H1N1 Information

Many people are asking about the H1N1 vaccine and if they should get it for themselves or their kids.

We are recommending the vaccine and trying to follow the CDC recommendations and the summary is as follows. The biggest issue is that everyone is wanting Tamiflu and it really is not recommended for everyone because the majority of people have mild self-limiting disease. But it takes more time talking patients out of getting the prescription because for the majority of them, thier insurance pays for it. For patients who have to pay the $60 or more for the prescription, they usually choose to ride out the symptoms.

This is another perfect example of how when patients have more of the burden of the cost, they choose more wisely and are more cost-conscious

Recommended Use of Influenza A (H1N1) 2009 Monovalent Vaccine

ACIP recommends that vaccination efforts should focus initially on persons in five target groups (Box) whose members are at higher risk for influenza or influenza-related complications, are likely to come in contact with influenza viruses as part of their occupation and could transmit influenza viruses to others in medical care settings, or are close contacts of infants aged <6 href="http://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0821a1.htm#box#box">Box).
Initial Target Groups

When vaccine is first available, ACIP recommends that programs and providers administer vaccine to persons in the following five target groups (order of target groups does not indicate priority):

1. pregnant women,
2. persons who live with or provide care for infants aged <6 months (e.g., parents, siblings, and daycare providers),
3. health-care and emergency medical services personnel,§
4. persons aged 6 months--24 years, and
5. persons aged 25--64 years who have medical conditions that put them at higher risk for influenza-related complications.¶

These five target groups comprise an estimated 159 million persons in the United States. This estimate does not accurately account for persons who might be included in more than one category (e.g., a health-care worker with a high-risk condition). Vaccination programs and providers should begin vaccination of persons in all these groups as soon as vaccine is available.

Subset of Target Groups During Limited Vaccine Availability

Current projections of initial vaccine supply indicate that establishment of a subset of the five initial target groups will not be necessary in most areas. However, demand for vaccination and initial supply might vary considerably across geographic areas. If the supply of the vaccine initially available is not adequate to meet demand for vaccination among the five target groups listed above, ACIP recommends that the following subset of the initial target groups receive priority for vaccination until vaccine availability increases (order of target groups does not indicate priority):

1. pregnant women,
2. persons who live with or provide care for infants aged <6 months (e.g., parents, siblings, and daycare providers),
3. health-care and emergency medical services personnel who have direct contact with patients or infectious material,
4. children aged 6 months--4 years, and
5. children and adolescents aged 5--18 years who have medical conditions that put them at higher risk for influenza-related complications.

This subset of the five target groups comprises approximately 42 million persons in the United States. Vaccination programs and providers should give priority to this subset of the five target groups only if vaccine availability is too limited to initiate vaccination for all persons in the five initial target groups.

Antiviral Chemoprophylaxis

The infectious period for persons infected with the 2009 H1N1 virus appears to be similar to that observed in studies of seasonal influenza. Infected persons may shed influenza virus, and potentially be infectious to others, beginning one day before they develop symptoms to up to 7 days after they become ill. Children, especially younger children, and persons who are immune compromised can shed influenza virus for longer periods. However, the amount of virus shed generally correlates with magnitude of fever and for these recommendations, the infectious period for influenza is defined as one day before until 24 hours after fever ends.

Post exposure antiviral chemoprophylaxis with either oseltamivir or zanamivir can be considered for the following:

**Persons who are at higher risk for complications of influenza and are a close contact of a person with confirmed, probable, or suspected 2009 H1N1 or seasonal influenza during that person’s infectious period.

**Health care personnel, public health workers, or first responders who have had a recognized, unprotected close contact exposure to a person with confirmed, probable, or suspected 2009 H1N1 or seasonal influenza during that person’s infectious period. Information on appropriate personal protective equipment is available at: Infection Control for Patients in a Healthcare Setting and might be updated frequently as additional information on transmission becomes available.

· Antiviral agents should not be used for post exposure chemoprophylaxis in healthy children or adults based on potential exposures in the community, school, camp or other settings.
· Chemoprophylaxis generally is not recommended if more than 48 hours have elapsed since the last contact with an infectious person.
· Chemoprophylaxis is not indicated when contact occurred before or after, but not during, the ill person’s infectious period as defined above.

Patients given post-exposure chemoprophylaxis should be informed that the chemoprophylaxis lowers but does not eliminate the risk of influenza and that protection stops when the medication course is stopped. Patients receiving chemoprophylaxis should be encouraged to seek medical evaluation as soon as they develop a febrile respiratory illness that might indicate influenza.

For antiviral chemoprophylaxis of 2009 H1N1 influenza virus infection, either oseltamivir or zanamivir is recommended (Table 1). Duration of post-exposure chemoprophylaxis is 10 days after the last known exposure to 2009 H1N1 influenza.

Oseltamivir was authorized for use for chemoprophylaxis under the EUA for children younger than 1 year of age, subject to the terms and conditions of the EUA. (See Treatment and Chemoprophylaxis for Children Younger than 1 Year of Age, below.) Age-based dosing recommendations are provided in the fact sheetsincluded with the EUA letter of authorization, however weight-based dosing is an alternative preferred by some experts who are currently conducting studies of oseltamivir use in this age group.

An emphasis on early treatment is an alternative to chemoprophylaxis after a suspected exposure. Persons with risk factors for influenza complications who are household or close contacts of confirmed or suspected cases, and health care personnel who have occupational exposures, can be counseled about the early signs and symptoms of influenza, and advised to immediately contact their health care provider for evaluation and possible early treatment if clinical signs or symptoms develop. Health care providers should use clinical judgment regarding situations where early recognition of illness and treatment might be an appropriate alternative to chemoprophylaxis.

Persons at ongoing occupational risk for exposure (e.g., health care personnel, public health workers, or first responders who are working in communities with influenza outbreaks) should carefully follow guidelines for appropriate personal protective equipment. Efforts to reduce the risk of exposure or infection for healthcare personnel should include appropriate administrative controls (e.g. having health care personnel stay home from work when ill, and triaging for identification of potentially infectious patients), cough and hand hygiene, personal protective equipment, and vaccination when available.

**information taken from CDC website