1. Barry S. Lachman, MD, MPH Medical Director 11/4/2011

2. The Issue Vaccine utilization rates remain low The ACIP has endorsed universal vaccination Influenza has a high impact on Medicaid STAR plans in the first quarter of every year Influenza poses an increased risk in pregnant women Cocooning has been proposed as a strategy to improve protection against disease spread

3. Pregnant Women and Children under Age 1 Influenza poses increased risk in pregnant women Influenza has an increased risk in children under one year Influenza vaccine cannot be given under on six months Vaccination of pregnant women has been shown to lower risk in their children under a year Influenza vaccine is safe during pregnancy OB providers often do not provide immunizations

4. Targeted Populations Pregnant women and their children under one year Children under 18 Parents and other household members

5. PCHP Response:Pregnant Women Produce a brochure in collaboration with Merck Vaccines to promote immunization of pregnant women for pertussis and influenza Provide the brochure to offices of community ob providers in the Parkland Community Health Plan Medical Director academic detailing to high volume community providers on vaccination during pregnancy Parkland Hospital which accounts for 2/3 of PHCP 22,000 deliveries per year (1:1000 US births!) routinely offers pertussis and influenza vaccine

6. PCHP Response: Children Expansion of the partnership with Pfizer Vaccines to use Televox automated calls and reminder cards for immunization from present 12-18 month olds to all children in PCHP under age 5 Working on developing a similar partnership for children over age 5 with another vaccine manufacturer

7. PCHP Response: Adult Cocooning The issue – many parents of PCHP members are uninsured Possible response – provide vaccine vouchers to parents of PCHP members Barrier – Rules on use of Medicaid funds for non members PCHP is exploring this strategy further

8. Contact Information For further information contact Barry S. Lachman, MD, MPH, Medical Director PCHP Barry.lachman@phhs.org 214-266-2104