1. Getting the shots! Let’s get all kids immunized Lawrence J. Losey, MD, FAAP Brunswick Pediatrics, CMMG

2. Maine vs rest=worse! 4:3:1:3 rate from national Immunization survey

3. Shot Schedule, 1979 2 MonthDTPOral Polio 4 MonthDTPOral Polio 6 MonthDTPOral Polio 12 MonthMMR 18 MonthDTPOral Polio 5 YearDTPOral Polio Every 10 yrsTetanus or Td booster

4. Shot Schedule, 2011 (ignoring combo vaccines) BirthHep B 1 MonthHep B 2 MonthDTaPIPVPN13HIBRota 4 MonthDTaPIPVPN13HIBRota 6 MonthDTaPPN13(HIB)(Rota) 9 MonthHep BIPV 12 MonthHIBPN13Hep A 15 MonthDTaPMMRVZV 18 MonthHep A 5 YearDTaPIPVMMRVZV 11 YearTdaPMCV4HPV 16 YearMCV4 YearlyInfluenza

5. New focus--Teens

6. Maine not a leader

7. Skyrocketing Cost19801996200020062009 DTaP/DT wP 3796114105152 Td/TdaP26173656 Polio5516891125 MMR15939081125 HepB425164100 VZV6459104251 PCV0219277333 MCV40082123 HepA006178 Flu <3 0052 Flu >3 0022167 Rota00190296 HPV00360478 Total5935261815252554

9. Hepatitis A in US Hep A vaccine available Vaccine for High Risk States Vaccine for All States

10. Hep A Immunization Childhood rates, not teen

11. How have we paid? In 80’s cost was minimal In 90’s developed “Gentlemen’s Agreement” with MCO’s for universal coverage--about $1M/yr Fell apart for multiple reasons More Vaccines More expensive More “self-funded” Less “317” money from CDC For brief period, only VFC children State funding allowed “universal select” for school mandated

12. Solving the Cost PL595 Passed last year, established Maine Vaccine Board Provides funding mechanism to immunize ALL Maine children through insurance/TPA assessments Vaccines to be available January 1, 2012 Vaccines for ALL diseases recommended by ACIP Assessment budgeted at $6.98/PMPM (<19)

13. How will it work? Maine Vaccine Board--10 members (3 Insurers, 3 providers, 1 from self-insured [employers], 1 from industry, one each from DHS & state treasurer) Establish vaccine list, budget, assessment Collect money from insurers and TPA and send to Maine Immunization Program

14. How do you join? Same as current vaccine for VFC Will need to use ImmPact2 for ordering Can be simply aggregate reporting, not by dose (lose biggest benefit of registry then) Will need to anticipate for ordering in fourth quarter (from Maine Immunization Program and private sources) Unsure what insurance company will do in interim for payment for purchased vaccines

15. How do we prepare? Aim for zero stock of privately purchased vaccine on 1/1/12--realistically need some to assure full vaccines until then Participate in Maine Immunization Program--if currently using for VFC, you are all set Use ImmPact for ordering and inventory (also use for full registry if possible) Decide which vaccines and what schedule you will use