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Influenza 2009: 2009 H1N1 Pandemic Influenza Provider Guide

Public Health Bulletin prepared by Dr. Diana Yu, Thurston County Health Officer

What are the priority groups for H1N1 Pandemic Influenza ? • Pregnant women • Persons who live with or provide care for infants <6months of age • Health-care and emergency medical services personnel • Persons 6 months to 24 years of age • Persons 25 to 64 years of age who have medical conditions that put them at higher risk for influenza-related complications

What are the contraindications for H1N1 Pandemic Influenza vaccination? • Hypersensitivity to eggs, egg and chicken protein, or a history of life-threatening reaction to previous influenza vaccination • Health care providers should give careful consideration before vaccinating those who have experienced Guillian-Barré Syndrome within 6 weeks of receiving a previous influenza vaccination and those who are\immunocompromised persons.

Can I give seasonal with H1N1 vaccine? What about with other ? • Seasonal and H1N1 influenza vaccines are available in two formulations: a live, (LAIV or FLumist®) for intranasal administration and an for injection. • Encourage individuals who plan on receiving seasonal fly vaccine to get it as soon as it is available and not wait for the availability of H1N1 vaccine. • You can administer injectable seasonal and H1N1 inactivated influenza shots on the same day, at different injection sites or at any time before or after each other. • You can administer one live, attenuated vaccine and another inactivated, killed vaccine, on the same day or at any time before or after each other. • If not administered on the same day, all live virus vaccines should be given 4 weeks apart. • You can administer multiple live, attenuated virus vaccines (MMR, Varicella, Yellow Fever, LAIV) on the same day at different injection sites except for LAIV seasonal influenza and LAIV 2009 H1N1 influenza. • Administer LAIV 2009 H1N1 influenza and LAIV seasonal influenza 4 weeks apart and not on the same day.

Can I charge an administration fee for H1N1 vaccines? Yes. Most insurance companies will cover the H1N1 vaccination, just as they cover seasonal influenza vaccines. Providers may charge patients an administration fee the regional Medicare vaccine administration fee – the dollar amount will be forthcoming.

How can my practice or office receive H1N1 Vaccine? To provide 2009 H1N1 Pandemic Influenza Vaccine providers must meet minimum requirements and enter into a contract with the State of Washington. If you are not a current H1N1 Vaccine Provider and are interested in becoming one, please contact: Jillian Heist at [email protected] Page 1 of 2

2009 H1N1 Monovalent Influenza Vaccination Guidelines

Manufacturer Vaccine Delivery Special Notes Ages Dosages All dosages are 0.2mL and Influenza A (H1N1) 2 doses one month apart (0.2mL Intranasal Spray are to be administered by one 2-9 years of age MedImmune, 2009 Monovalent each dose) • pre-filled single dose 0.1mL spray into each nostril. LLC Vaccine live, sprayer Intranasal spray DOES NOT Intranasal 10- 49 years of age 1 dose (0.2mL dose) contain thimerosal Each presentation of this IM Injection 6 months -35 months 2 doses one month apart (0.25mL vaccine is made specifically • 0.25mL pre-filled of age each dose) for set age ranges. Pre-filled Influenza A (H1N1) single dose syringes Sanofi Pasteur syringes and single dose vials 2009 Monovalent • 0.5mL pre-filled single Inc. DO NOT contain thimerosal. 36 months- 9 years 2 doses one month apart (0.5mL Vaccine dose syringes Multi-dose vials DO contain of age each dose) • 0.5mL single dose vial thimerosal ( 25mcg mercury 10 years of age and • 5mL multi-dose vial 1 dose (0.5mL) per 0.5mL of vaccine) older Pre-filled syringes contain only TRACE amounts of 4 years -9 years of 2 doses one month apart (0.5mL IM injection Novartis Influenza A (H1N1) thimerosal (less than 1mcg age each dose) • 0.5mL pre-filled Vaccines and 2009 Monovalent per 0.5mL of vaccine). Multi- single dose syringes Diagnostics Ltd. Vaccine dose vials DO contain 10 years of age and • 5mL multi-dose vial 1 dose (0.5mL) thimerosal (25mcg mercury older per 0.5mL of vaccine) Pre-filled single dose syringes IM injection Influenza A (H1N1) DO NOT contain thimerosal. • 0.5mL pre-filled single 18 years of age and CSL Ltd. 2009 Monovalent Multi-dose vials DO contain 1 dose (0.5mL) dose syringe older Vaccine thimerosal (24.5mcg mercury • 5mL multi-dose vial per 0.5mL of vaccine) Glaxo Smith Not yet determined Kline (GSK)

Useful links: CDC clinician Q & A: www.cdc.gov/h1n1flu/vaccination/clinicians_qa.htm CDC General and Handling Toolkit: http://www2a.cdc.gov/vaccines/ed/shtoolkit/.htm FDA 2009 H1N1 Pandemic Influenza Vaccine Composition: http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm181950.htm CDC H1N1 Vaccine Q & A: http://www.cdc.gov/h1n1flu/vaccination/public/vaccination_qa_pub.htm ACIP Recommendations: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0821a1.htm General Flu information: http://www.flu.gov Adverse reactions reports: www.vaers.hhs.gov

Created: 10/01/2009 Revised: For up-to-date information call 360.709.3080 or website Page 2 of 2 www.co.thurston.wa.us/health