HINI Flu Vaccine - Why Physicians Need to Start the ConversationAward Category #9 - Op/Ed

Background and Research - Our issue with HINI flu vaccine was two-fold. First, we had received severalreports from people who visited their doctor for another reason other than flu-like symptoms like a pregnancycheck-up, saying HINI vaccine was discussed or offered. This was happening in the early fall when our statewas experiencing some of our highest levels of flu activity. We found it very concerning that some physiciansweren't starting the conversation about the benefits ofHINI flu vaccine with their patients, including ones whowould be considered high risk. We also knew there were people making the decision not to receive HINIvaccine without even talking with their doctor.

Secondly, HINI flu vaccine arrived in October of 2009. Much of our early vaccine was FluMist. Some of ourhealth care providers were reluctant to use it. Our local health departments told us that providers were eitherunfamiliar with the product or concerned about it being a live virus. Some providers were also uncomfortablewith FluMist and felt there wasn't enough clarity as to who within the health care system could or couldn't getit. This led to uncertainty among some providers - perception of risk was too high so FluMist was avoided.One of our local health departments told us they "couldn't give it away."

Materials Used - Op/ed article to the Nebraska Medical Association. Health alert to all health care providers,local health departments and hospitals within the state.

Planning - The goal was to get physicians to start a conversation about HINI vaccine with their patients andto help them feel more comfortable using FluMist. We have an established relationship with the NebraskaMedical Association (NMA). The NMA represents more than 3,000 Nebraska physicians, students andresidents and is a go-to source for doctors wanting the latest information. We partnered with the NMA back in2006 and submitted several articles on pandemic preparedness for a special edition of the NMA's magazinefocusing specifically on pandemic flu and what physicians need to know now. We knew from our previousexperience we could reach physicians across the state through an op/ed in NMA's magazine.

Execution - Article was written based on interviews with our state epidemiologist and our chief medicalofficer, both physicians, about why it's important for doctors to talk to their patients about vaccine and dispelany myths. And, why FluMist is a safe and effective product. The CDC's Myths Versus Facts was also used assource information for the article.

Results - The NMA magazine reached its 3,000 members. FluMist usage did get increasingly better accordingto our local health departments. Although we have no way to measure exactly how many physicians hadconversations about HINI vaccine with their patients, we do know Nebraska had a higher percentage of dosesadministered in every category compared to the national and regional average according to CDC data.Nebraska numbers according to April 2 MMWR - HINI vaccination coverage through end of Jan., 2010:

Children 6 months-I7 yrs.NE - 40.8% coverage, Regional average - 37.1%, median - 36.8%

People in initial target groupsNE - 39.6% coverage, Regional average - 30.7%, median - 33.2 %

It's important to mention the NMA article was in addition to sending a health alert to all health careproviders/hospitals statewide stressing the importance of vaccination especially among high-risk patients likepregnant women and encouraging doctors to use FluMist and why it's an excellent choice for certain people.The NMA magazine is a great way to reach physicians but not the only way. When it comes to protectingNebraskans, we want to be sure we're using the avenues available to us to reach physicians.

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HINI Flu Vaccine - Why Physicians Needto Start the Conversation

by fosnn Schaefer,Chief Medical Otticer and Directorof the Division of Public Health of theNebraska Department of Health andHuman Services

Vaccination is the best protection

against HINI flu. We knowthe vaccine is safe and effective so why

are some people deciding not to get it?It's something that's puzzling even the

highest-ranking health officials.

More and more HINI vaccine is

being distributed to states and availabil-

ity is on the rise. We know large num-

bers of people are seeking out vaccine,but at the same time we're hearing

reports of parents refusing to havetheir children vaccinated and pregnant

women who won't get a shot. Peoplesay they're concerned about thevaccine's safety, the short turnaroundtime on production and the manufac-

turing process itself. Many times they're

making the decision not to receive

vaccine without even talking with aphysician. That's why it's up to us to

start a conversation with the peoplewe see in our office every day.

The HINI vaccine is safe and

effective. The manufacturing processis the same tried and true process that's

been used to make seasonal flu vaccine

for decades. The same safeguards are in

place. It's made in the same factories

that produce seasonal flu vaccine and

has been rigorously tested. The speed

at which the HINI vaccine has been

manufactured, tested and released is

due to a collaborative effort betweenmanufacturers, the federal government,

health care providers and state and local

health departments along with old-fash-

ioned hard work. There have been no

shortcuts.

A quote in a recent Chicago Tribunearticle from Kenneth Alexander, an

infectious disease expert at the

University of Chicago sums it upnicely, "We've been baking this bread

for 60 years and we're pretty good at it,buddy."

HI N 1 vaccine does not containan adjuvant; in fact no flu vaccine

produced in the U.S. does, and themultidose vials containing thimerosalare safe to use on children and pregnant

women. There is no convincing evi-

dence of harm caused by low doses of

thimerosal in vaccines. Another optionavailable to accommodate patient

preferences is single dose units that are

thimerosal free. Side effects from HINI

vaccine are expected to be the sameones typically associated with seasonal

flu vaccine.

Bottom line - the risks from a bout

with HINI flu are much greater than

any risks that might come from thevaccine. HINI flu vaccination is a

benefit not a detriment.

The initial target groups to receive

HI N 1 vaccine are:

• Anyone 6 months-24years old

• Pregnant women• People who live with or

care for babies 6 months

old and younger

• Health care and emer-gency medical services

personnel

• And, people 25-64 years old withunderlying medical conditions, like

heart disease or asthma.Keep in mind Flulvlist is an excellent

product that's been on the U.S. market

for more than five years. The live atten-

uated flu vaccine is not a shot, and theFlulvlist HINI vaccine can be given to

healthy people 2-49. Pregnant womenand some people with chronic medical

conditions, like heart disease, asthma,

reactive airways disease, diabetes or

kidney failure, or weakened immune

systems can only receive the injectableform of the HINI vaccine.

I urge you to start the conversationabout HINI vaccination. As advocates

of medicine with the best interests of

our patients in mind, saving lives and

improving health is truly a benefit for

all human kind. 0