H1N1 Vaccine FAQs

2009 H1N1 Recommendations

EFFECTIVE 12/28/09 VACCINE RESTRICTIONS HAVE BEEN LIFTED

Who will be recommended to receive the 2009 H1N1 vaccine? - (NOW OPEN TO EVERYONE)

Vaccine to protect against the 2009 H1N1 flu virus is available; however, initial supplies are limited. CDC’s Advisory Committee on Immunization Practices (ACIP) recommends that certain groups of the population receive the 2009 H1N1 flu vaccine first. These target groups include pregnant women, people who live with or care for infants younger than 6 months of age, healthcare and emergency medical services personnel with direct patient contact, infants 6 months through young adults 24 years of age (especially children younger than 5 years of age), and adults 25 through 64 years of age who are at higher risk for 2009 H1N1 complications because of chronic health disorders or compromised immune systems. For a more detailed description of children at highest risk, read Children with Developmental Disabilities and Chronic Medical Conditions.

The committee recognized the need to assess supply and demand issues at the local level. The committee further recommended that once the demand for vaccine for these target groups has been met at the local level, programs and providers should begin vaccinating everyone from ages 25 through 64 years. Current studies indicate the risk for infection among people age 65 or older is less than the risk for younger age groups. Therefore, as vaccine supply and demand for vaccine among younger age groups is being met, programs and providers should offer vaccination to people over the age of 65.

ACIP has issued separate recommendations on Who Should Get Vaccinated Against Seasonal Flu.

How many doses of vaccine are required?

The U.S. Food and Drug Administration (FDA) has approved the use of one dose of 2009 H1N1 flu vaccine for people 10 years of age and older. For children younger than 10 years of age, two doses of the 2009 H1N1 flu vaccine is needed. This is slightly different from CDC’s recommendations for seasonal influenza vaccination which states that children younger than 9 who are being vaccinated against influenza for the first time need to receive two doses. Infants younger than 6 months of age are too young to get the 2009 H1N1 and seasonal flu vaccines.

What is the recommended interval between the first and second dose of 2009 H1N1 vaccine for children younger than 10 years of age?

CDC recommends that the two doses of 2009 H1N1 vaccine be separated by 4 weeks. However, if the second dose is separated from the first dose by at least 21 days, the second dose can be considered valid.

Do those that have been previously vaccinated against the 1976 swine influenza need to get vaccinated against the 2009 H1N1 influenza?

The 1976 swine flu virus and the 2009 H1N1 virus are different enough that it's unlikely a person vaccinated in 1976 will have full protection from the 2009 H1N1. People vaccinated in 1976 should still be given the 2009 H1N1 vaccine.

Can people who are allergic to eggs receive the 2009 H1N1 flu vaccine?

People who are allergic to eggs might be at risk for allergic reactions from receiving influenza vaccines, including the 2009 H1N1 vaccine. People who have had any of the following symptoms or experiences should consult with a doctor or other medical professional before considering any influenza vaccination:

• hives or swelling of the lips or tongue
• acute respiratory distress (trouble breathing) after eating eggs
• documented hypersensitivity to eggs, including those who have had asthma related to egg exposure at their workplace or other allergic responses to egg protein

Because children with severe asthma are at high risk of serious complications from influenza, a regimen has been developed for giving influenza vaccine to children with severe asthma and egg hypersensitivity (J Pediatr 1985;106:931-3).

Supply and Distribution

What is a “project area”?

CDC distributes vaccine to 62 “project areas.”  These project areas include 50 states, the District of Columbia, 8 US Territories and freely associated states, and 3 large metropolitan areas.

How do project areas know how much vaccine is available for them to order?

CDC sends project areas a 2009 H1N1 allocation report each morning. The report indicates how much of each formulation of 2009 H1N1 vaccine is available for them to order.

How many sites can a project area designate to receive vaccine?

There is a maximum of 150,000 sites to which vaccine can be shipped via the centralized distribution system. Project areas have been provided a pro rata allocation of the sites.

How is vaccine shipped to project areas?

CDC’s contractor for centralized distribution ships vaccine directly to hospitals, clinics, doctor’s offices, health departments, and other providers of vaccines that have been designated as vaccine-receiving sites by the project area.

What is the number of doses “allocated” for ordering?

The number of doses "allocated" for ordering is the amount that is at the distribution depots and ready for states to order. The quantity of vaccine allocated is based on the project area's population size. As an example, if 6 million doses total (3 million doses of nasal spray vaccine AND 3 million doses of injectable vaccine) are ready for ordering nationally and a state has 10% of the US population, then their allocation for today is 600,000 doses total (300,000 doses of the nasal spray vaccine and 300,000 doses of injectable vaccine).

What should project areas expect with respect to frequency of vaccine shipments?

Vaccine will be shipped as it becomes available, taking into account state allocations and orders. The process is modeled after that utilized by immunization programs to order seasonal influenza vaccine off the federal contract. Details about CDC's ordering/allocation process for seasonal influenza are described in the all-grantee message sent to immunization program grantees on August 11, 2009 (Grantee message for allocation).

What is the minimum dose order for shipments of 2009 H1N1 vaccine?

For each vaccine formulation (identified by its National Drug Code) the minimum dose order is 100 doses and all orders must be placed in increments of 100 doses. Each ancillary supply kit contains supplies to support 100 doses of vaccine, with different kits available for prefilled syringe products and for multi-dose vial products.

When and how much of the 2009 H1N1 vaccine will be available?

Both the flu shot (in the arm) and nasal spray form of 2009 H1N1 vaccines have now been produced and licensed by the Food and Drug Administration. The 2009 H1N1 vaccine first became available in early October and more doses are becoming available every week. Vaccine availability, however, depends on many factors so these numbers will be frequently updated. The first doses of live attenuated 2009 H1N1 flu vaccine were administered on October 5, 2009 and the first doses of the 2009 H1N1 flu shot were administered the week of October 12.

Where will the vaccine be available?

Every state is developing a vaccine delivery plan. Vaccine will be available in a combination of settings such as vaccination clinics organized by local health departments, healthcare provider offices, schools, and other private settings, such as pharmacies and workplaces. For more information, see State/Jurisdiction Contact Information for Health Care Providers Interested in Providing H1N1 Vaccine.

For information on seasonal vaccine supply and distribution, visit Seasonal Influenza Vaccine Supply for the U.S. 2009-2010 Influenza Season.

Can I get the 2009 H1N1 Vaccination at my workplace?

CDC has recommended that when possible worksites offer both seasonal and 2009 H1N1 influenza vaccination. It also suggests that workplaces consider granting employees time off from work to get vaccinated if not offered at the worksite. For more information on CDC’s influenza guidance for businesses and employers visit: http://www.cdc.gov/h1n1flu/business/guidance/.

What kind of providers can be designated as vaccine recipients?

Project areas are responsible for registering vaccine providers in their jurisdiction.  Providers may include, but are not limited to, individual clinicians, provider offices, places of work, hospitals, local health departments, retail pharmacies and community vaccinators.  Providers or facilities receiving vaccine must be capable of receiving and properly storing vaccine.

Who determines which providers receive the vaccine?

Specific determinations about where vaccine will be shipped and how it will be distributed to providers are made at the state and local level.  The federal government allocates vaccine based on population to public health departments in the 62 project areas. These public health departments then make decisions about how to distribute vaccine to providers equitably and efficiently within their jurisdictions with the goal of reaching the priority groups first.  State and local immunization programs have planned their efforts according to local capacity and needs. CDC continues to encourage state and local health officials to review and revise their vaccine distribution plans in response to changing needs.

How does CDC ensure that providers’ vaccination practices are consistent with ACIP recommendations?

Providers who offer the 2009 H1N1 influenza vaccine must sign an agreement stating that they will adhere to recommendations issued by the U.S. Advisory Committee on Immunization Practices (ACIP).

Seasonal and H1N1 Vaccine

Does the seasonal flu vaccine also protect against the 2009 H1N1 flu?

The seasonal flu vaccine will not protect you against 2009 H1N1 flu. For more information about the seasonal flu vaccine, read Key Facts About Seasonal Flu Vaccine.

Is this vaccine made differently than the seasonal influenza vaccine?

No. The 2009 H1N1 vaccine has been made using the same processes and facilities that are used to make the currently licensed seasonal influenza vaccines.

Can the seasonal vaccine and the 2009 H1N1 vaccine be given at the same time?

Inactivated 2009 H1N1 vaccine can be administered at the same visit as any other vaccine, including pneumococcal polysaccharide vaccine. Live 2009 H1N1 vaccine can be administered at the same visit as any other live or inactivated vaccine EXCEPT seasonal live attenuated influenza vaccine.

Prior Illness

Should I get vaccinated against 2009 H1N1 if I have had flu-like illness since the Spring of 2009?

The symptoms of influenza (flu-like illnesses) are similar to those caused by many other viruses. Even when influenza viruses are causing large numbers of people to get sick, other viruses are also causing illnesses. Specific testing, called “RT-PCR test,” is needed in order to tell if an illness is caused by a specific influenza strain or by some other virus. This test is different from rapid flu tests that doctors can do in their offices. Since most people with flu-like illnesses will not be tested with RT-PCR this season, the majority will not know whether they have been infected with 2009 H1N1 flu or a different virus.

Therefore, if you were ill but do not know if you had 2009 H1N1 infection, you should get vaccinated if your doctor recommends it. So, most people recommended for 2009 H1N1 vaccination should be vaccinated with the 2009 H1N1 vaccine regardless of whether they had a flu-like illness earlier in the year. If you have had 2009 H1N1 flu, as confirmed by an RT-PCR test, you should have some immunity against 2009 H1N1 flu and can choose not to get the 2009 H1N1 vaccine. However, vaccination of a person with some existing immunity to the 2009 H1N1 virus will not be harmful. For more information on flu tests, see Influenza Diagnostic Testing During the 2009-2010 Flu Season.

Any immunity from 2009 H1N1 influenza infection or vaccination will not provide protection against seasonal influenza. All people who want protection from seasonal flu should still get their seasonal influenza vaccine.

Prevention

Are there other ways to prevent the spread of illness?

Take everyday actions to stay healthy.

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. If soap and water are not available, use an alcohol-based hand rub.*
• Avoid touching your eyes, nose or mouth. Germs spread that way.
• Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

Follow public health advice regarding school closures, avoiding crowds and other social distancing measures. These measures will continue to be important after a 2009 H1N1 vaccine is available because they can prevent the spread of other viruses that cause respiratory infections.

What about the use of antivirals to treat 2009 H1N1 infection?

CDC has issued interim guidance for the use of antiviral drugs for this season. CDC also has published Questions & Answers related to the use of antiviral drugs for this season.

Are natural remedies (also referred to as “complementary” or “alternative” medicine) recommended to prevent the 2009 H1N1 flu virus?

The first and most important step to prevent the flu is to get vaccinated. Vaccination stimulates an immune response using a killed or weakened virus that uses the body’s own defense mechanisms to prevent infection. CDC's current recommendations to protect against 2009 H1N1 virus do not include natural remedies as a sole prevention method. If you want to use a natural remedy to reduce symptoms, CDC recommends that you talk to your healthcare provider about options.

Alternative medicine should not be used as a replacement for proven conventional care, or to postpone seeing a doctor about a medical problem. The National Institutes of Health (NIH) provides information at http://health.nih.gov/topic/AlternativeMedicine on specific alternative options, including scientific information, potential side effects, and cautions for each.

The Federal Trade Commission (FTC) warns consumers to be cautious about products that claim to prevent, treat, or cure 2009 H1N1 influenza, specifically products like pills, air filtration devices, and cleaning agents can kill or eliminate the virus