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National Flu Activity?During week 40 (September 28 – October 4, 2014), influenza activity was low in the United States.??Viral Surveillance:??Of 6,192 specimens tested and reported by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories during week 40, 199 (3.2%) were positive for influenza.?Pneumonia and Influenza Mortality:? The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold.?Influenza-associated Pediatric Deaths:??No influenza-associated pediatric deaths was reported. ??Influenza-associated Hospitalizations:? The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts all age population-based surveillance for laboratory-confirmed influenza-related hospitalizations in select counties in the Emerging Infections Program (EIP) states and Influenza Hospitalization Surveillance Project (IHSP) states.? FluSurv-NET estimated hospitalization rates will be updated weekly starting later this season.? Additional FluSurv-NET data can be found at: and Illness Surveillance:? The proportion of outpatient visits for influenza-like illness (ILI) was 1.3%, which is below the national baseline of 2.0%. ?All 10 regions reported ILI below region-specific baseline levels. Puerto Rico experienced high ILI activity, all 50 states and New York City experienced minimal ILI activity and the District of Columbia had insufficient data.?Geographic Spread of Influenza:? The geographic spread of influenza in Guam was reported as widespread; Puerto Rico reported regional activity; three states reported local activity; 28 states, the District of Columbia, and the U.S. Virgin Islands reported sporadic activity; 18 states reported no influenza activity; and one state did not report.?Antiviral Resistance:? The majority of currently circulating influenza viruses are susceptible to the neuraminidase inhibitor antiviral medications, oseltamivir and zanamivir; however, rare sporadic cases of oseltamivir resistant 2009 H1N1 and A (H3N2) viruses have been detected worldwide. ?Antiviral treatment with oseltamivir or zanamivir is recommended as early as possible for patients with confirmed or suspected influenza who have severe, complicated, or progressive illness; who require hospitalization; or who are at greater risk for serious influenza-related complications. ?Additional information on recommendations for treatment and chemoprophylaxis of influenza virus infection with antiviral agents is available at Activity in Massachusetts?Influenza-like illness (ILI, defined by fever >100°F and cough and/or sore throat) was sporadic in Massachusetts at minimal intensity.? ?Detailed weekly flu surveillance reports are posted on the Mass Public Health Blog.????????????????????????????????? Percentage of ILI visits reported by sentinel provider sitesQuestions and ResourcesJoint Letter Urging Vaccination of Pregnant Women with Flu and Tdap. ?CDC and a host of professional medical organizations and public health partners have jointly published a letter to health care professionals encouraging flu vaccination in pregnant women to protect them and their unborn babies. ?The letter is available on the CDC website at . ?It is also attached to this email.Assess the immunization status of each patient. Recommend the indicated vaccines to each patient. Administer any necessary vaccines or, if you do not stock the vaccine, refer the patient to a provider or location that can vaccinate the patient. Document the vaccinations that your patient is given, ideally in your state or local immunization registry. ?NEJM Article on about Influenza Vaccine Pregnant Women.? On October 9, 2014, a perspective piece by CDC experts Sonja Rasmussen, MD, MS and Denise J. Jamieson, MD, MPH was published in the New England Journal of Medicine. ?The perspective, entitled “2009 H1N1 Influenza and Pregnancy — 5 Years Later,” explores what experts have learned about how the influenza virus affects pregnant women and their unborn babies since the 2009 H1N1 influenza pandemic. .Pregnant women are at high risk for complications from influenza. Yet pregnant women and some providers remain unaware of this fact.Data continue to support the safety and effectiveness of influenza vaccine in pregnant women.? Flu shots during pregnancy protect not only the pregnant woman, but also her unborn baby and even her infant during the first 6 months of life. ?Studies have also shown that vaccinating the mother during pregnancy may reduce the occurrence of adverse outcomes like small size for gestational age and preterm birth in infants.? Recommendation from a health care provider is essential. ?A recent CDC study showed that patients who were offered influenza vaccination during an office visit were 7 times more likely to be vaccinated for influenza than patients who reported their provider did not recommend or offer vaccination. ?Patients who received a recommendation alone were twice as likely to be vaccinated as those that received no recommendation.? Pregnant women can and should receive early presumptive antiviral treatment if needed.? It should be initiated based on clinical evaluation rather than diagnostic testing, begun regardless of whether they have been vaccinated and even if it is beyond48 hours from onset.An interview with Dr. Rasmussen and Dr. Jamieson was also posted as a Medscape Expert Commentary and is available at (log-in may be required). Medicare Immunization Billing: ?Are You Billing Properly? (From National Government Services, Inc.)National Government Services wants to remind providers the only administration code for influenza vaccine is G0008. ?G0008 is special because it bypasses deductible and coinsurance amounts for the beneficiaries, allowing these services to be paid at 100%. ?A billing guide titled, “Quick Reference Information: Medicare Immunization Billing (Seasonal Influenza Virus, Pneumococcal, and Hepatitis B)” can be found on the CMS website.Influenza Vaccine Products for the 2014-2015 Influenza Season Seasonal Influenza Vaccines Pricing Quick Reference Information: Medicare Immunization Billing (Seasonal Influenza Virus, Pneumococcal, and Hepatitis B) (1.1 MB)Vaccine Ordering and Locating Clinics?Providers Wishing to Order Flu Vaccine for Private Purchase:The national Influenza Vaccine Availability Tracking System (IVATS) assists providers wishing to privately purchase flu vaccine. IVATS identifies available doses of influenza vaccine by formulation and distributor/vendor throughout the season.?Location of Flu and Adult Vaccination Services:Flu vaccination clinics are listed on the website sponsored by the Massachusetts Health Officers Association (MHOA). ?MDPH urges agencies to post their clinics on this website.? Many boards of health (BOHs) may have clinics that make flu and other vaccines available to both adults and children. ?BOHs can be contacted individually for questions about possible flu vaccination clinics in Massachusetts municipalities, including the age groups served.? HealthMap Vaccine Finder assists the public with locating influenza and adult vaccination services within their communities. ?It is a free, online service where users can search for locations that offer immunizations. ?Its staff works with partners such as clinics, pharmacies, and health departments to provide accurate and up-to-date information about vaccination services. ?MDPH urges providers and other agencies to register their locations on the HealthMap Vaccine Finder site too.For questions about influenza please call the Massachusetts Department of Public Health Immunization Program at 617-983-6800 or your local board of health.? For questions about state-supplied influenza vaccine, please call the Vaccine Unit at 617-983-6828. ................
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