H1N1 Flu

Swine Flu Info

Content on this page was developed during the 2009-2010 H1N1 pandemic and has not been updated.

The H1N1 virus that caused that pandemic is now a regular human flu virus and continues to circulate seasonally worldwide.
The English language content on this website is being archived for historic and reference purposes only.
For current, updated information on seasonal flu, including information about H1N1, see the CDC Seasonal Flu website.

Guidance and Considerations for Health Care Providers and for State and Local Public Health Agencies*

Health Providers of Cardiovascular Disease

November 12, 2009 3:00 PM ET

*This interim guidance has been updated from Spring 2009 to include information regarding vaccination guidelines for 2009 H1N1 influenza and seasonal influenza.

Background

People with chronic cardiovascular disease and cerebrovascular disease (CVD) are at increased risk of experiencing an acute exacerbation of disease during influenza epidemics^1–7.
People with chronic cardiovascular disease are at higher risk for both seasonal and 2009 H1N1 influenza-related complications
Consideration should be given for having adequate supplies of commonly used cardiovascular medications for preventing and treating cardiovascular events⁸. "Recommendations of the Advisory Committee on Immunization Practices (ACIP)"
Health care providers should be aware that 2009 H1N1 influenza and seasonal influenza might produce increased numbers of cardiovascular events, leading to increased hospitalizations and use of resources to treat acute coronary events, heart failure, and stroke^9–11.
Early empiric use of influenza antiviral medication is recommended for those at increased risk of influenza complications who present with influenza-like symptoms. This includes adults aged 65 years or older and people with cardiovascular disease. See "Questions & Answers: Antiviral Drugs, 2009-2010 Flu Season" for more information.

Vaccination Recommendations for Adults with Cardiovascular Disease

Detailed information on 2009 H1N1 vaccination guidelines can be found at "2009 H1N1 Vaccination Recommendations"

Seasonal Influenza Vaccine

All patients with cardiovascular disease, including those ≥ 65 years, should receive the seasonal (annual) influenza vaccine as soon as it is available. Detailed information on seasonal (annual) influenza immunization guidelines are available at "Recommendations of the Advisory Committee on Immunization Practices (ACIP)"

2009 H1N1 Monovalent Influenza Vaccine

Patients aged 25–64 years with cardiovascular disease are considered a target group for 2009 H1N1 influenza vaccine and should be vaccinated as soon as vaccine is available.
Patients aged ≥ 65 years with or without cardiovascular disease are not considered an initial vaccine target group for 2009 H1N1 influenza, but should be vaccinated as more 2009 H1N1 influenza vaccine becomes available.
Additional 2009 H1N1 influenza vaccine target groups include pregnant women, household contacts and caregivers for children younger than 6 months of age, healthcare and emergency medical services personnel, and all people from 6 months through 24 years of age.

For More Information:

References

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Nichol KL, Nordin J, Mullooly J, Lask R, Fillbrandt K, Iwane M. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly. N Engl J Med 2003;348(14):1322–1332.
Gurfinkel EP, de la Fuente RL, Mendiz O, Mautner B. Influenza vaccine pilot study in acute coronary syndromes and planned percutaneous coronary interventions: the FLU Vaccination Acute Coronary Syndromes (FLUVACS) Study. Circulation 2002;05(18):2143–2147.
Ciszewski A, Bilinska ZT, Brydak LB, et al. Influenza vaccination in secondary prevention from coronary ischaemic events in coronary artery disease: FLUCAD study. Eur Heart J 2008;29(11):1350–1358.
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Madjid M, Aboshady I, Awan I, Litovsky S, Casscells SW. Influenza and cardiovascular disease: is there a causal relationship? Tex Heart Inst J 2004;31:4–13.
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Madjid M, Casscells SW. Of birds and men: cardiologists' role in influenza pandemics. Lancet 2004;364(9442):1309.
Mensah GA, Grant AO, Pepine CJ, et al. ACCF/AHA/CDC conference report on emerging infectious diseases and biological terrorism threats: the clinical and public health implications for the prevention and control of cardiovascular diseases. J Am Coll Cardiol 2007;49(12):1373–1412.
Smeeth L, Thomas SL, Hall AJ, Hubbard R, Farrington P, Vallance P. Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med 2004;351(25):2611–2618.
Madjid M, Miller CC, Zarubaev VV, et al. Influenza epidemics and acute respiratory disease activity are associated with a surge in autopsy-confirmed coronary heart disease death: results from 8 years of autopsies in 34,892 subjects. Eur Heart J 2007;28(10):1205–1210.