H1N1 for every kid in NYC

[Tapout 42]

Hello, all--- I am organizing the mass vaccinations of every, single child in the NYC school system, in both public and private schools- for all 5 boroughs. This Dept of Health/Dept of Education program will go on for at least the next 2 months (likely more). I will be one of TWO trainers for the entire program (300+RN's). God help me-- it's overwhelming, to say the least.

The only reason I am putting this out there for you all is so that when I call EMS for some weird anaphylactic rxn to the H1N1 vaccine or intranasal admin at some school anywhere in the 5 boros over the next 2 months, you'll know WHY. Anyone allergic to EGGS, LATEX, GENTAMYCIN, KIWI, MOST NUTS and MOST MELONS can and will react to the vaccine my nurses will be giving. Most kids won't know they are allergic to these things TILL WE GIVE THEM THIS VACCINE and they react in a bad way to it.

We will have Epi Pens on hand but that's it. Get there soon (like seriously FORTHWITH) to provide everything else you'd expect from a true anaphylaxis (have the ETT ready so you WON'T need it).

Also, as an FYI: any kid 10 or less will need TWO H1N1 vaccines or intrasal admins to be truly protected. Most kids won't react to the first dose but WILL react in an anaphylactic way for the 2nd dose. ALWAYS ASK THESE QUESTIONS upon arrival: 1st dose of H1N1 vaccine? 2nd dose? Allergic to eggs? Latex? Gloves? Tape? Gentamycin? Kiwi fruit? Nuts? Melons?

I am so grateful in advance (and I hope to never need any of you).

[mfkap 0]

The only reason I am putting this out there for you all is so that when I call EMS for some weird anaphylactic rxn to the H1N1 vaccine or intranasal admin at some school anywhere in the 5 boros over the next 2 months, you'll know WHY. Anyone allergic to EGGS, LATEX, GENTAMYCIN, KIWI, MOST NUTS and MOST MELONS can and will react to the vaccine my nurses will be giving. Most kids won't know they are allergic to these things TILL WE GIVE THEM THIS VACCINE and they react in a bad way to it.

Can you cite a source for any of this? It seems to be gleamed more from anti-vax literature than from information that someone with any decision-making power should be using. The "can and will" line seems bizarre coming from someone that has any more training than a Red Cross First Aid course.

Aside from the anti-vax tone, I assume that you are getting parental consent for the vaccine? Wouldn't the vaccine consent form mention the egg allergy, the only concerning one, unless you are using latex gloves, which is just irresponsible at this point.

[ny10570 745]

Vaccinations have been going on for two days now and I haven't seen anything like this in the Bronx or heard anything about it through the usual rumor mill. Deadly sick kids definitely get the rumor mill going. We had a rash of asthmatic arrests the last few weeks and BLS crews have become very gun shy because its something a lot of people were talking about. I also just checked with Lincoln ER and they've had zero pediatric anaphylactic cases today in their code room.

on that latex point, latex gloves still dominate the prehospital setting in NYC from EMS, FD, PD, and many school nurse offices.

Edited October 30, 2009 by ny10570

[mfkap 0]

I have only worked in the hospitals in NYC, and most have moved from latex. I am surprised that latex is still around prehospital. I guess it takes time (and money).

As for the anaphylaxis, it has been well documented that it happens in around one out of every million vaccinations given. So statistically, if every single child in NYC schools were vaccinated, there would be one case. It appears that a few (million) people have received the flu vaccine in the past in NYC, and I don't ever remember the ICU overflowing with intubated vaccine casualties.

[PEMO3 523]

I hope this sheds some light on the risks. Remember even if one person in the clinical trial had a reaction it becomes a risk regardless of how insignificant the chances. I still feel that the benefit outweighs the risk by that is my opinion.

From the insert to the monovalent H1N1v vaccine manufactured by Medimmune:

4 CONTRAINDICATIONS

4.1 Hypersensitivity

Influenza A (H1N1) 2009 Monovalent Vaccine Live, Intranasal is contraindicated in individuals with a history of hypersensitivity, especially anaphylactic reactions, to eggs, egg proteins, gentamicin, gelatin, or arginine or with life-threatening reactions to previous influenza vaccinations.

------------------------------DRUG INTERACTIONS-------------------------------

• Antiviral agents active against influenza A and/or B: Do not administer Influenza A (H1N1) 2009 Monovalent Vaccine Live, Intranasal until 48 hours after antiviral cessation. Antiviral agents should not be administered until 2 weeks after Influenza A (H1N1) 2009 Monovalent Vaccine Live, Intranasal administration unless medically necessary.

And directly from the Novartis package insert:

CONTRAINDICATIONS

• History of systemic hypersensitivity reactions to egg proteins, or any other component of Influenza A (H1N1) 2009 Monovalent Vaccine, or life-threatening reactions to previous influenza vaccinations.

[Tapout 42]

Can you cite a source for any of this? It seems to be gleamed more from anti-vax literature than from information that someone with any decision-making power should be using. The "can and will" line seems bizarre coming from someone that has any more training than a Red Cross First Aid course.

Aside from the anti-vax tone, I assume that you are getting parental consent for the vaccine? Wouldn't the vaccine consent form mention the egg allergy, the only concerning one, unless you are using latex gloves, which is just irresponsible at this point.

This info came directly from the Dept. of Health, specifically Dr. Sheila Palevsky, spalevsk@health.nyc.gov , during training sessions several hundred RN's and I were given yesterday (also an RN with a wee bit more knowldege than a Red Cross 1st aid provider). We all attended the same training yesterday at 1 Police Plaza downtown NYC. The same training is being provided again today, same time/same place, for more RNs who will eventually flood the NYC school system with Novel H1N1 vaccine and Flumist.

The program HAS NOT BEGUN YET. It will begin November 4 for 1st wave of RN team deployment and Nov 9 for 2nd wave.

I put this info out there simply as a "heads-up" and courtesy to any who MAY come into contact with NYC school kids over the next 2 months. I did NOT put this out there to be questioned about my own credentials and sources of information in a snide, condescending way.

BTW, yes of COURSE we are obtaining consent from parents prior to vaccinating any kid. But allergies to foods like melon, nuts, etc and meds like Gentamycin are going to be big QUESTION MARKS for the parents. They won't know the kid is allergic until we expose them to it. As for latex, no we do not use latex gloves but some of the hubs of the multi-dose vials of injectable vaccine do still contain minute amts of latex. So we have to ask to be overly-cautious.

We will be administering 5 different brands of inactivated H1N1 vaccine, but only 1 brand of live attenuated intranasal spray. The later is FluMist www.flumist.com .

I'd be happy to provide more info about H1N1 vaccine if you want it. PM me and I'll send you the PP presentation given to us yesterday. Again, thanks in advance.

Edited October 30, 2009 by Tapout

[mfkap 0]

This info came directly from the Dept. of Health, specifically Dr. Sheila Palevsky, spalevsk@health.nyc.gov , during training sessions several hundred RN's and I were given yesterday (also an RN with a wee bit more knowldege than a Red Cross 1st aid provider). We all attended the same training yesterday at 1 Police Plaza downtown NYC. The same training is being provided again today, same time/same place, for more RNs who will eventually flood the NYC school system with Novel H1N1 vaccine and Flumist.

The program HAS NOT BEGUN YET. It will begin November 4 for 1st wave of RN team deployment and Nov 9 for 2nd wave.

I put this info out there simply as a "heads-up" and courtesy to any who MAY come into contact with NYC school kids over the next 2 months. I did NOT put this out there to be questioned about my own credentials and sources of information in a snide, condescending way.

BTW, yes of COURSE we are obtaining consent from parents prior to vaccinating any kid. But allergies to foods like melon, nuts, etc and meds like Gentamycin are going to be big QUESTION MARKS for the parents. They won't know the kid is allergic until we expose them to it. As for latex, no we do not use latex gloves but some of the hubs of the multi-dose vials of injectable vaccine do still contain minute amts of latex. So we have to ask to be overly-cautious.

We will be administering 5 different brands of inactivated H1N1 vaccine, but only 1 brand of live attenuated intranasal spray. The later is FluMist www.flumist.com .

I'd be happy to provide more info about H1N1 vaccine if you want it. PM me and I'll send you the PP presentation given to us yesterday. Again, thanks in advance.

I apologize if my remarks were harsh or critical. Your initial post presented the scenario of children dropping like flies, and pediatric intubations occurring all over the city. Studies have shown that this is just not the case, and even without screening for these rare non-egg allergies, occurrences of anaphylaxis is extremely rare, around the order of one in a million.

This is a divisive and emotional issue across the country, full of misinformation and half-truths on both sides. In the best case scenario, many will get the vaccine, and people will complain that the outbreak wasn't so bad and we didn't need the vaccine, despite the fact that the vaccine very well could have been the reason the outbreak wasn't so bad.

[ny10570 745]

I don't know what to tell you, but Icahn and Bronx Success were both starting the vaccinations on Wednesday and I'm assuming they weren't the only two. Even got my very first swine flu complication this morning. Shockingly the injection site was tender and his arm sore the next morning!!!! Poor mother thought her son was gonna die from "the swines flus".

[dpfd144 5]

NY Daily News web site has an article today, in their "Local" section related to this subject:

"Public school nurses give swine flu vaccine to kids without parents' OK, sends child to hospital"

(I tried posting the URL but it is not working correctly)

I know that news organizations will not always report all the correct details, so take this with a grain of salt: the story says that the nurse did not confirm the patient's identity before giving the med. If true, that is a big nursing no-no.