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PUBLIC HEALTH UPDATE
Maine Department of
Health and Human Services
Bureau of Health
1
State House Station, Augusta, Maine 04333
Call
(207) 1-800-821-5821 Fax (207) 287-7443
2004
PUBLIC HEALTH UPDATE #16
TO:
BOH Leadership II, Emergency Departments, EMS, Hospital Assoc., Infection Control Practitioner’s, Local Health Depts., Maine Lab
Facilities, Maine Primary Care, MEMA, Public Health Nurses, Regional Resource Centers, State Leadership I, Bureau of Health/Division of Disease Control and Maine Correctional Facilities
FROM:
DORA ANNE MILLS, M.D., M.P.H., STATE HEALTH OFFICER
SUBJECT:
Updated Guidance on Influenza 10/13/04
DATE:
October 13, 2004
TIME:
9:45 AM
PAGES:
4
Updated
Guidance on Influenza 10/13/04
Due to recently announced loss of half the nation’s
expected influenza vaccine supply for the 2004 – 2005 season, vaccine
availability continues to be extremely
limited. At this time
the supply is insufficient to provide flu vaccine to all persons for whom
it is recommended.
Our goal at the Bureau of Health is to help minimize
death and severe disease from influenza by working with our partners to
improve access to vaccination for those in Maine who are most vulnerable
to severe influenza disease; and to minimize transmission of influenza.
In these very difficult circumstances, the Bureau of Health is making the
following recommendations:
- Healthy
people between 2 and 64 years of age should not be vaccinated.
- At
this time, State-Supplied
Vaccine (through the Bureau of Health’s Maine Immunization
Program), including this vaccine administered at rural health clinics,
must be restricted to these two groups:
- High-Risk
Children (all children 6-23 months and children 2-18 years with
underlying chronic medical conditions, including those on chronic
aspirin therapy);
- Appropriate
residents of long-term care facilities (appropriate in light of the
resident’s current health prognosis).
- Non-State
Supplied Vaccine should be given to the following groups (who are
population groups at highest risk for severe disease):
- High-Risk
Children;
- Appropriate
residents of long-term care facilities.
And the most
vulnerable members of the following groups:
o
Adults 65 years and older;
o
Other adults with chronic underlying medical conditions;
o
Women who will be pregnant during the influenza
season.
- If
your health system has the capacity to provide influenza vaccine clinics, we ask that you:
- Help
improve access to vaccine for high-risk children and appropriate
residents of long-term care facilities by either re-directing
vaccine to these populations or by promoting and providing vaccine
to one or both of them at your clinics.
- Please
implement measures (such as patient forms and signs) that will help
assure vaccine is distributed to those needing it the most at this
time (the five population groups listed above for non-state supplied
vaccine).
- If
you have no vaccine for the above populations:
- If
you are part of a health system, contact your parent company to
determine if you can acquire vaccine from within that system.
- Maintain
a list of those needing vaccine, especially noting those who are
high-risk children.
- Call
the Maine Flu Vaccine Hotline at 1-888-257-0990 to report severe
shortages, and note how much is due to a shortage of childhood
vaccine. This
information will assist us with planning and (hopefully) further
vaccine distribution.
- Check
www.MainePublicHealth.Gov
for clinic sites in your area.
There are a number of flu vaccine clinics being held for
high-risk people over the age of 9 in Maine through October 16th.
- Vaccination
with injectable flu vaccine of healthy out of home caregivers and
household contacts of children < 6 months as well as healthy
health care workers involved with direct patient care should be postponed at the present time, until additional vaccine supplies
become available.
These two groups are not
themselves at highest risk for severe disease.
However, we also recognize the importance of trying to assure
access to flu vaccine for health care workers, especially those in
high-risk settings for transmission to vulnerable patients and/or in
settings where there are already significant workforce shortages.
To achieve this access:
o
We anticipate providing additional guidance on this issue
within the next two weeks (which is still much before our normal flu
season begins), as we get a clearer picture of vaccine supplies.
o
Designated health care
workers younger than 50 years old can be vaccinated with intranasally
administered LAIV (live, attenuated influenza vaccine) Flumist®
o
Those who are pregnant, or
who care for or live with someone whose immune system is severely
compromised should not receive this vaccine.
An example of the latter is a health care worker with direct
patient contact caring for recipients of stem cell transplants in a
specialized unit.
- Many
children under age 9 years
require two doses of vaccine a month apart if they have not
previously been vaccinated. Doses
should not be held in reserve
to ensure the second dose will be available.
If vaccine supplies allow, the second dose should be
administered when it is due.
- We
expect some pediatric flu vaccine formulation (single-dose 0.25 ml
preservative-free vials) to be distributed as soon as possible.
However, children 6 – 35 months needing vaccine can also be administered a
half dose (0.25 ml) of FluZone® (Aventis Pasteur adult
formulation product). Children
three years and older can receive the full adults dose of 0.50 ml.
FluZone multi-dose vials do contain some thimerosol
preservative (25 mcg of mercury/0.5 ml dose).
- Please
post Keep Germs to Yourself
and other respiratory etiquette materials in your health care
settings. Such materials
can be found at www.MainePublicHealth.Gov.
- In
all health care settings, universal
respiratory infection control measures (first promoted for SARS
prevention last year) should be implemented soon to avoid transmission
of influenza and other respiratory tract infections between patients
and from patients to health care workers.
More detailed guidelines will be distributed soon through the
Maine Health Alert Network (HAN).
The good news is that there are no identified
influenza outbreaks in the U.S. at this time, and we normally do not see
influenza outbreaks in Maine for several weeks.
However, we want to use this window to assure improved access to
flu vaccine for Maine’s most vulnerable people.
We very much appreciate your hard work and cooperation!
For more information contact:
- www.MainePublicHealth.Gov
or
- the
Maine Flu Vaccine Hotline at 1-888-257-0990 or
- the
Maine Immunization Program’s Provider Line (especially for childhood
vaccine-related issues) at 1-800-867-4775.
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