2009-2010 Influenza Season Update #4
H1N1 Vaccination of School-Aged Children
To: Health Care Providers, Hospitals, Infection Control Practitioners, Schools, Home Health Agencies
From: Wendy Davis, MD, Commissioner of Health
Date: October 23, 2009
– Please Distribute Widely –
School based vaccination clinics
Last week, the Centers for Disease Control & Prevention (CDC) notified states that vaccine manufacturers are experiencing delays in the production of the 2009 H1N1 vaccine. Since that time, the Vermont Department of Health (VDH) has been working with our many partners – including health care providers and schools – to review our vaccination plans and make adjustments as needed.
The first school clinics will begin on October 26; subsequent school clinics will occur less frequently than previously planned and some will need to be rescheduled. We will continue to provide vaccine to health care providers, hospitals, health agencies, and to schools as soon as we can, based on vaccine supply.
Our goal continues to be to move vaccine to providers and clinics as quickly as possible, to ensure vaccination of those individuals who need it most, including school-aged children.
Public and Private schools
- All private, parochial, independent and public schools were offered the opportunity to provide vaccine to their students in a school setting. The vaccination efforts are voluntary.
- Schools with 300 or more students were offered Health Department-run clinics.
- Schools with fewer than 300 students were asked to run their own clinics. Some chose to combine with other schools making them eligible for a Health Department-run clinic.
- We collaborated with small schools which are without a school nurse, and schools with a nurse working limited hours, to provide vaccinator staffing from either the Vermont Emergency Response Volunteer (VERV) vaccinator pool or contracted nursing staff.
- Schools that have not already scheduled a vaccination clinic are still able to do so. If interested in providing vaccine to students, schools may call their Health Department district office. Due to vaccine supply delays, newly scheduled clinics may not occur until December/January.
Parents in schools during vaccination clinics
- Parents have been encouraged to not attend the Health Department-run school based clinics. This is for logistical and security reasons, including making sure clinic flow is not slowed to a point where we are not able to vaccinate all the children scheduled for that day.
- Ultimately, the decision to allow parents to accompany their child during clinic is a local school decision.
Vaccine in provider offices
- It is our hope that vaccinating children at the school based clinics will help keep providers from being overwhelmed by calls and demand for vaccine from parents of children who can receive it at school. At the same time, we recognize that not all these children will be vaccinated at a school clinic, and that providers are faced with managing the currently limited supply of vaccine.
- Health Department continues to follow the CDC guidance, and is focusing its vaccination efforts on the ACIP identified target groups – taking care of those individuals who need it most. Please see the attached ACIP guidance for when initial supply of vaccine is not adequate to meet immediate and short term demand.
- Because of vaccine supply delays, Health Department recommends that providers balance the CDC guidance with their patient needs when determining which patients should receive the H1N1 vaccine. The attached guidance should help providers in making these determinations.
Other (non-school) vaccine availability sites
Public Clinics
- VAHHA agencies will begin conducting public clinics for the target group population in early November.
- Once scheduled, a frequently updated list of these public H1N1 clinics will be available online at the Health Department Web site: http://healthvermont.gov/prevent/flu/flu_clinics_h1n1.aspx. Members of the public may also dial 2-1-1 for information.
Provider Offices
- Health Department is recommending that patients not be instructed to call around to other providers to seek H1N1 vaccine. Patients should be in contact with their own provider, can check the above Health Department Web site, or dial 2-1-1.
Recommended Use of Influenza A (H1N1) 2009 Monovalent Vaccine
Excerpt from Morbidity and Mortality Weekly Report
Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009
August 28, 2009 / Vol. 58 / No.RR-10
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5810a1.htm
ACIP recommends that vaccination efforts should focus initially on persons in five target groups whose members are at higher risk for influenza or influenza-related complications, are likely to come in contact with influenza viruses as part of their occupation and could transmit influenza viruses to others in medical care settings, or are close contacts of infants aged <6 months (who are too young to be vaccinated). In the event that vaccine availability is unable to meet initial demand, priority should be given to a subset of the five target groups.
Initial 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, and
- persons aged 25--64 years who have medical conditions that put them at higher risk for influenza-related complications.
These five target groups comprise an estimated 159 million persons in the United States. This estimate does not accurately account for persons who might be included in more than one category (e.g., a health-care worker with a high-risk condition). Vaccination programs and providers should begin vaccination of persons in all these groups as soon as vaccine is available.
Subset of Target Groups During Limited Vaccine Availability
Current projections of initial vaccine supply indicate that establishment of a subset of the five initial target groups will not be necessary in most areas. However, demand for vaccination and initial supply might vary considerably across geographic areas. If the supply of the vaccine initially available is not adequate to meet demand for vaccination among the five target groups listed above, ACIP recommends that the following subset of the initial target groups receive priority for vaccination until vaccine availability increases (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 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.
This subset of the five target groups comprises approximately 42 million persons in the United States. Vaccination programs and providers should give priority to this subset of the five target groups only if vaccine availability is too limited to initiate vaccination for all persons in the five initial target groups.