Implementing Lessons Learned from the 2004 – 05 Flu Season Donna Lazorik, RN, MS Massachusetts Department of Public Health

Seasonal Influenza Preparedness Pandemic Influenza Preparedness

MDPH State-Supplied Flu Vaccine 50% of flu vaccine administered in MA Prioritized to: Children 6 – 23 m/o and older HR children All LTC residents HR people seen at public sites Some private providers get some state-supplied vaccine

State-Supplied Flu Vaccine 2004-05 462,000 Chiron doses (NOT available) 167,900 SP doses 25% received Sept 8 (to pediatric sites) 25% received Sept 30 (held awaiting national guidelines) 167,900 (26%) Aventis 41,970 received 9-8-04 to pedi sites, CHC 41,970 received 9-30-04 being held 462,000 (73%) Chiron will NOT come Total 630,000

MDPH Legal Order (10/13/04) Health Care Providers required to: Limit flu vaccine to HR groups Report to MDPH on vaccine inventory Penalties associated with non-compliance (“fine not less than $50 and not more than $200 or imprisonment for not more than 6 months, or both”)

Additional Activities Hotline Alerts via the HHAN Conference calls with local HDs and hospitals Campaign to promote other control measures

MDPH Legal Order 10/27: Further restrict vaccine (> 75 y/o) Received 1.3 M doses 700,000 state-supplied; 600,000 privately purchased 95% of state-supplied vax by Nov 9 12/1: Expand TIV eligibility; lift LAIV restrictions 12/21: Legal orders rescinded

Inactivated Flu Vaccine In MA 49,000 doses (7%) of state-supplied vaccine unused vs. 0.6% in 03 - 04 167,900 (26%) Aventis 41,970 received 9-8-04 to pedi sites, CHC 41,970 received 9-30-04 being held 462,000 (73%) Chiron will NOT come Total 630,000

2004 Flu Season Review Internal after-action meetings 2 facilitated focus groups Adult Immunization Coalition Workshop at Adult Immunization Conference Flu season look-back with Rand BRFSS data

Lessons Learned Providers and consumers made sure that HR people received vaccine 63% of > 65 y/o vs. 66% in 2003-04 48% of children 6 – 23 m/o 9% of non-HR adults vs. 18% in 2003-04 Need to promote LAIV Providers need information on a regular basis Whether there is anything new or not

Lessons Learned Providers need to know about policy changes before the media Public needs to know they will be told when vaccine is available – waiting lists, call-backs Need for plan flexible enough to ensure that no vaccine goes unused

Lessons Learned – Public Health Order Cons Order limited vaccine for too long Physician autonomy News stories leading with ”Doctors will go to jail…” Pros Clarified for providers and the public who was eligible for vaccine Some providers felt supported by the order Rationing Flu Vaccine (Lee TH. N Engl J Med 351;23)

Actions Taken in 2005–06/ Pandemic Plan Coordination Contingency plans for various vaccine scenarios Weekly MDPH flu team meetings Epi, Vaccine Unit, Health Ed, Commissioner’s Office Review vaccination distribution Monitor calls, questions to determine content of MDPH Flu Advisories

Actions Taken in 2005–06/ Pandemic Plan Communication MDPH Flu Advisories to providers and stakeholders Status of vaccine distribution, recommendations and guidelines, disease surveillance q 1 – 2 weeks, Aug – Jan Email, partners, web, HHAN

Actions Taken in 2005–06/ Pandemic Plan Communication Enhanced and promoted flu clinic website Contracted for hotline services Expanded promotion of non-vaccine control measures

Lemons to Lemonade Better coordination Enhanced communication Revised pandemic plan Seasonal Influenza Preparedness Pandemic Influenza Preparedness