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H1N1 Vaccine Storage _ Delivery.ppt

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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
  St. Joseph County Health Department

  Indiana State Department of Health
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
 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
 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
 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
 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
 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 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
 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
 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
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 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
 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)
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)
 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
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 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 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.
How?
 Occupational settings
 Community clinics
 Pharmacists
 Providers’ offices
 Other ideas?



                          Maintain the cold chain!
Persons Six Months
Through 24 Years
 High risk of illness
 Disruptive school closures
 Reduce transmission into the community
 Also applies to child care centers
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
 Under age 65
 Asthma
 COPD
 Obesity (not so much)
 Other chronic conditions and immune
 deficiencies
How?
 Occupational settings
 Provider offices
 Home Care Agencies
 Community Health Clinics
 Health Department Offices
 Other ideas?

                              Maintain the cold chain!
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?
 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…
   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
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
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
 Telephone 800-CDC-info (for patients and parents)
 E-mail www.nipinfo@cdc.gov (for providers)
 Website www.cdc.gov/vaccines
 CDC H1N1
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:
        Barbara Baker, MS, RNC
          Director of Nursing
St. Joseph County Health Department
               235-9745
      bbaker@co.st-joseph.in.us

				
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