Transcript Flu 2010-2011 Season Vaccine Update

Flu Season 2010-2011
Vaccine Update
INFLUENZA AND INFECTIOUS DISEASE FORUM
JULY 29, 2010
ERIN BACHUS, ADULT IMMUNIZATION COORDINATOR
COMMUNICABLE DISEASE CONTROL AND PREVENTION
SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH
A blast from the past: Lessons learned about H1N1
Vaccine Distribution
 Vaccine distribution was divided into phases
 Phase 1 (mid-October): Limited doses available, focused only
on providers serving primarily priority groups – based on how
provider registered (Ob/Gyn, Pediatrics, Family Practice,
Hospital, etc.)

Strategy: decrease each order by the same percentage based on
total number of doses available for each type of vaccine
 Best option since SFDPH had no way of knowing how large or
small a provider/practice was
 Orders decreased by 0-82%, depending on vaccine type
 Learned that this was not the most equitable strategy because
some providers over-ordered
A blast from the past: Lessons learned about H1N1
Vaccine Distribution
 Vaccine distribution was divided into phases
 Phase 2 (Nov-Dec): Divided into 3 tiers: A, B, C
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Strategy: same basic concept for each tier – distribute a certain
number of doses based on what a provider ordered rather than
cutting by percentages; restrictions lessened as more vaccine
became available
Phase 3 (late Dec-Jan): Divided into 4 tiers: A, supplemental,
B-C

Strategy: same as Phase 2
 By the end of this phase, we were able to provide some vaccine
for every provider registered, regardless of provider type
 All need for p-free doses and LAIV was met
 Demand for Multidose vials and Pediatric formulations always
outweighed supply
A blast from the past: Lessons learned about H1N1
Vaccine Distribution
 Some things we had control over…
 # doses of vaccine going to a specific office
 Vaccination, testing, and treatment recommendations being
communicated to providers
 Some things we had no control over at all…
 # doses ordered by each provider – did they under-order, overorder?
 When the vaccine would arrive
 The amount of vaccine coming into San Francisco
 The potency recalls/short-dating of vaccine
 Whether or not providers actually followed priority group
restriction guidelines
 Supplies providers were receiving
Other Lessons Learned from H1N1
 Logistics planning for school-based mass clinics
proved to be too difficult
 You don’t have to bring vaccine to the people

If they want it, they will come!
 Our Mass Prophylaxis Plan works great!
 Used for December 22 clinic at Bill Graham
Civic Auditorium
 Vaccinated over 9,000 people in 9 hours
Most people waited less than 30 minutes!
 Most reported that the clinic met or exceeded their expectations
 Conducted a shift change during the clinic without closing

2010-2011 Flu Season Update
2010-2011 Flu Season Update
 2010-2011 official influenza recommendations
from CDC are still pending
 ACIP
Provisional Recommendations
New
recommendation for the 2010-2011 influenza
season for influenza vaccine annually for all
persons 6 months and older
ACIP Provisional Recommendations for Use of Influenza Vaccines:
http://www.cdc.gov/vaccines/recs/provisional/downloads/flu-vac-mar-2010-508.pdf
What’s in this year’s flu vaccine?
Content:
2010-2011
A/California/07/2009 (H1N1)
A/Perth/16/2009 (H3N2)-like
B/Brisbane/60/2008-like
2009-2010 Seasonal
A/Brisbane/59/2007 (H1N1)-like
A/Brisbane/10/2007 (H3N2)-like
B/Brisbane/60/2008-like
2009-2010 (monovalent pandemic H1N1)
A/California/07/2009 (H1N1)
ACIP Provisional Recommendations for Use of Influenza Vaccines:
http://www.cdc.gov/vaccines/recs/provisional/downloads/flu-vac-mar-2010-508.pdf
Who needs 2 doses for 2010-2011?
 Only applies to children less than age 9
 A child who got any H1N1 vaccine during the 2009-2010
season AND who got seasonal influenza vaccine prior to the
2009-2010 flu season should get 1 dose.
 A child immunized for influenza before 2009-10 but who did
not get H1N1 vaccine during the 2009-10 influenza season
should get 2 doses.
 A child immunized for influenza before 2009-10 but who got 1
or 2 doses of H1N1 vaccine during the 2009-10 influenza
season should get 1 dose
 A child with an unknown or uncertain history of seasonal or
H1N1 influenza vaccine should get 2 doses
Source: California Department of Public Health, Immunization Branch
Who needs 2 doses for 2010-2011?
 For children less than age 9 never immunized against influenza before
2009-10:
 If your practice has kids <9 years who did not get H1N1 vaccine, but who got 2
doses of seasonal in 2009-2010 or at least 1 dose in an earlier season, but none
in 09-10, you can give them 1 dose of H1N1 now, then they will only 1 dose
during the 2010-2011 season.
 Summer travelers to the Southern Hemisphere should be immunized with 1 or
2 doses depending on age.
Source: California Department of Public Health, Immunization Branch
Who needs 2 doses for 2010-2011?
DRAFT Algorithm for providers
being developed by CDPH
•Meant to be used for all patients
<9 years
Source: California Department of Public Health, Immunization Branch
New Influenza Vaccines
 Fluzone High-Dose® (Sanofi-Pasteur) licensed by FDA
on December 23, 2009 for use in persons ages 65 years
and older
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Inactivated influenza virus vaccine
0.5 mL prefilled syringe
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Gray syringe plunger rod
Contains four times the amount of influenza antigen
Higher antibody levels in one study
However, it is not known whether this vaccine will be more effective in
protecting people over age 65 from getting sick
 Studies are being conducted, but data will not be available before the
2010-2011 flu season
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Slightly higher frequency of local reactions
ACIP Provisional Recommendations for Use of Influenza Vaccines:
http://www.cdc.gov/vaccines/recs/provisional/downloads/flu-vac-mar-2010-508.pdf
New Age Indications
 Afluria® (CSL) now licensed for use in persons 6
months of age and older (36 months in CA).
 Fluarix® (GSK) licensed for use in persons 36
months and older
 Reminder: Flumist® licensed for healthy persons
ages 2 through 49 years
ACIP Provisional Recommendations for Use of Influenza Vaccines:
http://www.cdc.gov/vaccines/recs/provisional/downloads/flu-vac-mar-2010-508.pdf
Reminders
 Pre-filling of syringes for Flu Clinics
 Not recommended
 If you must do it, all doses that are drawn up must be used
within 24 hours
 The Mercury Free Act of 2004 - AB 2943 is still in
effect for children <36 months and women
“knowingly pregnant”

An exemption waiver is in place until September 30, 2010

Only applies for influenza A (H1N1) 2009 monovalent influenza
vaccine
Legislation Update
 SB 739 (Health and Safety Code Section 1288.7) went
into effect July 1, 2007 requiring general acute care
hospitals
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Annually offer onsite flu vaccinations to all employees at no cost
Institute respiratory hygiene and cough etiquette protocols
Revise/develop disaster plans to include pandemic influenza
components
 Vaccines required to be offered to health care workers is
expanding with Cal/OSHA Aerosol Transmissible
Disease (ATD) standard

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Goes into effect September 1, 2010
Applies in most health care settings and other high risk
environments
Source: California Department of Public Health, Immunization Branch
Vaccines that are required to be offered* per the Cal/OSHA Aerosol
Transmissible Disease (ATD) standard as of September 1, 2010
Vaccine
Schedule
 Influenza†
 One dose annually
 Measles
 Two doses
 Mumps
 Two doses
 Rubella
 One dose
 Tetanus, diphtheria, and
 One dose, booster as
acellular pertussis (Tdap)
 Varicella-zoster (VZV)
recommended
 Two doses
* To all susceptible employees who might be exposed. If vaccine is
declined, a declination form must be signed.
† Seasonal vaccine was required to be offered in 2009.
Source: California Department of Public Health, Immunization Branch
Where is the best place to find updated
Flu Vaccine information?

San Francisco Department of Public Health,
Communicable Disease Control & Prevention Flu Webpage
www.sfcdcp.org/flu
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Flu vaccine recommendations
Where to get a flu shot
Information about the Influenza Vaccine Distribution Program
Vax Faxes and Health Alerts
Much, much more!

Influenza Vaccine Availability Tracking System (IVATS)
http://www.preventinfluenza.org/ivats/
Vaccine Information Statements (VIS) http://www.immunize.org/vis/
California Department of Public Health Flu Webpage
http://www.cdph.ca.gov/healthinfo/discond/Pages/Influenza%28Flu%29.aspx
ACIP Recommendations http://www.cdc.gov/vaccines/pubs/ACIP-list.htm
CDC Flu Webpage http://www.cdc.gov/flu
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Cal/OSHA Aerosol Transmissible Disease (ATD) standard
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http://www.dir.ca.gov/Title8/5199.html
Questions?
Erin Bachus, MPH (expected spring 2011)
Adult Immunization Coordinator
Communicable Disease Prevention Unit
San Francisco Department of Public Health
101 Grove Street, Room 408
San Francisco, CA 94102
Tel: (415) 554-2798
Fax: (415) 554-2579
[email protected], http://www.sfcdcp.org/