A Local View of the 2009 H1N1 Influenza Pandemic
Across the county, Whatcom County emergency preparedness partners are rallying to provide coordinated, timely, and accurate 2009 H1N1 information and education to Whatcom residents. This is a determined and well-planned, behind-the-scenes response to the World Health Organization (WHO) declaration of an H1N1 pandemic in early summer. The H1N1 Pandemic Whatcom Unified Incident Command is led by the City of Bellingham, Whatcom County and PeaceHealth/St.Joseph Hospital and includes many other partners, including Western Washington University, Port of Bellingham, Whatcom Transportation Authority, Bellingham School District, other schools, community colleges and a broad spectrum of medical practices.
The 2009 influenza A (H1N1) emerged in Mexico this past spring and quickly spread. In early April, the new influenza virus was identified, and at the same time cases were found in the United States and quickly spread to many other countries, leading the World Health Organization (WHO) to declare an influenza pandemic on June 11, 2009. The outbreak in the Northern Hemisphere peaked and then slowed down, but remained at a low level here while the virus spread in the Southern Hemisphere during its winter influenza season this summer.
The virus causes disease similar to seasonal influenza; usually fever and cough with a runny nose, sore throat, headache, and muscle aches. Many people infected with the 2009 H1N1 virus have vomiting and diarrhea with or instead of respiratory symptoms. Unlike seasonal influenza, which tends to affect older people and infants more than older children, teens, and younger adults, the 2009 H1N1 influenza has caused more disease in older children and young adults, with relatively few cases in people over 65. People with chronic medical conditions are at higher risk of having complications from influenza than other people, but otherwise healthy people have been hospitalized and died, too.
Most people who become infected with the H1N1 virus do not need medical attention or treatment. The proportion of infected people who need hospitalization or who die is similar to seasonal influenza infections. Because most people do not have immunity to the new virus, many more people are likely to become infected and ill than with seasonal influenza, so the total number of people who are hospitalized or die is likely to be more than during usual influenza seasons, and will be younger than those affected by seasonal influenza.
While the 2009 H1N1 has remained of mild to moderate severity over the summer, it continues to spread and is now reaching more extensively into the Northern Hemisphere as we move into the fall and winter months—the traditional months for spread of any flu virus.
Local partners want you to be prepared to protect yourself and your family so that you can avoid both seasonal and H1N1 flu, know what to do if you or someone you love becomes ill, and other important information so that you are well informed and prepared to act.
FLU PREVENTION BASICS
By now you’ve probably heard the top three messages on how to prevent yourself and your family from getting the flu. You may have heard these messages multiple times. They are:
• Wash your hands
• Cover your cough
• Stay home if you’re sick
Coming to a movie theater near you: Starting September 25th, all local Regal Cinemas will begin showing a short public service announcement about flu prevention before each movie and on lobby screens. Approximately 15,000 people go to the movies each month and H1N1 pandemic partners are hoping that these messages will reinforce good prevention throughout the county.
Also, knowing a little more detail on each of these basic prevention facts can help you be more successful.
Washing your hands is the foundation of flu prevention. If we all took the time to wash our hands with warm, soapy water for at least 20 seconds, the spread of flu and colds would be reduced. Also, be sure to carry an alcohol-based hand sanitizer to wash your hands with if you’re out and about. These are relatively inexpensive and can be purchased at most pharmacies and food stores. Also, never touch your nose, eyes, or mouth unless you have first washed your hands thoroughly. This is very important because the flu virus can enter your body very easily through your nose, the corner of your eyes, and also your mouth.
Covering your cough is an art. The best way to assure that a virus isn’t spread to others is to cough into your sleeve. Just raise your arm and cover your cough by placing your mouth against the inside of your shirt sleeve. You can also cover your cough with a tissue. However, be sure to properly dispose of the tissue in an appropriate waste receptacle. You don’t want to leave used tissues around where someone else would need to dispose of them. Wash your hands after you cough or blow your nose.
Finally, if you do get the flu—whether it is the seasonal flu or H1N1—stay home so that you aren’t exposing others to the flu virus you have. Current local advice is to stay home until you’ve been free of a fever for at least 24 hours without having taken fever-reducing medications.
Beyond these prevention basics, you need to know the what, why, and how of flu vaccines.
BEYOND THE BASICS: IMMUNIZATION FACTS YOU NEED TO KNOW
Vaccination is the most effective way to prevent illness from influenza. It is better to become immune to influenza by being vaccinated than it is to be infected and risk the complications and of spreading influenza to others.
Three key immunization messages you need to know are these:
• It is possible for one person to get both seasonal flu and the H1N1 flu
• Get a seasonal flu vaccination now
• Get an H1N1 vaccination when it is available to you
Seasonal flu vaccine is now widely available in Whatcom County from local pharmacies as well as local health care providers. Costs are about $25 and some health care insurance policies will reimburse this cost. The Whatcom County Health Department web site has an up-to-date schedule of local flu clinics listed under Hot Topics & News:
http://www.co.whatcom.wa.us/health/index.jsp.
Because it takes about two weeks before you are fully protected, it is important to get a seasonal flu vaccination now. The seasonal influenza vaccine does not protect against the 2009 H1N1 virus, so a separate H1N1 vaccine is also needed.
Approximately 25,000 doses of the H1N1 flu vaccine are expected to arrive in our community by mid-October with additional shipments to follow. The initial doses will be targeted to the following high priority groups, following the recommendations of the US Centers for Disease Control (CDC):
• pregnant women,
• people who live with or provide care for infants <6 months of age (e.g., parents, siblings, and daycare providers),
• healthcare and emergency medical services personnel who have direct contact with patients or infectious material,
• Children ages 6 months to 4 years of age, and
• Children and adolescents 5 years to 18 years who have medical conditions that put them at higher risk for influenza-related complications
These groups will be the first to be offered the H1N1 vaccine. As additional doses become available, other children and young adults ages 5-24 years will be offered the vaccine as well as those ages 25-64 years who have medical conditions that put them at higher risk for flu-related complications.
The Health Department particularly urges that pregnant women be vaccinated. According to Astrid Newell, MD, Community Health Manager for the department, “If you are pregnant it is extremely important that you receive both the seasonal vaccine and the H1N1 vaccine because pregnant women and their newborns are particularly vulnerable to severe health complications if they get influenza.”
Greg Stern, MD, Whatcom County Health Officer, says “It is very important to protect young infants from influenza. Babies cannot get the vaccines until they are six months old, so it especially important that their families and caregivers are vaccinated to protect them.”
A LOCAL PERSPECTIVE ON VACCINE SAFETY
According to Dr. Stern, “Vaccines are the most effective protection we have against flu because even ‘mild’ influenza seasons cause significant disease, hospitalizations, and deaths, many of which can be prevented.” Some people are allergic to components of the vaccines, and should be asked about allergies before being offered vaccines. Serious side effects are very rare. People sometimes get flu-like symptoms from the influenza vaccine, but this is most often due to their immune response to the vaccine, a sign that the vaccine is working to make them immune.
Local officials want the public to know that the H1N1 vaccine is not an experimental vaccine. The H1N1 vaccine that is licensed in the US is made by the same methods that the seasonal influenza vaccines are made. Each year, three influenza viruses are chosen and grown for vaccine production. The H1N1 vaccine has gone through the same rigorous testing procedures that are used with all seasonal influenza vaccines. The only difference is that the H1N1 process started later in the year than the seasonal vaccine testing and production cycle. This is why H1N1 vaccine is arriving later in our community than the seasonal vaccine. Safety tests have shown no unusual responses to the new vaccine and ongoing monitoring systems are in place to detect quickly any such occurrences.
Some people are concerned about thimerosal, a preservative used in multi-dose influenza vaccine. Washington State law prohibits the use of vaccines with thimerosal for children under three and pregnant women, except in emergencies declared by the Secretary of Health. The concern is about exposure to the mercury in thimerosal. We anticipate that we will have enough thimerosal-free vaccine to provide it for young children and pregnant women. The amount of mercury in a dose of vaccine with the preservative is about equal to the amount found in a can of albacore tuna. Studies have shown no evidence of neurodevelopmental abnormalities effects from childhood vaccines when they contained thimerosal and although autism rates have continued to increase, they did not go down when thimerosal was eliminated from routine childhood vaccines in 2001.
According to Dr. Stern, “The benefits of vaccination in protecting individuals from influenza and their close contacts from spread far outweigh the rare serious and theoretical side effects of vaccination. We have been able to eliminate smallpox from the world and polio from the Western Hemisphere through the use of vaccines. They are like seatbelts and airbags in cars. We know that overall they save lives and reduce the severity of injuries.”
CARE INSTRUCTIONS IF YOU OR SOMEONE YOU LOVE GETS THE FLU
Like seasonal flu, H1N1 can cause fever, cough, sore throat, body aches, headache, chills, fatigue, diarrhea and vomiting. Flu symptoms vary from mild to severe. If you get sick with flu, you should do the following:
• Stay home at least 24 hours after your fever is gone (without the use of fever-reducing medicine). In general, a fever means you have a temperature of 100 degrees Fahrenheit (37.8 degrees Celsius) or greater.
• Drink clear fluids (water, broth, sports drinks, electrolyte beverages for infants) to avoid dehydration.
• Get plenty of rest.
• If possible, limit your contact with other people.
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