As of September 23, 2009 here is what the United States and Territories had reported for the H1N1 “swine flu” activity. As health care workers we are on the front lines and need to protect ourselves. Protecting ourselves is best done with knowledge including vaccines, personal protective equipment, transmission based precautions and accurate information.

The VA reports both inpatient and outpatient case and the numbers break down as follows:
Outpatient: Suspected 924
Probable/Confirmed 282
Inpatient: Suspected 311
Confirmed 77 of the 77 confirmed cases it is noted that secondary lower respiratory infections were also present.
Deaths: 2
There a currently 5 companies manufacturing the vaccine they include Sanofi Pasteur, Novartis, CSL, Medimmune, and GLaxo Smith Kline (the last is not currently FDA approved). They expect to produce 200-250 million doses.
The Vaccine is supplied in multidose vials with 10 doses per vial and should be refrigerated. The Vaccine also comes with a kit which provides needles, syringes, solution for reconstitution, alcohol pads and vaccination cards.
The initial doses of the vaccine have been shipped and it is expected that eventually there will be enough vaccine for everyone who would like to be vaccinated. Currently the VA is prioritizing eligibility. The priority list is as follows
A) Healthcare workers and emergency medical service personnel expected to have direct patient contact/contact with infectious material.
B) Pregnant women
C) Care givers and contacts of infants of 6 months or less
D) Adolescents with medical conditions that increase their risk for flu-related complications
Risk factors thought to increase risk of flu/ flu complications include
A) Younger age <65 years
B) Pregnancy
C) Pre-existing illness: Asthma, Metabolic Disease
D) Obesity
The nasal spray is a live attenuated version and should not be used in the cases of pregnancy and those individuals with pre-existing conditions/immunosuppressive states. These individuals should receive the inactive version (shot).
Documentation of the vaccine is done via CPRS for both employees and patients. There are training resources available to assist in learning this new documentation. The VA intranet site address is vaww.vistau.med.va.gov and LMS will have training available by January 2011.
As with all medications/ vaccines there are some adverse events and contraindications:
A) Sensitivity/allergy to eggs
B) Pain at injection sight
C) Swelling at injection sight
D) With nasal dose there is a risk of getting the flu
E) Only approved for people ages 2-49 years of age
F) History of SEVERE asthma and bronchospasm
G) Do not use antiviral medications 48 hours prior to and 14 days post vaccine
H) Do not give live vaccines within 2 weeks of any other live vaccines. There is not contraindication to giving the inactive vaccines together but separate the injection sites.
Vaccination is only one of the ways we as direct care providers utilize to protect ourselves. We need to be familiar with the right Personal Protective Equipment (PPE) and transmission based precautions utilized when caring for patients with suspected/confirmed nH1N1. The current standard for PPE include the N-95 respirator and STANDARD based precautions (previously pt’s were placed on contact precautions). Recently, a JAMA article addressed the question of the surgical mask being as effective as the respirator (N95) the CURRENT standard remains the respirator and employees MUST use this here at the VAMHCS.
The CDC on 10/13/2009 issued new guidelines that emphasize the importance of vaccination and respiratory hygiene/cough etiquette as facility control measures. They also discussed minimizing outpatient visits and minimizing visitors as feasible. The CDC recommended engineering controls such as partitions in triage areas, excluding sick workers, isolation for hospitalized patients for at least 7 days (doesn’t mean keeping them in the hospital for that length of time), and precautions for transporting sick patients. It is expected that OSHA will follow these recommendations within a few weeks to keep hospitals current.
The recommendations will continue to change as we learn more about the virus and how it behaves. One recommendation which remains a constant is hand hygiene. Always remember to wash your hands before and after any patient exposure. If you have flu like symptoms and a fever get yourself checked! Keep yourself informed and you will increase your chances to stay healthy.