October 16, 2009 - Update on pH1N1 vaccine strategy

Dr. Isra Levy, Medical Officer of Health
Dr. Merrilee Fullerton, President, Academy of Medicine Ottawa

October 16, 2009

As planning parameters for the delivery of the pandemic H1N1 (pH1N1) influenza vaccine continue to be defined and communicated to decision makers within the City of Ottawa, many of you will have heard about some aspects of the delivery strategy via media updates in the past 48 hours.

The Province has established that local public health units are responsible for overseeing the delivery of the pH1N1 vaccine in Ontario, with each health unit deciding upon the best strategy based on local resources. The pH1N1 vaccine has unique characteristics that are leading to a different approach to influenza immunization than in previous years. The pH1N1 vaccine comes in packages of 500 doses, requires reconstitution and loses potency after 24 hours of reconstitution. As the pH1N1 vaccine contains an adjuvant new to the Canadian market, documentation requirements for each dose given are enhanced. Ottawa Public Health (OPH) is implementing a new software program to capture the documentation requirements. When OPH conducted a focus group with primary care physicians to discuss the above challenges to vaccine delivery, primary care providers pointed to additional reasons to adjust the usual influenza vaccine delivery strategy: the desire to focus on being available to treat their patients with influenza-like illness (ILI) and the challenges in infection control when people at high risk of complications seek the vaccine and potentially mix with patients presenting with ILI. Thus, OPH has had to make significant changes in delivery of the pH1N1 vaccine compared to the usual seasonal influenza vaccine program.

The Province has also requested that each vaccine provider undergo a qualification process to meet specific criteria to be able to provide the pH1N1 vaccine to its patients. OPH is responsible for administering this process in our area. The Province has recently discussed revising its prequalification guidelines to ensure more primary care doctors will be able to deliver the pH1N1 vaccine. OPH welcomes this proposed change, however, City clinics are still expected to be the main delivery method. Please stay tuned, as we will shortly be able to inform you of the qualification requirements.

OPH will start the distribution of pH1N1 vaccine via mass immunization clinics, complemented by several smaller outreach clinics. OPH is prepared to open these clinics by the end of October, but is awaiting imminent announcements by the federal and provincial governments that the vaccine has been approved and will be distributed to public health units.

As part of the City's delivery strategy the pH1N1 vaccine will be available at seven permanent pH1N1 clinics. These fixed clinics will be located at Kanata Recreational Centre; Tom Brown Arena in Ottawa centre; Richelieu Vanier Recreation Centre; Orléans’ Client Service Centre (Orléans Centrum); 100 Constellation Crescent in Nepean; Walter Baker Sports Centre in Barrhaven and one site serving the south end alternating between Fred G. Barrett Arena and Jim Durrell Arena. The hours of operation of these clinics will be announced soon; the clinics are expected to be open seven days a week.

Additional staff will provide the pH1N1 vaccine throughout the vaccination period at multiple “roving clinic” locations throughout the city, including Ottawa’s rural areas. Hospitals, long-term care homes and student health centres will be supplied with pH1N1 vaccine to offer to their staff and clients.

Since the initial supply of the pH1N1 vaccine is expected to be limited, OPH, with your support, will be asking the following groups to be vaccinated first:

  • People with chronic medical conditions, from six months to 65 years of age (underlying medical conditions include heart or lung diseases – including asthma – or conditions or illnesses that compromise the immune system, such as diabetes and cancer treatments)
  • Pregnant women
  • Healthy children from six months to five years old
  • Health care workers involved in the pandemic response or the delivery of essential health care services
  • Household contacts and care providers of persons at high risk who cannot be immunized or may not respond to vaccines

Pregnant women have two options: receive the adjuvanted pH1N1 vaccine as soon as it is available or wait and receive the non-adjuvanted H1N1 vaccine expected in mid-November.

The pH1N1 vaccine will be available to the general public as soon as adequate supply is delivered to OPH.

Still, there is much that can be done for your patients when it comes to influenza prevention and management:

  • Promote seasonal influenza vaccination for adults 65 years and older
  • Inform your patients that seasonal influenza vaccination for other groups will be considered after pH1N1 vaccination, depending on the epidemiology of circulating influenza strains
  • Ensure you are protected with the pH1N1 shot when it is available
  • Educate patients about general prevention measures such as hand hygiene and staying home when ill
  • Recommend the pH1N1 vaccine to your patients, especially priority groups
  • Discuss the safety of this vaccine and the importance of getting the pH1N1 flu shot
  • See patients who would benefit from antiviral treatment within 48 hours of onset of ILI symptoms

OPH encourages you to become familiar with the latest clinical guidelines from the MOHTLC that have been published earlier this week. They can be accessed at http://health.gov.on.ca/english/providers/program/emu/ihn.html.

For updated vaccination clinic and pH1N1 flu information, please recommend to your patients to visit ottawa.ca/health or contact the Ottawa Public Health Information Line at 613-580-6744.

As always, we would like to thank you for your ongoing support and collaboration in the response to pH1N1. If you have any questions, please call 613-580-6744, ext. 15414.

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