County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services School Located H1N1 Vaccination Clinics in San Diego County Presented by: Karen Waters-Montijo, MPH Epidemiology and Immunization Services

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services San Diego County 3.2 million population –827,060 aged 0-18 years 44 public school districts (K-12) –496,702 Students Private & Charter schools 4,526 square miles Population estimates were abstracted from SANDAG.org School info was abstracted from ed-data.k12.ca.us

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services

SLV Models Vaccine provided to school RN for administration Linked UCSD medical resident with small local school district to administer nasal only Vaccine provided to mobile clinic linked to community health center Vaccine administered by commercial vaccinators

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services School/County Planning Established ad hoc work group with County Office of Education and large school district Major issues identified –Liability –Funding –School Board approval –Consent form –Logistics –Vaccinators

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services Planning Sent online survey to all public districts in September –31 of 44 responded –24 interested in SLV CDC SLV Guidance to create templates –Letters from the superintendent/principals –Promotional materials –Consent form in multiple languages

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services Roles and Responsibilities County of San Diego: Epidemiology & Immunization Services University of California, San Diego Immunization Partnership Commercial Vaccinators

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services County Roles & Responsibilities Execute MOA with participating districts Contract with commercial vaccinators Coordinate with SDCOE Respond to media Develop consent form Allocate vaccine Quality assurance

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services SLV Participation Protocol Must have MOA completed Determining clinic schedule Accounting for doses Cancelling clinics Priority groups Promoting SLV and notifying families

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services Quality Assurance  Public Health Nurse assigned to each SLV  Checklist utilized –Vaccine storage and handling –Vaccine administration –Consent forms properly completed –VIS available and distributed –Medical screening –Vaccinator station set-up –Emergency plan and supplies available  After-Clinic Report

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services UCSD Roles & Responsibilities Coordinated with vaccinators Outreach to school districts Prepared schools for what to expect –Space for vaccine administration –Parking –Volunteer roles –Patient flow –Security –Translators –Signage –Media relations

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services UCSD Roles & Responsibilities Vaccinator orientation & training Clarification of school/vaccinator/county role Scheduling clinics and maintaining master calendar of multiple clinics throughout the county Coordinating with schools to tailor clinic model –During school hours –After school or weekends

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services Vaccinator Responsibilities Operations Lead Set-up and break-down of clinic Storage & handling of vaccine Recruitment and supervision of nurses Reporting adverse events Notifying County and/or UCSD of problems

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services Allocating Vaccine Tier 1 only –students and siblings age 6 months to 18 years –pregnant women –healthcare staff Up to 20% of enrollment Opened to all Tiers as of Jan 1, 2010

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services Outcomes Nov 7, 2009 through March 23, 2010 Total clinics: districts, 143 schools* 64,254 doses total –During school day: 29,060 –After school: 12,628 –Saturday: 22,566 *includes private schools

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services

Doses by Age –6-23 month 761 –2-4 years 4,717 –5-18 years 49,704 –19-24 years 1,042 –25-49 years 5,863 –50-64 years 1,811 –

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services Total H1N1 Flu Vaccines Delivered Total of 23,372 injection and 40,882 nasal H1N1 vaccines. Grand total: 64,254 doses.

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services School Located H1N1 Vaccination Clinics Rate of school absenteeism and number of lab flu detections reported peaked in the week of Nov. 2 Peak of ED ILI in the week of Oct. 29

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services San Diego Immunization Registry Registry disclosure built into consent form Doses entered into Registry (after clinic) Reminder postcards mailed for second dose

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services

Post-Clinic Assessment Survey Factors important in decision to host –Improve student attendance –Provide community service to district families –Limited availability of H1N1 vaccine in community –Risk of H1N1 outbreak in school 93.1% reported none or minimal challenges in obtaining permission from parents

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services School Staff Responsible for Planning Clinics

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services School Costs Paid staff –99% used paid staff –Average cost= $2,345 Volunteers –66% used volunteers –Average 21 volunteers contributing a total of 56 hours per district Other costs –5 schools indicated “other costs” –Promotional materials, duplication, small supplies, lunch for volunteers

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services Time Away From Classroom

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services School Satisfaction Survey

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services School Satisfaction Survey

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services School Satisfaction Survey What was the least beneficial aspect of the clinics hosted in your District/School? Planning time Vaccine availability and delays

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services Lessons Learned Staffing Clinics Estimating number of doses by: Length of clinic Number of volunteers & stations Number of vaccinators Efficiency improved over time with more clinics Commercial vaccinators gained experience and efficiency

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services Not all vaccinators are equally proficient Importance of real time training (adjustments in procedures due to vaccine product availability) Inventory accountability was a challenge due to: –multiple vaccinators –varying products –multiple clinics scheduled in short period of time Lessons Learned

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services Conclusions Families viewed schools as a safe, trusted and convenient location to receive vaccines Children were comfortable receiving vaccine in a familiar setting Schools provided valuable community service School personnel welcomed opportunity to assist PHER funding provided critical resource for hiring vaccinators and overall coordination of SLV

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services Acknowledgements Coauthors: Michelle DeGuire, MSW, MPH; Terri Olson, RN, MPH, CHES; Nancy Fink MSW, MPH, PPS; Wenrong Wang, MPH, Mark Sawyer, MD Wilma Wooten, MD, MPH, Public Health Officer, County of San Diego Participating schools throughout San Diego County San Diego Epidemiology and Immunization Services Staff

County of San Diego ● Health and Human Services Agency ● Public Health Services ● Epidemiology and Immunization Services