Experts: Immunize kids for flu before outbreak

On the same day the first global flu epidemic in 41 years was confirmed, Valley health authorities took the opportunity to urge parents to immunize their children against seasonal flu before an outbreak hits this winter.

Doing so, the officials said, might help avoid an overload on hospitals, doctors and community health workers caused by the expected second wave of the H1N1 influenza virus - known as the "swine flu."

On Thursday, World Health Organization officials said the spreading of H1N1 has reached a pandemic level. WHO said 74 countries had reported 28,774 cases, including 144 deaths.

The last pandemic - an outbreak of Asian flu in 1968 - killed between 750,000 and 1 million people, including nearly 34,000 in the U.S.

According to the Arizona Department of Health's most recent tally, made Wednesday, there were 597 H1N1 cases statewide, including six deaths. Maricopa County is home to 322 victims.

Maricopa County public health director Dr. Bob England declared, "This epidemic will be back," basing his statement upon studies of past pandemics and news from the Southern Hemisphere, where it is now flu season.

Although England said the WHO's announcement "changes nothing," it presents "a teachable moment," because he wants to get word out to stress the importance of seasonal flu immunizations when they become available.

It's difficult to say how many children get vaccinated for the flu each year, because it's not required, England said.

"Our goal this year is to get as many kids as possible vaccinated so you can dramatically cut the regular flu count," he said. "Frankly, it's something we should have done before."

PREPARATIONS UNDER WAY

If enough children are immunized against the flu, England said, that creates a "herd effect," or "herd immunity," in which the virus cannot find a toehold in a community. And if a child does come down with the flu, the odds of the virus spreading are greatly reduced because the victim's peers are immune.

The seasonal flu vaccine may be available as early as September. But England said federal officials are telling state and county health authorities the vaccine for swine flu, which requires a separate inoculation, won't be ready until mid to late fall.

Even prior to the appearance of H1N1, the state's Vaccines for Children program placed an order for nearly three times as much seasonal flu vaccine as it did last year, said Will Humble, interim director of the Arizona Department of Health Services.

Last year, the department ordered 152,000 children's vaccines for the state's uninsured children, Native Americans and those on Medicare. For next year, the program will have 408,000 doses available.

The push came because the Centers for Disease Control changed its policy. It now recommends the seasonal flu vaccine for all children, and not just those under 18 months or with underlying health issues, Humble said.

Another order may be put in if supplies are available.

Chandler Regional Medical Center conducts flu vaccine clinics around the East Valley each season. Cheryl Shafer, director of pharmacy services, said 8,000 doses of adult vaccine have been ordered for this coming flu season. That's 1,000 more than 2008 and 2,000 more than 2007.

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"We base it on last year's usage and increase it a little bit," Shafer said. "It's also based on how many clinics we have, which we don't know yet. So we'll be placing more orders."

While the seasonal flu vaccine created for this coming winter will not protect against H1N1, drug makers are working on a vaccine for the previously unknown influenza.

Nadine Miller, director of health services for the Mesa Unified School District, said the nearly 69,000-student school district has joined with city and county officials in discussions, including what could happen in the case of a widespread flu outbreak.

While the junior high and high schools have had roving "shot clinics" in the past, Miller said that has not been done in the elementary schools because of logistics.

"We can't have 30 kids crying in a classroom with one teacher," she said. But there may be other options, such as using a nasal spray version of the influenza vaccine that's now in use or setting up a clinic at a time parents can come to the school with their children.

Mary Ann Yahl, the senior infection preventionist at Banner Desert Medical Center and Cardon Children's Hospital, said regular planning meetings take place every year for flu preparations. Steps include taking stock of mask, antiviral and glove supplies, as well as looking at medical data.

This spring, the hospital received some of the national stockpile of antivirals and still has that available for fall and winter, Yahl said. The H1N1 virus responds well to those.

Communication with patients, employees and the community will be key, Yahl said, as the hospital places restrictions on visitors and asks coughing patients to don masks as they enter.

Susan Horan, director of the Chandler Care Center (formerly known as the San Marcos Family Resource Center), said each year notices are sent out to school families about the vaccine and the vaccine clinics held at the care center.

"We push and push, and we send home information on fliers," Horan said. "People either love flu shots or hate them. Some would rather take the chance or say they got the flu" from the shot. That is not likely happening, Horan said, because people cannot get the flu from the dead virus used in the seasonal flu vaccine.

COMMON SENSE URGED

Another message England said he wants to get out is the need for sick kids - and their parents - to stay home. Parents should start thinking about what they will do if they need to keep their kids home, he said.

"Who spreads the virus each year? Children are the main amplifier of the flu," England said Thursday. "Every flu season we see the first signs of influenza in the school setting."

Schools can be germ farms with younger kids standing in line close together or just playing right up in each other's faces. Besides the vaccine, parents can help by keeping sick kids with high fevers at home, Miller said.

"It's very important. That's the only way we're not going to spread this," Miller said.

The problem, Miller said, is that people think of the flu as the aches, pains and troubles they may feel when the get a virus or a stomach bug. They don't think of the flu as what it is - a respiratory ailment.

"We have to continually ramp up information," Miller said. "People say, 'Oh, I didn't get it (the shot) last year and it wasn't bad. It's hard sometimes to talk to people about respiratory flu. It's not a little tummy ache and throwing up. I don't think people understand the difference ... Seasonal flu is serious."

England added businesses also must prepare during these months before swine flu's expected return. What happens when employees must stay home to tend to sick children? And what's the plan when employees themselves fall ill?

Said England: "We have to use the time we've got now."

DIFFERENT STRAINS

The seasonal flu and the H1N1 virus can affect people in different ways. The seasonal flu for some may cause aches and pains but can be deadly to those with underlying respiratory issues.

The H1N1 virus may do the same, but there have been deaths reported around the world in people who were otherwise healthy prior to getting the virus.

Because there's been an increase in tracking influenza in Arizona with the H1N1 strain, England said health officials have discovered that the seasonal flu sticks around longer than previously thought.

Arizona was still reporting widespread seasonal influenza to the Centers for Disease Control the last week of May. As of June 2, there have been 4,877 confirmed cases of seasonal flu in Arizona and six influenza-associated pediatric deaths for the 2008-09 flu season.

School, county and city officials will join together for a pandemic preparedness course in August. There, officials can collaborate on plans that may be put in place should a large flu outbreak affect the East Valley, said Mesa assistant fire chief Gil Damiani, emergency management coordinator for the city.

WHAT YOU CAN DO TO STAY HEALTHY

• Stay informed.
• Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people, so watch out for that.
• Take everyday actions to stay healthy.
• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
• Avoid touching your eyes, nose or mouth. Germs spread that way.
• Stay home if you get sick. The Centers for Disease Control recommend that you stay home from work or school and limit contact with others to keep from infecting them.
• Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
• Find healthy ways to deal with stress and anxiety.

Source: Centers for Disease Control

H1N1 FLU HOTLINE

(602) 263-8856

(800) 352-3792

24 hours/7 days (bilingual)

Source: Community Information and Referral

WHAT IS A PANDEMIC?

The World Health Organization characterizes a pandemic by outbreaks in at least three countries on at least two continents. As of Thursday, at least 74 countries around the world have confirmed swine flu cases.

HOW SEVERE IS THIS PANDEMIC?

At this time, WHO considers the overall severity to be moderate. This is based upon the following: most people recover from infection without the need for hospitalization or medical care; national levels of severe illness appear similar to levels seen during local seasonal influenza periods; and, most countries' hospitals and health care systems have been able to cope with the numbers of people seeking care.

DOES WHO EXPECT THE SEVERITY OF THE PANDEMIC TO CHANGE OVER TIME?

The severity of pandemics can change over time and differ by location or population. Future severity assessments would reflect one or a combination of the following factors: changes in the virus; underlying vulnerabilities; or limitations in health system capacities.

Source: World Health Organization