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Nearly a year after the H1N1 virus was first detected in the United States, the mass concern about H1N1 in Harford County and the rest of the nation has subsided — for now, at least.

The H1N1 virus, also known as the swine flu, was first detected in people in the U.S. last April, and exponentially spread across the nation within months, hospitalizing more than 250,000 people and killing 12,000.

Twenty-one deaths have occurred in the Baltimore-metropolitan region, which includes Harford and three other counties and Baltimore City. State public health officials won’t identify in which specific jurisdictions the deaths occurred.

While the H1N1 activity significantly declined after October, the virus is still active in the U.S. and is the predominant flu virus in circulation during the 2009-10 flu season, according to the Centers for Disease Control.

A third wave of the H1N1 is possible, and this period of down time may just be the calm before the storm.

“The virus is circulating and there are still cases,” Fran Phillips, deputy secretary for public health with the Maryland Department of Health and Mental Hygiene, said. “There is an uncertainty about the future.”

Phillips said nearly 40 percent of Marylanders are protected against the H1N1 virus.

“If you have 40 percent of the population immune [in Maryland], is that enough to stop the third wave?” Phillips asked. “No one knows. It’s not clear whether that would snuff out the next outbreak.”

Phillips said the best bet still is to get vaccinated against H1N1.

“It comes back to the vaccine,” she said. “It has shown to be safe and effective.”

The threat of a third wave remains a reality, and the Harford County Health Department has done its part to prepare for another outbreak of the virus.

Leftover vaccine

Since the H1N1 vaccine became available in October, the local health department has administered 27,827 doses, but another nearly 11,500 doses sit unused.

Based on the latest Harford County population estimate of 246,000, the health department may have vaccinated about 11 percent of the population against H1N1; however, those clinics were not restricted to county residents.

Also unavailable are statistics on how many Harford residents received the H1N1 vaccine at doctor’s offices, private clinics or other private providers.

In recent months, the local health department has seen the demand for the H1N1 vaccine dramatically decrease and poor attendance at the public clinics.

“H1N1 currently remains in circulation and, in contrast with seasonal flu, already has demonstrated its viability in warmer weather,” Bill Wiseman, spokesperson for the local health department, wrote in an e-mail. “The public must remain vigilant about protection and prevention for a while longer, particularly in light of the possibility of another wave of infection in late spring.”

Wiseman said the department’s last H1N1 vaccination clinic on Feb. 27 at Harford Mall was poorly attended with less than 200 people getting vaccinated.

“That’s much less than we expected, let alone hoped for,” Wiseman said Thursday. “It’s been extremely slow.”

Statewide slowdown

The problem of dwindling interest in being vaccinated isn’t confined to Harford County. It is also a statewide issue.

“We are seeing a falloff in the demand of the clinics, and a lot of that is driven by people having a knowledge of the disease,” Phillips said.

She said people aren’t hearing about H1N1 as much or the H1N1 flu virus going around, so people have turned away from the vaccine.

“That’s part of the complacency we are seeing,” she said. “People are taking chances.”

To promote and encourage vaccination across the state, Phillips said a statewide vaccination campaign will be launched within the next couple weeks.

H1N1 deaths

In Maryland, as of March 3, there had been a total of 44 deaths and 1,060 hospitalizations associated with H1N1.

Of those 44 deaths, 21 have occurred in the Baltimore-metropolitan region, which includes Baltimore, Anne Arundel, Howard and Harford counties, as well as Baltimore City.

A breakdown of how many of those deaths occurred in Harford County is unavailable, as health department officials decline to identify the specific jurisdiction of residence.

Health officials also will not disclose the age or gender of flu victims; however, DHMH has confirmed 39 of Maryland’s H1N1 victims were adults and the remaining five were pediatric deaths.

Of Maryland’s 44 H1N1 deaths, 81 percent involved pre-existing underlying health conditions, according to the DHMH’s Web site.

On a national level, there have been nearly 260,000 hospitalizations and 12,000 deaths, according to flu.gov.

Since Aug. 30, the CDC has received 265 reports of influenza-associated pediatric deaths, of which 217 were due to the H1N1 virus, according to the CDC’s Web site.

Overall, there have been 277 deaths in children associated with the H1N1 virus reported to the CDC.

The best form of protection against the H1N1 virus remains the vaccination.

The vaccine

Since January, there has been an abundance of the H1N1 vaccine available, but that was not always the case.

The H1N1 virus appeared last April, but a successful vaccine against the virus wasn’t available until mid-October, and even then, only in limited quantities.

The vaccine is available in two forms, FluMist and injectable.

The first shipment of the vaccine arrived in Harford County on Oct. 6 and the first batch was administered to students at St. Margaret School in Bel Air, where there was an unusually high absentee rate attributed to the H1N1 virus.

The first shipment contained 700 doses of the nasal spray form of the H1N1 vaccine, compared to the 130,700 doses Maryland received and the 5.85 million shipped nationwide the first two weeks of October.

Maryland health officials expected the state to receive one million doses of the H1N1 vaccine by the end of October, but about half of that was received because of a lag in production.

After October, distribution of the H1N1 vaccines steadily continued around the nation with 99.4 million doses shipped around the country and 1.8 million in Maryland by the end of 2009.

By the end of January, H1N1 vaccines were widely available across the nation with more than 118.9 million doses shipped across the country.

Harford County had received 93,900 doses of the vaccine as of Thursday, according to William Honablew, chief of policy and public information for the infectious disease and environmental health administration with DHMH.

Schools first

The local health department embarked on an H1N1 vaccination campaign in the county’s public and private schools, administering the vaccine to students with parent approval at all schools. Unlike the seasonal flu vaccine, the H1N1 vaccine is free to the public.

Once the vaccine became readily available, the local health department began hosting public vaccinations.

Of the 27,827 H1N1 vaccine doses administered in Harford County since last October, 19,222 were administered at school clinics to students and some faculty, and another 7,886 doses at public clinics.

Nearly 150 of the local health department’s employees also have been vaccinated.

The local health department was also able to administer almost 150 doses to health care workers outside of the health department and to 90 EMS personnel or other first responders.

There were also 230 doses administered by the health department outside of a public clinic.

23 percent statewide

In Maryland, more than 1.3 million people, or 23 percent of the state’s population, have been vaccinated against the H1N1 virus, and 2.3 million doses have been ordered, according to Phillips of the state health department.

The estimated 1.3 million does not include federal government employees or military personnel.

With 23 percent of Maryland’s population vaccinated, and 25 percent of Marylanders having had the H1N1 virus, 40 percent of people in Maryland are immune to H1N1, according to Phillips.

Phillips said there is some overlap of some people who have had the virus and then received the vaccine, but she said about 40 percent of Marylanders are protected against the H1N1 virus.

The future

A U.S. Food and Drug Administration Advisory Committee recommended that the H1N1 vaccine be included in the seasonal flu vaccine this fall. The World Health Organization, or WHO, has also made the same recommendation.

“That means that, barring some unforeseen circumstance, this fall, most Americans will be able to return to the traditional routine of having one flu vaccine to protect them against the major circulating flu viruses,” according to flu.gov. “As is always the case with seasonal vaccine, younger children who have never had a seasonal vaccine will still need two doses.”

The vaccine, according to Phillips, will be available late summer or early fall.

The committee that made the recommendation is the FDA’s Vaccines and Related Biological Products Advisory Committee, which typically guides vaccine manufacturers in preparing each season’s flu vaccines, according to the Web site.

H1N1 details

The H1N1 virus was first detected and contained in Mexico, but the virus spread across the border into the U.S. and then around the world.

By the time WHO declared a pandemic in June, 74 countries and territories had reported confirmed cases of H1N1, according to the WHO’s Web site, www.who.int.

“To date, most countries in the world have confirmed infections from the new virus,” according to the Web site.

When the vaccine was first available, the target group recommended to receive the vaccine included pregnant women, people who live with or care for children under six months of age, health care and emergency medical services personnel, people between the ages of six months and 24 years and people between the ages of 25 and 64 who have chronic health conditions such as diabetes and asthma.

The vaccine now is recommended for the general public.

Medicines available to treat H1N1 are oseltamivir (marketed as Tamiflu) and zanamivir (marketed as Relenza).

To assist with the H1N1 crisis, federal money was awarded to individual states.

Maryland received $24.9 million in federal funds, with $647,677 going directly to Harford County.

“As far as the funding piece is concerned, we have found that the impact of H1N1 in Maryland was not as severe as originally thought,” the state health department’s Honablew said.

The H1N1 virus also forced Upper Chesapeake Health to institute visitation restrictions at its Upper Chesapeake Medical Center in Bel Air and Harford Memorial Hospital in Havre de Grace in October that has since been lifted.

The revised visitation policy did not allow any visitors who were sick or under age 12. The policy also allowed only two visitors at a time to see a patient during new visitation hours, which were from noon to 8 p.m.

Those restrictions were lifted Jan. 18, as the threat of massive infections waned.

Continued surveillance

In normal flu seasons, DHMH would stop collecting flu data by May 1, but this year flu monitoring will continue through the summer.

The local health department also has received 12,370 doses of the seasonal flu vaccine and had used 8,384 as of Monday.

To get the H1N1 vaccine or the seasonal flu vaccine, contact the Harford County Health Department, 410-838-1500.

The H1N1 vaccine is free; the seasonal vaccine costs $20.

For additional information, visit the local health department’s Web site, www.harfordcountyhealth.com.

One reason DHMH will continue to monitor the the flu situation is to make sure the H1N1 strand does not mutate and become resistant to the treatments available for the virus.

In Maryland, DHMH’s Phillips said, there have been three cases where the H1N1 virus has mutated and the antiviral medication did not work.

The last mutated case occurred in November.

Phillips said the most common drugs were not successful against the mutations, so an experimental drug that was released last fall was used as treatment.

“There is a fallback drug, but it’s an IV drug and experimental, so it is not the drug of choice for sure,” she said.

Aside from being on the lookout for mutations, the state health department says H1N1 virus remains the primary flu virus circulating, although both H1N1 and seasonal flu data will continue to be collected.

“There is very little seasonal flu,” Phillips said. “It has been such a mild year.”


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