December 7, 2005
To: All Vaccines for Children (VFC) Providers
Re: Influenza Vaccine Survey: 2005 – 2006 Flu Season (Update 2005-4)
The Immunization Program would like to do a final assessment of available influenza vaccine in the state of Rhode Island. We are still receiving requests from pediatricians who need additional influenza vaccine and returns from others who over-estimated their needs and have excess.
Many adult practices have also contacted the Department of Health to request influenza vaccine. However, it is our policy not to release any vaccine that was purchased for pediatric use to adult practices until we are certain that pediatric practices do not need any more.
Please fill out the information below so that we can learn how much influenza vaccine is available. We would like to collect all viable influenza vaccine in the state for redistribution to those in need.
Please fill out this survey and fax it back to 222-1442 by December 12 th.
After we receive this survey from you, we will contact you about arrangements for returning excess vaccine or picking up additional vaccine. If you have any questions, contact Mark at 222-5988 or markf@doh.state.ri.us.
Fill in all fields so we can contact you about your return or request.
Name of Practice:
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Tel. Number: |
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Contact Person:
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Date: |
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Practice Address:
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Pick Up Site: (circle one) |
DOH Fatima Kent Landmark Memorial Miriam Newport So. County St. Joseph’s Women & Infants Westerly Pilot Site |
Age Group |
Product |
Package |
Number of Doses to Return |
Number of Doses Requested |
6-35 Months |
Sanofi Fluzone® |
0.25mL
Pre-filled syringe |
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3-18 Years |
Sanofi Fluzone®* |
0.50mL
10-Dose vials |
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5-18 Years |
MedImmune FluMist®**
(live intranasal) |
0.50mL
Pre-filled single-use sprayers |
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*May also be used for children 6-35 months at 0.25mL dose
** For healthy children |
