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H1N1 Vaccine. Barbara Baker, MS, RNC Director of Nursing St. Joseph County Health Department. Contributions from: Kelly Jolliff Epidemiologist & Emergency Preparedness Supervisor St. Joseph County Health Department Lesley Craft, MPH, CHES Director of Health Education

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H1N1 Vaccine


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H1N1 Vaccine

Barbara Baker, MS, RNC

Director of Nursing

St. Joseph County Health Department

slide2

Contributions from:

Kelly Jolliff

Epidemiologist & Emergency Preparedness Supervisor

St. Joseph County Health Department

Lesley Craft, MPH, CHES

Director of Health Education

St. Joseph County Health Department

Indiana State Department of Health

vaccine manufacturing
Vaccine Manufacturing
  • CDC provided H1N1 virus gene segment for vaccine manufacturing in May 2009
  • Novel H1N1 vaccine is being procured by the U.S. government from five (5) vaccine manufacturers (4 have been approved by FDA)
    • Inactivated licensed novel H1N1 vaccine will be available in multi-dose vials and in single-dose syringes
    • Live attenuated vaccine will be available in limited numbers in inhaler sprayers
    • made employing the same methods and facilities used annually to produce seasonal influenza vaccine
    • clinical trials at this time to determine the size of the dose and the number of doses that will be needed for protection
vaccine purchase allocation
Vaccine Purchase & Allocation
  • H1N1 vaccine will be made available at no cost
    • Syringes, needles, sharps containers, alcohol swabs, and pocket-size vaccination cards will also be provided
    • Gloves and band aids will NOT be provided
    • Some providers may be able to charge an administration fee
  • Vaccine will be allocated to states proportional to their population
    • Indiana will allocate vaccine to each Local Health Department by county or city population
    • St. Joseph County initially to receive up to 39,144 doses
    • Additional weekly shipments of 17,397
h1n1 vaccine
H1N1 Vaccine
  • What we know:
    • CDC estimates that approximately 45 million doses of H1N1 influenza vaccine will be available in mid-October
    • Approximately 20 million doses will be released in each subsequent week
  • What we don’t know:
    • Exactly when the vaccine will be ready-probably mid-late October
    • If it is 1 shot or 2 shots (early data indicates 1 for adults)
    • When and how it will be delivered
    • Exactly who will get it first
  • SJCHD is currently working with ISDH and CDC to determine how to deliver vaccinations to the target groups and community
vaccine delivery system
Vaccine Delivery System
  • Centralized distribution through McKesson
  • This system will allow for a larger number of ship-to sites (up to 76 in St. Joseph County)
  • Local Health Department responsible for working with local health care providers to determine which sites are eligible for direct ship (at least 100 doses)
  • St. Joseph County Health Department to receive remaining vaccine

Maintain the cold chain!

vaccine administration
Vaccine Administration
  • Novel H1N1 vaccine must be maintained at 2-8°C
  • CDC is developing a H1N1 Vaccine Provider Agreement and a Vaccine Information Statement (VIS)
  • All vaccine doses must be entered into CHIRP within 24-48 hours of administration
  • Two doses may be needed per person, with 21 to 28 days between the first and second doses
  • However, vaccine should NOT be kept in reserve for later administration of a second dose

Maintain the cold chain!

administration fees
Administration Fees
  • The federal implementation funds that public health is receiving may be expected to cover these costs (decisions are pending)
  • Health care providers and clinics with contractual arrangements with insurance companies may bill those companies for the administration fee
  • Medicare will cover administration fees
  • It is NOT known whether providers will be able to charge uninsured patients for vaccine administration

Maintain the cold chain!

private sector partners
Private Sector Partners
  • Private sector partners who wish to administer the H1N1 vaccine are asked to work with the Health Department
  • Health Department responsibilities when providing H1N1 vaccine to private sector partners include:
    • Maintaining the cold chain
    • Managing target/priority groups receiving the vaccine
    • Ensuring that all vaccine doses are entered into CHIRP

Maintain the cold chain!

monitoring coverage safety effectiveness
Monitoring Coverage, Safety & Effectiveness
  • Initially, providers will be expected to report weekly on the number of doses administered and the ages of persons who were vaccinated
  • Such data are critical for assessing early uptake
  • In addition, the Vaccine Adverse Event Reporting System (VAERS) will serve as the foundation for safety monitoring
  • VAERS accepts reports from patients, providers, public health officials and others
  • VAERS reporting information is currently available on www.chirp.in.gov

Maintain the cold chain!

2009 2010 seasonal influenza vaccine
2009-2010Seasonal Influenza Vaccine

Seasonal influenza vaccine was approved by the FDA in July

The vaccine became available in late August and September

Vaccination efforts should begin as soon as the vaccine is available

The process for ordering the vaccine is unchanged from previous years

Season influenza vaccine is not expected to protect against the novel H1N1 virus

Seasonal influenza and H1N1 vaccines may be able to be administered on the same day

Maintain the cold chain!

h1n1 vaccine target groups
H1N1 Vaccine Target Groups

When vaccine is first available, ACIP recommends that programs

and providers administer vaccine to persons in the following five

target groups (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

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

Source: http://www.cdc.gov/mmwr/PDF/rr/rr5810.pdf

subset of target group
Subset of Target Group

Subset of Target Groups During Limited Vaccine Availability

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, and

Children and adolescents aged 5-18 years who have medical conditions that put them at higher risk for influenza-related complications

Source: http://www.cdc.gov/mmwr/PDF/rr/rr5810.pdf

pregnant women
Pregnant Women

Reduce excess hospitalizations and deaths

Reduce pre-term labor and delivery

May protect the infant in utero and the first six months

Pregnant women account for only 1% of US population

During the Novel H1N1 pandemic pregnant women have accounted for 6% of laboratory confirmed cases and 8% of deaths (CDC)

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How?

Prenatal clinics

Family practice

OB/GYN

Community Health Clinics

Pharmacists

Local Health Department clinics

Other ideas?

Maintain the cold chain!

persons who live with or provide care for infants aged 6 mos parents siblings daycare providers
Persons who live with or provide care for infants aged <6 mos (Parents, siblings, daycare providers)

Younger infants are at higher risk of influenza-related complications and cannot be vaccinated.

Vaccination of those in close contact with infants less than 6 months of age might help protect infants by “cocooning” them from the virus.

Includes

Children six months to four years not in daycare

New parents

Household contacts of children under six months

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How?

Family Practice

OB/GYN Providers

WIC

Pediatricians

Community Health Clinics

Health Department Clinics

Pharmacists

Other ideas?

Maintain the cold chain!

health care workers and ems personnel
Reduce risk of illness

Sustain health system functioning

Reduce absenteeism among front-line providers

Reduce transmission to patients

Additional protection in increased exposure

Health Care Workers and EMS Personnel
health care workers and ems personnel clarification
Health Care Workers and EMS Personnel Clarification

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.

Source: MMWR vol. 58: Use of Influenza A (H1N1) 2009 Monovalent Vaccine Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0821a1.htm

health care workers and ems personnel clarification20
Health Care Workers and EMS Personnel Clarification

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.

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.

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How?

Occupational settings

Community clinics

Pharmacists

Providers’ offices

Other ideas?

Maintain the cold chain!

persons six months through 24 years
Persons Six Months Through 24 Years

High risk of illness

Disruptive school closures

Reduce transmission into the community

Also applies to child care centers

slide23
How?

School mass vaccination efforts

Colleges & Universities

PK-12

Remember permission slips!

Pediatricians

Family physicians

Community Health Clinics

Head Start

Pharmacists for children four and over

Other ideas?

Maintain the cold chain!

persons 19 to 64 with chronic diseases
Persons 19 to 64 with Chronic Diseases

Under age 65

Asthma

COPD

Obesity (not so much)

Other chronic conditions and immune deficiencies

slide25
How?

Occupational settings

Provider offices

Home Care Agencies

Community Health Clinics

Health Department Offices

Other ideas?

Maintain the cold chain!

then everyone else
Then Everyone Else

Once demand for vaccine for the prioritized groups has been met, providers should begin vaccinating everyone from the ages of 25-64 years.

Current studies indicate the risk for infection among persons age 65+ is less than the risk for younger age groups.

Once demand has been met among younger age groups, vaccination should be offered to people 65 years of age and older

Mass Vaccination sites for the public?

Maintain the cold chain!

who should not be vaccinated
Who Should Not Be Vaccinated?

People who have a severe allergy to chicken eggs

People who have had a severe reaction to a past influenza vaccine

Children less than 6 months of age

People who have a moderate or severe illness with a fever

what st joseph county is doing
What St. Joseph County is doing…
  • Pan Flu Working Group and Immunization Task Force Meetings held in August to outline methods for vaccinating target groups
  • Engaging additional community partners
  • Letter sent to all providers 9/14/09 with a brief survey to collect data on: Willingness to administer H1N1 Vaccine, Target Population Stats, CHIRP Registry status, Office Point of Contact

Maintain the cold chain!

what st joseph county is doing29
What St. Joseph County is doing…

SJCHD to review survey results and determine which sites are appropriate for Direct Ship and those who will have to receive from SJCHD

Send Direct Ship Provider Agreements

Ensure all sites registered for CHIRP-Roll out CHIRP MIM module training for direct ship sit

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More…

Identify Community Clinic Locations (including school based clinics), staffing needs, and estimates target groups to reach out to

Utilize federal grant funding to support vaccination efforts

Develop educational materials and launch campaign to inform public about H1N1 vaccine sites

Question: How to best Communicate?

Maintain the cold chain!

cdc vaccines and immunization contact information
CDC Vaccines and Immunization Contact Information

Telephone 800-CDC-info (for patients and parents)

E-mail www.nipinfo@cdc.gov (for providers)

Website www.cdc.gov/vaccines

CDC H1N1

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Additional Information

  • United Way 211
  • www.nd.edu/~pandflu
  • www.in.gov/isdh
  • www.in.gov/flu
  • www.who.int
  • www.pandemicflu.gov
contact information
Contact Information:

Barbara Baker, MS, RNC

Director of Nursing

St. Joseph County Health Department

235-9745

bbaker@co.st-joseph.in.us