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Healthcare Provider Information |
Influenza (Flu) Information
H1N1
Address:
Garrett Co. Health Dept.
1025 Memorial Drive
Oakland, MD 21550
Main Phone:
301-334-7777
or 301-895-3111
FAX: 301-334-7701
See department pages for individual phone numbers
E-Mail Webmaster
Notes: June 2009- - - - - - - - - - - - - - -Previous Notes
Maryland Cancer Program to Change Billing Instructions:
The state D& T (Diagnosis & Treatment of Breast Cancer) program will be soon changing contracts and billing instructions for FY10. We are not yet sure of the details, but it includes the local health department becoming responsible for the contracts and the processing of some, or all, of the bills. This program pays for diagnostic mammography, colposcopy, and surgical and medical treatments for low-income patients with breast or cervical cancer. Watch for further information which we will send to you as we receive it.
This virus seems to have gone through Garrett County with minimal effects. GCMH Laboratory ran 393 tests during Nov, 2008-March,2009, of which 71 were positive for Type A, and 19 for Type B. In April-May 2009, the lab did 89 tests and none were positive, even though the new A H1N1 virus would also have been expected to test positive for type A.
Avian Influenza cases continue appear in humans in China (7,4), Egypt (27,4), and Viet Nam (4,4), with 38 total cases in 2009 and 12 deaths. There is no pattern of human-to-human spread.
Influenza- Swine Now referred to as “A H1N1”
Incidence: Continues to spread gradually, both nationally and internationally.
Nationally now reported in 52 states and territories, with 11,054 cases and 17 deaths. Maryland has identified 69 cases in 13 jurisdictions, but only as far west as Montgomery County. Cases have been identified in Morgantown and Pittsburgh.
Internationally, now reported in 66 countries, with 19,273 cases and 117 deaths. Mexico has had 5029 of those cases and 97 of the deaths. Other countries with deaths are Canada (1530, 2) and Costa Rica (50,1).
Surveillance : We will continue to request that severe cases of influenza-like illness and pneumonia be tested for influenza at GCMH, with any cases positive for type A sent to the state for further characterization. The rapid test used at our laboratory is not as accurate as the state testing, but will alert us to the arrival of the new virus in our county. Such cases will also receive epidemiologic investigation by the health department.
Pathogenicity : Clearly the disease has not been as severe as first feared, but that has been one of the lessons of this outbreak so far. In the earliest stages of a pandemic, when development of an accurate test of infection is underway, it is difficult to identify how many cases, severe, mild, and sub-clinical, are occurring and what the pathogenicity index might be.
Communicability : This was also difficult to assess early in the outbreak, but it seems now to be the same or less communicable than seasonal flu. Thus, early on it was felt necessary to invoke some community infection control procedures, such as school closing, while waiting for more information to develop.
Treatment : Laboratory tests have shown sensitivity of the new virus to Tamiflu and Relenza, but resistance or ineffectiveness with amantadine and rimantadine. The factors responsible for the higher death rate in Mexico have not yet been identified.
What to Expect Next?: The current virus might gradually enter our area either from the east, west or north, and give us a mild return of influenza this summer. Some speculate that the immunity gained from a milder disease might be helpful if the virus were to change its pathogenicity and/or communicability this Fall.
Past pandemics have shown a “herald wave” which proceeds the main outbreak by 3-6 months and characteristically is milder in effect.
A vaccine available by October is a possibility, but the new virus may not grow well in culture, and may not give useful immunity with a single dose, requiring adjuvants and an additional dose for protection. Extensive testing will also be required to avoid the repeat of the experience with Guillian Barre Syndrome which accompanied the last swine flu vaccine.
Production of Seasonal Influenza Vaccine is well underway, both the injectable and nasal spray formulations, and will be distributed before and separately from any vaccine for the new virus. The health department expects to be able to provide the nasal spray seasonal flu vaccine in elementary schools again this Fall for the third year.
The Clinical Newsletter from Dr. Manasse at WMHS this month covers the new virus and pandemic terms in greater detail and can be accessed here .
And this interesting report:
Protecting Pigs from Human H1N1 (Swine) Flu
Recent Research Results: A2009 H1N1 Influenza Virus - USDA - May 26 USDA's Agricultural Research Service researchers tested serum samples from pigs previously infected with U.S swine influenza viruses or vaccinated with commercial vaccines to determine if U.S commercial swine herds are susceptible to the new swine origin (S/O) H1N1 influenza virus. They found that there was limited cross reactivity against the new S/O H1N1 influenza virus.
Next they plan to try infecting pigs with the human A 2009 H1N1 Influenza Virus to see if vaccinated pigs are protected by the vaccines for pigs. There was one case in Canada of a pig having been infected by the new human virus.Regular Reports: - - - - - - - - - - - - - - - - - - - - - - - - - - -- -Previous Reports
Infection Reports:
GCMH updated August 2009
WMHS June 2009 Clinical Newsletter: The Influenza Pandemic: What will it be?
References:
Advanced Directives/Living Wills
Quick Guideto Protecting Yourself and Your Family
Four Simple Things You Can Do to Protect You and Your family
GCMH Antibiogram, July 2006-June 2007
GCMH Antibiogram, July-December, 2007
Immunization Schedules and State Regulations
Maryland Lead Follow-Up Recommendations
