Immunization Program 2009 H1N1 Adventure

1. Immunization Program2009 H1N1 Adventure Governor’s Child Health Advisory Committee Immunization Workgroup Topeka, KS February 19, 2010 Sue Bowden, RN, BS Immunization Program Manager Kansas Department of Health & Environment To protect the health and environment of all Kansans by promoting responsible choices.

2. Received Health Alert Network notice regarding 1st H1N1 case in Kansas. April 24, 2009 To protect the health and environment of all Kansans by promoting responsible choices.

3. May 2009 • Began discussions with registry staff and KDHE IT staff about documentation of patient level data for mass vaccination clinics. To protect the health and environment of all Kansans by promoting responsible choices.

4. June 2009 • Received first communication from CDC regarding estimated allocation of H1N1 vaccine under different planning scenarios. • Scenarios ranged from an initial vaccine shipment to Kansas of 360,000 to 1.5 million doses with 90,000-300,000 doses per week after that. • Program staff discussed plans for surge capacity for vaccine ordering, distribution and inventory management. • Conference call with GIV regarding 3rd party distribution, in addition to investigation of local resources for receipt and distribution of vaccine by KDHE staff. • ARRA grant application To protect the health and environment of all Kansans by promoting responsible choices.

5. July 2009 • Developed plans for enhancement of the immunization module for the preparedness KS-CRA information system. • First vaccine is projected to be available by late fall • Annual CDC Grant application preparation To protect the health and environment of all Kansans by promoting responsible choices.

6. August 2009 • Met with KSWebIZ vendor to define modifications to KS-CRA system for H1N1 vaccine inventory management and doses administered reporting. • Received first hint that vaccine may be made available as early as mid September. • Participated in weekly conference calls with LHDs and their partners. • Vaccine availability projections change. • 8/05 120M doses (1M doses for KS) • 8/14 45M doses (408,000 doses for KS) To protect the health and environment of all Kansans by promoting responsible choices.

7. August continued • Developed process for granting user access to immunization module of KS-CRA system. • Developed online system for H1N1vaccine provider pre-registration. • Encouraged early vaccination with seasonal flu vaccine • Drafted H1N1 Provider Enrollment Form • Communicated Target Groups for vaccination • McKesson was named as centralized vaccine distributor so local distribution of Kansas vaccine allocation would not be necessary. To protect the health and environment of all Kansans by promoting responsible choices.

8. September 2009 • Kansas one of 22 states with an established process for pre-registering private sector providers for H1N1 vaccine administration. • Approximately 920+ providers had pre-registered on the KDHE website by the first week of September. • Conducted webinars with LHDs to clarify provider enrollment process. • Local Health Departments began vetting and approving private H1N1 providers within their county • Finalized the H1N1 Vaccine Distribution Plan with local, state and federal input. To protect the health and environment of all Kansans by promoting responsible choices.

9. Kansas H1N1 Vaccine Plan http://www.kdheks.gov/H1N1/download/KS_H1N1_Vaccine_Distribution_Plan.pdf To protect the health and environment of all Kansans by promoting responsible choices.

10. The immunization team spent many hours working through each step of the process to • Enroll providers • Submit and approve orders by the LHD • Place orders with CDC by KIP • Enter vaccine shipments into KS-CRA inventory • Accomplish weekly on-hand inventory amount reports by providers To protect the health and environment of all Kansans by promoting responsible choices.

11. Process Flow – Vaccine Distribution To protect the health and environment of all Kansans by promoting responsible choices. To protect the health and environment of all Kansans by promoting responsible choices.

12. September Continued • Developed tools for daily and weekly allocation of vaccine to counties. • Developed vaccine storage and handling protocols; identified resources for reputable vaccine storage equipment; drafted standing orders for H1N1 vaccine administration and patient documentation and consent form. • Initial KS-CRA customization for vaccine inventory management and patient level documentation completed. (6 weeks from 1st JAD session!) • Began process to create KS-CRA accounts and grant users access to the system. • Conducted KS-CRA training for local health departments To protect the health and environment of all Kansans by promoting responsible choices.

13. September Continued • Sept 18 • Vaccine availability projections continue to change. Initial KS allocation of vaccine expected to be 27K doses instead of larger amounts previously communicated. • Kansas one of 11 states with signed H1N1 provider agreements in place • Sept 30 • Received first allocation of H1N1 vaccine from CDC • 16,300 doses of LAIV The challenge changed from coping with a large amount of vaccine to coping with a small amount of vaccine that could not be given to all of the highest risk individuals. To protect the health and environment of all Kansans by promoting responsible choices.

14. October 2, 2009 • First vaccine allocation amounts were communicated to each county • Processed all vaccine orders submitted by LHDs that day (1,400) H1N1 Vaccine Distribution Began! To protect the health and environment of all Kansans by promoting responsible choices.

15. October 2009 • 1552 providers had pre-registered and 498 had been approved by LHDs by the first week of October. • Continued to communicate provider enrollment, vaccine ordering and documentation process during the KDHE weekly conference call with LHDs and their partners. • Developed web-based training for administration of both injectable and nasal vaccines To protect the health and environment of all Kansans by promoting responsible choices.

16. Vaccine Distribution & Administration Challenge • Vaccine came from five manufacturers and was licensed for different age groups To protect the health and environment of all Kansans by promoting responsible choices.

17. October Continued • Distributed an average of 41,000 doses of vaccine per week for a total of 164,000 doses during the month of October. 68,000 doses reported as administered. • Four functions required significant staff time • Provider enrollment • Vaccine orders • Inventory management of doses shipped • Doses administered reporting • KS-CRA/KSWebIZ data quality • Immunization team met weekly to review processes and reassign resources. • Immunization program staff averaged over 200 H1N1 calls per day • Essential VFC program operations were maintained • Remaining LHDs were brought on to KSWebIZ through bidirectional interface To protect the health and environment of all Kansans by promoting responsible choices.

18. Provider Enrollment Comparison To protect the health and environment of all Kansans by promoting responsible choices.

19. H1N1 Doses Allocated/Shipped/Administered • Data as of February 18, 2010 • Doses distributed = 76% of doses allocated to KS. To protect the health and environment of all Kansans by promoting responsible choices.

20. H1N1 Doses Administered • 626,000 H1N1 doses reported as administered • 70% of doses distributed • 53% of doses allocated to Kansas To protect the health and environment of all Kansans by promoting responsible choices.

21. November 2009 • Distributed an average of 83,000 doses of vaccine per week for a total of 332,000 doses during the month. 170,000 doses reported as administered in November To protect the health and environment of all Kansans by promoting responsible choices.

22. December 2009 • Distributed an average of 77,000 doses of vaccine per week for a total of 309,000 doses during the month. 255,000 doses reported as administered in December To protect the health and environment of all Kansans by promoting responsible choices.

23. January 2010 • Distributed an average of 17,000 doses of vaccine per week for a total of 85,000 doses during the month. 110,000 doses reported as administered in January To protect the health and environment of all Kansans by promoting responsible choices.

24. February • Distributed 3,300 doses thus far this month. 23,000 doses reported as administered To protect the health and environment of all Kansans by promoting responsible choices.

25. KIP distributed a total of 893,000 doses of H1N1 vaccine in the four months since the first week of October During CY 2009 KIP distributed 643,000 doses of all VFC vaccines To protect the health and environment of all Kansans by promoting responsible choices.

26. Questions? To protect the health and environment of all Kansans by promoting responsible choices.