School-based influenza vaccination

Transcription

1 Public-Private Funding Partnerships National Association of County & City Health Officials (NACCHO) November 9, 2006 Presenters: James King M.D. University of Maryland School of Medicine & Kinn Elliott - MedImmune For technical assistance please naccho@commpartners.com. School-based influenza vaccination James King M.D. Professor of Pediatrics University of Maryland School Of Medicine November 9, Special thanks to: Carroll County Health Department: Elizabeth Ruff, M.D., Larry Leitch, Susan Kiler Carroll County Public Schools: Stephen Guthrie, Marge Hoffmaster R.N. MedImmune: Jeffrey Stoddard M.D., Nancy Bukar J.D., Frank Malinoski M.D., Edward Lewin M.D. 1

2 Why consider school-based influenza vaccinations? School children are primary transmitters of influenza to the community Students are a captive audience Convenient for parents not to miss work or other activities Reduced burden on medical offices and clinics More efficient than the medical home Opportunity to involve the community Probably cost efficient or even cost saving 3 SchoolMist I pilot study: 1 target elementary school matched with two control schools Intervention: 40% of eligible students in target school received LAIV in their school Results 45-70% relative reduction in flu related outcomes in the families of the target school (medications, doctor visits, work or school days lost) Significant difference between vaccinated and non- vaccinated student absenteeism within the target school King et al. A pilot study of the effectiveness of a school-based influenza vaccination program. Pediatrics 2005 Dec;116(6): e

3 SchoolMist II Multicenter study : 2005: 11 clusters of target schools, each matched with one to two control elementary schools in four states Intervention: approximately 46% of eligible target school students received LAIV in school Results Target school families had fewer ILI related: symptoms; lower prescription and OTC medication use; fewer physician visits for children; lower absence rates for elementary and high school students; fewer missed work days among parents 5 King et al. Effectiveness of a school-based influenza immunization program. In press, New England Journal of Medicine. SchoolMist III Public Health Intervention County wide elementary school vaccination plan devised by Carroll Co. Health Dept. Carroll Co. Public Schools Univ. of Maryland, Balt. Professional Schools and Medical Center Carroll Co. Medical Center Maryland DHMH MedImmune All 22 Carroll County elementary school healthy children > 5 years of age were offered LAIV donated by MedImmune 6 3

4 Public Health Intervention September 2005 Program information and consent forms disseminated Consents reviewed and organized by the school nurse (15-20 hours per school) Frozen vaccine shipped to a central training site and later transported to each school with assistance from medical volunteers and trustees of local jail 7 Public Health Intervention Licensed volunteers were recruited from local health department and hospitals, University of Maryland, Baltimore Professional Schools and DHMH Volunteers met at central location on initial vaccination days to receive a 45 minute training session and were then dispersed to each school 8 4

5 Public Health Intervention First dose 4189 doses given in hours Make-up days on Oct 28 and Nov 1 for total of 5319 doses Second dose Repeat dosing over 5 days in December for 3124 students (88% of those scheduled to get a second dose) Volunteers administered vaccine to 44% of all elementary school children 10-15% 15% of students received TIV outside the intervention 9 Hypothesis Mass influenza vaccination of Carroll County elementary school students will be associated with a reduced rise in absenteeism during peak, influenza outbreak periods in Carroll County when compared to Frederick County for: elementary schools (direct impact) middle schools (indirect association) high schools (indirect association) 10 5

6 Assumptions Annual influenza outbreaks occur at a similar time in Carroll and Frederick Counties School absenteeism rates routinely rise over baseline during influenza outbreak periods Absenteeism rise is similar in both counties during non-intervention years 11 A few demographics Carroll County Frederick County Attendance Rate Race/Ethnicity Monthly Housing Costs (2000) Median Household Income (2000) Elementary 96%, Middle 95%, High 95% 96% White 2.3% African American 1.0% Hispanic $1,321 60,021 Elementary 96% Middle 95%, High 93% 89% White 6.4% African American 2.4% Hispanic $1,321 60,

7 Influenza : 2006: Carroll and Frederick County Hospitals Influenza Cases /13/ /13/2005 1/13/2006 2/13/2006 3/13/2006 4/13/2006 5/13/2006 Frederick Carroll Week 13 Frederick county elementary 8 7 Absenteeism (%) Baseline Peak School year 14 7

8 Carroll county elementary 6 Absenteeism (%) Baseline Peak School year 15 Frederick county high Absenteeism (%) Baseline Peak School year 16 8

9 Carroll county high Absenteeism (%) Baseline Peak School year 17 Conclusions A school-based, volunteer run, mass influenza vaccination program is feasible. Lessons learned will make this type of program even better during future efforts and should serve as a base for early and rapid responses against influenza pandemics or other biologic threats. Mass influenza vaccination of elementary school students is associated with direct benefits such as decreased absenteeism in elementary pupils during influenza outbreaks. Also, mass vaccination of elementary school pupils is associated with indirect or downstream benefits such as fewer ILI related illnesses in family members and decreased absenteeism in middle, and high school students 18 9

10 19 NACCHO Public-Private Private Partnership Webcast November 9, 2006 Kinn Elliott MedImmune 20 10

11 MedImmune, Inc. Founded 1988, IPO 1991; profitable 1998 ~2,200 employees; HQ in Gaithersburg, MD Four marketed products $1.2B revenues 2005; $383MM R&D 2005 Therapeutic areas: infectious disease, immunology and oncology Primarily antibodies and vaccines 21 FluMist for Schools Program Demonstrate the public health benefits of vaccinating school age children and staff Determine whether a school-based FluMist immunization program can be a viable option Leverage school-based flu immunization to support broader ACIP recommendations and federal funding for immunization of all children in grades K-12K 22 11

12 FluMist for Schools Program LHD meet a public health need Gain experience in broad-based based immunization program for children Opportunity to work with local organizations not in the traditional public health network 23 FluMist for Schools Program AK HI 19 Projects in 12 states CA (4), CT, FL(2), MA, MD (2), MN, PA, TN, TX, UT, WA, WI 129,000 doses donated 24 12

13 FluMist for Schools Program Success for LHD Overwhelming success for all involved LHDs and School District Administration developed partnerships LHD improved/developed relationships with community partners around the project Public awareness opportunity around the importance of influenza immunization and the LHD role in the community 25 Considerations in Public-Private Private Partnerships Industry can support your needs Legal/Regulatory concerns quid pro quo on donated product, liability, LHD governmental/ethical policies Understand private partner s s expectations on the front end of the project Make your concerns known as well Offer to provide regular feedback through verbal/written communication measure effectiveness Working on a project an lead to other opportunities 26 13

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