Download 2009 H1N1 Influenza General Talking Points

2009 H1N1 Influenza
General Talking Points
Communications Office · Minnesota Department of Health
Revision of Nov. 24, 2009
Please replace and discard any prior revisions of this document –
Including any versions posted to a Web site or otherwise archived.
These talking points will be revised in response to emerging events and new information.
Please check back regularly for updates.
The Current Situation

The second wave of illness caused by the 2009 H1N1 influenza virus appears to
have peaked in Minnesota.

The CDC classification of flu activity in Minnesota has now been downgraded
from “widespread” to “regional.”

Over the past few weeks, several indicators have suggested a general decline in
influenza-like illness. These indicators include;
o schools reporting influenza-like illness (five percent or more of all
students OR three or more students in the same elementary school
classroom)
o hospitalizations for confirmed H1N1 illness
o patients seeking treatment for influenza-like illness at sentinel clinics
around the state

Nonetheless, the Minnesota Department of Health continues to report additional
deaths from 2009 H1N1.

The deaths being reported may have occurred up to several weeks prior to being
identified as “H1N1 deaths.”
o What’s being reported is the completion of investigations into possible
H1N1deaths, rather than deaths as they occur.
2009 H1N1 Influenza – General Talking Points – Rev. of Nov. 24, 2009 – p. 2
It’s Not Over

Although the second wave of illness appears to have peaked, the public health
threat posed by H1N1 continues.

We may continue to see cases of H1N1 illness for sometime – just as we did
during the summer, following the first wave of illness.

Based on what we know about past flu pandemics, we may see a third wave of
2009 H1N1 illness, possibly in January or February.

Our situation is complicated by the fact that we may also see a typical wave of
regular, seasonal flu, possibly beginning as early as December.

Because H1N1 continues to be a threat, it is still important to get vaccinated, as
more vaccine for H1N1 becomes available. That’s especially true if you are in one
of the high-priority groups for vaccination.

Although the severity of the illness caused by H1N1 continues to be similar to
that for seasonal flu, that doesn’t mean that it isn’t dangerous.

Influenza is always a potentially serious, life-threatening illness – especially for
people at high risk of complications. Nationwide, seasonal flu kills an estimated
36,000 people a year, making it one of our leading causes of death, year in and
year out.

H1N1 is of special concern because the groups at highest risk for serious illness
are different from the high-risk groups for seasonal flu:
o Older adults appear to be at lower risk than other groups for becoming ill
with 2009 H1N1 – although it can still cause severe illness in this group.
They are among those at highest risk from seasonal flu.
o Pregnant women appear to be at increased risk.

Based on data from the first wave of H1N1 illness, pregnant women
are several times as likely as the general population to be hospitalized
if they develop 2009 H1N1 influenza.

The death rate for pregnant women with H1N1 has been described as
“remarkably high.”
o Children, adolescents and young adults appear to be at increased risk.

The median age of patients hospitalized with 2009 H1N1 in Minnesota
last spring was 12 years.

Younger children, in particular, seem to be at increased risk. In
Minnesota, during the first wave of illness, children under five were
hospitalized with 2009 H1N1 at twice the rate of children aged five to
12.
o People with underlying health conditions appear to be at increased risk of
severe illness or complications from 2009 H1N1 – just as they are from
seasonal flu.
2009 H1N1 Influenza – General Talking Points – Rev. of Nov. 24, 2009 – p. 3
Vaccination Against 2009 H1N1
Who should get it

Although available supplies of vaccine remain limited – both in Minnesota and
nationwide – MDH is now recommending that the vaccine be offered to all of the
groups designated as “high priority” by CDC.

The following have been identified as priority groups for getting the H1N1
vaccine, based on their risk of severe disease from H1N1:
o Pregnant women
o People who live with or care for children under the age of six months.
o Health care workers and emergency personnel
o All children, adolescents and young adults aged six months through 24 years
o People aged 25 to 64 who are at risk of complications because of an
underlying medical or immune system condition, including:
 some kinds of conditions that may interfere with breathing
 chronic lung disease
 chronic cardiovascular disease (except high blood pressure)
 chronic kidney disease
 chronic liver disease
 chronic metabolic conditions or conditions involving the blood or bloodforming organs (including diabetes)
 suppressed immune systems (due to medical treatment or infection)

Although people age 65 and older are still a priority group for seasonal flu
vaccination, they are not among the priority groups for 2009 H1N1 vaccination.

Older people appear to be at lower risk than other groups for getting 2009 H1N1
flu – although it can still cause severe illness in this group.

The priority groups identified by CDC for H1N1 vaccination include an estimated
159 million people in the U.S. – and 2.7 million in Minnesota.
Availability of Vaccine

Addition H1N1 vaccine continues to be allocated for Minnesota, and ordered for
Minnesota providers, on a daily basis.

The latest information on doses allocated and ordered is available on the MDH
website at www.mdhflu.com.

As more vaccine becomes available, it is ordered for local health departments and
health care providers who have registered with MDH. The vaccine is then
delivered directly to local public health agencies and providers.

MDH has attempted to order and distribute vaccine to providers as equitably as
possible, emphasizing providers who serve high risk groups.
2009 H1N1 Influenza – General Talking Points – Rev. of Nov. 24, 2009 – p. 4

Because available supplies of vaccine have so far been limited, some providers
have inevitably gotten their vaccine before others – and some people in high risk
groups may have had trouble getting vaccinated.

People have understandably been concerned about the distribution and availability
of the vaccine. We share their frustration.

As more and more vaccine becomes available, inequalities in the distribution of
the vaccine should begin to even out, and people in priority groups should be able
to get vaccinated.

People in the priority groups should be patient and persistent, and stay in contact
with their health care provider or their local health department.

Eventually, we should have enough vaccine for everyone who wants it.

Until we reach that point, we would ask people not in a priority group to postpone
getting vaccinated, and give people in priority groups a chance to go first.

In the coming weeks, local public health agencies will be holding public
vaccination clinics in schools and other locations around the state. These clinics
are being organized at the local level, as vaccine becomes available.

Watch for announcements or contact your local health department to find out
about public vaccination clinics in your area.

As more vaccine becomes available and more clinics are scheduled, MDH will be
launching a “clinic finder” tool for 2009 H1N1 vaccinations at www.mdhflu.com.

The clinic finder will help people find a time and place where they can get
vaccinated.

MDH plans to activate the clinic finder on Nov. 30.
General Information About Vaccines

This year, you will need to get vaccinated against two kinds of flu to be fully
protected – 2009 H1N1 and regular seasonal flu.

The seasonal flu vaccine will not protect you against 2009 H1N1 flu.
o The seasonal vaccine does protect against a type of H1N1 virus, as well as
two other flu virus strains.
o However, the strain in the seasonal vaccine is a different H1N1 virus –
and it’s not the same strain as the 2009 H1N1 virus.

People who’ve been ill with flu symptoms since late April should not assume they
are immune to 2009 H1N1. They should still get the 2009 H1N1 vaccine.
o Most people with flu-like illness cannot assume they had 2009 H1N1 flu.
o Most have never had their illness laboratory confirmed as flu, and even
fewer have had their illness confirmed as H1N1.

Like all vaccinations, vaccination against 2009 H1N1 is completely voluntary –
but it is highly recommended for people at high risk for flu complications.
2009 H1N1 Influenza – General Talking Points – Rev. of Nov. 24, 2009 – p. 5

Being vaccinated against 2009 H1N1 vaccine doesn’t carry any greater risk than
being vaccinated against seasonal flu.
o The two vaccines are manufactured in exactly the same way.
o They are just formulated to protect against different flu viruses.
o Otherwise, the two types of flu vaccine are identical – and the seasonal
vaccine has a long history of safe use.

There was some discussion earlier about using additives – known as adjuvants –
to enhance the effectiveness of the H1N1 vaccine. However, the H1N1 vaccine
does not contain any of these additives.

Although some of the H1N1 vaccine will contain mercury-based preservatives, a
preservative-free version of the vaccine is also available.

Like the regular, seasonal flu vaccine, the H1N1 vaccine is available in two forms
– either a shot or a nasal spray.

The shot uses vaccines made with killed viruses.

The nasal spray vaccines are made with viruses that have been weakened – but
not killed.

The nasal spray can only be given to people 2 to 49 years of age.

Experts have concluded that most people will only need a single dose of the 2009
H1N1 vaccine to be fully immunized.

Children under 10 (9 and under) will need two doses of the H1N1 vaccine.

Children under 9 (8 and under) will need two doses of the seasonal vaccine if
they’ve never been vaccinated before.

You can get vaccinated for both kinds of flu at the same time if
o You get shots for both kinds of flu
o You get a shot for one kind of flu and the nasal spray vaccine for the other
kind.

You cannot be vaccinated for both kinds of flu at the same time using the nasal
spray vaccine for both vaccinations.

The two doses of nasal spray vaccine – for H1N1 and seasonal flu – would need
to be given at least 4 weeks apart.

The seasonal vaccine is especially recommended for people at high risk of serious
complications from the flu. These groups include:
o Children and adolescents from six months to 18 years of age
o Adults age 50 and over
o Women who will be pregnant during flu season
o Health care workers
o People living in nursing homes or other chronic care facilities
o People who live with or care for children age five or younger (especially
those under six months, who cannot be vaccinated against flu)
2009 H1N1 Influenza – General Talking Points – Rev. of Nov. 24, 2009 – p. 6
o Children and adolescents who regularly take aspirin as part of their
medical treatment (because they may be at risk of a complication called
Reye Syndrome if they get the flu)
o People who are at risk of complications because of an underlying medical
condition, including:
 some kinds of conditions that may interfere with breathing
 chronic lung disease
 chronic cardiovascular disease (except hypertension)
 chronic kidney disease
 chronic liver disease
 chronic metabolic conditions, or conditions involving the blood or
blood-forming organs (including diabetes)
 suppressed immune systems (due to medical treatment or
infection)
o People who live with or care for people with conditions that place them at
high risk of flu complications.

Because of distribution issues – and because vaccine manufacturers have switched
over to making the 2009 H1N1 vaccine – some providers may not have the
seasonal vaccine right now.

As with the H1N1 vaccine, you should stay in touch with your provider about
getting vaccinated against seasonal flu – if you haven’t been vaccinated already.

Seasonal flu hasn’t made an appearance yet in Minnesota this year, and probably
won’t peak until later in the winter.
2009 H1N1 Influenza – General Talking Points – Rev. of Nov. 24, 2009 – p. 7
Antiviral Drugs

Antiviral drugs like Tamiflu and Relenza currently appear to be effective in
treating 2009 H1N1 flu.

To be most effective, antivirals need to be administered within 48 hours of the
time that flu symptoms first appear.

These drugs need to be individually prescribed by a physician.

Antiviral drugs are normally made available through the private sector health care
system.

If shortages of these drugs occur in the private-sector health-care system during a
pandemic, public stockpiles can be used to fill the gap.

Enough antivirals for slightly more than one million courses of treatment from
state and federal stockpiles are available for use in Minnesota.

If the regular health-care system is overwhelmed during a severe pandemic,
antivirals can be provided through specially designated regional “flu centers.”

Although a number of flu centers were activated during the second wave of the
H1N1 pandemic, they have all since closed.

Activation of flu centers would again be an option during a possible third wave of
H1N1 illness later in the winter.

If you have possible symptoms of the flu, you can also call the Minnesota FluLine
at 1-866-259-4655.
o Nurses staffing the FluLine can refer you to an appropriate source of help,
based on your situation.
o If necessary, antiviral medications can be prescribed for you over the
phone.
o If you lack health insurance to pay for needed anitivirals, they can be
provided free of charge.
2009 H1N1 Influenza – General Talking Points – Rev. of Nov. 24, 2009 – p. 8
Protecting yourself against flu: a few simple steps

Taking a few simple, common-sense precautions is still the most important thing
you can do to keep from getting the flu – or spreading it to others. That applies to
both seasonal flu and 2009 H1N1.
o Stay home from work or school – and generally avoid going out in public
– if you are sick with symptoms of the flu.
o Cover your nose and mouth with your sleeve or a tissue when you cough
or sneeze.
o Clean your hands frequently and thoroughly – with soap and water or an
alcohol-based hand-sanitizer solution.
o Get vaccinated against the flu.
o Avoid contact with others who may be ill.
o Clean your hands after shaking hands or having other close contact with
others and before eating or preparing food, or touching your eyes, nose or
mouth.
o Be aware of the symptoms of H1N1 flu – which are generally the same as
those for seasonal flu.
o H1N1 symptoms include fever of 100 degrees or more with sore throat or
cough.
o H1N1 symptoms may also include
 runny or stuffy nose
 body aches
 headache
 chills
 fatigue
o In some cases, symptoms of 2009 H1N1 can also include vomiting and
diarrhea – which are not typical symptoms of seasonal flu.
o If you are an employer, encourage your employees to stay home if they are
sick with flu symptoms.
o In general, if you are ill with flu symptoms, stay home from work, school
or other places where people gather until 24 hours after your fever
subsides.
o Stricter guidelines apply to children or staff in day care settings or early
education programs attended by children under five years of age.
 In programs serving children under five, children and staff with flu
symptoms should stay home until seven days after their symptoms
first appeared – or 24 hours after their symptoms go away –
whichever is longer.
 The stricter child care recommendations also apply to facilities
where children under five and older children are both present,
unless the two groups – as well as staff who interact with them –
can be kept separate.
2009 H1N1 Influenza – General Talking Points – Rev. of Nov. 24, 2009 – p. 9
o Health care workers who have contact with patients should also remain
home until seven days after symptoms first appear or 24 hours after
symptoms go away, whichever is longer.
o If you are severely ill with flu symptoms, you should contact your health
care provider.
o You should also contact your health care provider if you have flu
symptoms and you are pregnant, or you have an underlying health
problem or condition.
o If you are at high risk for flu complications, you can be given anti-viral
drugs, which may lessen the severity of your illness or help you get well
faster.
o However, anti-virals need to be given within the first 48 hours after you
become ill in order to be most effective.
o If you decide you need to talk to a health care provider, take steps to avoid
exposing others to the flu:
 Call first to see if you need to actually see your provider in person.
 If you do need to see your provider, steps can be taken to avoid
exposing other patients to the flu.
o If you have possible symptoms of the flu, you can also call the Minnesota
FluLine at 1-866-259-4655.



Nurses staffing the FluLine can refer you to an appropriate source
of help, based on your situation.
If necessary, antiviral medications can be prescribed for you over
the phone.
If you lack health insurance to pay for needed anitivirals, they can
be provided free of charge.
2009 H1N1 Influenza – General Talking Points – Rev. of Nov. 24, 2009 – p. 10
Flu Viruses on Environmental Surfaces
(counter-tops, door knobs, phones, keyboards, etc.)

Flu viruses can survive for a time on environmental surfaces.

However the length of time they survive can vary greatly – and can’t be reliably
predicted. It depends on factors like the type of surface, temperature and
humidity.

Because you can’t really tell when an object or surface might be contaminated,
attempting to fight the flu by cleaning these surfaces isn’t really practical.

The best defense against flu viruses that you might pick up from objects or
surfaces is frequent handwashing.

It’s most important to wash your hands before doing certain things:
o eating or preparing food.
o touching your eyes, nose or mouth.
Masks

We do not recommend the use of simple face masks – or “surgical” masks – as an
effective protective measure for healthy members of the public.

We do recommend that people ill with flu-like symptoms wear masks in situations
where they might expose others to the flu.

If people with flu symptoms are not able to tolerate wearing a mask, they should
take other precautions. They should be especially careful to cover their noses and
mouths with a sleeve or a tissue when they cough or sneeze.

A special kind of mask – known as an N95 respirator – may provide some
protection for health care workers who have close contact with patients who have
flu symptoms.

Although CDC is currently recommending use of N95s by health care workers,
CDC recommendations also allow for restricting use of N95s to workers in highrisk situations if there is a shortage.

The CDC recommendations also emphasize that N95s are not the first or most
important “line of defense” for preventing the spread of H1N1 in health care
settings.

N95 respirators are not recommended for use as a flu prevention measure by the
general public.
o They have to be specially fitted and properly used to be effective.
o They make it more difficult to breathe, and could even be dangerous for
people with heart or lung disease.
2009 H1N1 Influenza – General Talking Points – Rev. of Nov. 24, 2009 – p. 11
Oral Secretions

Flu viruses – seasonal or H1N1—can be spread through any activity that may
involve the sharing of oral secretions (saliva).

Those activities include the sharing of
o drinking cups or glasses
o water bottles
o beverage cans or containers
o smoking materials
o cosmetic products used on the lips
2009 H1N1 Influenza – General Talking Points – Rev. of Nov. 24, 2009 – p. 12
Information for and about Faith Communities

Faith-based communities and other community groups have an important
role to play in responding to H1N1.

MDH is working with the Governor’s Office on Faith and Community Service
in efforts to involve faith communities and community groups in the response
to 2009 H1N1.

We know that the kind of spiritual support offered by faith communities is
especially important to people during difficult times. They provide an
irreplaceable source of support for many people during events like a pandemic.

Faith communities and other community groups can also play an important role
in the pandemic response – for example, by providing accurate information
about flu and how to prevent it.

In particular, they can play an important role in connecting vulnerable and
underserved populations with information and sources of help.

The most important information they can provide to their members is the basic
steps people can take to prevent the spread of flu from person to person and
protect themselves against the flu.
o Stay home from work, school or public gatherings if you have flu
symptoms.
o Cover your nose and mouth if you cough or sneeze
o Wash your hands – frequently and thoroughly.
o Get vaccinated against the flu.

We respect people’s religious beliefs and practices, and know that they can be
especially important to people during an event like a pandemic.

At the same time, faith communities may also want to consider modifying
religious practices that could spread the virus from person to person, such as
use of the common communion cup.
o They might want to consider making hand sanitizers available to their
members at group activities and gatherings.
o They may also want to consider providing alternative ways to
participate in activities for people who are at high risk of flu
complications.
2009 H1N1 Influenza – General Talking Points – Rev. of Nov. 24, 2009 – p. 13
Tracking 2009 H1N1 Flu

It isn’t practical to track and provide laboratory confirmation for every single –
much less every case of 2009 H1N1 influenza.

For that reason, MDH tracks both flu-like illness and 2009 H1N1in a very
targeted way

For 2009 H1N1, MDH has emphasized tracking cases where people have been
severely ill with flu symptoms.
o The MDH lab tests for 2009 H1N1 in all cases where people with flu-like
symptoms have been hospitalized or died.

MDH also receives reports about how many people are being treated for flu
symptoms at a statewide network of “sentinel” clinics.

The sentinel clinics also submit specimens for a selected number of patients to
MDH so they can be tested for 2009 H1N1.

People with flu-like symptoms are also tested for H1N1 if they have had contact
with pigs.
o People with exposure to pigs are not tested because the pigs represent a
likely source of exposure to H1N1 for humans.
o The actual concern is potential introduction of H1N1 into swine herds
through exposure to infected humans.

MDH also currently uses reporting by schools to track influenza-like illness (not
necessarily confirmed H1N1)
o Schools have been asked to report to MDH whenever:


5% or more of the students in any given school are absent with
possible symptoms of flu
3 or more children are absent with flu symptoms from the same
elementary school classroom

As of Nov. 21, there had been 1,767 total 2009 H1N1 hospitalizations in
Minnesota since April, and 1,507 since the second wave of illness began in
September.

That is most likely the “tip of the iceberg” in terms of the actual number of people
who have been ill with 2009 H1N1 in the state.

Current information about confirmed 2009 H1N1 cases and reports of flu-like
illness in schools is available on the MDH website at mdhflu.com.