Planning Guide for Vaccinating Pediatric Patients Against 2009 H1N1 Influenza in Primary Healthcare Settings

Planning Guide for Vaccinating Pediatric Patients Against 2009 H1N1 Influenza in Primary Healthcare Settings
October 16, 2009, 11:45 PM ET

Purpose of this document: To provide guidance for planning and conducting 2009 H1N1 influenza vaccination of pediatric patients in primary healthcare settings including:

Provider offices (pediatricians, family practice physicians, primary care providers, obstetricians/gynecologists)
Federally Qualified Health Centers and "look-alikes", Community health clinics, Urgent Care clinics, Retail-based clinics
This document is a companion document to the Healthcare Providers and Facilities - Decision Tree for 2009 H1N1 Vaccination located at (http://www.cdc.gov/H1N1flu/vaccination/decisiontree.htm).

Target Audience: Physicians, nurses, office managers, infection control coordinators, and anyone responsible for carrying out 2009 H1N1 influenza vaccination in pediatric healthcare settings. This document can be adapted for use by providers and healthcare facilities that serve adult patients. This document can also be used by state and local public health planners to assist with vaccine distribution and coordination of related community mitigation.

Background:
The first available doses of the 2009 H1N1 influenza vaccine are anticipated by early to mid-October. The Advisory Committee on Immunization Practices (ACIP) has recommended that the following target groups (no ordering among groups) first receive the 2009 H1N1 vaccine when it becomes available: people ages 6 months to 24 years; pregnant women, people 25-64 years who have certain chronic medical conditions, such as heart or lung disease, diabetes, weakened immune systems, blood disorders, neurologic or neuromuscular disease, and other illnesses; parents and caregivers of children less than 6 months of age; and healthcare workers and emergency medical services personnel.

The target age groups include pediatric patients 6 months through 18 years of age, a group that is also recommended to receive the annual seasonal influenza vaccine (http://www.cdc. gov/mmwr/preview/mmwrhtml/rr58e0724a1.htm). This year there will be a fully-implemented recommendation for seasonal influenza vaccination for all children 6 months through 18 years old. In previous years, seasonal influenza vaccination was recommended only for certain age and medical groups. CDC estimates that in implementing this recommendation, about 30 million additional children will need to receive seasonal influenza immunizations this year. As state and local planners determine the 2009 H1N1 vaccine planning actions needed in their community (http://www.cdc.gov/H1N1flu/vaccination/ statelocal/planning_checklist.htm ), they may or may not consider primary healthcare providers as a key partner in an overall tiered approach.

Most communities are planning on several approaches to vaccinating children including vaccination in primary healthcare settings, vaccination at clinics organized by public health in collaboration with other partners, and potentially at school-located vaccination clinics. The latter approach is especially important for school-age children who infrequently visit their primary healthcare provider or for those children whose school is their primary place of care, or "medical home."

There are several potential benefits to vaccinating children in primary healthcare settings:
Vaccinating in primary healthcare settings allows children to remain in the care of their medical home (http://www.medicalhomeinfo.org/Joint%20Statement.pdf) - this ensures comprehensive care and easy access and tracking of children's medical records.
Primary care physicians have established relationships with families of children requiring vaccination - parents are used to seeking care and advice from their child's physician and trust these individuals to treat their children.
Younger children and children with high-risk conditions regularly visit primary healthcare settings for care - this gives an opportunity to combine vaccination with health supervision visits, acute, trauma and chronic visits (e.g., asthma or diabetes visits), and to educate others who may accompany a child to their appointment.
Primary healthcare providers are familiar with monitoring, responding to, and reporting any adverse events associated with routine vaccinations.
Primary healthcare settings are familiar with the billing and recording procedures that accompany typical vaccine distribution. Many pediatric primary healthcare settings have access to statewide immunization information systems (IIS) in those states where they are available, which will allow for better tracking, recall, and reminder of immunizations against both seasonal influenza and 2009 H1N1 influenza.
Primary healthcare settings may be able to vaccinate children ages 6 months to 4 years that might be missed by school-located vaccine clinics because they do not attend school.
There are also several potential challenges with providing 2009 H1N1 influenza vaccines in primary healthcare settings or "medical home":
Providing 2009 H1N1 influenza vaccine and seasonal influenza vaccine could result in a surge in visits that may be overwhelming to staff. Providing 2009 H1N1 Influenza vaccine may not be a feasible option for all primary healthcare facilities depending on their size, available resources, and capabilities.
Without prior planning, vaccinating in primary healthcare offices could mix ill (or exposed) children with well children waiting to be vaccinated.
Some primary healthcare entities may not have the clinical space needed or plans in place to accommodate 2009 H1N1 influenza vaccination.
Some providers may not have the cold-storage capacity to appropriately refrigerate 2009 H1N1 Influenza vaccine in addition to seasonal influenza vaccine. Purchasing additional refrigerators for storage can be costly.
Providing 2009 H1N1 influenza vaccine could present a considerable financial burden to clinicians. The federal government is providing vaccine and supplies to providers at no charge and providers are allowed to charge an administration fee. However, reimbursement for vaccine administration from private insurers, Medicaid or Medicare may not cover all associated costs (e.g., overtime expenses for staff).
In some areas, healthcare providers are not normally part of community emergency planning activities. They may not be aware of public health's role in the 2009 H1N1 response and may not know how to engage with public health and other emergency responders.
Instructions
This planning guide contains two short checklists. These include:

Initial Planning Checklist: The purpose of this checklist is to outline items your office should consider when deciding whether your facility is able to provide the 2009 H1N1 influenza vaccine.
Moving Forward Checklist: The purpose of this checklist is to help your facility develop a plan to provide 2009 H1N1 influenza vaccine.
Each checklist presents basic questions and information in a step-by-step format. Resource links are provided at each step, should you need additional information regarding a specific topic.

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Planning Guide for Vaccinating Pediatric Patients Against 2009 H1N1 Influenza in Primary Healthcare Settings