Welcome to Pediatric Specialists of Foxborough and Wrentham

INFLUENZA IMMUNIZATIONS

January 7, 2010: In a recent conversation with the state Department of Public Health we have found that we will not be receiving any further doses of H1N1 Pediatirc Vaccine (preservative free). Because of the recall which included all of our supply we are left with none of this preparation to give initial or second doses. The state suggested we look for extra doses from practices who did not have vaccine included in the recalled lots to see if they have extra. This doesn't seem feasible at this point but we will investigate it. They also said there will be no further manufacturing of this preparation this year which rules out ordering privately. Likewise live intranasal H1N1 has been expended and we are not to expect any further shipments. We still have adequate supplies of multidose vaccine for children 3 years and older which has preservative. This can be an option at half dose for children under 3 years should you wish your child to receive it. We continue to have adequate supplies of seasonal flu vaccine. We,as providers of health care for your children, are very disturbed by these circumstances which have remained totally out of our control. We will update this site should the situation change.

December 15, 2009: Pediatric Specialists has received a memo stating that certain lots of the pediatric prparation of the H1N1 vaccine are being voluntarily recalled due to a minimal decrease in potency.The lots distributed to us through the Mass DPH were included in this recall. The memo states that this is not in any way dangerous and that children should still have a good immune response to these vaccines. They also recommend that we do not need to reimmunize but children in the 6 month to 9 year age group should plan to get their second dose when available. Pediatric Specialists has received a shipment of H1N1 vaccine in the multidose vials which contain thimerosol preservative. We will be administering this at mini clinics to anyone wishing to receive it until our supply is expended. For children in the 6 month to 35 month age group parents will need to decide if they would like to have their child receive this vaccine containing preservative. At this point we are uncertain when we will receive additional doses of the pediatric preparation.

December 3, 2009:Pediatric Specialists has received a limited supply of H1N1 mist (live intranasal preparation). We will be making appointments for several mini clinics to use this supply. The intranasal preparation is for children 2 years and older with no chronic problems such as asthma, othe respiratory problems, diabetes or immune issues. We feel that we also have adequate supply to give second doses for those who receievd one previous dose of H1N1 mist and are 9 years old or younger. We also are continuing to schedule children 35 months or younger to receive the pediatric H1N1 injection. We have adequate supply now of the seasonal flu vaccine and anyone wishing to receive this shoud call. We encourage all to receive this vaccine,especially those with chronic illnesses as mentioned above.

November 30, 2009: Pediatric Specialists has received a good size shipment of pediatric H1N1 vaccine. This is preservative free vaccine for children 6 months to 35 months. If your child has not yet received this vaccine please call for an appointment . We will also be offering second doses of this vaccine for children in the 6 months to 35 month age group who already received one dose of the pediatric H1N1 vaccine. We are still working out details of whether this will be scheduled during the regular hours or at a mini clinic.

November 29, 2009:Just a quick update. Status of immunizations remain the same as the November 24,2009 entry. Hopefully we will have further information about both the H1N1 vaccine and seasonal flu vacine this week. Please check back here frequently. Hoping all had a happy Thankgiving. Pediatric Specialists would like to express thanks for our wonderful group of patients, our staff and the patience and understanding all have demonstrated during this very chaotic flu season. Remember our goals are the same: the health and well being of your children.

November 24, 2009UPDATE: We have received a limited supply of H1N1 vaccine in the nasal mist (live) form for healthy children 3 years and older (again with some preference to those nine and under who will need two doses) and the pediatric presrvative free injection for children 6 months to 35 months. Pediatric Specialists will hold two mini clinics to administer these vaccines. We will schedule appointments based on the specifications for each vaccine and our available supply. When our appoinments equal supply we will ask that you call back when further supply is available.

November 23, 2009:Sorry for the brief hiatus in messaging as our web site has been down for a period. Pediatric Specialists will continue to receive small allotments of H1N1 vaccine although we are never sure of what form until it is received. If we receive dosing for our high risk popuation they will continue to be a priority. We will also try to give the majority of our first doses of the vaccine before we begin offering second doses to those requiring second doses (children 6 months to 9 years). We also are hoping to see additional doses of the seasonal flu vaccine by the end of November or beginning of December. As always this site will be updated to reflect our supplies and intentions.Hopefully we will not have further web page problems.

November 15, 2009: As of this point in time Pediatric Specialists has not received any advance notice of upcoming shipments of H1N1 vaccine. Thus for the time being we do not have any H1N1 vaccine available. This could change and this site will be updated when we become aware of further supplies. In the meantime we continue to have supplies of seasonal Flumist and seasonal pediatric preservative free vaccine for children 6 months to 35 months. Please take note this is seasonal flu vaccine and not H1N1. Continue to check this site for further updates.

November 9, 2009:UPDATE: Pediatric Specialists has received a shipment of H1N1 vaccine in the preservative free pediatric unit dosing. This is to be given to children 6 months to 35 months. We are setting up a couple of mini clinics to distribute this vaccine. We ask that you call after 11 AM to check on available scheduling for these clinics. As we have a limited number we will only schedule based on availability. Should you have an appointment and cannot keep it, please call the office to cancel. Remember the phones are extraordinarily busy and we ask your patience and prefer that you call a little later in the morning so that people with sick calls have an easier time reaching us. We have not received any further doses of nasal H1N1 vaccine nor additional doses of the multi-dose preparation for children three and older (this is the one which we have been using for our high risk patients).So far we have no further notice of additional vaccine shipments but hope that we see more soon.

November 5, 2009:We are starting to get regular small shipments of H1N1 vaccine. Frequently we do not know what form of the vaccine is being shipped. As long as a steady supply is received we will continue to hold mini clinics to be able to schedule patients based on supply on hand. We are encouraging the healthy children 2 years and older to receive the H1N1 live nasal mist and are trying to reserve the injectable form for our high risk children who cannot receive the live nasal preparation. Once supplies become more plentiful we will be more flexible regarding choice. When calling the office if you have a child who is considered high risk because of chronic respiratory disease, asthma, under two years old or having some immune issues or treatments with aspirin or other immunosuppressive drugs please ask for availability of the injectable vaccine. Unless we receive preservative free vaccine we will be offering vaccine with preservative (thimerosol) to all children as previously listed as recommended by the CDC and DPH. The final decision of whether to get the vaccine with preservative of course will be up to the parent. The dilemma in this choice is it may be uncertain when adequate supplies of preservative free vaccines are available. If your child is healthy and 2 year old or older when calling the office please ask for availability of live nasal H1N1 vaccine.

We will schedule based on amounts allotted to these mini clinics. Please realize that frequent calls to the office to check on vaccine availability have caused our lines to be tied up most of the day. We would encourage you not to call for this information until after 11 AM to allow those with sick children to have a better chance to get through. Although when calling, some clinics might be filled, it is hoped, if we are able to continue to regularly schedule these clinics, that we will be able to shortly accommodate your request . Unfortunately as we still have no control of what and when vaccine is shipped to us we cannot plan or pre-book clinics based on vaccine we have not yet received. We will continue to use this web page to give you an update on clinics and availability of vaccine.
As an additional comment we have a fair supply of seasonal flu vaccine in the intranasal (FluMist) form and a fairly good supply of pediatric preservative free seasonal flu vaccine for children 6 months to 35 months.

October 31, 2009: This flu season has been a trying period for us all. To some degree we have all been victimized by the shortages of vaccines. Our staff has worked diligently to accommodate all and answer the myriad of questions that come through our office each day. We have also been seeing an inordinate number of sick children who require our attention. As H1N1 flu vaccine has been in short supply we have received more and more angry and irate calls questioning why their child was not a priority while a neighbor's child received the vaccine. At times our staff has been verbally abused and this cannot be tolerated. If you have been following these posts you will see that recommendations and plans have changed frequently. When we were informed we would receive a steady supply of vaccine we immunized based on that assumption. Then when we were later told there would be significant delays we immunized only by a stricter prioritization. Keep in mind that Pediatric Specialists employs 7 physicians and 8 nurse practitioners. Our patient base is considerable and our number of high risk patients total in the thousands. Our shipments of vaccine appropriate for our high risk population has been about 50 doses per office. If you do the math you will realize that many of our high risk patients continue to wait for the vaccine. We have certainly given priority to our children with cystic fibrosis , cancer, other chronic diseases and are trying to work through our numerous patients with asthma. However when we are dealing with such a small number of vaccines this has been a very slow and tedious process. Along with those mentioned, our children in the 6 month to 2 year age group are also considered high risk and we have only just received a very limited amount (50 dose per office and some already used) of vaccine which is appropriate. This will be expended quickly. Also children who have an infant in the home who is under 6 months or a mother who is in her last month of pregnancy are likewise considered high risk. Needless to say if a child is in the office and qualifies as high risk he/she will receive the vaccine if available. Patients who call will also be scheduled based on availability. Remember that while we are dealing with such small numbers of doses this availability can change from moment to moment. We had considered a call list but then who would decide who is first and who is last? Also the logistics are most difficult when dealing with such small inventory. As mentioned in previous posts when we have a large enough number of vaccines we will schedule clinics and this will be announced on this web site. We can only schedule for as many doses as we have available.
The majority of vaccine which we have been able to administer has been the live intranasal vaccine which is used in children over 2 years with no significant history of asthma, chronic diseases ,immune issues or close exposure to someone who is severely immunocompromised secondary to immunosuppressive drugs or chemotherapy. We have been asked to prioritize the children in the 2-9 year age group as they will require two doses. It may seem unfair that if you have a child with asthma that your neighbor's child has received vaccine and your child is still waiting. The majority of immunizations we have received for H1N1 has been in this live nasal form and unfortunately is inappropriate and contraindicated for our patients with asthma or other chronic illness. We know this has caused a good deal of discontentment but what we receive from the state is currently out of our hands. We hope that we will get increasingly more supply of appropriate vaccines so that we are able to immunize a larger segment of our high risk population. Should we receive a major amount we will certainly hold clinics in order to expediently administer this vaccine. We will do the same when seasonal flu vaccine again becomes available.
In the meantime we ask for your patience and civility. Our staff is working very hard to try to accommodate you when at all possible. We also must continue to see and treat patients on a daily basis while dealing with the numerous calls for advice. President Obama has declared a state of emergency regarding this pandemic flu. Under that heightened urgency we are ready to move swiftly to immunize as many as possible as quickly as possible as soon as we receive adequate supplies to make this possible. Let's hope we can all work together to get through this most difficult period and know that we at Pediatric Specialists are keeping on top of this as well as being prepared to see and if necessary treat your child. Our goals are the same: the health and well being of your children. Let's go forward with that truth and see each other through these most difficult times.

October 29, 2009:UPDATE FROM MASSACHUSETTS DPH

More Details About the H1N1 Vaccine Distribution Program

As of today, more than 480,000 doses of H1N1 vaccine have been distributed to providers in Massachusetts –- just the tip of the iceberg of the total 3.5 million doses of vaccine that we expect to receive this flu season. This is not where we expected to be at this point based on what we were initially told by the federal government, and it creates a difficult and frustrating situation for everyone, especially those people at greatest risk of complications from the H1N1 flu.

These initial limited supplies have been prioritized for distribution to the health care providers who serve populations at the highest risk of H1N1 flu –- children and pregnant women. It has also been prioritized for health care workers with direct patient contact in light of their vital role in ensuring a functioning health care system. DPH believes this targeted distribution approach, using health care providers who serve these high risk groups every day, is the most effective way to ensure the vaccine gets to those who need it most as quickly as possible.

As vaccine supplies arrive in larger quantities, more and more providers will receive vaccine for their patients. Vaccine will then be targeted to young adults up to 24 years old and people 25-64 with chronic health problems. Eventually, flu clinics for the general public will begin. However, they won’t be scheduled until there are large enough quantities of vaccine available to support them. Based on current projections from the Centers for Disease Control and Prevention, these flu clinics will not likely be feasible until December. When they have been scheduled, you can find one near you at http://flu.masspro.org. It is important to note that no H1N1 vaccination clinics are listed at this time.

This vaccine supply situation is complex and confusing. We continue to receive requests for further details on how vaccine arrives in the state, the role of DPH in that process, and how providers receive word on upcoming vaccine availability. Here’s how the system works:

Major vaccine manufacturers are producing H1N1 vaccine in addition to the seasonal flu vaccine they produce every year. There are nine different H1N1 vaccine formulations approved for various age groups. Vaccine comes as thimerisol-free prefilled syringes, multidose vials with thimerisol, and live, attenuated virus nasal spray (Flumist). More detailed information is available on this chart.

When a provider first registers with DPH to receive H1N1 vaccine, they include key details about their practice, including:

Type of practice and target patient population served
Capacity to vaccinate (how many people could they vaccinate in a month with sufficient vaccine supplies)
Whether they consent to receive live attenuated vaccine formulations (e.g., Flumist vaccine)
How much vaccine and which formulations they would like to order

Several times each week, DPH receives notice about how much newly available vaccine, and in which formulations, the state can expect to receive. We use the details provided to our vaccine registration system to figure out where that vaccine can and should be shipped. For instance, pregnant women can’t take Flumist, so if a manufacturer tells us there is a new batch of Flumist coming, we cannot send that new quantity to OB/GYNs. It can however, be administered to healthy children, and would therefore be sent to pediatricians.

DPH does not play any role in physically receiving and redistributing H1N1 vaccines, which are shipped directly to providers in the community. However DPH does play a vital role in matching up available formulations to appropriate providers as vaccine comes off the production line.

There are more than 4,000 health care providers in Massachusetts that have signed up with DPH to receive H1N1 vaccine this year. (The actual number of vaccination sites is higher, because some of the larger providers will further distribute their allocations of vaccine to their affiliated provider locations.) Virtually all of the providers that serve the priority groups have received some amount of vaccine and will receive more in the coming weeks.

Unfortunately, the vaccine supply is unpredictable during these early days of distribution even to the point of not having enough for the highest priority groups. Thus, it is possible that a pregnant woman with an underlying health condition may not be able to get vaccinated right away. As more vaccine becomes available in all of the various formulations, these allocations will even out, and all pregnant women who wish to be vaccinated can be.

Understandably, given the delays in receiving large quantities of vaccine, people want to know exactly where the vaccine has been shipped. We have received requests for specific information on which providers have which quantities of which formulations at any given time. This information is difficult to accurately convey as the situation is constantly evolving. Furthermore, releasing that level of information would likely result in an overwhelming surge of calls and visits to providers, preventing them from quickly and efficiently dispensing the vaccine that they have available to their most at-risk patients. These disruptions may also discourage providers from participating in the H1N1 vaccination program, contributing to further delays in getting vaccine to individuals in the community.

DPH is as frustrated as you are about the current situation. Regrettably, neither the states nor the federal government have the ability to speed production. What we can do is pledge to distribute the vaccine to the appropriate providers as soon as it becomes available and to continue providing the most up to date information on the situation.

A final note: please remember that while we encourage all residents to utilize the comments section on this blog, DPH will no longer be able to respond to specific questions and comments.

October 21, 2009: More delays. According to the latest update as reported in the BostonGlobe today there appears to be a further delay in receiving the H1N1 vaccine along with the delays in further shipments of the seasonal flu vaccine.School and state run clinics have been cancelled for now. Pediatric Specialists will immunize based on availability of vaccine. (see below).Other than our already scheduled mini-clinics we will hold off scheduling any further clinics until supply is available. As we now anticipate shipments will be delayed, as future small supplies are delivered we will continue to prioritize high risk children and younger children.In order to expedite this process,if your child has a chronic disease such as asthma, heart disease, other chronic respiratory illness, diabetes,other chronic illness,is in the 6 month to 9 year age group or mom is in her last trimester of pregnancy please check this web site frequently and pass this message to friends and relatives who also use our practice.We will post notice here as vaccine becomes available and ask that you be available to come to the office on relatively short notice. Do to the large numbers and delays we are unable to maintain a call-back list.

On a more personal note we would like to thank our patients for their patience in this situation which has caused a good deal of concern. We share your concerns and are frustrated with a situation over which we have very little control. It is disturbing that information regarding availability can change so quickly. Pediatric Specialists has always prided itself with getting flu vaccine to our patients each year in an efficient and timely manner with well organized clinics and getting children into the office for their vaccine when clinics are full. This year has been a challenge for all. We will continue to do our best within the current constraints to get our patients immunized. Please review previous notes (below) to appreciate the frequent changes which have transpired.

October 17, 2009:Pediatric Specialists has received limited supplies of H1N1 (pandemic flu) vaccines in the live nasal mist and injectable multidose vials. The multidose vials contain preservative (thimerosol). Thus far we have not received pediatric single dose preservative free vaccine. The CDC has given clearance to use the thimerosol containig vaccine on children six months or older in order to get immunized in a timely fashion as younger children are at higher risk of serious complications. We also are prioritizing children 6 months to 9 years of age or those who are unable to receive the intranasal preparation.

We are currently scheduling mini-clinics on Thursdays and Fridays in Foxboro and Mondays (starting Oct 26,2009) in Wrentham. We ask that you call for appointments keeping in mind that the number of available appointmetns will be determined by the availability of vaccine. Please see below for guidelines of who may receive live intra-nasal vaccine as we have been receiving larger shipments of this form of the vaccine.We are also making the intranasal preparation available for all age groups over two years old ( again based on supply and prioritizing children in the 2 to 9 years age group who will need two doses). At this time we cannot guarantee the availability of the second dose but it is expected that supplies will be increasing with time. It will be your responsibility to call to set up an appointment to have your child receive the second dose which must be at least one month following the first dose.

Please be patient with our staff when you call as we are receiving daily updates from the DPH. We have no control over the shipments (hence availability) of these vaccines. Our intent is to get all our patients immunized as quickly as possible and we will provide additional opportunities as larger supplies become available. Should you have the option to receive the vaccine at school or through another clinic we would encourage you to take advantage of that opportunity. We ask that you call and give us the date the vaccine was administered so that we may add this to your child's health record.

Please continue to check this site for future updates.

October 14, 2009:Just an update of status. Pediatric Specialists now has a limited supply of H1N1 in the FluMist (live intranasal) form. The DPH has now designated this for the time being for children in the two year to nine year age group as they will need two doses. We expect that we will get additional supplies on a regular basis. This preparation cannot be given to children with chronic repiratory diseases such as asthma, egg allergy,chronic disease such as diabetes, having or are closely exposed to someone whose immune system is severely weakened. If your child is in the two to nine year age group and would not be excluded by the above mentioned conditions and you would like him/her to receive this vaccine please call either office to set up an appointment. As mentioned supply is limited and we will schedule based on supply. However more is expected. We do still have some FluMist(see above for restrictions although we may use for patients beyond 9yo as well) for seasonal flu and some pediatric flu vaccine (seasonal-preservative free) for children age 6 months to 35 months. You may call for availability and may schedule appointment based on that availability. We hope to receive additional seasonal flu vaccine in the next few weeks. Remember that if your child receives a live viral vaccine of any type he/she cannot receive another live viral vaccine for 28 days. H1N1 nasal and seasonal nasal cannot be given together.Please be patient as we are working very hard to try to be sure that all our patients get immunized in a timely fashon. Some of this timing is out of our control.

October 7, 2009 Pediatric Specialist has received a very limited supply of H1N1 (swine) flu vaccine in the nasal spray form. As the supply for each office is small we are not yet asking for people to call for appointments to receive this vaccine. Currently the CDC is saying this initial allotment should be used for health care workers, children age 2-9 years (as they will be needing a second dose), children with a sibling who is under six months old and children whose mother is in her third trimester of pregnancy.Some will be offered vaccine during their regular office visit if supply is available. We anticipate that we should gradually receive more supply and are awaiting the first supply of injectible vaccine which will be more useful for our children under two years old and our children with chronic respiratory diseases such as asthma. Remember the nasal vaccine is a live viral vaccine and cannot be used in children under two years old, children or adults with asthma or other chronic respiratory diseases and individuals with any form of immune deficiency. We are still awaiting further supplies of seasonal flu vaccine but do have some nasal (Flumist) vaccine available. Should your child receive the nasal(live) vaccine of either flu type he/she cannot receive another live vaccine (Flumist,MMR or Chickenpox) for at least four weeks. There would be no restriction involving the dead flu vaccine which is an injection.If your child had presumed swine flu in the spring or early summer he/she should still receive the H1N1 vaccine.

Also we should address the safety issues which have caused some concern regarding the H1N1 vaccine. These vaccines are formulated in the same manner as all previous seasonal flu vaccines. Therefore they have the same risk profile as all flu vaccines. As with all flu shots they cannot be given to one who is egg allergic. The H1N1 vaccine has udergone testing comparable to the seasonal flu vaccine and has been reported as safe. The choice of whether your child receives this vaccine is of course your decision. Should your child receive this or any vaccine through the schools or any other provider we would appreciate that you call the office with the date the shot was administered so that we can add this to your child's health record. This page will be updated further when more supply is available or if there is other information we need to share.

September 28, 2009 Seasonal Flu vaccine has been administered in both offices since early September.The administration was started earlier this year in anticipation of having to then administer H1N1 (swine) flu vaccine sometime in October. We proceded with the idea that we should give as many seasonal flu vaccines as were requested in as timely a fashion as possible as recommeneded by the DPH and CDC. This had worked well until recently when we were told there would be delays in delivery of furhter stock of seasonal flu vaccne due to the resources being expended on H1N1 vaccine. This has created concern to our patients and parents as we have been unable to schedule further appointments for this shot. As a compromise we have moved one of our clinics to the end of October with the expectation that we would have adequate supplies by that time and perhaps would also be able to administer H1N1 at the same time as recommended by the CDC. Some parents have felt it unfair that their friends got the shot at their well visit and now their child is being put off. We were not able to anticipate this occurrence of delayed shipments along with an increased demand for the vaccine. Keep a couple of things in mind. Currently H1N1 is in epidemic proportions in areas of the United States and is expected to spread to a large segment of the population. Seasonal flu has not yet begun in our area. Most times we see this in the winter months (Late December, January , February and March). Normally we do not hold flu clinics for the seasonal flu until mid to late October. In short we should be able to deliver the rest of the seasonal flu vaccine to our patients before the seasonal flu outbreak begins just as we have in previous years as long as deliveries get back on track.. Of bigger concern is the timing of reciving the H1N1 vaccine as cases of this are increasing. If you would like us to call you when seasonal flu vaccine is again available please call us to put you on a list or send an email to businessoffice@pediatricspec.com Please include your child or childrens' names and a phone number where you can be reached. Availability of both vaccines will also be posted on this site.See directive(below) we received from Massachusetts Department of Public Health:

Massachusetts Department of Public Health (MDPH)
Division of Epidemiology and Immunization

Seasonal Influenza Vaccine Supply May Be Delayed for 2009-2010
--Need to Plan for Concurrent Seasonal and H1N1 Vaccine Efforts--

September 24, 2009

Based on national guidance from the Center’s for Disease Control and Prevention (CDC) and in preparation for H1N1 flu vaccine arriving in October, the Massachusetts Department of Public Health (MDPH) Immunization Program asked health care providers to begin vaccinating with seasonal influenza vaccine as soon as it became available in August. We asked local health departments that rely on state-supplied vaccine to schedule the majority of their seasonal flu clinics in early October.

Unfortunately, we have recently learned from both the CDC and the vaccine manufacturers that the scheduled delivery for the remaining doses of seasonal flu vaccine will not be as accelerated as originally anticipated, due to prioritization of H1N1 vaccine and other challenges.

We have received over 40% of our seasonal flu vaccine supply to date. Remaining doses are expected to become available over the next 4-6 weeks with the majority of doses still expected by the end of October and all doses delivered by early November.

Additionally, doses of both state-supplied and privately purchased pediatric formulation vaccines (0.25ml pre-filled syringes for 6-35 months of age) have also been delayed. Currently, less than 30% of our total supply is available and the majority of doses are expected to be delivered by the end of October.

However, the timing of vaccine availabity for the different types (seasonal vs. H1N1) may closely match virus circulation. Almost all of the influenza viruses currently circulating are H1N1. Seasonal influenza virus strains may not appear until later in the season.

Recommendations
MDPH recommends that all health care providers continue to vaccinate patients with seasonal influenza vaccine during routine visits and in scheduled clinics as supply allows.

Local Health Departments and Schools

Large public clinics and school based flu clinics should be delayed until mid October (and possibly into early November) unless there is sufficient vaccine on hand to meet the expected demand. By mid-October, we anticipate vaccine supplies will be sufficient to mount large clinics efforts.
Anticipate holding clinics for H1N1 flu vaccine starting in early November as well. Consider offering both seasonal and H1N1 flu vaccine at these clinics.

(over)

Pediatric Providers

Continue to vaccinate your patients based on your available vaccine supply and formulation types.
Schedule vaccination appointments in late October for any infants who cannot now be vaccinated due to lack of current supplies. By late October there should be sufficient supplies of both state-supplied and privately-purchased pediatric formulation seasonal flu vaccine.
Plan for simultaneous administration of both seasonal and H1N1 flu vaccine starting in mid-late October. H1N1 flu vaccine will become available starting in early October. Young children are one of the highest risk groups for H1N1 influenza. Pediatric providers will be allocated some of the initial doses of H1N1 vaccine that become available in Massachusetts.

Note: doses of the intranasal H1N1 LAIV and seasonal LAIV must be separated by 4 weeks, but you can administer H1N1 and seasonal vaccines simultaneously if one or both vaccines are the injectable vaccine.

We want to thank you for your efforts at this most difficult and challenging of times. MDPH will notify you if there are any changes in influenza vaccine supply.

Be assured that we are working diligently to make sure our patients receive these vaccines in a timely fashion and are checking daily for any updates regarding their availability.

Seasonal flu vaccine is now recommended for all children 6 months old or older. It is most important in younger children and those with chronic illness. Egg allergic individuals cannot receive the flu vaccine.

Currently we understand that the H1N1 (swine) flu vaccine will be available mid to late October. It is likely that two shots will be needed for children under eleven years old. Remember for both H1N1 and seasonal flu shots it generally takes about three weeks following the immunization for the body to build up adequate protection although early reports with H1N1 show a good response within 10 days. In the meantime practice good handwashing techniques and keep sick/febrile children out of school or daycare until they have been without fever(without treatment) for at least 24 hours. It is our impression that supplies will be somewhat limited at first.We will place notice on this site when H1N1 vaccine is available.Please read the information copied from the CDC site (www.cdc.gov) regarding the H1N1 vaccine:

Novel H1N1 Vaccine

Every flu season has the potential to cause a lot of illness, doctor’s visits, hospitalizations and deaths. CDC is concerned that the new H1N1 flu virus could result in a particularly severe flu season this year. Vaccines are the best tool we have to prevent influenza. CDC hopes that people will start to go out and get vaccinated against seasonal influenza as soon as vaccines become available at their doctor’s offices and in their communities (this may be as early as August for some). The seasonal flu vaccine is unlikely to provide protection against novel H1N1 influenza. However a novel H1N1 vaccine is currently in production and may be ready for the public in the fall. The novel H1N1 vaccine is not intended to replace the seasonal flu vaccine – it is intended to be used along-side seasonal flu vaccine.

CDC’s Advisory Committee on Immunization Practices (ACIP), a panel made up of medical and public health experts, met July 29, 2009, to make recommendations on who should receive the new H1N1 vaccine when it becomes available. While some issues are still unknown, such as how severe the virus will be during the fall and winter months, the ACIP considered several factors, including current disease patterns, populations most at-risk for severe illness based on current trends in illness, hospitalizations and deaths, how much vaccine is expected to be available, and the timing of vaccine availability.

The groups recommended to receive the novel H1N1 influenza vaccine include:

Pregnant women because they are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated;
Household contacts and caregivers for children younger than 6 months of age because younger infants are at higher risk of influenza-related complications and cannot be vaccinated. Vaccination of those in close contact with infants less than 6 months old might help protect infants by “cocooning” them from the virus;
Healthcare and emergency medical services personnel because infections among healthcare workers have been reported and this can be a potential source of infection for vulnerable patients. Also, increased absenteeism in this population could reduce healthcare system capacity;
All people from 6 months through 24 years of age
- Children from 6 months through 18 years of age because we have seen many cases of novel H1N1 influenza in children and they are in close contact with each other in school and day care settings, which increases the likelihood of disease spread, and
- Young adults 19 through 24 years of age because we have seen many cases of novel H1N1 influenza in these healthy young adults and they often live, work, and study in close proximity, and they are a frequently mobile population; and,
Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.

We do not expect that there will be a shortage of novel H1N1 vaccine, but flu vaccine availability and demand can be unpredictable and there is some possibility that initially, the vaccine will be available in limited quantities. So, the ACIP also made recommendations regarding which people within the groups listed above should be prioritized if the vaccine is initially available in extremely limited quantities. For more information see the CDC press release CDC Advisors Make Recommendations for Use of Vaccine Against Novel H1N1.

Once the demand for vaccine for the prioritized groups has been met at the local level, programs and providers should also begin vaccinating everyone from the ages of 25 through 64 years. Current studies indicate that the risk for infection among persons age 65 or older is less than the risk for younger age groups. However, once vaccine demand among younger age groups has been met, programs and providers should offer vaccination to people 65 or older.

Links to non-federal organizations are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the federal government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.

PLEASE SCROLL DOWN FOR FLU SHOT OFFICE UPDATES

OUR COMMITMENT TO PATIENT SATISFACTION

INFLUENZA IMMUNIZATIONS

October 29, 2009:UPDATE FROM MASSACHUSETTS DPH

More Details About the H1N1 Vaccine Distribution Program

Please continue to check this site for future updates.

Massachusetts Department of Public Health (MDPH)
Division of Epidemiology and Immunization

Unfortunately, we have recently learned from both the CDC and the vaccine manufacturers that the scheduled delivery for the remaining doses of seasonal flu vaccine will not be as accelerated as originally anticipated, due to prioritization of H1N1 vaccine and other challenges.

We have received over 40% of our seasonal flu vaccine supply to date. Remaining doses are expected to become available over the next 4-6 weeks with the majority of doses still expected by the end of October and all doses delivered by early November.

However, the timing of vaccine availabity for the different types (seasonal vs. H1N1) may closely match virus circulation. Almost all of the influenza viruses currently circulating are H1N1. Seasonal influenza virus strains may not appear until later in the season.

Recommendations
MDPH recommends that all health care providers continue to vaccinate patients with seasonal influenza vaccine during routine visits and in scheduled clinics as supply allows.

Local Health Departments and Schools

Large public clinics and school based flu clinics should be delayed until mid October (and possibly into early November) unless there is sufficient vaccine on hand to meet the expected demand. By mid-October, we anticipate vaccine supplies will be sufficient to mount large clinics efforts.

Anticipate holding clinics for H1N1 flu vaccine starting in early November as well. Consider offering both seasonal and H1N1 flu vaccine at these clinics.

(over)

Pediatric Providers

Continue to vaccinate your patients based on your available vaccine supply and formulation types.

Schedule vaccination appointments in late October for any infants who cannot now be vaccinated due to lack of current supplies. By late October there should be sufficient supplies of both state-supplied and privately-purchased pediatric formulation seasonal flu vaccine.

Note: doses of the intranasal H1N1 LAIV and seasonal LAIV must be separated by 4 weeks, but you can administer H1N1 and seasonal vaccines simultaneously if one or both vaccines are the injectable vaccine.

We want to thank you for your efforts at this most difficult and challenging of times. MDPH will notify you if there are any changes in influenza vaccine supply.

Be assured that we are working diligently to make sure our patients receive these vaccines in a timely fashion and are checking daily for any updates regarding their availability.

Seasonal flu vaccine is now recommended for all children 6 months old or older. It is most important in younger children and those with chronic illness. Egg allergic individuals cannot receive the flu vaccine.

Novel H1N1 Vaccine

PLEASE SCROLL DOWN FOR FLU SHOT OFFICE UPDATES

OUR COMMITMENT TO PATIENT SATISFACTION

INFLUENZA IMMUNIZATIONS

October 29, 2009:UPDATE FROM MASSACHUSETTS DPH

More Details About the H1N1 Vaccine Distribution Program

Please continue to check this site for future updates.

Massachusetts Department of Public Health (MDPH) Division of Epidemiology and Immunization

Unfortunately, we have recently learned from both the CDC and the vaccine manufacturers that the scheduled delivery for the remaining doses of seasonal flu vaccine will not be as accelerated as originally anticipated, due to prioritization of H1N1 vaccine and other challenges.

We have received over 40% of our seasonal flu vaccine supply to date. Remaining doses are expected to become available over the next 4-6 weeks with the majority of doses still expected by the end of October and all doses delivered by early November.

However, the timing of vaccine availabity for the different types (seasonal vs. H1N1) may closely match virus circulation. Almost all of the influenza viruses currently circulating are H1N1. Seasonal influenza virus strains may not appear until later in the season.

Recommendations MDPH recommends that all health care providers continue to vaccinate patients with seasonal influenza vaccine during routine visits and in scheduled clinics as supply allows.

Local Health Departments and Schools

Large public clinics and school based flu clinics should be delayed until mid October (and possibly into early November) unless there is sufficient vaccine on hand to meet the expected demand. By mid-October, we anticipate vaccine supplies will be sufficient to mount large clinics efforts.

Anticipate holding clinics for H1N1 flu vaccine starting in early November as well. Consider offering both seasonal and H1N1 flu vaccine at these clinics.

(over)

Pediatric Providers

Continue to vaccinate your patients based on your available vaccine supply and formulation types.

Schedule vaccination appointments in late October for any infants who cannot now be vaccinated due to lack of current supplies. By late October there should be sufficient supplies of both state-supplied and privately-purchased pediatric formulation seasonal flu vaccine.

Note: doses of the intranasal H1N1 LAIV and seasonal LAIV must be separated by 4 weeks, but you can administer H1N1 and seasonal vaccines simultaneously if one or both vaccines are the injectable vaccine.

We want to thank you for your efforts at this most difficult and challenging of times. MDPH will notify you if there are any changes in influenza vaccine supply.

Be assured that we are working diligently to make sure our patients receive these vaccines in a timely fashion and are checking daily for any updates regarding their availability.

Seasonal flu vaccine is now recommended for all children 6 months old or older. It is most important in younger children and those with chronic illness. Egg allergic individuals cannot receive the flu vaccine.

Novel H1N1 Vaccine

Massachusetts Department of Public Health (MDPH)
Division of Epidemiology and Immunization

Recommendations
MDPH recommends that all health care providers continue to vaccinate patients with seasonal influenza vaccine during routine visits and in scheduled clinics as supply allows.