The intranasal mist form of the H1N1 vaccine will begin to become available in mid to late October in sufficient quantities to support statewide school-based vaccination programs, according to John M. Colmers, Secretary of the Maryland Department of Health and Mental Hygiene.
Secretary Colmers wrote in a September 29th memo to local health officers that the 2009 H1N1 influenza disease has re-emerged as anticipated and “is now widespread across the State.” The memo continues:
Children are disproportionately impacted by this influenza strain, and reports of H1N1 outbreaks in school settings continue to increase. This strain is now by far the predominant circulating influenza strain and is very likely to remain so for some time to come.
Given the prevalence of the H1N1 disease, it is important to vaccinate as many children as possible, along with those in other priority populations, using early shipments of H1N1 vaccine.
But the memo goes on to say that because a 4-week waiting period is required between the administration of the Seasonal FluMist vaccine and the intranasal mist form of the H1N1 vaccine, all school-based programs planning to offer the H1N1 mist should suspend their Seasonal FluMist programs until after the H1N1 mist is administered.
No interval of separation is required between the injectable forms of the seasonal and H1N1 vaccines, or between the Seasonal FluMist and the injectable H1N1 vaccine.
Bill Wiseman, spokesman for the Harford County Health Department explained in an e-mail to The Dagger that “there is a 4 week interval required between any intranasal mist influenza immunizations in order to ensure the greatest protection (or, in other words, in order to avoid compromising the level of protection afforded by the vaccine).”
Wiseman said in a phone interview that Harford’s school-based programs, which administer the Seasonal FluMist, were originally planned with the expectations that the H1N1 vaccine would not be available until late October or November and that the vaccine would come first in the injectable form. Now that the H1N1 intranasal mist is expected, he said that the suspension of the Seasonal FluMist program was recommended to allow for the soonest possible administration of the H1N1 mist, given that H1N1 is the primary flu virus currently in circulation.
Harford County Public Schools have suspended the Seasonal FluMist program on the advice of health officials.
Wiseman reiterated the message from State Health Secretary Colmers that there was sufficient time given the normal cycle of the seasonal flu for children to be protected from both the seasonal and H1N1 viruses through the less invasive intranasal mists, but said:
Parents wishing to have their children immunized now against the seasonal strain of flu, are strongly encouraged to take advantage of injectable vaccination opportunities. By doing so, this will render the 4 week waiting time a non-issue when the LAIV/H1N1 vaccine mist becomes available via the HCHD [Harford County Health Department], school outreach initiatives, or otherwise.
Seasonal Flu Vaccinations To Continue at Harford County Clinics
The Harford County Health Department cancelled the first of several seasonal flu vaccination clinics planned for the general population due to delays in the distribution of shipments, saying in a September 25th press release that, despite the delay, no shortage of seasonal flu vaccine was anticipated. Wiseman said again Friday that “no lack of vaccine is expected” and noted that that seasonal flu vaccines are currently available through other venues.
The Dagger contacted several local retail chain stores advertising seasonal flu clinics and found that the vaccine was available at some stores, but not others. Calls to Walmart and Walgreens confirmed that vaccine was being dispensed at some locations. But both the Aberdeen and Bel Air Target stores said they ran out and did not know when new shipments would arrive. A call to the Target corporate office was not immediately returned but a September 29th press release on the corporate website said the vaccine would be available nationwide in October.
Wiseman said the availability of vaccine through the Health Department’s community clinics was an issue of distribution and not a supply problem. He said that sufficient quantities are expected for the next clinic planned for October 16th in Fallston. But the public is encouraged to check for updates at www.harfordcountyhealth.com
Regarding the 4-week waiting period required between applications of intranasal mist vaccines, Wiseman said a decision was made late last week to offer only the injectable form of the seasonal flu vaccine at the community clinics to avoid any conflict with the administration of the H1N1 mist.
Here’s the letter from State Health Secretary Colmers:
STATE OF MARYLAND
Maryland Department of Health and Mental Hygiene
201 W. Preston Street • Baltimore, Maryland 21201
Martin O’Malley, Governor – Anthony G. Brown, Lt. Governor – John M. Colmers, Secretary
To: Local Health Officers
From: John M. Colmers
Date: September 29, 2009
Subj: H1N1 Flu Mist Suspension
The anticipated re-emergence of 2009 H1N1 influenza disease has occurred, and is now widespread across the State. Children are disproportionately impacted by this influenza strain, and reports of H1N1 outbreaks in school settings continue to increase. This strain is now by far the predominant circulating influenza strain and is very likely to remain so for some time to come.
Given the prevalence of H1N1 disease, it is important to vaccinate as many children as possible, along with those in other priority populations, using early shipments of H1N1 vaccine. At this time, it is anticipated that quantities of intranasal (LAIV) H1N1 vaccine, sufficient to support school-based H1N1 (LAIV) campaigns, will begin to become available in Maryland sometime in mid- to late October. Again, the objective is to promptly provide vaccine as it arrives to large numbers of children and others at special risk.
There must be a 4 week interval between the application of FluMist® and intranasal H1N1 (LAIV) vaccine. This interval is NOT required between FluMist® and injectable H1N1 vaccine, nor between doses of injectable seasonal and H1N1 vaccines.
Children who have received FluMist® must wait 4 weeks in order to receive a dose of H1N1 (LAIV). Unless injectable H1N1 vaccine is administered, these children will remain unprotected from the primary circulating influenza strain during this 4 week period.
Toll Free 1-877-4MD-DHMH • TTY for Disabled – Maryland Relay Service 1-800-735-2258
Web Site: www.dhmh.state.md.us
Local Health Officers
September 29, 2009
For this reason, as was discussed on local conference calls today and last week, it will be necessary to postpone FluMist clinics in jurisdictions planning to use H1N1 LAIV in school-based clinics. Effective October 1, local health department school-based FluMist® clinics should be suspended where H1N1 LAIV is being planned for subsequent school-based clinics. This suspension will allow for school-based H1N1 (LAIV) clinics planned by many local health departments to go forward without delay. Four weeks following completion of these H1N1 (LAIV) school-based clinics, school-based FluMist® clinics could be resumed. Alternatively, local heath departments may arrange for other use of the FluMist® vaccine, consistent with the purposes of the ARRA stimulus funding.
Suspension of FluMist® in school-based clinics is NOT necessary for those jurisdictions planning to immunize school-aged children with injectable H1N1 vaccine, as the 4 week separation is not required.
I recognize that this suspension will result in many challenges. However, it is a public health imperative that steps are taken now to allow for the greatest number of children to have access to H1N1 vaccine, including LAIV, as soon as it is available in the State. I appreciate your efforts and commitment to the success of this unprecedented undertaking.
cc: Frances Phillips
Deputy Secretary for Public Health Services