Influenza: Seasonal, Avian and Pandemic Update
Media Talking Points
December 1, 2006
Seasonal Influenza
Activity:
- In Michiganthere are 3 confirmed cases of influenza, 2 Influenza A (awaiting classification), and 1 Influenza B (Malaysia/2506/2004-like, consistent with vaccine). 2 are from OaklandCounty, 1 from Jackson, 2 pediatric, 1 adult.. There have been no reported pediatric deaths related to influenza illness. This sporadic activity level is consistent with activity being reported in surrounding states.
- Nationally, as of November 18, the proportion of patient visits to sentinel providers for influenza-like illness (ILI) and the proportion of deaths attributed to pneumonia and influenza were below baseline levels. Four states reported regional influenza activity; four states reported local influenza activity; 23 states, the District of Columbia, and New York City reported sporadic influenza activity; and 19 states reported no influenza activity.
Vaccine:
- Nationally this season, there are more doses of vaccine than has ever been produced in the United States. CDC is still projecting between 110 and 115 million doses will be produced this season. As of November 24th, 94 million doses of flu vaccine have been distributed nationally.
- While CDC anticipates an unprecedented number of influenza vaccine doses this season, and CDC understands from the manufacturers that the vast majority of doses will be distributed by the end of November, we recognize that many providers didn’t receive their vaccine as early in the vaccination season as they would have liked, making it difficult for them to vaccinate all of their patients during October and early November.
- Based on the information provided to us by CDC, it is expected that a significant amount of influenza vaccine should be available in physicians' offices and communities after Thanksgiving.
- Early in the season, some providers appeared to have more influenza vaccine than others because there are multiple manufacturers, distributors and distribution channels-- each of which has different distribution plans and schedules. Some health care providers may not have received their full allotment of vaccine until November or later, depending on which manufacturer or distributor an individual provider ordered vaccine from, and when they ordered it. With the manufacturers and major distributors implementing policies designed to facilitate delivery of some influenza vaccine by the end of October to all providers who ordered it, providers should have had some vaccine in October to begin vaccinating their patients. Getting some vaccine to all providers early in the season is important, because we know that all providers serve at least some high-risk patients and their household contacts.
- The challenge that MDCH and the Flu Advisory Board (FAB) are facing is that flu vaccine is not equitably distributed across the state and there are still certain providers in some health agencies who are having trouble getting their doses. Manufacturers and the distributors have said that they are making every effort to provide partial shipments and to distribute the vaccine as quickly as it is becoming available. There are still inequities between the need and the supply in some parts of the state. MDCH has only a limited capacity to do anything about that because the vast majority of this vaccine is in the private sector, and the state is the distributor for only VFC vaccine. The FAB works to look at these inequities and seek resolution for it, but even they are limited in their ability to impact decisions by distributors and other private sector venues.
- MDCH anticipates that providers may be unable to obtain sufficient vaccine for their 3-year-old patients. There is a single supplier of vaccine for this age group and the timing of expanded recommendation (changed the ACIP recommendation from 6 months –23 months to 6 months –59 months) after the vaccine was pre-booked.
- Providers in need of vaccine, or looking to redistribute excess vaccine should view the Influenza Vaccine Exchange Network (IVEN) system at to see if redistribution opportunities are available.
- The federal Vaccines for Children (VFC) program provides influenza vaccine to eligible children. The VFC program provides free vaccines in private provider offices and public health clinics to children and adolescents age 18 and younger, who are either uninsured, Medicaid-eligible, American Indian, or Alaska Native. In Michigan, children who are underinsured for influenza vaccine (have insurance coverage that does not cover vaccination) may receive vaccine at their private provider’s office or public health clinic.
- Insurance companies usually cover the cost of ACIP recommended vaccines. Private providers will be asked to assess which patients are covered by their health plans for this vaccine
Key Messages on Influenza Vaccine
- Vaccination efforts against influenza needs to continue into December and January and throughout the flu season. Ideally, people should be vaccinated by the end of November, but it is certainly not too late to get the vaccine in December or January in most years. The flu season typically peaks in February or later, so CDC recommends continuing to vaccinate into December, January, and beyond as needed. This is why CDC and other groups are sponsoring National Influenza Vaccination Week during the last week of November, to get out the message that continuing to vaccinate beyond Thanksgiving is important to protect Americans against the flu.
- Of the nation’s 300 million people, 218 million people are recommended to have influenza vaccine.
- This year’s vaccine is a good match for the influenza viruses that are now circulating.
- Encourage all patients and anyone wishing to protect themselves from influenza that they can be vaccinated later in the season.
- Vaccines administered to children and adults should be entered into the web-based immunization registry, the Michigan Care Improvement Registry (MCIR) at
- Flu vaccines are safe and effective. And flu vaccines cannot give you influenza.
- The Advisory Committee on Immunization Practice (ACIP) also highlights the importance of administering 2 doses of influenza vaccine for children aged 6 months up to 9 years of age who are receiving flu vaccine for the first time.
- Each flu season is different and presents new challenges both nationally at in Michigan. As always, influenza is unpredictable so we're not going to be able to say how fast it's going to evolve, where it will hit next, how bad it will be, how serious it would be and we're just at the very beginning of the flu season. This means that there's time to get vaccinated against influenza, and that's the major message of the Flu Advisory Board (FAB).
Influenza Recommendations for 2006-2007
ACIP recommendations for annual influenza vaccination to include:
- All children 6-59 months of age, their healthy household contacts and their care providers;
- Women who will be pregnant during influenza season;
- All healthcare workers;
- All patients older than 6 months of age with certain chronic medical conditions and their healthy household contacts and care providers;
- Children 6 months-18 years of age on aspirin or salicylate therapy;
- All persons 50 years of age or older
- Persons who live with or care for persons at high risk, including household contacts who have frequent contact with persons at high risk and who can transmit influenza to those persons at high risk;
The viruses in the 2006-07 vaccine are A/New Caledonia/20/99 (H1N1 virus), A/Wisconsin/67/2005 (H3N2)- like virus (A/Wisconsin/67/2005 and A/Hiroshima/52/2005 strains) and B/Malaysia/2506/2004-like virus (B/Malaysia/2506/2004 and B/Ohio/1/2005 strains)
For more information, go to
Michigan VFC order: (to be updated 11/30)
- 96,500 doses of preservative-containing vials were requested but we were only allowed to order 84,460 (short 12,040 doses that had been requested by local health departments and private providers)
- 61,300 doses of preservative-free vaccine
- 7,830 doses of FluMist (LAIV) were ordered and delivered to offices.
Avian Influenza
- The avian influenza A (H5N1) virus continues to circulate in poultry and some wild birds in Asia (most recently in South Korea), Eurasia, Africa and Europe.
- There have been no reports of highly pathogenic Asian strain influenza A (H5N1) virus in wild birds, poultry, mammals, humans in the Western Hemisphere as of this date.
- In Michigan, over 544 wild birds have been tested for avian influenza since April 1, 2006, as part of standard surveillance for avian influenza.. 3 birds have been positive for a low-pathogenic strain of H5N1, which usually circulates in North America, and is NOT related to the highly pathogenic Asian strain. St. Clair had LPAI H5N1 in mallard ducks, Tuscola in a green-winged teal, and Monroe in one mute swan.
- Asian H5N1 does not move easily to humans, andthere are only a few documented cases of humaninfection from wild birds.
- Hunters: As a precaution, the U.S. Department ofInterior’s NationalWildlifeHealthCenterhas issued the following guidelines forhandling wild birds:Do not handle birds that areobviously sick or birds found dead.Do not eat, drink, or smoke whilehandling or cleaning your birds.Use rubber gloves when cleaningyour birds.Wash your hands with soap andwater or alcohol wipes after dressingbirds.Clean all tools and surfacesimmediately afterward; use hotsoapy water, then disinfect with a10% chlorine bleach solution. Cook all meat thoroughly to aninternal temperature of 165° F to killthe virus.
- Reports of dead waterfowl should be to the MI Department of Natural Resources. If you see a die-off of waterfowl, gulls or shorebirds, please call the Department of Natural Resources Wildlife Disease Lab at (517) 336-5030 from 8:00 a.m. to 5:00 p.m. After hours: 1-800-292-7800. Sick or dead waterfowl, gulls or shorebirds will be laboratory tested for avian influenza if they are from a die-off (a die-off is defined as 6 or more birds found sick or dead in a short time period).For birds fewer than 6 and/or species other than waterfowl, gulls or shorebirds, please use the web form for submitting your sighting. (
- The Michigan Department of Agriculture is working closely with the poultry industry and domestic poultry surveillance for avian influenza Resources
Human H5N1 Activity:
- Human cases are still being seen in southeast Asia and northern Africa. 10 countries have reported 258 human cases with 153 deaths since late 2003; the majority of cases have resulted from close contact with a sick or dead bird with influenza A (H5N1).
- Recent human activity has been seen in Egypt and Indonesia
Pandemic Influenza Preparedness
- The World Health Organization pandemic influenza alert phase remains at a 3: no or very limited human-to-human transmission.
- Development of a Pandemic Influenza School Toolkit with the Department of Education was released in September to State School Health Coordinators, Emergency Preparedness Coordinators (EPC) at local health departments, and was given to attendees of the Michigan Association of School Nurses Fall Conference.
- A Travel Toolkit for pandemic influenza has been developed and distributed to travel clinics across the state in September.
- During the month of October the Michigan Department of Community Health conducted a survey on pandemic influenza preparedness in long-term care facilities. Survey is completed and analysis is pending.
- A workgroup has been put together regarding non-pharmaceutical interventions as they pertain to school closures. Members of the group are MDCH, Department of Education, School superintendents and nurses, and Local Health Department representation.
- MDCH has formed a State Pandemic Influenza Coordinating Committee (PICC) and one steering group meeting has been held.
- Michigan State University Cooperative Extension is putting together an avian influenza video to be used by field agents to deliver a consistent message. Drs. Halstead (MDA), Fulton (MSU), Schmitt (MDNR) and Wells (MDCH) are the presenters giving their perspectives on avian influenza (domestic poultry, wild birds, and humans). Video will be ready for release early December 2006 and a copy will be provided to each local health jurisdiction.
- MDCH has been involved with infection control training with the Departments of Agriculture and Natural Resources.
- Many regional and local health departments have hosted community preparedness summits that have included various stakeholders from the respective communities.
- Multiple exercises have taken place at regional and local health departments pertaining to mass vaccination with seasonal flu and use of Modular Emergency Medical System (MEMS) with great success.
- Interim guidelines on respiratory protection for healthcare providers have been released from Centers for Disease Control and Prevention and can be found at:
- Since May 2006, MDCH staff have reached approximately 5200 people through 74 presentations on pandemic influenza.