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Benton County Health Department - Health Alerts

New H1N1 Vaccine Distribution Method (December 28, 2009)

 

Oregon Public Health Division and CDC have announced a new method for distributing H1N1 vaccine. Starting immediately H1N1 vaccine will be available for shipping directly to several national and regional pharmacy chains. This is intended to improve public access to vaccine.

Participating pharmacies must adhere to state laws and reporting requirements for vaccine administration. Pharmacies cannot charge for the vaccine itself, but may charge an administration fee not to exceed the regional Medicare vaccine administration fee.
 
This program will not reduce any state, county, or medical provider's allocation and
will not affect the system for allocating or ordering H1N1 vaccine by medical clinics, hospitals or other providers. The vaccine for pharmacy chains will come from the pool of unordered vaccine now that medical providers are not ordering all available vaccine.

 

At this time all but four states (California, Georgia, Hawaii and West Virginia) are adopting this strategy. Eleven chains have indicated interest in participating: Costco, CVS, Duane Reade, Kroger, Publix, Rite Aid, Safeway, Supervalu, Target, Walgreens and Walmart.

 

Pandemic H1N1 Influenza Vaccination Efforts in Oregon (November 18, 2009)

 

Based on Oregon and national data about which groups have been most severely affected by the pandemic H1N1 influenza strain to date, and on projections of a continuing pandemic H1N1 influenza vaccine shortage for at least the next three weeks, the Oregon Public Health Division:

1. Reaffirms the target groups for vaccination as identified July 29, 2009, by the Advisory Committee on Immunization Practice (ACIP) of the Centers for Disease Control. 
2. Recommends that, in light of the continuing shortage of pandemic H1N1 influenza vaccine, counties and others administering vaccine in Oregon conduct outreach and allocate vaccine in order to help ensure that those in the following sub-groups of the ACIP target groups get vaccinated: 

Age		Initial CDC Target Groups	Focus for special outreach and vaccine allocation decisions
Any Age
	Household contacts and caregivers for children under 6 months; pregnant women	Yes	Yes
	Healthcare and emergency medical services personnel	Yes	Yes
6 mo-4 years		Yes	Yes
5–24 years
	with no underlying medical condition	Yes	No *
	with underlying medical condition†	Yes	Yes
25–64 years
	with no underlying medical condition	No	No
	with underlying medical condition†	Yes	Yes
≥65 years		No	No
Available at www.cdc.gov/mmwr/preview/mmwrhtml/rr5810a1.htm?s_cid=rr5810a1_e † Includes children and adults with on-going medical disorders involving the lungs, heart, kidneys, blood, liver, or metabolic system (such as diabetes). Also includes those with neuro-developmental or other conditions that can compromise respiratory function or increase the risk of aspiration.

* The nasal spray preparation of the vaccine should be used to vaccinate this group of healthy children and young adults.

Background and Rationale:

Data recently released by CDC indicate that hospitalization rates for H1N1 influenza are highest among children <5 years of age, but roughly similar for all older age groups. (http://www.cdc.gov/vaccines/recs/acip/downloads/mtg-slides-oct09/12-2-flu-vac.pdf) Pregnant women are about 5 times the risk of hospitalization as others.  In addition, most patients hospitalized with influenza have had underlying medical conditions that put them at high risk: 62% of pediatric hospitalizations and 76% of adult hospitalizations reported during April 15 – August 31 had at least one high-risk condition.  A recently published review of hospitalizations in California showed similar results (JAMA 2009; 302:1896–902).

 

National data on laboratory-confirmed deaths from H1N1 to date indicate that the rate of death increases with age, until age 64.  Those 50-64 years old had almost twice the rate of death as those 24-49 and those 65 or older.  Among a sample of adult deaths studied, 76% had a chronic medical condition.  Pregnant women also appear to have approximately a six-fold increased risk of death, compared with the general population.

Oregon has had five deaths in children to date; of those, four occurred in children with special health needs, including two with cerebral palsy.

 

Oregon has received approximate 25% of the vaccine needed to vaccinate all of the 1.9 million Oregonians in the initial target group.

 

Although vaccine continues to arrive in Oregon each week, current projections provided by the vaccine manufacturers to CDC suggest that Oregon is unlikely to have received enough vaccine for this entire group until at least January 2010.

 

Oregon Public Health authorities are requesting voluntary deferral of the second dose of vaccine for healthy children until more vaccine becomes available.

 

Benton County Health Department:

Has suspended operation of public access clinics at least until vaccine availability changes and will no longer utilize 30% of local vaccine allocations. Public health efforts will focus on vaccinating vulnerable people without medical homes and other traditional high-risk public health client groups.

 

This has already made larger amounts of vaccine available to medical providers in the county. We are confident that area medical providers will be able to effectively direct and rapidly use the additional vaccine to protect their most highly vulnerable patients.

 

The County will continue to operate a local telephone flu information line at 766-6246.

 

Current Food Recalls

See links below for recent food recalls:

FDA Recalls

USDA Food Recall

 

 

Codeine:  Life-Threatening Side Effects In Nursing Babies

FDA Public Health Advisory
Use of Codeine By Some Breastfeeding Mothers May Lead To
Life-Threatening Side Effects In Nursing Babies

FDA has important new information about a very rare, but serious, side effect in nursing infants whose mothers are taking codeine. Differences in drug metabolism among mothers taking codeine may contribute to side effects in nursing infants.

Infants of nursing mothers taking codeine may have an increased risk of morphine overdose if the mother is an ultra-rapid metabolizer of codeine. When codeine enters the body and is metabolized, it changes to morphine, which relieves pain. Many factors affect codeine metabolism, including a person’s genetic make-up. Some people have a variation in a liver enzyme and may change codeine to morphine more rapidly and completely than other people. These people are ultra-rapid metabolizers and are more likely to have higher than normal levels of morphine in their blood after taking codeine. Nursing mothers taking codeine may also have higher morphine levels in their breast milk. These higher levels of morphine in breast milk may lead to life-threatening or fatal side effects in nursing babies. In most cases, it is unknown if someone is an ultra-rapid codeine metabolizer.

Codeine has been used safely for many years in nursing mothers. Codeine is an ingredient in many prescription pain relievers and some over-the-counter cough syrups. Once the body changes codeine to morphine, the morphine relieves the pain or cough and may also be responsible for any side effects people may experience. Infants exposed to very high levels of morphine through breast milk can get a morphine overdose as described below.

Last year, a medical journal described a healthy 13-day-old breastfed baby who died from a morphine overdose. The mother was taking less than the usual amount of codeine normally prescribed for episiotomy pain (Koren, et al, Lancet, vol. 368 p. 704, Aug 2006). Laboratory tests showed high levels of morphine in the baby’s blood, and genetic testing showed that the baby’s mother was an ultra-rapid metabolizer of codeine.

FDA is issuing this public health advisory to inform healthcare professionals and nursing mothers about the following important safety information:

• When prescribing codeine for a nursing mother, doctors should prescribe the lowest dose for the shortest amount of time to relieve pain or cough.  Doctors need to tell their nursing patients how to recognize signs of high morphine levels in themselves and their babies.

• If you are a nursing mother taking codeine, call your doctor if you become extremely sleepy and have trouble caring for your baby.

• Breastfed babies usually nurse every two to three hours and should not sleep more than four hours at a time. If your baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, talk to the baby's doctor immediately. If you cannot reach the doctor right away, take the baby to an emergency room or call 911 (or local emergency services).

• Nursing mothers should talk to their doctors if they have any questions about taking codeine.

The estimated number of ultra-rapid metabolizers varies among different population groups from less than 1 per 100 people up to 28 per 100 people. For people who are ultra-rapid metabolizers, the risk of having an adverse event when taking codeine is not known.

Anyone can be an ultra-rapid metabolizer without knowing it. The only way to find out is with a genetic test. There is a FDA-cleared test to determine whether a patient is an ultra-rapid metabolizer, but there is limited information about using this test for codeine metabolism. At this time, the test result alone may not correctly predict if a mother's breast milk will have too much morphine if she uses codeine to treat pain. This test isn't a substitute for a doctor's judgment.

Among pain relievers, ultra-rapid metabolism has only been reported as a problem with codeine, although it has the potential to affect other narcotics. All narcotics can cause the same serious side effects in breastfed babies if the levels of drug in breast milk are too high.

FDA has asked the makers of prescription codeine-containing products to include information about differences in codeine metabolism and concerns with breastfeeding in the drug label. Use of codeine products to manage pain after birth is common, but reports of serious side effects in nursing infants are very rare. Doctors who prescribe codeine need to be aware of the potential for the increased risks to breastfeeding babies of mothers who are ultra-rapid metabolizers of codeine.

The FDA urges healthcare providers and nursing mothers to report side effects that occur while using codeine to the FDA's MedWatch Adverse Event Reporting program:

• On-line [at www.fda.gov/medwatch/report.htm];

• by returning the postage-paid FDA form 3500 [available in PDF format [at www.fda.gov/medwatch/getforms.htm to 5600 Fishers Lane, Rockville, MD 20852-9787;

• faxing the form to 1.800.FDA.0178; or

• by phone at 1.800.332.1088.

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