Md. czar marks orders to deliver the limited supply of vaccine to those who need it most
In the battle against swine flu, the first line of defense for Maryland’s vaccine czar is a blue highlighter pen.
That’s what Greg K. Reed used this week to mark orders for vaccine against the H1N1 virus that he planned to fill. But with limited supplies, there were tough choices for the man at the center of the state’s logistical effort to stem a pandemic.
Reed, 42, who runs Maryland’s Center for Immunization on behalf of the federal Centers for Disease Control and Prevention, has been hunkered down with state health department officials in their Preston Street offices, combing their lists for places that could administer vaccine the fastest to those considered most vulnerable to swine flu – children, health care workers, pregnant women and adults with chronic conditions or compromised immune systems.
Reed had to consider that rural counties have fewer pediatricians to do vaccinations, so health departments there would need more doses. Hospitals need large amounts. But practices that cater to pregnant women should not get the first doses shipped, because they will be nasal spray made with live virus.
Boxes started to trickle in Tuesday to 114 providers given first priority to receive the vaccine across the state. In late afternoon, state officials walked a few doses from their offices to nearby Maryland General Hospital and began administering them to health care workers to show reporters how the spray would be given.
Alexis Braxton, a nurse in the hospital’s emergency room, said she was getting the vaccine because she has young children at home and wants to protect patients. “I work with a lot of people who can’t get the vaccine themselves, and it’s important to help protect them and protect the community,” she said.
The decisions made daily since Sept. 30, when the federal government began giving states their quotas of the vaccine, will result in a total of about 60,500 people being inoculated in every Maryland county and Baltimore this week. It is just a fraction of those who will likely want to be vaccinated.
“We’ll keep pushing out doses until everyone who wants a vaccination gets one,” Reed said. “We’ll be getting shipments on almost a daily basis.”
Unlike the seasonal flu vaccine, for which orders are usually filled immediately each year from federal supplies generated well in advance of the start of influenza season, the surprise spread of the H1N1 virus meant that the vaccine-making process was ramped up late. Doses are being shipped in groups of 100 to states from five manufacturers as they are produced and approved. Shots won’t be available until next week.
With pregnant women and those with underlying health conditions unable to take the FluMist nasal spray, Reed has focused on schoolchildren, caretakers for infants who cannot be vaccinated, and health workers. That means sending vaccine to hospitals, doctors’ offices and local health departments.
The health departments will decide how to dispense their doses. Most plan to hold large school clinics when they get more vaccine. For now, they plan smaller clinics for other vulnerable groups such as homeless children.
Each office set to get vaccines got highlighted with that blue pen, a labor-intensive process that Reed said ensured that the doses were going to the right places first.
Before the highlighting began, decision-makers met in a conference room to figure out how many people might want vaccine, how many were in target groups and where they lived.
State epidemiologist Dr. David Blythe and John P. Krick, director of the state Office of Epidemiology, met with Reed on Monday afternoon to talk about the numbers. They know about 5.5 million people are recommended to get the vaccine in the state, with 2.9 million in high-priority groups. Less than a third of the population and only about 40 percent of health care workers typically get the seasonal flu vaccine, though officials believe that heavy publicity surrounding deaths of children, who are disproportionately affected by swine flu, probably will lead more people to seek protection from both viruses.
The CDC estimates that 3.4 million doses of the H1N1 vaccine will be used in Maryland by the first week in January, Reed said.
There have been outbreaks in every state in the nation. A private school in Laurel, St. Vincent Pallotti High School, plans to close today so a cleaning company can disinfect after five students came down with flu, according to a note on the school Web site from Principal Stephen J. Edmonds. Doctors are not testing for the H1N1 virus, and it had not been determined whether the cases are swine flu or seasonal flu.
Nationwide, there have been limited reports of shortages of the antiviral Tamiflu in liquid form used by children. And there have been reports of clinics running out of vaccine for seasonal flu, of which there has not yet been an outbreak.
That is not the reason the state requested that schools suspend their seasonal flu clinics. Seasonal and H1N1 nasal spray vaccines cannot be given within four weeks of each other, and the state wanted localities to be ready to administer swine flu vaccine as soon as it is available because there is a more pressing need.
Nationwide, nearly all of the cases of flu this year have been swine flu, said CDC Director Thomas R. Frieden in a conference call with reporters.
Several states have begun administering FluMist to target populations, Frieden said. He said the H1N1 pandemic has spread across the country and that the states have ordered more than 2 million doses.
