Carl Chu, PharmDCarl Chu, PharmDHawaii Department of HealthHawaii Department of Health

Paul V. Effler, M.D., M.P.H. Paul V. Effler, M.D., M.P.H.

Only one public school system statewideOnly one public school system statewide

Success implementing other school-based Success implementing other school-based vaccination programs (i.e., hepatitis B vaccine for vaccination programs (i.e., hepatitis B vaccine for 55thth graders) graders)

To be prepared for possible mass vaccinations of To be prepared for possible mass vaccinations of school children during an influenza pandemicschool children during an influenza pandemic

Evidence of substantial seasonal influenza attack Evidence of substantial seasonal influenza attack rates in children including reports of school rates in children including reports of school outbreaksoutbreaks

Preliminary dataPreliminary data

Ideal setting for assessing impactIdeal setting for assessing impact Hawaii’s geographic isolation means residents usually Hawaii’s geographic isolation means residents usually

receive medical care within statereceive medical care within state Statewide hospital discharge databank that may be used Statewide hospital discharge databank that may be used

to ensure comprehensive ascertainment of influenza to ensure comprehensive ascertainment of influenza hospitalizations (hospitalizations (http://www.hhic.org/about.html))

Two major health care providers/payersTwo major health care providers/payers Provide 72% coverage of civilian population (930,381 of Provide 72% coverage of civilian population (930,381 of

1,285,498 in 2006)1,285,498 in 2006) Should permit robust assessment of effect of program on Should permit robust assessment of effect of program on

health care encounters, including outpatient visits, health care encounters, including outpatient visits, statewidestatewide

Only 20% of 44,725 privately insured childrenOnly 20% of 44,725 privately insured children

Only 40% of 8,154 privately insured asthmatic Only 40% of 8,154 privately insured asthmatic childrenchildren

Only 50% of 68 privately insured diabetic childrenOnly 50% of 68 privately insured diabetic children

Preliminary dataPreliminary data

Grades K-8Grades K-8

All Hawaii public and private schools asked to All Hawaii public and private schools asked to participate participate

Offered TIV (shot) and LAIV (nasal spray)Offered TIV (shot) and LAIV (nasal spray)

Two clinics >6 weeks apart if school had children age Two clinics >6 weeks apart if school had children age <9 years who might need 2 doses<9 years who might need 2 doses

Voluntary written informed consent of Voluntary written informed consent of parents/guardians requiredparents/guardians required

Preliminary dataPreliminary data

JanJan Feb Feb MarMar AprApr MayMay JunJun JulJul AugAug SepSep OctOct NovNov DecDec JanJan

Order VaccinesOrder Vaccines

Staffing Staffing ArrangedArranged

Consents Consents Due/ReviewDue/Review

SchoolsSchoolsScheduledScheduled

ClinicsClinics

Consents Consents SentSent

SchoolsSchoolsAskedAsked

Promotion Promotion

59 working days59 working days

Preliminary dataPreliminary data

School ParticipationSchool Participation 340/377 (90%) of all schools with grades K-8340/377 (90%) of all schools with grades K-8

242/251 (96%) of public schools242/251 (96%) of public schools

98/126 (78%) of private schools98/126 (78%) of private schools

622 school-based clinics (277 second dose clinics)622 school-based clinics (277 second dose clinics)

Preliminary dataPreliminary data

Student participation:Student participation: 63,15363,153 (94%) of 67,203 students who consented(94%) of 67,203 students who consented

43% of 146,777 children at participating schools vaccinated 43% of 146,777 children at participating schools vaccinated 46% of 132,775 children aged 5-13 years46% of 132,775 children aged 5-13 years in Hawaii in Hawaii

according to censusaccording to census 18,172 18,172 children received 2children received 2ndnd dose dose 81,325 total flu vaccine doses given81,325 total flu vaccine doses given

School staff participation: ~School staff participation: ~9,281 9,281 school-based school-based staff vaccinated, representing (43%) of the staff vaccinated, representing (43%) of the workforce cohortworkforce cohort

Preliminary dataPreliminary data

Preliminary dataPreliminary data

ADMINISTERED

PREFERENCE

TIV

56%

LAIV

26%

Either

18%

0

200

400

600

800

1000

1200

1400

1600

0 to 5 6 to 10 11 to 15 > 15

Stu

den

ts

Minutes

72%

3%5%

20%

MeanMeanMediaMedia

nn ModeMode

0:050:05 0:040:04 0:020:02

**Based on n = 1,970 students at 199 schools; approx 10 Based on n = 1,970 students at 199 schools; approx 10 students/schoolstudents/school

Preliminary dataPreliminary data

Cost for 2007-2008 program:Cost for 2007-2008 program:

Preliminary dataPreliminary data

Vaccine: 1,049,096$ 50%Medical Supplies: 135,000$ 5%Print Materials: 148,278$ 5%Data Entry: 42,230$ 1%Nursing Services: 300,000$ 10%Staff: 130,199$ 5%Curriculum & Training: 35,300$ 1%Public Relations: 216,706$ 8%Courier: 19,300$ 1%Promotion & Incentives: 7,000$ 0%

TOTAL 2,083,108$

Average of $23.69 for every flu vaccine dose administered.Average of $23.69 for every flu vaccine dose administered.Average of $23.69 for every flu vaccine dose administered.

Keep kids healthy and in schoolKeep kids healthy and in school Help keep older adults and pre-school kids healthyHelp keep older adults and pre-school kids healthy Enhance our capability to respond to a potential Enhance our capability to respond to a potential

pandemicpandemic Strengthen relationships with all community Strengthen relationships with all community

partners, including public, private, professional, partners, including public, private, professional, and individualsand individuals

Mahalo!Mahalo!