Vulnerable groups still wait for H1N1 vaccine

Heather Faulhefer

Nov. 8, 2009 (McClatchy-Tribune Regional News delivered by Newstex) -- As parents of young children, Matt and Shannon Albright have been paying close attention to the H1N1 virus.

Their children receive the seasonal flu vaccine, and after researching the H1N1 vaccine, the Littlestown couple decided they wanted their kids to be vaccinated against that virus.

There's just one problem.

The Albrights have a 19-month-old and a 4-year-old -- children not yet of school age.

And while local school-aged children are starting to get vaccinated through their school districts, the vaccine is not yet available to younger children, according to officials with the York/Adams Metropolitan Medical Response System, the group coordinating the bulk of the area's vaccination efforts.

The Albrights have spent weeks searching for places offering the vaccine, but have come up short everywhere they've looked.

In the U.S., the federal government is paying for the vaccine and rationing supplies to each state. Then state and local health departments decide where it goes next -- from schools to doctors' offices to community health clinics and even some large companies with health directors.

On Thursday, the director of the federal Centers for Disease Control and Prevention wrote to local health departments, asking them to ensure the vaccine is getting to high-risk groups first. Dr. Thomas Frieden warned that decisions that appear to send the vaccine beyond high-priority groups "have the potential to undermine the credibility of the program." Locally, most pediatric offices in the area are allowing WellSpan Health and YAMMRS to coordinate the vaccination efforts in the community, "rather than encourage children to go to overfilled pediatric practices, where they're managing a lot of sick children now," said Kevin Alvarnaz, the H1N1 vaccination coordinator for YAMMRS.

The vaccine is also not yet available to people in the area with serious medical conditions, or those in regular contact with children under 6 months old.

Those groups, along with pregnant women, school-aged people and health-care employees, are considered the most vulnerable to complications from the H1N1 virus and should get the vaccination as soon as it becomes available, according to the Centers for Disease Control and Prevention.

So when might that be? Alvarnaz said YAMMRS only recently got enough supply to start its school-based effort. Once it gets a sufficient supply of both the H1N1 flu shot and the nasal spray vaccine, it will look into scheduling community clinics that would first reach out to vaccinate the priority groups, Alvarnaz said.

Asked about a time frame for starting the clinics, Alvarnaz said, "We're hoping sometime in December, but we cannot say that for sure."

For the organization, it's a matter of waiting for the state to ship enough vaccine supply to get started. That takes time, since the state can only ship the vaccine as it comes to them from the federal government, and has to distribute it among nearly 4,400 doctors, retailers and health-care groups that pre-registered for it statewide.

YAMMRS has to have the vaccine supply on hand before it can schedule the community clinics, Alvarnaz said.

"We do not want to have to turn people away," he said.

Vaccine distribution

As of last Friday, Oct. 30, southcentral Pennsylvania had been issued the second-largest amount of vaccine statewide, with 179,700 doses approved, according to the Pennsylvania Department of Health.

The amount changes regularly as the state continues to receive shipments, said Stacy Kriedeman, a spokeswoman for the department.

The first supplies of the H1N1 vaccine were initially sent in late September to the southwest, southeast and northcentral regions of the state -- the areas that were seeing the most disease at the time, Kriedeman said.

But within days, the state Department of Health was alerted to more cases of influenza statewide and expanded the distribution effort to the entire state, she added.

As more vaccine was available, more was allocated to providers across the state, Kriedeman said, and that process continues today.

Vaccine distribution starts at the federal level with the Centers for Disease Control and Prevention. On its Web site, the CDC explains that once a shipment of vaccine becomes available from a manufacturer and is ready to order, the quantity of vaccine allocated to a state is based on its population size.

The example given by the CDC is if 6 million doses of the vaccine are ready for ordering nationally, and a state has 10 percent of the U.S. population, then the state's allocation of that shipment would be 600,000 doses.

When the state receives its allocation, it distributes it among the more than 4,000 providers in the Commonwealth that pre-registered and were certified to receive a supply of the vaccine. The providers include doctors and hospitals, retailers, and health-care organizations like YAMMRS that provide the vaccine to schools.

A number of factors determine how the vaccine supply is divided among the providers, Kriedeman said.

The state considers what type of vaccine is being allocated -- the flu shot or the nasal spray vaccine -- and who is allowed to receive the vaccine. While the nasal spray vaccine is recommended for use in healthy people from 2 years old to 49 years old, it is not recommended for pregnant women or people with serious medical conditions.

The state also looks at to whom each provider would be giving the vaccine, specifically whether the provider will be giving it to one of the target groups that are most vulnerable to being affected by H1N1.

Using those factors, it matches the vaccines with the orders from providers and sends shipments to the providers as they come in.

When it comes to getting the vaccines to schools, the state has provided vaccines to schools or their distributing organizations that pre-registered and got certified early, Kriedeman said.

"We've gone in order," she said, noting that the virus has spread throughout schools in the entire state.

The department is working to get the vaccine delivered to the target groups as quickly as possible, Kriedeman said.

Eventually, as larger doses become available and shipped to the state, the vaccine will be available to anyone in the public, according to the department's Web site.

What to do while you wait

For families like the Albrights, who are still waiting for the vaccine for their young children, the best way to fend off the H1N1 virus is to maintain good hand hygiene and practice social distancing in public areas, Alvarnaz said.

Washing hands, coughing or sneezing into a tissue or sleeve and keeping hands away from the face are some of the prevention techniques recommended by the state Department of Health.

Parents should also be on the lookout for symptoms of the flu, which include a fever, cough, fatigue, runny or stuffy nose, headaches or body aches, chills, vomiting and diarrhea.

It's advice parents have heard since the H1N1 outbreak began. But until a vaccine is available to all children, Matt Albright said he will still be concerned for the health of his young ones.

He's glad that school-aged children in the area are starting to get the H1N1 vaccine, but "there are other children out there," he noted.

He wishes school districts and the health groups they work with would offer the vaccine to all children residing in the districts, not just school-aged ones.

School-aged kids may interact with other kids on a daily basis, running the risk of spreading germs, but those same kids could be going home to their younger, unvaccinated siblings, he said.

"You worry, especially having such young children," Albright said. "They can't speak for themselves."

Widespread illness

Adams County recently had the state's first H1N1-related pediatric death, with the tragic death of 5-year-old Kyree Gamble, a kindergartner at Rolling Acres Elementary School in the Littlestown Area School District. Kyree died on Saturday at Penn State Hershey Medical Center of complications related to swine flu, according to Megan Shreve, the executive director at South Central Community Action Programs Inc., where Kyree's mother, Marci Place, works.

CDC officials said 129 children have died from swine-flu complications since the virus was first identified in April. About two-thirds of them had other health conditions, like asthma or neurological problems like cerebral palsy or muscular dystrophy. The government does not keep a close count of all swine-flu deaths, but estimates the number is above 1,000. Many millions of Americans have been infected with the virus, though most suffered only mild illness, health officials say.

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