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Notes: February 2010- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Previous Notes

Type A H1N1 Influenza Winds Down

It's still important to press immunization coverage with the new vaccine, but currently there is no active threat of a large number of cases here or elsewhere in the world. A theoretical “Third Wave” does not seem imminent. Immunization with H1N1 yet this season may facilitate a quicker and more effective immune response with next year's immunization. While almost all countries are reporting declining numbers, and H1N1 as the predominant virus of those tested, China is reporting 63% of influenza viruses tested to be Type B influenza virus. There is no increase in severity or resistance in the H1N1 virus. The chart of 4 years of pediatric deaths nationally shows the sharp upswing of deaths in this age group observed due to the type A H1N1 virus.

Influenza-Associated Pediatric Mortality

Zostavax – Zoster vaccine

Along side of the promotion of H1N1 vaccine, the Garrett County Health Department obtained a grant to provide a limited number of doses of Zostavax at no charge. A single advertisement in the Republican, plus word-of-mouth, recruited 270 persons over age 60 to receive this vaccine. The disease which we seek to prevent is all too common and often disabling for older citizens. The vaccine is expensive and made difficult to obtain by the Medicare population as it is included in Medicare D, and only covered by a few of the many drug plans which have been established. We will be exploring avenues in the future to make it easier for all older persons to have access to this vaccine.

Map of Haiti


Primer on Haiti

Haiti shares a 225 mile border on the island of Hispaniola with the Dominican Republic, and is 50 miles by sea from Cuba. The following comparisons with the state of Maryland can give some understanding:







9.8 million

5.6 million

Sq. Mi.



Population Density

940 per sq. mi.

540 per sq. mi.

Spread in miles

370 x 300

250 x 100

Median Household Income



Per capita Gross Domestic Product

$790, or $2/person per day


Public Health Issues and Priorities for the Haiti Earthquake from CDC

Based on previous experience with disasters in Haiti and earthquakes in other countries, CDC has a general understanding of what the public health needs will be in Haiti following the January 12th earthquake. The following projections and recommendations take into account Haiti 's socio-economic and demographic situation, and the health of its people prior to the earthquake.

Dispelling Earthquake Disaster Myths

  1. Dead bodies rarely spread disease
  2. Earthquakes rarely trigger major epidemics

Following the earthquake, the most pressing public health concerns in Port-au-Prince and surrounding affected areas will include:

•  Adequate quantity and quality of water

•  Food security

•  Appropriate shelter and protection from the elements

•  Prevention and treatment of gastrointestinal, respiratory, and vector-borne illnesses

•  Provision of health services to prevent maternal and infant deaths

•  Prevention of violence and further unintentional injury

•  Treatment of kidney failure due to crush injuries

•  Prevention of deaths from infected wounds

•  Prevention and treatment of inflamed lung tissue caused by concrete dust

Public Health Priorities

      1. Reduce and prevent further deaths, injuries, and illnesses
      2. Determine and meet critical needs for water and sanitation, healthcare, and food
      3. Verify the status of healthcare facilities and assist in standing up healthcare services
      4. Assess and address emergency maternal and infant health needs
      5. Provide health education to help people protect their own health and safety
      6. Conduct disease and injury surveillance in displaced and non-displaced populations

Providing Help for Haiti

  1. Monetary donations are the best early option.  Non-monetary donations, including people, equipment, and materials, can quickly overwhelm the response system.
  2. Occupational health and safety for responders is a significant concern.
  3. Responders should be self-sufficient. In general, they will not be able to rely on local resources for food, water, shelter, medical needs, transportation, and security.

Many lessons can be learned from following the biweekly Situation Reports from UN Office for the Coordination of Humanitarian Affairs (OCHA) on relief status and coordination. The latest Situation Reports "on the ground" in Haiti are summarized at the following home page, with the complete report reached from the link at the right lower section of this home page:

To prepare any local health personnel considering volunteering, I am recommending they review the CDC recommendations right now and start getting the recommended immunizations and medications to develop a maximum of protection for themselves well before deployment.

If you follow off this last page above to the "What's New" on the left side of the page, you can see CDC's latest recommendations on a variety of related current disaster management advice as well.

What if a medical calamity happened here? The Maryland Professional Volunteer Corps

Would you like to be able to offer your services in the event such a disaster strikes within the U.S.? You can join the Maryland Professional Volunteer Corps (MPVC) and be pre-credentialed and trained in the Incident Command Structure through training available from the Maryland Board of Physicians. More information is available at their website:

Enrollment, training, and preparation of identity cards takes less than a day, but currently is only offered in Baltimore. The Corps currently has over 5000 volunteers, of whom about 700 are physicians. In this current event the only state-wide call up of volunteers has been to assist in health screening of American citizens returning from Haiti to Baltimore area airports and Andrews Air Force Base. Response for deployments is always voluntary.

The National Disaster Medical System (NDMS) is the national level which brings together volunteers and has deployed more than 270 health professionals to Haiti on Disaster Medical Assistance Teams. An additional component of the NDMS enrolls large hospitals as volunteers. This latter component has been activated for placement of carefully-selected Haitian patients evacuated for life-saving care. These hospitals receive reimbursement at %110 of Medicare rates by the federal government for rendering of such specialized care.


Regular Reports: - - - - - - - - - - - - - - - - - - - - - - - - - - -- -Previous Reports

Infection Reports:
GCMH updated January 2009
WMHS Clinical Newsletter (January 2010) DNA Vaccines—A viable alternative?


Advanced Directives/Living Wills

Avian Influenza

Quick Guideto Protecting Yourself and Your Family

Four Simple Things You Can Do to Protect You and Your family

Cancer Screening Guidelines

Disease Fact Sheets - CDC

GCMH Antibiogram, July 2006-June 2007

GCMH Antibiogram, July-December, 2007


Immunization Schedules and State Regulations

Maryland Lead Follow-Up Recommendations

Pertussis Management

Reportable Diseases and Conditions

School Health


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Last Updated on: April 9, 2010

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