1. 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) Email: CarltonC2@michigan.govCarltonC2@michigan.gov

2. 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)

3. 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)

4. Flu Advisory Board (FAB)  Formed in response to the 2004-05 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

5. 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 swineflu@michigan.gov Responses via subject matter experts (SMEs)

6. Influenza Websites  Existing seasonal flu website: www.michigan.gov/flu  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

7. 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

8. 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

10. 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

11. 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  2-1-1 Call Centers

12. 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

13. 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.

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

15. Email 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?

16. Emails – Too many? Not Enough?  MDCH sent emails to partners as new information became available  One person designated to send the email Include a list in the email 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

17. 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

18. 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

19. 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: www.ruthiecherryfineart.com/id5.html and http://www.cdc.gov/h1n1flu/images.htm www.ruthiecherryfineart.com/id5.html http://www.cdc.gov/h1n1flu/images.htm

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

21. 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

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