Please click below for an announcement from Angela Sorrells-Washington, Program Manager, Vaccine Preventable Disease Program, introducing the Central Vaccine Recovery Program organized by the US Federal Government to recover unused doses of the 2009 H1N1 influenza vaccine.

You may have already received the mailing labels from H1N1 Recovery Program included are instructions on how to request pickup via the Internet as well as a sample mailing label. Providers have the option of utilizing the Recovery Program or continuing to use the instructions given in the New Jersey Department of Health and Senior Services H1N1 Vaccination Program and Clinical FAQs as follows:

What do I do with unused or expired H1N1 Vaccines?
Continue to properly store any remaining H1N1 vaccines and ancillary supplies until the
expiration dates. Although there may be little demand for the vaccine at this time, influenza is unpredictable and we do not know the likelihood of a future wave of 2009 H1N1 influenza A. Please remember to enter your inventory, doses administered, and maintain temperature logs to ensure vaccine efficacy and to avoid vaccine wastage.
Any expired vaccines, vaccine delivery devices (needles and syringes), vaccine containers (vials of killed or live/attenuated vaccine), and other associated, potentially contaminated materials must be handled and properly disposed of in accordance with Regulated Medical Waste (RMW) guidelines.

The New Jersey Animal Rabies Cases by County and Species for January 1 through December 31, 2009 document has been released.  In calendar year 2009, there were 255 terrestrial animal cases and 32 bats, for a total of 287 confirmed rabid animals statewide. Although the total number of cases in 2009 was similar to 2008 (285), there were fewer bats (32) in 2009 compared to 2008 (56) and more raccoons (189) in 2009 compared to 2008 (155) confirmed positive. One coyote was confirmed positive for rabies in 2009. Nineteen (19) cats were confirmed positive in 2010, which is comparable to the 5 year average of 17 rabid cats per year. Cats have accounted for 90% of the domestic animal rabies cases in New Jersey since 1989. The counties with the highest number of diagnosed animal rabies cases in 2009 are Burlington (30), Morris (23), Ocean (25), and Passiac (24).

For more information on rabies visit the NJDHSS website (http://www.state.nj.us/health/cd/documents/faq/rabies.pdf) or contact the Infectious and Zoonotic Disease Program at 609-588-3121.

NJDHSS has released a CSL vaccine flyer summarizing the CDC's recommendations for use of the 2009 H1N1 monovalent influenza vaccine in pre-filled syringes and multi-dose vials. As you are aware, on November 11, 2009, the FDA expanded the approved use of CSL's 2009 H1N1 monovalent influenza vaccine to include children aged 6 months and older. This vaccine had previously been approved only for use in adults, aged 18 years and older. Please refer to this document when determining how best to utilize your available vaccine and ancillary supplies.

 

Children ages 6 months through 9 years of age (up to their 10th birthday) need two doses of 2009 monovalent H1N1 vaccine. While children are likely to have partial protection after a single dose, two doses are needed for full protection against this virus. It is recommended that the second dose be administered four weeks after the first dose. For the H1N1 vaccine, the 2nd dose may be given as early as 21 days after the first dose. The level of protective immunity will not be affected by a delay in receiving the 2nd dose.With limited supplies of 2009 monovalent H1N1 vaccine, providers may prioritize specific groups within the CDC target groups or take steps to ensure that vaccine is available to members of those groups. Therefore, providers may give priority to unvaccinated children over those children ages 6 months through 9 years of age (up to their 10th birthday) who have already received one dose of vaccine. This is consistent with CDC guidance. The CDC does not recommend holding vaccine in reserve for children who already have received one dose.

Three updated documents from NJLINCS Health Alert Network
1. 2009 H1N1 Influenza Vaccine - Dose Spacing and Administration with Seasonal Influenza and Other Vaccines; 2. 2009 H1N1 Influenza Vaccine - Dose Spacing for Children 6 Months through 9 Years of Age; 3. 2009 H1N1 Influenza Vaccine - Administration with Seasonal Influenza and Other Vaccines

From NJDHSS: The purpose of this memo is to provide guidance for all schools, preschools, or child care facilities concerning the requirement at N.J.A.C. 8:57-4.2 that a principal, director or other person in charge of a school, preschool, or child care facility shall not knowingly admit or retain any child whose parent or guardian has not submitted acceptable evidence of the child's immunization

H1N1 Vaccine Administration Fees – Coding: QualCare reimburses for the administration of the H1N1 vaccine when appropriately billed with CPT code 90470.    

Therefore, the instructional notes following the add-on vaccine administration codes have not been updated to include 90470 in the list of primary procedures.However, appropriate reporting of multiple vaccine administrations is to report one initial administration code and the appropriate add-on administration code(s) 90466, 90468, 90472, or 90474 for the additional administration(s). Be sure to check with your payer or visit the AAP Payment and Coverage section for more information.

For face-to-face physician counseling of the patient and family during the pediatric administration of a vaccine, the following codes are reported according to the route of administration in addition to the initial service code 90470: +90466 +90468

For immunization administration of any vaccine that is not accompanied by face to-face physician counseling to the patient/family, without limit on the age of the patient, the following codes are reported according to the route of administration in addition to code 90470: +90472 +90474 Please refer to the Payment and Coverage section on aap.org  for more information on carrier's reporting policies

A brochure for parents titled, Seasonal and 2009 H1N1 Flu: For Parents Who Have Children or Adolescents With High-Risk Medical Conditions is now available from the Centers for Disease Control and Prevention. The brochure provides specific information regarding what children are considered to be at risk including those with asthma; neurological and neurodevelopmental conditions including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders), stroke, intellectual disability (mental retardation), moderate to severe developmental delay, muscular dystrophy, or spinal cord injury; chronic lung disease (such as cystic fibrosis); heart disease (such as congenital heart disease and congestive heart failure); blood disorders (such as sickle cell disease); endocrine disorders (such as diabetes mellitus); kidney disorders; liver disorders; metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders); weakened immune system due to disease or medication (such as people with HIV or AIDS, cancer, or those on chronic steroids); receiving long-term aspirin therapy for chronic disorders; and/or pregnancy.

Encouraging your employees to get vaccinated against H1N1 and seasonal flu benefits everyone. Vaccination can help stop the spread of these viruses as well as reduce absenteeism and improve productivity. But many employees, particularly parents, have questions about the newly released H1N1 vaccine. You can provide information to help them make informed decisions about vaccination. You may also want to consider offering vaccination opportunities at your worksite or giving your employees time off to get vaccinated.  See Links on the right side of this page for FAQ about the vaccine.

The following information from the CDC provides information regarding the use of the LAIV (live-attenuated influenza vaccine) in the health care setting. LAIV transmission from a recently vaccinated person causing clinically important illness in an immunocompromised contact has not been reported. The rationale for avoiding use of LAIV among HCP or other close contacts of severely immunocompromised patients is the theoretical risk that a live, attenuated vaccine virus could be transmitted to the severely immunosuppressed person. As a precautionary measure, HCP who receive LAIV should avoid providing care for severely immunosuppressed patients requiring a protected environment for 7 days after vaccination. Hospital visitors who have received LAIV should avoid contact with severely immunosuppressed persons in protected environments for 7 days after vaccination but should not be restricted from visiting less severely immunosuppressed patients.

Deputy Commissioner Susan Walsh, MD, was a featured presenter at the recent Pandemic Influenza Preparedness Summit in July. Dr. Walsh presented results from the New Jersey local health officer surveys during the morning plenary session. The surveys were distributed in May to local health officers to assess issues and concerns after the initial public health response to the spring H1N1 outbreak. A total of 51 completed surveys from local, county, and regional health officers were received. The surveys included demographic data by municipality, including the number of hospitals, long-term care facilities and available vaccinators. Not surprisingly, the results indicate that current resources, such as manpower and space, are inadequate for a large-scale flu response, emphasizing the fact that changes need to be made to ensure readiness for the upcoming flu season.

Children aged <5 years or with certain chronic medical conditions are at increased risk for complications and death from influenza (1--3). Because of this increased risk, the Advisory Committee on Immunization Practices (ACIP) has prioritized influenza prevention and treatment for children aged <5 years and for those with certain chronic medical and immunosuppressive conditions (4,5). CDC monitors child influenza deaths through its influenza-associated pediatric mortality reporting system. As of August 8, 2009, CDC had received reports of 477 deaths associated with 2009 pandemic influenza A (H1N1) in the United States, including 36 deaths among children aged <18 years. To characterize these cases, CDC analyzed data from April to August 2009. The results of that analysis indicated that, of 36 children who died, seven (19%) were aged <5 years, and 24 (67%) had one or more of the high-risk medical conditions. Twenty-two (92%) of the 24 children with high-risk medical conditions had neurodevelopmental conditions. Among 23 children with culture or pathology results reported, laboratory-confirmed bacterial coinfections were identified in 10 (43%), including all six children who 1) were aged=2 0≥5 years, 2) had no recognized high-risk condition, and 3) had culture or pathology results reported. Early diagnosis of influenza can enable prompt initiation of antiviral therapy for children who are at greater risk or severely ill. Clinicians also should be aware of the potential for severe bacterial coinfections among children diagnosed with influenza and treat accordingly. All children aged ≥6 months and caregivers of children aged <6 months should receive influenza A (H1N1) 2009 monovalent vaccine when available.

 

NJDHSS has released the following updated H1N1 information from the CDC for health care providers. The information outlines updated information related to the H1N1 vaccine. For further information, please contact the NJDHSS Vaccine Preventable Disease Program at 609-588-7512 or visit the NJDHSS website at www.nj.gov/health.