Commonly Asked Questions From Providers
Who is Prioritized for Treatment with Influenza Antiviral Drugs?
How Reliable is Laboratory Testing for 2009 H1N1 Flu?
How Important is Testing and Should I Wait for Test Results to Treat Suspect Flu?
How Do I Find Out What Flu Viruses are Circulating In WV and at What Levels?
General Information:
West Virginia Flu Surveillance Data: (WVDHHR) (Updated weekly) WV trends for influenza like illness, laboratory data on circulating viruses, flu related hospitalizations & deaths, etc.
Information for Health Care Professionals (CDC): Links to a variety of topics for clinicians
Information On and How to Report Suspect Fraudulent H1N1 Products (FDA)
Receive CDC Updates for Clinicians and Notification of Trainings (CDC- COCA)
H1N1 Testing, Treatment and Patient Management
Diagnostic Testing
Recommendations on Testing for Flu During the 2009-10 Season (CDC)
Provider Q and A on Influenza Diagnostic Testing (CDC)
Antivirals
Updated Recommendations: Use of Antiviral Medications for the 2009-2010 Flu Season (CDC): Primary Antiviral Guidance Document
Questions & Answers: Antiviral Drugs, 2009-2010 Flu Season (CDC)
Quick Facts for Clinicians on Antiviral Treatment (CDC)
Antivirals: Summary of Side Effects (CDC)
IV Peramivir Clinician Portal: Emergency Use Authorization for Hospitalized Patients with Influenza (CDC)
Pharmacist Information
Information for Pharmacists (CDC): Includes information from FDA and CDC on compounding and advanced compounding of oseltamivir suspension
EMS and 911 Information
Guidance for EMS and 911 Public Safety Answering Points (CDC)
Guidance on Use of Paramedics to Administer H1N1 Vaccine in Local Health Clinics (WVDHHR – STECS)
Specialty Info
American Academy of Pediatrics: H1N1 Resources for Clinicians
American College of Obstetrics and Gynecology: H1N1 Resources
Infection Control Professionals
WV Reporting and Investigation Tools (WVDHHR)
Q&A: Respiratory Protection For Preventing 2009 H1N1 Influenza Among Healthcare Personnel (CDC)
H1N1 Vaccine
Vaccine Information Statements
H1N1 Injectable Vaccine (Flu Shot) (CDC)
H1N1 LAIV Vaccine (Nasal Spray) (CDC)
General Information on H1N1 Vaccines
ACIP Recommendations: Influenza A (H1N1) 2009 Monovalent Flu Vaccine
Top 10 FAQs for Immunization Programs and Providers (CDC) This information sheet addresses questions about co-administration of H1N1 and Seasonal Flu Vaccines and about vaccine intervals (including 2 dose intervals for children)
H1N1 Vaccine Clinician Questions and Answers (CDC) Broader Questions
Q&As about H1N1 Live Attenuated Intranasal Vaccine (the nasal spray) (CDC)
Healthcare Workers and H1N1 Vaccine (WVDHHR): A Fact Sheet on HCW Vaccination
Q & As about H1N1 Vaccine and Pregnant Women (CDC)
ACOG site on Pregnancy, H1N1, and H1N1 Vaccine (ACOG)
Use of Pneumococcal Vaccines during the 2009 H1N1 Outbreak (CDC)
Vaccine Safety
Q & As on Vaccine Safety (CDC)
Q & As on Thimerosal (CDC)
Q & As on Guillain-Barré syndrome (GBS) (CDC)
MMWR: Update on Influenza A (H1N1) 2009 Monovalent Vaccine (CDC): Vaccine Formulations and Basic Clinical Trial Data
VAERS: Vaccine Adverse Event Reporting System (HHS)
Monitoring Vaccine Safety (CDC)
Vaccine Supply
Q & As on Vaccine Supply (CDC)
WV Vaccine Distribution by Jurisdiction and Vaccine Projections (WVDHHR)
WV H1N1 Vaccination Program: Tools for Enrolled Providers
Provider H1N1 Vaccine Pre-Registration Survey (WVDHHR): 1st step of enrolling as an H1N1 provider; also see Health Alert #24 Below
Submit a Question about H1N1 Vaccine Provider Enrollment (WVDHHR)
Submit a Question about H1N1 Vaccine Ordering (WVDHHR)
WVSIIS : West Virginia Statewide Immunization Information System
2009 H1N1 Vaccine Financing Q&A (CDC)
CMS Billing for the Administration of the Influenza A (H1N1) Virus Vaccine (CMS)
WV Information on H1N1 Vaccine Billing (Excerpt from WESGRAM) (WVSMA)
Downloadable Educational Materials For Offices and Patients
2009-2010 WV H1N1 Campaign Long Flyer (jpeg file)
2009-2010 WV H1N1 Campaign Long Brochure (Color)
2009-2010 WV H1N1 Campaign Large Poster 18x24
2009-2010 WV H1N1 Campaign General Poster
2009-2010 WV H1N1 Campaign Parent Flyer (3 copies per page)
2009-2010 WV H1N1 Campaign Employer Flyer (3 copies per page)
2009-2010 WV H1N1 Campaign Clinic Poster (fill in the blanks with a Sharpie)
When to Seek Medical Care for Possible Flu (WVDHHR): Fact Sheet for Patients
Treating Flu, Both H1N1 (Swine) and Seasonal (WVDHHR): Fact Sheet for Patients
Flu: What to do if you get sick (CDC): Fact Sheet for Patients
What You Should Know About Flu Antiviral Drugs (CDC): Fact Sheet for Patients
Pregnancy, Flu and Flu Vaccines (WVDHHR): Fact Sheet for Patients
Healthcare Workers and H1N1 Vaccine (WVDHHR): Fact Sheet for Healthcare Workers
Posters and Flyers for Various Groups (CDC): Downloadable Vaccine Posters, Parent Brochures on H1N1, Flyers for Persons with High Risk Conditions, etc.
"Prevent the Spread of H1N1 and Seasonal Flu" Poster (WVDHHR)
“Prevent the spread of H1N1 and Seasonal Flu” Flyer - for the Visually Impaired (WVDHHR)
H1N1 Related Health Alerts (WV and CDC):
WV Health Alert #28 Outbreak of Acute Viral Hepatitis B
(November 17,
2009)
WV Health Alert #27: Investigational IV Antiviral (Peramivir) Available under EUA For Use In Hospitalized Patients With Influenza (November 3, 2009)
WV Health Alert #26: Recommendations in Caring for Pregnant, Postpartum and Other Persons at Higher Risk of Complications from Influenza (October 23, 2009)
WV Health Alert #25: Influenza Guidance for the 2009-2010 Season (September 14, 2009)
WV Health Alert #24: H1N1 Vaccine: Provider Pre-registration for West Virginia Provider Offices, Hospitals, and Other Health Care Facilities (September 3, 2009)
CDC Health Advisory: Recommendations for the amount of time persons with Influenza-like illness should be away from others (August 7, 2009)
Commonly Asked Questions From Providers
Who is prioritized for treatment with influenza antiviral drugs?
Most people ill with influenza will recover without complications.
Some people are at highest risk of influenza-related complications and are
prioritized for treatment with influenza antiviral drugs this season. They
include:
· People with more severe illness, such as those hospitalized with suspected or confirmed influenza
· People with suspected or confirmed influenza who are at higher risk for complications
o Children younger than 2 years old
o Adults 65 years and older
o Pregnant women
o People with certain chronic medical or immunosuppressive conditions
· People younger than 19 years of age who are receiving long-term aspirin therapy
Children 2 years to 4 years old are more likely to require hospitalization or urgent medical evaluation for influenza compared with older children, although the risk is much lower than for children younger than 2 years old. Children aged 2 years to 4 years without high risk conditions and who are not severely ill do not necessarily require antiviral treatment.
Children and adults presenting with suspected influenza who have symptoms of lower respiratory tract illness or clinical deterioration should also receive prompt empiric antiviral therapy, regardless of previous health or age.
Physicians may also decide not to treat some people in these groups and/or treat people who are not in these groups based on their clinical judgment.
For more complete Information see the CDC Interim Updated Recommendations on the Use of Antivirals document and the Questions and Answers: Antivirals document. These can be found under the “H1N1 Treatment” Section of this page.
How Reliable
is Laboratory Testing for 2009 H1N1 Flu?
Rapid influenza diagnostic tests (RIDTs) are widely available but have variable sensitivity (range 10 – 70%) for detecting 2009 H1N1 influenza when compared with real-time reverse transcriptase polymerase chain reaction (rRT-PCR), and a negative rapid flu diagnostic test result does not rule out influenza virus infection. More information on sensitivity, specificity and interpretation of RIDT results can be found at http://www.cdc.gov/h1n1flu/guidance/rapid_testing.htm.
Like RIDTs, direct immunofluorescence assays (DFAs) are widely available, have variable sensitivity (range 47 – 93%) for 2009 H1N1 influenza virus, and a high specificity (≥96%). DFAs detect and distinguish between influenza A and B viruses but do not distinguish among different influenza A subtypes.
When influenza viruses are circulating in a community, the positive predictive value of the RIDT and DFA tests are generally high and a positive test result indicates that influenza virus infection is likely. However, as stated above, a negative test does not rule out influenza virus infection.
Nucleic acid amplification tests, including rRT-PCR, are the most sensitive and specific influenza diagnostic tests, but they may not be readily available, obtaining test results may take one to several days, and test performance depends on the individual rRT-PCR assay. As with any assay, false negatives can occur. Not all nucleic acid amplification assays can specifically differentiate 2009 H1N1 influenza virus from other influenza A viruses. If specific testing for 2009 H1N1 influenza virus is required, testing with an rRT-PCR assay specific for 2009 H1N1 influenza or viral culture should be performed (primarily available only through public health labs).
How Important is Testing and Should I wait for Test Results to Treat Suspect
Flu?
Most patients with clinical illness consistent with uncomplicated influenza who reside in an area where influenza viruses are circulating do not require diagnostic influenza testing for clinical management.
Patients who
should be considered for influenza diagnostic testing include:
- Hospitalized patients with suspected influenza
- Patients for whom a diagnosis of influenza will inform decisions regarding clinical care, infection control, or management of close contacts.
- Patients who died of an acute illness in which influenza was suspected.
When a decision is made to use antiviral treatment for influenza, treatment should be initiated as soon as possible without waiting for influenza test results. Antiviral treatment is most effective when administered as early as possible in the course of illness.
The sensitivities of rapid influenza diagnostic tests (RIDTs) and direct immunofluorescence assays (DFAs) are lower than real-time reverse transcriptase polymerase chain reaction (rRT-PCR) tests and viral culture. A negative RIDT or DFA result does not rule out influenza virus infection. (http://www.cdc.gov/h1n1flu/guidance/rapid_testing.htm). Further, these tests cannot distinguish between 2009 H1N1 and seasonal H1N1 or H3N2 influenza A viruses.
How Do I Find Out What Flu Viruses are Circulating In WV and at What Levels?
WV Flu Surveillance Data is posted weekly and can be found by clicking here (also found under Resources: Data and Statistics). This site contains charts and graphs outlining current trends in Influenza Like Illness, Laboratory Surveillance (what viruses are circulating and frequency of each), and Flu-related Hospitalizations and Deaths Data.
Yes. Seasonal Flumist vaccine (nasal spray) has been used for several years now and has shown both a good safety profile (for both vaccinee and for close contacts of the vaccinee) and good efficacy. The H1N1 nasal spray vaccine has been made just like seasonal nasal spray vaccine has been made.
Live virus vaccines are not new. They are made with weakened versions of the virus enabling them to invoke an immune response but not cause disease. MMR (measles, mumps, rubella) vaccine, chickenpox vaccine, and rotavirus vaccines are all examples of commonly used live virus vaccines. The virus used to make the live attenuated influenza vaccine is cold-attenuated. It cannot survive at temperatures warmer than those found in the nasal passages. Therefore, it does not cause systemic infection or disease in the person being vaccinated. Studies show that vaccine virus can occasionally transmit to others (0.6 – 2.4% of the time), but even when this happens, it has never been shown to cause disease (for again, the virus transmitted is cold attenuated). Therefore, it is fine to use this vaccine in contacts of individuals at increased risk and in healthcare workers. The only exception listed in its licensure is that it should not be used for persons who will be in contact with persons who are so immunocompromised that they need to live in specially engineered environments (like bone marrow transplant units). This is not because it’s even been shown to cause a problem in this setting, but out of an abundance of caution.
Intranasal flu vaccine (seasonal and H1N1) is licensed for people 2 through 49 who are otherwise healthy and not pregnant. It is a great and effective alternative for these individuals, including healthcare workers who fall into these categories. The most common side effect is a stuffy nose for a few days.
