balancing act: launching pentacel during the hib shortage jan hicks-thomson, msw, mpa washington...
TRANSCRIPT
Balancing Act: Launching Pentacel
during the Hib Shortage
Jan Hicks-Thomson, MSW, MPAWashington State Department of Health
Problems IdentifiedProblems Identified
Concern
DiseaseConcern
Missed Doses
Extra Visits
Wait Lists
Limiting Shots
Extra Work
Worried Parents
ResponseResponse
No New Doses
No ACIP Change “Enough”
Listen Respond
Transfer Reallocate
Guidance from VAC
Was the Allocation Enough?Was the Allocation Enough?
21.420
24.7
20
23.7
20.2
15.4
19.3
0
5
10
15
20
25
July Aug. Sept. Oct.
05 - 07 3 Dose Ave. 08 Allocation
87,000 (projected births 08)
x3 (shortage series)
261,000 (sub-total)
% 12 (monthly average)
21.750 (@ 100%)
x .90 (expected rate)
19,574 (calculated need)
Order History Birth Cohort
Spreading the News at Light SpeedSpreading the News at Light Speed
Communication
SupportTools
Population Based Population Based 2 Product Allocation2 Product Allocation
County January
Total ActHib Pentacel
Adams 120 0
Asotin 210 0
Benton - Franklin 920 290
Chelan - Douglas 380 120
Clallam 190 90
Clark 440 1460
Benton-Franklin
Hib Order Tracking January
ActHib Pentacel
Total Monthly Allocation 920 290
Balance (MUST BE ≥ 0) 730 230
PIN Provider Name Approved Approved
152001 Delos, Reyes C. 50 20
152002 Richland Family Medicine 40
152004 Chou, H.D. 50 20
152006 Ahart, S. 20
152007Columbia Family Medicine 30 20
AllocationStrategy
Overlay High Volume ProvidersOverlay High Volume Providers
PIN Name Monthly
HibPediarix
Inventory
181045 MALLARD PEDIATRICS 196 195
181037 MARINER PEDIATRICS- PINELAKE 139 not entered
181135 GRIFFEY PEDIATRICS 143 150
195002 SOUNDER MEDICAL 250 595
197003 YELLING PEDIATRICS 200 320
193005 OLYMPIC PRACTICE 200 191
187107 GENOME KIDS CLINIC 200 235
186054 SEAHAWKS CLINIC - Lake Stevens 100 not entered
186056 SEAHAWKS CLINIC - Silver Lake 100 not entered
191005 BUNKO PEDIATRICS 250 484
Clallam
Jefferson
GraysHarbor
Pacific
Whatcom 1
Skagit 3
Snohomish 6
King 23
Pierce
Lewis
Mason
CowlitzThurston 2
Clark 5
Skamania
Klickitat
Yakima 2
Kittitas
Chelan
Douglas
Grant
Okanogan FerryStevens
Pe
nd
Ore
ille
Sp
okan
e 2
Lincoln
Adams Whitman
Franklin
Benton
Walla W
alla 1
Colum
biaG
arfield
Asotin
Kits
ap
9 Counties
45 Provider Sites
Beginning Provider ParticipationBeginning Provider Participation
Hib Containing Vaccine Hib Containing Vaccine Before and After PentacelBefore and After Pentacel
May 2008 – Feb. 2009May 2008 – Feb. 2009
0
5
10
15
20
25
30
May June July Aug Sept Oct Nov Dec Jan Feb
Pentacel Doses ActHib Doses Total Hib Containing
45 41332266 158
Clallam 5
Jefferson 1
Grays
Harbor 2
Pacific
Whatcom 10
Skagit 6
Snohomish 32
King 171
Pierce 49
Lewis 1
Mason 1
Cowlitz 2Thurston 15
Clark 26
Skamania 1
Klickitat
Yakima 19
Kittitas
Chelan / Douglas 6
Grant 4
Okanogan 2 FerryStevens
Pe
nd
Ore
ille
Spok
ane
16
Lincoln
Adams1
Whitman 2
Bento
n /
Frankl
in 2
4
Walla W
alla 5
Colum
biaG
arfield
Asotin
Kitsap 10
Island 1
N.E. Tri 1
27 Counties
413 Provider Sites
Wahkiakum
Ending Provider ParticipationEnding Provider Participation
Trouble ShootingTrouble Shooting
Single
DoseDisease
Risk
New Vaccine
Medical Errors
Inventory
ManagementLot Numbers
Vaccine Supply IssuesVaccine Supply IssuesPentacel, Hep. B and PediarixPentacel, Hep. B and Pediarix
July 2008 – Feb 2009July 2008 – Feb 2009
0
2
4
6
8
10
12
14
16
18
July August Sept Oct Nov Dec Jan Feb
Pentacel Pediarix Hep B
Inventory ManagementInventory Management
Pediarix Inventory: February
# ProvidersInventory
(doses)
2 >500
3 301 - 500
19 101 - 300
32 100
359 <100
Hepatitis B Back-Orders
Week # Providers
3/16/09 20
3/20/09 60
Through May Normal Supply?
Summer 2009 Spotty Supply?
Fall 2009 Normal Supply?
How Are We Doing?How Are We Doing?
YearYear All All CasesCases
Type BType B Up to Up to DateDate
Ages B Type Ages B Type CasesCases
20062006 55 11 11 3 mos.3 mos.
20072007 66 33 11 0, 3, 14 mos.0, 3, 14 mos.
20082008 22 00 N/AN/A N/AN/A
20092009 22 UKUK UKUK UKUK
HiB Disease Reported in Washington
How Are We Doing?How Are We Doing?
Born 11/1/07 to 3/31/08
Receiving 1, 2, and 3 doses
by 9 months of age
Dose Hib PCV-7
1 96.2% 96.7%
1 & 2 82.4% 85.1%
1, 2 & 3 55% 64%
Children w/ 2 or
more immunizations.
Getting Kids Vaccinated in Washington
Registry Recorded Doses
Area 3 Hib 3 IPV 4 Hib
Adams 89% 90% 4%
Grant 88% 89% 8%
Chelan 90% 89% 11%
Douglas 92% 92% 14%
Based on Immunization Registry Data
National Immunization Survey National Immunization Survey ResultsResults
Washington State NIS Rates and Rankings, 2007-2008
Vaccine2007 2008 Difference, 2007-2008
Rate Rank Rate Rank Rate Rank
4+DTaP 80.9±5.4 41 82.7±5.0 33 1.8±7.3 ↑ 8
3+Polio 85.1±5.1 49 88.7±4.1 48 3.6±6.6 ↑ 1
1+MMR 90.5±3.9 36 91.2±3.5 33 0.7±5.2 ↑ 3
3+Hib 90.1±4.0 41 89.6±3.9 24 -0.6±5.6 ↑ 173+HepB 85.0±4.7 49 88.8±3.9 48 3.7±6.1 ↑ 1
1+Var 84.0±4.9 44 86.8±4.1 43 2.8±6.4 ↑ 1
4+PCV 73.8±6.0 30 77.2±5.5 36 3.5±8.2 ↓ 6
4:3:1:3:3:1 69.0±6.1 46 73.5±5.8 32 4.5±8.5 ↑ 14
4:3:1:3:3:1:4 64.6±6.2 30 67.3±6.2 25 2.7±8.8 ↑ 5
Held our own with rates!
How Are We Doing?How Are We Doing? Implementation – System Indicators Implementation – System Indicators
Successful Integration
Within Reason of
ACIP
Balance with CDC Reports
Responsive to Providers
Never over
Allocation Secured Additional
Vaccine
AcknowledgementsAcknowledgements
Mike Bin Wendy Bowman
Chris HalsellFlo Zikas
Janna Bardi
Lin Watson
Contact: Jan Hicks-Thomson, MSW, [email protected]
Blessed are the Balanced, for they shall outlast us all!