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, MPAJan.Hicks-Thomson@doh.wa.gov360-236-3578

Blessed are the Balanced, for they shall outlast us all!