The Surge Taskforce focus was on H1N1 and seasonal flu.
Al DeMaria, MD said that in the last month H1N1 in the southern Hemisphere is supplanting seasonal flu as the major threat there. That’s good news that that is happening rather than a recombination of viruses. The virus there is behaving much like it did here in the northern Hemisphere this past spring—to date.
He noted that it is probably more severe—thou not by any order of magnitude” than seasonal flu.
CDC announced yesterday that the supply of H1N1, originally announced as 120 ml doses will now come in at around 2/3 of the amount expected, or 90 ml doses.
Al also said-in responding to an inquiry from Frank Singleton (head of the Lowell Public Health dept and a member of MNA’s EP Task Force) that vaccination is voluntary-that no one will be forced to get vaccinated. They are expecting to receive the seasonal vaccine “momentarily.”
DPH is now preparing circular letters which will have more detail; they will be out next week. The H1N1 is intended to be given as two doses, 3-4 weeks apart, and Al said it is better to get the doses further apart than too close. Even if widely separated in time, the second dose is “still helpful.” Gloves not needed for administration. The seasonal vaccine can be given with either the first or second H1N1 dose. Pneumococcal vaccine can also be given along with one other vaccine, “probably not with two other vaccines.’” Smokers and asthmatics in particular are encouraged to get pneumococcal vaccine and there is a pneumococcal vaccine for children. One vaccination confers lifetime immunity with no harm to getting more than one.
Studies show the average rate of vaccination among healthcare workers in the U.S. is under 50% so that is a primary focus of the flu campaign this fall.
Maureen McMahon, BMC’s EP director, discussed the intense flu vaccination program planned again this year by BMC: BMC supervisors will do a "sweep" of who didn’t get shots in the first round and encourage them to do so in round 2. Their goal is 90% compliance, which includes decliners (i.e. they have a goal of either vaccinating or getting declension forms signed by 90% of staff.
Interesting: Maureen said "our (BMC) staff are usually pretty easy going but they really fought having to give a declination reason, so we think we’ll get more cooperation by NOT requiring people to say why they are declining." Priscilla Fox, DPH attorney concurred. Earlier, Al DeMaria had also noted that DPH ("at this point") does not want to make vaccination mandatory–they don’t want to take the time to fight the resistance was what he inferred. And it sounds like they feel that way about the declension language. Still evolving though.
It was noted that the new emergency regs passed on August 12 by the Public Health Council will mandate hospitals (any entity licensed by DPH under 111 c 130, 140, 150); clinics (including dialysis); and long-term care facilities (who were already mandated but new language is uniform for all three groups) to offer vaccine to all direct caregivers, and includes members of the medical staff and volunteers with direct patient contact. These regs will not be filed with the MA Secretary of State until Sept 14 because they expire in 90 days (Dec 14) and the council wanted to stretch them out as long as possible over the fall.
HOWEVER (note from Mary Crotty):
The next meeting of the council is scheduled for Sept 9 and it is likely that they will amend their August 12 regs to address some deficiencies: for ex., paramedics according to the Aug 12 regs would only be allowed to administer H1N1 so they will broaden that to include seasonal flu vaccine. In addition based on suggestions at today’s meeting, it is likely the council will append language permitting the Commissioner of Public Health to designate new groups of vaccinators to also administer vaccines beyond H1Na and seasonal flu. Anthrax was specifically mentioned.
Volunteers who wish to participate in the vaccination program will only be allowed to do so if they are currently licensed. It was suggested that interested persons should investigate joining their local MRC (Medical reserve Corps). Please note though: It is quite likely that volunteers will not have liability protections for actions of theirs or workers’ comp-like protection should they become ill. A bill sponsored by Sen. Moore has some language which provides liability under some circumstances but it is a long, wordy bill that does not appear to have support currently on Beacon Hill. In addition the state already has wide public health powers to push the necessary triggers to provide liability protections should they choose.
More from Mary re H1N1 and seasonal flu:
A number of issues to be aware of:
- The vaccine is still in the testing stage. Final approvals yet needed
- McKesson, the federal distributor of vaccines, has told MDPH they want ONE drop off point in Boston to have to deliver to -they do not want to stop at every hospital or clinic. (We ought to check out who is on McKesson’s board—some interesting parties I’m sure). That’s causing a hubbub not to mention that there is no central point that has refrigeration room for the supply. Should hospitals, clinics, public health departments receive vaccine as in the past, they still will not need capacity for 2-3 times the amount of vaccine. Local public health departments have been told by state auditors that they cannot order more refrigerators because they have no money in their budget. There are at least 3 “chunks” of money coming ($10.5 ml from CDC to MA, with $5.5 ml already received); an additional sum from the Federal Office of Emergency Preparedness that will go to hospitals; and a third pot of money from CDC in the fall for vaccine administration “ (? Who gets that). Nevertheless that money has not yet landed with the folks who need refrigerators,
- LOTS of concerns over college and prep school students who are the target age for H1N1—and the fact that college health clinics are 9 to 5 weekdays at best; prep/private schools have not yet been included in flu planning communications at all.
