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					Novel H1N1 (Swine Flu) Disease and Vaccine Information for Pharmacists

Fast Facts about H1N1 Virus  Symptoms: fever, chills, myalgia, lethargy, headache, loss of appetite, rhinorrhea, cough, sore throat, shortness of breath, nausea, diarrhea, and vomiting.  The infectious period lasts 1-3 days before onset to 2-7 days after onset of illness.  H1N1 spreads through respiratory droplets that are generated when an infected person coughs or sneezes and expels droplets of fluid. Treatment and prophylaxis:
Antiviral medication dosing recommendations for treatment or chemoprophylaxis of novel influenza A (H1N1)
(Table extracted from IDSA guidelines for seasonal influenza.)

Agent, grou p Oseltamivir (Tamiflu®) Adults Children ≥ 12 months 15 kg or less 16-23 kg 24-40 kg >40 kg Zanamivir (Relenza®) Adults Children

Treatment 75 mg capsule twice per day for 5 days 60 mg per day divided into 2 doses 90 mg per day divided into 2 doses 120 mg per day divided into 2 doses 150 mg per day divided into 2 doses Two 5 mg inhalations (10 mg total) twice per day Two 5 mg inhalations (10 mg total) twice per day (age, 7 years or older)

Chemoprophylaxis 75 mg capsule once per day 30 mg once per day 45 mg once per day 60 mg once per day 75 mg once per day Two 5 mg inhalations (10 mg total) once per day Two 5 mg inhalations (10 mg total) once per day (age, 5 years or older)

Additional information available at: www.cdc.gov/h1n1flu/recommendations.htm#table1

Protect Your Pharmacy by Planning Ahead  Start early - plan to continue providing seasonal flu shots this fall in addition to stocking antivirals.  Educate pharmacy staff on practicing good hand hygiene and cough etiquette and encourage all staff to obtain an annual influenza vaccination.  Alert pharmacy staff with children that in the event of a widespread pandemic in your area, school may close and therefore they should have a plan to care for children. Make sure your pharmacy has a staffing plan in place in the case of high employee absenteeism due to illness or childcare concerns.  If necessary, cross-train employees so that all tasks are covered in the event of absenteeism.

 Keep antibacterial gel, tissues, and a wastebasket on hand in the patient waiting area and frequently clean

surfaces that patients and staff touch (i.e. workstations, door handles, keyboards, telephones, and countertops).  Encourage employees who are suspected of having H1N1 to stay home at least 24 hours after their fever has resolved. Make it clear that employees do not risk losing their jobs because of missed work due to illness. Estimate sick employees will be out three to five days for planning purposes.  Work with state and local health departments to assure the pharmacy receives sufficient quantities of stockpiled items during a pandemic (links provided).

H1N1 Vaccine  Manufacturing o Novel H1N1 vaccine is being purchased by the U.S. government from five vaccine manufacturers. The availability of novel H1N1 vaccine is dependent on several factors, including antigen yield and formulation and the number of doses required. o Note: For planning purposes, assume that two doses will be needed.
 Purchase and Allocation

o Materials required for the production of the H1N1 vaccine will be purchased by the federal government and made available to vaccinators at no cost. o Syringes, needles, sharps containers, and alcohol swabs will also be provided. o The vaccine will be allocated across states proportional to population. o State health departments will then direct their allocation to local health departments and other vaccination partners. o Many state health departments are partnering with private sector partners to ensure the novel H1N1 vaccine is delivered to as many recommended persons as rapidly as possible. Vaccine will thus be available in a combination of settings including public health organized vaccination clinics, and in private sector settings including pharmacies. o Pharmacists who wish to administer the novel H1N1 vaccine will need to enter into relationships with their public health department, so that vaccine can be directed to them (links provided).
 Administration

o Key target populations identified:  Pregnant women  People who live with or care for children younger than 6 months of age,  Health care and emergency services personnel  Persons between the ages of 6 months through 24 years of age  People from ages 25 through 64 years who are at higher risk for novel H1N1 because of chronic health disorders (such as obesity, diabetes, smoking, asthma, and COPD) or compromised immune system o Seasonal influenza vaccine is not expected to protect against the novel H1N1 flu
 Reimbursement

o

While providers will receive the vaccine at no charge, information on reimbursement for administration is needed. CDC asked AHIP (America’s Health Insurance Plans) whether insurance plans would reimburse private providers for administration and received the following answer: “Just as health plans have provided extensive coverage for the administration of seasonal flu vaccines in the past, public health planners can make the assumption that health plans will provide reimbursement for the administration of a novel H1N1 vaccine to their members by private sector providers in both traditional settings e.g., doctor’s office, ambulatory clinics, health care facilities, and non-traditional settings, where contracts with insurers have been established.”

Full document available at: www.cdc.gov/h1n1flu/vaccination/provider/preparing.htm Additional resources:

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CDC H1N1 General Info: www.cdc.gov/h1n1flu/general_info.htm CDC H1N1 Flu – Novel H1N1 Swine Flu and You: www.cdc.gov/h1n1flu/qa.htm CDC Information for Vaccine Planners: www.cdc.gov/h1n1flu/vaccination/statelocal Novel H1N1 Vaccine FAQ’s: www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm Pandemic Flu Planning: www.pandemicflu.gov