1. Live, attenuated intranasal H1N1 vaccine

2. Indications Healthy people 2-24 years old Those 25-49 and – Live with or care for infants younger than 6 months – Health care or emergency medical personnel As becomes more available, any healthy 2-49 year old

3. Contraindications Allergy to: – Previous influenza vaccine – Eggs, egg products, gentamicin, gelatin, arginine Fever or acute illness Age less than 2 or greater than 49 Pregnant females Immunocompromised or contact with History Guillain-Barre syndrome Long term medical condition

4. Contraindications All not absolute – Discuss with nurse or physician May “qualify” for injection

5. Vaccine Considerations For 2009, only one manufacturer – MedImmune Supplied in pre-filled unit-dose nasal syringes Storage: 35-46° F (2-8° C) Can be administered at same time as any other vaccine EXCEPT another intra-nasal vaccine

6. Dosing 0.2mL (0.1mL per nostril) Dosing same regardless of age Age 2-9: 2 doses 3-4 weeks apart Age 10-49: 1 dose sufficient

7. Procedure Obtain and verify vaccine – Colorless to pale yellow – Clear to slightly cloudy – Some small proteinaceous particles may be present Ensure VAR complete

8. Procedure Patient in upright position Remove rubber tip protector Insert tip just inside nare Rapidly depress plunger until dose-divider clip stops Remove from nose, remove dose-divider clip, and administer remainder in opposite nare

9. Considerations If patient sneezes, no need to repeat Immunocompromised should not give vaccine Possible reactions – Runny nose or congestion – Fever, chills, malaise, myalgia – Headache, sore throat, nausea, vomiting