2009 H1N1 influenza vaccine distribution and administration: Current
best information
Important developments regarding pharmacist involvement in 2009
H1N1 vaccine administration.
APhA is actively working with the National Association of Chain Drug
Stores, the National Community Pharmacists Association, state
associations, CDC, and the Association of State and Territorial Health
Officials in an effort to get pharmacies included in each state’s
2009 H1N1 influenza virus immunizing program. Although referral to their
county health department may occur, pharmacists interested in immunizing
for H1N1 should start the process by visiting CDC's state/jurisdiction
contact information for providers interested in providing H1N1
vaccine page and by calling their state and local health
departments for details (Web links provided below).
CDC will control the distribution and administration of the 2009 H1N1
influenza vaccine and has contracted with McKesson Specialty for
centralized distribution. The federal government has purchased all of
the H1N1 vaccine; therefore, there will be no charge for the vaccine.
However, providers may charge a fee for the administration of the
vaccine to the patient, their health insurance plan, or other
third-party provider.
Information received by the Association suggests that CDC has
approached state health departments to assist with distributing the H1N1
vaccine and coordinating vaccine administration. APhA has also learned
that some state health departments have contacted county health
departments for assistance in establishing a much more localized
plan.
Further investigation by APhA has revealed the following important
information for pharmacists:
- Efforts are under way by national and state pharmacy associations to
reduce barriers to the scope of pharmacist participation in H1N1 vaccine
administration. CDC has identified targeted patient populations for
initial vaccine release—45 million doses expected by October 15,
then 20 million per week afterwards, according to CDC. These targeted
groups include school-age children and pregnant women. Pharmacists
should consider what their current state law and protocol allow, as well
as their comfort level and ability if authority is expanded beyond
current limitations. Because CDC has specifically targeted school-age
children, pharmacists should discuss their interest in helping meet the
needs of this population with their state health department. Of
important note, access to H1N1 vaccine will be limited in mid-October
because of the limited supply at that time. As supply increases, more
providers will be needed to meet the increased demand, and public health
has recognized the important role that pharmacists can play in
increasing patient access to H1N1 vaccine.
- From a regulatory perspective, age restrictions and specific
protocol processes regarding influenza vaccination may vary on a
state-by-state basis. (H1N1 is another influenza antigen; therefore,
authority currently exists for pharmacists administering the vaccine.)
Pharmacists who are uncertain about the legality of H1N1 as it applies
to their state should contact their state board of pharmacy for
clarification.
- McKesson Specialty has the contract with the CDC for centralized
distribution of the H1N1 vaccine. McKesson can only distribute the
vaccine to CDC-authorized sites.
- In certain instances, administration of the vaccine will coincide or
be directly related to the Vaccines for Children (VFC) program. For
pharmacists interested in administering H1N1, APhA strongly suggests
exploring the mechanism being considered by the state or local health
department. In some cases, pharmacists may need to register for the VFC
program in their state and should check with their department of health
to determine whether this is a requirement.
- Immunizing pharmacists who are interested in administering H1N1
should contact their county or state health department to determine the
criteria for participating in their administration networks. Because
immunizing pharmacists will likely have an opportunity to administer the
vaccine at a school or college, they should check with their insurance
carrier to verify whether off-site administration is covered.
Although details and procedures may vary on the state or local level,
all providers will be required to comply with the following:
- Minimum order per shipment is 100 doses. Providers serving less than
50 clients should work with local health departments to provide vaccines
to their population(s).
- Vaccine shipments will include supplies such as syringes, alcohol
swabs, and patient documentation cards (gloves still under
discussion).
- Providers will be responsible for printing and copying H1N1 vaccine
information statements, which will be available online.
- Providers are required to report aggregate doses administered
weekly. (Weekly reporting deadline will be close of business each
Monday.)
CDC recommends that the following groups receive the novel H1N1
influenza vaccine (in no priority order):
- Pregnant women because they are at higher risk of complications and
can potentially provide protection to infants who cannot be
vaccinated.
- Household contacts and caregivers for children younger than 6 months
of age because younger infants are at higher risk of influenza-related
complications and cannot be vaccinated. Vaccination of those in close
contact with infants less than 6 months of age might help protect
infants by “cocooning” them from the virus.
- Health care and emergency medical services personnel because
infections among health care workers have been reported, and this can be
a potential source of infection for vulnerable patients. Also, increased
absenteeism in this population could reduce health care system
capacity.
- All individuals aged 6 months through 24 years.
- Children from 6 months through 18 years of age because many cases of
novel H1N1 influenza have arisen in children and they are in close
contact with one another in school and day care settings, which
increases the likelihood of disease spread.
- Young adults 19 through 24 years of age because many cases of novel
H1N1 influenza have occurred in these healthy young adults and they
often live, work, and study in close proximity and are frequently a
mobile population.
- Individuals aged 25 through 64 years who have health conditions
associated with higher risk of medical complications from
influenza.
(Note: During limited vaccine supply times, the above categories
will be further restricted, in accordance with recommendations of the
Advisory Committee on Immunization Practices.)
Also, because the seasonal influenza vaccine season is currently
under way, pharmacists are strongly encouraged to vaccinate as many
patients as possible now, before the onset of H1N1 influenza
intensifies.
Web links
Joe Sheffer (jsheffer@aphanet.org)
Posted September 4, 2009
Updated September 11, 2009
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