In midsummer, with the World Health Organization (WHO) reporting setbacks in efforts to produce and test a pandemic (H1N1) 2009 virus vaccine in time for mass production by the fall flu season, some were warning that vaccine supplies could prove inadequate to meet worldwide need-especially if the virus were to mutate and grow more deadly. U.S. Department of Health and Human Services (DHHS) secretary Kathleen Sebelius had committed to buying nearly $1.9 billion of vaccine ingredients from several pharmaceutical companies, but early predictions that vaccinations could begin by early October may have been overly optimistic. Delays were reported, and additional time was needed for human clinical trials to establish safety and dosages.
Whom to vaccinate first. The WHO recommended that health care workers receive the first vaccinations. The U.S. Department of Homeland Security and the DHHS have existing vaccine allocation guidelines (http://www.pandemicflu.gov/vaccine/allocationguidance.pdf) that, in the event of a pandemic, recommend allocating vaccine to target groups in five tiers. First up would be health care workers and others, such as emergency services workers, who are "essential to the pandemic response"; essential community services workers; children up to three years old; pregnant women; and deployed military personnel. Succeeding tiers allocate vaccine based on occupation, age, and health status.
Determining who should receive vaccinations will depend to some degree on disease severity and characteristics, and some patterns have already begun to emerge. Younger people, those who are pregnant or obese, and patients with asthma are experiencing more severe illness, says Victoria J. Davey, deputy chief officer for public health and environmental hazards at the Department of Veterans Affairs in Washington, DC. Those whose health status or occupation increases their risk may be vaccinated first, says Davey, "followed by the age groups shown to be most at risk over the next couple of months of the pandemic."
Can nurses feel confident that the vaccine, when it's finally available, is safe-for them and for their patients? Davey thinks so: "The Food and Drug Administration [FDA] is charged with protecting the public in its licensing process for vaccines. In many ways, testing a new flu vaccine in a short time frame is what they do every year. No testing is ever 100%, but we should be assured that the FDA will not release H1N1 vaccine if it doesn't pass rigorous human clinical trials."
The pandemic (H1N1) 2009 virus may simply run its course without further mutation and die out later this year. In the meantime, says Davey, nurses "should look to their state and local public health departments and the Centers for Disease Control and Prevention, which has an excellent Web site (http://www.cdc.gov/h1n1flu), for the best quality, most up-to-date information. Nurses should help translate this information for their employers, communities, and patients."
Nurses should also keep in mind that nonpharmaceutical measures are crucial to slowing the spread of any pandemic, especially when vaccine supplies are unavailable. These strategies-handwashing, covering up sneezes and coughs, and using antiviral medications for treatment and prevention, face masks and respirators, and "social distancing" measures such as closing schools-should be applied in public places, workplaces, and homes.
Jacob Molyneux, senior editor