Microsoft word - public qsas influenza final jan21-2014 (2).doc
Questions and Answers Influenza Season/Vaccine Supply January 21, 2014
1. Why did Saskatchewan decide to open up vaccinations to all residents from two to 59 years of age? Saskatchewan has just received a large shipment of FluMist nasal vaccine, with the help of the Public Health Agency of Canada. This enables us to provide vaccinations to a larger segment of the public. Medical Health Officers from all health regions have agreed on this course of action. 2. When will health regions receive the vaccine and reschedule clinics? Vaccine is being distributed to health regions now. We expect they will be ready to provide immunizations as early as tomorrow (Wednesday). Regions will determine whether to schedule drop in clinics or take appointments - or some combination of the two - and will make that information available to the public as soon as possible. 3. How do people find out where and when the clinics are scheduled? People can call HealthLine 811 or check their health region website. 4. Is FluMist suitable for everyone? FluMist is a live “attenuated” vaccine, which means it contains live virus that has been weakened. (Injectable or “inactivated” vaccine contains dead virus.) As a result, there are specific guidelines around the use of FluMist. It is not used for children under two, pregnant women, or people with compromised immune systems. Measles, mumps and rubella vaccines are all live attenuated vaccines like FluMist. 5. Do you have enough injectable vaccine for children under two and pregnant women who can’t have FluMist (and the immune-compromised)? Saskatchewan’s remaining supplies of injectable vaccine are being reserved for infants, pregnant women, persons with compromised immune systems and persons 60 years and older. More injectable vaccine shipments are expected in early February, and will be used for those persons for whom FluMist is not recommended. 6. Can health providers get vaccinated? FluMist is not recommended for health care workers who are providing care to patients with severe immune-compromised conditions who require hospitalization in a protective environment. Health care workers who are do not provide care to patients in those situations can receive FluMist as long as they have no vaccine-specific contraindications. Those employees may receive vaccinations through public health, or in some circumstances from Employee Health or their physician. 7. Isn’t it too late in the season to worry about vaccination? We are still recommending vaccination – the flu season began later than usual this year, and there is sometimes a second spike in cases in the spring. Sometimes a different influenza strain circulates later in the season.
Every flu season is different. This situation underscores the wisdom of getting a flu shot in the fall, when most immunizations clinics are offered. It’s encouraging that about 25 per cent of the province’s residents recognize the value of immunization and have already been vaccinated. 8. Is Saskatchewan still trying to get more vaccine? We are expecting another shipment of injectable vaccine in early February, which will be used for specific populations not eligible to receive FluMist. 9. Do you expect the high demand to continue? What if you have tens of thousands of doses left over? It’s difficult to gauge demand, but we encourage everyone who has not yet gotten a flu shot (and is eligible) to get immunized. If we satisfy the demand here in Saskatchewan, we may be asked to resupply eastern Canadian jurisdictions, as flu season tends to start in the west and move east. 10. How much more vaccine has the Ministry purchased this year? In 2012/2013, we purchased 280,000 doses and had to dispose of 30,000 unused doses at the end of the season. In anticipation of the 2013/2014 flu season we purchased 280,000 doses. We will have purchased an additional 149,500 doses once the final shipment of injectable vaccine arrives in a couple of weeks, so we have purchased approximately 50% more vaccine. (10,000 injectable overage; 12,000 FluMist QB; 9,000 injectable ON; 107,000 FluMist US; 9,000
11. How much vaccine will you purchase for next season? A decision has not yet been made. We will be conferring with our provincial/territorial public health colleagues about this. 12. What is the annual budget for the immunization program in Saskatchewan? The annual budget is $17.8 million. 13. How much does the province spend on flu vaccine? We spend about $1.6 million on seasonal influenza vaccines. 14. What are you spending on bringing in additional vaccines due to the shortage? The cost of additional vaccines is approximately $1.4 million. Some of the increased expense is due to the use of a product that was not used in Saskatchewan during the normal seasonal influenza program. FluMist is nearly double the cost of the other injectable vaccines that are normally used in Saskatchewan; however, it is the product that is available to meet our needs at this time. 15. How many people does the province order vaccine for through the seasonal influenza program? The number of doses ordered varies slightly from year to year. However in the 2013-14 season, Saskatchewan ordered enough to provide coverage to 25.3% of the population.
This was consistent with the order for the 2012-13 season as well as the requests for vaccine that were submitted by Regional Health Authorities, First Nations Inuit Health Branch, and the Northern Inter-Tribal Health Authority. Normally we have surplus vaccine at the end of a season so the demand is unpredictable from one year to the next. 16. Other provinces are providing coverage for the use of antiviral medications. Is Saskatchewan taking this approach as well? Since the pandemic year (2009-2010), two antivirals - Tamiflu and Relenza - have been on Saskatchewan’s provincial drug formulary every flu season, so that there are no financial barriers for persons over 65 years and persons who are financially needy to getting treatment for influenza. In addition, we provide vaccine free of charge. 17. How have influenza vaccination coverage rates changed since Dec 31, 2013? In children 6 months to under 2 years, coverage rates have increased from 24% to 36% (as of January 20) In children 2 years to under 5 years, coverage rates have increased from 14% to 24% (as of January 20) In children 5 year to under 9 years, coverage rates have increased from 9% to 13% (NOTE: Coverage rate increased before restriction put on vaccine use. Coverage rate was 13% on Jan 13 and has remained stable since that date.) We do not have coverage rates for children 9 years and older. There are variations in coverage rates by health region. 18. Are you offering vaccinations to anyone over 60 years of age? Yes, people 60 and over can still be vaccinated, although they would not receive FluMist, which is only approved for using in people from two to 59. Health regions have varying supplies of injectable vaccine left; they will continue to provide injectable vaccines to high-risk groups (children under two, pregnant women, immune-compromised) and to people over 60, until supplies run out. We do expect to receive an additional shipment of injectable vaccine towards the end of the month.
DANIELE DELLA SANTA (1), MARCO BIZZETI (2)Nel cane l’ipokaliemia è una rara complicazione della terapia diuretica con furose-mide. In medicina umana circa il 10% dei pazienti in terapia con diuretici d’ansa ed il20-30% di quelli in terapia con diuretici tiazidici, sviluppa ipokaliemia. Tale incidenzarisulta superiore per i tiazidici (nonostante l’escrezione frazionata del potassio legata
Instructions for assembly Foldable footplates, new Assemble the foldable footplates as follows:Assembly is easier if performed in steps. Step 1 (see figure 1) 1. First assemble the plastic cover (4) on the foot support tubing using bolts M5x35 (12) andM5x30 (13) with the appropriate nuts (18). NB! Make sure that the small hole on the lower edge of the tubing is visible on the plas