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Q&A Tamiflu Webinar 5/12/2009  
Q: Dr. Glimp-Would we be able to get Tamiflu for our client if they approved the purchase to keep here in A: I won’t be able to extend that far. I am pleased to be able to do this for our associates. One factor is that Tamiflu is now only recommended for healthcare workers and those with risk factors for complication of influenza, including age > 65, age < 5, HIV or other immunosuppressed state, pregnancy, chronic lung/heart/liver/renal/muscular/neurological disease. Others should not be given Tamiflu. Medcor qualifies because we are a healthcare company – it is important that we be able to provide care to others who come down with flu. Q: Is this something that will be sent to our full time administrative assistants? A: Yes, everyone in our company is important to the mission as a healthcare company. Q: Will there be a flu shot for this type next fall? A: That’s the goal, but producing vaccine takes many months and the virus could change to the extent that a vaccine would not be completely effective. Q: Should we go get blood work done if we get sick at all in the next few weeks? A: No. Bloodwork is not part of the evaluation. The confirmatory test is a nasal swab or nasal washing sent for virus culture or a test called “reverse transcriptase-polymerase chain reaction” (RT-PCR). Confirmatory tests are not now recommended, unless the person falls in a high risk group (above) or is hospitalized or dies from an influenza-like illness (ILI). Q: Are the effects of this flu any worse for an average healthy person than other flus that go around? A: Right now, it doesn’t look like it. But, remember that seasonal flu kills an average of 30,000 Americans annually and this flu doesn’t look any milder. Q: Is the vaccine safe? I read that more people died from the vaccine than from the disease in the 70's A: There is no vaccine yet. Vaccines always have the potential to cause adverse effects and in the 1976 Swine Flu epidemic, many people developed Guillian-Barré Syndrome, characterized by progressive weakness, loss of reflexes and variable sensory loss. The 1976 Swine Flu epidemic dissipated for unclear reasons. Q: What did you say about concern for the Avian flu (H5N1)? A: Influenza viruses have their nucleic acids in nine distinct segments, almost like mini-chromosomes. If an animal is infected with two influenza viruses, the nucleic acid from the two viruses can mix. This may produce a more pathogenic or transmissible virus. The fear is that H1N1 and H5N1 could combine to produce a very serious, highly transmissible virus that would cause a deadly pandemic. Q: You mentioned kids under 5 and the elderly, over 65 being at greater risk, but aren't most people A: In Mexico, where the current H1N1 epidemic began, many of those who were infected and died were young and otherwise healthy. H1N1 now appears much milder with few deaths. It is assumed that the same risk factors for severe disease in seasonal flu (see the first question) will also hold true for Q&A Tamiflu Webinar 5/12/2009  
H1N1 – it’s too early to tell for sure, but it’s a good assumption. It is clear that all age groups will be likely to get this flu. It is novel to humans and there is no immunity in the human population – so, expect Q: What harm is done if Tamiflu is taken in error, that is, when the pt doesn't really have influenza? A: For the individual there’s no harm. Tamiflu is very safe and has no effect on other medications. But, if everyone took Tamiflu for every cold, very soon the influenza virus would develop resistance. Q: Who do we contact regarding the shipping of the Tamiflu? A: Tamiflu shipped on Monday May 11th. If you haven’t received it by the end of the week, contact Paula Melone ( or at extension 5586). Q: What about clinic employees who work for the client, not medcor.will you provide them with Tamiflu A: This program is only for full-time Medcor employees. We cannot provide medication for non-Medcor employees, per diems or part-time employees. Q: Will we also be given the vaccine when available? A: Yes. I anticipate there will be large scale, community vaccination programs. Q: I am assuming that SBUs will be getting these in the mail as well. A: Yes. And, that brings up a good point. SBUs travel extensively. If you travel, take your Tamiflu with you. Keep the Tamiflu at home, not in your office – if you become ill, you may be kept from the office and unable to get to your Tamiflu. Q: How will we know if it is a confirmed case? A: You won’t know if you have a confirmed case. Testing is now limited to certain categories only. Everyone else who has an ILI is assumed to have H1N1. The rapid influenza test is insensitive – only 50-70% of the time is it positive when a person has influenza by culture or RT-PCR, and these tests (which are more sensitive) take too long to perform. So, the H1N1 diagnosis is clinical. Q: Is there a diagnostic test to confirm the flu? Not a good one that is practical and sensitive (see above). Q: How do you know if it is seasonal or H1N1? A: Only by confirmation test and that isn’t really necessary. In the current epidemic/pandemic, all ILIs Q: Do the vintage site need to order gowns now? A: All sites should have appropriate personal protective equipment (PPE) that includes, gown, gloves, N- 95 mask and eye protection. Yes, order them. Q&A Tamiflu Webinar 5/12/2009  
Q: How will this impact the current Medcor "HR temp Illness policy?" A: There is a specific temporary policy for the current epidemic. It is posted on the Medcor flu webpage ( and can be explained in greater detail, if needed, by HR. Q: What distance should we consider "community"? We have a confirmed case about 35 miles away in a neighboring town - would that be considered in the community? A: Yes, a confirmed case in the state is considered a “confirmed area”. Remember that each “confirmed” case is just the tip of the iceberg – for each confirmed case, there are many cases that haven’t been tested. Q: Has Tamiflu been helping already infected patients? A: It’s not known, but the current H1N1 is sensitive to Tamiflu and it’s likely that it will shorten the duration of illness and may prevent complications. Q: Given the increasing numbers, do you anticipate a longer flu season? Would someone with positive symptoms be eligible for multiple doses of Tamiflu? A: All flu flourishes in the winter. It is anticipated that the current outbreak will slow down, but smolder along until next winter when it comes back strong. Remember that most people don’t need Tamiflu (only for those at high risk of complications or healthcare providers), but if someone had two or more episodes of an ILI, yes, they might receive more than one course of Tamiflu. The multiple episodes might represent H1N1 and seasonal flu, but probably not the same influenza more than once. Q: Will Medcor offer flu vaccines to employees this year or will this need to be obtained from our local A: Medcor has been reimbursing for seasonal flu vaccine for years. Get it from a local provider and we will reimburse your cost. However, providing the vaccine and injection for so many clinics has made it logistically impossible to do for every clinic. Q: Do you worry that the lack of recent media coverage is giving the public a false sense of security? My wife thinks it has gone away, I had to tell her that it's still spreading. A: Absolutely! This is a big concern. It continues to increase geometrically and will cause many people to become ill, develop complications and die. Q: My client feels that this flu is going away and has not authorized the purchase of masks, hand sanitizer, etc. If I need to purchase the PPE (N95 masks, gowns, etc.) for the clinic, can it be billed to Medcor? Also, what about the fit testing? We do not do that here. A: Please speak with your SBU about PPE. Fit testing for N-95 respirators will be done, but it may take some time. In the meantime, please wear a snug N-95 respirator; we’ll get around to fit testing and respirator certification ASAP – remember that this is a “national health emergency”. Q: What happens if the Tamiflu isn't taken when you get the flu? A: You will be sick a day or two longer than if you took Tamiflu and perhaps more likely to develop complications. If you aren’t going to use your Tamiflu, please return it care of Paula Melone. Q&A Tamiflu Webinar 5/12/2009  
Q: Have all full time EEs received the information re: this webinar or do we need to notify our OHTs? A: Information was sent with each course of Tamiflu. Q: What are the contra-indications for Tamiflu? Who should avoid using it? A: Tamiflu has very few contraindications. They include allergy to the contents and behavioral changes or seizures while taking the medication. Pregnant or breastfeeding women should discuss with their obstetrician or pediatrician before taking the medication. The most common side effect is nausea and vomiting; it is recommended that Tamiflu be taken with food. Q: Will previous flu vaccinations help with immunity for H1N1? A: No one is sure, but that may be why the death rate is so much lower in the U.S. as opposed to Q: So Tamiflu is safe for people with allergies, asthma, or other lung issues? A: Yes. Relenza, which is similar to Tamiflu, but taken by inhaler, may cause bronchospasm. Tamiflu, however, is safe in persons with lung disease. Q: Should we stay out of work if a family member in the household is confirmed to have H1N1 and for A: No, you only need to stay out of work if you are ill. You should take all precautions possible to avoid secondary infection from a family member – the basics are your best defense, cough etiquette and hand hygiene. Q: What about people who have recently had chemo? A: This would qualify as immunosuppressed and so at high risk of complications. Someone who recently had chemotherapy would receive Tamiflu for an ILI.


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