1. WHAT COULD A LOCAL ADULT IMMUNIZATION PROGRAM LOOK LIKE? Anne Bailowitz, MD, MPH Baltimore City Health Department March 20, 2008

3. The Local Approach to Adult Immunization – Basic Assumptions Free Vaccines: TdaP, HPV, MCV4, Flu, Shingles + Free Vaccines: TdaP, HPV, MCV4, Flu, Shingles + Ages: Universe – (VFC + Medicare) = goal Ages: Universe – (VFC + Medicare) = goal Initial target = 19-26 y. and 50-64 y. Initial target = 19-26 y. and 50-64 y. Growth from the established margins Growth from the established margins IIS: An immunization registry is in place IIS: An immunization registry is in place Regulation: History of effective mandates Regulation: History of effective mandates A Local Health District is not a State HD A Local Health District is not a State HD

5. Educate and Motivate Adults (Host) Education: message is simple, attractive, culture- based Education: message is simple, attractive, culture- based Motivation: what happens when there’s no vaccine Motivation: what happens when there’s no vaccine Focus groups: develop the approach/content Focus groups: develop the approach/content Campaign champions: grassroots / “big ticket” Campaign champions: grassroots / “big ticket” Evaluation: Impact Knowledge? Impact Behavior? Evaluation: Impact Knowledge? Impact Behavior? Media: stay current but know your audience Media: stay current but know your audience transit ads, audiovisuals, print transit ads, audiovisuals, print

7. An Example – Baltimore’s “Don’t Wait to Vaccinate” Campaign 11/05 Maryland mandates 5 th -9 th graders receive HBV, VZV by 9/06 11/05 Maryland mandates 5 th -9 th graders receive HBV, VZV by 9/06 4/06 – 23,647 students non-compliant 4/06 – 23,647 students non-compliant “Don’t Wait to Vaccinate” multimedia focus “Don’t Wait to Vaccinate” multimedia focus LHD’s Partners: school system, State, City agencies LHD’s Partners: school system, State, City agencies Evaluation at clinics/office/PMDs; best - radio, letter Evaluation at clinics/office/PMDs; best - radio, letter 10/07 – compliance 99.4 %; 1/3 LHD iz’d (7% avg) 10/07 – compliance 99.4 %; 1/3 LHD iz’d (7% avg)

8. An Example – Baltimore’s ACE ACE – Action for Community Enrichment (iz coalition) ACE – Action for Community Enrichment (iz coalition) Founded 1997- “Good Neighbor Flu” – HCFA (CMS) $ Founded 1997- “Good Neighbor Flu” – HCFA (CMS) $ Initial focus: urban minority seniors, Medicare flu/pneu Initial focus: urban minority seniors, Medicare flu/pneu 1997-2008: 48,369+ Baltimoreans immunized 1997-2008: 48,369+ Baltimoreans immunized 2/14/08: Add adult Hep B, Hep A, TdaP, HPV, MCV4 2/14/08: Add adult Hep B, Hep A, TdaP, HPV, MCV4 Benefits: diversity, partnerships, longevity, funding

9. Educate and Motivate Public Providers (Environment) Redefine “missed opportunity” (1) Child presents for immunization, accompanying caretaker not queried/offered immunization (2) Adult presents for non-immunization health department services, not queried/offered immunization (3) LHD employees not queried/offered immunization (4) LHD doesn’t offer iz to EHS, business, hospitals

10. Educate and Motivate Private Providers (Environment) Teach vaccinology in medical school and residency (iz schedules, iz administration) Offer CME/iz advocacy to practicing physicians via professional societies (AAFP, ACP) plus CDC, LHD LHD “details” physicians: unbiased vaccine info, aid Financial incentives: CMS Medicare expansion; HMO/MCO role; Hedis adds adult coverage standards

11. Tools for Change (Environment) 1995 Regulation: Baltimore City providers of City children (0-6 years) must report all immunizations to Baltimore Immunization Registry Program (BIRP); now includes adolescent/some adult iz IIS: Data depot aids providers, parents, agencies Identifies pockets of need for outreach Research trends, surveillance, etc. Success: 2001-2004 coverage rates for 19-35 month olds rise 17.8% Future: ?Regulations-college/grad/trade school, food services, HCWs, criminal justice system – with IIS input

13. A WISH LIST Staff: community health educators (CHE) nurses – cross train all LHD staff in iz data managers and staff clerical Media: radio, TV, transit computer-based – internet, MP3, DVD, + Supplies: medical, educational, office, software

14. SCENARIOS Small – strong LHD staff (nurses/CHE/IT) + media + iz coalition targets adult iz to 19-26, 50-64 yr olds via LHD clinics, community sites w/ IIS expanded to capture iz Medium - above plus partners = business (e.g. pharmacy, mass immunizer, employee health service); private providers; media penetration up Large – above plus broader partnerships- business, government, private health/ hospitals

15. Conclusions Now is the time for adult immunization Agent / Host / Environment LHD is the catalyst Knows its people; educates and evaluates Iz coalitions bring ideas, partners, diversity Regulations, IIS “New” : missed opportunities / service integration Wish List: staff, media, supplies Scenarios

17. Questions? Anne Bailowitz, MD, MPH Chief, Bureau of Child Health and Immunization Baltimore City Health Department 4 South Frederick Street, 3 rd Floor Baltimore, MD 21202 ( E ) Anne.Bailowitz@baltimorecity.govAnne.Bailowitz@baltimorecity.gov ( C ) 410 236 9285