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Appendix 20 Vaccine Priority Group Recommendations

By Clifford Willis,2014-05-08 20:43
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Appendix 20 Vaccine Priority Group Recommendations

    Appendix 20: Vaccine Priority Group Recommendations

    Vaccine Priority Group Recommendations*

    Tier Sub-Tier Population Rationale

    1 A ; Vaccine and antiviral manufacturers and ; Need to assure maximum

    others essential to manufacturing and production of vaccine and antiviral

    critical support (~40,000) drugs

    ; Medical workers and public health workers ; Healthcare workers are required for

    who are involved in direct patient contact, quality medical care (studies show

    other support services essential for direct outcome is associated with staff-to-

    patient care, and vaccinators (8-9 million) patient ratios). There is little surge

    capacity among healthcare sector

    personnel to meet increased

    demand

    B ; Persons > 65 years with 1 or more influenza ; These groups are at high risk of

    high-risk conditions, not including essential hospitalization and death. Excludes

    hypertension (approximately 18.2 million) elderly in nursing homes and those

    who are immunocompromised and ; Persons 6 months to 64 years with 2 or

    would not likely be protected by more influenza high-risk conditions, not

    vaccination including essential hypertension

    (approximately 6.9 million)

    ; Persons 6 months or older with history of

    hospitalization for pneumonia or influenza

    or other influenza high-risk condition in the

    past year (740,000)

    C ; Pregnant women (approximately 3.0 million) ; In past pandemics and for annual

    influenza, pregnant women have ; Household contacts of severely

    been at high risk; vaccination will immunocompromised persons who would

    also protect the infant who cannot not be vaccinated due to likely poor

    receive vaccine. response to vaccine (1.95 million with

    transplants, AIDS, and incident cancer x 1.4 ; Vaccination of household contacts

    household contacts per person = 2.7 million of immunocompromised and young

    persons) infants will decrease risk of

    exposure and infection among ; Household contacts of children <6 month

    those who cannot be directly olds (5.0 million)

    protected by vaccination

    D ; Public health emergency response workers ; Critical to implement pandemic

     critical to pandemic response (assumed response such as providing

    one-third of estimated public health vaccinations and

    workforce=150,000) managing/monitoring response

    activities ; Key government leaders

     ; Preserving decision-making

     capacity also critical for managing

     and implementing a response

    Tier Sub-Tier Population Rationale

    2 A ; Healthy 65 years and older (17.7 million) ; Groups that are also at increased

    risk but not as high risk as ; 6 months to 64 years with 1 high-risk

    population in Tier 1B condition (35.8 million)

    ; 6-23 months old, healthy (5.6 million)

    B ; Other public health emergency responders ; Includes critical infrastructure

    (300,000 = remaining two-thirds of public groups that have impact on

    health work force) maintaining health (e.g., public

    safety or transportation of medical ; Public safety workers including police, fire,

    supplies and food); implementing a 911 dispatchers, and correctional facility

    pandemic response; and on staff (2.99 million)

    maintaining societal functions ; Utility workers essential for maintenance of

    power, water, and sewage system

    functioning (364,000)

    ; Transportation workers transporting fuel,

    water, food, and medical supplies as well as

    public ground public transportation (3.8

    million)

    ; Telecommunications/IT for essential

    network operations and maintenance (1.08

    million)

    3 ; Other key government health decision-; Other important societal groups for

    makers (estimated number not yet a pandemic response but of lower

    determined) priority

    ; Funeral directors/embalmers (62,000)

    4 ; Healthy persons 2-64 years not included in ; All persons not included in other

    above categories (179.3 million) groups based on objective to

    vaccinate all those who want

    protection

    *** http://www.hhs.gov/pandemicflu/plan/appendixd.html

    Appendix 21: Antiviral Drug Priority Group Recommendations

    Rationale Group

    1 Patients admitted to hospital*** Consistent with medical practice and ethics to treat those with

    serious illness and who are most likely to die.

    2 Health care workers (HCW) with direct Healthcare workers are required for quality medical care. There

    patient contact and emergency medical is little surge capacity among healthcare sector personnel to

    service (EMS) providers meet increased demand.

    3 Highest risk outpatientsGroups at greatest risk of hospitalization and death;

    immunocompromised persons and immunocompromised cannot be protected by vaccination.

    pregnant women

    4 Pandemic health responders (public Groups are critical for an effective public health response to a

    health, vaccinators, vaccine and antiviral pandemic.

    manufacturers), public safety (police, fire,

    corrections), and government decision-

    makers

    5 Increased risk outpatientsyoung children Groups are at high risk for hospitalization and death.

    12-23 months old, persons >65 yrs old,

    and persons with underlying medical

    conditions

    6 Outbreak response in nursing homes and Treatment of patients and prophylaxis of contacts is effective in

    other residential settings stopping outbreaks; vaccination priorities do not include nursing

    home residents.

    7 HCWs in emergency departments, These groups are most critical to an effective healthcare

    intensive care units, dialysis centers, and response and have limited surge capacity. Prophylaxis will best

    EMS providers prevent absenteeism.

    8 Pandemic societal responders (e.g., critical Infrastructure groups that have impact on maintaining health,

    infrastructure groups as defined in the implementing a pandemic response, and maintaining societal

    vaccine priorities) and HCW without direct functions.

    patient contact

    9 Other outpatients Includes others who develop influenza and do not fall within the

    above groups.

    10 Highest risk outpatients Prevents illness in the highest risk groups for hospitalization and

    death.

    11 Other HCWs with direct patient contact Prevention would best reduce absenteeism and preserve optimal

    function.

    *The committee focused its deliberations on the domestic U.S. civilian population. NVAC recognizes that Department of Defense (DoD) needs should be highly prioritized. A separate DoD antiviral stockpile has been established to meet those needs. Other groups also were not explicitly considered in deliberations on prioritization.

    These include American citizens living overseas, non-citizens in the U.S., and other groups providing national security services such as the border patrol and customs service.

    **Strategy: Treatment (T) requires a total of 10 capsules and is defined as 1 course. Post-exposure prophylaxis (PEP) also requires a single course. Prophylaxis (P) is assumed to require 40 capsules (4 courses) though more may be needed if community outbreaks last for a longer period.

    ***There are no data on the effectiveness of treatment at hospitalization. If stockpiled antiviral drug supplies are

    very limited, the priority of this group could be reconsidered based on the epidemiology of the pandemic and any additional data on effectiveness in this population.

*** http://www.hhs.gov/pandemicflu/plan/appendixd.html

Appendix 22: Mass Clinic Management

    A pre-established off-site occupational health clinic(s) location is important in managing HCW health issues. This pre-planning is especially important when the in-hospital OH clinic becomes overwhelmed or when the hospital is quarantined.

When determining a location, consider:

    ; ample parking

    ; location(s) close to majority of HCW’s home address

    ; ability to secure the building; identify who will do this

    ; availability of restrooms

    ; availability of space for staff’s rest breaks and meals

    ; hours of operation

    ; staffing of clinic, including clerical

    ; available equipment in building

    ; additional supplies needed: clerical and clinical (where to obtain items; who will deliver

    them; who will do set up)

    ; drawn floor plan to include flow of HCW/work processes (e.g. registration, vital signs (if

    needed), education center, consent signing, treatment/vaccination, holding area (rule out

    reactions with vaccinations)

    ; directional signs

    ; meals for clinic workers (who will provide food; who will deliver; storage of food, clean-up) ; routine cleaning/maintenance of environment: who and how often

Appendix 23: Strategies for the Use of Anti-Viral Medications

Inter-Pandemic and Pandemic Alert Periods

    ; Continue the administration of seasonal influenza and pneumococcal vaccine to reduce

    the possibility of co-infection and to maintain and develop influenza vaccination

    infrastructure.

    ; Continue the use of antivirals to control healthcare associated outbreaks. ; Continue to treat all patients admitted to the hospital with influenza within 48 hours. ; Use antivirals in the medical management of novel cases of influenza as outlined in

    clinical protocols.

    ; Plan for the implementation of treatment, prophylaxis, and PEP protocols. ; Develop plans to implement distribution of antivirals to priority groups.

    Pandemic Period - No Pandemic Influenza Detected in the United States or only Sporadic Cases Reported in the United States

    ; Continue the administration of seasonal influenza and pneumococcal vaccine to reduce

    the possibility of co-infection, and to maintain and develop influenza vaccination

    infrastructure.

    ; Continue the use of antivirals to control nosocomial outbreaks.

    ; Plan for the use of antiviral drugs in the management of persons infected with novel

    strains of influenza and their contacts.

    ; Target treatment to influenza patients admitted to a hospital that present within 48 hours

    of symptom onset.

    ; Administer antivirals to all persons sick with influenza that enter the hospital based on

    clinical algorithms. Do we have these?

    ; Begin treatment of patients with influenza-like illness and a positive rapid antigen test for

    influenza A.

    ; Base the continuation of treatment decisions on laboratory confirmed subtype

    identification of the pandemic strain by viral isolations, RT-PCR, or other means

    recommended by CDC or the severity of disease and susceptibility of the infective strain

    in illness caused by other influenza subtypes.

    ; Help to develop and implement health guidance that encourages drug-use practices that

    minimize the development of drug resistance.

Pandemic Period - When Pandemic Influenza is Detected in the United States

    With increasing disease activity base treatment decisions on:

    ; Laboratory confirmation of infection with a pandemic subtype,

    ; Detection of influenza A by rapid antigen test, or

    ; Epidemiologic and clinical characteristics.

    ; Initiate treatment before laboratory confirmation is obtained.

    ; Continue treatment awaiting confirmatory tests.

    ; Target prophylaxis to priority groups.

    ; Use PEP to control small well-defined disease clusters and to protect individuals with a

    known exposure to a pandemic virus, such as household contacts.

    ; PEP may be used to protect those prioritized during the period between vaccination and

    the development of immunity.

    ; If possible reserve the use of antivirals for prophylaxis only during period of peak viral

    circulation if that information is available.

Appendix 23: Strategies for the Use of Anti-Viral Medications (Con’t.)

    Pandemic Period When There is Widespread Transmission of Pandemic Influenza in the United States

    As the pandemic becomes more widespread treatment decisions are made more on clinical characteristics and epidemiologic features. Laboratory confirmation will no longer be necessary. ; Treat those at highest risk of severe illness and death if antiviral supplies are limited. ; Decrease use of prophylactic antivirals as needed once a vaccine is available. ; Continue to administer antiviral prophylaxis between the first and second dose, or until

    immunity develops if recommended.

    ; Continue to administer antiviral prophylaxis to those for whom the vaccine is

    contraindicated or whose response to the vaccine is likely to be inadequate.

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