2011 Model Practice Application (Public)

Sustaining New Programs in Public Health: "A Work in Progress"

Kanawha-Charleston Health Department

Sustaining New Programs in Public Health: "A Work in Progress"

The 2009 H1N1 SLV clinic model was used to develop a self-sustaining public health program to increase seasonal influenza vaccination coverage in school-aged children. Even with recommendations from the Centers for Disease Control and Prevention (CDC), the American Academy of Pediatrics, and other organizations vaccination rates fell well below the Healthy People 2010 objectives. In 2008, the Advisory Committee for Immunization Practices (ACIP) expanded recommendations for seasonal flu vaccination for all children 6 months and older. Prior to the 2009 H1N1 pandemic, vaccination efforts targeting children were unsuccessful. The Childhood Influenza Immunization Coalition reports," Although protection of children is the main goal of increasing childhood influenza immunization rates, there is evidence to suggest that vaccinating children will provide additional benefits to society. Widespread childhood vaccination can interrupt influenza transmission since influenza outbreaks usually begin in children and then move on to the community at large."(CIIC report) In 2009-10 over 1,000 children are estimated to have died during the 2009 H1N1Influenza Pandemic. Seasonal influenza vaccination rates did increase in 2009 largely due to the overwhelming concern during the H1N1 pandemic. Summaries in the MMWR report that 3 of the 4 states with the highest vaccination rates delivered the vaccine through SLV clinics. The ability to implement sustainable SLV immunization programs is crucial to improving vaccination rates in children.

Kanawha-Charleston Health Department and Kanawha County Schools signed a Memorandum of Understanding (MOU) which designates the health department as the lead agency in this collaborative effort. The MOU sets forth the roles and responsibilities of each agency. In this agreement the health department is responsible for the up-front costs of the campaign, producing and printing materials for the parent packets, engaging media, training vaccinators and clerical support staff.

Congress allocated over 1.4 billion dollars to state and local health departments to mount a response during the 2009 pandemic. This funding allowed the creation of many new and innovative practices. If these programs are to continue, public health must find ways fund them. The 2009 H1N1 Pandemic forced a new urgency in public health to “think outside the box” and explore new venues to increase influenza vaccination coverage in children. Children were especially vulnerable to the novel virus. Over 1,000 children died from flu-related illness during the pandemic. The Kanawha-Charleston Health Department partnered with the school system and a health center to organize school-located Vaccination (SLV) clinics. There are 80 public and private schools with enrollment of over 28,000 students in grades K – 12. Over 15,000 children received the H1N1 vaccination in school and 5,000 booster doses were given in elementary schools.. Vaccination rates ranged from 57% in elementary schools to 31% in high school with a median rate of 49%. The success of this campaign demonstrates that implementation of SLV clinics can be an important venue to increase vaccination coverage for children. As the pandemic ended, Kanawha-Charleston Health Department (KCHD) began looking for opportunities to build on the momentum of the H1N1 response. A new program was developed incorporating SLV clinics into the health department’s 2010-11 Seasonal Influenza Vaccination Campaign. Each year the health department administers over 10,000 seasonal flu shots. Initially targeting seniors and adults at most risk for flu-related complications and death, the campaign has expanded to include recommendations of the Advisory Committee on Immunization Practices (ACIP). KCHD receives no additional state or local funding to provide influenza vaccination clinics and up-front costs of vaccine, supplies, and staffing are made possible through third party billing of government and private insurances. The program was structured using the H1N1 SLV model with the addition of requesting insurance information on registration forms. Even though parents were asked to provide insurance information, the vaccination was offered to all children regardless of their insurance status. KCHD used proceeds from the 2009-10 Seasonal Flu Campaign to cover up-front costs. Projections indicate that over 90% of expenses will be recouped from insurance reimbursement. (Tables below). This program runs from October thru December 2010.

Increase influenza immunization rates in school-aged children to match Healthy People 2010 immunization objectives. Quantitative data collected from registration forms include age, gender, race (optional), school location, and grade. This data will be compiled after completion of this program to evaluate vaccination coverage. Plans are to collect data from the WV Immunization Registry to evaluate vaccination rates given by other providers. Prevent disease, disability, and death from infectious diseases, including vaccine-preventable diseases. (Healthy People 2010). Data from the West Virginia Division of Disease Epidemiology (DIDE) includes comparison of influenza-like illness (ILI) rates from previous years. Data evaluation on this objectives will be completed at the conclusion of this program.