prepackaged single dose thimerosal-free ..... mist spray thimerosal-free, for deposit in the nose ..... Weekly meetings
Should pregnant women skip the H1N1 (swine) flu shot until after giving birth? Absolutely not. Pregnant women are among the highest priority groups to be vaccinated. Women who are pregnant are at increased risk for complications from flu. Pregnant women should only receive the prepackaged single dose thimerosal-free injection. Which trimester is safest? Getting the vaccine is safe during any trimester of pregnancy. According to the CDC, influenza is more dangerous to the mother and child than any complication of the vaccine. Still, typically, only 12 - 14 percent of pregnant women get a flu shot, even though all are advised to do so. Can a new mother with the flu continue to breastfeed her baby? Yes. Mothers who are breastfeeding can continue to nurse their babies while being treated for the flu. A mother’s milk is made to fight diseases in her baby. This is really important in young babies, when their immune system is still growing. Mothers should not stop breastfeeding if they are ill, but rather, breastfeed early and often. Limit formula feeds. This will help protect the baby from infection. The mother must be careful not to cough or sneeze in the baby’s face. She should wash her hands often with soap and water. Mothers too sick to breastfeed should pump and have someone else give the expressed milk to the baby. Who should not receive this vacccine? Children less than 6 months of age, persons with a moderate or severe illness with a fever, and persons who have a severe (life-threatening) allergy to chicken eggs or to any other substance in the vaccine should not be vaccinated. I blew it. I didn’t get vaccinated. Now I have H1N1 (swine) flu. Now what? CDC recommends the use of antivirals (pills, liquids or inhalers) for the treatment and/or prevention of infection with H1N1 (swine) flu virus for persons at high risk for complications of influenza. Antivirals are not recommended for persons with mild symptoms due to the risk of the virus building up resistance to the medication. Antivirals will not help reduce symptoms from the common cold or other non-influenza infections. Can a person be contagious even when there are no obvious symptoms? Yes. You can pass the virus along to oth-
ers without even realizing it. Once exposed to a cold or flu virus, there’s an incubation period of as much as 5 days during which there may be no outward signs of being sick. One can infect others one day before getting sick and up to 5 to 7 days after becoming ill. The length of time an infected person can pass along germs can also depend on age and health. The young and persons with weaker immune systems may be contagious for longer periods than healthy adults. People are most contagious when they have a fever. How long does the H1N1 (swine) flu last? How long should I stay home if I am sick? This flu usually lasts 3 to 7 days, although cough and malaise can persist for more than 2 weeks. Human influenza virus infections can: 1) cause primary influenza viral pneumonia; 2) worsen underlying medical conditions, such as pulmonary or cardiac disease; 3) lead to secondary bacterial pneumonia or sinusitis; or 4) cause co-infections with other viral or bacterial pathogens. The CDC recommends staying home from work or school until the fever is gone for at least 24 full hours without the aid of a feverreducing medication. Health care workers are advised to stay home for 7 days from symptoms onset or until the resolution of symptoms, whichever is longer. If I am sick and my doctor can not see me, may I come to the health department? If you are symptomatic, we suggest you stay home. But, if you really need to seek treatment at the health department, call ahead of time and notify the front desk that you have flu symptoms. If you feel immediate medical attention is necessary or it’s during nights/weekends, you must seek treatment at your local ER. If you have a prescription from your doctor, we will fill it at the Pinellas County Health Department’s St. Petersburg or Clearwater Centers ONLY. At this time testing is no longer required or recommended for H1N1 (swine) flu unless the patient is hospitalized. My child was exposed to H1N1 (swine) flu at a daycare, camp or school. What should I do? Watch your child for symptoms such as fever, cough, sore throat, sneezing, headache, runny or stuffy nose. Make sure your child washes his or her hands frequently with soap and water or uses hand sanitizer. Make sure your child avoids touching eyes, nose and/or mouth. Seek immediate medical attention if your child is experienc-
ing any of the following symptoms: fast or troubled breathing, bluish skin color, not drinking enough fluids, not waking up or interacting, improved symptoms followed by a return of fever with a worse cough, or fever with a rash. What kills influenza virus? Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodinebased antiseptics and alcohols are effective against influenza viruses if used in proper concentrations for sufficient lengths of time. Common areas of a house or office are most important to clean, such as doorknobs, bannisters, bathroom and kitchen countertops, tables (including nightstands) and toys.
So, antibacterial soaps and hand sanitizers really are effective in preventing H1N1 (swine) flu? Yes. There’s no question that good hand hygiene is a most effective means of cold and flu prevention. It is more effective than Echinacea, zinc, Vitamin C or any herbal, homeopathic or other folk remedy. Just plain soap and water, by the way, is as good as using fancy antibacterial soaps. Hand gels and hand sanitizers are a very effective alternative to soap and water when soap and water is not around. But be mindful: Clean hands won’t prevent someone from walking up and sneezing right in your face. Only a vaccination can ensure immunity. There is no substitute for a vaccination in halting the spread of H1N1 (swine) flu.
[Teachers: Go to tampabay.com/nie for online lessons.]
H1N1 (swine) flu informational resources Pinellas County Health Department
General Information – www.pinellashealth.com/ Flu Information – www.pinellashealth.com/H1N1SwineFlu.asp Pinellas Flu Information Line: 727-824-6964, M-F, 8am-5pm
Clinic Centers
Tarpon Springs, 301 South Disston Ave., 727-942-5457 Clearwater, 310 North Myrtle Ave., 727-469-5800 Largo, 12420 130th Ave N., 727-588-4040 Pinellas Park, 6350 76th Ave N., 727-547-7780 St. Petersburg, 205 Dr. Martin Luther King St. N., 727-824-6900
Pinellas County Emergency Management
H1N1 (swine) flu Information –http://pinellascounty.org/emergency/special_advisory.htm
Pinellas County Schools
General Information – www.pinellas.k12.fl.us/ Flu Information – www.pcsb.org/News/PCSNews_Story_2.html 727-588-6000
Florida Department of Health
General Information – www.doh.state.fl.us Flu Information – www.myflusafety.com/ Florida Flu Information Line: 1-877-352-3581, 7 days, 8am-8pm (English, Spanish and Creole)
Centers for Disease Control and Prevention
General Information – www.cdc.gov 1-800-CDC-INFO (1-800-232-4636); TTY:1-888-232-6348, 24 hours/7 days Flu Information – www.cdc.gov/h1n1flu U.S. Department of Health and Human Services Flu Information – www.flu.gov/ http://espanol.pandemicflu.gov/pandemicflu/enes/24/_www_flu_gov (Spanish)
World Health Organization
Flu Information – www.who.int/csr/disease/swineflu/en/index.html
H1N1 (swine)
Flu
Preparedness: A community affair
Frequently Asked Questions H1N1 Prevention
Without a doctor, how do I know if I have the flu or just a common cold? That’s usually easy. If you don’t know, it’s a cold. When you have the flu, you know it. With a cold there’s usually no fever. There’s a runny nose and cough, but mild, and there are no severe body aches. You can usually continue your daily routine functions. The flu, however, most often occurs in community waves. There is fever, usually above 100 degrees for 3-4 days; respiratory symptoms; sometimes even vomiting and diarrhea. And you feel terrible – your body aches and it’s very hard to continue your daily routine.
Wash your hands. With soap and water while you sing Happy Birthday all the way through. Twice. Or with an alcohol-based hand sanitizer. Frequently. Before and after eating. After shaking hands. After using a bathroom. After using the ATM, the elevator, the soda machine. After touching paper money, a public hand rail or the television remote control.
Good hand-washing hygiene is a great idea for folks at any age, for any type of disease prevention. But, here at the beginning of the H1N1 (swine) flu pandemic, WASH YOUR HANDS is the single most consistent and, by far, the loudest message one receives among the plethora of H1N1 (swine) flu Web sites, newspaper articles and television programs. It is true that washing hands is one of the best defenses against contracting the swiftly multiplying and powerfully resilient H1N1 (swine) flu virus. But it is not the only way. The top tool in the prevention toolbox is a vaccination, soon to be administered en masse to all who qualify in the highest risk groups across Pinellas County, the state of Florida and this entire country. Such pandemic immunizations have been extremely successful in wiping out plagues (polio, smallpox et al) that threatened every human on Earth. Yet, despite the consistent success of mass vaccination programs over the past 100 years, today’s fruited plain of world humanity, facing the world’s first real influenza pandemic in 40 years, is teeming with enigmas, puzzles, confusion and general bewilderment. Questions abound: Why are mass vaccinations being scheduled across the planet, including right here in Pinellas County for a strain of Influenza Type A that, for most, is reported as a relatively mild disease? Why did the government of Egypt kill every single pig in that country – more than 300,000 – despite the protests of the international science community and solid evidence it would have no effect on the pandemic? Why has the French government demanded everyone, from children to grand papa, stop kissing? Why did Argentine citizens stone a bus arriving from Chile recently, just because a suspected H1N1 (swine) flu carrier was on board? (Hint: Chile has the most H1N1 (swine) flu cases in South America.) In the United States, why have political rivals blamed President Obama for H1N1 (swine) flu? His support for mass vaccinations is merely a tool, they say, to strengthen support for his health care agenda.
throat, runny or stuffy nose, body aches, headache, chills and fatigue. The vomiting and diarrhea known to be associated with H1N1 are not usually seen with seasonal. As of Oct. 1, 99 percent of all flu diagnosed in Pinellas County has been H1N1 (swine).
What? Confused? Here, then, are the FAQs, with a few IQAs (Important Questions to Ask) thrown in for good measure:
What is “swine flu”? Swine influenza (the swine flu that pigs get) was first suspected to have a human influenza connection during the 1918 Spanish flu pandemic, when pigs became sick at the same time as humans. The first lab identification of an influenza virus as a cause of disease in pigs occurred in 1930. Since then, swine influenza has been common throughout pig populations worldwide, with 50 percent of breeders and 25 percent of all animals infected. When a highly contagious human influenza suddenly appeared in tiny La Gloria, Mexico (March 2009) it quickly became known as “swine flu” due to initial studies that indicated similarities with influenza viruses normally occurring in North American pigs. Further studies, however, revealed the new virus also contained genes from a) European and Asian pigs; b) birds and c) humans – a rare “quadruple reassortant” virus. Unfortunately for pigs and the pork industry, the name stuck even though it’s not exactly accurate. Why the name H1N1? Okay, you asked for it. The scientific name for H1N1 (swine) flu is H1N1 Influenza A. The H means hemagglutinin and the N means neuraminidase and the 1s refer to their antibody type. Influenza A is a genus of the Orthomyxoviridae family of viruses and refers to the fact that the virus is first identified in an animal, usually a pig or a bird. It also is believed that influenza A viruses caused the pandemics of 1918, 1957 and 1968. This virus has genes from both avian and swine flu viruses, in addition to the genes typically found in seasonal human flu viruses. This
strain has never been seen in humans; that is why it is often referred to as the “novel” H1N1 flu. How does H1N1 (swine) flu spread? In the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing and sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their eyes, nose or mouth. How does H1N1 (swine) flu kill? The most common cause of death is respiratory failure. Other contributing factors are pneumonia (leading to sepsis), high fever (leading to neurological problems), dehydration (from excessive vomiting and diarrhea) and electrolyte imbalance. Studies of the H1N1 (swine) flu so far have revealed that fatalities are more likely in young children, pregnant women and persons with chronic health conditions. What is the difference between a pandemic and an epidemic? An epidemic is a contagious, infectious or viral illness that spreads to much larger numbers of people in one geographic region than would usually be expected. A pandemic refers to a contagious, infectious or viral illness that spreads to many populations across the globe. On June 11, 2009, the World Health Organization (WHO) declared that a pandemic of 2009 H1N1 flu was underway. It is now classified as Phase 6, the highest level, indicating widespread world human infection, a true global pandemic. Do the symptoms of seasonal influenza and 2009 H1N1 (swine) flu differ? No, they are mostly the same: fever, cough, sore
Can you describe the 2009 H1N1 (swine) flu vaccine? There will be 3 vaccine configurations available: 1) prepackaged single dose thimerosal-free vaccines for intramuscular injection; 2) multi-dose vials with thimerosal for intramuscular injection and 3) a nasal mist spray thimerosal-free, for deposit in the nose and nasopharynx. Both the prepackaged singledose injections and the multi-dose vials contain inactivated vaccine – killed virus – and provide complete protection for all age groups, except children 10 and under, who are advised to receive two single doses 28 days apart. The nasal mist spray, recommended only for persons with no underlying health conditions between the ages of 2 and 49, contains attenuated (weakened) live virus. Children 10 and under who are given the nasal mist spray are advised to take two doses 28 days apart. Pregnant women will not be administered the nasal mist spray or the multi-dose injection. The first shipment of 45,000 doses to Pinellas County is expected to be all nasal mist spray. How do vaccines work? When one is sick, disease-causing organisms produce at least two distinct effects on the body: 1) sickness (fever, nausea, vomiting, diarrhea, rash, etc.); and 2) an immune response in the infected host – an effect that leads to eventual recovery from the infection. In addition, this immune response produces “memory cells” which remain in the blood stream – sometimes for the lifespan of the host – ready to mount a quick protective immune response against subsequent infections. This response is so rapid that infection doesn’t develop. You are immune from subsequent infections. A vaccination accomplishes the same task, using inactivated (killed) or live attenuated (weakened) vaccines to induce production of the protective antibodies that make up an immune response without the full-blown disease. Consider smallpox, which was once a major cause of death worldwide. The smallpox virus is now found only in freezers in high-containment laboratories at
various laboratories around the world – thanks to an intensive and very successful worldwide vaccination program. What is the difference between an inactivated (killed) and a live attenuated (weakened) vaccine? An inactivated (killed) vaccine consists of dead but antigenically active viruses or bacteria, and evokes production of protective antibodies – the immune response – without causing disease. The live attenuated vaccine is prepared from live microorganisms or functional viruses whose disease-producing ability has been weakened but whose immunogenic properties have not. Measles, mumps and rubella are live vaccines. You cannot get the flu from the inactivated (killed) vaccine. Some persons do get minor flu symptoms from the live attenuated (weakened) vaccine but will not generally suffer the “big sickness” complications of the flu. How are the flu vaccines made? The formula for the seasonal vaccine is developed during the previous year’s flu season and takes 6 months to make. Researchers look at current circulating strains of influenza and study their mutations to determine strains most likely to cause illness during the next flu season. Influenza viruses mutate constantly – one reason yearly flu shots are necessary. However, if the virus mutates to an unanticipated form, the shot may not work well. Even if it does not prevent the illness, those who have a flu shot will likely have a less severe case of the illness. What are the side effects of the H1N1 (swine) flu vaccine? Mild problems that may be experienced include soreness, redness or swelling where the shot was given, headache, muscle aches, fever and nausea. These problems usually begin soon after the vaccine and last 1-2 days. Life-threatening allergic reactions to vaccines are rare, and they usually occur within minutes to a few hours after the dose is administered. Will the seasonal flu vaccine also protect against the 2009 H1N1 (swine) flu? No. They are two different viruses. Can seasonal influenza vaccine and the 2009 H1N1 (swine) flu vaccine be given at the same visit? Yes and no. Both seasonal and 2009 H1N1 (swine) flu vaccines are available as inactivated (killed) and live attenuated (weakened) formulations. Existing recommendations are that two inactivated vaccines can be administered at any time before, after or during the same visit as each other. Current recommendations also state that an inactivated and live vaccine may be administered at any time before, after or during the same visit as each other. Live attenuated (weakened) seasonal vaccine and live attenuated (weakened) 2009 H1N1 (swine) flu vaccines should NOT be administered at the same visit until further
studies are done. If a person is eligible and prefers the live attenuated (weakened) vaccine for both, the administration of these vaccines should be separated by a minimum of four weeks. Can 2009 H1N1 vaccine be administered at the same visit as other vaccines? Yes and no. Inactivated 2009 H1N1 vaccine can be administered at the same visit as any other vaccine, including pneumococcal polysaccharide vaccine. Live 2009 H1N1 (swine) flu vaccine can be administered at the same visit as any other live or inactivated vaccine EXCEPT seasonal live attenuated (weakened) influenza vaccine. I have concerns about the use of thimerosal. Is thimerosal safe? Yes. Thimerosal is a mercury-based preservative that prevents the growth of contaminating micro organisms, such as bacteria and fungi. Thimerosal is used only in the H1N1 (swine) flu multi-dose vials. The prepackaged single-shot injections and the nasal mist spray are used primarily for young children and do not contain the preservative thimerosal. The most recent and rigorous scientific research does not support the hypothesis that thimerosal-containing vaccines are harmful. Three leading federal agencies (CDC, FDA and NIH) have reviewed the published research on thimerosal and found it to be a safe product to use in vaccines. Three independent organizations [The National Academy of Sciences’ Institute of Medicine, Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP)] reviewed the published research and also found thimerosal to be a safe product to use in vaccines. The scientific community supports the use of thimerosal in influenza vaccines. Why get the 2009 H1N1 (swine) flu vaccine? It is the very best prevention against contracting H1N1 (swine) flu. Who should get the H1N1 (swine flu) vaccine? When the vaccine is first available, the CDC Advisory Committee on Immunization Practices has recommended the 2009 H1N1 (swine) flu vaccine be administered to the following 5 initial target groups (approximately 450,000 persons in Pinellas): 1) pregnant women; 2) household and caregiver contacts of children younger than 6 months of age (i.e. parents, siblings and daycare providers); 3) health care and emergency medical services personnel; 4) persons from 6 months through 24 years of age; 5) persons aged 25 through 64 years who have medical conditions associated with a higher risk of influenza complications. When the demand is met for vaccine among the initial target groups, healthy persons 25 through 64 years of age are the next priority. Once the demand is met for the younger age groups, people 65 or older, will be vaccinated.
Priority list for H1N1 (swine) flu vaccination The CDC’s current list of population groups recommended to receive the 2009 H1N1 influenza vaccine include: • Pregnant women: They are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated. • Household contacts and caregivers for children younger than 6 months of age. Younger infants are at higher risk of influenza-related complications and cannot be vaccinated. Vaccination of those in close contact with infants younger than 6 months old might help protect infants by “cocooning” them from the virus. • Health care and emergency medical services personnel. Infections among health care workers have been reported and this can be a potential source of infection for vulnerable patients. Also, increased absenteeism in this population could reduce health care system capacity. • All people from 6 months through 24 years of age. • Children from 6 months through 18 years of age. Cases of 2009 H1N1 (swine) flu have been seen in children who are in close contact with each other in school and day care settings, which increases the likelihood of disease spread. • Young adults 19 through 24 years of age. Many cases of 2009 H1N1 (swine) flu have been seen in these healthy young adults. They often live, work and study in close proximity and comprise a frequently mobile population. • Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza. Persons with compromised immune systems, including persons suffering a chronic illness, such as asthma or diabetes. No shortage of 2009 H1N1 vaccine is expected, but vaccine availability and demand can be unpredictable and there is some possibility that initially, the vaccine will be available in limited quantities. So, the ACIP also made recommendations regarding which people within the groups listed above should be prioritized if the vaccine is initially available in extremely limited quantities. For more information, visit the CDC Web site at www.cdc.gov/h1n1flu/vaccination/acip.htm
Pinellas County responds to the
H1N1 (swine) flu myths
H1N1 (Swine) Flu pandemic
Everywhere you look, there is coverage about H1N1 (swine) flu and the new vaccine: On the Web, TV, radio and in newspapers. With the amount of information accessible to the public there is bound to be misinformation that can lead to unnecessary panic. Here are the facts about H1N1 (swine) flu to address some of the more popular myths.
MYTH: You can only get H1N1 (swine) flu if you are in contact with pigs. H1N1 (swine) flu is caused by a respiratory virus that is transmitted from person to person through respiratory droplets produced when an ill person coughs or sneezes, or through your hands if you touch your eyes, nose or mouth before washing after touching a contaminated surface. In fact, if the illness were primarily transmitted from pigs to people, the number of people infected would be a much smaller group, primarily farmers, than what we are seeing now.
MYTH: Eating pork or pork products puts you at risk for H1N1 (swine) flu infection. Handling and consuming animal products that are not fully cooked can transmit some viruses and bacteria. But this is not how H1N1 (swine) flu is spreading. You cannot contract H1N1 (swine) flu from eating pork. It is safe to eat properly handled pork or pork products such as bacon, ribs or ham as long as it is cooked to an internal temperature of 160°F, which kills off most bacteria and viruses.
MYTH: The seasonal flu vaccination will protect you from H1N1 (swine) flu. This fall, two different flu vaccines will be available: the seasonal flu vaccine and the vaccine against H1N1 (swine) flu. The seasonal vaccine protects against strains of the flu that are likely to circulate this season with the H1N1 (swine) flu strain. It is recommended that adults and children be vaccinated against both. This is especially true for individuals that are at risk of developing complications from the flu. However, the seasonal vaccine by itself will not protect you from the H1N1 (swine) flu strain.
MYTH: You should avoid public events and locations until the virus is contained.
The H1N1 (swine) flu virus has become the 21st century’s first pandemic, the first influenza pandemic the world
WHO estimates about 3 billion doses of H1N1 (swine) flu
tion Planning and Communication Plan was designed and
Weekly meetings and daily conference calls kept Pinellas
vaccine have been ordered worldwide for the Earth’s 6 billion
assignments went out in accordance with six objectives: 1)
health and safety agencies on the same page, in union with
people. Health authorities hope to vaccinate well over half the
Create a work plan for reaching vaccination priority groups; 2)
each other and with the state Departments of Health (DOH),
population in just a few months against swine flu, which doc-
Recruit/engage partners to assist with H1N1 (swine) flu vac-
Education (DOE) and Emergency Management (DEM) as well
has seen in more than 40 years. Until the appearance of this
tors call the 2009 H1N1 strain. That would be a feat. No more
cine administration; 3) Develop an H1N1 (swine) flu vaccine
as the CDC, itself. In this way a customized Pinellas mass
virus, there had been no substantial changes in the overall
than 100 million Americans usually get vaccinated against
administration plan; 4) Develop an H1N1 (swine) flu communi-
vaccination plan was debated and developed, complete with
epidemiology of swine influenza in the United States and
regular winter flu and never in such a short period. As the
cation and public information plan; 5) Ensure comprehensive,
deadlines and protocols for setting up vaccine clinics and
Canada for more than 60 years.
disease runs rampant, and nations rich and poor scramble to
appropriate and timely ongoing H1N1 (swine) flu informa-
immunizing thousands of school children at all Pinellas County
From its arrival in the United States (six months earlier
obtain the vaccine, best estimates are that by New Year’s Eve
tion-sharing among PinCHD/DOH, government, health care
schools, as well as at many private schools and child care
than the usual influenza) on April 23 to its speedy infection of
only about five percent of the world population will have been
providers and first responders; and 6) Ensure the general
centers.
all 50 states in little more than a month, H1N1 (swine) flu has
immunized.
public (Pinellas County residents and visitors) and the private
“We are taking steps to prepare, mitigate and respond
business sector remain informed/educated regarding H1N1
to this health emergency,” said Dr. Julie M. Janssen, Pinellas
(swine) flu activities, initiatives, news and information.
County Schools superintendent. “Rest assured that the safety
proved more powerful than the typical seasonal flu. Puerto
Now the world’s most dominant strain of influenza, H1N1
Rico logged its first H1N1 (swine) flu case on May 29, and the
(swine) flu, officially hit Florida on May 2, when Gov. Charlie
Virgin Islands theirs on June 19, a week after the World Health
Crist declared a public health emergency. That same day, lab
Organization (WHO) declared H1N1 (swine) flu the first such
tests confirmed H1N1 (swine) flu contributed to the deaths
H1N1 (swine) flu community task force which includes Pinellas
pandemic since Hong Kong flu killed more than 750,000 peo-
of an 11-year-old boy from Lee County and a 17-year-old
County Emergency Management, Pinellas County Sheriff’s
ple (33,000 in the U.S.) in 1968 and 1969. Though worldwide,
Broward County female. In less than four months, H1N1
Department, Pinellas County Emergency Medical Services,
of hundreds of thousands of other Pinellas citizens at the
nearly half of all today’s H1N1 (swine) flu cases (44 percent)
(swine) flu was reported in all 67 state counties and the Florida
Pinellas County Schools, Metropolitan Medical Response
five PinCHD Health Centers and several public immunization
System (MMRS) and a Pinellas County hospital liaison.
“PODs” to be set up at still-to-be-determined sites. All angles
have been reported in the U.S.
Surgeon General declared testing no longer necessary. By the end of September, there have been 808 reported
Worldwide pandemics An epidemic is a contagious, infectious or viral illness that spreads to much larger numbers of people in one geographic region than would usually be expected. A pandemic refers to a contagious, infectious or viral illness that spreads across continents to many populations across the globe. On June 11, 2009, the World Health Organization (WHO) declared that a pandemic of 2009 H1N1 flu was underway. It is now classified as Phase 6, the highest level, indicating widespread world human infection, a true global pandemic. 165 – 180: Antonine Plague, perhaps smallpox, began in Seleucia (Iraq), brought to Rome by troops 251 – 266: Plague of Cyprian, smallpox, began in Rome 541: the Plague of Justinian, bubonic plague, originated in Ethiopia 1300s: the Black Death, bubonic plague, began in Central Asia and covered the world, killing an estimated 30-60 percent of all people in Europe, dropping world population by 25 percent 1501 – 1587: typhus, first known in the Roman empire 1732 – 1733: influenza, from Russia 1775 – 1776: influenza, North America 1781 – 1782: influenza, began in China 1816 – 1826: cholera, killed 38 million people in India alone, began in Bengal 1829 – 1851: cholera, first found in India, then Russia, Germany and Hungary 1847 – 1848: influenza, began with a sweep through the Mediterranean 1852 – 1860: cholera, started in India 1855 – 1950s: bubonic plague: Third Pandemic, began in China. Outbreaks were discovered on every continent in the world and casualties continued for nearly 100 years 1857 – 1859: influenza, North American origins 1863 – 1875: cholera, began in Bengal 1889 – 1892: cholera, began in the Hamburg, Germany, water supply 1899 – 1923: cholera, began in the Middle East 1918 – 1920: influenza: Spanish flu, more people were hospitalized in World War I from this epidemic than wounds. Estimates of the dead range from 20 to 100 million worldwide. Origins unknown but outbreaks swept through North America, Europe, Asia, Africa, Brazil and the South Pacific 1957 – 1958: influenza: Asian flu, began in the Far East 1968 – 1969: influenza: Hong Kong flu, began its journey around the world in Asia 1960s: cholera called El Tor, from Indonesia 1980s – present: HIV, origins in sub-Sahara Africa 2009 – influenza: 2009 H1N1 (swine) flu pandemic, first found in La Gloria, Mexico
Edwards also would represent PinCHD on a countywide
“We have spent a lot of time and effort in educating our
of students and staff will be of paramount importance as we deal with this health emergency.” Plans are still being refined regarding the immunization
were explored regarding the first shipment of 45,000 doses
hospitalizations and 110 confirmed H1N1 (swine) flu
employees. There are posters set up in all our buildings and
and the many subsequent weekly shipments to come after
deaths in Florida, one of 37 states reporting widespread
mandatory videos for them to watch,” said Corporal Ernie Ar-
that. The Pinellas business community also was contacted
influenza activity – very unusual for September. Extrapo-
mistead of the Pinellas County Sheriff’s Dept. “Internally, I can
regarding private plans to set up immunization programs.
lating from national estimates released by the CDC, the
assure you we have plans to continue to serve this county
Florida Department of Health (DOH) estimates that more
no matter how bad this pandemic turns out to be. I just can’t
and enroll more than 3,000 Pinellas providers into Florida
than 60,000 Floridians already have been infected.
divulge to you our security plans, but be assured, they are in
SHOTS (State Health Online Tracking System) the statewide,
place.”
centralized online registry that keeps track of immunization
In Pinellas County, the first case attributed to the
A major effort included plans to reach, educate, recruit
H1N1 (swine) flu virus – a 24-year-old male who had
Cpl. Armistead expressed dismay at “irresponsible Web
records. Private providers who want to order the vaccine for
recently traveled to Mexico – was announced on May
sites and the individuals who run them” that are inciting panic
their patients must first enroll in Florida SHOTS, which stores the immunization history of Florida children and produces the 680 form required by law for child-care center and school attendance in Florida. The plan expanded to consider anything H1N1 (swine) flu related, including vaccine refrigeration storage issues, complicated staffing plans, plans to immunize “first responders” (deputies, firefighters, paramedics, etc.), shortages of ventilators, masks and special H1N1 policies regarding absences at school, in government agencies and in the private workplace. As always, planning for the worst case scenarios was vital. The specter of a hurricane AND a pandemic was definitely in the plans.
The Centers for Disease Control and Prevention (CDC) say that it is safe for the public to continue their normal activities. The normal precautions for avoiding disease in public places are sufficient to prevent the transmission of the H1N1 (swine) flu virus. These include: • Washing your hands often • Avoid close, prolonged contact with people who have symptoms of the flu • Avoid touching your nose, eyes or mouth unless you have just washed your hands • Receive the flu vaccines
MYTH: The vaccine is not safe. There has been a considerable amount of commentary on the safety of the H1N1 (swine) flu vaccine. Some concerns rise from the aftermath of the 1976 swine flu national vaccination campaign when some people developed Guillain-Barré syndrome (GBS) after receiving the vaccine. GBS is a rare disorder in which a person’s immune system attacks the nerve cells and can lead to muscle weakness and paralysis. While most people recover fully from GBS, some people suffer permanent nerve damage. There was a small risk of GBS following the 1976 swine flu vaccination – about one additional case per 100,000 people who received the swine flu vaccine compared to the national average. Scientists do not fully understand why the 1976 vaccine was associated with a slight increased risk for developing GBS. The CDC and its partners have an aggressive plan to actively monitor the 2009 H1N1 (swine) flu vaccine to ensure its safety. Vaccine safety is a high priority. Several systems are in place to monitor the safety of the vaccine and detect any possible side effects early on. It is expected that the 2009 H1N1 (swine) flu vaccine will have a similar safety profile as seasonal flu vaccines. The seasonal influenza vaccine has not been consistently associated with GBS and has a very good safety track record. In addition, there have been some concerns about the use of thimerosal, a mercury-based preservative used only in multi-dose vials of the H1N1 (swine) flu vaccine. Thimerosal prevents contamination of the vaccine that may occur when the vial is opened. The possible association of thimerosal in vaccines and autism has led to much research and testing. Numerous studies have found no association between thimerosal exposure and autism. Since 2001, no new vaccine approved by the Food and Drug Administration (FDA) for use in children has contained thimerosal as a preservative. However, since this change took place, there has not been a reduction in the number of children diagnosed with autism. This indicates that autism is not caused by a single exposure, such as the thimerosal in vaccines. The 2009 H1N1 (swine) flu influenza vaccines that are approved by the FDA will be manufactured in several formulations. Some will come in multi-dose vials that contain thimerosal while others, such as the single-dose injection and live-attenuated vaccine nasal spray formulations, will not contain the preservative. -- Andrea Dopico, MPH is Public Health Services Manager for the Disease Control Division of the Pinellas County Health Department
“Pinellas County’s businesses and employers will play a vital role in educating our citizens to protect their health and limit the impact of this virus to our community and economy. Thoughtful continuity of operations planning, policies that encourage sick employees to stay home and flexible work options such as teleworking can reduce downtime,” said
Planned vacCination sites
Stacey Swank, of Pinellas County Economic Development. “We encourage our local companies, especially those that provide critical infrastructure services, to prepare for hurricane season every year. This year we’re asking them to extend that planning through flu season.”
PATIENT
VACCINATION SITE
Pregnant women
Prenatal care provider Health Department WIC site
Household contacts of children 0-6 months of age (family members, including new mother, regular visitors, etc.)
Primary doctor Health Department WIC site
Caretakers of children 0-6 months of age (babysitters: neighbor, grandma, friend)
Primary doctor Health Department
Children 6 months – 5 years old
Pediatrician Child care Health Department WIC site
K-12th grade students
School Pediatrician Health Department
Young adults 18 – 24 years old
Student Health Center Primary doctor Health Department
Persons with high risk medical conditions (i.e. asthma, diabetes, COPD) any age older than 6 months
Primary doctor Specialist Health Department
Persons 65 years or older who are also a Household Contact or Caretaker of children 0-6 months old
Primary doctor Health Department
Health care workers
Work site Primary doctor Health Department
Volunteer vaccinators (doctors, nurses) were sought through mailing lists, medical associations, clinic-to-clinic visits and recruiting events presented by PinCHD health educators. PinCHD staff is still canvassing the county, reaching out to all groups. Specialized communication “tool boxes” 4. The young man did not require hospitalization and
and spreading false information about H1N1 (swine) flu locally.
are being used to educate and inform private businesses,
recovered at home. The first Pinellas fatality – a 36-year-
“It’s made a lot of citizens upset unnecessarily. It’s one thing
faith-based organizations, Hispanic communities, college stu-
old male with an underlying health condition – was an-
to have to deal with the flu itself, but we all have to spend
dents and child care operators. An H1N1 (swine) flu informa-
nounced in an Aug. 10 press release. At the time, Florida
valuable time discounting this harmful information that affects
tion toll-free telephone line was set up, manned by staff who
had 41 laboratory-confirmed deaths related to the H1N1
parents, teachers, workers, retirees, everyone in the county.”
answer 60-100 calls per day. Volunteers conduct physician
(swine) flu virus. That number would double in less than
Like the Sheriff’s Dept., the county’s entire emergency
“follow-up” calls from a call center set up in the PinCHD St.
a month. Nationwide, confirmed H1N1 (swine) flu deaths
preparedness leadership was taking
have surpassed 4,000.
a “healthy” attitude toward preventing
Creative immunization projects
and dealing with the worsening H1N1
are ready for implementation: “We
flu took the medical and emergency response community
(swine) flu pandemic. “All partnering
will position a nurse and a vaccina-
by surprise. Nationally, final touches were being applied
agencies are working hard behind the
tion station at major county birthing
to the considerable seasonal flu vaccine program, as it
scenes to ensure they are healthy and
hospitals to capture new moms,
was readied for the typical November seasonal influenza
able to continue providing services
dads and other household contacts
debut. New vaccine development began, followed by
to the populations they serve,” said
right on the spot,” said Edwards,
H1N1 (swine) flu clinical trials as the science community
Edwards, who compiled data regard-
who monitored a vigilant effort that
moved quickly in designing and developing enough ap-
ing the number of policemen, depu-
sent PinCHD health educators to visit
proved vaccine to cover more than 100 million persons in
ties, paramedics, firefighters and other
every single obstetrics and pediatric
the CDC’s first-wave national priority list.
emergency personnel who also would
practice in the county. “We will also
require the H1N1 (swine) flu vaccine
post nurses inside our own Health
when it arrived.
Department clinics to capture moms
The spring discovery and early arrival of H1N1 (swine)
At the Pinellas County Health Department (PinCHD), the lead agency for Pinellas County’s H1N1 (swine) flu response, the action was immediate and comprehensive. Health director Dr. Claude Dharamraj surveyed her
Petersburg Health Center.
“We are preparing the same way
and their kids as they arrive for WIC,
we suggest to our citizens, by getting
dental and Healthy Start services.”
entire agency, which employs more than 600 persons in
information to employees for their use in
five health centers and several satellite sites across Pinel-
preparing and responding to the H1N1
planning: To educate and immunize
las. She quickly appointed an internal H1N1 (swine) flu
flu,” said Sally Bishop, the director of
as many Pinellas residents as pos-
Action Team to be headed by Public Health Preparedness
Pinellas County Emergency Management who had to struggle
(PHP) manager Sharlene Edwards. PHP staff was already
with getting ready for both a potential hurricane AND an influenza
in full gear preparing for the 2009 hurricane season and
pandemic at the same time. “Like any other hazard, we strongly
the myriad tasks PinCHD must implement as part of the
encourage everyone to be armed with information and have an
County’s multi-agency hurricane response.
emergency supply kit at home to care for themselves, as well as
A Pinellas H1N1 (swine) flu 2009 Mass Vaccina-
getting the flu vaccination.”
The overall objective for all the
sible. – Peter B. Gallagher is Human Services Program Specialist for the Pinellas County Health Department
All other Pinellas County residents/visitors
Primary care provider Health Department
