1. Pertussis/Flu Update 9/28/2010
CDPH, Immunization Branch

2. AGENDA Overview: Dr. Gil Chavez/Dr. Rob Schechter
Pertussis Disease: Kathleen Harriman/Kathleen Winter
Maxim Contract Update: Nisha Gandhi
Tdap Expansion Program Update: Maria Volk
Pertussis Campaigns/Materials: Tiffany Sutter
LHD Clinics/Activities: Open Discussion
Influenza Update: Dr. Rob Schechter/Nisha Gandhi

3. California Pertussis Cases – 2010
As of 9/28/2010, there have been 4,461 confirmed, probable and suspect cases of pertussis reported in 2010 for a state rate of 11.4 cases/100,000.
4,447 of reported cases had disease onset in 2010.
238 new cases have been reported this week, compared to 206 in the prior week (Figure 1)
Case Classification:
Confirmed: ~63%
Probable: ~19%
Suspect: ~18%

4. California Pertussis Cases – 2010
This is the most cases reported in 55 years when 4,949 cases were reported in 1955 and the highest incidence in 48 years when a rate of 11.7 cases/100,000 was reported in  Previously, the peak was in 2005 when there were 3,182 cases reported (Figure 2).
Of the 46% of cases with known hospitalization information (11%) cases have been hospitalized
128 (59%) of hospitalized cases were infants <3 months of age and 160 (74%) were infants <6 months of age.
124 (78%) of the hospitalized infants <6 months of age with known race and ethnicity were Hispanic.

5. California Pertussis Cases – 2010
Nine deaths have been reported; 8 (89%) were Hispanic infants.  Eight fatalities were infants <2 months of age at time of disease onset and had not received any doses of pertussis-containing vaccine and the remainder was an ex-28 week preemie that was 2 months of age and had received the first dose of DTaP only 15 days prior to disease onset.  The majority of infant cases in 2010 have occurred in infants <3 months of age (Figure 3).
Rates are highest in infants <6 months of age (205 cases/100,000), in children aged 7-9 years (35 cases/100,000) and adolescents aged years (27 cases/100,000) (Figure 4). The majority of adolescent cases are in year-olds (Figure 5).

6. California Pertussis Cases
Overall rates by race/ethnicity are highest in whites (10.9/100,000), however age-specific rates indicate that the highest rates are seen in Hispanic infants <6 months of age (2.48.8/100,000) ( Figures 3 and 4).
The median case rate by county is 10.5 cases per 100,000 (range 0-134) (Figure 6 and Table 1).

7. Maxim Tdap Clinics CDPH will supply vaccine directly to Maxim
Contract currently allows up to 90,000 persons to be vaccinated with Tdap vaccine
Contract ends September 30, 2010
Proposed new contract starts October 1 (still waiting for signed contract)
307 Clinics Scheduled (9/27)
Approximately 32,883 doses administered (9/27)

8. Tdap Expansion Program
694 organizations enrolled in program: 508 CHCs and 180 hospitals.
Approximately 145,000 doses approved.
New end date: December 31, 2010.
Applicants have been notified that the date is extended.
Still accepting new applicants.
Working on evaluation study: key informants interviews, and Survey Monkey survey.

9. Overall Tdap Vaccine Distribution

10. I & E Updates Statewide radio campaign started English and Spanish
September 6–26
Spanish Tv PSA in production
Ready September 23
Media Buy TBD
Archived webinar available now 10

11. QUESTIONS?

12. Influenza Update

13. “State Purchased” Adult Flu Products
Brand name/ Trade name
Packaging
Age Indication
Manufacturer
Doses Ordered
Doses Shipped
Fluzone®
10 dose vials
6 months +
Sanofi Pasteur
300,000
295,250
(replaces CSL)
Fluarix® Preservative-free
5 pack - 1 dose syringe
3 years +
GlaxoSmithKline
40,000
FluLaval
10 dose vial
18 years +
FluMist Virus Vaccine Live, Intranasal
Intranasal Spray 10 pack-1 dose
2-49 years
Medimmune Vaccines, Inc.
225,000
168,100 *
*Remainder of LHD FluMist orders placed this week.
 TOTAL DOSES
865,000
758,600

14. LHD Flu/Pneumo/Tdap
Reminder-please let outside providers know that they are receiving state-purchased flu product
Tdap and Pneumo for flu clinics should have arrived
Limited quantities of MDV, PPV23 in reserve
Plenty of Flumist available

15. VFC Flu Shipments Round 1-Shipments: Ordered 8/25
Products: FluMist & sanofi MDV
All orders less than 100 doses have shipped in full
Orders over 100 doses were filled at 25%
Round 2-Shipments: Ordered 9/1
Products: sanofi 0.5mL PF (syringes and vials)
All orders less than 100 doses have shipped in full.

16. VFC Flu Shipments Round 3-Shipments: Ordered 9/9
Products: sanofi MDV
Approximately another 25% of total confirmed doses shipped.
Partially filled orders that were placed into the system after the initial shipments (new providers, limited number of providers that didn’t confirm by deadline)
Round 4-Shipments: Ordered 9/16
Products: FluMist
Approximately another 25% of FluMist total confirmed doses shipped.

17. VFC Flu Shipments Round 5-Shipments: Ordered 9/23
Products: sanofi 0.25 pediatric
All orders less than 100 doses will be fulfilled
Orders over 100 doses will be filled at 25%.
Round 6-Shipments: This Week
Products: FluMist and PF
Another 25% of FluMist orders will be filled.
Will partially fill PF orders over 100 doses.

18. (Prioritized for pregnant teens)
VFC Flu Vaccine Supply
Brand
Manufacturer
Packaging
Age Group
% doses Received
Fluzone®
PF Pediatric Dose
Sanofi Pasteur
10 pack - 1 dose syringes (0.25mL)
6-35 months
32%
10 dose vials (5mL)
3-18 years
56%
Fluzone® PF
 Sanofi Pasteur
10 pack - 1 dose syringes (0.5mL)
(Prioritized for pregnant teens)
70%
10 pack - 1 dose vials (0.5mL)
FluMist Vaccine, Live Intranasal
 MedImmune
Intranasal Spray 10 pack-1 dose
Healthy
2-18 years
68%

19. Distinguishing VFC vs. State Flu Doses
Confirmation
Separate confirmation sent to all sites receiving State Influenza Program doses
Order Transmission
Set days for VFC and State Influenza Program Order Transmissions to CDC
M-T: State Flu order transmission (SFOT) days
W-Th: VFC Flu order transmission (VFOT) days
Shipment Packing Slip
Cannot be used to distinguish supply

20. VFC Supplemental Ordering
VFC has additional doses of all products available for supplemental ordering.
Targeting to open it in October once more doses have shipped.
VFC Providers will not be able to order additional doses of a product until they have received their initial allocation (product by product-don’t have to wait until all products are received).
Providers will be asked to provide doses administered when re-ordering.

21. Flu I&E
Video & print contest September 15–November 7
Cdphfilmfest.org

22. Flu Vial Chart

23. Flu Dosing Chart
Download from eziz.org (Vaccine Admin or Flu Materials pages)