1. Adult Immunization: What could an ideal state program look like?
Vaccination Across
the Lifespan
Adult Immunization: What could an ideal state program look like?
March 20,2008
Susan M. Lett, M.D., M.P.H.
Medical Director, Immunization Program
Division of Epidemiology and Immunization
Massachusetts Department of Public Health

2. Disclaimers
The ideas presented in the presentation can be attributed only to the presenter
They do not represent the official position of the Massachusetts Department of Public Health (MDPH)
MDPH 3-08
MDPH February 2008

3. Massachusetts Adult Immunization Program Current Status

4. MDPH Immunization Program – September 2007
Estimated Vaccination Coverage with the 4:3:1:3:3:1* Series Among Children 19 – 35 Months of Age, 2006 National Immunization Survey
MA has highest
rates in nation
for 3rd year in
a row!!! 60
MA = 84%
D.C.
NATIONAL COVERAGE = 77%
*4+DTP, 3+Polio, 1+MCV, 3+Hib, 3+HepB, 1 Varicella
55-59%
60-69%
70-74%
75-79%
80-85%
MDPH 3-08
MDPH Immunization Program – September 2007

5. Influenza Vaccination Rates for MA Adults
2003, 18 –64, diabetes and asthma
MA 2006 BRFSS
MDPH 3-08
MDPH February 2008

6. Projected MA State-Supplied Vaccine for Adults – FY 08 and Staffing
Universal Distribution
Td 370,000 doses
PPV ,000
Select Distribution
Flu 337,000
Hep B ,000
Hep A 18,000
MMR 20,000
Varicella 3,000
No Tdap
Staffing: 1 part-time adult coordinator, 35 other staff spend approximately 10% of their time on adult immunization activities. TOTAL = 4.1 FTEs
MDPH 3-08
MDPH February 2008

7. MA Childhood & Adult Vaccine Budgets
Fed (VFC/317)
$ 0
$ 69 M
State
$7 M
$ 40 M
Total
$109 M
MDPH 3-08

8. Adult Immunization Coalition Annual Adult Immunization Conference
53 member organizations
Annual Adult Immunization Conference
Flu clinic website
1,500 clinics; 55,000 visitors
Special projects
Hospital, LTC standing orders
Hospital employee vaccination
MDPH 3-08
MDPH February 2008

9. Assumptions

10. Assumptions (1)
There is a federal Vaccines for Adults (VFA) Program for all those > 19 years of age:
Covers all ACIP recommended vaccines given in all locations
Regardless of insurance or residency status
Timeline for funding after recommendation extremely short!
MDPH 3-08
MDPH February 2008

11. There are no ERISA plans
Assumptions (2)
As a safety net, every state has 1st dollar coverage for vaccine and administration costs, regardless of place of vaccination:
While awaiting federal funding
For vaccines, beyond the recommendations
Reimbursement should be clear and transparent
There are no ERISA plans
MDPH 3-08
MDPH February 2008

12. Assumptions (3)
There is sufficient federal funding dedicated for immunization registries, including:
Functionality for data exchange and interaction with
electronic medical records systems
personal health information records
Platform for communication within and between states
MDPH 3-08
MDPH February 2008

13. Massachusetts Adult Immunization Program Future Possibilities

14. Vaccination Across the Lifespan
MDPH 3-08

15. State Adult Immunization Program (1)
Build on successful strategies used in childhood immunizations and hospital standing orders
Identifying partners is key
Begin with demonstration projects
Medical setting
Nonmedical setting
Identify providers and agencies who have overcome existing barriers and successfully vaccinated adults
Recruit them to become champions
Education and assessment are essential
MDPH 3-08

16. State Adult Immunization Program (2)
Immunization program would double in funding and size
MA could have at least 13 FTEs working on adult activities
Adult Immunization Coalition expansion to enhance public private partnerships
Platform for all major adult initiatives
Dedicated funding to staff the coalition office
Subcommittee for outreach to nonEnglish-speaking, minority communities and newcomer communities
In MA, 1 million (20%) do not speak English at home
Subcommittee for private sector
Subcommittee for public sector
MDPH 3-08

17. Adult Immunization Coalition
Objectives
1. Promote vaccination in traditional and non-traditional settings among all sectors, with traditional and non-traditional vaccinators
2. All primary care and specialty provider associations will adopt
“assessment of vaccination status and offering vaccine at every visit as a standard of care”
3. Enrolling all uninsured adults in a health plan
(Health Connector)
4. Immunization registry ‘roll-out’
MDPH 3-08

18. Expanding Adult Access to Immunizations (1)
Massive enrollment of all adults in health plans to increase number with medical home
MA embarked on health care reform initiative
Health Connector
Commonwealth Care
Commonwealth Choice
Standing orders projects
Hospitals, LTC, other settings
Pharmacists pilot project
Flu, PPV23, zoster
Community vaccinators
Partnerships
STD, HIV C &T, correctional facilities
Hep A & B
Outreach
Minority , non-English-speaking communities
MDPH 3-08
MDPH February 2008

19. Expanding Adult Access to Immunizations (2)
Massive enrollment of all providers in ‘VFA’ program (both primary care and specialties)
Target OB/GYN
Encourage primary care providers and specialty practices to vaccinate not refer
Standing orders projects
Hospitals, LTC, other settings
Pharmacists pilot project
Flu, PPV23, zoster
Community vaccinators
Partnerships
STD, HIV C &T, correctional facilities
Hep A & B
Outreach
Minority , non-English-speaking communities
MDPH 3-08
MDPH February 2008

20. Expanding Adult Access to Immunizations (3)
Standing orders projects
Vaccination of women ante- and postpartum
Include other family members
Pharmacists projects
Community vaccinators
Partner with schools, worksites
STD, HIV C & T, correctional facilities
Outreach
Standing orders projects
Hospitals, LTC, other settings
Pharmacists pilot project
Flu, PPV23, zoster
Community vaccinators
Partnerships
STD, HIV C &T, correctional facilities
Hep A & B
Outreach
Minority , non-English-speaking communities
MDPH 3-08
MDPH February 2008

21. Education Providers General Public
Nursing, medical and pharmacy
schools -- coordinated curriculum
Mass Medical Society Faculty
Grand rounds
Academic detailing
Webinars
On-line courses
Other innovative technologies
General Public
Multimedia approach that is audience appropriate
Focus on Non-English Speaking and newcomer communities
MDPH 3-08

22. Assessment Expanded state-specific data from BRFSS, NIS, NHIS, CMS, MD
Includes all recommended antigens
‘Immunization Site’ assessments (Adult AFIX)
Providers, employers, commercial and community vaccinator, churches, etc
Redefine missed opportunities
Multi-generational, multi-site approach
New approaches needed to effective feedback for this diverse group
MDPH 3-08

23. Requirements for Adult Immunization
Positive approaches better than negative ones
But, having funding facilitates requirements, if needed
Unified national recommendations and endorsement essential (ACIP,AAP, AAFP, ACOG, etc.)
National standards/ regulations much more efficient than state-by-state (JCAHO, CMS, OSHA, etc.)
Focus state-by-state requirements on ‘most important’ groups
Healthcare workers
Childcare workers/teachers
Public safety and essential infrastructure
MDPH 3-08

24. “It Takes a Village to Vaccinate Adults”
Expand access to health care
Empower and encourage vaccination in medical homes
Support vaccination outside of medical home
Use traditional and non-traditional vaccinators
Use immunization registries
MDPH 3-08

25. Contact Information
Massachusetts Immunization Program
Website
Susan M. Lett MD, MPH
Medical Director, Immunization Program
Division of Epidemiology and Immunization
Massachusetts Department of Public Health
305 South Street
Jamaica Plain MA 02467
MDPH 3-08

26. EXTRAS
MDPH 3-08

27. Disclosures
The speaker has no financial interest or conflict with the manufacturer of any product named in this presentation
The speaker will not discuss the use of vaccines in a manner not approved by the U.S. Food and Drug Administration
The speaker will no specifically discuss vaccines not currently licensed by the FDA
MDPH 3-08
MDPH February 2008

28. Flu & PPV23 Vaccination Rates in MA Long-Term Care Facilities
MA DMA
* 2006 – CMS MDS
MDPH 3-08

29. Massachusetts Immunization Program Universal Vaccines Distributed for Children and Adults – Future Possibilities
DTaP, DT, Td, Tdap
IPV
MMR
Hib
Meningococcal Conjugate vaccine (MCV4)
Pneumococcal Conjugate 7-Valent (PCV7)
Hepatitis B
Varicella
Influenza (TIV and LAIV)
Pneumococcal Polysaccaride 23-Valent
Hepatitis A
Human Papillomavirus
Rotavirus
MMRV (Measles, Mumps, Rubella and Varicella)
Zoster Vaccine
MDPH 3-08

30. Pneumococcal Vaccination Rates for MA Adults
MA BRFSS
MDPH 3-08
MDPH February 2008