H1N1 Vaccine Medical Directive Training October 27, 2009
Two Parts Part 1 - The Virus Part 2 - The Vaccine
Characteristics of Seasonal vs. ph1n1 Influenza Characteristics Incubation Seasonal Flu mean=2; range:1-4 Same? ph1n1 Communicability Transmission Risk Groups Symptoms 3-7 days droplet; contact Pregnant Women Children <5 yrs Seniors 65+ Chronic Conditions Immunocompromised Cough Fever Sore throat Headache Aches and pains Tiredness Runny nose Vomiting Up to 10 days? Same Same Is obesity/metabolic disorder a new risk? (92%) (91%) (41%) (35%) (30%) (28%) (21%) (15%)
How does the H1N1 flu virus spread? The same as seasonal influenza The virus can live on hard surfaces for up to 48 hours
Treatment Supportive Therapy including: Rest Plenty of fluids Take steps to treat fever (light clothing, room temp at 20ºC) Consider taking basic pain and fever relievers such as acetaminophen, ibuprofen or ASA unless contraindicated Patients who are at risk of complications should be treated with antivirals within 48 hours of onset Those considered at risk include: People with conditions that increase risk of complication People over 65 years Children under 5 years Pregnant women Persons living in rural remote areas Residents of LTC homes
Pregnant Women and ph1n1 The likelihood of pregnant women contracting the virus is no different from that of the general public. Pregnant women are one of the groups considered at higher risk of complications / hospital admission. The relative risk increase of complications is 4 fold. This has always been true of seasonal influenza as well. The absolute background risk is still small (projection based on the Australian data would be 20 / 100,000). Highest risk in the third trimester
Panvax H1N1 Vaccine Australia New as of Oct 26 A/California/7/2009 (H1N1) PHAC and Health Canada approval for use in pregnant women
Part 2 The Vaccine
Indication Arepanrix H1N1 Adjuvanted Vaccine indicated for active immunization against H1N1 influenza strain in an officially declared pandemic situation. Due to the d risk of ph1n1 complications, pregnant women at any stage of pregnancy with medical comorbidities should be immunized against ph1n1 as soon as possible using adjuvanted vaccine. Healthy pregnant women in the second half of pregnancy and up to six weeks post-partum partum are at significant risk from ph1n1 infection and should be immunized against ph1n1 as soon as possible using adjuvanted vaccine. Healthy pregnant women in the first half of pregnancy may also be immunized with adjuvanted vaccine but their risks from ph1n1 are less and they may prefer to wait for unadjuvanted vaccine (available at earliest November 9th).
How is the H1N1 vaccine given? Intramuscular (IM) injection Age 6 months to 10 years of age 10 years and older 0.25 0.50 Dose (ml) 2** 1 # of Doses **Given 21 days apart Awaiting confirmation re need for 2 doses
Implementation Prior to administering the vaccine, nursing staff will: Assess the client s s immunization history Assess health status and potential contraindications to administering the vaccine Obtain informed consent
Contraindications An allergy to any component of the vaccine or an anaphylactic reaction to a previous dose of influenza vaccine. ***Both unadjuvanted and adjuvanted vaccines are latex free Vaccination is not recommended for those who develop anaphylactic type reactions when they eat eggs (urticaria( (hives), oedema of the mouth and throat, difficulty in breathing, hypotension and shock). Subjects whose allergy to eggs is not of the anaphylactic type, as well as those who are allergic to chicken and to feathers may be vaccinated. Vaccination should be postponed in cases of febrile or acute illness. However, a minor afebrile illness, such as a mild upper respiratory infection is not usually a reason to postpone vaccination.
Contraindications Immunization should be delayed in a patient with an active neurological disorder, but should be considered when the disease process has been stabilized. It is prudent to avoid vaccinating persons who are not at high risk of influenza complications if they have experienced Guillain-Barre Syndrome (GBS) within 8 weeks after a previous influenza vaccination.
General Precautions Review of risks/benefits of immunization Standard sterile technique to be used Follow established protocols in the event of an adverse/anaphylactic reaction Staff will store and handle the vaccine according to the manufacture ture s recommendation. Pandemic H1N1 Influenza vaccine is light sensitive and needs to be protected from light. The adjuvanted vaccine should be discarded 24 hours after the vial has been entered. The unadjuvanted vaccine should be discarded 28 days after the vial v has been entered.
Next Steps Nurses will need to review the following key documents as soon as a they are available, prior to the commencement of H1N1 clinics: PHAC Guidance Document on the Use of Pandemic Influenza A (H1N1) 2009 Vaccine VPD Medical Directive # 23 - Administration of Pandemic H1N1 Influenza Vaccine VPD Medical Directive # 24 Administration of AZ Pandemic H1N1 Completion of the H1N1 Vaccine Quiz, and forward to MA Holmes for filing prior to the commencement of the clinics.