Ahead of Print -Distribution of Pandemic Influenza Vaccine and Reporting of Doses Administered, New York City, New York, USA - Volume 20, Number 4—April 2014 - Emerging Infectious Disease journal - CDC

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Ahead of Print -Distribution of Pandemic Influenza Vaccine and Reporting of Doses Administered, New York City, New York, USA - Volume 20, Number 4—April 2014 - Emerging Infectious Disease journal - CDC

Volume 20, Number 4—April 2014

Synopsis

Distribution of Pandemic Influenza Vaccine and Reporting of Doses Administered, New York City, New York, USA

Article Contents

• Distribution of pH1N1 Vaccine and Reporting of Doses Administered
• Implications for Future Pandemic Planning
• Limitations
• Lessons Learned
• Conclusions
• Acknowledgment
• References
• Table 1
• Table 2
• Table 3
• Table 4
• Suggested Citation

Roopa Kalyanaraman Marcello1, Vikki Papadouka, Mark Misener, Edward Wake, Rebecca Mandell2, and Jane R. Zucker 

Author affiliations: New York City Department of Health and Mental Hygiene, Queens, New York, USA (R.K. Marcello, V. Papadouka, M. Misener, E. Wake, R. Mandell, J.R. Zucker); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (E. Wake, J.R. Zucker)

Suggested citation for this article

Abstract

In 2009, the New York City Department of Health and Mental Hygiene delivered influenza A(H1N1)pdm09 (pH1N1) vaccine to health care providers, who were required to report all administered doses to the Citywide Immunization Registry. Using data from this registry and a provider survey, we estimated the number of all pH1N1 vaccine doses administered. Of 2.8 million doses distributed during October 1, 2009–March 4, 2010, a total of 988,298 doses were administered and reported; another 172,289 doses were administered but not reported, for a total of 1,160,587 doses administered during this period. Reported doses represented an estimated 80%–85% of actual doses administered. Reporting by a wide range of provider types was feasible during a pandemic. Pediatric-care providers had the highest reporting rate (93%). Other private-care providers who routinely did not report vaccinations indicated that they had few, if any, problems, thereby suggesting that mandatory reporting of all vaccines would be feasible.

In April 2009, a novel swine-origin influenza A (H1N1) virus (now called influenza A(H1N1)pdm09 [pH1N1]) was detected in the United States (1). During the next 2 months, more than 1 in 10 New York City (NYC) residents reported influenza-like illness; cases occurred primarily among children and young adults (2). By June 2009, the World Health Organization had declared an influenza A (H1N1) pandemic (3). In July 2009, in anticipation of limited vaccine supply, the Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention prioritized groups for receipt of monovalent pH1N1 vaccine (4,5).

Building on previous pandemic influenza preparedness planning, in the summer of 2009, the NYC Department of Health and Mental Hygiene (DOHMH) began planning for pH1N1 vaccine allocation and distribution. To efficiently provide limited doses to a diverse population of providers in a large urban setting, DOHMH developed an allocation plan that included hospitals, private care providers (including adult, pediatric, and obstetric practices), and other outpatient facilities (including federally qualified health centers, pharmacies, DOHMH walk-in immunization clinics, and NYC agencies with a medical unit). In addition, DOHMH conducted a large-scale school-located vaccination program that offered pH1N1 vaccine to virtually all of the 1.4 million NYC schoolchildren in kindergarten through grade 12 (6). DOHMH also conducted 58 point-of-dispensing mass vaccination clinics over 5 weekends (7).

In NYC, all vaccine doses administered to persons <19 years of age must be reported to the Citywide Immunization Registry (CIR), DOHMH Immunization Information System; this requirement includes influenza vaccine (8). Vaccine doses administered to patients >19 years of age can be reported to the CIR with the patient’s consent. Electronic files containing birth certificates are entered into the CIR on a weekly basis to establish a population base and to facilitate reporting among pediatric-care providers. Since 2008, the CIR has been one of the Immunization Information System sentinel sites in the United States and has met data-quality and population-capture requirements, including those of receiving complete and timely data from at least 85% of providers and participation of at least 85% of children <19 years of age (9).

On October 28, 2009, because of the pH1N1 pandemic, various provisions of New York State public health law were suspended, including the requirement to obtain consent to report vaccines given to adults. This change authorized the NYC Health Commissioner to issue a Declaration of a Public Health Emergency and to modify the NYC Health Code to require reporting to the CIR of all pH1N1 influenza vaccinations administered, including those administered to persons >19 years of age. This change was made to increase provider accountability, track vaccine uptake, and assist with estimating vaccine coverage.

Acknowledgment

We thank James Hadler for his thoughtful review and helpful comments on the manuscript. We also thank the many health department staff members who contributed to the pH1N1 vaccine distribution efforts, staff from the Citywide Immunization Registry, and the medical providers who administered pH1N1 vaccinations to help protect the health of New Yorkers.

References

1. Novel Swine-Origin Influenza A. (H1N1) Virus Investigation Team; Dawood FS, Jain S, Finelli L, Shaw MW, Lindstrom S, Garten RJ, et al. Emergence of a novel swine-origin influenza A (H1N1) virus in humans. N Engl J Med. 2009;360:2605–15. Epub 2009 May 7.PubMed
2. Hadler JL, Konty K, McVeigh KH, Fine A, Eisenhower D, Kerker B, Case-fatality rates based on population estimates of influenza-like illness due to novel H1N1 influenza: New York City, May–June 2009. PLoS ONE. 2010;5:e11677. DOIPubMed
3. Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic. (H1N1)2009 Influenza; Bautista E, Chotpitayasunondh T, Gao Z, Harper SA, Shaw M, Uyeki TM, et al. (H1N1) 2009 Influenza. Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection. N Engl J Med. 2010;362:1708–19.
4. US Department of Health and Human Services, Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices (ACIP). Summary Report, July 29, 2009, Atlanta, Georgia [cited 2013 Nov 8].http://www.cdc.gov/vaccines/acip/meetings/downloads/min-archive/min-jul09.pdf 
5. Centers for Disease Control and Prevention. Use of influenza A (H1N1) 2009 monovalent vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recomm Rep. 2009;58(RR-10):1–8http://www.cdc.gov/mmwr/pdf/rr/rr5810.pdf .PubMed
6. Narciso HE, Pathela P, Morgenthau BM, Kansagra SM, May L, Scaccia A, Description of a large urban school–located pandemic H1N1 vaccination campaign, New York City 2009–2010. J Urban Health. 2012;89:317–28. DOIPubMed
7. Rinchiuso-Hasselmann A, McKay RL, Williams CA, Starr DT, Morgenthau BM, Zucker JR,Protecting the public from H1N1 through points of dispensing (PODs). Biosecur Bioterror.2011;9:13–21. DOIPubMed
8. New York City Department of Health and Mental Hygiene. New York City Health Code, section 11.04 [cited 2013 Jul 22].http://www.nyc.gov/html/doh/downloads/pdf/cir/healthcode2005.pdf 
9. Centers for Disease Control and Prevention. Q&A about IIS sentinel sites: what are sentinel sites? [cited 2013 Nov 7].http://www.cdc.gov/vaccines/programs/iis/activities/sentinel-sites.html
10. Zucker J. Central 2009 H1N1 Influenza Vaccine Recovery Program, June 15, 2010 [letter] [cited 2014 Jan 31].http://www.nyc.gov/html/doh/downloads/pdf/imm/imm-2009-2010-vaccine-recovery-prov-letter.pdf 
11. Hadler JL, Baker T, Papadouka V, France AM, Zimmerman C, Livingston K, Effectiveness of one dose of 2009 influenza A (H1N1) monovalent vaccine at preventing hospitalization with pandemic H1N1 influenza in children 7 months to 9 years of age, New York City. J Infect Dis. 2012;206:49–55. DOIPubMed
12. Community Preventive Services Task Force. Increasing appropriate vaccination: Immunization Information Systems [cited 2013 Nov 13].http://www.thecommunityguide.org/vaccines/imminfosystems.html
13. Health IT. gov. HealthIT regulations. Meaningful use regulations [cited 2011 Mar 20].http://healthit.hhs.gov/portal/server.pt?open=512&objID=2996&mode=2

Tables

• Table 1. Doses of pH1N1 vaccine distributed and reported to the Citywide Immunization Registry, New York City, New York, USA, October 2009–March 2010
• Table 2. Estimated pH1N1 vaccine administration among surveyed providers, New York City, New York, USA, October 1, 2009–March 4, 2010
• Table 3. Provider feedback with regard to Department of Health and Mental Hygiene communications and procedures, New York City, New York, USA, October 1, 2009–March 4, 2010
• Table 4. Provider feedback with regard to problems encountered with regard to pH1N1 vaccine, New York City, New York, USA, October 1, 2009–March 4, 2010

Suggested citation for this article: Marcello RK, Papadouka V, Misener M, Wake E, Mandell R, Zucker JR. Distribution of pandemic influenza vaccine and reporting of doses administered, New York City, New York, USA. Emerg Infect Dis [Internet]. 2014 Apr [date cited].http://dx.doi.org/10.3201/eid2004.131114

DOI: 10.3201/eid2004.131114

1Current affiliation: The Corkery Group, New York, New York, USA.

2Current affiliation: University of Michigan, Ann Arbor, Michigan, USA.