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A report to May 20, 2011

A report to May 20, 2011. Vast majority of children are vaccinated-only 0.6% receive no immunizations at all Some immunizations are having even better results than anticipated Shingles even better than original tests Influenza protects babies who’s mothers got immunized

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A report to May 20, 2011

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  1. A report to May 20, 2011

  2. Vast majority of children are vaccinated-only 0.6% receive no immunizations at all • Some immunizations are having even better results than anticipated • Shingles even better than original tests • Influenza protects babies who’s mothers got immunized • Some immunizations are not meeting expectations • All races and ethnicities start the HPV series but there are racial disparities in completing the 3 dose series • After 2-5 years protection against meningitis drops off-2nd dose now recommended at age 16 • VTrckS-Central distribution system now piloted with 4 health departments-future-bar codes, date and date of expiration-better decision-making, better safety tracking, managing shortages, meaningful use (incentive pay)

  3. Great Expectations • Records Broken – 162 million doses distributed of seasonal flu vaccine • Rotavirus – 80% drop in the disease • Outbreak – Pertussis in California – last time such high rate- • 1947-13,845 cases • 2010-9,477 • Economic Return on Investment-key points to address Federal budget concerns

  4. Estimated Return on Investmentof Childhood Vaccines • For each birth cohort vaccinated against 13 diseases in accordance with the schedule for DTaP, Hib, IPV, MMR, hep B, Varicella, Hepatitis A, Pneumo-7, and Rotavirus vaccines: • 42,000 lives are saved • 20M cases of disease are prevented • 13.6 billion dollars in direct costs are saved • 68.9 billion dollars in direct plus indirect (societal) costs are saved • For each dollar invested in these vaccinations, $10.20 is saved Full Presentation on Tues Mar 29, Workshop D2, 11:30AM Preliminary results of updated analysis from Zhou et al, Arch of Ped and Adolesc Med 2005

  5. www.cdc.gov/vaccines/conversations

  6. Immunizations Globally • The Meningitis Project - Africa • Vaccine produced in India • In 10 days 11 million people were vaccinated in Burkina Faso (entire population) • As of today only 2 cases of Meningitis A in unvaccinated adults

  7. Immunizations Globally • Polio Eradication • 1988 1,000 cases/day to now 1,000 cases/year • 2008 WHO developed a new strategy based on lessons learned • Lesson 1 – Immunity gaps allow virus to persist in smaller populations than originally thought • Lesson 2 – Immunity thresholds to stop Polio differ, being higher in Asia than Africa • Lesson 3 – Very different to optimize balance of monovalent and trivalent OPV • Lesson 4 – Routes of Polio virus spread and outbreaks are predictable

  8. Immunizations Globally • Update on Cholera Vaccines • 1800’s Vaccine from Spain – no proof of effectiveness • 1960’s – 2 dose vaccine; high side effects; Dc’d in 2000 • 1980’s – Live attenuated; No efficacy; Dc’d • Dukoral – 2 does in adults, 3 doses < 6 years of age; 1-6 weeks apart; Cold chain; Buffer required; Licensed in 61 countries (not U.S.); pre-qualified by WHO • Shanchol – 2 doses 14 days apart; No buffer required; $21 per dose; Ages 1 year and up; Not WHO pre-qualified; Licensed in India • Vaccines used in conjunction with prevention and control strategies where Cholera is endemic

  9. Communicating in a Fast Moving World • Moving away from Interpreting marketing and towards conversation marketing • Monitor the Internet – Google alerts; Google reader; Technorati.com (blogs) • When and how to respond • Monitor, watch, and listen • Respond quickly • Be conversational & Be transparent • To deliver a message you must know: • Who is the audience • What channel to get the message out • Who is the spokesperson

  10. Communicating in a Fast Moving World • Technology is great but you have to get the message right. • Be First • Be Right • Be Credible • You can’t rely on your credibility you earned the other day, you have to keep earning it.

  11. Telling the Story of Vaccine Preventable Diseases • Book – Vaccine Preventable Diseases – The Forgotten Story • Updated 2010 • 95% responded having parents change their minds about immunizations • Shot by Shot - Shotbyshot.org • Video based project • Story gallery with 90 stories organized by the disease

  12. Telling Our Story: Developing a Compelling Narrative about Immunization • To be a person you have a story • Stories transfer wisdom • Stories define who we are • Most importantly the evoke emotion • Hero • Villain • Journey • Surprise • Message • Awe-Inspiring Emotion

  13. Adolescents • School Vaccination Assessment • North Dakota – State law all doses administered to individuals <18 years of age have to be entered into their state immunization registry

  14. Pregnant & Postpartum Women • Good Ideas: • With physician’s recommendation uptake for seasonal flu is higher • Standing orders for Tdap in hospitals • Voucher for 1 other primary person named by mother – 84.9% got vaccinated • Immunize for seasonal flu at WIC clinics – monthly pregnancy visits, grew from 9.3% coverage to over 20%

  15. The Future of Immunizations Things to consider: • Seasonal vs. pandemic • Pipeline Trajectory:

  16. The Future of Immunizations • Live attenuated • DNA vaccine – optimizing antigenic combinations • Vector – means by which virus is delivered to cell???? • Virus-like particle – particles of virus put into vectors • Subunit/Peptide • “Universal’ vaccine – Human B-cells generating antibodies to vaccines and natural infections • Novel adjuvants • Move away from egg-based=cell-based production • PCAST report • Recombinant – get a platform that can be approved by FDA then plug in antigens in lower concentrations - virus vector combined with influenza virus genes

  17. The Future of Immunizations

  18. The Future of Immunizations Promise of recombinant technologies for producing/improving influenza vaccines • Speed • Flexibility • Scale up • Downstream processing simplified. • Other aspects…stability, formulation. • Tailored approaches eg. Targeting cellular responses, target groups, universal/broader protection.

  19. Pharmacies • Pharmacies are within 3 miles of every American • Health Professional Shortage Areas (HPSA’s)– 26% of American population live in these – approximately 80 million people – 2600 Walgreens in these areas serving approximately 43.8% • Missouri has more than 50% of population living in HPSA’s • 6.2 million got flu immunizations at Walgreens with stores in all 50 states – adolescent and adult • Their targets: well-intentioned moms, prevention-focused seniors, existing Rx patients • Goal in addition to giving immunizations – partner with healthcare provider, physician notification letter • Promotional efforts – tried to instill urgency and pride “I got a flu shot for _____ (name), pre-sell – flu shot card, flu shot heroes website • Free for employees 25% last year, 50% this year

  20. References 2011 National Immunization Conference: State of the Nation's Immunization, Anne Schuchat, MD, Rear Admiral, US Public Health Service Director, National Center for Immunization and Respiratory Diseases From Epidemic to Elimination: Serogroup A Conjugate Meningococcal Vaccine for the Meningitis Belt, Nancy Messonnier, M.D., Chief, Meningitis and Vaccine Preventable Diseases Branch, 2011 National Immunization Conference, March 2011 Polio Eratication: Progress and Challenges, Bruce Aylward, MD, MPH, World Health Organization, 2011 National Immunization Conference, March 2011 Update on Cholera Vaccines, Eric Mintz, MD, MPH, National Immunization Conference, March 29, 2011 Health and Risk Communications, Norm Hartman, TMT worldwide, National Immunization Conference, March 2011 Selling Your Story: Inside and Out, Tim Church, WA State Department of Health, National Immunization Conference, March 2011. Stories that Change Behavior, Bill Smith, EDD, PHD, makingchange4u@gmail.com. , 2011 National Immunization Conference, March 2011

  21. References Matching School Immunization Records to NDIIS Data, Abbi Pierce, MPH, BAS, Immunization Surveillance Coordinator, North Dakota Department of Health; Keith LoMurray, BA, in, Sociology Influenza Vaccination Coverage Among Pregnant Women From the National 2009 H1N1 Flu Survey (NHFS), 2009-10 Influenza Season, Helen Ding, MD, MSPH, Epidemiologist, Chenega Government Consulting LLC, National Immunization Conference, March 2011 Lessons Learned In Implementing a Cocoon Program to Prevent Infant Pertussis at Four Kansas Hospitals, Elizabeth Lawlor, MS, Epidemiologist, Kansas Department of Health and Environment, National Immunization Conference, March 2011 New Influenza Vaccine Technologies, Michael Perdue, PhD, BARDA, U.S. Department of Health and Human Services, National Immunization Conference, March 2011 Novel Approaches to Influenza Vaccines: What’s Coming? Frederick Cassels, PhD, NIAID, NIH, US Department of Health and Human Services, National Immunization Conference, March 2011 Community Pharmacy Impact on Access to Immunization s for Health Professional Shortage Areas, Patricia Murphy, MPH, Senior Research Analyst, Walgreen Co; Ed Cohen, PharmD; DevoneeHarshburger, MS, National Immunization Conference, March 2011

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