2004 Influenza: The Best of Times, the Worst of Times Kristen Ehresmann, R.N., M.P.H. Minnesota Department of Health March 2005

Acknowledgements  MDH flu team  LPH staff across Minnesota  Private providers statewide  Employer groups

“It was the best of times, it was the worst of times…” Charles Dickens, Tale of Two Cities

Initial Public Health Response  The ‘flu team’ met immediately  Identified 3 areas of focus:  Communication with our public health partners  Data assessment  Public messages

Communication with Public Health Partners  Lessons learned from the 2003 ‘crisis’  Prescheduled conference calls ensured that infrastructure was in place  Conference call with LPH scheduled for Oct 5 and daily thereafter  Opportunity to share information and promote vaccine redistribution  Forum for discussion and consensus decision making

Data Assessment  Goal: Characterize the influenza vaccine shortage situation in Minnesota  LPH survey of providers within their jurisdiction  Collected information on doses ordered, manufacturer, doses received, doses needed

Data Assessment (cont.)  Survey conducted Oct 6-7, collected and analyzed Oct 8-10  Data available by Monday, October 11

Minnesota Situation  Clinics serving children & families least affected –75% ordered vaccine from Aventis  Local public health (LPH) purchased from distributor who ordered from Chiron  LTC facilities, adult practitioners, and many hospitals ordered from Chiron

Public Health Response  LPH worked within their communities to facilitate vaccine redistribution  Redistribution prioritized to meet needs within: 1. County 2. Region 3. State

Nursing Homes  Nursing home residents not covered  LPH and healthcare providers advocated to meet the needs of NH residents

Proportion of LTC Facilities with Flu Vaccine, October 11

Proportion of LTC Facilities with Flu Vaccine, October 14

Proportion of LTC Facilities with Flu Vaccine, October 22nd

Proportion of LTC Facilities with Flu Vaccine, October 25th

Proportion of LTC Facilities with Flu Vaccine, November 5th

This represented a huge success for public/private partnerships!

Employer Groups  Source of vaccine not already earmarked for high-risk individuals  Cancelled state employee vaccination campaign; vaccine used for high-risk public clinics  Letters sent to CEOs  Many corporations sold or donated vaccine to meet the needs of high-risk individuals

Healthcare Workers: MDH Definition  Healthcare workers should be vaccinated if:  Spend the majority of day with ill patients AND  Have face-to-face contact with those patients AND  Provide direct patient care  We modified our screening form to include this information

Healthcare Workers (HCWs)  Not enough injectable vaccine for both high risk and HCWs  Many areas deferring HCWs to vaccinate high-risk patients  Vaccination recommended to prevent or limit transmission in the healthcare setting

Healthcare Workers (cont.)  38% vaccinated in a typical influenza season (national data)  MDH in conjunction with LPH requests HCW forgo vaccination with inactivated vaccine  FluMist preferred for healthy HCWs 49 and under

Health Care Workers: Concerns  Decision to defer HCW vaccination was not popular in some circles  Concerns about medical and PH collaboration  Concerns about work force issues  Confusion about prophylaxis of essential service personnel

“Search, ‘seize’, and please”

Communication Strategy

Visits to MDH Home Page and Flu Clinic Page Views, December 2003

Communication Strategy  Population demographics influence resources we provide consumers  Older population, less likely to use web, hotline more important tool  Hotline received 17,000+ calls over an 8-week period

Where did we end up?  Additional doses of vaccine arrived in Minnesota in November  Reinstated HCW vaccination December 1, 2004  Opened vaccination to persons 50+ years and contacts of high-risk individuals on December 1, 2004  Began redistribution to other states

Where did we end up?  Opened vaccination to anyone December 17, 2004 and continued to redistribute doses to other states  3 goals:  ensuring high risk received vaccine,  ensuring other states in need got vaccine, and  ensuring that no vaccine went unused  Doses remained at the end of the season

Plans for Next Year…  In order to improve communication with healthcare providers a ‘flu subgroup’ will be established  Representatives from the medical community: pediatricians, infectious disease specialists, internal medicine physicians, long-term care providers, and clinic systems  Meet prior to the beginning of the influenza season and regularly throughout the season

Plans for Next Year…  Maintain and establish coalitions of private healthcare providers and employers in the community  Coalitions can serve as a community resource for decision-making re: influenza vaccine

Challenges  Delayed federal vaccine distribution created in ‘interim crisis’  National needs not well coordinated between states  Minnesota was 3-4 weeks ahead of the nation, so our decision making was out of sync with the rest of the country

Lessons Learned  Data is critical to drive public health policy and facilitates collaboration  Prioritizing use of limited resources is difficult and can be unpopular!  Humor helps!  Public response is very unpredictable (e.g. “Minnesota Nice”)  Communication remains critical

Happy Endings…  The January 2005 BRFSS identified:  77% of persons 65+ in MN reported receiving a flu shot this season (59% nationally)  45% of persons with a chronic health condition in MN reported receiving a flu shot this season (34% nationally)  47% of HCWs in MN reported receiving a flu shot this season (43% nationally)  We reached our target populations!

In Conclusion…  FLU VACCINE: whatever can go wrong, will…  Working together, building on past experiences, we can address the challenges of the future!