Experts did their best to answer questions and allay fears over H1N1 flu and the associated vaccine during a Nov. 10 online town-hall meeting hosted by the Military Health System.

Questions — submitted via a special Web site — included concerns such as whether it’s possible to distinguish between seasonal or H1N1 flu based on symptoms. The answer, provided by Army Col. (Dr.) Ted Cieslak, the Defense Department’s liaison to the Centers for Disease Control and Prevention, was simple.

“You cannot differentiate seasonal flu from H1N1 based on symptoms,” he said. He later emphasized that it’s tough to make a claim that one version of the flu is more dangerous than another.

“‘Dangerous’ can be defined in many different ways,” Cieslak said. “This particular strain does not appear to produce more severe disease in most people, but it does affect certain subgroups [such as pregnant women and people with some underlying medical conditions] disproportionately.

“Moreover,” he continued, “susceptibility to the H1N1 strain is almost universal in persons under 50 years of age, which is not always the case with seasonal flu.”

The topic of alcohol-based hand sanitizer versus good old soap and water as a way to keep from preventing the spread of H1N1 was broached, as well. Soap and water wins out, one doctor said, because that method removes and kills organisms.

“Alcohol-based hand gel can and should be used when soap and water are not available,” said Navy Capt. (Dr.) Tanis Batsel Stewart, director of Emergency Preparedness and Contingency Support for the Bureau of Medicine and Surgery. “Use enough to fully wet your hands, and rub them together.”

Some participants were concerned with the content of the H1N1 vaccine and its safety overall, especially for children.

Navy Lt. Cmdr. (Dr.) Tom Shimabukuro offered assurances that the vaccine is safe, contains no squalene, and was licensed in the same way that seasonal flu vaccines are licensed every year. Squalene, a substance found in some vaccines, has been the subject of some controversy, with opponents to its use claiming a link between the substance and Gulf War Syndrome.

“The H1N1 vaccines were licensed as a strain change to an existing biologic license application with the [Food and Drug Administration],” he said. “There was no fast track or waiver provided to the vaccine manufacturers, and the vaccine is not experimental. H1N1 vaccines are licensed flu vaccines, and [people should] expect them to have a safety profile similar to regular flu vaccines.”

Shimabukuro is the pandemic influenza vaccine coordinator for the immunization services division of the CDC’s National Center for Immunization and Respiratory Diseases.

Army Col. (Dr.) Wayne E. Hachey addressed the effects the H1N1 vaccination might have on small children in response to a participant’s question about the controversy over childhood vaccinations and links to autism.

Hachey, director of preventive medicine and surveillance in the Military Health Affairs force health protection and readiness division, said no evidence exists that the H1N1 vaccine — in either its injectable or mist forms — poses a threat to the neurodevelopment of children.

The experts also provided guidance on the spacing of vaccinations for the seasonal flu and H1N1, and age restrictions for the mist version of the vaccine.

A person can receive two injectable flu vaccines or one nasal-spray vaccine and one injectable vaccine at the same time, Shimabukuro said. But someone who gets nasal spray vaccines for both strains should separate those vaccines by at least 28 days, he added.

The nasal vaccine is available only to people age 2 to 49, said Air Force Lt. Col. (Dr.) Philip Gould, chief of preventive medicine operations for the Air Force Medical Support Agency. “There are three injectable vaccines,” he added, each with different … age limits: one from 6 months and older, one from 4 years and older, and one from 18 years and older.”

Those over the age of 49 must get the injectable vaccine, he added.

A replay of the town-hall session is available on the Military Health System’s Web site. The Military Health System is a worldwide partnership of medical educators and researchers, health-care providers and support personnel, including Defense Department and military officials, combatant command surgeons and Tricare providers.

The military is receiving its first doses of the H1N1 vaccine and health officials will begin distributing them in the coming weeks.

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Military medical experts expect to have enough H1N1 vaccine available for all servicemembers and their families.

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As shipments of some 3.7 million doses of H1N1 vaccine ordered by the Defense Department continue to arrive from the manufacturer, more than enough will be available for all military personnel and their beneficiaries, military medical experts say.

Navy Cmdr. Danny Shiau, division chief for the Bureau of Navy Medicine and Surgery’s force health protection, and Dr. Robert Morrow, the bureau’s preventive medicine programs and policy officer, took questions about the military’s seasonal flu and H1N1 preparedness efforts during an Oct. 29 “DoDLive” bloggers roundtable.

Morrow explained why it has taken the primary manufacturer, Novartis, longer than expected to produce the vaccine.

“This is a tough little virus to grow,” he said. “It’s pretty nasty when it gets in the eggs, so they haven’t been able to grow it quite as fast as they had hoped, and everybody’s supplies are linked to each other since we’re are all getting it from the same manufacturer.”

Immunization for both seasonal flu and H1N1 is mandatory for all military personnel and it is highly recommended for beneficiaries. When the first cases of H1N1 were diagnosed in April, Morrow said, the department bought 2.7 million doses of the vaccine for mission assurance purposes.

At the time, it was unclear how many doses, per person, would be needed. But a single dose has been determined to be effective, Morrow said. The Health and Human Services Department donated 1 million doses of the vaccine, Sanofi Pasteur, to the department, “so that’s a total of 3.7 million individuals for [Defense Department] active duty, reservists, civilians and essential contractors,” he said.

First priority for the vaccine will go to deployed forces, Shiau said, first in places like Iraq and Afghanistan, then to ships, trainees and health care workers based on prioritizations.

Priorities for beneficiaries in the United States will follow federal and state guidelines, whether beneficiaries opt to get the H1N1 vaccine at military treatment facilities or at non-military clinics, Shiau said. In either case, since the vaccine is free, and there will be plenty of it, it will not matter whether they get their shot from the military or civilian supply.

Overseas, civilian defense workers and beneficiaries will be able to get the H1N1 vaccine at military treatment facilities.

Shiau added that so far, the general severity of cases seen has been mild to moderate and there’s been no operational effect on defense. But, he said, those with symptoms should contact their doctor or treatment facility before heading to an emergency room, because some facilities have special procedures. “The bottom line is, you don’t want to spread it in the ER,” he said.

The extra care being taken may be because “this is the first time that we’ve had two different kinds of influenza going around at the same time and two different kinds of influenza shots going around at the same time, and it’s very confusing, even to those who do this day in and day out,” Morrow said.

His best advice is that when you have questions, “ask and clarify.” Shiau added that to help prevent spreading seasonal and H1N1 flu, people should wash their hands thoroughly, cover their mouths when coughing and, when possible, do not go to work sick.

The Defense Department has acquired enough doses of the H1N1 flu vaccine to immunize all 460,000 members of the National Guard, officials announced today.

The supply will go out to the Guard through the Army Medical Materiel Agency, said Army Lt. Col. Dawn Barrowman, chief of occupational health for the Army National Guard.

All states have ordered the H1N1 injectable vaccine through the agency, which is the same way that states order the seasonal flu vaccine.

Army Guard officials in two states, Arkansas and Indiana, plan to use the Department of Health and Human Services allotment procured by their state, said Army Col. Rob Brown, the Army Guard’s chief surgeon.

For Air Guard personnel, the H1N1 injectable vaccine has been ordered through the active duty host base, using the same method and guidance as for the seasonal flu vaccine, said Air Force Capt. Tonya Moser, chief of medical logistics for the Air National Guard.

Shipments of the Defense Department vaccine are scheduled for the second week of November, but “exact dates will differ from state to state,” Brown said.

The Defense Department has acquired 2.7 million doses of the H1N1 vaccine, which may be allocated to active duty members, reservists, Guard members, Defense Department civilians and essential contractors, according to a department memorandum.

Despite its availability this way, Guard members are encouraged to get the vaccine through the “most expedient route,” Barrowman said. This includes registered H1N1 providers or a HHS source.

Army Guard members who receive a H1N1 vaccine from another source are strongly encouraged to provide the documentation to their unit’s medical readiness noncommissioned officer, Barrowman said, so the Army Guard can track the number of soldiers who have received the vaccine.

The vaccine will be mandatory for uniformed personnel and highly encouraged for all others, according to a Defense Department memo. Priority would be given to deployed and deploying forces, new accession sites, including the service academies, and health care personnel.

Brown said the vaccine was produced by the same companies that made the seasonal flu vaccine, and it went through strict quality assurance inspections by the Food and Drug Administration before it was approved for release to the public.

He emphasized the H1N1 vaccine is the best and most effective way for people to protect themselves.

Brown also encourages Guard members to take everyday actions to stay healthy, including:

• Covering their nose and mouth with a tissue when they cough or sneeze.
• Washing their hands often with soap and water, especially after coughing or sneezing.
• Avoid touching their eyes, nose or mouth, because germs spread that way.
• Staying home if they get sick.

H1N1 vaccine for active duty personnel and their family members is now expected in early November.