Report to/rapport au : Ottawa Board of Health Conseil de santé d Ottawa Monday October 15 2012/le lundi 15 octobre 2012 Submitted by/soumis par : Dr./D r Isra Levy, Medical Officer of Health/Médecin chef en santé publique Contact Person / Personne ressource: Siobhan Kearns, Manager/Gestionnaire Environment, Health Protection & Outbreak Management / Direction de l'environnement, de la protection de la santé et de la gestion des éclosions Ottawa Public Health/Santé publique Ottawa 613-580-2424, ext./poste 23483, siobhan.kearns@ottawa.ca CITY WIDE / À L ÉCHELLE DE LA VILLE ASC2012-OPH-EHP-0002 SUBJECT: INFLUENZA IMMUNIZATION PROGRAM 2012-2013 OBJET : PROGRAMME DE VACCINATION CONTRE LA GRIPPE 2012-2013 REPORT RECOMMENDATIONS That the Board of Health for the City of Ottawa Health Unit: 1. Approve Ottawa Public Health s endeavours to improve influenza immunization uptake, as outlined in this report; and 2. Direct staff to report back in Q4 2013 on the effectiveness of program innovations. RECOMMANDATIONS DU RAPPORT Que le Conseil de santé de la circonscription sanitaire de la ville d Ottawa approuve ce qui suit : 1. Les efforts de Santé publique Ottawa visant à accroître la vaccination contre la grippe, comme ils sont décrits dans le présent rapport; 2. La présentation d un rapport par le personnel au quatrième trimestre de 2013 portant sur l efficacité des innovations apportées au programme.
BACKGROUND Ottawa Public Health s Influenza Immunization Program Influenza, commonly known as "the flu" is a serious, acute respiratory illness caused by a virus. People of any age can get influenza. The illness usually lasts two to seven days, sometimes longer in the elderly and in people with chronic diseases. Most people who get influenza are ill for only a few days. However, some people can become very ill, possibly developing complications and requiring hospitalization. In Ontario each year, influenza and its complications result in up to 1,000 hospitalizations and lead to 500 to 1,000 deaths. Data from the 2010-2011 season demonstrated that hospitalization rates were highest for children less than five years old and adults over the age of 65 years, with the highest mortality rate occurring in adults over 45 years of age. An economic appraisal of Ontario's Universal Influenza Immunization Program indicated that the program reduced influenza cases by 61 per cent and mortality by 28 per cent. The study indicated that preventing these cases resulted in saving Ontario's health system about $7.8 million for each flu season. i Ottawa Public Health (OPH) has a comprehensive approach to influenza control: participating in Ontario s Universal Influenza Immunization Program, providing public education through the Ottawa s Health is in Your Hands community awareness campaign and managing influenza outbreaks in long-term care facilities, retirement homes, child care facilities, hospitals and schools. OPH participates in Ontario s Universal Influenza Immunization Program in a variety of ways: Receiving influenza vaccine supply from the Ontario Government Pharmacy and distributing the vaccine and reference material to physicians, hospitals, long-term care homes, paramedics, retirement homes, workplaces and nursing agencies Conducting influenza immunization clinics throughout the city Ensuring health care providers adhere to proper vaccine storage and handling requirements for influenza vaccines via educational activities and annual cold chain inspections of vaccine providers offices or clinics Promoting the importance of influenza immunization and OPH clinics through local advertising, earned media, social media and OPH s website Table 1: OPH s influenza vaccine distribution for the 2011-2012 influenza season Agency Doses Per cent of total doses (%) Physician s offices 218,386 65 OPH influenza clinics 28,562 9 Hospitals 25,880 8 Health care agencies 27,090 8 Long-term care facilities (residents and staff) 16,880 5 Retirement homes (residents and staff) 8,380 2
Workplaces 5,690 2 Community Health Centres 4,090 1 Other (e.g. schools) 1,550 <1 Correctional facilities and youth justice facilities 380 <1 Total 336,888 100 Accountability Agreement Indicator 7b This indicator relates to the effectiveness of vaccine storage, handling and management practices of a local public health unit. Boards of Health, through public health units, are accountable for ensuring that health care providers adhere to proper vaccine management and that vaccines are distributed in an equitable and timely manner to health care providers. Furthermore, it is required that influenza vaccine wastage does not exceed five per cent. In 2011-2012, only 0.6 per cent of the influenza vaccine stored and administered by OPH was wasted. This wastage was primarily due to unused doses of vaccine. Influenza immunization clinics throughout the city OPH will launch its 2012 influenza immunization clinics on October 27, 2012. The OPH clinics will run until December 15, 2012. There is an adequate supply of vaccine and enough clinics distributed throughout the city for everyone who would like to receive the influenza vaccine. Last year, OPH vaccinated more than 28,000 people at its clinics. The majority of Ottawa residents who seek the vaccine will be immunized by their primary care physicians. The distribution of vaccine to physicians began during the last week of September. Targeting high risk groups Although the Ontario Influenza Immunization Program is universal, OPH aims to maximize coverage in specific target populations, following national and provincial guidelines. The target groups for each year s influenza program are announced by the National Advisory Committee on Immunization and the Ministry of Health and Long- Term Care (MOHLTC). The targeted groups for 2012 include: Adults and children with chronic health conditions, including individuals with morbid obesity (body mass index of greater than 40) Residents of long-term care homes, chronic care facilities and retirement homes Healthy children aged six months to five years of age People capable of transmitting influenza to those at high-risk, such as health care workers People providing essential community services People 65 years of age and older Healthy pregnant women Aboriginal people During the 2011-2012 influenza seasons, OPH directly immunized 5,276 adults aged 65 years and older as well as 1,997 adults under the age of 65 years with high-risk chronic conditions.
Communications Plan The annual influenza communications campaign is supported by the MOHLTC. OPH s locally-tailored influenza campaign focuses on advertising, earned media, social media and the OPH website to provide information on clinic locations, dates and times, as well as information about influenza immunization (Document 1). DISCUSSION Uptake of the influenza vaccine Approximately 44 per cent of adult Ottawa residents reported receiving an influenza vaccination during last year s flu season. Over the past four years, influenza vaccination rates in Ottawa have been consistently higher than the provincial average. Uptake of the influenza vaccine among adults aged 65 years and older was 78 per cent in the 2011-2012 season. Seasonal influenza vaccination among residents of long-term care and residential retirement homes are consistent with Ontario values and have generally exceeded 90 per cent since the 2005-2006 season (Document 2). Vaccination among staff is generally lower for all institutional types compared to residents, with the lowest seen in hospitals (52 per cent in 2011-2012). Proportions of vaccinated staff decreased from 2006-2007 until 2009-2010 to the lowest levels since the 2005-2006 season. This pattern was seen across Ontario (Document 2). The lower seasonal vaccination proportions in 2009-2010 may have been as a result of competing priorities with pandemic H1N1 vaccination (Document 2). Staff vaccination has been increasing year by year but has yet to reach 2005-2006 levels for long-term care facilities. Reported cases of influenza in 2011-2012 The number of reported cases of influenza represents only a very small fraction of the true number of people ill with influenza, because in order to be reported, a case must have a positive laboratory test and very few influenza cases are actually tested. However, reported cases help the public health sector gain a better understanding of influenza in the community. By June 2012, the number of laboratory-confirmed influenza cases in Ottawa was fewer in 2011-2012 compared to 2010-2011: 147 compared to 200. However, significantly more Influenza B was reported in the 2011-2012 season than in the 2010-2011 season: 94 cases compared to 16 cases. Forty-five of the reported influenza 2011-2012 cases (30 per cent) were hospitalized. Most of those hospitalized were children with just over 50 per cent of hospitalized cases being under the age of five years old. Surveillance activities Ottawa Public Health monitors influenza activity by: Monitoring emergency room visits by people with symptoms of influenza-like illness at all Ottawa emergency rooms Routinely liaising with hospital infection control practitioners Monitoring reports of laboratory-confirmed cases of influenza in the community Investigating respiratory outbreaks in child care and institutional facilities
Receiving reports of increased school absenteeism due to respiratory illness Reviewing reports of province-wide respiratory illness lab testing results from the Ontario Public Health laboratory Reviewing influenza activity in the rest of Ontario and across Canada The announcement in September 2012 by the MOHLTC regarding an Ontario resident infected with an H1N1 variant (H1N1v) influenza virus, and the subsequent knowledge and information sharing that is taking place with all local health units and provincial partners is an example of how OPH plays a key role in a broader surveillance system. Ongoing and new program improvements In an ongoing effort to improve influenza immunization rates, find efficiencies and bring together innovative partnerships, OPH is launching several new initiatives for the 2012-2013 influenza season, as well as maintaining several existing and effective outreach activities: Partnering with three acute care hospitals, Bruyère Continuing Care and The Royal to conduct clinics for hospital staff, their families and visitors. Research has shown that influenza clinics that offer the vaccine to hospital staff along with their family members and visitors have greater immunization uptake than clinics that focus solely on staff. Adding three new community immunization clinics, bringing the total number of influenza immunization clinics available to the general public to 36 (Document 3). These locations were selected based on the size of the facility, availability of parking, ease of accessibility and proximity to public transit routes. There is at least one clinic in each ward. Collaborating with 16 City of Ottawa child care facilities to vaccinate up to 200 staff and potentially a number of children who attend the child care facilities and their family members Continuing OPH s comprehensive street health outreach to ensure clients who are homeless or living in shelters have easy access to the influenza vaccine. More than 800 clients at 26 clinic locations were immunized through this outreach activity last year. Providing nine clinics for seniors living in Aging in Place apartment buildings. Last year, nearly 600 seniors were immunized at similar clinics. Offering four clinics to the community partners who make up the Young Single Parents Network. More than 130 parents and their young children were immunized in the 2011-2012 influenza season through this initiative. Supporting physicians to ensure they have adequate storage capacity and supply of influenza vaccine Enhancing efforts to promote influenza immunization of OPH staff and volunteers, and to measure vaccine uptake by this group In order to maintain the high quality of client service interactions, the online clinic appointment booking system is available at four clinics during the 2012-2013 influenza season. This service was available at eight clinics during the previous influenza season; however, due to limited uptake at some clinic sites, this option will only be provided at
four clinics where use was high last year. OPH also continues to increase the bilingual capacity of staff at the immunization clinics to ensure that clients may access health services in the official language of their choice. OPH provides all of its public health nurses with the opportunity to work at the OPH influenza immunization clinics. Not only does this enable nurses to maintain their immunization competency, but it helps to reduce the operational costs of the clinics through use of existing staff. CONSULTATION The City of Ottawa s Occupational Health and Safety Department will offer influenza vaccination clinics in 16 City of Ottawa child care facilities. Influenza immunization clinics will be offered at these facilities from October 15 to 22, 2012. In the spring of 2012, discussions with acute care hospitals in the Ottawa area were held with the aim to offer collaborative influenza vaccine clinics. Five facilities have requested to collaborate with OPH by hosting one clinic in each facility from October 23 to November 6, 2012. Each of the facilities have identified their target population as clients who require outpatient services, families of their vulnerable patients, visitors to the facility, and families of staff members. It is estimated that between 500 and 1,000 people will be immunized per clinic. The City of Ottawa s Legal department has reviewed the consent form, which a vaccine recipient (or the parent-guardian of a vaccine recipient) is asked to sign before receiving an influenza vaccination by OPH staff to ensure the form meets legal requirements. LEGAL IMPLICATIONS There are no legal impediments to the implementation of the report recommendations. FINANCIAL IMPLICATIONS There are no financial implications in implementing the recommendations of this report. TECHNOLOGY IMPLICATIONS There are no technology implications associated with this report. BOARD OF HEALTH STRATEGIC PRIORITES The recommendations in this report support the Board of Health Strategic Priorities: A2 Increase integration with other City departments and community agencies; B5 Reduce health risks related to preventable infectious and non-infectious diseases; C1 Increase access to services for populations facing health inequities; E2 Leverage technology to extend our services and make better connections with our citizens. TERM OF COUNCIL PRIORITIES The recommendations in this report support the 2010-2014 Term of Council Priorities under Healthy and Caring Communities.
SUPPORTING DOCUMENTATION Document 1 OPH Annual Influenza Immunization Communications Plan Document 2 Influenza Immunization Rates Among Health Care Workers and Residents of Hospitals, Long-Term Care Facilities and Residential Retirement Homes Document 3 OPH Community Influenza Clinics DISPOSITION Ottawa Public Health staff will carry out the activities stated in this report, specifically disseminating influenza vaccine to physician s offices and other community partners, providing influenza immunization clinics and making use of web and social media communications to promote influenza immunization. Ottawa Public Health staff will also endeavour to improve influenza immunization uptake and report back on program effectiveness in 2013. i Sander B, Kwong JC, Bauch CT, Maetzel A, McGeer A, et al. (2010) Economic Appraisal of Ontario's Universal Influenza Immunization Program: A Cost-Utility Analysis. PLoS Med 7(4): e1000256. doi:10.1371/journal.pmed.1000256