Pandemic Planning and First Nations

by **admin** » Sat Jul 25, 2009 7:25 am

Influenza Self-Assessment Tool
http://www.health.gov.on.ca/en/ccom/flu/h1n1/public/tools/assessment
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H1N1 Flu
Check Your Symptoms . . .
http://www.healthlinkbc.ca/tools/h1n1/symptom_checker/
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On November 10, 2009 at 12:00 noon EST
Health Minister Leona Aglukkaq and National Chief of the Assembly of First Nations (AFN) Shawn Atleo
will co-host a Virtual Summit on H1N1 preparedness for First Nations communities.
For more information . . .
http://www.turtleisland.org/discussion/viewtopic.php?p=10667#p10667
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Health Canada has approved vaccine to fight H1N1 flu virus
October 21st, 2009
http://www.turtleisland.org/discussion/viewtopic.php?p=10596#p10596
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BC unveils vaccine plans to fight H1N1 outbreak . . .
October 21, 2009
http://www.turtleisland.org/discussion/viewtopic.php?p=10599#p10599
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http://www.phac-aspc.gc.ca/alert-alerte/h1n1/guide/index-eng.php

http://www.phac-aspc.gc.ca/alert-alerte/h1n1/guide/index-eng.php

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First Nations pandemic planning, preparedness
and response resources, news and information updates
Turtle Island Native Network
http://www.turtleisland.org/discussion/viewtopic.php?p=10229#p10229
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Assembly of First Nations and Canadian Government sign Communications Protocol to affirm their commitment to work together on pandemic planning efforts.. .
http://www.turtleisland.org/discussion/viewtopic.php?p=10482#p10482
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October 6, 2009
BC
Tripartite First Nations Health Plan
An Information Bulletin from the Tripartite First Nations H1N1
Working Group
Dear First Nations Community Members . . .
http://www.turtleisland.org/discussion/viewtopic.php?p=10548#p10548
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H1N1 Community Checklist
Dear First Nations Chiefs and Health Directors,

As you are all aware, cases of the H1N1 flu virus have occurred in people throughout BC and Canada, including in First Nations communities. The vast majority of these people have had mild to moderate illness and most of those affected have recovered successfully at home.

It’s important to ensure your community is in a state of readiness - primarily through a pandemic plan - and is using preventative measures.
http://www.fnhc.ca/index.php/news/article/h1n1_checklist_for_leadership/

http://www.fnhc.ca
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The Pandemic H1N1 Virus and Your Community
B.C. First Nations H1N1 action plan
http://www.turtleisland.org/discussion/viewtopic.php?p=10428#p10428
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Swine Flu - News and Information . . .
CANADA UPDATES!
http://news.google.com/news?=en&q=swine+flu+canada

U.S.A. UPDATES!
http://news.google.com/news?=en&q=swine+flu+united+states

WORLD-WIDE UPDATES!
http://news.google.com/news?=en&q=swine+flu+world-wide

ABORIGINAL UPDATES!
http://news.google.com/news?=en&q=swine+flu+aboriginals
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World Health Organization
http://www.who.int/csr/disease/swineflu
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Public Health Agency of Canada
http://www.phac-aspc.gc.ca/alert-alerte/swine_200904-eng.php

http://www.phac-aspc.gc.ca/alert-alerte/swine_200904-eng.php

CANADA HOTLINE: 1-800-454-8302

H1N1
Canadian Medical Association Journal
http://www.cmaj.ca
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U.S. Centers for Disease Control and Prevention
H1N1 Flu (Swine Flu)
http://www.cdc.gov/h1n1flu/

U.S. Department of Health & Human Services
http://pandemicflu.gov/

UNITED STATES HOTLINE: 1-800-232-4636

H1N1
Journal of the American Medical Association
http://jama.ama-assn.org/cgi/search?fulltext=h1n1
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The Lancet, one of the world's leading medical journals
H1N1 Resource Centre - medical researchers and science experts
http://www.thelancet.com/H1N1-flu
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The Canadian Pandemic Influenza Plan for the Health Sector.
Influenza Pandemic Planning Considerations in
On Reserve First Nations Communities
http://www.turtleisland.org/healing/flujune09.pdf
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Ontario Health Plan for an Influenza Pandemic
Chapter #20: Guidelines for First Nations . . .
http://www.turtleisland.org/healing/flufnsont08.pdf
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H1N1 booklet created by Six Nations Health Services . . .
http://www.sixnations.ca/H1N1InfoBooklet.pdf

http://www.turtleisland.org/resources/h1n1sixnations.pdf
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Assembly of Manitoba Chiefs and the Southern Chiefs Organization of Manitoba
View video here . . . http://www.manitobachiefs.com/pandemic/video.html

http://www.manitobachiefs.com/pandemic/video.swf
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Guidance for Primary Health Care Workers
Providing Care to Indigenous Australians
http://www.turtleisland.org/resources/auspandemic.pdf
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More pandemic flu virus news and information resources
http://www.turtleisland.org/discussion/viewtopic.php?p=10153#p10153

by **admin** » Sat Aug 22, 2009 5:46 pm

Vaccines would be better used to prevent transmission within schools . . .

Yale Researcher Questions Federal Guidelines for Seasonal and Swine Flu Vaccines
Published: August 20, 2009

New Haven, Conn. — With the seasonal flu season approaching and uncertainty over whether swine flu will become more severe, new research published by Yale School of Public Health has found that more people are likely to avoid illness if vaccines are given out first to those most likely to transmit viruses, rather than to those at highest risk for complications. This research differs from current vaccination recommendations of the Centers for Disease Control (CDC) and the Advisory Committee on Immunization Practices (ACIP).

The Yale study appears in the August 20 issue of the journal Science online at the Science Express website, http://www.sciencemag.org/cgi/content/abstract/1175570

It will be published in the print journal Science at a later date.

The ACIP currently recommends that groups at high risk for complications of swine flu (novel influenza A or H1N1) be given priority for vaccination. The CDC recommends the same for seasonal flu vaccination. High-risk groups include children younger than 5 years old, adults 65 years of age and older, pregnant women, and those suffering from pulmonary, cardiovascular and other disorders.

But the study by Alison P. Galvani, Ph.D., an associate professor in the division of Epidemiology of Microbial Diseases at Yale, suggests that vaccines targeted at groups more likely to transmit flu viruses, rather than those at highest risk of complications, would result in fewer infections and improved survival rates.

Galvani used mathematical models to measure outcomes based on deaths, years of life lost and economic costs. Strikingly, these models found that schoolchildren and their parents, generally in their 30s, are the best groups to vaccinate when even a modest amount of an effective vaccine is available, because schoolchildren are most responsible for transmission and their parents serve as bridges to the rest of the population. By targeting these two age groups, the study found, the remainder of the population is better protected.

“Our results illustrate the importance of considering transmission when allocating vaccines” said Galvani. The paper was co-authored by Jan Medlock of Clemson University.

The CDC expanded its seasonal flu vaccination recommendations in 2008 to include children up to 18 years old. Still, Galvani’s study determined that previous, and new, guidelines for both swine and seasonal flu performed substantially worse than the optimal strategies that she and her group identified.

For example, using the ACIP’s new vaccination policies for the swine flu, the study determined that ACIP recommendations would result in 1.3 million infections, 2,600 deaths, and $2.8 billion in economic impact. In contrast, Galvani’s model resulted in 113,000 infections, 242 deaths, and $1.6 billion in cost.

Galvani said reducing CDC prioritization of children under age 5 and the elderly could significantly improve the CDC’s recommendations.

“The optimal allocation of vaccines is paramount to minimizing mortality and morbidity in the population, particularly when there is a supply shortage,” she said.
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August 2009

Clemson University

Optimal control of the spread of the seasonal flu and H1N1 is achieved by prioritizing vaccinations for schoolchildren and for adults aged 30 to 39 in the United States. Those are the findings of a new study by Clemson University mathematician Jan Medlock and colleague Alison Galvani of the Yale University School of Medicine.

The researchers have developed models that challenge the recommendations of the Centers of Disease Control and its Advisory Committee on Immunization Practices for which segment of the population should be vaccinated against the flu. In their findings, published Aug. 20 in Science Express, the researchers say the United States population can be best protected by stopping the high levels of transmission among schoolchildren and to their parents, despite the fact that other age groups may suffer more severe symptoms if they catch the flu. (See related video.)

“Current flu vaccination recommendations include children under age 5 and for seasonal flu, people over age 50,” said Medlock. “The vaccines would be better used to prevent transmission within schools and out to parents, who then spread the flu to the rest of the population. The CDC recommendations have been changing the last few years, particularly due to the new H1N1 strain, and have been moving in the right direction.”

The researchers studied mortality data from the United States and survey-based data on infectious contacts from the influenza pandemics of 1918 and 1957, taking into consideration multiple ways to quantify the impact of an influenza outbreak: deaths, infections and other measures that vary with the age of those infected. Strikingly, they found that all the measures led to the conclusion that schoolchildren and their parents are the best groups to vaccinate when even a modest amount of an effective vaccine is available.

The World Health Organization has announced the possibility of shortfalls in the production of H1N1 vaccines this year due to the slow growth of the swine-origin H1N1 in chicken eggs. The researchers concluded that when vaccine availability is limited or when vaccine efficacy is low, optimal allocation of vaccines is imperative to minimize the spread of the illness.

The research was funded with a $650,000 grant from the National Science Foundation.

MORE . . .
http://www.clemson.edu/newsroom/multimedia/video/2009/august/flu_vaccine.html

by **admin** » Tue Sep 08, 2009 2:12 pm

http://www.phac-aspc.gc.ca/alert-alerte/h1n1/guide/index-eng.php

http://www.phac-aspc.gc.ca/alert-alerte/h1n1/guide/index-eng.php

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Here are some Health Resources For You and Your Families

Elmo Influenza Prevention Public Service Announcement

Happy & Healthy on Sesame Street: Elmo offers his influenza prevention tips on staying happy and healthy. This video helps kids practise habits such as washing their hands, avoiding touching their eyes, nose and mouth, and sneezing into their elbow.
http://www.youtube.com/watch?v=zG4hX8TEkAA&NR=1

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First Nations-specific pneumococcal poster:
http://immunize.ca/uploads/posters/flu2 ... mo_3_e.pdf
This new poster's messaging is similar to that on the general adult pneumococcal poster.
The image shows a First Nations elder. Order your copies now by e-mailing immunize@cpha.ca

THE FACTS . . .
http://immunize.ca/uploads/posters/flu2 ... heet_e.pdf

by **admin** » Wed Sep 16, 2009 2:46 pm

The Public Health Agency of Canada priority list for H1N1 flu shots says pregnant women, health workers, children, and adults with chronic conditions should be first to roll up their sleeves to get the vaccine when it's ready in early November.
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Government of Canada Issues Guidance on H1N1 Influenza Vaccine Sequencing
(OTTAWA) – Canada’s Chief Public Health Officer, Dr. David Butler-Jones, today issued guidance for provinces and territories on H1N1 vaccine sequencing.

“Canadians should know that we will have enough vaccine for everyone who needs and wants to be immunized,” said Dr. Butler-Jones. “Our focus in the coming weeks and months is to ensure that those who need it most get it first.”

The guidance identifies groups and individuals that will benefit most from immunization, and those who care for them. These include:

people with chronic medical conditions under the age of 65;
pregnant women;
children six months to under five years of age;
people living in remote and isolated settings or communities;
health care workers involved in pandemic response or who deliver essential health services;
household contacts and caregivers of individuals who are at high risk, and who cannot be immunized (such as infants under six months of age or people with weakened immune systems); and
populations otherwise identified as high risk.
These groups are not listed in priority sequence. Provinces and territories are expected to use the guidance for planning purposes and will interpret it based on local circumstances and realities.

The guidance has been reviewed and is supported by public health officials from across Canada. It is based on the latest scientific evidence on H1N1 virus characteristics, current information on the H1N1 vaccine and Canada’s Pandemic Influenza Plan for the Health Sector. The guidance could be adjusted as new information about the H1N1 virus and vaccine effectiveness becomes available.

“Public health authorities from across Canada are working together to protect Canadians, and I welcome this latest contribution to our efforts,” said Health Minister Leona Aglukkaq, who will present the guidance document to her colleagues for discussion at a meeting of federal, provincial and territorial health ministers on September 17 in Winnipeg. “I would like to thank the Public Health Agency of Canada for leading the sequencing effort.”

The document also identifies others who would benefit from immunization:

children 5 to 18 years of age;
first responders (e.g. police and firefighters);
poultry and swine workers;
adults 19 to 64 years of age; and
adults aged 65 years of age or over.
“The approach we have taken is balanced, objective, and reflects the best available scientific and technical information that is currently available,” said Dr. Butler-Jones. “I encourage all Canadians to get vaccinated against H1N1, as this is our best defence against the spread of the virus.”

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Guidance on H1N1 Vaccine Sequencing

Preamble
It is recognised that some individuals or groups not identified below may be at higher risk of severe illness or hospitalization due to socio-economic and lifestyle conditions, access to health care, and elevated risk of exposure to the H1N1 flu virus. Consideration will be given to targeting these individuals for immunization as our understanding of the virus evolves. Further consideration could be given to immunizing additional groups or individuals if needed to minimize societal disruption.

Recognizing that many Aboriginal populations are younger; may be more socio-economically disadvantaged compared to Canadians as a whole; have higher numbers of pregnant women; have higher rates of diagnosed and possibly un-diagnosed chronic disease; and may live in remote and isolated communities, all efforts will be made to enable those Aboriginal people who would benefit most from immunization, wherever they reside, to have access to H1N1 vaccine as soon as possible.

1. Those Who Will Benefit Most From Immunization and Those Who Care For ThemPersons with chronic conditions (NACI list) under the age of 65
Rationale: at higher risk of complications; 65+ less affected to date, Canadian modeling suggests immunizing this group decreases population morbidity and mortality more than immunizing children (i.e. groups with highest attack rate)

Pregnant women
Rationale: at highest risk of severe disease, and to potentially protect their infants1

Children 6 months to less than 5 years of age
Rationale: Children 6-23 months of age are at particular risk of severe disease and hospitalisation and are the primary focus of this group. Children aged 2 years to less than 5 years of age were included within this group because:

they are at higher risk of severe disease and hospitalisation than older children, and
from a targeting perspective for operationalizing vaccine delivery the single category of 6 months to less than 5 years effectively captures all "pre-school" aged children.
Note that vaccine may not be authorised for use in children less than 6 months of age
Persons residing in remote and isolated settings or communities
Rationale: limited access to medical care, potential for development of mass immunity and prevention of infection, logistically easier to target whole community; equity, high concentration of persons with chronic conditions, observed morbidity/mortality in some remote Aboriginal communities

Health care workers (all health care system workers involved with the pandemic response or delivery of essential health services*)
Rationale: prevent HCW spread to vulnerable patients, prevent outbreaks, protect HCW (reciprocity) and protect essential health infrastructure

All health care workers involved with the pandemic response or delivery of essential health services:

Those who provide direct patient care as well as those who support the provision of health care services
Includes full-time staff, part-time staff, students, regular visitors and volunteers i.e. all persons carrying out the health care function
Settings include acute care, chronic care, ambulatory/community care, emergency medical services, laboratory, public health departments, pharmacies etc.
Includes Canadian Blood Services/Héma Québec and vaccine manufacturers
Household contacts and care providers of:
Infants <6 months of age
Persons who are immunocompromised
Rationale: indirect protection for persons at high risk who cannot be immunized or may not respond to vaccine

Populations otherwise identified as high risk

2. Others Who Will Benefit From ImmunizationChildren 5 to 18 (inclusive) years of age
Rationale: high attack rates experienced by this age bracket would suggest they be considered a priority within this phase of immunization to possibly reduce transmission of the virus, children identified as a priority in public consultations

First responders (police, firefighters)
Rationale: frequently attend emergency health situations with EMS

Poultry and Swine Workers
Rationale: to prevent opportunities for viral reassortment

Adults 19 to 64 (inclusive) years of age
Rationale: increased risk of severe H1N1 disease

Adults 65 years of age and over
Rationale: low attack rates, potential for reduced response to vaccine

1 This is a WHO definition refers to the maternal antibodies transferred to the fetus in utero protecting the infant after birth as well as to include the post-partum period.

by **admin** » Thu Sep 17, 2009 1:45 pm

Flu death on Vancouver Island prompts a top Health official to emphasize the importance of high risk individuals discussing treatment with their doctor

"We implore people who are in these risk groups to in fact take advantage of the opportunity to be able to take what steps we can until a vaccine is available."

News and Comment
by Tehaliwaskenhas
Bob Kennedy,
Copyright
Turtle Island Native Network
http://www.turtleisland.org

September 17th, 2009

Health officials in Victoria, BC today confirmed the death of a Sci'anew (Beecher Bay) First Nation woman who was in hospital with the H1N1 Swine Flu since last weekend when she was admitted with respiratory illness.

Dr. Richard Stanwick, Chief Medical Health Officer Vancouver Island Health Authority (VIHA), also said a child from Beecher Bay First Nation is in Victoria General Hospital with the H1N1 flu, but "he is doing well".

The woman passed away yesterday afternoon.

The BC Centre For Disease Control confirmed that this was H1N1.

"Obviously our deepest sympathies go out to the family," Dr. Stanwick told reporters at the news conference.

This is the first death from H1N1 in the VIHA region - the sixth death in BC, in what the health officials described as a continuation of the first wave of the H1N1 flu.

Dr. Stanwick explained that the Beecher Bay woman belonged in a high risk group and had previously a chronic medical condition "that predisposed her to this adverse outcome". The woman had been admitted to Victoria General Hospital this past Saturday, September 12th. "We are working with the family, community and schools to ensure that people are aware of the steps they need to take, and that those individuals that need to gain access to Tamiflu secure a prescription or supply if necessary, and obviously we are assisting in monitoring those that are sick," Dr. Stanwick explained. He went on to ask the media to be aware of the personal needs by Beecher Bay and its residents, "I am going to ask that you respect this community's privacy. I have been speaking to the chief. They are going through their period of grieving and that really any sort of disruption by basically descending upon the reserve to find out what's happening would be disrespectful to their funeral processes - and that they're asking at this time of loss that this please be respected. They wish to grieve in private as a community."

The VIHA Chief Medical Officer of Health added, "At this point our primary purpose is going to be supporting the Beecher Bay community and providing whatever assistance they ask of us".

Dr. Stanwick says an important message that can be taken from the woman's death, is that individuals who have existing serious medical conditions who have not contacted their doctor about getting a prescription for Tamiflu, "need to do so". He added that it is a good opportunity to intervene early in the course of the flu infection. "We implore people who are in these risk groups to in fact take advantage of the opportunity to be able to take what steps we can until a vaccine is available."

In a letter sent to Beecher Bay community members this week, Dr. Stanwick explained, "The symptoms of the illness include: Fever - New cough or cough that has become worse. Some of these symptoms may also happen: Headache - Muscle ache / Joint ache - Tiredness - Shortness of breath - Lack of appetite - Sore throat - Nausea / Vomiting - Diarrhea. It is important to watch for flu illness among people in your home and community. If you or someone in your home becomes ill with symptoms of Flu, please: Let the community health nurse or community health representative know. Ask the ill person to stay home for seven (7) days, if possible in a separate bedroom from others. Ask non-household members to not visit during this time. Talk to your doctor about the medicine Tamiflu for the ill person. This medicine must be started within two (2) days of becoming ill. Ask people in your home to wash their hands well. A nurse is also available for more information 24 hours a day, 7 days a week, by dialing 8-1-1. If more people in your home also become ill, please let the community health nurse or community health representative know. This information will help to make sure that your community gets needed care and treatment as soon as possible."

by **admin** » Wed Oct 21, 2009 10:47 am

Turtle Island Native Network is reporting that in a matter of days, Canadians will be able to get a flu shot to fight the H1N1 Swine Flu virus . . .

October 21st, 2009

Minister of Health Leona Aglukkaq today announced that Health Canada has approved AREPANRIX, a vaccine against the pandemic H1N1 flu virus. This means that the adjuvanted vaccine has been judged safe and effective for use in Canada by both the Canadian manufacturer, GlaxoSmithKline, as well as by the Health Canada regulator. "This is a milestone in our efforts to fight the pandemic H1N1 flu virus," said Minister Aglukkaq. "Thanks to careful planning we now have a safe and effective vaccine being distributed to provinces and territories that they will be rolling out in a matter of days. I encourage all Canadians to get vaccinated because it is the best way to protect our health and the health of our loved ones." Health Canada and the Public Health Agency of Canada are currently working with provincial and territorial governments to deliver the H1N1 flu vaccine to health care facility sites to begin immunization programs. "Canada is in the enviable position to be able to offer vaccine to every citizen who needs and wants it," said Canada's Chief Public Health Officer, Dr. David Butler-Jones. "Getting the vaccine is the most effective way we know of to curb the spread of the pandemic H1N1 flu virus. I too encourage all Canadians to get the pandemic H1N1 flu vaccine when it becomes available in their provinces and territories." The Chief Public Health Officer also noted that the Public Health Agency of Canada, Health Canada and the regulatory and public health agencies of other countries, are working together to ensure that appropriate control measures are in place to monitor the safety and effectiveness of the vaccine and to ensure the timely communication of any potential adverse events following immunization. There is also a global commitment amongst regulatory authorities to rapidly share clinical and safety data on H1N1 flu vaccines and on any potential adverse events following immunization. National recommendations on the use of H1N1 flu vaccine have been developed based on the latest scientific evidence, including clinical trial results. The recommendations include: - All Canadians 10 years of age and older should receive one dose of adjuvanted vaccine; - Children from six months and up to 10 years of age should receive the adjuvanted vaccine in two half-doses, administered at least 21 days apart; - Children age 0-6 months - immunization not authorized; and - Pregnant women should receive one dose of the unadjuvanted vaccine, of which Canada has ordered 1.8 million doses. In cases where the unadjuvanted vaccine is unavailable and pandemic H1N1 flu rates are high or increasing in the community, women more than 20 weeks pregnant should be offered one dose of the adjuvanted vaccine. The Government of Canada has ordered 1.8 million doses of unadjuvanted vaccine for pregnant women which will be available in early November.

by **admin** » Wed Oct 21, 2009 10:48 am

NEWS RELEASE
For Immediate Release

October 21, 2009
Ministry of Healthy Living and Sport
BC Centre for Disease Control

H1N1 PANDEMIC VACCINE APPROVED, TIMING CONFIRMED

VICTORIA - Following today's approval by Health Canada regulators, the
pandemic H1N1 influenza vaccine will be made available to British
Columbians beginning the week of Oct. 26, announced Minister of Healthy
Living and Sport Ida Chong and Provincial Health Officer Dr.
Perry Kendall.

"Now that the H1N1 flu vaccine has been approved, I encourage British
Columbians to get immunized and protect themselves against this novel
flu virus," said Kendall. "Even if some of the population has already
contracted H1N1 so far, we know that most British Columbians have not
been infected yet and can still benefit from receiving the vaccine to
protect themselves."

The first batch of vaccine has arrived in British Columbia and is
currently being distributed around the province to regional health
authorities, based on population numbers in each region. Beginning
Monday, it will be available first to those people who would benefit
most from immunization: individuals under 65 years of age with chronic
disease, pregnant women and individuals - including First Nations
people - living in remote or isolated communities. These groups are at
high-risk for suffering complications from pandemic H1N1 infection.

"B.C. will receive the H1N1 vaccine shipments in phases. Our plan is to
first immunize those individuals considered to be at most risk to
ensure that more vulnerable groups are protected," said Chong. "During
this time, we would ask that those people who are not at highest risk
to wait until mid-November to get immunized when we receive our full
orders."

The pandemic H1N1 vaccine is an adjuvanted vaccine. Adjuvants are
compounds that boost the immune system's response to vaccine, allowing
smaller doses to be used per person. A version of the H1N1 vaccine
without adjuvant will also be available in B.C. beginning the second
week of November. While the unadjuvanted H1N1 vaccine is recommended
for pregnant women, the adjuvanted version, available early next week,
is approved for everyone who wants to protect themselves from this
pandemic.

Once clinics begin next week, British Columbians who fall into the
high-risk groups listed above who need and want the H1N1 vaccine, and
for whom the seasonal flu shot is also recommended, will be able to
receive both at the same time.

"The national expert committees that are providing guidance on the use
of the pandemic vaccines have recommended that giving seasonal and
pandemic vaccines together is not expected to affect the immune
response to either one. This is in keeping with what we know about
almost all other vaccines." said Dr. Monika Naus, director of
immunization at the BC Centre for Disease Control, an agency of the
Provincial Health Services Authority. "By getting the seasonal and
pandemic vaccines together, the risk from both sorts of influenza can
be reduced at the same time."

When B.C.'s seasonal influenza campaign launched in mid-October, the
seasonal flu shot was only recommended for seniors and those living in
long-term care facilities.

"While I can understand there may be some confusion in the public about
how and when to get vaccinated, and with which vaccine, this decision
to offer the H1N1 and seasonal vaccines together addresses these
concerns," said Kendall. "B.C.'s initial recommendation to delay the
seasonal vaccine campaign for everyone under the age of 65 was made
using the best available evidence and before the pandemic vaccine was
available. Now that pandemic vaccine is here, we can give protection
against both seasonal and pandemic viruses at the same time"

For more information on the H1N1 flu vaccine, visit www.gov.bc.ca/h1n1.
To find where you can get your H1N1 and/or seasonal flu shot, visit the
Flu Clinic Locator at www.ImmunizeBC.ca or contact your local public
health unit. More locations will be added as they are confirmed.

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BACKGROUNDER

WHAT VACCINE YOU SHOULD GET, AND WHEN

Now:

Those people 65 and over and those living in long-term care homes are
currently eligible to receive only the seasonal flu vaccine.

Week of Oct. 26:

Starting the week of Oct. 26, the people who will benefit most from
pandemic H1N1 immunization, and who need and want to get vaccinated,
will be able to receive that vaccine should they choose to do so. These
groups include:
* Persons under the age of 65 with chronic conditions.
* Pregnant women.
* Persons living in remote and isolated settings or communities
(including all First Nations people living on-reserve).

People who fall into these groups AND for whom the seasonal flu vaccine
is normally recommended will be able to receive both shots at the same
time.

People who do not fall into these groups are asked to put off receiving
the H1N1 vaccine for a few weeks to allow those at most risk to get
their vaccine first.

Week of Nov. 2:

Starting the week of Nov. 2, the people eligible to receive the H1N1
vaccine will expand to include the following groups:
* All initial groups.
* Children 6 months to less than 5 years of age.
* Health-care workers (including all health-care system workers
involved with the pandemic response or delivery of essential health
services).
* Household contacts and care providers of infants less than 6 months
of age, and persons who are immunocompromised.

People who fall into these groups AND for whom the seasonal flu vaccine
is normally recommended will be able to receive both shots at the same
time.

Mid- to late-November (when notified):

Beginning three or four weeks later, everyone else who needs and wants
the H1N1 vaccine will be recommended to receive it. Public notification
will happen at this time so that everyone is aware the vaccine is
available to them.

Again, those people normally recommended to receive the seasonal flu
vaccine will be able to get both shots at this time.

Adjuvanted vs. unadjuvanted vaccines:

The pandemic H1N1 vaccine is an adjuvanted vaccine. Adjuvants are
compounds that boost the immune system's response to vaccine, allowing
smaller doses to be used per person. A version of the H1N1 vaccine
without adjuvant will also be available in B.C. beginning the second
week of November.

While the unadjuvanted H1N1 vaccine is recommended for pregnant women,
the adjuvanted version, available earlier next week, is approved for
everyone who wants to protect themselves from this pandemic. Pregnant
women in the second half of pregnancy are among those at highest risk
of severe outcomes from the pandemic H1N1 virus.

Since B.C. is experiencing epidemic levels of the H1N1 virus now,
pregnant women in second half of pregnancy are advised not to wait
until November for unadjuvanted vaccine, but to get immunized now with
the adjuvanted version.

To find out where you can get your H1N1 and/or seasonal flu shot, visit
the Flu Clinic Locator at www.ImmunizeBC.ca or contact your local
public health unit. Once the H1N1 flu vaccine arrives, more locations
will be added as they are confirmed.

BACKGROUNDER

CO-ADMINISTRATION OF H1N1 AND SEASONAL FLU VACCINES

After extensive consideration at the national level, B.C. and the
Provincial Health Officer are recommending that those British
Columbians who normally receive the seasonal flu vaccine now be able to
receive that vaccine at the same time as their H1N1 shot.

National review and examination of both the sequential and the
simultaneous administration of the pandemic H1N1 vaccine and the
seasonal flu vaccine have determined that administering the seasonal
and H1N1 vaccines at the same time is unlikely to impair the immune
response to either one.

B.C.'s initial recommendation to delay the seasonal vaccine campaign
for everyone under the age of 65 was made based on the best available
evidence and before pandemic vaccine was available.

Now that pandemic vaccine is available, B.C. has updated the vaccine
administration recommendations to ensure those who need to be protected
against both the H1N1 and seasonal flu strains of viruses can
accomplish that in the shortest period of time.

As well, co-administration will allow B.C. to leverage and maximize the
province's clinic and public health resources during the largest
immunization campaign in the history of this province.

To find out where you can get your H1N1 and/or seasonal flu shot, visit
the Flu Clinic Locator at www.ImmunizeBC.ca or contact your local
public health unit. Once the H1N1 flu vaccine arrives, more locations
will be added as they are confirmed.

BACKGROUNDER

H1N1 VACCINE BY THE NUMBERS

223,500: The number of doses already in B.C. and ready for
administration starting Oct. 26.

Four: The number of trucks that drove the vaccine to B.C.

351: The number of large shoe boxes required to hold all the vaccine
doses.

4,174,149: The total number of doses of adjuvanted vaccine that B.C.
has ordered.

216,000: The number of doses of unadjuvanted vaccine that B.C. will
receive in the second week of November - the province's entire order.

Two: The number of half-doses children under 10 will need to receive,
spread three weeks apart.

1.4 million: The number of doses of seasonal vaccine the Province
purchases on a yearly basis to administer those in high-risk groups.

0-6: The ages, in months, of children who should not receive the H1N1
vaccine.

Four - six: The time, in weeks, in which B.C. expects all British
Columbians who need and want the vaccine will be able to receive it.

-30-

by **admin** » Tue Oct 27, 2009 2:45 pm

Turtle Island Native Network is reporting that the "second wave" of the Swine Flu is reported in First Nation communities.

The H1N1 virus is hitting some First Nations harder than others, forcing leaders to make some tough decisions, including shutting down the Band office and suspending some community programs.

News and Comment
by Tehaliwaskenhas - Bob Kennedy
Copyright
Turtle Island Native Network
http://www.turtleisland.org

October 27th, 2009

Swine Flu forces First Nation in BC, and another in Ontario to shut down daily activities.

Batchewana cancels activities as swine flu precaution

Chief Dean Sayers, Batchewana First Nation announced programs are being cancelled "as a precautionary measure to decrease the possibility of H1N1 and the flu in our communities". Programs cancelled until December 1st include - Elders' Halloween Dance - Kickboxing at BLC - After School G8 Program - Community Planning Session Elders Complex - Halloween Pumpkin Carving Contest Please pick up your pumpkin at the Shkniiji Gamig Teen Centre and carve it at home and then drop it off at the Teen Centre for judging - Niigaaniin After School Program: postponed - Batchewana Village Community Planning Session - BLC Handyperson Program - Youth Corn Maze Event - Youth Wellness Session #1 - Family Halloween Dance - Youth Haunted Corn Maze Event - Community Planning Session Rankin Arena - YMCA Family Night - Community Social Rankin Arena - Community Meeting Rankin Arena - the open invitation to use the BLC's exercise equipment will also be postponed.

In British Columbia, Maureen Luggi of Wet'suwet'en First Nation informed us that the Wet'suwet'en First Nation office is CLOSED "indefinitely". "Our Staff and Community have been exposed to the H1N1 flu virus and our Chief and 1 of our Council members and Staff already have the flu symptoms. We are arranging to have our office disinfected and all Staff/Community members as well as First Nations organizations personnel to remain 'away from our office'. . . . Our goals and intentions are to prevent the spread of the H1N1 virus as it is highly contagious and has proven to be very deadly with all of the media reports that are now out. We are taking all responsible steps to protect the people in our office and in our community. We are especially concerned about our Elders and our Children. We respectfully ask for your prayers for our community. Thank you and God bless you."

by **admin** » Fri Nov 06, 2009 7:54 pm

On November 10, 2009 at 12:00 noon EST
Health Minister Leona Aglukkaq and National Chief of the Assembly of First Nations (AFN) Shawn Atleo
will co-host a Virtual Summit on H1N1 preparedness for First Nations communities.

For more information . . .
http://www.turtleisland.org/discussion/viewtopic.php?p=10667#p10667
- - -

by **admin** » Fri Nov 20, 2009 11:36 am

Turtle Island Native Network notes that this advisory is not specifically targeted at First Nations,
HOWEVER the use of the phrase Communal Living Settings might be relevant to some of our communities
where houses have numerous residents - including homes where we know more than twenty people are housed
in a very small living area "on-the-rez".

Unfortunately this sitation DOES exist in Canada.

As for the advisory's references to the homeless, this IS of importance to us as we know Aboriginal Canadians make up at least one quarter of the homeless population in the urban areas of this country.
- - -

Public Health Agency of Canada
November 19th, 2009
Public Health Guidance for the Prevention and Management of Influenza-like Illness (ILI),
Including the Pandemic (H1N1) 2009 Influenza Virus, Related to Communal Living Settings

http://www.phac-aspc.gc.ca/alert-alerte/h1n1/guidance_lignesdirectrices/commun-eng.php
- - -

Also of interest . . .

Backgrounder: Vaccine Myths

The most effective way to protect yourself and your loved ones from flu viruses, including the H1N1 flu virus, is to get immunized.

It is important to know what is myth and what is fact. The following are among the more common myths surrounding flu vaccines, including both the seasonal and the H1N1 flu vaccines.

Myth 1: Vaccines don't work.
Fact 1: It is true that when there is an outbreak of a disease, some people who have been immunized get sick. This leads to the idea that vaccines don't work. Because each individual is different, about 10 to 15 per cent of people vaccinated will not develop immunity to the disease. Nevertheless, immunization reduces the risk of severe disease. In the case of the H1N1 flu virus, since very few people are immune, it is predicted that without interventions like a vaccine and antivirals, close to 25 to 35 per cent of the population could become ill over the period of a few months. Immunization is the most effective way to prevent illness and to reduce the risk of transmitting the flu to those around you.

Myth 2: There are many serious side effects from vaccines.
Fact 2: We acknowledge that there are concerns with respect to immunization. There are some risks association with flu vaccine, but the potential risk for serious adverse events, like Guillan-Barré Syndrome, is low.

For regular seasonal influenza, about 5 to 10 percent of the population will get sick and on average about 4000 people die every year. The risks of serious side effects from the flu are far greater than the risk of experiencing an adverse event after receiving the flu shot. The risk of suffering Guillan-Barré as a complication from the flu is greater than the risk of getting it as a reaction to the flu shot.

Vaccines are among the safest tools of modern medicine. In Canada, serious side effects about one for every 100,000 doses of vaccine distributed. The vast majority of side effects from vaccines are minor and temporary, like a sore arm or mild fever. These are much less severe than influenza infection, and last for a much shorter time. No long-term effects have been associated with any vaccine currently in use.

Myth 3: Because the H1N1 flu vaccine is new, it is untested and unsafe.
Fact 3: Careful research into the safety of any vaccine is done prior to its widespread use. The requirements for vaccines approved for sale in Canada are stringent. Every vaccine lot is safety-tested by the manufacturer and by the Biologics and Genetic Therapies Directorate at Health Canada. Health Canada will review all available test results, including international data, to ensure the vaccine is safe and effective before it is authorized for use in Canada. The dangers of vaccine-preventable diseases are much greater than the risk from a serious reaction to a vaccine.

The use of an adjuvanted vaccine is not new. The adjuvant used in the H1N1 flu vaccine although new in Canada, has been widely used safely in Europe in other vaccines. This adjuvant has already been evaluated by Health Canada, and no safety concerns have been found.

Myth 4: Taking the regular flu shot puts me at risk of becoming very ill with H1N1
Fact 4: Preliminary findings from some Canadian studies indicate that those healthy adults that tested positive for H1N1 were twice as likely to have received seasonal vaccine. More research is needed to establish whether or not there is a causal relationship between these factors. What is important is that there is no association with receiving seasonal vaccine and experiencing serious illness from H1N1.

Studies in Canada and the U.S. have shown that there appears to be no increased risk of severe disease from the H1N1 flu virus among people who received seasonal flu shots. Studies in the U.S., Australia and Britain have not shown an association between the seasonal flu shot and getting the H1N1 flu virus.

Myth 5: The influenza vaccine can give you influenza.
Fact 5: The influenza vaccine cannot give you influenza. The influenza vaccine contains dead influenza viruses and they cannot cause infection.

Myth 6: Getting an influenza vaccine every year overwhelms and weakens the immune system.
Fact 6: The influenza vaccine gives you a high level of immunity to the virus. People who get the influenza vaccine every year are better protected against influenza than those who do not get it.

Myth 7: The influenza vaccine contains thimerosal (mercury), which is harmful, especially for young children.
Fact 7: The amount of thimerosal used in the influenza vaccine is very small and has not been shown to cause any harm. Canada's National Advisory Committee on Immunization (which includes recognized experts in the fields of paediatrics, infectious diseases, immunology, medical microbiology, internal medicine and public health) has reviewed the latest science and concluded, "there is no legitimate safety reason to avoid the use of thimerosal-containing products for children or older individuals." The vaccines that Canadian children and adults receive are safe.

Myth 8: Pregnant women should not get the influenza vaccine.
Fact 8: The influenza vaccine is safe during pregnancy. Being immunized is the best way to protect yourself and those around you, including your unborn infant. It is also safe for babies to breastfeed after mothers receive the influenza vaccine.

Although women who are pregnant are not more likely to get the H1N1 flu virus, they are more likely to suffer complications if they do get infected. This is particularly true in the second and third trimester of the pregnancy.

If you have any questions about getting an influenza shot during your pregnancy, speak with your doctor or health care provider.

Myth 9: My child got the influenza vaccine (flu shot) last year so there is no need to give him the shot again. He is still protected against the virus.
Fact 9: It is important for children over the age of six months to be immunized every year to make sure their body forms antibodies against the most common strains of influenza viruses circulating that year. Because the flu viruses may change from year to year, the vaccine is updated annually, so your child should get the flu shot every year.

These are only a few of many myths circulating about immunization and the influenza vaccine (regular seasonal flu and H1N1). When seeking information on such vital issue as your health, it is important to refer to official sources such as Health Canada, the Public Health Agency of Canada, and your provincial and territorial departments of health.

You can access current, updated information through http://www.fightflu.ca or by calling toll-free 1 800 O-Canada (1-800-622-6232). Being and staying protected against any illness starts with knowing the facts.

Knowledge is Your Best Defence

by **admin** » Thu Dec 31, 2009 9:49 am

Research

H1N1 and American Indian/Alaska Natives (AI/AN)

News and Comment
by Tehaliwaskenhas - Bob Kennedy
Copyright
Turtle Island Native Network
http://www.turtleisland.org/healing/healing-wellness.htm

December 31, 2009

The Swine Flu was named top news story of the year.

However, Turtle Island Native Network points to the real story that must be told regarding the deaths related to 2009 Pandemic Influenza A (H1N1).

American Indians and Alaska Natives represent a disproportionate number of the deaths according to research released this month by the U.S.Center for Disease Control. Turtle Island Native Network points to the following key findings . . .

"This report demonstrates that American Indian/Alaska Natives (AI/ANs) in the participating 12 states had an H1N1 mortality rate that was four times higher than the rate for all other racial/ethnic groups combined."

"Factors that might contribute to increased influenza-related mortality in the AI/AN population, including the role of underlying chronic medical conditions and social determinants of health, should be topics for future investigation." Indigenous populations from Australia, Canada, and New Zealand have been found to have a three to eight times higher rate of hospitalization and death associated with infection with the 2009 pandemic influenza A (H1N1) virus.

The research also included the following . . .

In October, two U.S. states (Arizona and New Mexico) observed a disproportionate number of deaths related to H1N1 among American Indian/Alaska Natives (AI/ANs). These observations, plus incomplete reporting of race/ethnicity at the national level, led to formation of a multidisciplinary workgroup comprised of representatives from 12 state health departments, the Council of State and Territorial Epidemiologists, tribal epidemiology centers, the Indian Health Service, and CDC.

The workgroup assessed the burden of H1N1 influenza deaths in the AI/AN population by compiling surveillance data from the states and comparing death rates.

The results indicated that, during April 15--November 13, AI/ANs in the 12 participating states had an H1N1 mortality rate four times higher than persons in all other racial/ethnic populations combined.

Reasons for this disparity in death rates are unknown and need further investigation;
however, they might include a high prevalence of chronic health conditions (e.g., diabetes and asthma) among AI/ANs that predisposes them to influenza complications, poverty (e.g., poor living conditions), and delayed access to care.

Efforts are needed to increase awareness among AI/ANs and their health-care providers of the potential severity of influenza and current recommendations regarding the timely use of antiviral medications. Efforts to promote the use of 2009 H1N1 influenza monovalent vaccine in AI/AN populations should be expanded.
- - -

December 2009

Deaths Related to 2009 Pandemic Influenza A (H1N1) Among American Indian/Alaska Natives --- 12 States, 2009

Indigenous populations from Australia, Canada, and New Zealand have been found to have a three to eight times higher rate of hospitalization and death associated with infection with the 2009 pandemic influenza A (H1N1) virus (1).

In October, two U.S. states (Arizona and New Mexico) observed a disproportionate number of deaths related to H1N1 among American Indian/Alaska Natives (AI/ANs). These observations, plus incomplete reporting of race/ethnicity at the national level, led to formation of a multidisciplinary workgroup comprised of representatives from 12 state health departments, the Council of State and Territorial Epidemiologists, tribal epidemiology centers, the Indian Health Service, and CDC. The workgroup assessed the burden of H1N1 influenza deaths in the AI/AN population by compiling surveillance data from the states and comparing death rates.

The results indicated that, during April 15--November 13, AI/ANs in the 12 participating states had an H1N1 mortality rate four times higher than persons in all other racial/ethnic populations combined. Reasons for this disparity in death rates are unknown and need further investigation; however, they might include a high prevalence of chronic health conditions (e.g., diabetes and asthma) among AI/ANs that predisposes them to influenza complications, poverty (e.g., poor living conditions), and delayed access to care.

Efforts are needed to increase awareness among AI/ANs and their health-care providers of the potential severity of influenza and current recommendations regarding the timely use of antiviral medications. Efforts to promote the use of 2009 H1N1 influenza monovalent vaccine in AI/AN populations should be expanded.

In November 2009, all state health departments were invited to participate in the workgroup investigation by providing data on influenza-related deaths among their residents. Twelve states (Alabama, Alaska, Arizona, Michigan, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Utah, Washington, and Wyoming) chose to participate, representing 50% of the AI/AN population in the United States. An H1N1 death was defined as a death in a resident of a participating state reported during April 15--November 13 with any positive result from an influenza test, including rapid enzyme immunoassay, direct or indirect influenza fluorescent antibody, real-time reverse transcription--polymerase chain reaction assay (rRT-PCR), or viral culture. Because >99% of influenza specimens tested during the study period had been found to be H1N1, all cases with a positive influenza test were presumed to be H1N1 and not seasonal influenza. Race/ethnicity and influenza risk status* of decedents were determined through review of death certificates, medical records, or death investigation reports. CDC-defined groups at higher risk for influenza complications were used to classify decedents as at high risk for influenza complications. Bridged-race vintage 2008 postcensal population estimates† were used by all states to determine population data for rate calculations.§ Death rates by race/ethnicity were age adjusted to the 2000 U.S. standard population. Using rate ratios, AI/AN death rates were compared with death rates for all other racial/ethnic populations, including deaths in persons of unknown race.

A total of 426 H1N1 deaths were reported by the 12 states during April 15--November 13 (Table 1). Forty-two deaths (9.9%) occurred among AI/ANs,¶ although AI/ANs make up approximately 3% of the total population in the 12 states.

The overall AI/AN H1N1-related death rate was 3.7 per 100,000 population, compared with 0.9 per 100,000 for all other racial/ethnic populations combined,** resulting in a mortality rate ratio of 4.0. Age group--specific H1N1-related death rates were 3.5 for persons aged 0--4 years, 1.1 for persons aged 5--24 years, 4.2 for persons aged 25--64 years, and 7.2 for persons aged ≥65 years. In all age groups, the AI/AN death rate was higher than the rate for all other racial/ethnic populations combined
(Table 1). http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5848a1.htm

Among the AI/AN deaths related to H1N1, 81.0% of decedents had high-risk health conditions, compared with 77.6% of persons in all other racial/ethnic populations combined (Table 2). http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5848a1.htm

In addition, greater percentages of AI/AN decedents had asthma (31.0%) and diabetes (45.2%) than decedents in all other racial/ethnic populations combined (14.1% asthma and 24.0% diabetes).

Reported By: L Castrodale, DVM, J McLaughlin, MD, Alaska Div of Public Health. S Imholte, MPH, K Komatsu, MPH, Arizona Dept of Health Svcs. E Wells, MD, Michigan Dept of Community Health. M Landen, MD, D Selvage, MHS, M Sewell, DrPH, C Smelser, MD, D Thompson, MD, New Mexico Dept of Health. K Bradley, DVM, C McDonald, MPH, Oklahoma State Dept of Health. R Leman, MD, M Powell, MPH, Oregon Dept of Human Svcs. T Miller, MPH, L VanderBusch, North Dakota Dept of Health. L Kightlinger, PhD, South Dakota Dept of Health. R Boulton, MSPH, Utah Dept of Health. K Lofy, MD, AA Marfin, MD, Washington State Dept of Health. R McClinton, MPH, Wyoming Dept of Health. M Hoopes, MPH, Northwest Portland Tribal Epidemiology Center. T Kim, MD, California Tribal Epidemiology Center. JM Hayes, DrPH, Tribal Epidemiology Center, United South and Eastern Tribes. Z Mahal, MBBS, Inter Tribal Council of Arizona Epidemiology Center. E Chao, MPH, Council of State and Territorial Epidemiologists. T Weiser, MD, Portland area; JE Cheek, MD, JT Redd, MD, Div of Epidemiology and Disease Prevention, Indian Health Svc. R Bryan, MD, Office of State and Local Support, Office of the Director; M Jhung, MD, Influenza Div, National Center for Immunization and Respiratory Diseases; M Morrison, MPH, D O'Leary, DVM, Career Epidemiology Field Officer Program, Coordinating Office for Terrorism Preparedness and Emergency Response; M Nichols, DVM, EIS Officer, CDC.
Editorial Note:

The AI/AN population is culturally diverse and spread among approximately 560 federally recognized tribal communities in 34 states and multiple urban areas (2). Health disparities between the AI/AN population and other racial/ethnic populations are well documented (3). Mortality rates and trends for respiratory diseases indicate that AI/ANs are at increased risk for death resulting from pneumonia and influenza (4,5). Although AI/AN death rates varied among the 12 participating states in this study, the aggregate AI/AN H1N1-related death rate from 12 states was four times higher than that of all other racial/ethnic groups combined.

The higher mortality rate among AI/ANs observed in this investigation is consistent with reports of increased influenza-related morbidity and mortality among indigenous populations in other parts of the world during the current H1N1 pandemic and also is consistent with observations from previous pandemics (1,2). After the influenza pandemic of 1918--19, U.S. government investigators reported that influenza-related mortality rates among AI/ANs were four times higher than the rates observed among persons in general urban populations (2).

The factors that produce a higher influenza mortality rate among AI/ANs are unknown but might include higher prevalence of underlying chronic illness such as diabetes. The age-specific prevalence of diabetes in AI/AN adults is two to three times higher than for all U.S. adults (6). In addition, AI/ANs are twice as likely to have unmet medical needs because of cost (7). AI/ANs also have the highest poverty rate (30%), which is twice the national rate and three times the rate for whites among households with children aged <18 years (8), suggesting that delayed access to medical care and living conditions associated with poverty might contribute to their higher influenza mortality rate.

The findings in this report are subject to at least five limitations. First, AI/AN decedents often are misclassified as persons of other races on death certificates, decreasing the number of A1/AN deaths by as much as 30% in some reports (9). Second, the time lags in reporting of deaths and the manner in which states collect death data and classify decedents as at high risk for influenza complications might vary and affect rate ratios in an unpredictable manner. Third, race and ethnicity were unknown for 19 deaths, although for a conservative comparison, these deaths were included with the combined group of all other racial/ethnic populations. Fourth, greater incidence of influenza disease among AI/ANs might have contributed to the higher mortality rate; however, the incidence of disease among AI/ANs is unlikely to be so much greater than all other populations that it could account for a mortality rate that is four times higher. Data on race/ethnicity are not collected consistently for influenza patients. Finally, although >99% of all identified influenza strains in the United States during the investigation period were thought to be H1N1, confirmation by rRT-PCR or viral culture was not required for inclusion in this analysis.

Effective public health responses to influenza will depend on accurate and complete reporting of race/ethnicity in all state and federal mortality surveillance systems. Community education regarding the risk for influenza mortality among AI/ANs should be expanded. Increased efforts should be made to promote awareness among AI/ANs and their health-care providers about the signs and symptoms of influenza and recommendations for vaccination and the use of influenza antiviral medications early in the course of suspected influenza illness for those at increased risk for complications.

Finally, factors that might contribute to increased influenza-related mortality in the AI/AN population, including the role of underlying chronic medical conditions and social determinants of health, should be topics for future investigation.

Acknowledgments

This report is based, in part, on contributions by CA Snider, MPH, Oklahoma City Area Tribal Epidemiology Center, and BL Cadwell, MSPH, Career Development Div, Office of Workforce and Career Development, CDC.
References

1. La Ruche G, Tarantola A, Barboza P, et al. The 2009 pandemic H1N1 influenza and indigenous populations of the Americas and the Pacific. Euro Surveill 2009;14:1--6.
2. Groom AV, Jim C, LaRoque M, et al. Pandemic influenza preparedness and vulnerable populations in tribal communities. Am J Public Health 2009;99(Suppl 2):S271--8.
3. Jones DS. The persistence of American Indian health disparities. Am J Public Health 2006;96:2122--34.
4. Samet JM, Key CR, Kutvirt DM, Wiggins CL. Respiratory disease mortality in New Mexico's American Indians and Hispanics. Am J Public Health 1980;70:492--7.
5. Day GE, Provost E, Lanier AP. Alaska native mortality rates and trends. Public Health Rep 2009;124:54--64.
6. CDC. Diabetes prevalence among American Indians and Alaska Natives and the overall population---United States, 1994--2002. MMWR 2003;52:702--4.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5230a3.htm
7. Barnes PM, Adams PF, Powell-Griner E. Health characteristics of the American Indian and Alaska Native adult population: United States, 1999--2003. Adv Data 2005(No. 356).
8. US Department of Education, Institute of Education Sciences, National Center for Education Statistics. Status and trends in the education of American Indians and Alaska Natives: 2008. Available at http://nces.ed.gov/pubs2008/nativetrends/ind_1_6.asp. Accessed December 7, 2009.
9. Arias E, Schauman WS, Eschbach K, Sorlie PD, Backlund E. The validity of race and Hispanic origin reporting on death certificates in the United States. Vital Health Stat 2 2008(No. 148).

* CDC defined groups at high risk for influenza complications: children aged <2 years; persons aged ≥65 years; pregnant women and women up to 2 weeks postpartum (including after pregnancy loss); persons of any age with certain chronic medical or immunosuppressive conditions (i.e., chronic pulmonary [including asthma], cardiovascular [except hypertension], renal, hepatic, hematologic [including sickle cell disease], or metabolic disorders [including diabetes]); disorders that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders); immunosuppression, including that caused by medications or by human immunodeficiency virus; and persons aged <19 years who are receiving long-term aspirin therapy. Available at http://www.cdc.gov/h1n1flu/recommendations.htm.

† Race bridging is a method used to make multiple-race and single-race data collection systems sufficiently comparable to permit estimation and analysis of race-specific statistics.

§ Available at http://wonder.cdc.gov/population.html.

¶ Alabama (one death), Alaska (two), Arizona (16), Michigan (zero), New Mexico (eight), North Dakota (zero), Oklahoma (three), Oregon (one), South Dakota (four), Utah (two), Washington (four), and Wyoming (one).

** Death rates per 100,000 population for the other racial/ethnic populations were 1.4 for Hispanics, 1.1 for Asian or Pacific Islanders, 0.8 for whites, and 0.7 for blacks.

What is already known on this topic?

Increased rates of influenza-related morbidity and mortality among indigenous populations in other parts of the world have been reported during the current H1N1 pandemic.

What is added by this report?

This report demonstrates that American Indian/Alaska Natives (AI/ANs) in the participating 12 states had an H1N1 mortality rate that was four times higher than the rate for all other racial/ethnic groups combined.

What are the implications for public health practice?

Health professionals and agencies should expand community education regarding the risk for influenza mortality, ensure access to and early empiric use of influenza antiviral medication, promote H1N1 vaccination, and investigate factors contributing to a higher influenza-related mortality rate among AI/ANs.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5848a1.htm
- - -

Also of interest . . .

http://blog.veratect.com/2009/12/22/highlight-advisories-contributed-by-veratect-regarding-impact-of-pandemic-h1n1-2009-on-indigenous-peoples/

After the detection of a global pandemic involving a novel type A / H1N1 influenza virus (pH1N1) in April 2009, Veratect analysts began to focus their efforts on the potential impact of the pandemic on vulnerable populations. Of particular concern was the possibility of severe clinical and sociological impact on the indigenous peoples. During the 1918 influenza pandemic, high case fatality rates were documented in the Inuit peoples, an indigenous group of the Americas located in Alaska. The reasons proposed for this apparent higher risk of adverse clinical outcomes included poor access to medical care and genetic predisposition, among other factors.

Veratect first documented an outbreak of suspected pH1N1 virus affecting indigenous peoples in Cauca, Colombia on May 14, 2009. On May 26 and 27, fatalities were reported among several different indigenous communities in Tocumen and Cascabel, Panama with clinical and epidemiological features consistent with pH1N1, included were the Kuna, who are native to both Panama and Colombia. On May 29, Veratect reported the first confirmed case of pH1N1 in Nunavut Province, Canada, a predominantly Inuit population. On June 1, Veratect reported medical evacuations due to pH1N1 from Nunavut to Yellowknife, Northwest Territories of Canada.

On June 2, an outbreak of influenza A was reported among the First Nations community in St. Theresa Point in Manitoba Province, Canada. The outbreak required medical evacuation of seven individuals to Winnipeg for treatment as tribal leaders struggled to reduce community anxiety. The same day, Veratect sent an advisory to the American Indian Health Service (IHS) expressing concern about the event and discussing implications for the Inuit peoples and other Native American Tribal Nations. The Veratect advisory was followed up the next day with an advisory sent to the international pediatric critical care community. Over the course of the next several days, other First Nations communities in Manitoba were affected. On June 9, the World Health Organization publicly expressed concern about the events involving the First Nations communities in Manitoba, issuing a statement regarding indigenous peoples on June 10.

On June 15, Veratect reported the first pH1N1 infections among indigenous peoples in Australia. Two weeks later, Veratect reported on high infection rates and adverse clinical outcomes among indigenous peoples in the Northern and Western Territories and Queensland. Veratect presented summary findings to the international pediatric intensive care community on July 3. On July 7 and 13, Veratect shared its findings with an online physician social network managed by Ozmosis.com.

On July 19, Veratect alerted the National Congress of American Indians (NCAI) to an increase of pH1N1 adverse clinical and sociological affects on indigenous peoples from Canada, Australia, Panama, and Colombia. On August 11, NCAI invited Veratect to present these findings at the Health and Homeland Security Subcommittees of the NCAI Annual Conference in Palm Springs, California, which we did on October 14. We are thankful to NCAI for the opportunity to participate in those important meetings.

On December 11, the United States Centers for Disease Control and Prevention validated our concerns with its publication in the Morbidity and Mortality Weekly Report (MMWR), “Deaths Related to 2009 Pandemic Influenza A (H1N1) Among American Indian/Alaska Natives — United States, 2009”.

by **admin** » Wed Jan 13, 2010 11:14 am

First Nations Flu Fight, a Success says
First Nations Health Council, BC Government, Canadian Government . . . (Tripartite First Nations H1N1 Working Group )

News and Comment
by Tehaliwaskenhas - Bob Kennedy ( Onyota'a:ka / Oneida )
Copyright
Turtle Island Native Network
http://www.turtleisland.org/discussion/viewtopic.php?p=10153#p10153

January 13th, 2010

The number of First Nations residents tackling the H1N1 flu by getting vaccinated, has surpassed the rate of the general population, according to an Information Bulletin from the Tripartite First Nations H1N1 Working Group in British Columbia.

"Dear First Nations Community Members, As we start a new year, the incidence of H1N1 influenza is decreasing in First Nations communities in British Columbia and across Canada. The Tripartite First Nations H1N1 Working Group is very pleased to report that the H1N1 vaccination coverage for the First Nations on-reserve population is over 75%. This is an impressive achievement - and is approximately three times higher than the vaccination coverage for the general provincial population.

This achievement would not have been possible without the hard work, cooperation and commitment from community leaders, health staff and volunteers who ensured that the H1N1 vaccine and important information about H1N1 and its prevention and treatment reached people in the communities. You all deserve our thanks and congratulations. We also wanted to let you know that in an effort to continually improve our processes and functions, we will be reviewing our management of H1N1 in First Nations communities in the coming months and may be seeking your input and guidance.

For those who have not received the H1N1 vaccine, we are still advising you to discuss this with your local health care provider - particularly because there is still the possibility of a resurgence of the H1N1 virus over the course of this winter and into 2010. Many thanks again for your continued support and commitment.

Questions?
Please contact your local Community Health Nurse or your local health care worker with any questions you have related to H1N1 or Seasonal Influenza. For more information about accessing H1N1 or Seasonal influenza vaccine, clinic locations and time of clinics, visit: www.immunizebc.ca For more information on the H1N1 Influenza virus, visit: www.gov.bc.ca/h1n1. "

by **admin** » Thu Jan 21, 2010 11:12 am

Turtle Island Native Network notes the following from a new study reported in the Canadian Medical Association Journal . . .
"First Nations ethnicity was associated with severe H1N1 disease requiring ICU admission. The proportion of First Nations people increased as the severity of disease increased . . ."

Canadian Medical Association Journal

Disease severity in H1N1 patients

OTTAWA, JANUARY 21, 2010 — A new study published in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/cgi/doi/10.1503/cmaj.091884 concerning the severity of H1N1 influenza has found that admissions to an intensive care unit (ICU) were associated with a longer interval between symptom onset and treatment with antivirals and with presence of an underlying medical condition.

People of First Nations ethnicity were also found to be at higher risk of severe H1N1 infection compared to people of other ethnic origins.

"Predicting disease and mitigating hazard in at-risk populations is an important aim of public health epidemiology, and in preparation for future waves of H1N1, determining the correlates of disease severity is incredibly important," write Dr. Ryan Zarychanski, University of Manitoba and coauthors.

The highest incidence of severe H1N1 occurred in Manitoba, where 45 residents of the province were admitted to an ICU. As of September 5, 2009, there had been 795 laboratory confirmed cases of H1N1 in the province where location of treatment could be determined. Seventy-two percent (569) of patients remained in the community, 23% (181) were admitted to hospital but not the ICU and 6% (45) were admitted to the ICU. The mean age of people with H1N1 was 25.3 years old.

In this study, which included all confirmed H1N1 cases in Manitoba, the authors found that longer intervals from symptom onset to eventual treatment with antivirals (Tamiflu) were strongly associated with more severe disease necessitating admission to an intensive care unit. Those who had untreated symptoms the longest required more life support, compared to people who were treated within 48 hours.

"Of course not everyone with H1N1 symptoms requires treatment, but this finding underscores the importance of prompt medical therapy for those experiencing serious symptoms, such as shortness of breath, in patients with underlying medical conditions, and among First Nations people," states lead researcher Dr. Ryan Zarychanski.

In the study, Dr. Zarychanski and colleagues also found that First Nations ethnicity was associated with severe H1N1 disease requiring ICU admission. The proportion of First Nations people increased as the severity of disease increased; 28% of confirmed H1N1 cases in the community occurred in First Nations people, compared with 54% of hospital admissions and 60% of admissions to the ICU. Similar trends have been observed in Aboriginal communities in Australia and New Zealand. This is "consistent with historical records from the 1918 Spanish influenza pandemic, during which mortality in Aboriginal communities was far higher than in non-Aboriginal communities," write the authors.

While the authors note that a genetic predisposition hypothesis is interesting, Aboriginal peoples in Canada, Australia and the Torres Strait do not share common ancestry. "What they do have in common is a history of colonization, combined with historic and continuing social inequities that have led to significant health disparities," write the authors. They also suggest the increased risk for First Nations peoples may be because of substandard living conditions, low income, diet, additional health issues or lack of access to health care.

These findings may have implications for public, and health care provider education, as well as for future public health planning and community outreach programs in the face of the current, or future outbreaks.
- - -

Recently reported on this topic . . .

January 13th, 2010

The number of First Nations residents tackling the H1N1 flu by getting vaccinated, has surpassed the rate of the general population, according to an Information Bulletin from the Tripartite First Nations H1N1 Working Group in British Columbia.

"Dear First Nations Community Members, As we start a new year, the incidence of H1N1 influenza is decreasing in First Nations communities in British Columbia and across Canada. The Tripartite First Nations H1N1 Working Group is very pleased to report that the H1N1 vaccination coverage for the First Nations on-reserve population is over 75%. This is an impressive achievement - and is approximately three times higher than the vaccination coverage for the general provincial population. This achievement would not have been possible without the hard work, cooperation and commitment from community leaders, health staff and volunteers who ensured that the H1N1 vaccine and important information about H1N1 and its prevention and treatment reached people in the communities. You all deserve our thanks and congratulations. We also wanted to let you know that in an effort to continually improve our processes and functions, we will be reviewing our management of H1N1 in First Nations communities in the coming months and may be seeking your input and guidance. For those who have not received the H1N1 vaccine, we are still advising you to discuss this with your local health care provider - particularly because there is still the possibility of a resurgence of the H1N1 virus over the course of this winter and into 2010. Many thanks again for your continued support and commitment.

Questions?
Please contact your local Community Health Nurse or your local health care worker with any questions you have related to H1N1 or Seasonal Influenza. For more information about accessing H1N1 or Seasonal influenza vaccine, clinic locations and time of clinics, visit: http://www.immunizebc.ca For more information on the H1N1 Influenza virus, visit: http://www.gov.bc.ca/h1n1. "
- - -
Also recently reported on this topic . . .

American Indians and Alaska Natives represent a disproportionate number of deaths from the H1N1 virus.
December 2009
http://www.turtleisland.org/discussion/viewtopic.php?p=10874#p10874

- - -

Also of interest . . .

Genome British Columbia: Genomic Surveillance of Pandemic H1N1

VANCOUVER, BRITISH COLUMBIA

Jan. 21, 2010

The BC Centre for Disease Control has launched an influenza genome sequencing project to better understand how the pandemic H1N1 flu virus has evolved in British Columbia, and may continue to evolve in the coming months.

This project capitalizes on BC's expertise and capacity in genome sequencing to generate hundreds of complete genomes from circulating influenza viruses collected in British Columbia during the H1N1 pandemic, as well as during and after the Olympics. By comparing the evolution of BC's influenza virus to that of viruses sequenced in other regions, researchers hope to learn how a mass gathering such as the Olympics can impact the virus' genetic sequence. The project will also allow researchers to track the geographic origins of the H1N1 virus that entered BC in 2009.

"We know from earlier studies that one of the most important drivers of an influenza virus' evolution is the mixing of different lineages of virus from around the world," explains Dr. Robert Brunham, Provincial Executive Director of the BC Centre for Disease Control. "While we are not expecting a third wave of H1N1 in BC, we will have over 250,000 visitors in Vancouver in February, which may impact influenza virus evolution."

Although researchers predict that exposure to influenza viruses from different countries will lead to changes in the H1N1 virus' genetic sequence, these changes are unlikely to change the severity of disease due to the H1N1 virus.

"The data uncovered from this project will enable BC to track how the virus moved through the population - information that can assist public health officials in understanding the virus and preparing for future outbreaks," explains Dr. Perry Kendall, British Columbia's Provincial Health Officer.

Large-scale genome projects such as this have only become common in the last five years, as sequencing technologies have improved and become faster and more cost-efficient. "This is the first time since this technology has matured that both a pandemic and an Olympics have occurred together," says Dr. Alan Winter, President and CEO of Genome BC. "The timing provides a very significant opportunity to study how a virus evolves when it is meeting and mixing with viruses from around the world."

While influenza activity has declined to baseline or below baseline levels in Canada, pandemic H1N1 activity elsewhere remains variable, with some Eastern European and Western Asian countries continuing to report above-baseline activity levels.

This project is jointly funded by the BC Centre for Disease Control, Genome British Columbia and Genome Canada. Research is being conducted at both the BCCDC Public Health Microbiology & Reference Laboratory and Canada's Michael Smith Genome Sciences Centre.

For more information please visit:

* http://www.bccdc.ca
* http://www.genomebc.ca

by **admin** » Tue Jun 08, 2010 6:17 pm

CSA Roundtable

June 8, 2010

Resulting White Paper Shares Insights Into Current Pandemic Preparedness Measures In Canada And What More Should Be Done

Toronto – June 8, 2010 – How did Canada fare during the H1N1 influenza pandemic? What plans worked and what didn't – and why not? What more needs to be done given the threat of future, potentially more serious pandemics? These were some of the questions CSA Standards (CSA) sought to answer when hosting a national Roundtable on Healthcare and Emergency Service Sector Pandemic Preparedness. A comprehensive white paper from the roundtable was released today at the World Conference on Disaster Management.
Roundtable participants concluded that the 2006 Canadian Pandemic Influenza Plan (with updates since) was a positive step toward mitigating serious illness and deaths during the mild H1N1 influenza pandemic outbreak. However, CSA roundtable participants also concluded there were some gaps and inconsistencies in protection during the 2009 H1N1 influenza pandemic, and changes to existing pandemic plans now need to be made in the event of future more moderate or severe influenza pandemics. Roundtable participants included senior representatives from Canada's healthcare and emergency service sectors such as infectious disease, family medicine, first responders, nursing, and hospital / healthcare administration.

"The mildness of the H1N1 pandemic may have given Canadians a false sense of security about the potential devastating impact of future pandemics," said Dr. Allan Holmes, CSA roundtable moderator and pandemic planning expert. "CSA Roundtable participants were unanimous in stressing that 2009 should not be used as the new yardstick for future pandemic preparedness planning. We must remain vigilant in ensuring our pandemic plans continue to evolve as the threat of a more moderate or severe pandemic is always a possibility."

Voices From the H1N1 Pandemic Front Lines: A White Paper on How Canada Could Do Better Next Time, the resulting CSA roundtable white paper released today, outlines constructive recommendations on how Canada's healthcare and emergency service sectors can work more in collaboration with governments and other key decision-makers to improve influenza pandemic preparedness plans going forward. The white paper reinforces that many things went right during the recent H1N1 influenza pandemic but although there were successes, there were also challenges that must be addressed.

"CSA has been involved in the emergency management and healthcare fields for years and we're all about developing standards-based solutions to help protect the health and safety of people," said Doug Morton, director of health and safety, CSA. "Because of the H1N1, we wanted to contribute to the discussion on influenza pandemic preparedness in Canada and hope this white paper will act as a catalyst for improved preparation to protect us from future pandemics. We also thought the timing was perfect in light of the new Federal Emergency Response Plan that is designed to coordinate the federal emergency response efforts for any kind of disaster."

More Steps to Achieving Protection

Harmonization CSA roundtable participants felt the Canadian Pandemic Influenza Plan was useful in providing a broad resource for decision-makers, however there were multiple pandemic preparedness plans during the 2009 H1N1 pandemic – federal, provincial, regional, local, institutional and international – and this patchwork system of protection caused tremendous confusion among front-line workers, resulting in an uneven delivery of care. Roundtable participants called for the harmonization of federal and provincial frameworks to create a single pan-Canadian standard approach for pandemic preparedness planning, while preserving flexibility for local level implementation.

Scalability In addition, roundtable participants felt the Canadian Influenza Pandemic Plan recognized that unknown factors such as the severity of the illness caused by the pandemic strain and the transmissibility of the virus from person-to-person would impact response measures. But the plan lacked both a severity index for infections and implementation triggers (events or milestones in the epidemic or pandemic process that signal a qualitative change in the situation – such as an elevated and sustained rate of absenteeism in the schools). The severity index and the implementation triggers would better help guide decision-making by provincial and local authorities.

Personal Protective Equipment and Antivirals Roundtable participants also felt that influenza pandemic plans must take a multi-faceted approach to protection – including offering protective tactics between: preventing the spread of disease through hand-washing, sneezing into sleeves instead of hands, and staying home if ill; and immunization through a vaccine.

Given that it takes approximately six months to develop a vaccine once the virus is identified, as was the case with the H1N1, roundtable participants felt strongly that more emphasis needs to be put on access to personal protective equipment (such as specialized masks, gowns, and gloves) and antivirals (medications that work by interfering with the ability of the virus to reproduce in the body).

Why both? Because despite the benefits, protective equipment is not foolproof and cannot be solely relied upon before a vaccine is available. Its use requires proper training and fitting, and not all healthcare workers and first responders can be realistically outfitted. Roundtable participants therefore, felt that antivirals were particularly important in the event of a moderate or severe pandemic, and should be available not just for treatment, but also for prophylaxis (prevention). The existing plan does not address pre-exposure prophylaxis for healthcare workers and first responders, no matter how severe the influenza pandemic, and prior to a vaccine being made available. Roundtable participants felt clear guidelines for the preventative use of antivirals – including the identification of "triggers" that would activate the deployment of antiviral stockpiles – are needed.

Vaccine In addition, CSA roundtable participants identified there was much confusion during the H1N1 about who met the criteria for "priority" access to the vaccine, and who did not. They felt that when healthcare workers and first responders are expected to be on the front lines during an influenza outbreak, they should both be categorized as priority groups. Not only are they at higher risk of getting sick, but the nature of their jobs means they are efficient "spreaders" of disease in the community should they fall ill.

Communication And lastly, CSA roundtable participants felt there is a need for communication improvements among all levels of government, healthcare organizations and the general public, and recommended the creation of an integrated federal / provincial / territorial communications body comprised of medical officers and disaster management experts. This integrated body would enable the various jurisdictions to interpret events unfolding in real-time, to ensure communications is relevant to their region, and to provide "bottom-up" feedback to high-level officials.

In addition, roundtable participants recommended a primary care and emergency service communication network be established to reach those on the frontlines working outside hospital settings (e.g., family physicians, those working in walk-in clinics, home-care and long-term care settings, and first responders).

About the CSA Roundtable and White Paper On December 15, 2009, CSA hosted the national Roundtable on Healthcare and Emergency Service Sector Pandemic Preparedness that was moderated by Dr. Allan Holmes, a fellowship-trained emergency physician, president of Global Medical Services, and pandemic advisor to federal and provincial governments and corporations across Canada. This one-day roundtable was possible thanks to arms-length support from Hoffmann-La Roche (Roche Canada).

CSA roundtable Participants included representatives from the following organizations: Association of Medical Microbiology and Infectious Disease Canada; Canadian Association of Emergency Physicians; Canadian Healthcare Association; Canadian Nurses Association; Centre for Excellence in Emergency Preparedness, College of Family Physicians of Canada; Hamilton Health Sciences Centre; National Emergency Nurses Affiliation; Ontario Hospital Association; Ottawa Hospital; and Prince George Fire Fighters Union.

The CSA White Paper, Voices From the H1N1 Pandemic Front Lines: A White Paper on How Canada Could Do Better Next Time, is available online at CSA.ca .

About CSA CSA Standards is a leading standards-based solutions organization serving industry, government, consumers and other interested parties in North America and the global marketplace. Focusing on standards and codes development, application products, training, advisory and personnel certification services, the organization aims to enhance public safety, improve quality of life, preserve the environment and facilitate trade. CSA Standards is a division of CSA Group, which also consists of CSA International, which provides testing and certification services for electrical, mechanical, plumbing, gas and a variety of other products; and OnSpeX, a provider of consumer product evaluation, inspection and advisory services for retailers and manufacturers. For more information visit www.csa.ca

by **admin** » Wed Jul 27, 2011 12:37 pm

Jukly 2011

A new study
("The responses of Aboriginal Canadians to adjuvanted pandemic (H1N1) 2009 influenza vaccine") was released this week, and
says there was a "robust" response to the H1N1 vaccine that was used by First Nations and Metis during the 2009 flu Pandemic. . . Because many Aboriginal Canadians had severe cases of pandemic (H1N1) 2009 influenza, they were given priority access to vaccine.

"First Nations and Métis adults responded robustly to ASO3-adjuvanted pandemic (H1N1) 2009 vaccine. Virtually all participants showed protective titres, including those with chronic health conditions."

The responses of Aboriginal Canadians to adjuvanted pandemic (H1N1) 2009 influenza vaccine
Ethan Rubinstein,Gerrald Predy,Laura Sauvé,Greg W. Hammond,Fred Aoki,Chris Sikora,Yan Li,
Barbara Law,Scott Halperin,David Scheifele

+ Author Affiliations
From the Health Sciences Center, University of Manitoba (Rubinstein, Hammond, Aoki) Winnipeg, Man.; Alberta Health Services (Predy, Sikora), Edmonton, Alta.; Vaccine Evaluation Center (Sauvé, Scheifele), University of British Columbia, Vancouver, BC; Virology Section (Li), National Microbiology Laboratory, Winnipeg, Man.; Public Health Agency of Canada (Law), Ottawa, Ont.; Canadian Center for Vaccinology (Halperin), Dalhousie University, Halifax, NS; Public Health Agency of Canada/Canadian Institutes of Health Research Influenza Research Network (Rubinstein, Predy, Sauvé, Hammond, Aoki, Sikora, Li, Law, Halperin, Scheifele), Halifax, NS

Dr. David Scheifele, E-mail dscheifele@cfri.ca

Abstract

Background: Because many Aboriginal Canadians had severe cases of pandemic (H1N1) 2009 influenza, they were given priority access to vaccine. However, it was not known if the single recommended dose would adequately protect people at high risk, prompting our study to assess responses to the vaccine among Aboriginal Canadians.

Methods: We enrolled First Nations and Métis adults aged 20–59 years in our prospective cohort study. Participants were given one 0.5-mL dose of ASO3-adjuvanted pandemic (H1N1) 2009 vaccine (Arepanrix, GlaxoSmith-Kline Canada). Blood samples were taken at baseline and 21–28 days after vaccination. Paired sera were tested for hemagglutination-inhibiting antibodies at a reference laboratory. To assess vaccine safety, we monitored the injection site symptoms of each participant for seven days. We also monitored patients for general symptoms within 7 days of vaccination and any use of the health care system for 21–28 days after vaccination.

Results: We enrolled 138 participants in the study (95 First Nations, 43 Métis), 137 of whom provided all safety data and 136 of whom provided both blood samples. First Nations and Métis participants had similar characteristics, including high rates of chronic health conditions (74.4%–76.8%). Pre-existing antibody to the virus was detected in 34.3% of the participants, all of whom boosted strongly with vaccination (seroprotection rate [titre ≥ 40] 100%, geometric mean titre 531–667). Particpants with no pre-existing antibody also responded well. Fifty-eight of 59 (98.3%) First Nations participants showed seroprotection and a geometric mean titre of 353.6; all 30 Métis participants with no pre-existing antibody showed seroprotection and a geometric mean titre of 376.2. Pain at the injection site and general symptoms frequently occurred but were shortlived and generally not severe, although three participants (2.2%) sought medical attention for general symptoms.

Interpretation: First Nations and Métis adults responded robustly to ASO3-adjuvanted pandemic (H1N1) 2009 vaccine. Virtually all participants showed protective titres, including those with chronic health conditions.

Trial registration: ClinicalTrials.gov trial register no. NCT.01001026.

The research report . . .
"The responses of Aboriginal Canadians to adjuvanted
pandemic (H1N1) 2009 influenza vaccine"
http://www.cmaj.ca/content/early/2011/0 ... l.pdf+html

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