H1N1 spike in Georgia raises concerns of possible third wave

With regional flu activity also seen in Alabama and South Carolina, CDC officials stress it's not too late to encourage patients to get vaccinated.

By — Posted April 12, 2010

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The solo practice of Brooklet, Ga., family physician W. Scott Bohlke, MD, has been seeing about 20 patients with influenza A(H1N1) virus each week since mid-March.

He is concerned about a third wave of the flu, in part because he said some patients have had a tepid interest in the H1N1 vaccine. Lately, however, interest is picking up.

"They're asking, 'Is it too late to get [the vaccine]?' And I tell them, 'No,' " said Dr. Bohlke, chair of the Medical Assn. of Georgia board of directors.

A resurgence of the flu virus is happening throughout Georgia.

During March, about 40 Georgians were hospitalized each week due to H1N1, said Patrick O'Neal, MD, director of the Division of Emergency Preparedness and Response for the state's Dept. of Community Health. That is the state's highest mark of H1N1-confirmed hospitalizations since October 2009, according to the Centers for Disease Control and Prevention.

The CDC is investigating Georgia's spike in influenza activity and monitoring what some fear may be the start of a third wave of the virus. Earlier waves rolled across the nation in the spring and fall of 2009.

On the national level, the CDC is urging physicians and other health professionals to continue vaccinating the public to prevent flu activity. As of April 1, Alabama, Georgia and South Carolina were reporting regional activity, which is one step below widespread activity.

The CDC considers influenza to be widespread when at least half the regions in a state report outbreaks or increases in influenza-like illness and laboratory-confirmed influenza. No states reported widespread activity during the 11-week period ending March 27.

"Although people refer to it as a resurgence, H1N1 influenza never really left us" in Alabama, said Jim McVay, DrPA, director of health promotion and chronic disease at the state's Dept. of Public Health. He said Alabama's H1N1 cases peaked in October 2009, but 4% to 5% of physician visits are still due to H1N1-related illnesses.

Vaccination rates vary

Interest in the H1N1 vaccine has dwindled since the U.S. epidemic peaked in late October 2009. But the CDC reported that nearly 91 million doses of vaccine had been administered by mid-February. The agency estimates about 81 million Americans received the vaccination, including children 6 months to 9 years, who require two doses.

Vaccination rates were highest in New England, where Rhode Island topped the list with 38.8% of people 6 months and older immunized by the end of January, according to the CDC's April 1 Morbidity and Mortality Weekly Report.

Mississippi had the lowest vaccination rate at 12.9% of the population. In Georgia, 16.6% of residents were immunized.

The CDC also analyzed seasonal influenza and H1N1 vaccine rates among health care professionals during the 2009-10 season. Of the 1,417 surveyed who work in a health care setting or are first responders, 61.9% had received the seasonal flu vaccine by mid-January. This marks the first time the nation's health care vaccination rate met the Dept. of Health and Human Service's Healthy People 2010 target of 60%.

But H1N1 vaccination among health care professionals was 37.1%.

Those who work with critically ill patients were more likely to be vaccinated against both viruses than were other health professionals, the study found. Vaccination rates for seasonal influenza and H1N1 also were higher among those working in hospitals than among professionals working in long-term-care facilities or other settings.

"To me, this emphasizes the idea that influenza vaccination is a patient safety issue. And it is a good idea for health care workers to be vaccinated to protect their patients," Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, said during an April 1 briefing.

Dr. Schuchat said more could be done to bolster vaccine use among health professionals. For example, more health facilities could recommend, or even require, employees to get immunizations against seasonal influenza and H1N1, she said.

"Overall, the country did an extraordinary job of responding to this new influenza strain, but there is room for improvement going forward," she said. "We all know that if we had had more vaccine earlier, more people could have received vaccine, and we could have prevented more disease."

The CDC estimates that approximately 60 million Americans had been infected with H1N1 as of March 29. About 265,000 were hospitalized, and nearly 12,000 died.

H1N1 vaccine supplies remain widely available across the nation. Although some doses will expire by the end of June, others will last until 2011, Dr. Schuchat said. The CDC plans to release guidelines on how to discard unused vaccines.

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H1N1 vaccination rates

A new report by the Centers for Disease Control and Prevention shows disparities in influenza A(H1N1) vaccination rates among states. Here are the five states with the highest and lowest H1N1 immunization rates for people 6 months and older as of the end of January.

Highest ratesLowest rates
Rhode Island38.8%Mississippi12.9%
South Dakota36.9%Alabama15.7%

Source: "Interim Results: State-Specific Influenza A(H1N1) 2009 Monovalent Vaccination Coverage -- United States, October 2009 -January 2010," Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, April 2 (link)

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