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H1N1 swine flu vaccination clinics in Washington, D.C., Maryland, and Fairfax, Va.

Dr. Pierre Vigilance, Glen Barbour and Dr. Cliff Mitchell
Health officials for the District, Fairfax, Va. and Maryland
Friday, October 23, 2009; 1:00 PM

The federal government's unprecedented campaign to protect the nation against the swine flu pandemic has gotten off to a sputtering start, frustrating parents, pregnant women and others anxious to get immunized against the new virus.

Dr. Pierre Vigilance, director of Public Health for the District of Columbia, Glen Barbour, spokesperson for the Fairfax County Health Department, and Dr. Cliff Mitchell, director of the Infectious Disease and Environmental Health Administration at the Md. Dept. of Public Health were online Friday, Oct. 23, at 1 p.m. ET to answer questions about the mass vaccination clinics being held in their respective jurisdictions on Saturday, Oct. 24.

A transcript follows.

Check out our directory of local clinics and our Swine Flu special report for more information.

Find more information on the flu vaccination programs for Fairfax County and the District.

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Dr. Pierre Vigilance: Good afternoon, this is Dr. Pierre Vigilance from the DC Department of Health, I am happy to be here to answer any questions you have on this important issue.

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Fairfax, Va.: I am confused about who will be able to receive the H1N1 vaccine at the Government Center on Saturday. We have college students who will be home for the weekend and would like to know if and when they can get the vaccine.

Glen Barbour: The clinic will be open to all children 6 months to 36 months of age and pregnant women. These groups are being targeted because children in this age range and pregnant women are most likely to be hospitalized and/or die following H1N1 infection. The decision was made to target this group initially, knowing that we would be able to broaden our vaccination efforts as more vaccine becomes available in the coming weeks.

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Oakton, Va.: Hi, Thanks for doing this! Q for the Fairfax County representative: My wife is pregnant (first trimester), and my son is 36 months this month (October)... may I be allowed to wait in line FOR them during the long, rainy, early morning hours (say 4-5 hrs before the 9:00am opening) to save them the frustration and discomfort? (not to mention the risk of actually catching H1N1 from someone else waiting in line for hours) I would give up my spot to them when we got about 30 minutes out. ...Thanks in advance for answering!!!

Glen Barbour: It's your choice, however, consider this: At the time the clinic opens, parking will be restricted and your wife may not be able to be close to the building. So you may want to have them dropped off by someone else to replace you in line. Also, if you have already entered the building before they arrive, they will not be able to take your place. I'm sure you understand that would appear to others as though they were "line hopping," which would be inequitable.

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Alexandria, Va.: I'm 8 weeks pregnant and planning to get the H1N1 flu shot on Saturday at the Fairfax County clinic. Do you have any idea what kind of crowd you are expecting? Also, we just moved to Fairfax County, and I'm wondering if I need to provide some kind of proof of residency or my pregnancy in order to get the shot? If so, what kind of proof do you need?

Glen Barbour: The Oct. 24 clinic will operate on the honor system. We ask that only parents of children who are 6 months through 36 months and pregnant women come to the vaccination clinic at the Government Center on Saturday. In an effort to streamline the process, the Health Department will not ask for residency information, or proof of age or pregnancy status. We expect crowds to be large and cannot guarantee that everyone who fits the target group will get the vaccine.

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DC: Just wanted to say that I took my two small children to Kelly Miller Middle School yesterday to be vaccinated and it was extremely well organized and my wait was all of about 10 minutes. It doesn't mitigate the issues and concerns that a lot of people are facing but I wanted to point out that the hard work of what I imagine are a LOT of people are producing results, and as a DC resident and parent I appreciate it.

Dr. Pierre Vigilance: Thank you. I will pass this along to staff. It will keep them encouraged!

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Vienna, Va.: I know children under a certain age will need a second boost of the vaccine in a month. Does Fairfax anticipate that another batch will be available in a month's time for the kids who get vaccinated on Saturday?

Glen Barbour: The second dose of 2009 H1N1 vaccine should be given about one month following the initial vaccination. You will be given a vaccination record card that contains a reminder date. By that time, there should be enough vaccine in the community for children to receive this dose through the normal influenza vaccine distribution channels including private providers, pharmacies, big box stores, and other private outlets. However, the Health Department will be closely monitoring the vaccine availability situation and, if necessary, will provide additional vaccination opportunities through our district offices or a subsequent mass vaccination clinic.

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Dupont Circle, DC: Thank you so much for taking questions about the H1N1 vaccine and vaccination clinics.

My son is 3 years old. I understand that he will need two shots - an initial dose and a booster one month from now. If we get him vaccinated at one of the clinics, where will he get his follow-up shot in one month? Is there any chance that there will not be enough vaccine for the second dose?

Dr. Pierre Vigilance: We anticipate opening more clinics for the general public in the coming weeks as we receive more vaccine. Your son can receive his second dose at one of those clinics.

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Centreville, Va.: How many vaccine doses will be available tomorrow at Fairfax County Government Center? How many people are you expecting to arrive and how early do you suggest arriving to ensure vaccination?

Glen Barbour: We believe that we will be able to vaccinate about 12,000 people on Saturday, but there will be limited quantities of the flu shot and nasal spray, so we cannot guarantee you will get your preferred choice of vaccine (shot vs. spray) when you arrive at the vaccination station because of supply and demand.

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Washington, D.C.: When do you expect the vaccines to be available for everyone, not just "high risk" groups?

Dr. Pierre Vigilance: Vaccine availability has been delayed, however we expect to be able to provide vaccine to our pharmacy partners and to open clinics for all-comers in mid-November. Should vaccine availability change for the better, we will be able to make it accessible to you sooner.

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Fairfax, Va.: I understand the ages for tomorrow's vaccination for children will be 6 months to 36 months. My son is four so that means I'm unable to take him. When will be the next time I may be able to take him for the H1N1 shot for his age group? If I can't take him here, am I able to take him in NY or does it have to be where I live? I'm concerned about this as the death toll rises amongst children.

Glen Barbour: The delay in distribution of 2009 H1N1 vaccine has impacted the entire nation and has resulted in uneven availability. The October 24 clinic will not be the only opportunity to receive 2009 H1N1 vaccine. The Fairfax County Health Department is committed to vaccinating all individuals in the CDC target groups as quickly as vaccine becomes available. Depending on the quantities of vaccine available each week, vaccine will be distributed through the Health Department's district offices or additional mass vaccination clinics. Updated information about the availability and distribution of 2009 H1N1 vaccine will be posted on the county's Web site, www.fairfaxcounty.gov/flu.

It is important to note that private health care providers are also receiving 2009 H1N1 vaccine and beginning to distribute this vaccine to their patient populations. You may also check with your provider about vaccine availability.

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Washington, DC: I am 32 weeks pregnant and planning to go to one of DC's H1N1 vaccine clinics in my ward tomorrow. Will there be enough vaccine? I have seen articles about MD and VA receiving fewer doses than expected, but nothing about DC. Do I need to be prepared to stand in line for a while? What has the turnout been like at other vaccine clinics in the District this week?

Dr. Pierre Vigilance: I advise that you get to the site early tomorrow morning. We too have received less vaccine than anticipated. Clinics have run smoothly this week with moderate lines. People have experienced waits of up to approximately 90 minutes. We have served every member of the priority groups that we are currently targeting (youth and expectant mothers).

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Washington, DC: Do I have to live in Maryland or Montgomery County to get my H1N1 shot at a flu clinic there? I live in DC but the clinics in Montgomery County are more convenient.

Also, do I have to provide any proof that I have asthma? (I'm only 35)

Dr. Cliff Mitchell: At this point, people who visit clinics are not, to my knowledge, being asked for proof of residence -- our goal is to vaccinate as many people as possible, not to put up barriers. Obviously the temporary shortage has created some challenges, but this is the situation currently. You do not need to provide any proof that you have asthma; again, our goal is to immunize as many people as possible as quickly as we can.

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Alexandria, Va.: Are there preservative-free shots being offered for pregnant women? If not, will we be given the single-dose shot that has trace amounts of the preservative?

Thank you

Glen Barbour: There is no preservative free injectable H1N1 vaccine for Saturday's Fairfax County clinic. However, the "flu shot" vaccine is safe for individuals 6 months of age and older and pregnant women. The Health Department has also ordered preservative free injectable vaccine, but due to production delays by the vaccine manufacturers, we have not received any preservative-free vaccine for distribution. If you only want a preservative-free injectable flu shot, do not attend the clinic on Saturday. It is anticipated that there will be options for preservative-free shots in the future when more vaccine is received.

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Maryland: I was able to get an H1N1 shot for my 2 year old this week at his pediatrician's office, but have to go back in 30 days for the second dose. What happens if there is no vaccine available in a month's time? How have public health officials prepared for the two doses necessary for kids under 10?

Dr. Cliff Mitchell: I am happy that you were able to get the first dose. The supply situation should be improved in a month's time; the shortage we are experiencing right now will gradually correct as additional manufacturing/supply comes on line. We estimate we are about two to three weeks behind where we intended to be in terms of vaccine delivery, so I suspect you will be able to get the second dose without as much difficulty. Also, it does not have to be at exactly 4 weeks; if it is a little past that point, your child will still be protected.

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Capitol Hill, DC: We just attended the clinic at Eliot-Hine last night. We were surprised at the demographic schism in the waiting line -- it was almost entirely white, leading us to worry that word is not getting out about the DC clinics to those who might need it most.

Dr. Pierre Vigilance: Your point is well taken. Thank you for making this observation. We are working with a number of partners to get the word out about the clinics.

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Alexandria, Va.: You say that parking will be restricted tomorrow. What does that mean? Is there information on your website about where to park?

Glen Barbour: Parking is available in the lots surrounding the Government Center. Because of expected large crowds and knowing that spaces closest to the building will be taken first, you may have to walk from as far away as the outer lots up to the building. By "restricted" we mean that large numbers of people may be arriving at the same time. If you park illegally, you will be towed.

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Washington DC: Hello Dr Vigilance and Mr Barbour,

I am a vet(erinarian). How much does "herd health" play into this epidemic? I am 32, and not considered high risk, but was hoping that if enough high risk people can be vaccinated before I am, that "herd health" might protect me until I can. Thoughts?

Thank you

Dr. Pierre Vigilance: Herd health will be effective once enough people have been vaccinated. Before the H1N1 vaccine is available to you, the best way to prevent yourself from getting the flu is to wash your hands, cover your cough, stay home if you are sick, and get your seasonal flu shot.

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Silver Spring, Md.: Wouldn't you agree that it's a bad thing for the government to hammer the message that it's critical for parents to get their kids vaccinated, and then not be able to provide the vaccine they just told everybody it's critical to get? Doesn't such a scenario guarantee panic, fear and anger?

Dr. Cliff Mitchell: Dear Silver Spring:

I understand the frustration that many are feeling about not being able to get vaccine right now. The entire public health community has been geared up to get vaccine out as quickly as possible, especially to the priority populations. I can tell you that as soon as we are told that vaccine doses are available, they are sent out to the many community vaccinators who want to provide the vaccine. Ultimately we will have enough vaccine for everyone who wants it, but in this period where we are building up supplies, it is enormously frustrating for the public. I hope that people will understand that the vaccine will be available, and we will continue to provide people with all of the information we can so that they know where we are.

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Vienna, Va.: Although most questions have been answered, I have not read what the anticipated wait will be. When should people start lining up? Thank you.

Glen Barbour: We don't know how long the wait will be, but please check our official sources such as fairfaxcounty.gov/flu, twitter.com/fairfaxcounty, facebook.com/fairfaxcounty and other sources for updates. The clinic will be open from 9 a.m. to 5 p.m. and the place to line up will be clearly marked.

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Washington, DC: I am pregnant and due in a few weeks. I've already gotten my H1N1 vaccine, but I was wondering if my husband would qualify as one of the CDC's priority group, as he would be caring for an infant under 6 months old soon.

I know he doesn't qualify for the clinics in DC this weekend, but some other clinics are vaccinating all the CDC priority groups. I absolutely don't want to take away a vaccine for another pregnant woman or a child, so am leaning towards waiting another few weeks for him. Your thoughts?

Dr. Pierre Vigilance: Thanks for your question. We appreciate your patience as we work our way through the highest priority groups. Your husband will be able to receive his vaccine at one of our upcoming clinics, or at a pharmacy in the next few weeks.

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New York, NY: Thanks for taking our questions. My 8-month-old son will be receiving the H1N1 vaccine today, the first of two doses he needs. If our pediatrician happens to run out before he can receive his second dose in a month, will he still have a level of protection?

Dr. Cliff Mitchell: The answer is yes. In addition, as the supply situation improves over the next month, it is likely that you will be able to get him the second dose, and it will still be effective even if it is given a little after the 4 week period.

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FCPS teacher: As a teacher and mother of a 4 1/2 month old, I have been told I need to get both the seasonal flu and H1N1 (and I'm on the CDC list since I have a child younger than 6 months at home). I can get the seasonal flu through the school, but when do you anticipate the H1N1 being ready for more distribution? My doctor's office said that they don't even anticipate getting any in the next month. Aren't we running out of flu season by the end of the year??

Glen Barbour: Flu season can run as long as March/April, so flu shots received in the next few months will still be effective for this flu season. Additionally, depending on the quantities of vaccine available each week, vaccine will be distributed through the Health Department's district offices or additional mass vaccination clinics. You may also continue to check with your private health care providers about availability.

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Vienna, Va.: For the Fairfax clinic tomorrow, will you circulate information in line when the shot version of the vaccine is no longer available? My two year old son has a preexisting condition (reactive airway disease/asthma) and cannot get the mist version of the vaccine.

Glen Barbour: Yes, we will update people in line with the latest information about availability.

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Fairfax, Va.: For Glen Barbour: what is the rationale for not allowing strollers? It's pretty difficult to keep a toddler reined in or give them a comfortable place to sit/nap without the stroller option. Thanks.

Glen Barbour: As a parent, you know that at places with large crowds such as amusement parks, there are often stroller parking lots to accommodate the use of strollers up to a point. In this specific clinic, you can use strollers up until you enter the building. Once inside the Government Center, there will be stairs and limited space that preclude the use of strollers.

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Cumberland, Md.: Doesn't this demonstrate that we should NOT allow production of ANY critical product to relocate overseas even if it means a massive subsidy to keep it in the US?

Dr. Cliff Mitchell: I appreciate the question. That is certainly a policy question that is worth raising, but I don't think I could hazard an informed opinion in this forum about the answer. I do think it is a very important question to address.

Dr. Cliff Mitchell: I should add that this is a Federal, as opposed to a State question, but obviously one that has implications for people in every state.

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Washington DC: I have a few questions as a mother of a 3 year old and a 18 month old.

1. Spacing between receiving seasonal flu mist and H1N1: My son is 38 months and received seasonal flu mist 7 days ago. How long do I have to wait before he can receive H1N1.

2. At the DC clinics are both shots and mist available at the flu clinics?

3. It is my understanding that children need to get 2 doses? Is this only if they get the shot? If they require 2 doses for everything can they get the shot and then mist or vice versa?

Dr. Pierre Vigilance: 1 - Your child can receive the H1N1 SHOT at any time, BUT he will have to wait 28 days from the date of receiving the seasonal mist before he can receive the H1N1 mist.

2 - Yes.

3 - Children under the age of 10 need to get 2 doses (with 28 days between each dose) of H1N1 vaccine. This applies to both the mist AND the shot. Yes, the shot and the mist can be combined.

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Washington, D.C.: I have several questions: How are you defining "youth" for the clinics in the District tomorrow, and in what form will the vaccine be given? I am hoping my 15-year-old daughter is eligible. Also, she just had her regular flu shot on Wednesday. Is there any reason we should wait to get her the H1N1 vaccine because of this?

Dr. Pierre Vigilance: Youth are defined as being from 6 months to 24 years of age. Having received the seasonal flu shot, she can receive the H1N1 vaccine at any time.

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Washington, DC: There have been issues raised that some non-priority adults have been able to receive the vaccine, by the urging of the clinic staff. Is it up to the clinic to make that call?

Dr. Pierre Vigilance: Clinic staff have been instructed to restrict vaccinations to youth (6 months - 24 years old), and expectant mothers. We want to ensure that these groups have access to vaccine now, and will continue to communicate this to those who come to our clinics. We appreciate the patience and understanding of those who are not in the priority groups.

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Annandale, Va.: Bringing my kids tomorrow...daughter is 16 months and currently has a cold. Can she still receive the vaccine? Thanks.

Glen Barbour: Anyone in our vaccination target group who happens to have a moderate or severe illness with fever on Saturday is advised to wait until they recover before getting the vaccine. There is no need to postpone vaccination because of a mild cold or other illness.

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Washington, DC: I live in DC and my children attend private schools in Montgomery County. Does it matter where they get the shot? Both of my children fall into the high risk category because they have asthma.

Dr. Pierre Vigilance: We are happy to vaccinate our residents, and look forward to serving you tomorrow.

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Fairfax, Va.: Given that most of the targeted population for the Fairfax clinic can not get the mist, too young in most cases, will you mandate those that can get the mist do so, so that more of your target population can be vaccinated? If not how much of the shot do you have. My interest I have a 2 year old with Cystic Fibrosis who is not medically approved to get the mist.

Glen Barbour: People will have a choice of the nasal spray vaccine or flu shot on Saturday. However, quantities of both types of vaccine are limited and we cannot guarantee that your preference for vaccine will be available by the time you reach the vaccination station.

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Dr. Pierre Vigilance: Thank you for all your questions. I hope you found the responses to be useful. I appreciate the feedback from our clinics to date, and look forward to serving you in the future. Be well. PV

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Not feeling well: Can my children or I be vaccinated if we currently have colds?

Dr. Cliff Mitchell: Generally, no. We recommend that you not have a cold when you receive the vaccine.

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Burke, Va.: Can you please explain how some doctor's offices have the vaccine already while other offices, even in the same county, do not?

Glen Barbour: The delay in distribution of 2009 H1N1 vaccine has impacted the entire nation and has resulted in uneven availability. The vaccine development and allocation process is complex, forecasting how much vaccine will be available to us at any particular time will be challenging because amounts will vary from week to week. In the coming weeks, more vaccine is expected to be delivered to health care providers, hospitals, and local health departments. You can check with their health care providers about the availability of 2009 H1N1 vaccine.

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Falls Church, Va.:

1) Should I be concerned that my 2yr old may receive a nasal spray of the vaccine since there's no way of requesting at the Gov't center? I've heard it may be dangerous for children under 2 since it's a live virus as opposed to the shot.

2) Why are you not able to provide a follow up date for the next round of vaccinations? Do you know if there are any specific plans for the city of Falls Church?

Glen Barbour: The nasal spray vaccine is approved for people 2 years and older who are generally healthy and not pregnant. As for your second question, we cannot predict when we will receive vaccine, therefore we cannot provide a specific date beyond tomorrow.

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Glen Barbour: Thanks for your questions. Please go to www.fairfaxcounty.gov/flu for more information.

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Dr. Cliff Mitchell: I noticed that Glen Barbour and I gave slightly different answers on whether you could get vaccinated if you have a cold. In general, most physicians would not give vaccine if you have a fever, whether it is from a cold or something else. So if you have just a head cold, without fever, you may be able to receive vaccine. If you have a fever, you will generally not be able to receive vaccine at that time.

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Dr. Cliff Mitchell: Thank you for the opportunity to chat with you. Good bye.

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