Swine Flu

MMS President: Get a Flu Shot and Check Vaccination Updates

Posted in Health, Physician Focus, Public Health, Swine Flu on October 7th, 2010 by MMS Communications – Comments Off on MMS President: Get a Flu Shot and Check Vaccination Updates

Flu season approaches, and public health officials this year arevaccination 5 encouraging everyone over six months old to get their flu shot as soon as possible. That’s good advice. But in a published article earlier this week in local media, Massachusetts Medical Society President Alice Coombs, M.D., encourages everyone not to stop with just a flu shot. She’s urging patients to review all of their immunizations.

“The growing resurgence of preventable diseases,” she writes, “should make us all pay attention to the importance of immunization.” Dr. Coombs cites recent outbreaks of measles, mumps, and whooping cough in several states, where low immunization rates have contributed to those conditions.  

Dr. Coombs also reminds us that while childhood conditions get the most attention for vaccinations, “Infectious diseases know no age limits, and immunization should be a regular part of medical care for all age groups.” 

The issue was recently highlighted in a story in The New York Times, which said part of the problem is immunization awareness, which applies to both doctors, who may forget to remind their patients, and patients, who may not be well informed about the need for booster shots or keeping up with vaccination schedules.

Read Dr. Coombs’ article.

MMS Flu Advisory: New CPT Codes for H1N1 Immunizations

Posted in Flu, Flu Advisory, H1N1, Swine Flu on September 28th, 2009 by MMS – Comments Off on MMS Flu Advisory: New CPT Codes for H1N1 Immunizations

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The AMA today announced two new CPT codes for the upcoming H1N1 immunizations. Coding from the AMA:

Use code 90470 to report H1N1 immunization administration and counseling. Code
90663 was revised by the CPT Editorial Panel to refer specifically to
the H1N1 vaccine product. Both, revised code 90663 and Category I CPT
Code 90470 are effective immediately.

For quick reference, the two codes are below:

90470-H1N1 immunization administration (intramuscular, intranasal), including counseling when performed

90663-Influenza virus vaccine, pandemic formulation, H1N1

For more information:

http://www.ama-assn.org/ama/pub/news/news/cpt-codes-h1n1-immunizations.shtml

MMS Flu Advisory: FDA Approves H1N1 Vaccine; Some Seasonal Flu Vaccine Shipments Delayed

Posted in Flu, Flu Advisory, H1N1, Swine Flu on September 17th, 2009 by MMS – Comments Off on MMS Flu Advisory: FDA Approves H1N1 Vaccine; Some Seasonal Flu Vaccine Shipments Delayed

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The U.S. Food and Drug Administration has approved four vaccines against the 2009 H1N1 influenza virus. The vaccines will be distributed nationally after the initial lots become available, which is expected within the next four weeks. The state will be responsible for distributing vaccine to health care and public health providers. Massachusetts health care practices wishing to receive vaccine must complete an online registration by October 9. Click here to read the FDA press release.

Seasonal Flu Vaccine Delayed
Due to prioritization of H1N1 vaccine and other challenges, remaining shipments of seasonal flu vaccine may be delayed. The state Department of Public Health (MDPH) has received over 40% of its seasonal flu vaccine supply to date. Remaining doses are expected to become available over the next 4-6 weeks. The majority of doses are still expected by the end of October and all doses expected by early November. Additionally, doses of both state-supplied and privately purchased pediatric formulation vaccines (0.25ml pre-filled syringes for <4 years of age) have also been delayed. Currently, less than 30% of the state’s total supply is available now; the majority of doses are expected to be delivered by the end of October. 

Almost all of the influenza viruses currently circulating are H1N1.

MDPH Recommendations
MDPH recommends that all health care providers continue to vaccinate patients with seasonal influenza vaccine during routine visits and in scheduled clinics as supply allows.

Pediatric Providers
MDPH recommends that pediatric providers:

  • Continue to vaccinate patients based on their available vaccine supply and formulation types.
  • For infants who cannot now be vaccinated due to lack of current supplies, schedule vaccination appointments in late October, when MDPH expects supplies of both state-supplied and privately-purchased pediatric formulation seasonal flu vaccine to be sufficient.
  • Plan for simultaneous administration of both seasonal and H1N1 flu vaccine starting in mid-late October. H1N1 flu vaccine will become available starting in early October. Young children are one of the highest risk groups for H1N1 influenza. Pediatric providers will be allocated some of the initial doses of H1N1 vaccine that become available in Massachusetts. Note: Doses of the intranasal H1N1 LAIV and seasonal LAIV must be separated by 4 weeks, but  you can administer H1N1 and seasonal vaccines simultaneously if one or both vaccines are the injectable vaccine.

School and Public Clinics
MDPH is recommending that large public clinics and school based flu clinics be delayed until mid October (and possibly into early November) unless there is sufficient vaccine on hand to meet the expected demand.  By mid-October, we anticipate vaccine supplies will be sufficient to mount large clinics efforts. 

MDPH is advising schools and public health departments to anticipate holding clinics for H1N1 flu vaccine starting in early November as well, and to consider offering both seasonal and H1N1 flu vaccine at these clinics.

Sources: U.S. Food and Drug Administration (September 15, 2009) and Massachusetts Department of Public Health (September 17, 2009).

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H1N1 Vaccine Reimbursement Policies in Massachusetts

Posted in Flu, H1N1, Swine Flu on September 11th, 2009 by MMS – Comments Off on H1N1 Vaccine Reimbursement Policies in Massachusetts

The MMS has canvassed the payers operating in Massachusetts to determine their reimbursement policies for administration of the H1N1 vaccine.

Aetna, Cigna, Fallon, Health New England, Harvard Pilgrim, Medicare, and Network Health have provided their reimbursement policies. We're waiting to hear from Blue Cross, MassHealth, Tufts and Neighborhood Health Plan.

The emerging trend is that payers will reimburse for the administration, but not for the vaccine or supplies, since those are being supplied free of charge by the federal government.

For an overview and the policies and related billing codes, click here.

Reminder: Practice sites wishing to administer the H1N1 vaccine must register with the state by October 9. Click here to visit the state registration site.

MMS Flu Advisory: DPH Opens Online Provider Registration for H1N1 Vaccine

Posted in Flu, Flu Advisory, H1N1, Swine Flu on September 8th, 2009 by MMS – Comments Off on MMS Flu Advisory: DPH Opens Online Provider Registration for H1N1 Vaccine

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The state Department of Public Health (DPH) has launched its online registration for H1N1 vaccine. This fall, the federal government will provide states with H1N1 vaccine and supplies (needles, syringes, sharps containers, alcohol swabs, H1N1 immunization cards) at no cost. DPH is responsible for directing the vaccine and supplies in Massachusetts. Providers (including private providers, hospitals, local health departments, regional public health coalitions, visiting nurses associations, clinics, pharmacists and commercial community vaccinators) wishing to receive and administer H1N1 vaccine must register with the DPH. The deadline for registering is October 9, 2009. Click here to be directed to more information and the online registration, or visit http://www.mass.gov/dph/h1n1registration.

Statewide H1N1 Conference

On September 30, DPH will host the Massachusetts Statewide Conference on H1N1 Influenza Response for public health, health care, school and community leaders at the DCU Center in Worcester. For information and to register, click here. The conference will present the latest situation update regarding the flu in Massachusetts, and elsewhere and what the outlook is for the coming months. And will provide the latest information on guidance and planning for flu vaccination, both seasonal and H1N1.
 

Seasonal Influenza Vaccine Still Available for Purchase

For information about vaccine distributors with seasonal influenza vaccine available for purchase, go to the National Influenza Vaccine Summit website at: http://www.preventinfluenza.org/ivats/ivats_09_10.xls

Source: Massachusetts Department of Public Health (September 8, 2009).

MMS Flu Advisory: State Passes Emergency Regulations for Flu Vaccination

Posted in Flu, Flu Advisory, H1N1, Swine Flu on August 14th, 2009 by MMS – Comments Off on MMS Flu Advisory: State Passes Emergency Regulations for Flu Vaccination

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On Wednesday, the state Public Health Council adopted emergency regulations to increase vaccination among health care workers and the public against seasonal and pandemic influenza.

The regulations promulgated by the MA Department of Public Health (DPH) require hospitals and clinics in the state to offer vaccinations to their employees, patient care volunteers and medical staff against seasonal and novel H1N1 as soon as the vaccines are available.

Additional regulations also allow the Commissioner of Public Health to license and certify additional categories of health care workers, such as dentists and paramedics, to administer vaccinations against pandemic or novel influenza pursuant to a prescriber’s order if the Commissioner issues a determination that additional health care professionals are needed for timely vaccination of the population.

DPH to allocate H1N1 vaccine

The federal government has contracted to develop enough novel H1N1 vaccine for widespread use in the fall of 2009. DPH will be responsible for the allocation of vaccine once it arrives—as early as late September—and anticipates getting it to providers within two weeks. DPH’s plan for allocation is in development.

DPH recommends vaccinating against seasonal flu early

DPH stated that 90% of the national vaccine supply for seasonal flu is anticipated to be available in August, and is recommending providers vaccinate patients against seasonal flu as soon as they receive it.

View the emergency regulations for hospital and clinic vaccination of health care workers, and for administration of vaccine.

Source: Massachusetts Department of Public Health (August 12 and 13, 2009), Massachusetts Executive Office of Health and Human Services (August 13, 2009).

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MMS Flu Advisory: ACIP Recommends Target Groups for novel H1N1 Vaccination

Posted in Flu, Flu Advisory, H1N1, Swine Flu on August 13th, 2009 by MMS – Comments Off on MMS Flu Advisory: ACIP Recommends Target Groups for novel H1N1 Vaccination

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The CDC’s Advisory Committee on Immunization Practices (ACIP) announced its recommendations for novel H1N1 (swine) flu vaccine when it becomes available.

ACIP recommends that vaccination efforts focus on five key populations.  When vaccine is first available, the committee recommended that programs and providers try to vaccinate:

  • pregnant women
  • people who live with or care for children younger than 6 months of age

  • health care and emergency services personnel

  • persons between the ages of 6 months through 24 years of age

  • people from ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders or compromised immune systems.

These key populations include those who are at higher risk of disease or complications, those who are likely to come in contact with novel H1N1, and those who could infect young infants.

The committee said it does not expect that there will be a shortage of novel H1N1 vaccine, but availability and demand can be unpredictable. There is some possibility that initially the vaccine will be available in limited quantities. In this setting, the committee recommended that the following groups receive the vaccine before others:

  • pregnant women

  • people who live with or care for children younger than 6 months of age

  • health care and emergency services personnel with direct patient contact

  • children 6 months through 4 years of age

  • children 5 through 18 years of age who have chronic medical conditions.

The federal government is working to have a safe and effective H1N1 vaccine available for distribution as early as mid-October. However, because it is possible, even probable, that epidemics may begin in different parts of the country before then, the CDC is urging Americans to plan and prepare. Planning and preparation checklists for individuals, workplaces and health care providers can be found on the federal flu website, www.flu.gov.

The Massachusetts Department of Public Health is developing a vaccine delivery plan for allocation of H1N1 vaccine.

Read the full ACIP news release.

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Source: www.flu.gov (July 30, 2009)

MMS Flu Advisory: DPH to Stop Routine Testing for H1N1 Virus

Posted in Flu, Flu Advisory, H1N1, Swine Flu on June 8th, 2009 by MMS – Comments Off on MMS Flu Advisory: DPH to Stop Routine Testing for H1N1 Virus

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As swine-origin influenza A H1N1 infections become increasingly widespread, laboratory confirmation of the novel H1N1 influenza is becoming less critical to decisions regarding antiviral treatment, chemoprophylaxis and disease control measures.

In addition, as the number of seasonal influenza A infections have declined, the identification of influenza A by rapid tests and other methods has become more useful as an indicator of the presence of the novel H1N1 influenza. Antiviral treatment must normally be initiated prior to the results of confirmatory laboratory testing and therefore will depend on the results of rapid tests and clinical judgment.

As such, effective June 12, the Hinton State Laboratory Institute (HSLI) will no longer perform diagnostic testing for the novel H1N1 influenza except in rare circumstances. Testing will be performed ONLY where confirmatory results will significantly impact clinical management of a patient, or where there is a clear public health benefit. Such specimens should be submitted only after the approval of a state Department of Public Health (MDPH) epidemiologist.

Specimens from influenza sentinel sites will continue to be tested at HSLI. This will provide a representative sample for disease surveillance, and will allow for identification of significant mutations in the viral genetic structure over time.

Testing for swine-origin influenza A H1N1 is now available through commercial and clinical laboratories. CDC and MDPH recommend that the individuals who are either hospitalized with severe respiratory illness OR who are at high risk for complications from influenza be treated for influenza empirically, as soon as possible after symptom onset.

DPH's latest recommendations pertaining to H1N1 are on the MDPH website at www.mass.gov/dph/swineflu. Information from CDC can be found at www.cdc.gov/h1n1flu/.  

Clinicians and laboratories can contact an MDPH epidemiologist at 617-983-6800 (available 24/7) with any questions regarding test, treatment, or control measures.

MMS Flu Advisory: DPH Updates Guidance on Flu Testing

Posted in Flu, Flu Advisory, H1N1, Swine Flu on May 25th, 2009 by MMS – Comments Off on MMS Flu Advisory: DPH Updates Guidance on Flu Testing

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The Massachusetts DPH on May 22 updated its guidance testing, treatment and phrophylaxis for the H1N1 (swine flu) virus. The full text of the guidance is below.

The total number of confirmed cases in Massachusetts is now 284. Seventy-eight percent are under the age of 21.

– – –

This update is intended to clarify guidance on testing for the novel swine-origin influenza A (H1N1), and to limit the use of testing to those situations where they are most likely to be beneficial. This guidance also gives the website links to the latest antiviral diagnosis, management, treatment and prophylaxis guidelines.

Testing

CDC and Massachusetts Department of Public Health (MDPH) recommend that testing and treatment be focused on those with severe respiratory illness and those at highest risk of complications from influenza.   Individuals with mild illness should be advised to stay at home.  They do NOT need to be tested or treated unless they meet one of the high-risk criteria listed below.

Specimens should only be submitted to the Hinton State Laboratory Institute (HSLI) for testing for patients in the following situations:

  • Those with flu-like febrile respiratory illness or sepsis-like syndrome requiring hospitalization
  • Those at high risk of complications with influenza and who are exhibiting more serious signs of influenza like illness.  Such groups include:
    • Children < 2 years old
    • Persons > 65 years
    • Adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV);
    • Adults and children who have chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders;
    • Pregnant women;
    • Children and adolescents (less than 18 years) who are receiving long-term aspirin therapy who might be at risk for experiencing Reye syndrome after influenza virus infection;

New:

For individuals with asthma or other high risk conditions who are experiencing mild illness, a rapid influenza test may be performed.  If the result it positive, no further testing for novel influenza A (H1N1) is needed and appropriate treatment should be initiated.

Specimen Collection

Clinicians and laboratories should always contact an MDPH epidemiologist at 617-983-6800 (available 24/7) before submitting specimens. They will be able to assist in guidance for all issues regarding specimen collection and submission guidance, including assistance with transportation of specimens to the HSLI.  We will be posting our latest guidance about specimen collection and other recommendation on the MDPH website at www.mass.gov/dph/swineflu.

Clinical Management and Treatment

Adults and children with fever and one of the following: cough, sore throat or runny nose, should stay home from work or school for at least 7 days from the onset of illness (or 24 hours after the end of illness if symptoms persist longer).   They should not return to work or school before the end of the exclusion period even if asymptomatic because viral shedding can continue for 7 days. A health care provider’s note recommending a child return to school before the end of the full exclusion period does not supercede the public health guidance during this outbreak.  However, individuals who have recovered from influenza-like illness do not need to be “cleared” by a health care provider before returning to work or school after the end of their 7 day exclusion period. 

The latest information for clinicians on identifying and managing patients with influenza A H1N1 infection can be found at: http://www.cdc.gov/h1n1flu/identifyingpatients.htm

The latest information about antiviral treatment and prophylaxis, including new FDA emergency use authorization for the use of antivirals in children < 1 year and pregnant women, can be found at: http://www.cdc.gov/h1n1flu/recommendations.htm

Special Populations

The latest clinical guidance for treating the following special populations can be found on the CDC website:

For additional information from CDC, please go to http://www.cdc.gov/h1n1flu/.

MMS Flu Advisory: Updated Guidance for Schools and Child Care Settings

Posted in Flu, Flu Advisory, H1N1, Swine Flu on May 20th, 2009 by MMS – 1 Comment

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As of 11:00 a.m. today, the Massachusetts Department of Public Health (MDPH) is reporting a total to date of 193 confirmed cases of H1N1 (swine flu). Charts produced by DPH reveal the majority (70%) of cases are occurring in patients aged 6 – 20 years old. Eight percent of cases have required hospitalizations. For details, see today’s updated case count report on the MDPH website.

Several schools across the state have had high rates of absenteeism due to influenza like illness. Yesterday, the Massachusetts Department of Public Health (MDPH) provided updated guidance for schools and child care settings. Guidance may continue to change in the upcoming weeks as the situation changes, and as more information becomes available. 

The updated May 19 guidance document is available on the DPH website, and is copied below:

The guidance document provides information in three categories:

  • Surveillance and Prevention Measures for ALL Schools and Child Care Facilities
  • Enhanced Surveillance and Prevention Measures for Schools with Cases of Influenza-like Illness (ILI)
  • Factors to Consider with Regard to School Closings

Recommendations for Surveillance and Prevention of Swine-Origin Influenza A H1N1 in Massachusetts Schools and Child Care Settings

The following recommendations apply to all schools in the Commonwealth, regardless of whether or not they are experiencing higher than usual rates of absenteeism. They are designed to help prevent the spread of ILI in school and child-care settings.

  • Emphasize to students and parents, the importance of proper hand washing and cough etiquette in preventing the spread of diseases. Educational materials, posters, etc. are available on the MDPH website, www.mass.gov/dph/swineflu.
  • Inform parents and caregivers that they should assess all family members (and especially all school-age children) for symptoms of influenza before sending them to school.  ILI may include fever plus cough, sore throat or runny nose.  It may also include other symptoms, such as vomiting or diarrhea. A Flu Symptoms Checklist is on the DPH website at www.mass.govdph/swineflu.
  • All school staff should assess themselves for symptoms of influenza before reporting to work, and should stay home if they are symptomatic.
  • Schools should consider screening students and staff for visible signs of possible influenza illness upon arrival at school.
  • Students or staff who appear ill with influenza-like illness should be promptly isolated and sent home.  All such students and staff should stay out of school for at least 7 days even if their symptoms resolve sooner. Students and faculty who are still sick at 7 days should continue to stay home from school until at least 24 hours after they have completely recovered.
  • If a child or adult is ill with other symptoms, they should stay home at least one day to observe how the illness develops and until completely well for 24 hours.  This period of exclusion can be shortened if it is found that the child is unlikely to have influenza, for example if an alternative diagnosis, such as strep throat, is made.
  • School nurses and student health centers should report higher than normal absenteeism to your local health department or to the MDPH at 617-983-6800.

Recommendations for Enhanced Surveillance and Prevention of Swine-Origin Influenza A H1N1 in Massachusetts Schools and Child Care Settings

If cases of influenza-like illness are identified, schools/child care facilities should consider increasing their surveillance and infection control measures to limit the further spread of illness in their facilities.  These measures are enhancements of what schools/child care facilities do during flu season to prevent illness in children and staff.

Because CDC and MDPH recommend testing only those who are seriously ill, or who have underlying conditions which put them at increased risk for complications from influenza for H1N1, schools should consider implementing these enhanced measures when they see an increase in absenteeism due to influenza-like illness. They do not need to await confirmation of H1N1.

  • Monitor absenteeism in students and staff and follow up to determine if absence is due to influenza-like illness. School nurses and student health centers should report higher than normal absenteeism to your local health department and to the MDPH Epidemiology Program at 617-983-6800.
  • Screen students and staff as they enter school, during home room, or other appropriate times to identify anyone with fever and symptoms of influenza-like illness.  Any child that appears to have ILI should be isolated and sent home.  If the ill student or staff member has a cough, as well as fever, he/she should wear a mask (if available) until leaving the school to decrease the spread of the virus.If there are an unexpected number of absences in a particular class room or grade, screen the children in that class or grade to identify any that may have symptoms of ILI.
  • Place hand sanitizer in each classroom to facilitate regular hand hygiene.  Encourage younger students to use the sanitizer before snacks and lunch.  Encourage older students that change classrooms to use hand sanitizer each time they change classes.
  • Ask teachers or school nurses to demonstrate proper hand washing and cough etiquette in each class, and to explain why it’s important.  Educational materials, posters, etc., are available on the MDPH website, www.mass.gov/dph/swineflu.
  • Send hand washing or other flu control educational materials home to parents and ask for their assistance in reinforcing these messages with their children.
  • Distribute the Flu Symptom Checklist to families and ask that parents use it if they are unsure if their child is well enough to go to school.
  • Consider increasing routine cleaning of classroom surfaces likely to be touched.  This should be considered only as an adjunct to the efforts to increase hand washing, improve cough etiquette and keep ill children and staff home, because cleaned surfaces can easily become re-contaminated during the day.

Preparedness Planning: Schools and childcare facilities should prepare for the possibility of school or childcare facility closure before facing this decision.  This includes asking teachers, parents, and officials in charge of critical school-associated programs (such as meal services) to make contingency plans.

Parent and Staff Reassurance

Parents, faculty and staff may need to be reassured that the school/child care facility is taking appropriate steps to limit the spread of illness.

Concerned parents, faculty and staff can be reminded that illness caused by swine-origin influenza A H1N1 is similar to that caused by seasonal flu, so our responses should be what they would be for seasonal flu.

Influenza is highly likely to be in the school or community, whether or not there is a confirmed case.    Parents and staff should assume that they could be exposed to this new flu at school, at work or anywhere else in the community.  Therefore, it is very important for everyone to continue to protect themselves with hand washing, cough etiquette, etc.

Special Populations

Some children or staff may be at greater risk for complications from any flu – seasonal or swine.  These include:

  • Children less than 2 years old
  • Persons aged 65 years or older
  • Pregnant women
  • Children and adolescents (less than 18 years) who are receiving long-term aspirin therapy who might be at risk for experiencing Reye’s syndrome after influenza virus infectionAdults and children who have chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders
  • Adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV infection)

Staff or parents of children who fit any of the above criteria should discuss their specific situation with their doctor, just as they do when regular flu season starts.

Source: Massachusetts Department of Public Health (May 20, 2009)