1. DSHS Adult Vaccine Program

2. Adult Safety Net Vaccines
Available at LHDs and DSHS regional clinics
Uninsured and Underinsured adults
Hepatitis A & B, HPV, MMR, MCV4, Pneumococcal polysaccharide, Tdap, Varicella, and Zoster vaccines
Influenza vaccine for DSHS Regional Clinics (for high-risk adults/seniors)
Expansion to FQHC, Family Planning, HIV/STD, Substance Abuse Centers in 9/09 (w/ ARRA funds)
Over 400 clinic sites enrolled (as of 6/20/09)
Brand new availability!
Hep B-not available for refugee health programs
Meningococcal-at risk
DSHS has recently hired an Adolescent/Adult Coordinator and in process of hiring regional coordinators
New activities aimed at adults and adolescents will be coming soon!

3. Texas Influenza Program

4. Flu Season- In Review

5. Flu Vaccines Licensed in the US
Brandname/ Tradename
Manufacturer
Total Projected Doses Manufactured
Influenza (Age 6 months and older)
Fluzone®
Sanofi Pasteur
38,000,000
Influenza (Age 6-35 months)
Fluzone® Pediatric dose Preservative-free
6,000,000
Influenza (Age 36 months and older)
Fluzone® No-Preservative
7,000,000
Influenza (Age 4 years and older)
Fluvirin®
Novartis
28,275,000
Fluvirin® Preservative-free
15,225,000
Influenza (Age 18 years and older)
Fluarix™
GlaxoSmithKline
13,000,000
FluLaval™
23,000,000
Afluria
CSL Biotherapies
Influenza Live, Intranasal (Age 2-49 years)
FluMist®
MedImmune
12,500,000
TOTAL
149,000,000
CDC US VFC Allocation (as of 9/1/2008): 22,000,000
CDC US VFC Allocation: 22,000,000

6. Flu Vaccine Age Indications
6 months mo mo mo mo. …18 yrs…….49 yrs……+85 yrs
Fluzone®
Sanofi .25 mL
Sanofi .5mL
Sanofi .5 mL(no pres.)
FluMist®
Medimmune LAIV
Fluvirin®
Norvatis .5mL
FluLaval™
GSK .5mL
Fluarix™
Afluria
CSL Biotherapies .5mL
Note: Children < 9 years of age need 2 doses of influenza vaccine (administered 1 month apart) the first time they receive the vaccine. If they only received 1 dose the first year, they need to receive 2 doses the following year.

7. Texas Immunization Branch Influenza Programs
Texas Vaccines For Children Program
Federal funded program for eligible children 0-18 years of age
Projected 809,270 doses (20% increase from year)
State purchased vaccine
Used by HSRs for high-risk adults
Projected 110,000 doses for
Local Health Departments
Can purchase direct from manufacturer, from a 3rd party distributor, and off State of Texas Contract

8. Estimated Population of Texans to be Served Ages 0-18 Years by Public Funding Source in CY 2008*
Total Public: 4,769,682
% Public: 69% 3% 6%
91%
*Reported to National Immunization Program in Population Estimates
Total 0-18: 6,899,565

9. Texas VFC Population Children 0-18 in Texas: 6,899,555
VFC Eligible Children : 4,769,681
Non VFC eligible VFC: 2,129,884
VFC Doses for Texas ( )
293,960 (.25 mL)
569,410 (.5 mL/mist)
863,370 total doses for +4,700,000 VFC eligible children
Ordered additional 50,032 doses than originally projected

10. Texas DSHS Flu Doses Ordered for TVFC 2006-2008
Formulation
2008
2007
2006
.25 mL doses:
293,960
286,450
316,000
.5 mL doses and mist:
569,410
386,370
229,700
TOTAL
863,370
672,820
545,700

11. Doses of non .25 pf Texas VFC Flu Vaccine Shipped By Health Service Region1
2/3
4/5N 7
9/10
Region 1: 23,160
Region 2/3: 174,010
Region 4/5N: 41,940
Region 6/5S: 133,430
Region 7: 66,960
Region 8* ,220
Region 9/10: ,060
Region 11: 71,630
6/5S 8 11
Total Doses: 569,410
* Does not include doses shipped for Bexar County

12. Doses of Texas VFC .5 and Flumist® Vaccine Shipped By Health Service Region
Public Health Region
Total Doses of Flumist®
Total Doses of .5 Formulation w/o Flumist
Total Doses of .5 Formulation & Flumist 1
3,510
19,650
23,160
2/3
28,720
145,290
174,010
4/5 N
8,310
33,630
41,940
6/5S
25,810
107,620
133,430 7
16,130
50,830
66,960 8
1,760
12,460
14,220
9/10
10,130
33,930
44,060 11
11,440
60,190
71,630
TOTAL
105,810
463,600
569,410

13. Flu Season

14. Provisional recommendations for prevention and control of influenza (2009-2010 influenza season):
On February 25, 2009, the ACIP made policy recommendations for use of influenza vaccine for the influenza season.
The 2009–2010 trivalent influenza vaccines will contain A/Brisbane/59/2007 (H1N1)-like, A/Brisbane/10/2007 (H3N2)-like, and B/Brisbane/60/2008-like antigens. Compared to the Northern Hemisphere influenza vaccines, only the B strain has changed.
Age and risk groups previously recommended for annual vaccination against influenza have not changed.
All children aged 6 months through 18 years are recommended to receive vaccination against influenza for the influenza season.

15. Projected Doses Manufactured for 2009-2010
GSK: estimates 20 million total doses supplied to the US, 1 million delivered by the end of July, 80% of doses shipped by end of August.
Novartis: estimates 30 million total doses supplied to the US, 10 million delivered by the end of August and the remaining doses delivered by the end of September.
Sanofi Pasteur: estimates 50 million total doses (8 million will be pediatric formulation) supplied to US, 25 million delivered by the end of August and the remaining doses delivered in September and October.
CSL Biotherapies: estimates 8 million total doses supplied to US, this could increase to 20 million if new filling plant in Illinois becomes operational.
MedImmune: estimates million doses of FluMist® supplied to US, shipping in August.

16. Summary
Manufacturers' projections for availability of seasonal influenza vaccines*
Total ~120 Million doses
~15 M doses available by mid August
~40M doses available by Sep 1
>90% shipped by November 1
Preservative-free and infant-toddler doses formulations included in early releases

17. Influenza Recommendations
No change from Season
All children 6 months – 18 years of age
Persons aged > 50 years
Women who will be pregnant during influenza season
Persons who have chronic pulmonary, cardiovascular, renal, hepatic, hematological or metabolic disorders
Persons who have immunosuppression
Residents of nursing homes and other chronic-care facilities
Health-care personnel
Household contacts and caregivers of children aged <5 and adults aged > 50, with particular emphasis on vaccinating contracts of children aged <6 months
Household contacts and caregivers of persons with medical conditions that put them at high risk for severe complication from influenza

18. Texas DSHS Flu Doses Ordered for TVFC 2008-2009
Formulation
2009
2008
.25 mL doses:
355,930
293,960
Flumist®
297,270
105,810
.5 mL doses:
439,120
459,652
TOTAL
1,092,320
859,422

19. Doses of Texas .25 PF Pediatric Vaccine Ordered By Health Service Region1
2/3
4/5N 7
9/10
Region 1: 12,640
Region 2/3: 110,848
Region 4/5N: ,201
Region 6/5S: ,553
Region 7: 46,008
Region 8* ,024
Region 9/10: ,365
Region 11: 42,290
6/5S 8 11
Total Doses: 355,930
* Does not include doses shipped for Bexar County

20. Doses of non .25 pf Texas VFC Flu Vaccine Shipped By Health Service Region1
2/3
4/5N 7
9/10
Region 1: 23,472
Region 2/3: 208,749
Region 4/5N: 50,142
Region 6/5S: 189,054
Region 7: 116,771
Region 8* ,506
Region 9/10: ,703
Region 11: 82,994
6/5S 8 11
Total Doses: 736,390
* Does not include doses shipped for Bexar County

21. Doses of Texas VFC .5 and Flumist® Vaccine Ordered By Health Service Region (2009-2010)
Public Health Region
Total Doses of Flumist®
Total Doses of .5 Formulation w/o Flumist®
Total Doses of .5 Formulation & Flumist® 1
8,328
15,144
23,472
2/3
62,425
146,324
208,749
4/5 N
23,588
26,553
50,142
6/5S
70,442
118,612
189,054 7
71,376
45,395
116,771 8
5,629
10,877
16,506
9/10
23,877
24,826
48,703 11
31,605
51,389
82,994
TOTAL
297,270
439,120
736,390

22. % Flumist vs. total non .25 pf doses
Doses of Texas VFC Flumist® and .5 ml Formulation By Percent ( )
Public Health Region
Total Doses of Flumist®
% Flumist vs. total non .25 pf doses
Total Doses of .5 Formulation w/o Flumist®
% .5 vs. total non .25 pf doses
Total Doses of .5 Formulation & Flumist® 1
8,328
35.48%
15,144
64.52%
23,472
2/3
62,425
29.90%
146,324
70.10%
208,749
4/5 N
23,588
47.04%
26,553
52.96%
50,142
6/5 S
70,442
37.26%
118,612
62.74%
189,054 7
71,376
61.12%
45,395
38.88%
116,771 8
5,629
34.10%
10,877
65.90%
16,506
9/10
23,877
49.03%
24,826
50.97%
48,703 11
31,605
38.08%
51,389
61.92%
82,994
TOTAL
297,270
40.37%
439,120
59.63%
736,390

23. Flu Season
The Flu Season generally runs from early September to late May
CDC encourages ‘flu campaigns’ to continue until the vaccines expires (June)

24. Healthcare worker target goal (2010)-60% (2020)-90%

25. Influenza Coverage Levels
The 2007 NIS estimated 30.5% of children (6 to 23 months) within Texas has received one or more doses of Influenza Vaccine (US 32.2%)
Texas 2007 Bi-Annual Childcare Assessment Survey estimated 18.1% of children surveyed,19-59 months of age, received one or more doses Influenza Vaccine
The 2008 Texas Behavioral Risk Factor Surveillance System estimated 71.7% of adults 65 and older had received a flu shot

26. Influenza Coverage Levels
2007 NIS-Adult Survey currently estimated national percent vaccinated against the flu
37.3 % of High Risk Adults, years of age,
42.2 % of all adults, years of age
68.8 % of all adults 65+
Adolescent Immunization Rates* (one of the new influenza target population) for year olds
MMR (2 doses): 88.9%
Hepatitis B (3 doses): 87.6%
Td/Tdap: 72.3% (higher in older age group)
Meningococcal Conjugate: 32.4%
2007 National Immunization
Survey (13-17 year olds)

27. Texas Influenza Legislation
House Bill (HB) 3184, which requires the DSHS to publish information about the benefits of annual vaccination against influenza; and, together with the Department of Family & Protective Services (DFPS), ensure the information is annually distributed to parents of children attending child-care in August or September.  A newly created Flu Fact Sheet for Child-Care Settings was mailed in September to child-care facility centers in Texas for distribution to all enrolled children. 

28. Texas Influenza Legislation
Senate Bill (SB) 811, which requires the DSHS to allow each health care provider participating in the vaccines for children program to:
select influenza vaccines from the list of all influenza vaccines that:
(i)  within the limits of the vaccines annually allocated by the CDC to the department for the vaccines for children program; or
(ii)  not offered in the annual allocation under Subparagraph (i), but are available from the Centers for Disease Control and Prevention of the United States Public Health Service and for which the Centers for Disease Control and Prevention awards to the department additional funds; and
use both inactivated influenza vaccines and live, attenuated influenza vaccines.

29. DSHS Immunization Branch Resources
DSHS Webpage
Where to get a flu shot
Call 211 (or visit 211 website for clinics)
DSHS HSR or LHD Locations
Flu Season Resources
Recommendations
Information for Health Care Professionals
Vaccine Information Statements
News Releases

30. (Slide as written)

31. DSHS Immunization Branch Resources
Release Date: 2009
Influenza Roadmap: Implementing the Universal Childhood Influenza Vaccination Recommendation in Texas
Adolescent/Adult Business Plan
Pandemic Influenza Plan

32. Challenges Vaccine Supply (annual uncertainty)
Universal Recommendation vs. prioritization of high-risk groups
Vaccine Distribution (pre-booking)
Vaccine delivery and reimbursement systems
Vaccine uptake (especially in new recommended groups)
Vaccine coverage levels (13 additional cohorts added to annual campaign with existing resources)
Vaccine Funding and over-reliance on public health programs
H1N1

33. Communication Strategies
Transparency: identify and acknowledge uncertainty
Provide context (compare to other public health threats and previous flu seasons)
Build and maintain trust and credibility (provide timely and accurate information)
Provide partners with information to support response efforts
If seasonal flu vaccine is available first, promote using standard messages and encourage vaccination as soon as vaccine is available

34. Communication Strategies
If H1N1 vaccine is available at same time as flu vaccine, use seasonal flu vaccination as communication core: promote seasonal flu vaccine broadly, early vaccination without waning immunity, vaccination throughout season until vaccine runs out. Be clear that seasonal influenza vaccine does not protect against H1N1.
H1N1 messages will depend on a number of variables, don’t have clear information yet. But plan for key scenarios and identify and train spokespersons.

35. Considerations
Need for clear program goals, roles and responsibilities
Timelines for a vaccine program must consider all possibilities
What vaccines are likely to be available, when, and in what quantities?
What basic information is needed for the public and the providers and how will it be communicated effectively?
How might a pandemic influenza vaccine program co-exist with a seasonal program?
(Slide as written)

36. Reference Websites DSHS Flu Website:
CDC Flu Website:
CDC H1N1 Flu Website:
Prevent Influenza Now (National Influenza Vaccine Summit):