Medical, public-health officials prepare to rein in swine flu

By William K. Alcorn

People over 65 without underlying medical conditions will be last to get the swine-flu vaccine.

YOUNGSTOWN — “If we do this right, we’ll avoid a [swine-flu] epidemic,” said Dr. Jay Osborne, medical director for Forum Health Northside Medical Center.

And doing it right is what a multiagency swine-flu group nicknamed “flu busters” has been working on for months.

Part of the group’s focus is on schools from kindergarten to college age, which are among the population groups targeted to get the first round of swine-flu vaccine when it becomes available, said Mahoning County Health Commissioner Matthew Stefanak, who co-chairs the group with Dr. John Venglarcik, the county health district’s medical director.

“We are in the midst of surveying school districts to see if they are interested in hosting H1N1 flu clinics,” Stefanak said. H1N1 is swine flu.

School districts with school nurses and enough volunteers will be able to manage flu clinics on their own. However, in smaller school districts that may not have enough resources or personnel, public health may have to send in nurses and volunteers, Stefanak said.

The college-age population is one of the groups being hardest hit by the H1N1 virus.

However, Youngstown State University had no confirmed swine-flu cases before the health department stopped testing this summer, though there were four cases confirmed in Mahoning County.

The university did have one student within the last two weeks who tested positive for Type A influenza, of which swine flu is a variety. The student was masked and sent to her dorm, where arrangements were made to feed her, said Ron Cole, YSU spokesman.

Cole said the university is following the guidelines provided by the federal Centers for Disease Control and Prevention.

“We are telling students and employees that if they have a fever of 100.6 and other flulike symptoms such as cough, sore throat, runny or stuffy nose, body aches and fatigue, they should stay home or in their residence hall.

Students should contact the student health center at YSU, and students and employees should not go to work or school.

If they live in a residence hall, they should wear a mask and stay in their room. Meals will be brought to them. Students and employees are free to return to work/school and class once there is no sign of fever for 24 hours, without the use of fever-reducing medication, Cole said.

“We are preaching prevention — wash hands often, cover your mouth and nose with a tissue when you cough or sneeze, avoid touching your eyes, nose or mouth, and avoid contact with ill persons,” he said.

Prevention is also the thrust of area public health and the medical communities.

They are urging people to get the seasonal-flu vaccine and then the swine-flu vaccine when it becomes available, which health officials say likely will be November.

“Our strategy for dispensing the H1N1 flu vaccine ... is to recruit as many vaccine providers in the community as possible,” Stefanak said.

Potential vaccine providers are schools, hospitals, retail pharmacy chains, community health centers and local health departments. Once providers are registered, they will receive the vaccine directly, he said.

But the primary providers are expected to be family physicians and pediatricians.

“If you are a candidate for a swine-flu shot, you should be able to go first to your family doctor or pediatrician. If ... your doctor isn’t offering the vaccine, you should be able to get a shot at your school or workplace,” Stefanak said.

“We’re getting ready. We are as prepared as we can be at this time. The limiting factor is the release of the H1N1 vaccine,” said Dr. Venglarcik.

But, in the final analysis, it is the primary physicians on whom health officials say they will rely to distribute the vaccine. To that end, Stefanak says he is surveying doctors now to find out which doctors will offer the swine-flu vaccine.

There are a couple of reasons the family doctors and pediatricians are crucial to the success of an immunization program, said Dr. Venglarcik and Stefanak.

First, about 85 percent of people get their flu shots from family doctors, pharmacies or somewhere in the private sector. Only about 15 percent get seasonal-flu shots from the health department, Stefanak said.

“I think of us as the safety net to catch the people who don’t have a medical home or whose doctor doesn’t offer the vaccine,” he said.

“The doctors have said they will do it. We’re going to deliver doses to those who sign up. What vaccine they don’t use, we’ll take back. The vaccine is free, so there is no up-front cost for them, and the government will reimburse them about $15 per shot as an administration fee,” Dr. Venglarcik said.

SDLqWe need the physicians. The fact is, when physicians recommend their patients get a vaccine, there is a 92 percent take rate. When the physician does not recommend a flu vaccine, the take rate is 7 percent,” he said.

“I’m recommending to all my patients that they get the seasonal-influenza shot within the next two months and stay tuned for H1N1 information: when the vaccine is available, how it is to be distributed, the severity of the disease, and potential side effects of the shot,” said Dr. Osborne.

The best advice, he said, is frequent hand washing. Also, a person who has flu symptoms should stay home, call the doctor and get plenty of fluids and rest.

Because the swine-flu vaccine is a two-shot series, people will be getting three vaccines between now and the end of the year, including the seasonal vaccine, Dr. Osborne said.

Not everybody will be eligible for the first round of immunizations. People over 65 without underlying medical conditions will be last on the list to get the swine-flu vaccine.

It is believed that age group may have some latent immunity from previous exposure in 1957 and 1976, when the flu shots had H1N1 virus in them, and therefore are not as vulnerable, he said.

Some of these viruses are nastier than others, and H1N1 can be nasty, especially when it hits people whose immune systems are compromised, such as those with diabetes, heart or lung conditions, cancer, asthma or who use steroids.

“If everybody would follow the recommendations of the CDC and 159 million people got vaccinated, there would not be an H1N1 problem. With such a barrier, the flu would be a very mild process if anything at all,” Dr. Venglarcik said.

“But, if we don’t do everything right, there will be a problem,” he said.

alcorn@vindy.com