UPDATE: Clinic Dates will be changed
November 2, 2009
Flu FAQ
Several most common questions weíre receiving right now:
Where can I get a flu shot? The short answer is if you're in a high priority group and cannot find it, keep trying with your health care provider. The vaccine supply is increasing every week.†
Right now there are few if any public clinics since there is not sufficient vaccine. This is the case in many other states as well. Eventually there will be enough vaccine for anyone who wants it. In the meantime, we are distributing vaccine to those who are in the high priority groups. Right now there is a focus on pregnant women and children. So, the vast majority of vaccine is currently being distributed to schools, pediatric, and obstetrical health care providers. Early on some vaccine went to hospitals for health care workers with frequent direct contact with patients and infectious material, especially to those with contact with pediatric and obstetrical patients.† his past few days we also received a very tiny amount of some adult-only vaccine formulations for the first time, so we distributed
that to some specialty practices (pulmonary, cardiac, dialysis, etc) and large internal medicine/family practices.
Why are healthy school children getting vaccine and I cannot find any? The answer is threefold. First, all children are disproportionately affected by H1N1 and are at risk. Second, by vaccinating school children we also provide protection for the entire community since they are the major transmitters of flu. Third, because about 40% of the H1N1 vaccine formulation we have received to date is the nasal spray, which is only licensed for otherwise healthy non-pregnant people ages 2 - 49, we could not offer this vaccine to many high priority categories of people because they have underlying conditions. It therefore seemed most effective to use this vaccine with our healthy school and pre-school aged children, though we are also distributing some injectable vaccine into schools and
pediatric practices for their children with underlying conditions.
How are you deciding which schools are getting vaccine? The first few schools that held clinics this past week were simply those that had ordered early and were ready to vaccinate right away. Since then, we have received a surge of orders from schools across the state and not enough vaccine to fulfill these orders. We are distributing vaccine to those schools indicating readiness to vaccinate and we are also assuring an even distribution across the state and within counties in proportion to the population.
Who are the overall priority groups for vaccine?
They are:
Pregnant women
All people ages 6 months ñ 25 years old
People with underlying conditions who are 25 ñ 65 years old
Caregivers and household contacts of those <6 months old
Health care workers
However, it should be emphasized that these priority groups number ~700,000 in Maine, so with only 99,000 doses of vaccine in the state right now, we are asking that vaccine in state and not administered yet be prioritized for pregnant women and children.
Who are the priority groups for receiving antiviral medications (Tamiflu or Relenza) if they have symptoms of H1N1 or are heavily exposed to someone with H1N1 (eg is a household contact)? They are:
Pregnant women
Children < 2 years old
People >64 years of age
People with underlying medical conditions, including children on chronic aspirin therapy
Anyone with more severe H1N1 disease such as that involving a pneumonia or a hospitalization (which children at any age are more likely to encounter)
People in certain outbreak situations involving many at high risk: prisons outbreaks, for instance
Why are these two priority groups not the same, for instance, seniors? Epidemiology of pandemic H1N1 indicates that seniors are at low risk for contracting H1N1 since they seem to have some underlying immunity. However, if they do contract H1N1, they are at risk for complications and should receive antiviral medications.
What are the details on how the H1N1 vaccine is distributed?
As of today, 99,000 doses of pandemic H1N1 vaccine have been distributed to health care providers in Maine - just the tip of the iceberg of the total doses of vaccine that we expect to receive this flu season. This is not where we expected to be at this point, based on what we were initially told by the manufacturers and the federal government, and it creates a difficult and frustrating situation for everyone, especially those people at greatest risk of complications from the H1N1 flu.
These initial limited supplies have been prioritized for distribution to: schools as well as pediatric and obstetrical health care providers for their patients and students, including caregivers and household contacts of infants <6 months old. Some very initial supplies (10,000 doses) were distributed to hospitals for highest priority health care workers - those with frequent direct contact with patients and infectious materials, especially with pediatric and obstetrical patients. However, currently children and pregnant women are where we believe almost all of the very limited supply of vaccine should be targeted. Last week we received some small amounts of adult-only vaccine that we have distributed to some specialty and large medical practices for high-risk adults.
As vaccine supplies arrive in larger quantities, more and more health care providers will receive vaccine for their patients. Vaccine will then be more available to young adults up to 25 years old and people 25-64 with chronic health problems. Eventually, flu clinics for the general public will begin. However, they won't be scheduled until there are large enough quantities of vaccine available to support them. Based on current projections from the US CDC, these flu clinics will not likely be feasible until December. When they have been scheduled, you can find one near you at www.maineflu.gov. It is important to note that no public H1N1 clinics are listed at this time because there is not enough vaccine to run them.
This vaccine supply and distribution situation is complex and confusing. We continue to receive requests for further details on how vaccine arrives in the state, the role of Maine CDC in that process, and how we receive word on upcoming vaccine availability. Here are some details on how the system works:
There are 9 different vaccine formulations approved for various age groups and populations. Vaccine comes as thimerisol-free prefilled syringes, multi-dose vials with thimerisol, and live, attenuated virus nasal spray (Flumist). So, the doses of vaccine are not interchangeable. They can only be used for the groups they were made and approved for. More detailed information is available on the chart below.†
When a health care provider first registers with Maine CDC to receive H1N1 vaccine, they include key details about their practice, including:
Type of practice; and
How much vaccine and which formulations they would like to order.
Several times each week, Maine CDC receives notice about newly available vaccine we can expect to receive and in which formulations. We use several pieces of information to determine where the vaccine should be shipped.
We have a very high-level 4 month distribution plan based on national timelines and very rough estimates of vaccine availability. Each week (late Friday or early Monday) we receive the national estimates for vaccine availability for that week. We then develop a detailed plan for that weekís distribution. We have not distributed this plan because it changes as the week progresses, since each week some vaccine formulations do not become available as estimated and other factors change unexpectedly.
That one-week plan is based on several pieces of information. First, we use the tables of estimated amounts of each vaccine formulation available in Maine for the week that we derive from the national estimates. Second, we use details provided to our vaccine registration system by health care providers who have ordered vaccine to match the type of health care provider they are and the types of patients they have ordered for with the types of vaccine formulation available. Third, we use tables of information compiled by our Vaccine Coordinators in each DHHS District on which health care providers have ordered for high priority settings such as schools and day cares, how many doses these settings need, and when these settingsí clinics are scheduled for or generally how ready they are to administer the vaccine.
Fourth, we use tables of information showing where vaccine has already been shipped in Maine and the population numbers for each area, in order to assure even distribution across the state related to the population.
Each morning when we receive a vaccine allocation, we sit with that weekís plan and all the various pieces of information to decide where to ship vaccine. The staff in the Maine CDCís Immunization Program must also simultaneously order the appropriate amount of type of supplies, which are shipped separately from the vaccine. It is all a very complicated process of braiding a large number of factors together to try to insure vaccine is being distributed to where it is most effective.†
For instance, pregnant women and people with underlying conditions cannot take the nasal spray. So, if the only vaccine available to us is nasal spray, we cannot send that new quantity to obstetricians. It can however, be administered to healthy children, and would therefore likely be sent to pediatricians and schools. The first 3 weeks of October, the very vast majority of vaccine coming into Maine was nasal spray, which is one reason we focused on providing vaccine through schools, and why there was not vaccine available for people with underlying conditions, since this formulation of vaccine is inappropriate for them.
There are about 600 health care providers in Maine who have signed up with Maine CDC to receive H1N1 vaccine this year. The actual number of vaccination sites is higher, because some of the larger providers, such as some hospitals, will further distribute their allocations of vaccine to their affiliated health care provider locations and schools. Almost all obstetrical and most pediatric practices that have registered with us and ordered vaccine have received some doses, but almost none has received all that they ordered.
Unfortunately, the vaccine supply is unpredictable during these early days of distribution, and at this time, the state does not have enough vaccine for everyone in the highest priority groups. Maine has a total of 1.37 million people, with 700,000 people fitting into one of the 5 high priority groups. As of November 1st there are 99,000 total doses of vaccine distributed into Maine. Thatís 1 dose per 7 in the high priority groups, and 1 in 14 for the population as a whole. 600 health care providers have ordered close to 800,000 doses of vaccine. Clearly, there will be a deficit of vaccine supply to meet the demand for a while. But, eventually there will be sufficient vaccine for all health care providers who want to administer it and for all people who want it.
Maine CDC is frustrated, as many are, about the current situation. Regrettably, neither the states nor the federal government have the ability to speed vaccine production. What we can do is pledge to distribute the vaccine to the appropriate providers as soon as it becomes available and to keep providing the most up to date information on the situation.
Manufacturer
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Dose/ Presentation
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Age Group
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sanofi Pasteur
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0.25 mL† prefilled syringe
0.5 mL prefilled syringe
0.5 mL vial single dose vial
5.0 mL multidose vial
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6-35 mos
> 36 mos
> 36 mos
> 6 mos
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Novartis
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0.5 mL prefilled syringe
5.0 mL multidose vial
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> 4 yrs
> 4 yrs
|
CSL Biotherapies
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0.5 mL prefilled syringe
5.0 mL multidose vial
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> 18 yrs
> 18 yrs
|
MedImmune
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Nasal Spray
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Healthy, non-pregnant 2 ñ 49 yrs
|
September 23, 2009
On February 25, 2009, the Advisory Committee on Immunization Practices (ACIP) made policy recommendations for use of seasonal influenza vaccine for the 2009-2010 influenza seasons. Starting with this upcoming influenza season (2009/2010). All children aged 6 months through 18 years are recommended to receive vaccination against seasonal influenza for the 2009-2010 influenza season. We expect that there will be an increase in the number of parents who will want to have their children vaccinated against seasonal influenza. It will be impossible for all these children to be vaccinated at their local healthcare provider offices.
In light of this new influenza recommendation the Departmentof Education (DOE) and the Maine Immunization Program (MIP) is offering seasonal influenza immunization clinics in your child’s school for all school aged children who are students in SAD#61. Tentative dates for influenza clinics in the school district are September 25, 29, and 30, October 5 and 7. When the date for your school is determined you will be informed. The school influenza clinics will be held during the normal school day. Times will be established for each grade level and parents are encouraged to accompany their young children.
If you have any questions, please contact the school nurse.
Sincerely,
The Department of Education and the Maine Immunization Program
May 29, 2009
All: Our SAD #61 H1N1 team met today to review the most recent information available from Maine CDC and to consider any resulting modifications to our District responses. Today's posting on the CDC website contains the following guidance for Maine schools:
"We advise schools to follow the recommendations of the Maine CDC and U.S. CDC with regard to the H1N1 flu:
o Individuals with fever (100 F or 37.7 C) and sore throat or cough may have influenza. These persons should remain home from school for seven days or until symptoms are gone for 24 hours, whichever is longer.
o Individuals who test negative for influenza by a PCR test may return to school when asymptomatic. A negative rapid antigen test is not an acceptable substitute for a PCR test because of a significant proportion of false negative results.
o The above guidance remains in effect even if an individual has a note from a physician, unless an alternative diagnosis is supported by laboratory results (e.g., strep throat, pertussis)
o If an individual has fever alone, vomiting or diarrhea, a sore throat or a new cough, he/she should remain home from school until symptoms are gone for 24 hours.
All of the above strategies can: delay the peak of the disease in order to “buy time” for the production and distribution of a vaccine against this new virus; decrease the number of people who get sick from this virus in a given community, thus reducing any surge on healthcare systems; and reduce the total number of people who get sick or die."
Thus, we will keep in place our current practice of maintaining the 7 days out of school when students or faculty have flu-like symptoms. Our previous protocol (return after 48 hours of being symptom free with a doctor's note) is not consistent with the CDC's most recent guidance, and will therefore be dropped from our options. So it's 7 days minimum when folks have the flu!
We are planning to go ahead with all events as scheduled, but with our recent practice in place of having hand sanitizer available and encouraging folks who are sick to remain away.
Please share this message with staff.
Have a great weekend!
Patrick
April 30, 2009
In our ongoing efforts to keep parents informed of evolving public health implications of the outbreak of H1N1 (swine flu), I am providing the following information:
Maine has now at least three cases of confirmed H1N1 influenza. The cases are in central and southern Maine and have resulted in the closure of the Kennebunk Elementary School and a day-care facility in the community. This instance reflects the Maine CDC’s approach to curtailing the spread of the virus: one positive test result will lead to an immediate closure of the school for seven calendar days. As we reported to you yesterday, all families need to be monitoring media—just as you would for possible snow days—as we will be notifying the same TV and radio stations if one or more of our schools will be closed.
It is extremely important that parents use good judgment if any of your children show flu-like symptoms, especially fever in conjunction with coughing and sneezing. Please do not send students to school if they have any such symptoms. This influenza typically lasts seven days. Students should not return to school until they have been symptom free for 48 hours.
If such symptoms appear, we have been advised by Maine CDC to advise parents to seek medical attention and, if your physician recommends, undergo testing for the H1N1 virus. Maine CDC is gathering data on a daily basis to make informed judgments about public health responses. The better the data, the better their decisions can be.
The District has taken a number of steps to monitor the status of the outbreak and to minimize the likelihood of school closures, including:
Posting notices for all visitors to school to use hand sanitizer upon entry, to avoid coming into SAD 61 buildings if experiencing flu symptoms, and to be made aware of common practices for curtailing the spread of influenza;
Evaluating on a case-by-case basis all trips and activities for possible postponement or cancellation (all such news will be posted on the District’s website at www.sad61.k12.me.us);
Intensifying all cleaning and hygiene practices; and
Remaining in daily contact with the Maine Department of Education and monitoring announcements from Maine CDC.
We also will be waiving any attendance requirements when students are absent due to the influenza to ensure that parents and students need not worry about potential negative consequences of missing school. Maine DOE will also be waiving minimal attendance requirements if schools are closed due to influenza outbreaks.
We will continue to keep you informed of all information regarding this extreme public health emergency.
Sincerely,
Patrick R. Phillips, Superintendent of Schools
April 29th, 2009
M.S.A.D.#61 Initial Response to
Swine Influenza A
Everyone has an important role in making sure the swine flu has a minimal impact in Maine, including parents and students. People returning from out-of-state vacations need to pay close attention to their health. If you become sick with the symptoms of the swine flu (coughing, sneezing, fever), you should call your health care provider with your symptoms and where you have traveled in the week prior to the onset of symptoms. Stay home if you are sick, especially with a fever, regardless of your travel history, and stay home until 24 - 48 hours after your symptoms resolve.
While there are no confirmed cases reported in Maine at this time, it is important to take precautions to ensure that the CDC can quickly track and identify any outbreak. At this time, the Maine CDC recommends that schools and child care settings report any calls that they receive from parents that students are out with the “flu. Students who have flu-like symptoms at school will be sent home with parent or guardian, and in the event the student or family members have traveled over the vacation, a doctor’s note will be required for readmission to school.
If the extent of the outbreak becomes more serious, and as we receive new information from the CDC, our District’s response plan may change.
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