Diabetes and H1N1

Everyone should be back in school now. In one of my recent blogs, I discussed a "teacher cheat sheet" that is helpful for teachers on the front lines. One of my patient families suggested that I discuss the potential H1N1 influenza epidemic. The Maryland Department of Health and Mental Hygiene continually updates Maryland healthcare professionals on influenza and infectious diseases. My latest update is as follows.

H1N1 Influenza Update: August 28, 2009
Throughout the summer, Maryland DHMH has continued to monitor H1N1 influenza virus. Outbreaks, especially in summer camps, have been reported, and Maryland's sentinel surveillance systems have documented ongoing H1N1 influenza activity. As of August 24, there have been 164 hospitalizations (approximately 40% among children) and 7 deaths identified in the state. At this time, no resistance to antivirals has been found in Maryland, although there are scattered instances of Oseltamavir (Tamiflu) resistance noted, including in NC, WA and CA. There is no data yet to indicate any change in severity or character of the H1N1 influenza virus, but this remains a legitimate concern. The outbreak continues to affect those in younger age groups, including pregnant women, and those with underlying medical conditions. Click here to view Maryland's flu data.

Antiviral Resistance
In light of documented Oseltamavir (Tamiflu) resistance, and since most otherwise healthy H1N1-infected children and adults have had uncomplicated illnesses, federal and state authorities warn healthcare providers to limit use of influenza antivirals, when possible, to decrease selective pressure and subsequent development of antiviral resistance. Post-exposure antiviral chemoprophylaxis is recommended for those at high risk of influenza complications (age < 5 years, pregnant females, those with underlying chronic medical conditions or immunosuppression). Treatment is recommended for those with elevated risk of influenza complications and those severely ill or hospitalized with influenza-like symptoms.

What is the reality for both H1N1 and the seasonal flu epidemics? The biggest concern in regard to H1N1 is that it is a new strain of influenza virus with the only epidemiologic history recorded in the spring of the Northern Hemisphere and winter in the Southern hemisphere. By most accounts, it is a relatively mild illness with most people recovering without complications. The biggest difference between H1N1 and seasonal influenza is the target population. In seasonal influenza, the high-risk populations are the very young and the elderly. Because of possible exposure to some of the swine components of the flu many years ago, adults older than 64 may be less susceptible to the disease. Thus, high-risk groups include ages 6 mos to 24 years, the medically vulnerable (chronic medical conditions between 25 and 64 years of age), and pregnant women. Decisions on who has priority to receive the vaccination are based on these guidelines. Healthcare workers and first responders are included in the first wave of vaccinations. Currently, H1N1 influenza vaccination is expected to begin some time in mid-October. Your pediatric and internal medicine offices are fully informed and will be expected to stock the vaccine. It appears that only one dose of vaccine will be required based on the latest information from The New England Journal of Medicine.