H1N1 clinics

lamazeteacher · Dec 13, 2009

Thank you for starting this thread, itsmejuli.

As a (retired) Public Health Nurse, I've been wondering how the health departments across the nation have been handling vaccination against H1N1. Each has been given the program to run as they choose.

The general attitude where I am, in CA has been varied, in regard to safety of the vaccine, need for it, and who needs it. There's a university and a college in the county where I live; and a "now you seem them, now you don't" community of counter culture folks left over from the '60s, homeless people and many drug addicts, as well as working people who commute with bigger cities.

When the first supply of vaccine dribbled in, I went to the local health department to offer my services in any capacity, as a volunteer. The person to whom I was referred, was the epidemiologist who said he was in charge of the program; and he was putting up a sign saying that the vaccine had run out, and no further clinics would have it, until the end of October. Then I read the CDC website, in which the stats showed a huge overage of vaccine, compared to the number of people who had gotten it.......

Since the epidemiologist told me that Maxim had been hired to give the vaccine, and I'd refused to work for them at the paltry wage they offered R.N.s I figured that there wasn't a need for my services. Well, today I went for my shot, as they'd opened their clinics to everyone, instead of only those at high risk. It was steadily raining, when I arrived a half hour after the clinic started, and a long line of about 200 individuals: bedraggled families with young children, seniors, 20 to 50 year olds, and pregnant women stood in silence, in a column that wound down a hill.

Since I have a handicapped sign on my car, I was ushered regally into a parking space as close to the main building as possible, and accompanied by a relay of yellow slicker clad young men, to the front of the line. That really embaressed me, as my disability isn't apparent and I would have preferred to wait my turn. The consideration of my unknown impairment stopped after I promptly got my shot (without being asked to sign permission for it), as the exit led to an outside area in the back of the complex, far from my car.

So I went back in and said that I'd prefer to go out the same way I'd come in. The same young man who had handed me over to the nurses was there, and the relay of escorts prepared to usher me back to my car. I stopped short of leaving outside the building when I realized that no written materials had been given those waiting, and after getting the vaccine a coloring book and "insurance information" were handed to children only.

Since I'd given information sheets to those waiting for seasonal flu vaccine in the previous clinics when I worked for Maxim, I asked if they had any and was told that only children got something written. Then I inquired whether written permission was necessary. No one appeared concerned when I said I hadn't been asked to sign anything, but the local Maxim manager (wearing his name tag 2 inches from his member - I suggested that he move it to his collar) overheard the exchange and wanted me to tell him which nurse gave me the shot. That furthered my discomfort, as I didn't want to get her in trouble, so I said that I didn't remember.

He insisted on taking me to each nurse, arriving at the desk where I'd been, and I was shown a list of names (so much for HIPPA). I signed the list proffered and asked how they'd know which lot number was in the dose I'd received; and was shown that each list had a lot # at the bottom of it.

It seems to me that a great opportunity to do some public health teaching was ignored. There was no informaton given about side effects of the vaccine or contraindications; and especially, that it would take 3 weeks before immunity would be attained...... with a few exceptions. Emphasis was placed on getting people through as fast as possible (200/hour, I was told), and providing forms regarding children's insurance (although parents weren't told about that, just the children were given the packet).

itsmejuli · Dec 13, 2009

Wow...did you complete a health history before receiving the vaccine? I'm surprised that didn't need to be signed.

The H1N1 information sheets are provided by the CDC as well as the little cards to give to the clients with the shot info. But I'm sure the info sheets must be locally reproduced.

Our clients completed a health history and signed the form. The lot number was recorded for every individual on these forms. Eventually, every vaccination will be recorded into the state's vaccination database.

It would be interesting to see the final results of the number of people immunized when the campaign is over. This campaign is a good test of the readiness of federal to local health departments ability to handle a pandemic.

What scares me at this point is what would happen if we had a pandemic of bird flu or SARS.

I hope some more nurses working in public health and the H1N1 clinics chime in with their experiences.

lamazeteacher · Dec 13, 2009

Dear itsmejuli:

It seems that the local health departments have responded to feedback about the long lines, and how much time people spent getting their immunization against H1N1, by minimizing the time people spend waiting to get their vaccine, rather than including their foremost objective, which is prevention of disease and/or progression and spread of all diseases.

It's clear to me that their sense of their responsibility for accomplishing that objective, stops with the administration of the vaccine in a timely manner; and without considerable complaints about their methods. The possibility of adding to their caseloads, seems to lack import/is repulsive, as jobs have been eliminated, not filled when vacated, and cut back in the current economic situation. Of course the money they spent on agency personnel, which included 18 nurses and some administrative individuals, could have covered a part time position ofntheir own, for a year........

My offer to volunteer by getting forms signed, was countered by the explanation that those suffering job loss due to the above cutbacks, could see volunteers working there as usurping the jobs they might have held..... (sigh)

Thank goodness that people suffering from complications of H1N1, will be treated at hospitals and not at the health department, whose remaining employees have been away from the bedside for considerable lengths of time. In extreme pandemics in this country, most residents pretty much know that they should go to the hospital when having difficulty breathing, and have the ability to get themselves there. Now if a secondary disaster hit..... :eek:

There was an American Red cross Disaster Response vehicle at the entrance to the clinic, serving coffee (to workers at the clinic), and providing small bottles of water for anyone requesting them. That presence lent a sense of proper reaction to a pandemic atmosphere.....

itsmejuli · Dec 14, 2009

from http://www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm

In addition, the data continues to confirm previous findings that this disease primarily affects people younger than 65 year old, with the number of cases, hospitalizations and deaths overwhelmingly occurring in people 64 years and younger. The risk of illness, hospitalization and death related to 2009 H1N1 is very age specific and very different from seasonal influenza. With seasonal influenza, about 60 percent of seasonal flu-related hospitalizations and 90 percent of flu-related deaths occur in people 65 years and older. The proportion of younger people being impacted by 2009 H1N1 is much greater than what occurs during seasonal flu and their risk of serious illness, including hospitalization and death from 2009 H1N1 is much greater than that for seasonal flu. People 65 and older are much less affected by this virus than what routinely occurs with seasonal influenza and therefore the risk of serious illness, hospitalization and death from 2009 H1N1 in people in this age group is much less than that posed by seasonal flu.

from http://www.cdc.gov/flu/weekly/index.htm#MS

Since August 30, 2009, CDC has received 204 reports of influenza-associated pediatric deaths that occurred during the current influenza season (37 deaths in children less than 2 years old, 21 deaths in children 2-4 years old, 76 deaths in children 5-11 years old, and 70 deaths in children 12-17 years old). One hundred sixty-five (81%) of the 204 deaths were due to 2009 influenza A (H1N1) virus infections, 38 were associated with influenza A virus for which the subtype is undetermined, and one was associated with an influenza B virus infection. A total of 224 deaths in children associated with 2009 influenza A (H1N1) virus infection have been reported to CDC.
Among the 204 deaths in children, 96 children had specimens collected for bacterial culture from normally sterile sites and 30 (31.3%) of the 96 were positive; Streptococcus pneumoniae was identified in nine (30.0%) of the 30 children and Staphylococcus aureus was identified in eight (26.7%) of the 30 children. One S. aureus isolate was sensitive to methicillin, six were methicillin resistant, and one did not have sensitivity testing performed. Twenty (66.7%) of the 30 children with bacterial coinfections were five years of age or older, and eight (26.7%) of the 30 children were 12 years of age or older.