When H1N1 vaccine first became available in Fall 2009, the Otter Tail County Public Health department received 100 doses of H1N1 FluMist and 200 doses of H1N1 injectable vaccine. The injectable vaccine was from Sanofi Pasteur, which is the only manufacturer of vaccine for infants age 6 months to 35 months.
The department convened a short-term ethics committee to quickly discuss and decide how to allocate the few doses of injectable vaccine. Committee members included a pastor, an infection control nurse, a parent with a child with special health needs, a behavioral health specialist, and a district nursing consultant. The members struggled with the issue that this was the only vaccine manufactured for children 6 months to 35 months of age. Members also struggled with the need to target vaccine to pregnant women and children with underlying medical conditions.
The recommendation from the committee was to target the available vaccine to children 6 months to 4 years of age and caregivers of infants less than 6 months of age through scheduled appointments at a mass clinic. Nurses would triage phone calls to schedule persons for the appropriate vaccine based upon the ACIP target population.
Later, Otter Tail County Public Health was informed by the Minnesota Department of Health that the county could not limit the vaccine only to this target group, but had to make it available to all persons in the ACIP subgroup. During the triage call, additional family members were identified who were either pregnant or were children with underlying medical conditions. These persons were then offered the Sanofi Pasteur injectable vaccine. All other persons were told they could only receive FluMist at this time. The telephone triage process was very time-consuming; however, it made the clinic flow smoothly.
Otter Tail County Public Health also used a Web-based system as an alternate method of scheduling appointments. The Web-based system worked well. Parents completed a few screening questions. This information was sent to a public health e-mail address. One nurse monitored these e-mails. She then sent a return e-mail to the parent with a link to schedule an appointment for the type of vaccine the child was eligible to receive. Using the Web-based system significantly decreased time spent on the phone trying to reach families.