Vacine Recommendations For A(H1N1)

When the vaccine for influenza A(H1N1) becomes available, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) recommends that the following groups be vaccinated:

• pregnant women
• people who live with or care for children less than 6 months old
• health care and emergency services personnel
• people between the ages of 6 months through 24 years of age
• people ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems

In the event of a vaccine shortage, the ACIP recommends that the following groups receive the vaccine before others:

• pregnant women
• people who live with or care for children less than 6 months of age
• health care and emergency services personnel with direct patient contact
• children between 6 months and 4 years of age
• children ages 5 through 18 years of age who have chronic medical conditions

To decrease the incidence of secondary pneumococcal pneumonia, the CDC is also recommending prophylactic administration of 23-valent pneumococcal polysaccharide vaccine (PPSV23) during the outbreak of novel influenza A(H1N1). The recommendations of the CDC's Advisory Committee on Immunization Practices (ACIP) are as follows:

• Vaccination for all persons over 65 years of age
• Vaccination for persons 2 to 64 years with the following medical conditions:
  
  
  • Chronic cardiovascular disease (congestive heart failure and cardiomyopathies)
  • Chronic pulmonary disease, including COPD and emphysema
  • Diabetes mellitus
  • Alcoholism
  • Chronic liver disease, including cirrhosis
  • Cerebrospinal fluid leaks
  • Functional or anatomical asplenia, including sickle cell disease and splenectomy
  • Immunocompromised 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
  
  
  
  
• Vaccinations for persons 19 to 64 years who have asthma or smoke.

*Note: A single revaccination at least five years after initial vaccination is recommended for people 65 years and older who were first vaccinated before age 65 years as well as for people at highest risk, such as those who have no spleen, and those who have HIV infection, AIDS or malignancy.

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Learn How To Treat And Prevent A(H1N1)

The CDC has outlined specific antiviral guidelines for prevention and treatment of confirmed, probable, and suspected cases of patients with influenza A(H1N1) and their close contacts.

Current antiviral dosing recommendations are as follows:

oseltamivir (Tamiflu)

To prevent influenza A(H1N1).
 
Adults: 75 mg capsule by mouth (P.O.) once daily for 10 days
Children 12 months and older weighing greater than 40 kg: 75 mg P.O. once daily for 10 days
Children 12 months and older weighing 24 kg to 40 kg: 60 mg P.O. once daily for 10 days
Children 12 months and older weighing 16 kg to 23 kg: 45 mg P.O. once daily for 10 days
Children 12 months and older weighing 15 kg or less: 30 mg P.O. once daily for 10 days
Infants 6 to 11 months: 25 mg P.O. once daily for 10 days
Infants 3 to 5 months: 20 mg P.O. once daily for 10 days
Infants less than 3 months: Not recommended unless situation judged critical due to limited data on use in this age group.

To treat influenza A(H1N1).
 
Adults: 75 mg capsule P.O. twice daily for 5 days
Children 12 months and older weighing greater than 40 kg: 150 mg P.O. per day divided into two doses for 5 days
Children 12 months and older weighing 24 kg to 40 kg: 120 mg P.O. per day divided into two doses for 5 days
Children 12 months and older weighing 16 kg to 23 kg: 90 mg P.O. per day divided into two doses for 5 days
Children 12 months and older weighing 15 kg or less: 60 mg P.O. per day divided into two doses for 5 days
Infants 6 to 11 months: 25 mg P.O. twice daily for 5 days
Infants 3 to 5 months: 20 mg P.O. twice daily for 5 days
Infants less than 3 months: 12 mg P.O. twice daily for 5 days

Click here for complete prescribing information for oseltamivir (Tamiflu).
Click here for drug information from NDH2009

zanamivir (Relenza)

To prevent influenza A(H1N1)
 
Adults: Two 5 mg inhalations (10 mg total) once per day for 10 days
Children 5 years and older: Two 5 mg inhalations (10 mg total) once per day for 10 days

To treat influenza A(H1N1)
 
Adults: Two 5 mg inhalations (10 mg total) twice per day for 5 days
Children 7 years and older: Two 5 mg inhalations (10 mg total) twice per day for 5 days

Click here for complete prescribing information for zanamivir (Relenza).
Click here for drug information from NDH2009.

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Are Vaccines Ready For A(H1N1)?

Vaccines are not ready yet for A(H1N1) but work is well under way to develop such a vaccine. Making new influenza vaccines ready to immunize people generally takes five to six months after first identification of the pandemic virus. The pandemic influenza A (H1N1) 2009 virus was identified at the end of April 2009.

How quickly will pandemic influenza A (H1N1) vaccines be available for use?
The very first doses of influenza A (H1N1) vaccine usable to immunize people, from one or more manufacturers, are expected as early as September 2009.

What implications does the declaration of a pandemic (phase 6) have on influenza vaccine production?
When the WHO Director-General declared the influenza A (H1N1) pandemic on 11 June 2009, she noted that production of seasonal influenza vaccines would be completed soon and that full industrial production capacity would then be available to ensure the largest possible supply of pandemic vaccine in the months to come.

Which manufacturers will make pandemic influenza A (H1N1) vaccines?
There are currently around twenty vaccine manufacturers with licenses to produce seasonal influenza vaccines. There are other qualified vaccine manufacturers who are preparing to make influenza A (H1N1) vaccine, but do not yet have a licensed seasonal influenza vaccine.

What is the global manufacturing capacity for a potential influenza A (H1N1) pandemic vaccine?
Based on a global survey made by WHO on 15 May 2009, a maximum of 4.9 billion doses potentially could be produced in 12 months, but only if several assumptions are met. First, full global manufacturing capacity is devoted to this production. Second, production yields for influenza A (H1N1) vaccine are similar to those usually obtained for seasonal vaccines. Third, each manufacturer uses the vaccine formulation that is most "dose-sparing" (i.e. using a smaller quantity of active principle). A more conservative estimate of global capacity is at least 1 to 2 billion doses per year. The numbers of persons who might be vaccinated will not be known until it is determined whether one or two doses of the vaccine will be needed to achieve protection.

What technologies will be used to grow pandemic influenza A (H1N1) viruses to make vaccines?
Most of these vaccines will be produced using chicken eggs, while a few manufacturers are using cell culture technology for vaccine production.

How is the production capacity for influenza vaccines distributed geographically?
Around 70% of the global seasonal influenza vaccine production capacity today is located in Europe and North America, with further significant manufacturing capacity in Australia, Japan and China. During the past three years, six manufacturers in developing countries have begun to acquire the technology to produce influenza vaccines and have received technical and financial support from WHO. Since May 2009, five additional new producers have joined this initiative.

Will there be enough pandemic influenza A (H1N1) vaccine for everyone?
When pandemic vaccine first becomes available, it is anticipated that the demand will be greater than the supply. This gap will narrow as more vaccine becomes available over time.

Who will receive priority for vaccination?
WHO is working with the Strategic Advisory Group of Experts (SAGE) on Immunization and partners on the options for deciding in which target groups vaccination should begin first. At its July 7 meeting, SAGE recommended that health care workers worldwide should be immunized as a first priority (see: Pandemic (H1N1) 2009 briefing note 2 below). Ultimately, national authorities will identify priority groups for vaccination based on circumstances within the country.

Will developing countries have access to pandemic influenza vaccines?
The WHO Director-General has called for international solidarity to provide fair and equitable access for all countries to pandemic vaccine when it becomes available. WHO has requested that manufacturers set aside future influenza A (H1N1) vaccines for developing country populations, through donations or affordable pricing arrangements.

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What Shall I Do With A(H1N1)

What can I do to protect myself from catching influenza A(H1N1)?
The main route of transmission of the new influenza A(H1N1) virus seems to be similar to seasonal influenza, via droplets that are expelled by speaking, sneezing or coughing. You can prevent getting infected by avoiding close contact with people who show influenza-like symptoms (trying to maintain a distance of about 1 metre if possible) and taking the following measures:

• avoid touching your mouth and nose;
• clean hands thoroughly with soap and water, or cleanse them with an alcohol-based hand rub on a regular basis (especially if touching the mouth and nose, or surfaces that are potentially contaminated);
• avoid close contact with people who might be ill;
• reduce the time spent in crowded settings if possible;
• improve airflow in your living space by opening windows;
• practise good health habits including adequate sleep, eating nutritious food, and keeping physically active.

What about using a mask? What does WHO recommend?
If you are not sick you do not have to wear a mask. If you are caring for a sick person, you can wear a mask when you are in close contact with the ill person and dispose of it immediately after contact, and cleanse your hands thoroughly afterwards. If you are sick and must travel or be around others, cover your mouth and nose. Using a mask correctly in all situations is essential. Incorrect use actually increases the chance of spreading infection.

How do I know if I have influenza A(H1N1)?
You will not be able to tell the difference between seasonal flu and influenza A(H1N1) without medical help. Typical symptoms to watch for are similar to seasonal viruses and include fever, cough, headache, body aches, sore throat and runny nose. Only your medical practitioner and local health authority can confirm a case of influenza A(H1N1).

What should I do if I think I have the illness?
If you feel unwell, have high fever, cough or sore throat:

• stay at home and keep away from work, school or crowds;
• rest and take plenty of fluids;
• cover your nose and mouth when coughing and sneezing and, if using tissues, make sure you dispose of them carefully.
• Clean your hands immediately after with soap and water or cleanse them with an alcohol-based hand rub;
• if you do not have a tissue close by when you cough or sneeze, cover your mouth as much as possible with the crook of your elbow;
• use a mask to help you contain the spread of droplets when you are around others, but be sure to do so correctly;
• inform family and friends about your illness and try to avoid contact with other people;
• If possible, contact a health professional before traveling to a health facility to discuss whether a medical examination is necessary.

Should I take an antiviral now just in case I catch the new virus?
No. You should only take an antiviral, such as oseltamivir or zanamivir, if your health care provider advises you to do so. Individuals should not buy medicines to prevent or fight this new influenza without a prescription, and they should exercise caution in buying antivirals over the Internet.

What about breastfeeding? Should I stop if I am ill?
No, not unless your health care provider advises it. Studies on other influenza infections show that breastfeeding is most likely protective for babies - it passes on helpful maternal immunities and lowers the risk of respiratory disease. Breastfeeding provides the best overall nutrition for babies and increases their defense factors to fight illness.

When should someone seek medical care?
A person should seek medical care if they experience shortness of breath or difficulty breathing, or if a fever continues more than three days. For parents with a young child who is ill, seek medical care if a child has fast or labored breathing, continuing fever or convulsions (seizures).

Supportive care at home - resting, drinking plenty of fluids and using a pain reliever for aches - is adequate for recovery in most cases. (A non-aspirin pain reliever should be used by children and young adults because of the risk of Reye's syndrome.)

Should I go to work if I have the flu but am feeling OK?
No. Whether you have influenza A(H1N1) or a seasonal influenza, you should stay home and away from work through the duration of your symptoms. This is a precaution that can protect your work colleagues and others.

Can I travel?
If you are feeling unwell or have symptoms of influenza, you should not travel. If you have any doubts about your health, you should check with your health care provider.

Is it safe to travel?
Yes. WHO is not recommending travel restrictions related to the outbreak of the influenza A(H1N1) virus. Today, global travel is commonplace and large numbers of people move around the world for business and leisure. Limiting travel and imposing travel restrictions would have very little effect on stopping the virus from spreading, but would be highly disruptive to the global community.

Influenza A(H1N1) has already been confirmed in many parts of the world. The global response now focuses on minimizing the impact of the virus through the rapid identification of cases, and providing patients with appropriate medical care, rather than on stopping its spread internationally.

Although identifying signs and symptoms of influenza in travellers can help track the path of the outbreak, it will not reduce the spread of influenza, as the virus can be transmitted from person to person before the onset of symptoms.

Scientific research based on mathematical modelling shows that restricting travel would be of limited or no benefit in stopping the spread of disease. Historical records of previous influenza pandemics, as well as experience with SARS, validate this.

Does WHO recommend screenings at country entry and exit points to detect if ill people are travelling?
No. We do not believe entry and exit screenings would work to reduce the spread of this disease. However country-level measures to respond to a public health risk are the decision of national authorities, under the International Health Regulations 2005.

Countries that adopt measures that significantly interfere with international traffic (e.g. delaying an airplane passenger for more than 24 hours, or refusing country entry or departure to a traveller) must provide WHO with the public health reasoning and evidence for their actions. WHO will follow up with all of its Member countries on such matters.

Travellers should always be treated with dignity and respect for their human rights.

How can I protect myself from influenza A(H1N1) when I am travelling?
People who are ill should delay travel plans. Returning travellers who become ill should contact their health care provider.

Travellers can protect themselves and others by following simple prevention practices that apply while travelling and in daily life.

Are some people more at risk?
More study is needed to determine if some populations (i.e. younger or older people, or people with other medical conditions) could be affected by the outbreak, of if they are at higher risk for severe illness. WHO recommends that everyone take precautions to prevent the spread of infection.

Are there any special recommendations for pregnant women?
Yes, they are vulnerable. Like everyone, they should take all the necessary precautions.

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A (H1N1) Frequently Asked Questions - Part 1

The spread of A (H1N1) are already getting crazy. A lot of people are dying each day. In Malaysia alone there are already 38 death cases with a total number of 2,253 cases as of August 11, 2009 and still counting and few victims are children ages under 10 years old.

So it is high time for us to be vigilant and be cautious of our health and our environment. Below you will find Frequently Asked Questions on A(H1N1) hoping to eradicate and reduce the pandemic.

What is the new influenza A(H1N1)?
This is a new influenza A(H1N1) virus that has never before circulated among humans. This virus is not related to previous or current human seasonal influenza viruses. This pandemic influenza A (H1N1) 2009 virus was identified at the end of April 2009.

How do people become infected with the virus?
The virus is spread from person-to-person. It is transmitted as easily as the normal seasonal flu and can be passed to other people by exposure to infected droplets expelled by coughing or sneezing that can be inhaled, or that can contaminate hands or surfaces.

To prevent spread, people who are ill should cover their mouth and nose when coughing or sneezing, stay home when they are unwell, clean their hands regularly, and keep some distance from healthy people, as much as possible.

There are no known instances of people getting infected by exposure to pigs or other animals.

The place of origin of the virus is unknown.

What are the signs and symptoms of infection?
Signs of influenza A(H1N1) are flu-like, including fever, cough, headache, muscle and joint pain, sore throat and runny nose, and sometimes vomiting and diarrhoea.

Why are we so worried about this flu when hundreds of thousands die every year from seasonal epidemics?
Seasonal influenza occurs every year and the viruses change each year - but many people have some immunity to the circulating virus which helps limit infections. Some countries also use seasonal influenza vaccines to reduce illness and deaths.

But influenza A(H1N1) is a new virus and one to which most people have no or little immunity and, therefore, this virus could cause more infections than are seen with seasonal flu. WHO is working closely with manufacturers to expedite the development of a safe and effective vaccine but it will be some months before it is available.

The new influenza A(H1N1) appears to be as contagious as seasonal influenza, and is spreading fast particularly among young people (from ages 10 to 45). The severity of the disease ranges from very mild symptoms to severe illnesses that can result in death. The majority of people who contract the virus experience the milder disease and recover without antiviral treatment or medical care. Of the more serious cases, more than half of hospitalized people had underlying health conditions or weak immune systems.

Most eople experience mild illness and recover at home. When should someone seek medical care?

A person should seek medical care if they experience shortness of breath or difficulty breathing, or if a fever continues more than three days. For parents with a young child who is ill, seek medical care if a child has fast or labored breathing, continuing fever or convulsions (seizures).Supportive care at home - resting, drinking plenty of fluids and using a pain reliever for aches - is adequate for recovery in most cases. (A non-aspirin pain reliever should be used by children and young adults because of the risk of Reye's syndrome.)

Is it safe to eat pork and pork products?
Yes. influenza A(H1N1) has not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs. The influenza A(H1N1) virus is killed by cooking temperatures of 160°F/70°C, corresponding to the general guidance for the preparation of pork and other meat.

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