By Jennifer Larson, contributor
Sept. 16, 2009 - It seems that H1N1, often called the swine flu, is constantly being mentioned in the news – so much so that it is easy to lose site of the big picture. What, then, are the most important things that health care workers need to know?
Here is a short recap to put the H1N1 news in perspective and help nurses, physicians and other health workers prepare for the coming flu season. A timeline of major events and announcements relating to the H1N1 flu is included at the end of this article.
How It Began
H1N1 influenza first appeared in early 2009 and quickly generated a public uproar. It resulted in a wave of hospitalizations, closed schools and general panic. Reports of the virus seemed to dissipate when the hot summer weather arrived in the Northern Hemisphere, but now that autumn is here, the 2009 H1N1 virus is poised to come surging back, stronger than ever.
“It never went away,” explained Thomas Frieden, M.D., MPH, director of the Centers for Disease Control and Prevention (CDC), during a media briefing on Sept. 3.
What Is H1N1 Exactly?
According to the CDC, 2009 H1N1 is a new influenza virus that has been spreading from person-to-person worldwide and was declared a pandemic by the World Health Organization (WHO) in June.
This virus was originally referred to as “swine flu” because laboratory testing showed that many of the virus’s genes were similar to influenza viruses that occur in pigs in North America. Further study, however, showed that this new virus is very different.
2009 H1N1 spreads in the same way that seasonal flu spreads; from person to person through coughing or sneezing by people who are infected. People can also become infected by touching something with flu viruses on it and then touching their mouth or nose.
Symptoms of the virus include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people with the virus also have reported diarrhea and vomiting. Illness from the new H1N1 virus has ranged from mild to severe, and although most people have recovered without needing medical treatment, hospitalizations and deaths have occurred.
The Current Outlook
Now that schools and universities are back in session, public health officials anticipate the number of reported H1N1 flu cases will increase—due in part to the fact that H1N1 influenza seems to affect school-age children and young adults much more than the seasonal flu does. The U.S. Department of Health and Human Services announced guidelines for colleges and universities to aid them in preparing for and responding to this year’s flu season.
Although there have been deaths associated with the virus, the hope is that most people who contract the virus this fall and winter will not become critically ill. Because of last season’s media attention, more patients may be aware of the symptoms and seek treatment earlier, and medical facilities, school districts and health agencies are expected to be better prepared. In addition, there are high hopes for a vaccine currently undergoing clinical trials.
The H1N1 Vaccine
Eight vaccine and treatment evaluation units around the country are currently conducting trials on a vaccine for H1N1. The trials began in early August, funded by the National Institute of Allergy and Infectious Diseases (NIAID), with volunteers receiving one dose of the vaccine.
The trials aim to determine the appropriate dosage for the vaccine, explained Anthony Fauci, M.D., director of the NIAID, which is part of the National Institutes of Health. “We are doing (the trial) mostly to determine the right dose and to make sure it’s immunogenic,” he said.
Early data indicate that a single dose is likely to produce a protective immune response in most healthy adults, an NIH official said on Sept. 11, 2009.
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“This is very good news for the vaccination program, both with regard to supply of the vaccine and its potential efficacy,” said Fauci. Early results indicate that a single 15-microgram dose of vaccine is well tolerated and induces a robust immune response in healthy adults under age 65.
“For adults aged 65 and over, the immune response to 2009 H1N1 influenza vaccine is somewhat less robust, as is the case with seasonal influenza vaccines,” he said.
NIAID expects preliminary findings from clinical trials in children in about two weeks, and results from trials in pregnant women by mid-to-late October, Fauci said. Once the dosing schedules are finalized, the vaccine is expected to be ready by late October.
Recommended Actions
At the end of August, the World Health Professions Alliance released a call to action to prepare for a pandemic. The report called on countries to prioritize high risk groups, to train health workers to identify symptoms, increase stocks of medical supplies and to educate the community about home care. The alliance also emphasized the need to identify target groups to receive the first doses of vaccination, and officials should create plans for mass vaccination when the vaccine is available.
In the United States, the CDC’s Advisory Committee on Immunization Practices has recommended that the following groups be moved to the top of the priority list for receiving the vaccine when it is ready:
• Pregnant women
• People who care for children younger than six months of age
• People between the ages of six months and 24 years of age
• People between the ages of 25 and 64 who are at higher risk for H1N1 because of chronic health problems or compromised immune systems.
• Health care workers and emergency medical services personnel.
The Institute of Medicine recently released a report that emphasized the importance of protection for health care workers from the H1N1 virus.
The CDC’s Frieden agreed, saying, “Protecting health care workers is critically important. We want to ensure that health care workers are and feel safe when they come to work. They are the first line of defense, and we need to ensure that we do everything we can to reduce, to the greatest extent possible, their risk of becoming ill on the job.”
Nurses, physicians and other health care workers are always advised to get a seasonal flu vaccination, too, for similar reasons, but unfortunately that doesn’t always translate into a high vaccination rate.
The rate of health care workers getting vaccinated “is about half of what it should be,” Fauci said. “Health care workers should definitely get the (H1N1) vaccine.”
Fauci said he hoped people would understand that “this is a real pandemic that we’re in the middle of” and take it seriously. “There’s a much greater risk of getting sick without the vaccine,” he said.
The American Nurses Association recommends that nurses get vaccinated against both H1N1 and the seasonal flu. The Institute of Medicine supports the vaccination of health care workers and adds the recommendation that health care workers who are exposed to the virus wear N95 respirators.
For further details and to keep up on the latest H1N1 information, visit the CDC’s H1N1 site.
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