Pertussis/Flu Update 6/21/2011 CDPH, Immunization Branch

AGENDA Opening Remarks Influenza Update AB 354 Discussion CAIR School Report VFC Online Ordering

Influenza Update

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

Looking ahead to fall Late summer- fall availability of vaccine 3 strains will be unchanged Recommended for all > 6 months No reports of production delays yet CDPH Guidelines Continue to prioritize 60+ School-based clinics LHDs will have a mixture of VFC and 317 vaccine Will need to screen for VFC eligibility On-line confirmation of state-purchased flu vaccine now live

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

Governor’s May Revise Budget Flu vaccine money was included in May Revise Budget. Will not know if it will be reinstated until the budget is passed. The funding would be for 2012-2013 flu vaccine.

VFC Flu 2011-2012 Vaccine Order Confirmations VFC On-line Flu Order Confirmation System will be available 6/22/2011 Access to the system will be through MyVFCVaccines Providers will have approximately 4 weeks to review and submit allocations Confirmation deadline is set for 7/15/2011

Order Confirmation Process Providers will have ~3 weeks to review, edit, and submit allocations. VFC will review submitted numbers, brand allocation requests, and approve them according to demand and available vaccine supply Unconfirmed request will be released into a general vaccine inventory for supplemental ordering. Providers will receive an e-mail with final order confirmations (brand allocation numbers) late July 2011. All orders remain in queue until vaccine supply becomes available.

Access to VFC’s Flu Order Confirmation

Step 1: Verification of Practice Information

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

6/13/11 Tdap Coverage in 10-18 years by CAIR region/county Tdap doses Coverage Rate Northern (INNC) 26,059 63% North CV (SFT) 24,865 35% Central CV (RIDE) 60,994 South CV (CVIIS) 90,362 44% Bay Area 176,337 37% Central Coast 39,004 44% LA - Orange 278,942 53% Inland Empire 77,372 26% San Diego 120,829 36% Imperial 10,747 Total 606,144

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 22

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 Let us know about exemplary CHCs / RHCs health plans, other partners! What factors have increased turnout for your Tdap clinics? How have you been distributing stickers and forms to private schools? Via County Office of Education? CDPH links to LHDs – update your clinic information on your local links Providers not giving Tdap?

Legislative modification? School organizations have proposed modifying Tdap law to permit 10 day extension at start of school year IZ Branch is interested in how partners feel about such a change and the likely consequences May aspects unclear – stay tuned for more information

AB 354 Communications Radio PSA – posted on ShotsForSchool Video PSA – posting this week Outdoor Advertising Potential NIAM Communications Push – please fill out survey ASAP

What’s New on ShotsForSchool.org Spanish Parent FAQs New Rule Flyer – Chinese, Vietnamese, Cambodian AB 354 Ticker Messages

Summary from 3 Reporting Periods 317 doses administered << initial projections. VFC administration: 30,273 doses (63%) 317 administration: 17,669 (37%) ( 84,436 projected for April-mid June) Doses unused in April/May can be used in coming months.

LHD Tdap Allocations Report your Tdap vaccine usage every two weeks. By VFC vs. non-VFC, routine vs. outreach clinics  Allocations deducted from reported 317 vaccine administration, not from orders Orders include both VFC- and 317- eligible patients Current balance of allocation doses given and doses remaining listed on the reporting page.  May use IZB vaccine tracking form or your own system to count doses for reporting.  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 – stay tuned

Maxim Tdap Clinic Update May/June clinics have administered 4757 doses (10,018 doses allocated for these clinics) Turnout at May and June clinics are not meeting projections Reminders: We strongly encourage you to send county staff to Maxim clinics VFC screening can occur at Maxim clinics but by LHD staff only Maxim nurses not accustomed to large-scale clinics, so we encourage sharing basic principles of mass vaccination clinics with Maxim nurses before clinic starts VFC doses administered by Maxim can not be reported on the same page as Tdap administration by LHDs

School Report in CAIR Presented by: Cecilia Sandoval, MPH Tuesday, June 21, 2011

Topics Covered Introduction to the new School Report in CAIR Accessing the School Report Explanation of option #1 Explanation of option #2 www.CAIRWeb.org Accessing the upload manual for option #2. Accessing training modules 14 and 15 for detailed instructions on how to run both options. Contacting the CAIR Help Desk

School Report in CAIR Designed to assist schools in determining whether students have received the vaccines required for school entry. Applies to the Kindergarten requirements and to the new Tdap law for 7th-12th graders. Provides two options Option #1: creating your own list in CAIR Option #2: uploading a list of students to CAIR (Tdap req. only). Housed within the CAIR application, making it easier for users to access.

Option #1 Allows users to create a student list in CAIR. Generates the school report and Blue cards for the students found in CAIR and listed in the report. Gives users the option of printing all the Blue Cards or accessing the Blue Card for individual students. There is greater search flexibility since the user creates the list and is able to use different search parameters. Convenient for students with misspelled names, hyphenated or two last names. May create list for Kindergarten or a Tdap report for 7th-12th graders.

Option #2 Requires that the user uploads a student list file in .CSV format to CAIR. Upon uploading CAIR evaluates the file to make sure it is in the correct format and that information is not missing. Great option for large schools or school districts needing to match many students. Only available for the Tdap Match /7th-12th grade requirement. Returns a file with any matches found in 24 hours. Please note: this file contains EXACT matches only and does not allow users to print the Blue Card for students in the list.

New Look for CAIRWeb.org

Questions? Help desk contact information: Available Monday-Friday, 8:00 am to 5:00 pm 1-800-578-7889 helpdesk@ca-siis.org

VFC’s On-Line Ordering Now available to LHDs All vaccine orders should be submitted through this system Phased Introduction to VFC Providers  Phase 1: Local Health Departments, effective June 7th, 2011.  Phase 2: Mid July 2011- all VFC providers Please share your feedback soon after submitting your first order Survey included in the e-mail communication