Program implementation

Pascale Wortley, MD, MPH

January 22, 2010

Program Managers Meeting

H1N1 Response: overall structure

Incident Manager

State Coordination Task Force

Community Mitigation

Task Force

Medical Countermeasures

Task Force

Vaccine Task Force

Epi/surveillanceTask Force

Deputy Incident Manager

Chief of Staff

Chief Health Officer

H1N1 Vaccine Task Force

Task Force DirectorJay Butler

Vaccine Task Force Deputy

Tom Shimabukuro

Vaccine Coverage &

Monitoring teamJim Singleton

Gary Euler

Vaccine Data Management

TeamDavid Walker

Doses Administered Team

Jeanne Tropper Warren Williams

Vaccine Effectiveness

TeamDavid Shay

VaccineSafety Team

Claudia VellozziFrank DeStefano

Vaccine Communication& Education Team

Kris Sheedy

Vaccine Distribution

TeamJeanne Santoli

Vaccine Implementation

TeamPascale Wortley

Vaccine Task Force Operations

AnalystEric Marble

Vaccine EOC DeskDuane KilgusVicki Evans

H1N1 Vaccine

Steering Committee

Task ForceChief of Staff

Dave Brownell

Task ForceSenior Deputy for Science

Cynthia Whitney

Status Update• Doses ordered to date (Sept 31-January 15): 120 million doses

• VFC program annual ordering: 80 million doses

• Almost 120,000 provider agreements signed

• Almost 70,000 unique ship-to sites

Cumulative Number of Provider Agreements, H1N1 Vaccine Program, Sept 2009-Jan 2010

0

20000

40000

60000

80000

100000

120000

140000

Pre-launch

Cumulative Number of Ship-to Sites, H1N1 Vaccine Program, Oct 2009-Jan 2010

0

10000

20000

30000

40000

50000

60000

70000

80000

Vaccination Distibution, United States, 2009-2010

0

20,000,000

40,000,000

60,000,000

80,000,000

100,000,000

120,000,000

140,000,000

160,000,000

27-Sep

4-Oct 11-Oct 18-Oct 25-Oct 1-Nov 8-Nov 15-Nov

22-Nov

29-Nov

6-Dec 13-Dec

20-Dec

27-Dec

3-Jan 10-Jan

17-Jan

Date

Do

ses

Pro-Rata Allocations (Received at McKesson)

Ordered by States

Shipped from McKesson to States

As of 15 Jan 2009Pro-Rata Allocation: 139,334,000Advance Allocation: 5,691,500Retail Allocation: 5,521,800

CA Depot: AZ, CA, CO, HI, NV, OR, UT, WA, Pacific Territories

Number of Doses Shipped From Each Depot (7-Day Moving Averages)

OH Depot: IN, MI, MN, NE, NJ, NY, NYC, OH, PA, Philly, WI

GA Depot: AL, CT, DE, FL, GA, KY, ME, MD, MA, NH, NC, RI, SC, TN, VA

Number of Doses Shipped From Each Depot (7-Day Moving Averages)

TN Depot: AK, AR, DC, ID, IL, Chicago, IA, KS, LA, MS, MO, MT, NM, ND, OK, PR, SD, TX, VT, VI, WV, WY, Federal Employees

Note: Among the general population, 43% of those who intend to get vaccinated for H1N1 have already done so.

Projected H1N1 Influenza Vaccination Coverage Based on Reported IntentNHFS, Interviews Conducted September 28 - January 2, 2010

0

10

20

30

40

50

60

70

80

90

100

Vaccinated Will Definitely Get Will Probably Get

Initial Target Children Adults 19-24y Adults 50-64y Adults 65+yTotal Population Adults 25-49y

Reported intention to be vaccinated

Target Group Sample Size Weighted

Coverage95% CI

Population Size estimate (millions)

Pregnant women <30 **NA NA 1.0

Adults living with or caring for infants <6m

(not HCP)69 *19.8% UNK 16.0

Health Care Personnel (HCP) 157 *43.3% 29.9, 56.7 28.4

Persons 6m-24y 1,716 25.9% 20.6, 31.2 101.0

Children 6m-4y 500 *33.0% 21.6, 44.4 19.1

Children 5-18y with medical conditions 109 *53.7% 29.3, 78.1 7.7

Adults 25-64y with medical conditions 192 24.7% 15.8, 33.6 29.4

Total initial target groups 2,101 27.9% 23.5, 32.3 160.2

Limited vaccine subset 807 37.5% 30.1, 44.9 61.5

Total population 3,023 20.3% 17.2, 23.4 299.3

H1N1 Influenza Vaccination Coverage by ACIP Target Groups, NHFS Dec 27, 2009-Jan 02,

2010

*Estimate may not be reliable, (CI half-width/estimate)≥0.6 or (CI half-width)≥10.**Estimates with an unweighted denominator of <30 observations are not reported and are coded as NA.

H1N1 Influenza Vaccination Coverage - childrenSource: National H1N1 Flu survey

• Month of Dec 2009 - picture of mid Dec

Age

• 6-23 months 33.4±6.4

• 2-4 years 30.0±5.5

• 5-18 years 24.2±3.2

– 5-9 years 32.6±5.8

– 10-12 years 21.8±5.6

– 13-18 years 18.7±4.6

Proportion of People Receiving H1N1 Vaccine, by Initial Target Group Status, NHFS Dec 27-Jan 2

Initial Target Group, 73%

Not Initial Target, Aged 25-64y, 22%

Not Initial Target, Aged

65+y, 5%

Note: The proportion of people in non-initial target groups receiving H1N1 vaccine has increased as states have

relaxed prioritization.

Note: In some weeks, black non-Hispanics appear to have somewhat lower coverage rates than other

groups.

H1N1 Vaccination Coverage by Race/EthnicityNHFS, Interviews Conducted September 28 - January 2, 2010

0

10

20

30

40

50

60

White, non-Hispanic

Initial Target Limited Vaccine Subset Total Population

HispanicHispanicHispanic Other non-HispanicOther non-HispanicOther non-Hispanic White, non-HispanicWhite, non-Hispanic Black, non-HispanicBlack, non-HispanicBlack, non-Hispanic

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Cumulative H1N1 influenza vaccination coverageamong children aged 6 months-17 years, by state

based on combined estimates from the December 2009 BRFSS and NHFS interviews

Significantly >30%: Indiana, Massachusetts, Connecticut, South Dakota, Maine, Rhode Island.Significantly >20%: Washington, New York, Ohio, Virginia, Nebraska, Kansas, Iowa, Delaware, Hawaii, New Hampshire, Pennsylvania, Minnesota, Illinois, West Virginia, South Carolina, Vermont, Arkansas.Significantly <20%: Texas.

Combined national estimate=27.6%

Cumulative H1N1 influenza vaccination coverageamong persons 6 months and older, by state

based on combined estimates from the December 2009 BRFSS and NHFS interviews

0

10

20

30

40

50

60

National estimate: 13.6% (12.5-13.7)

Range: 6.2-23.1%

Note: In December, more people reported receiving H1N1 vaccine in non-medical locations, particularly schools and worksites, than in October and

November.Totals do not equal 100% due to “don’t know”

Place of VaccinationNHFS, Interviews Conducted December 2009

0

5

10

15

20

25

30

35

40

45

50

Doctor'sOffice

Clinic orHealthCenter

Hospital OtherMedically-

RelatedPlace

HealthDepartment

Pharmacyor Drug

Store

Workplace School OtherNon-

MedicalPlace

Medical LocationSeasonal 66%, H1N1 60%

Non-Medical LocationSeasonal 31%, H1N1 39%

H1N1

Seasonal

Weekly uptake of seasonal and H1N1 influenza vaccines through January 02, 2010, SDI

Note: An uptick in billing for seasonal and H1N1 influenza vaccinations in physician offices occurred after the Thanksgiving

holiday week, but decreased again during the Christmas holidays.

H1N1 Influenza Vaccine Uptake in Physician Offices, through January 2, 2010, SDI

Note: Observed dips in billing for H1N1 vaccinations represent Thanksgiving and Christmas holiday weeks.

Situational Awareness Project (Univ of Michigan)

Next steps• Completing the campaign, determining how to scale

back efforts

• Evaluation: what are the most important things to learn

» for seasonal vaccination

» for future responses