Health Advisory
2009-2010 Influenza Season Update #13

H1N1 Flu Vaccine Allocation, Distribution & Target Groups

To: Vermont Health Care Providers, Hospitals
From: Wendy Davis, MD, Commissioner
Date: November 25, 2009

– Please Distribute Widely –

Allocating and distributing the 2009 H1N1 influenza vaccine is a complex process in Vermont, just as it is for other states. Our goal is always to move vaccine as quickly and as fairly as we can to reach as many people who are recommended to be vaccinated first. The 2009 H1N1 vaccine was developed, tested and produced in record time. However, we continue to hear every week about problems with production, resulting in delays and shortages of vaccine in Vermont and across the country.

We have heard from hospitals and health care providers about their concerns in not having vaccine for their patients and health care workers, as well as questions about how vaccine is being allocated around the state. The Vermont Department of Health continues to work with partners to review and revise vaccination distribution plans on a near-daily basis to assure – to the greatest extent possible – that people most at risk for serious complications from the flu have first access to vaccine.

Vaccine Allocation, Ordering, Shipment & Administration

Vaccine is allocated on a daily basis to the Vermont Department of Health by the Centers for Disease Control & Prevention (CDC), according to a formula that takes into account vaccine available and the state’s population. Although we get weekly projections, we do not know how much has been actually allocated to the state until CDC sends its report. It may be zero doses one day, and thousands the next.

Once we know the amount of vaccine and the form of vaccine (nasal spray or shot in various configurations) that has been allocated to us, we then place orders to have the vaccine direct-shipped to a variety of locations. There is always a lag time between shipping and administration – actual vaccination of people with either the nasal spray or flu shot.

Vaccination Progress

From Oct. 1 through Nov. 24, Vermont has ordered and received a total of 118,100 doses of vaccine, and 69,002 doses have been administered to people in the target groups (see below).

Of the doses administered so far, 23,448 have been in school clinics and offices of very small provider practices, and 45,554 have been in public clinics, hospitals, provider offices, and other institutional settings. A more detailed summary of vaccination progress to date is attached. This information will be updated weekly.

Encourage Early Vaccination

Although a patient’s medical home (provider office) is the ideal place to vaccinate many individuals within the target groups, it may be possible for some of your patients to receive their 2009 H1N1 vaccine earlier in another setting. Please encourage your patients to seek the earliest opportunity for vaccination, regardless of the setting.

Both school clinics (that offer flu shots) and public clinics (that offer both flu shots and nasal mist) will continue over the next few months. Parents can check with their school about vaccination clinic opportunities for school-age children (and some pre-school students when the pre-school is co-located at a participating school). Public clinics are generally open to people of all ages who fall within the target groups. Information about when and where public clinics are occurring in Vermont, as well as other flu information, can be found at the Health Department’s website: or by dialing 2-1-1.

Encourage Nasal Spray Vaccine for Healthy 2- to 49-year-olds

To date, about 20 percent of our H1N1 vaccine supply has been in the nasal spray form of the vaccine. This means that, as much as possible, people who are eligible should only be offered nasal spray vaccine, and not the flu shot, to conserve supplies of flu shot for those who cannot have the nasal spray form of vaccination. The next health advisory will address questions about nasal spray vaccine is more detail.

ACIP Recommendations for Vaccination – Target Groups

The Vermont Department of Health continues to recommend that health care providers follow the recommendations of the Advisory Committee on Immunization Practices (ACIP) for use of influenza A (H1N1) 2009 monovalent vaccine. ACIP recommends that vaccination efforts should focus first on people in these five target groups:

Subsets of Target Groups

ACIP does not rank the target groups in terms of priority for vaccine. However, if the supply of vaccine initially available is not adequate to meet demand for vaccination among the five target groups, ACIP recommends that the following subset of the five target groups have priority for vacination until vaccine availability increases. Again, ACIP does not rank these subsets:

We encourage all providers to assess which of their patients fall within the ACIP target groups (and subsets) and to plan vaccination accordingly. We also encourage providers to offer other measures to their higher-risk patients who become ill, such as early evaluation and treatment. 

* Conditions that increase risk of complications from 2009 H1N1 influenza include (but are not limited to):

Weakened immune system due to disease or medication (such as people with HIV or AIDS, cancer, or those on chronic steroids) ion for all persons in the five initial target groups.

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