Since a second dose of Varicella vaccine is being recommended at "school entry" as well at the "one year" visit, we recommend that the four-disease combination vaccine (MMRV) be used on both occasions.
The preferred conjugate vaccine (Menactra) is in short supply, even at the Health Department. We are administering what vaccine we have to students entering college this Fall, and developing a waiting list for children still in high school (as is recommended) who are asking for the vaccine. We expect supplies to slowly increase so this backlog will be erased. This vaccine is on the VFC list, while for insurance and self-pay, the charge is $106. We have a few doses of the polysaccharide vaccine, (Menomune) but do not plan to replace it when it expires, unless the Menactra shortage is prolonged.
We have started to administer the new HPV vaccine at the health department. The cost of the series of three injections is $450. The vaccine will be available through VFC, but until VFC supplies arrive, we cannot administer this vaccine at no charge. The vaccine does not cover all HPV strains, there is no test of, or studies of effectiveness in, the presence of previous infection with HPV, so PAP smears or other surveillance for HPV in women will continue to be necessary. Studies of the use of this vaccine in young males are underway, but have not yet received FDA approval.
The recommendations for the up-coming season include expanded coverage for the pre-school group, now from >5 months up to <60 months. Generous supplies are expected this Fall, and they may be on time, or early, but we still can't finalize clinic plans until we have vaccine in hand. Our target for community clinics is early November.
Influenza virus vaccine live- intranasal (FluMist)
The Garrett County Health Department in partnership with the Garrett County Board of Education will be offering the nasal spray vaccine free of charge to all children grades K-5, with parental consent. This community-wide opportunity was piloted last year in three Maryland counties, and resulted in reduced absenteeism by students and teachers and less influenza in the communities. No adverse reactions to the vaccine were encountered. The first round of this vaccine will be administered at the schools in late October; a second dose will be given 4-6 weeks later for those who have not had an influenza immunization in a prior year. A warning with this immunization concerns asthma, and we do not intend to offer it to persons medicated for asthma within the last one or more years. Current studies suggest that this is not really a problem, but the final word in not in. The alternative of the injectable vaccine will be offered at the health department for those found ineligible for the intranasal vaccine. Vaccine for this project will be provided by VFC, by a donation of vaccine by the manufacturer (MedImmune), and the direction of special state funds by the governor to this project.
Pandemic Influenza -
The best over view of the current situation that I have seen is given by Dr. Mike Magee. Click Here
Medical Economics had an article (Click Here for full article) which made the following seven points:
1. Know where to turn for help. (We hope that in Garrett County that will be the local health department, 301-334-7770, Eric Cvetnick, Jennifer Lee-Steckman or William Pope)
2. Anticipate Staffing needs. Expect staff to be out with illness- there own or family.
3. Educate Patients. Stay home if ill and keep away from public gatherings.
4. Develop a strategy for infection control. Office procedures, signs, supplies, hand-washing attention.
5. Determine who's first in line for vaccines. Recently there was mention of "pre-pandemic" vaccinations for healthcare workers, to be followed by pandemic specific vaccine when it is available.
6. Plan to refocus your practice when a pandemic strikes. We have discussed having local HCP's staff a triage center (on rotation) for all patients with influenza symptoms, to separate those clearly infected from those requiring other care.
7. "Federalizing" vaccines. This has become necessary because the current system is not meeting needs- will it be expanded to non-pandemic vaccines?
A special checklist has been developed by the CDC for doctors' offices to help them plan and prepare their practice and office in advance for a pandemic. Click Here for checklist.
A State Pandemic Influenza Plan, version 6 "DRAFT" has seen limited distribution, but is not for public release. We have brought together a local draft version, based on the state plan with local input which can be accessed at our website. The latest addition to the Federal Pandemic Influenza Plan was released in May, and adds additional areas of consideration. The basics of prevention continue to be infection control: voluntary home isolation, respiratory hygiene, hand washing and social distancing. Face masks for the general public are not of proven benefit, but can be used voluntarily. Although the current influenza virus is thought to spread by contact, and droplets, (surgical mask adequate) healthcare workers directly caring for patients may start with airborne precautions, (N95 mask, etc.) until the level of contagiousness of a pandemic virus is established by additional studies. Click Here to access the federal plans.