Influenza-like illness is now “widespread” across Minnesota, using CDC’s classification system and reports of influenza-like illness continue to be sent to MDH. In particular, an increasing number of schools are reporting influenza-like illness in students. Thankfully, the severity of the illness caused by novel H1N1 does not currently appear to have increased, however this could change.

The groups at highest risk for serious illness from novel H1N1 include:

• pregnant women
• people who live with or care for children younger than 6 months of age,
• health care and EMS personnel,
• persons between the ages of 6 months through 24 years of age, and
• people from ages 25 through 64 years who have chronic health disorders or compromised immune systems.

H1N1 Vaccine

A vaccine for novel H1N1 is arriving in Minnesota in a series of shipments that will continue through the end of the year. The first shipment arrived the week of October 5, 2009. The H1N1 vaccine will be available in two forms - either a shot or a nasal spray. The first shipment will be weakened live virus vaccine in nasal spray form (”Flumist”) and can only be given to people 2 to 49 years of age.

The initial shipment will be relatively small, so we are targeting health care and emergency medical workers for the initial round of vaccinations in order to safeguard our healthcare system. The CDC estimates over 250 million doses of the H1N1 vaccine will be available, so eventually, everyone who wants to be vaccinated, should be able to do so. It is not known how many doses will arrive and when, or in what form.

Only one dose of the H1N1 vaccine will be needed for most people. Children under age 10 will need two doses.

You can get vaccinated for both kinds of flu at the same time if:

• You get shots for both kinds of flu.
• 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 only the nasal spray vaccine. The two doses of nasal spray vaccine would need to be given at least 4 weeks apart. Like all vaccinations, vaccination against novel H1N1 is completely voluntary - but it is highly recommended for people at high risk of complications.

Should large enough quantities arrive to justify mass vaccination clinics, they will be organized and staffed by Mayo, OMC and Public Health at locations and times convenient to most.

Influenza signs and symptoms

Be aware of the symptoms of H1N1 flu - which are generally the same as those for seasonal flu. H1N1 symptoms include:

• fever of 100 degrees or more with sore throat and/or cough
• runny or stuffy nose
• body aches
• headache
• chills
• fatigue
• in some cases, vomiting and diarrhea - which are not typically symptoms of seasonal flu.

If you have flu symptoms

• Don’t go to the Emergency Department, Express Care or your primary care provider if you’re generally healthy and you develop influenza-like symptoms. Healthy individuals with flu-like illness do not require treatment with antivirals, and you risk exposing other patients.
• Do call your doctor if you are pregnant, have a chronic health condition; or if children under 5 or older than 65 have flu-like symptoms.
• Do stay home from school or work until your fever is gone for 24 hours without the use of fever reducing medicines.

Seasonal Flu Vaccine

Supplies of seasonal flu vaccine should be ample - sufficient to vaccinate anybody who wants it. However, due to delays in vaccine delivery, many providers are temporarily out of flu shots, including Public Health Services.

Although getting vaccinated early for seasonal flu is a good idea this year, there is still plenty of time to get vaccinated. Seasonal flu doesn’t usually appear in Minnesota until November, and doesn’t typically peak until late January or February. You can get vaccinated anytime during flu season.

Novel H1N1 and Schools

As many experts predicted, we are now seeing a “second wave” of illness caused by H1N1. Many schools are now reporting influenza-like illness in their students. Because young people are at high risk for novel H1N1, it is a special concern for schools and child care providers. Schools are helping MDH track the occurrence of flu across Minnesota.

This year, schools will report to MDH when : the number of students with flu-like illness rises above five percent of all children in the school  -or- three or more cases of flu-like illness are reported among students in a single elementary school classroom.

If three or more cases of flu like illness are reported in a single classroom, parents will be notified. Parental notification is especially important for children at high risk of severe illness or complications from the flu. Children with chronic health problems are at higher risk.

Information about the number of schools reporting influenza-like illness will be posted weekly to the MDH flu website at www.mdhflu.com. Schools are not recommended to close because of H1N1 activity; schools may have to close in the event a high number of student and staff are absent on an individual schools basis.

Influenza Prevention

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 novel H1N1.

• Stay home from work or school - and generally avoid going out in public - if you are sick with symptoms of the flu. 
• Cover your nose and mouth with your sleeve or a tissue when you cough or sneeze.
• Clean your hands frequently and thoroughly - with soap and water or an alcohol-based hand-sanitizer solution. 
• Get vaccinated against the flu.  Avoid contact with others who may be ill. 
• 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.

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 :

• community food items 
• drinking cups or glasses  water bottles 
• beverage cans or containers 
• smoking materials 
• cosmetic products used on the lips

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.

Masks

The CDC and MDH do not recommend the use of simple face masks - or “surgical” masks - as an effective protective measure for healthy members of the public. It is recommended that people ill with flu-like symptoms wear masks in situations where they might expose others to the flu. N95 respirators (when fit-tested) - may provide some protection for health care workers who have close contact with patients who have flu symptoms.

Use of N95 respirators or facemasks generally is not recommended for workers in non-healthcare occupational settings for general work activities.

For specific work activities that involve contact with people who have ILI (influenza-like illness), such as escorting a person with ILI, interviewing a person with ILI, providing assistance to an individual with ILI, the following are recommended:

• workers should try to maintain a distance of 6 feet or more from the person with ILI;
• workers should keep their interactions with ill persons as brief as possible;
• the ill person should be asked to follow good cough etiquette and hand hygiene and to wear a facemask, if able, and one is available;
• workers at increased risk of severe illness from influenza infection should avoid people with ILI (possibly by temporary reassignment); and,
• where workers cannot avoid close contact with persons with ILI, some workers may choose to wear a facemask or N95 respirator on a voluntary basis.