Meningitis B Outbreak Response

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2 Meningitis B Outbreak Response William Kinsey, MD, MPT, Medical Director Sarah Van Orman, MD, MMM, Executive Director University Health Services University of Wisconsin-Madison November 11, 2016

3 UW-Madison Meningitis B Cases ONSET Age RESIDENCE Contacts Case 1 Oct 3rd 18 Dorm 1 No Case 2 Oct 5 th 19 Off Campus No Case 3 Oct 27th 18 Dorm 2 No Whole gene sequencing-matching sequence type and clonal complex

4 OUTBREAK DEFINITION (ORGANIZATION) Number of Primary Cases Organization Size Time Period Serogroup Genetic Testing 2 < months Match Match 3 > months Match Match Interim Guidance for Control of Serogroup B Meningococcal Disease Outbreaks in Organizational Settings

5 UW-Madison Response Case reporting and contact evaluation in coordination with Public Health Madison Dane County to determine close contacts for chemoprophylaxis Education Meningitis signs, symptom awareness Respiratory Hygiene recommendations Vaccination Partner with DHS, CDC to define sub-population at risk Undergraduates through age 25 Graduate and professional students who live with or are in an intimate relationship with an undergraduate Minimize barriers to vaccination Saturate campus with communications

6 Meningitis B Vaccines Bexsero (MenB-4C, GSK) Four Components : FHbp subfamily B/v1, NhbA, NadA, PorA1.4 Two (O, >1 Month) Dose Schedule Licensed in US Jan 23, 2015 Trumenba (MenB-FHbp, Pfizer) Two Components : FHbp subfamily A/v2,3; B/v1 Three (0,1-2,6 Month) Dose Schedule (2-Dose also approved) Licensed in US Oct 29,2014 Fall, 2016 Entrance Medical Form < 5%(825) of undergraduates had received 1-dose or more of either vaccine.

7 s to students, parents, faculty/staff Communication Pieces Posters Dorm Room Hangers Digital TV Ads Bookmark Information Sheet Power Point for Faculty Buttons Large External Signs Stickers Social Media-Twitter, Instagram, Snap Chat Communications

8 POD Bookmark Document for students to read while in line and take home with them to help identify symptoms of meningitis and learn about possible ways it can be spread. front back uhs.wisc.edu

9 Stickers Given to students after they received their first dose to advertise to members of campus to get the vaccine or practice good respiratory hygiene. uhs.wisc.edu

10 Selfie wall and Snapchat filter To promote the clinic on social media Facebook, Instagram, Twitter, Snapchat, and Youtube by selfies taken to show students who got vaccinated and invite others to do so. uhs.wisc.edu

11 Social media Creative use of photos and animated gifs posted on a variety of social media helped keep the broadcasts about the POD fresh, interesting, and fun. uhs.wisc.edu

12 Mass Vaccination Clinics (POD) Point Of Dispensing (POD) Plan Activated FEMA Model Applied to Public Health Emergency Serogroup B Organizational Outbreak vaccine preventable illness Timely Manner Coordinate with Multiple Campus, Local, State and National Resources 10/20 POD #1 10/21 POD #2 10/25 10/27 POD #3 POD #5 10/26 POD #4 10/31 11/2 POD #6 POD #7 11/7/ /18/2016 Walk-In UHS 10/1/ /3 10/5 Case #1 Case #2 10/26 Case #3 11/1/ /18/2016

13 Registration line uhs.wisc.edu

14 SWAG and Cookies uhs.wisc.edu

15 ipad used for screening, administration; real time reporting within electronic health record and WIR upload uhs.wisc.edu

16 Immunization Summary Bexsero administered preferentially Trumemba to students reporting previous first dose All data available in Wisconsin Immunization Registry Clinic Clinic 1 Clinic 2 Clinic 3 Clinic 4 Clinic 5 Clinic 6 Clinic 7 Misc Walk In Date 10/20/ /21/ /25/ /26/ /27/ /31/ All All Total Administ ered Location SERF SERF SERF SERF SERF SERF SERF SERF, UHS UHS Bexsero Trumemba Total

17 Immunization Summary Immunization Rates Residence Hall 74% Target Undergradautes-67% Freshman 70% Sophomore 71% Junior 68% Senior 63% State Percent Number Wisconsin 59.4 % 11,790 Minnesota 9.8 % 1945 Illinois 8.9 % 1766 Other 21.9 %

18 Due on or after 11/21-12/1 2 nd Dose Strategies Communication to students/parents begins week of 11/14/16 Options: Return to In-network provider over winter recess Retail Clinics UHS Clinics with support All 2 nd Doses should be loaded into WIR (Wisconsin) or students asked to inform UHS through on-line account

19 Follow up reminders for second dose This was given out to students after they received their first dose with an area to put the date when they can get their second dose. This was perforated so the student could tear off the relevant info they needed for the second dose and store it in a wallet or purse. front back uhs.wisc.edu

20 Issues Confusion between Menactra and Serogroup B vaccines Students were unaware of which series they had started-bexsero vs. Trumemba Limited window to be vaccinated 12/24/16-1/16/17 Home PCP strategy increases barriers The vaccine HURTS

21 QUESTIONS AND DISCUSSION