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Commissioner, Suffolk County Department of Health Services 1. This periodic “H1N1 Influenza Virus Fall Update, Suffolk County” replaces the “Novel H1N1 Influenza A Virus Update for Suffolk County” that was first transmitted electronically to various individuals beginning on April 29, 2009. Though the Fall season (or Autumn) formally begins in the United States on September 22, 2009, the information contained in this “Fall Update #1” reflects planning and preparedness leading up to the Fall in Suffolk County. Future updates will be transmitted as appropriate, and as events or information dictate. 2. There have been at least 181 confirmed cases of the H1N1 Influenza virus in Suffolk County since April 26, 2009. There have been no new confirmed cases of H1N1 Influenza virus in Suffolk County during the week of August 16, 2009-August 22, 2009, the latest information available, according to the New York State Department of Health. There were 4 new confirmed cases in all of New York State during that week, including one new case in Erie County (which has had the greatest number of confirmed cases, 279, outside of New York City). Suffolk County has had the third highest number of cases in New York State. Nearly all of Suffolk County’s cases have been mild and the vast majority fully recovered, either with treatment or on their own. Of the 8 deaths in Suffolk County residents linked to the H1N1 Influenza virus thus far, all had one or more underlying medical problem. 3. According to a September 4, 2009 report of the Centers for Disease Control and Prevention (CDC), visits to doctors for influenza-like illness (ILI) were highest in the United States in February during the 2008-09 flu season, but rose again in April 2009 after the new H1N1 Influenza virus emerged. Current visits to doctors for influenza-like illness are down from April, the CDC said, but are higher than what is expected in the summer and have increased over the last two weeks. Six states (Alabama, Alaska, Florida, Georgia, Mississippi, and South Carolina) and Puerto Rico are reporting widespread influenza activity at this time. Any reports of widespread influenza activity in August are very unusual. Almost all of the influenza viruses identified, though not all, were the new H1N1 Influenza virus. According to an article that appeared in the New York Times two days ago, at least 2,000 Washington State University students have been found to have Influenza-like Illness (ILI) (though none are reported hospitalized) since their Fall semester began two weeks ago, in what appears to be one of the largest outbreaks of the virus on a college campus. 4. The H1N1 Influenza viruses currently being identified, the CDC reports, remain similar to the viruses chosen for the H1N1 Influenza virus vaccine and remain susceptible to antiviral drugs (oseltamivir and zanamivir) with rare exceptions. As of September 4, 2009, there have been 593 deaths and 9,079 hospitalizations attributed to the H1N1 Influenza virus in the United States. As of August 30, 2009, according to the World Health Organization (WHO), there have been more than 254,206 confirmed cases and at least 2,837 deaths worldwide (N.B. Countries are no longer required to test and report individuals cases, so the number of cases reported actually understates the real number of cases). The CDC estimates that between April and June of 2009, more than 1 million unconfirmed cases of H1N1 Influenza virus occurred in the United States. 5. On Thursday, September 3, 2009, Suffolk County Executive Steve Levy and I formally released Suffolk County’s Public Health Emergency Preparedness Plan for Fall, 2009 for dealing with the H1N1 Influenza virus. The document is available at the website of the Suffolk County Department of Health Services,, and was formally presented in outline form to representatives of Suffolk County’s 71 School Superintendents at a 90-minute meeting at the offices of Eastern Suffolk BOCES in Holbrook, New York. Suffolk County’s planning for the Fall envisions several measures and steps that assume a “moderately severe illness” scenario. Though there is no evidence at this time from the CDC or the WHO that the virus has become more lethal or has changed at all from its presentation in the Spring, Suffolk County’s plan also includes certain steps and measures that may be taken should there be “increased severity of illness.” During a presentation to Suffolk County’s school superintendents, Dennis Russo, M.D., director of our department’s Public Health Emergency Preparedness efforts, Lauren Barlow, R.N., R.D., M.S., Nurse Epidemiologist in our department’s Division of Public Health, and I shared the details of our guidance document and also answered questions about the guidance documents released recently by the CDC, the NYSDOH, and the New York State Department of Education. In recent weeks, the CDC has issued guidance documents for schools (K-12), secondary schools and colleges/universities, child care and early childhood programs, correctional facilities, and many other populations of interest. The Suffolk County Department of Health Services has been in touch with school superintendents through their leadership bodies, with a number of colleges and universities, and with other community based organizations to answer any questions or concerns that may arise from the application of such guidance. 6. On Thursday, September 3, 2009, I joined New York State Health Commissioner Richard Daines, M.D.; Nassau County Health Commissioner Maria T. Carney, M.D.; Charles Szuberla, Executive Director of School Operations and Management Services for the New York State Department of Education; and John Gibb, New York State Director of the State Emergency Management Office (SEMO) at a New York State Novel H1N1 Influenza A Town Hall meeting for Long Island at the C.W. Post Campus of Long Island University in Brookville, New York. During the 90-minute session, I gave a presentation about Suffolk County Department of Health Services’ planning and preparedness and, like the other presenters, answered questions from the audience. 7. On Tuesday, September 1, 2009, I participated in a conference call with the New York State Department of Health’s Deputy Health Commissioner Guthrie Birkhead, M.D., MPH; Linda Lambert, CAE, Executive Director of the New York Chapter of the American College of Physicians (NYACP); and Babette Peach, Director of Advocacy and Communications, NYACP, to explore possible options and means to communicate guidance about H1N1 Influenza virus to the more than 10,000 physician and medical student members of the NYACP. Dr. Birkhead indicated that similar discussions are being held with the New York State Chapters of the American College of Obstetrics- Gynecology, the American Academy of Family Physicians, the American Academy of Pediatrics, and with the Medical Society of the State of New York and other groups. On August 28, 2009, I transmitted a letter about H1N1 Influenza virus to the leadership of the Suffolk County Medical Society to distribute to all physician members of their organization. On September 2, 2009, a modified version of the letter to all physicians in Suffolk County who are listed on a departmental emergency fax list was sent. 8. Beginning this week, we will initiate formal weekly meetings between the leadership of the Suffolk County Department of Health Services and the leadership of the Suffolk County Department of Fire Rescue and Emergency Services, which is led by Commissioner Joseph Williams. The first meeting of this Working Group will be held on Friday, September 11, 2009. The senior leadership of the Suffolk County Department of Health Services will hold an internal meeting on September 10, 2009 to discuss planning and preparedness in anticipation of the expected receipt in October from the New York State Department of Health of the new H1N1 vaccine. Suffolk County’s Public Health Emergency Preparedness Plan for the Fall, 2009 for H1N1 Influenza A Virus envisions active promotion to relevant target priority patient populations, as vaccines become available, of both seasonal influenza vaccine and the H1N1 influenza vaccine. In Suffolk County, the H1N1 vaccine is expected to be requested and administered by physicians and other health care providers in their private practices, hospitals and medical centers, participating retail pharmacies, community health centers operated by the Suffolk County Department of Health Services, mass vaccination PODs (Points of Dispensing) that are planned throughout Suffolk County, and at those public and private schools that are planning to do so. The NYSDOH has said that it anticipates being able to assist local health departments in these vaccination efforts by providing supplementary vaccinators and staff. The seasonal influenza vaccine became available in Suffolk County last week and our department plans to start administering it at mass vaccination POD clinics throughout Suffolk County this week. 9. As an important reminder, the new H1N1 Influenza vaccine being developed is not intended to replace the seasonal flu vaccine – it is intended to be used alongside seasonal flu vaccine to protect people against illness and disease. While the H1N1 vaccine is not mandatory for the general public, and the CDC has stated that it will “provide the public with transparent information about what we know and do not know about the safety and efficacy of Novel H1N1 vaccines to help them make informed decisions,” those who choose vaccination for themselves or their children will be screened for contraindications (such as egg allergy) and will receive information sheets describing the vaccine’s risks and benefits, signs and symptoms of adverse events to look for following vaccination, and how to report adverse events. Suffolk County Dept. of Health Services’ Division of Public Health: 1-631-853-3055 (Monday-Friday, 9:00 am to 5:00 pm; no weekend hours)


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