December 10, 2009
by Gina Hamilton
Coastal Journal staff
AUGUSTA — A funny thing happened on the way to pandemic flu season in Maine this year, at least so far. While influenza has been fairly widespread, mortality and morbidity from the flu have not.
That is not to minimize the eleven deaths so far from H1N1 flu since July. But according to Dr. Dora Mills of Maine Centers for Disease Control (CDC), all of Maine’s flu casualties have been people with serious underlying medical conditions, such as asthma, lupus, certain kinds of arthritis, diabetes, cancer, heart disease, or HIV/AIDS. These are roughly the same populations who have died from H1N1 nationwide, as well, although in some cases, otherwise healthy young people have succumbed.
“Because H1N1 is so widespread, it is important for those at high risk for complications to take extra precautions. We advise staying away from large crowds and starting antiviral medicines at the first sign of illness for those who are at high risk, which include anyone with an underlying medical condition, everyone over 64 years of age, under two years of age, and pregnant women,” advised Dr. Mills. “It is also important that those who are ill not travel.”
Misty Green, director of Sagadahoc Emergency Management, credits preparedness, in part, for stemming the tide of serious disease. “People are using hand sanitizers and staying home when they are sick,” she said. “Businesses and schools are stepping up and owning disease prevention.”
The Coastal Journal’s service area, from Freeport to Camden, including all of Sagadahoc and Lincoln Counties, has seen no deaths due to H1N1, and only a few hospitalizations, since the flu season began.
Vaccination clinics have also finally gotten off the ground in Maine, although less than a quarter of the population has had the vaccine. Most of them are children, many of whom were vaccinated at school clinics in the last few weeks.
Currently, the H1N1 flu is on the decline in Maine and across the country. Hospitalizations, school absenteeism, and outpatient visits have all declined this past week in Maine.
In a normal flu season in Maine, an estimated 150 people die and about a dozen outbreaks occur in long term care facilities. Usually, fewer than a half dozen schools report high absentee rates. In a typical year, 36,000 Americans die from seasonal flu nationally, but for reasons not completely understood, seasonal flu has also been on the decrease in Maine and nationwide.
In our region, which includes all of New England, only 17 cases of seasonal flu were reported by CDC in the week ending November 28, while 2700 cases of H1N1 were reported, and another 400 cases were presumed to be H1N1 but not tested. The data seems to suggest that the milder H1N1 is crowding out seasonal flu to a large extent in New England. If this holds true, and also holds true nationwide, the deaths from flu in 2009-10 may actually be fewer than the normal toll taken by seasonal flu.
Part of the reason is that seasonal flu does not appear to be mutating with the H1N1 virus at all. This creates a two-virus season, requiring two separate vaccines for complete protection, but since H1N1 is prevalent, and is milder than typical seasonal flu, fewer people are dying or becoming seriously ill.
However, both Mills and Green stress that although this ‘wave’ appears to be winding down, those at increased risk should seek the vaccine and everyone should practice good hygiene habits, such as hand washing, sneezing into a tissue or upper sleeve, remaining at home when ill, and using sanitizers when water is unavailable or impractical. Those who get the flu in one of the risk groups - the very young, pregnant women, those with underlying medical conditions, and those over the age of 64 - should visit a doctor at the first signs of flu and get a prescription for an antiviral drug such as Tamiflu, which may be free to uninsured people in some high-risk categories. Uninsured patients should ask their doctor to note on their prescription form that the drug should be filled from state stockpiles.
No one can be sure whether there will be another ‘wave’ of flu this season, so those at highest risk should obtain the vaccine if possible. More vaccine is arriving daily. Currently, there is enough vaccine to meet less than half of the needs of the high-risk populations. The state has prioritized the available vaccine resources to provide immunization to the following populations:
• Pregnant women and recently pregnant women;
• Caregivers and household members of infants younger than six months old;
• All people six months through 24 years of age; and
• People ages 25 through 64 with underlying medical conditions, including COPD, asthma, chronic heart disease (except hypertension), kidney disease, liver disease, cognitive disability, neurologic/neuromuscular, blood disorder, metabolic disorders (including diabetes) or compromised immune systems (including HIV, organ transplant, people undergoing chemotherapy).
Most K-12 students have already had the opportunity to get vaccinated, but first dose vaccine will continue to be provided for children aged nine and younger throughout the flu season. Some regions have enough vaccine now to provide second doses for children aged nine and younger. Check with your school or doctor about second vaccines.
Most importantly, no one should assume that the emergency is over. Use sensible precautions against influenza, wash hands frequently, stay home if sick, and don’t return to school or work until you have been fever-free for 24 hours.