Drive-through flu vaccination program tested in PA

From Saturday's Philadelphia Inquirer, here's a light-hearted story ("Start your engine, roll up your sleeve") about a drive-through flu vaccination program tested at a firehouse in Montgomery County, PA. According to the story, 238 vaccinations were administered in four hours. The county health director describes the test program as a success, pointing to its potential benefit in the event of an outbreak or pandemic. (In addition to being fairly quick, keeping vaccinees in their cars has the added benefit of limiting person-to-person contact at vaccination centers, a potentially serious problem during a pandemic.) The county plans to increase the number of drive-through clinics in 2007.

Short-lived plan for flu vaccine at Houston polling places dropped

The Houston Chronicle has been on top of the mild controversy in Houston this week surrounding the "Vote and Vax" program that would have administered free flu vaccinations at polling places on election day. Here's the lead from yesterday's Chronicle...

"Voting is good. Flu shots are good. But mix them together in the middle of a hard-fought election season and politics takes over.

Mayor Bill White ordered a halt Wednesday to the city health department's privately funded drive to offer flu vaccinations at early voting sites in predominantly Hispanic and black neighborhoods, amid conservative criticism that the effort would boost Democratic turnout."

Regardless of the motivation for the ill-fated program, the good news, as this story in today's Chronicle reports, is that the 1,600 free vaccine doses have been donated to clinics and churches in low-income areas.

This AP story courtesy of the New York Times explains that the "Vote and Vax" program is part of a $320,000 grant from the Robert Wood Johnson Foundation for similar initiatives in 25 American cities.

Los Angeles school district planning to offer Gardasil to students

A very interesting story in Monday's Los Angeles Times -- "Schools to Offer STD Vaccine" -- explains that the Los Angeles Unified School District will make Gardasil available to students in its schools in as little as six months, administering vaccines provided by the federal Vaccines for Children program. Here are three noteworthy excerpts from the story:

"Karen Maiorca, who retired two weeks ago as L.A. Unified's director of nursing services, said the vaccine would be offered each year at dozens of clinics that the district operates. The district's 600 school nurses will be responsible for spreading the word. And though the Vaccines for Children program is designed for uninsured and underinsured children, she said, no student will be turned away."

While turning no student away is an admirable policy, it would seem that such a practice would run afoul of the eligibility requirements of the VFC program. Likewise, Gardasil's manufacturer, Merck, must not be thrilled to learn that students with adequate insurance to cover the cost of vaccine could receive doses sold to the government at significantly reduced rates as part of the VFC program.

"[Peter] Kerndt, [director of the county health department's sexually transmitted disease program], said he will soon recommend to county supervisors that all female adolescents in Los Angeles County receive the vaccine unless their parents opt out."

Only a recommendation at this point, Kerndt's 'opt out' comment seems to suggest creating a presumed consent policy for HPV vaccination, rather than requiring active parental consent to vaccinate. Again, this would presumably be an effective strategy to deliver the vaccine to as many girls as possible, but it would seem that the county would likely face legal opposition to such a policy, the resolution of which is unclear.

"County and L.A. Unified officials said they have not received opposition to the idea of providing the vaccine to students. But they have not yet publicized its availability and a number of groups said they were not aware of the school district's plans.

'Wow, that really is different,' said Linda Klepacki, a spokeswoman for Focus on the Family in Colorado Springs, Colo., who originally believed that the vaccine would be available only through private physicians and government welfare agencies."

The use of schools as a vaccine distribution mechanism is not particularly common in the U.S. today, but in a recent paper in Lancet Infectious Diseases (which we wrote about here), school vaccination programs were suggested as a way to increase Gardasil's uptake among African-American populations disproportionately impacted by HPV infection and cervical cancer mortality.

Strategies for distributing limited supplies of avian flu vaccine

One of the most difficult public health and ethical questions a potential flu pandemic raises is how best to allocate limited supplies of vaccine (which will only be of limited effectiveness at first, as we've written previously). There's general consensus that first responders or other 'essential personnel' (the definition of which varies widely) should be a top priority, including hospital staff, police, firefighters, top government leaders, etc.

Eventually, though, the focus shifts to larger segments of the population, and the key question becomes how to equitably distribute vaccine supplies while most effectively combating the virus' spread. According to this story in today's Seattle Times, flu researches Ira Longini and Elizabeth Halloran have an answer: school-aged children...

"At school, kids are close together, they don't practice the best hygiene, and they help germs spread like pollen in spring. At home, they do the same with their families.

Giving them the best available vaccine at the earliest sign of a major epidemic might fend off a deadly pandemic, say two of the nation's most prominent influenza researchers, newly arrived at the Fred Hutchinson Cancer Research Center.

'A lot of people believe kids are the best transmitters of the virus, and with a limited supply of vaccine, this might work,' said Elizabeth Halloran, who has studied epidemics for decades.

Halloran and her colleague, Ira Longini, believe using available vaccine would buy time for manufacturers to create a vaccine that matches the pandemic flu virus exactly and would protect millions of people worldwide."

Ask any teacher and they (and their immune system) will agree that school-age children are highly effective vectors of bacteria and viruses. This public health strategy is not new in itself and has implications reaching well beyond avian flu. As in most discussions of vaccines, the challenge is weighing individual benefits versus societal good. Children may be a common vector of transmission, but their immune systems are (generally) better equipped to fight off infections. Thus, alternative strategies suggest vaccinating the elderly, the immunocompromised, pregnant women, and other groups that individually are more susceptible to the effects of infections.

The story in today's Seattle Times actually references a Science paper published by Halloran and Longini back in February. (Science, 3 February 2006, 311:615-616 -- subscription required). In the paper, the authors call for increased research of vaccinating schoolchildren against seasonal flu in order to better understand the impact of such a strategy in limiting transmission.

Speaking of Science, the current (April 21) issue is devoted entirely to influenza and is available free (with registration). In an introduction to the issue titled "Influenza: The State of Our Ignorance," Caroline Ash and Leslie Roberts write,

"An energetic response to H5N1 does not have to be alarmist. We can marshal existing concern about this particular strain of avian influenza to build a long-lasting international infrastructure to monitor and thwart threats from such emerging infections."

Agreed.