H1N1 - Vaccine Issues Resources

CLINICAL COMMENTARY: Among healthy persons, two groups are notable for increased risk of serious illness and hospitalization with influenza infection: healthy women in pregnancy and their healthy infants (aged 0 to 6 months). Inactivated influenza vaccine has been used in pregnant women since the 1960s in both the United States and Canada; however, currently, only 15% of pregnant women receive the vaccine. A randomized, controlled trial has shown influenza immunization of pregnant women reduced influenza-like illness by more than 30% in both the mothers and the infants and reduced laboratory-proven influenza infections in 0- to 6-month-old infants by 63%. Physicians caring for pregnant women should be aware of the risks of influenza and of the availability of an effective and cost-saving intervention.

BACKGROUND: Young infants and pregnant women are at increased risk for serious consequences of influenza infection. Inactivated influenza vaccine is recommended for pregnant women but is not licensed for infants younger than 6 months of age. We assessed the clinical effectiveness of inactivated influenza vaccine administered during pregnancy in Bangladesh.
METHODS: In this randomized study, we assigned 340 mothers to receive either inactivated influenza vaccine (influenza-vaccine group) or the 23-valent pneumococcal polysaccharide vaccine (control group). Mothers were interviewed weekly to assess illnesses until 24 weeks after birth. Subjects with febrile respiratory illness were assessed clinically, and ill infants were tested for influenza antigens. We estimated the incidence of illness, incidence rate ratios, and vaccine effectiveness.
RESULTS: Mothers and infants were observed from August 2004 through December 2005. Among infants of mothers who received influenza vaccine, there were fewer cases of laboratory-confirmed influenza than among infants in the control group (6 cases and 16 cases, respectively), with a vaccine effectiveness of 63% (95% confidence interval [CI], 5 to 85). Respiratory illness with fever occurred in 110 infants in the influenza-vaccine group and 153 infants in the control group, with a vaccine effectiveness of 29% (95% CI, 7 to 46). Among the mothers, there was a reduction in the rate of respiratory illness with fever of 36% (95% CI, 4 to 57).
CONCLUSIONS: Inactivated influenza vaccine reduced proven influenza illness by 63% in infants up to 6 months of age and averted approximately a third of all febrile respiratory illnesses in mothers and young infants. Maternal influenza immunization is a strategy with substantial benefits for both mothers and infants.

Comprehensive Website for California-specific information.
PREVENTION: Provides general information and access to posters and brochures.
VACCINATION: Information about the status of California's vaccine supply.
WHATS NEW: H1N1 (2009) Influenza Data and Statistics Update with reported hospitalized, ICU, and fatal cases of H1N1 (2009) influenza virus infections in California.
GUIDANCE: In the box section on the right, there is a section for California-specific guideline updates from CDPH.

Provides up to date links to a variety of good resources. Includes information for pregnant women and parents; information for clinicians and health officials, general H1N1 and seasonal flu information.

OVERVIEW: The single best place to visit for connections to a wide variety of resources (some of which we have individually indexed).
KEY STEP: Visit here often for updates.

Great site for a large variety of PDFs of education materials for general use, parents, pregnant women, vaccine, and anti-flu drugs. Many are also in Spanish and a few in Chinese.

Multiple topics covered including: general questions, Thimerosal, Guillain-Barre, Adjuvants, Testing and Monitoring, and Adverse Effects Monitoring.

Clinician Outreach Communication Activity (COCA) Conference Calls are designed to serve as the venue for timely education and two-way communication with CDC Subject Matter Experts (SME).
FIND: Scroll to the September 29, 2009 date.
CONTENTS: Transcript and MP3 audio recording that go with the Slide Set (Slides are in the CMQCC H1N1 Documents area (below) or can be directly downloaded from this same site). The presentation is broken into 5 areas: Overview of influenza; Infection control guidance; Testing and treatment; Vaccination; and The Atlanta experience.

SUMMARY: very comprehensive set of Q+A for clinicians about the use of H1N1 vaccine in pregnancy.

SUMMARY: This is the required CDC Vaccine information statement for all patients who receive the inactivated 2009 H1N1 vaccine. A Spanish translation is also available.

SUMMARY: Likely the best and most comprehensive vaccine Q+A sheet for pregnant women.

SUMMARY: Comprehensive set of Q+A for clinicians about the Nasal Spray Vaccine (aka: Live Attenuated Influenza Vaccine or LAIV). While this vaccine is contraindicated for pregnant women on theoretical grounds, it is safe and recommended for post-partum mothers, mothers who are breast-feeding, and for partners and others living with pregnant women.

SUMMARY: This is the required CDC Vaccine information statement in SPANISH for all patients who receive the inactivated 2009 H1N1 vaccine.

Slide set (55 slides) discussing the latest CDC guidelines with some background. Largely replaces the earlier CDC COCA slides.

SUMMARY : Since 2006, California law [Health and Safety Code Section 124172 subdivision (a)] has stated that vaccines containing specific levels of mercury cannot be administered to pregnant women and young children, except under certain circumstances. The Secretary of the California Health and Human Services Agency has granted an exemption to this restriction for Influenza A (H1N1) 2009 Monovalent Vaccine in children younger than 3 years of age and pregnant womenfrom October 12, 2009 – November 30, 2009. The exception is being granted because of the present dangers posed by pandemic (H1N1) influenza and because there are insufficient supplies of thimerosal-free influenza A (H1N1) 2009 monovalent influenza vaccine to comply with the law. The need for an extension of the exemption will be assessed over this period.

A good general slide set made for OB Grand Rounds or Nursing Education. Covers epidemiology, pregnancy risks, triage assessment, treatment and prophylaxis, vaccine issues, and isolation/visitor policies.

Clinician Outreach Communication Activity (COCA) Conference Calls are designed to serve as the venue for timely education and two-way communication with CDC Subject Matter Experts (SME).
SLIDE SET: broken into 5 areas: Overview of influenza; Infection control guidance; Testing and treatment; Vaccination; and The Atlanta experience. Note that this slide set is in.pps format so that it is not editable.
TRANSCRIPT AND AUDIO TAPE: can be obtained using the citation noted in Web Resources with the same authors.