H1N1 (Swine) FLU 09 Information

General Practice Pandemic Resources

Monday 12th October 2009

DoHa H1N1 Influenza 09 Vaccination campaign communication resources are available via their website.

The website contains;

• Vaccination information poster (PDF 239 KB)
• Vaccination press advertisement (PDF 207 KB)
• Vaccination brochure (PDF 484 KB)
• Community Q&As Indigenous Australians (PDF 662 KB)
• Press Advertisement Indigenous Media (PDF 675 KB)
• Vaccination Poster Indigenous Australians (PDF 4483 KB)
• Vaccine TV Commercial (MP4 4495 KB)
• Vaccine TV Commercial Script
• Vaccine radio advertisement (WAV 8438 KB)
• Vaccine radio advertisement script
• Indigenous Radio Advertisements

Note: There are two posters, one of which lists the priority groups and another specific for indigenous Australians. DoHa has advised that the generic posters are being printed and delivered as per the “NICS Flu and You” posters which in the past have come directly GPs via post or through Divisions. The exact means by which they will reach GPs has not yet been confirmed.

http://www.healthemergency.gov.au/internet/healthemergency/publishing.nsf/Content/media-downloads

Friday 2nd October 2009

Powerpoint presentation - Panvax Overview pdf version attached below

Also attached below is

• H1N1 Flu Vaccination Clinic Guide
• DoHA Medicare Item Numbers for Vaccination SAervices 20090928
• AMA Statement provided t members on H1N1
• Waiting Room poster for H1N1 Vaccination
• Information about updating MD software

H1N1 vaccination campaign

The official program 'start date' has been confirmed as Wednesday 30 September.

There are three Teleconferences have been organised to provide information on use of Multi Dose Vials etc. A pdf copy of Overview of Panvax for GP's is attached below.

The teleconferences are scheduled on

Wednesday 30th September 2009  11 - 11.30 am 

Wednesday 30th September  1 - 1.30 pm

 Thursday 1st October 2009 11am to 11.30am  

Other Important Information

1. Consent form:

A small error was picked up in the consent form, there was an extra tick box in the gender identification section of the form. This has now been fixed, the amended version is attached below.

     2.  Vaccine and vacpac orders

Vaccine has started to be distributed across NSW. Please encourage your stakeholders to order if they have not already done so.

      3    Medicare Charging

DOHA has provided the following advice:

a. GPs and mass vaccination clinics issue

Answer

The DOH H1N1 vaccination team Departmental legal advice on this issue is that GPs engaged in delivery of the pandemic vaccine to patients, whether these are regular patients or new patients and whether the services are delivered to individual patients when they present at the GP's premises, or at specially arranged sessions dedicated to pandemic vaccination, would not(without something more) constitute a 'mass immunisation'  for the purposes of the Health Insurance Act.  In general, the activity will notconstitute mass immunisation unless the vaccination is arranged by or atthe behest of a State, Territory government or authority. The NSW Health vaccination team would interpret the last line as meaning in a clinic specifically set up by NSW Health alone (e.g., an outpatients clinic in a hospital).

b.  Whether  a  GP  can  charge  both an item 3 (brief consultation) plus a Practice Nurse item 10993

Answer

The Health Insurance (General Medical Service Table) Regulations 2008 provides that Item 10993 can be claimed by a medical practitioner (including a general practitioner) where a suitably qualified practice nurse provides an immunisation on behalf of, and under the supervision of, a medical practitioner (and the patient is not admitted to hospital).  This means that it is the practice nurse who provides the service. The medical practitioner can only make a claim under item 3 that is additional to a claim under item 10993 if the medical practitioner provides advice to the patient that is over and above simply supervising the practice nurse who performs the immunisation.

     4. Vacpac contents

Vaccination packs (disposable items for vaccination) are optional - AHSs are not required to order them if they do not feel that the packs would be of use. However, if you do order, you will receive the full pack - you are not able to choose only partial contents.

Unfortunately, due to the size of the box and the supply of "long" 23G needles neither the GP or the AHS VacPac will contain enough 23G needles (about 140 rather than 200) for drawing up. Please encourage GPs to ensure they have additional 23G needles on hand.

Also, the VacPac contains a SHARP 19G needle. This is fine for drawing up in the large clinic setting, however please caution people appropriately.

Each Vacpac's includes the following information:

-   Per 50 vial blue box (900 doses) - 9 bundles of information sheets, 9 copies of MDV guidelines

- Per 10 vial blue box (180 doses) - 2 bundles of information sheets, 2 copies of MDV guidelines

- Per 10 vial red box (100 doses) - 1 bundle of information sheets, 1 copy of MDV guidelines

Note that each bundle of information sheets contains 100 paper banded together. The above allocation allows 1 information sheet for every dose of vaccine.

      5. AHS support of AMSs

Some AMSs are requesting additional support regarding training with MDVs. Could PHUs please support AMS staff, possibly taking them through the training presentation by teleconference?

      6. Dosage in the immunosuppressed

Dosage is in the PI, no change in dosage

        7.Annual vaccination (shouldn't we just wait?)

It is quite possible we will see higher than usual influenza activity during this summer. It is still relevant to protect people now, particularly those in vulnerable groups.

Another group that had a number of outbreaks in the Northern Hemisphere were summer camps involving young people - so it is still relevant for all ages, if they wish to be vaccinated.

Similar to natural immunity to a seasonal flu strain, being vaccinated with the monovalent pandemic flu vaccine will not be a contraindication to being vaccinated with the trivalent flu vaccine come next year.

        8. What to do if interrupted whilst drawing up?

If a HCW commences drawing up with a 19G needle with the intent of drawing up the whole 18 doses, but happens to get distracted part way through, e.g. after 11 doses have been extracted, can they then return and continue to draw up the remaining 7 doses? If so, what size needle should be used? A new 23G for each dose or can a 19G be used again for the 7 doses?

Our understanding is that there are two issues if you re-enter the vial with a 19G needle (or any needle with a larger bore than 21G):

a)"coring" of the bung into the vaccine which may be significant if the vial is entered more than once and

b)potential contamination of the vial (it may "leak" if you pierce it again with a 19G needle is our understanding).

We would suggest that if there is any possibility of being disrupted it's best to use the 23G/small clinic technique rather than start with the 19G and regret it later. It's really important when using the MDV that you draw it up in an area "without distraction" as per the guidelines.

Whilst not answering the question the safest message for us to give GPs and HCWs is that IF you are drawing up all of a MDV that's the ONLY thing you are doing.  Don't do it if you are in a position where you may be distracted.

       9.Cold Chain Breaches & Wastage

Cold chain breaches should be managed and notified to the Immunisation Unit as per usual.

Vaccine vials that have been opened (ie: had a dose withdrawn) should be discarded after 24 hours. Vaccine that has been drawn up in a syringe should be discarded at the end of the vaccination session OR after 4 hours whichever is shorter.

Thursday 10/9/09, NSW Health  sent a H1N1 Vaccination Program GP and AMS order forms to GPs and Aboriginal Medical Services via fax stream to assist them in placing orders for the vaccine. They will also be writing to private hospitals and aged care facilities to assist them in ordering the vaccine.. Attached are the final documents that were sent.

These documents are also available via the following website: http://www.emergency.health.nsw.gov.au/swineflu/vaccination/index.asp. This site will be rapidly expanded as information is released by the Australian Government.

At Friday's Health Ministers Meeting (4/9/09) the following was agreed:

• Ministers noted that pandemic flu was the dominant strain of influenza this winter in Australia and that the vaccine was the best defence against further spread of the virus.
• CSL has provided further data on safety and efficacy to both the Commonwealth Government and the TGA.
• Ministers noted the desirability of commencing the vaccination program as soon as possible following TGA registration.
• The Commonwealth is working with the States and Territories as they finalise their detailed plans to rollout the vaccine to their populations. 

Further information: http://www.ahmac.gov.au/cms_documents/2009%20-%20Sept%204%20AHMC%20Joint%20Communique.doc

In light of this, NSW Health is still awaiting the decision of the full National Pandemic Emergency Committee regarding eligibility for vaccination before making any public announcements, however in anticipation of a possible start date at the end of September, they have sent the attached information to GPs and Aboriginal Medical Services via fax stream to assist them in placing orders for the vaccine. NSW Area Health Services are also planning to roll out the vaccine to their staff, to some vulnerable patients and to work with Divisions of General Practice and Aboriginal Medical Services to enhance services where access may be an issue.

Thanks to all for your patience and support for this program. If you have any further queries or concern in relation to the attached or the rollout of the program, please contact your local PHU.

24th July 2009   FLU CLINIC GUIDELINES Information below and attached

GUIDELINES FOR IMPLEMENTATION AND OPERATION OF FLU CLINICS DURING THE PROTECT PHASE OF THE RESPONSE TO H1N1 INFLUENZA, ‘09

Please find attached below , NSW influenza clinic guidelines and protocols, along with NSW Health Policy Directive re supply of anti-influenza medications to influenza patients.  The guidelines and directives appear appropriate to the management of H1N1 flu clinics and response within the GP setting.

Practices should consider using the flow chart and questionnaire from the flu clinics documents sent out by NSW Health and consider "splitting" their patients into ILI and others and setting the practice up to fast track with a practice nurse where possible. Evidence form Sydney metro tells us that about 80 % of patients can be effectively seen by Registered Nurse and given tamiflu via the protocol.

A key message is to ensure GP's are "triaging” their high risk patients who have Influenza like illnesses to be seen within the 48 hour window for treatment with Tamiflu.

Vulnerable groups are:

Immunosuppressed people (including some cancers, HIV/AIDS infection, immunosuppressive drugs)
Pregnant women especially second and third trimester
Aboriginal and Torres Strait Islanders of any age
Diabetes Mellitus
Chronic lung disease including asthma
Chronic cardiac disease(congenital,rheumatic,ischemic heart disease)
Chronic renal disease
Chronic liver disease
Chronic neurological conditions
Hemoglobinopathies

Below please find attached documents as listed. NSW Health has moved the pandemic to “PROTECT” phase and is offering free anti viral medication and surgical masks to general practices .

• UPDATE 24072009 Managing Pregnant women with suspected INFLUENZA document attached below
• NSW Health H1N1 Influenza 09 General Practitioners Update #10 17 July 2009
• GP & AMS PROTECT phase Summary sheet 19062009
• H1N1 Flu GPs and AMS order form 17062009
• GP treatment record form 17062009
• Protect Phase Annexure 17062009
• GP Antivral Flow Chart 19062009
•  DISCOUNTED PPE Equipment for General Practice order form and information flyerV15 is attached below. Please contact the Division on 66515774 for the unique order number to secure the discount
• H1N1  Protect Q & A
• Screning Flow Chart
• Protect Antivirals for GPs19062009
• NSW Health Swine Flu Infection Control 29 May 2009
• Plan you Pandemic- A Guide for GPs
• RACGP Pandemic Checklist
• NSW Swine Flu Patient Fact Sheet
• WHO Swine Influenza FAQ's April 09

For the latest information and fact sheets on H1N1 Flu 09 from NSW Health please click here.

Please click on the relevant  link for NSW HEALTH information on

ADVICE for GENERAL PRACTICE 

RELEVANT RESOURCES 

PANDEMIC PHASE CALLED PROTECT

The NSW Health website has links to useful information and a comprehensive list of Fact sheets on correct use of PPE's , Handwashing Cough Etiquette, Caring for someone with H1N1 Flu, Key points for Travellers, Hotels with guests in Quarantine or Isolation, Businesses and Schools, Pharmacists, Prescribers, Child Care & Health Care workers. There are also resources on cough etiquette and Infection Control and an isolation poster. Please click on the NSW Health link above to access the comprehensive information

A comprehensive Q&A's from NSW Health can be accessed online at http://www.emergency.health.nsw.gov.au/swineflu/consumers/qa.asp#para_10.

NSW Health has also updated their webpage with comprehensive information targeting all areas of the community. This is still the most accurate source of information for GPs in NSW and its important Divisions are familiar with it. See http://www.emergency.health.nsw.gov.au/swineflu/index.asp.

RACGP Pandemic resources for General Practices

• The RACGP Pandemic Resource Kit
• Practice Support Poster
• Educational Resources
• Links to Useful websites
• Infection Control Standards for Office -based practices (4th Edition)
• RACGP Influenza Pandemic Checklist (attached below)