BAPMG News

Standard Protocol for Influenza Vaccination

Sunday, 08 November 2009 18:31

The standard protocol for an Influenza Vaccination season relies on two essential factors.  First there must be an adequate supply of vaccine.  Secondly we must have ample time between when we receive the vaccine and the onset of Influenza illness.  During a normal year we order our entire allotment in January and receive it in September.  That gives us three months to distribute the vaccine before flu season begins in January (usually).  The most expeditious way to administer the vaccine to all needy patients is to run multiple flu “clinics” and to vaccinate healthy patients and siblings when they come to the office for other reasons such as well child checks.  

H1N1 vaccine Vaccination Program

This year we have been presented with the task of a distributing a second set of vaccinations.  Compounding that monumental task is the fact that we have very limited supply of vaccine and had no lead time before the illness arrived in the community.   The HIN1 vaccine procurement program is managed by the federal government and shipments are made to County Public Health Departments who then distribute it to registered clinics such as ours.  We have no control over how and when we receive vaccine. Given these circumstances we are forced to modify our distribution strategies. 

The first modification is to create a need based tier system.  Patients who are at higher risk for flu related complications are in Tier 1 and those at normal risk are in Tier 2.  We maintain a waiting list for vaccine.  When we do receive shipments we begin calling Tier 1 patients in for vaccine.  If and when we receive a significant supply we will also resume vaccinating patients when the opportunity presents at well child checks.  Because shipments are unpredictable in size and type we need to adapt our distribution strategies on a weekly and sometimes daily basis.

To date we have only received about 15-20% of the needed vaccine and most of it has been the Live Attenuated Nasal Vaccine. (this type of vaccine should only be given to healthy patients over the age of three) Once we start receiving large amounts of the various injectable forms of the vaccine we will expand our distribution strategy to include some open “first come first served” vaccination days.  It is unlikely that we will have that volume of vaccine until December.

While we know that the media reports about H1N1 illness have been alarming to many of you, we want to reassure you that our experience so far has been that the illness is mild and self limited for the vast majority of patients.   In fact, even though we are seeing more influenza like illness than we have in the past twenty years; complicated cases of this H1N1 virus are exceedingly rare as compared to the seasonal virus.

Seasonal Vaccine

The regular seasonal vaccine supply has also been unpredictable this year.  The injectable preparation that can be given to children and adolescents over the age of three has been particularly difficult to obtain.  While our orders for that vaccine were placed in January of 2009, delivery of the vaccine was interrupted because the manufacturers have directed their attention to H1N1 delivery.  By contract our complete order needs to be delivered by December 1, 2009 so we expect to receive that vaccine in time to complete the vaccination process before January 2010.  Fortunately Seasonal Influenza Virus is not expected to be active before January. 

Many parents have speculated that we under ordered the vaccine this year and that is why deliveries have been delayed.  That is not the case.  Our orders placed in January were placed on time, were complete, and will fulfill our expected demand.  

We will continue to update the BAPMG web site as the supply status changes.