Immunization Coalition of Los Angeles County

Mission: To foster collaborative efforts to prevent vaccine preventable diseases since 1997

Wendy Berger, MPHICLAC Coordinatorwberger@ph.lacounty.gov

ICLAC UPDATEPROJECT WORK PLANS

March 21, 2019

Why Collaborate?

ICLAC Updates Overview

Update:• New ICLAC Partnerships• Status of ICLAC Workgroup Projects and Activities • Overview of ICLAC Accomplishments 2018-2019

ICLAC Workgroup Projectsas of 2019

• Adolescent Immunization Workgroup

• Adult Immunization Workgroup

• Vaccine Communications Workgroup (Inactive)

Adolescent Workgroup

Adolescent Workgroup MembersOrganization RepresentativeHealth Net Jason L. Moore, M.P.H.

LA County Dept. of Public Health- Women’s Health Program

Rita Singhal, M.D., M.P.H.

LA County Dept. of Public Health – Vaccine Preventable Disease Control Program

Wendy Berger, M.P.H.

LA County Dept. of Public Health, Div. of HIV + STD Kristen Meyer, Ph.D.

LA Care Health Plan Keren Mahgerefteh, M.P.H.

Northeast Valley Health Corporation Debra Rosen, R.N., M.P.H. (Co-Chair)

MiOra Ozlem Equils, M.D. (Co-Chair)

Pfizer Paul Collick

Sanofi Pasteur Elsie Nash

Adolescent WorkgroupRationale for Collaborating

11-12 Years

•Diphtheria, Tetanus, Pertussis•Human Papillomavirus•Meningococcal •(groups ACWY)•Seasonal Flu

16 Years (boosters)

•Meningococcal (groups ACWY)•Meningococcal (group B)•Seasonal Flu

• Preteens may fall behind on age-recommended vaccines and booster doses.

• Falling behind with the recommended vaccines and booster doses places adolescents at higher risk for vaccine preventable diseases.

Adolescent WorkgroupGOAL: Advocate to increase adolescent

immunization coverage levels in Los Angeles County.

Preteen Vaccine Week March 3-9, 2019

Adolescent Workgroup

Adolescent WorkgroupMethods – Social Media Messaging

• Used standardized messaging themes for every day of the Preteen Vaccine Week:

• Monday - HPV • Tuesday – General Awareness• Wednesday: Meningococcal • Thursday: Chickenpox Vaccination• Friday: Pertussis Vaccination (Tdap)

• #PreteenVax, #ProtectOurPreteens, #HPVAwarenessday

Adolescent WorkgroupFuture Strategies - 2020

• Collaborate with LAUSD to engage student “ambassadors” at School Based Health Centers during PVW 2020,

• Monitor social media activity with data analytics for evaluation purposes.

Adult Immunization Workgroup

Adult Immunization Workgroup Members

Organization RepresentativeCA Dept. of Public Health, Immun. Branch Rebeca Boyte, M.A.S.

LA County, Department of Public Health – Vaccine Preventable Disease Control Program

Wendy Berger, M.P.H.

EB Rubinstein Associates Elan Rubinstein, Pharm.D., M.P.H.

MiOra Ozlem Equils, M.D.

Pfizer Paul Collick

Sanofi Pasteur Elsie Nash

West Coast University School of Pharmacy Keri Hurley-Kim, M.P.H., Pharm.D.

Ralph’s Pharmacy Salpi Pashkam, Pharm.D.

Health Services Advisory Group David Mittra, Ph.D.

California Association for Adult Day Services and Alliance for Leadership and Education

Lydia Missaelides, Executive Director

UCLA Fielding School of Public Heath – Biostatistics Dept. Thomas Belin, Ph.D.

Adult Immunization WorkgroupRationale for Collaborating

Adult Immunization WorkgroupBackground

• Less than 60% of CA adults > 65 self-report receiving pneumonia and influenza vaccinations.1 Healthy People 2020 goals are 90%.

• Less than 60% of pregnant women in CA in 2015, self-report receiving influenza vaccination and less than half report receiving Tdap vaccination.2 Healthy People 2020 goals are 80%.

• Unvaccinated homeless adults are at highest risk for invasive pneumococcal disease (IPD) due to late stage diagnosis and management of influenza and pneumonia infections.

Sources: 1Surveillance Summaries/February 5, 2016/65 (1); 1-36. 2MIHA 2015 data, CA Dept. of Public health, Immunization Branch

What are the Barriers?

Adult Immunization WorkgroupProvider Barriers

• Many contracted primary care providers are expected to pre-pay for adult vaccine then wait for reimbursement.

• Medical specialty practices (e.g., OB-GYN, Endocrinology, Cardiology)stock limited to no adult vaccine inventory.

Adult Immunization WorkgroupHealth Delivery System Barriers

• No standardized pharmacy benefit (“carve out”) among commercial health plans and Medicare advantage plans.

• CAIR 2.0 is still not yet fully integrated with a diverse set of Electronic Health Records (EHRs).

• Some medical practices may still lack Electronic Health Record technology (EHR).

Adult Immunization WorkgroupVaccination Delivery Barriers

• No sustainable vaccine delivery system for adults living within encampment sites.

• Screening for health insurance on the street is complex and difficult.

• Monitoring vaccination doses among homeless adults in the CA Immunization Registry (CAIR) is not yet possible.

Adult Immunization Workgroup

GOAL: Protect all of LA County adults >19 years of age from vaccine preventable diseases (VPD), with a special focus on pregnant women, seniors (50+) with immune compromising health problems, and indigent/homeless adults.

Adult Immunization Workgroup

Objectives:By March 1, develop strategic partnerships with state and local agencies serving adults at highest risk for vaccine preventable diseases (VPDs).

By December, 2019, Assess the influenza and pneumococcal vaccination screening policies and practices among 145 Community Based Adult Service (CBAS) Centers and 228 Adult Day Program (ADP) Centers in Los Angeles County Service Planning Areas (SPAs). N=373.

By October 30, 2019, - Develop a vaccine delivery pilot project to administer 200 influenza doses and 200 pneumococcal vaccination (PPSV23) doses at homeless encampment sites in LA County (location TBD).

Adult Immunization Workgroup Methods – Phase 1

Community Based Adult Service (CBAS) Centers –“Medical Model”

Administer an electronic survey to 145 CBAS Centers that provide adult day care services to frail seniors over 65 years of age and other disabled adults with cognitive impairment and compromised immune function.

Adult Immunization WorkgroupMethods – Phase 1

Adult Day Program (ADP) Centers – “Social Model”Administer an electronic baseline survey to 228 Adult Day Program (ADP) Centers across LA County Service Planning Areas (SPAs).

Adult Immunization WorkgroupCBAS/ADP Project Methods – Phase 2

Provider Education

• Partner with the Alliance for Leadership and Education (ALE) to host a topic on adult immunization standards and practices at CBAS and ADP Centers.

• Invite well-known experts from the immunization field.

Adult Immunization Workgroup Homeless Influenza and Pneumococcal (PPSV23) Vaccination Pilot

Methods:Develop a vaccination protocol with an eye toward sustainability to deliver influenza and pneumococcal (PPSV23) vaccinations at encampment sites.

ICLAC AccomplishmentsFY 2018-2019

ICLAC AccomplishmentsFY 2018-2019New ICLAC Organizational Partnerships

• Health Services Advisory Group (HSAG)• California Department of Aging• The Alliance for Leadership Education• UCLA Fielding School of Public Health –

Biostatistics Department.• LA County Health Agency- (Dept. of Health

Services, Dept. of Mental Health, and Dept. of Public Health).

ICLAC AccomplishmentsFY 2018-2019

• ICLAC and LA Care Health Plan hosted the adult immunization section of the LA Care Health Plan provider symposium in September 2018.

• ICLAC hosted its first statewide webinar on “How to Talk About Vaccines” with vaccine expert, Dr. Paul Offit. The webinar reached over 100 stakeholders from clinics, schools, hospitals, and health department programs statewide in November 2018.

• Convened a Homeless Health Stakeholder meeting on March 13, 2019. The meeting was attended by representatives from across LA County Health Agency (DMH, DHS, DPH) to discuss a plan for a sustainable vaccination delivery system at homeless encampments in LA County.

Closing Thought

• “They say if you want to go fast, go alone. If you want to go far, GO TOGETHER”!!

• --African Proverb

Questions