2. Maximizing Influenza Vaccine During Time of Increased Demand Andie Denious, MS, RN Kathy Fredrickson, MS, MPH Arizona Immunization Program Office

3. A little history… 2003-04 flu season began unusually early – activity reported in early October Reports of severe pediatric illnesses and deaths created unusually high demand for flu vaccine Vaccine supply quickly depleted - demand exceeded supply Arizona Immunization Program Office

4. October News releases to TV, radio and newspapers (English and Spanish) to get vaccinated Promoted Flu Hotline through Community Information and Referral 45,000 doses flu vaccine shipped to VFC providers Arizona Immunization Program Office

5. November Beginning early November, 30 second PSAs aired on Cox Cable urging the public to get a flu shot Mass immunization clinics well underway in grocery stores, employee wellness sites, etc. Arizona Immunization Program Office

6. December Increased flu activity and reports of severe illness in children created unprecedented demand for vaccine “Influenza Alert” blast faxed/mailed to over 2,500 providers, school nurses, hospitals, IHS and others –Prevention message –Vaccine information –Treatment guidance –Information about when to stay home Arizona Immunization Program Office

7. December Messages emphasized importance of reporting deaths and severe illness from flu and pneumonia targeting high-risk patients with remaining vaccine PSAs changed message to target high risk only Arizona Immunization Program Office

8. FluMist  available and suitable as 2 nd dose for healthy kids at least 5 years old using flu vaccine correctly, i.e., DO NOT use “off label” (don’t split doses to make vaccine go further) December

9. Overall direction - State Epidemiologist and BT Medical Director (Infectious Disease Physician) – Calls, faxes on disease questions, treatment - Infectious disease epi’s Media - PIO (Public Information Officer) Vaccine information/locations – Immunization Program staff Arizona Immunization Program Office Roles of the State Health Department

10. Immunization Program Strategies Implemented (or, how to manage vaccine when there is none…) Immunization program staff acted as “clearing house” for individuals/facilities with/without vaccine –Assessed flu vaccine demand was greater than supply –Activated call center to conduct active surveillance of vaccine supplies to identify providers with available doses and those in need of doses to refer public to sites with vaccine Arizona Immunization Program Office

11. How to manage vaccine when there is none… Spreadsheet of VFC provider sites indicated 215 of 750 in need of influenza vaccine Staff called/faxed each site daily/weekly to monitor flu vaccine status Additional vaccine that became available through CDC/NIP distributed to VFC and non-VFC providers Arizona Immunization Program Office

12. Developed spreadsheet of hospitals/employee health (70) Staff called/faxed each hospital daily/weekly to determine: –# of doses on hand initially 7,568 adult 36 pediatric –# of doses willing to “share” (either donate or sell) 4,510 adult 0 pediatric Arizona Immunization Program Office How to manage vaccine when there is none…

13. Hospitals (6) with available doses and willing to “share” (the “haves”) Hospitals (2) in need of doses (the “have nots”) Remainder of the hospitals were out of vaccine and didn’t need more, or were saving remaining doses for own staff Arizona Immunization Program Office How to manage vaccine when there is none…

14. Developed spreadsheet of other immunization sites (~25) Staff called each site to determine availability of vaccine/services. For example: –Health Plan – would accept non-member high-risk –Juvenile Corrections – saved remaining doses for incoming inmates Arizona Immunization Program Office How to manage vaccine when there is none…

15. –Mass Immunizers – unable to screen for high-risk so first come, first serve; no children Mollen Clinics Healthwaves Health Styles –IHS hospitals – Pharmacist at Phoenix Indian Medical Center took lead in distributing vaccine among IHS facilities Arizona Immunization Program Office How to manage vaccine when there is none…

16. –Hospital outpatient clinics that had vaccine willing to accept high risk individuals referred by ADHS –Others Dialysis facility had 500 doses available – donated to pediatricians in the area 2 large hospitals in Tucson shared vaccine with the county health department 350 (of 500) doses of vaccine donated for homeless program that was not needed was redirected to largest CHD for high risk How to manage vaccine when there is none… Arizona Immunization Program Office

17. Throughout December, staff: –Conducted ongoing active surveillance of vaccine supply and immunization clinic sites via: daily meetings to update staff on vaccine supplies and distribution daily/weekly phone calls/faxes to providers and sites daily online tracking of statewide clinic locations redistributed VFC vaccine (picked up vaccine from “haves” and delivered to “have nots”) Arizona Immunization Program Office How to manage vaccine when there is none…

18. “Vaccine broker” role was appropriate for the immunization program –Able to identify providers and clinics with vaccine –Able to act as facilitator between vaccine “haves’ and “have nots” –System worked but resources strained Although “touch and go” at times, high risk children and adults were able to get vaccine Arizona Immunization Program Office Lessons Learned…

19. Communication between private sector and public health to optimize available vaccine critical Work closely with mass immunizers to prioritize high risk individuals Reduce/eliminate vaccine wastage Arizona Immunization Program Office Lessons Learned…

20. Arizona Immunization Program Office

21. Questions or Additional Information Andie Denious, MS, RN Immunization Services Manager Arizona Immunization Program Office Phone: 602-364-3626 Fax: 602-364-3285 Email: edeniou@hs.state.az.us Arizona Immunization Program Office