All military personnel will be vaccinated against the H1N1 flu virus, and the vaccine will be available to all military family members who want it, a Defense Department health affairs official said today.

The H1N1 vaccination program will begin in early October, said Army Lt. Col. (Dr.) Wayne Hachey, director of preventive medicine for Defense Department health affairs.

The vaccine, which has been licensed by the Food and Drug Administration, will be mandatory for uniformed personnel, the colonel said. “What we want to do is target those people who are at highest risk for transmission,” he said.

Health-care workers, deploying troops, those serving on ships and submarines, and new accessions are at the top of the list. “Any place where we take a lot of people, squash them all together and get them nice and close and put them under stressful conditions will get the vaccine first,” he said.

The department will use the usual seasonal flu vaccine distribution chain for the H1N1, Hachey said, noting that while the mass H1N1 vaccinations are new to the general population, the process for vaccinating against seasonal flu is old hat for the Defense Department. “We’ve been doing this for decades,” the colonel said. “The system is tried and true.”

The department initially will receive 1 million doses of the H1N1 vaccine, and another 1.7 million doses later in October.

Officials don’t know yet whether people will need one dose or two, Hachey said. “The assumption right now is that people will need two doses, 21 days apart,” he said. “That may change.”

FDA officials still are studying H1N1 and the vaccine, and the results should be known by the end of the month.

Seasonal flu vaccine already is available, and the Defense Department will begin giving those shots shortly, Hachey said. “That has been our message to immunizers: to try and get as many people as they can immunized against the seasonal flu early,” he said.

Guidelines for giving priority to family members will follow those for the general population, Hachey said. The Department of Health and Human Services is buying millions of doses of the vaccine.

“Installations are going to register with each state as an immunizer,” Hachey said. “They will tell how many people they care for. This includes dependents, retirees and so on.”

The Centers for Disease Control will place the order and will ship the vaccine where needed. Family members will have multiple opportunities to get the vaccine, whether at Defense Department medical facilities or off post, Hachey said.

The CDC has established target groups for those at greatest risk for transmitting or being affected by the H1N1. They include pregnant women, health-care workers, those younger than 25 or older than 65, and those with pre-existing health conditions.

Hachey said previous plans are serving the Defense Department well. “We have been preparing for pandemic flu because of its potential impact on the mission,” he said.

The symptoms of the H1N1 flu are almost the same as the seasonal flu: fever, sore throat, runny nose, nausea, muscle aches and feeling rundown. The 2009 H1N1 virus – formerly known as swine flu – is a pandemic virus, according to the World Health Organization. U.S. officials call the virus “troubling” and urge communities across the United States to take actions to mitigate the effects of it. The federal government is urging states and municipalities to begin preparing now for the fall flu season.

President Barack Obama addressed the H1N1 pandemic following a White House meeting today.

“As I said when we saw the first cases of this virus back in the spring, I don’t want anybody to be alarmed, but I do want everybody to be prepared,” he said. “We know that we usually get a second, larger wave of these flu viruses in the fall, and so response plans have been put in place across all levels of government.”

But government cannot do it all, and the American people have a responsibility to stop the spread of the disease, Obama said. “We need families and businesses to ensure that they have plans in place if a family member, a child or a co-worker contracts the flu and needs to stay home,” he said.

“And most importantly, we need everyone to get informed about individual risk factors, and we need everyone to take the common-sense steps that we know can make a difference,” the president said. “Stay home if you’re sick. Wash your hands frequently. Cover your sneezes with your sleeve, not your hands. And take all the necessary precautions to stay healthy. I know it sounds simple, but it’s important and it works.”

The H1N1 is a never-before-seen combination of human, swine and avian flu viruses, officials said. First detected in Mexico in February, it quickly spread around the world. According to July WHO statistics, there have been 94,512 H1N1 cases worldwide, and 429 people have died from it. In the United States, 33,902 contracted H1N1, and 170 have died.

DVIDS
Story by Jim Garamone

A microscopic photo of the pandemic H1N1 virus

Of note in the latest Department of Defense report on novel H1N1 or swine flu are these statements:

• Fort Bliss (Texas) and Fort Sam Houston (Texas) and Tripler Army Medical Center (Hawaii) continue to report increases in pH1N1cases
• Isolated cluster of hospital-acquired pH1N1 observed among healthcare workers at Landstuhl Regional Medical Center
• Marines and Navy personnel in Okinawa, Guam and Hawaii are seeing increases in clinically mild influenza activity in active duty service members returning from joint military exercises in the Southern Hemisphere.
• Febrile respiratory illness (FRI) rates in recruits at MCRD-SD and Parris Island are substantially elevated.
• States experiencing noticeably higher ILI visit counts include South Carolina (Fort Jackson, Parris Island), New Jersey (Cape May) and California (NMCSD, MCRD-SD, Camp Pendleton)

The Landstuhl report is significant because of the phrase hospital-acquired. It suggests that universal precautions are not being used effectively. We saw failures of similar nature in the SARS epidemic, and those in the Canadian healthcare system were especially deadly.

Hawaii has just opened its schools for the fall. As our only tropical state, the pandemic never reduced in severity as we saw it do in northern states. The potential for clusters in school settings is high and should be evident by August 14 or so. One concern is the nature of the infections arriving from the Southern Hemisphere. Any genetic variance could alter the expected virulence of the pandemic in the islands.

The United States military has been experiencing its own version of the pandemic. We’ve discussed it here before and the situation continues to evolve.

Ships at sea are a natural place for outbreaks to occur, with a crew of young people in close quarters and isolated for several days at a time. USS Boxer has reported 69 cases of pandemic H1N1 or swine flu. USS BonHomme Richard has reported 128 cases.

Another military location ideal for a flu outbreak is recruit training. The Air Force Academy in Colorado Springs is a case in point, with well over 100 cases in its incoming freshman class. Lackland AFB has seen an outbreak among recruits. Camp LeJeune in North Carolina is having such an outbreak, as well.

The Texas bases for all services are experiencing the pandemic. The San Antonio region is especially feeling the effects, and the Rio Grande river valley is the hotspot for Texas as a whole. Fort Bliss near El Paso is reporting 208 cases.

The DoD is doing its best, treating both active duty personnel as well as family and retired service members. You may recall that a military hospital in Texas identified two of the first four cases of pandemic flu in the United States.

The Department of Defense is following its civilian counterparts with reporting on the pandemic swine flu’s effects its personnel and dependents.

All of the cases in the DoD report that are in the United States are also part of a state report. Just as with the states and the CDC, there can be a delay in the data being reported between sources.

Since April 1, military facilities have treated 1,327 cases of pandemic swine flu, also called pandemic novel H1N1. 722 of these patients have been active duty personnel. 31 cases have been found in recruits, with the Marines having just over half of the cases.

These military facilities also treat family members and retirees. Only 14 retirees have been found with pandemic influenza and 510 dependents.

Colonel Jonathan Jaffin, director, Health Policy and Services, Office of the Surgeon General, discussed the military’s response to the pandemic in a recent Bloggers’ Roundtable. One of the points he made was that they are not just looking for pandemic flu, but a wide variety of illnesses that are common in situation where people are in close quarters. ILI’s (influenza like illnesses) and noroviruses are two of the illnesses that can break out aboard ship or in a barracks.

Jaffin stressed the importance of service members not reporting for duty if they are ill. He reviewed a number of preventative measures such as frequent hand washing.

Col. Jaffin revealed that all soldiers are being screened for pandemic H1N1 before they are sent overseas. The screening is also being done on returning troops from certain theaters of operation. In response to a question, he was able to report that the pandemic flu had not affected any Army operations.

The following images are from the most recent DoD report. Please note the median ages for family and retirees. These are much younger ages than are seen with seasonal influenza.

DoD statistics of pandemic swine flu patients treat at military facilities 6-23-2009

DoD report of clusters of pandemic swine flu activity in the military 6-23-2009