BACKGROUND:
On October 4, 2004, it was announced that Chiron, one of the two manufacturers of injectable influenza vaccine had their manufacturing license revoked. As a result, the supply of influenza vaccine that would be available in the United States would be cut in half. In the 2003/2004 influenza vaccination season, approximately 87 million doses of vaccine were administered. Projected supply for 2004/2005 would be approximately 54 million doses.

OBJECTIVE:
With a decreased supply of vaccine, the overall objective was to insure that remaining doses of vaccine be used for people in high priority groups. Before that could happen, there was a need to assess current inventories of vaccine, define and quantify high-risk populations, identify sources of vaccine and create and implement communication strategies for providers and the general public.

METHOD:
Beginning October 5, 2004, the Rhode Island Department of Health implemented an Incident Command System (ICS) to deal with this public health crisis. ICS team members were identified and all planning and action was organized through the ICS operational structure.

RESULT:
As of November 19, an Incident Action Plan is in place for each of the 23 operational periods. The ICS team has identified additional stakeholders and has solicited feedback from them when appropriate. Provider and general public educational materials have been printed and posted on the department's website. Staffing on the centralized, state-wide information line was increased to meet demand.

CONCLUSION:
In a time of public health crisis, implementing an ICS management system supports a proactive and inclusive response to the situation.

LEARNING OBJECTIVES:
1. How an ICS management system is structured.
2. Why an ICS management system is beneficial in responding to a public health crisis.
3. The value of including external stakeholders.
4. Communication strategies for providers and the general public.