Texan Perspective on Influenza Vaccine...White only, non-Hispanic 44.6% Black, non-Hispanic 37.2%...

Texas Department of State Health Services

Texas Perspective Influenza Vaccine Texas DSHS Immunization Unit Assessment, Compliance, and Evaluation Epidemiologists


DSHS Immunization Unit

Mission: Eliminate the spread of vaccine

preventable diseases by increasing vaccine

coverage for Texans, raise awareness of the

diseases that vaccines prevent, and educate the

public about vaccine safety.


Coverage Measures

Hepatitis B Birth Dose MMR Vaccine Coverage for 19-35

Coverage, 2008-2016 Month Old Texas Children, 2016 100% 100%

90% 90%80%78% 75% 80%80% 68%

70%70% 60% 73% 72%71% 60%60% 62% 50%50%

51% 40%40%

30%30%

20%20% 10%10% 0%0%

2008 2010 2012 2014 2016 US Texas City of Houston

Bexar County El Paso County Dallas County Texas U.S.


Adult Coverage

Tetanus Vaccine Coverage for Texas Adults,

2016

70%

Yes No

0%

10%

20%

30%

40%

50%

60%

Tdap Other Tetanus Not Sure Type No Tetanus

Flu Vaccine Coverage by Age Group, Texas 2016-2017 Flu Season

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

72%

60% 62%

50%

33%

6 mos−4 yrs 5−12 yrs 13−17 yrs 18−64 yrs ≥65 yrs

····O c::J ccccc ccccc ccccc


Challenges with Flu

Annual Efficacy and Belief about

Recommendation Effectiveness Disease Risk


Introduction

Texas Flu Family Grandma Flu

Mama Flu

Baby Flu

Papa Flu

Sissy Flu


Baby Flu

Profile

• 12 month-old baby

• Vaccinated

Flu Fact: Children 6 months – 4 years are the highest vaccinated age group:

• Texas: 71.9% • US: 70.0% • HP2020 Goal: 70%

the child received >2 doses of

trivalent or quadrivalent influenza vaccine

before July 1, 2017 (Doses need not have been given during san1e or

consecutive seasons)

, , Yes

+ 1 dose of

2017-18 influenza vaccine

, , No I Don't know

+ 2 doses of

2017-18 influenza vaccine

( ad1ninistered >4 weeks apart)

Child Vaccine Recommendations


Who should absolutely be vaccinated?

Groups

• Children and infants

• Pregnant women

• Seniors

• Residents of nursing homes and long-term care facilities

• American Indians and Alaska Natives

• Healthcare workers

• Care givers and close contacts of infants and elderly

Chronic Health Conditions

• Asthma

• Neurological and neurodevelopmental conditions

• Chronic lung disease

• Heart disease

• Blood, Endocrine, Kidney, Liver, and Metabolic disorders

• Immunosuppression

• Children receiving long-term aspirin therapy

• BMI of 40 or more


Who should discuss with their health care provider?

• Guillain-Barré Syndrome (GBS)

• Moderate to severe illness with or without a fever

• IIV Precaution: Egg allergy (not hives)

• With supervision of a health care provider able to manage severe allergic reactions

• LAIV Precautions

• Asthma in persons ≥ 5 years

• Those at higher risk of complications attributable to influenza


Who should not receive flu vaccine?

1. Children <6 months

2. Those with severe, life threatening allergic reaction(s) to vaccine/ingredients

3. LAIV Contraindication • Adolescents and Children: Use of aspirin • Influenza antivirals within the previous 48

hours • Pregnant women


Grandma Flu

• 70 year old, female

• Received high dose vaccine at a pharmacy

Flu Fact: In 2016, 62.1% of Texans 65+ were vaccinated against influenza.

Profile

• Vaccinated

TEXAS Health and Human Services


Flu Vaccine Types

• Trivalent Inactivated Vaccine (IIV3)

o Adjuvanted

• High-dose (IIV3)

• Quadrivalent Inactivated Vaccine (IIV4)

• Cell culture-based (ccIIV4)

• Recombinant Influenza Vaccine (RIV3 & RIV4)

• Live attenuated influenza vaccine (LAIV4)

https://www.cdc.gov/flu/protect/vaccine/vaccines.htm

https://www.cdc.gov/flu/protect/vaccine/vaccines.htm


Sissy Flu

Profile

• 7 years old

• Not vaccinated

• Enrolled in Medicaid - eligible to receive Texas Vaccines for Children (TVFC) vaccine

Flu Fact: Coverage for annual flu vaccine varies by race.

Race/Ethnicity 2016 Flu Vaccine Coverage

White only, non-Hispanic 44.6%

Black, non-Hispanic 37.2%

Hispanic 44.0%

Other and multiple races 42.5%

TEXAS Health and Human Services


TVFC

Passed nationally in 1994 as the Vaccines for Children Program,

our Texas Vaccines for Children Program guarantees ACIP-

recommended vaccines will be available at no cost to providers in

order to immunize children who meet the eligibility requirements.

• Texas has approx. 3,200 VFC provider sites

• 2017-2018 1.7 million influenza doses distributed

Prebook Allocation Distribution

2019 Texas Target Population (TVFC)

•Total (0-18) Population: 8,258,118

•Total TVFC Eligible Children (0-18): 4,577,748

Projected TVFC Percent of Age Age Eligible Group Eligible

0-1 285,277 62.4%

1-2 517,033 56.9%

3-6 1,000,199 55.5%

7-18 2,775,239 54.5%

18

2019 Texas Target Population (TVFC)

Eligibility No. VFC

Medicaid 3,019,202

Uninsured 795,723

CHIP 405,372

FQHC 149,538

American Indian/Alaska Native 147,719

Underinsured 60,194

Total 4,577,748

Total Flu Doses Pre-booked in 2018-19:

1,851,230 Pediatric IIV4 + 117, 420 FluMist

19

2018-19 Flu Doses Pre-Booked

Region Total TVFC Providers

TVFC Providers Not TVFC Providers

Ordering Flu/Did Not Ordering Flu

Complete Survey

% Providers Ordering Flu

Vaccine

00 (San Antonio) 152 141 11 92.8%

01 145 121 24 83.4%

02 95 78 17 82.1%

03 566 512 54 90.5%

04 163 145 18 89.0%

05 96 75 21 78.1%

06 369 322 47 87.3%

07 322 302 20 93.8%

08 161 138 23 85.7%

09 100 80 20 80.0%

10 124 104 20 83.9%

11 430 363 67 84.4%

25 (City of Houston) 305 250 55 82.0%

Grand Total 3,028 2,631 397 86.9%

13% of TVFC Providers will not be offering flu vaccine to their eligible clients in 2018-2019

2017-18 Flu Doses Wasted/Expired

33.6% Vaccinated

2,991,649 Missed opportunities

1,513,326

Doses Administered

1,831,890

Doses Ordered

4,504,975

TVFC Eligible Children


Mama Flu

Profile

• Vaccinated

• 31 year old, female

• Works in health care facility

Flu Fact: Adult women (34.5% 95% CI:31.8-37.4%) are more likely to be vaccinated than adult men (31.8%; 95% CI: 29.1-34.5%).


Type of Employee Influenza Policy, Texas

Policy Type 100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

54%

38%

5% 3%

Mandatory Recommended Combined Unspecified

Mandatory Requires dates of immunization or laboratory evidence of immunity.

Recommended Recommends but does not require immunizations for employment.

Combined Designates employees in specified areas as required but only recommends immunizations for others.

Location of Flu Shot Receipt, .All .Adults, 2016 Texas BRFSS

Health and Human SNvices

Te,as Department ofState Health Sen,lces

Clinic or Health

At Work Center 12°/o 12°/o

Doctors office 34°/o Store 30°/o Hospital 9°/o 1 0/o

Texas Department oJ State Health Services

Papa Flu

Profile

• Not vaccinated

• 38 year old male

• Covered by Adult Safety Net (ASN) but…ASN does not offer flu vaccination

Flu Fact: Coverage for annual flu vaccine varies by insurance status.

2016 Flu Vaccine Coverage

Insured 37.8%

Uninsured 19.2%

Reasons for not getting flu shot, 2015 Texas BRFSS

Health and Human SNvices

Te,as Department ofState Health Sen,lces

Believe that

Unlikely to flu vaccines do not work

get very Other 8°/o very well 7°/o Did not have time sick from 19°/o the flu

Cannot Do not

12°/o likeafford it Sideshots

Concerned 7°/o effects

about 5°/o 4%

getting the Do not Do not

flu from the trust

Never get the flu vaccination need the Allergic/C govern

ontraindic ment...

18°/o 9°/o shot 6°/o ation 40/o 10/o


Safety


Safety Monitoring

• Vaccine Adverse Events Reporting System

• Vaccine Safety Data Link

• Clinical Immunization Safety Assessment


Option 1 • Report Online to VAERS (Preferred) Submit a VAERS report on line. The report must be completed onllne and submitted in one sitting and cannot be saved and returned to at a later time. Your information will be erased If you are inactive for 20 mlnutes: you will receive a warning after 15 minutes.

DSHS Vaccine Safety Role

• Encourage providers to submit directly to VAERS online

HHS VAERS website: https://vaers.hhs.gov/

• Facilitate reporting to VAERS if receiving paper forms

• Facilitate follow-up on specific cases

• Gathering death certification, autopsy reports, etc.

• about how and what to report Respond to questions from the public and providers

https://vaers.hhs.gov/


Education, Awareness, and ImmTrac2


Public Education, Information, and Training Activities

• Printed educational materials https://www.dshs.texas.gov/immunize/flu.shtm

• Media Campaigns • Radio

• Print

• Television

• National Influenza Vaccination Week

https://www.dshs.texas.gov/immunize/flu.shtm


The Emily Lastinger Story Emily was a liltle kid who got Ille flu.

U n Wednt"sday. January 28. 2004 threc-ytar-uhl Em:ly Lastinger took a long :13p 3.nd began to ,ho·N signt th.al she wa.; gtttir.g skk. Strep throat vr,u goi.ngaround in her pteschool. her pare-nt5 kept hc1: home a:ld took her to see :te:-doctor to 1r.:1kc .sure she was ok. Aftc-.r running some tests the doctor detcrrnin~d ~he had the flu.

The doctor g:3.vc Er.'lity a.nti·Yiral medication to Jes.sen tbe severity ()( 1ht ill nN~ . HM p:u~nr.~ w?rt' mlcl It) gtw htr p1tn1y off!uic1~ a n,1 keep 11n eye on her fc..,,er.

On that J-riday. :i.nd over the •Neckcnd, ~mily got skkc-r. Her ic!vcr ~pikt<l. sht· bc:-gan tu vomit. kt:pt on \'omiting. and she hat.1 uoubli: holdi ng down fluids.

On Monday momrng, February 2, ~ 1ly's p3rcnts made a JO\'.tor's appoinlltX:111 fut· later that day. When they ca] ed 1hey ~,'ere mid rn5tw• F.mi'y Onid~ f'vf'~y l 'l ltli nm,~i unril ~hf' go1 ro1 h.~OOt1or·s ofu.

Emily had o bath, ~ot dre=d -~he wa~ read;t to gu to Lhe Joctor. \\rhile sh<' waited, :;he lo.id dm.,.n on htJ pa1cots' bc:d to resl ;,nJ watch tcle\'ision. Hftcen m:nutes l:Hn·, sht' Wli lifeles~ .. As soon as her parents found her they b•gan CPR.

f-orty.fi,rc m:nutes later in the cmerg<'nc-y room the doctor.; were able rn g,-,r h.~r NY,lrr M:i m"Ct lht"y s.~.,, hM t-> the loc1l children's trru.uno. center for � ure trcallncnL Pur LWdve hou:s, t:ic doctors :ll the renttr tried to fulty

Flu Mail-Out

• Required by House Bill (HB) 3184 of the 80th Texas Legislature

• Mail-outs to 15,000 childcare facilities

• Scheduled for Sept. 15th

Included

• Flu brochures in English and Spanish

• Influenza fact sheet

• Child-care provider and employee letters

• Required vaccines for childcare (does not include flu)

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TVFC Score Card

Goals

• Increase vaccine coverage

• Decrease vaccine wastage

Plan

• Send to all TVFC providers each month of the flu season

• Include provider-, county-, and state-level data on ordering and coverage

Texas Department of S_tate Health Services

ImmTrac2

• Texas Immunization Registry

• Bi-directional capabilities January 2018

• Evolving data quality improvements

• Re-vitalized push for adult consent via

emergency responders


HURRICANE EVACUATION

ROUTE

Hurricane Harvey Response

• Stood up immunization response

team

• Coordinated with SMOC to fulfill

vaccine requests

• Courier service to affected sites

• Total Flu Doses Sent: 7,690


Take Home Message

The flu vaccine is safe and protects

you and your family!

Immunization Unit flu vaccine

resources are readily available to help

you educate and protect Texans!


Questions?

Lauren Hoffman, MPH Jessica Cheng, MPH

[email protected] [email protected]

mailto:[email protected]

mailto:[email protected]


Extra Slides

Texas Department of S_tate Health Services

Option 1- Report Online to VA ERS

IPreferredi

5ubrnll a VArn5 rEp�l" t on rne. T 1e re1X1rt must be co mple:cd onlinc, and submitted h one aitt i,1g

and ca1r,o : te saved and retur1Ed to a: a later time. YD111· infDrr.1ation ;,,· ill be e rascci if yoc are

in.,ctiv,, ' ,v ?llrr i111JtP<· w, , .,,, ill r<>c<>iV",

VAERS

Strengths

All U.S. states and territories

Data on the vaccine, the recipient, and the AE

Data is publicly available

Early warning system to identify rare AEs

Follow-up with patients to obtain health records, when necessary.

Limitations

Cannot determine causality

Cannot assess prevalence in the general population

Reports often lack details/contain errors

Serious AEs are more likely to be reported than mild side effects

Reporting may increase due to new recommendations and media attention.


Vaccine Safety Datalink

• Electronic Health Data

• Vaccine type, date, and co-administered vaccines

• In-patient, urgent care, and ED visits, hospital stays

• Purpose:

• Conduct studies on rare and serious adverse events (AEs)

• Monitor safety of new vaccines and recommendations

• Investigate issues submitted in VAERS or the medical literature

• Provide information to committees


CISA (Clinical Immunization Safety

Assessment)

• Clinical Case Reviews

• Expert Evaluation of Vaccine Safety Issues

• Research

• Well suited to study more common, non-medically attended events (e.g., fever) and to collect biological specimens after vaccination.

• CISA investigators also have access to special populations (e.g., persons with autoimmune diseases) and specialists who care for these patients.

• Public Health Response


Safety Q&A

Pregnancy

• Any trimester.

• Protect Mom + Protect Baby.

Febrile seizures

• Vaccines can cause fevers.

• Febrile seizures are rare after vaccination.

• Getting sick with the flu also can cause febrile seizures.

Thimerosal (Mercury-based preservative)

• Contained in some multi-dose preparations of flu vaccine.

• Today, breastfed infants ingest 15 times more mercury in breast milk than is contained in the influenza vaccine.

Texan Perspective on Influenza Vaccine...White only, non-Hispanic 44.6% Black, non-Hispanic 37.2%...

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Transcript of Texan Perspective on Influenza Vaccine...White only, non-Hispanic 44.6% Black, non-Hispanic 37.2%...