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Working With TheWorking With TheH1N1 Influenza VaccineH1N1 Influenza Vaccine

The single most effective way to prevent influenza disease is with influenza vaccine!

Carolee’s Corner November 2009

MPCA

cbesteman@mpca.net

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•This power point is very limited in space - It covers only a small portion of the information available

- Please check these websites frequently for updated information

www.cdc.gov/fluwww.michigan.gov/flu

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Don’t let yourself become confused: Similarities between H1N1 Influenza Vaccine and Seasonal Flu vaccine

Types Both vaccines come as

- TIV (inactivated)

- LAIV (live, attenuated)

Storage All influenza vaccine is to be stored in frig at 35°-46° F (2°-8°C)

Label ALL flu vaccine very carefully in frig

Route of administration TIV of both vaccines given IM

LAIV of both vaccines given intranasally

Presentations Both vaccines packaged by manufacturer as

- Pre-filled 0.25mL syringes

- Pre-filled 0.5mL syringes

- Multi-dose vials

Dosage Administration of both vaccines

- if 6-35 mos old -- give 0.25mL per dose

- if 3 yrs and older --give 0.5mL per dose

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Don’t let yourself become confused: (cont) Similarities between H1N1 Influenza Vaccine and Seasonal Flu vaccine

Influenza vaccines from all

manufacturers are licensed only for

specific age groups!!

Some are licensed for

- only 6-35 mos old children

- only 6 mos and older

- only 2-49 years old

- only 3 yrs and older

- only 4 yrs and older

- only 18 years and older

Check very carefully that the person to whom you are giving a vaccine fits into the licensed age group for that vaccine!

Need for Health Care Personnel to

give vaccinated

YOU need to get both influenza vaccines to protect

- Yourself

- Your patients

- Your family and friends

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Don’t let yourself become confused: (cont) Differences between H1N1 Influenza Vaccine and Seasonal Flu vaccine

Diseases -H1N1 vaccine ONLY protects against disease caused by H1N1 virus- Seasonal flu vaccine ONLY protects against Seasonal flu viruses

Groups of people who initially need vaccine

There are differences.

See next slide for priority groups for H1N1 vaccine

Who gets two doses - H1N1 vaccine: Unless contraindicated, ALL children 6 mos through 9 years of age automatically need two doses

- Seasonal Flu vaccine: All children 6 mos through 8 years need to be evaluated for two doses

Vaccines for Children (VFC) vaccine

- All H1N1 vaccine is public vaccine. You do not need to assess for VFC qualifications

- Seasonal Flu is available on VFC for children who qualify

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Priority Target Groups for H1N1 vaccine when vaccine is in limited supply • Remember: - Priority groups may change - As vaccine supply increases or decreases

Priority Group Give TIV? Give LAIV?

Pregnant women Yes No

Persons 6 mos thru 24 yrs old Yes Yes, if 2 yrs of age and older, healthy, not preg.

Persons living with or caring for infants less than 6 mos old

Yes Yes, if 2 -49 yrs of age, healthy, not preg.

Persons 25 thru 64 yrs old with medical condition that

puts them at high risk

Yes No

Health care and emergency medical services personnel

Yes Yes, if 2 yrs of age and older, healthy, not preg.

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Which Seasonal Vaccines & H1N1 Vaccines can you

give to a patient during the same visit?

Can these vaccines be given at the same time?

Two inactivated vaccines: Seasonal TIV & H1N1 TIV ? Yes

One inactivated and one live, attenuated vaccine:

Seasonal TIV and H1N1 LAIV? Yes

One inactivated and one live, attenuated vaccine:

H1N1 TIV and Seasonal LAIV? Yes

Two LAIV vaccines: Seasonal LAIV and H1N1 LAIV?

Remember the Live-Live rule: If two live vaccines are not given at the same time, they must be separated by 28 days

No

When giving Seasonal TIV and H1N1 TIV flu vaccines at the same time, administer vaccines in different sites

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Many of your patients will be wondering:

How safe is H1N1Influenza Vaccine?

• Reassure your patients that– This vaccine is made just like Seasonal Flu Vaccine

• With use of different influenza virus• By a method that has been used for many years

– H1N1 vaccine will be watched very closely for problems

• Vaccine Adverse Event Reporting System (VAERS) will be used

• We are encouraged to report any clinically significant adverse event after H1N1 vaccine to VAERS

• OK to submit a report even if the reporter is not certain that the vaccine caused the event

• Reports may be completed on line, faxed or mailed• For more information: www.vaers.hhs.gov

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Do influenza vaccines contain Thimerosal?

• Thimerosal is a preservative in some vaccines– Used in multi-dose flu vials to prevent growth of

bacteria• TIV single-dose vials and syringes are either

– Thimerosal free (Preservative Free – PF) or – Contain only a trace amount of thimerosal

• LAIV (nasal sprayers) do not contain thimerosal• Studies have NOT shown that thimerosal-

containing flu vaccine has evidence of harm to anyone, including pregnant women and children

• Benefits of flu vaccine outweigh any hypothetical risks posed by thimerosal

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Influenza Vaccine and Antiviral Medications

• Some of your patients may be taking antiviral meds

• If a patient has had influenza antiviral medication, wait 48 hours to give H1N1 LAIV (live, attenuated vaccine)

• If patient has had H1N1 LAIV (live, attenuated vaccine) wait 2 weeks to give influenza antiviral medication

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Patient Education about H1N1 Vaccine • There are FOUR Vaccine Information Statements (VIS)

– Make certain you print the Michigan-specific VIS• These contain the paragraph about MCIR• This is how patients are informed that their vaccines are

entered into MCIR

– Give correct VIS to each patient • Differentiate between H1N1 and Seasonal Influenza VIS

– Publication Date of H1N1 Flu Vaccine VIS

» 10-2-09 for both TIV and LAIV

– Do not confuse with Seasonal Flu Vaccine VIS

» Publication date 8-11-09 for both TIV and LAIV

• Differentiate between TIV and LAIV Influenza VIS– TIV – identified as inactivated influenza vaccine

– LAIV – identified as live (attenuated, nasal) influenza vaccine

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Documentation of Influenza Vaccine

• Very carefully document the specifics about which vaccine you gave– Make certain you are very clear

• Did you give H1N1 influenza vaccine? • OR was it Seasonal influenza vaccine?• Was it TIV vaccine?• OR was it LAIV vaccine?

• Document in three places– 1) In your medical charts/EMR

• Follow all the routine documentation requirements– 2) In MCIR

• ALL doses of H1N1 vaccine MUST go into MCIR– For children– For adolescents– AND for adults!!

• Documentation in MCIR for VFC vaccine is never optional – 3) On a record card which you give to the patient

Thank you