Flash FAX : 2009-09-23 - H1N1 UPDATE

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Flash FAX

September 23, 2009

      H1N1 2009: For the most recent reporting week, the CDC again documented an
      increased number of confirmed cases of infection due to H1N1, including
      two pediatric deaths. There are now 21 states with widespread disease
      reported, but even in those states disease occurrence is not uniformly
      distributed. We continue to see positive cases both by rapid diagnostic
      tests and PCR. For each of the last three weeks, we have seen a steady
      increase in the number of tests submitted for analysis as well as the
      number of positives. As of today, about half of our requests for testing
      are internal (ED, UCC, CHC, pulmonary) and the other half are from the
      offices of community physicians.
      We have received a number of questions about the sensitivity and
      specificity of the various testing kits that are commercially available.
      The CDC reported data in August on the ability of three kits to detect
      influenza isolates in general and novel H1N1 more specifically. In the
      case of the H1N1 isolates, the numbers are small. For the three kits
      (BinaxNOW, Directigen EZ Flu and QuickVue A+B), the sensitivity for all
      flu isolates was 51%, 58% and 72%, while for H1N1, it was 40%, 49% and
      69%. Investigators from Atlanta reported on four kits, looking at all
      isolates not just H1N1, and concluded that the sensitivity was 88-96% for
      Directigen, 62-88% for Flu OIA, 73-81% for QuickVue and 57-65% for
      ZstatFlu. There is significant variation in the sensitivity of the tests,
      as well as some concern over specificity values of 93%, which means that
      false positives are also an issue.
      In a recent publication, the CDC says that in the event that a rapid test
      is negative for Flu A and B, the clinician “should use clinical symptoms,
      severity and underlying disease to decide if antiviral treatment is
      appropriate, should not use a negative rapid test to send a symptomatic
      child back to school, to rule out an institutional outbreak or to dictate
      infection control practices, should consider whether additional testing is
      needed by using viral culture and rRT-PCR and should consider whether
      additional diagnostic testing and/or empiric antibiotic therapy for
      co-infections is indicated”.

      H1N1 VACCINE AVAILABILTY: On Friday, the CDC released more information on
      the availability and distribution of the novel H1N1 vaccine. There are
      five manufacturers producing vaccine for the US. The first vaccine is
      expected to be shipped by mid-October, with the possible availability of
      some vaccine by late September. Vaccine will be shipped to clinics,
      offices, health departments and other project area-designated sites. The
      vaccine will be purchased by the federal government. Charges for
      administration fees will be allowed. Vaccine will be allocated based upon
      population. One dose of vaccine will be sufficient for persons aged 10
      years and older. Dosing schedule for children is not yet known. Seasonal
      and novel H1N1 can be given at the same time (except seasonal live vaccine
      and live H1N1 should not be combined). There will be a separate allocation
      for Department of Defense personnel, but not for dependents, retirees and
      civilian employees. Recommendations for vaccine include pregnant women,
      people who live with or care for children under 6 months of age, health
      care and emergency medical services personnel, persons between the ages of
      6 months and 24 years of age, and people from 25 years of age to 64 years
      of age with chronic medical conditions. It may be necessary to prioritize
      further within these groups based upon vaccine availability. Stay tuned
      for more details.


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