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Most Popular Questions

• Are the H1N1 vaccines safe?
• What is H1N1 Flu?
  
• Can I catch the H1N1 Flu from other people?
  
• What are the signs and symptoms of H1N1 Flu?
  
• How can I protect myself and my family?
  
• What should I do if I get sick?
  
• Who should and should not recieve the H1N1 vaccine?
  
• Which H1N1 vaccination should I get?
  
• Where can I get the H1N1 Flu vaccination?
  
• How much will the H1N1 vaccine cost?
  

General Information

»General Information: Overview

What is H1N1 Flu?
H1N1 Flu is a new flu virus causing illness in people. H1N1 Flu was first detected in people in the United States during April 2009. Florida's first case of H1N1 Flu was diagnosed on May 1, 2009. Visit www.myflusafety.com regularly for the most up-to-date information about H1N1 Flu in Florida.

What's the current status of H1N1 Flu in Florida?
The H1N1 Flu is causing illness in infected persons in Florida, the United States and countries around the world. The Centers for Disease Control and Prevention (CDC) expects that illnesses may continue for some time. As a result, you or people around you may become ill. If so, you need to recognize the symptoms and know what to do.

Where can I find the most current flu activity for Florida?
http://www.doh.state.fl.us/Disease_ctrl/epi/swineflu/Reports/reports.htm

Additional weekly reports can be found at
http://www.doh.state.fl.us/Disease_ctrl/epi/htopics/flu/2009/index.html

Why is the flu virus sometimes called “swine flu”?
H1N1 Flu was initially referred to as "swine flu" because laboratory testing showed that many of the genes in this new virus were very similar to flu viruses that normally occur in swine (pigs) in North America. Further study has shown this new virus is very different from what normally circulates in North American pigs. It also has avian (bird) genes and human genes.

Can I catch the H1N1 Flu from other people?
H1N1 Flu is contagious and can spread from person to person. The virus spreads in the same way regular seasonal flu viruses spread. Most people who have become ill with this new virus have recovered without requiring medical treatment.

How is H1N1 Flu spread?
The H1N1 Flu appears to be transmitted from person to person through close contact, in ways similar to other flu viruses. Flu can be transmitted through:

• Coughing and sneezing
• Contact, usually of hands, with someone who has H1N1 Flu
• Touching a surface that is contaminated and then touching the nose, mouth, or eyes.

What are the signs and symptoms of H1N1 Flu in people?
The symptoms of H1N1 flu in people are similar to the symptoms of regular seasonal flu and include sudden onset fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with H1N1 flu. People may be infected with the flu, including H1N1 Flu, and have respiratory symptoms without a fever like seasonal flu. H1N1 flu may cause a worsening of underlying chronic medical conditions.

Is anyone immune to the H1N1 Flu?
Older individuals, age 65 and older, have been reported to have lower rates of H1N1 Flu infection when compared to other age groups. Why this is the case is not fully understood.

How severe is illness associated with H1N1 Flu?
Illness with the H1N1 Flu has ranged from mild to severe. While most people who have been sick have recovered without needing medical treatment, hospitalizations and deaths from infection with this virus have occurred. About 70 percent of people who have been hospitalized with H1N1 Flu have had one or more medical conditions previously recognized as placing people at “high risk” of serious seasonal flu-related complications. This includes:

• Pregnancy
• Diabetes
• Heart disease
• Asthma
• Kidney disease

One thing that appears to be different from seasonal flu is that adults age 65 and older do not yet appear to be at increased risk of the H1N1 Flu related complications.

CDC laboratory studies have shown that no children and very few adults younger than 60 years old have existing antibodies to H1N1 flu virus; however, about one-third of adults older than 60 may have antibodies against this virus. It is unknown how much, if any, protection may be afforded against H1N1 flu by any existing antibody

What is the incubation period?
According to information from the Centers for Disease Control and Prevention (CDC), the estimated incubation period for H1N1 flu is from 1 to 4 days with an average of 2 days. Flu virus shedding (the time during which a person might be infectious to another person) begins the day before illness onset and can persist for 5 to 7 days. Some persons may shed virus for longer periods, particularly young children and severely immunocompromised persons.

How long are people infectious to others?
People infected with seasonal and H1N1 flu shed the virus and may be able to infect others up to 1 day before getting sick and up to 5 to 7 days after becoming ill. This can be longer in some people, especially children and people with weakened immune systems, and in people infected with the new H1N1 flu virus. People are most infectious when they have a fever. In most situations, people can safely return to work or school if they have been free of fever without taking anti-fever medicines for 24 hours or more.

How long does the illness last?
The flu usually lasts three to seven days, although coughing and exhaustion can persist for more than two weeks. Human flu virus can cause primary flu and viral pneumonia. Human flu virus can worsen underlying medical conditions, such as pulmonary or cardiac disease; lead to secondary bacterial pneumonia or sinusitis; or cause co-infections with other viral or bacterial pathogens.

Can H1N1 flu re-infection occur?
The human body produces antibodies (parts of your immune system that can recognize and attack germs if you are exposed to the germ again) that offer a level of protection from being re-infected from viruses.

Getting infected with any flu virus, including H1N1 Flu, should cause the body to develop immune resistance to that virus so it's not likely that a person would be infected with the identical flu virus more than once. (However, people with weakened immune systems might not develop full immunity after infection and might be more likely to get infected with the same flu virus more than once.) It's also possible that a person could have a positive test result for flu infection more than once in a flu season. This can occur for two reasons:

• A person may be infected with different flu viruses (for example, the first time with 2009 H1N1 and the second time with a regular seasonal flu virus. Most rapid tests cannot distinguish which flu virus is responsible for the illness. And,
• Flu tests can occasionally give false positive and false negative results so it's possible that one of the test results were incorrect. This is more likely to happen when the diagnosis is made with the rapid flu tests. More information about flu diagnosis is available at http://www.cdc.gov/h1n1flu/diagnosis/

Some tips to prevent infection include:

• Those who experience illness should take time to fully recover
• Stay home from work or school if illness is suspected to cut down on exposure to others
• Frequent hand washing cuts down exposure and re-exposure to contagious diseases
• Use of germicide gels that kill germs on contact is suggested
• Using spray disinfectants keeps surfaces clean

What kind of health problems does flu cause?
Flu can cause serious short-term complications, including pneumonia and respiratory failure, and can worsen underlying diseases such as asthma or diabetes. Those who suffer from these complications of flu may have a delayed recovery time, but there are no long-term health issues caused by flu itself.

Should I attend social gatherings?
If you are sick, you should stay home and limit your contact with other people as much as possible and avoid attending or participating in events or other social gatherings.

In all situations, both children and adults should follow basic health and hygiene practices. These practices include regular hand washing, covering your nose and mouth with a tissue when you cough or sneeze and throwing the tissue into the trash, and avoiding touching your eyes, nose and mouth.

Will the state mandate isolation for those who are ill and/or mandate quarantine for those have been exposed?
No. The Florida Department of Health recommends that people who are ill with flu-like illness stay home from work or school and minimize their exposure to others. Strategies for stopping the spread of some communicable diseases include isolation of those who are ill and quarantining those who have been exposed to the disease. Voluntary isolation is recommended for H1N1 Flu. Schools or employers may exclude those who are ill until they have recovered, following their own personnel policies.

What additional steps are being taken to protect those most vulnerable to severe illnesses from H1N1 Flu?
The Department of Health is engaged in a number of activities to ensure current CDC H1N1 Flu guidance is disseminated in a timely manner to health care providers, the general public has access to accurate information, and the disease is actively monitored throughout the state. The Department, in coordination with its federal, state and other public and private partners, is leading the state vaccination campaign against H1N1 Flu. Initial priority target groups for vaccination include those who are at greatest risk for flu complications and/or transmission of disease. This includes healthcare workers. Additional information about the Department of Health’s activities can be found at the following link:
http://www.myflusafety.com/SwineFlu/documents/DOHandH1N120090904.pdf

Where can I get the H1N1 Flu vaccination?
If your health provider is not offering the H1N1 vaccine, visit http://www.myflusafety.com/myfluclinic.htm to locate a public health sponsored H1N1 vaccine clinic near you. H1N1 vaccine is arriving in Florida, so continue to check with your healthcare provider or local health department for availability. There will be enough vaccine available for those who request to receive it. Your county health information can be obtained here: http://www.doh.state.fl.us/chdsitelist.htm

Will there be enough vaccine available?
The Centers for Disease Control and Prevention (CDC) anticipates having enough vaccine available for everyone requesting to be vaccinated. However, flu vaccine availability and demand can be unpredictable and initially, the vaccine will be available in limited quantities. While vaccine supply is limited, the Florida Department of Health will follow CDC guidance for vaccinating groups of people who are at higher risk for contracting the H1N1 Flu.

The President declared a National Emergency for H1N1 Flu. What does this mean?
This declaration provides hospitals the ability to request waivers of legal requirements that could limit their ability to respond to a surge of patients with the H1N1 Flu. These waivers will not be granted in a blanket fashion and will be determined on a case-by-case basis.

How many cases of H1N1 Flu do we have in Florida? How is Florida tracking flu?
Doctors are not asked to report all diagnoses of flu at this time, as the numbers would be very large. For many people, the treatment is the same for H1N1 Flu or other seasonal flu. A public health response is not needed in every case. Florida doctors are asked to report deaths in people with H1N1 Flu, people admitted to hospital with serious illnesses due to H1N1 Flu, and pregnant women admitted to hospital with such illness; and to notify their County Health Department of flu outbreaks of which they become aware. More information can be found here: http://www.myflusafety.com/data.html

»General Information: Signs and Symptoms

What are the signs and symptoms of H1N1 Flu?
The symptoms of H1N1 flu are similar to the symptoms of regular seasonal flu and include:

• Fever
• Cough
• Sore throat
• Body aches
• Headache
• Chills
• Fatigue

Some people have reported diarrhea and vomiting associated with H1N1 Flu. Like the seasonal flu, H1N1 Flu may cause a worsening of underlying chronic medical conditions.

People infected with seasonal and H1N1 Flu shed the virus and may be able to infect others up to 1 day before getting sick and up to 5 to 7 days after becoming ill. This can be longer in some people, especially children and people with weakened immune systems. People are most infectious when they have a fever. In most situations, people can safely return to work or school if they have been free of fever without taking anti-fever medicines for 24 hours or more.

If I have flu-like symptoms, should I go to the Emergency Room?
Always call your regular healthcare provider before going to the Emergency Room, even if it is at night or on the weekend. Healthcare providers have systems in place to respond to their patients' needs during times when the office isn't open.

I have flu symptoms but I can't get tested for H1N1 Flu? Why?
Currently, almost all flu in Florida is caused by the H1N1 Flu virus. If you have flu-like symptoms, it is very likely you have H1N1 Flu.

Your healthcare provider is the expert on diagnosing illnesses and determining what tests should be ordered for you. You and your doctor are partners in your care. Ask questions, follow your doctor's instructions, and be sure you keep your doctor informed of any changes in your condition.

» General Information: Prevention

How can I protect myself and my family?

• The Centers for Disease Control and Prevention (CDC) recommend you get the H1N1 vaccine when it becomes available to protect you and your family. The vaccine will be given to priority groups first. If you have any questions about whether you should be vaccinated you should contact your primary healthcare provider.
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it, and wash your hands with soap and water.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
• Avoid touching your eyes, nose or mouth. Germs spread this way.
  
• Try to avoid close contact with sick people.
  
• If you are sick with a flu-like illness, stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible. This is to prevent you from making others sick.
  
• While sick, limit contact with others to keep from infecting them. If you are sick and share a common space with other household members in your home, wear a facemask if you are within six feet of others, if available and tolerable, to help prevent spreading the virus to others.
  
• Follow public health advice regarding school dismissals, avoiding crowds, and other social distancing measures.
  
• If you don’t have one yet, consider developing a family emergency plan as a precaution, so you don’t have to make trips to the store while you are ill. This should include storing a supply of extra food, medicines, and other essential supplies.
  

What is the best technique for washing my hands?
Washing your hands often will help protect you from germs. Wash with soap and water or clean with alcohol-based hand cleaner. It is recommended that when you wash your hands with soap and warm water for 15 to 20 seconds (singing “Happy Birthday” to yourself twice is about 15-20 seconds). When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn't need water to work; the alcohol in it kills the germs on your hands.

I'm allergic to hand gels. What should I do?
Wash with soap and water.

If I have a family member sick at home with H1N1 Flu, should I go to work?
Persons who are well but who have an ill family member at home with the H1N1 flu can go to work as usual. You should monitor your health every day, and take everyday precautions including covering their coughs and sneezes and washing their hands often with soap and water, especially after they cough or sneeze. If you become ill with flu-like symptoms, including fever, body aches, runny or stuffy nose, sore throat, nausea, or vomiting or diarrhea, you should stay home and avoid contact with other people. If you become ill, you should notify your supervisor and stay home. Employees who have an underlying medical condition or who are pregnant should call their health care provider for advice, as they may need to receive flu antiviral medications. Staying at home means you should not leave your home except to seek medical care. This means avoiding normal activities, including work, school, travel, shopping, social events, and public gatherings.

Can H1N1 Flu re-infection occur?
The human body produces antibodies (parts of your immune system that can recognize and attack germs if you are exposed to the germ again) that offer a level of protection from being re-infected from viruses.

Getting infected with any flu virus, including H1N1 Flu, should cause the body to develop immune resistance to that virus so it's not likely that a person would be infected with the identical flu virus more than once. (However, people with weakened immune systems might not develop full immunity after infection and might be more likely to get infected with the same flu virus more than once.) It's also possible that a person could have a positive test result for flu infection more than once in a flu season. This can occur for two reasons:

• A person may be infected with different flu viruses (for example, the first time with H1N1 Flu and the second time with a regular seasonal flu virus. Most rapid tests cannot distinguish which flu virus is responsible for the illness. And,
  
• Flu tests can occasionally give false positive and false negative results so it's possible that one of the test results were incorrect. This is more likely to happen when the diagnosis is made with the rapid flu tests. More information about flu diagnosis is available at http://www.cdc.gov/h1n1flu/diagnosis/
  

Some tips to prevent infection include:

• Those who experience illness should take time to fully recover
  
• Stay home from work or school if illness is suspected to cut down on exposure to others
  
• Frequent hand washing cuts down exposure and re-exposure to contagious diseases
  
• Use of germicide gels that kill germs on contact is suggested
  
• Using spray disinfectants keeps surfaces clean
  

Should I attend social gatherings?
If you are sick, you should stay home and limit your contact with other people as much as possible and avoid attending or participating in events or other social gatherings. In all situations, both children and adults should follow basic health and hygiene practices. These practices include regular hand washing, covering your nose and mouth with a tissue when you cough or sneeze and throwing the tissue into the trash, and avoiding touching your eyes, nose and mouth.

» General Information: Cleaning Tips

How long can flu viruses live outside the body?
Flu virus can survive on surfaces (like desks and counter tops) and can infect a person for 2 to 8 hours after being deposited on the surface. Frequent hand washing will help you reduce the chance of getting contamination from these common surfaces.

What kills flu virus?
Flu virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human flu viruses if used in proper concentration for a sufficient length of time. For example, wipes or gels with alcohol in them can be used to clean hands. The gels should be rubbed into hands until they are dry.

What surfaces are most likely to be sources of contamination?
Germs can be spread when a person touches something that is contaminated (a table for example) with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air for a distance of about six feet.

What if soap and water are not available and alcohol-based products are not allowed in my facility?
Though the scientific evidence is not as extensive as that on hand washing and alcohol-based sanitizers, other hand sanitizers that do not contain alcohol may be useful for killing flu germs on hands.

How should waste disposal be handled to prevent the spread of flu virus?
To prevent the spread of flu virus, it is recommended that tissues and other disposable items used by an infected person be thrown in the trash. Additionally, persons should wash their hands with soap and water after touching used tissues and similar waste.

What household cleaning should be done to prevent the spread of flu virus?
To prevent the spread of flu virus it is important to keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.

How should linens, eating utensils and dishes of persons infected with flu virus be handled?
Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but more importantly these items should not be shared without washing with soap and water thoroughly first. Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid “hugging” laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water or use alcohol-based hand-sanitizers immediately after handling dirty laundry.

» General Information: Treatment

What should I do if I get sick?
Pay extra attention to your body and how you are feeling. If you get sick with flu-like symptoms, stay home, limit contact with others, and call your health care provider. Your health care provider will decide if testing or treatment is needed. Tests may include a nasal swab which is best to do within the first 4-5 days of getting sick. Like regular flu, H1N1 Flu may make other medical problems worse. If you are alone at any time, have someone check in with you often if you are feeling ill. This is always a good idea. If you have close contact with someone who has H1N1 Flu or is being treated for exposure to H1N1 Flu, contact your health care provider to discuss whether you need treatment to reduce your chances of getting the flu.

How is H1N1 Flu treated?
Treat any fever right away. Tylenol® (acetaminophen) is the best treatment of fever in pregnancy.

Drink plenty of fluids to replace those you lose when you are sick.

Your doctor will decide if you need antiviral medicines such as Tamiflu® (oseltamivir) or Relenza® (zanamivir). Antiviral medicines are prescription pills, liquids or inhalers that fight against the flu by keeping the germs from growing in your body. These medicines can make you feel better faster and make your symptoms milder.

Antiviral medicines work best when started soon after symptoms begin (within two [2] days), but they may also be given to very sick or high risk people (like pregnant women) even after 48 hours.

Tamiflu® and Relenza® are also used to prevent H1N1 Flu.

There is little information about the effect of antiviral medication in pregnant women or their babies, but no serious side effects have been reported. If you think you have had a side effect to antiviral medication, call your doctor right away.

I don't have a doctor, where can I go to be seen if I am sick?
Local clinics or urgent care centers may be an option, if you don’t have a doctor. You can contact your local or county health department. They may be able to help. This information can be found at www.floridashealth.com. You can also try http://findahealthcenter.hrsa.gov/ to find a health center near you.

When should I get emergency medical care?
If you have any of these signs, seek emergency medical care right away:

• Difficulty breathing or shortness of breath
  
• Pain or pressure in the chest or abdomen
  
• Sudden dizziness
  
• Confusion
  
• Severe or persistent vomiting and/or diarrhea
  
• Decreased or no movement of your baby
  
• A high fever that is not responding to Tylenol®
  

How can human infections with H1N1 Flu be diagnosed?
Your physician can diagnose if you have H1N1 Flu based on signs and symptoms that you are having or by lab tests. To diagnose H1N1 Flu, a respiratory specimen would generally need to be collected within the first four to five days of illness (when an infected person is most likely to be shedding virus). If your doctor feels you need a lab test, this testing can now be done through private clinical laboratories.

My doctor says I have H1N1 Flu, but he won't test me.
At this time, almost all flu in Florida is caused by the H1N1 Flu. If you have flu-like symptoms, it is very likely you have H1N1 Flu. Your doctor is the expert on diagnosing illnesses and determining what tests should be ordered for you. You and your doctor are partners in your care. Ask questions, follow your doctor's instructions, and be sure you keep your doctor informed of any changes in your condition.

Are there medicines to treat H1N1 Flu infection?
Yes. The Centers for Disease Control and Prevention (CDC) recommends the use of antiviral medication for the treatment and/or prevention of infection with H1N1 Flu virus. Antiviral medications are prescription medicines (pills, liquids or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral medications can make your illness milder and make you feel better faster. They may also prevent serious flu complications. The priority use for flu antiviral medications is to treat severe flu illness (for example, hospitalized patients) and people who are sick that have a condition which places them at high risk for serious flu-related complications.

Do I need a prescription for these medicines?
Yes, you need a prescription. Contact your physician on how to get the antiviral medication.

The doctor prescribed antiviral medications and I can't afford them. What do I do?
Florida is working on agreements with different retailers throughout the state to ensure Floridians have access to antiviral medications. The Bureau of Statewide Pharmaceutical Services has developed a Public Antiviral Stockpile Program to ensure healthcare providers have a resource for referring their patients who cannot afford antiviral medications. Patients can be directed to one of several participating pharmacies throughout the state: Publix, Walgreen’s, Winn Dixie and Navarro.

County Health Departments will also have supplies of antiviral medications, so Floridians who need it can get it.

In addition, many healthcare providers are aware of community prescription assistance programs. If you have internet access, you can utilize the Partnership for Prescription Assistance site: http://www.pparx.org/prescription_assistance_programs/free_clinic_finder for information about prescription assistance near you.

How effective are antiviral medications at preventing the flu?
When used to prevent the flu, antiviral medications are about 70% to 90% effective against susceptible viruses (i.e. viruses that are not resistant to the antiviral medication). It's important to remember that flu antiviral medications are not a substitute for getting a flu vaccination.

Can flu antiviral medications help with other illnesses such as the common cold?
No. Flu antiviral medications only work against flu viruses. They will not help reduce symptoms from the common cold or any other flu-like illnesses caused by viruses other than flu viruses. Many other viruses cause winter illnesses besides the flu.

What are the treatment benefits of flu antiviral medications?
Treatment, when indicated, should be initiated as early as possible because the benefits are greatest when started within the first 2 days of illness. However, some studies of hospitalized patients with seasonal and H1N1 flu has suggested the benefit of antiviral treatment even when treatment was started more than 2 days after illness onset. When used this way, these drugs can reduce the severity of flu symptoms and shorten the time you are sick by 1 or 2 days. They may also prevent serious flu complications. Some studies of oseltamivir treatment of hospitalized patients with seasonal flu have indicated benefit, including reductions in mortality or duration of hospitalization even for patients whose treatment was started more than 48 hours after illness onset. Antiviral medications may be especially important for people who are very sick (hospitalized) or people who are sick with the flu and who are at increased risk of serious flu complications, such as pregnant women, young children and those with chronic health conditions.

Can antiviral medications be given even if a person is not tested for flu or if a flu test does not indicate that they have flu?
Yes. Treatment should not wait for laboratory confirmation of flu because laboratory testing can delay treatment and because a negative rapid test for flu does not rule out flu.

The healthcare provider’s assessment of a patient’s clinical presentation as well as underlying risk factors is always an essential part of decisions about the need for further medical evaluation or treatment.

Why are people 65 and older prioritized for antiviral treatment if they get sick with the flu, but they are not in one of the early groups prioritized to get H1N1 vaccine?
Persons who are 65 years and older are less likely to become ill with H1N1 flu compared to younger persons. However, when persons aged 65 years or older become ill with flu, they are at higher risk for severe flu-related complications.

The Centers for Disease Control and Prevention (CDC) recommendations for antiviral treatment:
The CDC’s most current recommendations can be found at: http://www.cdc.gov/h1n1flu/recommendations.htm

These interim recommendations have been updated to provide additional guidance for clinicians in prescribing antiviral medications for treatment and prevention of flu during the 2009-2010 seasons. In general, the priority use of antiviral medications during this season continues to be in people who are hospitalized with flu and those at increased risk of flu-related complications. This document has been updated to:

1. Clarify treatment and chemoprophylaxis considerations for persons vaccinated with the 2009 H1N1 and seasonal flu vaccines.
2. Include women up to 2 weeks postpartum at higher risk for complications from 2009 H1N1 flu.
3. Provide additional oseltamivir dosing instructions for children younger than 1 year of age.
4. Review adverse events and contraindications associated with oseltamivir and zanamivir.

This document: (http://www.cdc.gov/h1n1flu/recommendations.htm, should be considered interim, and will be updated as needed.

The updated recommendations continue to balance between providing clinicians the information and guidance needed to reach those at greatest risk with appropriate and timely treatment; to reduce the chances of antiviral resistance through inappropriate or unnecessary chemoprophylaxis; and yet to still recognize the overarching importance of clinical judgment in making treatment and chemoprophylaxis decisions. The healthcare provider’s assessment of a patient’s clinical presentation as well as underlying risk factors is always an essential part of decisions about the need for further medical evaluation or treatment.

For more information, please visit http://www.cdc.gov/h1n1flu/antiviral.htm for additional information on this topic

Vaccine

» Popular Questions About the Vaccines

Where's the Vaccine? (Video)

Are the H1N1 Vaccines safe?

Who should and who should not receive the H1N1 vaccine?

Which H1N1 vaccination should I get?

Where can I get the H1N1 vaccination?

How much will the H1N1 vaccine cost?

Is the H1N1 vaccine mandatory?

When will the rest of the population be able to get vaccinated with the H1N1 vaccine?

» Vaccines - H1N1

Are the H1N1 vaccines safe?
H1N1 vaccines are manufactured and tested using the same processes used for the seasonal vaccine. Many millions of doses of seasonal vaccine have been distributed every year for many years, and seasonal vaccines have a well-established safety profile.

Who should and who should not receive the H1N1 vaccine?
The Centers for Disease Control and Prevention (CDC) has identified five priority groups who are at higher risk for flu or flu-related complications, or are likely to come in contact with flu viruses as part of their occupation and could transmit flu viruses to others in medical care settings, or are close contacts of infants less than 6 months old, (who are too young to be vaccinated). Those priority groups are:

• Pregnant women
• Persons who live with or provide care for infants less than 6 months old (e.g. parents, siblings, and daycare providers)
• Health-care and emergency medical services personnel as defined in the Morbidity and Mortality Weekly Report (MMWR) (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0821a1.htm)
• Persons aged 6 months - 24 years, and
• Persons aged 25 - 64 years who have medical conditions that put them at higher risk for flu-related complications

Some people should not be vaccinated without first consulting a physician. They include:

• People who have a severe allergy to chicken eggs.
• People who have had a severe reaction to a flu vaccination in the past.
• People who developed Guillian-Barré syndrome (GBS) within 6 weeks of getting an flu vaccine previously.
• Children less than 6 months of age (flu vaccine is not approved for use in this age group).
• People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms lessen.

If you have questions about whether you should get a H1N1 flu vaccination, consult your health-care provider.

Which H1N1 vaccination should I get?
The nasal spray vaccination is approved for:

• Healthy people 2-49 years of age who are not pregnant
• Healthy persons who live with or care for those in a high risk group

The nasal spray is not recommended for:

• Infants under 2 years of age
• Adults over 49 years of age
• Pregnant women
• Persons who care for people with a severely weaken immune system
• Anyone with a range of underlying health problems

The injection (shot) vaccine is recommended for:

• pregnant women
• People who live with or care for infants younger than 6 months of age
• Health care and emergency medical personnel
• Anyone from 6 months through 24 years of age
• Anyone from 25 through 64 years of age with certain chronic medical conditions or a weakened immune system
• Healthy 25 through 64 year olds
• Adults 65 years and older

The injection (shot) vaccine is not recommended if you have a severe (life-threatening) allergy to eggs or to any other substance in the vaccine. Talk with your healthcare provider if you have had a life-threatening allergic reaction after a dose of seasonal flu vaccine, or Guillain-Barré Syndrome (a severe paralytic illness also called GBS).

Where can I get the H1N1 vaccination?
If your health provider is not offering the H1N1 vaccine, visit http://www.myflusafety.com/myfluclinic.htm to locate a public health sponsored H1N1 vaccine clinic near you. H1N1 vaccine is arriving in Florida daily, so please continue to check with your healthcare provider or local health department for availability. There will be enough vaccine available for those who request to receive it. Your county health information can be obtained here: http://www.doh.state.fl.us/chdsitelist.htm

How much will the H1N1 vaccine cost?
The vaccine is provided free of charge by the federal government. There is no cost for the vaccine. Private providers may charge patients an administration fee.

Is the H1N1 vaccine mandatory?
The state is NOT mandating any vaccinations. However, individual healthcare facilities may have their own policy regarding their employees. Healthcare staff will need to check with their human resource/employee health office regarding their specific workplace policy. If you have questions about whether you should get the vaccine, please consult with your healthcare provider.

How many forms of the H1N1 vaccine are there?
Similar to other flu vaccines, the H1N1 vaccine is being manufactured in several forms: The “flu shot" is an inactivated vaccine (containing killed virus) that is given with a needle, usually in the arm. The flu shot is approved for use in people older than 6 months, including healthy people and people with chronic medical conditions (such as asthma, diabetes, or heart disease).

The nasal-spray flu vaccine, a vaccine made with live, weakened flu viruses that do not cause the flu, is approved for use in healthy people 2-49 years of age who are not pregnant.

Various vaccine manufacturers are producing some of the H1N1 vaccine in single-dose units, which do not require the use of thimerosal as a preservative. Thimerosal is a mercury-based preservative that is used in some flu vaccines to keep them free from contamination of microorganisms.

In addition, the live-attenuated version of the vaccine, which is administered through the nose, is produced in single-units and will not contain thimerosal.

Some vaccine will come in multi-dose vials and will contain thimerosal as a preservative. See the CDC website, http://www.cdc.gov/h1n1flu/vaccination/thimerosal_qa.htm for more information.

What do we know about Florida's H1N1 vaccine shipments?
Florida counties began receiving vaccine shipments the week of October 5th.

• Private health care providers have registered to become a H1N1 vaccine provider under the Florida Shots program and are committed to providing vaccination services.
• Vaccine is being made available to the states as quickly as it is being manufactured. While the vaccine amounts are much less than what was anticipated, the state continues to receive steady shipments of vaccine on a daily basis.
• Counties are offering public vaccination clinics. The Florida Department of Health has a “Vaccine Clinic Locations” webpage at http://www.myflusafety.com, which provides information about public health sponsored vaccination clinics within each county.

In addition to the FluMist nasal spray which contains the live attenuated (weakened) version of the vaccine, Florida is receiving shipments of the H1N1 “flu shot” which does not contain the live virus. It is appropriate for use in children and adults. This is an inactivated vaccine, which does not have live virus in it. Some of the H1N1 vaccine given as a shot contains the preservative thimerosal. If you are concerned about thimerosal, ask your provider if they have vaccine without it.

Florida is receiving vaccine each week, as vaccine is manufactured and distributed by our federal partners. We do not expect there to be a shortage of H1N1 vaccine. Once the demand for vaccine for all prioritized groups has been met at the local level, programs and providers will begin offering vaccinations to healthy adults including people 65 or older who request it.

How many doses of vaccine are required?
The Federal Drug Administration (FDA) approved and preliminary clinical trials data support:

• One dose of H1N1 vaccine for persons 10 years of age and older
• Two doses of H1N1 vaccine for children 3-9 years of age
• Children aged 6 months through 35 months get two doses of H1N1 vaccine that contains one-half the dose used for older children and adults.

What will be the recommended interval between the first and second dose?
The FDA approved and the vaccine package inserts indicate that a second dose should be administered about one month after the initial dose.

How will the public be notified if a second dose is needed?
Information will be provided about the second dose at the time the first dose is administered. The media (TV, radio, newspapers, and Internet) will also provide information as a primary means of educating persons about who needs a second dose administered.

Will it be necessary for the first and second dose to be the same product?
Ideally, first and second doses would be from the same product. However, practical considerations may make this difficult to implement. The CDC has been permissive on this issue but prefers that individuals who require a second dose be vaccinated with the same product, if possible. While not preferred, administering one dose as inactivated vaccine and another dose as live vaccine is acceptable.

What about side effects?
Expected side effects will be similar to those of the seasonal vaccine, potentially including a mild fever, body aches, and fatigue for a few days after the vaccine, and soreness at the injection site. The most common side effects seen with administration of the nasal vaccine include runny nose or nasal congestion in recipients of all ages; fever more than 100 degrees Fahrenheit in children two to six years of age, and sore throat in adults. Side effects are more common in individuals who have not previously been immunized with flu vaccines. As with any medical product, serious adverse events may occur.

Can I continue my regular medications after receiving the H1N1 vaccine?
You will need to contact the healthcare provider who prescribed the medications.

What medications can patients take after vaccination?
In general:

• Those on medications can continue to use their medications as prescribed before, during or after receiving flu vaccines except as noted below
• Those who wish to use medications for symptomatic relief of side effects of vaccines (such as acetaminophen, ibuprofen or aspirin) should discuss with their regular provider any contraindications or potential drug interactions.
• There are a number of precautions and contraindications for the live attenuated flu virus vaccine (LAIV, administered through the nose) related to underlying illnesses and immunosuppression.
  • Those on medications that can cause immunosuppression (e.g., steroids, cancer chemotherapy, immune modulating drugs for rheumatoid arthritis, etc.) should not receive LAIV.
  • Children under 19 on chronic aspirin therapy should not receive LAIV because of the potential for Reye Syndrome

  Therefore, children receiving LAIV should not be given aspirin, or any aspirin or salicylate containing products to treat fever, headaches or other side effects of LAIV vaccination. Instead, use acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) as directed, as long as the children don’t otherwise have contraindications to taking these medicines (this should be discussed with their regular provider).

  Note – children under 19 with symptoms of ILI or any other type of viral syndrome should not be given aspirin, or any aspirin or salicylate containing products because of the increased risk for Reye Syndrome

  • Those on antiviral medications should not be given LAIV because they may interfere with developing an adequate immune response to the live virus vaccine.

  • LAIV should not be administered until 48 hours after cessation of flu antiviral therapy
    
  • Flu antiviral medications should not be administered for 2 weeks after receipt of LAIV. If they are, then the vaccination is not considered valid.

Those on antiviral medications can receive the inactivated flu vaccines.

Where can providers sign up to distribute H1N1 vaccine?
Florida providers interested in administering H1N1 vaccine in the state/local programs need to submit a request via the following the FLSHOTS website:
https://www.flshots.com.

Providers can receive additional information by either calling or e-mailing the Florida SHOTS help desk below:
Florida SHOTS Help Desk Hours: Monday - Friday
8:00 AM - 5:00 PM Eastern
Phone: (877) 888-SHOT (7468)
Fax: (850) 412-5801

When will the rest of the population be able to get vaccinated with H1N1 vaccine?
Each county has developed plans for holding vaccination clinics throughout the county. An H1N1 Vaccine Clinic locator for the State of Florida can be found at http://www.myflusafety.com/myfluclinic.htm. CDC has provided guidance to public health officials as to which groups of people are at higher risk for contracting the H1N1 swine flu virus and should therefore be prioritized for early vaccination.

As of December 4, 2009, counties are authorized to expand provision of the H1N1 flu vaccinations beyond the five priority groups based on local availability of vaccine. Counties have developed plans which allow them to expand vaccination availability to additional population groups when ready, to meet their respective population’s demands. Each county is unique in its population and this guidance will help them plan for expansion beyond the ACIP priority groups as more vaccine arrives.

When will the H1N1 vaccine be available to those older than 65?
Current studies indicate the risk for infection among persons age 65 or older is less than the risk for younger age groups. However, once vaccine demand among younger age groups has been met, programs and providers should offer vaccination to people 65 or older.

Will the state of Florida be giving vaccines to non-residents?
Each county should have plans in place to address non-residents (i.e. seasonal residents, migrant workers, etc.). However, persons who travel in multi-state areas for example interstate truck drivers should check within their state of residence regarding receiving vaccinations (e.g. their local county health department in their county of residence). Additionally, they may check with their employer to see if any arrangements have been made to vaccinate their employees, and to receive additional information regarding the targeted priority groups for the H1N1 Mass Vaccination Campaign.

Can my patients go across county lines to get their vaccinations if their county does not have or is not holding vaccine clinics at this time?
Since the H1N1 vaccine is allocated based on county population, residents’ crossing county lines is not ideal. However, we anticipate there will be instances where this will happen in counties across Florida. County health departments have experience with this (based on seasonal flu clinics) and have plans for managing these scenarios.

Patients should be advised to contact their appropriate county health department to determine vaccine availability and obtain flu clinic information. It might be useful to try and ascertain whether or not the patient falls within one of the priority groups (e.g. pregnant woman) because you could then advise her to contact her obstetrician to see if they are a participating as a H1N1 vaccine provider - same concept for someone calling to inquire about getting their children vaccinated - refer them to their children's pediatrician. Above all, it is important that if the patient does not fall within one of the priority groups, we must advise them of Florida's current strategy for the mass vaccination campaign and the associated priority groups.

Additionally, it might be reassuring to patients to advise them weekly shipments of vaccine are coming into the state of Florida, and that the CDC has advised there will be enough vaccine to immunize all those who want to receive the H1N1 vaccine.

Will there be enough H1N1 vaccine available?
Florida is expected to receive 11 million doses of H1N1 vaccine by January 2010. A shortage of the vaccine is not expected.

How many manufacturers are producing vaccine?
Currently, four manufacturers are producing vaccine that has been licensed by the FDA for use in the U.S.: Sanofi Pasteur, Novartis, Medimmune and CSL.

How long after I get the H1N1 vaccine before I start building immunity to the virus?
About 2 weeks after vaccination, antibodies that provide protection against 2009 H1N1 flu virus infection will develop in the body.

What is the Live Attenuated Vaccine (weakened) – Nasal Spray/FluMist?
It is a vaccine made with live, weakened viruses that do not cause the flu (sometimes called LAIV for "live attenuated flu vaccine"). LAIV is approved for use in healthy people 2 years to 49 years of age who are not pregnant. The nasal spray vaccine for use in the United States is being made by MedImmune, the same company that makes the seasonal nasal spray vaccine called “FluMist.” The 2009 H1N1 nasal spray vaccine is being made in the same way as the seasonal nasal spray vaccine.

Where can I find additional information regarding the H1N1 vaccine?
http://www.myflusafety.com/SwineFlu/documents/H1N1VaccineOct082009.pdf - Provides a fact sheet about the H1N1 vaccine.

http://www.myflusafety.com/H1N1_Vaccines.html - Provides the product inserts for FDA-approved H1N1 vaccines.

Inactivated H1N1 Vaccine Information Sheet (VIS) (Source: Centers for Disease Control and Prevention)

Attenuated H1N1 Vaccine Information Sheet (VIS) (Source: Centers for Disease Control and Prevention)

The Florida Department of Health's website: www.myflusafety.com

The Centers for Disease Control and Prevention website: http://www.cdc.gov/h1n1flu/general_info.htm

The toll free Florida Flu Information Line, 1-877-352-3581, is available 24/7 for recorded messages in English, Spanish, and Haitian-Creole. Operators are available 8am to 8pm Eastern Standard Time.

The Federal Government's Health and Human Services flu information website: www.flu.gov

Can you tell me more about the vaccine recall?

• On December 15th and again on January 29th, certain lots were recalled but not due to purity or safety issues.
• The recall was due to postproduction monitoring efforts that found select batches (or lots) of vaccine that did not meet manufacturing specifications.
• The only doses affected are manufacturer Sanofi Pasteur’s .25mL pre-filled pediatric vaccines vaccines and one lot of 0.5 mL single-dose pre-filled syringe for older children and adults.
• Those that have received the designated lots of vaccine do not need to be revaccinated – it is an effective vaccine. Therefore, individuals that received the identified lots of vaccine will not be notified.
• If a child younger than ten years of age has received the initial dose of H1N1 vaccine, they should receive the 2nd dose as directed.
• Because of existing public concerns regarding H1N1 vaccine, the manufacturer felt obligated to release this information although it has no implications for safety of the vaccine.
• For more information and frequently asked questions please visit:
  • December 15, 2009 recall: http://www.cdc.gov/h1n1flu/vaccination/syringes_qa.htm
  • January 29, 2010 recall: http://www.cdc.gov/H1N1flu/HAN/012910.htg
    
    

Why are some lots of the 2009 H1N1 flu nasal spray vaccine being recalled from the market?

• On December 23rd certain lots of the H1N1 nasal spray vaccine were recalled but not due to purity or safety issues.
• The recall was due to postproduction monitoring efforts that found select batches (or lots) of vaccine that did not meet manufacturing specifications.
• The only doses affected are manufacturer Medlmmune’s nasal spray monovalent (single strain) 2009 H1N1 flu vaccine.
• Those that have received the designated lots of vaccine do not need to be revaccinated – it is an effective vaccine. Therefore, individuals that received the identified lots of vaccine will not be notified.
• If a child younger than ten years of age has received the initial dose of H1N1 vaccine, they should receive the 2nd dose as directed.
• Because of existing public concerns regarding H1N1 vaccine, the manufacturer felt obligated to release this information although it has no implications for safety of the vaccine.
• For more information and frequently asked questions, please visit http://www.cdc.gov/h1n1flu/vaccination/sprayrecall_qa.htm

Flu season seems to be dying down—Why do people still need a vaccination against 2009 H1N1?
The flu season is not over yet. Some states were still reporting regional flu activity, so flu is still out there. Also, seasonal flu typically peaks in February and March and influenza activity can occur as late as May. So, increased activity from either seasonal flu, 2009 H1N1 or both are still possible this season. Even if flu activity dies down in January, as it has this year, the season is not over. It’s still important to get vaccinated against the flu and be as prepared as possible if activity increases again this season.

Will the vaccine against 2009 H1N1 influenza virus (also called "swine flu") be the same vaccine in 2010?
The vaccine to protect against the 2009 H1N1 influenza virus will be the same for the entire 2009-2010 influenza season, which extends into the spring of 2010. The "2009" in the name only relates to the year the virus was first identified; it does not have to do with how long the vaccine will work or the year in which it should be administered.

 

» Vaccines - Seasonal Flu

What is seasonal flu?
Seasonal Flu (also known as the flu) is a contagious respiratory illness caused by flu viruses. It can cause mild to severe illness, and rarely can lead to death. The flu is different from a cold and usually comes on suddenly.

Who should get vaccinated with the seasonal flu shot?
In general, anyone who wants to reduce their chances of getting the flu can get vaccinated. However, certain people should get vaccinated each year either because they are at high risk of having serious flu-related complications including young children, pregnant women, people with chronic health conditions like asthma, diabetes or heart and lung disease and people 65 years and older or because they live with or care for high risk persons. Seasonal flu vaccine is also important for health care workers, and other people who live with or care for high risk people to prevent giving the flu to those at high risk. People who should get vaccinated each year are:

• Children aged 6 months up to their 19th birthday

• Pregnant women
• People 50 years of age and older
• People of any age with certain chronic medical conditions
• People who live in nursing homes and other long-term care facilities
• People who live with or care for those at high risk for complications from flu, including: health care workers, household contacts of persons at high risk for complications from the flu, household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated).

Who Should Not Be Vaccinated?
Some people should not be vaccinated without first consulting a physician. They include:

• People who have a severe allergy to chicken eggs

• People who have had a severe reaction to an flu vaccination in the past
• People who developed Guillian-Barré syndrome (GBS) within 6 weeks of getting an flu vaccine previously
• Children less than 6 months of age (flu vaccine is not approved for use in this age group).
• People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms lessen.

If you have questions about whether you should get a flu vaccination, consult your health-care provider.

What is the difference between seasonal flu and H1N1 flu?
Even though H1N1 is an flu virus like seasonal flu, it is affecting different groups of people more significantly than seasonal flu. People do not have immunity to the H1N1 virus unless they have gotten sick with H1N1 and have recovered.

Does the seasonal flu vaccine protect against H1N1?
One vaccine will not protect against the other. Everyone is encouraged to get both vaccinations as they become available, and as recommended by their healthcare provider.

How Far Apart Should You Get the Seasonal Flu Vaccine and the H1N1 Vaccine?
Simultaneous administration of inactivated vaccines (shots) against seasonal and the H1N1 flu virus is permissible if different anatomic sites are used. However, simultaneous administration of live, attenuated virus vaccines (flu mist) against seasonal and 2009 H1N1 flu is not recommended. Seasonal and H1N1 live attenuated flu vaccines should be administered a minimum of 4 weeks apart.

Can the H1N1 Flu nasal spray vaccine and the seasonal nasal spray vaccine be given at the same time to the same person?
No. The seasonal nasal spray vaccine and the H1N1 Flu nasal spray vaccine should not be given at the same time. This is because the nasal spray vaccines might not be as effective if given together. It is fine to receive the H1N1 Flu nasal spray at the same time as the seasonal flu (flu) shot, or the seasonal flu shot at the same time as the H1N1 Flu nasal spray vaccine.

Who can be vaccinated with the H1N1 Flu nasal-spray flu vaccine (LAIV)?
The H1N1 Flu nasal spray vaccine is recommended for use in healthy people 2 years through 49 years of age who are not pregnant.

Who should not get the H1N1 nasal spray vaccine?
It is not recommended for infants under 2, adults over 49, pregnant women or anyone with a range of underlying health problems. Additionally, it is not recommended for healthy persons, such as healthcare workers, who care for persons with a severely weakened immune system.

When should the H1N1 Flu nasal-spray flu vaccine be given?
Flu vaccination should begin as soon as vaccine is available and continue throughout the flu season, into December, January, and beyond. In early October 2009, extensive H1N1 Flu activity was being reported in the United States. Its possible there may be waves of H1N1 Flu activity during the 2009-2010 flu season that hit communities more than once over the course of the flu season, which typically peaks in January or February but can last as late as May.

How many doses of the H1N1 Flu nasal spray vaccine are needed?
In adults, only one dose of the H1N1 vaccine, including the H1N1 Flu nasal spray vaccine, is needed for protection. All children 2 through 9 years of age getting a H1N1 vaccine will need two doses of the H1N1 vaccine (either the H1N1 Flu shot or the H1N1 Flu nasal spray vaccine), The first dose should being given as soon as vaccine becomes available. The second dose should be given 28 or more days after the first dose. The first dose "primes" the immune system; the second dose provides immune protection. Children who only get one dose of vaccine when they need two doses may not be fully protected. Be sure to follow up to get your child a second dose if they need one. It usually takes about two weeks after the second dose for protection to begin.

Can my child get H1N1 Flu from being around other children who received the nasal spray vaccine in a school based clinic?
No. School based flu vaccine clinics using LAIV do not pose undue risk to un-immunized students/staff.

What are the symptoms of seasonal flu?

• Fever (usually high)
• Headache
• Extreme tiredness
• Dry cough
• Sore throat
• Runny or stuffy nose
• Muscle aches
• Stomach symptoms, such as nausea, vomiting, and diarrhea, also can occur but are more common in children than adults

Having these symptoms does not always mean that you have the flu. Many different illnesses, including the common cold, can have similar symptoms.

How do I know if I have the seasonal flu?
It is very difficult to distinguish the flu from other infections on the basis of symptoms alone. A doctor's exam may be needed to tell whether you have developed the flu or a complication of the flu. There are tests that can determine if you have the flu as long you are tested within the first 2 or 3 days of illness. If the flu is widespread in your community, the doctor may not order a lab test and may make their diagnosis based on your signs and symptoms.

Who is at risk for getting seasonal flu?
If you develop flu-like symptoms and are concerned about your illness, especially if are at high risk for complications of the flu, you should consult your healthcare provider. Those at high risk for complications include people 65 years or older, people with chronic medical conditions (such as asthma, diabetes, or heart disease), pregnant women, and young children.

How does the seasonal flu spread?
The flu usually spreads from person to person in respiratory droplets when people who are infected cough or sneeze. People occasionally may become infected by touching something with flu virus on it and then touching their mouth, nose or eyes.

What are some of the complications from seasonal flu?
Pneumonia, bronchitis, and sinus and ear infections are examples of complications from flu. The flu can make many chronic health problems worse.

How long is a person contagious with seasonal flu?
With seasonal flu, people may be contagious up to one day before they develop symptoms and up to 7 days after they get sick. Children, especially younger children, might potentially be contagious for longer periods. In most situations, people can safely return to work or school if they have been free of fever without taking anti-fever medicines for 24 hours or more.

What should I do if I am sick with seasonal flu?
If you are sick, you may be ill for a week or longer. You should stay home and keep away from others as much as possible, including avoiding travel and not going to work or school, for at least 24 hours after your fever is gone without the use of fever-reducing medicine except to get medical care or for other necessities.

Is it possible to tell for sure if you have the flu based on symptoms?
No. Doctors can perform tests to see if you have the flu if you are in the first few days of your illness. Your health care provider will determine whether flu testing or treatment is needed. Be aware that if the flu becomes widespread, less testing will be needed, so your health care provider may decide not to test for the flu virus.

Are rapid tests reliable?
Tests are available that can test for flu viruses in as little as 30 minutes or less. Flu testing can be used to rapidly confirm the flu as the cause of outbreaks. However, results from these rapid tests are not 100% accurate; the test may indicate that a person does not have flu even though they really do have the flu.

What is the treatment for seasonal flu?
While getting a flu vaccine each year is the first and most important step in protecting against seasonal flu, washing your hands and staying away from those who are ill with fever and cough are the second line of defense. Antiviral medications are a third line of defense in the prevention and treatment of flu.

Antiviral medications can be given to treat those who become severely ill with flu or for those at high risk of developing complications from the flu following an exposure to someone with the flu. These antiviral medications are prescription medicines (pills, liquid or an inhaler) with activity against flu viruses, including H1N1 Flu virus.

When can practitioners expect to receive their seasonal flu vaccine shipment?
This year's seasonal flu vaccine shipments will be in line with previous years. Contact your health care provider for additional information.

How can I get an antiviral medication for flu?
These medications must be prescribed by a health care professional.

What are the treatment benefits of flu antiviral medication?
For treatment, antiviral medications should be started within 2 days after becoming sick. When used this way, these drugs can reduce the severity of flu symptoms and shorten the time you are sick by 1 or 2 days.

How effective are antiviral medications at preventing the flu?
When used to prevent the flu, antiviral medications are about 70% to 90% effective against susceptible viruses (i.e. viruses that are not resistant to the antiviral medication). It's important to remember that flu antiviral medications are not a substitute for getting a flu vaccine.

Can antiviral medications be given even if a person is not tested for flu or if a flu test does not indicate that they have flu?
Yes. For individual patients, flu testing is not required for antiviral medications to be prescribed. Testing is done based on health care provider recommendations.

Can flu antiviral medications help with other illnesses such as the common cold?
No. Flu antiviral medications only work against flu viruses. They will not help reduce symptoms from the common cold or any other flu-like illnesses caused by viruses other than flu viruses. Many other viruses cause winter illnesses besides the flu.

Can people who are not in a high-risk group receive antiviral medications?
Yes. Consult with your doctor if you are ill or have been exposed to flu to determine if you should take antiviral medications.

Can flu antiviral medications be used in pregnant women?
You should always consult your physician prior to taking any medication when pregnant.

What is the best protection against the seasonal flu?
By far, the single best way to prevent the flu is for individuals, especially people at high risk for serious complications from the flu, to get a vaccination each fall.

What are other steps that can be taken to prevent the flu?
There are other good health habits that can help prevent the flu. These are:

• Avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
• If possible, stay home from work, school, and errands when you are sick. You will help prevent others from catching your illness.
• Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.
• Washing your hands before eating, after using the bathroom and after coughing or sneezing into your hands will help protect you and others from germs.
• Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.

» Vaccines - (pneumonia vaccine)

Are there any changes in recommendations for pneumonia vaccines?
The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) recommends a single dose of Pneumococcal polysaccharide vaccine (PPSV) for all people 65 years of age and older and for persons 2 through 64 years of age with certain high-risk conditions (see table below). Most people in these groups are at increased risk of pneumococcal disease as well as serious complications from flu virus’s infections. 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. A single revaccination is also recommended as well as for people at highest risk of disease, such as those who have functional and anatomical asplenia, and those who have HIV infection, AIDS or malignancy and have at least five years elapsed from receipt of first vaccination.

Pneumococcal vaccine can be given at any time during the year and may be given at the same time as flu vaccine.

Table: U.S. ACIP Recommendations for use of Pneumococcal Polysaccacharide Vaccine
Universal vaccination	All adults 65 years of age and older
Medical Indications	Persons 2 through 64 years of age who have one or more of the following long-term health problems: chronic cardiovascular disease (congestive heart failure and cardiomyopathies) chronic pulmonary disease (including chronic obstructive pulmonary disease and emphysema) diabetes mellitus alcoholism chronic liver disease (including cirrhosis) cerebrospinal fluid leaks, cochlear implant functional or anatomic asplenia including sickle cell disease and splenectomy immunocompromising conditions including HIV infection, leukemia, lymphoma, Hodgkin’s disease, multiple myeloma, generalized malignancy, chronic renal failure, nephrotic syndrome; those receiving immunosuppressive chemotherapy (including corticosteroids); and those who have received an organ or bone marrow transplant residents of nursing homes or long-term care facilities Adults 19 through 64 years of age who: smoke cigarettes have asthma

Individuals and Families

» Individuals and Families: School Information

See the "Education & Childcare" Section

»Individuals and Families: Pregnancy and Infants

What if I get H1N1 Flu and I am pregnant?
Woman who are pregnant and have flu symptoms or have close contact with someone with the flu should consult their doctor right away. Pregnant women who get sick with the flu can have serious health problems. Problems may include early labor and severe pneumonia.

Are infants at higher risk for the H1N1 virus?
Infants are thought to be at higher risk for severe illness from the H1N1 Flu infection. If possible, only adults who are not sick should care for infants, including providing feedings. Sick women who are able to express their milk for bottle feedings by a healthy family member should be encouraged to do so.

What are the recommendations for sick mothers taking care of their infants?
Practicing good hand hygiene and cough etiquette is critical, especially for sick women who do not have anyone to help with infant care while they are ill. Women with flu-like illness are recommended to use facemasks when providing infant care and feedings. Parents and caretakers should:

• Practice good hand hygiene and cough etiquette at all times

• Keep the infant away from persons who are ill and out of crowded areas.
• Limit sharing of toys and other items that have been in infants' mouths. Wash thoroughly with soap and water any items that have been in infants' mouths.

What can I do to protect myself, my baby and my family?
Take these everyday steps to help prevent the spread of germs and protect your health: Cover your nose and mouth with a tissue when you cough or sneeze, or sneeze into your sleeve. Throw the tissue in the trash after you use it, and wash your hands with soap and water or alcohol-based gel hand cleaner. Avoid touching your eyes, nose or mouth. Germs spread this way. Try to avoid close contact with sick people. (If you are pregnant and you live or have close contact with someone who has H1N1 Flu, talk to your doctor about medicines to prevent the flu.) Develop an emergency plan to care for sick family members. Stock up on household, health, and emergency supplies, such as water, Tylenol®, non-perishable foods.

Is there special guidance for feeding newborn babies?
Yes, the Centers for Disease Control and Prevention (CDC) recommendations can found at the following website - http://www.cdc.gov/h1n1flu/infantfeeding.htm. Some pertinent information from that site includes:

• Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent others from catching your illness

• Washing your hands often will help provide some protection from germs
• Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose or mouth
• Practice other good health habits such as getting plenty of sleep, be physically active, manage stress, drink plenty of fluids and eat nutritious foods

Is it ok to for me to feed my baby if I am sick?
If you are breastfeeding or giving your baby infant formula, a cautious approach would be to protect your baby from exposure to the flu virus in the following ways:

• Ask for help from someone who is not sick to feed and care for your baby, if possible.

• If there is no one else who can take care of your baby while you are sick, try to wear a face mask at all times when you are feeding or caring for your baby. You should also be very careful about washing your hands and taking everyday precautions to prevent your baby from getting flu http://www.cdc.gov/flu/protect/habits.htm
• Using a cloth blanket between you and your baby during feedings might also help.
• If you are breastfeeding, someone who is not sick can give your baby your expressed milk. Ideally babies less than about 6 months of age should get their feedings from breast milk. It is OK to take medicines to treat the flu while you are breastfeeding.

Does breastfeeding protect babies from this new flu virus?
There are many ways that breastfeeding and breast milk protect babies’ health. Flu can be very serious in young babies. Babies who are not breastfed get sick from infections like the flu more often and more severely than babies who are breastfed. Since this is a new virus, we don’t know yet about specific protection against it. Mothers pass on protective antibodies to their baby during breastfeeding. Antibodies are a type of protein made by the immune system in the body. Antibodies help fight off infection. If you are sick with flu and are breastfeeding, someone who is not sick can give your baby your expressed milk.

Should I stop breastfeeding my baby if I think I have come in contact with the flu?
No. Because mothers make antibodies to fight diseases they come in contact with, their milk is custom-made to fight the diseases their babies are exposed to as well. This is really important in young babies when their immune system is still developing. It is OK to take medicines to prevent the flu while you are breastfeeding. You should make sure you wash your hands often and take everyday precautions http://www.cdc.gov/flu/protect/habits.htm or visit www.flu.gov

However, if you develop symptoms of the flu such as fever, cough, or sore throat, you should ask someone who is not sick to care for your baby. If you become sick, someone who is not sick can give your baby your expressed milk.

Is it okay to take medicine to treat or prevent novel H1N1 flu while breastfeeding?
Yes. Mothers who are breastfeeding and taking medicine to treat flu because they are sick should express their breast milk for bottle feedings, which can be given to your baby by someone who is not sick. Mothers who are breastfeeding and are taking medicines to prevent the flu because they have been exposed to the virus should continue to feed their baby at the breast as long as they do not have symptoms of the flu such as fever, cough, or sore throat.

Why do the Centers for Disease Control and Prevention recommend that pregnant women receive the H1N1 flu vaccine?
It is important for a pregnant woman to receive the H1N1 flu vaccine as well as a seasonal flu vaccine. A pregnant woman who gets any type of flu is at risk for serious complications and hospitalization. Pregnant women who are otherwise healthy have been severely impacted by the H1N1 flu virus. In comparison to the general population, a greater proportion of pregnant women infected with the H1N1 flu virus have been hospitalized. In addition, severe illness and death has occurred in pregnant women. Six percent of confirmed fatal H1N1 flu cases thus far have been in pregnant women while only about 1% of the general population is pregnant. While hand washing, staying away from ill people, and other steps can help to protect pregnant women from flu, vaccination is the single best way to protect against the flu.

Is there a particular kind of flu vaccine that pregnant women should get?
There are two types of flu vaccine. Pregnant women should get the "flu shot"— an inactivated vaccine (containing fragments of killed flu virus) that is given with a needle, usually in the arm. The flu shot is approved for use in pregnant women.

Are there flu vaccines that pregnant women should not get?
The other type of flu vaccine — nasal-spray flu vaccine (sometimes called LAIV for “live attenuated flu vaccine) is not currently approved for use in pregnant women. This vaccine is made with live, weakened flu viruses that do not cause the flu). LAIV (FluMist®) is approved for use in healthy people 2-49 years of age who are not pregnant.

Is the H1N1 flu vaccine safe for pregnant women?
Flu vaccines have not been shown to cause harm to a pregnant woman or her baby. The seasonal flu shot (injection) is proven as safe and already recommended for pregnant women. The H1N1 flu vaccine will be made using the same processes and facilities that are used to make seasonal flu vaccines.

What are the symptoms of H1N1 Flu?
Symptoms are like seasonal flu and include the following:

• Fever

• Cough
• Sore throat
• Body aches
• Headaches
• Chills and fatigue
• Sometimes, diarrhea and vomiting

What should I do if I get sick?
If there is H1N1 swine flu in your community, pay extra attention to your body and how you are feeling. If you get sick with flu-like symptoms, stay home, limit contact with others, and call your health care provider. Your health care provider will decide if testing or treatment is needed. Tests may include a nasal swab which is best to do within the first 4-5 days of getting sick. Like regular flu, H1N1 Flu may make other medical problems worse. If you are alone at any time, have someone check in with you often if you are feeling ill. This is always a good idea. If you have close contact with someone who has H1N1 Flu or is being treated for exposure to H1N1 Flu, contact your health care provider to discuss whether you need treatment to reduce your chances of getting the flu.

How is H1N1 Flu treated?
Treat any fever right away. Tylenol® (acetaminophen) is the best treatment of fever in pregnancy. Drink plenty of fluids to replace those you lose when you are sick. Your doctor will decide if you need antiviral medications such as Tamiflu® (oseltamivir) or Relenza® (zanamivir). Antiviral medications are prescription pills, liquids or inhalers that fight against the flu by keeping the germs from growing in your body. These medicines can make you feel better faster and make your symptoms milder. These medicines work best when started soon after symptoms begin (within two [2] days), but they may also be given to very sick or high risk people (like pregnant women) even after 48 hours. Tamiflu® and Relenza® are also used to prevent H1N1 Flu. There is little information about the effect of antiviral medications in pregnant women or their babies, but no serious side effects have been reported. If you think you have had a side effect to antiviral medications, call your doctor right away.

When should I get emergency medical care?
If you have any of these signs, seek emergency medical care right away:

• Difficulty breathing or shortness of breath

• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Decreased or no movement of your baby
• A high fever that is not responding to Tylenol®

Is it OK to take medicine to treat or prevent H1N1 Flu while breastfeeding?
Yes. Mothers who are breastfeeding can continue to nurse their babies while being treated for the flu.

» Individuals and Families: Persons at Risk

Are there groups of children at higher risk of serious complications?
Yes, children under age 5, and those with certain chronic illnesses are at increased risk of complications and serious illness from the H1N1 swine flu virus. These illnesses include chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological (including sickle cell disease), neurological, neuromuscular, or metabolic disorders (including diabetes mellitus); and immunosuppression, including that caused by medications or by HIV. Persons younger than 19 years of age who are receiving long-term aspirin therapy are also at increased risk.

What should parents of children at high risk of serious complications do?
If your child is in a high risk group, and develops flu-like illness (such as sudden onset of fever, cough, sore throat, muscle aches, extreme tiredness), please consult your child's usual source of medical care about starting antiviral therapy. Such therapy works best if started right away, but in any case in the first 48 hours of illness. If your child remains well, but has been exposed to a person with confirmed or suspected H1N1 Flu, or attends a school where this virus is circulating; consult with your child's usual source of medical care about taking antiviral medications to prevent disease.

What disability groups are at particular risk for flu?
If you have one of the disabilities listed below, you may be at increased risk of becoming infected or having unrecognized illness. You should discuss your risk of illness with your healthcare provider. Disability groups at risk of getting flu and/or having unrecognized flu symptoms include:

• People who have limited mobility or who cannot limit coming into contact with others who are infected, like staff and family members

• People who have trouble understanding or practicing preventive measures such as hand washing
• People who may not be able to communicate symptoms of illness
• People who may not be monitored closely for symptoms of illness

Are people with HIV/AIDS at greater risk than other people of infection with the H1N1 swine flu? At the present time, we have no information about the risk of the H1N1 Flu in people with HIV/AIDS. In the past, people with HIV/AIDS have not appeared to be at any greater risk than the general population for infection with routine seasonal flu. However, HIV-infected adults and adolescents, and especially persons with low CD4 cell counts or AIDS, can experience more severe complications of seasonal flu. It is therefore possible that HIV-infected adults and adolescents are also at higher risk for complications from infection with the H1N1 Flu virus. So it is recommended they receive flu vaccinations.

If I have HIV/AIDS should I get the vaccine?
Yes, the “flu shot.” Persons between the ages of 25 and 64 years old with health conditions associated with higher risk of medical complications from flu, including HIV infection, are an initial target group for the H1N1 vaccine and should be vaccinated. Once the demand for vaccine among the initial target groups has been met at the local level, programs and providers should offer the H1N1 Flu shot to all persons 25-64 years of age and then to persons age 65 years or older, including HIV-infected adults. Persons age 65 or older, including HIV-infected adults age 65 or older, are not prioritized groups because current studies indicate that the risk for infection among persons age 65 or older is less than the risk for younger persons. Although initial supplies of vaccine are limited, supplies are expected to increase sufficiently to vaccinate all persons not in initial target groups.

How does arthritis affect how I respond to the flu?
People with certain types of arthritis, called inflammatory or systemic arthritis or autoimmune rheumatic disease, have a higher risk of getting flu-related complications, such as pneumonia. Also, many medications given to treat inflammatory arthritis can weaken the immune system. Rheumatoid arthritis and lupus are the most common types of inflammatory arthritis. People with degenerative arthritis, are likely not at increased risk of complications from the flu unless they also have other high-risk conditions for flu such as asthma, diabetes, heart disease, or cancer.

If you are taking medications for your arthritis (this does not apply to creams and ointments applied to the skin), you may be at high risk for getting the flu or complications from the flu. Talk to your healthcare provider if you have any questions about your condition, medications and flu risk.

Do people with inflammatory arthritis need to get the flu shot?
Yes, the Centers for Disease Control and Prevention (CDC) recommends certain persons within any of the prioritized groups get the H1N1 vaccine and the seasonal flu shot who have weakened immune systems, which includes people with inflammatory arthritis. People with inflammatory arthritis should get the "flu shot"— an inactivated vaccine (containing fragments of killed flu virus) that is given with a needle, usually in the arm. The flu shot is approved for use in people with inflammatory arthritis. The other type of flu vaccine — nasal-spray flu vaccine (sometimes called LAIV for “live attenuated flu vaccine)—is not currently approved for use in people with inflammatory arthritis.

Persons age 65 or older (including those with inflammatory arthritis) are not included in these prioritized groups because current studies indicate that the risk for H1N1 flu infection among persons age 65 or older is less than the risk for younger age groups. Once the demand for vaccine among the younger groups has been met, however, people age 65 or older with inflammatory arthritis should receive the H1N1 flu shot.

» Individuals and Families: Travel

I plan to travel soon and I'm scared about H1N1 Flu. What should I do?
The Centers for Disease Control and Prevention (CDC) recommends that travelers at high risk for complications from any form of flu discuss their travel plans with their health care provider. Together, they should look carefully at the H1N1 Flu situation in their destination and the available health-care options in the area. They should discuss their specific health situations and possible increased risk of traveling to the area affected by H1N1 Flu. For more information, visit, http://wwwn.cdc.gov/travel/content/novel-h1n1-flu.aspx

Travelers at high risk for complications include:

Children less than 5 years of age

Persons aged 65 years or older (seasonal flu)

Children and adolescents (less than 18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after flu virus infection

Pregnant women

Adults and children who have chronic pulmonary, cardiovascular, hepatic, hematological, neurological, neuromuscular, or metabolic disorders

Adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV)

Healthy people may make travel plans as they normally would and take common sense precautions to protect their health during travel.

Before Your Trip
If you are planning travel to an area where cases of H1N1 Flu are being reported, the following recommendations will help you reduce your risk of infection and stay healthy.

Prepare for your trip

• Stay informed.
• Be sure you are up-to-date with all your routine vaccinations, including seasonal flu vaccine, when available.
• Find out about the other health risks and travel recommendations for your destination.
• Pack a travel health kit that contains basic first aid and medical supplies.
• Identify the health-care resources in the area(s) you will be visiting.
• Find out if your health insurance plan will cover medical care during your trip; many insurance companies do NOT cover these costs.
• The Centers for Disease Control and Prevention (CDC) recommends purchasing additional insurance that covers medical care costs during international travel and medical evacuation.
• For more information, see Medical Information for Americans Traveling Abroad from the U.S. Department of State. This can be found at: http://travel.state.gov/travel/tips/brochures/brochures_1215.html
• Remember that U.S. embassies, consulates and military facilities do not evacuate or give medications, vaccines, or medical care to private U.S. citizens during international travel.

Check Your Own Health
Do not travel if you are sick. If you have flu-like symptoms, you should stay home and avoid travel for 7 days after you get sick or for at least 24 hours after you stop having symptoms, for example a fever (without the assistance of medications and medications), whichever is longer. This is to keep others from getting the virus.

• Symptoms of H1N1 Flu virus are similar to the symptoms of seasonal flu and include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue.
• Some people also have diarrhea and vomiting.

During Your Trip
Follow local guidelines

• Pay attention to announcements from the local government and monitor the local health and security situation.
• Follow any movement restrictions and prevention recommendations.
• Be aware that some countries are checking the health of arriving and/or exiting passengers and screening them for illness due to H1N1 Flu to prevent others from getting sick. For more information, see the Possible International Travel Delays Due to Novel H1N1 Flu Screening Procedures announcement. This can be found at: http://wwwn.cdc.gov/travel/content/news-announcements/delays-H1N1-screening.aspx

Practice healthy habits to help stop the spread of H1N1 Flu

• Wash your hands often with soap and running water, especially after coughing or sneezing.
• Use alcohol-based hand sanitizers (containing at least 60% alcohol) when soap is not available and hands are not visibly dirty.
• Cover your mouth and nose with a tissue when you cough or sneeze, and put your used tissue in the trash. If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands. Wash your hands with soap and water.
• Avoid close contact with sick people.

What to do if you feel sick

• It is expected that most people will recover without needing medical care.
• If you have severe illness or you are at high risk for flu complications, seek medical care.
• A U.S. consular officer can help you find local medical care in a foreign country. To contact the U.S. embassy or consulate in the country you are visiting, call Overseas Citizens Services at:
• 1-888-407-4747 if calling from the U.S. or Canada,
• 00-1-202-501-4444 if calling from other countries, or
• Visit http://www.usembassy.gov to find the contact information for the local U.S. Embassy of the country you are visiting.
• Avoid further travel until you have been symptom-free for 24 hours (without the assistance of medications and antiviral medications), whichever is longer.
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it, and wash your hands with soap and water.
• Wash your hands often with soap and running water, especially after you cough or sneeze. Alcohol-based hand gels are also effective.
• Avoid touching your eyes, nose or mouth.
• Follow all local health recommendations. For example, if you are sick, you may be asked to put on a surgical mask to protect others or to stay in your home or hotel to prevent the spread of H1N1 Flu.
• For more information about what to do if you become sick while you are traveling outside the United States, visit the Centers for Disease Control and Prevention (CDC) site: http://wwwn.cdc.gov/travel/content/survival-guide.aspx
• For information on the Centers for Disease Control and Prevention (CDC) recommendations for antiviral medication use during the H1N1 Flu outbreak, please visit http://www.cdc.gov/h1n1flu/recommendations.htm

After Your Trip

• Closely monitor your health for 7 days.

If you become ill with fever and other symptoms of H1N1 Flu such as a cough, sore throat, and possibly vomiting and diarrhea, see the information in the section above titled “What to do if you get sick” and the What to Do If You Get Flu-Like Symptoms which can be found on the Centers for Disease Control and Prevention (CDC) website which is: http://www.cdc.gov/h1n1flu/

Education and Childcare

Will they close my child's school?
Closing schools is unlikely, but possible. The Centers for Disease Control and Prevention (CDC) and the Florida Department of Health have made recommendations to school officials about how to manage flu-like illness in a school setting without dismissing schools. The decision to dismiss schools will be made by your local school board, the school district and other local officials. The Florida Department of Education provides a current listing of closed schools here: http://www.fldoe.org/closed-schools.asp

Who makes the decision about whether schools should be dismissed?
Local school districts will make the decision of whether to dismiss schools. They will consult with state and local health and emergency management officials to make that decision. The Florida Department of Health provides recommendations and guidance to school districts on whether they should close or take certain steps to ensure the safety and welfare of the students and staff. These recommendations are based on guidance from the Centers for Disease Control and Prevention. Educators and staff can help slow the spread of colds and flu. Always remind children to:

• Cover their nose and mouth with a tissue when they cough or sneeze—have them throw the tissue away after they use it, and wash their hands with soap and water.

• Wash their hands often with soap and water, especially after they cough or sneeze. If water is not near, use an alcohol-based hand sanitizer.
• Remind them to not to touch their eyes, nose, or mouth. Germs often spread this way.
• Children who are ill or become ill at school should be sent home.

There is a "daycare/school/public gathering place" where sick children/people are being allowed to attend. What can I do?
First, speak to your supervisor or facility director. Also, you can call your county health department. They employ staff trained to work within your community to prevent the spread of many diseases. Use this link to find the appropriate county health department. http://www.doh.state.fl.us/chdsitelist.htm The core of every community's flu response is for sick people to stay home (unless they are so sick they need hospital care), and for everyone in the community to work to support this behavior.

Does my child need to wear a mask at school? (Or) Why has my child been asked to wear a mask in school?
If your child becomes ill with flu-like symptoms at school, the school may place a mask on the child while he/she is in the "clinic" waiting to be picked up. This is the current recommendation to schools by the Centers for Disease Control and Prevention (CDC). The mask is to prevent flu germs from being spread to others when an ill person coughs or sneezes. When you pick up your child, the staff person assigned to the "clinic" will likely be wearing a mask as well to prevent her/him from inhaling flu germs since she/he is in very close contact with ill persons. The Centers for Disease Control and Prevention (CDC) has only recommended the use of masks in very specific situations and has not recommended mask use as general prevention measures for healthy children and adults.

How can I protect my child from the seasonal flu?
The flu vaccine is the best way to protect against seasonal flu. The Centers for Disease Control and Prevention (CDC) recommends that all children from the ages of 6 months up to their 19th birthday get a flu vaccine every fall or winter (children getting a vaccine for the first time need two doses).

• Flu shots can be given to children 6 months and older.

• A nasal-spray vaccine can be given to healthy children 2 years and older (children under 5 years old who have had wheezing in the past year or any child with chronic health problems should get the flu shot).
• You can protect your child by getting a flu vaccine for yourself too. Also encourage your child's close contacts to get a flu vaccine. This is very important if your child is younger than 5 or has a chronic health problem like asthma (breathing disease) or diabetes (high blood sugar levels).

What should I use for hand cleaning?
Washing hands with soap and water (for as long as it takes to sing the Happy Birthday song twice) will help protect your child from many different germs. When soap and water are not available, wipes or hand sanitizer gels with alcohol in them can be used (the gels should be rubbed into your hands until they are dry).

How long can a sick person spread the flu to others?
Healthy adults may be able to spread the flu from 1 day before getting sick to up to 5 days after getting sick. This can be longer in children and in people who don't fight disease as well (people with weakened immune systems).

What can I do if my child gets sick?
Consult your doctor and make sure your child gets plenty of rest and drinks a lot of fluids. If your child is older than 2 years, you can buy medicine (over-the-counter) without a prescription that might make your child feel better. Be careful with these medicines and follow the instructions on the package. Never give aspirin or medicine that has aspirin in it to children or teenagers who may have the flu. This may cause a rare but serious illness called Reye’s syndrome.

What if my child seems very sick?
Call or take your child to a doctor right away if your child:

• has a high fever or fever that lasts a long time

• has trouble breathing or breathes fast
• has skin that looks blue
• is not drinking enough
• seems confused, will not wake up, does not want to be held, or has seizures (uncontrolled shaking)
• gets better but then worse again
• has other conditions (like heart or lung disease, diabetes) that get worse

Are there groups of children at higher risk of serious complications?
Yes, children under age 5, and those with certain chronic illnesses are at increased risk of complications and serious illness from the H1N1 flu virus, please consult your child’s usual source of medical care These illnesses include chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological (including sickle cell disease), neurological, neuromuscular, or metabolic disorders (including diabetes mellitus); and immunosuppression, including that caused by medications or by HIV. Persons younger than 19 years of age who are receiving long-term aspirin therapy are also at increased risk.

What should parents of children at high risk of serious complications do?
If your child is in a high risk group, and develops flu-like illness (such as sudden onset of fever, cough, sore throat, muscle aches, extreme tiredness), please consult your child's usual source of medical care about starting antiviral therapy. Such therapy works best if started right away, but in any case in the first 48 hours of illness. If your child remains well, but has been exposed to a person with confirmed or suspected H1N1 swine flu, or attends a school where this virus is circulating; consult with your child's primary healthcare provider about possibly taking antiviral medications to prevent disease.

Can children go to school if he or she is sick?
No. They should stay home to rest and to avoid giving the flu to other children.

Should children go to school if other children are sick?
It is not unusual for some children in school to get sick during the winter months. If many children get sick, it is up to parents to decide whether or not to send their child to school. Parents may wish to check with their doctor, especially if their child has other health problems.

When can children go back to school after having the flu?
Keep your child home from school until his or her temperature has been normal for 24 hours (without the assistance of fever-reducing medicines). Remind your child to cover their mouth when coughing or sneezing, to protect others (you may want to send some tissue and wipes or gels with alcohol in them to school with your child).

Is there medicine to treat seasonal or H1N1 Flu?
Antibiotics like penicillin will not cure the flu. There are antiviral medicines for children 1 year and older that can make a child feel better and get better sooner. These medicines need to be prescribed by a doctor. They should be started during the first 2 days that the child is sick for them to work best. Doctors can discuss with parents if these medicines are right for their child.

What can the schools do to protect my child?

• Any employee, student, teacher, or staff suspected of having the flu should not attend school.

• Students and teachers should wash hands several times a day using soap and warm water for 15-20 seconds (this is generally around the time it takes to sing the ABC's). Dry hands with paper towels or automatic hand dryers if possible. Allowing and encouraging regular breaks for the students and teachers to wash hands. Young children should be instructed and assisted to ensure proper hand washing. Restrooms should be checked regularly to ensure that soap and paper towels are always available.
• Make sure tissues are available in all classrooms. Students and staff should cover their mouths when coughing (for example, cough or sneeze into your elbow) and use a tissue when sneezing or blowing their noses. Tissues should be thrown away immediately. Students and staff should follow-up with proper hand washing techniques (alcohol hand gels may be used in the classrooms to minimize disruption).
• Staff and students (especially those with medical conditions and anyone else who wants to lower their risk of getting the flu) should get the flu shot when it becomes available. Remember, it is never too late in the flu season to be vaccinated. Check with your healthcare provider or local health department on availability of vaccine:
• Dismissal of individual schools in the event of an outbreak has not proven to be an effective way of stopping the flu, yet that decision should be made by the appropriate school officials in cooperation with their local health department based on other considerations.
• Schools should be extra-vigilant that ill students exclude themselves from sports activities, choir or any activities that may involve close contact, since transmission of the flu may be easier in these situations. All students and staff should avoid sharing glasses, water bottles, drinks, spoons/forks, etc.
• School buses, because of the enclosed space, may allow for easy spread of the flu. Tissues should be available on the buses, and students should be encouraged to cover their nose and mouth while coughing or sneezing (for example, cough or sneeze into your elbow). Disinfect commonly handled interior surfaces (i.e. door handles, hand rails, etc.) on a regular basis.
• Clean commonly used surfaces such as door handles, handrails, eating surfaces, desks, etc., frequently with disinfectant. (commercial disinfectants are appropriate.)

Will my child need to wear a mask at school? (Or) Why has my child been asked to wear a mask in school?
If your child becomes ill with flu-like symptoms at school, the school may place a mask on the child while he/she is in the "clinic" waiting to be picked up. This is the current recommendation to schools by the Centers for Disease Control and Prevention (CDC). The mask is to prevent flu germs from being spread to others when an ill person coughs or sneezes. When you pick up your child, the staff person assigned to the "clinic" will likely be wearing a mask as well to prevent her/him from inhaling flu germs since she/he is in very close contact with ill persons. the Centers for Disease Control and Prevention (CDC) has only recommended the use of masks in very specific situations and has not recommended mask use as general prevention measures for healthy children and adults.

I'm curious, what recommendations are being made for schools? Can you give me more information about H1N1 Flu and schools?
Yes, the Centers for Disease Control and Prevention (CDC) have several resources for you. Visit http://www.cdc.gov/h1n1flu/schools/ for more information.

Communities and Workplace

» Communities and Workplace: Information for Employers

What can employers do to protect employees?

• Encourage sick workers to stay home and away from the workplace, and provide flexible leave policies.

• Encourage infection control practices in the workplace by displaying posters that address and remind workers about proper hand washing, respiratory hygiene, and cough etiquette.
• Provide written guidance (email, etc.) on H1N1 Flu appropriate for the language and literacy levels of everyone in the workplace. Employers should work closely with local and state public health officials to ensure they are providing the most appropriate and up-to-date information
• Provide sufficient facilities for hand washing and alcohol-based hand sanitizers (or wipes) in common workplace areas such as lobbies, corridors, and restrooms.
• Provide tissues, disinfectants, and disposable towels for employees to clean their work surfaces, as well as appropriate disposal receptacles for use by employees.

One study showed that flu virus can survive on environmental surfaces and can infect a person for up to 2-8 hours after being deposited on the surface. To reduce the chance of spread of the H1N1 Flu virus, disinfect commonly-touched hard surfaces in the workplace, such as work stations, counter tops, door knobs, and bathroom surfaces by wiping them down with a household disinfectant according to directions on the product label.

What do I do when an employee comes to work with flu-like illness symptoms in a community where H1N1 Flu virus is circulating?

• Notify appropriate health center or first aid personnel.
• Place the employee in a room by him- or herself.
• If the employee needs to go into a common area, he or she should cover coughs/sneezes with a tissue or wear a facemask if available and tolerable.
• Notify the employee's supervisor or employer.
• Send the employee home as soon as possible.
• Call for emergency medical services if the ill person develops any of the emergency warning signs.

In adults, emergency warning signs that need urgent medical attention include:

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms improve but then return with fever and worse cough

Ensure the ill employee stays home for at least 24 hours after their fever is gone except to get medical care or for other necessities (fever should be gone without the use of fever-reducing medicines).

For recommendations on facemask and respirator use for the person assisting the ill employee visit the Centers for Disease Control and Prevention (CDC) website http://www.cdc.gov/h1n1flu/masks.htm

What do I do for an employee with confirmed H1N1 Flu while he or she is on work-related travel?

• Notify his or her supervisor or employer if an employee becomes ill on travel or temporary assignment.
• If outside the U.S., contact medical provider or overseas medical assistance companies to assist in finding an appropriate medical provider in that country, if needed. A U.S. consular officer can help locate medical services. Take note that U.S. embassies, consulates, and military facilities do not have the legal authority, capability, and resources to evacuate or to give medications, vaccines, or medical care to private U.S. citizens overseas.

See the Centers for Disease Control and Prevention (CDC) website on travel for more information: http://wwwn.cdc.gov/travel/content/novel-h1n1-flu.aspx

What kind of special considerations are there for pregnant employees with suspected H1N1 Flu?
Pregnant women are at higher risk for flu complications. Pregnant women with flu-like symptoms should contact their health care provider. You can also visit the Centers for Disease Control and Prevention (CDC) website: http://www.cdc.gov/h1n1flu/guidance/pregnant.htm for more information.

What can businesses do to protect their operations?

• Identify a workplace coordinator who will be responsible for dealing with H1N1 Flu issues and impact at the workplace, including contacting local health department and health care providers in advance and developing and implementing protocols for response to ill individuals.
• Determine who will be responsible for responding to ill individuals in the workplace, either through an established health clinic or as a first aid duty.
• Share your plans with employees and clearly communicate expectations.
• Review interim recommendations for facemask and respirator use in non-health care settings. This can be found at: http://www.cdc.gov/h1n1flu/masks.htm
• Identify essential employees, essential business functions, and other critical inputs (Continuity of Operations Plan - COOP) required to maintain business operations by location and function should there be disruptions during the H1N1 Flu outbreak.
• Implement business continuity plans if there is significant absenteeism in the workplace during this outbreak.
• Review your plan with regard to increases or decreases in demand for your products and/or services during the outbreak (e.g., the need for hygiene supplies).
• Review the Centers for Disease Control and Prevention (CDC) travel-related websites for up-to-date information and communicate these recommendations to employees who may have upcoming business-related travel. See for more information: http://wwwn.cdc.gov/travel/content/novel-h1n1-flu.aspx
• Establish an emergency communications plan. This plan includes identification of key contacts (with back-ups), chain of communications (including suppliers and customers), and processes for tracking and communicating business and employee status.
• Develop hotlines and dedicated websites for communicating H1N1 Flu status and actions to employees, vendors, suppliers, and customers inside and outside the worksite in a consistent and timely way, including redundancies in the emergency contact system.

What can businesses do to protect employees?

• Examine policies for leave and employee compensation and review with managers, supervisors, and employees so they are up-to-date on sick leave policies, leave donation, and employee assistance services that are covered under the different employee-sponsored health plans. Leave policies should be flexible and non-punitive.
• Plan for the possibility of unscheduled leave that encourages employees who are sick to stay at home to care for themselves and others who are ill with the flu or children dismissed from school.
• Establish policies for flexible worksite (e.g., telecommuting) and flexible work hours (e.g., staggered shifts), if needed.
• Communicate policies for employee access to, and availability of, health care, mental health, and social services including corporate and community resources.

You can find additional resources at http://www.myflusafety.com/

» Communities and Workplace: Information for Employees

What can employees do to reduce the spread of the H1N1 Flu in the workplace?

• Stay home if you are sick. If you have symptoms of flu-like illness, stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities (your fever should be gone without the use of fever-reducing medicines). Keep away from others as much as possible. This is to keep from making others sick.

• Employees who are well but who have an ill family member at home with H1N1 Flu can go to work as usual. These employees should monitor their health every day, notify their supervisor and stay home if they become ill. Employees who have an underlying medical condition or who are pregnant should call their health care provider for advice, because they might need to receive flu antiviral medications to prevent illness.
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it, and wash your hands with soap and water.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand sanitizer can be used if soap and water are not available.
• Avoid touching your eyes, nose, or mouth. Germs spread this way.
• Avoid close contact with sick people. If an employee suspects that they have been exposed to a sick person with the H1N1 Flu they may continue to go to work as usual. These employees should monitor their health every day and should notify their supervisor and stay home if they become ill.

What do I do for co-workers if an employee has a suspected or confirmed case of H1N1 Flu?
Inform the employees of their exposure in the workplace with confirmed, probable, or suspected H1N1 flu during the ill person’s infectious period. Such disclosure of information should be conducted in accordance with the privacy and confidentiality requirements of the Americans with Disabilities Act (ADA), which stipulates that employers are required to keep all employees’ medical information private and confidential. Please visit http://www.eeoc.gov/facts/pandemic_flu.html for more information on privacy issues

• Have the exposed employees monitor themselves for symptoms.

• Advise employees to check with their health care provider about any special care they might need if they are pregnant or have a chronic health condition such as diabetes, heart disease, asthma, or emphysema.

Healthcare

» Healthcare: General

Where can providers sign up to distribute H1N1 vaccine?
Florida providers interested in administering H1N1 vaccine in the state/local programs need to submit a request via the following the FLSHOTS website: https://www.flshots.com/

Providers can receive additional information by either calling or e-mailing the Florida SHOTS help desk below:
Florida SHOTS Help Desk Hours: Monday - Friday
8:00 AM - 5:00 PM Eastern
Phone: (877) 888-SHOT (7468)
Fax: (850) 412-5801

What is the incubation period?
In general, the incubation period for flu is estimated to range from 1 to 4 days, with an average of 2 days. Flu virus shedding (the time during which a person might be infectious to another person) begins the day before illness onset and can persist for 5 to 7 days, although some persons may shed the virus for longer periods, particularly young children and persons with severely weakened immune systems. The amount of virus shed is greatest in the first 2-3 days of illness and appears to correlate with fever, with higher amounts of virus shed when temperatures are highest.

How long are people infectious to others?
People infected with seasonal and H1N1 Flu shed the virus and may be able to infect others up to 1 day before showing signs or symptoms of illness, and up to 5 to 7 days after becoming ill. This can be longer in some people, especially children and people with weakened immune systems. People are most infectious when they have a fever. In most situations, people can safely return to work or school if they have been free of fever without taking anti-fever medicines for 24 hours or more.

How long does the illness last?
The flu usually lasts three to seven days, although cough and malaise can persist for more than two weeks. Human flu virus infections can cause primary flu viral pneumonia; worsen underlying medical conditions, such as pulmonary or cardiac disease; lead to secondary bacterial pneumonia or sinusitis; or cause co-infections with other viral or bacterial pathogens.

Can H1N1 Flu re-infection occur?
Getting infected with any flu virus, including 2009 H1N1, should cause the body to develop immune resistance to that virus so it's not likely that a person would be infected with the identical flu virus more than once. (However, people with weakened immune systems might not develop full immunity after infection and might be more likely to get infected with the same flu virus more than once.) However, it's also possible that a person could have a positive test result for flu infection more than once in an flu season. This can occur for two reasons:

• A person may be infected with different flu viruses (for example, the first time with 2009 H1N1 and the second time with a regular seasonal flu virus. Most rapid tests cannot distinguish which flu virus is responsible for the illness. And,

• Flu tests can occasionally give false positive and false negative results so it's possible that one of the test results were incorrect. This is more likely to happen when the diagnosis is made with the rapid flu tests. More information about flu diagnosis is available at http://www.cdc.gov/h1n1flu/diagnosis/.

Some tips to prevent infection include:

• Those who experience illness should take time to fully recover
• Stay home from work or school if illness is suspected to cut down on exposure to others
• Frequent hand washing cuts down exposure and re-exposure to contagious diseases
• Use of germicide gels that kill germs on contact is suggested
• Using spray disinfectants keeps surfaces clean

Are there documents (a clearinghouse) prepared for the public that providers can print off the internet and distribute to their patients?
Yes. Visit the Centers for Disease Control and Prevention (CDC) website: http://www.cdc.gov/h1n1flu/flyers.htm for more information and items you can download.

Fraud and abuse related to 2009 H1N1 Influenza vaccine
Information for state/local immunization programs regarding options for reporting certain criminal, fraud and abuse matters relating to the 2009 H1N1 influenza vaccine and ancillary supplies can be found at: http://www.cdc.gov/h1n1flu/vaccination/h1n1_fraud_abuse.htm

» Healthcare: Vaccines Distribution & Storage

When will the vaccine be available?
The Department of Health and its public health and medical partners have prepared for the mass H1N1 flu vaccination campaign, which began in mid-October - and will extend throughout the flu season, or as needed. People at greatest risk for H1N1 swine flu infection or transmission include children and young adults, caregivers of very young children, pregnant women, healthcare and emergency medical services personnel and people with chronic health conditions like asthma, diabetes or heart and lung disease.

When will vaccine shipping begin?
Vaccine shipments began October 5th and continue to come into the state daily in limited quantities. The quantity of vaccine being shipped is expected to increase later this month (November).

When will the decision to administer vaccine be made?
Vaccination efforts began in mid-October.

How many manufacturers are producing vaccine?
The U.S. Food and Drug Administration announced the approval of four vaccines against the 2009 H1N1 flu virus. The vaccines are made by the following groups: Sanofi Pasteur, Inc; Novartis Vaccines and Diagnostics Limited; MedImmune LLC; CSL Limited. All manufacturers of the 2009 H1N1 vaccines are using the same processes used for making the seasonal flu vaccines, which have a long record of producing safe seasonal flu vaccines.

How will the vaccine be purchased?
2009 H1N1 vaccine has been procured and purchased by the federal government and made available for vaccinators at no cost. See section below titled “Vaccine Administration Fees” for information on cost of administration.

How will the 2009 H1N1 vaccine flow from manufacturers to providers?
The Federal Government is allocating vaccine to states based on population size. States are responsible for identifying providers who will participate in administration of 2009 H1N1 vaccine. Vaccine is being shipped to participating providers through a centralized distribution process. Through this process, placing of orders is facilitated by the state/local health department, and this information is sent to CDC to be transferred to the distributor for processing. Because of limitations related to the number of sites to which the distributor can directly ship vaccine, some project areas (includes all states, territories, Chicago, DC, NYC, and LA county) may develop additional means of distributing vaccine to providers which will be communicated to providers on a local level.

How can providers obtain vaccine?
State/Local public heath departments are responsible for directing the flow of vaccine to providers within every state. They are determining which providers will receive vaccine, and will allocate vaccine among providers as it becomes available to them. Public health departments continue to ascertain which providers are interested in administering vaccine. Providers who would like to partner with local health departments can register through the Florida SHOTS system at www.flshots.com/ Providers who plan to administer less than 100 doses should contact their local county health department for guidance Additional information can be found on the FLSHOTS website: https://www.flshots.com/ Providers can also receive additional information by either calling or e-mailing the Florida SHOTS help desk through the contact information below:

Florida SHOTS Help Desk Hours: Monday – Friday, 8:00 AM – 5:00 PM Eastern
Phone: (877) 888-SHOT (7468)
Fax: (850) 412-5801
E-mail: flshots@doh.state.fl.us

Will vaccine be distributed equitably across providers?
Public health departments will strive to ensure equitable distribution, taking into account which target groups are seen by different types of providers as well as their internal resources for possible re-distribution of vaccine. Doses of vaccine are “allocated”, or set aside, for each state based on their population size. It is up to the Department of Health in each state to decide how to distribute the doses. CDC’s contractor for centralized distribution ships vaccine to hospitals, clinics, doctor’s offices, health departments, and other providers of vaccines that have been designated as vaccine-receiving sites by the state.

How should vaccine be stored?
Vaccine storage and handling recommendations included in the product package inserts should be followed carefully and will provide you with the most up-to-date information. If you have concerns about vaccine that may not have been stored or handled properly, follow your state health department immunization program policy and contact either the manufacturer’s quality control office or the immunization program for guidance. H1N1 vaccine will need to be maintained at 2-8°C. Additional vaccine storage information can be found at: http://www.cdc.gov/h1n1flu/vaccination/dosage.htm

Are hospitals expected to assist County Health Departments in a public vaccination campaign?
The Department of Health encourages healthcare facilities to work closely with their local county health departments to implement the H1N1 flu campaign in ways that best meet the needs of the community.

What efforts are underway to include the vast number of primary care providers to assist in the care, treatment and potential vaccination of people affected by H1N1 Swine Flu?
County health departments are coordinating the H1N1 Flu vaccination campaign and are engaging private providers to participate. They are also working with their health care partners on managing the disease in their communities. The Department of Health is using a multi-faceted approach to disseminate information to health care providers to ensure they are aware of the latest H1N1 flu guidance and strategies to assist in disease management in their communities.

What do we know about Florida’s initial H1N1 vaccine shipments?
Florida counties began receiving vaccine shipments the week of October 5th. The initial shipment included the FluMist nasal spray only. During the week of October 12, Florida began receiving injections (shots) vaccine. The total available H1N1 flu vaccine for Florida is estimated to be 9.8 million doses by January 2010.

As of January 18, 2010, Florida has received allocations for over 7 million doses of H1N1 vaccine by the state. These doses are being distributed to county health departments and private providers throughout the state. Counties are submitting additional orders each day.

The nasal spray contains live attenuated virus and is indicated for healthy people 2 to 49 years of age who are not pregnant, and includes healthy persons who live with or care for those in a high risk group. The one exception is healthy persons who care for persons with a severely weakened immune system. It is not recommended for infants under 2, adults over 49, pregnant women or anyone with a range of underlying health problems.

As additional H1N1 vaccine becomes available,

• Over 4,800 private health care providers have registered to become a H1N1 provider under the Florida Shots program. Providers can register at http://www.flshots.com.

• Counties are beginning to offer public vaccination clinics. The Florida Department of Health has a “Flu Clinic Locations” webpage at http://www.myflusafety.com/myfluclinic.htm which provides information about public health sponsored vaccination clinics within each county, as it becomes available.

What is the minimum dose order for shipments of 2009 H1N1 vaccine
For each vaccine formulation (identified by its National Drug Code) the minimum dose order is 100 doses and all orders must be placed in increments of 100 doses. Each ancillary supply kit contains supplies to support 100 doses of vaccine, with different kits available for pre-filled syringe products and for multi-dose vial products.

Will there be a separate allocation for active duty DoD?
Yes, there will be a separate allocation for active duty DoD

Will there be a separate allocation for DoD dependants, retirees and civilian employees?
There is no separate allocation for these groups. Military facilities may be willing to vaccinate these groups, but there will need to be allocated vaccine for these populations and coordination with the state.

Will there be a separate vaccine allocation for IHS-served populations and other tribal communities?
There will be no separate allocation. States and local areas needs to ensure that IHS-served population and other tribal communities are included in their state vaccination plans.

Can you tell me more about the Live Attenuated Vaccine (weakened) – Nasal Spray/FluMist?
It is a vaccine made with live, weakened viruses that do not cause the flu (sometimes called LAIV for "live attenuated flu vaccine"). LAIV is approved for use in healthy people 2 years to 49 years of age who are not pregnant. The nasal spray vaccine for use in the United States is being made by MedImmune, the same company that makes the seasonal nasal spray vaccine called “FluMist.” The 2009 H1N1 nasal spray vaccine is being made in the same way as the seasonal nasal spray vaccine.

» Healthcare: Vaccine Administration Fees

Will insurance plans reimburse private providers for administration of 2009 H1N1 vaccine?
This is up to each individual health plan but the general expectation is plans will reimburse for vaccine administration. According to America's Health Insurance Plans, a national association representing nearly 1,300 companies that provide health insurance to over 200 million Americans, "Every year health plans contribute to the seasonal flu vaccination campaign in several ways:

a) Health plans communicate directly with plan sponsors and members on the current ACIP recommendations and encourage immunization; they also provide information on where to get vaccinations, and who to contact with any questions.
b) Just as health plans have provided extensive coverage for the administration of seasonal flu vaccines in the past, public health planners can make the assumption that health plans will provide reimbursement for the administration of a novel (A) H1N1 vaccine to their members by private sector providers in both traditional settings e.g., doctor's office, ambulatory clinics, health care facilities, and in non-traditional settings, where contracts with insurers have been established."

Will private providers be able to charge patients for vaccine administration if they are uninsured?
Yes, private providers may charge a fee for the administration of the vaccine to the patient. Should they choose to charge an administration fee, the fee may not exceed the regional Medicare payment rate for seasonal flu vaccine administration. If the patient is unable to pay, the provider may choose to administer the 2009 H1N1 vaccine for free or for a reduced fee. Providers are encouraged to ensure that cost is not a barrier to vaccination.

Can persons be charged for vaccine administration in public health-organized large scale vaccination clinics?
There will be no administration fee for vaccination in public-health organized large scale vaccination clinics.

Will Medicaid reimburse H1N1 flu vaccinations?
Medicaid’s long-standing policy is that Medicaid is not liable for services that are available without charge to the beneficiary or other legally liable third parties. In general, Medicaid is obligated to ensure that other legally liable third parties pay primary to Medicaid.

My patient cannot afford to get their antiviral prescription filled. Where can they get assistance?
Florida is working on agreements with different retailers throughout the state to ensure Floridians have access to antiviral medicine. The Bureau of Statewide Pharmaceutical Services has developed a Public Antiviral Stockpile Program to ensure healthcare providers have a resource for referring their patients who cannot afford antiviral medications. Patients can be directed to one of several participating pharmacies throughout the state: Publix, Walgreen’s, Winn Dixie and Navarro.

County Health Departments will also have supplies of antiviral medicine, so Floridians who need it can get it.

In addition, many healthcare providers are aware of community prescription assistance programs. If you have internet access, you can utilize the Partnership for Prescription Assistance site: http://www.pparx.org/prescription_assistance_programs/free_clinic_finder

Who should I contact if I believe I’ve been over-charged or mis-charged for the H1N1 vaccine, antivirals and other supplies?
Please refer to the Florida Attorney General’s Office Price Gouging Hotline at (toll-free): 1-866-966-7226.
For additional information, go online at: http://myfloridalegal.com/pages.nsf/0/308348F71208C29085256EED00604673?OpenDocument

State and local partners or agencies can also report any such matters directly by sending an email to the CDC H1N1 Vaccine Fraud mailbox at: H1N1FraudAbuse@cdc.gov.

The email should include the person’s contact information, as well as a detailed description of the situation, including when it occurred.
Other reportable H1N1 fraud situations include:

• Charging for the 2009 H1N1 influenza vaccine (H1N1 influenza vaccine doses are provided at NO cost to providers and health departments by the Federal government. Patients may not be charged for the vaccine or other supplies, however, small administration fees may be charged)
• Requesting an out-of-pocket fee directly from the patient that is above the maximum regional Medicare allowable charge
• Selling the H1N1 influenza vaccine or other supplies provided by the Federal government
• Counterfeiting H1N1 vaccines, adulteration or tampering of the vaccine
• Theft of the vaccine
• Charging fees for antivirals
• Illegally marketing and advertising on websites or through the Internet, including fraudulent product claims, bogus products, and implied endorsement by federal agencies (including the illegal use of federal government agency logos),
• Diversion, including situations where legitimate prescription vaccines are brought into illegal channels such as the black market, vaccines acquired or obtained by an illegal method such as distributor theft, or smuggling vaccine into the U.S.
• Illegal sale to an unauthorized person without a prescription

 

» Healthcare: Ancillary Supplies

Which ancillary supplies will be provided with vaccine?
The Federal Government will purchase vaccine and supplies (syringes, alcohol swabs, sharps containers, and vaccine record cards) and distribute these at no cost to healthcare providers who make agreements with state and local public health authorities to provide the H1N1 vaccine.

How will ancillary supplies be distributed?
Supplies will be shipped separately from vaccine and are expected to arrive before or on the same day as vaccine.

» Healthcare: Vaccine Administration

Will two doses of vaccine be required?
The FDA approved and preliminary clinical trials data support:

One dose of 2009 H1N1 flu vaccine for persons 10 years of age and older (This is slightly different from CDC’s recommendations for seasonal flu vaccination which states that children younger than 9 who are being vaccinated against flu for the first time need to receive two doses.)

Two doses of 2009 H1N1 flu vaccine for children 3-9 years of age

Children ages 6 months through 35 months get two doses of 2009 H1N1 flu vaccine that contains one-half the dose used for older children and adults

**Infants younger than 6 months of age are too young to get the 2009 H1N1 and seasonal flu vaccines.

What will be the recommended interval between the first and second dose?
The FDA approved and the vaccine package inserts indicate that a second dose should be administered about one month after the initial dose. CDC recommends that the two doses of 2009 H1N1 vaccine be separated by 4 weeks. However, trials of the inactivated 2009 H1N1 vaccines have often used a 21 day interval. Administering the two doses of a 2009 H1N1 monovalent inactivated flu vaccine at least 21 days apart is safe and acceptable. Therefore, if the second dose of an inactivated 2009 H1N1 monovalent vaccine is separated from the first dose by at least 21 days, the second dose can be considered valid. If the interval separating the doses is less than 21 days, the second dose should be repeated 28 or more days after the invalid (second) dose (≥ 21 days is acceptable for this interval also).

How will the public be notified if a second dose is needed?
There will be no federal requirement to send out recall notices. Providing information on second dose at the time of the first dose, as well as using the media to disseminate this message will be the primary means of educating persons about who needs a second dose.

Will it be necessary for the first and second dose to be the same product?
Ideally, first and second doses would be from the same product. However, practical considerations may make this difficult to implement. The Centers for Disease Control and Prevention (CDC) has been permissive on this issue but prefers that individuals who require a second dose be vaccinated with the same product, if possible. While not preferred, administering one dose as inactivated vaccine and another dose as live vaccine is acceptable.

Where can my patients, my staff or I as a healthcare provider get the H1N1 Flu vaccination when it becomes available?
Each county has developed plans for holding vaccination clinics throughout the county. An H1N1 Vaccine Clinic locator for the State of Florida can be found at http://www.myflusafety.com/myfluclinic.htm. CDC has provided guidance to public health officials as to which groups of people are at higher risk for contracting the H1N1 swine flu virus and should therefore be prioritized for early vaccination.

As of December 4, 2009, counties are authorized to expand provision of the H1N1 flu vaccinations beyond the five priority groups based on local availability of vaccine. Counties have developed plans which allow them to expand vaccination availability to additional population groups when ready, to meet their respective population’s demands. Each county is unique in its population and this guidance will help them plan for expansion beyond the ACIP priority groups as more vaccine arrives

Where can providers sign up to distribute H1N1 vaccine?
Florida providers interested in administering H1N1 vaccine in the state/local programs need to go to the Florida SHOTS Website at www.flshots.com for H1N1 registration. Providers who plan to administer less than 100 doses should contact their local county health department for guidance.

Additional information can be found on the FLSHOTS website: https://www.flshots.com/

Providers can also receive additional information by either calling or e-mailing the Florida SHOTS help desk through the contact information below:
Florida SHOTS Help Desk Hours: Monday - Friday, 8:00 AM - 5:00 PM Eastern
Phone: (877) 888-SHOT (7468)
Fax: (850) 412-5801
E-mail: flshots@doh.state.fl.us

How Far Apart Should You Get the Seasonal Flu Vaccine and the H1N1 Vaccine?
Simultaneous administration of inactivated vaccines against seasonal and the 2009 H1N1 flu viruses is permissible if different anatomic sites are used.

However, simultaneous administration of live, attenuated virus vaccines against seasonal and 2009 H1N1 flu is not recommended. Seasonal and H1N1 live attenuated flu vaccines should be administered a minimum of 4 weeks apart. These are considered to be 2 different vaccines. The ACIP recommendations were developed based on data from studies using attenuated injection (shot) live virus vaccines such as the measles, mumps and rubella vaccine. Trials of 2009 H1N1 live attenuated vaccines have used a 28 day interval between doses and therefore, 28 days is the recommended interval between 2 doses of LAIV (seasonal and H1N1 monovalent LAIV). However, based on previous studies of LAIV replication and immune response, as little as 14 days (2 weeks) might be sufficient to allow for an appropriate immune response to both vaccines. Therefore, an interval between the two types of LAIV of 2 weeks or more may be acceptable, although an interval of 28 days is preferred.

Can seasonal vaccine and H1N1 vaccine be administered at the same time?
Both seasonal and 2009 H1N1 vaccines are available as inactivated and live attenuated flu virus (LAIV) formulations. The simultaneous and sequential administration of seasonal and 2009 H1N1 inactivated vaccines is currently being studied. However, existing recommendations are that two inactivated vaccines can be administered at any time before, after, or at the same visit as each other (General Recommendations on Immunization, MMWR 2006; 55[RR-15]). Existing recommendations also state that an inactivated and live vaccine may be administered at any time before, after or at the same visit as each other.

Consequently, providers can administer seasonal and 2009 H1N1 inactivated vaccines, seasonal inactivated vaccine and 2009 H1N1 LAIV, or seasonal LAIV and inactivated 2009 H1N1 at the same visit, or at any time before or after each other. Live attenuated seasonal and live attenuated 2009 H1N1 vaccines should NOT be administered at the same visit until further studies are done. If a person is eligible and prefers the LAIV formulation of seasonal and 2009 H1N1 vaccine, these vaccines should be separated by a minimum of four weeks.

When will the rest of the population be able to get vaccinated with H1N1 vaccine?
Each county has developed plans for holding vaccination clinics throughout the county. An H1N1 Vaccine Clinic locator for the State of Florida can be found at http://www.myflusafety.com/myfluclinic.htm. CDC has provided guidance to public health officials as to which groups of people are at higher risk for contracting the H1N1 swine flu virus and should therefore be prioritized for early vaccination.

As of December 4, 2009, counties are authorized to expand provision of the H1N1 flu vaccinations beyond the five priority groups based on local availability of vaccine. Counties have developed plans which allow them to expand vaccination availability to additional population groups when ready, to meet their respective population’s demands. Each county is unique in its population and this guidance will help them plan for expansion beyond the ACIP priority groups as more vaccine arrives.

Will there be enough vaccine available?
Florida is receiving vaccine each week, as vaccine is manufactured and distributed by our federal partners. Florida is expected to continue receiving doses of the H1N1 vaccine through January of 2010. We do not expect there to be a shortage of H1N1 vaccine. Once the demand for vaccine for all prioritized groups has been met at the local level, programs and providers will begin offering vaccinations to everyone from the ages of 25 through 64 years who request it. Because vaccine availability is expected to increase over time vaccine should NOT be held in reserve for patients who received one dose and might require a second dose.

How much Thimerosal-free vaccine will be available?
It is anticipated that enough thimerosal-free vaccine in pre-loaded syringes will be available for young children and pregnant women.

Will vaccine be adjuvanted?
According to current federal plans, only unadjuvanted vaccines will be used in the United States during the 2009 flu season. This includes all of the H1N1 and seasonal flu vaccines that will be available for children and adults in both the injectable and nasal spray formulations. None of these flu vaccines that will be used in the U.S. during the 2009-10 seasons will contain adjuvant. Florida Department of Health also has a new fact sheet on vaccine safety available under the Spotlight and Individuals and Families sections of our www.myflusafety.com website. For additional information, visit the Myths and Facts page of flu.gov at http://www.flu.gov/myths/index.html or the CDC’s H1N1 Vaccine page at http://www.cdc.gov/h1n1flu/vaccination/

For whom will novel H1N1 vaccine be recommended?
When vaccine is first available, the CDC Advisory Committee on Immunization Practices (ACIP) has recommended the 2009 H1N1 vaccine for the following 5 target groups (approximately 159 million persons nationally):

• Pregnant women

• Household and caregiver contacts of children younger than 6 months of age (e.g. parents, siblings, and daycare providers)
• Health care and emergency medical services personnel
• Persons from 6 months through 24 years of age
• Persons aged 25 through 64 years who have medical conditions associated with a higher risk of flu complications

Once providers meet the demand for vaccine among persons in these initial target groups, vaccination is recommended for all persons 25 through 64 years of age. Current studies indicate that the risk for infection among persons age 65 or older is less than the risk for younger age groups. However, once vaccine demand among younger age groups has been met, programs and providers should offer vaccination to people 65 or older.

Will there be a shortage of the vaccine?
No, however, the flu vaccine availability can be unpredictable. Forecasting how much vaccine will be available at a certain time is challenging and projection amounts will vary from week to week. Millions of doses of vaccine are in the pipeline and federal, state and local public health authorities are working hard to get vaccine out to the public as soon as it becomes available for ordering As of January 2010, about 139 million doses of vaccine were available for states to order, much less than is needed to vaccinate the total U.S. population. Given this situation, states will initially be conducting targeted vaccination efforts that take into consideration how widespread 2009 H1N1 is in their area.

The vaccine situation changes rapidly each day, vaccine is being shipped from the vaccine manufacturers to the distribution centers; orders are coming in; orders are being processed and shipped; and vaccine is arriving in thousands of places across the country. It is important to also keep in mind that there are lag times between states placing orders, vaccine being shipped, and vaccine arriving in provider offices or clinics

Will those over 65 be able to get the vaccine?
Yes. The U.S. government has purchased 250 million doses of H1N1 vaccine, so anyone who wants to get the vaccine will have the opportunity to do so. While people 65 and older are not included in the groups recommended to get the earliest doses of vaccine, they can get the H1N1 flu vaccine as soon as the high risk groups have had the opportunity to be vaccinated. Some communities and providers will offer the H1N1 vaccine to people 65 and over sooner than others, depending on how quickly they meet the needs of the initial prioritized populations. While the early doses of H1N1 vaccine are being given to those in high risk groups, the Centers for Disease Control and Prevention (CDC) priority for people 65 and older is to have them get their seasonal flu vaccine first, and to seek medical advice quickly if they develop flu-like symptoms this season. This will determine whether they need medical evaluation and possible treatment with antiviral medications.

Will there be requirements for documentation of priority group membership?
There will be no federal requirements for vaccinators to require documentation of priority group status such as a doctor's note documenting pregnancy or risk status.

What is an adjuvant?
These are ingredients often included in vaccines that help boost its potency. None of the flu vaccines being used in the U.S. during the 2009-10 seasons contains adjuvant.

Does the vaccine contain Thimerosal?
The 2009 H1N1 flu vaccine is being manufactured in several formulations: Various vaccine manufacturers will be producing some of the 2009 H1N1 flu vaccine in single-dose units, which will not require the use of thimerosal as a preservative. Thimerosal is a mercury-based preservative that is used in some flu vaccines to keep them free from contamination of microorganisms. In addition, the live-attenuated version of the vaccine, which is administered through the nose, is produced in single-units and will not contain thimerosal. Some vaccine will come in multi-dose vials and will contain thimerosal as a preservative. See the Centers for Disease Control and Prevention (CDC) website, http://www.cdc.gov/h1n1flu/vaccination/thimerosal_qa.htm, for more information.

Is thimerosal safe when used as a preservative in vaccines?
Yes. We are aware of the concerns that some people have regarding thimerosal in vaccines. However, the vast majority of research conducted in the U.S. and around the world does not support an association between thimerosal in vaccines and autism. The Institute of Medicine and the World Health Organization, among other authoritative medical and scientific bodies, have affirmed that the scientific evidence shows no association between vaccines (with or without thimerosal) and autism. Regardless, since 2001, no new vaccine licensed by FDA for use in children has contained thimerosal as a preservative. All vaccines routinely recommended by the Centers for Disease Control and Prevention (CDC) for children under six years of age are thimerosal-free, or contain only trace amounts, except for some formulations of flu vaccine. All formulations in multi-dose vials contain some thimerosal. Please see the following link for additional information: http://www.cdc.gov/h1n1flu/vaccination/thimerosal_qa.htm

What are some possible approaches a practice might take to administer the H1N1 vaccine?
Options include holding special clinics, integrating the H1N1 vaccination into usual care, providing walk-in immunizations, or coordinating with local public health clinics if unable to administer H1N1 vaccine themselves. In determining the best option, each practice should consider several factors, including availability of vaccine, practice resources and patient demand.

If my patients are vaccinated outside of my practice, how will that information be available for inclusion in the patient's permanent medical record?
Recipients of the H1N1 vaccine will be provided with a hand-held card to serve as a record of vaccination and a source of information should a report to the Vaccine Adverse Event Reporting System (VAERS) be needed. Vaccine recipients will be encouraged to bring the hand-held card at their next visit to their primary care provider so that vaccination information can be transcribed into the patient's permanent medical record.

Can H1N1 vaccine be administered at the same visit as other vaccines?
Inactivated H1N1 vaccine can be administered at the same visit as any other vaccine, including pneumococcal polysaccharide vaccine. Live H1N1 vaccine can be administered at the same visit as any other live or inactivated vaccine EXCEPT seasonal live attenuated flu vaccine. If a person is eligible and prefers the LAIV formulations of seasonal and H1N1 vaccine, these vaccines should be separated by a minimum of four weeks. In general:

• Live virus vaccines (e.g., MMR, varicella, LAIV) may be administered at the same visit; but if not, they should be administered at least four weeks apart. The exception is live attenuated seasonal and H1N1 flu virus vaccines, which should not be administered simultaneously.
• Inactivated and live vaccine may be administered at any time before, after or at the same visit as each other.
• Two inactivated vaccines can be administered at any time before, after, or at the same visit as each other.

Will vaccine be in multi-dose vials?
The majority of vaccine will be in multi-dose vials, the remainder in single dose syringes or nasal sprayers. The aim is to have enough vaccine in single dose syringes (i.e. preservative free) for young children and pregnant women.

What Centers for Disease Control and Prevention information will be available for use in practices to help explain the need for both seasonal and H1N1 vaccine?
A variety of materials are available on the Centers for Disease Control and Prevention (CDC) H1N1 website at http://www.cdc.gov/h1n1flu/vaccination/. In addition, a H1N1-specific Vaccine Information Statement (VIS) will be available that will help explain the vaccine to recipients.

Will the H1N1 vaccine be recommended for patients who had flu-like illness since spring 2009?
All people in a recommended vaccination target group who did not have 2009 H1N1 virus infection confirmed by real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) test should be vaccinated with the 2009 H1N1 vaccine. People who had an illness confirmed by rRT-PCR to be 2009 H1N1 virus earlier in 2009 can be considered to be immune and do not need to be vaccinated this year. However, most people with respiratory illnesses since this spring have not had testing with the rRT-PCR test, which is the only test that can confirm infection specifically with the 2009 H1N1 virus. Tests such as rapid antigen detection assays and diagnoses based on symptoms alone without rRT-PCR testing, cannot specifically determine if a person has 2009 H1N1 flu. Although people who were not tested, but who became ill within 1-4 days after close contact with a person with lab confirmed 2009 H1N1 flu might have been infected with 2009 H1N1, they cannot be certain since many pathogens can cause respiratory illness. These people should get the 2009 H1N1 vaccine as recommended for their age and risk group.

People who were infected with the 2009 H1N1 virus and who are not severely immune compromised will likely have immunity to subsequent infection with 2009 H1N1 virus. However, vaccination of a person with some existing immunity to the 2009 H1N1 virus will not be harmful, and patients who are uncertain about how they were diagnosed should get the 2009 H1N1 vaccine. In addition, people recommended for seasonal vaccine should get a seasonal vaccine because infection with the 2009 H1N1 virus does not provide protection against seasonal flu viruses.

Should the 2009 H1N1 flu vaccine be given to someone who has had an flu- like illness since between April and now? Do I need a test to know if I need the vaccine or not?
There is no test that can show whether a person had 2009 H1N1 flu in the past and therefore, whether a vaccination is indicated or not. Many different infections, including flu, can cause flu-like symptoms such as cough, sore throat and fever. In addition, infection with one strain of flu virus will not provide protection against other strains. People for whom flu vaccine is recommended should receive the 2009 H1N1 vaccine, even if they had an flu-like illness previously, unless they can be certain they had 2009 H1N1 flu based on a laboratory test (done at the time of illness) that can specifically detect 2009 H1N1 viruses. CDC recommends those persons who were tested for 2009 H1N1 flu discuss this issue with a healthcare provider to see if the test they had was either an RT-PCR or a viral culture that showed 2009 H1N1 flu. There is no harm in being vaccinated if you had 2009 H1N1 flu in the past.

What novel H1N1 vaccines are approved and expected to be available?
The U.S. Food and Drug Administration (FDA) approved supplements to existing vaccine licenses to protect against the pandemic (H1N1) 2009 flu virus. The Flu A (H1N1) 2009 Monovalent vaccines contain an A/California/7/09-like virus (see Information on the Flu A (H1N1)2009 Monovalent Vaccine approvals). Four vaccines have been licensed by the FDA. All currently licensed vaccines for use in the United States are unadjuvanted.

• MedImmune Flu A (H1N1) 2009 Vaccine Live, Intranasal
• Live attenuated virus vaccine for healthy individuals 2-49 years of age
• Should not be administered to individuals with asthma, children <5 years of age with recurrent wheezing, any child <24 months of age, or children and adolescents on concomitant aspirin therapy
• Avoid use in immunocompromised individuals, pregnant women, and individuals with underlying medical conditions that predispose them to complications of flu infection
• Prefilled single-dose intranasal sprayer containing 0.2 mL suspension; no preservative
• Sanofi Pasteur Flu A(H1N1) 2009 Monovalent Vaccine
• Inactivated virus vaccine for persons 6 months of age and older, given by intramuscular injection
• Prefilled syringe, 0.25 mL; no preservative
• Prefilled syringe, 0.5 mL; no preservative
• Single-dose vial, 0.5 mL; no preservative
• Multi-dose vial, 5 mL; contains preservative thimerosal
• Novartis Flu A(H1N1) 2009 Monovalent Vaccine
• Inactivated virus vaccine for persons 4 years of age and older, given by intramuscular injection
• Prefilled syringe, 0.5 mL; trace preservative thimerosal (<1 mcg Hg/ 0.5mL dose)
• Multi-dose vial, 5 mL; contains preservative thimerosal
• CSL Flu A(H1N1) 2009 Monovalent Vaccine
• Inactivated virus vaccine for persons 18 years of age and older, given by intramuscular injection.
• Prefilled syringe, 0.5 mL; no preservative
• Multi-dose vial, 5 mL; contains preservative thimerosal
• GlaxoSmithKline (GSK) – vaccine not yet licensed by the FDA

Are there some people who should not receive this (H1N1) vaccine?
Anyone who has a severe (life-threatening) allergy to eggs or to any other substance in the vaccine should not get the vaccine. People should always inform their immunization provider if they have any severe allergies, if they've ever had a severe allergic reaction following flu vaccination, or if they have ever had Guillain-Barré Syndrome (GBS).

Vaccine providers should review each of the specific vaccine package inserts for listed contraindications and warnings/precautions, as formulations may differ by manufacturer. Additionally, the live attenuated flu virus vaccine is only indicated for those ages 2-49 years old that are healthy and not pregnant.

Common substances found in vaccines include:
Antibiotics, formaldehyde, monosodium glutamate (MSG) and 2-phenoxy-ethanol and thimerosal. Healthcare providers should be aware of their patient’s allergies prior to vaccination.

Reference Materials:
What You Should Know About Vaccines:
http://www.cdc.gov/vaccines/vac-gen/additives.htm

Vaccine Ingredients sorted by vaccine:
http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/excipient-table-2.pdf

What is the recommended interval between the first and second dose for children under 10 years of age?
Package inserts for the FDA approved vaccines state that the second dose should be given approximately 1 month after the first. CDC recommends that the two doses of 2009 H1N1 monovalent vaccine be separated by 4 weeks. However, if the second dose is separated from the first dose by at least 21 days the second dose can be considered to be valid. If the interval separating the doses is less than 21 days the second dose should be repeated four weeks after the first dose was given.

What are the contraindications and precautions to administering 2009 H1N1 vaccines?
See vaccine inserts for specific information pertaining to each vaccine. In addition to the contraindications and precautions noted above specific to the live virus vaccine, if the patient had Guillain-Barré syndrome within 6 weeks of a previous flu vaccination, the decision to give vaccine should be based on careful consideration of the potential benefits and risks. Immunocompromised persons who receive inactivated vaccine (live vaccine should be avoided), may have a reduced immune response. Contraindications include severe hypersensitivity to egg proteins or any component of the vaccine, and/or life-threatening reactions after previous administration of any flu vaccine. Asking persons if they can eat eggs without adverse effects is a reasonable way to determine who might be at risk for allergic reactions from receiving flu vaccines. Persons who have had symptoms such as hives or swelling of the lips or tongue, or who have experienced acute respiratory distress after eating eggs, should consult a physician for appropriate evaluation to help determine if flu vaccine should be administered. Persons who have documented (IgE)-mediated hypersensitivity to eggs, including those who have had occupational asthma related to egg exposure or other allergic responses to egg protein, also might be at increased risk for allergic reactions to flu vaccine, and consultation with a physician before vaccination should be considered. A regimen has been developed for administering flu vaccine to asthmatic children with severe disease and egg hypersensitivity.

Can you tell me more about the Sanofi Pasteur prefilled pediatric syringes vaccine recall?

• On December 15th and again on January 29th, certain lots were recalled but not due to purity, potency or safety issues.
• The recall was due to postproduction monitoring efforts that found select batches (or lots) of vaccine that did not meet manufacturing specifications.
• The only doses affected are manufacturer Sanofi Pasteur’s .25mL pre-filled pediatric vaccines and one lot of 0.5 mL single-dose pre-filled syringe for older children and adults.
• Florida received 40,000 doses of the recalled vaccine.
• Those that have received the designated lots of vaccine, do not need to be revaccinated – it is an effective vaccine. Therefore, individuals that received the identified lots of vaccine will not be notified.
• If a child has received the initial dose of H1N1 vaccine, they should receive the 2nd dose as directed.
• Providers will be contacted by the manufacturer (Sanofi Pasteur) with instructions for returning any unused vaccine from the following lots to the manufacturer:
• 0.25 mL pre-filled syringes, 10-packs (NDC # 49281-650-25, sometimes coded as 49281-0650-25): UT023DA, UT028DA, UT028CB
• 0.25 mL pre-filled syringes, 25-packs (NDC # 49281-650-70, sometimes coded as 49281-0650-70): UT030CA
• Providers must reorder vaccine through the established procedures [utilizing FLSHOTS http://www.flshots.com/ ] to replace recalled doses. When you reorder, ancillary supplies will be provided at no cost.
  
• At this time, we do not anticipate any costs incurred by the healthcare provider. As more information is available, it will be promptly distributed to the healthcare community.
• Because of existing public concerns regarding H1N1 vaccine, the manufacturer felt obligated to release this information although it has no implications for safety or potency of the vaccine.
• For more information and frequently asked questions please see:
  • December 15, 2009 recall: http://www.cdc.gov/h1n1flu/vaccination/syringes_qa.htm
  • January 29, 2010 recall: http://www.cdc.gov/H1N1flu/HAN/012910.htg

Can you tell me more about the the MedImmune H1N1 nasal spray vaccine recall?

• On December 23rd certain lots of the MedImmune nasal spray vaccine were recalled but not due to purity, potency or safety issues.
• The recall was due to postproduction monitoring efforts that found select batches (or lots) of vaccine that did not meet manufacturing specifications.
• Florida received 297,650 doses of the recalled vaccine.
• Those that have received the designated lots of vaccine, do not need to be revaccinated – it is an effective vaccine. Therefore, individuals that received the identified lots of vaccine will not be notified.
• If a child has received the initial dose of H1N1 vaccine, they should receive the 2nd dose as directed.
• Providers will be contacted by the manufacturer (MedImmune) with instructions for returning any unused vaccine from the following lots to the manufacturer:
  500754P
  500751P
  500756P
  500757P
  500758P
  500759P
  500760P
  500761P
  500762P
  500763P
  500764P
  500765P
  500776P
• Providers must reorder vaccine through the established procedures [utilizing FLSHOTS http://www.flshots.com/ ] to replace recalled doses. When you reorder, ancillary supplies will be provided at no cost.
• At this time, we do not anticipate any costs incurred by the healthcare provider. As more information is available, it will be promptly distributed to the healthcare community.
• Because of existing public concerns regarding H1N1 vaccine, the manufacturer felt obligated to release this information although it has no implications for safety or potency of the vaccine.
• For more information and frequently asked questions please see http://www.cdc.gov/h1n1flu/vaccination/syringes_qa.htm

 

» Healthcare: Antiviral Medication

What are the treatment benefits of flu antiviral medications?
The majority of Florida residents who have died have had known risk factors for adverse outcomes from flu. The Centers for Disease Control and Prevention (CDC) and the Florida Department of Health recommend early treatment with oseltamivir or zanamivir for those with confirmed, probable, or suspected infection with the 2009 H1N1 virus who are ill enough to be hospitalized or have risk factors for severe outcomes, including pregnancy. For treatment, antiviral medications should be started within 2 days after becoming sick. When used this way, these drugs can reduce the severity of flu symptoms and shorten the time you are sick by 1 or 2 days.

Can antiviral medications be given even if a person is not tested for flu or if a flu test does not indicate that they have flu?
Yes. For individual patients, flu testing is not required for antiviral medications to be prescribed. Testing is done based on health care provider recommendations.

Can people who are not in a high-risk group receive antiviral medications?
Yes, but it is not generally necessary. Consult with your doctor if you are ill or have been exposed to flu to determine if you should take antiviral medications.

Can flu antiviral medications be used in pregnant women?
The CDC recently issued interim recommendations for obstetric health care providers related to the use of antiviral medication; this information can be found at http://www.cdc.gov/h1n1flu/pregnancy/antiviral_messages.htm

What are the CDC's recommendations for antiviral treatment?
As in earlier antiviral recommendations, the priority for use of antiviral medications this season continues to be in people with more severe illness, such as people hospitalized with flu, and people at increased risk of flu-related complications. Recommendations have been updated to provide additional clarification on several issues, including the increased risk for complications in young children, particularly children younger than 2 years of age.

New information in the updated guidance dated September 22, 2009 includes:

• Additional context and guidance for clinicians regarding the risk for complications and treatment considerations for young and very young children.
• Information regarding the oral dosing dispenser included in the Tamiflu® for Oral Suspension packaging and instructions to insure the units of measure on the prescription instructions match the dosing device are also included.
• More information about the possible underlying physiological conditions that may be associated with neuromuscular and neurocognitive disorders that might contribute to the increased risk for flu complications in persons with these types of disorders.

The updated recommendations continue to balance between providing clinicians the information and guidance needed to reach those at greatest risk with appropriate and timely treatment; to reduce the chances of antiviral resistance through inappropriate or unnecessary chemoprophylaxis; and yet to still recognize the overarching importance of clinical judgment in making treatment and chemoprophylaxis decisions. For more information, please visit the CDC's website on this topic at: http://www.cdc.gov/h1n1flu/antiviral.htm

My patient cannot afford to get their antiviral prescription filled. Where can they get assistance?
Florida is working on agreements with different retailers throughout the state to ensure Floridians have access to antiviral medications. The Bureau of Statewide Pharmaceutical Services has developed a Public Antiviral Stockpile Program to ensure healthcare providers have a resource for referring their patients who cannot afford antiviral medications. Patients can be directed to one of several participating pharmacies throughout the state: Publix, Walgreen’s, Winn Dixie and Navarro.

County Health Departments will also have supplies of antiviral medications, so Floridians who need it can get it.

In addition, many healthcare providers are aware of community prescription assistance programs. If you have internet access, you can utilize the Partnership for Prescription Assistance site: http://www.pparx.org/prescription_assistance_programs/free_clinic_finder for information about prescription assistance near you.

What are the doses of the antiviral medications?
Visit the Centers for Disease Control and Prevention website: http://www.cdc.gov/h1n1flu/recommendations.htm#table1 for that information.

Can clinicians prescribe antiviral medications for individuals that they may not have a provider-patient relationship with, and/or have not been examined and/or consulted by the provider?
The Centers for Disease Control and Prevention provides specific recommendations for clinicians on administering either antiviral chemoprophylaxis to asymptomatic high risk close contacts of a confirmed, probable or suspect case of H1N1 flu or administering early antiviral treatment, should signs and symptoms of flu develop in these close contacts. For details, see http://www.cdc.gov/h1n1flu/recommendations.htm. Clinicians must still follow all applicable Florida Statutes, Florida Administrative Code, licensure and scope of practice requirements for issuing such prescriptions.

Do you have any information for pharmacists?
The Centers for Disease Control and Prevention (CDC) has issued recommendations for clinicians on the use of antiviral medications in the treatment and prevention of flu for the 2009-2010 seasons. Oseltamivir (Tamiflu®) and zanamivir (Relenza®) are the two recommended flu antiviral medications at this time. The priority use for these drugs this season is to treat people who are very sick (hospitalized) or people who are sick with flu symptoms and who are at increased risk of serious flu complications, such as pregnant women, young children, people 65 and older and people with chronic health conditions.

The current situation will likely impact the nation's pharmacies as a greater number of people than usual seek to fill prescriptions for flu antiviral medications or antibiotics to treat secondary infections, in addition to seeking advice on over-the-counter flu medications. This may impact supplies and availability of antiviral medications and other materials that may be needed to fill such prescriptions.

At this time, the CDC discussions with the antiviral supply chain (manufacturers, distributors and retailers) indicate that supplies of adult formulation (75 mg) oseltamivir (Tamiflu®) and zanamivir (Relenza®) are meeting current demand for this product. However, the Food and Drug Administration (FDA) and Roche (maker of Tamiflu®) have acknowledged that commercial and stockpiled supplies of Tamiflu® oral suspension are limited.

Pharmacies should be aware of the importance of providing patients with these flu medications as quickly as possible when they are prescribed. Both Tamiflu® and Relenza® work best when administered within 48 hours of onset of symptoms. Having product at the pharmacy store level, including doses of oseltamivir and zanamivir and supplies to compound Tamiflu® if necessary, will be critical to ensuring that patients needing treatment receive it as quickly as possible.

For more information, visit: http://www.cdc.gov/H1N1flu/pharmacist/pharmacist_info.htm

Is there a shortage of oral suspension (liquid) Tamiflu®?
The Food and Drug Administration (FDA) and the maker of Tamiflu® (Roche ) have said that available supplies of liquid Tamiflu® for children are limited.

What is being done about this?
There are child doses of Tamiflu® in capsules (30 mg and 45 mg). It also is possible for a pharmacist to create a liquid children’s dose from dry forms of the medication. The Centers for Disease Control and Prevention is alerting pharmacists, doctors, and parents about these options.

What can I do if my child cannot swallow capsules?
If your doctor prescribes Tamiflu® capsules for your child and your child cannot swallow capsules, the prescribed capsules may be opened and mixed with a sweetened liquid, which may be sugar-free, that the child will consume completely.

What liquids can I use?
A thickened and sweet liquid that masks the flavor of the medicine can be mixed with the contents of the Tamiflu® capsule. Sugar-free sweetened liquids are available. The child should consume the liquid mixture entirely. Examples are: applesauce, corn syrup, pudding, or chocolate/caramel/butterscotch syrup. Honey may be used if the child is older than 1 year. If you have any questions about mixing the medication; contact the pharmacy where you filled the prescription or your healthcare provider’s office.

Do you have information on the emergency compounding of an oral suspension from Tamiflu?
The FDA has posted a statement on their website at http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm100228.htm to remind health care providers and pharmacists of the FDA-approved instructions for the emergency compounding of an oral suspension from Tamiflu® 75mg capsules as described in the FDA approved manufacturer package insert for oseltamivir (Tamiflu ®). (Compounding is the mixing of drugs by a health care professional to fit the unique needs of a patient.)

Can people who are taking antiviral medications receive LAIV?
Patients should be off antiviral medications for 48 hours before getting a LAIV. If antiviral medications are administered to a patient within two weeks of receiving LAIV, then the vaccine dose should not count as valid. Antiviral medications do not interfere with the immune response to inactivated virus vaccines.

» Healthcare: Case Definition and Lab Testing

What is the H1N1 case definition?
The Centers for Disease Control and Prevention (CDC) H1N1 case definition can be found at the following website: http://www.cdc.gov/h1n1flu/casedef.htm

The case definition was last updated by the Centers for Disease Control and Prevention (CDC) on June 1, 2009 12:15 PM ET Flu-like-illness (ILI) is defined as fever (temperature of 100°F [37.8°C] or greater) and a cough and/or a sore throat in the absence of a KNOWN cause other than flu.

A confirmed case of H1N1 virus infection is defined as a person with a flu-like illness AND laboratory confirmed novel flu A H1N1 virus infection by one or more of the following tests:

• real-time RT-PCR
• viral culture

A probable case of H1N1 virus infection is defined as a person with an flu-like-illness who is positive for flu A, but negative for human H1 and H3 by flu RT_PCR

Optional

A suspected case of H1N1 virus infection is defined as a person who does not meet the confirmed or probable case definition, and is not novel H1N1 test negative, and is/has: a previously healthy person < 65 years hospitalized for ILI
OR
ILI and resides in a state without confirmed cases, but has traveled to a state or country where there are one or more confirmed or probable cases
OR
ILI and has an epidemiologic link in the past 7 days to a confirmed case or probable case For further information please contact the Bureau of Epidemiology at 850-245-4401

Testing Recommendations:
The following people should be tested for H1N1 infection through the Florida Bureau of Laboratories:

• People admitted to hospital with life-threatening illness suggesting influenza infection.
• Limited numbers of people who appear to be part of outbreaks of influenza, especially in certain group settings – please see below for further information.
• A sample of people presenting with influenza-like illness at specific practices participating in the Sentinel Practice Influenza Surveillance System.

Others should not be tested through the Florida Bureau of Laboratories.

If influenza is suspected, and if the diagnosis would change the management of the patient, specific testing is required. FDOH supports CDC’s position that “… most patients with an uncomplicated illness consistent with influenza can be diagnosed clinically and do not require influenza testing for clinical management, including antiviral treatment decisions.”

When Do I Report Cases to the County Health Department?

• Report to your county health department people with lab-confirmed or highly suspected influenza who a) have a life-threatening or fatal illness, b) are pregnant or post-partum (up to six weeks) and hospitalized c) have documented repeat influenza infections, d) develop documented influenza in spite of vaccination, e) have documented infections that are highly suspected to be resistant to antiviral therapies or f) are part of outbreaks
• Outbreaks of particular interest are those occurring in settings not seen during the recent wave of influenza, such as retirement communities or nursing homes, or those that have unusual or severe presentations such as hemorrhagic pneumonia. Laboratory testing for influenza is recommended for persons in these groups. Reports may also be made to the Bureau of Epidemiology at 850-245-4401.

» Healthcare: Infection Control

What precautions should I take when treating a patient with H1N1 (or suspected H1N1)?
Standard precautions should be followed for all patient care. For any activity that might generate splashes of respiratory secretions, gowns along with eye protection should be worn. Healthcare workers who are in close contact with patients suspected or confirmed to have 2009 H1N1 flu should wear a fit-tested, disposable N95 respirator.

Some procedures may be higher-risk for potential exposure, such as aerosol generating procedures, that could increase inhalation of respiratory droplets.

Healthcare personnel should:

• Apply isolation precautions - The following isolation precautions are recommended for healthcare personnel who are in close contact with patients with suspected or confirmed 2009 H1N1 flu. For the purposes of this document, close contact is defined as working within 6 feet of the patient or entering into a small enclosed airspace shared with the patient (e.g., average patient room):
• Standard Precautions - For all patient care, use nonsterile gloves for any contact with potentially infectious material, followed by hand hygiene immediately after glove removal; use gowns along with eye protection for any activity that might generate splashes of respiratory secretions or other infectious material. (See http://www.cdc.gov/ncidod/dhqp/gl_isolation_standard.html.)
• Respiratory Protection
• Recommendation: the Centers for Disease Control and Prevention (CDC) continues to recommend the use of respiratory protection that is at least as protective as a fit-tested disposable N95 respirator for healthcare personnel who are in close contact with patients with suspected or confirmed 2009 H1N1 flu. This recommendation applies uniquely to the special circumstances of the current 2009 H1N1 pandemic during the fall and winter of 2009-2010 and CDC will continue to revisit its guidance as new information becomes available, within this season if necessary.
• Use N-95 respirators and eye protection for aerosol generating procedures including:

  1. Bronchoscopy
  2. Open suctioning of airway secretions
  3. Resuscitation involving emergency intubation or cardiopulmonary resuscitation (CPR)
  4. Endotracheal intubation and extubation
  5. Sputum induction
  6. Autopsies
  

To reduce exposure risk, healthcare personnel should only perform these procedures on patients with suspected or confirmed flu when medically necessary and limit the number of healthcare personnel in the room. These procedures may also be conducted in airborne infection isolation rooms, when available. Healthcare personnel should adhere to standard precautions and wear respiratory protection (N95 or higher) when conducting these activities.

The following links outline the current Department of Health guidance related to mask use: http://www.myflusafety.com/SwineFlu/documents/FLGuidanceMasksRespirators081309.pdf

http://www.myflusafety.com/SwineFlu/documents/FlInterimGuidanceforinfectioncontrol081209.pdf

It is important to regularly monitor the official Department of Health website www.myflusafety.com for updates.

Why are the recommendations for respiratory protection of healthcare workers different for H1N1 flu and seasonal flu?
The respiratory protection recommendations for healthcare personnel for protection against H1N1 Flu differ from recommendations for seasonal flu as there is little pre-existing immunity to the H1N1 Flu strain in the population, including healthcare personnel.

Additional Information

» Additional Information: Water

Is there a risk from drinking water?
Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of flu viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. To date, there have been no documented human cases of flu caused by exposure to flu-contaminated drinking water.

Can the H1N1 Flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues?
Flu viruses infect the human upper respiratory tract. There has never been a documented case of flu virus infection associated with water exposure. Recreational water that has been treated at the Centers for Disease Control and Prevention recommended disinfectant levels do not likely pose a risk for transmission of flu viruses.

Can the H1N1 Flu virus be spread at recreational water venues outside of the water?
Yes, recreational water venues are no different than any other group setting. The spread of H1N1 flu is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with flu. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

» Additional Information: Animals and the Flu

What animals can be infected with the H1N1 Flu
In addition to humans, live swine and turkeys, we know that ferrets (which are highly susceptible to flu A viruses) and a domestic cat have been infected with the H1N1 virus. The Centers for Disease Control and Prevention (CDC) is working closely with domestic and international public and animal heath partners to continually monitor this situation and will provide additional information to the public as it becomes available.

How do companion animals become infected with H1N1 Flu?
All available information suggests that the ferrets and domestic cat with H1N1 infections acquired the virus through close contact with ill humans. Transmission of H1N1 virus from humans to animals appears similar to human-to-human transmission

Can I get H1N1 Flu from my pet?
Evidence suggests that transmission has been from ill humans to their companion animals. No evidence is available to suggest that animals are infecting humans with the H1N1 virus.

What do I do if I am sick with flu-like symptoms and I have pets?
If you are sick with flu-like illness, take the same precautions with your pets that you would to keep your family and friends healthy:

• Cover your coughs and sneezes
• Wash your hands frequently
• Minimize contact with your pets until 24 hours after your fever is gone

What should I do if I suspect my pet has the H1N1 Flu virus?
If members of your household have flu-like symptoms, and your pet exhibits respiratory illness, contact your veterinarian.

Is there a vaccine available for my pet?
Currently, there is not a licensed and approved H1N1 vaccine for companion animals. (There is a canine flu vaccine, which protects dogs from the H3N8 canine flu virus, but it will not protect pets against the H1N1 virus and should not be used in any species other than dogs.)

How serious is this disease in companion animals?
Pet ferrets with naturally occurring H1N1 infection have exhibited illness similar in severity as seen with ferrets exposed to seasonal flu viruses and the H1N1 virus in laboratory settings, including sneezing, inactivity, and weight loss. The single confirmed cat exhibited respiratory illness and recovered with supportive care.

The following links provide additional information:
American Veterinary Medical Association
http://www.avma.org/public_health/influenza/default.asp

United States Department of Agriculture
http://www.usda.gov/wps/portal/?navid=USDA_H1N1

Can I get H1N1 Flu from eating or preparing pork?
No. H1N1 Flu viruses are not spread by food. You cannot get flu from eating pork or pork products. It is safe to eat properly handled and cooked pork products. Cooking pork to an internal temperature of 160°F kills bacteria and viruses.

How does swine flu spread among pigs?
Swine flu viruses are thought to spread mostly through close contact among pigs and possibly from contaminated objects moving between infected and uninfected pigs. Herds with continuous swine flu infections and herds that are vaccinated against swine flu may have sporadic disease, or may show only mild or no symptoms of infection.

What are signs of swine flu in pigs?
Signs of swine flu in pigs can include sudden onset of fever, depression, coughing (barking), discharge from the nose or eyes, sneezing, breathing difficulties, eye redness or inflammation, and going off feed.

How common is swine flu among pigs?
H1N1 and H3N2 swine flu viruses are typically found among pig populations in the United States and something that the industry deals with routinely. Outbreaks among pigs normally occur in colder weather months (late fall and winter) and sometimes with the introduction of new pigs into susceptible herds. Studies have shown that the swine flu H1N1 is common throughout pig populations worldwide, with 25 percent of animals showing antibody evidence of infection.

 

More Links and Resources

Listing of County Health Departments including addresses and phone numbers: http://www.doh.state.fl.us/chdsitelist.htm

 

Health Center Locator   http://findahealthcenter.hrsa.gov/

 

Partnership for Prescription Assistance: http://www.pparx.org/prescription_assistance_programs/free_clinic_finder

 

Florida Department of Health flu website: www.myflusafety.com

 

CDC Seasonal Flu http://www.cdc.gov/flu/

 

CDC H1N1 Swine Flu  http://www.cdc.gov/h1n1flu/

 

Health & Human Services Website: http://flu.gov/

 

Partnership for Prescription Assistance: http://www.pparx.org/prescription_assistance_programs/free_clinic_finder

 

SHINE (Serving Health Insurance Needs of Elders) http://elderaffairs.state.fl.us/shine/presassis.html 

 

 

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