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 Weekly H1N1 Update Newsletter

September 25, 2009

 Welcome to the MaineHealth H1N1 Weekly Update Newsletter
A Publication of the MaineHealth H1N1 Workgroup

About this newsletter 
This publication will be released each Friday morning throughout the fall and early
winter to assist healthcare providers and infection prevention specialists in preparing for
the effects of the H1N1 virus on the Maine population.

 Each issue will contain:

  • updates from national and state-wide public health organizations
  • timely information related to workforce and target population vaccinations
  • supply considerations

If you have additional questions or suggestions for this newsletter, please feel free to
contact the publisher.

Maine CDC Update:
To date, Maine has identified 388 cases of H1N1, which include 19 individuals requiring
hospitalization and one individual who has died. The outbreak at Bowdoin College
appears to be subsiding. In addition, there have been 2 apparent outbreaks of influenzalike
illness in Central Maine schools creating absentee rates above 15%.


  • Maine CDC is working with:


On 9/17/09, US CDC updated its Interim
Recommendations for Obstetric Health Care Providers:




October. Please see the area below that provides more information
regarding health care workers.

2.) The Regional Resource Centers at Eastern Maine Medical Center,
Central Maine Medical Center, and Maine Medical Center, to assure
that all health care providers and Emergency Medical Services
personnel (EMS) are offered H1N1 vaccine during the first few weeks
of its arrival.

H1N1 vaccine is anticipated to be available by mid




The Maine CDC has distributed about 114,000 doses of
seasonal flu vaccine, with most of this being distributed to schools or
pediatric providers. About 14 schools or school districts have held
seasonal flu vaccine clinics. Due to nationwide delays in shipping of
seasonal flu vaccine, the Maine CDC recommended this week that schoollocated
clinics be rescheduled if vaccine for those clinics had not already



  • The Maine CDC will be holding two conference calls for all interested
    stakeholders on H1N1 vaccine efforts
    from 12:00-1:00 p.m. on Monday, Sept.
    28 & Monday Oct. 5. The call-in number for both calls is 1-800-914-3396, pass
    code is 473623.
  • Seasonal Influenza Vaccine Supply Delayed for 2009-2010. The Maine CDC
    has recently learned from both the US CDC and the vaccine manufacturers that
    the scheduled delivery for the remaining doses of seasonal flu vaccine will not be
    as accelerated as originally anticipated, due to prioritization of H1N1 vaccine and
    other challenges. This delay is being felt across the country, and other states are in
    the process of postponing large scale seasonal flu vaccine clinics. Maine has
    received about 40% of its overall seasonal flu vaccine supply to date. Remaining
    doses are expected to become available over the next 4-6 weeks with the majority
    of doses still expected by the end of October and all doses delivered by early
  • The Maine CDC recommends that all health care providers continue to vaccinate
    patients with seasonal influenza vaccine during routine visits and in scheduled
    clinics as supply allows.
  • Timing of vaccine availability for the different types (seasonal and H1N1) may
    closely match virus circulation.
  • Almost all of the influenza viruses currently circulating are H1N1.
    Seasonal influenza virus strains may not appear until later.
  • Good news! Preliminary clinical studies released this week by US DHHS
    revealed that children 10 - 18 may only need one dose of the H1N1 vaccine.
    Previous results in adults ages 18 - 65 indicate this population will also only need
    one dose. Dosage results for younger children are pending:
  • Simultaneous administration of inactivated vaccines against seasonal and
    H1N1 influenza viruses is permissible if different anatomic sites are used.
    However, simultaneous administration of live, attenuated vaccines against
    seasonal and H1N1 influenza viruses is not recommended, and should be
    separated by 1 month.

Health Care Workers:
The Maine CDC has developed a health care provider tool kit which is now available at The tool kit
includes frequently asked questions, the Governor's Declaration, billing information,
information related to the H1N1 vaccine and guidelines for maintenance, storage and
transport of the vaccine.

H1N1 influenza vaccine will only be available through Maine CDC/DHHS in Maine, and
will not be available for private purchase from manufacturers. Those interested in
offering H1N1 vaccine must complete and submit the H1N1 Provider Agreement
(even if already registered as a Maine Immunization Program provider). Additional
information can be found at

Healthcare workers who volunteer to provide vaccinations in school or community
clinics must register with MAINE RESPONDS ( to receive
state liability protection. Maine Responds will verify the credentials of registered
volunteers, and names of verified volunteers will be added to a list posted by Maine


Emergency Management Agency (MEMA) at: If the volunteer is
not on this list, he or she should not assume that they are covered by the Governor's

Healthcare workers who will administer vaccine as part of their regular employment are
not required to register with Maine Responds, as liability coverage is traditionally
provided by the employer for healthcare providers working within their normal scope of

For additional information please contact Amanda Walker, Maine Responds Program
Coordinator at (207) 662-5142 or by email at

A common question health care organizations have is "What is the definition of healthThe US CDC
care personnel for the purposes of prioritizing the H1N1 vaccine?"
defines health care personnel (HCP) as "all paid and unpaid persons working in healthcare
settings who have the potential for exposure to patients with influenza, infectious
materials, including body substances, contaminated medical supplies and equipment, or
contaminated environmental surfaces. HCP might include (but are not limited to)
physicians, nurses, nursing assistants, therapists, technicians, emergency medical service
personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel,
students and trainees, contractual staff not employed by the health-care facility, and
persons (e.g., clerical, dietary, housekeeping, maintenance, and volunteers) not directly
involved in patient care but potentially exposed to infectious agents that can be
transmitted to and from HCP. The recommendations in this report apply to HCP in acutecare
hospitals, nursing homes, skilled nursing facilities, physicians' offices, urgent care
centers, and outpatient clinics, and to persons who provide home health care and
emergency medical services. Emergency medical services personnel might include
persons in an occupation (e.g., emergency medical technicians and fire fighters) who
provide emergency medical care as part of their normal job duties."


Please note the new email addresses
(below) for Maine H1N1 issues. These do not replace, but rather supplement the public
hotline (888-257-0990, M-F 9-5) and the disease reporting and emergency consultation
hotline (800-821-5821 24hr/7d). There is also a new healthcare provider/clinician FAQ
for common questions to these addresses and hotlines, available at:

Antiviral Medications: 
MaineHealth Supply Chain Management has received a proposal
from Roche, the makers of Tamiflu that provides for several options for member and
affiliate hospitals. Supply Chain staff has reached out to Pharmacy and Materials
Councils across the health system to help determine the projected Tamiflu need. Once all
the information is compiled, Supply Chain leadership will work with Roche to ensure that
hospitals have adequate supply at the best possible cost. The federal government is also
contracting with a variety of vendors for emergency supplies, which could cause a
temporary interruption of MaineHealth supply. The Supply Chain staff is watching the
situation closely and is working with the distributor to avoid any problems.

The pediatric suspension of Tamiflu is no longer available, but please see the attached
link for Roche's solution to this shortage:

Regional Event:
SMRRC is hosting a "Southern Maine Regional Influenza Preparedness and Response
Meeting" on October 7, 2009, 10:00 a.m. - 2:00 p.m., Hilton Garden Inn, Freeport, ME.
This meeting targets healthcare and EMS professionals in decision-making positions
within their organizations around seasonal and H1N1 influenza. This event is specific to
the southern Maine region, inclusive of York, Cumberland, Sagadahoc, and
Lincoln Counties.
Registration information and agenda will soon be available at:

Vaccine Coordinators:
Vaccine Coordinators have been appointed for each Public Health District in Maine.
Vaccine Coordinators will be one component of district leadership teams, which also
include staff from the three Regional Resource Centers for Public Health Emergency
Preparedness and Emergency Management Agencies.


  • District 1 - York: Sharon Leahy-Lind, 490-4625
  • District 2 - Cumberland: Meredith Tipton, 592-5631
  • District 3 - Western Maine: MaryAnn Amrich, 753-9103
    (Franklin, Oxford, and Androscoggin counties)
    District 4 - Mid Coast: Jen Gunderman-King, 596-4278
    (Waldo, Knox, Lincoln, and Sagadahoc counties)
  • District 5 - Central Maine: Sue Lee, 592-5634
    (Somerset and Kennebec counties)


Jackie Cawley, DO
Senior Medical Director for Clinical Integration



Intake Line: (207) 761-6644 | Toll-Free: 1-844-292-0111 | Administrative Office: (207) 842-7700