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.

1 comment:

Anonymous said...

Dora, the recommendation for the
H1N1 vaccine for children 9 and younger is two doses. However, if a child has had previous seasonal influenza vaccines, does she need a second H1N1 vaccine?