1. Pertussis/Flu Update 9/6/2011
CDPH, Immunization Branch

2. AGENDA Opening Remarks Influenza Update AB 354 Discussion
Slides posted on the Immunization Coordinators’ website
Influenza Update
AB 354 Discussion

3. Influenza Update

4. 2011 CA Flu Program Vaccine Update
Order
Doses Available
Shipped
Fluvirin (vials)
193,230
102,050
8/25
FluLaval (vials)
155,000
8/18
Fluarix (syringes)
20,000
Flumist
30,000

5. CDPH Flu Program Guidelines
Community clinics
TIV = State-purchased +/- VFC
LAIV = VFC >> 317
Screening for VFC eligibility:
Yes, if giving VFC supplies at a clinic;
No, if non-VFC supplies only, such as 317-funded Flumist or state-purchase vaccine.
Prioritization for elderly as before.

6. DPH Flu Program Guidelines
Who has the least access to influenza vaccine?
Prioritize vaccine for 60+ first
Look at your supply:
How many clinics can you schedule?
Do you have enough vaccine for outside providers

7. VFC Flu 2011-2012: Vaccine Supply
Brand
Manufacturer
Packaging
Age Group
VFC Pre- booked doses
Available Doses
Fluzone®
PF Pediatric
Sanofi Pasteur
10 pack - 1 dose syringes (0.25mL)
 6-35 months
600,000
39%
10 dose vials (5mL)
 3-18 years  
500,000
37%
 Fluarix
  GSK
10 pack - 1 dose syringes (0.5mL)
 3-18 years
(Prioritized for pregnant teens)
300,000
100%
FluMist Vaccine,
Live Intranasal
 MedImmune
Intranasal Spray 10 pack-1 dose
Healthy
2-18 years
440,000
21%

8. Order Processing & Shipments
VFC Flu :
Order Processing & Shipments
Initial VFC flu shipments went out the week of 8/29/2011
Providers should expect shipment to arrive no later than Sep 9th, 2011.
Orders are shipped to providers within 3-4 days of order receipt from State VFC Program
Order Transmission
VFC flu orders are transmitted M-W-F
State flu orders are transmitted T-TH

9. Order Processing & Shipments
VFC Flu :
Order Processing & Shipments
Fulfillment Schedule
Full supply available:
Fluarix® (GlaxoSmithKline), no preservative
all confirmed orders have been shipped in full
Limited supply
Fluzone® PF Pediatric, PF, 0.25mL pre-filled syringes
Fluzone®, preservative-containing MDVs
FluMist®, PF, LAIV
partial shipments were processed (20-25% of ordered doses)
subsequent shipments will be automatically processed as additional vaccine supplies become available.

10. Order Processing & Shipments
VFC Flu :
Order Processing & Shipments
Second round of shipments will go out the week of September 12, 2011
Fulfillment Schedule (as of 9/6/2011)
Partial shipments for:
Fluzone® PF Pediatric, PF, 0.25mL pre-filled syringes
Fluzone®, preservative-containing MDVs

11. Order Processing & Shipments
VFC Flu :
Order Processing & Shipments
Receipt of influenza orders
Upon receipt, verify shipment contents against packing slip and order confirmation
If discrepancies are found, please notify VFC immediately
All incidents related to the receipt of influenza orders MUST be reported by VFC to McKesson Specialty within 2 hours of shipment receipt.
We’ll need a copy of the shipment packing list

12. Number of 10-18 year olds with Tdap Dose in CAIR, 2010-11

13. 9/6/11 CAIR Tdap Doses in 10-18 years 98% compared to 9/27/10
Tdap doses Coverage Rate
Northern (INNC) K 80%
North CV (SFT) K 44%
Central CV (RIDE) K* 55%
South CV (CVIIS) K 56%
Bay Area K 45%
Central Coast K 53%
LA - Orange K 63%
Inland Empire K 38%
San Diego K 45%
Imperial K*
Total 1,210 K

14. Numbers still needing immunization?
2010 NIS Teen 71% (66-77) with Tdap If coverage rate… Students needing Tdap 70% 0.9 M 80% 0.6 M 90% 0.3 M LHDs, 4/18 – 9/2 ~0.16 M Unused >0.15 M Unused VFC – eligibility is only limit Staffing - ??? Tdap only clinic option – 10/14/11

15. What’s your plan for the final stage? Which School have lower rates?
LHD Schools Vaccinators

16. Messages for providers - Act now
Messages for providers - Act now! Keep pertussis from coming back to school
Keep track of who has and hasn’t received Tdap. 
Immunize your patients with Tdap NOW if they haven’t had it yet.
Provide clear documentation of Tdap immunization that your patients can bring to school.
Remind patients about Tdap by letter, postcards, telephone, s and clinic displays – CMAF.
Apply seasonal flu strategies: drop-in, after-hours
Ensure that you have adequate vaccine supplies and proper storage for them.

17. Messages for schools - Act now
Messages for schools - Act now! Keep pertussis from coming back to school
Continue alerting parents and students
If haven’t already, get your Tdap shot ASAP
From your doctor or other - Provide list of local options
Get a record of Tdap booster from doctor to share with school
Get your immunization record to school!
Clear instructions for submissions
Collect Tdap records as soon as possible.
Staffing and systems for collecting records
During any SB 614 grace period

18. Tools for schools
Resources to help ensure that unimmunized students meet the new school Tdap requirement include:
Letter from Schools to Parents (Template) English / Spanish
Message to Go Home with Unimmunized Student (Template) English / Spanish
Script for Recorded Message from Schools to Parents (Template)  English / Spanish
Additional information and materials are available at

19. Information, please Experience to date at local schools
Updated links to LHDs and local clinic schedules
Exemplary…
schools
health plans
CHCs / RHCs
other community partners!
Upcoming local press events and publicity

20. AB 354 Communications New FAQ added to ShotsForSchool.org:
Instead of getting a Tdap booster to meet the new requirement, can a student get a blood test to check for protection (immunity) against pertussis?
No. Testing for immunity to pertussis is not reliable and will not meet the new school requirement.
to schools encouraging continued efforts to ensure unimmunized students meet requirement

21. AB 354 Communications
School Immunization Assessment Reporting now available on ShotsForSchool.org

22. Tdap Ordering Order Frequency Vaccine Supply
Due to the size of current LHD Tdap orders, order frequency is shifting from monthly to every two weeks
Vaccine Supply
All products are now available at McKesson
VFC vaccine doses & schools
Early guidance released in January and subsequently in April
For a limited timeframe, LHD’s VFC doses could be shared with schools (October 2011)
LHD is responsible for ensuring compliance with VFC requirements .
LHD is also responsible for vaccine distribution and retrieval from schools, as well as for ordering and accountability for all VFC doses received.

23. Summary of Tdap Administration Data
Now on weekly reporting periods
>158K doses administered
VFC administration: 106K (67%)
317 administration: K (33%)
Many of these doses from pre-allocation inventory
Large amounts of 317 allocated doses remain unused, however, significant doses of 317 vaccine doses have been purchased and distributed to LHDs with routine orders
317 doses are part of existing LHD inventory
Reminder about allocations: your allocation is in addition to the inventory you started with in April. If you are concerned about exceeding your allocation, please contact Nisha Gandhi.
Please complete the “snapshot” Tdap inventory sent to Coordinators last week

24. Maxim Tdap Clinic Update
Reminders:
Send county staff to Maxim clinics
Utilize school nurses at school-located clinics (to help with the logistics)
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
NOTE: some late August clinics are being cancelled by LHDs (and schools) because of SB 614-we recommend that you keep your clinics-contract ends Sept 30, 2011
Currently working on re-allocating unused doses-7 LHDs have indicated an interest in the remaining 10,000 doses