These questions were posed by attendees during the Pandemic Flu webcast and answered by Dr. Campos-Outcalt. Not all of the answers were included in the webcast.
Webcast Q & A
Q: Can I assume that LAIV (Live Attenuated Influenza Vaccine) can be given with other inactivated vaccines, i.e., Gardisil, Tdap?
A: Yes, they can be given at the same time or in close proximity.
Q: How is the strain of concern determined for a particular year?
A: CDC, WHO and other influenza experts monitor the strains that are circulating and make their best estimate of the three most likely strains.
Q: In case of a pandemic, will medical workers have priority in receiving a vaccine?
A: Yes
Q: Pertussis seems to have made a resurgence in recent years. Do you have any advice for differentiating clinical syndromes of influenza versus pertussis? Do you expect a continued increase in pertussis cases?
A: Pertussis is often just a chronic cough in adults or a severe cough with paroxysms in children. With the new Tdap vaccine and expanded vaccine recommendations, we expect to see fewer cases of pertussis.
Q: I live in Georgia, the country's largest poultry producer. It looks like our job is actually harder now than in an actual pandemic. Until the pandemic is identified, does every poultry worker with fever and sore throat require an evaluation and notification of public health authorities?
A: Until bird flu is confirmed in the United States, poultry workers here are not at risk for bird flu. Once it does arrive in this country, you will need to be on the lookout for human cases of bird flu in poultry workers in areas where poultry have been infected with bird flu.
Q: What is the interval between flu vaccination and protection from disease onset?
A: It takes two weeks for full protection from the vaccine to develop. In those who need two doses, this would be six weeks from the first vaccine and two weeks from the second.
Q: Is it true that researchers are currently extracting DNA from victims of the 1918 influenza pandemic in hopes of making a vaccine? What are the similarities?
A: There are attempts to map the genome of the cause of the 1918 pandemic to better understand the pathophysiology.
Q: Should we anticipate any infrastructure failures during a pandemic, i.e., power and water outages?
A: Not if planning is conducted correctly.
Q: Should employees of health care facilities be required to have a flu vaccine unless allergic (as is the case with Hepatitis B or PPD)?
A: It is up to each state and/or facility to set requirements for flu vaccine. The CDC recommends that health care workers receive the flu vaccine. Personally, I would not oppose requiring it.
Q: Do health care workers have any legal obligations to work in pandemic situations?
A: Each state sets its own laws on health professionals. I am not aware of any that require work in a pandemic. Infection control practices will be important for protecting health care workers and increasing their comfort for working in an influenza pandemic.
Q: What is your response to patients who request a prescription for an anti-viral (Tamiflu) now to hold in case of an influenza pandemic?
A: I understand their concerns, but hoarding of the vaccine by those who are not at high risk will create a shortage for those who are at high risk and/or in high-priority positions. It will lead to a worse situation.
Q: In case of an influenza outbreak in a nursing home, how long should we give prophylaxis treatment to residents?
A: For one to two weeks after the last case of influenza.
Q: What do you think about the use of Live Attenuated Vaccine (LIV) in patients using nasal steroids?
A: I'm not sure about that. I suspect you would need to use caution.
Q: Why is TIV (Trivalent Inactivated Influenza Vaccine) contraindicated in adolescent pregnancy?
A: I do not believe it is.
A: Yes, they can be given at the same time or in close proximity.
Q: How is the strain of concern determined for a particular year?
A: CDC, WHO and other influenza experts monitor the strains that are circulating and make their best estimate of the three most likely strains.
Q: In case of a pandemic, will medical workers have priority in receiving a vaccine?
A: Yes
Q: Pertussis seems to have made a resurgence in recent years. Do you have any advice for differentiating clinical syndromes of influenza versus pertussis? Do you expect a continued increase in pertussis cases?
A: Pertussis is often just a chronic cough in adults or a severe cough with paroxysms in children. With the new Tdap vaccine and expanded vaccine recommendations, we expect to see fewer cases of pertussis.
Q: I live in Georgia, the country's largest poultry producer. It looks like our job is actually harder now than in an actual pandemic. Until the pandemic is identified, does every poultry worker with fever and sore throat require an evaluation and notification of public health authorities?
A: Until bird flu is confirmed in the United States, poultry workers here are not at risk for bird flu. Once it does arrive in this country, you will need to be on the lookout for human cases of bird flu in poultry workers in areas where poultry have been infected with bird flu.
Q: What is the interval between flu vaccination and protection from disease onset?
A: It takes two weeks for full protection from the vaccine to develop. In those who need two doses, this would be six weeks from the first vaccine and two weeks from the second.
Q: Is it true that researchers are currently extracting DNA from victims of the 1918 influenza pandemic in hopes of making a vaccine? What are the similarities?
A: There are attempts to map the genome of the cause of the 1918 pandemic to better understand the pathophysiology.
Q: Should we anticipate any infrastructure failures during a pandemic, i.e., power and water outages?
A: Not if planning is conducted correctly.
Q: Should employees of health care facilities be required to have a flu vaccine unless allergic (as is the case with Hepatitis B or PPD)?
A: It is up to each state and/or facility to set requirements for flu vaccine. The CDC recommends that health care workers receive the flu vaccine. Personally, I would not oppose requiring it.
Q: Do health care workers have any legal obligations to work in pandemic situations?
A: Each state sets its own laws on health professionals. I am not aware of any that require work in a pandemic. Infection control practices will be important for protecting health care workers and increasing their comfort for working in an influenza pandemic.
Q: What is your response to patients who request a prescription for an anti-viral (Tamiflu) now to hold in case of an influenza pandemic?
A: I understand their concerns, but hoarding of the vaccine by those who are not at high risk will create a shortage for those who are at high risk and/or in high-priority positions. It will lead to a worse situation.
Q: In case of an influenza outbreak in a nursing home, how long should we give prophylaxis treatment to residents?
A: For one to two weeks after the last case of influenza.
Q: What do you think about the use of Live Attenuated Vaccine (LIV) in patients using nasal steroids?
A: I'm not sure about that. I suspect you would need to use caution.
Q: Why is TIV (Trivalent Inactivated Influenza Vaccine) contraindicated in adolescent pregnancy?
A: I do not believe it is.
Pandemic Flu
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