Flu Vaccine Update
Current estimates for seasonal flu vaccine from manufacturers is 114-115 million doses, which is slightly lower (3%) than, but not substantially changed from, earlier estimates. Slight changes in production estimates are to be anticipated because of the uncertainties involved in making biological products.
H1N1 vaccine production efforts currently under way are being carried out in such a way as to minimize any impact upon the total amount of seasonal vaccine available.
Some providers seeking to order vaccine currently and during the past several weeks have experienced challenges in doing so. Reasons for these challenges include:
* One of the manufacturers adjusted down their seasonal flu vaccine estimates, which resulted in some customers switching prebooks to other products. These switches reserved un-prebooked vaccines that were still available for order, making doses that are normally available for order during the summer and early fall months no longer available.
* There may be more providers seeking to purchase vaccine at this time of year than normally occurs due to (1) recent H1N1 influenza and its coverage in the media that may have increased the demand for seasonal flu vaccination, and (2) a desire to complete seasonal flu vaccination efforts in advance of H1N1 flu vaccination efforts to the extent possible.
Unfortunately, some healthcare facilities are having difficulty finding available vaccine to purchase. Be assured that though seasonal influenza vaccine may be in temporary short supply in some settings right now, production is expected to catch up to demand soon.
To assist providers in finding seasonal influenza vaccine available for purchase, the National Influenza Vaccine Summit supports IVATS (Influenza Vaccine Availability Tracking System). IVATS provides information about vaccine manufacturers and distributors with vaccine available for purchase. To access this information in Excel spreadsheet format, go to: http://www.preventinfluenza.org/ivats/ivats_09_10.xls
CDC ADDS INTERIM RECOMMENDATIONS FOR CLINICAL USE OF INFLUENZA DIAGNOSTIC TESTS TO ITS H1N1 WEB SECTION
On September 29, CDC issued interim recommendations for clinical use of diagnostic tests during the 2009-10 influenza season. The recommendations are intended for the use of clinicians in treating patients with suspected 2009 H1N1 influenza virus infection. They and a related Q&A for healthcare providers are posted at the CDC’s H1N1 Flu web section.
"Interim Recommendations for Clinical Use of Influenza Diagnostic Tests During the 2009-10 Influenza Season http://www.cdc.gov/h1n1flu/guidance/diagnostic_tests.htm
Related Q&A http://www.cdc.gov/h1n1flu/diagnostic_testing_clinicians_qa.htm
To make it easier for you to keep up to date with developments, IAC has gathered important information related to H1N1 influenza into a single web section. To access this resource, go to: http://www.immunize.org/h1n1
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AT LONG LAST–THE VISs FOR INJECTABLE AND NASAL SPRAY 2009 H1N1 INFLUENZA VACCINE ARE NOW ONLINE
Dated 10/2/09, the VISs for inactivated (injectable) and live attenuated (nasal spray) 2009 H1N1 influenza vaccine are now available in English only. Important note: Spanish versions are not yet available. IAC Express will notify readers when versions in Spanish and other languages become available.
VIS for injectable 2009 H1N1 influenza vaccine, go to: http://www.immunize.org/vis/h1n1_inactiveflu.pdf
VIS for nasal spray 2009 H1N1 influenza vaccine, go to: http://www.immunize.org/vis/h1n1_liveflu.pdf
AAP PUBLISHES POLICY STATEMENT ON THE PREVENTION AND CONTROL OF INFLUENZA IN CHILDREN
On October 4, the American Academy of Pediatrics (AAP) published a policy statement in Pediatrics titled "Recommendations for the Prevention and Treatment of Influenza in Children, 2009-2010."
The purpose of the statement is to update current recommendations for routine use of trivalent seasonal influenza vaccine and antiviral medications for the prevention and treatment of influenza in children.
To access the statement in web-text (HTML) format, go to: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;124/4/1216
To access a ready-to-print (PDF) version of the statement, go to:
http://aappolicy.aappublications.org/cgi/reprint/pediatrics;124/4/1216
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CDC ISSUES A HEALTH ALERT NETWORK MESSAGE ABOUT UPDATED PEDIATRIC ANTIVIRAL DOSING SYRINGE AND COMPOUNDING INFORMATION FOR 2009 H1N1 AND SEASONAL INFLUENZA
On September 25, CDC’s Health Alert Network (HAN) issued an Info Service Message titled "Updated Pediatric Antiviral
Dosing Syringe and Compounding Information for 2009 H1N1 and Seasonal Flu." A link to the complete message, which contains many useful references, is given at the end of this IAC Express article, as is a link to the FDA document "FDA Public Health Alert: Potential Medication Errors with Tamiflu for Oral Suspension." The FDA document includes a dosing chart based on the weight of pediatric patients age 1 year and older.
BACKGROUND
As of September 25, 2009, influenza activity is increasing in the United States with 26 states reporting widespread influenza activity. So far, ninety-nine percent of all subtyped influenza viruses being submitted to CDC are 2009 influenza A (H1N1) viruses.
The current situation will likely affect pharmacies as a greater number of people than usual seek to fill prescriptions for influenza antiviral drugs or antibiotics to treat secondary bacterial infections, in addition to seeking advice on over-the-counter flu medications. This may affect supplies and availability of antiviral medications and other materials that may be needed to fill prescriptions.
Pharmacists and physicians who care for pediatric patients should be aware of two issues: (1) the possible need to compound Tamiflu on site if commercially manufactured pediatric oral suspension formulation is not available, and (2) the need to ensure that the units of measure on the dosing dispenser and the dosing instructions match.
These situations are addressed in the updated interim recommendations issued by CDC on September 22, 2009, for the use of antivirals in the treatment and prevention of influenza which can be found at http://www.cdc.gov/H1N1flu/recommendations.htm and in the 2009-2010 Influenza Season: Information for Pharmacists available at http://www.cdc.gov/H1N1flu/pharmacist/pharmacist_info.htm
ALTERNATIVES TO TAMIFLU ORAL SUSPENSION FOR PEDIATRIC PATIENTS
If pediatric formulations of Tamiflu are not available, pharmacists may compound Tamiflu 75 mg capsules into an oral suspension onsite. For the FDA-approved instructions for the emergency compounding of an oral suspension from Tamiflu 75mg capsules, see the FDA approved manufacturer package insert for oseltamivir (Tamiflu), available on the FDA Web site at
http://www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/UCM147992.pdf
Compounding an oral suspension from Tamiflu 75mg capsules provides an alternative when commercially manufactured oral suspension formulation is not readily available. Tamiflu capsules 75 mg may be compounded using either of two vehicles: Cherry Syrup (Humco) or Ora-Sweet SF (sugar-free) (Paddock Laboratories). Other supplies needed to compound include mortar and pestle and amber glass or amber polyethyleneterephthalate (PET) bottle.
NOTE ON TAMIFLU ORAL SUSPENSION SYRINGE
The second issue that pharmacists and physicians may face is the need to ensure that the units of measure on the dosing dispenser and the dosing instructions match. An oral dosing dispenser with 30 mg, 45 mg, and 60 mg graduations of Tamiflu is provided in the packaging for the manufacturer’s product rather than graduations in milliliters (mL) or teaspoons (tsp). This can lead to patient or caregiver confusion and dosing errors. When dispensing commercially manufactured Tamiflu oral suspension, pharmacists should ensure the units of measure on the dosing instructions match the dosing device provided. If prescription instructions specify administration using mL or tsp, then the device included in the Tamiflu product package should be removed and replaced with an appropriate measuring device, such as an oral syringe if the prescribed dose is in milliliters (mL). When dispensing Tamiflu oral suspension for children younger than 1 year of age, the oral dosing dispenser that is included in the product package should always be removed.
Pharmacists and health care providers should provide an oral syringe that is capable of accurately measuring the prescribed milliliter (mL) dose, and counsel the caregiver how to administer the prescribed dose. Oseltamivir is authorized for emergency use in children younger than 1 year of age under an Emergency Use Authorization (EUA) issued by FDA. For the EUA, see http://www.cdc.gov/h1n1flu/eua/pdf/tamiflu-hcp.pdf
To access the entire HAN message, go to: http://www.cdc.gov/h1n1flu/HAN/092509.htm
To access the FDA public health alert, go to: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm183649.htm
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HHS PUBLICATIONS AND WEB SECTIONS MAKE IT EASY TO EDUCATE PATIENTS ABOUT PROTECTING THEMSELVES AND THEIR FAMILIES AGAINST INFLUENZA
The U.S. Department of Health and Human Services (HHS) influenza website has recently posted a number of attractive, downloadable brochures, fact sheets, and posters on influenza disease and vaccines. Healthcare providers can print these out and use them to educate parents and patients. HHS has also added patient-friendly videos to its website that providers can make patients aware of. Details follow.
FLU ESSENTIALS: WHAT YOU NEED TO KNOW This is a collection of attractive 1-page information sheets that cover various groups of people (e.g., asthmatics, diabetics, pregnant women) for whom influenza vaccine is recommended. The collection also includes information for the general public. To access the information sheets in this collection, go to: http://www.flu.gov/know.htm
OF PARTICULAR NOTE: The sheet titled "Emergency Warning Signs" is essential information that every individual, family, work group, church, day care facility, school classroom, or other venue should post prominently. It lists the symptoms–for children and adults–that indicate that medical attention is needed urgently. To access "Emergency Warning Signs," go to:
http://www.flu.gov/pdfs/emergencywarningsigns.pdf
WWW.FLU.GOV
This website offers information for the media, individuals and families, healthcare professionals, and major institutions (i.e, work places, schools, transportation, hospitals, state and local governments, etc.). In addition to print resources and web pages, the site offers users access to information through a blog, Twitter, FaceBook, YouTube, and recent CDC videos. To access this website, go to: http://www.flu.gov
CDC’S FREE RESOURCES WEB SECTION http://www.cdc.gov/flu/freeresources/print.htm
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