H1N1 Vaccine Coming in October

The Centers for Disease Control and Prevention (CDC) has notified Texas Department of State Health Services (DSHS) officials that Texas can expect to receive its first shipment of novel H1N1 flu vaccine during the first week of October, a second shipment by mid-October, and regular weekly shipments by the end of the month.

DSHS will coordinate ordering and distributing the vaccine and has established a procedure physicians must follow to order it.

Physicians must register at www.TexasFlu.org. Although DSHS encouraged physicians to preregister by Sept. 13 to aid statewide planning, officials now say preregistration will continue throughout the H1N1 vaccination campaign.

The H1N1 vaccine is free to physicians and vaccine recipients. A DSHS memo says details on reimbursement for administering the vaccine will be distributed when available.

CDC also notified states that the syringes, needles, sharps containers, and alcohol swabs will be provided for free. Shipping information on these items is not available.

The Texas Vaccines for Children Program (TVFC) will not offer the vaccine. TVFC physicians must use the novel H1N1 ordering process.

Provider Registration
The preregistration form physicians must fill out also asks for:

Shipping address, hours when vaccine deliveries are accepted, and contact information;
An estimate of the maximum number of doses you can receive for your initial order, based on your refrigeration capacity;
An estimate of the number of seasonal influenza doses administered during the 2008-09 influenza season;
The ImmTrac PFS number if currently enrolled in ImmTrac, and TVFC PIN number if you are a TVFC provider, and
Your best estimate of the number of patients (not number of doses) you expect to vaccinate, by age and risk categories (if a patient falls into more than one category, enter that patient in only one group):

Children 6-23 months
Children 24-35 months
Children 36-47 months
Children 48-59 months
Children 5-18 years, by high risk and non-high risk
Adults 19-24 years, by high risk and non-high risk
Adults 25-64 years, by high risk and non-high risk
Adults 65 years and older
Pregnant women
Health care and EMS personnel – w/direct patient contact
Health care and EMS personnel – all other
Household contacts and caregivers of infants younger than 6 months

Final Registration
Final registration will come later and will consist of electronically signing the H1N1 Provider Agreement required by CDC. DSHS will notify physicians when the final registration is available.

Vaccine Ordering
Once the vaccine is available, DSHS will e-mail physicians to log on to www.TexasFlu.org to approve their order. You can only reduce the number of doses ordered until more vaccine is available. Then you can order more from www.TexasFlu.org. The type of vaccine (intranasal or injectable), allocation, and timing will be based on priority populations.

Doses Administered and ImmTrac Reporting
CDC requires each state to report weekly on doses administered. All physicians who receive novel H1N1 vaccine must agree to report doses-administered information to DSHS each week. DSHS is developing an online reporting system that will allow physicians to report aggregate doses-administered information weekly. The system will allow physicians to report doses administered by dose one or dose two and by various age groups (CDC specifications).

You can use ImmTrac, the statewide immunization registry and disaster preparedness and tracking system, to report specific vaccination information on each person immunized regardless of age in this novel H1N1 response situation. The person immunized can then retrieve his or her immunization record in the future.

Additional Information for Physicians
Report any adverse reaction to the vaccine that requires hospitalization or causes disability or death to the Vaccine Adverse Event Reporting System (VAERS). You also can call the VAERS Information Line at (800) 822-7967.

Additional information is available at www.TexasFlu.org.

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A Letter from your ACOG District Officers:

As the State of Texas are preparing for the H1N1 flu, please be aware of the following key facts:

Pregnant women are at high risk of severe infection and complications from the novel N1H1 flu.

Pregnant women with severe H1N1 influenza can experience adverse pregnancy outcomes.

Infected pregnant women may require hospitalization for treatment, and some will need ICU critical care.

Prevention and early treatment are the essential components to control of H1N1 infection. We ask you, as a Women's Health Provider, to help spread this message:

Step 1 is Prevention:

1. Preregister for the H1N1 vaccine (through www.texasflu.orgwebsite) or the Texas Dept of State Health Services (https:/vaccineregistration.questionpro.com/) - the vaccine is free, and your office personnel can register for the vaccine

2. Encourage all your pregnant patients to receive the seasonal flu vaccine.

3. Encourage all your pregnant patients to receive the H1N1 vaccine.

4. Educate your patients regarding hand washing and staying away from people ill with flu-like symptoms.

5. Develop a plan for quickly identifying sick individuals who come into your office, clinic or hospital waiting areas. You can use isolation, masks, and segregation.

6. Use antiviral chemoprophylaxis if susceptible pregnant patients are exposed to influenza.

Step 2 is Treatment:

1. Treat antepartum infection as early as possible with oseltamivir (Tamiflu) or zanamivir (Relenza), optimally in the first 48 hours of symptoms. Use antipyretics to control fever, too.

2. Treat pregnant women empirically, based on your clinical suspicion. Do not delay treatment waiting for test results to confirm your diagnosis or withhold treatment if testing is not available.

3. Healthy pregnant women may have a rapid progress to severe infection. Be vigilant for viral pneumonia and secondary bacterial infections. Monitor for signs of fetal distress and preterm labor.

Novel H1N1 Vaccine Information:

The State recently announced that the novel H1N1 flu vaccine will not be available through traditional vaccine distribution channels, but rather will be distributed exclusively through the Texas Department of State Health Services. To receive the vaccine, physicians must register at www.texasflu.org or https://vaccineregistration.questionpro.com/. Physicians must be able to estimate the number of office personnel and patients in each age and risk category that are to be vaccinated. For more information, physicians can call 1-877-623-6274.

The vaccine will be free. The details on the administration fee are not final at the federal level, but it is expected that an administrative fee will be reimbursed by the government programs and the private plans. The vaccine is expected to be available by mid-October.

It is recommended that the following groups are vaccinated first:

• pregnant women;
• household contacts and caregivers of children younger than 6 months;
• healthcare and emergency medical services personnel;
• all people from 6 months to 24 years of age; and
• persons aged 25 through 64 years who have health conditions associated with a higher risk of medical complications from influenza.

Seasonal flu vaccine should arrive in early September. H1N1 vaccine will not protect against seasonal flu. The seasonal flu vaccine should be given as soon as possible, and both vaccines can be given simultaneously. Do not wait for H1N1 vaccine before giving seasonal flu vaccine.

Key Resources:

1. To view the latest information from ACOG, go to: http://www.acog.org/departments/dept_notice.cfm?recno=20&bulletin=4866

2. To view Dr. Gerald Joseph's letter on this subject, click here: http://www.acog.org/departments/dept_notice.cfm?recno=30&bulletin=4902.

3. Updates on how the state is responding will be available at Texas Department of State Health Services web site: http://www.texasflu.org. You can also sign up to receive daily updates.

4. The Center for Disease Control Web site can be viewed at www.flu.gov.

5. Updates from the American Public Health Association can be viewed at www.apha.org .