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Flu Vaccine Shortage – 2004-2005 Department of Veterans Affairs Experience

Lawrence R. Deyton, MSPH, MD Chief, Public Health Department of Veterans Affairs. Flu Vaccine Shortage – 2004-2005 Department of Veterans Affairs Experience. National Vaccine Advisory Committee February 8, 2005. Outline. Who is VA? Usual Flu Vaccine Program Response to the Shortage

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Flu Vaccine Shortage – 2004-2005 Department of Veterans Affairs Experience

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  1. Lawrence R. Deyton, MSPH, MD Chief, Public Health Department of Veterans Affairs Flu Vaccine Shortage – 2004-2005Department of Veterans Affairs Experience National Vaccine Advisory Committee February 8, 2005

  2. Outline • Who is VA? • Usual Flu Vaccine Program • Response to the Shortage • Lessons Learned

  3. Who is “VA” ? Veterans Health Administration • 5.1 million patients, ~ 7.5 million enrollees • ~ 1,300 Sites-of-Care • 158 medical centers or hospitals, • ~ 850 clinics, long-term care, domiciliaries, home-care programs • ~ $27.4 Billion budget • ~193,000 Employees (~15,000 MD , 56,000 Nurses, 33,000 AHP)

  4. Who is “VA” ? Veterans Health Administration • Affiliations with 107 Academic Health Systems • Additional 25,000 affiliated MD’s • Largest provider of health professional education • Most US health professionals (70% MD’s) have some training in VA (80,000+ trainees in 2004) • ~ $1.7 Billion Research Program • Basic, Clinical (Cooperative Studies), Rehabilitation, Health Services

  5. Fully Deployed Electronic Health Record

  6. Clinical Reminder System Links Reminder Contemporary Expression of Practice Guidelines Drives Performance Time & Context Sensitive Reduce Negative Variation Create Standard Data set With the Action With Documentation

  7. Typical Flu Program Cycle • January—contract written for next year’s purchases • Summer—Influenza Program Directive drafted—priorities, clinical information • Summer—Influenza Tool Kits prepared • Early Fall—Influenza Program Directive released; Tool Kits distributed; vaccine shipments begin to arrive • Throughout year—ID, Public Health, Pharmacy, Prevention meet regularly to plan, trouble-shoot

  8. VA’s Flu Vaccine Purchases

  9. VA Flu Immunization Performance MeasureRates—Chart Review Source: External Peer Review Program (EPRP) Surveys, 2003 and 2004, 11 clinics + SCI & D

  10. FY 03 All (> 49 yo) 75% >64 yo 84% NH Whites 74% NH Blacks 60% Non-VA vaccine 45% n=102,347 FY 04 All (> 49 yo) 82% >64 yo 88% NH Whites 83% NH Blacks 72% Non-VA vaccine 38% n=159,142 Veterans’ Self-Reported Vaccination Rates Source: Survey of Healthcare Experiences of Veterans (SHEP)

  11. October 5, 2004—Potential Eligibles within VA SystemVA Worst-Case Scenario • Estimated 80% of 7.5 million enrollees • over 65 • or with qualifying chronic illness • Estimated 60% of VHA employees • + trainees + volunteers • Total vaccine potential need 6 M doses following revised CDC criteria • VA expected < 2.2 mil doses

  12. VA—Response to Shortage • Assessed VA purchase: 100% purchased from Aventis Pasteur • Expected shortage: in 2003-4 season, of those who got vaccinated, 38% got it from non-VA source • Most of these expected to come to VA for vaccination • Entered discussions with CDC and AP to assure VA vaccine supply

  13. VA—Response to Shortage Six VA Under Secretary for Health “Flu Vaccine Advisories” October - January • Established priority groups to receive vaccine • Defined “hands-on” health care providers • Provided contacts for questions • Provided status updates of vaccine supplies • Clarified VA relationship to state/local health departments • Recommended appropriate use of antivirals • Redefined priority groups

  14. VA—Response to Shortage • Distributed Advisories broadly via email and other channels • Arranged purchase of LAIV • Re-assessed regional supplies of vaccine in mid-December • Re-distributed vaccine within VA regions in December and January • Removed restrictions January 21, 2005

  15. Estimated Usage2005 • 21 VHA regions surveyed mid-December, 2004 • 73% of vaccine used (range 58% to 91%) • Within-region re-distribution occurred • No region needed more

  16. Ongoing Activities • Non-vaccine preventive measures encouraged in a national campaign: Infection: Don’t Pass It On http://www.publichealth.va.gov/infectiondontpassiton

  17. Lessons Learned • Multiple Sources for VA Vaccine Needed • Clear, timely communication is vital • Within VA • With CDC, state/local health departments & other agencies • With pharma • Needed: • understanding of patient decision-making surrounding immunization • data on vaccine uptake, outcomes within VA • ongoing education of patients and staff about importance of flu vaccine, differences in formulations, non-vaccine preventive measures

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