1. Pertussis/Flu Update 5/10/2011
CDPH, Immunization Branch

2. AGENDA
Opening Remarks
Influenza Update
AB 354 Discussion

3. Influenza Update

4. LHD Influenza Purchase 2011-2012
CDPH has identified funds for the limited purchase of influenza vaccine for the season. 
CDPH State Purchase:
Afluria: 193,230 doses
CDPH Federal Purchase:
Flulaval: 155,000 doses
Fluarix: 20,000 doses
Flumist: 30,000 doses

5. Comparing Flu Vaccine Purchase
Multidose Vials
600,000
348,230
Single Dose syringes
40,000
20,000
Nasal Sprayers
225,000
30,000

6. Looking ahead to fall Late summer- fall availability of vaccine
3 strains will be unchanged
Recommended for all > 6 months
No reports of production delays yet
CDPH Guidelines
Continue to prioritize 60+
Majority of LAIV will be coming through VFC
School-based clinics
LHDs will have a mixture of VFC and 317 vaccine
Will need to screen for VFC eligibility

7. VFC Flu 2011-2012 Vaccine supply
Expanding availability of PF doses for 3-18 year olds
Pre-booking allocations begin in June 2011
May request more or fewer doses of products for 3-18yrs (as long as TOTAL allocated doses remain the same).
Order Processing
Will be able to process specific PINs first
LAIV
Screen for eligibility at school-located clinics

8. Provider Allocations Individual allocations are based on:
Total flu doses received on previous season for each age category
Allocated + ordered through supplemental ordering
Plus a variable % increase
No doses allocated for products that were not ordered in the preceding year
Providers wishing to receive doses for unallocated products can order them through supplemental ordering.

9. VFC Flu Purchase 2011-2012 Fluzone 0.25ml: 600,000 doses
Fluzone MDV: 500,000 doses
Fluarix PF: 300,000 doses
Flumist: 440,000 doses

10. 2011 Flu Vaccine Supply Brand Manufacturer Packaging Age Group Doses
Fluzone® PF Pediatric
Sanofi Pasteur
10 pack - 1 dose syringes (0.25mL)
 6-35 months
60,000
Fluzone®
10 dose vials (5mL)
 3-18 years  
500,000
 Fluarix
  GSK
10 pack - 1 dose syringes (0.5mL)
 3-18 years
(Prioritized for pregnant teens)
300,000
FluMist Vaccine,
Live Intranasal
 MedImmune
Intranasal Spray 10 pack-1 dose
Healthy
2-18 years
440,000

11. Data: British Columbia Centre for Disease Control

12. Tdap rates to date - AB 354 cohort
2009 NIS % (46-59%)
1) ~60% of cohort in CAIR (all counties)
10-18 years >820K doses- ~37%
20%-53% by region
11-17 years ~43%
~12K doses per week added to CAIR
Doses not entered = ???
2) ~20% in Kaiser Permanente %
Members immunized out-of-plan = ???
3) ~20% Non-CAIR, Non-Kaiser ???

13. Tdap doses in CAIR, 10-18 years old

14. Pertussis cases by month of onset --California, 2010

15. Messages for providers - Act now Pertussis isn’t taking summer vacation
Send reminder and recall phone calls and notices NOW and repeatedly before school starts to patients who have not yet received a Tdap booster
including those who have received Td but not Tdap.
Immunize with Tdap NOW & at every opportunity
e.g., sports physicals & visits for mild illness or injury
Give other recommended immunizations and care
Order enough Tdap and other adolescent vaccines; ensure you have adequate refrigerator storage – for many clinics, multiple orders will be indicated

16. Messages for providers
Provide clear and accurate documentation about Tdap immunization to your patients and their schools.
CAIR – consider printing Blue Card for patients
Provider form – EZIZ and LHDs now, other sites soon
New CDPH flyer
Be broadly aware of how local schools are processing Tdap documentation and prepare accordingly.
Post downloadable electronic banners on your practice’s website and in electronic newsletters to help notify your patients.

17. New Provider Document

18. Materials for Schools – Tdap Sticker
Tdap Blue Card Stickers and PBE forms
Any schools that haven’t received?
Contact field reps if more needed 18

19. Messages for schools - Act now Pertussis isn’t taking summer vacation
Review messages from State Superintendent Torlakson about the importance of the new Tdap vaccine requirement
New Video, Local communications
Continue alerting parents and students:
If you haven’t already, get your Tdap shot
Check in with your doctor
Get a record of the Tdap booster from your doctor to share with school
Bring your immunization record to school!

20. Messages for Schools New peer-to-peer draft tweets and texts
Post messages above and downloadable electronic banners on school’s
Websites, s and electronic newsletters
Marquee or billboard
Calendar
Report Cards and other notices
Student newspapers, newsletters
PTA, Community partners’ communications

21. Messages for Schools
Develop record collection systems and begin collecting Tdap records as soon as possible.
Staffing and systems for collecting records
Before the end of school
During summer vacation
Leading up to first day of school
Clear instructions for parents about when and how to submit Tdap records
Paper, phone and electronic messages

22. School Software Systems
Systems that can print an accurate, formatted Blue Card with Tdap information, including check off box if appropriate dose given
Aeries, Power School
Systems attempting to develop a Tdap Blue Card
Infinite Campus, GENESIS
Systems considering modifications
eSchoolMAX, IEM, SchoolPlus

23. School webinar on reporting
May 26, 2011 – registration link will be posted at ShotsForSchool

24. AB 354 Communications
Radio PSA
Outdoor Advertising

25. What’s New on ShotsForSchool.org
Link to Torlakson/CDE video for schools
Social Media Messages (Text, Tweet and FB Posts)
“What If” brochure (English and Spanish)
Office of Binational Border Health Flyer for Spanish-speaking Parents

26. Provider Kit – Repints from CMAF

27. Sources of LHD Vaccine for AB 354
VFC maximum doses = # of VFC eligible
Title 317 – allocations (tracked via reports)
Maxim contract residual (LHDs that requested)
Other? -- Local purchases, etc.

28. AB 354 Vaccine Distribution Guidelines
Whenever possible, give Tdap in the medical home along with comprehensive adolescent care. Ideal limited by
large # of adolescents affected by AB 354
Increasingly brief implementation period.
Doses of Tdap vaccine purchased with federal 317 funds should be targeted at underserved adolescents without a medical home or ready access to immunization.
April 18 - September 17: option of Tdap-only clinics

29. VFC Providers (Public and Private):
Tdap Only Option : April 18-September 17th
Must follow all other VFC requirements:
VFC Screening
Storage and Handling
Administration Fee Guidelines
Etc.

30. LHD Clinics VFC Screening required at all clinics.
May immunize patients that aren’t eligible for VFC using Title 317 doses (mixed inventory).
Target outreach clinics at underserved populations.

31. LHD Tdap Allocations
Coordinators have confirmed Apr-Sept allocations & requested additional doses if available.
Additional ~10K doses allocated shortly
This is your total 317 Tdap allocation.
When considering additional outreach, please account for routine needs, including adult use of Tdap.
LHDs may modify routine clinics as needed to help the demands of AB 354.

32. LHD Tdap Allocations
CDPH will update LHDs should additional Tdap doses become available.
Please make contingency plans on how you would use additional doses if available.
LHDs are expected to plan to utilize all of their allocations
for routine clinics and to implement AB 354
or else promptly release back to CDPH any doses that cannot realistically be administered.

33. Summary from 1st Reporting Period
317 doses projected were much higher than the 317 doses actually administered.
Summary of first period:
55 LHD reported as of 5/10
VFC administration: doses
317 administration: 3621 doses (35,858 projected for April)
Doses unused in April can be used in coming months.

34. LHD Tdap Orders Title 317 Tdap allocations NOT shipped separately.
Tdap ordering mechanism unchanged – via VFC Program.
Tdap orders should reflect VFC needs + Title 317 vaccine doses for period covered by order.
Please order with minimum 2 week lead time to ensure enough vaccine for upcoming clinics.
If you have sufficient storage space, consider larger initial order(s) to meet possible increased demand.
Please pay special attention to storage, handling and temperature monitoring to protect your larger inventories.

35. LHD Tdap Allocations Report your Tdap vaccine usage every two weeks.
First reporting period April 18-May 1st.
By VFC vs. non-VFC, routine vs. outreach clinics
 Allocations deducted from reported 317 vaccine administration, not from orders
Orders include both VFC- and 317- eligible patients
Current balance of allocation doses given and doses remaining listed on the reporting page. 
May use IZB vaccine tracking form or your own system to count doses for reporting. 
Use of CAIR for tracking VFC vs. non-VFC Tdap doses? We’ll keep you posted.

36. Q&A Does the allocation include doses for adults?
A: Yes, all Tdap doses, including those for adults.
How will requests for additional doses be approved?
A: Once all LHDs confirm their allocations, we will notify you if the additional doses are available.
Are underinsured children eligible for VFC vaccine?
A: Only if given at an FQHC/RHC licensed by HRSA.
I think that we are an FQHC or RHC. How can I confirm?
A: Check

37. Q&A What happens if LHD uses up allocation before Sept 17th?
A: Perhaps LHD could only immunize VFC-eligibles. We would try to avoid this by redistributing doses from places where demand is unexpectedly lower.
Can we turn away insured adults?
A: LHDs may choose between
administering a dose then referring future doses elsewhere
immediately referring insured patient to the provider
delaying immunization

38. Maxim Tdap Clinic Update
Remaining ~35,000 doses allocated to 35 participating LHDs and based on population distribution.
Clinic dates can be scheduled now - Submit requests to Nisha Gandhi as before
Guidance and allocations sent recently.

39. School Requirements Miscellany
How common are temporary medical exemptions these days?
TB data off of Blue Card in 2014
Homeless students Liaison
Others

40. Recap
Good
Bad