1. Local Health and H1N1 Anne Bailowitz, MD, MPH Acting Chief Medical Officer Baltimore City Health Department NVAC Conference January 20, 2010

2. Local Health and H1N1: Expansion of Target Groups Expansion of vaccination to the general population is a challenge during December-January. The decline in disease activity + post-holiday torpor + ”advertising anesthesia” have resulted in diminished turnouts for mass clinics: response to regular Baltimore Immunization Clinics and 2 nd dose school-located vaccination (SLV) remains steady. In Maryland, 3 of the top 5 lead jurisdictions have used SLV as the approach of choice and 2 have used the mass clinic venue. Creative advertising approaches in metro areas include use of: Twitter; sandwich board advertising; sidewalk/street painting; and autodialer calls. Staff burnout is a significant factor as the vaccination effort continues: temporary staffing is essential to mission completion. One-third of Baltimore’s Immunization Program is staffed with temporary or new personnel. Despite these challenges, pediatric vaccination for the “traditional” vaccine-preventable diseases has not been sacrificed.

3. Local Health and H1N1: Supply and Demand Challenges The current situation is the opposite of Fall: vaccine supply now exceeds demand. Approaches: - Complete second doses in high-yield sites: 16% of Baltimore City’s 82,000 school children have received at least 1 dose of vaccine through the Health Department (HD); 63% of all City HD H1N1 doses were administered via SLV programs - Couple seasonal vaccine with H1 vaccine option - Go to underserved areas: shelters in metro areas - Set up mobile Vaccination SWAT Teams: 2-3 nurses + additional non- clinical staff to address requests of small churches, etc - Get into the community with standing sites in the workplace e.g. Wednesday 1-4 at the Post Office, transit hubs, etc. - Connect with the Bureau of Tourism and schedule vaccination clinics in conjunction with special events e.g. Restaurant Week in Baltimore January 22 – January 31

4. Local Health and H1N1 Vaccine: Lessons Learned Mismatches between supply and demand require quick, creative thinking and persistence. Decisions re: when and how to ratchet down the H1 immunization effort, albeit temporarily pending H1 resurgence, need to be made soon. Data for making decisions include but are not limited to: disease activity, public vaccine demand, population vaccine coverage goals, and data entry status. Staff burnout is a serious problem: it should be treated immediately and requires more than increased use of temps. While the incident command structure is a useful approach to the H1N1 immunization effort, its interface with daily public health function/structure requires additional consideration.

5. Local Health and H1N1 - Future Complete 2 nd dose SLV efforts - January Consider day care approaches - February Add special populations e.g. shelter-based January- February Decrease mass clinics - February Shift to decentralized operations via Vaccination SWAT Teams in the community - February Work with state/federal leadership in formulation of step-down parameters and schedule - now Facilitate normalization of operations via transition back to the medical home for immunization as feasible – “soon”