Mass Vaccination by Self-Administration with Live Attenuated Influenza

Background:
A significant potential limiting factor in any pandemic mass vaccination effort will be mustering adequate nursing staff. Many positions in open community influenza clinics, such as crowd control and registration of the clients, can be filled by citizens with minimal training. Nurses, by contrast, have a particular skill in being able to vaccinate, which requires significant experience. Nursing or medical students or others can be trained to provide vaccinations, but they are likely to be far less efficient than nurses who vaccinate every day.
Live attenuated influenza vaccine (LAIV) is given via nasal spray. It is licensed to be given to by medical professionals. However, the vaccine was in its initial licensing trials self—provided by many patients with apparent success. If the vaccine could be self-provided on a mass scale, the human resource needs for standing up mass vaccine clinics would be significantly reduced.

Objectives:
To demonstrate that a mass vaccination public health clinic using self-inoculation with live attenuated influenza vaccine is practical and efficient.

Methods:
A walk-in immunization clinic was offered to healthy community first-responders 18-49 years of age. Patients first provided informed consent to a novel immunization process. After one public health nurse provided them with education, patients then self-vaccinated with FDA-approved live attenuated influenza vaccine in groups of 4-15. The clinic was videotaped for process evaluation and patients were given a post-immunization questionnaire to assess efficacy of the process.

Results:
One public health nurse was easily able to conduct the vaccination of 124 people over 3 hours using a self-vaccination format. Over 97% of vaccinees reported that they felt they were able to self-vaccinate effectively, with no adverse events with vaccination.

Conclusions:
A public health immunization clinic using self-inoculation with influenza vaccine is practical and efficient, and may offer a novel method for mass immunizing in a pandemic setting.