The victim was a 55-year-old woman from Middlesex County with "multiple underlying health conditions."
Department of Public Health Commissioner John Auerbach's statement said, in part, “While most cases of H1N1 in Massachusetts and across the nation have been relatively mild, this news demonstrates once again how serious flu can be.”
The state Department of Public Health will host a webcast of its Statewide H1N1 Conference.
The webcast will be archived on the webcast web site for one year. The program will include an H1N1 situation update and outlook for the months ahead, and discussion of activities related to H1N1, clinical management, surge capacity, vaccination, DPH communications activities, school and university issues.
To view the webcast, visit: http://video.webcasts.com/events/pret001/32329/
If you have trouble with the link, please copy and paste it into your web browser.
Source: Massachusetts Department of Public Health (September 29, 2009).
The AMA today announced two new CPT codes for the upcoming H1N1 immunizations. Coding from the AMA:
Use code 90470 to report H1N1 immunization administration and counseling. Code 90663 was revised by the CPT Editorial Panel to refer specifically to the H1N1 vaccine product. Both, revised code 90663 and Category I CPT Code 90470 are effective immediately.
For quick reference, the two codes are below:
90470-H1N1 immunization administration (intramuscular, intranasal), including counseling when performed
90663-Influenza virus vaccine, pandemic formulation, H1N1
For more information:
http://www.ama-assn.org/ama/pub/news/news/cpt-codes-h1n1-immunizations.shtml
The U.S. Food and Drug Administration has approved four vaccines against the 2009 H1N1 influenza virus. The vaccines will be distributed nationally after the initial lots become available, which is expected within the next four weeks. The state will be responsible for distributing vaccine to health care and public health providers. Massachusetts health care practices wishing to receive vaccine must complete an online registration by October 9. Click here to read the FDA press release.
Seasonal Flu Vaccine DelayedMDPH Recommendations
MDPH recommends that all health care providers continue to vaccinate patients with seasonal influenza vaccine during routine visits and in scheduled clinics as supply allows.
Pediatric Providers
MDPH recommends that pediatric providers:
School and Public Clinics
MDPH is recommending that large public clinics and school based flu clinics be delayed until mid October (and possibly into early November) unless there is sufficient vaccine on hand to meet the expected demand. By mid-October, we anticipate vaccine supplies will be sufficient to mount large clinics efforts.
Sources: U.S. Food and Drug Administration (September 15, 2009) and Massachusetts Department of Public Health (September 17, 2009).
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Statewide H1N1 Conference
On September 30, DPH will host the Massachusetts Statewide Conference on H1N1 Influenza Response for public health, health care, school and community leaders at the DCU Center in Worcester. For information and to register, click here. The conference will present the latest situation update regarding the flu in Massachusetts, and elsewhere and what the outlook is for the coming months. And will provide the latest information on guidance and planning for flu vaccination, both seasonal and H1N1.Seasonal Influenza Vaccine Still Available for Purchase
For information about vaccine distributors with seasonal influenza vaccine available for purchase, go to the National Influenza Vaccine Summit website at: http://www.preventinfluenza.org/ivats/ivats_09_10.xls
Source: Massachusetts Department of Public Health (September 8, 2009).
On Wednesday, the state Public Health Council adopted emergency regulations to increase vaccination among health care workers and the public against seasonal and pandemic influenza.
The regulations promulgated by the MA Department of Public Health (DPH) require hospitals and clinics in the state to offer vaccinations to their employees, patient care volunteers and medical staff against seasonal and novel H1N1 as soon as the vaccines are available.
Additional regulations also allow the Commissioner of Public Health to license and certify additional categories of health care workers, such as dentists and paramedics, to administer vaccinations against pandemic or novel influenza pursuant to a prescriber’s order if the Commissioner issues a determination that additional health care professionals are needed for timely vaccination of the population.
DPH to allocate H1N1 vaccine
The federal government has contracted to develop enough novel H1N1 vaccine for widespread use in the fall of 2009. DPH will be responsible for the allocation of vaccine once it arrives—as early as late September—and anticipates getting it to providers within two weeks. DPH’s plan for allocation is in development.
DPH recommends vaccinating against seasonal flu early
DPH stated that 90% of the national vaccine supply for seasonal flu is anticipated to be available in August, and is recommending providers vaccinate patients against seasonal flu as soon as they receive it.
View the emergency regulations for hospital and clinic vaccination of health care workers, and for administration of vaccine.Source: Massachusetts Department of Public Health (August 12 and 13, 2009), Massachusetts Executive Office of Health and Human Services (August 13, 2009).
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ACIP recommends that vaccination efforts focus on five key populations. When vaccine is first available, the committee recommended that programs and providers try to vaccinate:
people who live with or care for children younger than 6 months of age
health care and emergency services personnel
persons between the ages of 6 months through 24 years of age
people from ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems.
pregnant women
people who live with or care for children younger than 6 months of age
health care and emergency services personnel with direct patient contact
children 6 months through 4 years of age
children 5 through 18 years of age who have chronic medical conditions.
Source: www.flu.gov (July 30, 2009)
An official of the Mass. Department of Public Health wrote today that reports of flu-like illnesses are down from their peak of three weeks ago. The US Centers for Disease Control and Prevention reported, also, that flu-like illness in the New England region is returning to normal levels.
This advisory from the Massachusetts Department of Public Health (MDPH) is intended to provide guidance for the diagnosis and management of pregnant women with influenza like illness (ILI) during the current outbreak of novel influenza A H1N1 in Massachusetts.
Pregnant women are known to be at higher risk for complications from infection with seasonal influenza viruses, and severe disease among pregnant women was reported during past pandemics. Given the prevalence of circulating influenza A H1N1 virus, pregnant women presenting with signs and symptoms consistent with ILI (fever and respiratory symptoms, including cough or sore throat) should receive prompt empiric antiviral treatment for influenza A H1N1. Treatment should not be delayed awaiting confirmatory results of H1N1 virus testing. In particular, due to the varying sensitivity of rapid influenza A tests, pregnant women with ILI should be treated presumptively even if rapid influenza A tests are negative and should continue treatment unless more sensitive tests for influenza A H1N1 are specifically negative or until recommended treatment course is completed.
As of June 10, 37 of 1076 of confirmed cases (3.4 %) of H1N1 infection in Massachusetts were in pregnant women. For women whose hospitalization status was known, 9 of 22 or 41% were hospitalized; some requiring intubation and ventilatory support. If all those with missing data are assumed to have not been hospitalized, the hospitalization rate would be 24% (9 of 37), which is more than 3 times the overall rate of 7% among all confirmed cases. The average time between the initial clinical visit and initiation of antiviral therapy was 1.7 days.
Antiviral treatment of pregnant women*
The observed severity of illness among pregnant women in Massachusetts highlights the need for early, empiric antiviral treatment. Pregnancy should not be considered a contraindication to oseltamivir or zanamivir use. Pregnant women might be at higher risk for severe complications from novel influenza A (H1N1), and the benefits of treatment with zanamivir or oseltamivir likely outweigh the theoretical risks of antiviral use. Antiviral treatment with zanamivir or oseltamivir should be initiated as soon as possible after the onset of influenza symptoms, with benefit greatest if started within 48 hours of onset. See Table 1 for dosing information.
Oseltamivir and zanamivir are "Pregnancy Category C " medications, indicating that no clinical studies have been conducted to assess the safety of these medications for pregnant women. Although a few adverse effects have been reported in pregnant women who took these medications, no relation between the use of these medications and those adverse events has been established.
In addition, antiviral prophylaxis is indicated for pregnant women who are close contacts of suspect, probable and confirmed cases. This includes pregnant health care workers with direct exposure to patients with ILI without appropriate respiratory protection.
For specific details about antiviral treatment of pregnant women, see the CDC guidance Pregnant women and novel influenza A H1N1: clinical considerations, available at www.cdc.gov/h1n1flu/clinician_pregnant.htm.
Table 1: Influenza A H1N1 antiviral medication dosing recommendations*
|
Medication |
Treatment |
Chemoprophylaxis |
|
Oseltamivir |
75 mg capsule twice per day for 5 days |
75 mg capsule once per day |
|
Zanamivir |
Two 5 mg inhalations (10 mg total) twice per day |
Two 5 mg inhalations (10 mg total) once per day |
* From: Interim Guidance on Antiviral Recommendations for Patients with Novel Influenza A (H1N1) Virus Infection and Their Close Contacts; www.cdc.gov/h1n1flu/recommendations.htm.
For more information
The latest clinical guidance related to pregnant women and influenza A H1N1 can be found on the CDC website:
The Centers for Disease Control and Prevention (CDC) is urging health care professionals to vaccinate all individuals for whom PPSV vaccine is recommended to protect them from pneumococcal disease during this H1N1 influenza outbreak. Of special concern are persons with high-risk conditions for whom PPSV vaccine is recommended, but to whom the vaccine is rarely given. For example, in 2008, only 47% of Massachusetts adults 18 – 64 years of age with diabetes reported ever receiving pneumococcal vaccine.
CDC's Advisory Committee on Immunization Practices (ACIP) recommends a single dose of PPSV23 for all people 65 years and older and for persons 2 to 64 years of age with certain high-risk conditions. People in these groups are at increased risk of pneumococcal disease as well as serious complications from influenza.
A single revaccination at least five years after initial vaccination is recommended for people 65 years and older who were first vaccinated before age 65 years, as well as for people at highest risk, such as those who have no spleen, and those who have HIV infection, AIDS, or malignancy.
All people who have existing indications for PPSV23 should continue to be vaccinated according to current ACIP recommendations during the outbreak of novel influenza A (H1N1). Emphasis should be placed on vaccinating people aged younger than 65 years who have established high-risk conditions because PPSV23 coverage among this group is low and because people in this group appear to be overrepresented among severe cases of novel influenza A (H1N1) infection, based on currently available data.
Use of PPSV23 among people without current indications for vaccination is not recommended at this time. This recommendation may be revised as the epidemiology and clinical presentation of novel influenza A (H1N1) virus infection as well as the frequency and severity of secondary pneumococcal infections are better understood.
To read the entire document, including background about pneumococcal disease and PPSV and PCV vaccines, go to: http://www.cdc.gov/h1n1flu/guidance/ppsv_h1n1.htm
New Indications for PPSV
The ACIP recently released provisional recommendations recommending PPSV for all adults 19 – 64 years of age who smoke or who have asthma.
A new Vaccine Information Statement (VIS) for PPSV in English and other languages is available at http://www.immunize.org/vis/vis_ppsv.asp.
Availability of State-Supplied PPSV in Massachusetts
In Massachusetts, state-supplied pneumococcal polysaccharide vaccine is available for all Massachusetts children younger than 19 years of age with medical condition that are indications for PPSV, regardless of where they receive care; state-supplied PPSV is available for all Massachusetts adults seen at public sites who are 65 years of age and older, or 19 – 64 years of age with a medical indication for PPSV vaccination.
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