How will the H1N1 vaccine be distributed to patients?

by Michael Smith, North American Correspondent, MedPage Today

A minimum of 3.4 million doses of vaccine against H1N1 pandemic flu will be available in the first week of October, the CDC said.

Those doses — all in the form of a live attenuated nasal spray vaccine — may be supplemented by some injectable vaccine, according to Jay Butler, MD, the chief of the agency’s 2009 H1N1 vaccine task force.

“Additional vaccine may be available as well,” Dr. Butler told reporters, “but 3.4 (million) is the hard number that we have right now.”

After the first week of October, additional vaccine will become available, he said, eventually reaching 20 million doses delivered each week until the end of the year.

Butler cautioned that getting the vaccine to patients is likely to be logistically challenging, especially in the first days. “The flow of vaccine the first week or two may be slower than what we would like,” he said.

The U.S. has ordered 195 million doses of pandemic flu vaccine from five companies, and four of the vaccines have now been licensed by the FDA. (See FDA Approves H1N1 Vaccines)

To get them out, the government will use the same process employed by the Vaccine for Children program, which distributes medications to about 40,000 healthcare providers across the country, he said.

That network will be expanded by adding another 50,000 providers of various types.

But not all of those providers will have vaccine available for all patients immediately, he said. “There’s not a sudden appearance of vaccine in 90,000 refrigerators around the country,” Butler said.

The ordering process, he said, will begin with a request from a provider to the state health department, which will know from day to day how much vaccine is allocated to that state.

State allocations will be based on population.

The state authorities will do an initial triage to decide which orders will be filled, Butler said.

The orders will be transmitted daily to the CDC, which will collate them and transmit them to distributors by 5 a.m. the next day. They’ll be filled and shipped within three business days, Butler said.

Meanwhile, the flu season is well under way — and earlier than usual, according to Daniel Jernigan, MD, deputy director of the CDC’s influenza division.

Jernigan said flu — all of it pandemic H1N1 — is being reported in all 50 states, with 21 seeing widespread activity.

“It’s a very strange thing for us to see that amount of influenza at this time of year,” he said — about twice the level that would usually be reported.

On the other hand, he said, while there is an increase in children and young adults needing hospital care, it still has not reached the levels usually seen later in a normal flu season.

Dr. Jernigan urged people to get the seasonal flu vaccine, which is now available, and to take the usual preventive precautions, including hand hygiene, covering coughs, and staying home if ill.

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