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, 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.

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