Health Alerts > 8/31/09 H1N1 vaccine

Five manufacturers are producing H1N1 vaccine and the vaccine is expected to be available by mid-October. However, the initial supply of these vaccines might not be enough to meet the demand for vaccine. For this reason, CDC's Advisory Committee on Immunization Practices (ACIP) has made recommendations for priority groups to be the initial recipients of the vaccine. 

Priority Groups

Below are the priority groups we will follow until vaccine availability increases (order of target groups does not indicate priority):

• Pregnant women,
• Persons who live with or provide care for infants aged <6 months (e.g., parents, siblings, and daycare providers),
• Health-care and emergency medical services personnel who have direct contact with patients or infectious material,
• Children aged 6 months--4 years,
• Children and adolescents aged 5--18 years who have medical conditions that put them at higher risk for influenza-related complications.

As the vaccine supply increases we will move to the expanded priority groups

• Pregnant women,
• Persons who live with or provide care for infants aged <6 months (e.g., parents, siblings, and daycare providers),
• health-care and emergency medical services personnel,
• Persons aged 6 months--24 years,
• Persons aged 25--64 years who have medical conditions that put them at higher risk for influenza-related complications.

Once vaccination programs and providers are meeting the demand for vaccine among the persons in the five initial target groups, vaccination should be expanded to all persons aged 25--64 years. Current studies indicate the risk for infection among persons aged ≥65 years is less than the risk for persons in younger age groups. Expanding vaccination recommendations to include adults aged ≥65 years is recommended only after assessment of vaccine availability and demand at the local level.  AS this is contrary to our usual message, we are working on communication strategies to educate the public about this shift in priority groups.  We will share with you when available.

The definition of healthcare worker is as follows:

Health-care personnel (HCP) include all paid and unpaid persons working in health-care settings who have the potential for exposure to patients with influenza, infectious materials, including body substances, contaminated medical supplies and equipment, or contaminated environmental surfaces. HCP might include (but are not limited to) physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual staff not employed by the health-care facility, and persons (e.g., clerical, dietary, housekeeping, maintenance, and volunteers) not directly involved in patient care but potentially exposed to infectious agents that can be transmitted to and from HCP. The recommendations in this report apply to HCP in acute-care hospitals, nursing homes, skilled nursing facilities, physicians' offices, urgent care centers, and outpatient clinics, and to persons who provide home health care and emergency medical services (27). Emergency medical services personnel might include persons in an occupation (e.g., emergency medical technicians and fire fighters) who provide emergency medical care as part of their normal job duties.

Doses needed

The lack of preexisting antibody cross-reactive with the novel influenza A (H1N1) virus among children and younger adults raises the possibility that 2 doses of vaccine (typically separated by ≥21 days) also will be needed to provide protection for persons in these age groups. However, vaccine should not be held in reserve for patients who already have received 1 dose but might require a second dose.  Ongoing studies will provide additional information about the immune response vaccine, including which groups might need 2 doses.  It is anticipated that full immunity will occur approximately six weeks after the second dose.

Seasonal Flu Vaccine

The CDC is encouraging providers to administer seasonal flu vaccine as soon as they receive it.  While studies are currently pending, the CDC believes that simultaneous administration of inactivated vaccines against seasonal and novel influenza A (H1N1) viruses is permissible if different anatomic sites are used. However, simultaneous administration of live, attenuated vaccines against seasonal and novel influenza A (H1N1) virus is not recommended.

Delivery

The H1N1 vaccine will be shipped to the Dept of Health.  We would like to provide the vaccine to local providers to immunize their staff and provide to their patients who fall into the above mentioned priority groups.  While the vaccine if free of charge, you may charge an administration fee.  According to the weekly CDC and ASTHO calls the National Vaccine Advisory Committee (NVAC) voted on recommendations for reimbursement rates on July 27. Once the reimbursement rates are published, we will provide a link to the Web site. Insurance companies will be covering administration fees for vaccine administered in a health care provider's office. Medicare also has indicated that vaccine administration fees will be covered. CDC stated that public clinics will be able to charge an administration fee, but because the vaccine is being provided free of charge, persons who cannot pay the fee cannot be turned away.

Liability

There many liability protections for distribution and administration of the H1N1 vaccine conferred by the Public Readiness and Emergency Preparedness (PREP) Act. On June 15, 2009, the HHS Secretary amended his pandemic vaccine declaration under the PREP Act to include vaccines for the H1N1 virus. The declaration confers immunity to “qualified persons.” With regard to the administration or use of H1N1 vaccines, a “qualified person” is defined as a “licensed individual who is authorized to prescribe, administer, or dispense the countermeasure under the law of the State in which the covered countermeasure was prescribed, administered or dispensed.”

To provide more information and to address questions about providing H1N1 vaccine in your office, we have established five locations for a brief in-service.

9/22/09             Lutheran Hospital (Kachman Auditorium)

                        Set up time – 10:00 a.m.

                        Meeting   10:30 – 11:30 a.m.

9/22/09             Parkview Corporate Office   (large conference area)

                        Set Up time – 2:30 p.m.

                        Meeting    3:00 – 4:00 p.m.

9/24/09             Dupont Hospital   (Resource Center – 2^nd Floor  Classrooms 2&4

                        Set Up time – 9:30 a.m.

                        Meeting   10:00 – 11:00 a.m.

9/24/09             St. Joseph Hospital  (Assembly Room, Lower Level by cafeteria)

                        Set Up time:     1 p.m.

                        Meeting  1:30 – 2:30 p.m.

Please RSVP your attendance to Joanna at 449-4371 and please feel free to call for Candy Staadt for further information or questions about the H1N1 vaccine program at 449-3514.

I hope this answers some questions about H1N1 vaccine and I will continue to share information as it is confirmed.