H1N1 Update

H1N1 continues to spread in Maine, especially in the southern half of the state, and Maine is one of 11 states reporting widespread influenza activity. Although we have an overall total of 61 cases identified by testing in Maine (50 among Maine residents and 11 among those visiting or staying in Maine) it is important to note that individual case data are useful only in that they are markers of the presence of H1N1 and community transmission in a given county or geographical area. Most people with H1N1 do not need testing (such as symptomatic close contacts of confirmed cases or people with mild illness), and their illness is not reflected in the case counts. Counties or regions with no reported cases may still be affected.

Some Highlights from the Data:

• 
  Over half of those confirmed with H1N1 since late April in Maine are under the age of 25, confirming the higher spread seen nationally among children and young adults. Only one confirmed case in Maine is over 60 years old.
• Although most cases are from the southern and mid coast regions of Maine, there has been a recent increase in cases from Androscoggin County.
• A total of 4 Maine people have been hospitalized for H1N1; two have been discharged and two remain hospitalized. The preliminary hospitalization rate in Maine and some other states is approximately 5 – 12%, and appears highest among pregnant women, young – middle aged adults, and children, especially those with underlying conditions such as asthma, other lung diseases and chronic conditions. This is in contrast to the hospitalization rate of seasonal influenza, which is about 1% and is highest among those 65 and older.
  Cases have been identified in 4 summer camps, 1 jail, and among students from a number of different schools.
• Several recent cases have a common history of travel to other areas of New England, such as the Greater Boston area, or visits from relatives from these areas, emphasizing the importance of vigilant respiratory hygiene.
• Many cases have no history of travel or contact with a known case, and therefore are evidence of community transmission.
• As the H1N1 spreads we expect to see some increase in severity, as has been seen in other states.
  

Other H1N1 Data Updates:
Maine The Maine CDC public health laboratory (HETL) has performed about 2,200 influenza tests this past 2 months with PCR technology, and is now confirming H1N1 sub-typing.
http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml
New England 2,286 confirmed cases (with most states limiting testing to those who are hospitalized) and 5 deaths (1 in MA & RI, 3 in CT)
MA updates: http://publichealth.blog.state.ma.us/h1n1-swine-flu/
U.S. 21,449 confirmed cases with many times this number as the expected true number of cases, and 87 deaths. All 50 states affected. http://www.cdc.gov/h1n1flu/update.htm
International http://www.who.int/csr/disease/swineflu/en/index.html
WHO raised the level of the influenza pandemic alert from a phase 5 to a phase 6 on June 11, 2009. 74 countries have officially reported almost 45,000 cases, including at least180 deaths.

Mitigation:
It is especially important for those associated with any gathering or grouping of people (employment settings, reunions, meetings, youth camps, etc) to make sure the tools and reminders are readily available to maintain respiratory etiquette. Examples include making sure soap/water, hand sanitizer, tissues, and reminder posters are easily available.
In addition to these prevention recommendations it is also important for any setting where people are congregated routinely (employment settings, child care, day camps, shelters, etc) or for a length of time (overnight camps, prisons, cruises, etc) that measures are taken to assure appropriate: exclusion of ill participants and sometimes those at high risk for complications; screening for symptoms; and isolation and treatment of ill participants. Details and other guidance are found in the links below.

Several high priority areas include:
Pregnant Women (who are at high risk for complications from H1N1)
Guidance for Pregnant Women Likely to Be Exposed to H1N1 (those working in health care, education, child care)
http://www.cdc.gov/h1n1flu/guidance/pregnant-hcw-educators.htm
What Pregnant Women Should Know About H1N1
http://www.cdc.gov/h1n1flu/guidance/pregnant.htm
Guidance for Clinicians Caring for Pregnant Women
http://www.cdc.gov/h1n1flu/clinician_pregnant.htm
Summer Gatherings (family reunions, BBQs, weddings, parties, meetings, etc)
http://www.cdc.gov/h1n1flu/guidance/public_gatherings.htm
Day and Residential Camps
http://www.cdc.gov/h1n1flu/camp.htm
Homeless and Domestic Violence Shelters
http://www.cdc.gov/h1n1flu/guidance/homeless.htm
Child Care Facilities and School Programs
http://www.cdc.gov/h1n1flu/K12_dismissal.htm
Correctional facilities
http://www.cdc.gov/h1n1flu/guidance/correctional_facilities.htm
Travelers’ Health
http://wwwn.cdc.gov/travel/content/novel-h1n1-flu.aspx
Cruise Boats
http://www.cdc.gov/h1n1flu/guidance/cruiseships.htm
Businesses and Employers
http://www.cdc.gov/h1n1flu/business/
Taking Care of a Sick Person in Your Home
http://www.cdc.gov/h1n1flu/guidance_homecare.htm

Shared Responsibility for All People:

Maintain Respiratory Etiquette:
Cover coughs and sneezes with sleeves or a tissue. Sneezes can travel 100 miles per hour and the wet spray can radiate 6 feet. Droplets from an infected person can get into the air from sneezing, coughing, or simply talking, then can be inhaled by and infect people nearby, especially within 6 feet.
Wash hands frequently with soap and water or hand sanitizer, especially after you: cough, sneeze or wipe your nose; use the bathroom; have had contact with a sick person; touch handrails, doorknobs or other things handled by many people; before eating; and after handling garbage. Influenza germs can live for hours on surfaces like hands, doorknobs and other commonly touched surfaces, and can easily spread when a person touches these contaminated items then touches their eyes, nose, or mouth.
Avoid touching your eyes, nose, or mouth since germs spread this way.
Avoid close contact with sick people.
Stay home if you are ill.
If you are sick with an influenza-like illness (fever and other symptoms including a sore throat or cough), stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep you from infecting others and spreading the virus.
Stay informed since this event and guidance are changing.
Make preparations. If you do not have a pandemic influenza plan, then use a preparation check lists for your setting or situation, found at: http://www.pandemicflu.gov/plan/checklists.html.
Vaccination:

Seasonal Influenza Vaccine
Maine CDC and the Department of Education are partnering to offer free seasonal influenza vaccine to children through interested local schools this fall. We are very appreciative to partners in health care, public health, emergency management, and others who are reaching out to schools on these local initiatives. For more information on how you can become involved, check the recent health advisory on this subject at: http://www.maine.gov/tools/whatsnew/attach.php?id=74633&an=1
US CDC Power Point Overview of School-Based Seasonal Vaccines: http://www.ct.gov/dph/lib/dph/infectious_diseases/immunization/pdf/school_flu_clinic_march_2009_vogt_slides.pdf
H1N1 Influenza Vaccine

We anticipate and are planning for H1N1 vaccine to be available this fall. We ask that health organizations, emergency management, and others start planning for this. We expect much more information available in the coming weeks.
Some large scale vaccine planning guidance can be found at: http://www.cdc.gov/flu/professionals/vaccination/vax_clinic.htm
Updated information on H1N1 vaccine can be found at:
http://www.pandemicflu.gov/vaccine/index.html
Communication:
Basic Resources:
US CDC H1N1: http://www.cdc.gov/h1n1/
Maine CDC H1N1: http://www.maine.gov/dhhs/boh/swine-flu-2009.shtml
This is also found through the Maine CDC’s homepage:
www.mainepublichealth.gov
Maine Department of Education H1N1 page: http://www.maine.gov/education/h1n1/index.html
Maine CDC’s 24 hour clinical consultation line for health care providers or officials needing to report a suspected case, obtain testing information, or obtain clinical guidance: 1-800-821-5821
Maine CDC’s Health and Environmental Testing Laboratory (HETL) will perform influenza RT-PCR tests and sub-typing for influenza A positive specimens. Instructions on collecting and submitting laboratory diagnostic specimens for H1N1 influenza testing are available at http://www.maine.gov/dhhs/etl/micro/submitting_samples.htm.
Maine CDC Public Information Line: 1-888-257-0990 weekdays from 9am to 5pm.

Other Resources:
Posters and Flyers
http://www.maine.gov/dhhs/boh/Flu%20Posters.htm
http://www.cdc.gov/h1n1flu/flyers.htm
Foreign Language, Deaf/Hard of Hearing Materials
http://www.maine.gov/DHHS/boh/h1n1-foreign-lang-resources.shtml
Social Media Resources on H1N1
http://www.cdc.gov/socialmedia/h1n1/

H1N1 Update

Maine CDC has identified a total of 17 cases of H1N1 (14 confirmed and 3 probable) among Maine residents, along with an additional 4 out of state residents who were ill and tested while staying in Maine, for an overall total of 21. This total includes 7 additional cases this week, 5 in Cumberland County and 2 in York County. One of the two New York County residents is hospitalized. One of the new Cumberland County residents is a Brunswick High School student. Four recent cases are residents of the Brunswick area, indicating possible clustering in that area, and include 3 children or youth. Out of the 17 cases: 2 are health care workers; 3 have been hospitalized, and 1 of these remains hospitalized; 27 is the average age, with a range of 3 - 60 years; 7 are under the age of 18, with 3 being students of K-12 schools. Of the overall total of 21, 14 had an out of state travel history during the likely period of exposure, including 6 who traveled to other parts of New England or New York State. Of the 4 out of state residents, 1 was tested in York County, 1 in Hancock, 2 in Lincoln County. The Maine CDC public health laboratory (HETL) has performed over 1,700 influenza PCR tests this past month, and is now able to do confirmatory H1N1 testing, eliminating the need have specimens confirmed at US CDC.

Acting Surgeon General Promotes “Healthy Youth for a Healthy Future” and National Physical Fitness and Sports Month in the Nation’s Capitol

Acting Surgeon General Steven K. Galson, M.D., M.P.H., will make another stop on his nationwide tour to celebrate National Physical Fitness and Sports Month and promote the U.S. Department of Health and Human Services' Childhood Overweight and Obesity Prevention Initiative on May 18 in Washington, D.C. The initiative targets obesity prevention and the promotion of healthy lifestyles for young people.
The Healthy Youth for a Healthy Future project brings well deserved attention to communities throughout America that are coming together to address childhood overweight and obesity prevention. The project also recognizes local programs that use innovative approaches to encourage kids to eat right and exercise.
Rear Adm. Galson will present a Surgeon General’s Champion Award to the “Lighten Up” Campaign, a partnership between Children’s National Medical Center, Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., and W*USA 9 during an event with students at the Browne Educational Campus. In addition to the Champion Award ceremony, the students will participate in The Amazing Food Detective, presented by Kaiser Permanente's Educational Theater Program which includes interactive play focused on healthy diets. Dominique Dawes, Olympic Gold Medalist, and Lt. Andy Baldwin, M.D., an Ironman Triathlete, lieutenant in the U.S. Navy, and also known as “The Bachelor” from the tenth season of the reality show will also lead the students in a physical activity exercise.
“National Physical Fitness and Sports Month is a great opportunity to remind ourselves of the important benefits of being active” said Rear Adm. Galson. “The ‘Lighten Up’ campaign is an example of achievement that results from powerhouse organizations coming together to help our young people develop healthy habits that will last them a lifetime.”
The ‘Lighten Up’ Campaign engages public policy representatives to support educational efforts and encourages parents, primary care providers and school nurses to use interactive resources to combat childhood obesity.
“There is no better place to combat childhood obesity than in the nation’s capital, where we have the highest rate of overweight 10 to 17 year-olds in the country,” said Denice Cora-Bramble, MD, MBA, senior vice president of the Diana L. & Stephen A. Goldberg Center for Community Pediatric Health at Children’s National Medical Center. “As part of the LightenUp campaign, the Obesity Institute at Children’s National aims to help children and families nationwide avoid the health risks associated with childhood obesity, such as heart disease, and diabetes.”
“This campaign is about more than achieving a healthy weight, it's about living a healthier lifestyle," said Marilyn Kawamura, president of Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. "Our exclusive physician partners in the Mid-Atlantic Permanente Medical Group see the complications everyday and know all too well the best prescription for anyone is exercise as medicine for a happier, healthier life."
Childhood overweight is a serious health concern for children and adolescents in the United States. Since 1980, obesity has more than doubled among children ages two to five and more than tripled among youth ages six to 11 and adolescents ages 12-19. Additional information on the Surgeon General's Initiative can be found at http://www.surgeongeneral.gov/obesityprevention/index.html.

Nationwide MRC Response to H1N1

Since the initial announcement of the 2009 H1N1 Influenza outbreak, many MRC units have reported that they are maintaining their situational awareness, reviewing their pandemic response plans with their local public health, medical and emergency response partners, and planning for possible SNS distributions of antiviral medications. In addition, many MRC have conducted H1N1 flu-related activities in their communities, and you will find descriptions of these activities below.

To help us maintain our situational awareness, please make sure your MRC unit profile (http://www.medicalreservecorps.gov/login.asp) is current and accurate, and ensure that your unit's recent activities – especially those related to the H1N1 flu - are noted. We will continue to share this information with key leaders within HHS, including the Surgeon General, as well as with partner programs and others through reports and additional listserv messages. By being fully aware of the activities taking place across the country, we will best be able to tell the story of how the MRC made a positive impact during this public health emergency.

Your efforts and continued hard work are appreciated, and we look forward to reading and reporting on more of your responses.

REGION I

Massachusetts

Boston MRC hosted a H1N1 training for response and leadership level volunteers.
Amherst Health Department MRC staffed a First Aid station at local fair to distribute information on H1N1 and to display information on emergency and personal preparedness.

REGION II

New Jersey

Burlington MRC assisted local health authorities by staffing phones and working on issues related to patient tracking/follow-up.
Monmouth County MRC sent 2 volunteers to state call center to answer questions about H1N1 (approximately 2400 calls were received).

New York

New York City MRC physician volunteers assisted the NYC Dept of Health & Mental Hygiene with staffing of the Provider Access Line call center to answer questions related to H1N1.

REGION III

Maryland

Montgomery County MRC opened their Public Health Information Line (PHIL). The MRC volunteers have been utilized for every shift to answer phones and take questions from the community.

Pennsylvania

Southern Alleghenies EMS Council MRC made 250 H1N1 bags to hand out to church members to provide information from CDC on H1N1.

Virginia

Loudoun County MRC, Eastern Shore MRC, and Henrico County MRC all have volunteers that are assisting with logistics within their local EOC’s and assisting in call centers to convey public health information related to the H1N1 virus.

REGION IV

Alabama

North Alabama MRC was activated by the Huntsville/Madison County EMA to staff a phone bank with MRC volunteer nurses and physicians to answer questions and take information regarding the H1N1 influenza.

Florida

Flagler MRC is assisting the Department of Health and scheduling presentations dealing with Pandemic flu to the faith based organizations in the area

Kentucky

Gateway District Health Department MRC is assisting in a public information campaign concerning the H1N1 virus and all volunteers have been put on stand-by.

North Carolina

Chatham MRC volunteers provided public health education on H1N1 by reaching out to 200 adults and distributed 45 children’s disaster preparedness coloring books to prepare the community on emergency preparedness and response.

REGION V

Illinois

Douglas County MRC was activated to staff a call center. Volunteers are also assisting in SNS drop site activities
Maine Township MRC assisted the local hospital with their potential need for surge capacity.
Will County MRC was activated to staff a call center.
Oak Park Department of Public Health is on an active stand-by alert status after deployment of a SNS to state of Illinois.
Bureau & Putnam County MRC have been put on alert to answer calls for questions and concerns related to H1N1.

Indiana

The Allen County MRC, in partnership with the local health department, established a hotline for local residents to call with questions and concerns about the H1N1 virus.

Ohio

Franklin County MRC Volunteers underwent training on Contact Investigation and are staffing call centers
Logan County MRC called 98 community leaders to invite them to an H1N1 community planning meeting.
Holmes County MRC assisted in diagnostic testing of patients with risk factors for H1N1 flu.
Lorain County MRC was activated to staff a call center to answer question about the H1N1 outbreak.

Wisconsin

Southeast Wisconsin MRC volunteers are staffing call centers, and clinics where they are performing diagnostic testing on patients.

REGION VI

Arkansas

South Arkansas MRC volunteers are distributing information on H1N1 flu to local pharmacies, convenient stores, grocery stores, and other locations.
Western Arkansas River Valley MRC educated local clinicians and volunteers about H1N1 Flu identification and treatment.

Louisiana

Calcasieu Parish MRC is helping the Regional Office of Public Health in Lake Charles, LA with calls to hospitals, doctors’ offices and other healthcare facilities to check on their needs and current availability of supplies. They also are delivering test kits to healthcare facilities. Volunteers also have been involved in community mitigation efforts, teaching proper hand washing at local schools. Approximately 22 volunteers have been involved with this effort.
Northwest Louisiana MRC is providing care to local residents at free clinic. They also are providing education to vulnerable populations in the Caddo-Bossier area.
New Orleans MRC volunteers have been involved in community education on H1N1 flu and recruitment of volunteers.

New Mexico

Southern New Mexico MRC has provided H1N1 updates to their partners including Americorps, American Red Cross, American Legion, and New Mexico State University Health Programs. They also have assisted in coordination of community planning and mitigation efforts. They held a briefing for the local Onate High Junior MRC on a potential role with community education.

Oklahoma

18 MRC units have been activated to assist state health department personnel with staffing their phone bank. The phone bank is expanding its hours of operation due to high call volume. This information line is answering calls from medical providers as well as the general public

Texas

Dallas County MRC is assisting with staffing phone lines and distributing informational flyers from the County Health Department at bus stops across the county.
Brazoria County MRC is assisting the county Emergency Management Agency. They are staffing phone bank for incoming calls from concerned citizens and will be assisting with preparedness activities. They are validating phone lists of community partners and gathering emergency contact information for every pharmacy in the county.
Denton County MRC volunteers are staffing the drop off and pick up laboratory at the Health Department. The lab is supporting local doctors’ offices that need the Health Department to collect their specimens. Volunteers also distributed information flyers to patients visiting the health department.
Tarrant County volunteers are providing assistance with conducting basic contact investigations, staffing phones, and with assembling flu kits.
Gregg County MRC is assisting Gregg County Health Department with public information distribution on H1N1 Flu.

REGION VIII

Colorado

Boulder County MRC volunteers are answering phone calls from community on H1N1 flu and preparing to assist with medication distribution if needed.
Fremont County MRC is organizing and delivering information packets on H1N1 flu to physician's offices.
Mesa County MRC volunteers are making presentations to community on H1N1 flu.

Utah

Davis County MRC is conducting a POD training in anticipation of future mass vaccinations.

REGION IX

Arizona

Medical Reserve Corps of Southern Arizona (MRCSA) members are staffing alternate care sites, and the Student MRC has been placed on alert. Mental Health members met for response planning. MRCSA Task Force members are currently staffing the Health Department’s Call Center.

California

The San Francisco MRC leader was featured on a local television news station regarding H1N1 preparedness.
Orange County MRC was activated to assist in the receiving of supplies from the Stockpile. The MRC volunteers were able to receive and inventory the cache in one hour. Orange County MRC was also asked to provide some nurses to assist Public Health with their H1N1 Flu Hotline. Four MRC nurses volunteered in four hour shifts.
Sacramento Regional MRC is assisting Sacramento County Public Health with picking-up lab specimens from area health facilities and transporting them to the lab. Volunteers delivered testing kits to and picked up lab specimens 18 times from area health facilities and transported the specimens to the Sacramento County Public Health Lab. Requests to transport lab specimens are increasing. They currently have 10-12 volunteers available per day to make the pick-ups and deliveries.
The Marin County MRC had 44 volunteers active, working 355 hours. The volunteers donated $15, 074 worth of services. They provided the following services: Department Operations Center (DOC) set-up and logistical support; public "Hotline" training and staffing; providing DOC Unit Leaders; providing a Public Health Nursing Liaison; Mental Health support for DOC Staff and hotline call takers; field intelligence gathering; providing an IT technical specialist; providing administrative support; providing county laboratory support; and augmenting clinic and hospital staffing.

REGION X

Washington

Thurston County MRC has been deployed to assist the local health department with communication to special populations, phone triage, surveillance, and assistance to the health officer. In addition the MRC coordinator will be utilizing MRC volunteers to recruit for future fall flu season.
Whatcom County MRC volunteers have been involved in respirator fit testing for the local hospital. They are running 4 fit test stations from 7 am to 1 am with a goal to perform fit testing on 1000 people over 20 days. They also are staffing a telephone triage call line. Whatcom County MRC also developed a potential Alternate Care Facility for surge capacity in event of hospital overflow. Whatcom County MRC staffed a phone bank in conjunction with Peace Health St. Joseph’s Hospital.
Snohomish County MRC volunteers are staffing a call center, seven days a week, from 9am to 4pm to answer questions about H1N1 influenza.