H1N1 Resources for San Diego County Physicians

UPDATES …

FROM THE COUNTY OF SAN DIEGO:

• County Offers No-cost H1N1 Vaccine to All on February 16, 18, 20, 27, and March 5, 2010
• H1N1 Influenza Weekly Update (January 13, 2010)
• H1N1 Vaccine Update (December 30, 2009)
• San Diego County Influenza Surveillance Update (February 10, 2010)
• The Flu & You: Pandemic 2009 H1N1 Influenza Newsletter (December 2, 2009)

VIDEO PRESENTATIONS FROM THE COUNTY OF SAN DIEGO:

• "Pandemic 2009 H1N1 Influenza Treatment in Adults" by Wilma J. Wooten, MD, MPH (2009.12.14)
• "Treatment of Infants and Children: H1N1 Pandemic Influenza" by John Bradley, MD (2009.12.14)
• "H1N1 Epidemiology" by Michele M. Ginsberg, MD (2009.09.11)
• "Laboratory Diagnosis of Influenza During the H1N1 Pandemic" by Patricia McVay, MD (2009.09.11)
• "Pandemic H1N1 Influenza Vaccine" by Mark H. Sawyer, MD, and Robert Peters, MD, PhD (2009.09.11)

MISCELLANEOUS FROM THE COUNTY OF SAN DIEGO:

• Pandemic (H1N1) PowerPoint (2009.09.01)
• Public Health
• H1N1 Flu (Swine Flu)
• H1N1 Flu and You: FAQs
• Community Epidemiology
• Subscribe to CAHAN San Diego (California Health Alert Network for San Diego County)

FROM THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH (OCTOBER 15, 2009):

• Thimerosal Exemption Letter From the Calif. Dept. of Public Health to Physicians
• Thimerosal Exemption Letter From the Calif. Dept. of Public Health to Interested Parties

FROM SDCMS:

H1N1 Vaccine Q&A Focusing on the H1N1 Spray  (October 14, 2009)

1. What vaccines are available to protect against 2009 H1N1 Influenza?
   • ANSWER: Three formulations have been developed. An inactivated subunit vaccine available in either multidose vials or prefilled syringes (preservative free), the other a live attenuated intranasal vaccine (preservative free).
2. The first shipments of H1N1 swine flu were received in the county last week. To date, San Diego has received ONLY the live attenuated intranasal vaccine (spray) (LAIV). Who should receive this vaccine?
   • ANSWER: LAIV is approved for people from 2 to 49 years of age who are not pregnant. Groups recommended to receive 2009 H1N1 LAIV first are healthy people who are from 2 through 24 years of age, are from 24 through 49 years of age and live with or care for infants younger than 6 months of age or are healthcare or emergency personnel. As more vaccine becomes available, other healthy 25 through 49 year olds should also be vaccinated. Children through 9 years of age should get 2 doses of LAIV vaccine, about a month apart. Older children and adults need only one dose of LAIV.
3. Who should not receive the live attenuated intranasal spray?
   • ANSWER: The 2009 H1N1 vaccine should NOT be given to those who have a severe allergy to eggs, children younger than 2 and adults 50 years of age and older, pregnant women, anyone with a weakened immune system, a long-term health problem such as heart disease, kidney or liver disease, lung disease, metabolic disease such as diabetes, asthma, anemia, and other blood disorders, children younger than 5 years of age with asthma or one or more episodes of wheezing during the past year, anyone with certain muscle disorders such as cerebral palsy that can lead to breathing or swallowing problems, anyone in close contact with a person with a severely weakened immune system (requiring care in a protected environment, such as a bone marrow transplant unit), children or adolescents on long-term aspirin treatment. A life threatening allergic reaction after a dose of seasonal flu vaccine or Guillain-Barre syndrome (a severe paralytic illness) may be reasons to avoid the vaccine.
4. Can 2009 H1N1 LAIV (spray) be given at the same time as most other vaccines?
   • ANSWER: H1N1 LAIV may be given at the same time as most other vaccines. H1N1 LAIV(spray) and seasonal LAIV (spray) should not be given together. H1N1 LAIV (spray) and seasonal flu shots may be given together.
5. What are the risks from 2009 H1N1 LAIV?
   • ANSWER: The risks from 2009 H1N1 LAIV are expected to be similar to those from seasonal LAIV. Some children and adolescents 2-17 years of age have reported mild reactions, including, runny nose, nasal congestion or cough, fever, headache and muscle aches, wheezing, abdominal pain, or occasional vomiting or diarrhea. Some adults 18-49 years of age have reported runny nose or nasal congestion, sore throat, cough, chills, tiredness/weakness and headache. In 1976, an earlier type of inactivated swine flu vaccine was associated with cases of Guillain-Barre Syndrome (GBS). LAIV has not been linked to GBS.
6. I have registered to receive the H1N1 vaccine. What are my obligations in reporting vaccine usage?
   • ANSWER: The CalPanFlu provider agreement affirms that all California providers receiving H1N1 vaccine must report their vaccine usage weekly each Monday for vaccine administered the week before.
7. How do I report my vaccine usage?
   • ANSWER: You have two options. Option one: Enter H1N1 doses given into CAIR (California Immunization Registry) each week. That's it, you're done. Option two: Log into http://www.CalPanFlu.org and submit a weekly usage report. Click on the "Report H1N1 Vaccine Doses Administered" button on the main menu. Easy, step-by-step instructions are available on the site to guide you through the reporting process.

FROM HHS AND AMA ACTIONS ON H1N1 VACCINE ADMINISTRATION CODING AND PAYMENT:

September 25, 2009: CMS has developed two new H1N1 codes for the Medicare program:

• G9141 — Influenza A (H1N1) immunization administration (includes physician counseling the patient/family)
• G9142 — Influenza A (H1N1) vaccine, any route of administration

CMS indicated that the H1N1 vaccine will be provided free of charge to immunizers. For H1N1 vaccine administration, Medicare will pay the same rate as it does for administering seasonal flu vaccine, about $21. In addition, for both seasonal flu and H1N1 vaccine administration, Medicare will pay 100% and patients will not be charged any co-pays or deductibles. HHS has also asked private insurers to provide first-dollar coverage of H1N1 vaccine administration. Click here for further information.

FROM CMS:

CMS Encourages Flu Shots (October 15, 2009): The Centers for Medicare and Medicaid Services (CMS) wants all beneficiaries to be immunized against the various forms of influenza threatening Americans this fall and winter. Medicare and Medicaid pay for the regular seasonal flu shots and immunization for the new H1N1 flu strain, sometimes referred to as "swine flu." Most people will need both shots, although children and pregnant women are high priority for the H1N1 vaccine and for the seasonal flu vaccine. As part of this concern, CMS is distributing a fact sheet for Medicare beneficiaries and another for those enrolled in Medicaid and the Children's Health Insurance Program (CHIP). Both fact sheets have been posted on the CMS website. They also are being sent to physician offices and other healthcare providers, professional associations, patient and consumer advocacy groups, and others. The fact sheets give helpful information on flu symptoms and what to do if you develop them, priority lists of those groups most in need of immunization, what's covered, and where to get more information. They fact sheets can be found at these weblinks:

• Medicaid and CHIP Version
  
• Medicare Version

RESOURCES …

The Flu and You: Pandemic 2009 H1N1 Influenza — Top 10 Things You Need to Know! (Oct. 12, 2009, Poster)

FROM THE CDC:

• 10 Steps Medical Offices and Outpatient Facilities Can Take
• 2009 H1N1 Flu (Swine Flu)
• Situation Update
• Vaccination Resources
• General Information
• Information for Specific Groups
• Clinical and Public Health Guidance
  
  • Vaccination Guidance for State, Local, Tribal, and Territorial Health Officials
  • Clinician Guidance
  • Clinician Guidance for Specific Audiences
  • Infection Control
  • Laboratory Testing
  • Guidance for Patients
  • Guidance for Pregnant and Breastfeeding Women
  • Business and Employer Guidance
  • Emergency Personnel Guidance
  • Guidance for Schools, Colleges and Universities
  • Travel and Travel Industry Guidance
• Get Email Updates
• Cover Your Cough Posters
• CDC Homepage

FROM THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH:

• H1N1 Vaccine and Thimerosal Exemption — To California Physicians (October 15, 2009)
• H1N1 Vaccine and Thimerosal Exemption — To Interested Parties (October 15, 2009)
• CDPH Guidances for H1N1 influenza.
• CDC and Other Guidances for H1N1 influenza.

FROM THE SDCMS GERM COMMISSION:

"Use of the Pandemic H1N1 Vaccine for Fall 2009" Video Presentation by Mark H. Sawyer, MD, and Robert Peters, PhD, MD, Representing SDCMS' GERM Commission (2009.09.11)

MISCELLANEOUS RESOURCES:

• California's Site to Order H1N1 Vaccine and Report Usage
• H1N1 Resources From EZ-IZ
• WHO Pandemic Influenza Phases Explanation
• Report to the President on U.S. Preparations for 2009 H1N1 Influenza