Patient Flyer: H1N1 and You
Physician Flyer: Physician Guide for H1N1
To access the CDC flyers in Spanish, please click here.
For CPT coding of the H1N1 vaccine and its administration...
5/18/2010 In October 2009, the Department of State Health Services (DSHS) convened a 17-member multidisciplinary work group to recommend a decision-making framework to assist in allocating and distributing scarce health and medical resources during an influenza pandemic. The work group made consensus recommendations based on a series of assumptions at the time as outlined in this report.
DSHS seeks public comment on this report, A Medical Ethics Framework to Support Decision-Making in the Allocation and Distribution of Scarce Medical Resources During Pandemic Influenza. Comments will be considered and applied as appropriate to the decision-making framework contained in this report. This framework could serve as a model for addressing future public health emergencies pertaining to influenza. Comments regarding the report should be submitted to Bruce.Clements@dshs.state.tx.us by 5 p.m. on June 14, 2010.
3/31/2010 DSHS Encourages H1N1 Shots as Virus Continues to Circulate. With recent upticks in flu activitiy in the southeastern United States, the Texas Department of State Health Services is continuing to encourage people to get the H1N1 flu vaccination now to protect themselves. More
2/2010 The Houston Department of Health & Human Services (HDHHS) has lauched Fight the Flu Houston, the city's new, enhanced Web site for Houston-specific information about both seasonal and H1N1 influenza. Spanish version.
• City of Houston to Partner with Community for Free Flu Vaccination Clinics: H1N1 Vaccine City Clinic Locations.
2/10/10 If you have patients who cannot afford H1N1 vaccines at their nearest pharmacy, please direct them to the public clinics.
1/29/10 Non-Safety-Related Voluntary Recall of Unused Doses from Certain Lots of Sanofi Pasteur H1N1 Vaccine in Pre-Filled Syringes. More
1/22/10 The Texas Department of State Health Services updated its wasted/expired vaccine procedures, damaged vaccine procedures, and transfer/redistribution procedures. See links for details.
12/15/09 Non-safety Related Voluntary Recall of Certain Lots of Sanofi Pasteur H1N1 Pediatric (0.25 mL, for 6-35 month olds) Vaccine in Pre-Filled Syringes. More
12/14/09 H1N1 vaccine is available at select pharmacies around town. Below are websites for the various pharmacy chains that you can use to search for appropriate vaccine sites for patients. These vaccines are not free, costs are listed:
Walgreens, $18 (select “H1N1 Vaccinations” and location)
CVS/Minute Clinic, $15
Kroger Pharmacy, $10, should be at all Kroger pharmacies that offer immunizations
H-E-B Pharmacy, expect to have supply in pharmacies by the end of next week
These websites are not fully updated, so please encourage your patients to call the location in their neighborhood to make sure they are offering the immunizations.
12/11/09 Texas Opens H1N1 Vaccine Supply to General Public. The Texas Department of State Health Services today announced it is opening up the state’s H1N1 vaccine supply to the general public. More
12/4/09 The Texas Department of State Health Services continues to order the state's full allocation of the H1N1 vaccine as quickly as possible, with about 4.9 million doses ordered as of yesterday. More
12/01/09 The Texas Department of State Health Services urges H1N1 vaccine providers to target all priority groups. See details.
11/25/09 The Texas Department of State Health Services updated its gudelines on dose spacing and administration. See details
11/24/09 Current List of clinics providing H1N1 vaccines to the public. City County
11/20/09 Texas H1N1 Vaccine Update: The Texas Department of State Health Services continues to order the state's full allocation of the H1N1 vaccine as quickly as possible, with about 3.6 million doses ordered as of yesterday. More orders and shipments will follow as providers confirm their orders with DSHS. More
11/19/09 Flu Vaccine Locator: DSHS is usingthe Google-powered Flu Vaccine Locator service to help people find the H1N1 vaccine (and the seasonal flu vaccine) in their communities. More
11/13/09 Distribution of Swine Flu Vaccine Frustrates Docs - Houston Chronicle. More
11/13/09 Texas H1N1 Vaccine Update: The Texas Department of State Health Services continues to order the state's full allocation of the H1N1 vaccine as quickly as possible, with nearly 3 million doses ordered as of yesterday. More
11/6/09 Distribution of State and Federal Antiviral Caches during the H1N1 Influenza A Outbreak. More
11/6/09 Texas H1N1 Vaccine Update: The Texas Department of State Health Services continues to order the state's full allocation of the H1N1 vaccine as quickly as possible, with about 2.5 million doses ordered as of yesterday. More orders and shipments will follow as providers confirm their orders with DSHS. More
11/5/09 Open Records Request on H1N1 Vaccination Providers has been Made: A couple of weeks ago DSHS sent a notice to those that registered to give H1N1 vaccinations that information on them was potentially subject to an open records request; this has now occurred. Be aware that the DSHS is sending the message to all providers who are registered with DSHS as an immunizer for H1N1 vaccine. See message
11/2/09 Emergency Use Authorization of Peramivir IV. More
10/30/09 Coding and billing information for the administration of the H1N1 vaccine from six major health plans, Medicare and Medicaid. More
10/30/09 Texas H1N1 Vaccine Update: The Texas Department of State Health Services continues to order the state's full allocation of the H1N1 vaccine as quickly as possible, with more than 1.5 million doses ordered as of yesterday. More orders and shipments will follow as doctors and clinics confirm their orders with DSHS. More
10/29/09 H1N1 Vaccine is becoming more accessible in the greater Houston area. It is available on a first come, first served basis. The City of Houston has just released a flyer with information about sites now offering H1N1 (Click here for Flyer). For Harris County Health Centers, click here. There are HDHHS sites offereing the live H1N1 nasal mist vaccine for those ages 2-49. Currently there is a limited supply of injectable H1N1 vaccine available at these sites for pregnant and nursing women, babies, and those with an underlying health condition that cannot tolerate the nasal mist.
10/28/09 Letter from CDC/AAFP/ACOG & AMA encouraging the vaccination of pregnant women for seasonal & H1N1 vaccine. More
10/24/09 Obama declares swine flu a national emergency. More
10/21/09 Texas Continues to Order its full allocation of H1N1 vaccine, but the national supply still isn't adequate to meet the public demand. More
10/20/09 Texas H1N1 Vaccine Update: The U.S. Centers for Disease Control and Prevention allocated an additional 454,200 H1N1 vaccine doses to Texas last week bringing the total vaccine allocation for Texas to 960,400. More
10/15/09 HAN Health Update: On October 14, 2009 the Centers for Disease Control & Prevention (CDC) posted two updated documents related to 2009 H1N1 influenza infection control in healthcare settings to their website. These interim guidance documents apply to personnel working in all types of healthcare, home healthcare and clinical laboratory settings. More
10/13/09 Texas H1N1 Vaccine Update: A total of 506,200 doses of the H1N1 vaccine have been allotteed to Texasby the CDC during the first two weeks of national allocation of the vaccine supply. More
10/9/09 H1N1 Vaccine Update Oct 9: DSHS has asked that if you have signed up for the H1N1 vaccine, please confirm you still want the vaccine and the quantity you need. DSHS will send you an e-mail asking you to re-confirm your quanitity. Please be sure to reply when you receive that e-mail. For the Oct. 6 DSHS news release, please see below.
10/6/09 DSHS Provides Texas H1N1 Vaccine Update: A total of 142,400 doses of the H1N1 vaccine were earmarked for Texas in the U.S. Centers for Disease Control and Prevention’s first weekly allocation to states announced last week. Texas had expected to get 237,000 in the first allocation. More
10/5/09 Updated information for Laboratory Testing Protocol for the Surveillance of novel H1N1 Influenza and Seasonal Influenza. More
10/2/09 HAN Health Advisory: On October 2 the Centers for Disease Control & Prevention (CDC) released an algorithm designed to assist physicians and those under their supervision in identifying indicators of and responses to symptoms of flu-like illness (i.e., fever with cough or sore throat) in adults (> 18 years). (NOTE: this guidance is not intended for use by the general public and is not a substitute for sound clinical judgment.) The algorithm can be accessed at http://www.cdc.gov/h1n1flu/clinicians/pdf/adultalgorithm.pdf.
10/1/09 Updated H1N1 Information for Physicians and Patients: The Harris County Medical Society has created two downloadable flyers, one for physicians and one for patients, to provide you and your patients with the latest information on H1N1. The Physician Flyer includes information on vaccine availability, usage, CDC priority recommendations, etc. The Patient Flyer has information on what are the H1N1 symptoms, calling 2-1-1 for information, CDC vaccination priorities and more. You are encouraged to offer the Patient Flyers in your reception area. Flyers are in a pdf format.
The Harris County Medical Society has created two downloadable flyers, one for physicians and one for patients, to provide you and your patients with the latest information on H1N1. The Physician Flyer includes information on vaccine availability, usage, CDC priority recommendations, etc. The Patient Flyer has information on what are the H1N1 symptoms, calling 2-1-1 for information, CDC vaccination priorities and more. You are encouraged to offer the Patient Flyers in your reception area. Flyers are in a pdf format.
Patient Flyer: H1N1 and You
Physician Flyer: Physician Guide for H1N1
To access the CDC flyers in Spanish, please click here.
Please note – these flyers contain the latest information available as of Oct. 1, 2009. Information about H1N1 is constantly evolving. Be sure to disregard any past advice sent to you and monitor our website for changes in current advice. HCMS will be updating these flyers regularly. The release date of the flyers will always appear on the bottom of the flyer.
If you have trouble downloading the flyers, please email us or contact HCMS at 713-524-4267, ext. 243, and we will fax them to you.
10/1/09 Questions and Answers on 2009 H1N1 Vacinne Financing - More
9/30/09 Initial H1N1 Flu Vaccine Supply to Trickle In: Texas Department of State Health Services officials report that the amount of H1N1 flu vaccine available for the state over the next few weeks will be low and are urging the public and health care providers waiting for it to be patient. More
9/29/09 High Priority Groups First To Receive H1N1 Vaccine (KUHF Radio Houston)
9/29/09 Dial 2-1-1 for Flu Advice: Texans can now dial 2-1-1 to receive over-the-phone medical guidance about what they should do if they or a family member have flu symptoms. The state’s 2-1-1 health information helpline is now staffed with medical professionals who can provide information about managing flu symptoms and advice on when to seek medical care from a physician or emergency room. More
9/28/09 AMA Creates New CPT Codes For H1N1 Immunizations. With both seasonal influenza and H1N1 influenza circulating this flu season, the AMA announced yesterday it has expedited the publication of a new code specific to vaccine administration and revised existing code 90663 to include the H1N1 vaccine.
The new Current Procedural Terminology (CPT®) code issued by the AMA will streamline the reporting and reimbursement procedure for physicians and health care providers who are expected to administer nearly 200 million doses of the H1N1 vaccine in the United States. The codes will also help to efficiently report and track immunization and counseling services related to the H1N1 vaccine throughout the health care system. Visit http://www.ama-assn.org/ama/pub/news/news/cpt-codes-h1n1-immunizations.shtml to learn more in an AMA news release.
9/25/09: HHS & AMA Actions on H1N1 Vaccine Administration Coding and Payment. Senior officials managing the H1N1 public health emergency have reached out to the AMA and physician community for assistance in removing any barriers to a successful H1N1 immunization campaign. More
9/21/09: A decision algorithm is available through the Texas Department of State Health Services (DSHS) at www.dshs.state.tx.us/txflu/DCHHS-H1N1.pdf.
Stay informed by regularly visiting the Texas Department of State Health Services Web site (www.texasflu.org), the Harris County Health Department Web site (www.hchd.org/flu/pandemicplan.htm), and the city of Houston Web site (www.houstontx.gov/health/swineflu.html) for updates. Also, sign up to have HCMS e-mail you the latest information on H1N1 by going to www.hcms.org and clicking on News in the left margin, then clicking on HCMS Direct-Public Health. More information is available on CDC’s Web site, www.cdc.gov/h1n1flu/guidance/
9/17/09 Texas Department of State Health Services (DSHS) released guidance regarding the availability of the state stockpile of antivirals for H1N1. The state stockpile is intended for persons that are uninsured or underinsured. Twenty HEB retail pharmacies currently have State stock antiviral medications. See link to the DSHA process for dispensing State provided antiviral through private pharmacies. You are encouraged to contact your regional or local health department for further information.
H1N1 Vaccine Update - 9/14/09 The CDC announced on 9/14/09 a number of updates on the H1N1 flu vaccine.
1. The vaccine is expected to be available in early October, instead of mid October as stated in the past. Texas can expect to receive its first shipment of novel H1N1 flu vaccine during the first week of October, a second shipment by mid-October, and regular weekly shipments by the end of the month.
2. The Vaccine will confer protection from the virus eight to 10 days after administered.
3. A single injection (one dose) will suffice to protect against the virus. Previously it was thought that two doses will be required.
4. The H1N1 vaccine can be administered at the same time as the shot against the seasonal flu.
According to a Sept. 7 article in the American Medical News, “H1N1 on the horizon: Here's how to prepare your practice -- and staff” experts are advising physicians to plan now for what is expected to be a very unusual, active flu season. Plans should include:
· cross-training employees so that staff can cover for each other as staff becomes sick
· having staff work from home allowing productivity from those who are well enough to work but for various reasons can't come in.
· keeping patients with H1N1 symptoms away from other patients
· informing patients and staff that they may need H1N1 immunization in addition to the usual vaccine for seasonal flu.
September 9: The Centers for Disease Control and Prevention (CDC) has notified Texas Department of State Health Services (DSHS) officials that Texas can expect to receive its first shipment of novel H1N1 flu vaccine during the first week of October, a second shipment by mid-October, and regular weekly shipments by the end of the month.
DSHS will coordinate ordering and distributing the vaccine and has established the procedure physicians must follow to order it.
Physicians must register at www.TexasFlu.org. Although DSHS encouraged physicians to pre-register by Sept. 13 to aid statewide planning, officials now say pre-registration will continue throughout the H1N1 vaccination campaign.
On September 8, 2009 the CDC issued “Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season.” The full document may be found at http://www.cdc.gov/h1n1flu/recommendations.htm.
The Summary of recommendations is printed below.
- Treatment with oseltamivir or zanamivir is recommended for all persons with suspected or confirmed influenza requiring hospitalization.
- Treatment with oseltamivir or zanamivir generally is recommended for persons with suspected or confirmed influenza who are at higher risk for complications (children younger than 5 years old, adults 65 years and older, pregnant women, persons with certain chronic medical or immunosuppressive conditions, and persons younger than 19 years of age who are receiving long-term aspirin therapy.
- Persons who are not at higher risk for complications or do not have severe influenza requiring hospitalization generally do not require antiviral medications for treatment or prophylaxis. However, any suspected influenza patient presenting with warning symptoms (e.g., dyspnea) or signs (e.g., tachypnea, unexplained oxygen desaturation) for lower respiratory tract illness should promptly receive empiric antiviral therapy.
- Clinical judgment is an important factor in antiviral treatment decisions for all patients presenting for medical care who have illnesses consistent with influenza.
- Treatment should be initiated as early as possible because studies show that treatment initiated early (i.e., within 48 hours of illness onset) is more likely to provide benefit.
- Treatment should not wait for laboratory confirmation of influenza because laboratory testing can delay treatment and because a negative rapid test for influenza does not rule out influenza. The sensitivity of rapid tests can range from 10 % to 70%. View information on the use of rapid influenza diagnostic tests (RIDTs).
- Testing for 2009 H1N1 influenza infection with real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) should be prioritized for persons with suspected or confirmed influenza requiring hospitalization and based on guidelines from local and state health departments.
- Groups at higher risk for 2009 H1N1 influenza complications are similar to those at higher risk for seasonal influenza complications.
- Actions that should be taken to reduce delays in treatment initiation include:
- Informing persons at higher risk for influenza complications of signs and symptoms of influenza and need for early treatment after onset of symptoms of influenza (i.e., fever, respiratory symptoms);
- Ensuring rapid access to telephone consultation and clinical evaluation for these patients as well as patients who report severe illness;
- Considering empiric treatment of patients at higher risk for influenza complications based on telephone contact if hospitalization is not indicated and if this will substantially reduce delay before treatment is initiated.
- In selected circumstances, providers might also choose to provide selected patients at higher risk for influenza-related complications (e.g., patients with neuromuscular disease) with prescriptions that can be filled at the onset of symptoms after telephone consultation with the provider.
- Antiviral chemoprophylaxis generally should be reserved for persons at higher risk for influenza-related complications who have had contact with someone likely to have been infected with influenza.
- Based on global experience to date, 2009 H1N1 influenza viruses likely will be the most common influenza viruses among those circulating in the coming season, particularly those causing influenza among younger age groups. Circulation of seasonal influenza viruses during the 2009-10 season is also expected. Influenza seasons are unpredictable, however, and the timing and intensity of seasonal influenza virus activity versus 2009 H1N1 circulation cannot be predicted in advance.
- Persons with suspected 2009 H1N1 influenza or seasonal influenza who present with an uncomplicated febrile illness typically do not require treatment. However, some groups appear to be at higher risk for influenza-related complications.
- Currently circulating 2009 H1N1 viruses are susceptible to oseltamivir and zanamivir, but resistant to amantadine and rimantadine; however, antiviral treatment regimens might change according to new antiviral resistance or viral surveillance information.
- Information on the dose and dosing schedule for oseltamivir and zanamivir is provided in this document. An April 2009 Emergency Use Authorization authorizes the emergency use of oseltamivir in children younger than 1 year old, subject to the terms and conditions of the EUA.
Updated Novel H1N1 Vaccine Registration and Ordering Instructions - September 1, 2009
On September 1, the Department of State Health Services (DSHS) published a memo with additional details on the registration and ordering processes for the vaccine.
The memo details the four steps associated with obtaining the novel H1N1 vaccine:
- Stage 1: Provider Pre-registration – It is meant to capture each provider’s volume requirements.
- Stage 2: Final Registration – DSHS will require providers to electronically sign the H1N1 Provider Agreement. Providers will be notified when the final registration is available.
- Stage 3: Vaccine Ordering - Once vaccine becomes available for a provider, DSHS will notify the provider via email to
- logon to www.TexasFlu.org to approve the order. At that time, providers will have the ability to adjust the number of doses ordered.
- Stage 4: Doses Administered and ImmTrac Reporting - All providers who receive novel H1N1 vaccine must agree to report doses administered information back to DSHS each week via a streamlined online reporting system that will allow providers to report aggregate doses administered information.
In addition, the memo states that details on reimbursement for vaccine administration are not yet available; however, providers should assume that the vaccine administration fee will be a covered benefit. The CPT code for the vaccine is 90663.
The enitre memo can be viewed at the following link.