Pandemic influenza Q&A

August 17, 2009 • Stay home when sick:
Those with flu-like illness should stay home for at least 24 hours after they no longer have a fever, or signs of a fever, without the use of fever-reducing medicines.

• Separate ill students and staff:
Students and staff who appear to have flu-like illness should be sent to a room separate from others until they can be sent home.

• Hand hygiene and respiratory etiquette:
The new recommendations emphasize the importance of the basic foundations of influenza prevention: stay home when sick, wash hands frequently with soap and water when possible, and cover noses and mouths with a tissue when coughing or sneezing (or a shirt sleeve or elbow if no tissue is available).

• Routine cleaning:
School staff should routinely clean areas that students and staff touch often with the cleaners they typically use. Special cleaning with bleach and other non-detergent-based cleaners is not necessary.

• Early treatment of high-risk students and staff:
People at high risk for influenza complications who become ill with influenza-like illness should speak with their health care provider as soon as possible. Early treatment with antiviral medications is very important for people at high risk because it can prevent hospitalizations and deaths. People at high risk include those who are pregnant, have asthma or diabetes, have compromised immune systems, or have neuromuscular diseases.

• Consideration of selective school dismissal:
Although there are not many schools where all or most students are at high risk (for example, schools for medically fragile children or for pregnant students) a community might decide to dismiss such a school to better protect these high-risk students.

By "not" closing the schools as we did during the last outbreak, would it make it harder to stop the spread of the virus once it hits a school campus? Excluding sick children and staff, using good hand hygiene and respiratory etiquette, routinely cleaning and following the other recommendations can limit the spread of the virus in a school setting. In addition, if students and staff are vaccinated with the seasonal and pandemic influenza vaccines, they will be well protected from seasonal and pandemic influenza strains.

The guidance was made with the intent of balancing the goal of reducing the number of people who become seriously ill or die from influenza with the goal of minimizing social disruption and safety risks to children sometimes associated with school dismissal.

When will the vaccine be available to the public? This year, the regular, seasonal influenza vaccine will be available early. The Advisory Committee on Immunization Practices (ACIP) recommends that people get vaccinated against seasonal influenza as soon as vaccines become available. Although, it is not certain when the pandemic vaccine will be available, we have heard projections for vaccine to be available as early October.

What is the priority list of who gets the vaccine first?

The groups recommended to receive the pandemic influenza vaccine include:

• Pregnant women because 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 because younger infants are at higher risk of influenza-related complications and cannot be vaccinated. Vaccination of those in close contact with infants less than 6 months old might help protect infants by "cocooning" them from the virus;

• Healthcare and emergency medical services personnel because infections among healthcare workers have been reported and this can be a potential source of infection for vulnerable patients. Also, increased absenteeism in this population could reduce healthcare system capacity;

• All people from 6 months through 24 years of age

o Children from 6 months through 18 years of age because we have seen many cases of novel H1N1 influenza in children and they are in close contact with each other in school and day care settings, which increases the likelihood of disease spread, and

o Young adults 19 through 24 years of age because we have seen many cases of novel H1N1 influenza in these healthy young adults and they often live, work, and study in close proximity, and they are a frequently mobile population; and,

• Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.

Once the demand for vaccine for the prioritized groups has been met at the local level, programs and providers should also begin vaccinating everyone from the ages of 25 through 64 years. Once vaccine demand among younger age groups has been met, programs and providers should offer vaccination to people 65 or older.

Do you have any concerns about the safety of the vaccine since it is so new and we had heard that the makers were rushing to get the vaccine done?

The process that is used for making the pandemic vaccine is the same process that is used to make the regular, seasonal influenza vaccine. This process has been used for many years. The safety and efficacy of influenza vaccines manufactured in this way is well established.

Do you have any concerns that we won't have enough vaccines to go around? The Federal Government has contracted with 5 manufacturers to make vaccine. The pandemic vaccine development plan is for a total of 600 million doses of vaccine to be made (enough for 2 doses for every person in the US). Nonetheless, the pandemic vaccine is being made by the same process as seasonal influenza vaccine. Therefore, not all the vaccine will be available at once.

How will this vaccine be different than the regular flu vaccine, why is it a 2-dose vaccine? The pandemic vaccine is being made using the same process as the regular flu vaccine. It will be different than the regular flu vaccine because this vaccine will include the pandemic influenza strain exclusively. Seasonal flu vaccines usually contain 3 strains of influenza virus. It is not clear that 2 doses will be required. Clinical trials are being done to see if two doses are necessary.

How are human trials going? Have we seen any side effects from the vaccine? The clinical trials for the vaccine started at the end of July. The studies will look at the safety and efficacy of the vaccine. Results from the trials are not available.

Are there any additional precautions families/kids can take besides the usual washing of their hands?

This year, seasonal influenza vaccine will be available early. The Advisory Committee on Immunization Practices (ACIP) recommends that people get vaccinated against seasonal influenza as soon as vaccines become available. When the pandemic vaccine becomes available, people should get vaccinated with that vaccine, too.

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