Who gets a flu shot?

By Mary Meehan - mmeehan1@herald-leader.com

In Jessamine County, appointments are required.

In Madison County, schoolchildren are at the head of the line.

Fayette County is expecting to vaccinate thousands at mass clinics, and Jefferson County is administering drive-by shots at Papa John's Stadium.

Pablo Alcala | Staff

HERALD-LEADER - After making an appointment, Whitney Ward, 21, went to the Jessamine County Health Department on Wednesday for an H1N1 vaccination. Nurse Cindy Bishop administered the shot.

More Kentucky flu coverage
Question: What are the priority groups?
Answer: The Centers for Disease Control and Prevention have created a priority list for those at greatest risk from H1N1. On it are: pregnant women, children 6 months to 24 years old, people who live with or care for children younger than 6 months, people ages 25 to 64 with chronic health disorders or compromised immune systems, and health care and emergency services workers. Individual health departments may decide to focus on a particular group.
Q: How is the vaccine doled out?
A: The federal government provides vaccine to the states, which give it to local health departments based on population. Kentucky has been allocated enough vaccine to immunize about 10 percent of its population. As much as 50 percent of the state's population falls into high-risk priority groups. At some point, Kentucky expects to receive more doses and be able to immunize anyone who wants a shot.
Q: Will my doctor's office get some vaccine?
A: Individual providers may sign up to administer the vaccine. But, again, it's up to local health departments to get it in their hands. Some departments might not opt to give it to private providers. In Fayette County, there are some 120 providers who have signed to administer the vaccine. Across the state, 1,265 providers have signed up. Not all have received the vaccine.
Q: Do kids need one dose or two?
A: The CDC recommends children younger than 10 receive two doses. The World Health Organization said last week that, considering the limited supplies, it's best to give as many children as possible a single dose. The CDC has not changed its guidelines.
Q: How long between doses for children?
A: Ideally, a second dose should be administered 28 days after the first.
Q: What happens if you miss that window?
A: The month lag is considered best, but if the second shot is given a few days earlier, it still will be effective. If you get it after 28 days, there is no decline in immunity from the first shot. The child still will have some immunity and get that extra boost of immunity whenever the second dose is administered.
Q: There are different kinds of vaccine. Who should get what?
A: The injectable vaccine is appropriate for anyone. The nasal mist contains a live form of the virus and should not be given to pregnant women, people with chronic medical conditions or those older than 50.
Q: How much does a vaccination cost?
A: It's free if you get a dose from a public health department. Doctor's offices or private clinics may charge a fee; there is no cap on that fee.
Q: Do I need to prove I have an illness or am pregnant or am a resident of the county where the shot is offered?
A: No. Kentucky, like the most of the rest of the nation, is operating on an honor system.
Q: I'm not in a priority group. Can I still get a shot?
A: Yes. The CDC requires that people who ask for a shot get one, but health officials are hoping that people will be patient and let those at greatest risk go first.
Sources: CDC, Lexington Fayette-County Health Department, State Department of Public Health
Fayette CountyH1N1 clinics
■ 9 a.m. to 3 p.m. Saturday, Paul Laurence Dunbar and Bryan Station high schools.
■ 9 a.m. to 3 p.m. Nov. 21, Tates Creek and Jessie Clark middle schools.
■ 9 a.m. to 3 p.m. Dec. 5, Henry Clay and Bryan Station high schools
■ 1 p.m. to 5 p.m. Dec. 6, Henry Clay and Bryan Station high schools.
■ 9 a.m. to 3 p.m. Dec. 12, Beaumont Middle School and Lexington Traditional Magnet school.
■ 9 a.m. to 3 p.m. Dec. 19, Paul Laurence Dunbar and Tates Creek high schools.
Contact your local health department for vaccination clinics near you. For information on H1N1 or other clinics, call the Public Health Influenza Hotline at 1-877-843-7727 or visit http://healthalerts.ky.gov. Or contact the Lexington health department at www.lexflucrew.com or (859) 288-7529

Across the state, local health departments have varying strategies for how and when they distribute H1N1 vaccine.

Local officials are free to decide which of the at-risk groups identified by the Centers for Disease Control and Prevention should be made a priority or to emphasize some other group. And that's as it should be, said Dr. William Hacker, the state health commissioner. Local folks make the best local decisions, he said.

"There are different approaches," he said. "All of which are OK."

But the competing information can be confusing if you don't know the rules are different from locale to locale.

The Lake Cumberland Health District, for example, reacted quickly when the vaccine became available by holding the state's first public clinics on Oct. 14. Part of that was luck, said Amy Tomlinson, the district's public health services coordinator.

A seasonal flu clinic already was on the books, so workers and space were available. Plus, with the district's 10-county area and a limited supply of vaccine, there appeared to be "no logical way" to divvy up supplies fairly and quickly to offer more localized service. A mass clinic seemed the first, best choice, she said, although the district is working now with schools to begin vaccinating students.

Fayette County, which expects to vaccinate thousands at two clinics Saturday, waited to hold its first mass clinics while it got workers and locations in place and to obtain enough vaccine. While the clinics are not targeted at specific high-risk groups, officials hope only those in high-risk groups will show up.

"The reason you do a mass vaccination, it's one of the quickest and most effective ways to get it out with the most people in the shortest amount of time," said Dr. Melinda Rowe, the health commissioner. Scheduling the clinics on Saturday made them most accessible to parents with school-age children and people who work, she said.

The Madison County Health Department was one of the first in the state to focus on school-age children, holding clinics during school hours not only because kids are a high-risk group but because of the working relationship between health and school officials.

The health department contracts to provide school nurses, said Christie Green, the district's administrative services manager. Plus, she said, in-school clinics seemed to be a good way to ensure that children younger than 10 got both of the recommended doses.

"They are kind of a captive audience," she said.

In Jessamine County, a small staff and limited office space made appointments the right choice, public health director Nancy Crewe said.

Although local health officials are being asked to focus on those at greatest risk for getting H1N1, or swine flu, a health department could decide to focus on some of those high-risk groups or expand the list to others, Hacker said.

For example, Harrison County Schools employees received vaccines at a closed clinic last week although school workers are not on the CDC priority list.

Judy Feeback, district school health nurse, said she's grateful school employees were included, considering the district already has closed schools for two days because of illness.

But, she said, "I don't know why we were included. I just assumed we were included because we were in the top priority."

Officials with the WedCo health district, which serves Harrison, Scott and Bourbon counties, did not respond to requests for comment.

The message about who can get the shot is also a little murky. Health officials are encouraging people to be patient and wait until those at greatest risk get shots. It's basically an honor system across the country.

But, Hacker said, the CDC requires shots be given free to anyone who shows up to a public clinic. However, private providers such as doctor's offices may charge for a vaccination or decline to provide it.

While there have been scattered news reports that some clinics are requiring proof of an chronic illness, such as a doctor's note, Amanda Aldridge, a CDC spokeswoman, said she is not aware of any states that require it.

While the limited supply of H1N1 vaccine is much in the news, it's not the first time the state public health system has dealt with limited supplies. There have been shortages of seasonal flu vaccine, and the state allowed local health departments to control distribution without issue, Hacker said. Ultimately, he said, there will be plenty of H1N1 vaccine for anybody who wants to get a shot.

If there are concerns about the way the vaccine is distributed, he said, people should contact the Department of Public Health at 1-877-843-7727.

In the meantime, local departments will continue to figure out what works best for their communities.

"That vaccine does nobody any good in the refrigerator," Fayette County's Rowe said.