The Latest Updates about H1N1 (Swine Flu)

Website for up to date information on H1N1: www.flu.gov, www.cdc.gov/h1n1flu/guidance_hiv

H1N1 vaccine should be available by mid October and may end up being a series of two vaccinations approximately 4-6 weeks apart for H1N1. It is estimated that there will approximately 35 million doses of the H1N1 vaccine available.  The H1N1 vaccination does not replace the seasonal (routine) influenza vaccination. The Centers for Disease Control (CDC) and Department of Health and Human Services (DHHS) have recommended that the process for the routine influenza vaccination start as soon as possible (September).  The CDC and DHHS recommend that people with chronic illness or a compromised immune system also receive a Pneumococcal Vaccination if the person has not received it within the last five to seven years.

The World Health Organization (WHO) has currently placed H1N1 at Phase 6.

Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

Clinical Presentation would be similar to seasonal flu.

• consider mask
• symptoms may last up to 7 days or longer
• non infectious after 24 hours without a fever (not using medications)
• Clients can use antiviral medications (Tamaflu® and Relenza®) within the first 2-3- day to reduce symptoms. There are no published data on interactions between anti-influenza agents and HIV medications.

General Information and Recommendations for people with HIV

Work with state AIDS Service Organizations (ASO); to coordinate consistent information to clients. It is recommended that the ASO use their own web site to link clients to the websites that provide information on H1N1 and HIV.

Cases are classified as:

• Suspected case of novel influenza A (H1N1) virus infection is defined as a person who does not meet the confirmed or probable case definition, and is not novel H1N1 test negative, and is/has:
  • a previously healthy person < 65 years hospitalized for Influenza Like Illness (ILI)
  • ILI and resides in a state without confirmed cases, but has traveled to a state or country where there are one or more confirmed or probable cases
  • ILI and has an epidemiologic link in the past 7 days to a confirmed case or probable case
  • Links to non-federal organizations are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the federal government, and none should be inferred.
• A probable case of novel influenza A (H1N1) virus infection is defined as a person with an influenza-like-illness who is
  • positive for influenza A, but negative for human H1 and H3 by influenza RT_PCR
• A confirmed case of novel influenza A (H1N1) virus infection is defined as a person with an influenza-like illness with laboratory confirmed novel influenza A (H1N1) virus infection by one or more of the following tests:
  • real-time RT-PCR
  • viral culture

The groups recommended to receive the novel H1N1 influenza vaccine include:

• Pregnant women because they are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated;
• Household contacts and caregivers for children younger than 6 months of age because younger infants are at higher risk of influenza-related complications and cannot be vaccinated. Vaccination of those in close contact with infants less than 6 months old might help protect infants by “cocooning” them from the virus;
• Healthcare and emergency medical services personnel because infections among healthcare workers have been reported and this can be a potential source of infection for vulnerable patients. Also, increased absenteeism in this population could reduce healthcare system capacity;
• All people from 6 months through 24 years of age
• Children from 6 months through 18 years of age because we have seen many cases of novel H1N1 influenza in children and they are in close contact with each other in school and day care settings, which increases the likelihood of disease spread, and
• Young adults 19 through 24 years of age because we have seen many cases of novel H1N1 influenza in these healthy young adults and they often live, work, and study in close proximity, and they are a frequently mobile population; and,
• Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.
• HIV Positive clients with low T-Cell counts can be at risk for complications due to novel H1N1.

Preventative Measures for people with HIV

• Wash hands frequently with soap and water. If this is not available use alcohol based hand sanitizer (should be at least 60% Ethyl Alcohol).
• Avoid touching your eyes mouth and face (this is the way the virus is transmitted)
• Avoid contact with people that are ill a 6 foot distance is recommended, avoid large crowds
• Stay on HIV medications
• Persons at high risk of serious influenza-related complications should be given antiviral medications if they are likely to be exposed to other people with influenza. For example, when a family or household member is diagnosed with influenza, the exposed person with HIV/AIDS should be given chemoprophylaxis for 7 days.
• Get the seasonal flu vaccine, people with compromised immune systems should not take FluMist®. This is a live attenuated influenza vaccine (LAIV).
• Pneumococcal vaccine if you have not received it previously.