We now have a limited supply of vaccine for the H1N1 virus. We periodically have both the injectable and nasal spray form available for ALL PATIENTS. However, as our supply changes, we reserve the right to prioritize doses to our high risk patients. High risk patients include all patients with household contacts less than six months of age, all children ages 6 months to 4 years, and any child with significant medical conditions (asthma, immune deficiency, kidney or heart disease, sickle cell anemia, seizures, etc.) The quantity of our supply will vary widely, so contact your child's doctor regarding availability and as to whether or not your child might be of higher risk..

DUE TO THE HIGH VOLUME OF ILL PATIENTS AND THE DRAMATIC NEED FOR VACCINES, BEGINNING NOVEMBER 1ST, FORT WORTH PEDIATRICS WILL REQUIRE AN APPOINTMENT FOR VACCINE ADMINISTRATION.

You will not require an appointment to see a specific doctor and no additional co-pay will be required for such visits, but after November 1st we will no longer be able to accommodate "walk-in shots." We feel we must take this measure to minimize interaction between ill patients, specifically those with potential H1N1 infection, and the populations of patients we want to immunize. We realize that this might create some confusion and inconvenience, and we ask for your patience and understanding as we try to care for our patients as best we can.

BACKGROUND

One of the biggest stories of the year to date has been the emergence of a novel flu strain, swine origin influenza A (H1N1). This type of influenza originated from pigs but contains elements of swine, human, and avian viruses. The swine flu originated in Mexico but has quickly traveled throughout the globe. Being a novel strain of influenza, it can spread rapidly because essentially everyone could be considered susceptible. During normal flu seasons, a large majority of people will be immune to the flu if they were wise enough to get a flu vaccine or simply through the natural immunity they may have built up over time. Unfortunately, with this new strain, those protections are not present.

We are seeing few cases of influenza currently and this, with very rare exceptions, represents the H1N1 or swine flu. The affected patients don't seem to be more ill than the typical patients with influenza in a "typical" flu season, but we are seeing large numbers of children affected. Treatment with antiviral medication is recommended only in particular situations due to both shortages of the medication and the potential for the H1N1 virus to become resistant to it. Until a vaccine becomes available, the most effective means of curbing the swine flu are the most simple. Cover your mouth when you sneeze or cough. Dispose of facial tissues quickly. Wash hands often. Avoid individuals who are ill with fever. Avoid contact with others if you have a fever. Contact your doctor if you are feeling ill, especially if you have symptoms suspicious for influenza (fever greater than 101 with a cough, runny nose, body aches, chest pain, etc.)"

Obviously, the situation is changing rapidly. Some of the most reliable, up to date information can be found at http://www.cdc.gov/swineflu/
and the Tarrant County Health Department http://www.tarrantcounty.com/ehealth/cwp/view.asp?A=763&Q=471978.

H1N1 VACCINE

We currently have a limited supply of vaccine for the H1N1 virus. Our supply fluctuates daily. Some of the vaccine will be in the live, "mist" form and some will be in the more traditional, injectible form. The nasal spray will only be approved for use in children over 2 years of age, who don't have asthma or other lung problems, and as long as the patient and no one in their household suffers from immune deficiency. Also, It is recommended that doses of intranasal flu vaccine for H1N1 not be administered with intranasal "seasonal" flu vaccine, and that the H1N1 intranasal vaccine be separated from other vaccines containing live viruses for approximately one month. Otherwise, there are no restrictions on administration of the H1N1 vaccine in any form with any other vaccine.

Regardless of what form is administered, all children less than 10 years of age will need two different doses to be considered to be fully immunized. The two doses should be 28 days apart or more, but 21 days is considered sufficient. Children 10 years of age and older will be considered fully immunized after a single dose of the vaccine. As with any flu vaccine, the H1N1 vaccine is not approved in any form for children under six months of age. Individuals who have suffered from influenza, whether tested in the office or not, are still recommended to receive the vaccine, although Fort Worth Pediatrics predicts these individuals to have some degree of immunity and protection and are therefore not among those we suggest for high priority vaccination.

VACCINE AVAILABILITY

Because vaccine distribution is based on factors outside of our control, Fort Worth Pediatrics will not be able to vaccinate all its patients as rapidly as might be desired. As we receive vaccine, we plan to administer it to our patients as rapidly as possible, giving it first to those who seem to be most at risk. Risk groups identified by the CDC include pregnant women, health care workers, those with underlying health problems such as asthma and neurological damage, children less than 5 (especially those younger than two years old), and people with infants less than six months of age in the house. Depending on our supply, we will announce which groups of people we plan to vaccinate and that announcement will be seen here.
REMEMBER, AFTER NOVEMBER 1ST YOU WILL BE REQUIRED TO MAKE AN APPOINTMENT FOR THIS AND ANY OTHER VACCINE.

VACCINE EFFICACY AND SAFETY

As soon as the H1N1 virus was identified and its risk for public health was surmised, plans for the vaccine were undertaken. It is important to remember that the flu vaccine changes every year, in response to the way that the flu virus changes every year. The H1N1 virus simply represents a bigger change in the flu virus. If the virus had been identified earlier, it would have been incorporated into the "seasonal" flu vaccine. However, since it was identified after production of the seasonal flu vaccine was almost completed, the need for an additional, "new" vaccine against H1N1 arose. The procedures in manufacturing the new vaccine are identical to those used every single year. The vaccine itself just contains a "different" influenza virus, the H1N1.Studies have shown the H1N1 vaccine to mirror the effectiveness of the every year, "seasonal" flu vaccine, namely between 70-90%.

As far as safety is concerned, vaccination against any disease carries some risk. However, this very, very small risk tends to pale in comparison with the risk of contracting a serious disease. Infection with H1N1 influenza is currently rampant in Fort Worth with several otherwise healthy individuals dying from infection. Studies of the H1N1 vaccine have NOT shown any increased risks when compared to other vaccines, specifically the seasonal flu vaccine. The physicians at Fort Worth Pediatrics see the vaccine as safe and effective. To a person, we all plan to immunize ourselves and our family members as soon as possible.

In our modern culture, media (the intranet, TV, talk radio, etc.) tend to play upon fear, anger, and cynicism to propagate their message and stay in business. When in doubt, we would encourage you to talk to your doctor about what is best for the health of your children. We plan to promptly vaccinate our own children against the H1N1 virus. Why would we treat your children any differently?