Implementing a Statewide School-Based Influenza Vaccination Program

1. Implementing aStatewide School-Based Influenza Vaccination Program Carl Chu, PharmD Hawaii Department of Health

2. Paul V. Effler, M.D., M.P.H.

4. Hawaii’s Rationale for Statewide School-Based Influenza Vaccinations • Only one public school system statewide • Success implementing other school-based vaccination programs (i.e., hepatitis B vaccine for 5th graders) • To be prepared for possible mass vaccinations of school children during an influenza pandemic • Evidence of substantial seasonal influenza attack rates in children including reports of school outbreaks

5. Flu Testing and Results by Age Group in Hawaii, 2001-2008 Preliminary data

6. Hawaii’s Rationale for Statewide School-Based Influenza Vaccinations • Ideal setting for assessing impact • Hawaii’s geographic isolation means residents usually receive medical care within state • Statewide hospital discharge databank that may be used to ensure comprehensive ascertainment of influenza hospitalizations (http://www.hhic.org/about.html) • Two major health care providers/payers • Provide 72% coverage of civilian population (930,381 of 1,285,498 in 2006) • Should permit robust assessment of effect of program on health care encounters, including outpatient visits, statewide

7. Children Age 5-13 years Vaccinated against Flu in Hawaii, 2006-07 • Only 20% of 44,725 privately insured children • Only 40% of 8,154 privately insured asthmatic children • Only 50% of 68 privately insured diabetic children Preliminary data

8. Hawaii’s Stop Flu at School Program • Grades K-8 • All Hawaii public and private schools asked to participate • Offered TIV (shot) and LAIV (nasal spray) • Two clinics >6 weeks apart if school had children age <9 years who might need 2 doses • Voluntary written informed consent of parents/guardians required Preliminary data

9. Hawaii’s Stop Flu at School Program Timeline Schools Asked Order Vaccines Schools Scheduled Consents Sent Consents Due/Review Staffing Arranged Promotion Clinics 59 working days Preliminary data

10. Hawaii’s Stop Flu at School Program • School Participation • 340/377 (90%) of all schools with grades K-8 • 242/251 (96%) of public schools • 98/126 (78%) of private schools • 622 school-based clinics (277 second dose clinics) Preliminary data

11. Hawaii’s Stop Flu at School Program • Student participation: • 63,153(94%) of 67,203 students who consented • 43% of 146,777 children at participating schools vaccinated • 46% of 132,775 children aged 5-13 years in Hawaii according to census • 18,172 children received 2nd dose • 81,325 total flu vaccine doses given • School staff participation: ~9,281 school-based staff vaccinated, representing (43%) of the workforce cohort Preliminary data

12. Proportions of Influenza Vaccine Formulation Administered during Hawaii’s Stop Flu at School Program, 2007-08 ADMINISTERED PREFERENCE LAIV 26% TIV 56% Either 18% Preliminary data

13. Transit Times* at School Vaccination Cinics, Hawaii 2007-08 *Based on n = 1,970 students at 199 schools; approx 10 students/school Preliminary data

14. Hawaii’s Stop Flu at School Program • Cost for 2007-2008 program: Average of $23.69 for every flu vaccine dose administered. Preliminary data

15. Summary • Keep kids healthy and in school • Help keep older adults and pre-school kids healthy • Enhance our capability to respond to a potential pandemic • Strengthen relationships with all community partners, including public, private, professional, and individuals

16. Mahalo!