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

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 = y. and y. Initial target = y. and 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

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

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)

An Example – Baltimore’s ACE ACE – Action for Community Enrichment (iz coalition) ACE – Action for Community Enrichment (iz coalition) Founded “Good Neighbor Flu” – HCFA (CMS) $ Founded “Good Neighbor Flu” – HCFA (CMS) $ Initial focus: urban minority seniors, Medicare flu/pneu Initial focus: urban minority seniors, Medicare flu/pneu : 48,369+ Baltimoreans immunized : 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

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

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

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: coverage rates for month olds rise 17.8% Future: ?Regulations-college/grad/trade school, food services, HCWs, criminal justice system – with IIS input

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

SCENARIOS Small – strong LHD staff (nurses/CHE/IT) + media + iz coalition targets adult iz to 19-26, 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

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

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 ( E ) ( C )