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- Influenza Update
- Pneumococcal Vaccination
- Interim Influenza Antiviral Chemoprophylaxis And Treatment Guidelines from The CDC
- Any high-risk person who is within the first 2 days of illness onset should be treated with antiviral medications
Influenza Update
Nearly half of the counties in New York have reported cases of the flu, and federal health officials now consider the state's status to be "regional." That is one step below the highest designation of "widespread" -- reached only by Alaska and Delaware.
26 of New York's 62 counties had reported cases of the flu, but experts cautioned there's no way of knowing whether the state's relatively early outbreak of the virus indicates a tough flu season ahead.
One piece of good news for those able to get a shot: The cases of influenza confirmed so far this year are the same type the vaccine protects best against, according to lab tests. Because the flu virus constantly evolves, that is not true every year. Last winter's vaccine was a poor match to the type that predominated.
The state's picture may look worse than it is because New York is one of only a few states where hospitals and institutions are required to report all cases of the flu.
OMRDD is continuing to work with the State Department of Health (SDOH) to secure flu vaccine for those consumers defined as at highest risk. These are referred to as consumers in “category 1 and 2” and consist of:
1. Individuals who live in certified residential settings who are at highest risk:
a. Persons over the age of 65
b. Persons who are immunocompromised such as those with HIV/AIDS, and those on medication that suppress the immune system such as chemotherapy and long-term steroid use.
c. Persons with chronic conditions that put them at high risk such as pulmonary disease, cardiac disease, metabolic conditions (including diabetics) etc.
2. Other individuals who live in certified residential settings who:
a. live in the same residence as anyone listed in #1 above
b. live in residences with 24 hour nursing
c. live in a residence that serves medically frail individuals
Voluntary agencies should assess the people they serve in certified residential settings and identify those individuals who meet the criteria listed above and are not able to access flu vaccination from their primary care or other health care provider (such as a hospital or a clinic).
The SDOH has indicated that once voluntary agencies have completed their analysis, they should contact the local department of health (LDOH) in the county where the residence is located to discuss their need for flu vaccine. SDOH conducted a conference call with the LDOHs. During this conference call SDOH reports that it informed the LDOHs that they were to work with agencies certified by OMRDD to try and meet their need for flu vaccine. In addition, OMRDD has provided SDOH with a list of all voluntary operated agencies with at least one certified residential program to assist the LDOH in identifying agencies. This list has been provided in both an alphabetical and by-county format. The list is currently being uploaded to the SDOH website for convenient reference by the counties.
OMRDD has been told that counties will be receiving additional vaccine over the next several weeks. Some counties may not receive vaccine until January. Agencies should be encouraged to continue to work with the LDOH over this period of time. January is NOT too late to receive a flu vaccine. The weeks of highest incidence in NY state are the last 3 weeks of February and the first 2 weeks of March. Vaccination even in mid-January will be useful.
Pneumococcal Vaccination
An important medical intervention that should be promoted among high-risk patients is pneumococcal vaccination. Bacterial pneumonia is the most frequent complication of influenza infection, and pneumococcal pneumonia is one of the most common causes of bacterial pneumonia. According to the newest guidance from the CDC, the following individuals should receive the pneumococcal polysaccharide vaccine (PPV) whether or not they have received the flu vaccine:
- All adults 65 and older;
- Anyone over 2 years of age who has chronic cardiovascular disease (e.g., congestive heart failure or cardiomyopathy), chronic pulmonary disease (e.g. chronic obstructive pulmonary disease or emphysema, but not asthma), diabetes mellitus, alcoholism, chronic liver disease (e.g. cirrhosis), or cerebrospinal fluid leaks;
- Anyone over 2 years of age that has a disease that causes immunosuppression such as functional or anatomic asplenia, HIV infection, leukemia, lymphoma, Hodgkin’s disease, generalized malignancy, kidney failure, multiple myeloma, nephrotic syndrome, HIV infection or AIDS, or organ transplant;
- Anyone over 2 years of age who is taking any drug or treatment causes immunosuppression such as long-term steroids, certain cancer drugs, and radiation therapy;
- Persons in long term care facilities; and
- Alaskan Natives and certain Native American populations.
Interim Influenza Antiviral Chemoprophylaxis And Treatment Guidelines from The CDC
In the setting of the current vaccine shortage, CDC has issued interim guidelines for influenza antiviral chemoprophylaxis and treatment.
Any person experiencing a significant respiratory illness with fever should be tested for influenza.
CDC encourages the use of amantadine or rimantadine for chemoprophylaxis and use of oseltamivir or zanamivir for treatment as supplies allow, in part to minimize the development of adamantane resistance among circulating influenza viruses.
CDC guidelines for use of antiviral medication include:
Any high-risk person who is within the first 2 days of illness onset should be treated with antiviral medications
In the event of an outbreak in residences caring for high risk people, all persons who live or work in the residence should be given antiviral medications. Treatment of ill persons should be given for 5 days. Chemoprophylaxis of others should be given for at least 14 days. (pregnant women should consult their primary provider regarding use of influenza antiviral medications). If surveillance indicates that new cases continue to occur, chemoprophylaxis should be continued until seven days after the onset of the last identified case. Treatment and chemoprophylaxis should be initiated if influenza is strongly suspected but test results are not yet available. OMRDD recommends that agencies develop a plan regarding how the agency will communicate with staff and their primary care physicians regarding the need for prophylaxis. Such a plan should include a strategy for managing the situation should it occur on a weekend or holiday when primary care physicians may be unavailable.
Pharmaceutical distributors should be contacted directly for availability and procurement of antiviral medications. OMRDD suggests that agencies contact their pharmaceutical provider now to develop a plan for obtaining antiviral medications should the need arise. This plan should include how to obtain medication quickly over weekends and holidays when usual systems may not be in operation.
During a nosocomial outbreak of influenza, if a facility has made all reasonable efforts and has failed to procure antiviral medications from private distributors, the facility should convey its request to the state health department, which will contact CDC to obtain antivirals on an emergency basis from the U.S. Strategic National Stockpile.
You can get more information on Influenza from the Center for Disease Control and Prevention website at www.CDC.gov. If you have specific questions or require additional information, please feel free to contact Kathleen Keating at OMRDD at 518-473-9697 or by e-mail at
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