PLAN FOR SOUTH CAROLINA’S RESPONSE
TO AN INFLUENZA PANDEMIC
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THE NEXT
INFLUENZA PANDEMIC UNFOLDS…………………………. |
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I. |
COMMAND,
CONTROL, AND MANAGEMENT PROCEDURES………. |
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II. |
SURVEILLANCE…………………………………………………………….. |
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III. |
VACCINE AND
ANTIVIRAL DELIVERY…………………………………… |
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IV. |
EMERGENCY
RESPONSE………………………………………………… |
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V. |
COMMUNICATIONS…………………………………………………………. |
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APPENDICES |
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The next influenza pandemic unfolds ...
An outbreak of unusually severe respiratory illness is identified
in a small village in South China. At least 25 cases have occurred, affecting
all age groups; 20 patients required hospitalization at the local provincial
hospital, 5 of whom died from fulminant pneumonia and acute respiratory
failure. Surveillance in surrounding areas increases, and new cases begin to be
identified throughout the Province. Viral cultures collected from several of
the initial patients are positive for type A influenza virus, but cannot be
further subtyped by the Provincial or national laboratory with available
reagents. The isolates are sent to the World Health Organization (WHO)
Reference Center for Influenza at the Centers for Disease Control and
Prevention (CDC), Atlanta, for further characterization. CDC determines, using
special reagents, that the isolates are type A H7N1, a subtype never before
isolated from humans. This information is immediately transmitted back to the
Chinese Ministry of Health, and throughout the WHO network. CDC dispatches a
team of epidemiologists and laboratory personnel to further study the
epidemiologic and clinical features of the disease, and notifies quarantine
stations and large hospitals at major U.S. ports of entry to be on the alert
for arriving passengers with severe respiratory illness. Isolates of the new
H7N1 strain are sent to the FDA to begin work on producing a reference strain
for vaccine production, and influenza vaccine manufacturers are placed on
alert. The novel influenza virus begins to make headlines in every major
newspaper, and becomes the lead story on major news networks. Key U.S.
government officials are briefed on a daily basis as surveillance is
intensified throughout Southeast Asia and the Pacific Rim.
Over the next two months, outbreaks begin to appear in Hong Kong,
Singapore, South Korea and Japan. Although cases are reported in all age
groups, young adults appear to be the most severely affected, and case-fatality
rates approach 5%. Widespread panic begins because vaccine is not yet available
and supplies of antiviral drugs are severely limited. Several weeks later, the
CDC reports that H7N1 virus has been isolated from ill airline passengers
arriving from Hong Kong and Tokyo in Los Angeles, Honolulu, Chicago and New
York. States and local areas are asked to intensify influenza surveillance
activities and vaccine manufacturers are requested to go into full production.
A few more weeks pass and focal outbreaks begin to be reported
throughout the United States. Rates of absenteeism in schools and businesses
begin to rise. Phones at physician offices and health departments begin to ring
constantly. The media reports exaggerated accounts of illness. Citizens begin
to clamor for vaccine, but only 10% of the estimated needs are available.
Police departments, local utility companies and mass transit authorities begin
to have severe personnel shortages, resulting in severe disruption of routine
services. Hospitals and outpatient clinics become severely short-staffed when
physicians, nurses and other health-care workers become ill. Elderly patients
with chronic, unstable medical conditions are afraid to venture out for fear of
becoming seriously ill with influenza. Intensive care units at local hospitals
become overwhelmed, and soon there are widespread shortages of mechanical
ventilators for treatment of patients with pneumonia. Family members are
distraught and outraged when loved ones die within a matter of a few days.
Looting becomes a serious problem in major metropolitan areas due to shortages
of police officers. Several major airports close because of high absenteeism
among air traffic controllers. Further deterioration in health and other
essential community services occurs over the next 6-8 weeks as illness sweeps
across the country ....
Are you and others within your
jurisdiction prepared?
I. COMMAND,
CONTROL AND MANAGEMENT PROCEDURES
(“CONCEPT
OF OPERATIONS”)
A.
Command and
Management during a Pandemic
While the SC Emergency Operations Plan
should be the basis for our Pandemic Plan, influenza pandemics present certain
special challenges that must be addressed specifically, e.g. a special
surveillance system, rapid delivery of vaccines and antiviral drugs and a plan
for prioritization of recipients, legal authority to allocate these
appropriately, etc. These unique aspects of an influenza pandemic should be
addressed in an Annex to that SC EOP.
Environmental
Control in concert with the Director of Emergency Preparedness Division (EPD)
and the Deputy Commissioner for Health, will designate a Pandemic Influenza
Response Management Group (“Pandemic Response Group”, PRG) consisting of the
following persons or their designees:
State Epidemiologist (Chair), representative of Emergency Preparedness
Division (EPD), representative of the Governor’s Office, State Laboratory
Director, Director of DHEC Immunization and Prevention Branch, two DHEC
District Health Directors (DHDs), representative of SC Hospital Alliance (SCHA)
, representative of SC Medical Association (SCMA), and the DHEC and/or EPD
Public Information Officer.
Physicians by medical specialties, physicians volunteering for
disaster service, infection control practitioners, district epi-teams, acute-care
hospitals, chronic-care hospitals, federal and military hospitals, skilled
nursing facilities, clinical laboratories and laboratory directors, National
Guard medical units, DHEC health district offices, state emergency response
regional offices, county emergency preparedness directors, county coroners and
medical examiners, funeral homes and morticians, pharmacies by whether
certified to give immunizations, members of state Rapid Response Teams, DMAT, and DMORT Teams
Because the antigenic properties of influenza viruses are
constantly changing, both virologic surveillance -- in which influenza viruses
are isolated for antigenic and genetic analysis -- and disease surveillance --
in which the epidemiologic features and clinical impact of new variants are
assessed -- should be viewed as equally critical for pandemic preparedness.
In the United States, international influenza surveillance
activities are coordinated at the CDC by the WHO Collaborating Center for
Influenza Reference and Research. The
CDC participates in WHO's global influenza network with approximately 110
national laboratories in over 80 countries and four International Reference
Centers. The CDC maintains frequent
communications with WHO Headquarters in Geneva, with the other three WHO
International Reference Centers, and with national laboratories worldwide
concerning the numbers and types/subtypes of influenza viruses isolated and the
extent of influenza like disease which taking place at the time of virus isolation.
A.
National
Surveillance
National surveillance in the U.S. is also coordinated by CDC, with
State and county health departments assuming primary responsibility for
carrying out virologic, mortality, and morbidity components. These activities
currently c
uenza-like
illness (ILI) per total number of patient visits by age group each week; (4)
Vital Statistics Offices of 122 U.S. cities which report, each week, the
percentage of total deaths caused by influenza and pneumonia (ICD-9 codes
480-487); and (5) a variety of other sources which spontaneously report
influenza outbreaks or other influenza-associated events.
B.
Routine
Influenza Surveillance Activities in South Carolina
1.
Physician
Reporting - Influenza-like illness (ILI) is one of the mandated reportable
conditions in South Carolina; reporting is required by number only. ILI reports, along with the Source County of
the report, are entered into the disease surveillance data set and transmitted
weekly to the CDC via the National Electronic Telecommunications System for
Surveillance (NETSS). Physician
participation in this passive reporting system is generally poor.
2.
Viral
isolates - The DHEC Division of Laboratories (DOL) is capable of performing
influenza viral isolation and typing and subtyping for influenza A
isolates. They also perform influenza
serodiagnosis by complement fixation testing of acute and convalescent
sera. DOL is currently the only
in-state diagnostic lab that offers viral isolation. Some out-of-state commercial labs may perform viral isolations
for South Carolina physicians.
Laboratories are also required to report influenza isolates and
serologies to DHEC, and these like ILI reports are transmitted to CDC via
NETSS.
3.
Sentinel
Surveillance Sites
a)
DOL
coordinates the Influenza Surveillance Program for the 70 participating
sentinel physicians, colleges, hospitals and local health departments. Sites submit clinical samples for viral
isolation and typing. There is
currently about 1 sentinel site per 50,000 population, which exceeds the
national recommendation to establish one sentinel site per 250,000
population.
b)
The DHEC
Acute Disease Epidemiology Division has established a sentinel surveillance
system for influenza in 65 elementary schools throughout the state (five
schools in each of the 13 Health Districts).
Each week the participating schools fax reports that are compiled by the
surveillance coordinator who monitors absenteeism looking for rates of 10% or
greater lasting for several days.
Influenza is almost unique as a cause for high workplace and school
absenteeism and this surveillance system therefore provides our most timely and
geographically representative information about influenza circulation in the
state.
C.
National activities to enhance surveillance
1.
Improve
“early warning” and “readiness” capability - Although the basic influenza
surveillance infrastructure in the U.S. has generally been adequate to monitor,
on a "macro" level, the spread and impact of "drifted"
strains, the sensitivity of detecting an isolated importation event is
generally poor. There is a need to
enhance our surveillance activities to improve our ability to detect
importation and initial spread of novel variants emerging from other countries.
2.
Ability to
rapidly expand surveillance activities - Contingency plans for rapid expansion
of the basic surveillance systems are necessary to provide the level of detail
necessary to track the spread and impact of a pandemic variant in State and
local communities and to modify control measures as needed.
3.
Improved
ability to detect the emergence of novel variants in the U.S. - Although most novel strains of influenza
(pandemic variants) have emerged from China and the Pacific Rim, such variants
could arise in the U.S. Efforts are now
underway at the national level and in selected States to examine the potential
for highly pathogenic avian strains that are detected on poultry farms
nationwide and among live bird markets to be transmitted to humans. CDC is also
collaborating with USDA to determine if influenza viruses are being transmitted
to humans from infected swine and horses during outbreaks of influenza-like
disease in domestic farm animals.
DURING THE PRE-PANDEMIC PERIOD:
A.
Improve
virologic surveillance capability - The DHEC DOL can identify and type
influenza viruses and perform influenza A subtyping. It is estimated that DOL’s viral isolation capacity is about 100
isolates per week. The primary
limitation is the availability of tissue culture media, which would have to be
ordered two weeks in advance of the need.
Tissue culture could become limited in the event of a pandemic. As the use of antiviral agents for the
treatment and prophylaxis of influenza increase laboratories should address
their capability to conduct testing and surveillance for resistant viral
strains.
B.
Enhance
Disease-based surveillance capability
a.
District Epi
Teams will appoint an influenza surveillance coordinator in each district. Each surveillance coordinator will be given
a copy of the plan and information about influenza surveillance enhancements. In the event of a novel virus alert this
person will assume responsibility for supporting the enhanced surveillance
activity in their district. They will
maintain communications with local disease reporters, serve as contacts for
receiving surveillance data from additional reporting sites, and locally
disseminate surveillance data. This
responsibility will be delegated in advance and back-up personnel will be
identified in the event of staff absences.
b.
During any
stage of influenza transmission clusters of upper respiratory ILI will be rapidly
investigated and swabs for viral isolation will be collected to confirm or rule
out influenza. For influenza confirmed
outbreaks the population at risk, attack rate, and vaccine efficacy, if
applicable, will be defined. For those
outbreaks involving institutions education about future prevention will be
provided.
a.
Travelling
military personnel may be a potential source of importation of novel influenza
strains. Contacts will be established and
maintained with the preventive medicine and hospital epidemiology programs at
the state’s three military hospitals: Moncreif Army Community Hospital, Ft.
Jackson, Shaw Air Force Base Hospital, and the Naval Hospital in Charleston. Military medical facilities maintain their
own disease surveillance systems.
Standard, routine reporting systems should be established between these
facilities and DHEC. This data should
be included in the statewide surveillance data.
b.
Emergency
Departments and Managed Care Organizations should be included in the enhanced
surveillance activities. Department
heads affiliated with these should receive the annual communications described
above that will be sent to private practice physicians.
c.
The Catawba
Health District has initiated sentinel surveillance for influenza based in
nursing homes in the district. In this
system DHEC provides influenza isolation kits to participating facilities and a
point of contact for reporting clusters of ILI to DHEC has been
established. Other districts have been
encouraged to develop similar systems.
d.
Death
Certificate Data – DHEC will request that the Office of Vital Records and
Public Health Statistics generate a data set containing deaths coded as
attributable to P and I. (ICD-9 codes 480-487). The Board of Funeral Directors will be involved to emphasize the
importance of timely and accurate completion of death certificates to enhance
influenza mortality surveillance.
e.
Contacts
will be established with state airports and shipping ports to develop plans for
how to monitor for the possible importation of ILI in the event of the
identification of a novel strain.
C.
Develop
enhanced electronic and telecommunications capability for compiling,
transmitting and disseminating data.
This enhancement should address the handling of data at several
levels:
1)
Data
transmittal within DHEC can be improved.
The DHEC Division of Acute Disease Epidemiology is pilot testing an
electronic data transmittal of influenza viral isolation data from the DOL to the
Acute Disease Epi Division. This data
is now used as a reference but if the pilot is successful, information about
circulating strains could be transmitted electronically to each health
district. Health districts could them
more easily distribute data to their local reporting partners. Improved dissemination of influenza data
would better serve health care providers at the local level and would probably
stimulate additional reporting. The
electronic data could also be compiled in weekly summary reports.
2)
As much as
possible all providers should be included in the surveillance communications
loop. Weekly summary reports of flu
activity could also be distributed by local health departments to physician
offices, hospitals ICPs, sentinel schools, nursing homes, health care centers
in universities and in industry, and to health departments of neighboring
states. Reports could be posted on the DHEC Web site.
3)
DHEC DOL has
the capability to maintain a statewide lab users group linked by e-mail to
enhance communications among laboratories.
D. Animal surveillance – Those
in the state with expertise to monitor for avian, swine, and equine influenza
should develop plans to monitor for clinically consistent clusters of illnesses
in these animal groups and be vigilant for the potential for interspecies
transmission. The State Veterinarian
should coordinate this with the Clemson Livestock and Poultry Lab and the State
Public Health Veterinarian at DHEC.
DURING THE NOVEL VIRUS ALERT:
A.
DHEC Acute
Disease Epi Division will monitor bulletins from CDC regarding virologic,
epidemiologic and clinical findings associated with new variants isolated
within or outside the U.S.
B.
DHEC DOL
will obtain appropriate reagents from CDC to detect and identify the novel
strain if it is found to have the potential for sustained transmission in
humans. If other medical centers have
developed the expertise for viral isolation, the influenza kits will also be
distributed to all these sites. If
viral isolation capability is not widely available, state and local hospital
labs will be encouraged to stock and use rapid antigen tests. DOL will perform viral isolations to monitor
the circulating strains in South Carolina and to detect any antigenic drift or
shift in circulating strains. The H and
N types identified will be submitted to CDC.
C.
The
appropriate partners and stakeholders in the pandemic influenza planning will
meet within 2 weeks of the novel virus alert and review major elements of
enhanced surveillance activities and modify and update plan as needed.
D.
To detect
possible importation and local spread, the enhanced surveillance activities
described above that have not already been implemented will be activated. Those participants in enhanced surveillance
will be notified to begin weekly reports to the identified points of contact on
the District Epi Teams. Data about severe respiratory illness and unexplained
deaths should be captured from local hospitals and nursing homes. Surveillance for severe respiratory
illnesses among travelers from geographic areas in which the novel strains have
been isolated should be conducted.
Plans that have been put in place with South Carolina airports,
airlines, and commercial and passengers shipping lines will be implemented by
contacting the responsible parties with those entities. All surveillance data will be transmitted to
CDC via NETSS.
E. To keep communities informed and to prevent
the dissemination of misinformation, media representatives should be involved
in designing a plan for the collaborative dissemination of regular, relevant,
and timely surveillance data to the general public from an official source.
DURING THE PANDEMIC ALERT:
DHEC has broad authority to implement the
enhanced surveillance activities described above and to change reporting
requirements to conduct adequate surveillance in the event of a pandemic flu
alert. Regulation 44-1-80 states: “The Board of Health and Environmental Control…shall
investigate the reported causes of communicable or epidemic disease and shall
enforce or prescribe such preventive measures as may be needed to suppress or
prevent the spread of such diseases by proper quarantine or other measures of
prevention, as may be necessary to protect the citizens of the State.”
A.
In the event
of a pandemic flu alert, DHEC would change to designation of influenza to an
urgently reportable condition.
Providers will receive notification of this change by DHEC
communications with the Medical Association, Hospital Association, local
medical societies, and special mailings.
DHEC would request daily reporting of the total number of P and I
patients and total number of patients seen at emergency departments and large
primary care practices. The designated
influenza surveillance coordinators of the District Epi Teams would assume the
responsibility to be reassigned to specifically conduct and maintain enhanced
surveillance activities.
B.
Fully
activate enhanced surveillance activities; assess functionality, timeliness and
completeness of reporting (including "zero case" reporting), data
entry and dissemination, and links and feedback at higher and local levels of
the system. Include age group at each surveillance site; and characterize the
denominator to have a better idea where to utilize vaccine.
C.
Include
airlines and airports in surveillance of persons travelling from geographic
areas in which the novel strains have been isolated.
DURING THE PANDEMIC IMMINENT STAGE:
A.
Implement
and pilot-test final modifications, if any, in enhanced surveillance system.
Monitor the ability of hospitals and outpatient clinics to cope with increased
patient loads,
B.
In
collaboration with CDC and other groups at the national level, consideration
would be given to any special studies that could be conducted without further
compromising the anticipated limited resources. Special studies might include some of the following:
1)
collecting
data to document outbreaks of influenza in different population groups
2)
determining
age-specific attack rates, morbidity and mortality
3)
working with
health care providers and pathologists to collect data about any unusual
clinical syndromes associated with influenza infection (as well as risk factors
for those syndromes and appropriate treatment), or unusual pathologic features
associated with fatal cases
4)
conduct
efficacy studies of vaccination or chemoprophylaxis
5)
assess the
effectiveness of traditional control measures such as school and business
closings
Since its development more than 50 years ago, influenza vaccine
has been the cornerstone of influenza prevention and control. Vaccination will
also serve as the central preventive strategy during the next pandemic.
The World Health Organization (WHO)
collaborating influenza centers detect and monitor new variants of influenza
virus throughout the year for potential inclusion in the next year's vaccine.
Vaccine strains are chosen by spring. The four licensed U.S. manufacturers make
~70-80 million doses over the winter through summer months and the vaccine is
administered, primarily to "high risk" patients (as currently defined
by the Advisory Committee on Immunization Practices), from September through
January. Approximately 90% of all doses are administered through the private
sector, with most States and counties offering relatively small amounts of
vaccine through publicly funded programs. This system has served the American
public well -- with record levels of vaccination coverage during the 1990's--
and continues to improve over time.
Despite our ongoing improvements in the
manufacturing and delivery of annual flu vaccine the next pandemic will pose a
number of challenges, particularly to State and local health departments which
clearly must serve as the "linchpin" of vaccination delivery efforts:
·
The target
population for vaccination will be expanded far beyond the typical
"high-risk" groups to encompass, ideally, the entire U.S. population.
·
The
"warning period" preceding spread of the pandemic strain in the U.S.
is likely to be relatively short, so that vaccine will have to be distributed
and administered as rapidly as possible.
·
It is likely
that a severe and/or moderate vaccine shortage will exist, especially early on
during the course of the pandemic. Moreover, it is possible that no vaccine
will be available.
·
The
emergence of a pandemic strain will likely require a second dose of vaccine ~30
days later.
It is likely that the public sector will
take responsibility for vaccinating health care workers, other "first
responders", certain essential community servants, and the poor and the
uninsured.
Success of the pandemic vaccination program
will be determined in large part by the strength of State and local vaccination
programs during the inter-pandemic period.
Public confidence in the benefits of influenza vaccine must continue to
improve, and there must be increased emphasis on the use of pneumococcal
vaccine. Current coverage levels among high-risk persons are only 15-45% for
pneumococcal vaccine and 27-65% for influenza vaccine. To ensure more routine
acceptance of influenza vaccine, consideration should be given to expansion of
immunization promotion activities, to include media involvement. If additional
public funds are available to purchase and administer pneumonia vaccine, these
should be targeted to reach persons in “high-risk” groups, including those
under age 65 with chronic medical conditions.
1.
All persons
will be susceptible
2.
Due to vaccine
shortage, a priority list of vaccinees will need to be developed and adhered
to.
3.
One month’s
supply of vaccine will cover at most 20% of the state’s population.
4.
At least the
first month’s supply of vaccine will be purchased federally and distributed to
the states.
5.
All vaccine
available to the state may arrive via a single allotment.
6.
Two doses of
vaccine will be required per person vaccinated
7.
There may be
up to 40% attrition of essential personnel in the health care delivery sector.
8.
Vaccine
delivery will take priority over antiviral delivery.
9.
Federal
government’s stated responsibilities during a pandemic will be fulfilled, to
include point #4
Goals (in order of priority)
1.
Efficient
and rapid allocation, distribution, and administration of vaccine to officially
designated high priority groups
2.
High rates
of second dose completion (target 80% of high priority groups)
3.
Prompt
reallocation and redistribution of unused vaccine (though there may be little
or none)
Vaccine Delivery
Responsible Authority: DHEC Division of
Immunization. Will be responsible for:
1.
Command and
Control Functions, including:
·
Assurance of
redundancy
·
Communication
within the overall pandemic command
structure
·
Assurance of
legal authority for pandemic immunization activities
(Statute 44-29-210: Physicians, registered
nurses and certain authorized public health employees participating in mass
immunization projects exempt from liability)
·
Coordination
of vaccination activities with neighboring states and with groups such the VA
hospitals, IHS, military installations, etc.
2.
Acting as a
center for vaccine inventories and distribution
3.
Maintaining
supplies of federally distributed vaccine in central and ancillary storage
facilities.
Ultimate responsibility for above would
rest with a “vaccine controller” who, along with a designated back up in case
of illness, would oversee distribution of available vaccine and verify that
vaccine is being provided to priority groups.
The Immunization
Division has already stated its willingness to purchase vaccine during a
pandemic for use by both the public and private sector. The amount obtained will need to be
increased far above the current levels of influenza vaccine purchase; however,
the ability to purchase vaccine may be limited by shortages of supply (though
all states likely to receive some doses of vaccine), available storage, and the
amount of supplementary Federal funding available. The purchase of vaccine
using state funds may not be necessary until the second month of a pandemic and
may NOT be an option due to lack of vaccine availability.
Health Department vaccine purchase will
need to take priority over private sector purchase in a vaccine shortage
scenario. The possibility of vaccine reallocation to the private sector AFTER
priority public health activities have been accomplished should be anticipated.
This would best be accomplished by using the existing VAFAC vaccine
distribution network.
There should be a standing group of
advisors to the governor’s office to determine lists of priority groups for
vaccination. The proposed structure will be similar to that of a hospital
ethics board. The “Vaccine Priority Group” (VPG) will need to acknowledge that
their decisions center around potentially conflicting values and that a key
question to address will be “What are we hoping to prevent?” (Death, serious
illness, overall burden of illness, economic and productivity loss) The
advisory group should be broadly representative and should include
epidemiologists, other public health officials, ethicists, the faith community,
representatives of the medical community, business, law enforcement,
transportation, and citizens. The body’s makeup will be determined in advance
of the pandemic. The planning process should be presented to legislators.
The advisory group should generate more
than one plan for vaccine prioritization based on at least three scenarios:
severe or moderate vaccine shortage or no vaccine shortage. Several lists of
priority groups should be developed, rather than a single one, since the
epidemiologic characteristics of a pandemic strain cannot now be predicted. If
spread proceeds West to East, information about what population groups are at
highest risk will likely be available. It should be acknowledged that the order
of priority may change when the characteristics of the pandemic strain are
better defined. Decisions must involve overall pandemic command/control
structure.
“Essential service
workers” will be defined and prioritized as part of the above process; examples
identified from both planning workgroups include health care workers, EMS,
essential public service personnel such as public utility workers, police and
fire personnel, utility workers and public and private transportation workers.
Very specific lists of personnel will need to be developed and prioritized with
input from all parties so that no essential community workers are overlooked
and “fall between the cracks”. For example, severe illness among funeral
service personnel could have severe consequences for public morale and
potentially for the public’s health as well. Within priority groups, highest
priority subgroups should be identified, since vaccine shortages may preclude
immunizing all of the state’s 100,000 emergency responders and health care
personnel. Consideration should also be given to administration of vaccine to
elementary, secondary, and post-secondary school students, who number almost a
million in South Carolina and who may serve as points of entry for disease into
the community.
Resources for determining priority list for vaccination:
·
Federal
guidelines and published research
·
Surveillance
data on novel strain (CDC, WHO, DHEC
Division of Epidemiology)
Suggested
priorities for vaccine administration given limited supplies are the following:
(Also see Appendices A & B)
1)
First dose
for all high priority groups
2)
Second dose
for all high priority groups
3)
Private
sector, with first administration to high priority groups (possibility may
exist that sufficient supplies will be only enough to provide one dose for high
priority individuals, and that there will be no “supplementary” vaccine
available for private sector use.)
Sample criteria
for release of vaccine to the private sector have been developed; the
feasibility of adhering to and enforcing such criteria during a pandemic is
uncertain.
A single dose
vaccine strategy may need to be considered by the VPG if vaccine is in extremely
short supply, in the interest of protecting more persons in priority and/or
high risk groups.
An executive order on vaccine priority
from the Governor’s office would follow recommendations of the standing
advisory group. The priority list should be publicized once generated. Though
some advance notice to public of who priority groups are and how decision was
made will be necessary, shipment of vaccine to sites and administration of flu
vaccine should be “unannounced” to the extent possible.
Vaccine Allocation, Distribution, and Selection of Sites for
Vaccine Administration
Control of vaccine distribution by DHEC Immunization Division will help to insure equitable distribution to priority groups regardless of income or access to care and will also facilitate distribution of vaccine to essential community servants. All public sector vaccination would occur under DHEC auspices, bu