CDC 2009 H1N1 Vaccination Campaign Planning Checklist

August 31, 2009, 12:00 PM ET

Introduction

This document is intended for state and local planners. Its purpose is to outline the main 2009 influenza A (H1N1) monovalent vaccine (“2009 H1N1 vaccine”) planning actions. It is not meant to be exhaustive, and more detailed guidance is, or will be, available on specific topics. Within each state, the checklist should be tailored to distinguish between state and local responsibilities.

General

• Ensure clear delineation of responsibilities and establish regular communication between involved programs at state level (Preparedness, Immunization, others)
• Establish clear delineation of responsibilities and regular communication channels between state and local programs

Target and Priority Groups

• Determine estimated size in jurisdiction of target and priority groups as defined by ACIP (http://www.cdc.gov/h1n1flu/vaccination/acip.htm.)
• Develop plans which may include public health sponsored clinics or vaccination via private sector vaccinators to reach each target and priority group

Public Health Vaccination Clinics

(clinics that are conducted, organized or sponsored by public health)

• Determine populations that will be targeted for vaccination via large scale/public health sponsored clinics
• Identify clinic sites (number, locations, points of contact, alternative sites, accessibility)
• Estimate size and type (target and priority groups) of population to be served per site
• Determine staffing needs, and sources of staffing
• Develop plans for staffing, including identification of sources of volunteers and development of MOAs with relevant organizations.
• Initiate contracts with personnel agencies or community vaccinators to provide staff or organize/conduct clinic
• Define process to allow healthcare workers from other jurisdictions to vaccinate if necessary

Vaccination by Private Sector Vaccinators

• Meet with and disseminate information through medical societies, hospital associations, healthcare provider professional organizations
• Conduct mail outs or blast fax information to lists of providers obtained from licensing boards or medical societies or using existing tools for communicating with providers (e.g., HAN messages or state public health bulletins)
• Identify clinical providers and health systems interested in providing 2009 H1N1 vaccine (e.g. pediatricians, including non-VFC providers, family physicians, Obstetrician/Gynecologists, internists, HMOs, hospitals and other health care facilities)
• Identify commercial community vaccinators (e.g. retail based clinics, medical services firms, urgent care center) interested in administering 2009 H1N1 monovalent vaccine
• Develop a  pre-registration process so vaccinators can indicate interest, receive information updates as available, and provide information needed for vaccine delivery
• Provide easily-locatable information on health department web site for vaccinators, indicating what role they might play in given state/jurisdiction and how they can obtain information
• Use federal language, once available, to develop provider agreement between providers and public health
• Contact large businesses regarding plans for worksite vaccinations
• Contact college and university health centers

Coordination with Other Partners

• Collaborate with the following systems and facilities, where applicable, as above to ensure vaccination of populations served or associated with them:
• Military bases to develop plan for military dependants
• VA clinics
• IHS clinics and tribal clinics
• FQHCs and RHCs (including reaching out to state Primary Care office and Primary Care Association)

Coordination of Vaccine Distribution

• Determine overall relative allocations for public health clinics, including school-located vaccination, clinical providers, and other private sector providers (e.g. community immunizers, retail providers)
• Where jurisdictions cross state lines, coordinate vaccine allocations across states
• As part of pre-registration or registration process, collect number of influenza doses administered previous year, where applicable, to help determine provider capacity for administering influenza vaccine
• Determine plan for allocating vaccine (e.g. partial shipments to all providers, sequential shipments to sets of providers)
• Develop staffing plan for entry of data into VACMAN (application utilized by immunization program grantees)
• Develop plan for provider practices unable to accommodate minimum shipment size (internal distribution, limiting vaccine to larger sites)
• Develop plan for tracking vaccine usage by vaccinators to ensure vaccine supply is adequately directed where needed

Vaccination of Healthcare Workers and EMS Personnel

• Develop agreements with hospitals to delegate responsibility for vaccination of staff, and determine size of staff (total and staff with direct patient contact).
• Collect required information (e.g. shipping address, contact persons, etc.) for vaccine delivery
• Develop plan for outpatient providers (e.g. they may receive vaccine directly through centralized distribution, or if not among the first to receive vaccine may pick up at defined location)
• Develop plan for vaccinating EMS personnel

Vaccination of School-Aged Children

• Make connections with education partners at state level
• Make connections with education partners, including school districts, at local level; create a list of schools/school districts willing to participate in school-located clinics
• Develop plans for staffing school-located clinics, including identification of sources of volunteers and development of MOAs with relevant organizations
• Develop informational materials for parents
• Work with local legal advisors to design consent forms
• Develop plans to distribute and maximize return of consent forms where applicable (i.e., if school clinics during school hours and without parents present are planned)
• Ensure VIS is provided to parents for each vaccination dose
• Develop plan to inform and obtain support of  principals, teachers and parent organizations
• Develop plan for informing and obtaining support from physicians in the community about school-located vaccination

Hard to Reach and Vulnerable Populations

• Define hard to reach populations
• Estimate size of populations
• Develop plan for reaching these populations and/or transporting to clinic sites
• Develop MOAs with public agencies, volunteer organizations, and others to reach these populations

Tribal Populations

• Include IHS and tribal planners in developing and finalizing vaccinations plans
• Ensure tribal populations are included in state vaccine allocation plans

Communications

• Ensure clear communication about implementation of target and priority group recommendations and need for second dose
• Develop targeted (to recommended groups) messages to advertise vaccination clinics and vaccinators participating in 2009 H1N1 vaccination
• Involve local stakeholders and/or key audience liaisons in shaping outreach strategies
• Identify language and cultural barriers and plan for addressing
• Plan testing of messages for receptivity, understanding.
• Create MOAs with channels for communication (e.g. Community and social or religious networks, commerce or local business partners) 
• Determine best means for targeting communication broadly to different ethnic and socioeconomic populations (Media, clinician outreach, websites or new media)
• Reach out to widely diverse local partners, volunteer groups and other NGOs with specific instructions and technical support on how to help disseminate messages and aid the general public in accessing vaccination sites.
• Plan information communication network throughout agencies at state and local levels to ensure coordination of messages
• Conduct ongoing assessment of strategies, and adjust messages as needed

Large Scale Clinic Planning

See guidelines at 2009 H1N1 Flu Vaccine

a) General

• Determine cold storage capacity for vaccine at site
• Determine status of communications equipment
• Develop procedure for receiving and accounting for vaccine
• Develop site layout, patient flow, job descriptions, equipment needs
• Develop plan to provide ID to clinic staff
• Develop plan for responding to medical emergencies or adverse events (e.g. fainting)
• Develop plan for data collection
• Develop process for vaccination of non-English speakers (identify language needs and needed staffing)
• Ensure information on return date for second dose is provided
• Contact information for staff updated and available
• Develop training materials including just in time training plan
• Develop contingency plans in the event of staff absenteeism
• Develop plan for advertising clinics to public and potential vaccinators

b) School-located clinics

• Address issues specific to vaccination of children (flow from classroom to vaccination)
• Plan for consent related issues at time of clinic (verifying identity of consented child when parent is not present)

Doses Administered Tracking

• Determine data collection system and method for reporting minimum required data elements
• Define local data collection needs
• Distribute educational materials to vaccine administration sites
• Develop staffing plan and training for data collection, entering and forwarding at public clinics and at local and state health departments
• Determine equipment needs at all data collection and forwarding sites

Safety Monitoring

• Identify and implement mechanisms to communicate vaccine safety information on a routine and urgent basis with vaccine providers
• Disseminate information to vaccinators to increase awareness of VAERS reporting
• Develop a plan to respond to vaccine safety concerns from providers and patients at the state and local level
• Identify staff that could assist in the event of a field investigation of adverse events following immunization
• Communicate to vaccine providers the availability of CDC provided vaccination cards with date of vaccination, 1st dose/2nd dose, lot number, return date for 2nd dose, VAERS information

Legal

• Contact primary public health counsel to determine which allied health professionals are legally permitted to administer vaccine, to what types of patients, and under what conditions.
• Ensure dissemination/explanation of PREP Act information to planners and vaccinators

For state and local jurisdictions where at least some vaccine will be shipped to a central receiving site and repackaged for shipping to other sites/providers:

General

• Develop system to track inventory from receiving site to further points of distribution to be able to replenish supply in timely manner

Vaccine receiving sites

• Define staff responsibilities with respect to vaccine administration
• Calculate staff needs for receiving, storing, breakdown, repackaging (taking into account absenteeism)
• Develop training materials

Storage and Handling

• Ensure adequate storage space for both refrigerated (preloaded syringes and multidose vials of vaccine and possibly, adjuvant) and non-refrigerated supplies
• Ensure adequate supplies to maintain cold chain during storage and transportation of vaccine at both the storage and vaccination clinics

Transportation

• Plan for transporting vaccine from receiving site to distribution sites
• Review and, if necessary, revise, contingency plan for transportation
• Identify source and number of transportation staff needed (taking into account absenteeism)
• Develop training materials

Security

• Provide security at receiving sites, in transport to administration sites, and at administration site
• Have contingency plan in place for unexpected disruptions at administration site(s)
• Identify staffing for security
• Develop training materials