Memorandum Workplace Fight the Flu Participants

To: From: Memorandum Workplace Fight the Flu Participants Rachel E. Lynch, MPH Manager (703) 698-2426 rachel.lynch@inova.org Date: Fall 2009 Re: Promotional Tool Kit & Certificate Ordering Information Thank you for choosing Inova HealthSource for your 2009 flu shot clinic. Flu-related complications can lead to a loss in productivity at work and higher medical expenses. You re taking a great step toward protecting your employees as well as your company by encouraging prevention and offering flu shots at the workplace. Please note that we can now vaccinate anyone 4 years and older at your clinic. Also, please remember that we do have a 30-person or $690 minimum charge. To help you have the most successful and well-attended flu shot clinic possible, enclosed you will find promotional materials for use at your location. Please feel free to use any or all of this information in upcoming bulletins or newsletters. Don t hesitate to contact me if you wish to receive additional information or have specific questions about the progr. Here are several hints for increasing participation at your flu clinic: Advertise with posters in high traffic areas such as restrooms, break rooms, kitchens, lobbies, elevators Use your newsletter or bulletin, e-mail system, or memos to notify potential participants that flu shots will be offered at your site Invite others - neighboring offices, fily members, or other groups to join your clinic (must be age 4 or older) Distribute information about flu shots so people have accurate information to make a decision about getting a flu shot Encourage people to visit our web site: www.inova.org/flu Please contact Sarah Patterson with any questions, at 703-698-2424. Inova HealthSource * 2700 Prosperity Avenue * Suite 100 * Fairfax, VA 22031 * 703-698-2400

2009-2010 FLU VACCINE PROGRAM INFORMATION Enclosed you will find the following materials: Appointment Sheets 2009-2010 Influenza Fact Sheet handout; please photocopy and distribute to participants ahead of time Posters Certificate ordering form Please note: The cost of each vaccine is $23. Make checks payable to Inova Flu Shot Progr. There is a 30-person minimum or a minimum charge of $690 per clinic. Please note that Consent Forms are not included in the packet. Nurses will bring one form for each employee. The participant will receive a copy of the signed consent form, which will act as a receipt. **We request that you assign one administrative person for the duration of the progr to do the following: Collect Payment Distribute Fact Sheets (an original for copying is included in this packet) Distribute Consent Forms (provided by the nurse) Equient that you will need to provide includes: One 6 ft. table for administrative area One 3-6 ft. table for immunization area Chairs: one at the administrative table, two at the immunization table, and chairs for preand post-immunization waiting One small wastebasket Access to a phone Participants will be expected to: Read the Fact Sheet and Sign a Consent Form. Receive immunization in upper arm area (it is helpful to remind participants to wear clothing that will allow easy access to the upper arm). Wait 15 20 minutes after the immunization before leaving the building. Consult with the nurse if any side effects should occur. Inova HealthSource * 2700 Prosperity Avenue * Suite 100 * Fairfax, VA 22031 * 703-698-2400

INSTRUCTIONS FOR FILLING OUT THE 2009-2010 FLU CLINIC APPOINTMENT SCHEDULE SHEET 1. The appointment sheet is designed to help manage the flow of employees from their work area to the flu shot area. This will ensure that employees do not spend excessive time away from their desks, which can affect their productivity. Employees will be expected to be on time so other employees are not inconvenienced. 2. Each nurse can generally vaccinate about 30 people per hour. Have employees sign up for a 15- minute window of time. Fill in all blanks for each time block, starting at the beginning of your clinic time. By doing this, the nurse s time is better utilized and she can leave when your clinic ends. 3. Do not schedule any participants for the 15-minute block of time that corresponds to the ending time of your clinic. The nurse is expected to stop giving shots at that time. For exple, if your clinic is scheduled from 12:00 3:00, do not schedule anyone in the 3:00 time slot, the last available time will be 2:45. 4. This is a general form, and includes all times from 7:00 a.m. until 6:00 p.m. Your flu shot clinic is not scheduled for the entire time span covered by this form. It will be very helpful if you cross out the appointment times on the sheets that are not available for your employees. 5. If two or more nurses are assigned to your flu shot clinic, make copies of the appointment schedule so employees can sign up for these nurses, too. Follow the other instructions above. (You will be informed if two or more nurses are assigned to your clinic.) 6. For clinics in excess of 4 hours, we must make sure the nurse has a 15-minute break. Please block off time on the schedule to allow a break for the nurse mid-way through your progr. If interest in flu shots is substantially more or less than your original estimate, kindly Sarah Patterson at 703-698-2424. Scheduling Exple: Your clinic is scheduled to start at 9:00 a.m. and end at 10:30 a.m. You cross out the blocks of time from 7:00 a.m. through 8:45 a.m. You cross out the blocks of time at the end of the clinic, starting with the time block labeled 10:30 a.m. You have 6 different appointment times for employees, and can accommodate 43 employees without a problem. Inova HealthSource * 2700 Prosperity Avenue * Suite 100 * Fairfax, VA 22031 * 703-698-2400

2009-2010 FLU CLINIC APPOINTMENT SCHEDULE Time Ne Time Ne Time Ne 7:00 8:15 9:30 7:15 8:30 9:45 7:30 8:45 10:00 7:45 9:00 10:15 8:00 9:15 10:30

2009-2010 FLU CLINIC APPOINTMENT SCHEDULE Time Ne Time Ne Time Ne 10:45 12:00 1:15 11:00 12:15 1:30 11:15 12:30 1:45 11:30 12:45 2:00 11:45 1:00 2:15

2009-2010 FLU CLINIC APPOINTMENT SCHEDULE Time Ne Time Ne Time Ne 2:30 3:45 5:00 2:45 4:00 5:15 3:00 4:15 5:30 3:15 4:30 5:45 3:30 4:45 6:00

2009-2010 INFLUENZA VACCINE FACT SHEET WHAT IS THE SEASONAL FLU? Many people confuse influenza (commonly known as the flu) with a cold or a 24-hour virus. But the flu can cause high fever, headaches, body pains, extreme fatigue, sore throat, cough and other symptoms that restrict or limit activity for three to four days or more. Although many flu cases are mild, some people can suffer complications or have a severe case. Even in years of mild flu outbreaks, 36,000 Americans have died and more than 110,000 hospitalized due to complications. The flu season generally peaks from late December through March; however flu can occur throughout the year. WHO SHOULD CONSIDER GETTING A SEASONAL FLU SHOT? You should consider getting a flu shot if you: would like to avoid the flu have chronic medical conditions, such as asthma, diabetes, high blood pressure or heart disease are 50 years of age or older have contact with people at high risk for complications of the flu are a health care provider are a woman who will be any stage of pregnancy during the flu shot season are or will be the parent of a young child during the flu season provide essential community services have demanding fily or work responsibilities have holiday or winter vacation plans are around children frequently YOU SHOULD NOT RECEIVE THE VACCINE IF: You are allergic to chicken eggs, thimerosal (often found in contact lens solution) or other mercury compounds, or other vaccine components. You have a past history of Guillain-Barré syndrome. You are ill with a fever or have an active respiratory infection. (NOTE: persons with any of these conditions will NOT receive a vaccine). PLEASE NOTE: You will be asked to wait near the clinic area for 15-20 minutes after receiving the vaccine. Please inform the nurse immediately of any symptoms such as hives, rash, swelling of the lips, tongue or mouth, or breathing difficulty. If such a reaction occurs later, seek medical attention immediately. THE VACCINE: The Influenza Virus Vaccine 2009-2010 Formula is a non-infectious vaccine effective against two type A and one type B flu viruses. This vaccine will reduce the chances of your getting the flu or lessen the severity of the disease if infection does occur. An injection of the flu vaccine will NOT give you the flu because the vaccine is made with killed viruses. This vaccine has been standardized according to the United States Public Health Service requirements for current influenza season.

RISKS AND POSSIBLE SIDE EFFECTS: There may be local redness, swelling, or soreness at the site of injection lasting one to two days. Take acetinophen (Tylenol), ibuprophen (Advil) or aspirin if this occurs. Allergic responses may occur if you are allergic to eggs or have had an allergic response to flu vaccine in the past. A possible risk of all vaccines is Guillain-Barré syndrome, a form of paralysis. Fever, muscle soreness and headaches may occur 6-12 hours after the vaccination and last for one to two days. This most often affects persons who have never had exposure to influenza virus antigens (i.e. young children) but seldom occurs in adults. COMMON QUESTIONS ABOUT THE FLU SHOT When is the best time to get a flu shot? October and November are great times to start giving flu shots, but getting a shot in January or even later can still be beneficial since most influenza activity occurs in January or later in most years. Though it varies, flu season can last as late as May. Those considered high-risk, should be vaccinated as soon as flu vaccine becomes available. It takes two weeks for the vaccine to be effective. I m a healthy, working adult. Should I really consider a flu shot? Yes! A study reported in the New England Journal of Medicine indicates that ong healthy, working adults, 18 to 64 years old, vaccination against the flu can decrease the frequency of upper respiratory illness, reduce the number of visits to doctors offices for upper respiratory illnesses and reduce absenteeism. For most younger, healthier people, flu vaccination can be effective even if given in December or January. Who should not get a seasonal flu shot? People who are allergic to chicken eggs, thimerosal or other mercury compounds, or other vaccine components; have ever had Guillain-Barré syndrome; or have a fever or active respiratory infection should not receive a flu shot. I received a flu shot last year. Do I need another one this year? Yes. Flu shots only work for a single season since the strains of the virus gradually change over the course of a year. Can I get the flu from a flu shot? No! The viruses in the flu shot are inactivated and noninfectious. Therefore, you CANNOT get the flu from a flu shot. Is there anything else I can do to keep from getting the flu? Yes. Getting enough sleep, regular exercise, eating a balanced diet, drinking adequate ounts of water or juices, and washing your hands throughout the day all help to preserve your natural immunity to infection. ADDITIONAL INFORMATION The Inova HealthSource Fight the Flu progr also offers flu clinics in a variety of community locations for adults and children. Please encourage your fily members and friends to get their flu shot from an Inova HealthSource community flu clinic. A weekly listing of dates, times and Virginia locations at Inova hospitals, libraries, congregations, malls, and senior centers can be found at 1-877-895-5BUG or online at www.inova.org/flu.

2009 H1N1 Influenza Information As of 8/5/09 What is 2009 H1N1 (swine flu)? 2009 H1N1 (referred to as swine flu ) is a new influenza virus causing illness in people. This virus was originally referred to as swine flu because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs (swine) in North America. But further study has shown that this new virus is very different from what normally circulates in North American pigs. Are there human infections with 2009 H1N1 virus in the U.S.? Yes. Human infections with the new H1N1 virus are ongoing in the United States. Most people who have become ill with this new virus have recovered without requiring medical treatment. Is 2009 H1N1 virus contagious? CDC has determined that 2009 H1N1 virus is contagious and is spreading from human to human. How does 2009 H1N1 virus spread? Spread of 2009 H1N1 virus is thought to occur in the se way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something such as a surface or object with flu viruses on it and then touching their mouth or nose. What are the signs and symptoms of this virus in people? The symptoms of 2009 H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting. Severe illnesses and death has occurred as a result of illness associated with this virus. How severe is illness associated with 2009 H1N1 flu virus? Illness with the new H1N1 virus has ranged from mild to severe. While most people who have been sick have recovered without needing medical treatment, hospitalizations and deaths from infection with this virus have occurred. In seasonal flu, certain people are at high risk of serious complications. This includes people 65 years and older, children younger than five years old, pregnant women, and people of any age with certain chronic medical conditions. About 70 percent of people who have been hospitalized with this 2009 H1N1 virus have had one or more medical conditions previously recognized as placing people at high risk of serious seasonal flu-related complications. This includes pregnancy, diabetes, heart disease, asthma and kidney disease. One thing that appears to be different from seasonal influenza is that adults older than 64 years do not yet appear to be at increased risk of 2009 H1N1-related complications thus far. CDC laboratory studies have shown that no children and very few adults younger than 60 years old have existing antibody to 2009 H1N1 flu virus; however, about one-third of adults older than 60 may have antibodies against this virus. It is unknown how much, if any, protection may be afforded against 2009 H1N1 flu by any existing antibody. How does 2009 H1N1 flu compare to seasonal flu in terms of its severity and infection rates? With seasonal flu, we know that seasons vary in terms of timing, duration and severity. Seasonal influenza can cause mild to severe illness, and at times can lead to death. Each year, in the United States, on average 36,000 people die from flu-related complications and more than 200,000 people are hospitalized from flu-related

causes. Of those hospitalized, 20,000 are children younger than 5 years old. Over 90% of deaths and about 60 percent of hospitalization occur in people older than 65. Information analyzed by CDC supports the conclusion that 2009 H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people. At this time, there are few cases and few deaths reported in people older than 64 years old, which is unusual when compared with seasonal flu. However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear to be associated with increased risk of complications from this 2009 H1N1. These underlying conditions include asthma, diabetes, suppressed immune systems, heart disease, kidney disease, neurocognitive and neuromuscular disorders and pregnancy. How long can an infected person spread this virus to others? People infected with seasonal and 2009 H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children and people with weakened immune systems and in people infected with the new H1N1 virus. What can I do to protect myself from getting sick? There is no vaccine available right now to protect against 2009 H1N1 virus. However, a 2009 H1N1 vaccine is currently in production and may be ready for the public in the fall. As always, a vaccine will be available to protect against seasonal influenza Are there medicines to treat 2009 H1N1 infection? Yes. CDC recommends the use of oseltivir or zanivir for the treatment and/or prevention of infection with 2009 H1N1 flu virus. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. During the current pandemic, the priority use for influenza antiviral drugs is to treat severe influenza illness (for exple hospitalized patients) and people who are sick who have a condition that places them at high risk for serious flu-related complications. Can I get infected with 2009 H1N1 virus from eating or preparing pork? No. 2009 H1N1 viruses are not spread by food. You cannot get infected with novel HIN1 virus from eating pork or pork products. Eating properly handled and cooked pork products is safe. Note: Much of the information in this document is based on studies and past experience with seasonal (human) influenza. CDC believes the information applies to 2009 H1N1 (swine) viruses as well, but studies on this virus are ongoing to learn more about its characteristics. This document will be updated as new information becomes available.

2009 H1N1 Influenza Vaccine As of 8/28/09 What are the plans for developing 2009 H1N1 vaccine? Vaccines are the most powerful public health tool for control of influenza, and the U.S. government is working closely with manufacturers to take steps in the process to manufacture a 2009 H1N1 vaccine. Working together with scientists in the public and private sector, CDC has isolated the new H1N1 virus and modified the virus so that it can be used to make hundreds of millions of doses of vaccine. Vaccine manufacturers are now using these materials to begin vaccine production. Making vaccine is a multi-step process which takes several months to complete. Candidate vaccines will be tested in clinical trials over the few months. When is it expected that the 2009 H1N1 vaccine will be available? The 2009 H1N1 vaccine is expected to be available in the fall. More specific dates cannot be provided at this time as vaccine availability depends on several factors including manufacturing time and time needed to conduct clinical trials. Will the seasonal flu vaccine also protect against the 2009 H1N1 flu? The seasonal flu vaccine is not expected to protect against the 2009 H1N1 flu. Can the seasonal vaccine and the 2009 H1N1 vaccine be given at the se time? It is anticipated that seasonal flu and 2009 H1N1 vaccines may be administered on the se day. However, we expect the seasonal vaccine to be available earlier than the H1N1 vaccine. The usual seasonal influenza viruses are still expected to cause illness this fall and winter. Individuals are encouraged to get their seasonal flu vaccine as soon as it is available. Who will be recommended to receive the 2009 H1N1 vaccine? CDC s Advisory Committee on Immunization Practices (ACIP) has recommended that certain groups of the population receive the 2009 H1N1 vaccine when it first becomes available. These target groups include pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months and 24 years old, and people ages of 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems. We do not expect that there will be a shortage of 2009 H1N1 vaccine, but availability and demand can be unpredictable. There is some possibility that initially the vaccine will be available in limited quantities. In this setting, the committee recommended that the following groups receive the vaccine before others: pregnant women, people who live with or care for children younger than 6 months of age, health care and emergency medical services personnel with direct patient contact, children 6 months through 4 years of age, and children 5 through 18 years of age who have chronic medical conditions.

The committee recognized the need to assess supply and demand issues at the local level. The committee further recommended that once the demand for vaccine for these target groups has been met at the local level, progrs and providers should begin vaccinating everyone from ages 25 through 64 years. Current studies indicate the risk for infection ong persons age 65 or older is less than the risk for younger age groups. Therefore, as vaccine supply and demand for vaccine ong younger age groups is being met, progrs and providers should offer vaccination to people over the age of 65. Do those that have been previously vaccinated against the 1976 swine influenza need to get vaccinated against the 2009 H1N1 influenza? The 1976 swine flu virus and the 2009 H1N1 virus are different enough that it is unlikely a person vaccinated in 1976 will have full protection from the 2009 H1N1. People vaccinated in 1976 should still be given the 2009 H1N1 vaccine. Where will the vaccine be available? Every state is developing a vaccine delivery plan. Vaccine will be available in a combination of settings such as vaccination clinics organized by local health departments, healthcare provider offices, schools, and other private settings, such as pharmacies and workplaces.

Inova HealthSource 2009-2010 Fight the Flu Certificate Order Form Your company may purchase Fight the Flu certificates for employees to use at any public Fight the Flu location. A weekly listing of these public clinics may be found on our web site at www.inova.org/flu or on our 24-hour toll-free hotline, 1 (877) 895-5BUG. Certificates offer the following advantages: 1. For companies with multiple locations, certificates eliminate the need to gather employees in one location to hold a work-site clinic. 2. Smaller companies who do not have the 30-person minimum for an on-site clinic may purchase certificates to offer the flu shot benefit to their employees. 3. Employees may receive the vaccination at numerous locations throughout the Northern Virginia area at their own convenience. Order certificates by faxing this order form to (703) 698-2401. Company Ne: Contact Person: Address: City: Zip Code: Phone: Fax: # of Certificates: Date of Order: Please note: Certificate orders will be processed and mailed within 72 business hours, and will be accompanied by an invoice. Each certificate costs $25. There is no additional charge when the certificate is redeemed, although customers may make tax-deductible donations if desired. The Fight the Flu public cpaign will operate October 1 through December 31, 2010. There is no minimum purchase. Companies may purchase as few or as many certificates as needed. Certificates are non-refundable.