1. Carl Chu, PharmD Hawaii Department of Health

2. Paul V. Effler, M.D., M.P.H.

4. Only one public school system statewide Only one public school system statewide Success implementing other school-based vaccination programs (i.e., hepatitis B vaccine for 5 th graders) Success implementing other school-based vaccination programs (i.e., hepatitis B vaccine for 5 th graders) To be prepared for possible mass vaccinations of school children during an influenza pandemic To be prepared for possible mass vaccinations of school children during an influenza pandemic Evidence of substantial seasonal influenza attack rates in children including reports of school outbreaks Evidence of substantial seasonal influenza attack rates in children including reports of school outbreaks

5. Preliminary data

6. Ideal setting for assessing impact Ideal setting for assessing impact Hawaiis geographic isolation means residents usually receive medical care within state Hawaiis geographic isolation means residents usually receive medical care within state Statewide hospital discharge databank that may be used to ensure comprehensive ascertainment of influenza hospitalizations (http://www.hhic.org/about.html) Statewide hospital discharge databank that may be used to ensure comprehensive ascertainment of influenza hospitalizations (http://www.hhic.org/about.html)http://www.hhic.org/about.html Two major health care providers/payers Two major health care providers/payers Provide 72% coverage of civilian population (930,381 of 1,285,498 in 2006) Provide 72% coverage of civilian population (930,381 of 1,285,498 in 2006) Should permit robust assessment of effect of program on health care encounters, including outpatient visits, statewide Should permit robust assessment of effect of program on health care encounters, including outpatient visits, statewide

7. Only 20% of 44,725 privately insured children Only 20% of 44,725 privately insured children Only 40% of 8,154 privately insured asthmatic children Only 40% of 8,154 privately insured asthmatic children Only 50% of 68 privately insured diabetic children Only 50% of 68 privately insured diabetic children Preliminary data

8. Grades K-8 Grades K-8 All Hawaii public and private schools asked to participate All Hawaii public and private schools asked to participate Offered TIV (shot) and LAIV (nasal spray) Offered TIV (shot) and LAIV (nasal spray) Two clinics >6 weeks apart if school had children age 6 weeks apart if school had children age <9 years who might need 2 doses Voluntary written informed consent of parents/guardians required Voluntary written informed consent of parents/guardians required Preliminary data

9. JanFebMarAprMayJunJulAugSepOctNovDecJan Order Vaccines Staffing Arranged Consents Due/Review SchoolsScheduled Clinics Consents Sent SchoolsAsked Promotion 59 working days Preliminary data

10. School Participation School Participation 340/377 (90%) of all schools with grades K-8 340/377 (90%) of all schools with grades K-8 242/251 (96%) of public schools 242/251 (96%) of public schools 98/126 (78%) of private schools 98/126 (78%) of private schools 622 school-based clinics (277 second dose clinics) 622 school-based clinics (277 second dose clinics) Preliminary data

11. Student participation: Student participation: 63,153 (94%) of 67,203 students who consented 63,153 (94%) of 67,203 students who consented 43% of 146,777 children at participating schools vaccinated 43% of 146,777 children at participating schools vaccinated 46% of 132,775 children aged 5-13 years in Hawaii according to census 46% of 132,775 children aged 5-13 years in Hawaii according to census 18,172 children received 2 nd dose 18,172 children received 2 nd dose 81,325 total flu vaccine doses given 81,325 total flu vaccine doses given School staff participation: ~9,281 school-based staff vaccinated, representing (43%) of the workforce cohort School staff participation: ~9,281 school-based staff vaccinated, representing (43%) of the workforce cohort Preliminary data

12. ADMINISTERED PREFERENCE TIV 56% LAIV 26% Either 18%

13. MeanMedianMode0:050:040:02 * Based on n = 1,970 students at 199 schools; approx 10 students/school Preliminary data

14. Cost for 2007-2008 program: Cost for 2007-2008 program: Preliminary data Average of $23.69 for every flu vaccine dose administered.

15. Keep kids healthy and in school Keep kids healthy and in school Help keep older adults and pre-school kids healthy Help keep older adults and pre-school kids healthy Enhance our capability to respond to a potential pandemic Enhance our capability to respond to a potential pandemic Strengthen relationships with all community partners, including public, private, professional, and individuals Strengthen relationships with all community partners, including public, private, professional, and individuals

16. Mahalo!