1. A Targeted Approach to Vaccinating School-Aged Children: Selecting Schools for H1N1 School Located Vaccination (SLV) Efforts Susan Ashkar, MA Kathleen M. Sanchez, PhD, MPH Michelle T. Parra, PhD Los Angeles County Immunization Program

2. Objectives 1.To provide an overview of three, collaborative outreach strategies used to vaccinate school-aged children (grades K- 12) in Los Angeles County 2.To describe three approaches to implementing H1N1 School Located Vaccination (SLV) clinics 3.To review the successes and lessons learned to improve upon future collaborative efforts with SLV clinics

3. Overview of K-12 Schools in Los Angeles County There are 80 school districts in Los Angeles County – District sizes vary from <50 to nearly 700,000 students –Over 2,100 schools (including private, parochial and charter schools) –Approximately 2 million 5–18 year olds in LAC Access to routine immunization services on campuses –School-based clinics –School nurses –Mobile Units/Travelling medical staff

4. Figure 1. Los Angeles County School Districts

5. H1N1 Vaccine Ordering and Allocation Vaccine Ordering –All providers used same ordering mechanism California statewide website: www.CalPanFlu.org Vaccine Allocation –From CDC to California State Department of Public Health to Los Angeles County Immunization Program (LACIP)

6. Prioritizing Vaccinators of School-Aged Children – Tier 1: Pediatricians; Family Practitioners; OB/GYN; School Districts; School-based Clinics (K-12); Mobile Vans serving Schools; Non-Profit Community Health Centers and DHS Clinics – Tier 2: Internal Medicine Practitioners; University/College Health Services Centers; Mobile Vans not otherwise included and Multispecialty Clinics – Tier 3: Long-Term Care; Corrections; Surgical Centers; Pharmacies Other Community Vaccinators not already covered

7. Strategies Implemented To Vaccinate School-Aged Children in LAC DPH Points of Dispensing (PODs) – Mass vaccination clinics held in pre-determined areas identified as ‘low-access’ –Mid-October thru December 8, 2009 –109 PODs –65% of parent-friendly days/hours: Weekdays 6 p.m. to 9 p.m. Saturdays and Sundays –Site locations: Community Centers; Parks and Recreation Centers Private Providers Community Based Organizations School Located Vaccination (SLV) Clinics

8. Educational Campaign Targeting Schools Mass Education Campaign –School Presentations: reached 3,460 school representatives/partners –Technical Assistance – Parent Education Packet –Web-based School Tool Kit http://publichealth.lacounty.gov/ip/school/FluToolKitOverview2009.htm http://publichealth.lacounty.gov/ip/school/FluToolKitOverview2009.htm (Data Source: EPRP School Meeting and Seminar Report, 3/12/2010)

9. Approaches to Implementing H1N1 School Located Vaccination (SLV) Clinics Phase I: Mid October thru December 31, 2009 –Limited Vaccine –High Demand Phase II: January 1, 2010 thru February 28, 2010 –Targeted Approach -‘Schools In Need’ –Ample Vaccine –Reduced Interest Phase III: March 1, 2010 to the Present –DPH Facilitated Vaccination Effort –Limited Interest

10. Phase I: October 2009 to December 31, 2009 Model 1: School Facilitates & Staffs Event School prepares & copies forms, promotes event & handles setup School provides vaccine School nurses document health data & vaccinate LACIP provides technical assistance

11. Phase I: October 2009 to December 31, 2009 Model 2: School Partners with Mass Vaccinator School prepares & copies forms, promotes event & handles setup Mass vaccinator provides nursing staff to support either ‘full service’ clinics or to serve in ‘plug in’ capacity LACIP serves as liaison between school nurses and mass vaccinator & provides technical assistance

12. Figure 2. Snapshots of a SLV Clinic

13. Phase I: October 2009 to December 31, 2009 Model 3: School Partners with Mobile Van Units School prepares & copies forms & promotes event Mobile van staff serves as on-site vaccinator LACIP serves as liaison between school nurses and mobile van unit & provides technical assistance

14. Figure 3. Los Angeles County School Districts

15. Phase II: January 1, 2010 to February 28, 2010 Algorithm to Identify ‘Schools in Need’ 5 data points were used to create an algorithm that would identify ‘schools with limited access to H1N1 vaccine’ by zip code. We included real time data on vaccine allocation to external partners and doses administered during the PODs

16. ‘Schools In Need’ Algorithm A Zip Code was chosen as having ‘Schools In Need’ if it met 3 or more of the following criteria: –If the zip code was identified as a LACIP ‘pocket-of-need’(PON) –If >50% of doses allocated in the zip code went to providers NOT serving healthy children (e.g., OB/Gyn and Hospitals) – If the zip code had been allocated less than 1,000 doses to date –If the zip code had 3 or more schools with 50% or more of its students on the ‘Free or Reduced Lunch Program’ –If a POD was NOT held in the zip code

17. Phase II: January 1, 2010 to February 28, 2010 Interest in H1N1 vaccine diminishing Only 2 school districts continued to place orders for vaccine after January 1st, however, schools continued to deplete vaccine supply The largest school district used mass vaccinators to focus on identified ‘Schools in Need’

18. Schools Partner with DPH Public Health Nurses Director of Public Health offers Free, on-site vaccination clinics to all public and private schools School provides space, security & promotes event LACDPH prepares & copies forms LACDPH provides vaccine & vaccinators Mass vaccinators serve in a ‘plug in’ capacity Phase III: March 1, 2010 to Present

19. H1N1 Doses Administered to School-Aged Children 5 – 18 years* *Data are preliminary Sources: LACDPH POD Data, California Immunization Registry (CAIR), CalPanFlu.org, LACIP Scanned Data, LACIP telephone correspondence PODs 52,841 External Partners167,342 Schools104,036 Total Doses324,219

20. Lessons Learned Importance of school relationships/school buy-in Importance of understanding school capacity Impact of school holiday calendar Consent process Organized and standardized data collection Mass vaccinators

21. QUESTIONS?

22. For further information, please contact: Susan Ashkar, MA County of Los Angeles Department of Public Health Immunization Program 3530 Wilshire Blvd Suite 700 Los Angeles, CA 90010 Phone (213) 351-7800 Fax (213) 351-2780 sashkar@ph.lacounty.gov