Influenza A

Our national epidemiologist, Izzy Gerstenbluth, received an award from CAREC for his great job done for the Netherlands Antilles regarding the AH1N1 virus awarness, treatment and vaccination program.

See a copy of his last newsletter.

 
17 November 2009
 Dear all,
 Many of you have been asking about the arrival of the A H1N1 Vaccine and I can now finally give you some info on that.
 
The Vaccine (Pandemrix) will be arriving in Curaçao, Bonaire and St. Maarten this week.
In Curaçao we are targeting Monday November 23rd as starting date for vaccination against Influenza A H1N1.
Considering the requirements for maintaining the cold-chain for vaccines, we will be storing the bulk of the vaccines in a facility that can accommodate the amount of vaccines, that can store them at an adequate temperature (between 2 and 8 ˚C), that can maintain and monitor the cold chain and that has a back-up generator in the event of power failure (as has been known to happen on a regular basis).
The vaccines will be distributed evenly among the pharmacies on the island, in phases. Each pharmacy will initially receive 50 vials which equals 500 doses of vaccine.  
 
GP’s are recommended to make arrangements with a pharmacy in the nearby vicinity of their practice to receive a working stock of vaccine. Each GP will receive a maximum of 5 vials plus adjuvant per order. This is equivalent to 50 vaccines. The reason for this is again to limit the risk of losing vaccine in case of power outages. Each vial will be accompanied by one 5 ml syringe and ten 1 ml syringes including hypodermic needles.
 
Our recommendation is for GP’s to organize vaccination by designating specific vaccination clinics (“vaccinatiespreekuren”) and to have those who are eligible for vaccination come to those clinics in stead of vaccinating in between regular clinics. The reason for this is to avoid as much as possible waste of vaccine. Remember that once you have mixed the antigen with the adjuvant you can store the mixture for a maximum of 24 hours and then you must discard it. Each mixture will contain vaccine for 10 patients. For information on preparing the vaccine (mixing) I kindly refer to my previous mails and also to the CHV website (http://www.chv-site.org/epidemiologie/h1n1/366-gegevens-product-pandemrix and click on instructiekaart Pandemrix).
When the stock is down to one remaining vial for 10 patients, you can reorder 5 vials but only after submitting a filled out registration form to the pharmacist. Attached please find a slightly revised form (including insurance as a variable) for registration of H1N1 vaccinated persons.
 
Remember that ideally, those who are eligible should receive their seasonal flu shot first, after an interval of at least 2 weeks they can receive their first H1N1 shot and after an interval of 3 weeks thereafter they can receive their final H1N1 shot.
 
Regarding the targeted risk groups, I again refer to my previous mails as well as to the CHV website (http://www.chv-site.org/epidemiologie/h1n1); This site also contains information leaflets with info on seasonal flu & Influenza A H1N1 in 4 languages.
 
Please note that our risk groups do not (as yet) include otherwise healthy children fom 6 months to 4 years as in the Netherlands . Persons with chronic illness according to the defined risk groups of all ages , are targeted.
 
The public will be advised to contact their GP’s from Monday the 23rd onwards for further information on eligibility and vaccination days.
 
Regarding the dosage of vaccine for children: children in the age group 6 months- 9yrs that are eligible for vaccination should receive a first dose of 0,25 ml i.m in an upper arm muscle and after a 3-week interval a second dose of 0,25 ml i.m in an upper arm muscle.
Children aged 10-17 who are eligible, should receive 2 doses with an interval of 3 weeks between them of 0,5 ml i.m in an upper arm muscle. This is the same dosage as recommended for eligible adults aged 18 and over.
It is not recommended to vaccinate children under the age of 6 months. For Children in this age group that pertain to a risk group, vaccination of family members can be considered.
 
From our colleague Alex Roose who supervises dosages of patients on anti coagulants from the ADC, we received the recommendation to please also remember to inquire about the use of anti coagulants in all patients prior to vaccination. Suggested questions to this effect: do you take acenocoumarol or fenprocoumon ? or do you take medicine “to make your blood thinner” according to a list?
People on anticoagulants should NOT receive intramuscular vaccination because of a greater risk on muscular hemorrhage.
They should rather receive DEEP subcutaneous vaccination. The best site for this is the thigh because it is easier to grab a skin fold for vaccination. The gluteal muscle is not an adequate site for vaccination as there is evidence of a poor immune response to several vaccines.
Persons on anti coagulants should also not be massaged at the vaccination site, because this increases the risk of hematoma.
 
I can imagine that there are several questions and that there is a need to further discuss (some of) these issues.
For this reason and in cooperation with the Curaçao GP association (CHV) a meeting with and for all GP’s and all Pharmacists working in Curaçao is planned for this Thursday evening November 19 at the CEMS facility at 19.15.
 
I hope to have informed you sufficiently and also hope to see you all on Thursday evening,
Warm regards,
Izzy
 
 

Edited: Removed personal information, see comment policy. Contact us if you need to reach Izzy. Thanks.