Tennessee's H1N1 immunization system is model for other states

6:51 AM, Nov 16, 2009   |    comments
Dr. Kelly Moore heads immunization program./THE TENNESSEAN
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By Christina E. Sanchez, The Tennessean 

An H1N1 vaccine shot in the arm or a nasal spray squirt up the nose takes less than a minute. To the patient, the H1N1 vaccine process may come across as simple.

For Dr. Kelly Moore, medical director of the state immunization program, it's a process of spreadsheets, numbers and formulations.

Five manufacturers are producing the H1N1 vaccine in nine formulations, each licensed only for certain populations. More than 1,500 health facilities in Tennessee want the vaccine.

Add manufacturing delays and the Centers for Disease Control and Prevention's requirement for who gets the vaccine first. Plus, states' public health agencies have never distributed and managed flu vaccine programs this large for the private sector. This was new territory.

It was all a recipe for Tennessee's Pandemic Vaccine Pre-registration System, created in less than four weeks this summer because of H1N1. The system became a model for other states and recently won a national award. More than 25 states have set up similar programs.

"They recognized early on that this was something they would need to partner with the private sector on," said Claire Hannan, executive director of the Association of Immunization Managers. "They knew they had to find the best way to do that. They were just ahead of the curve."

Instead of trying to go to private health-care providers, the state had the providers come to it.

Providers pre-register orders

Once the software was developed in August, the state health department spread word to licensed health-care providers across the state through media, e-mails and word of mouth that they could pre-register their orders for the H1N1 vaccine. They had to list who their patients were, where to send the vaccine, how many vaccines they would want and in which form, mist or shot. There was no cost to join.

"When the CDC tells us there is an order available, we look at our health regions, the providers, what they want and if they serve the highest risk groups," Moore said. "We never know how much to expect. We usually order three times a week."

Jessi Muse Cundiff, a pharmacist for Vanderbilt Medical Group, said the state has been good about keeping Vanderbilt updated on vaccine dose availability and gives about two days' notice that it will arrive. The process is a lot more unpredictable than the seasonal flu vaccine shipments. Vanderbilt orders about 50,000 seasonal flu vaccine doses annually from a manufacturer.

TN program gets award

"We usually get the seasonal flu vaccine all in one or two shipments," Cundiff said. "With this vaccine, we get about one shipment a week. They may not always be large shipments, but it's enough to keep us going."

Vanderbilt has ordered 20,000 doses and received about 11,300 to date, given to health-care workers and the sickest patients. Cundiff anticipates that eventually about 50,000 doses will have been ordered.

Moore has gotten into an ordering routine. In the spring, she wasn't sure how that would be possible.

The H1N1 virus, initially known as swine flu, first appeared in the U.S. in mid-April. Tennessee health officials announced the state's first confirmed case April 29. The World Health Organization declared a pandemic, meaning it was widespread, in early June, and almost concurrently, plans were under way to develop the vaccine.

The federal government would buy it. But how much, when and who would deliver it was anyone's guess. Public health departments didn't know who their customers were.

"We were faced with all these uncertainties, and we couldn't wait for the federal government to figure it out," Moore said.

Hospitals and doctors' offices order seasonal flu vaccine directly from the manufacturer. The state plays no part, except to order for the county health departments.

"We asked manufacturers for a customer list, but they were afraid the list would become public and other manufacturers would know who their customers were," Hannan said.

Hannan's organization, a membership group for states' and U.S. territories' immunization programs, gave Tennessee an award for the H1N1 distribution program. Three Bullseye awards are given out each year for immunization program strategies. Tennessee was the only one recognized this year for H1N1 vaccinations.

"What Tennessee did was really innovative," Hannan said. "The concept definitely caught on."

Moore said the vaccine distribution has been a learning process.

"My biggest priority is to make sure the vaccine is not sitting in a warehouse somewhere," Moore said. "Our goal at the Health Department is to make it available as quickly as possible to our communities."

Additional Facts
Ordering H1N1 vaccine: The state Health Department has ordered more than 830,000 vaccine doses to be sent to clinics and hospitals across Tennessee.

Giving H1N1 vaccine: Tennessee represents 2 percent of the nation's population, yet almost 6 percent of the total H1N1 vaccine given out weekly across the nation is in the state. About 265,000 vaccine doses have been given.

The system: Tennessee set up the Pandemic Vaccine Pre-registration System for health-care providers to streamline the H1N1 vaccine ordering process. It has become a model used nationwide. The public can view the site, though not access it, at http://health.state.tn.us/twis.

H1N1-related deaths: 46 confirmed H1N1 deaths, including 35 adults and 11 children.

Source: Tennessee Department of Health

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