Flu Advisory

MMS Flu Advisory: H1N1 Vaccine Recommendations Expanded to All Residents

Posted in Flu, Flu Advisory, H1N1 on December 17th, 2009 by MMS – Comments Off on MMS Flu Advisory: H1N1 Vaccine Recommendations Expanded to All Residents

Flu Advisory BoxAlthough it remains focused on vaccinating priority groups, the state Department of Public Health (DPH) today expanded H1N1 vaccine recommendations to all residents. To date, DPH has distributed over two million doses of the H1N1 vaccine, and expects to receive additional large shipments from the federal government in the next month.

DPH’s initial target for shipments were health care providers vaccinating the priority groups, including pediatric and obstetric providers, but it is now shipping vaccine to internal medicine. While not all physicians who have registered with the DPH have received their full supply, DPH expects they will in the next several weeks. Physicians who would like to receive vaccine must register with the DPH; there is no charge for the vaccine.

DPH has also asked local public health departments to begin planning large-scale public flu clinics open to all residents. As these clinics are planned they will be posted on http://flu.masspro.org.

MMS Flu Advisory: H1N1 Increasing in Massachusetts

Posted in Flu, Flu Advisory, H1N1 on November 3rd, 2009 by MMS – Comments Off on MMS Flu Advisory: H1N1 Increasing in Massachusetts
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H1N1 in Massachusetts
There has been a continuous increase in influenza-like illness (ILI) in Massachusetts over the last few weeks.
The Massachusetts Department of Public Health (MDPH) continues to receive reports of ILI clusters in schools and the State Laboratory is receiving an increased number of specimens for H1N1 testing. Follow-up of individual cases by MDPH epidemiologists and local health departments continues to focus on severely ill and hospitalized cases.
From October 4 – 29, 1004 cases of H1N1 have been confirmed by the state laboratory, including 14 hospitalizations and one death due to laboratory-confirmed 2009 H1N1 influenza were reported in Massachusetts.

The Emergency Use Authorization of Peramivir for Treatment of 2009 Influenza A (H1N1)
On November 2, The New England Journal of Medicine released a Perspectives article on The Emergency Use Authorization of Peramivir for Treatment of 2009 Influenza A (H1N1).
H1N1 Vaccine in Massachusetts

MDPH reports that, by the end of this week, more than 660,000 doses of H1N1 vaccine will have been distributed to providers in Massachusetts, enough to vaccinate 10% of the state’s population. Massachusetts expects to receive a total of 3.5 million H1N1 vaccine doses this flu season.

These initial limited supplies have been prioritized for distribution to the health care providers who serve the populations at the highest risk of H1N1 flu – pregnant women, children, and caregivers of infants less than 6 months old. It has also been prioritized for health care workers with direct patient contact in light of their vital role in keeping the health care system working. MDPH believes this targeted distribution approach, using health care providers who serve these high risk groups every day, is the most effective way to ensure the vaccine gets to those who need it most as quickly as possible.
As vaccine supplies arrive in larger quantities, more and more providers will receive vaccine for their patients. Vaccine will then be targeted to young adults up to 24 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 Centers for Disease Control, these flu clinics will not likely be feasible until December. When they have been scheduled, they will be listed on http://flu.masspro.org, searchable by town or zip code. No H1N1 clinics are listed at this time.

MDPH Vaccine Distribution Processes

In response to requests for details on how vaccine arrives in the state, the role of MDPH in that process, and how providers receive word on upcoming vaccine availability, MDPH has provided the following information:

There are 9 different vaccine formulations approved for various age groups. Vaccine comes as thimerisol-free prefilled syringes, multidose vials with thimerisol, and live, attenuated virus nasal spray (Flumist). So, the doses of vaccine are not interchangeable. Each formulation can only be used for the groups for which it was made and approved.
When a provider first registers with MDPH to receive H1N1 vaccine, they include key details about their practice, including:

• Type of practice and target patient population served
• Capacity to vaccinate (how many people could they vaccinate in a month with sufficient  vaccine supplies)
• Whether they are willing to receive live attenuated vaccine formulations (e.g., Flumist vaccine)
• How much vaccine and which formulations they would like to order
Several times each week, MDPH receives notice about how much newly available vaccine, in which formulations, it can expect to receive. It uses the information in the vaccine registration system to figure out where that vaccine should be shipped. For instance, pregnant women can’t take Flumist, so if the only vaccine available is Flumist, it will not be sent to OB/GYNs. It can however, be administered to healthy children, and would therefore be sent to pediatricians.
MDPH does not play any role in physically receiving and redistributing H1N1 vaccines, which are shipped directly to providers in the community. However MDPH does match up available formulations to appropriate providers as vaccine comes off the production line.
More than 4,000 health care providers in Massachusetts have signed up with MDPH to receive H1N1 vaccine this year. (The actual number of vaccination sites is higher, because some of the larger providers will further distribute their allocations of vaccine to their affiliated provider locations.) Virtually all of the providers that serve the priority groups have received some amount of vaccine and will receive more in the coming weeks. However, very few have received all of the vaccine that they wanted because we just have not gotten enough vaccine yet.
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. Massachusetts has 3.4 million residents that fall into one of the target groups for H1N1 vaccine.

MMS Flu Advisory: H1N1 Vaccine Allocation in Massachusetts

Posted in Flu, Flu Advisory, H1N1 on October 23rd, 2009 by MMS – Comments Off on MMS Flu Advisory: H1N1 Vaccine Allocation in Massachusetts
H1N1 Vaccine Allocation in Massachusetts
flu badgeTo date, the Massachusetts Department of Public Health (MDPH) has received approximately 270,000 doses of H1N1 vaccine in all formulations, or between 5% and 10% of the total H1N1 doses it expects to receive this season.
MDPH has prioritized allocation of H1N1 vaccine to ob-gyn, pediatric, family and multi-specialty practices in order to reach the priority populations of pregnant women, health care workers and youth (including high risk youth). In addition, all registered hospitals and community health centers have been prioritized to receive vaccine. This week, the MDPH H1N1 Vaccine Program began allocating limited quantities of vaccine to Local Boards of Health.

Provider Reporting of Doses Administered
Providers receiving H1N1 are required to report use to the MDPH. MDPH’s system for reporting of doses administered went live on Friday, October 9. On Tuesday, October 20, MDPH reported to the CDC a total of 51,879 doses administered in Massachusetts from October 11-17.

Registration for H1N1 Vaccine
Providers who would like to receive and administer H1N1 vaccine may still register with MDPH. As of 10/21/09, 2,416 sites registered as primary sites to receive H1N1 vaccine. These primary sites registered an additional 1,807 secondary sites for a total of 4,223 sites across the Commonwealth. If you have questions about registering or reporting, please contact the MDPH H1N1 Vaccine Program Help Desk:
o Help Desk phone number: 888-578-5585
o Help Desk email address: MDPHH1N1Registration@state.ma.us
For additional information, including clinical and patient resources, visit www.mass.gov/flu.

MMS Flu Advisory: Seasonal Flu Vaccine Supply

Posted in Flu, Flu Advisory on October 20th, 2009 by MMS Communications – Comments Off on MMS Flu Advisory: Seasonal Flu Vaccine Supply
MDPH Announces Seasonal Influenza Vaccine Shipment Delaysflu badge
Massachusetts Department of Public Health (MDPH) today informed its providers that the remainder of its seasonal flu vaccine supply is expected to arrive over the course of the next 4-6 weeks with the balance of MDPH vaccine not arriving until the end of November. MDPH had previously projected all seasonal vaccine would be available by early November. To date, MDPH has received and distributed 631,530 doses of state-supplied seasonal flu vaccine, which is 71% of its total order of 885,000 doses.

MDPH states that the supply situation is similar for private-purchased seasonal flu vaccine. As of October 2, 2009, approximately 61%, or 77 million doses, of the expected doses for this season had been distributed nationally.

For questions regarding seasonal flu vaccine availability, please contact the MDPH Vaccine Management Unit at 617-983-6828.


MDPH Recommendations for Physicians
MDPH recommends that pediatric and other providers continue to vaccinate their patients with seasonal influenza vaccine during routine visits and in scheduled clinics as supply allows based on their available vaccine supply and formulation types.


 
Flu Clinics at Local Health Departments and Schools
MDPH is recommending that local health departments and schools delay large public clinics and school-based seasonal flu clinics until additional information about vaccine supply is available, unless they have an adequate amount of vaccine on hand to meet the expected demand.

 
Flu Clinic Locator
Physicians who do not have vaccine can refer patients seeking seasonal or H1N1 flu vaccination to http://flu.masspro.org for a searchable database of locations offering flu vaccination in their area. Currently there are no public H1N1 vaccination clinics currently scheduled in the state.

MMS Flu Advisory: Vaccine Adverse Events Reporting

Posted in Flu Advisory, H1N1 on October 13th, 2009 by MMS – Comments Off on MMS Flu Advisory: Vaccine Adverse Events Reporting
Vaccine Adverse Events Reportingflu badge
The Massachusetts Department of Public Health and the CDC remind you to report clinically significant adverse events after vaccination, whether or not you administered the vaccine and even if you are not sure if the vaccine caused the adverse event. Clinically significant adverse events are those events that are of concern to you or your vaccinated patients or their caregivers.

VAERS, the Vaccine Adverse Events Reporting System, a US vaccine safety surveillance system, co-managed by the CDC and FDA, collects and analyzes voluntary reports of adverse events following vaccination to identify potential vaccine safety concerns that may need further study or public health action.
To report to VAERS:
1) Submit a report online via a secure federal Health and Human Services website
2) Fax a completed VAERS form to 877-721-0366, or
3) Mail a completed VAERS form to VAERS, P.O. Box 1100, Rockville, MD 20849-1100.
A VAERS form may be downloaded from the VAERS. For additional information on VAERS or vaccine safety, visit the VAERS website at www.vaers.hhs.gov or call 800-822-7967. You can also call the Massachusetts Department of Public Health at 617-983-6800 and ask to speak with a nurse or epidemiologist if you have any questions.

Influenza Vaccination Record Cards
Influenza vaccination record cards will be given to people who receive 2009 influenza A (H1N1) monovalent vaccine, and can be used to track H1N1 and 2009-10 seasonal influenza vaccination information. The information on this card may be helpful in completing a VAERS report for an adverse event that occurred after 2009 H1N1 vaccination.

MMS Flu Advisory: H1N1 Vaccine in Massachusetts

Posted in Flu Advisory, H1N1 on October 9th, 2009 by MMS – Comments Off on MMS Flu Advisory: H1N1 Vaccine in Massachusetts
H1N1 Vaccine in Massachusettsflu badge

H1N1 vaccine has begun arriving in Massachusetts. The state Department of Public Health (MDPH) reports it has received 3.1% of what Massachusetts will receive over the next 3 to 4 months. The state is allocating the doses it is currently receiving, and those it will receive in the next 3 weeks to clinical sites. By the end of this week (October 9), all Massachusetts hospitals and community health centers, many pediatric care providers, and some obstetric care providers will have received small quantities of H1N1 vaccine.
After October 23, MDPH expects to allocate a significant percentage of H1N1 vaccine to local health to allow public clinics to begin in November.
As of 10/7/09, 2,191 sites registered as primary sites to receive H1N1 vaccine. These primary sites registered an additional 1,604 secondary sites.
Visit the Massachusetts Department of Public Health (MDPH) and the CDC H1N1 websites for additional guidance on H1N1 vaccine.

Influenza-Like Activity in Massachusetts

In Massachusetts, the current ILI (influenza-like illness) activity level is ‘regional,’ defined as ‘Outbreaks of influenza or increases in ILI and recent laboratory confirmed influenza in at least two but less than half the regions of the state with recent laboratory evidence of influenza in those regions.’ Thirty-seven states are reporting ‘widespread’ activity indicating flu or ILI in at least half of the regions of the state.
In Massachusetts since April 2009, 184 people with H1N1 have been hospitalized and 12 have died. Of those deaths, 10 had underlying conditions. Over 63% of H1N1 cases have been aged 18 or younger; the median age is 14 and cases have ranged from 0 to 84 years old.

Handling and Administration of Seasonal and H1N1 LAIV

The updated Handling and Patient Administration of Live, Attenuated Influenza Vaccine (LAIV) video is now available on FluMist.com. Watch the video to learn how the intranasal vaccine works in the body, how it is stored, and how it is administered to eligible patients. The instructions in this video apply to both seasonal and H1N1 LAIV.�


H1N1 Vaccine Information Statements (VIS) Available

Vaccine Information Statements (VIS) dated October 2, 2009 for injectable and intranasal vaccine for 2009 H1N1 Influenza are available in English online.
Click here for the VIS for injectable 2009 H1N1 influenza vaccine.
Click here for the VIS for intranasal 2009 H1N1 influenza vaccine.

Seasonal Flu Vaccine Availability

Although manufacturers have produced 114-115 million doses of seasonal flu vaccine, some providers are experiencing shortages, and either have not received their full shipment, or are unable to order more. This may be due to significantly increased demand for vaccine, delays in some shipments of vaccine, and slightly (3%) lower production than originally projected.
Providers who have not received their preordered vaccine:
• If your vaccine is supplied by the state, contact the DPH Immunization Program at 617-983-6828.
• If you privately purchase vaccine, contact your distributor.
• If you purchase directly from Sanofi Pasteur, Sanofi expects to deliver every customers’ full reservation of Fluzone vaccine, but will communicate specific shipping information to customers only after doses are available and ready to ship.
New Orders of Seasonal Flu Vaccine
Few sources are currently taking new orders for vaccine, but that as double-booked orders open up, doses are expected to once again become available.
To find out what distributors have  vaccine in stock, check the online spreadsheet maintained by the National Influenza Vaccine Summit, which is co-sponsored by the Centers for Disease Control and Prevention and the American Medical Association. The spreadsheet lists distributors with flu vaccine currently in stock, and their contact information.

Public Flu Clinics

If you are unable to accommodate your patients’ requests for a seasonal flu vaccination, they may be directed to flu.masspro.org, a database of public seasonal flu vaccine clinics in Massachusetts, searchable by zip code or town.

MMS Flu Advisory: Mass. Announces First Autumn Death from H1N1

Posted in Flu, Flu Advisory, H1N1 on October 2nd, 2009 by MMS – Comments Off on MMS Flu Advisory: Mass. Announces First Autumn Death from H1N1

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The victim was a 55-year-old woman from Middlesex County with "multiple underlying health conditions."

Department of Public Health Commissioner John Auerbach's statement said, in part, “While most cases of H1N1 in
Massachusetts and across the nation have been relatively mild, this
news demonstrates once again how serious flu can be.”

Read the complete DPH announcement.

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MMS Flu Advisory: September 30 Statewide H1N1 Webcast

Posted in Flu, Flu Advisory, H1N1 on September 29th, 2009 by MMS – Comments Off on MMS Flu Advisory: September 30 Statewide H1N1 Webcast

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The state Department of Public Health will host a webcast of its Statewide H1N1 Conference.

The webcast will be archived on the webcast web site for one year. The program will include an H1N1 situation update and outlook for the months ahead, and discussion of activities related to H1N1, clinical management, surge capacity, vaccination, DPH communications activities, school and university issues.

To view the webcast, visit: http://video.webcasts.com/events/pret001/32329/

If you have trouble with the link, please copy and paste it into your web browser.

Source: Massachusetts Department of Public Health (September 29, 2009).

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MMS Flu Advisory: New CPT Codes for H1N1 Immunizations

Posted in Flu, Flu Advisory, H1N1, Swine Flu on September 28th, 2009 by MMS – Comments Off on MMS Flu Advisory: New CPT Codes for H1N1 Immunizations

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The AMA today announced two new CPT codes for the upcoming H1N1 immunizations. Coding from the AMA:

Use code 90470 to report H1N1 immunization administration and counseling. Code
90663 was revised by the CPT Editorial Panel to refer specifically to
the H1N1 vaccine product. Both, revised code 90663 and Category I CPT
Code 90470 are effective immediately.

For quick reference, the two codes are below:

90470-H1N1 immunization administration (intramuscular, intranasal), including counseling when performed

90663-Influenza virus vaccine, pandemic formulation, H1N1

For more information:

http://www.ama-assn.org/ama/pub/news/news/cpt-codes-h1n1-immunizations.shtml

MMS Flu Advisory: FDA Approves H1N1 Vaccine; Some Seasonal Flu Vaccine Shipments Delayed

Posted in Flu, Flu Advisory, H1N1, Swine Flu on September 17th, 2009 by MMS – Comments Off on MMS Flu Advisory: FDA Approves H1N1 Vaccine; Some Seasonal Flu Vaccine Shipments Delayed

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The U.S. Food and Drug Administration has approved four vaccines against the 2009 H1N1 influenza virus. The vaccines will be distributed nationally after the initial lots become available, which is expected within the next four weeks. The state will be responsible for distributing vaccine to health care and public health providers. Massachusetts health care practices wishing to receive vaccine must complete an online registration by October 9. Click here to read the FDA press release.

Seasonal Flu Vaccine Delayed
Due to prioritization of H1N1 vaccine and other challenges, remaining shipments of seasonal flu vaccine may be delayed. The state Department of Public Health (MDPH) has received over 40% of its seasonal flu vaccine supply to date. Remaining doses are expected to become available over the next 4-6 weeks. The majority of doses are still expected by the end of October and all doses expected by early November. Additionally, doses of both state-supplied and privately purchased pediatric formulation vaccines (0.25ml pre-filled syringes for <4 years of age) have also been delayed. Currently, less than 30% of the state’s total supply is available now; the majority of doses are expected to be delivered by the end of October. 

Almost all of the influenza viruses currently circulating are H1N1.

MDPH Recommendations
MDPH recommends that all health care providers continue to vaccinate patients with seasonal influenza vaccine during routine visits and in scheduled clinics as supply allows.

Pediatric Providers
MDPH recommends that pediatric providers:

  • Continue to vaccinate patients based on their available vaccine supply and formulation types.
  • For infants who cannot now be vaccinated due to lack of current supplies, schedule vaccination appointments in late October, when MDPH expects supplies of both state-supplied and privately-purchased pediatric formulation seasonal flu vaccine to be sufficient.
  • Plan for simultaneous administration of both seasonal and H1N1 flu vaccine starting in mid-late October. H1N1 flu vaccine will become available starting in early October. Young children are one of the highest risk groups for H1N1 influenza. Pediatric providers will be allocated some of the initial doses of H1N1 vaccine that become available in Massachusetts. Note: Doses of the intranasal H1N1 LAIV and seasonal LAIV must be separated by 4 weeks, but  you can administer H1N1 and seasonal vaccines simultaneously if one or both vaccines are the injectable vaccine.

School and Public Clinics
MDPH is recommending that large public clinics and school based flu clinics be delayed until mid October (and possibly into early November) unless there is sufficient vaccine on hand to meet the expected demand.  By mid-October, we anticipate vaccine supplies will be sufficient to mount large clinics efforts. 

MDPH is advising schools and public health departments to anticipate holding clinics for H1N1 flu vaccine starting in early November as well, and to consider offering both seasonal and H1N1 flu vaccine at these clinics.

Sources: U.S. Food and Drug Administration (September 15, 2009) and Massachusetts Department of Public Health (September 17, 2009).

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