Influenza Communication in Michigan: How Existing Partnerships Were Utilized and Strengthened during the 2009 Influenza Pandemic National Immunization Conference April 20, 2010 Cristi Carlton, MPH Vaccine-Preventable Disease Epidemiologist Division of Immunization Michigan Department of Community Health (MDCH)

Office of Public Health Preparedness (OPHP) Communicable Disease Div. of Immunization Bureau of Labs (BOL) VFC Public, Providers, Coalitions, Partners, etc. LHD Education, Outreach & Surveillance Immz. Registry (MCIR) Flu Vaccine Communication (Immunization Div. Perspective)

Flu Education Workgroup (FEW)  Internal group within the Div. of Immunization  Representatives from multiple programs  Adult, Adolescent, Immunization Nurse Education, Education and Outreach, Epidemiology, VFC, Immunization Registry (MCIR)  Meets regularly  Created the Flu Fighter Action Kit in 2007  Guides health care organizations on the implementation of immunization campaigns  Develops and updates flu education material  Provider and Public  Works closely with the Flu Advisory Board (FAB)

Flu Advisory Board (FAB)  Formed in response to the flu vaccine shortage  Over 170 members from nurse associations, health systems, private medical practice, health advocacy groups, pharmacies, LHDs, Medicaid, Dept. of Ed, other state govt. groups, etc.  Creates a communication infrastructure for internal policy makers and external stakeholders  Workgroups established in 2009:  Preschool and Younger  Children and Adolescents (K-12 Schools)  Adults (including Colleges and Vocational Schools)  Health Care Personnel  Non-Vaccine Interventions/Antivirals*  Ad-Hoc: Vaccine Distribution, Supply, Ordering

Response to 2009 H1N1  Goals for communication:  Create consistent, coordinated messages  Provide timely, helpful and accurate guidance  Utilize multiple communication channels to reach the maximum number of people  Be transparent  Coordinated effort between MDCH departments  Set-up regular meetings and conference calls Weekly Pandemic Partners’ conference call State and local health departments  Created Responses via subject matter experts (SMEs)

Influenza Websites  Existing seasonal flu website:  Updated website for the public with frequently asked flu questions  Provider materials  Frequent updates  Created an H1N1 website  OPHP hired new staff  SMEs reviewed  Views to main page: >250,000  Peaked on 10/24 27,404 views Vaccine Available Peak Flu Activity in MI

2009 H1N1 Provider Toolkit  Created as the “one-stop shop” for H1N1 immunization providers  Alliance for Immunization in Michigan (AIM) toolkit – used as a model  Provided consistent messages and one place to look for up-to-date guidance  Resource for: new & existing providers; depts. not familiar with immunization programs  Views to main page: 8,571  1,521 the week of Oct 4 th

Michigan Care Improvement Registry  MI’s immunization registry used since 1998  All providers required to use MCIR to track and document administration and dispensing of 2009 H1N1 vaccine and antivirals  Played a critical role in communication to providers and the public  Welcome screen messages  Inventory from McKesson uploaded  All-Hazards component

Michigan Care Improvement Registry  Non-safety related recalls of vaccine Rapid notification to providers with affected lots in inventory  Reminder/recall letters sent to parents Children at high-risk for influenza-related complications Children needing a second dose for full coverage Children that never received a dose  Assessment of coverage levels by LHD, age and target group

Presentations Galore  Utilized existing partnerships to disseminate up-to-date information  Direct provider education – private and public sectors Developed a “flu slide deck” Office-based “Grand rounds”  Coalitions Local and state-level  Conference presentations “Hot topic” at 8 regional conferences in MI Professional organizations  Michigan Advisory Committee on Immunization (MACI)  FAB  Call Centers

FluBytes Newsletter  Weekly newsletter  Sent with surveillance update: MI FluFocus  Direct distribution: ~780  Redistribution to ~4,500  Summary of journal articles, new guidance, recent news, etc.  Contained links to full documents

Flu Communication Survey  10 question, brief survey via SurveyMonkey  Purpose:  to gain an understanding of the usefulness of FluBytes  to identify strengths and weaknesses of pandemic flu communication  Directly distributed to ~780 people  Response rate: 18.3% (143) 68 (53%) from LHDs 19 (15%) from Private Practices 14 (11%) from State Health Dept.

Who was your Primary Source of Information? MDCH CDC LHD MediaHHS

was considered very useful: 76% responded “extremely helpful” 54% said websites were “extremely helpful” 43% said conference calls were “extremely helpful” What Information was Useful?

s – Too many? Not Enough?  MDCH sent s to partners as new information became available  One person designated to send the Include a list in the of which groups the message was distributed to Goal: to reduce duplicate messages & keep messages consistent Challenge: information updated frequently  Survey question on the amount of info from MDCH:  77% responded it was the appropriate amount of information  19% responded too much information  4% not enough information

Additional Feedback from Survey  Regardless of our efforts, people still received the same message from multiple sources  Would like information BEFORE the media  Since H1N1 was the “hot topic” a lot of people were involved that had limited experience with vaccines  Weekly pandemic partners’ calls were very helpful

Take Home Messages  Coordinated efforts  Critical to have regular meetings early on to ensure everyone is on the same page  Consistent messages  Have one place where the most up-to-date information can be found  Have a review process in place  Timely, helpful and accurate guidance  Always include “date last updated” on guidance documents

Take Home Messages cont.  Utilize multiple communication channels  Know who is disseminating information and through what means (ListServs, media interviews, websites, etc.)  Challenge: avoiding overlap  Be transparent  Be upfront and open as soon as info becomes available  Challenge: occasionally too much information can lead to more confusion  Challenge: plans were frequently modified Images from: and

Take Home Messages cont.  Additional messages  Use feedback to direct educational messages

Summary  Successes  Strengthened partnerships on multiple levels  Engaged new partners Carry over to future flu vaccination campaigns  Emphasized the crucial role of a robust immunization registry (MCIR)  Utilized existing programs and communication channels  Applying lessons learned  Streamline dissemination of information  Use feedback to create and modify existing seasonal flu messages Multiple formats to reach diverse audiences  Engage new and existing partners to expand our immunization program Important for “universal” ACIP recommendations

If you have seen one flu season…. You have seen one flu season.