion of cases with underlying medical conditions was still increasing with severity of illness this week (see Characteristics table). While women and men had similar hospitalization rates, more females were admitted to ICU, required ventilation and died compared to men (approximatively 60% females vs. 40% for males for all these outcomes). As well, for those with severe outcomes, females had more underlying medical conditions than males; 74.2% vs. 68.4% of ICU admissions and 81.6% vs. 71.8% of deaths. In the Canadian population, there are more females than males in older age groups which may partially explain the differences observed.

The national crude hospitalization rate was 4.8 per 100,000 population with the highest rates in children under 15 years of age (11.2 per 100,000). The national crude mortality rate was 0.25 per 100,000 population; those 45 years and older had the highest mortality rate (0.36 per 100,000). ICU admission rate and ventilation rate were also elevated in children under five years of age (1.7 and 1.1 per 100,000, respectively).

There were 85 (27.8%) hospitalized pregnant women out of 306 hospitalized women between 15 and 44 years of age for whom the information on pregnancy was available. The median age among all pregnant cases was 28 years (range 16 to 42 years). Information on pregnancy trimester was available for 39 hospitalized women: 28 (71.8%) of these 39 pregnant women were in their third trimester. Pregnant women had a higher burden of morbidity and mortality. Assuming 1% of the population is pregnant in a given year, approximately 5% of hospitalized cases and 5% of deaths occurred in this group. However, hospitalized pregnant women were admitted to ICU less frequently (18.8% vs. 30.3%), required ventilation less frequently (5.9% vs. 16.7%) and had less underlying medical conditions (36.7% vs. 58.0%) compared to hospitalized non-pregnant women between 15 and 44 years of age. The main underlying medical conditions reported by hospitalized pregnant women were pulmonary disease (including asthma) (11) and diabetes (5). Four pregnant cases resulted in death and three of these women were in their third trimester (the trimester was unknown for one case).

Overall Influenza Summary - Week 41 (October 11 to October 17, 2009)

The overall influenza activity has increased for a fifth consecutive week. All indicators (proportion of positive influenza tests, national ILI consultation rate, number of regions reporting widespread and localized activity and number of influenza outbreaks) were higher this week compared to the previous weeks.

Four regions reported widespread activity in BC & NT and fourteen regions in BC, AB, SK, ON, NB & NL reported localized activity, while twenty-three regions reported sporadic activity in BC, SK, MB, ON, QC, NB, PEI, NS, NL, YK & NU and thirteen regions in NB, NS & NL reported no activity. The fifty-eight influenza outbreaks reported this week were all in schools except 1 in a long-term care facility (BC), 1 in an unspecified location (AB) and 1 in a workplace (NB). The schools outbreaks were in BC (38), AB (9), NT (5), SK (1), NS (1) and NL (1). Note that this is the first year that all the provinces and territories are reporting on influenza outbreak in schools (greater than 10% absenteeism on any day most likely due to ILI) which is increasing considerably the total number of outbreaks reported compared to the previous years.

ILI consultation rate

This week, the national ILI consultation rate was 48 consultations per 1,000 patient visits which is higher compared to the previous weeks and still above the expected range for this time of the year. Four provinces (AB, SK, ON and NT) had higher ILI consultation rates compared to their ILI rates in previous weeks. The ILI rates of these four provinces were also higher than the national level this week. People under 20 years of age had the highest consultations rates with 98.3 and 88.9 per 1,000 patient visits among children under 4 years of age and among those 5 and 19 years of age, respectively.

Paediatric Influenza Hospitalizations and deaths

In week 41, no laboratory-confirmed influenza-associated paediatric hospitalizations or deaths were reported through the Immunization Monitoring Program Active (IMPACT) network. 379 hospitalizations had been reported since week 17 (April 26); 93.7% of these hospitalizations were due to Pandemic (H1N1) 2009. Since the beginning of the pandemic, four deaths due to Pandemic (H1N1) 2009 had been reported through the IMPACT network among children under 16 years of age.

Vaccination

The Minister of Health announced on October 21, 2009, that Health Canada has approved AREPANRIX, a vaccine against the Pandemic (H1N1) 2009 virus. Health Canada and the Public Health Agency of Canada are currently working with provincial and territorial governments to deliver the A/H1N1 flu vaccine to health care facility sites to begin immunization programs.

Antigenic Characterization

Since September 1, 2009, NML has antigenically characterized 40 Pandemic (H1N1) 2009 viruses and two seasonal influenza viruses (one influenza A/H1N1 and one B virus) that were received from Canadian laboratories. All 40 Pandemic influenza A (H1N1) viruses characterized were antigenically related to A/California/7/2009, which is the pandemic reference virus selected by WHO as Pandemic (H1N1) 2009 vaccine. The one seasonal influenza A/H1N1 virus characterized was related to A/Brisbane/59/07, which is the influenza A/H1N1 component recommended for the 2009-10 influenza vaccine. The one influenza B virus characterized was antigenically related to B/Brisbane/60/08, which is the recommended influenza B component for the 2009-10 influenza vaccine.

Antiviral Resistance

NML: The 40 Pandemic (H1N1) 2009 specimens were tested for resistance to neuraminidase inhibitors (oseltamivir and zanamivir) by phenotypic assay and/or sequencing. The testing results showed that the virus was sensitive zanamivir and resistant to amantadine. One out of 21 Pandemic (H1N1) 2009 isolates tested for oseltamivir resistance was found to be resistant.

Provinces: Three cases of oseltamivir resistant Pandemic (H1N1) 2009 were reported to date in Canada from the province of Quebec on July 21, 2009, from Alberta on September 15, 2009 and from Ontario on October 13, 2009.

1026 Canada works with Australia to secure additional H1N1 vax for pregnant women [Ottawa ON]--Health Minister Leona Aglukkaq and Canada's Chief Public Health Officer, Dr. David Butler-Jones, announced today that the Government of Canada had secured additional unadjuvanted H1N1 flu vaccine from Australia.

“The Government wants pregnant women across the country to have access to unadjuvanted vaccine as soon as possible,” said Minister Aglukkaq. “While our order from GSK remains on schedule, the unadjuvanted vaccine we have secured from Australia will be available ahead of the GSK order.”

The Minister thanked both manufacturer CSL Australia and the Australian Government for their cooperation and underscored that pregnant women remain a priority group for vaccination.

“The Government of Canada has purchased 200,000 doses of unadjuvanted H1N1 vaccine from manufacturer CSL Australia,” stated Dr. Butler-Jones. “Barring any distribution delays, the vaccine will be available to the provinces and territories as early as the first week of November.”

This vaccine has been approved for use in Australia and the United States. Canada has authorized access to Australia's unadjuvanted vaccine to ensure that pregnant women in Canada would have access to an unadjuvanted vaccine on a timely basis. The GSK vaccine is still on target for delivery in early November, however given that the increase in cases of H1N1 flu across the country, this purchase from Australia will allow for earlier access to the unadjuvanted vaccine.

Women more than 20 weeks pregnant, and women in earlier stages of pregnancy with risk factors for severe disease, should consider getting the adjuvanted vaccine until the unadjuvanted vaccine is available.

An adjuvant is a substance that is added to a vaccine to improve immune response. In the case of the H1N1 flu vaccine, the adjuvant includes naturally occurring oil, water and vitamin E. All evidence suggests that adjuvanted vaccines are just as safe as unadjuvanted vaccines; however there adjuvanted vaccines have not been widely tested in pregnant women. The World Health Organization has recommended that pregnant women receive unadjuvanted vaccine where possible, but adjuvanted vaccine could be used if necessary.

1026 Cautionary note on provincial Tamiflu supply [Vancouver, BC]--As British Columbia continues to experience increased pandemic H1N1 influenza activity, health officials are reiterating important messages regarding the use of antivirals to treat infection from this novel virus.

“Over 9,000 prescriptions of antivirals were filled last week alone, which is a 78 per cent increase from the previous week” said Dr. Fawziah Marra, pharmacy director at the BC Centre for Disease Control, an agency of the Provincial Health Services Authority. “We want to remind British Columbians that if you have received a prescription for Tamiflu from your physician as part of your ‘flu plan’, then please do not fill the prescription unless you are experiencing moderate to severe influenza-like symptoms, or experiencing mild symptoms but have a high risk condition. Tamiflu is intended for treatment and not prevention. It is important to follow your physician’s instructions carefully to help reduce the risk of this virus becoming drug-resistant.”

Last week, 38 influenza-like illness (ILI) outbreaks were reported in B.C. schools and, since September, over 99 per cent of all respiratory samples testing positive for influenza at the Provincial Laboratories at the BC Centre for Disease Control (BCCDC) were subtyped as pandemic H1N1 flu virus. These numbers confirm that pandemic H1N1 is by far the dominant circulating influenza strain in British Columbia at this time.

“Earlier this month, B.C.’s stockpile of Tamiflu, an antiviral medication used to treat pandemic H1N1 influenza, was made available through community pharmacies,” explained Dr. Perry Kendall, British Columbia’s provincial health officer. “This supply is to be accessed by patients only if they are experiencing moderate to severe influenza-like symptoms, such as fever, cough, and fatigue.”

Tamiflu may also be used in patients with mild symptoms but who are at risk of developing complications, including pregnant women and new mothers who are less than a month postpartum; people with underlying health conditions, and especially those with chronic conditions such as asthma, diabetes and morbid obesity; and children under five years of age.

“Influenza activity in B.C. remains above the expected range for this time of year,” said Dr. Kendall. “We have mechanisms in place to monitor and respond to outbreaks throughout the province, including early treatment through antiviral use in remote communities and for those at higher risk of severe illness.”

Tamiflu, the brand name for oseltamivir, is an antiviral medication that works by inhibiting an enzyme that the flu virus needs in order to spread through your body. Medical experts caution against widespread use of this medication as a number of cases of oseltamivir resistance have been seen within Canada and other countries, making it imperative that doctors not over-prescribe a critical medication that can be used for treatment of influenza.

People can protect themselves the same way they can protect themselves against the seasonal flu, which includes getting vaccinated with the pandemic H1N1 flu shot, staying home when sick, proper hand washing and coughing into a sleeve or tissue.

For more information on the H1N1 flu virus visit www.gov.bc.ca/h1n1, or call HealthLink BC at 8-1-1, 24 hours a day/seven days a week to speak to a nurse.

1026 H1N1 vax clinics now open [Alberta]--Alberta Health Services will begin offering the H1N1 vaccination in mass vaccination clinics across Alberta on Monday, October 26.

All Albertans aged six months and older are eligible to receive the vaccine free of charge. Individuals at high risk for influenza-related complications are encouraged to get their H1N1 vaccination as soon as possible.

Vaccination is the best defense against influenza and Alberta Health Services is committed to vaccinating every Albertan who wants the H1N1 vaccine, as efficiently as possible. Mass vaccination clinics are the most effective way of delivering vaccine to our communities in a short period of time, however, we ask Albertans to be patient should they encounter line-ups at their local mass vaccination clinic.

H1N1 immunization is expected to be the most prevalent strain of influenza this year, and all Albertans will benefit from the H1N1 vaccination.

For detailed clinic information, including dates, times and locations, visit www.albertahealthservices.ca or call HEALTHLink Alberta toll-free at 1-866-408-LINK (5465), in Edmonton-area at 780-408-LINK (5465) or in Calgary-area at 403-943-LINK (5465).

Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than 3.5 million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.

1026 Statement on Declaration of Emergency [Massachusetts]--Governor Deval Patrick and health and human services officials in Massachusetts praised President Obama for the declaration of national emergency related to the H1N1 influenza outbreak.

"The President's actions allow us to continue on the path we have been on in response to H1N1; namely working in partnership with health care providers and public health officials to prepare for an increase in the number of residents with the flu".

The declaration would permit the federal government to waive specific hospital-related legal requirements. This would allow hospitals to take certain actions to respond to increased demands for care and to fully implement their disaster operations plans that enable appropriate care during emergencies.

The Governor joined the President in downplaying the significance of such a declaration. "This does not mean that conditions have dramatically changed or that the public should be alarmed".

Secretary of Health and Human Services JudyAnn Bigby, MD, emphasized that the plans to prepare and respond to the H1N1 flu have been in place for months as state health officials have collaborated with a wide spectrum of organizations - from hospitals and medical practices to local health officials to school superintendents and nurses. "Each of these sectors is actively working to reduce risk of infection and serious illness".

The Patrick Administration has conferred with the Massachusetts Hospital Association regarding the President’s declaration and joint efforts are being made to inform hospitals of its content.

The declaration does not increase the pace at which the H1N1 vaccine will become available to the public. Production delays have decreased the shipments of vaccine to Massachusetts and all other states. So far in Massachusetts, 300,000 doses of the vaccine have been distributed to clinical sites. Hundreds of thousands more are expected in the coming weeks.

Public health officials reaffirmed that residents of the state can play an active role in decreasing the spread of the flu by staying home when sick and by carefully practicing health hygiene.

1024 State has received only 5 percent of requested H1N1 vax - officials ask for patience [Alaska]--The Alaska Department of Health and Social Services is continuing to receive H1N1 flu vaccine from the federal Centers for Disease Control and Prevention.

This week the state received additional supplies of both injectable and nasal vaccine. To date, Alaska has received 30,800 doses of vaccine.

“We have only received about 5 percent of what we ultimately expect to get,” said Sally Abbott, manager of the Division of Public Health’s preparedness program. “We are still targeting all vaccine for use by our five priority groups. We’re asking everyone else to wait until we have larger supplies.”

The state will be sending 2,800 injectable and 5,700 nasal spray vaccine doses to pharmacies and public health centers around the state. The vaccine is expected to be in those locations before the end of October.

The five groups considered to be priorities for receiving the H1N1 vaccine include:
 

• pregnant women;
• anyone who lives with or cares for children younger than 6 months old;
• health-care and emergency service workers;
• everyone age 6 months–24 years old; and
• adults age 25–64 who have chronic health disorders or compromised immune systems.

Other actions that can help prevent the spread of viruses include:

• Cough or sneeze into your sleeve, or cover your nose and mouth with a tissue. Throw the tissue
in the trash after you use it.
• Wash your hands often with soap and water or use an alcohol-based hand sanitizer.
• Avoid touching your eyes, nose or mouth.
• Disinfect hard surfaces using a diluted bleach solution or commercial sanitizer.
• Stay home if you get sick.

For more information go to: www.pandemicflu.alaska.gov or call the Pan Flu Hotline at 1-888-9PANFLU.

1023 Four more H1N1-related deaths reported [Nebraska]--Four H1N1 deaths have been reported to the Nebraska Department of Health and Human Services:

Feeling sick?
Most people who get H1N1 recover on their own without additional treatment. If you are only mildly ill, you don’t need to seek treatment.

If you are moderately to severely ill with a cough or sore throat and a fever over 100 degrees, particularly if you have underlying medical conditions, call your physician. A physician may prescribe an antiviral, which can lessen the symptoms and possibly shorten the duration of your illness. Your physician may feel comfortable treating you without being seen if you have serious underlying health conditions.

People who are sick should stay home from work or school for 24 hours after their fever ends. Parents should have a plan on how to keep their child home if he or she becomes ill.

Additional symptoms of H1N1 are body aches and sometimes may include vomiting and diarrhea.

For more information, see the DHHS Web site: http://www.dhhs.ne.gov/H1N1Flu/ and subscribe to updates for the most current information. For a list of local health departments go to: http://www.dhhs.ne.gov/puh/oph/lhd.htm.

1023 Dept for Public Health urges patience on H1N1 while reporting two additional H1N1-related deaths [Frankfort KY]--Kentucky Department for Public Health (DPH) officials provided an update today on H1N1 (swine flu) activity in the state, including the reporting of two additional H1N1-related deaths.

The deaths involved a woman in her 80s from Knox County with significant underlying health issues who died in September, and a man in his 40s from the Kentucky State Reformatory in Oldham County who was being treated off-site. The state now has 10 recognized H1N1-associated deaths.
 

"It is always a tragedy when we lose any Kentuckian to illness," said DPH Commissioner William Hacker, M.D.. "We know that seven of the 10 individuals we have lost in Kentucky are in target groups for the H1N1 vaccine. People in these groups are at higher risk for complications from the swine flu and should get the H1N1 vaccine as soon as it is available in their community. While we don't yet have as much of the swine flu vaccine on hand as we would like, we know more will arrive in the coming weeks."
 

Kentucky has been allocated 177,400 doses of the swine flu vaccine so far, with more than 138,000 doses of that having shipped to health departments and health care providers in the state. 
 

"Kentucky continues to experience widespread flu activity at the moment. I'd like to remind everyone that your mother's advice—washing your hands, covering your cough and staying home when sick—is very effective at preventing the spread of flu," said Dr. Hacker. "The flu vaccine is also one of the most effective tools we have against influenza, and while there are a few clinics already taking place in the state, we hope to begin immunizing more Kentuckians in the weeks ahead. We ask that people find out if they or their family members are in a target group for the H1N1 vaccine, and that we all let those higher-risk individuals get vaccinated first."
 

The state's allotment of vaccine so far has been about half nasal spray vaccine, which can only be taken by healthy individuals ages 2-49, with the rest in the form of the H1N1 flu shot vaccine. The target groups that health officials are recommending receive vaccine first are:
      - pregnant women;
      - people who live with or care for children younger than 6 months old;
      - health care and emergency medical services workers;
      - children and young adults 6 months to 24 years old, especially those with chronic health problems; and
- people 25 to 64 years old with chronic health problems.
 

People over the age of 65 appear to be at lower risk of catching the swine flu, and should receive the vaccine once those in the target groups have received it.
 

Kentuckians can always visit http://healthalerts.ky.gov for information on H1N1 and Kentucky, including updated information about H1N1 vaccine clinics, or follow KYHealthAlerts on Twitter. Kentucky's toll-free influenza hotline number is 1(877)843-7727, and operates from 8 a.m.-10 p.m. daily.        

1023 Children ages 5-18 with underlying medical conditions will receive H1N1 vax as supplies permit [Little Rock, Arkansas]--In order to reach more children with underlying medical conditions and possible risk for complications from H1N1 flu, the Arkansas Department of Health (ADH) will be offering H1N1 vaccine as supplies permit to children ages 5-18 with underlying medical conditions at the Mass Flu Clinics on October 29, 30, 31. We will have seasonal vaccine available for the general public, and, the H1N1 vaccine available for pregnant women and children ages 6 months through 4 years.

Previously scheduled school clinics scheduled through December statewide will continue to give seasonal flu and H1N1 vaccine as supplies allow to students whose parents request the vaccine for their children. Additionally, the ADH will work with public and private schools that have not scheduled a clinic and work towards meeting their needs.

As Arkansas gets more H1N1 vaccine, those doses will continue to be given to priority groups first. Priority groups include pregnant women, children ages 6 months through 24 years, health care workers and emergency medical responders, people caring for infants under 6 months of age, and people ages 25-64 years with underlying health conditions.

If your child is experiencing flu-like symptoms (fever over 100 degrees, headache, body aches, sore throat, dry cough, runny nose, and in some instances vomiting and diarrhea) and especially if they have underlying medical conditions, call your private physician for advice on what to do.

Children with underlying medical conditions include those with: chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, cognitive, neurologic/neuromuscular, hematological or metabolic disorders (including diabetes mellitus); are immunosuppressed (including immunosuppression caused by medications or by human immunodeficiency virus); are receiving long-term aspirin therapy and therefore might be at risk for experiencing Reye syndrome after influenza virus infection; are residents of long-term care facilities.

Vaccine supplies are expected to increase in the coming months, and there will be plenty of vaccine for any Arkansan that would like to receive it.

Additional Mass Flu Clinics will be scheduled at later dates.
For more information go to www.healthyarkansas.com or www.flu.gov .

1023 Mayor Menino urges patience in light of delays in vax delivery [Boston, Massachusetts]--Mayor Thomas M. Menino today urged Boston residents at high risk of getting the 2009 H1N1 virus to be patient in light of anticipated delays in the delivery of the H1N1 vaccine, as he joined public health officials in outlining the city’s vaccination plans once ample supplies of the H1N1 vaccine arrive.

"When we get the H1N1 vaccine, we will move it out as quickly as we can,’’ Mayor Menino said during a visit to a clinic at the Boston Public Health Commission offering free seasonal flu vaccinations. "We will work in partnership with community health centers, hospitals, and primary care providers to ensure that these providers are able to vaccinate their patients, particularly those at high risk.’’

Of the roughly 270,500 doses of the H1N1 vaccine shipped to Massachusetts so far, about 27,000 doses have been distributed to healthcare providers in Boston for pregnant women, children, and health care workers. The Boston Public Health Commission has been told it can expect its first doses - 200 doses of the nasal spray - this week. Those at highest risk for 2009 H1N1 influenza include children 6 months through 24-years old, adults under 65 with underlying health conditions, people in close contact with infants under 6 months, and health care and emergency medical responders.

Dr. Barbara Ferrer, executive director of the Boston Public Health Commission, said that in addition to working with local healthcare providers, the agency’s H1N1 vaccination plan will include a series of free public flu clinics in neighborhoods across the city, once the vaccine is available.

She said the initial doses the Public Health Commission receives will go to front-line public health clinical staff and emergency medical responders who have direct contact with patients. Community health centers will also be assisted if they need additional vaccine for patients at high risk and once there are enough vaccine doses, the Commission will sponsor public health clinics.

"Our promise today is that once vaccine arrives at the Boston health department, we will keep residents informed about where and when they can get vaccinated,’’ Dr. Ferrer said. "And although initial efforts will prioritize vaccinating those at risk of complications from flu or transmitting it to those at high risk, we have been told by the US Centers for Disease Control and Prevention that later in the season, there should be enough doses available to vaccinate all who request H1N1 vaccine.’’

So far this season, the Public Health Commission has vaccinated 30,000 people, significantly more than in previous years. Many more Boston residents have been vaccinated by their primary care provider or at other sites. The Public Health Commission is continuing to provide seasonal vaccine to community health centers for free flu clinics for Boston residents. To find out where they are, visit bphc.org.

1023 Many school H1N1 vax clinics postponed due to limited vaccine supply [Vermont]--The Vermont Department of Health has been notifying a number of schools today that H1N1 vaccine clinics that had been planned to take place next week will be postponed, due to the limited supply of vaccine in the state. Schools that are participating in the vaccination effort will be notifying parents about changes in clinic scheduling.

• Postponed School Clinics
• Scheduled School Clinics

Extensive information, tools and resources about seasonal and pandemic flu, healthy habits and preparedness are available at the Health Department’s website: healthvermont.gov or dial 2-1-1. You can also follow us on Twitter at twitter.com/healthvermont.

1023 DoH continues statewide distribution of H1N1 vax [Pennsylvania]--The Department of Health today announced the Centers for Disease Control and Prevention, or CDC, has allocated more than 566,000 doses of H1N1 vaccine to Pennsylvania. While delays in vaccine production have occurred, the department is placing orders as soon as vaccine is allocated to ensure it reaches Pennsylvania residents as quickly as possible. 

1023 Gov Paterson issues disaster declaration for Essex County and area impacted by Lake Champlain bridge closure [Albany NY]--Governor David A. Paterson today declared a State Disaster Emergency in Essex County and the neighboring areas adversely affected by the emergency closure of the Lake Champlain Bridge. In addition, at the Governor’s direction, the State has established a toll-free hotline for residents and businesses and has opened an outreach center at the site of the bridge.

“The closure of the Lake Champlain Bridge has disrupted the lives of many North Country residents and has affected their businesses,” Governor Paterson said. “I am firmly committed to protecting the safety of those who drive across the bridge daily. With this disaster declaration, we are working to expedite repairs and to provide the highest level of assistance possible to the community.

“I have directed the New York State Department of Transportation (NYSDOT) to expedite the repair of the bridge to re-open it to traffic and to work with Vermont to put alternative transportation in place while the bridge is closed. In addition I have directed NYSDOT to work with Vermont and the federal government to expedite the study and design of a permanent solution,” the Governor continued. “In the meantime, I have directed State agencies to provide assistance to those affected by the closure.”

The toll-free hotline number - 1-888-769-7243 - will be open Monday through Friday from 9 a.m. to 5 p.m. Those calling from the 518 area code may dial 518-485-1159. The State outreach center is located in the Lake Champlain Visitors Center at 814 Bridge Rd. in Crown Point.

Representatives from the Governor’s Office and State agencies remain on site to assist the community in dealing with the closure. For information about State assistance, residents may call the hotline or visit the outreach center. In addition, callers may contact the hotline to provide the State with information about the impact of the bridge closure on their lives. This information will be immensely helpful as the State moves forward in assessing the magnitude of the disruption caused by the closure, determining what temporary and remedial actions can be taken to assist the community and seeking federal assistance to mitigate the impact.

On Monday, State officials met with local leaders at the Crown Point Historic Site to discuss the closure and the impact the lengthy detour would have on commuters, the farming community, businesses, emergency service providers and the general public. Representatives from the Governor’s Office, NYSDOT, State Police, Department of Labor, Department of Health, Empire State Development Corporation, Office of Fire Prevention and Control, Department of Agriculture and Markets and the State Emergency Management Office attended the meeting.

The Lake Champlain Bridge, also known as the Crown Point Bridge, spans the lake between Crown Point, New York, and Chimney Point, Vermont. On Friday, NYSDOT and the Vermont Agency of Transportation decided to close it indefinitely after finding problems with the foundation. The emergency closure was necessary for the safety of those who use the bridge.

NYSDOT is designing repairs and developing a timeline for re-opening. A signed detour is in place that will divert motorists on U.S. Route 4 through Whitehall, New York, and on Vermont Route 22A and 17, a distance of about 100 miles.

1023 New Castle County death of 15-year-old boy examined for H1N1 [Delaware]--Following notification today, Delaware’s Division of Public Health (DPH) is reviewing the Oct. 19 death of a 15-year-old New Castle County boy to determine if the cause of death is related to H1N1 influenza.

The boy, who had a number of underlying health conditions, went to his doctor on Oct. 19 and was later transported to a Delaware hospital where initial testing for strep infection was positive and influenza was negative. Post-mortem test results Friday were positive for H1N1 influenza and the death will be reported to the CDC as H1N1-related since flu was present.

• Get vaccinated against both H1N1 and seasonal flu.
• Wash your hands frequently with soap and warm water or use an alcohol-based hand sanitizer.
• Cover your cough/sneeze with a tissue, or cough/sneeze into your inner elbow and not into your hands.
• If you are sick, stay home for at least 24 hours after your fever goes away. This means no fever for at least 24 hours after you have stopped taking any fever-reducing medication. Employers are encouraged to be flexible with their employees on the issue of staying home when ill.

1023 SOGC recommends that all pregnant women over 20 weeks gestation receive the H1N1 vax immediately [Ottawa ON]--After discussion with the Public Health Agency of Canada, and based on the evidence for other adjuvanted vaccines as well as experience around the world to date with the adjuvanted H1N1 vaccine, Canadian experts say that both the adjuvanted and non-adjuvanted H1N1 vaccines are safe for pregnant women.

Earlier this week in Ottawa, Health Minister Hon. Leona Aglukkaq announced the approval of the adjuvanted H1N1 vaccine which has been judged to be both safe and effective. Provinces and territories will start rolling out their vaccination programs in a matter of days.

An adjuvant is a substance that helps stimulate the body's immune response; it helps boost and speed up the body's ability to fight a virus. It is a natural product made of fish oil, water and vitamin E. While it is the first time these substances are being used in an influenza vaccine, these adjuvants have been used in other vaccines for decades. Countries around the world are stating that both types of H1N1 vaccine are safe, even for pregnant women.

"Women should be provided with the option to receive either H1N1 vaccine based on facts, not fear about safety. More important than the decision about which H1N1 vaccine a pregnant woman should take is the decision to get vaccinated, regardless of the vaccine type selected," said Dr. Michel Fortier, President of the Society of Obstetricians and Gynaecologists of Canada.

Considerations for pregnant women when it comes to which H1N1 vaccine to
choose are:

- The amount of viral inoculate required to protect an individual: The
adjuvanted vaccine includes 4 times less viral material than the non-
adjuvanted vaccine.
- The number of doses required to achieve immunity: One single dose of
the adjuvanted vaccine and possibly multiple doses of the non-
adjuvanted vaccine.
- The potential for cross-protection against mutations of the virus:
The adjuvanted vaccine has a greater likelihood for cross-protection
against mutations.

Safety

The adjuvant used by GSK has been tested in approximately 45,000 people around the world and has been evaluated by Health Canada and other regulatory authorities as part of the review of the H5N1 vaccine in the pre-pandemic period. No significant safety concerns regarding the use of the adjuvanted vaccine were detected.

In June 2009, the World Health Organization (WHO) held consultations on the safety of adjuvanted influenza vaccines to review and discuss known and theoretical safety concerns and prospective vaccine safety evaluation. The outcome - no significant safety concerns or barriers to evaluating or using adjuvanted vaccines for the current H1N1 virus were raised.

All evidence suggests that adjuvanted vaccines are just as safe as non-adjuvanted vaccines. The WHO's Strategic Advisory Group of Experts (SAGE) recommended in July that pregnant women should receive non-adjuvanted vaccine where possible, but that an adjuvanted vaccine could be used if necessary.

Dr. Butler-Jones stated that "vaccination is truly the best defence for mother and baby from the potentially devastating effects of the H1N1 virus. The perceived risks associated with either H1N1 vaccine are clearly outweighed by the expected benefits of receiving the vaccine."

SOGC Recommendations for Pregnant Women

Vaccination

The SOGC recommends that all pregnant women over 20 weeks gestation and those less than 20 weeks with underlying risk conditions be vaccinated against H1N1 as soon as a vaccine is available, whether or not it includes an adjuvant. In areas where H1N1 flu rates are high or increasing, health-care providers should offer immediate vaccination with adjuvanted vaccines and not wait for non-adjuvanted vaccines which may only be available in November.

Antiviral Prescriptions

The SOGC recommends that each pregnant woman be given a prescription to be used only if H1N1 symptoms appear. Antivirals should not be used for prophylaxis. Women and their families should be aware of serious symptoms of H1N1, leading patients to seek emergency care.

Posters, Information Tear-Out Sheets

Public information materials about H1N1 and pregnancy have been produced and will be mailed to health-care providers this week. If by the end of next week, information materials have not yet been received, providers are invited to notify the SOGC.

Leading by Example

The SOGC recommends that health-care providers, family members, and office staff get immunized as soon as possible. Dr. Michel Fortier (SOGC President), Dr. André Lalonde (SOGC Executive Vice-President), and Dr. Vyta Senikas (SOGC Associate Executive Vice-President) plan on receiving the H1N1 vaccine in the next few days.

1023 Début de la campagne de vaccination volontaire contre le virus de la grippe A(H1N1) dans la région de l'Outaouais [Gatineau QC]--Réunis en conférence de presse aujourd'hui, les représentants de l'Organisation régionale de sécurité civile (ORSC) et de l'Agence de la santé et des services sociaux de l'Outaouais ont présenté les actions actuellement en cours pour lutter contre la pandémie de grippe A(H1N1), de même que l'information générale sur l'importante campagne de vaccination qui se déploiera progressivement dans la région à partir du 26 octobre prochain.

Les cinq centres de santé et de services sociaux, soit le CSSS du Pontiac, le CSSS de la Vallée de la Gatineau, le CSSS des Collines, le CSSS de Papineau et le CSSS de Gatineau, vont amorcer progressivement, à compter du lundi 26 octobre, la vaccination des travailleurs de la santé.

Par la suite, les personnes du groupe 1 seront invitées, par leur CSSS, à se faire vacciner. Les informations seront disponibles au fur et à mesure dans les médias locaux et dans le site de Pandémie Québec. Les personnes du groupe 1 sont les suivantes :

- Les personnes atteintes d'états chroniques âgées de moins de 65 ans;
- Les femmes enceintes;
- Les enfants âgés de 6 mois jusqu'à moins de 5 ans;
- Les personnes qui résident dans des localités ou des communautés
éloignées et isolées;
- Les personnes qui résident avec des personnes à risque élevé qui
pourraient ne pas bien répondre au vaccin (les personnes
immunocompromises) ou les personnes qui ne peuvent pas être vaccinées
(nourrissons âgés de moins de 6 mois).

En ce qui concerne le groupe 2, soit les 5 ans et plus, c'est au cours du mois de novembre que des centres de vaccination de masse seront déployés au fur et à mesure de la disponibilité des vaccins. La directrice de la Santé publique de l'Outaouais, la Dre Hélène Dupont, encourage fortement toute la population à se faire vacciner puisqu'il s'agit de la meilleure protection contre la grippe A(H1N1) : "Le virus a recommencé à circuler dans la région de l'Outaouais et en attendant de se faire vacciner, il est d'autant plus important d'appliquer les mesures d'hygiène comme le lavage régulier des mains pour en limiter sa propagation", a soutenu la Dre Dupont.

Le président directeur de l'Agence de la santé et des services sociaux, le Dr Guy Morissette, a souligné les efforts de tout le réseau régional pour l'organisation de cette campagne de vaccination : "Nous sommes confiants en notre capacité d'unir nos forces et d'offrir les soins nécessaires à la population pour faire face à la deuxième vague de la pandémie de grippe A(H1N1)."

L'ORSC de l'Outaouais, composée des ministères et des organismes du gouvernement du Québec présents dans la région, multiplie ses efforts afin d'épauler les autorités régionales de la santé dans la présente opération de vaccination : "La mobilisation de tous est essentielle dans la lutte au virus H1N1. J'assure les docteurs Dupont et Morissette de l'entière collaboration des membres de l'ORSC de l'Outaouais tout au long de la présente campagne de vaccination, mais aussi dans chacune des actions entreprises pour contrer la grippe A(H1N1)", a déclaré la coordonnatrice régionale de l'ORSC, Mme Diane Barbeau.

Il est possible d'obtenir toute l'information en lien avec la vaccination et les mesures d'hygiène dans le site www.pandemiequebec.gouv.qc.ca. Les détails sur la tenue des cliniques de vaccination (dates, lieux, horaires) seront disponibles, dès le 24 octobre, dans la section "Dans ma région - Outaouais" du site Internet et par téléphone, en communiquant avec Services Québec, au numéro sans frais 1 877 644-4545. Pour toute question relative à la santé, il faut cependant contacter Info-Santé au 811.

1023 Students continue to learn about H1N1 prevention at schools [Saskatchewan]--Deputy Premier and Education Minister Ken Krawetz talked with young students today during Education Week to reinforce how they can protect themselves and others from influenza and H1N1.

Where can I get more information?
http://www.health.gov.sk.ca/influenza-monitor

For information regarding the Saskatchewan School Boards Association (SSBA) - A Guide for School Board Pandemic Influenza Preparedness visit
http://www.saskschoolboards.ca/insurance/riskmanagement/08-07.pdf

For information regarding Regina Catholic Schools and their flu information, see http://www.rcsd.ca/

1023 Everyone encouraged to get vax'd [Prince Edward Island]--H1N1 Vaccine Clinics are scheduled to begin on Monday and Chief Health Officer, Dr. Heather Morrison is encouraging everyone to get vaccinated in the coming weeks to protect themselves and their families.

“Similar to other provinces across the country, we are seeing an increase in Influenza Like Illness (ILI) in Prince Edward Island,” said Dr. Morrison. “During the past week specifically, we have noticed that surveillance data for the province is showing an increase in the amount of ILI activity here in PEI. We know that immunization is one of the most effective ways to prevent the spread of infectious disease and we’re hoping that people will decide to get vaccinated over the coming weeks.”

As part of ongoing surveillance efforts, the Chief Health Office collects information from various sources across the province to get an overall picture of how much flu activity is happening in the community. This includes collecting information from the provincial laboratory, hospitals, pharmacies, schools and early learning centres, and sentinel physicians and tracking calls to the toll-free information line.

“Based on surveillance information to date, including the number of confirmed H1N1 cases, we have seen a recent increase in influenza-like activity on PEI,” said Dr. Carolyn Sanford, Provincial Epidemiologist for the Department of Health.“The information we collect is analyzed and interpreted to assist in informing health officials as to how much influenza activity is happening locally, nationally and internationally.” Dr. Sanford works in the Epidemiology Unit of the Department of Health, which is primarily responsible for surveillance of both communicable and chronic disease.

In addition, national information is collected through participation in Federal Provincial and Territorial groups and through surveillance programs by the Public Health Agency of Canada, such as Fluwatch, which is a program designed to inform health professionals on how much flu activity is happening on a national level. The Chief Health Office monitors international data on influenza activity as well.

Clinics will begin on Monday for those who would benefit most from the vaccine as well as those who care for them. The program will be rolled out over the next four to six weeks and the schedule is based on the recommendations of the Public Health Agency of Canada.

The vaccine will be delivered by Public Health Nurses and others at no cost, at various sites across the province, including Public Health Nursing clinics, schools, health centres, correctional facilities and healthcare facilities. For a complete list of the times and locations of upcoming clinics, watch the newspaper, visit www.gov.pe.ca/flu or call 1-888-748-5454 for further information.

1023 Tamiflu to be available free of charge with prescription [New Brunswick]--H1N1 flu vaccination clinics will open in New Brunswick on Monday, Oct. 26, following Health Canada's approval of AREPANRIX, a vaccine against the pandemic H1N1 flu virus. Dr. Eilish Cleary, chief medical officer of health, made the announcement today.

Clinic listings will be posted online at www.gnb.ca/flu or be available by calling 1-800-580-0038.

For more information on the pandemic H1N1 flu vaccine, visit www.gnb.ca/flu.

1023 Plans for H1N1 flu clinics being finalized with launch next week [Manitoba]--Manitoba Health and Healthy Living has released the list of Manitobans who would benefit the most from getting the H1N1 flu shot and has confirmed the province’s regional health authorities will begin delivering H1N1 immunizations the week of Oct. 26.

The H1N1 flu shot is expected to help protect Manitobans against the new pandemic strain of the flu now in circulation. Manitobans are strongly encouraged to get the H1N1 flu shot at no charge at flu clinics run by their regional health authorities.

Plans for the flu clinics are now being finalized by regional health authorities (RHAs). RHAs will have the most current information about flu clinics and vaccine delivery in their areas.

The vaccine is expected to arrive in batches and the early clinics will be for Manitobans who should get the shot first. Once these Manitobans are immunized over the course of a few weeks, the H1N1 flu shot will be made available to every Manitoban who needs or wants to be vaccinated and will benefit from vaccination.

Manitobans who should get the H1N1 flu shot first include:
· children aged six months to under five years old;
· anyone of Aboriginal ancestry (First Nations, Métis or Inuit);
· disadvantaged individuals (for example, the homeless);
· people living in remote or isolated areas;
· people under 65 with a chronic medical condition or other risks including severe obesity, substance abuse or alcoholism;
· anyone with a weakened immune system or those who live with or care for them;
· those who live with or care for infants under six months old;
· single parents or anyone solely responsible for a dependent;
· health-care workers and medical first responders; and
· pregnant women

In November, an unadjuvanted shot recommended for pregnant women will be available. Women who are pregnant can wait until that shot arrives or they can talk to their health-care provider about the pros and cons of getting the adjuvanted vaccine sooner.

It is recommended that children between the ages of six months and nine years receive two half‑doses of the shot with 21 days between the first and second shot.

Manitoba expects to have 134,000 vaccine doses the week of Oct. 26 and subsequent deliveries of vaccine will continue weekly.

Manitoba’s priority groups are based on national recommendations and have been tailored to address the province’s conditions and experiences with H1N1 flu so far.

As more vaccine arrives, the H1N1 shot will be offered at flu shot clinics to other Manitobans who need or want it and are expected to benefit from it. Later, it may also be available from family doctors and other health-care providers.

The H1N1 flu shot will be available for all adults and children five years of age or older who need or want it and are expected to benefit from it, once additional batches of vaccine arrive. All employers are encouraged to identify people who provide services that are critical to meeting the necessities of life and support the daily operation of Manitoba communities, particularly where there are limited numbers of people who can perform those jobs if someone becomes ill. People who work directly with swine and poultry should also be vaccinated once additional batches arrive because this can help limit the spread of illness in these animals. Individuals in these groups are encouraged to get an H1N1 flu shot early.

The H1N1 flu vaccine is not licensed for infants under six months of age. People who are allergic to eggs or other influenza vaccine components should not be vaccinated. The H1N1 vaccine is also not recommended for anyone who has had a lab-confirmed diagnosis of H1N1 flu.

During the H1N1 flu clinics, Manitobans who are eligible for the seasonal flu shot may be offered both flu shots if they have not yet received their seasonal shot this year. Both flu shots have been designed to provide protection against the known flu viruses expected to be circulating in Manitoba this year. Manitobans aged 65 and older should also get a pneumococcal shot at the same time as the seasonal flu shot unless they have had a pneumococcal shot in the past. Most adults only need one pneumococcal shot in their lifetime.

Health Canada has assessed available data on the safety, quality and effectiveness of the H1N1 vaccine and concluded the benefit-to-risk profile is favourable for active immunization against the H1N1 in an officially declared pandemic situation. As part of the authorization, the manufacturer will be required to continue submitting data on the safety and effectiveness of the vaccine. This approach is similar to that used in other countries.

For more information about H1N1 or to find links to flu shot clinics operated by regional health authorities, visit www.manitoba.ca.

1023 Province sends first shipment of 700,000 doses of H1N1 vax to health units [Ontario]--Ontario has shipped 700,000 doses of H1N1 flu vaccine to the province's public health units since October 21 in order to allow immunization clinics to begin next week.

Beginning the week of Oct. 26, H1N1 flu vaccine will be offered to all Ontarians that need and want it, starting with:

* People under 65 with chronic conditions;
* Pregnant women;
* Healthy children 6 months to under five years of age;
* People living in remote or isolated communities;
* Health care workers; and
* Household contacts and care providers of persons at high risk who cannot be immunized or may not respond to vaccines.

All pregnant women with pre-existing health conditions and healthy pregnant women in the second half of their pregnancy (more than 20 weeks) should speak to their health care provider about receiving the adjuvanted vaccine. Healthy pregnant women in the first half of their pregnancy are at less risk of complications from the flu, and should wait to receive the unadjuvanted vaccine, when it is available. Ontario has developed a fact sheet for pregnant women that will be available on the ministry website.

On October 21, Health Canada approved the use of the H1N1 flu vaccine.

A province-wide advertising campaign will be launched next week to remind people of the importance of getting the H1N1 flu vaccine. The campaign features Chief Medical Officer of Health Dr. Arlene King and includes print, radio and online ads.

1023 Persons at risk for complications and healthcare workers - H1N1 vax to be offered beginning Oct 26 [Quebec]--“Given the onset of a second wave of outbreaks in the influenza A(H1N1) pandemic, in the coming days, the Gouvernement du Québec will launch a far-reaching public vaccination campaign,” announced Minister of Health and Social Services Dr. Yves Bolduc in a joint press briefing with the Direction nationale de la santé publique and the Organisation de la sécurité civile du Québec (OSCQ).

Vaccination against the influenza A(H1N1) virus will begin Monday, October 26 and initially target persons at risk for complications and health-care workers. Once this first phase has been completed, the entire population will be summoned to vaccination centres throughout Québec.

“This will be the most widespread vaccination campaign in Québec history. We will join the rest of the world in fighting the influenza A(H1N1) pandemic”, declared Dr. Bolduc.

National Public Health Director Dr. Alain Poirier encouraged the public to get vaccinated according to the proposed sequence because vaccination is currently the most effective means of protection against influenza A(H1N1).

The Gouvernement du Québec has more than 400 000 doses of the vaccine, which has just been validated by the federal government. In the coming weeks, Québec will receive more doses to meet the population’s vaccination needs. The vaccine will be offered free of charge and on a voluntary basis. Vaccination procedures and locations will vary, reflecting the specific characteristics of each region.

Government Civil Safety Coordinator Michel C. Doré joined Dr. Poirier in encouraging the public to get vaccinated: “The fight against the virus will inevitably require Quebeckers’ involvement. Mass vaccination remains one of the best means of uniting to meet the pandemic head on, thereby minimizing its potential consequences for Québec society. In addition to providing individual protection, vaccination constitutes respect and solidarity with those around us, since it limits the virus’ spread.”

To this end, all OSCQ and ORSC member departments and agencies have stepped up their efforts to support health authorities in this major influenza A(H1N1)vaccination operation.

In the coming days, health and social services agencies will release vaccination-related details for their territories. Beginning Saturday, October 24, information on the next steps in the vaccination procedure (dates, locations, times) will be available in the “In my region” section of the www.pandemiequebec.gouv.qc.ca  website, which will be updated on a daily basis as the situation evolves, and repeated in local newspapers.

Necessary information can also be obtained by calling Services Québec, 644-4545, available in area codes 418 and 514 and, toll-free, under 1 877. To underpin these communications efforts, an information campaign (TV, Internet, radio) will run in November.

“Much is being said about influenza A(H1N1). Because the media and the Internet give all kinds of information, the government has activated the website www.pandemiequebec.gouv.qc.ca and set up a toll-free phone line to inform the public about influenza A(H1N1) prevention, symptoms and protection measures. Making sure you get the most recent information available is also your responsibility”, said Minister Bolduc.

1023 KDHE announces additional H1N1-related death [Kansas]--The ninth death in Kansas of a person infected with the pandemic H1N1 influenza virus has been confirmed by state public health officials.

The death occurred in a 62 year-old man from northeast Kansas who had underlying health conditions that put him at greater risk for serious complications from the virus. The H1N1 virus was determined to be a contributing factor in the man’s death. Laboratory testing conducted yesterday confirmed that the man had the H1N1 virus.

KDHE Secretary Roderick Bremby and Dr. Jason Eberhart-Phillips, Kansas State Health Officer, expressed sympathy and offered their deepest condolences to the man’s family.

“This death reminds us that this virus can be extremely severe for people with underlying health conditions,” Dr. Eberhart-Phillips said. “As more vaccine becomes available across the state we hope everyone who is able will choose to get vaccinated. Until that time, it is very important that people take seriously the potential dangers of the disease and recognize the importance of working towards preventing its further spread.”

The national Advisory Committee on Immunization Practices (ACIP) has recommended that certain people who are at greater risk from H1N1 flu receive the vaccine earlier than others, as the amount of H1N1 vaccine is currently very limited. Those who should receive the vaccine first include pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons 6 months through 24 years of age, and people ages of 25 through 64 years of age who are at higher risk for H1N1 flu because of chronic health disorders or compromised immune systems.

KDHE has established a phone number for concerned Kansans to call with questions about the 2009 H1N1 influenza A virus. The toll-free number is 1-877-427-7317. Operators will be available to answer questions from 8 a.m. – 5 p.m. Monday through Friday. Persons calling will be directed to press “1” on their touch-tone phone to be directed to an operator who can answer questions.

Kansans with questions about the virus can email H1N1fluinfo@kdheks.gov.  Information is also available from KDHE at www.kdheks.gov.

1022 Limited availability of flu vax - Focus on the highest priority groups immediately [Maine]--Vaccine has begun to arrive in Maine and is slowly becoming available. Approximately 21,800 doses of H1N1 vaccine arrived this week, both injectable and nasal spray. This additional supply should bring the total to about 55,500 doses in the state, which are being shipped to registered health care providers immediately.

State CDC estimates that Maine will receive about 340,000 doses of various formulations of H1N1 vaccine by early December (although this estimate could change). There are approximately 700,000 people in Maine who are in the high priority groups for receiving vaccine, out of about 1.3 million people total. The state will eventually receive enough vaccine to be able to offer it to all Mainers who want it.

In the meantime, it is important that the vaccine be focused on those in the highest priority groups: pregnant women; household members and caregivers of infants less than six months old; children ages six months to 25 years; people ages 25-65 with severe underlying conditions, especially respiratory and neurodevelopmental conditions; and health care workers, especially those with
frequent direct contact with patients and infectious material who work in hospital emergency departments, pediatric, labor/delivery, and intensive care units.

This list means that many people who work in health care settings, first responders, and even those administrating vaccine at this point in time will not be vaccinated. Over the next few weeks, this will change, but it is very important to focus the limited vaccine supplies on where it will be most effective, and that is
primarily protecting pregnant women as well as children who are both disproportionately affected by novel H1N1 and are also major transmitters of influenza to others.

The highest priority populations for H1N1 vaccine are children and pregnant women. We are asking that health care providers receiving shipments of this vaccine make sure it is immediately available to schools if they are serving as a distribution site for schools, and that in general, pregnant women and children be prioritized. About 90% of the H1N1 vaccine supply arriving in Maine these first few weeks should be directed to pregnant women and children. We encourage pediatric providers to collaborate with other practitioners who see relatively few pre-schoolers to ensure access to vaccine.

Because supplies are limited and 40% of the vaccine that is currently available is the nasal spray form that is contraindicated for pregnant women, children under two, and people with health conditions, it is possible that there will not be sufficient supplies of vaccine for even the highest priority people until December.

Maine CDC is providing vaccine to obstetrical health care providers for pregnant women; to pediatric providers for very young and some high-risk children; and the majority of vaccine is going to schools.

Several school districts are starting their vaccine clinics for H1N1 on October 26. They include some schools in Portland, Lewiston, and the Augusta area. Some of these clinics are listed on the clinic locator at www.maineflu.gov.

While waiting for your H1N1 vaccine, the best precautions you can take are to avoid close contact with those who are ill and to frequently wash or sanitize your hands.

1022 Flu activity widespread - H1N1 confirmed in all regions [Vermont]--The Vermont Department of Health has confirmed cases of H1N1 influenza in all regions of the state, and increased levels of influenza-like illness are being reported in most regions.  

Extensive information, tools and resources about seasonal and pandemic flu, healthy habits and preparedness are available at the Health Department’s website: healthvermont.gov or dial 2-1-1. You can also follow us on Twitter at twitter.com/healthvermont.

1022 DHHS takes steps to limit H1N1 spread at state facilities [North Carolina]--State-operated hospitals, residential schools, developmental disability centers, neuro-medical treatment centers and alcohol and drug treatment centers have already implemented plans to limit the potential spread of H1N1 flu at their facilities as North Carolina prepares for the fall flu season.

“I am confident that we have taken the wise and appropriate measures to prepare as best we can to protect the health and well-being of our patients, residents and employees,” Welsh added.  “We will continue to be vigilant. We will notify the media immediately for changes in visitation status as a means of letting families and others know if they will be able to visit residents or patients. We also plan to use the state’s facilities website as a rapid means of posting information concerning flu, breaking news or other information a person may need to know about the status at one of our hospitals, developmental centers, residential schools or substance abuse treatment centers or neuro-medical treatment centers.”

1022 Rumor control: Letter concerning H1N1 vax and prison inmates [Massachusetts]--October 19, 2009

Dear Colleague, 

Commissioner

1022 State reports first H1N1-related death [Delaware]--Delaware's Division of Public Health (DPH) has learned of the first H1N1- related death in the 2009 season, a 35 year old female from Kent County who died this morning. The individual had a number of underlying health conditions and had been hospitalized on October 12 in Delaware but was later transferred to a Maryland hospital.

"We are sad to have learned of this, the first H1N1-related death of a Delaware resident. This news is a reminder that while in many cases the flu can be mild, in some cases the flu can be serious, even life threatening. Our heartfelt sympathy is with the family and friends of this individual, " said Dr. Karyl Rattay, DPH director.

1022 National H1N1 vax supply not adequate enough to meet public demand [Texas]--Texas continues to order its full allocation of H1N1 vaccine, but the national supply still isn't adequate to meet the public demand.

“We know that the best way for people to protect themselves from the flu is to get the vaccine, but the national supply is still very low,” said Dr. David Lakey, Texas Department of State Health Services commissioner.

Texas had expected to receive 3.4 million doses of the vaccine by mid-October, according to the initial projections from the U.S. Centers for Disease Control and Prevention (CDC). However, the state has received less than 1 million doses so far.

The CDC allocates the vaccine to states based on population and tells states each week how much vaccine is available for them to order. As of today, the state has ordered about one million doses allocated to the state and provided the CDC with information on where to ship those doses. The vaccine is still in the process of being shipped out.

“Given the limited national supply at this point, we want to make sure we use our first shipments to protect those at highest risk of complications from the flu – pregnant women and children,” Dr. Lakey said.

About 12,000 doctors and other health care providers have signed up to provide the vaccine in Texas. The state directed the first shipments to 5,000 providers who serve primarily pregnant women, children and health care workers who provide patient care.

Dr. Lakey said the state hopes to receive 15 million doses of the H1N1 vaccine by mid-January, assuming that production meets initial projections.

“Vaccine will be available to the general public as soon as production catches up with the demand,” he said. “The process is driven by the manufacturers' capacity.”

1022 Culebra Meat Market recalling certain beef products for E.coli 0157:H7 [San Antonio, Texas]--Culebra Meat Market is recalling three beef cuts it produced and distributed in the San Antonio area earlier this month because of possible contamination with E. coli O157:H7, a bacterium that can cause severe illness.

Products included in the recall are beef stew meat, carne asada and ground beef produced by the company from Oct. 2 through Oct. 17. Products were sold to some San Antonio-area restaurants and in the company's retail store, 2800 Culebra Road in San Antonio.

The Texas Department of State Health Services is investigating whether the products also were sold at other Culebra retail store locations in San Antonio.

People are advised to discard or return the products. Cooking the beef is not recommended.

Products sold to consumers at the company's retail store were packaged in various weights and wrapped in white butcher paper with no markings. Products sold to restaurants were packed in 10-pound boxes labeled with the company and product names and lot codes 100209 through 101709. The boxes have the inspection label “TEXAS INSP. & PSD. 740” located inside an outline of the state of Texas.

The recall volume is approximately 4,000 pounds.

DSHS laboratory testing detected E. coli O157:H7 in samples collected from the meat company. The testing was done as part of a routine DSHS inspection.

DSHS is not aware of any illnesses associated with the recalled product.

Symptoms of E. coli O157:H7 illness include bloody diarrhea and stomach pains. People with these symptoms should seek medical attention immediately. Symptoms typically occur two to nine days after exposure.

Infection can lead to serious kidney damage or death. Most healthy adults recover in five to 10 days, but children under age 5 and the elderly are more likely to develop a severe illness.

Infected people can pass E. coli O157:H7 to others through contaminated feces.

More information is available from the company by calling 210-432-2170.

1022 Response to new FluLine service is “very heavy” - efforts underway to expand system [Minnesota]--Officials at the Minnesota Department of Health (MDH) report that the response to their new phone-based service for people with flu symptoms has been “very heavy.”

The number for the Minnesota FluLine is 1-866-259-4655.

1022 State records three more deaths associated with H1N1 novel influenza [Minnesota]--Three more Minnesota residents have died from complications due to infection with the H1N1 novel influenza virus, the Minnesota Department of Health (MDH) reported today. They were a Martin County woman in her early sixties, a Steele County child and a Freeborn County child, both under 7 years of age. All died within the last two weeks and all had underlying health conditions. These cases bring to 10 the total Minnesota deaths related to the H1N1 outbreak since last April.

The department has been awaiting medical confirmation on the causes of the deaths before announcing them.

“We are sad to report these deaths and we extend our sympathies to the families and loved ones,” said Dr. Sanne Magnan, Minnesota Commissioner of Health.

To date, MDH has received reports of 611 hospitalized cases of confirmed H1N1 novel influenza in Minnesota. In addition, 230 schools reported last week to MDH that they had either five percent of their student body absent or three students in an elementary school classroom absent due to flu-like illness.

“We continue to follow this pandemic closely, and although we are seeing widespread infection due to H1N1 influenza, we are not seeing a change in the severity of the disease. Most people recover without complications, but unfortunately some people, particularly those who are pregnant, those who are very young or elderly, or those who have underlying medical conditions, are at risk for more severe illness or complications,” said Dr. Ruth Lynfield, state epidemiologist for MDH. “This is why we urge people to help stop the spread of this virus by staying home when they are sick and covering their coughs and washing their hands and by getting vaccinated.”

Getting vaccinated is the best protection against the virus. While the vaccine for H1N1 is not yet available for the general public, it is being provided to health care workers and some of the very highest risk pediatric patients and pregnant women. Priority groups will then include the remaining children and adults under 25 years, and those under 65 who have certain medical conditions; and following these groups anyone else who wishes vaccination. Vaccine shipments are expected to continue over the coming months.

Until vaccine is more widely available, it is important for people to continue to take steps to protect themselves and reduce the spread of influenza:
 

• Stay home from work or school – and generally avoid going out in public – if you are sick. Remain home until 24 hours after your symptoms resolve without the aid of fever-reducing medications.
• If you are an employer, encourage your employees to stay home if they are sick.
• Limit your contact with others who may be ill.
• Cover your nose and mouth with your sleeve when you cough or sneeze.
• Clean your hands frequently and thoroughly with soap and water or an alcohol-based hand sanitizer.
• Clean your hands after shaking hands or having other close contact with other people, before eating or preparing food, or touching your eyes, nose or mouth.
• Make sure to take enough fluids while you’re sick.
• If you develop possible flu symptoms and you want to consult your health care provider, call before going in for an office visit. You may not need to go in, and if you do need to be seen, a time should be set up when you will not risk exposing others to influenza in the waiting room.
• People at risk for severe flu or flu complications should contact their health care provider promptly if they develop flu symptoms or have been closely exposed to people with flu symptoms to determine whether they should receive antiviral medication.
• People who develop severe symptoms or who develop new symptoms after initial improvement should seek medical care without delay.
• Get vaccinated for both seasonal and H1N1 novel influenza as soon as vaccine becomes available for you.
• If you do have flu symptoms and want to speak with a nurse about your illness, call your health care provider or the Minnesota FluLine at 866-259-4655.

1022 FluLine to offer support and treatment options for people with possible symptoms of influenza [Minnesota]--A new phone-based service is now available for Minnesotans who think they may have the flu.

People who need information about the flu, but do not have symptoms, are encouraged to visit the flu information page on the MDH Web site at www.mdhflu.com. The Web site offers a wide range of information and resources, including an interactive flu shot clinic finder.

1022 Anticipated supplies of H1N1 vax slow to arrive [Arkansas]--Anticipated supplies of the H1N1 Influenza A (Swine Flu) vaccine have been arriving in the state but in limited quantities, according to public health officials.

James Phillips, M.D., Branch Chief, Infectious Disease at the Arkansas Department of Health (ADH) said, “We would like to be ready to vaccinate everyone who wants to get the vaccine at next week’s mass seasonal flu clinics, but right now we don’t see how that can happen.

"We are requesting the maximum amount of vaccine doses that we can order each week, but supplies are limited.

"At the Mass Flu Clinics on October 29, 30, 31, we will have seasonal vaccine available for the general public; however, the H1N1 vaccine will be available only for pregnant women and children ages 6 months to 4 years until supplies run out.”

Previously scheduled school clinics statewide will continue to give seasonal flu and H1N1 vaccine as supplies allow to students whose parents request the vaccine for their children.

As Arkansas gets more H1N1 vaccine, those doses will continue to be given to priority groups first. These include pregnant women, children ages 6 months to 24 years, health care workers and emergency medical responders, people caring for infants under 6 months of age, and people ages 25-64 years with underlying health conditions (like asthma and diabetes).

The ADH expects to eventually receive enough H1N1 vaccine for any Arkansan that would like to receive vaccine. It is important that every Arkansan get both the seasonal and H1N1 flu vaccine during this flu season. Additional Mass Flu Clinics will be scheduled at later dates.

Flu is a sickness that infects the nose, throat and lungs and is caused by the influenza virus. If you’re young and healthy, the flu vaccine may be 70 to 90 percent effective in preventing illness.

Children less than 9 years who have never received a seasonal flu shot before will need a second seasonal flu shot for full protection. Children less than 10 years will also need to receive a second H1N1 shot. Parents will need to contact a local ADH health unit or health care provider, see if vaccine is available and take their children in for a second shot 4 weeks after the first shot.

The 2009 H1N1 vaccine is produced in the same manner as regular seasonal flu in the same manufacturing plants. The H1N1 vaccine simply contains a different strain of influenza virus. Reactions to all flu vaccines might include a mild soreness and redness near the site of the shot and perhaps a little fever or slight headache. The flu shot cannot give you the flu.

Persons who should not receive influenza vaccine for health reasons are: persons with a severe allergy (i.e. anaphylactic allergic reaction) to hens’ eggs and persons who previously had onset of Guillain-Barre syndrome.

1022 Public health director warns of potentially contaminated baby food - Plum Organics recalling Apple & Carrot Portable Pouch baby food [Illinois]--Dr. Damon T. Arnold, Director of the Illinois Department of Public Health (IDPH), is urging parents to check their pantry shelves for packets of 4.22-ounce Apple & Carrot Portable Pouch baby food made by Plum Organics and sold individually at Toys-R-Us and Babies-R-Us locations nationally.

Consumers who have purchased the Plum Organics Apple & Carrot pouch-based baby food with a “best by” date of May 21, 2010 and with the UPC #890180001221, can return the product for a full refund at any Toys-R-Us or Babies-R-Us store. Consumers with questions can call Plum Organics at 888-974-3555 between 8 a.m. - 5 p.m. PST or e-mail info@plumorganics.com.

1022 State's 211 'clinic finder' connects public to flu shot clinics statewide [Wisconsin]--Looking for a flu shot clinic? Finding a location in your area is as easy as picking up the phone and dialing "2-1-1." Calling 2-1-1 is a free and confidential service in all 72 Wisconsin counties. Translators are available.

In addition, 2-1-1 Wisconsin has broadened its call services to include a “clinic finder,” which is available online at http://pandemic.wisconsin.gov or www.wisconsinfluclinic.info. You can search by zip code for either seasonal or H1N1 flu clinics nearest you.

Health care providers and other organizations across Wisconsin are calling 2-1-1 and providing detailed information on the type of flu shot that is available (seasonal or H1N1), date, time and locations of vaccination clinics. Flu clinic information can be submitted directly by providers at http://pandemic.wisconsin.gov or www.wisconsinfluclinic.info.

The flu clinic finder, along with all the human services information available from 2-1-1, is supported by United Way, community foundations, hospitals, local government and the Wisconsin Department of Health Services.

1022 Another death linked to H1N1 flu [Wyoming]--The death of a third Wyoming resident infected with the swine (novel H1N1) influenza virus has been reported to the Wyoming Department of Health. The adult female resident of Laramie County had underlying health conditions linked with higher risk of severe illness.

Flu activity continues to be high and widespread across the state and is almost 100 percent due to the H1N1 flu strain. Influenza symptoms include fever, cough, sore throat, body aches, headaches, and fatigue. Some patients also report diarrhea and vomiting.

Actions recommended to slow the spread of illness include:

· When available, get immunized with both a swine flu and a seasonal flu vaccine.
· In general, people who develop influenza-like illness should stay home from work, school or travel until at least 24 hours after they are free of fever. Those who are severely ill (such as having trouble breathing) should seek medical care.
· Avoid contact with ill persons.
· Covering noses and mouths with a tissue or sleeve when coughing or sneezing, and throwing used tissues in a trash can.
· Frequent hand washing with soap and water or the use of an alcohol-based hand gel.

Of the total 1,614 reported flu cases in Wyoming since late May, 419 have been confirmed as swine flu cases. Most other cases were not subtyped. Over the same timeframe, the Department has received reports of 28 Wyoming hospitalizations in connection with the virus. The Department expects the number of actual flu infections around the state to be much higher, because most ill persons do not seek medical care or are not tested. Specific swine (novel H1N1) flu counts provided by the Department only reflect cases confirmed by specialized lab testing, as the H1N1 strain is part of the Department’s ongoing surveillance activities.

1022 State releases cache of N95 respirators from emergency stockpile to combat spread of H1N1 in healthcare settings [California]--Following an announcement by Governor Schwarzenegger, the California Department of Public Health (CDPH) is deploying half of the state’s emergency stockpile of N95 respirators to local health departments for dispersal to hospitals and clinics so they will have them on hand to ensure they can protect patients and themselves from the spread of H1N1 in health care settings and continue to safely provide care to those infected with H1N1.

“These 25 million respirators are tools of the trade for the safety of patients and health care workers,” said Dr. Mark Horton, director of CDPH. “We were forward-thinking when we purchased these devices; we have the largest supply in the country, and the time is now to use them wisely.”

Truckloads of the N95s, part of the state’s stockpile of emergency medical supplies, are on their way around the state to be used by health care workers as needed. Meanwhile, Horton said, California Occupational Health and Safety Administration (Cal OSHA) has released new guidance to the health care community for the proper use of the respirators. In 2006, the State purchased the cache of respirators as part of its pandemic planning.

The California Department of Public Health (CDPH) continues to observe widespread activity from the H1N1 (2009) influenza virus in the state. To date, there have been more than 3,500 H1N1-related hospitalizations, and 233 deaths. Although H1N1 is causing more severe illness in young children, persons with underlying medical conditions and pregnant women, and healthy persons can also have serious illness.

The California Department of Public Health also continues to coordinate with the federal Centers for Disease Control and Prevention on the distribution of H1N1 vaccine.

Horton said as of this week, California has registered more than 12,000 providers who will be able to administer vaccine. Vaccinators had ordered more than 1.7 million doses of H1N1 vaccine in California, but because of delays in manufacturing the vaccine Californians will have to remain patient and check with their providers and public health departments for availability.

“We fully expect that, in time, enough vaccine will be available for everyone who wants to get vaccinated,” said Horton. “Meanwhile, continue to fight the flu by using common sense—washing hands, covering coughs and sneezes and staying home when sick until 24 hours after symptoms and fever pass.”
 

1021 Flu pandemic requires national plan, say Atlantic mayors [Charlottetown, PEI]--With the effects of the seasonal flu starting to be felt in the region, mayors from across Atlantic Canada are concerned that the lack of a national pandemic plan could leave many communities in the region vulnerable to a potential H1N1 outbreak.

The mayors, in Charlottetown for a meeting of the Atlantic Mayors Congress (AMC) say that an outbreak of the deadly H1N1 virus could leave many front-line municipal workers, from police to emergency personnel to health workers sick and unable to do their jobs.

"With flu season on us, we cannot wait much longer for a national H1N1 pandemic plan," said Halifax mayor and Chair of the AMC Peter Kelly. "Municipal workers are at the front lines of any potential health emergency but we have yet to see any strategy to keep them safe and on the job."

The mayors are calling on the federal government to quickly roll out a comprehensive plan that takes into account the critical role of municipal front-line workers as well as the need for factual and timely information and communication.

The mayors say that while many municipalities have developed or are developing their own pandemic plans this is being done in a largely uncoordinated way, without any national support. This has left many smaller communities across the region and the country, struggling to prepare for the potential health emergency.

Compounding the problem, the mayors say that there is so much, sometimes conflicting, information on H1N1 that confusion could set in with catastrophic health consequences.

"We cannot rely on a patchwork of pandemic responses or a deluge of conflicting information" said mayor Kelly. "Municipalities from St. John's to Edmunston must be assured that their citizens and the services they rely on will be protected and only the national government can provide the leadership, the resources and the coordination necessary."

1021 H1N1 outbreak on turkey farm confirmed [Kitchener ON]--Hybrid Turkeys is confirming that a case of H1N1 is located at one of their barns in Ontario. The firm is asking the media to respect the strict biosecurity measures in place at their turkey farms.

The Canadian Food Inspection Agency (CFIA) has confirmed that the cause of an egg production drop in a flock in a single barn of Hybrid Grand Parent Breeding turkeys in Ontario was due to the novel H1N1 influenza virus. Recently novel H1N1 was reported as the cause of an egg production drop in turkey breeding hens in Chile where employees also were seen as the source.

The only symptom in the affected Ontario flock was a decrease in egg production with no associated illness or mortality. The flock is showing normal feed and water consumption and is expected to fully recover, consistent with other flus that are more common in turkeys.

The most likely source of the virus is from human transmission. A limited number of employees prior to the egg production drop exhibited "cold-like" symptoms and one sought medical attention. Employee health is being monitored and some employees are now being tested for the virus.

Influenza is not transmissible from hatching eggs nor through the consumption of turkey meat which continues to be a safe, healthy product.

The firm has been working closely with the CFIA since the identification of the egg production drop. They received notification of the novel virus late yesterday. A self-imposed quarantine remains in effect and will until the flock is fully recovered.

Hybrid Turkeys is a division of Hendrix Genetics Ltd, a primary breeder of turkeys based in Kitchener, Ontario, Canada. The company produces eggs and poults for parent stock customers around the world. Hybrid Turkeys has approximately 180 employees working in various locations across Canada, USA, France and Germany.

1021 Province announces rollout of H1N1 vax campaign [Prince Edward Island]--The province has announced the rollout of its H1N1 Influenza Vaccine campaign following an announcement made today by Health Canada that regulatory approval has been received and the H1N1 vaccine is now approved for use.

“We are pleased to announce the launch of our H1N1 influenza vaccine campaign here in PEI,” said Doug Currie, Minister of Health. “We know that there is enough vaccine for every person who needs and wants it in PEI and, starting next week, staff will begin to offer the vaccine to those who would benefit most from immunization against the H1N1 Flu Virus.”

The vaccine program will be rolled out over the next four to six weeks and the schedule is based on the recommendations of the Public Health Agency of Canada. The vaccine will be delivered by Public Health nurses and others at no cost, at various sites across the province, including public health nursing clinics, schools, health centres, correctional facilities and healthcare facilities.

“Each year there are different strains of influenza going around and, this year, the predominant strain is H1N1,” said Dr. Heather Morrison, Chief Health Officer for the Department of Health. “Over the past few weeks, there has been an overall increase in H1N1 activity in Canada and for most people, the H1N1 vaccine is the vaccine they need first that will offer the best protection against influenza this fall.”

The H1N1 vaccine is developed the same way as the regular seasonal influenza vaccine but offers protection against the H1N1 influenza virus. It is important to note that for those who receive the vaccine, it often takes up to two weeks to develop immunity to the virus.

Most people will require only one dose of the vaccine, with the exception of children who are six months up to 10 years of age, who will require two half doses of the vaccine to develop adequate immunity. The vaccine is usually given into the arm of adults and children over one year of age and into the thigh for infants, six months to one year of age. The vaccine is not given to infants under the age of six months.

The H1N1 Vaccine Schedule in PEI will be the following:

Week of October 26

• Health Care Workers

• Household contacts of children less than 6 months

• Children six months old up to school entry

• People with chronic conditions under the age of 65

• Household contacts and care providers of people who are immune compromised

• First Nations and Aboriginal Population

Week of November 2

• Elementary Schools

• First responders

Week of November 9

• Junior and Senior High Schools

• Pregnant women

Week of November 16

• Mass public clinics

Week of November 23

• Second dose for children six months of age to school entry

Week of November 30

• Second dose for children school entry to nine years of age

A specialized clinic for people with egg allergies will be offered as well to ensure that every person can receive the vaccine if they wish.

Announcements will start next week on the times and locations for upcoming clinics. The public is advised to watch the newspapers, visit www.gov.pe.ca/flu or call 1-888-748-5454 for further information.

1021 Province to start H1N1 vax program next week [Newfoundland and Labrador]--The Provincial Government confirmed today that the province will begin administering the H1N1 influenza vaccine starting the week of October 26. The Honourable Jerome Kennedy, Minister of Health and Community Services, and Dr. Faith Stratton, Chief Medical Officer of Health, made the announcement following Health Canada’s official authorization today for use of the H1N1 influenza vaccine.

“As the Minister of Health and Community Services, I am committed to updating the people of Newfoundland and Labrador on a regular basis about the status of H1N1 in the province, how our government is responding and the latest information available,” said Minister Kennedy. “We have secured enough H1N1 vaccine for anyone in the province who wants it so that we can protect all of our residents against the pandemic virus.”

H1N1 Vaccine

Starting the week of October 26, the province’s regional health authorities will begin the H1N1 vaccination program. The vaccine will not be available through physician offices. It will be offered through public health mass immunization clinics. As the program expands in the coming weeks, residents can expect to see detailed clinic information through their local media and their regional health authorities. The H1N1 vaccination is not mandatory but is recommended for all residents of the province. There is no charge to receive the vaccine.

“The H1N1 influenza vaccine is the best protection against the pandemic virus and we are encouraging residents to avail of it,” said Dr. Stratton. “Health Canada has officially authorized this vaccine which means it has proven to be both safe and effective.”

“Our regional health authorities have been diligently planning for the delivery of the H1N1 influenza vaccine across the province,” said Minister Kennedy. “I am pleased to say that we will be ready to begin the immunization program next week at the same time as other provinces and territories.”

Consistent with all other jurisdictions, Newfoundland and Labrador will receive the vaccine in stages. The first supply of the H1N1 vaccine contains 28,000 doses and these will be distributed to the health regions by next week. Immunizations will begin on a limited basis and will expand as more vaccine arrives in the province.

Based on recommendations from the Public Health Agency of Canada, the vaccine will be offered first to people who will benefit most from it. These groups include:

• Individuals under 65 with chronic health conditions;
• Individuals living in remote and isolated settings or communities;
• Children six months up to five years of age;
• Health care workers involved in pandemic response or the delivery of essential health care services;
• Pregnant women; and
• Household contacts and caregivers of persons at high risk who cannot be immunized or may not respond to vaccines and populations otherwise identified as high risk.

The H1N1 vaccine in Canada is an adjuvanted vaccine which means it includes a substance which provides a more rapid and increased immune response to the vaccine. The adjuvant in Canada’s H1N1 vaccine is made up of natural ingredients such as water, oil and vitamin E. Women who are pregnant are recommended to receive a vaccine that is unadjuvanted. The supply of unadjuvanted vaccines will be made available to all jurisdictions for pregnant women as soon as it is available in early November.

“The recommendation for pregnant women was made based on the fact that there is less data available on how pregnant women respond to adjuvanted vaccines and so we want to be very cautious,” said Dr. Stratton. “It does not mean there are any safety issues with the adjuvanted vaccine. If there are high levels of pandemic influenza in a community, pregnant women may be offered the adjuvanted vaccine to reduce their risk of disease.”

Antivirals

Antivirals are oral medications that are used to treat moderate to severe disease. Due to increased influenza-like-illness activity and laboratory confirmed H1N1 cases in the province, Newfoundland and Labrador’s share of the National Antiviral Stockpile (NAS) was released on October 16.

“As we indicated in our media briefing earlier this week, our province has enough antivirals to treat anyone who may require it,” said Minister Kennedy. “This is in addition to the many other measures we have put in place to ensure our province is ready to respond to potentially more severe disease virus this flu season.”

Dr. Stratton added: “The release of antivirals was done as a precautionary measure following the confirmation of new cases of H1N1 influenza in the province late last week. The experience to date with H1N1 in Canada is that it is a mild disease. However, we do want to be ready in the event that the H1N1 cases become more severe.”

Health care providers will determine if individuals require antiviral treatment for H1N1 influenza and it must be prescribed by a physician. The prescription can be filled at pharmacies across the province. Antiviral medications include Tamiflu (Oseltamivir) and Relenza (Zanamivir). Residents and visitors of the province who meet the criteria for antiviral treatment will be eligible to receive the medication free of charge.

“Currently the use of anti-virals is indicated only for those patients who have severe disease, or who are at risk of complications,” said Dr. Stratton. “Not all patients with H1N1 influenza need to either see their doctor, or receive an antiviral medication. People with mild influenza-like-illness and no chronic health conditions should stay at home to prevent spread to others and should contact their health care provider if their disease becomes more severe.”

People at a higher risk of complications for the H1N1 influenza virus include:

• Individuals with chronic conditions such as heart or kidney disease, diabetes, asthma and chronic lung disease, suppressed immune systems, neurological disorders, liver disease, blood disorders and severe obesity;
• Children under five years of age; and,
• Women who are pregnant.

Antivirals are taken by mouth and can reduce influenza symptoms, shorten the length of illness, and reduce the serious complications of influenza if taken within 48 hours of getting sick. Antivirals do not provide immunity against the virus and should not be confused with the H1N1 vaccine.

The province invested $800,000 in 2006 to increase the stockpile of antivirals for use during a pandemic and have added to this supply since that time. There are over 800,000 doses in supply, with 10 doses required for each treatment.

“The Provincial Government has plans in place to deal with an influenza pandemic and in the past several months we have ramped up our efforts to deal specifically with the H1N1 influenza virus,” said Minister Kennedy. “We will continue work in co-operation with our federal and regional counterparts to do whatever is necessary to ensure the people of our province have the best and timeliest protection from and treatment for H1N1.”

Minister Kennedy added that the province has secured a stockpile of all necessary equipment and supplies to respond to H1N1 for laboratories, pharmacies, housekeeping and front line service providers. This includes personal protective equipment for its health care workers and enough ventilators for every ICU bed in the province.

In November 2007, the Department of Health and Community Services established Planning Guidelines Roles and Responsibilities for the health care sector in the event of a pandemic. In addition, the Provincial Government invested $4.7 million in 2006 to respond to health emergencies such as a pandemic. This investment included the purchase of antivirals, establishing four regional health emergency professionals and required supports to develop regional emergency response plans, adding 39 public health nurses across the province; and, establishing new positions in the public health division of the department.

For further information regarding the H1N1 vaccine visit www.fightflu.ca

1021 Province completes test of tsunami notification system [Victoria, BC]--The Provincial Emergency Program has successfully completed a test of the B.C. Provincial Emergency Notification System (PENS).

In total, more than 1,100 calls were made using the state-of-the-art phone notification system to local governments, local emergency officials, police and fire departments, federal and provincial ministries, First Nations, utilities, regional health authorities and the media. In addition, approximately 300 email and fax notifications were sent to these same stakeholders.

These tests are run on a regular basis to verify the system’s capabilities to send timely tsunami bulletins to coastal communities at risk, key stakeholders and the news media. The media is a key partner in getting critical information to the public during emergency situations.

Monitoring for tsunamis is done by the West Coast and Alaska Tsunami Warning Center, located in Palmer, Alaska. This organization immediately notifies the Provincial Emergency Program (PEP) of any tsunami activity in the Pacific Basin.

In the event coastal British Columbia could be impacted by a tsunami, PEP activates PENS. Local authorities are required to have community emergency response plans that they will activate in the event of a tsunami.

1021 Province to begin H1N1 immunization campaign [Halifax, NS]--With the announcement of federal authorization of the pandemic H1N1 vaccine, Nova Scotia is set to begin its biggest immunization campaign yet, Dr. Robert Strang, the province's chief public health officer, announced Oct. 21.

The federal authorization order for H1N1 vaccine means the government of Canada is satisfied the vaccine is safe and effective.

Specifics of the Nova Scotia plan include:

* H1N1 vaccine will be available for free to all Nova Scotians who want it;
* People in high-risk groups for seasonal flu can get seasonal flu and H1N1 shots at the same time;
* H1N1 vaccine will be available through community clinics, some doctor offices and workplace clinics;
* Community clinics will begin across Nova Scotia within the next two weeks.

"I have every confidence that the H1N1 vaccine is safe and effective for Nova Scotians," said Dr. Strang. "I urge all Nova Scotians to get the H1N1 vaccine. It is the best way to protect yourself and your community."

Nova Scotia has ordered 1.4 million doses of the vaccine. The first shipment, 52,000 doses, arrived Oct. 19. The province will pay about $4.5 million for the vaccine.

District health authorities are organizing community immunization clinics. Doctors will also have the option to offer the vaccine in their offices. Private nursing agencies can also get the vaccine for workplace clinics. H1N1 vaccine is also being provided to hospitals and long-term care facilities to immunize staff.

Each district health authority will organize its immunization program, including clinic dates and times. Nova Scotians should check with local district health authorities for dates and times.

"Every Nova Scotian who wants the H1N1 vaccine will be able to receive it," Dr. Strang said. "Our priority is to ensure that all Nova Scotians have the opportunity to receive the vaccine in a timely manner."

If Nova Scotians have questions about the vaccination, they can go to www.gov.ns.ca/h1n1 , call their local public health unit or call HealthLink 811.

Groups at high risk for seasonal flu can receive that vaccine at the same time.

"In the weeks past, we were recommending that only people above the age of 65 and those in long-term care facilities get the seasonal flu vaccine," said Dr. Strang. "Our decision was based on the best information we had available to us at that time.

"New data indicates that we can offer the vaccines concurrently. In an effort to make it easier for Nova Scotians, both the H1N1 vaccine and seasonal flu vaccine will be offered at the mass immunization clinics."

As in previous years, the seasonal flu vaccine will also be available through doctors' offices.

We are now starting to see signs of H1N1 activity in Nova Scotia. There have been 17 cases of H1N1 in the province since Aug. 29. There has been one death in Nova Scotia associated with the virus.

Dr. Strang continues to advise Nova Scotians to make every effort to minimize the spread of the virus. The most important step is to stay home if sick with flu-like symptoms, which are fever and/or cough with unusual tiredness, head/muscle/joint aches or sore throat.

Along with immunization, people are also encouraged to take the following precautions to prevent illness:

* Wash hands often with soap and water, especially after a sneeze or cough. When soap and water are not handy, alcohol-based hand sanitizers are an acceptable alternative.
* Cough and sneeze into elbow or sleeve.
* If using tissues, dispose of them appropriately and wash hands.
* Limit touching eyes, nose and mouth.
* Do not share drinking glasses, water bottles, mouth guards, cosmetics or eating utensils.
* If concerned that medical advice or care is needed, contact HealthLink 811. Like any illness, should symptoms worsen, visit a doctor or walk-in clinic.
 

1021 Vax will be available in province starting Oct 26 [Edmonton, AB]--Alberta will begin rolling out the H1N1 vaccine following today’s announcement by the Public Health Agency of Canada that the H1N1 vaccine is safe, effective and authorized for use across Canada.

“The availability of this vaccine is the boost we have been waiting for to help win the battle against pandemic H1N1 for all Albertans,” said Minister of Health and Wellness Ron Liepert.

As H1N1 is expected to be the most prevalent strain of the influenza virus this year, Alberta is focusing its efforts on providing this vaccine to as many Albertans as possible.

“This vaccine has undergone rigorous testing processes and clinical trials around the world and is established to be safe,” said Dr. André Corriveau, Alberta’s Chief Medical Officer of Health. “Getting immunized is one of the most effective ways of preventing the spread of this virus.”

Clinics will begin immunizing all Albertans over six months of age against H1N1 as early as October 26. High-risk groups are encouraged to get their immunization as soon as possible.

Alberta Health Services has been delivering the seasonal influenza vaccine for the past several weeks to people identified as high risk, as well as others who want it.

“These programs will shift their priority to H1N1 vaccine delivery,” said Dr. Gerry Predy, Senior Medical Officer of Health for Alberta Health Services. “However, seasonal influenza immunization will still be available at these sites to those who want it.”

Clinic timing may differ slightly in some areas. For detailed information on locations and times of H1N1 influenza immunization clinics near you, or to find out more information about high-risk groups that will receive priority immunization, visit www.albertahealthservices.ca or www.healthlinkalberta.ca, or call Health Link Alberta in Edmonton at 780-408-5465, in Calgary at 403-943-5465, or toll free at 1-866-408-5465.

For more information on Alberta’s plans for pandemic H1N1 influenza, please visit www.health.alberta.ca , or www.albertahealthservices.ca.

1021 H1N1 vax approved and timing confirmed [Victoria, BC]--Following today’s approval by Health Canada regulators, the pandemic H1N1 influenza vaccine will be made available to British Columbians beginning the week of Oct. 26, announced Minister of Healthy Living and Sport Ida Chong and Provincial Health Officer Dr. Perry Kendall.

“Now that the H1N1 flu vaccine has been approved, I encourage British Columbians to get immunized and protect themselves against this novel flu virus,” said Kendall. “Even if some of the population has already contracted H1N1 so far, we know that most British Columbians have not been infected yet and can still benefit from receiving the vaccine to protect themselves.”

The first batch of vaccine has arrived in British Columbia and is currently being distributed around the province to regional health authorities, based on population numbers in each region. Beginning Monday, it will be available first to those people who would benefit most from immunization: individuals under 65 years of age with chronic disease, pregnant women and individuals – including First Nations people – living in remote or isolated communities. These groups are at high-risk for suffering complications from pandemic H1N1 infection.

“B.C. will receive the H1N1 vaccine shipments in phases. Our plan is to first immunize those individuals considered to be at most risk to ensure that more vulnerable groups are protected,” said Chong. “During this time, we would ask that those people who are not at highest risk to wait until mid-November to get immunized when we receive our full orders.”

The pandemic H1N1 vaccine is an adjuvanted vaccine. Adjuvants are compounds that boost the immune system’s response to vaccine, allowing smaller doses to be used per person. A version of the H1N1 vaccine without adjuvant will also be available in B.C. beginning the second week of November. While the unadjuvanted H1N1 vaccine is recommended for pregnant women, the adjuvanted version, available early next week, is approved for everyone who wants to protect themselves from this pandemic.

Once clinics begin next week, British Columbians who fall into the high-risk groups listed above who need and want the H1N1 vaccine, and for whom the seasonal flu shot is also recommended, will be able to receive both at the same time.

“The national expert committees that are providing guidance on the use of the pandemic vaccines have recommended that giving seasonal and pandemic vaccines together is not expected to affect the immune response to either one. This is in keeping with what we know about almost all other vaccines.” said Dr. Monika Naus, director of immunization at the BC Centre for Disease Control, an agency of the Provincial Health Services Authority. “By getting the seasonal and pandemic vaccines together, the risk from both sorts of influenza can be reduced at the same time.”

When B.C.’s seasonal influenza campaign launched in mid-October, the seasonal flu shot was only recommended for seniors and those living in long-term care facilities.

“While I can understand there may be some confusion in the public about how and when to get vaccinated, and with which vaccine, this decision to offer the H1N1 and seasonal vaccines together addresses these concerns,” said Kendall. “B.C.’s initial recommendation to delay the seasonal vaccine campaign for everyone under the age of 65 was made using the best available evidence and before the pandemic vaccine was available. Now that pandemic vaccine is here, we can give protection against both seasonal and pandemic viruses at the same time”

For more information on the H1N1 flu vaccine, visit www.gov.bc.ca/h1n1. To find where you can get your H1N1 and/or seasonal flu shot, visit the Flu Clinic Locator at www.ImmunizeBC.ca or contact your local public health unit. More locations will be added as they are confirmed.

1021 Pharmacists to give H1N1 vax [Victoria, BC]--Specially-trained pharmacists in British Columbia can now provide patients with vaccine injections.

“As we are facing both regular flu season and the H1N1 flu pandemic, pharmacists can now help administer the annual flu vaccine, including vaccinations for H1N1,” said Health Services Minister Kevin Falcon. “Expanding the role of pharmacists gives patients more choice for, and increased access to health care.”

About 150 pharmacists from across the province have already completed the training to meet the certification program. More pharmacists are expected to complete the training in additional sessions scheduled over the next couple of months.”

“Expanding the role of pharmacists to give preventative injections will increase access to safe health-care services,” said Suzanne Solven, deputy registrar of the College of Pharmacists British Columbia. “Our focus is on ensuring that pharmacists can continue to provide the safe, high level of care British Columbians have come to depend on.”

Changes are effective following a 30-day public consultation that resulted in amendments to regulations that govern the scope of practice for pharmacists, in addition to changes and processes required by the College of Pharmacists of British Columbia.

The BC Pharmacy Association is the first to offer an accredited training program for pharmacists to learn injection skills.

“We are pleased to assist in the training of pharmacists to safely administer injections,” said Marnie Mitchell, CEO of the BC Pharmacy Association. “Given pharmacists’ medication expertise, and with the advanced training, they are a logical choice for British Columbians seeking safe and convenient access to flu vaccine and other injections.”

To be able to give vaccines, pharmacists are required to successfully complete the training program before receiving authorization from the college to administer injections for vaccination purposes. The college has also established standards of practice for injection based on the recommendation of an inter-professional committee.

The H1N1 flu vaccine will be made available to British Columbians beginning the week of Oct. 26. It will be available first to those people who would most benefit from immunization (individuals under 65 years of age with chronic disease, pregnant women and individuals – including First Nations people – living in remote or isolated communities).

Following that, it will be available to other groups who would benefit most (children under five years old, health-care workers and household contacts and care providers of infants and immunocompromised people) and then to members of the general public in a phased approach. When people are eligible for their H1N1 vaccine and if they fall under the usual guidelines for seasonal flu, it will now also be possible for them to receive both shots at the same time.

For information about upcoming flu clinics at your local pharmacy, talk to your pharmacist.

1021 H1N1 vax to begin on Oct 26 [Whitehorse, Yukon]--Yukon health centres will begin administering the H1N1 vaccine on October 26, Health and Social Services Minister Glenn Hart announced today.

Health Canada authorized the release of the vaccine today, and Canada’s medical officers of health followed by endorsing use of the vaccine in their own jurisdictions.

“I am pleased at the speed with which federal authorities moved to obtain, test and release the vaccine,” Yukon Medical Officer of Health Dr. Brendan Hanley said. “As Yukon is starting to see a rise in influenza, the timing for protecting Yukoners could hardly be better.

The seasonal flu vaccine will be offered at the same time as the H1N1 flu vaccine, for convenience to Yukoners.

“Yukon is ready to start administering the doses,” Hart added. “We have 55,000 doses on hand, enough to vaccinate every Yukoner who wants or needs the vaccine, and we are encouraging all Yukoners to get vaccinated.”

The H1N1 vaccine was produced by pharmaceutical company GlaxoSmithKline at its Quebec plant.

The H1N1 immunization campaign will start unrolling in community health centres starting on Monday, October 26. Clinic dates, locations and times will be advertised in newspapers and on the Health and Social Services web site at www.hss.gov.yk.ca.

1021 Guidelines for H1N1 and sporting events [Northwest Territories]--Q: What steps can sport organizers take to help prevent participants, coordinators, and chaperones from getting sick?

A: There are a number of steps organizers can take to prevent the spread of illness at all times and not just during a flu pandemic. These steps include: ensure that there are adequate hand-washing stations and hand sanitizers for event participants and that there is signage to remind people of the proper hand-washing technique; encourage good hygiene by providing all organizers, participants, and chaperones with educational material (i.e. posters or brochures) and reminders about covering coughs and sneezes; washing hands with soap and water; and not sharing drinks, food or chapstick; keep additional tissue supplies and waste receptacles at the venue; have all coordinators, chaperones and organizers on alert to recognize flu symptoms and isolate anyone with flu symptoms; arrange to have parents/guardians pick-up sick participants as quickly as possible; get any organizers, chaperones, or coordinators who are ill to go home, and if that is not possible, ensure they self-isolate; if you have out-of-town participants, have a room with a cot available in case somebody gets sick and needs to be isolated; and advise all participants, organizers, coordinators, chaperones and families that sick people must stay at home until at least 24 hours after they no longer have flu symptoms. It is especially important that they no longer have a fever or signs of a fever. This should be determined without the use of fever-reducing medicines, like any medicine that contains ibuprofen or acetaminophen.

Q: What happens if a participant becomes sick while en route to/from or at the organized event?

A: Participants who are feeling somewhat sick before an event should not attend. If the participant becomes sick during the event, the person should be isolated right away. Participants who are competing in their home town should be picked up by a family member right away. Out-of-town participants should be isolated from the other participants.

Q: Who will pay for a participant to go home early if he/she becomes sick?

A: Out-of-town participants who become sick while at a sporting event should not be sent home immediately. Travel should be avoided while sick. Participants from out-of-town should be isolated from the other participants. If the participant must travel while sick, the participant should wear a surgical mask or a bandana over the nose and mouth to avoid making other people sick.

Q: Will families be notified if a participant becomes sick at an event?

A: Organizers should work with chaperones to advise parents/guardians if a participant becomes ill at an event. Participants who are competing in their home town should be picked up by a family member right away. Out-of-town participants should be isolated from the other participants.

Q: Should we cancel sports events because of H1N1?

A: There is no need at this time to cancel sports events. Simple precautions at the individual level, like frequent hand washing, coughing and sneezing into the arm instead of hands, and staying home when sick will help slow the spread of the H1N1 flu virus.

Q: I hear Edmonton Soccer is banning shaking hands after the game. Should we do the same?

A: Banning shaking hand after the game is not necessary; however, all participants should be encouraged to wash their hands after each game, and to avoid touching their mouth, nose and eyes to avoid spreading germs.

1020 Thirty-three new severe cases of H1N1 since Oct 13 [British Columbia]--British Columbia continues to monitor and respond to the spread of the pandemic H1N1 flu virus. Since Oct. 13, there have been 33 new severe cases of H1N1 identified in B.C. – thirteen in Fraser Health, twelve in Vancouver Coastal Health, six in Interior Health and two on Vancouver Island – with two new deaths, both in Fraser Health.

The majority of lab-confirmed cases in B.C. have been mild or moderate in severity, with the patients either having already recovered or currently recovering.

In total, BC Centre for Disease Control (BCCDC) has confirmed 111 severe H1N1 cases in British Columbia since April 2009, including:

Forty-four in Fraser Health, including five deaths.

Twenty in Interior Health, including two deaths.

Five in Northern Health.

Thirty-one in Vancouver Coastal Health, including one death.

Eleven on Vancouver Island, including one death.

Of these 111 lab-confirmed cases admitted to hospital, 30 of those have been admitted to the ICU. Six new cases have been admitted to the ICU in the last week.

To date, nine laboratory-confirmed H1N1 cases in B.C. are reported to have died. In eight of those cases, there were underlying medical conditions.

1020 Seasonal flu vax manufacturers notify DoH of delay and reduction in shipments [Rhode Island]--Three vaccine manufacturers have notified the Rhode Island Department of Health (HEALTH) of changes in previously scheduled seasonal flu vaccine shipments. HEALTH’s adult immunization program was notified that approximately 18% of the total amount of vaccine ordered for the season will not be delivered.

This change in delivery was based on two manufacturers, GlaxoSmithKline (GSK) and Novartis, ending shipments of injectable flu vaccine to distributors. In addition, Sanofi Pasteur, makers of injectable seasonal flu vaccine that was ordered for children and adolescents ages 3 through 18, says remaining shipments to HEALTH’s pediatric program will be delayed.

HEALTH anticipates delivery sometime in December. HEALTH purchases the seasonal influenza vaccine from several different manufacturers every year to lessen the impact on the state when there are vaccine shortages or delays.

Public demand for the seasonal flu vaccine has been up this year from years past creating some shortages and cancellations of clinics. By the end of this year’s flu season in Rhode Island, HEALTH will have provided more seasonal flu vaccine than in any previous flu season even with this reduction announced today.

“While this news is not what we would have hoped for,” said Director of Health David R. Gifford, MD, MPH, “we are confident that HEALTH will receive all the seasonal vaccine that was ordered for children. We are asking all providers to prioritize current supplies of vaccine for high-risk individuals. In addition, even with the reduction in the amount of vaccine we will receive for adults, we will still have more doses than what was used last year. And we have ordered 10,000 additional doses for adults and 14,000 additional doses for children.”

At this time, HEALTH is recommending that healthcare providers reserve injectable vaccine for the elderly and patients who are pregnant or have underlying medical conditions, as they are at higher risk of complications from seasonal influenza. Providers should contact individuals with underlying medical conditions who still need a seasonal flu vaccine. People who have not gotten a seasonal flu shot can contact their providers or consult the schedule of public clinics at www.projo.com/news/flu/clinics/. People should check this website which will continue to be updated as clinic dates and times change.

Almost all of the influenza illness occurring in Rhode Island right now is due to H1N1, not to seasonal flu. Rhode Islanders are encouraged to receive the H1N1 vaccine once it becomes available to them. Nasal spray H1N1 vaccine is currently available for children ages 2-5 in pediatric provider offices. More shipments will be arriving to the state weekly and will be allocated first to pregnant women (starting next week) and children. School-based vaccination clinics for children in K-12 are expected to begin sometime in early November and run into December.
Visit http://www.health.ri.gov/flu/about/vaccination/index.php for the most up-to-date information on H1N1 and seasonal flu vaccination
 

1020 Bloomberg launches Flu Fighters initiative to bolster flu prevention efforts [New York City]--Mayor Michael R. Bloomberg, Deputy Mayor for Health and Human Services Linda I. Gibbs, Commissioner of the Department of Health and Mental Hygiene Dr. Thomas Farley and the City’s Chief Service Officer Diahann Billings-Burford last week launched Flu Fighters, an NYC Service initiative to help combat the spread of influenza this season.  The program will mobilize hundreds of volunteers to conduct outreach at community events, schools, senior centers and houses of worship in New York City to raise awareness about influenza and the importance of getting vaccinated.  Flu Fighters is one of the 40 initiatives of NYC Service announced by Mayor Bloomberg in April and is a component of the City’s comprehensive influenza prevention plan outlined by the Mayor in early September. 

The Flu Fighter program aims to engage 800 or more volunteers in the program.  Volunteers can start work on some opportunities right away. New Yorkers interested in helping prevent the spread of influenza this season by becoming a Flu Fighter should visit www.nyc.gov or call 311.

Each year, more than 1,000 New Yorkers die from influenza and its complications, and many others become ill. While many parts of the country are now battling high rates of influenza infection, so far, there is no sign that the flu has taken hold in New York City.  Information about influenza should is also available at www.nyc.gov or by calling 311.

NYC Service was launched by Mayor Bloomberg in April 2009 to meet his State of the City pledge for New York City to lead the nation in answering President Obama’s national call to service. The program has three core goals: channel the power of volunteers to address the impacts of the current economic downturn, make New York City the easiest city in America in which to serve, and ensure every young person in New York City is taught about civic engagement and has an opportunity to serve. NYC Service aims to drive volunteer resources to six impact areas where New York City’s needs are greatest: strengthening communities, helping neighbors in need, education, health, emergency preparedness and the environment. New Yorkers can find opportunities to serve their communities by visiting www.nyc.gov or by calling 311.

Once demand for these high priority groups is met, the Centers for Disease Control and Prevention recommends that everyone from 25 through 64 years be vaccinated against H1N1. After this wave of vaccinations, those 65 years and older are encouraged to be vaccinated. More details are available at www.cdc.gov/h1n1flu/.

The Health Department emphasizes that the best place for people to be vaccinated is at the office of their regular health care provider. In order to ensure that as many children as possible are vaccinated quickly, the City is also taking the extra steps of offering vaccines in elementary schools and in special weekend clinics. The city-wide, school-based vaccination program is planned to start in late October or early November and will last approximately eight weeks. Weekend clinics for middle-school and high-school children will open in early November at sites in all five boroughs and will continue for approximately five weeks. Parents of elementary school children will soon receive consent forms to sign and return if they want their children to be vaccinated at school.

1020 School-based H1N1 vax efforts ready for launch [New York City]--This week, New York City’s elementary school students will begin taking home H1N1 information packets that include vaccination consent and screening forms for the City’s upcoming school-based vaccination initiative. By signing and returning the forms – also available in 10 languages at nyc.gov/flu – parents can have their children vaccinated free-of-charge against the H1N1 influenza virus. The packets will be sent home with children over the next two weeks, starting today. All materials are available in Arabic, Bengali, Chinese, English, French, Haitian Creole, Korean, Russian, Spanish and Urdu.

More details are available at cdc.gov/h1n1flu/.

Although students will be given consent forms to bring home, parents can download the forms from nyc.gov/flu, sign printed copies and send them back to school with their children. Consent forms will also be available on site at the weekend vaccination clinics for middle-school and high-school students. More information about influenza is available at nyc.gov/flu or by calling 311.

1020 State officials understand and share frustration associated with H1N1 vax shortages [Massachusetts]--From the Mass.gov Commonwealth Conversations Public Health: "We have received many phone calls and comments on this blog from people across the Commonwealth who have been unable to locate the H1N1 and Seasonal flu vaccines. We understand -- and share -- in this frustration and would like to provide some general information on how vaccine distribution takes place in the state.

As background, this is an unprecedented flu season. There are five major vaccine manufacturers who are working day and night to produce both seasonal and H1N1 (swine) flu vaccines during the same time period. This has never been done before and, as a result, there have been some interruptions in the supply chain for both vaccines.

It's important to note that all vaccines are shipped directly from the manufacturer to the vaccine provider site -- DPH does not physically receive and then redistribute any vaccines. DPH does play two important roles in the vaccine distribution process: we serve as a registration point for health care providers who wish to receive vaccines for their patients and/or client populations, and we communicate with these providers about the weekly projected total amount of vaccine expected in the state.

The availability of vaccine at any given provider site at any given time may be sporadic at this time. Every effort is being made to ensure that providers who serve high-priority groups will receive vaccine as soon as possible. The single most effective way that you can stay informed about the availability of seasonal and H1N1 flu vaccine in your community is by staying in touch with your health care provider, and by visiting http://flu.masspro.org where you'll find a database of locations currently offering flu vaccines, searchable by your zip code.

It's important to note that there are no public H1N1 vaccination clinics currently scheduled in the state. This is because, like all other states, we have only received a very small allotment of the total amount of H1N1 vaccine expected.

Again, we share your concern and frustration about these delays. However, we are confident that the federal government will continue to do everything they can to ensure the efficient distribution of safe and effective flu vaccines as they become available. This situation is sure to continue to evolve, and we pledge to keep you updated on this blog as it does.

Comments

Q. Would someone please clarify for me whether or not I am in a high priority group to receive the H1N1 vaccine? I am the mom of a 9yr. old with asthma, a 2 year old with kidney issues, and a 4 mos. old. Last week the 2 older kids got their H1N1. But I have not been able to get one for myself. My pediatrician has stressed to me more than once that I need to have one as soon as I can get one, but my primary care office keeps telling me I am not a priority. Which is it??? Does anyone at MDPH have any suggestions as to how I could go about receiving a vaccine?
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DPH RESPONDS: Thank you for your questions. There are five groups that have been identified by the CDC as high priority to get the H1N1 vaccine:
• pregnant women; persons who live with or provide care for infants under 6 months of age (e.g., parents, siblings, and daycare providers)
• health-care and emergency medical services personnel;
• persons age 6 months to 24 years
• persons age 25 to 64 years who have medical conditions that put them at higher risk for influenza-related complications.

Every effort is being made to ensure that providers who serve high-priority groups will receive vaccine as soon as possible. The single most effective way that you can stay informed about the availability of vaccine in your community is by staying in touch with your health care provider, and by visiting http://flu.masspro.org  where you'll find a database of locations currently offering flu vaccines, searchable by your zip code.
 

Q. You are telling us to check with our health care providers and both my primary care physician and pediatrician are telling me to check with the MA dept of health. So who is telling the truth? Doctors are saying they have no clue when they will get shipments of H1N1 and it's up to the health dept to tell them and you give a different story. It has been drilled into people's minds that we need this vaccine, expecially for my 5 & 3 year old but as ususal with any program left to the state and fedral government it is screwed up beyond belief and our children are sitting ducks as this virus continues to spread because no one is organized or informed!! DISGUSTING!!!!!

Q. My daughter was diagnosised yest w H1N1, is it safe for her younger siblings to receive the H1N1 mist as that is all our pediatrician has?? -------------------------------------------------
DPH RESPONDS: Thank you for your question. The H1N1 nasal spray vaccine is approved for people from 2 through 49 years of age. You can find more information specifically on the H1N1 nasal spray vaccine on the CDC’s website at http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-laiv-h1n1.pdf

Q. Why can't I find any information on when shots will be available for H1N1 for children under 10? Given that two shots are required, it seems like we might want to vaccinate children asap.
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DPH RESPONDS: Thank you for your question. Every effort is being made to ensure that providers who serve high-priority groups, such as children, will receive vaccine as soon as possible. The single most effective way that you can stay informed about the availability of the H1N1 flu vaccine in your community is by staying in touch with your health care provider, and by visiting http://flu.masspro.org where you'll find a database of locations currently offering flu vaccines, searchable by your zip code. Once public H1N1 vaccination clinics are taking place they will also appear on the website.

Q.

My daughter (4 years old) pedatric office is out of seasonal vaccine. Every CVS and Walgreen in Massachusetts is out of seasonal vaccine. Clinic's are being cancelled the day of the clinic as they do not have supply.

Do you have an estimated date of when seasonal and H1N1 vaccine's will be available????

If they have shipped when will http://flu.masspro.org/clinic provide updated clinic information for people????????????
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DPH RESPONDS: Thank you for your questions and we appreciate your frustration. Like all other states, we have only received a very small allotment of the total amount of H1N1 vaccine expected. The most up to date H1N1 vaccine supply information can be found on the CDC website at http://www.cdc.gov/h1n1flu/vaccination/vaccinesupply.htm

They will be updating this page regularly so be sure to check back to see the latest numbers of vaccine being shipped across the country. Every effort is being made to ensure that providers who serve high-priority groups, such as children, will receive vaccine as soon as possible.

In terms of the seasonal flu vaccine, we have been informed by the manufacturers that we can expect additional shipments over the course of the next 4-6 weeks with the balance of our vaccine arriving at the end of November. This leaves plenty of time to be vaccinated against the seasonal flu since the majority of seasonal flu cases take place later in the flu season.

For both the H1N1 and seasonal flu vaccines, the single most effective way that you can stay informed about the availability of seasonal and H1N1 flu vaccine in your community is by staying in touch with your health care provider, and by visiting http://flu.masspro.org. As soon as clinics receive more vaccine, this will be reflected on the website.

Q. Is there any truth to the story that a large shipment of flu vaccine to Massachusetts providers was destroyed by overheating, due to an error by the shipper/driver, and that this explains why Massachusetts seems to have so much less available right now than other states?
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DPH RESPONDS: Thank you for your question. We have not heard anything in regards to this rumor. Like all other states, we have only received a very small allotment of the total amount of H1N1 vaccine expected. There are five major vaccine manufacturers who are working day and night to produce both seasonal and H1N1 (swine) flu vaccines during the same time period. This has never been done before and, as a result, there have been some interruptions in the supply chain for both vaccines. However, we are confident that the federal government will continue to do everything they can to ensure the efficient distribution of safe and effective flu vaccines as they become available.
 

1020 Finding flu shots in the face of increased demand for H1N1 vax [Delaware]--A number of developments this week increased the demand for both H1N1 and seasonal flu vaccine while also reducing supply. Those factors include:

* The Centers for Disease Control and Prevention (CDC) previously informed Delaware's Division of Public Health (DPH) that nearly 32,000 doses of H1N1 vaccine would arrive in Delaware this week from the federal government through various influenza vaccine manufacturers; however due to vaccine production delays with those manufacturers, the CDC now informs DPH only about 10,000 doses are now expected to arrive this week. While this slows the vaccine's distribution, it is only a delay, not a reduction in Delaware’s allotment.
 

* Many health care providers have run out of seasonal flu vaccine, for which there has been higher than normal demand this year due to increased public awareness of flu illnesses.
 

* Recent media coverage of the flu has spurred an increase in public demand for both H1N1 and seasonal flu vaccine from health care providers and from the Division of Public Health.

DPH provides the following information and guidance regarding flu vaccinations to Delawareans:

H1N1 vaccine:

* All pediatricians and family doctors who had requested H1N1 vaccine this week will still receive it, but in smaller quantities.
* Because of these reduced quantities, DPH has temporarily narrowed the target population for H1N1 vaccine to those most at risk. People in the following groups should contact their health care providers about H1N1 vaccine availability:
1. Pregnant women
2. People who live or care for children younger than 6 months of age
3. Children 6 months to 4 years of age
4. Children 5 to 18 years of age who have chronic medical conditions
 

* Quantity of vaccines will increase in coming weeks. By early November, H1N1 vaccines should be more widely available at health care providers, in clinics that will be conducted in schools, and in pharmacies. Delawareans are urged to receive H1N1 vaccine from their regular medical provider, and current vaccination efforts by medical providers should be directed at the narrowed target groups . Please note that the H1N1 vaccination from DPH will only be available to the priority populations described above. If those in the priority groups for H1N1 vaccines are unable to obtain it from their regular medical provider or a local pharmacy, they should call the following DPH offices to determine whether they qualify to receive the vaccine from DPH.

* New Castle County Hudson State Service Center, by appointment only, call (302) 255-4555 for age 6 months and above. Northeast State Service Center, by appointment only, call (302) 552-3600 for age 8 years and above

Kent County
* James Williams State Service Center, by appointment only, call (302) 857-5130 for ages 6 months and above

Sussex County
* Georgetown State Service Center, by appointment only, call (302) 856-5213 for ages 6 months and above Milford State Service Center, by appointment only, call (302) 424-7150 for ages 6 months and above.

Seasonal flu vaccine:
* Because a number of doctor’s offices and health care providers have run out of seasonal flu vaccine, current DPH flu clinics must also narrow their priority populations.
* For seasonal flu, the temporarily narrowed priority populations are individuals without insurance who are:
1. Pregnant women
2. Children 6 months to 18 years of age
3. People any age with chronic conditions (lung, heart, diabetes, compromised immune systems)
4. People 65 or older
5. If those in the targeted groups above for seasonal flu vaccines are unable to obtain it from their regular medical provider or a local pharmacy, they may qualify to receive the vaccine from DPH. Please note that the seasonal flu vaccination from DPH will only be available to the priority populations. If those in the seasonal priority groups are unable to obtain vaccination from their regular medical provider or a local pharmacy, they should call the following DPH offices to determine whether they qualify to receive the vaccine from the DPH.

New Castle County Hudson State Service Center, by appointment only, call (302) 255-4555 for age 6 months and above. Northeast State Service Center, by appointment only, call (302) 552-3600 for age 8 years old and above

Kent County James Williams State Service Center, by appointment only, call (302) 857-5130 for ages 6 months and above

Sussex County Georgetown State Service Center, by appointment only, call (302) 856-5213 for ages 6 months and above Milford State Service Center, by appointment only, call (302) 424-7150 for ages 6 months and above.

Delaware's flu vaccine shortages are similar to situations being faced in other states based on high nationwide demand. CDC expects this to be temporary and to ease in coming weeks. In the meantime, it is important that the priority groups above (which are different for the two types of flu) be given access to what vaccine there is in Delaware.

There are many things we can all do to slow the spread of influenza:

* Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
* Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
* Avoid touching your eyes, nose or mouth. Germs spread this way.
* Try to avoid close contact with sick people.
* If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. Your fever should be gone without the use of a fever-reducing medicine. Keep away from others as much as possible to keep from making others sick.
 

1020 At-risk group will be focus of first public H1N1 vax clinic [Marion County, Indiana]--The Marion County Health Department will hold a H1N1 vaccination clinic on Thursday, October 22 at the Lafayette Square Shopping Mall, 3919 Lafayette Road, inside the former Steve and Berry's retail-clothing store.

The H1N1 vaccine will be provided at no charge.

The vaccination clinic will be held from 8 a.m. until Noon. This clinic is intended for:

Women who are pregnant
People who live with or provide care for infants younger than 6 months (parents, siblings and day care providers)
Health care and emergency medical services personnel with direct patient contact.
Those ages 6 months to 24 years old
Persons aged 25 through 64 years who have certain medical conditions that put them at higher risk for influenza-related complications.

"Those not in the at-risk groups are asked to wait for additional H1N1 vaccine to arrive. It is critically important that those in the at-risk group have the opportunity to be vaccinated first," said Virginia A. Caine, M.D., director, Marion County Health Department. Health department officials will screen those wanting an H1N1 vaccination to ensure they are in the at-risk group.

Individuals coming to the Lafayette Square H1N1 Flu Clinic should be prepared to fill out paperwork and stand in long lines. Those coming to the clinic should follow the direction of informational signage and health department staff.

The clinic will function on a first come, first serve basis and vaccinations will be offered until the end of the clinic or in the unlikely situation where the supply of vaccine is exhausted.

HealthNet to Offer H1N1 and Seasonal Flu Vaccine Saturday

Indianapolis HealthNet's six community health centers will offer H1N1 and seasonal flu vaccine Saturday, October 24 from 10 a.m. until 2 p.m.

The H1N1 vaccine will be available only for those in the at-risk group. Vaccinations will be given on a first-come, first serve basis.

The HealthNet Clinic sites include:
 

Barrington Health Center, 3401 East Raymond Street
Martindale-Brightwood Health and Dental Center, 2855 North Keystone Ave
HealthNet Pediatric and Adolescent Care Center, 1633 North Capitol Avenue
Peoples Health and Dental Center, 2340 East 10th Street
Southeast Dental and Health Center, 901 Shelby Street
Southwest Health Center, 2202 West Morris Street

For more information on the HealthNet clinic sites, visit www.indyhealthnet.org

1020 DSHS officials expect weekly availability of H1N1 vax to be low for next few weeks [Texas]--The U.S. Centers for Disease Control and Prevention allocated an additional 454,200 H1N1 vaccine doses to Texas last week bringing the total vaccine allocation for Texas to 960,400.

Last week’s allocation of doses included 233,100 of the injectable, or shot, form and 221,100 doses of the mist form.

Texas’ allocation for the week that ended Oct. 9 was 363,800 and included 235,000 doses of the injectable form and 128,800 doses of the mist form.

Texas’ allocation for the week that ended Oct. 2 was 142,400 doses, all of it the nasal mist form of the vaccine.

Using a strategic approach to reach priority vaccine groups and subsets of those groups, DSHS has allocated the limited supply of vaccine to providers who serve pregnant women, children 2 years through 4 years of age, children 5 years through 18 years of age who are at higher risk of serious consequences should they get the flu and health care workers who provide direct patient care.

The 960,000 doses have been allocated to some 5,053 providers, with some of it distributed to local health departments as a safety net to meet special needs in communities. Some 12,000 Texas providers have registered to receive the vaccine.

The H1N1 vaccine distribution steps are:

* CDC allocates vaccine to the various state health departments each week.
* DSHS accepts the entire allocation and further apportions it to registered providers in Texas based on vaccine formulation, priority vaccination groups, geography and other factors.
* DSHS then notifies those providers to go online to confirm that they still want the vaccine, giving them a few days to confirm.
* Once confirmation is received, DSHS issues shipping instructions to a distributor to send the vaccine to the provider.

DSHS officials expect the weekly availability of the vaccine to be low for the next few weeks, adding that initial vaccine quantities are not high enough for public vaccination clinics to be held. They are urging providers and the public to be patient.

Texas expects to receive 15 million doses of the vaccine by the end of January.

1020 DoH recommends revax of some individuals against H1N1 [North Dakota]--On Oct. 19, 2009, the North Dakota Department of Health notified vaccine providers that some of the injectable H1N1 vaccine they received last week may be ineffective because of temperature issues while being shipped.

The vaccine that is affected is safe but may not be effective at preventing H1N1 influenza. The vaccine was shipped to the Department of Health, where it was repackaged October 14 and sent to 99 vaccine providers across the state. On October 15, the department received calls from some of the providers reporting that the freeze indicator in the packages showed temperatures below safe shipping and storage range. Fifty-five providers reported that their vaccine was not affected; 30 providers reported that temperature indicators showed their vaccine was frozen; and the department is still checking with 14 additional providers. About 1,700 doses of injectable vaccine are estimated to be affected out of a total 24,100 doses of injectable and Flumist vaccine received in the state.

The Flumist (nasal spray) vaccine was not affected.

The Department of Health is trying to determine why some of the monitors showed temperatures out of range. In the meantime, the department has recommended that providers not use the injectable vaccine they received if a temperature indicator showed frozen temperatures. Acting on the side of caution, the department also is recommending that people who received the affected vaccine be revaccinated and has asked providers to contact any patients who need to be
revaccinated. The Department of Health is working to determine how many people are recommended to be revaccinated.

1020 DNR and City of St Louis warn of high methane levels near demolition landfill [Missouri]--The Missouri Department of Natural Resources is working with the City of St. Louis to notify nearby residents of dangerously high methane levels at the St. Louis Demolition Landfill. The facility is located in the far northeast part of the city between Hall Street and the Mississippi River.

After receiving the results of testing done Monday Oct. 12 at the facility, the DNR found high methane levels. The DNR has ordered the city to notify all nearby homeowners and businesses of the risk and supply them with methane monitors. The monitors will alert homeowners if methane enters the home. The DNR found potentially high levels of methane Oct. 6, and immediately ordered the city to begin a notification plan for nearby residents and businesses. Further tests were performed, and DNR got confirmation of high methane levels on Oct. 14.

The landfill has three methane testing wells, and the City of St. Louis conducted sampling on Oct. 12. The southernmost well showed 4.3 percent methane by volume; the second and third wells to the north had readings of 11.3 and 46 percent methane by volume. Methane is a byproduct of the decomposition of waste and is explosive at concentrations between 5 and 15 percent. The regulatory limit for methane at a landfill property boundary is 2.5 percent by volume.

"The City of St. Louis is working cooperatively with the DNR to address this matter as quickly as possible and determine whether methane gas has reached the nearby homes," said Bill Bryan, DNR Deputy Director.

Additional investigation by the city is needed to determine if the methane is spreading off-site. The DNR has required the city to develop a plan to determine the extent of the spread and develop an appropriate cleanup plan. The city is also required to continue monitoring the wells and report the readings to the department on a weekly basis.

The department's Solid Waste Management Program has been working with the City of St. Louis to properly close Demolition Landfill and move the facility into post-closure status. The landfill was built before the current landfill design and operating requirements took effect, so it was grandfathered in and not required to monitor for methane gas. As part of the process of properly closing the landfill, the DNR required the city to prepare an investigation plan and install three gas-monitoring wells along the western perimeter of the facility.

The DNR and the city of St. Louis are encouraging residents and business owners to use caution and call 911 if they smell gas or the St. Louis Fire Department at 314-533-3406 if they have concerns with their monitoring device.

The department is encouraging citizens who live in the area and have questions or concerns to contact the city at 314-647-3111 or call the DNR Solid Waste Management Program at 800-361-4827 or 573-751-5401.

1020 DHH updates states of Fight The Flu campaign [Louisiana]--State Health Officer Jimmy Guidry, M.D., held a press briefing to update influenza activity in Louisiana as well as the state’s H1N1 vaccination campaign. Dr. Guidry emphasized that as the H1N1 vaccination campaign moves forward, it is important for Louisiana families to be patient if their provider has not yet received the H1N1 vaccine, as more vaccine is arriving every week. Residents should stay in contact with their provider as to the vaccine’s availability and to make an appointment when the time comes.

• The CDC reports that approximately 79,400 doses of H1N1 vaccine have been shipped to Louisiana as of Wednesday, October 14.
• The state has ordered a total of 180,100 doses on behalf of providers since vaccine became available.
• 259 providers in Louisiana have received vaccine.
• 3,945 doses have been administered thus far.
• The first doses of injectable vaccine are arriving now, with pregnant women and frontline health care workers serving as the initial target groups for injectable vaccine.
• DHH has launched a Twitter feed and a Facebook page to help ensure teenagers and young adults, both of which fall into high-risk groups for H1N1, have easy access to up to date information regarding the H1N1 virus and vaccine. You can follow the campaign on Twitter at www.twitter.com/FightTheFluLA and on Facebook at http://www.facebook.com/pages/Fight-The-Flu-LA/154425074450.

• Additional shipments of H1N1 vaccine are expected every 5-10 days for the next 2-3 months, with pregnant women, front line health care workers, and adults with pre-existing medical conditions as the next target groups for vaccination.
• Every Louisianian who wants the vaccine should have access by the end of January.
• Residents should check with their providers regarding the availability of H1N1 vaccine, and DHH will be posting a link on www.FightTheFluLA.com showing which providers across the state have received vaccine in the coming weeks.

DHH’s Fight the Flu campaign aims to keep Louisianians healthy by promoting immunizations and good hygiene to prevent the spread of the seasonal flu and the H1N1 virus. For more information on flu activity in Louisiana, including guidance for families and medical professionals, visit www.FightTheFluLA.com or follow the campaign at www.twitter.com/FightTheFluLA.

1020 H1N1 vax coming more slowly than expected [Oregon]--Last week the Centers for Disease Control announced that H1N1 vaccine yield is lower than earlier anticipated.

According to the CDC, nationwide 40 million doses had been estimated by the end of October but only about 28 to 30 million doses will be available during that time frame. To date, Oregon has received approximately 80,000 doses of H1N1 vaccine and more is scheduled to arrive next week.

At a news conference at the state public health department’s H1N1 center, Mel Kohn, MD, director of the Oregon Public Health Division discussed the state’s response to the delay. He was joined by Kathleen O’Leary, RN, Washington County Public Health Administrator and Gary Oxman, MD, health officer for Multnomah, Clackamas and Washington counties.

Dr. Kohn said that in spite of the delay in manufacturing more H1N1 vaccine is on the way to Oregon, some vaccine clinics are opening next week around the state and more will be opening throughout October and November.

“This kind of delay commonly occurs during flu vaccine production. It’s just the biology of the virus,” said Dr. Kohn. “No corners are being cut when it comes to the safety of manufacturing this vaccine. It’s meeting the same high standards as the seasonal flu vaccine.”

“The H1N1 vaccine is coming, but not as quickly as we would like,” added Dr. Kohn. “We know that demand for the vaccine is very high and we are asking people to be patient until it comes to their community and to keep checking back with the Web site or hotline for more information. Although we wish we had more vaccine to give now, there will still be value in vaccinating people in the coming months.”

The state sponsors a Web site at www.flu.oregon.gov that posts public flu clinics as well as a statewide hotline at 800-978-3040 – both have the most recent information so that people can stay informed about open flu clinics.

“People are disappointed that there isn’t more vaccine available – we are too,” said Ms. O’Leary. “Every county health department has a team working to make sure it is getting out to providers, hospitals, and clinics. Once received, we’re moving it out quickly.”

Until the vaccine arrives in adequate quantity, officials say that the other prevention measures become even more important.

“If you’re even thinking about going to work or to school if you’re sick, don’t,” said Dr. Oxman. “We all have to take responsibility for ourselves, our families and our communities and stop the spread of H1N1 flu.”

Dr. Oxman also reminded people to wash their hands, use hand sanitizer whenever possible, and to cover their coughs and sneezes.

For more information, call the Oregon Public Health Flu Hotline at 1-800-978-3040 or visit www.flu.oregon.gov.

1020 H1N1 vax available for people with no health insurance and significant health problems [King County, Washington]-- As private providers begin to receive H1N1 influenza vaccine for their patients at highest risk for complications, starting Wednesday, Oct. 21, Public Health - Seattle & King County is making vaccinations available for people without health insurance who are at increased risk because they have significant health problems.

Four Public Health vaccination clinics will be open to people up through 64 years of age who have significant health problems that put them at greater risk for serious complications for H1N1. Examples would include heart disease, lung disease, asthma, kidney disease, diabetes and HIV/AIDS.

Most children and pregnant women have public or private health care coverage, so it is anticipated that the clinics will primarily serve uninsured adults. People over age 65 are at relatively low risk for H1N1 influenza and so should not seek vaccination at this time.

For people who have health insurance, local health care providers are receiving initial, small shipments of vaccine for their existing patients who need protection most. Vaccine availability from health care providers is expected to improve gradually as additional supplies arrive in upcoming weeks.

Public Health clinic details

Four Public Health H1N1 vaccination clinics will be operated at the following locations:

White Center Public Health Center (10821 8th Ave. S.W., Seattle)
Alder Square Public Health Center (1404 Central Ave. S., Suites 101 & 112, Kent)
North Public Health Center (10501 Meridian Ave. N., Seattle)
Federal Way Public Health Center (33431 13th Place S., Federal Way)

All clinics will be open 8:30 a.m. - 5:30 p.m. on Monday, Tuesday, Wednesday and Fridays and 8:30 a.m. - 7:00 p.m. on Thursday. All clinics are walk-up and appointments will not be needed or scheduled. Visit the Public Health H1N1 influenza website at www.kingcounty.gov/health/H1N1 for clinic directions.

Vaccinations at these clinics will continue over time, pending vaccine availability from the federal government.
Clinic locations may also expand with demand. As supply increases, more vaccine will be available in Public Health clinics and other community locations. The Public Health website will be updated regularly with information on vaccine availability.

Last Friday, the Centers for Disease Control and Prevention (CDC) announced that vaccine production is proceeding slower than originally expected, which will result in smaller amounts of vaccine in ongoing deliveries over the next two months.

Call center activation

Beginning Wednesday morning, Oct. 21, the Flu Hotline at 877-903-KING (5464) will be staffed with operators to answer questions about H1N1 influenza and provide information about Public Health - Seattle & King County vaccine clinic locations for people without insurance and with significant health problems. Hours of operation with operators will be 9 a.m. to 5 p.m. weekdays; recorded information will be available 24 hours a day.

1017 H1N1 flu is widespread [Northwest Territories]--The Office of the Chief Public Health Officer (OCPHO), would like to update the residents of the NWT on the escalating H1N1 pandemic.

The H1N1 flu virus has spread to 22 of 33 NWT communities and is the dominant flu strain in the NWT at this time. At this point, there have been 19 hospitalizations and two cases of severe respiratory illness. There have been no deaths associated with the virus.

The Chief Public Health Officer would like to remind residents of the NWT that they can help stop the spread of influenza by washing their hands with soap and warm water, staying home if you feel sick, cover your mouth and nose when cough or sneeze, cleaning surfaces that may harbor influenza or other viruses.

For additional information on H1N1 influenza residents can call the Tele-Care Health Line at 1-888-255-1010 or the NWT’s Influenza Information Line at 1-888-920-3026. The Chief Public Health officer recommends calling these lines before visiting your local heath centre.

For the week of October 5-9, the flu line processed 120 calls. Of those calls, 77 residents were referred to their local health centre or hospital.

1017 Province issues updated guidance H1N1 documents to healthcare providers [Ontario]--Ontario has issued updated guidance documents to the province's health care sector including ambulatory care settings like doctors' offices, long-term care settings and emergency departments which set out recommendations for managing flu cases. Health care professionals can apply this guidance to diagnose, test, treat and advise their patients about the flu.

As part of phase one, Ontario is calling upon seniors 65 years and older and residents in long-term care homes of any age to be vaccinated against the seasonal flu in October. People 65 years and older should contact their local public health unit to find out how to get their seasonal flu shot.  During phase two, the province-wide rollout of the H1N1 vaccine will follow in early November.  Finally, phase three will offer the seasonal flu vaccine to all Ontarians six months of age and older.

1017 H1N1 flu update - vax may be available earlier than November [New Brunswick]--The following update on the H1N1 flu virus was issued by the Office of the Chief Medical Officer of Health for New Brunswick on Thursday, Oct. 15:

More information on the H1N1 flu virus may be found online or by calling the 24-hour H1N1 line, 1-800-580-0038.

1017 Clinical features of severe cases of pandemic influenza [Global]--To gather information about the clinical features and management of pandemic influenza, WHO hosted a three-day meeting at the headquarters of the Pan American Health Organization in Washington, DC on 14–16 October. Findings and experiences were presented by around 100 clinicians, scientists, and public health professionals from the Americas, Europe, Asia, Africa, the Middle East and Oceania.

The meeting confirmed that the overwhelming majority of persons worldwide infected with the new H1N1 virus continue to experience uncomplicated influenza-like illness, with full recovery within a week, even without medical treatment.
Need for intensive care

However, concern is now focused on the clinical course and management of small subsets of patients who rapidly develop very severe progressive pneumonia. In these patients, severe pneumonia is often associated with failure of other organs, or marked worsening of underlying asthma or chronic obstructive airway disease.

Treatment of these patients is difficult and demanding, strongly suggesting that emergency rooms and intensive care units will experience the heaviest burden of patient care during the pandemic.

Primary viral pneumonia is the most common finding in severe cases and a frequent cause of death. Secondary bacterial infections have been found in approximately 30% of fatal cases. Respiratory failure and refractory shock have been the most common causes of death.

Presentations during the meeting explored the pathology of severe disease in detail, with findings supported by work in experimental animals. These findings confirm the ability of the new H1N1 virus to directly cause severe pneumonia.

Clinical picture different from seasonal influenza

Participants who have managed such cases agreed that the clinical picture in severe cases is strikingly different from the disease pattern seen during epidemics of seasonal influenza. While people with certain underlying medical conditions, including pregnancy, are known to be at increased risk, many severe cases occur in previously healthy young people. In these patients, predisposing factors that increase the risk of severe illness are not presently understood, though research is under way.

In severe cases, patients generally begin to deteriorate around 3 to 5 days after symptom onset. Deterioration is rapid, with many patients progressing to respiratory failure within 24 hours, requiring immediate admission to an intensive care unit. Upon admission, most patients need immediate respiratory support with mechanical ventilation. However, some patients do not respond well to conventional ventilatory support, further complicating the treatment.

On the positive side, findings presented during the meeting add to a growing body of evidence that prompt treatment with the antiviral drugs, oseltamivir or zanamivir, reduces the severity of illness and improves the chances of survival. These findings strengthen previous WHO recommendations for early treatment with these drugs for patients who meet treatment criteria, even in the absence of a positive confirmatory test.

In addition to pneumonia directly caused by replication of the virus, evidence shows that pneumonia caused by co-infection with bacteria can also contribute to a severe, rapidly progressive illness. Bacteria frequently reported include Streptococcus pneumoniae and Staphylococcus aureus, including methicillin-resistant strains in some cases. As these bacterial co-infections are more frequent than initially recognized, clinicians stressed the need to consider empiric antimicrobial therapy for community acquired pneumonia as an early treatment.
 

Groups at greatest risk

Participants agreed that the risk of severe or fatal illness is highest in three groups: pregnant women, especially during the third trimester of pregnancy, children younger than 2 years of age, and people with chronic lung disease, including asthma. Neurological disorders can increase the risk of severe disease in children.

Evidence presented during the meeting further shows that disadvantaged populations, such as minority groups and indigenous populations, are disproportionately affected by severe disease. Although the reasons for this heightened risk are not yet fully understood, theories being explored include the greater frequency of co-morbidities, such as diabetes and asthma, often seen in these groups, and lack of access to care.

Although the exact role of obesity is poorly understood at present, obesity and especially morbid obesity have been present in a large portion of severe and fatal cases. Obesity has not been recognized as a risk factor in either past pandemics or seasonal influenza.

WHO and its partners are providing technical guidance and practical support to help developing countries better detect and treat illness caused by the pandemic virus. Patient care advice that can be applied in resource-limited settings is being rapidly compiled.

1017 States advised of production delays for the new H1N1 vax [Vermont]--The Vermont Department of Health was alerted Thursday that vaccine manufacturers are experiencing ongoing delays in the production of the 2009 H1N1 vaccine.

Extensive information, tools and resources about seasonal and pandemic flu, healthy habits and preparedness are available at the Health Department’s website: healthvermont.gov or dial 2-1-1. You can also follow us on Twitter at twitter.com/healthvermont.

1017 H1N1 flu vax clinics getting underway [Connecticut]--Governor M. Jodi Rell today announced that vaccination clinics for the H1N1 virus – the so-called swine flu – are getting underway in Connecticut and more are expected to be scheduled over the next several weeks as shipments of the vaccine continue to arrive in the state.

“These clinics are a great sign that the campaign to begin vaccinating Connecticut’s residents from H1N1 flu is off the ground,” the Governor said during a stop at a clinic for toddlers in Old Saybrook today. “We expect to see many more clinics around the state as shipments continue to come in to doctors and other health care providers. It is critical that those most at risk are given priority for the initial doses.”

The state Department of Public Health (DPH) says that the state has already received more than 83,000 doses of intranasal and injectable vaccines. Orders for the next shipment of vaccine are being placed and will include more intranasal vaccine.

The Old Saybrook Clinic, sponsored by the Connecticut River Area Health District, was by appointment only and targeted children between the ages of 2 and 4 years old, household contacts of children under the age of 6 months, and emergency and medical service and healthcare personnel with direct patient care.

The health district serves residents of the towns of Clinton, Chester, Deep River, Essex, Killingworth, Old Saybrook and Westbrook and used the intranasal, or nasal spray, form of the H1N1 flu vaccine. The intranasal vaccine has received federal approval for use in healthy persons 2-49 years of age, who are not pregnant.

The state expects to receive several thousand more doses of vaccine in weekly shipments. Shipment quantities may vary depending on the vaccine manufactures’ supply. As more vaccine is received, it will first be made available to those who are at greatest risk due to complications of H1N1 influenza: pregnant women, caregivers of children younger than age of six months, health care and emergency medical services personnel with direct patient contact, children aged six months to four years and children aged 5 to 18 with chronic medical conditions.

“People who belong to these priority groups should contact their healthcare provider or local health department for more information,” DPH Commissioner Dr. J. Robert Galvin said. “The vaccine is just now beginning to arrive into the state and we expect to receive more every week. People may need to be patient and persistent to get the vaccine in these early rounds of vaccine supply.”

Providers who have not pre-registered with the Department of Public Health and who are interested in receiving the H1N1 vaccine may still pre-register with the department. Information on pre-registering for the vaccine is available online at www.ct.gov/ctfluwatch/providers or by calling (860) 509-7929.

A public hotline for H1N1, staffed by representatives from DPH, is also available for people with questions about H1N1 flu or the H1N1 vaccine. The number for the H1N1 Hotline is: 800-830-9426. The public can call the hotline Monday through Friday, 7 a.m. to 7 p.m.

The H1N1 vaccine is only effective against the H1N1 virus and does not protect against seasonal influenza. Public health officials also encourage Connecticut residents to get their seasonal flu vaccination, as well as the H1N1 vaccination.
 

For more information on the H1N1 virus or the seasonal flu in Connecticut visit: http://www.ct.gov/ctfluwatch

1017 Bureau of Insurance announces progress and positive actions to cover H1N1 flu vax [Maine]--Bureau of Insurance Superintendent Mila Kofman is highlighting steps being taken by the Bureau and Maine insurance companies to facilitate access to the H1N1 vaccine for those individuals who voluntarily choose to be vaccinated. The Bureau of Insurance has been working with insurers and other State agencies on actions that will reduce or eliminate costs for health plan members, while also simplifying and streamlining the process.

Superintendent Kofman explained that Aetna, Anthem, CIGNA, Harvard Pilgrim, and United Health Care are taking important steps to eliminate barriers for their members who choose to be vaccinated as supplies become increasingly available. These companies are waiving copays, coinsurance, and deductibles for the administration of the H1N1 vaccine.

“These significant actions are very encouraging for Maine’s consumers, and they demonstrate how Maine insurers continue to take voluntary steps in the face of a potential public health emergency. Although receiving the vaccine is a voluntary decision, we want to make the process as easy as possible for people,” said Superintendent Kofman.

Beginning as early as August, these insurance companies began making exceptions to the requirement that vaccinations have full Food and Drug Administration (FDA) approval before coverage would be authorized. The vaccination has since been approved by the FDA.

In September, they additionally began voluntarily accepting roster billing in order to streamline the billing process for vaccination clinics. Vaccination clinics and mass immunization allow individuals to receive the H1N1 vaccination without having to schedule an appointment with their primary care providers.

Roster billing is a simplified billing process that can make it easier for clinics and mass immunizers–such as schools, pharmacies, or workplaces–to get people immunized quickly while still providing the information insurance companies need to pay claims, in this case to pay the fee for administering the vaccine.

“Clinics and mass immunizations take the pressure off the traditional delivery system, and we want to recognize that Maine insurers are going the extra mile by modifying their systems to accept this method of billing,” said Dr. Dora Mills of the Maine Center for Disease Control.

“My staff and I have been working closely with insurance companies and with the Maine Association of Health Plans to address H1N1 issues and to be fully prepared,” said Superintendent Kofman. “We are also working closely with other State agencies, including the Maine Health Data Organization to ensure that by accepting roster billing health plans are not inadvertently violating other laws.”

The Bureau of Insurance Web site is updated regularly with information for insurance carriers, care providers and consumers. For more information, visit www.maine.gov/insurance.

1017 Free H1N1 vax clinics for youth, pregnant women [Washington DC]--Mayor Adrian M. Fenty and Pierre Vigilance, MD MPH, director of the DC Department of Health (DOH) announced locations where District residents can receive a free vaccination for the H1N1 influenza based on priority categories. The District will have a clinic in each ward, beginning next week, which will be open to all youth and pregnant women in the District. Fenty also received his seasonal flu shot to remind residents that two flu vaccines are needed this year to protect themselves from the flu.

The District should eventually have enough vaccine for everyone in the District who wants it,” said Vigilance. “Residents in priority groups are strongly encouraged to seek out the vaccine to help protect themselves and the rest of the community from H1N1.”

Over the coming weeks, the H1N1 vaccine will be distributed to pharmacies in drugstores and groceries that have agreed to carry the vaccine. To help residents find a location, DOH will launch the Flu Shot Finder at flu.dc.gov next week to allow residents to search for the nearest location to get the seasonal or H1N1 influenza vaccine. Once the priority groups have been vaccinated, DOH will have clinics for the general public to receive the H1N1 vaccine.

Priority Groups
Individuals considered a priority by DOH and the CDC are:
 

• Health care workers and emergency medical responders
• Pregnant women
• Children and young adults from 6 months to 24 years
• People caring for infants under 6 months of age
• People aged 25 to 64 years with underlying medical conditions, such as asthma or diabetes

Select one of the links below to view :

• H1N1 Vaccine Clinic Schedule for Youth and Pregnant Women*
• H1N1 Vaccine Expected Availability*

DOH continues to monitor cases of influenza like illness (ILI) in the District and will keep residents updated on any new information regarding H1N1. For more information residents can go to flu.dc.govor call 311 to reach the Mayor’s Citywide Call Center.  

1017 Additional H1N1 flu vax coming to state [Oklahoma]--State health officials confirmed today an additional 65,900 doses of the novel H1N1 influenza vaccine is expected to arrive in the state next week. The doses will include both nasal spray and injectable vaccines.

For more information about the availability of H1N1 influenza vaccine in your area, call your local county health department or visit www.health.ok.gov, or call the Oklahoma State Department of Health toll-free H1N1 hotline at: 1-866-278-7134. Phones are answered Monday through Friday from 8 am to 5 pm.

1017 State receives fewer than anticipated H1N1 vax doses this week [Colorado]--State health officials today reported the amount of H1N1 vaccine received this week, 50,000 doses, is well below the 183,300 doses that were expected. They advised local health departments and hospitals to continue to provide available vaccine to health care workers who provide direct patient care and to other high-risk groups as vaccine supplies in individual locations allow.

The following individuals who are in the high-risk group for experiencing complications from H1N1 were advised to be the first in line to receive an H1N1 vaccine:

• Preschool children ages 6 months to 4 years
• School age children and young adults ages 5 to 18 with chronic health conditions
• Health care workers with direct patient contact
• Pregnant women
• Parents/caretakers for children younger than 6 months

Joni Reynolds, Immunization Program director at the Colorado Department of Public Health and Environment, said, “The federal government is doing everything it can to provide as much vaccine to states as possible. However, the vaccine estimates have changed nearly daily and have been lower than that anticipated and planned for.”

Ned Calonge, the state’s chief medical officer, said, “This is frustrating, especially for those individuals who know they have an increased risk and are anxious to get the vaccine. It is also proving difficult for local health departments and others who have set up flu clinics and now may not have enough vaccine this week to conduct them. However, we continue to be assured by our federal partners that we will receive the vaccine we need to provide immunizations for those Coloradans who need them, though later than originally anticipated.”

In the meantime, Calonge advised people to prevent the flu by practicing good hygiene, staying home when sick and avoiding others who are ill.

Good hygiene habits to prevent the flu include

• frequently washing hands;
• coughing and sneezing into the crook of your arm, rather than uncovered or in your hand;
• avoiding people with respiratory illness;
• staying home from work or school when sick, returning only after fever has subsided for 24 hours without the use of a fever-reducing medication.

Calonge said, “As soon as we have the vaccine needed to support community clinics, we will update our flu clinic finder at www.immunizecolorado.com.”

Two resources to assist the public during H1N1 flu season are available online, including the Colorado Department of Public Health and Environment’s Home Care Guide about caring for sick individuals at home and a link to CDC’s Web-based H1N1 flu self-evaluator, an online tool that will help people decide if they need to see a doctor for symptoms that might be caused by the flu. The Home Care Guide is available in English and Spanish at and CDC’s Flu Self-Evaluation is at http://www.flu.gov/evaluation/

For additional information about flu clinics or answers to other questions about H1N1 or seasonal flu, individuals may call the CO HELP hotline at 1-877-462-2911.

1017 H1N1 flu vax distribution underway - flu activity high [Wyoming]--As flu activity continues to be high across the state, the Wyoming Department of Health says swine (novel H1N1) vaccine distribution is underway in Wyoming at the same time delays in seasonal flu vaccine delivery are being reported here and around the country.

More information about swine (novel H1N1) flu and vaccination in Wyoming is available online at www.health.wyo.gov .

1017 First local H1N1 flu death this fall [King County, Washington]--A King County male in his 20s died yesterday from complications of H1N1 influenza (swine flu) and his underlying health conditions. This is the first reported H1N1 death in King County this fall as flu activity picks up.

"Our hearts go out to this man's loved ones," said Dr. David Fleming, Director and Health Officer for Public Health - Seattle & King County. "Flu activity is increasing locally, and this tragedy is a reminder that H1N1 influenza can be a very serious illness and that people with underlying health conditions are at higher risk for severe complications and death. Vaccine is the best protection, and more doses will be arriving weekly to immunize people, beginning with people who need the protection most."

In King County from April 25 to October 2, 2009, there have been 82 hospitalizations of patients with H1N1 influenza. Nearly 1 in 4 required intensive care, and 3 of the 82 patients died.

Initially, vaccine is being prioritized to protect people most at risk for H1N1 influenza, as recommended by the Centers for Disease Control and Prevention (CDC). Vaccine availability will be opened up to everyone who wants it as soon as supplies are sufficient to cover demand in risk groups. The priority groups include:

• Pregnant women
• People who live with or care for children younger than 6 months of age
• People between the ages of 6 months and 24 years old
• People between 25 through 64 years of age with chronic health conditions or weakened immune systems
• Healthcare and emergency workers

H1N1 vaccine availability

At this time H1N1 vaccine is still being manufactured and is not yet widely available for the general public in King County. Public Health is working with the State Department of Health and CDC to assure shipments to King County immunization providers on a rolling basis and as vaccine is produced.

Small, initial shipments totaling 20,000 doses of H1N1 vaccine began arriving in King County late last week for immunization of health care workers. A second shipment of 30,000 doses of vaccine may begin to arrive as soon as late this week to a limited number of health care providers so they can vaccinate their most at-risk patients.

Based on the best information currently available from CDC, larger supplies of vaccine needed for broader-scale administration to the public will begin to arrive in King County within the next several weeks. As more vaccine becomes available, vaccine will be provided through pharmacies, Public Health clinics and special community vaccination clinics.

Please visit www.kingcounty.gov/health/H1N1 or call the Flu Hotline at 877-903-KING (5464) for frequent updates about vaccine availability and, once more vaccine arrives, locations where you can get H1N1 vaccinations.

Flu activity

Through its monitoring, Public Health has found that flu activity is rising in King County.

• Emergency department visits for influenza-like illness have been increasing since the beginning of September and are higher than the 2008-09 seasonal flu peak. Emergency department visits have not reached the peak levels observed during the spring H1N1 outbreak.
• In recent weeks hospitalizations for flu have been at a level comparable to the height of the spring H1N1 outbreak.
• Public Health is asking local hospitals to report all patients admitted with influenza of any type. Since the beginning of September, there have been reports of 51 hospitalizations for influenza. Twenty-five of these were confirmed to be H1N1, and most of the others are expected to be H1N1 as well.

When to seek care

Persons with influenza do not need to see a doctor unless their symptoms are unusually severe or if they are at increased risk of severe illness due to an underlying health condition. Most people experience and recover from H1N1 flu without medication just as they do from seasonal flu. When antiviral treatment is necessary, it is most effective if started within 48 hours of the first symptoms of illness.

1017 State response to H1N1 continues, Joint Info Center opens [Arizona]--Since the discovery of the new strain of H1N1 influenza in April 2009, the Arizona Department of Health Services has responded to the 2009 H1N1 at all levels. The Office of Infectious Diseases and the Arizona State Public Health Laboratory are tracking influenza cases and evaluating the severity of the disease. The state has been using its emergency pandemic plan as a roadmap for serving the needs of the public.

The 2009 H1N1 vaccine is beginning to arrive in Arizona. ADHS is working with county health departments to make sure that the vaccine is going first to the priority groups that have the highest risk of infection and complications. As expected, the initial vaccine shipments are small. As larger shipments of vaccine arrive, the vaccine distribution will expand until everyone who wants the vaccine can get it.

"We’re getting a lot of calls at the Department from people who want the H1N1 vaccine. We want them to have it, but they need to be patient," said Will Humble, ADHS Interim Director. "The quantities of vaccine coming into the state continue to grow, but slowly. And in the meantime, use good health hygiene: Stay home where you are sick, cover your cough and wash your hands thoroughly."

The only type of influenza circulating right now is H1N1. People should not ask for a test because the results will not impact the treatment. If someone does want a test, they have to work with a private laboratory; the state is only testing the most severe cases and fatalities.

If you are normally healthy and think you have the flu, stay home and drink lots of fluids and treat your symptoms. If you feel worse after a day or two or have trouble keeping fluids down, contact your doctor. If you have problems breathing, chest pains or can’t take care of yourself, get immediate medical attention. If children are sick and become less responsive or cannot hold down fluids, contact a health care provider right away.

1015 FDA warns of unapproved and illegal H1N1 drug products purchased over the internet [USA]--The U.S. Food and Drug Administration today warned consumers to use extreme care when purchasing any products over the Internet that claim to diagnose, prevent, treat or cure the H1N1 influenza virus. The warning comes after the FDA recently purchased and analyzed several products represented online as Tamiflu (oseltamivir), which may pose risks to patients.

Consumers can also visit FDA's Web site for tips about how to protect themselves when buying medicines online.

FDA 2009 H1N1 (Swine) Flu Page
Fraudulent H1N1 Products Widget

1015 Dept of Health announces AmbuBus evacuation program [Mississippi]--The Mississippi State Department of Health (MSDH) has partnered with the Mississippi State Department of Education, individual school districts and several County Emergency Management Agencies in a new program called “AmbuBus” to help provide mass patient evacuations in the event of a public health emergency such as a hurricane.

“Many lessons were learned from previous hurricanes, one of these being the additional need for medical transportation to evacuate non-ambulatory individuals,” said Jim Craig, Director of the MSDH Office of Health Protection. “These new kits offer Mississippi an economical solution in addressing this need. Converting buses into medical transportation during disasters offers emergency responders an added resource to effectively and efficiently evacuate a large number of the special needs population at once and in as little time as possible.”

Installing the AmbuBus conversion kit

A completely converted AmbuBus

Utilizing a quick installation kit, local school districts can convert a bus into ambulance style transportation with room for up to18 stretchers, medical equipment, and a team of up to eight medical personnel. In the event of an emergency, the Mississippi Department of Education’s Transportation Department will provide buses for conversion as well as drivers. Currently, kits are located in the Jackson, Hattiesburg, Grenada, Lauderdale, Pearl and Rankin school districts. The AmbuBus program will soon expand to Harrison, Hancock and Covington counties. AmbuBuses can be dispatched anywhere they’re needed within the space of a few hours.

The AmbuBus conversion kits are a product of First Line Technology, LLC, of Chantilly, VA. They were purchased by MSDH through federal grant funds.

1015 Dept of Health to launch public health hotline [North Dakota]--The North Dakota Department of Health encourages North Dakotans to call a new toll-free hotline with questions about H1N1 and seasonal influenza, according to State Health Officer Terry Dwelle, M.D.

The toll-free hotline number is 866.207.2880, and it will operate from 8 a.m. until 5 p.m. Monday through Friday beginning tomorrow, October 16. Information about influenza also is available on the Department of Health’s hotline website at
www.ndhealth.gov/EPR/HealthHotline or its influenza website at www.ndflu.com.

“We want North Dakotans to be able to access the most current information available about H1N1 influenza, seasonal influenza and vaccinations,” Dwelle said. “The hotline and the department’s website are designed to provide easier access to the information they are seeking.”

The hotline is staffed with Department of Health personnel who will answer questions based on information provided by the North Dakota Department of Health’s Division of Disease Control, the U.S. Centers for Disease Control and Prevention, and local public health units. If an operator does not have the information a caller is requesting, the call will be referred for appropriate follow-up by a disease epidemiologist on staff.

“The hotline is not designed to give medical advice,” Dwelle said. “The purpose of the hotline is to answer questions about topics such as caring for someone who is ill, the symptoms of H1N1 flu, and vaccine safety. People who think they may be ill should contact their physicians.”

1015 New toll-free number to provide 24/7 H1N1 flu and vax info [Missouri]--issouri residents can call a new toll-free number for information about the H1N1 flu, from symptoms and basic medical advice to the availability of the new H1N1 vaccine.

The number, 1-877-FLU-4141 (1-877-358-4141), will be answered 24 hours a day, seven days a week.

Specialists with the H1N1 InfoLine will answer questions about flu symptoms, when to seek medical care and ways to limit the spread of the flu, including the new vaccine. Medical professionals will be available to assist the specialists with callers’ questions.

The information line is sponsored by the Missouri Department of Health and Senior Services.

“As we get further into flu season, we know many Missourians will have questions about the H1N1 flu,” said Margaret Donnelly, director of the state health department. “We urge Missouri residents to do everything they can to prevent the spread of the flu and keep their families healthy. The Flu InfoLine can help answer questions they might have.”

Health care professionals can also call the toll-free number for more information about the H1N1 flu and vaccine.

The state health department is encouraging Missourians to get the vaccine as it becomes available. Pregnant women, children and young adults are the most at risk of contracting the H1N1 flu, so they will be given priority to receive the vaccine first. Studies show that older people are less at risk because they appear to have some degree of resistance to the virus.

Missouri received its first shipment of aerosol mist vaccine early this month. Additional shipments of the aerosol mist and the injectable form of the vaccine began arriving from drug manufacturers this week.

The mist version of the flu vaccine can be used by healthy children and adults ages 2 through 49. Because it contains live virus, it is not appropriate for pregnant women, children under 2 years old or anyone with an underlying health condition such as asthma. Those groups should receive an H1N1 flu shot.

“Adequate supplies of the flu vaccine will be available for the high-risk groups,” Donnelly said. “As additional shipments of the vaccine arrive in Missouri, flu shots or vaccine mist should be available to everyone who wants them.”

H1N1 flu symptoms include fever, cough and sore throat. Most cases are relatively mild to moderate and do not require treatment. Most people with the H1N1 flu can recover at home. They should get plenty of fluids, take over-the-counter medication to reduce their fever and stay home and rest.

Pregnant women and people with underlying health conditions who think they might have the flu should contact their health care provider.

1015 Flu activity increases in state - 56 schools reporting more than 10 percent absenteeism due to illness [Iowa]--The number of Iowa schools with absences due to influenza-like illness is rising. Monday, October 12, 56 schools in 23 counties reported to the Iowa Department of Public Health (IDPH) that at least 10 percent of their enrollment was absent due to illness. The average percent absent for the schools reporting was 15 percent of students out due to illness.

By planning ahead, child care can be easier for everyone. Parents can contact others in the neighborhood or parents from their children’s classroom to make prior arrangements for ill children. For example, parents can stagger their time off from work by arranging for several children to go to one parent’s home one day, and someone else’s the next. If you have several ill children in one home, it’s a good idea to keep them in separate rooms if possible. This will help slow the spread of any additional viruses circulating among the kids.

Symptoms of H1N1 influenza are similar to seasonal flu and include a fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people with H1N1 flu may also have diarrhea and vomit. Because H1N1 is spread by person-to-person contact, it is important for students who are ill to stay home from school until their cough significantly improves and they are fever-free for 24 hours without the use of fever-reducing medication.

For more information about H1N1 influenza, visit www.idph.state.ia.us/h1n1/.

1015 WNv - Tests confirm state's first death from disease [Washington]--The Washington State Department of Health has confirmed the first death due to West Nile virus within the state. The Yakima County woman in her 70s died last month. Confirmatory tests to specifically identify West Nile virus as the cause of her infection were performed at the Washington State Public Health Laboratories and at the national Centers for Disease Control and Prevention.

Before her illness, the woman spent time in both Yakima County and Colorado. She couldve been exposed to the virus in either area, both of which have virus-carrying mosquitoes.

In addition to this case, 31 other West Nile infection cases have been reported with exposure in Washington during 2009, bringing the total this year to 32 human cases. Among these cases, 25 have had severe disease, including encephalitis, meningitis, and/or paralysis. Seven cases had mild illnesses, mostly with symptoms of fever and headache.

This is the states highest yearly confirmed human case total since West Nile virus was first detected in Washington early this decade. A count of three cases in 2008 had been the previous top annual count.

Washingtons West Nile virus monitoring program shows the virus was active this year in 15 counties, mostly in Eastern Washington Yakima, Benton, Franklin and Grant counties have had the most detections of the virus. The Department of Health tracks West Nile virus in the environment in mosquitoes, birds, and horses or other mammals. This year, there have been 341 positive mosquito samples, 22 positive birds, and 67 positive horses. Five infected birds have been found in Western Washington — in King, Lewis, Grays Harbor, Pierce and Mason counties.

West Nile virus is primarily a bird disease that can be spread to people who are bitten by an infected mosquito. Most infected people do not become ill or have only mild symptoms, but West Nile virus can cause serious infections in the brain (encephalitis) or in the spinal cord (meningitis) and can be fatal. People over age 50 are at highest risk for these serious infections, though younger people can also develop severe illness.

There is no vaccine to prevent West Nile virus infection in people. The best way to prevent infection is to avoid mosquito bites. Now that cooler fall weather has arrived, mosquito activity is winding down. However, some mosquitoes may still be out. People should protect themselves against West Nile virus and other mosquito-borne illnesses by avoiding mosquito bites.

1015 H1N1/ILI status report - Level of flu activity very unusual for this time of year and increasing [Utah]--Status summary as of Wednesday, October 14: Utah:

Circulation:
 

Influenza is currently circulating at a level that is typical for what is seen during regular flu seasons. This level of influenza activity is not typical and is considered very unusually for this time of the year, and is more common with levels seen much later in the flu season. At this time influenza activity appears to be increasing from week to week.

The indicator used by public health to measure the circulation of influenza in the community is influenza-like illness (ILI) as reported by sentinel clinics. (An ILI sentinel clinic is a clinic that reports to public health the percentage of patient visits seen for influenza-like illnesses).

For the past week (MMWR week 40), the ILI rate for Utah is 3.0% (up from 1.6% last week).

This value is above the ILI outbreak threshold of 1.1%.
ILI is up for the second consecutive week.
 

Severity:

The severity of an influenza outbreak (epidemic or pandemic) is measured by the number of influenza infections that result in hospitalization or death. To date, severity for the 2009 H1N1 Pandemic is comparable to or slightly greater than the severity seen during regular flu seasons.
 

At this time there is no evidence that severity for the 2009 H1N1 Pandemic is changing.
 

There have been 127 influenza-associated hospitalizations (IAHs) (due to both seasonal and 2009 pandemic strains) reported this season. The current number of IAHs is very unusual for this early in the influenza season. 41 have occurred during the past week.

2009 Pandemic A (H1N1) deaths:
 

The severity measure listed above is for influenza caused by all strains (regular seasonal flu and the 2009 Pandemic A (H1N1)). In addition, Utah is collecting data on patient deaths (whether hospitalized or not) known to have been caused by the 2009 Pandemic A (H1N1) strain.

3 deaths occurred in Utah during the past week in which the persons had confirmed 2009 Pandemic Influenza A (H1N1).

There have been a total of 3 deaths related to 2009 Pandemic Influenza A (H1N1) since the beginning of the 2009-2010 influenza season (which began August 30, 2009).
 

Circulating strains:
 

There were 65 total specimens submitted to the Utah Public Health Laboratory for confirmatory influenza testing during the past week. Of the 65 specimens tested, 27 specimens or 41% were positive for influenza, all of which were 2009 Pandemic A (H1N1) 100% due to 2009 Pandemic A (H1N1)
0% due to seasonal A (H1)
0% due to seasonal A (H3)
0% due to Influenza B
 

National/international surveillance:
 

Influenza illness is ongoing in the United States. At this time, national ILI levels are higher than what is expected during this time of year. During the past week, widespread influenza activity was reported in 37 states, with regional influenza activity being report in 11 states.

Nationally, the proportion of deaths attributed to pneumonia and influenza (P&I) during the past week was at the epidemic threshold, which is an increase from previous weeks in which P&I attributed deaths were below the epidemic threshold.

Viral circulation and resistance:
 

Data in this section comes from the CDC and is collected nationally:
 

99.7% of all influenza isolates typed at national reference labs this week were Influenza A:
99.8% of the subtyped isolates were 2009 Pandemic A (H1N1).
0.1% were seasonal A (H1)
0.1% were seasonal A (H3)
0.3% were Influenza B
 

The majority of influenza viruses currently circulating in the U.S. are 2009
Pandemic A (H1N1).

1015 With pandemic H1N1 on the rise, Public Health stresses importance of prevention and vaccination [Utah]--New statewide data released today by the Utah Department of Health (UDOH) indicate a substantial increase in the spread of the pandemic H1N1 virus throughout the state. Public health officials want Utahns to know there are specific actions they should take to protect against the flu.

The best protection comes in the form of the pandemic H1N1 vaccination. However, vaccine supplies are still very limited, and are being made available initially only to certain Utahns at most risk of influenza and serious complications of influenza. The U.S. Food and Drug Administration (FDA) has licensed four manufacturers to produce the vaccine – and each manufacturer produces vaccine that is only approved for use in certain age groups. Each of the state’s 12 local health departments is working within manufacturer parameters to target the initial, limited amount of vaccine to the people in their jurisdictions who stand to benefit most from receiving a vaccine.

“We know certain populations, such as infants and toddlers, are at a much higher risk of becoming severely ill if they are infected with the pandemic H1N1 virus,” said Salt Lake Valley Health Department Executive Director Gary Edwards. “It makes the most sense for us to vaccinate those who are high risk first. We hope the public will be patient, understanding that over the next few weeks we should have enough vaccine to start immunizing everyone who falls into a priority group.”

The UDOH’s weekly release of influenza data suggests the spread of pandemic H1N1 virus is accelerating throughout the state. Utah’s rate of influenza-like illness (ILI), a key indicator in determining how widely the virus is circulating, shows the state is above the “outbreak” level for the second consecutive week. Disease severity, which is measured by influenza-associated hospitalizations and deaths does not appear to have changed, but because more people are becoming ill with pandemic H1N1 influenza, more are developing severe disease. Since the beginning of September, 127 Utahns have been hospitalized and three have died from H1N1-associated causes.

“If you think of an outbreak occurring on a bell-shaped curve, we appear to be at the base of what could be a steep climb to the peak,” said UDOH Deputy State Epidemiologist Dr. Rachel Herlihy. “With vaccine in short supply, it’s critical people start taking proactive steps to protect themselves and their families against the disease. It is especially important that people stay home when they are sick with influenza symptoms.”

Simple, everyday preventive actions will help limit the spread of germs that cause influenza, such actions include:
• Coughing or sneezing into a tissue or your shirt sleeve;
• Avoiding touching your eyes, nose or mouth – germs spread this way;
• Avoiding close contact with sick people;
• Staying home from work or school when you are sick with influenza-like illness for at least 24 hours after your fever has broken and;
• Washing your hands regularly, especially after sneezing or coughing, using soap and water or alcohol-based hand sanitizers.

Families should prepare for what they would need if they are required to spend time isolated at home due to illness. Items like food, water, tissue, sanitizers, over-the-counter medications and prescription medications are all useful items to have on hand in the event you become ill and are confined to your home. Having these items in the home will also help to ensure sick people don’t need to go out into public to buy them.

Businesses should also consider how they would cope with increased absenteeism due to
potentially high rates of illness among their employees or their employee’s children. Having flexible leave policies or telecommuting policies will help protect healthy workers and will contribute to the health of the business as well.

More information on steps for preventing influenza can be found at www.health.utah.gov/h1n1. To find out where to get either an H1N1 or seasonal influenza vaccine, Utahns can visit www.immunize-utah.org or call 2-1-1.

1015 First H1N1 flu death of patient with no serious prior medical problems [Kansas]--The first H1N1 flu death in a Kansan with no serious prior medical problems was reported today by the Kansas Department of Health and Environment (KDHE). The death, which occurred in a 50-year-old woman from the Kansas City area, is the seventh in the state to be confirmed as due to the pandemic virus. It came after more than a week of hospitalization.

Laboratory testing confirmed that the woman had the H1N1 virus on October 5, and her death was reported to KDHE yesterday afternoon.

KDHE Secretary Roderick Bremby and Dr. Jason Eberhart-Phillips, Kansas State Health Officer, expressed sympathy and offered their deepest condolences to the woman’s family.

“The death being reported today reminds us of the importance of taking this virus very seriously,” Dr. Eberhart-Phillips said. “The H1N1 vaccine has started arriving in the state and it is important for Kansans to know that this is a safe and effective tool we have for fighting this virus. While supplies of the vaccine are very limited at this time, we will soon have sufficient quantities to starting vaccinating larger groups and I encourage Kansans to stay informed.”

The pandemic H1N1 virus is causing widespread illness throughout Kansas and the United States. Visits to healthcare providers for influenza-like illness have been increasing in most regions of Kansas as well as throughout the United States over the past few weeks and are substantially higher than what is typically seen at this time of year.

The symptoms of infection with the pandemic H1N1 virus are similar to the symptoms of seasonal flu and include fever greater than 100 degrees, body aches, coughing, sore throat, respiratory congestion, and in some cases, diarrhea and vomiting. Most people who have been ill with pandemic H1N1 influenza have recovered without medical treatment.

However, some people develop serious complications that require hospitalization or may lead to death, as today’s report illustrates. Although serious complications are more likely among persons with certain underlying chronic health conditions, this pandemic influenza virus has caused serious complications and deaths among persons without such factors.

In a recent review of hospitalized patients with confirmed 2009 H1N1 influenza virus infection across the U.S. that was published online October 8 by the New England Journal of Medicine, more than one-fourth of patients (27 percent) had no underlying chronic health conditions that are recognized to increase the risk of complications from influenza. And unlike typical seasonal influenza, the 2009 H1N1 virus is causing a greater disease burden among adolescents and young adults. Today’s report provides more evidence that severe illness from H1N1 virus infection among relatively young, healthy persons can occur.

1014 Central Region health directors encouraging parents to complete H1N1 vax permission forms [Virginia]--In an effort to protect the health of Central Virginia's children, the area's eight health district directors are encouraging all parents of school-age children to take advantage of the free novel H1N1 vaccination programs being offered in cooperation with K-12 schools throughout the region. The first step to doing so is to complete the novel H1N1 influenza vaccination form being sent home with students. While the vaccination is not mandatory, health officials are advising that everyone consider getting the vaccine.

For more information on the vaccine or the school vaccination clinics, call your local health department or log onto www.vdh.virginia.gov and click on novel H1N1 information.

1014 State University of New York launches H1N1 pandemic flu strategy [Albany]--In order to get out in front of a potential pandemic flu outbreak, The State University of New York has undertaken a comprehensive, collaborative system-wide campaign to prepare for all forms of flu; to educate about the virus and to respond effectively to parents, students, employees and the general public.

“SUNY’s response to all forms of the flu has been focused on three critical themes: Prepare, Educate, and Respond,” said Chancellor Nancy L. Zimpher. “Our first priority is to help keep students, faculty and staff healthy and safe. When there is illness, SUNY’s advanced planning and preparation aims to minimize it.” Chancellor Zimpher stressed that the potential for flu events to escalate rapidly requires a coordinated and collaborative response across the 64 SUNY campuses, as well as with state and federal agencies.

All SUNY policies and procedures undertaken to prepare, educate, and respond to pandemic flu follow medical guidelines from The Centers for Disease Control, U.S. Department of Health and the New York State Department of Health.

"Chancellor Zimpher's proactive efforts are a model for all academic institutions and will provide valuable situational awareness for SUNY campuses, maximizing the prevention of outbreaks and minimizing spread of illness in campus communities. We are working with SUNY and providing guidance. Together we are enhancing students' access to flu vaccinations on SUNY campuses. We look forward to collaborating in SUNY's surveillance efforts. The data being collected by SUNY and shared with the New York State Department of Health will greatly enhance our ability to provide consultation and will facilitate rapid response when it is warranted," said State Health Commissioner Richard F. Daines, M.D.

SUNY’s Three-pronged approach to pandemic flu

Prepare

* SUNY created a pandemic flu website last year, which is updated daily – http://www.suny.edu/h1n1

* A University-wide planning group was convened last year to provide system-wide guidance on critical issues pertaining to pandemic flu and other crises.

* At the Chancellor’s request, campuses are reporting cases of “Influenza-Like Illness” (ILI) centrally via a tool developed by SUNY System.

* SUNY monitors daily campus trends and is reporting overall illnesses to the NYS Department of Health.
 

To date, the daily reported new cases of ILI are minimal. SUNY educates nearly 440,000 students across 64 campuses. Average reported daily ILI cases thus far have amounted to less than 0.02 percent of that population (average of 83).
 

There have been no SUNY-related deaths reported from ILI or H1N1.

Educate

* The Chancellor has formed an H1N1 Medical Advisory Group that includes international experts on infectious diseases and public health. The group provides assistance to campuses and advises the Chancellor.

* SUNY held a symposium on H1N1 on September 14th in Syracuse that attracted 167 participants from 54 SUNY colleges. Speakers from the Centers for Disease Control and the U.S. Department of Health provided information and counsel, and a higher education expert from Carnegie Mellon University described their planning and response to a severe outbreak of H1N1 on that campus.

* SUNY campuses have been taking preventive steps to help educate students, faculty and staff regarding how to limit the spread of all types of flu. Campuses are:
o Publishing campus websites for H1N1;
o Holding ongoing meetings of campus emergency and planning groups;
o Providing education and outreach to their campus communities;
o Expanding respiratory protection efforts;
o Increasing inventories of essential items, such as face masks and hand sanitizers;
o Preparing to use their online course management systems to continue instruction;
o Becoming points of distribution for vaccines;
o Exploring alternative housing for ill students.

* Poster campaigns help educate people about how to properly wash hands, and cough and sneeze to limit germ spread.

Respond

* Seasonal flu shots are being offered on campuses.

* SUNY NY-Alert allows campuses to send text, email, voice messaging directly to students in the event of a emergency. SUNY NY-Alert is the largest such effort in the country. This system has been in place for more than two years now and enjoys nearly 100% campus participation.

* SUNY has launched a comprehensive system of daily reporting to assist campuses in monitoring Influenza Like Illness across the system.

About the State University of New York

The State University of New York is the largest comprehensive university system in the United States, educating nearly 440,000 students in 7,669 degree and certificate programs on 64 campuses. To learn more about how SUNY creates opportunity, visit www.suny.edu

1014 Indianapolis area hospitals modify visitation policies in response to flu season [Indiana]--All Marion County hospitals have adopted a plan to limit visitors who might infect hospital patients or staff with communicable diseases like the H1N1 flu. The announcement was made October 13 after Marion County members of the Indiana Coalition for Patient Safety completed the policy.

"The Marion County coalition members have been meeting for the last several months to develop a policy on visitor restriction that emphasizes a unified approach to protecting hospitalized patients and hospital staff," said Glen J. Bingle, MD, PhD and Chairman of the Indianapolis Coalition for Patient Safety.

The policy, reviewed and supported by the Marion County Health Department's Scientific Advisory Group, exemplifies the coordinated approach local healthcare providers are implementing to protect the best health interests of the community.

"This consensus policy is a collaborative response on the part of local healthcare and public health leadership to the rapidly evolving needs of our community," said Charles Miramonti, MD, Deputy Medical Director of Wishard Emergency Medical Services and Assistant Professor of Clinical Emergency Medicine in the Department of Emergency Medicine at Indiana University.

Health officials agree that even with the standard of excellent care and the rigorous preparation exemplified by public and private healthcare providers, a key to success remains the public's cooperation.

"At St. Vincent, our goal is to ensure the health and safety of our patients, associates and visitors at our facilities. We appreciate the opportunity to collaborate with other area hospitals in achieving this goal. By temporarily restricting visitors during a public health emergency, we can help to limit risk and continue to provide the appropriate level of care to our patients," said Robert M. Lubitz, MD, MPH, FACP, and Vice President, Academic Affairs and Research; Medical Director, Joshua Max Simon Primary Care Center and Executive Sponsor, Emergency Preparedness at St. Vincent Indianapolis Hospitals.

Local health officials agree that while the restrictions may create some inconveniences, protecting patients who have a weakened immune system or at a higher risk for infection such as pregnant women and newborn infants, is a critical step in controlling the spread of flu this season.

"Since this specific influenza virus is preferentially affecting children, adolescents and young adults, we have deemed it necessary to initiate a visitation restriction policy. Only parents, spouses, domestic partners and spiritual counselors will be allowed to visit. The cooperation of everyone during this pandemic will help prevent the spread of this serious and potentially deadly virus," said John C. Christenson, MD, Director of the Ryan White Center for Pediatric Infectious Disease, Riley Hospital for Children, and professor of Clinical Pediatrics, Indiana University School of Medicine.

The hospital visitation policy is one example of changes that the general public is likely to see during the flu season.

"We know our community will respond, as they have to other health issues. These steps are being taken to protect those vulnerable to infectious disease and to lower the risk of spreading communicable diseases like the flu," said Virginia A. Caine, MD, Director, Marion County Health Department.

1014 Seasonal flu shots now available at county health depts [Mississippi]--Seasonal flu shots are now available at all Mississippi State Department of Health (MSDH) county clinics. The seasonal flu vaccine is recommended for anyone age six months and older.

To locate a county health department clinic in your area or for more information on flu and pneumonia, visit the MSDH website at www.HealthyMS.com or call 1-866-HLTHY4U (1-866-458-4948).

1014 Schools providing free flu shots to state's children beginning today [Arkansas]--Beginning October 14, 2009 and continuing through December, the Arkansas Department of Health in conjunction with the Arkansas Department of Education and local school districts statewide will be providing free seasonal flu shots and H1N1 vaccine if supplies are available to school children at 1094 schools. This effort is funded by the tobacco tax passed during the recent legislative session and federal monies and is part of Governor Mike Beebe’s health initiative.

Dr. James Phillips, branch chief, infectious disease, said, “Flu is serious. Each year we lose some 36,000 Americans to complications from flu. H1N1 flu is placing an additional burden on the safety and well being of our school children. We have seen 9 deaths due to complications from H1N1 flu this season. Flu shots are not required for children to attend school, but they are highly recommended.”

The fastest, most efficient way to vaccinate the most children will be through the upcoming statewide school flu clinics beginning October 14th at Fair Park Elementary School in Little Rock, and the initial H1N1 vaccine supply will be for the first of these clinics. For a complete listing of all school clinics statewide, click on www.healthyarkansas.com and click on “Find Flu Clinics.”

The influenza virus is spread through coughing or sneezing and by touching a hard surface with the virus on it and then touching the nose or mouth. The best way to prevent the flu is to get vaccinated each year.

For more information go to www.healthyarkansas.com or www.flu.gov .

1014 Two additional deaths related to H1N1 [Arkansas]--The Arkansas Department of Health (ADH) is providing the following update on seasonal and H1N1 flu and the arrival of flu vaccine in the state.

Arkansas is reporting two additional deaths from complications of H1N1 flu. This brings the total deaths to 9 this flu season. The number of illnesses and deaths associated with H1N1 flu continues to rise in Arkansas and nationwide. The Centers for Disease Control and Prevention (CDC) has developed a flu hospitalizations and deaths tracking system that can be found at http://www.cdc.gov/flu/weekly/

The ADH has received H1N1 vaccine. This vaccine is being sent to local health units and OBGYN offices for distribution to children and pregnant women—two of the priority groups at most risk for serious complications from H1N1 flu. If you or a family member fit these priority groups, please call your local health unit or your private provider to see if vaccine is available. We will be giving seasonal flu and H1N1 vaccine at our school clinics beginning October 14 and continuing through December. We will also be giving H1N1 vaccine at our local health unit maternity clinics as supplies are available. We will be giving seasonal flu and H1N1 flu vaccine at our Mass Flu Clinics in every county statewide on October 29, 30, 31 as supplies are available. Go to www.healthyarkansas.com and click on Find Flu Clinics to see about dates, times and locations of school clinics for your children and Mass Flu Clinics in each county.

It is important for every Arkansan to receive both the seasonal and H1N1 flu vaccine. CDC is advising people to get the vaccine even if it is suspected that that individual has had the H1N1 flu. Lab testing conducted in your physician’s office is not designed to test for H1N1 flu and, therefore, is not reliable. Taking the vaccine will not hurt you even if you have had the flu.

1014 Cherokee County death linked to H1N1 flu [Alabama]--The Alabama Department of Public Health was notified this week about the death of a man in his 50s from Cherokee County who tested positive for 2009 H1N1 influenza. This brings the total number of deaths of persons with H1N1 influenza in Alabama to 17.

Previous deaths of persons positive for H1N1 influenza have occurred during 2009 to residents of Bullock, Calhoun, Dale, Houston, Jackson, Jefferson, Macon, Madison, Mobile, Montgomery, Russell and Talladega counties.

When H1N1 influenza vaccine becomes available, locations, dates and times of clinics will be announced at www.adph.org. Please check this site regularly to find a provider near you.

1014 Stop flu at school vax clinics begin [Hawai'i]--Now in its third year, Protect Hawai‘i’s Keiki: Stop Flu At School kicked off today with thousands of Hawai‘i elementary and middle school students receiving their free seasonal flu vaccine this week through the Hawai‘i State Department of Health (DOH) program. In all, 334 public, private and charter school clinics are scheduled across the state between now and December 3, 2009 and more than 68,000 students are expected to participate this year.

1014 H1N1: Tips for when to seek medical advice [Oregon]--As more people experience flu-like symptoms that could be pandemic H1N1 influenza, Oregon Public Health officials are reminding people of what they can do to protect themselves and others.

“So far, the H1N1 flu is not more serious than regular flu, so if you are sick, stay home to avoid spreading it to others and take good care of yourself,” says Mel Kohn, M.D., Oregon Public Health director. “If you have other conditions that put you at high risk or if symptoms get serious, that’s when you should call your doctor.” (See list of conditions below.*)

H1N1 influenza is now spreading across the country. Oregon public health officials urge people to stay home when sick.“So far, we’ve seen relatively mild cases of H1N1 flu,” says Dr. Mel Kohn, Oregon Public Health Director. "But that could change as the season progresses."

Public health officials are asking people to take the guidelines seriously about staying home, says Kohn.