It is projected that, for the 2001-2002 influenza season, the three vaccine companies licensed to distribute vaccine in the U.S. will produce between 69 million and 78 million doses. In addition, one of the companies is seeking FDA approval to expand production by 17 million doses. While these numbers are encouraging, they are subject to revision based on a variety of currently unknown factors. It is estimated that Illinois needs between 3.4 million and 3.9 million doses to meet the vaccine needs of its citizens, based on availability levels and usage in previous years.

During the 2000-2001 influenza vaccination season, many public and private health care practitioners experienced a four- to eight-week (or longer) delay in delivery of influenza vaccine. Because of this delay, both public and private providers had to modify their approaches to influenza vaccination. Most public influenza vaccination campaigns had to be delayed until organizers were assured they would have an adequate supply of vaccine; often this was November or later. Many clinics were canceled because vaccine was not available.

Little is known so far about the impact of the delay in production/distribution of last year’s vaccine, or the effect of the system-wide efforts to respond to the delay. Nevertheless, immunization program managers and public health decision makers should prepare for the possibility that such circumstances could arise in the future and that public health agencies at the federal, state and local levels will be expected to intervene and try to minimize any negative outcomes.

Illinois Influenza Vaccine Plan

Illinois’ influenza vaccine plan has been developed to prepare for any delays in shipments or possible shortages of vaccine during the 2001-2002, or any future year’s influenza season. It recognizes that influenza vaccination programs should give the highest priority to persons who are most likely to experience complications from influenza, including death. The voluntary cooperation of all providers of influenza vaccine in the state, both private and public, is needed to ensure the success of the plan.

Current recommendations from the federal Advisory Committee on Immunization Practices (ACIP), published in the April 20, 2001, edition of Morbidity Mortality Weekly Report, delineate risk categories for use in setting influenza vaccination priorities:

The following groups are at highest risk of influenza-related complications:

• Persons 50 years of age or older
• Residents of nursing homes and other chronic-care facilities that house persons of any age who have chronic medical conditions
• Adults and children who have chronic disorders of the pulmonary system, e.g., emphysema, chronic bronchitis or asthma
• Adults and children who have chronic disorders of the cardiovascular systems, e.g., congestive heart failure
• Adults and children who have required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, hemoglobinopathies, (e.g., sickle cell disease) or immunosuppression (e.g., caused by medications or HIV)
• Children 6 months to 18 years of age who are receiving long-term aspirin therapy and therefore might be at risk for developing Reye syndrome after influenza infection
• Women who will be in the second trimester of pregnancy during the influenza season

This category includes persons who can transmit influenza virus to persons in Category I because they provide direct care:

• Physicians, nurses, nursing assistants, orderlies, pharmacists, public safety workers, emergency response workers, laboratory staff, health care students, housekeeping staff, and other staff in hospital and outpatient settings who have direct patient contact
• Employees of nursing homes and chronic-care facilities who have direct contact with patients or residents
• Employees of assisted living and other residences for persons in high-risk groups who provide direct care
• Providers of home care to people at high risk (e.g., visiting nurses and volunteer workers)
• Household members (including children) of persons in high-risk groups

This final category covers otherwise healthy persons 6 months of age and older who wish to reduce the likelihood of becoming ill with influenza:

• Students and other persons in institutional settings (e.g., college students in dormitories)
• Employees of health care facilities who do not provide direct patient care
• Persons who provide essential community services
• Healthy persons in the workplace
• Work site clinics
• Others

If a vaccine shortage is severe, if the influenza season begins early, the highest priority if vaccination should be persons in Category I. Vaccination programs for persons in Category III should be delayed until adequate vaccine supplies are available, and until high risk persons, (Categories I and II), have been vaccinated. Becasue early vaccinations of high risk persons, (Category I), can leave them vulnerable to disease that occurs late in the season, providers should delay vaccination programs until mid-October.

The following may be used as a guide for providers in planning vaccination clinics. To avoid the possibility of canceling clinics, it is always best to have “vaccine in hand” before scheduling clinics.

If vaccine supply is received on time, schedule clinics for October 16 - November 17.
If vaccine supply is late, schedule clinics as soon as possible and for five to seven weeks after vaccine becomes available.

Vaccination of high-risk persons (Categories I and II). Private clinics should start routine vaccination of high-risk persons and their direct caregivers (Categories I and II) when patients are seen at their primary medical clinics for routine care, are hospitalized, or seen in home care as soon as vaccine is available. Local health departments (LHDs), and others may conduct vaccination clinics for groups or gatherings that focus on Category I and II persons (e.g., senior housing facilities, senior dining programs, diabetes support groups). Long-term care (LTC) facilities should begin vaccination programs for high-risk persons and their direct caregivers, (Categories I and II). Depending on the onset of the influenza season, LTC facilities may wish to delay immunizing patients until November 1 because antibody levels can begin to decline within a few months after vaccination. Pharmacists may begin offering vaccine on a case-by-case basis to high-risk clients.

If vaccine supply is on time, schedule clinics for November 18 - December 31.
If vaccine supply is late, schedule clinics five to 11 weeks after vaccine becomes available.

Redistribution of vaccine as needed. Vaccination programs for high-risk persons should be complete. If not, complete them as soon as possible. Private clinics, LTC facilities and other providers should not return unused vaccine to the manufacturer. Offer unused vaccine to other providers in your area who need vaccine by contacting the local health department. Contact the LHDs in your area if you do not have sufficient vaccine for persons in risk categories I and II (see page 2). LHDs will assess vaccine availability in LTC facilities and medical clinics in their area. LHDs, in consultation with the Illinois Department of Public Health as needed, will help to coordinate redistribution of vaccine among clinics and LTC facilities experiencing vaccine shortages as soon as it becomes clear that a shortage exists and a vaccine supply is identified. Some local areas may consider the option of re-directing patients to clinics having sufficient vaccine if allowed by insurance coverage.

If vaccine supply is on time, schedule clinics in January and February.
If vaccine supply is late, schedule clinics at least 12 weeks after vaccine becomes available.

Vaccination of low risk persons (Category III). Mass vaccination programs/campaigns, community- based clinics for the general public, work site clinics, (e.g., those conducted by the Visiting Nurse Association) and/or walk-in clinics should not be held until adequate vaccine supplies can be assured and all high-risk persons have been vaccinated. Vaccination of high-risk persons in all settings should continue.

Role of Local Health Department

In anticipation of influenza vaccine shortage, a local health departments should be prepared –

1. To determine if there are supplies of vaccine remaining in any clinic and/or facility in its jurisdiction following Category I and II vaccination programs, and
2. To share that information with clinics and facilities that are experiencing a vaccine shortage so that a temporary loan or sale of vaccine can take place to ensure that those in Categories I and II are covered.

Providers with a vaccine shortage and those with a surplus should make all the arrangements for vaccine exchange; IDPH can assist on a case-by-case basis. Local health departments will be called upon to pass information concerning the sharing of vaccines across jurisdictional boundaries to the state.

All local health departments are encouraged to join the consortium sponsored by the Illinois Public Health Association (IPHA), that each year purchases influenza vaccine and orders supplies a year in advance. This strategy proved to be highly efficient during the delayed shipments of vaccine during the 2000-2001 season. Local health departments that were a part of this consortium received vaccine in early August and were not highly affected by the delay in shipment.

State Health Department Role

The Illinois Department of Public Health will develop and distribute this plan and solicit the input of member organizations participating in the Adult Immunization Coalition. The Department will provide information statewide about status of influenza vaccine. In addition, IDPH will stress the importance of targeting vaccine to individuals at highest risk (Categories I and II) and will serve as a broker for redistribution of unused vaccine, both in the public and private sectors. With the assistance of the Illinois Department of Public Aid (IDPA), which purchases the vaccine annually for nursing home residents throughout Illinois, Public Health will monitor nursing homes and all other institutions for high-risk individuals to ensure they have adequate supplies. Traditionally, IDPA turns over any remaining vaccine to the state health department for distribution wherever the need is the greatest. IDPH will work closely with other organizations to monitor the vaccine needs in their communities.

The Department will notify the public about the current year’s vaccine supply situation. News releases and other information will be posted on the Illinois Department of Public Health Web site.

Illinois Department of Public Health 535 West Jefferson Street Springfield, Illinois 62761 Phone 217-782-4977 Fax 217-782-3987 TTY 800-547-0466 Questions or Comments