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The CDC today released new guidance for State and Local planners to help them prepare for what may end up being a national pandemic vaccination program this fall and winter.
The Five tier system (see The Tracks Of Our Tiers) – originally developed for a potential bird flu (H5N1) pandemic – isn’t considered appropriate for swine flu given this pandemic’s virulence and likely attack rate among children and young adults.
While early guidance, this document signals an intent to vaccinate school children and staff, pregnant women and toddlers, high risk adults, and health care workers first.
CDC Recommendations for State and Local Planning for a 2009 Novel H1N1 Influenza Vaccination Program
July 8, 2009, 4:30 PM ET
The purpose of this document is to describe planning scenarios for state and local governments to target high-priority populations for vaccination in order to reduce the health and societal impact of the novel H1N1 influenza virus.
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Planning Assumptions
These planning scenarios are based on the following assumptions at the time vaccine becomes available and distribution begins:
- severity of illness is unchanged from what has already been observed
- risk groups affected by this virus do not change significantly
- vaccine testing suggests safe and efficacious product
- adequate supplies of vaccine can be produced
- no major antigenic changes are evident that would signal the lack of likely efficacy of the vaccines being produced
Planning Scenarios (excerpts)
The following are best-case planning scenarios that would be recommended in a setting of limited initial vaccine availability.
Target population: Students and staff (all ages) associated with schools (K-12th grade) and children (age ≥6 months) and staff (all ages) in child care centers.
Primary venues: schools and child care centers.
Goals: Provide direct protection against illness among persons who have high attack rates of illness, reduce likelihood of outbreaks that may lead to disruptive school dismissals, reduce transmission from schools into homes and the community.
Target population: Pregnant women, children 6 months – 4 years of age, new parents and household contacts of children <6 months of age.
Primary venues: Provider offices, community clinics.
Goal: Reduce complications of novel H1N1 influenza, such as excess hospitalizations and deaths among those vulnerable for serious complications of influenza, as evidenced by higher rates of hospitalization; protect the youngest (<6 months) who are not themselves able to be vaccinated through immunization of their household contacts.
Target population: Non-elderly adults (age <65 years) with medical conditions that increase the risk of complications of influenza.
Primary venues: Occupational settings, community clinics, pharmacies, providers’ offices. (Experience with seasonal influenza vaccine suggests that persons with underlying illness age 50 to 64 years may be more likely to receive vaccine from their provider, while younger persons may be more likely to be vaccinated elsewhere).
Goal: Reduce risk of hospitalizations and deaths among persons with higher rates of these complications than the general population, and focus vaccine where its impact can be most beneficial for direct protection.
Target population: Health care workers and emergency services sector personnel (regardless of age).
Primary venue: Occupational settings, providers’ offices.
Goal: Reduce risk of illness, sustain health system functioning, and reduce absenteeism among front-line providers; reduce transmission from emergency services personnel and health care workers to patients; provide additional worker protection in settings of increased exposure; reinforce importance of influenza vaccination among all health care workers.
Note: Immunization of military (e.g., deployed forces) may be appropriate given the current circumstances; however, this memo focuses on vaccination of civilian populations under the authority of CDC and state and local health departments.
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