The Indiana Immunization Coalition exists to promote childhood immunization and raise community awareness about immunization issues

The Indiana Immunization Coalition exists to promote childhood immunization and raise community awareness about immunization issues.

The Indiana Immunization Coalition is a volunteer organization which

represents over 165 agencies from many different disciplines that are concerned about the immunization

of children.

Why Coalitions?

The health coalition movement is an emerging trend in the healthcare community. As society moves toward a greater focus on health and wellbeing for all citizens, the immunization coalition model will be replicated across many issues and ultimately will be the catalyst for changing the way communities look at health. Immunization Coalition Sustainability Project

Building Community Partners

“It is no longer just about the public health system. It includes private health care systems, private industry, and the nonprofit community. Coalitions bridge those systems and build a healthier community.” Immunization Coalition Sustainability Project

GOALS

• Promote and support statewide immunization registry development and use.• Develop marketing/awareness strategies for immunization issues.

• Provide statewide leadership to create opportunity for participation, education and collaboration on immunization issues.

IIC Beginnings•Support the statewide immunization registry.

•Share immunization information with organizations who are concerned with the welfare of children.

•Developed “Best Practices” brochure for providers.

•Actively supported, monitored and influenced policy regarding immunization bills in the state and federal legislature.

•Filmed and distributed an immunization awareness Public Service Announcement featuring former First Lady Judy O’Bannon.

CHIRP

Every Child By Two Registry Mentoring Grant

Shots For Tots

The Indiana Immunization Coalition Appreciation Awards recognize efforts in advocacy, registry, education and collaboration

Child health data shows a significant reduction in well baby checks and immunization visits after a child turns one year of age.

Immunize Hoosier Children

• 22% of Hoosier children don’t receive recommended immunizations by age 2

• Indiana ranks 39th nationally in immunization for 2-year-olds

• Allocate $11M to expand the child vaccination program

• Saves $25 in additional health expense for every additional $1 spent on childhood immunizations

Indiana’s Immunization Challenge

Proposed Solution

The Governor’s Plan for a Healthier IndianaSource: ISDH

www.inimcoalition.org

Why Adolescent Immunization?

• Many adolescents are under-immunized, putting their health and their futures at risk.

• Many states have implemented “catch-up” requirements for Hep B, MMR#2, Dtap.

• New vaccines are being developed many specifically for adolescents.

Adolescent Immunization

“The good news is we can now prevent so many diseases.

The bad news is it’s gotten more complicated.”

Dr. Anne Schuchat, U.S. Centers for Disease Control and Prevention, Immunization Programs.

Diseases Prevented by Vaccination of Children and Adolescents

January 1987 January 2007

DiphtheriaTetanus DTPPertussis

Diphtheria Hepatitis BTetanus DTaP VaricellaPertussis HPV

Polio - OPV Polio – IPV Pneumococcal

Disease

MeaslesMumps MMRRubella

Measles InfluenzaMumps MMR RotavirusRubella Hepatitis A

Hib - polysaccharide Hib – conjugate Meningococcal Disease

Vaccine Recommendations by Age Group, 2003 and

2007

2003 Diseases

Maximum Vaccine Doses

2007 Disease

s

Maximum Vaccine Doses

Children <2 years of age

11 20 14 28

Children 4-6 years

7 3 9 6 †

Children 11-12 years

2 1 5 5 ††

† Assumes 2 doses of influenza vaccine for 4 year olds†† Includes HPV, 3 doses for females only. For males, 4 diseases and 2 doses

Adolescent Immunization Barriers• Few well child visits-approximately 60%

receive primary care from a pediatrician or family physician. Others have different provider or no provider at all.

• No measurement or accountability system at state or local level

• May need to consider other points of access such as schools

Vaccination Success and Stresses, Walter Orenstein, MD

VT 85

81

Estimated Vaccination Coverage with the

4:3:1:3:3* Series, by Coverage Level and State 2004- National Coverage = 81%

*4+DTP, 3+Polio, 1+measles-containing vaccine, 3+Hib, 3+HepB

83 79

81

80

83

82

79

84

82

82

86

79

77

81

78

84

6871

83

82

75

81

79

78

89

85

82

80

8187

86

78

85

82

82

82

86

82

75

72

73

NJCT

MANH

RI

DC

DEMD

8689878883868083

80-89%70-79% 69%

90%

How is Your County Doing?

Healthy People 2010 Goal

•Immunization rate of 90%

VACCINATE BEFORE YOU GRADUATE INDIANA

2004 ENVIRONMENT • The state of Indiana passed new legislation

requiring 9th and 12th graders receive the Hepatitis B vaccine.

• A new recommendation for meningococcal immunization was forecasted for the coming year as well as a new vaccine.

• Pertussis was being added to tetanus and strongly recommended for adolescents.

• HPV wasn’t on the radar.


HEPATITIS B VACCINE LAW• Law passed in 2004, effective 6/05-6/08• Affects 9th and 12th graders• No school record audit or reporting to ISDH

required• No suspension of students if don’t meet the

requirement• An opportunity to promote Hepatitis B, other

vaccines for adolescents.


Adolescent Subcommittee The committee’s first meeting was in the spring of

2004. The committee is comprised of representatives from Indiana Immunization Coalition, Indiana State Department of Health, Indiana Department of Education, Kiwanis, School Nurse Association, Sanofi Pasteur, GlaxoSmithKline, Managed Health Centers and the Meningitis Foundation.


Promoting Immunization through community networks is a proven means to build trust and acceptance of vaccines.

Why Invest in Communication for Immunization? Silvia Waisbaord and Heidi J. Larson


MAP ITMobilize individuals and organizations

Assess the areas of great need

Plan your approach, start with a vision

Implement you plan with action steps

Track your progress

Healthy People 2010


PROGRAMSRhode Island developed a marketing

campaign as well as school based clinics.Virginia developed a marketing campaign,

tool kit and held a national satellite conference.

Arizona used at risk students to develop an award winning marketing campaign.


PLAN The vision of the Vaccinate Before You

Graduate program is to develop a statewide initiative that increases adolescent immunization coverage through education, collaboration and vaccination.


IMPLEMENTATION The committee created and implemented a

model program to share with others throughout the state. The program originally focused on Meningococcal, Tetanus, Hepatitis B, Varicella and Measles Mumps and Rubella.


PILOT PROGRAMS

• Hammond

• Vanderburgh County

• Vigo County


TRACKING

PROGRESS

OVER TIME


2006 HEALTH DEPARTMENT SURVEY

• 66% of Health Departments participated

• 50% had started a Hepatitis B program for adolescents

• 10% had started a VBYG program

• 62% were collaborating with schools

• 84% focused the program on high schoolers



• 35% of Health Departments participated

• 63% had started a Hepatitis B program for adolescents

• 16% had started a VBYG program

• 78% were collaborating with schools

• 88% focused the program on high schoolers



• School nurses did the paperwork

• 61% used postcards for notification

• 38% conducted special clinics hours

• 20% conducted school clinics

• 10% were using VBYG materials



• School nurses did the paperwork

• 84% used postcards for notification

• 22% conducted special clinics hours

• 19% conducted school clinics

• 16% were using VBYG materials


2006 HEALTH DEPARTMENT SURVEY• Difficult to complete due to vaccine shortages• Difficult to offer all vaccines at school based

clinics• Difficulty with staffing issues to do more• Great collaboration with school nurses


2007 HEALTH DEPARTMENT SURVEY• Increase in offering other vaccines from 2% to

34%• Reported reduction in school based clinics due to

poor turn out.• Collaboration with schools consists of schools

sending out Hepatitis B letter and health departments immunizing children.

• Staffing issues make it difficult to do more.


2007 SCHOOL NURSE SURVEY• Sent out required Hepatitis B letter.

• Eager for immunization information.

• Reported little contact with local health departments.

• Liked school based clinics.


UNEXPECTED OUTCOMES

• Vaccine availability-Healthy Indiana Plan

• School nurse module for CHIRP


“The campaign’s success relies in part on vaccine supply.”

Dr. Anne Schuchat, U.S. Centers for Disease Control and Prevention, Immunization Programs.

VFC and Section 317 Vaccine Funding to Immunization

Programs

$0

$200,000,000

$400,000,000

$600,000,000

$800,000,000

$1,000,000,000

$1,200,000,000

$1,400,000,000

$1,600,000,000

$1,800,000,000

$2,000,000,00019

90

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

PB

Section 317

VFC


VACCINE AVAILABILITYJanuary 2007--The Governor renewed his

legislative proposal to increase Indiana’s tobacco excise fees and introducing the Healthy Indiana Plan. The Plan would provide smoking cessation programs, fund the children's vaccine gap and provide insurance coverage for adults.


VACCINE AVAILABILITY May 2007—ISDH became one of the first

pilot site for VMBIP (Vaccine Management Business Improvement Project).

August 2007-- ISDH evaluating vaccine ordering system to ensure timely delivery of vaccines.


We may need to consider other points of access

such as schools.

Vaccination Success and Stresses, Walter Orenstein, MD

School Facts

• 22% of Indiana’s Citizens are 5 – 19 yrs. old

• Kindergarten to Grade 12– Public school

• 1,045,702

– Private school• 109,124

– Home school• 23,455

*2006-2007 Department of Education

School Facts

• School vaccination laws – Vary from state to state– Indiana allows for medical

and religious exemptions– Failure to vaccinate

results in exclusion from school

Documentation in Schools

• Parents must provide documentation for first time enterers– Kindergarten– First Grade– Sixth Grade– Transfer to a new school

• Becomes part of official student school record• Reported to state DOH and CDC

Documentation in Schools

• Paper• Electronic School Health Records

– Free-standing– “Home Grown”– Part of a larger student record management

system

• Subject to Federal Education Reform Privacy Act (FERPA) regulations

• Few commonly used applications

History of Schools and Registry

• Unreliable source of data• Use of non-clinical staff for data entry

– Transfer from paper records– Legibility of record– No knowledge of the immunization schedule

• Didn’t question suspicious dates• Didn’t question illegible dates

– No supervision by nursing• Limited computer skills & Internet access

School Immunization Reports

• Annual reporting requirements

• Reportable to state department of health and / or theDepartment of Education

• Due by mid-November annually

• School funding tied to immunization coverage rates

• Public health involved in this activity in some states

State Registries Working with Schools*

• Read Only– Arkansas– Colorado– Delaware– Georgia– Houston Harris

Co. TX– Idaho– Indiana*– Maryland

– Minnesota– Mississippi– Missouri– Nebraska– Nevada– New Jersey– New York State– North Carolina– North Dakota

– Oregon– Rhode Island– San Antonio, TX– Tennessee– Utah– Washington– West Virginia– Wisconsin– Wyoming– Virgin Islands

* AIRA Registry Profile http://www.immregistries.org/public.php/ImmRegs/regMain.php

State Registries Working with Schools

• Read and Add Data**

– California– Kentucky*– Louisiana– Michigan– New Mexico*– Oklahoma– Pennsylvania

* Registry laws in place

** AIRA Registry Profile http://www.immregistries.org/public.php/ImmRegs/regMain.php

Barriers

• Federal Education Rights and Privacy Act (FERPA)– FERPA not HIPAA regulates school

information – Requires parental consent unless state law

/ rules specifies reporting to registry– Consent added to general student consent

signed at outset of academic year

Barriers

• Double data entry– Multiple school

applications– Cost of interfaces– Level of IT staff in

schools not capable of doing interface work internally

• Nurse may not be entering data

Advantages• Frequently first to encounter child from out of

state• Required to collect immunization data• School nurses are active registry users →

“Ultimate Win Win”

• Connection to families / siblings

→ Outreach opportunities

→ Source of immunization record for many• Access to adolescents

Advantages

• Role in disease surveillance and outbreak management– Active members in community Pan Flu / BT response

planning– Schools frequent site for disease outbreaks

• Expanded use– School based clinics– Employee health– College / University Student Health Centers

The Louisiana Experience

• School nurses adding data into LINKS since March 2005– Through January 2007, schools have

entered 277,782 new immunizations

• School nurse data “marked” in LINKS

• Working on bi-directional interface with school application used in 42-parish schools

LINKS facts*

• As of March 7, 2007

– 68.9% of children < age 6 had at least two immunizations recorded

– 100% public providers participating– 75% private providers participating– 2,226,282 people of all ages– 20,268,607 individual immunizations

* Immunization Information Systems Use During a Public Health Emergency in the United States; Urquhart Gary, MPH; Centers for Disease Control and Prevention

After Katrina

• Estimated 200,000 displaced persons

• View only or HL7 links to other state registries allowed queries into LINKS

• Displaced children and adolescents enrolling in school were initially exempt from school immunization laws

Results• 21,295 successful external queries were made

into LINKS between August 29 and October 11, 2005– 44 states, 5 cities and Washington, D.C.

• Queries breakdown– 30.7% for children 0-5 years old– 39.6% for children 6–10 years old– 30.7% for adolescents 11-18 years old

• Houston Harris County registry alone responded to 17,000 requests for immunization records– Est. $850,000 savings in unnecessary shots

Registries and Physician Recruitment

• An average of 44% of private provider sites submitted data to Immunization Information Systems during the last six months of 2005

• Issues surrounding private provider participation– Reluctant to add workload to staff– Won’t pay the cost for electronic transfer of data to IIS– Data quality from billing systems– Many converting to Electronic Health Records

• 1 of 4 using EHR; 1 of 10 using for treatment decision– Smaller practices less likely to have electronic

data systems

Summary

• Schools hold immunization data that mirrors or exceeds what is held by private providers

• School nurses are motivated to work with registries → many would do double data entry

• Schools play a critical role in disaster, disease outbreak and Bioterrorism plans


SCHOOL NURSE MODULE FOR CHIRPGoals: 2007 ISDH purchase School Nurse Module2007 School Nurse Module pilot programs2007 Freshmen records reported2008 School Nurse Module used by all Indiana

schools2008 School nurses reviewing records of students

every year.


NATIONAL IMMUNIZATION COALITION’S TA NETWORK RECOGNITION

Vaccinate Before You Graduate/Indiana was recognized by IZTA as a Promising Practice


Vaccinate Before You Graduate information can be found on the Indiana Immunization Coalition’s website:

www.inimcoalition.org

Documents

The Indiana Immunization Coalition exists to promote childhood immunization and raise community awareness about immunization issues