viernes, 30 de julio de 2010

Regional Influenza A (H1N1) 2009 Monovalent Vaccination Campaign --- Skokie, Illinois, October 16--December 31, 2009 [CDC - MMWR]

Regional Influenza A (H1N1) 2009 Monovalent Vaccination Campaign --- Skokie, Illinois, October 16--December 31, 2009
July 30, 2010 / 59(29);909-913

On July 29, 2009, the Advisory Committee on Immunization Practices (ACIP) recommended a phased approach for administration of influenza A (H1N1) 2009 monovalent vaccine, with certain high-risk groups* in the United States receiving the first doses (1). In Illinois, state authorities gave responsibility for initial vaccine administration to local health departments and hospitals. This report describes the vaccination campaign of the Skokie Health Department (SHD), during October 16--December 31, 2009. The SHD campaign initially was planned to cover the 67,000 persons residing in Skokie only, but that plan was expanded on November 4, when, in response to a nationwide vaccine shortage, the state health director urged local health departments to vaccinate any person in the ACIP priority groups regardless of jurisdictional boundaries. SHD, with the assistance of 1,075 volunteers, either administered or distributed to medical providers 40,850 H1N1 vaccine doses during a 9-week period, including 8,904 doses administered at 52 Skokie schools and day-care facilities, and 12,876 doses at mass vaccination clinics visited by residents of 193 of the 1,313 Illinois municipalities. At the time of the campaign, widespread illness from 2009 H1N1 in Illinois, with highly publicized deaths, contributed to a public sense of urgency about vaccination. Consistent with published studies (2,3), mass clinics in Skokie were an effective means to vaccinate large populations rapidly. The campaign highlighted the need for flexible plans, including the possibility of vaccinating persons who resided well beyond SHD's jurisdictional borders.

SHD is one of six state-certified local health departments in Cook County, Illinois, and typically administers 3,000 seasonal influenza vaccinations each year. Beginning in July 2009, following ACIP guidelines, SHD staff members used census data and direct contacts with schools and medical practices to estimate that 38,900 residents and commuters† were members of the initial priority groups recommended by ACIP for vaccination, including 14,900 children in schools or day-care facilities. Based on priority group calculations, on September 27, SHD ordered 40,000 doses of influenza A (H1N1) 2009 monovalent vaccine through the Illinois Department of Public Health (IDPH). SHD initially targeted children in schools and day-care facilities. Planners anticipated that area health-care providers and retail pharmacies would have sufficient vaccine by mid-October to begin vaccinating the other high-risk target groups. SHD mass clinics were scheduled for early December to ensure all residents would have access to the vaccine. During October 5--16, SHD received 15,000 doses for schools and day-care facilities, 67% of the doses in the nasal spray formulation. SHD received an additional 25,000 doses during November 6--16. In all, SHD administered or distributed 40,850 doses,§ in what evolved into a five-phase campaign (Figure 1, Table) that resulted in SHD administering influenza A (H1N1) 2009 monovalent vaccine to persons who resided far beyond the village boundaries (Figure 2). Overall, 54% of vaccine recipients at SHD clinics were not residents of Skokie.

Five-Phase Campaign

Phase 1. Vaccination clinics were held during October 21--November 20 at 39 public and private schools and 13 day-care facilities in Skokie. Vaccinations were offered to children, staff members, and caregivers of children aged <6 months. Overall, 8,904 persons received vaccine, 53% of the estimated target population. At school clinics, a greater percentage of persons aged ≥19 years (71%) received vaccine than persons aged 6 months--18 years (49%), based on the actual target populations. Among those vaccinated at school and day-care clinics, 40% resided outside of Skokie.

Phase 2. During October 16--November 24, SHD administered 2009 H1N1 vaccinations to persons who volunteered to assist in the vaccination campaign. SHD also offered vaccine to emergency medical services (EMS) personnel from Skokie and seven neighboring municipalities, and a regional private helicopter 911 service. Altogether, SHD vaccinated 254 EMS workers, or 24% of the actual target population; 179 (70%) worked for municipalities other than Skokie.

Phase 3. During November 9--25, because approximately 48% of the vaccine allocated for schools had not been utilized, a total of 8,141 doses were distributed to 30 Skokie medical practices that had placed vaccine orders with IDPH; an additional 2,717 doses were distributed to a local hospital. Because of an ongoing national vaccine shortage and preferential ordering of single-dose syringes, which were not yet available, the medical practices had received only 3% of their 20,850 ordered doses by mid-November, and a four-hospital system in the area had received only 10% of 120,000 ordered doses. SHD did not collect information regarding the recipients of these vaccine doses; the medical practices signed an agreement with IDPH to abide by ACIP guidelines.

Phase 4. SHD conducted four mass vaccination clinics during December 3--12 that were open to anyone in the ACIP priority groups, ignoring jurisdictional borders as requested by IDPH. An online appointment system and a phone bank were established to schedule vaccinations, limiting participants to 600 per hour. At the clinics, 12,876 persons were vaccinated; 73% of recipients resided outside of Skokie.

SHD was able to modify procedures rapidly to improve clinic flow. For the first clinic, several hundred persons arrived well before the scheduled start time and could not be allowed to enter the building, which contributed to a slow start and resulting waits of 1--2 hours. For the remaining three clinics, SHD implemented refinements to reduce the entire vaccination process time to <30 minutes per vaccinee. Refinements included establishing an adults and teens express vaccination room, reorganizing patterns within the building to maintain a continuous flow, ensuring adequate staffing, and opening 1 hour earlier than scheduled to accommodate early arrivals. Overall, 25 persons were vaccinated per vaccinator, per hour.

Phase 5. During December 14--31, because of increased vaccine supply, IDPH opened 2009 H1N1 vaccinations to any person aged ≥6 months. SHD administered an additional 3,261 doses at the village hall, the public library, and to the homebound. At the same time, SHD distributed 3,780 doses to neighboring health departments, Skokie medical practices, and a long-term care facility.

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Regional Influenza A (H1N1) 2009 Monovalent Vaccination Campaign --- Skokie, Illinois, October 16--December 31, 2009

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