H1N1 vaccine for pre-schoolers
By Nelson Sigelman
Published: October 29, 2009
Against a backdrop of short supplies of H1N1 flu vaccine across the state and mounting anxiety among parents of young children, Martha's Vineyard Hospital learned this week it will receive a limited shipment of vaccine, perhaps tomorrow.
The hospital has made plans to distribute the vaccine to one of the identified high-risk groups as soon as possible.
A special, free vaccination clinic for pre-school age children, ages six months to five years, is scheduled Saturday, pending the delivery of the vaccine tomorrow. If the vaccine does not arrive Friday, the clinic will be held the following Saturday, November 7.
Watch mvtimes.com for confirmation of the clinic date.
A hospital advertisement published in both English and Portuguese appears on Page 9 in today's issue of The Times. The advertisement describes who should be vaccinated and directs people to the hospital website to check for the latest updates and to download forms at www.mvhospital.com/flu.
The Massachusetts Department of Public Health (DPH) is responsible for distributing H1N1 flu vaccine statewide.
More than two weeks ago, hospital pharmacy director David Caron told DPH that the Island hospital wanted to offer an Island-wide vaccination clinic for children who would not be covered by planned school clinics. At the request of Tim Walsh, hospital chief executive officer, Mr. Caron asked DPH officials for another way to secure additional doses more quickly.
On Tuesday, the hospital learned it would receive 500 injectable doses within two to five business days.
Given the recent delays in H1N1 flu vaccine delivery, Mr. Walsh was hedging his bets about exactly when the vaccine would arrive at the hospital. "If we get the batch by Friday, we will hold the clinic," he said. "But you never know."
Mr. Walsh said it is important to make arrangements to schedule the clinic without delay. "With the anxiety out there, we thought it was better to try to hold the clinic sooner, rather than later," he said.
Another factor driving the timing is that young children must receive two doses of vaccine at least 30 days apart. "That is why it was important to get it done," Mr. Walsh said.
Vaccine pipeline
This flu season has spawned an unprecedented demand for vaccinations against seasonal flu and H1N1, or swine flu. Unlike H1N1 flu vaccine, seasonal flu vaccine is available from commercial suppliers as well as the DPH. That accounts for flu clinics hosted by businesses such as CVS.
Due to delays, an initial Island-wide flu clinic initially planned for September is now scheduled for November 11. It will only offer vaccine for the seasonal flu.
In a recent public update, Massachusetts Commissioner of Public Health John Auerbach said five major vaccine manufacturers that are "working night and day to produce vaccines against both of these strains of flu." He acknowledged "some challenges" in the production and distribution of the vaccines and said the state had only received a fraction of what it could expect.
"These early supplies of H1N1 vaccine have been earmarked for providers who treat people at especially high risk for H1N1 flu, including pregnant women, children, caregivers of infants and healthcare workers with direct patient contact," Mr. Auerbach said. "As supplies grow, we'll expand to include young adults up to the age of 24, and people between the ages of 25 and 64 with certain underlying health problems, such as asthma and diabetes.... As vaccine supplies become more widely available, you'll begin to see public H1N1 vaccination clinics in your community, most likely in December."
The Martha's Vineyard Hospital, Dr. Michael Goldfein, a pediatrician in private practice with offices located at the hospital, and the Vineyard Nursing Association (VNA), which contracts with the six Island towns to provide an annual flu clinic, ordered both seasonal and H1N1 vaccines from DPH.
Although some deliveries of H1N1 have been received, it has not been enough to meet the demand. As a result, Island health officials have followed guidelines designed to insure that those most at risk receive vaccinations.
Hospital fills voids
Mr. Walsh said the problem was not in the ordering but in the supply line, and that left all of the Island's providers short. Because the Island towns contract with the VNA to run the flu clinic, DPH works with VNA.
The lack of enough H1N1 vaccine to stage an Island-wide flu clinic created voids, particularly among those in high risk groups, Mr. Walsh said. As the shortage became apparent he became concerned that the target groups such as pregnant women and young children not yet in school might not receive H1N1 vaccine in a timely manner.
"We have been trying to get all the pregnant women done and have been pretty successful," Mr. Walsh said.
Through its physician records, the hospital contacted pregnant women on the Island to arrange vaccinations. Because a large number of the women are Brazilian, the hospital also hired Portuguese translators to facilitate the process. As of Monday the hospital had contacted 88 patients and vaccinated 65. Ten patients declined, and 13 were still waiting to be vaccinated.
The hospital has also distributed available vaccine to its physicians. The physicians are reaching out to vaccinate children who may have a condition that puts them at risk.
The hospital is also in the process of vaccinating employees at Vineyard Medical Services, the Island Health Clinic, and Martha's Vineyard Community Services councilors.
"The hospital is trying to follow the situation closely and fill any voids we see," Mr. Walsh said. "My goal and my charge to my people is to make sure we distribute any vaccine as soon as it is acquired. I don't want a stock of vaccine in a refrigerator while people are getting the flu. Time is of the essence."
Private stock
The availability of the vaccine at one office and not another has been one source of confusion. For example, patients of Vineyard Pediatrics have received H1N1 vaccine.
"We're the only pediatric office on the Island and did receive a shipment of H1N1 vaccine. I do know the hospital did receive some as well - they initially used theirs to immunize pregnant women and hospital staff, particularly the people that would be coming in direct contact with patients," said Dr. Michael L. Goldfein of Vineyard Pediatrics. "Neither of us received our full request. We both got partial orders, so our office has been trying to prioritize and distribute the vaccine to kids at highest risk, rather than to healthy children."
Dr. Goldfein said his office has been immunizing his patients for the last several weeks. "We are probably going to be running out quickly," he said. "We're hoping the state will be able to supply us with some more vaccine soon. I know it was a decision to have some immunization clinics in schools, but that was predicated on the Visiting Nurses Association getting vaccine for clinics - so far, I'm not aware that has happened."
Dr. Goldfein said his office received just a fraction of what it had requested. "We're just hopeful that there will be more forthcoming," he said. "Once we have adequate supplies we will be able to start immunizing children less at risk. But our first priority has to be for those kids who are at greatest risk."
Cases rise
Martha's Vineyard Hospital reported that it had tested 40 individuals between Sunday and Tuesday of this week. Of those, 13 people tested positive for flu. Although the test is not specific to H1N1, the absence of seasonal flu this time of year points to H1N1.
Dr. Goldfein, hospital chief of primary care, explained that a nasal swab is the screening test, and it is not specific for H1N1. A nasal swab tests for influenza Type A and B. "H1N1 is in the group of influenza type A illnesses, so we can infer that if you have a positive nasal swab test for influenza type A, it is probably H1N1," he said. "We haven't really gotten into annual flu season just yet, which usually strikes the Island in the middle of the winter around January, so any flu of this type seen this time of year is likely H1N1."
Dr. Goldfein said once we get into the middle of winter and flu season it will be impossible to distinguish H1N1 from other seasonal types of influenza A.
More sophisticated tests are available by DPH. "The State has asked we not overburden them with tests for H1N1 unless it's for a patient who is extremely ill or a pregnant or high-risk patient," Dr. Goldfein said.
There is a lot of confusion in the community over who should receive Tamiflu, the trade name for the prescription medication oseltamivir phosphate. "The only people who need it are those in high-risk groups, such as children under 2 years old, anyone with asthma, pregnant women, for example," Dr. Goldfein said. "Someone who has H1N1 and is relatively healthy is not really a candidate."
Dr. Goldfein added, "Most of the time H1N1 is not going to be much more severe or any different than the usual seasonal flu. True, it's a serious bug - there are fatalities and some people who get very sick with it - but the vast majority of people will not."
Vaccine on the way
Ron MacLaren, Wampanoag Health Director and one of the coordinators of the all-Island seasonal flu clinic, said the Wampanoag Tribe has requested H1N1 vaccine for its tribal clinic but has not received any yet. He said DPH has assured the Tribe vaccine is on the way but provided no date.
Mr. MacLaren's first concern is high-risk groups. "The Healthcare Coalition, which is all six towns' health agents, the VNA, the county, the hospital and the Tribe, are all working on this together," he said. "So we're not fighting about doses, we're discussing the issues, because the problem is even if we have the doses, we don't have enough at this point."
Mr. MacLaren said The Healthcare Coalition has a plan to provide vaccinations at all of the schools, including any of the preschools that are part of the system on a school-by-school basis during the school day subject to being able to get vaccine. He said enough vaccine is expected within the next 30 days. "But again, this is what we anticipate, and until we get the actual vaccine, we can't put out a specific date to hold the clinic," he said.
Mr. MacLaren said the CDC indicated it has over 12 million doses, and orders for over 10 million doses. "So they have more vaccine than orders, and we feel comfortable this is more of a distribution problem than an actual vaccine shortage issue," he said.
Mr. MacLaren stressed that the simple basic precaution of proper hand-washing techniques and remaining home if ill would help reduce the spread of infection. "The vaccine is coming, and we will take care of the public and get the vaccine to them," he said.
Janet Hefler contributed to this story.
