South Bend, Washington – We have not seen the last of the swine flu that appeared this spring in Mexico and spread throughout world. Cases of pandemic H1N1 influenza, the new flu virus, have dropped in number over the last few weeks in Western Washington, but are still occurring at a low rate. Flu is quite unusual during summertime and predicts that the flu season this year may well be a tough one. As of July 24th, Washington State has reported 658 confirmed cases and 7 deaths from H1N1 influenza since April. Of those, 122 resulted in hospitalizations. Most of those cases have been in urban areas; however, Pacific County has had a small share with at least one seriously ill person requiring transfer out of the county for ongoing hospital care. In June the World Health Organization declared a “pandemic” meaning that there is sustained spread of H1N1 influenza virus in many countries on multiple continents. Currently countries in the wintertime of the southern hemisphere are experiencing the most cases. The H1N1 flu is expected to return to us this fall and winter with full force. School absences and need for medical care are expected to be high. The most severe H1N1 influenza infections are striking people in younger age groups. Older people appear to be relatively spared probably because they had exposure to a similar influenza type that circulated seasonally in the population prior to 1957 giving them partial immunity. Unfortunately, since spring, hospitalizations and deaths have predominantly been in less than 30 year olds. Influenza is spread by droplets sneezed or coughed by an infected individual. The droplets are either inhaled by a susceptible person in close proximity, or settle on surfaces later to be picked up on hands and transferred to the nose or eyes. Transmission is interrupted by covering coughs and careful, frequent hand washing. Hand sanitizers also work. Masks may be of some benefit, particularly when placed on infected coughing patients to protect those around them. Initial symptoms are usually cough and abrupt high fever perhaps with sore throat or nasal congestion, and, particularly in children, maybe nausea and vomiting. Complications in severe cases are usually in the lungs with pneumonia, but can sometimes be in the brain with a meningitis-like illness. When influenza severely attacks the lungs, often with associated bacterial infections, respiratory failure may lead to the need for mechanical ventilation or even to death. Oseltamivir (Tamiflu) and zanamivir (Relenza) are two drugs that can be used to treat H1N1 infection, although rare cases of resistance have been identified in Asia and Europe. There are currently good supplies of both drugs available commercially and a reserve supply provided by the federal government under secure storage in Pacific County and other counties throughout Washington. The drugs are recommended only in high risk patients, those most likely to develop severe disease. Ideally they should be used in the first couple of days of the onset of illness. High risk groups are those under age five, pregnant women, chronically ill people with immune suppression, and those over age 65. Vaccine for H1N1 has been developed and as of the end of July is being tested for safety and efficacy. It is expected to be available this fall in small amounts with increasing supplies coming in over the course of the influenza season. Unlike the usual seasonal flu vaccine (which will also be available this fall), all the H1N1 vaccine this year will be distributed through public health agencies, not through usual commercial supply routes. The initial supplies will be prioritized to those at most risk of infection and/or most at risk for complications to likely include school age children, pregnant women, and front line health care workers. As over time supplies become readily available, vaccine will be offered to the public at large, just as seasonal influenza vaccine routinely is. Still to be clarified is whether one or two doses will be required initially. Public recommendations will be to get your routine flu shot this fall, and when available, to also get your H1N1 influenza vaccination(s). Discuss with your health care provider as to whether you fall into one of the priority risk groups. One tactic actively being considered is whether to vaccinate children at school. That would be voluntary, requiring parental permission, and will depend upon whether it makes sense when vaccine supplies become sufficient. Pacific County Public Health, both county hospitals, medical care providers, and Shoalwater Bay Tribe along with hospitals and public health departments statewide are developing plans to deal with the anticipated autumn uptick in influenza. Those include anticipating increased patient loads, providing vaccinations as vaccine becomes available, and judiciously using antiviral medications. The Pacific County Health and Human Services Department welcomes medically skilled volunteers to help with these efforts. If you think you can help, call the South Bend office at (360) 875-9343. As the flu season approaches and progresses, practice covering your cough, washing your hands, and staying home from work when you are sick.
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