Friday, October 30, 2009

Are you in a priority group and worried because you can't get vaccine?

from this week's update on H1N1 in Maine:

H1N1 Vaccine Supply and Prioritization

As of October 28, a total of 99,000 doses of vaccine had been allocated to the state, which is about 14% of the total amount of vaccine needed for prioritized populations in the state. Vaccine is continuing to be shipped as soon as it is allocated. However, it is possible that there will not be sufficient supplies of vaccine for some of the highest priority people until December.

Maine CDC is developing short-term plans, which are constantly being reevaluated, based on the supply of vaccine being allocated to us from the federal government. Vaccine is being sent out in response to several factors, including current trends in infections, prioritized populations, and the supply available. Every county in the state has received some vaccine, and will continue to receive it as it is available.

Less than 2% of the vaccine that has arrived to date is in the formulation most frequently requested for children under age three. About a third of the vaccine that has arrived is in the nasal spray form, which cannot be given to many people in the priority populations, but can be administered to healthy children over the age of two.

We are focusing our first doses on children and pregnant women, because they are the most disproportionately affected by H1N1. We are providing some vaccine to pediatric providers for very young children, household members of children under six months old, and some high-risk children. Most of our vaccine is going to schools.

Vaccine clinics for school children have been held in the Sanford/Springvale, greater Portland, Lewiston, Augusta, and Bangor areas, as well as in Passamaquoddy Indian Township in the past week. Vaccinating children, who are the major transmitters of flu, provides some protection to the entire community.

As more vaccine arrives, we will broaden our distribution to other high risk groups, including young adults, people with health conditions, and health care and emergency services personnel. Once the full supply of vaccine has arrived, we plan to offer it to anyone who wants it.

In the mean time, people in priority groups who do not have access to vaccine yet can take some steps to protect themselves:
* If vaccine is appropriately available to other members of the household (for instance, children who can be vaccinated in their school), then this is one way to provide some protection to a high-risk individual.
* If you can get a seasonal flu vaccine (which is also in short supply in many areas), do so. The seasonal flu vaccine will not protect you from H1N1, but by protecting you from seasonal flu, it will keep you from getting run down and therefore being more likely to get H1N1.
* Avoid close contact with people who are sick. Wash or sanitize your hands often.
* Keep checking the clinic locator on our web site:
* Your health care provider may prescribe antiviral medicine if someone in the household is sick with a fever plus cough and/or sore throat and the sick person, or a household member, meets one or more of these criteria:
* Younger than 2 years-old
* Older than 64 years-old
* Pregnant
* Has an underlying medical condition
These antiviral prescription medicines (Tamiflu or Relenza) may help reduce the severity of the flu.

To read the full update:

Saturday, October 3, 2009

H1N1 Clinician Update

Below this blog post are some important recent (this last 2 days) updated documents from US CDC. The Treatment Algorithm for Adults, the H1N1 Vaccine Information Statements (which must be given to patients receiving the vaccine), updated information for seniors, pregnant women, other patients, and clinicians all may be of interest.

Maine CDC was one of few states that ordered its entire allotment of H1N1 vaccine this week. Our Immunization Program staff along with redeployed Maine CDC staff worked many hours to accomplish this. Over 300 health care providers were registered as H1N1 distribution sites. 8,700 doses of LAIV (Live Attenuated Influenza Vaccine), also known as nasal spray vaccine (analogous to the seasonal flu vaccine FluMist), will be arriving and distributed to about 70 clinical sites this coming week – most likely arriving at clinical sites Tuesday or Wednesday. We ask that these first few doses of vaccine be focused on healthy children, especially young children ages 2 – 5 years of age, and household contacts and caregivers of young infants under 6 months old. This LAIV is licensed for healthy non-pregnant 2 – 49 year olds, and as more vaccine arrives, this formulation should be expanded to include other high priority populations that fit the licensure parameters.

We expect to be able to order other formulations plus additional LAIV this coming week. As we are able to order and distribute more vaccine, the high priority populations it will be focused on will be expanded. For the next few weeks we anticipate focusing vaccine on the 5 high priority populations of:
· pregnant women;
· people ages 6 months – 25 years of age;
· household contacts and caregivers of young infants under 6 months old;
· people 25 – 65 years of age with underlying conditions; and
· health care workers including EMS.
Within the latter category of health care workers, we anticipate that this next several weeks the vaccine will most likely be focused on hospital-based health care workers with direct patient contact who work in emergency departments, intensive care units, labor and delivery units, and inpatient pediatric wards. As vaccine becomes more available, the priority groups it can reach can expand.

Our vaccine distribution and administration plans focus on settings where these high priority populations are in highest numbers and proportion. For instance, we are currently focused on distributing H1N1 vaccine to pediatric and obstetrical health care providers, hospitals, schools, and city health departments. This means that health care providers who have not been accepted by the end of this coming week as a distribution site most likely do not fit into these priority settings. If we are allowed more distribution sites, we may be able to expand to include these other health care providers. If not, H1N1 vaccine can easily be redistributed to these other health care providers from a distribution site. However, we ask that it still remain focused on high priority populations for now. Highlights from information sent to all current H1N1 vaccine distribution sites are below this email and the CDC documents.

Thank you for all the work you and many others are doing! It is exciting to think the vaccine is almost here, though I know these next few weeks will be quite busy for anyone involved with health care and public health.


2009-2010 Influenza Season Triage Algorithm for Adults (>18 Years) With Influenza-Like Illness
This algorithm is designed to assist physicians and those under their supervision in identifying indicators of and responses to symptoms of flu-like illness (i.e., fever with cough or sore throat). (NOTE: this guidance is not intended for use by the general public and is not a substitute for sound clinical judgment.)

Download and print the algorithm (PDF) >>

H1N1 Flu Vaccine Information Statements (VISs)
Vaccine Information Statements (VISs) are information sheets produced by CDC that explain to vaccine recipients, their parents, or their legal representatives both the benefits and risks of a vaccine.

Inactivated 2009 H1N1 Influenza Vaccine
(the flu shot)
Live, Intranasal 2009 H1N1 Influenza Vaccine
(the nasal spray vaccine)

Pregnancy and H1N1

Update: 2009 H1N1 Influenza Shots and Pregnant Women: Questions and Answers for Patients
Why does CDC advise pregnant women to receive the 2009 H1N1 influenza (flu) vaccine (shot)? Will the seasonal flu shot also protect against the 2009 H1N1 flu? Are there flu vaccines that pregnant women should not get? More...
2009 H1N1 Influenza Vaccine and Pregnant Women: Information for Healthcare Providers
Where can healthcare providers obtain 2009 H1N1 flu vaccine? How should healthcare providers organize their clinics for vaccination? How many vaccine doses will a pregnant woman need to get? More...

H1N1 Clinician Information

Update: H1N1 Clinicians Questions and Answers
The age for two doses is different for seasonal (6 months through 8 years) and 2009 H1N1 monovalent vaccine (6 months through 9 years) in the package inserts. Does CDC recommend that clinicians follow the recommendation in the package inserts? Can a person who has received LAIV test positive on a rapid influenza diagnostic test? And more...
Questions and Answers on 2009 H1N1 Vaccine Financing
Considerations of financing distinguish between those related to the vaccine itself, the ancillary supplies needed to administer the vaccine, and the actual administration of the vaccine.
Questions & Answers: Interim Recommendations for Clinical Use of Influenza Diagnostic Testing During the 2009-2010 Influenza Season - For Health Care Providers
What does CDC recommend this season regarding testing for influenza? What is the reason for these recommendations? Does CDC recommend diagnostic testing for patients with uncomplicated illness from suspected influenza infection? More...
Interim Recommendations for Clinical Use of Influenza Diagnostic Tests During the 2009-10 Influenza Season
To provide updated interim recommendations on influenza diagnostic testing for clinicians treating patients with suspected 2009 H1N1 influenza virus infection and to assist clinicians with testing decisions for the 2009-10 influenza season.

H1N1 Information for Patients

Preparing for the Flu: A Communication Toolkit for the Federal Workforce
The purpose of Preparing for the Flu: A Communication Toolkit for the Federal Workforce is to provide information and communication resources to help federal agencies and employees implement recommendations from CDC in planning and responding to the 2009–2010 Influenza Season.
2009 H1N1 Influenza Vaccine and Seniors
Questions and Answers about 2009 H1N1 Influenza Vaccine and Seniors
Questions & Answers: Influenza Diagnostic Testing During the 2009-2010 Flu Season - For the Public
How will I know if I have the flu this season? How can I know for certain if I have the flu this season? What kinds of flu tests are there? More...



· We expect approximately 800,00 doses of vaccine to be available in Maine by early January 2010.

· H1N1 vaccine will be offered in four different presentations: 7.5mg prefilled syringes, 15mg prefilled syringes, multi-dose vials and intranasal sprayers (LAIV).

· Approximately 40% of the vaccine will be in thimerosal free presentations (prefilled syringes and LAIV intranasal sprayers).

· Approximately 20% of the H1N1 vaccine that will be available over the course of this vaccine campaign will be in the form of the LAIV intranasal sprayer.

· The first vaccine available is in the form of LAIV intranasal sprayers.

· The first 7.5mg prefilled syringes (for children 6 months through 35 months old) are expected to be available in early November and should be available in sufficient quantity for this age group in late November.


· Vaccine distributed at this time is intended to be used as soon as possible. Please start using this vaccine in your practice right away and consider holding clinics in your practice, especially for young children.

· Please offer H1N1 LAIV to any healthly non-pregnant patient from 2 years of age through 49 years of age.

o At this point in time, primary foci should be on 2-5 year olds that do not have any other avenue for vaccination, and caregivers and household contacts (including sibilings) of paitents younder than 6 months of age.

o It is anticipated that the focus of this H1N1 LAIV will expand soon (in ~2 weeks) to all healthy children 6 months – 18 years of age (since this is thimerasol-free vaccine).

· School vaccination clinics will be starting as soon as mid-October. Please consider requests to partner with schools to vaccinate school children.

· WEEKLY reporting of doses adimintered is due by close of business every Saturday.

o Either fax report to 207-287-8127 or submit online at

· Order vaccine frequently.

Friday, October 2, 2009

Weekly Update on H1N1 in Maine October 1, 2009


US CDC reports that flu activity continued to increase in the US during the week of Sept. 13-19. Widespread influenza activity continues in much of the southern parts of the country, including higher than expected hospitalizations for this time of year. Outpatient visits for influenza like illness (ILI) increased in much of New England.

In Maine, visits to outpatient office settings and hospital emergency departments for influenza like illness increased this past week. There have been some occasional cases of H1N1 detected in students, but no new distinct outbreaks have been identified this past week.

However, the increases in outpatient visits and students indicate that this is the time to be extra vigilant in respiratory precautions, especially staying away from work and school when one has a fever, properly covering coughs and sneezes, and washing hands frequently. Recommendations for schools can be found in the “Quick Reference Guide” at: Guidance for other settings (child care, businesses, etc) can be found at

There continue to be delays in Maine receiving seasonal influenza vaccine, especially pediatric influenza vaccine for large scale clinics. We expect this vaccine to arrive in late October. Schools and other settings that have planned large scale clinics with this vaccine should postpone these clinics until early November if they have not yet received vaccine. They should be able to offer H1N1 vaccine concurrently at these clinics.

Maine CDC placed the first orders for H1N1 vaccine on Wednesday September 30th. The first orders should arrive next week and are for a small amount of live attenuated intranasal vaccine (LAIV) shipped primarily to pediatric health care providers for healthy toddlers and household contacts and caregivers of young infants. We are placing additional orders for this vaccine this week, and anticipate being able to place orders for other formulations of the H1N1 vaccine next week. It is important that health care providers who want to have H1N1 vaccine shipped directly to them register as an H1N1 provider and place orders as soon as possible. For more information see the section for health care providers at:

Seasonal influenza vaccine

Maine CDC has distributed about than 121,000 doses of seasonal flu vaccine, with most of this (80,000) going to pediatric providers and schools. Approximately 15 schools or school districts have held vaccine clinics. Due to nationwide delays in distribution of seasonal flu vaccine, Maine CDC recommended last week that large public clinics and school-located clinics be rescheduled if vaccine for those clinics had not already arrived. Clinic planners are advised to reschedule to early November, and to consider offering both seasonal flu vaccine and H1N1 flu vaccine at the same time.

H1N1 influenza vaccine

Maine CDC has placed its first orders with U.S. CDC for the first shipments of H1N1 vaccine this week, starting Wednesday, September 30th. The first shipments are not expected to arrive until the week of October 5th and will consist of only a limited number (~7,700) of one type of H1N1 vaccine, the H1N1 LAIV (Live Attenuated Intranasal Vaccine). This nasal formulation’s license is limited to healthy non-pregnant 2 – 49 year olds. In terms of the high-risk populations for H1N1, this vaccine is most appropriate for healthy children (especially those under 5 since they are at higher risk for H1N1 complications than older children) and household contacts of young infants. Maine CDC urges pediatric and obstetrical health care providers to register and submit orders for H1N1 vaccine as soon as possible.

If you are a licensed health care provider for children or their families, and have not registered as an H1N1 Provider, then please do so now. You must register even if you already receive vaccine from Maine CDC. To register, fill out and submit the H1N1 Provider Agreement for H1N1 Vaccine, which can be found at

If you have registered and have received ordering information, please submit your order as soon as possible to Maine CDC. We cannot ship vaccine to you unless you have submitted an order.

· For questions regarding H1N1 influenza vaccine ordering see the FAQ from the September 17th health advisory (

· For other questions:
Contact the Maine CDC’s Immunization Program at 287-3746 or the public information line at 1-888-257-0990.
Email us questions at:
More information, including consent forms and billing information, will be found at
Updated CDC guidance on H1N1 influenza vaccine including vaccine handling can be found at:
FAQ on H1N1 vaccine safety can be found at:

FAQs Related to H1N1 Vaccine (more detailed answers can be found at

Can seasonal influenza vaccine and H1N1 vaccine be given at the same visit?
Yes. However, both the nasal forms of the vaccine cannot be given at the same time. If both the nasal forms are to be given, then they should be separate by a minimum of 4 weeks. The injectable forms of the seasonal and H1N1 vaccine can be given at the same time (different anatomical locations), and a nasal vaccine of one and an injectable vaccine of the other can be given at the same time.

Can H1N1 vaccine be administered at the same visit as other vaccines?
Inactivated H1N1 vaccine can be administered at the same visit as any other vaccine, including pneumococcal polysaccharide vaccine. Live H1N1 vaccine can be administered at the same visit as any other live or inactivated vaccine EXCEPT seasonal live attenuated influenza vaccine.

Will the H1N1 vaccine be recommended for patients who had influenza-like illness since spring 2009?

Does the H1N1 vaccine contain adjuvants such as squalene or aluminum?

Is the H1N1 vaccine mandatory?

Does the H1N1 vaccine contain thimerosal?
The multi-dose vials of H1N1 vaccine contain a very small amount of thimerosal in order to prevent bacterial contamination. The single-dose syringes and nasal spray do not contain thimerosal. These thimerosal-free formulations are expected to represent about one-third of the H1N1 vaccine supply distributed in the next 3 months. This thimerosal-free vaccine is primarily being distributed to settings where pregnant women and young children are offered vaccine.

Who are the priority populations for H1N1 vaccine these first few weeks?
Pregnant women, all children and young adults ages 6 months to 25 years old, caregivers and household contacts of infants under 6 months, 25 – 65 year olds with underlying conditions, and health care workers including EMS.

Why does the seasonal flu vaccine list “H1N1” on it but does not protect against the H1N1 pandemic?
The seasonal flu vaccine protects against three major strains of influenza virus, including a seasonal (“regular”) strain of H1N1 influenza. However, protection against this seasonal strain of H1N1 does not protect you against the 2009 pandemic strain of H1N1.

Other New or Recently Updated H1N1 Guidance or News

US CDC posted the following materials on its web site:
· CDC announced the approval this week of H1N1 Vaccines. An FDA press release may be viewed at
· Updated Questions & Answers: Antiviral Drugs, 2009-2010 Flu Season is available at
· Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season was issued earlier this week and can be found at
· 2009-2010 Influenza Season: Information for Pharmacists is available at This document provides 1.) background information on influenza activity to date and how pharmacists may be affected this season, 2.) an update on antiviral drug supplies, 3.) information about compounding an oral suspension from Tamiflu® 75mg capsules and 4.) information about the oral dosing dispenser provided with certain formulations of Tamiflu® oral suspension.
· Updated Interim Recommendations for Obstetric Health Care Providers Related to Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season is now posted at
· Asthma Information for Patients and Parents of Patients is now posted at
· Brochure 2009 H1N1 and You is posted at

How to Stay Updated

Weekly Updates: Check the Thursday morning updates on H1N1 in Maine on Maine CDC’s H1N1 website. Now available as an RSS feed (midway down the center of the homepage):

Health Alert Network: Sign up to receive urgent updates from Maine CDC’s Health Alert Network (HAN). The easiest and quickest way is to sign up is through the HAN Alert RSS feed at (midway down the center of the homepage).

Follow Maine CDC’s Updates:
Facebook (search for “Maine CDC”)
Twitter (
MySpace (
Maine CDC’s Blog (

H1N1 Conference Calls: Maine CDC will be holding conference calls on a variety of topics related to H1N1 over the coming weeks. The next call will be held Monday, October 5, from noon to 1pm, to update interested stakeholders on H1N1 vaccine efforts. To participate, call 1-800-914-3396 and enter pass code 473623#.

Call or Email Us:
For clinical consultation, outbreak management guidance, and reporting of an outbreak of H1N1 call Maine CDC’s toll free 24-hour phone line at: 1-800-821-5821.
General Public Call-in Number for Questions: 1-888-257-0990NextTalk (deaf/hard of hearing) - (207) 629-5751Monday - Friday 9 a.m. – 5 p.m.
Email your questions to:

U.S. CDC H1N1 Recommendations and Guidance: and