The 2009 H1N1 Influenza Vaccination Campaign Summary of a Workshop Series (2010) / Chapter Skim
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4 Implementation of ACIP Recommendations
4 Implementation of ACIP Recommendations
Pages 25-36
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From page 25... ...
The specific implementation strategy for these recommendations was left to state and local jurisdictions. Because initial vaccine supplies were low, most state and local public health departments, including all of those represented at the workshops, requested that vaccine be given first to members of the initial target groups.
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From page 26... ...
Prioritizing Within Initial Target Groups ACIP provided both an initial set of target groups and a subset of those groups; jurisdictions were free to decide whether to focus initially on the broader set or on the subset. However, Utah's deputy director for public health practice, Teresa Garrett, said, "We were almost forced into moving to the subgroups just because of what we had -- not necessarily because of what we wanted to do and where we wanted to go first, but because of what was physically in our possession." The first deliveries of vaccine to many places were LAIV nasal spray formulations that were contraindicated for many members of the target groups.
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From page 27... ...
Cathy Slemp, acting state health officer and director of the Division of Threat Preparedness for the Bureau of Public Health in the West Virginia Department of Health and Human Resources, noted that West Virginia empowered private clinicians to use their best judgment in terms of priority groups. Most importantly, physicians had to use the vaccine and not let it sit on shelves.
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From page 28... ...
Herminia Palacio, director of Harris County Public Health and Environmental Services in the Houston, Texas, area, explained that they worried that if they were too strict with the recommendations, they would be left with unused vaccine -- a lesson learned from the seasonal vaccination campaign in 2004, when restrictive guidelines aimed at dealing with vaccine shortage eventually resulted in substantial surpluses. Lauren Smith, medical director of the Massachusetts Department of Public Health, agreed.
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From page 29... ...
This was a particular concern in tribal areas, where the exclusion of tribal elders was believed to have reduced vaccination rates among American Indians for whom vaccination was recommended because elders are highly respected role models and messengers in their communities. Finkbonner of the Northwest Portland Area Indian Health Board said giving tribal clinics flexibility to vaccinate elders in the future would improve vaccination rates throughout tribal communities.
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From page 30... ...
One lesson learned during the 2009 H1N1 vaccination campaign was that making the decision to expand vaccination beyond the original priority groups to the general public does not necessarily result in a significant rise in vaccine administration rates. Workshop participants discussed possible reasons.
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From page 31... ...
Cross-Jurisdictional Flexibility and Consistency In general, public health officials at the workshops reported that they valued the flexibility in implementing ACIP recommendations, despite the associated challenges. State public health officials also valued the flexibility to implement their own distribution plans in accordance with existing infrastructure and state needs.
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From page 32... ...
"It became clear during the outbreak that actual mortality risk was greatest in individuals with underlying disease who were between 25 and 64 years old," said Fleming from Seattle & King County. Although this group was included in the broader ACIP target groups, it was not included in the subset of target groups that was recommended if vaccine supplies were limited.
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From page 33... ...
First, it believed that changing recommendations during the campaign might cause confusion; second, it noted that local flexibility let healthcare providers vaccinate patients they believed to be at highest risk, including adults with relevant medical conditions; and third, at the time it believed that the shortage of vaccine supply would be brief and therefore that overprioritizing the vaccine would be counterproductive. Workshop participants discussed the difficulties that would be associated with changing target groups during an event, including the challenge of communicating the change to the public, the difficulty of changing operational plans midcourse, and the overall potential for confusion.
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From page 34... ...
West Virginia did not have much success in vaccinating healthcare workers with LAIV, so instead offered it to EMS workers, who often work with the targeted population groups. By Thanksgiving workers realized they would have a substantial LAIV surplus, so they offered it to college clinics.
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From page 35... ...
Opportunities in Using Priority Groups Numerous individual suggestions were made for addressing challenges related to using priority groups to help improve future emergency vaccination campaigns. These suggestions are compiled here as part of the factual summary of the workshops and should not be construed as reflecting consensus or endorsement by the workshops, the Preparedness Forum, or The National Academies.
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From page 36... ...
o Clinics and healthcare providers should consider (in a shortage situation) how nasal spray vaccine will be given unless contraindicated.
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