The Indiana Immunization Coalition
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The indiana immunization coalition exists to promote childhood immunization and raise community awareness about immu

The Indiana Immunization Coalition

exists to

promote childhood immunization

and raise community awareness

about immunization issues.


The indiana immunization coalition exists to promote childhood immunization and raise community awareness about immu

The Indiana Immunization Coalition is a volunteer organization which represents over 165 agencies from many different disciplines that are concerned about the immunization of children.


The indiana immunization coalition exists to promote childhood immunization and raise community awareness about immu

Why Coalitions?The health coalition movement is an emerging trend in the healthcare community. As society moves toward a greater focus on health and wellbeing for all citizens, the immunization coalition model will be replicated across many issues and ultimately will be the catalyst for changing the way communities look at health.Immunization Coalition Sustainability Project


The indiana immunization coalition exists to promote childhood immunization and raise community awareness about immu

Building Community Partners“It is no longer just about the public health system. It includes private health care systems, private industry, and the nonprofit community. Coalitions bridge those systems and build a healthier community.”Immunization Coalition Sustainability Project


The indiana immunization coalition exists to promote childhood immunization and raise community awareness about immu

GOALS

  • Promote and support statewide immunization registry development and use.

  • Develop marketing/awareness strategies for immunization issues.

  • Provide statewide leadership to create opportunity for participation, education and collaboration on immunization issues.


The indiana immunization coalition exists to promote childhood immunization and raise community awareness about immu

IIC Beginnings

  • Support the statewide immunization registry.

  • Share immunization information with organizations who are concerned with the welfare of children.

  • Developed “Best Practices” brochure for providers.

  • Actively supported, monitored and influenced policy regarding immunization bills in the state and federal legislature.

  • Filmed and distributed an immunization awareness Public Service Announcement featuring former First Lady Judy O’Bannon.


The indiana immunization coalition exists to promote childhood immunization and raise community awareness about immu

CHIRP

Every Child By Two Registry Mentoring Grant


Shots for tots

Shots For Tots


The indiana immunization coalition exists to promote childhood immunization and raise community awareness about immu

The Indiana Immunization Coalition Appreciation Awards recognize efforts in advocacy, registry, education and collaboration


The indiana immunization coalition exists to promote childhood immunization and raise community awareness about immu

Child health data shows a significant reduction in well baby checks and immunization visits after a child turns one year of age.


The indiana immunization coalition exists to promote childhood immunization and raise community awareness about immu

Immunize Hoosier Children

Indiana’s Immunization Challenge

  • 22% of Hoosier children don’t receive recommended immunizations by age 2

  • Indiana ranks 39th nationally in immunization for 2-year-olds

Proposed Solution

  • Allocate $11M to expand the child vaccination program

  • Saves $25 in additional health expense for every additional $1 spent on childhood immunizations

Source: ISDH

The Governor’s Plan for a Healthier Indiana


The indiana immunization coalition exists to promote childhood immunization and raise community awareness about immu

www.inimcoalition.org


Why adolescent immunization

Why Adolescent Immunization?

  • Many adolescents are under-immunized, putting their health and their futures at risk.

  • Many states have implemented “catch-up” requirements for Hep B, MMR#2, Dtap.

  • New vaccines are being developed many specifically for adolescents.


Adolescent immunization

Adolescent Immunization

“The good news is we can now prevent so many diseases.

The bad news is it’s gotten more complicated.”

Dr. Anne Schuchat, U.S. Centers for Disease Control and Prevention, Immunization Programs.


Diseases prevented by vaccination of children and adolescents

Diseases Prevented by Vaccination of Children and Adolescents


Vaccine recommendations by age group 2003 and 2007

Vaccine Recommendations by Age Group, 2003 and 2007

† Assumes 2 doses of influenza vaccine for 4 year olds

†† Includes HPV, 3 doses for females only. For males, 4 diseases and 2 doses


Adolescent immunization barriers

Adolescent Immunization Barriers

  • Few well child visits-approximately 60% receive primary care from a pediatrician or family physician. Others have different provider or no provider at all.

  • No measurement or accountability system at state or local level

  • May need to consider other points of access such as schools

Vaccination Success and Stresses, Walter Orenstein, MD


The indiana immunization coalition exists to promote childhood immunization and raise community awareness about immu

78

82

78

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NH

86

81

MA

89

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86

RI

87

83

81

CT

88

86

86

NJ

83

82

68

80

DE

86

79

83

71

81

87

MD

80

77

81

82

78

DC

83

79

82

82

79

72

82

84

80

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84

85

75

75

73

89

Estimated Vaccination Coverage with the 4:3:1:3:3* Series, by Coverage Level and State 2004- National Coverage = 81%

VT 85

81

 90%

80-89%

70-79%

 69%

*4+DTP, 3+Polio, 1+measles-containing vaccine, 3+Hib, 3+HepB


How is your county doing

How is Your County Doing?

  • Healthy People 2010 Goal

  • Immunization rate of 90%


Vaccinate before you graduate indiana

VACCINATE BEFORE YOU GRADUATE INDIANA

2004 ENVIRONMENT

  • The state of Indiana passed new legislation requiring 9th and 12th graders receive the Hepatitis B vaccine.

  • A new recommendation for meningococcal immunization was forecasted for the coming year as well as a new vaccine.

  • Pertussis was being added to tetanus and strongly recommended for adolescents.

  • HPV wasn’t on the radar.


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VACCINATE BEFORE YOU GRADUATE INDIANA

HEPATITIS B VACCINE LAW

  • Law passed in 2004, effective 6/05-6/08

  • Affects 9th and 12th graders

  • No school record audit or reporting to ISDH required

  • No suspension of students if don’t meet the requirement

  • An opportunity to promote Hepatitis B, other vaccines for adolescents.


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VACCINATE BEFORE YOU GRADUATE INDIANA

Adolescent Subcommittee

The committee’s first meeting was in the spring of 2004. The committee is comprised of representatives from Indiana Immunization Coalition, Indiana State Department of Health, Indiana Department of Education, Kiwanis, School Nurse Association, Sanofi Pasteur, GlaxoSmithKline, Managed Health Centers and the Meningitis Foundation.


Vaccinate before you graduate indiana3

VACCINATE BEFORE YOU GRADUATE INDIANA

Promoting Immunization through community networks is a proven means to build trust and acceptance of vaccines.

Why Invest in Communication for Immunization? Silvia Waisbaord and Heidi J. Larson


Vaccinate before you graduate indiana4

VACCINATE BEFORE YOU GRADUATE INDIANA

MAP IT

Mobilize individuals and organizations

Assess the areas of great need

Plan your approach, start with a vision

Implement you plan with action steps

Track your progress

Healthy People 2010


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VACCINATE BEFORE YOU GRADUATE INDIANA

PROGRAMS

  • Rhode Island developed a marketing campaign as well as school based clinics.

  • Virginia developed a marketing campaign, tool kit and held a national satellite conference.

  • Arizona used at risk students to develop an award winning marketing campaign.


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VACCINATE BEFORE YOU GRADUATE INDIANA

PLAN

The vision of the Vaccinate Before You Graduate program is to develop a statewide initiative that increases adolescent immunization coverage through education, collaboration and vaccination.


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VACCINATE BEFORE YOU GRADUATE INDIANA

IMPLEMENTATION

The committee created and implemented a model program to share with others throughout the state. The program originally focused on Meningococcal, Tetanus, Hepatitis B, Varicella and Measles Mumps and Rubella.


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VACCINATE BEFORE YOU GRADUATE INDIANA

PILOT PROGRAMS

  • Hammond

  • Vanderburgh County

  • Vigo County


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VACCINATE BEFORE YOU GRADUATE INDIANA

TRACKING

PROGRESS

OVER TIME


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VACCINATE BEFORE YOU GRADUATE INDIANA

2006 HEALTH DEPARTMENT SURVEY

  • 66% of Health Departments participated

  • 50% had started a Hepatitis B program for adolescents

  • 10% had started a VBYG program

  • 62% were collaborating with schools

  • 84% focused the program on high schoolers


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VACCINATE BEFORE YOU GRADUATE INDIANA

2007 HEALTH DEPARTMENT SURVEY

  • 35% of Health Departments participated

  • 63% had started a Hepatitis B program for adolescents

  • 16% had started a VBYG program

  • 78% were collaborating with schools

  • 88% focused the program on high schoolers


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VACCINATE BEFORE YOU GRADUATE INDIANA

2006 HEALTH DEPARTMENT SURVEY

  • School nurses did the paperwork

  • 61% used postcards for notification

  • 38% conducted special clinics hours

  • 20% conducted school clinics

  • 10% were using VBYG materials


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VACCINATE BEFORE YOU GRADUATE INDIANA

2007 HEALTH DEPARTMENT SURVEY

  • School nurses did the paperwork

  • 84% used postcards for notification

  • 22% conducted special clinics hours

  • 19% conducted school clinics

  • 16% were using VBYG materials


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VACCINATE BEFORE YOU GRADUATE INDIANA

2006 HEALTH DEPARTMENT SURVEY

  • Difficult to complete due to vaccine shortages

  • Difficult to offer all vaccines at school based clinics

  • Difficulty with staffing issues to do more

  • Great collaboration with school nurses


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VACCINATE BEFORE YOU GRADUATE INDIANA

2007 HEALTH DEPARTMENT SURVEY

  • Increase in offering other vaccines from 2% to 34%

  • Reported reduction in school based clinics due to poor turn out.

  • Collaboration with schools consists of schools sending out Hepatitis B letter and health departments immunizing children.

  • Staffing issues make it difficult to do more.


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VACCINATE BEFORE YOU GRADUATE INDIANA

2007 SCHOOL NURSE SURVEY

  • Sent out required Hepatitis B letter.

  • Eager for immunization information.

  • Reported little contact with local health departments.

  • Liked school based clinics.


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VACCINATE BEFORE YOU GRADUATE INDIANA

UNEXPECTED OUTCOMES

  • Vaccine availability-Healthy Indiana Plan

  • School nurse module for CHIRP


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VACCINATE BEFORE YOU GRADUATE INDIANA

“The campaign’s success relies in part on vaccine supply.”

Dr. Anne Schuchat, U.S. Centers for Disease Control and Prevention, Immunization Programs.


The indiana immunization coalition exists to promote childhood immunization and raise community awareness about immu

VFC and Section 317 Vaccine Funding to Immunization Programs


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VACCINATE BEFORE YOU GRADUATE INDIANA

VACCINE AVAILABILITY

January 2007--The Governor renewed his legislative proposal to increase Indiana’s tobacco excise fees and introducing the Healthy Indiana Plan. The Plan would provide smoking cessation programs, fund the children's vaccine gap and provide insurance coverage for adults.


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VACCINATE BEFORE YOU GRADUATE INDIANA

VACCINE AVAILABILITY

May 2007—ISDH became one of the first pilot site for VMBIP (Vaccine Management Business Improvement Project).

August 2007-- ISDH evaluating vaccine ordering system to ensure timely delivery of vaccines.


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VACCINATE BEFORE YOU GRADUATE INDIANA

We may need to consider other points of access such as schools.

Vaccination Success and Stresses, Walter Orenstein, MD


School facts

School Facts

  • 22% of Indiana’s Citizens are 5 – 19 yrs. old

  • Kindergarten to Grade 12

    • Public school

      • 1,045,702

    • Private school

      • 109,124

    • Home school

      • 23,455

*2006-2007 Department of Education


School facts1

School Facts

  • School vaccination laws

    • Vary from state to state

    • Indiana allows for medical and religious exemptions

    • Failure to vaccinate results in exclusion from school


Documentation in schools

Documentation in Schools

  • Parents must provide documentation for first time enterers

    • Kindergarten

    • First Grade

    • Sixth Grade

    • Transfer to a new school

  • Becomes part of official student school record

  • Reported to state DOH and CDC


Documentation in schools1

Documentation in Schools

  • Paper

  • Electronic School Health Records

    • Free-standing

    • “Home Grown”

    • Part of a larger student record management system

  • Subject to Federal Education Reform Privacy Act (FERPA) regulations

  • Few commonly used applications


History of schools and registry

History of Schools and Registry

  • Unreliable source of data

  • Use of non-clinical staff for data entry

    • Transfer from paper records

    • Legibility of record

    • No knowledge of the immunization schedule

      • Didn’t question suspicious dates

      • Didn’t question illegible dates

    • No supervision by nursing

  • Limited computer skills & Internet access


School immunization reports

School Immunization Reports

  • Annual reporting requirements

  • Reportable to state department of health and / or the

    Department of Education

  • Due by mid-November annually

  • School funding tied to immunization coverage rates

  • Public health involved in this activity in some states


State registries working with schools

Read Only

Arkansas

Colorado

Delaware

Georgia

Houston Harris Co. TX

Idaho

Indiana*

Maryland

Minnesota

Mississippi

Missouri

Nebraska

Nevada

New Jersey

New York State

North Carolina

North Dakota

State Registries Working with Schools*

  • Oregon

  • Rhode Island

  • San Antonio, TX

  • Tennessee

  • Utah

  • Washington

  • West Virginia

  • Wisconsin

  • Wyoming

  • Virgin Islands

* AIRA Registry Profile http://www.immregistries.org/public.php/ImmRegs/regMain.php


State registries working with schools1

State Registries Working with Schools

  • Read and Add Data**

    • California

    • Kentucky*

    • Louisiana

    • Michigan

    • New Mexico*

    • Oklahoma

    • Pennsylvania

* Registry laws in place

** AIRA Registry Profile http://www.immregistries.org/public.php/ImmRegs/regMain.php


Barriers

Barriers

  • Federal Education Rights and Privacy Act (FERPA)

    • FERPA not HIPAA regulates school information

    • Requires parental consent unless state law / rules specifies reporting to registry

    • Consent added to general student consent signed at outset of academic year


Barriers1

Barriers

  • Double data entry

    • Multiple school

      applications

    • Cost of interfaces

    • Level of IT staff in

      schools not capable of doing interface work internally

  • Nurse may not be entering data


Advantages

Advantages

  • Frequently first to encounter child from out of state

  • Required to collect immunization data

  • School nurses are active registry users →

    “Ultimate Win Win”

  • Connection to families / siblings

    → Outreach opportunities

    → Source of immunization record for many

  • Access to adolescents


Advantages1

Advantages

  • Role in disease surveillance and outbreak management

    • Active members in community Pan Flu / BT response planning

    • Schools frequent site for disease outbreaks

  • Expanded use

    • School based clinics

    • Employee health

    • College / University Student Health Centers


The louisiana experience

The Louisiana Experience

  • School nurses adding data into LINKS since March 2005

    • Through January 2007, schools have entered 277,782 new immunizations

  • School nurse data “marked” in LINKS

  • Working on bi-directional interface with school application used in

    42-parish schools


Links facts

LINKS facts*

  • As of March 7, 2007

    • 68.9% of children < age 6 had at least two immunizations recorded

    • 100% public providers participating

    • 75% private providers participating

    • 2,226,282 people of all ages

    • 20,268,607 individual immunizations

* Immunization Information Systems Use During a Public Health Emergency in the United States; Urquhart Gary, MPH; Centers for Disease Control and Prevention


After katrina

After Katrina

  • Estimated 200,000 displaced persons

  • View only or HL7 links to other state registries allowed queries into LINKS

  • Displaced children and adolescents enrolling in school were initially exempt from school immunization laws


Results

Results

  • 21,295 successful external queries were made into LINKS between August 29 and October 11, 2005

    • 44 states, 5 cities and Washington, D.C.

  • Queries breakdown

    • 30.7% for children 0-5 years old

    • 39.6% for children 6–10 years old

    • 30.7% for adolescents 11-18 years old

  • Houston Harris County registry alone responded to 17,000 requests for immunization records

    • Est. $850,000 savings in unnecessary shots


Registries and physician recruitment

Registries and Physician Recruitment

  • An average of 44% of private provider sites submitted data to Immunization Information Systems during the last six months of 2005

  • Issues surrounding private provider participation

    • Reluctant to add workload to staff

    • Won’t pay the cost for electronic transfer of data to IIS

    • Data quality from billing systems

    • Many converting to Electronic Health Records

      • 1 of 4 using EHR; 1 of 10 using for treatment decision

    • Smaller practices less likely to have electronic

      data systems


Summary

Summary

  • Schools hold immunization data that mirrors or exceeds what is held by private providers

  • School nurses are motivated to work with registries → many would do double data entry

  • Schools play a critical role in disaster, disease outbreak and Bioterrorism plans


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VACCINATE BEFORE YOU GRADUATE INDIANA

SCHOOL NURSE MODULE FOR CHIRP

Goals:

2007 ISDH purchase School Nurse Module

2007 School Nurse Module pilot programs

2007 Freshmen records reported

2008 School Nurse Module used by all Indiana schools

2008 School nurses reviewing records of students every year.


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VACCINATE BEFORE YOU GRADUATE INDIANA

NATIONAL IMMUNIZATION COALITION’S TA NETWORK RECOGNITION

Vaccinate Before You Graduate/Indianawas recognized by IZTA as a Promising Practice


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VACCINATE BEFORE YOU GRADUATE INDIANA

Vaccinate Before You Graduate information can be found on the Indiana Immunization Coalition’s website:

www.inimcoalition.org


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