Pertussis/Flu Update 7/12/2011 CDPH, Immunization Branch

AGENDA Opening Remarks Influenza Update AB 354 Discussion VFC Online Ordering

Influenza Update

National Supply for 2011-2012 Supply is expected to total 166-173 million doses in 2011-12.  The information below was provided by each manufacturer at the National Influenza Vaccine Summit. Manufacturer 2010-2011 Doses 2011-2012 Doses Delivery Date GSK 32 Million 35-37 Million Late July through October Medimmune 16 Million Early July Merck/CSL 7 Million 15 Million Early August Novartis 35 Million 30-35 Million Sanofi 70 Million Late July/early August TOTAL 160 Million 166-173 Million Most will have all doses out by October

2011-2012 Flu Season Late summer-fall availability of vaccine 3 strains unchanged Recommended for everyone 6 months and older CSL received warning letter from FDA CDPH Guidelines Continue to prioritize 60+ School-based clinics LHDs will have a mixture of VFC and 317 vaccine Screen for VFC eligibility On-line confirmation of state-purchased vaccine completed Flu Packet on Coordinators website later this summer

LHD Influenza Purchase 2011-2012 CDPH has identified funds for the limited purchase of influenza vaccine for the 2011-2012 season.  CDPH State Purchase: Afluria***: 193,230 doses CDPH Federal Purchase: Flulaval: 155,000 doses Fluarix: 20,000 doses Flumist: 30,000 doses

Comparing Flu Vaccine Purchase 2010-2011 2011-2012 Multidose Vials 600,000 348,230 Single Dose syringes 40,000 20,000 Nasal Sprayers 225,000 30,000

2011-2012 State Budget $7.3 M restored to GF for vaccine purchase Not designated as one-time Funding at least for 2012-2013 flu vaccine

VFC Flu 2011-2012 Vaccine Order Confirmations VFC On-line Flu Order Confirmation System Available June 27th to July 20th, 2011 Access via MyVFCVaccines Deadline for confirming doses allocated is July 20th, 2011.

Order Confirmation Process Next steps after VFC’s Order Confirmation System has closed (Late July/early August): VFC will review brand allocation requests, and approve/modify them according to available vaccine supply. Final brand allocation will be loaded in the system. Providers will receive final order confirmation (Total doses by Age group and brand allocation numbers) Unconfirmed requests will be released into a general vaccine inventory for supplemental ordering. All orders remain in queue until vaccine supply becomes available.

Order Confirmation Process All orders remain in queue until vaccine supply becomes available. Preliminary Shipping Schedule for MedImmune doses to CDC: ~20% doses Mid August, followed by ~25% early Sept.

Access to VFC’s Flu Order Confirmation

Step 1: Verification of Practice Information (including E-mail address)

Step 2: Review Allocations VFC + School-based Clinics

Step 3: Preview & Submit Allocations

Final Step: Order Confirmation

2011 Flu Vaccine Supply Brand Manufacturer Packaging Age Group Doses Fluzone® PF Pediatric Sanofi Pasteur 10 pack - 1 dose syringes (0.25mL)  6-35 months   600,000 Fluzone® 10 dose vials (5mL)  3-18 years   500,000  Fluarix   GSK 10 pack - 1 dose syringes (0.5mL)  3-18 years (Prioritized for pregnant teens) 300,000 FluMist Vaccine, Live Intranasal  MedImmune Intranasal Spray 10 pack-1 dose Healthy 2-18 years 440,000

SB 614 modification? School organizations proposing change to Tdap law 10 school day extension at start of school year January 1, 2012 effective date Up to 30 calendar day extension at start of year No resources for additional Tdap immunization Remaining steps to become law Assembly Vote Senate Vote Governor SB 614 updates at www.leginfo.ca.gov/bilinfo.html

SB 614 modification? Whether or not the legislation should become law, please continue with all efforts to protect students with Tdap ASAP -- before the start of school year Pertussis transmission continues at high levels Adolescents remain at risk of becoming ill and spreading pertussis in our communities Remaining needs for immunization and bringing documentation to school require a sustained effort throughout the summer whether or not additional time becomes available for implementation CDPH will prepare messages and materials to reflect any change in the law

7/11/11 Tdap Coverage in 10-18 years by CAIR region/county Tdap doses Coverage Rate Northern (INNC) 29,024 67% North CV (SFT) 26,112 37% Central CV (RIDE) 66,556 South CV (CVIIS) 98,171 47% Bay Area 184,754 39% Central Coast 41,100 46% LA - Orange 299,572 56% Inland Empire 89,797 29% San Diego 128,644 38% Imperial 11,389 Total 975,119

Numbers still needing immunization? If coverage rate… Students needing Tdap 50% 1.45 M 60% 1.16 M 70% 0.87 M 80% 0.58 M 90% 0.29 M 95% 0.15 M LHDs, 4/18 – 7/1 ~0.06 M

What’s your summer and back-to-school plan? LHD Schools Vaccinators

Pertussis cases by month of onset --California, 2010

Messages for providers - Act now Pertussis isn’t taking summer vacation Keep track of which patients have and haven’t received Tdap.   Immunize your patients with Tdap NOW if they haven’t had it yet. Use every opportunity to provide routine adolescent care, including Tdap and other recommended vaccines. Provide clear documentation of Tdap immunization that your patients can bring to school.

Messages for providers - Act now Pertussis isn’t taking summer vacation Print and send reminders to your patients about Tdap by letter, postcards, telephone, emails and clinic displays. Limited supplies free from CMA Foundation                                                                      Anticipate a rush of last-minute Tdap appointments before the first day of school, 2011-2012. Apply seasonal flu vaccine strategies to Tdap: e.g., drop-in visits, special clinic hours. Reduce the rush and protect your patients by immunizing now! Ensure that you have adequate vaccine supplies and proper storage for them.  

Materials for Schools Tdap Blue Card Stickers and PBE forms Contact Branch or field reps if more needed 27

Messages for schools - Act now Pertussis isn’t taking summer vacation Continue alerting parents and students: If you haven’t already, get your Tdap shot Check in with your doctor Get a record of the Tdap booster from your doctor to share with school Get your immunization record to school! Post messages and downloadable electronic banners on school’s Websites, emails and electronic newsletters Marquee or billboard, 2011-2012 Calendar Report Cards, PTA notices

Messages for Schools Collect Tdap records as soon as possible. Staffing and systems for collecting records During summer vacation Leading up to first day of school Clear instructions for parents about when and how to submit Tdap records Systems that can print an accurate, formatted Blue Card with Tdap information, including check off box if appropriate dose given Aeries, Power School

Information, please Experience to date at year-round schools Let us know about exemplary CHCs / RHCs health plans other community partners! What factors have increased turnout for your Tdap clinics? CDPH links to LHDs – update your clinic information on your local links Providers not giving Tdap?

AB 354 Communications Potential NIAM “Back to School” Campaign AB 354 Hotline in the works Facebook Ads (Mid-June to July 1)

AB 354 Communications 60 & 30 sec Video PSA –TV ready version available (request by emailing info@shotsforschool.org) CMA Foundation – Free copies of reminder recall cards, flyers and tent cards - Visit ShotsForSchool.org ‘Provider Info’ page for details.

Summary from 5 Reporting Periods 317 doses administered << initial projections. VFC administration: 37,614 doses (63%) 317 administration: 21,815 (37%) Doses unused in April/May can be used in coming months.

LHD Tdap Allocations Use of CAIR for tracking VFC vs. non-VFC Tdap doses? Instructions on using lot #s to track were sent out. Additional options for running reports – contact Nisha if you would like a CAIR-generated report

Maxim Tdap Clinic Update Summary of clinics scheduled (as of 7/12/11) June 33, July 6, August 68 Reminders: Send county staff to Maxim clinics VFC screening can occur at Maxim clinics by LHD staff only Maxim nurses not accustomed to large-scale clinics - share basic principles of mass vaccination clinics with Maxim nurses before clinic starts VFC doses administered by Maxim can now be reported on the same page as Tdap administration by LHDs