1. 8/18/09 Novel A (H1NI) Influenza Vaccination August 18, 2009 Massachusetts Department of Public Health

2. 8/18/09 Outline Seasonal flu update H1N1 vaccine update What we expect What we don’t know Operation PanVax

3. 8/18/09 2009 – 2010 Seasonal Flu Vaccine Nat’l supply expected to be early and adequate 885,000 doses state-supplied Multiple shipments Aug through Oct Vaccinate beginning in Aug, as soon as vaccine is available Clinics that rely on state-supplied vaccine – schedule for early Oct

4. 8/18/09 Waning Immunity to Flu Vaccine? Not a Problem No clear evidence exists that immunity declines more rapidly in the elderly Infections among the vaccinated elderly might be associated with age-related reduction in ability to respond to vaccine rather than reduced duration of immunity

5. 8/18/09 H1N1 Vaccine: What We Expect H1N1 Vaccine Shipments in Mass: By end of Oct 1.8 M doses Nov and beyond 420,000 doses/month while demand lasts

6. 8/18/09 H1N1 Vaccine: What We Expect > 5 formulations of H1N1 vaccine Approved for different age and risk groups Live nasal spray and inactivated injectable Provided with vaccine: Needles, syringes Alcohol swabs Sharps containers Vaccine record cards

7. 8/18/09 Initial Target Groups For H1N1 Vaccine Pregnant women HH contacts/caregivers of infants < 6 m/o HCP and EMS Persons 6 mos – 24 yrs/old HR persons 25 - 64 yrs/old 3.4 M in MA

8. 8/18/09 Target Groups for H1N1 Vaccine When Demand Exceeds Supply Pregnant women HH contacts/caregivers of infants < 6 m/o HCP and EMS with direct medical contact with pts or infectious materials Children 6 mos – 4 yrs/old HR children 5 – 18 yrs yrs/old 870,000 in MA

9. 8/18/09 When H1N1 Vaccine Supply Increases When vaccine is sufficient to vaccinate initial target groups, expand vaccination* to Healthy adults 25 through 64 years of age Provisional ACIP Recommendations * In consultation with state and local health departments 2 M in MA

10. 8/18/09 People > 65 y/o Have some immunity to novel H1N1 Risk for infection less Offer vaccine when demand among target groups met Still target group for: Seasonal flu vaccine Pneumococcal vaccine

11. 8/18/09 H1N1 Vaccine: What We Expect Most people need 2 doses Vaccinators not responsible for recall H1N1 vaccine should not be kept in reserve for later administration of the 2 nd dose No need to verify target group Seasonal and H1N1 vaccine can be given at same time Central distribution thru McKesson

12. 8/18/09 Liability Protection M.G.L. c. 112, § 12C provides complete immunity from liability for physicians and nurses who work in government-funded public health programs. PREP Act (Public Readiness and Emergency Preparedness Act) provides immunity from tort liability under state and federal law only for H1N1

13. 8/18/09 Monitoring Vaccine safety Vaccine Adverse Event Reporting System (VAERS) http://vaers.hhs.gov/http://vaers.hhs.gov/ Active Surveillance MCOs representing 3% of the U.S. pop. Vaccine Safety Datalink (VSD) Active surveillance for GBS with case follow-up

14. 8/18/09 Reimbursement We expect health plans will reimburse for cost of administering H1N1 vaccine to plan members in their medical home Discussion re: reimbursement outside of the medical home on-going at state and federal levels

15. 8/18/09 What We Don’t Know Demand for H1N1 vaccine Willingness/ability of traditional and non-traditional providers to administer vaccine Reimbursement for administration costs

16. 8/18/09 Operation PanVax Goals: Ensure that all MA residents have equal access to H1N1 vaccine within the target groups Administer vaccine to as many people as possible, as quickly as possible, for maximum protection against H1N1

17. 8/18/09 State responsible for vaccine allocation and distribution Local public and private sector responsible for vaccine administration Operation PanVax

18. 8/18/09 Operation PanVax Many partners/vaccinators needed Providers (primary care and specialists) Local and regional public health Schools Hospitals Commercial and nonprofit community vaccinators Home Health Pharmacists Occupational health All hands on deck!

19. 8/18/09 Operation PanVax In order to receive H1N1 vaccine, providers must register with DPH H1N1 Vaccine Program Including providers already enrolled Web-based registration begins early Sept Registration enables, but not guarantees, a provider to receive H1N1 vaccine

20. 8/18/09 In order to register… You will need: MDPH Vaccine Program Provider ID Number (PIN), if you have one Medical Director name and med. license # Name and contact info for shipping contact National Provider Identifier (NPI) https://nppes.cms.hhs.gov/NPPES/Welcome.do

21. 8/18/09 H1N1 Vaccine Allocation Allocations based on: # doses of each formulation in each shipment Provider pt population Provider capacity for mass vaccination

22. 8/18/09 H1N1 Vaccine Ordering After initial allocation, providers will be able to order additional doses Hopefully on-line, along with reporting vaccine usage

23. 8/18/09 H1N1 Vaccine Registration Provider sites, not individual practitioners, should register Local health departments Hospitals Practices VNAs Pharmacies Commercial community vaccinators

24. 8/18/09 H1N1 Vaccine Registration Limited number of vax receiving sites Hospital and provider networks that can assume responsibility for the following, should register as one entity Register Receive, store and distribute vaccine Report weekly vaccine usage

25. 8/18/09 Public Health H1N1 Clinics Ideally one entity in each community Single registration with H1N1 Vaccine Program Coordinate vax receipt, storage and distribution for: Public health clinics EDS School clinics Coordinate weekly vaccine usage reporting

26. 8/18/09 H1N1 vaccination clinics must be posted on the Masspro Flu Clinic website http://flu.masspro.orghttp://flu.masspro.org

27. 8/18/09 Public Health Departments If capacity allows, LHDs may be asked, but not required, to assist with: Distributing H1N1 vaccine, and Redistributing unused H1N1 vaccine

28. 8/18/09 H1N1 Vaccine Usage Reporting Weekly web-based reporting to MDPH of: # of doses administered to each age group # of 1 st and 2 nd doses MDPH reports aggregate to CDC Probably only for the first few weeks

29. 8/18/09 Pneumococcal Vaccine Pneumococcal disease Pneumonia, meningitis, bacteremia Complication of flu Increasing antibiotic resistance Vaccinate high risk groups now > 65 years of age Chronic medical conditions Asthma, smoking State-supplied PPV23 for public providers Vaccinating those at risk for pneumococcal disease protects them now, and during the next pandemic! New!

30. 8/18/09 Seasonal Influenza Preparedness Pandemic Influenza Preparedness

31. 8/18/09