Community and School Influenza Clinics Continue!
The community clinics offer either injectable or nasal-spray flu vaccines, and adult pneumococcal vaccine.
Medicare-eligibles need only show their card and give a signature. For all others, $25 is asked per vaccine. Persons with Medicaid and private insurance are directed to their primary care provider for covered services.
All children grades K-5 are offered either injectable or nasal-spray flu vaccines at no charge. Parents and siblings can receive vaccine at the school clinics at no charge if covered by VFC, or otherwise at $25.
These vaccines will continue to be available at the remaining clinics (click here), or by appointment at regular health department immunization clinics on Tuesdays through February (our FluMist expires Dec. 25).
The last case of human infection reported was October 25 in Indonesia, again in an area of unclassified poultry deaths. Indonesia has now reported 32 cases in 2007, the highest number for one country. Egypt has reported 20 cases in 2007.
A pre-pandemic vaccine for humans for an avian influenza strain (H5N1) is now being stockpiled with a goal of supplies to immunize 20 million in the critical workforce. A draft priority list has been published. Top of the list for receipt of vaccine Homeland and National Security, next are healthcare and community support services, Critical infrastructure (EMS, law enforcement and fire) and lastly general population beginning with prenant women, infants and toddlers, and their families. Each category is divided as well into subcategories, with different priorites.
In October, Canada experienced an outbreak of Highly Pathogenic Avian Influenza (HPAI) by an H7N3 strain in a commercial operation in Saskatchewan, requiring the "depopulation of 50,000 domestic birds and imposition of surveillance and quarantine measure in the area. Although the H5N1 strain has not shown must capacity for human-to-human spread, the H7 strain has shown greater capacity for human-to-human spread, but lower pathogenicity.
In February, Canada had reported results of their continuing survey of wild birds, and found no positive samples for HPAI in 12,000 tests during 2006.
MRSA in the community has been responsible for one student death in Virginia, and a huge amount of coverage in the press and concern by the public. The disease is not "reportable", but has not increased locally as observed by our laboratory. In random community surveys, the incidence of S. aureus runs about 30% and MRSA staph 1%. The pathogen therefore is quite widespread and easily transmitted and shared. Common hygienic precautions seem to generally keep the worst consequences from occurring. The S. aureus and S. epidermatis organisms locally remain sensitive to Bactrim (95% and 65%, respectively) and Tetracycline (87 and 82). The strain found in the community is distinct from that typically found in hospitals, but the genetic tests to make this distinction are expensive and not usually performed. Two useful references for your patients are:
Questions and Answers about Methicillin-Resistant Staphylococcus aureus (MRSA) in Schools
Community-Associated MRSA Information for the Public
Breast Cancer Screening: many slots open for grant-eligible women!
Have them call the health department to be checked for their eligibility.
Low Cost Drugs
Do not assume that the local super-store with their $4 generic program is giving your patient the best prices on drugs. These prices only apply to a fixed amount of pills, and only certain drugs. Local pharmacists have found that some of their local prices are lower than $4, and many of their prices for drugs not covered by the "generics" program are considerably lower than super-store prices. Each pharmacy has to net a profit, but the super-store has the luxury of operating one section at a loss to attract customers for other sections or other prescriptions. Patients make it more difficult to provide them with best care, e.g. poly-pharmacy or poly-provider practices, but still providers should fax prescriptions, or refer to care to the place/provider preferred by the patient.