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Influenza Vaccination: Providing Standard of Care Presentation to: Georgia Hospital Association Presented by: Matthew B. Crist, MD, MPH Date: September 27, 2012

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Outline Who should be vaccinated and vaccines offered Contraindications and side effects Strain selection and manufacturing of vaccine Healthcare Worker Vaccination Working Sick Mortality Benefit Improving vaccination rates Mandates

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Who gets the flu? From 5 -- 20 % of the U.S. population develops influenza each year. This leads to more than 200,000 hospitalizations from related complications. Persons at higher risk for complicated flu are: People with asthma People with diabetes People with heart disease or history of stroke People >65 years of age Pregnant women People with HIV infection People with cancer Children 65 years These people are urged to avoid pigs and pig arenas at fairs this season.

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Influenza A(H3N2) Variant Virus (akaH3N2v) Influenza A (H3N2) viruses with genes from avian, swine and human viruses that normally circulate in swine can sometimes infect humans. When these viruses are found in swine, they are called swine influenza A (H3N2) viruses. When human infections with these viruses occur, these viruses are called variant viruses (which can also be denoted with the letter v). In 2011, a new influenza A (H3N2v) virus was detected that had acquired the M gene from the influenza A(H1N1)pdm09 (2009 H1N1) virus. Continued human infections with this H3N2v virus have been detected in the US.

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Diagram of swine-origin trH3N2

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Summary of Ongoing H3N2v infections Influenza A (H3N2) viruses with genes from avian, swine and human viruses that normally circulate in swine can sometimes infect humans. Current outbreak of cases started in July 2012 12 total variant cases in 2011 As of Sept. 14 th, there were now 306 H3N2v total cases, 16 hospitalizations, and 1 death in 11 states. Cases have presented with mild illness 90% of cases are aged 10 and younger Main risk factor for infection is exposure to pigs, mostly in fair settings, However, CDC has previously reported the identification of likely cases of human-to-human spread of this virus during the current outbreaks.

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Summary of Ongoing H3N2v infections No cases have been observed in Georgia Enhanced surveillance by ILINet provider and District Epidemiologist Public Health messaging has been jointly developed and disseminated by Public Health and the Department of Agriculture Public health has also coordinated with the 4-H club, Jr. swine exhibitors, and Fair coordinators, to distribute education and prevention messages. GET YOUR Seasonal FLU SHOT!!

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H3N2v precautions