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Monday

HHS Establishes Pandemic Flu Countermeasure Injury Table

Pandemic flu countermeasures cause injury? Apparently they do and we have a compensation table to prove it.

The Countermeasure Injury Compensation Program(CICP)/Pandemic Influenza Countermeasure Injury Table has been published in the Code of Federal Register (CFR) and goes into effect on September 9, 2015. The CICP is established by the Department of Health and Human Services under the Public Readiness and Emergency Preparation Act of 2005 (PREP Act).

The CICP defines liability protection and compensation from a covered injury, defined as death or serious injury, that is

  1. presumed to be a direct result of use or administration of a covered countermeasure (full text link
  2. an injury or or health implication that is a direct result of an included countermeasure. This includes causing serious aggravation of a preexisting condition. (full text link)
Components of the pandemic CICP include
Anaphylaxis 
Pandemic Intranasal Vaccine
Antiviral use in children less than 2 years of age
Overal Children and Infants
Gillain-Barre` Syndrome
National Vaccine Injury Program
West Nile Virus

The Injury Table lists the covered countermeasures, covered serious injury (illness), and time interval from countermeasure use to symptom onset. 

Saturday

MMWR: Prevention and Control of Influenza with Vaccines 2015/2016

Vaccine Recommendations from CDC Advisory Committee on Immunization Practices

The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP) have released guidelines for 2015/2016 seasonal influenza vaccination.

As expected, the recommendations call for vaccination against seasonal influenza for anyone greater than six months old. Live Attenuated Influenza Vaccine (LAIV) and Inactivated Influenza Vaccine (IIV) are available. Both vaccine types are recommended for adults with a few exceptions, while LAIV may be better for children, according to the recommendations.

ACIP calls for vaccination to occur as soon as possible and before flu activity in your area. The recommendations also mentions the possibility of that antibody decline (vaccinating too early) may be more rapid in older adults and should be balanced with risks of vaccinating too late. (related Influenza vaccine overrated?)

The recommendations further state that vaccination of children six months or older "should occur before onset of influenza activity in the community." Children six months to 8 years old will require two doses of vaccine this season; the first dose given as soon as possible - "before onset of flu activity  in the community" - and the second dose after four weeks. The recommendations state that health children ages of 2-8 who have no contraindications, may revive LAIV or IIV.  Please note that LAIV is not recommended for ages less than 2 years or children between 2-7 years who are receiving aspirin or aspirin-containig products. LAIV is not recommended for ages greater than 49 years. 

There is a lot of discussion related to LAIV and asthma/wheezing. The "warnings and precautions" statement for LAIV also states that anyone with asthma, of any age, may be at greater risk for wheezing after receiving LAIV. While kids (ages 2-4 years) with asthma or a wheezing episode within the last 12 months prior to vaccination should not receive LAIV. 

Vaccine or not, its important to remember the non-pharmacolgical interventions for preventing spread of influenza. 

The issue of a two-dose vaccine season for children is worth additional consideration when planning for community events such as Points of Distribution (POD) activity and health care system utilization for routine vaccination. (Related Nurse Triage Line and Improving Service

LAIV is not recommended for those who have sever allergic reaction in the past, those who are pregnant, and people with who are immunocompromised. Further, caregivers of immunocompromised patients should avoid contact for 7 days due to a "theoretical risk of infection" after LAIV.  Anyone who has revived antiviral medications should delay vaccination for 48 hours. 

Please read the full report from CDC/ACIP for detailed information. Visit the CDC flu page and the ACIP page for additional updates. This summary is not intended as sole source of information or vaccination guidelines. 

Related: Three things to know about seasonal flu

Sunday

2015/2016 Flu: Forward Thinking for the next Epidemic

Its difficult to think about seasonal influenza and the potential of a seasonal epidemic when you're bathed in summer weather. Its difficult to research and write about it at this time of year, too. Believe me. Still, after last flu season, if we learned nothing (and maybe we did learn nothing) we learned to get prepared early.


The 2014/2015 flu season was particularly difficult. The vaccine was poorly matched and resulted in ~23% vaccine effectiveness (VE) overall with a ~18% VE for the (drifted) H3N2 strain. And it was worse for children. Add to that the particularly long season of 20 weeks as compared to the usual 13 week flu season and it becomes easy to see why we had such a difficult time last flu season. Thats why we need to get into gear now.

Epidemic on the horizon

We don't often get a lot of warning before a natural disaster strikes. Seasonal influenza gives us a bit of a break on that fact. We know seasonal influenza is coming every year. We know what it did last year, and the year before that and the year before that. We know what it can do to our emergency response systems, our emergency departments, intensive care units, walk-in clinics, and doctors offices. There remains a lot to learn and apply from Dark Winter and Atlantic Storm.

We have an awful lot of data and we need to use it, along with this time of relative quiet, to ramp up for the coming epidemic.

Plan for it

Drag out your biologic plans and review them with all members of your staff. Anyone who works in your facility (medical providers, secretarial support, food service, and environmental service) should be made aware of their responsibilities (and they all have them) during a biologic event. Remember, seasonal influenza is a naturally occurring biologic event. Treat it like one. Surge capacity and mass fatality plans are two additional plans you should be looking at.

Take a hard look at your staffing patterns 

Influenza-like illness (ILI) can result in an absentee rate greater than 20%. Now is a good time to review your call back procedures and evaluate who will be available/willing to come back to work. Keep in mind that the best way to keep people coming back to work is to keep them safe. Medical staff who feel they (and their families) are protected are more likely to report to work during a biologic event. The flip side of this is, of course, reminding sick staff to stay home.

Review triage 

In this case, triage of specialty medical resources such as ventilators and intensive care unit bed. At the height of a biologic event is not the time to decide who does or does not get the last bed or ventilator.

Points of Distribution

Points of distribution (POD) planning is critical to any successful pharmaceutical countermeasure program. Public (open POD) and closed POD plans need to be reviewed, updated and practiced. They will not run themselves and your organizations health, safety, and public image may hang in the balance. Make sure you POD system works!

Practice the non-pharmaceutical countermeasures

Hand washing, respiratory etiquette, and appropriate social distancing (staying home if you're ill) will go a long way towards keeping your staff and facility safe and functional. Endorse it, live it, practice it.

Forward thinking: Whats in store for the 2015/2016 flu season? 

The predicted strains included in this season are A H1N1, A H3N2, and two strains of B influenza. Go here for additional details on flu strains. Estimates are that between 164 million and 175 million doses of flu vaccine will be available between August and October, 2015. Sanofi Pasteur released their first flu vaccine shipment of the season in July, 2015.

A trivalent and quadrivalent vaccine will again be available for the 2015/2016 season. Intramuscular, nasal spray will be available. New this season is the Jet Injector that delivers vaccine by a high pressure stream rather than a needle.