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: November-December 2008 - - - - - - - - - - - - - - -Previous Notes

Lyme Disease: This disease is not endemic in Garrett County but a few cases are reported here each year. The diagnosis is often difficult to make as a significant number of cases never remember a tick bite, the skin lesions often are not diagnostic and can be confused with other causative factors, and the first level serologic testing will not be positive immediately or give a false positive. Although the disease appears to be very unusual in Garrett County, many visitors may expect antibiotic treatment for any tick bite, and others may carry the infection into the county from endemic areas. A single dose of antibiotic at the time of a tick bite may prevent systemic infection. When symptoms and a history of exposure are suspicious, treatment may be started and continued up to 30 days. Definitive diagnosis requires the Western Blot test.

Pertussis: Confirmed cases have appeared in infants before they have been immunized. Adults with declining protection who become carriers of the disease may be responsible for continuing transmission. Tdap is now available specifically to address this is problem, since it contains booster doses of pertussis and diphtheria antigens appropriate for older children and for adults. The recommendation is that all persons 10 to 64 years, but particularly those working with young infants, receive one dose of this new vaccine.

Diagnosis requires suspicion to be raised early, and a nasopharyngeal swab taken and submitted for PCR testing . The Lab Corp test is $142 to the patient, is done with minimal paperwork, and utilizes a viral kit which does not require refrigeration, does not out-date, and is reported reasonably promptly. On the other hand, the state will process these tests at no charge, and GCMH lab will receive and send the specimens to the state at no charge to the patient. The state collection kits must be refrigerated and out-date every few months. For the state to process a specimen, two forms must be completed, and all tubes and slides must be labeled. The state kit includes a flexible wire collection swab, two tubes to be inoculated, as well as two slides to be swabbed. State kits are available from the hospital lab or the health department. Return the kit to the source from which you received it. Send someone other than the patient to get an in-date state kit from the hospital lab. It is recommended that the physician perform the testing. See also a current summary on diagnosis and management of suspected Pertussis cases.

Rabies Vaccine Shortage: Manufacturing changes have led to limited supplies of this life-saving vaccine. Special measures have been established to assure that strict criteria of eligibility are followed in the utilization of the available vaccine. In order to maintain stock in the hospital pharmacy, the health department is working with the pharmacy and the emergency room to assure that all cases treated meet accepted criteria.

Questions to be asked & recorded in the decision-making process:

• Was the animal bite by a bat*? --Treat immediately
  
• Was there an open wound or exposure of a mucous membrane to saliva?
  
• What species of animal was involved?
  
• Was the animal captured?

*Treatment usually can be delayed 24 hrs. for other animal species while immediate testing is performed by the state lab.

Assistance is available from the local health department in making the decision to treat.

Influenza- Seasonal & Pandemic

Although Avian Influenza cases seem to have slacked off in humans, the concern about a possible future pandemic continues, and preparations continue. Three additional human cases have been reported in December, one each from Indonesia, Cambodia and Egypt, after 6 months with no reported human cases.

WHAT'S NEW WITH THE "FLU"?

One case has tested positive for Influenza A at GCMH as of Nov. 28, 2008. (add a second type A case as of Dec. 22) Please refer other suspicious cases for testing so we can alert everyone to the spread of the infection.

Influenza immunization of ALL children 6mo.-18 years now recommended. Under age 2, only the injectable vaccine can be used; limited injectable vaccine is available without the Thimerasol preservative.

LAIV (Flumist) can now be used in healthy children and adults, ages 2-49, but should not be administered to "children aged <5 years with possible reactive airways disease, such as those who have had recurrent wheezing or a recent wheezing episode."

The components of the 2008-2009 vaccine are all new this year.

Oseltamivir and zanamivir (Tamiflu, Relenza) continue to be the recommended antivirals by CDC for treatment of seasonal influenza. However, take note of early reports of extensive resistance to oseltamivir in strains of seasonal virus isolated so far this year, and the return of sensitivity to adamantanes. See Alert Above

Health Department Clinics and Elementary School FluMist Schedules:

The Health Department continues with community flu immunization clinics, and in-school FluMist clinics for all Garrett County Elementary Schools. Follow this link for the latest on both community and school immuniztion clinics. The first round of school visits were completed in December and visits to administer second doses will be made in January & February.

Medical Assistance in Maryland: Expanded in July 2008

This past year, the legislature established an expansion of medical assistance for the parents of MA children. It is being funded by the increase in the tobacco tax. The table below summarizes the differences between the current PAC and the new FMA programs:

MCHIP Premium Insurance

This new insurance is available for families at income levels higher than the above limits (250-300% of poverty), but the families must pay a monthly fee of $46-58, depending on their income.

Drug Abuse Treatment with Detox or Suboxone (Buprenorphine) in the Family Physician's Office

The Health Department is willing to assist local physicians who choose to detox their patients as out-patients or at the hospital with patient counseling support.

The Behavioral Health Department of the Garrett County Health Department is looking for family physicians with an interest in making suboxone available through their offices. The Health Department will provide counseling in conjunction with the physician's supervision of the medication. Opiate abuse is becoming more prevalent in our area and, although this treatment option is far from perfect, it is more than what we have now in this county, and may eventually help some to work themselves away from drug dependence.

RSV Season Now

Be alert also for the return of Respiratory Syncytial Virus which had peak occurrence in Jan-April of 2008. We are in Region 3 on this table below showing the RSV seasons for various geographical areas.

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

Infection Reports:
WMHS - updated Feb. 2008, GCMH updated January 2009
WMHS December 2008 Clinical Newsletter: Sputnik Mimivirus Mamavirus Part I: Defining "life"

References:

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

Influenza

Immunization Schedules and State Regulations

Maryland Lead Follow-Up Recommendations

Pertussis Management

Reportable Diseases and Conditions

School Health

All material copyright Garrett County Health Department, 2000
Last Updated on: September 29, 2009