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Story from the Field

Name of Health Department/Agency: Chicago Immunization Program
State: IL
Date Added: 11/11/2009
Themes: Communications - Vaccine Safety,Vaccine Planning and Administration
Issue Summary: Mass vaccination clinics at city colleges in Chicago provide several lessons learned
Description of Issue(s): In Chicago, we have scheduled 3 mass vaccination days per week for the next 4 weeks. We started last Saturday. Each day we have six sites where we?re vaccinating people and they are at six city colleges scattered throughout the city of Chicago.

Prior to scheduling these clinics, we determined what proportion of all the allocation we would set aside for these mass vaccinations clinics. We were concerned about taking away from our private sector distribution program. We set aside about 30,000 doses per week--combination of both LAIV and the inactivated vaccine.
Actions taken to address the issue(s): We started on a Saturday and ran our clinic from 9am until 2pm. On Tuesday evening, we ran our clinic from 3 -8pm. Each day vaccinated just over 6,000 people, so over 12,000 people in the two days. Overall we felt like things went very well but in general the demand for the vaccine far exceeded our capacity to vaccinate. We had planned not to use an appointment system so we just had people queue up in line and we ended up turning away many, many people from our clinic.
Outcomes that resulted from actions taken: LESSONS LEARNED: CLINICAL PERSPECTIVE?-
We learned very quickly on the first day that the BD syringes needed to be turned a half turn before drawing or administering the vaccine. It was an important message.
o In addition, we actually had teams of nurses pre-drawing vaccine before the clinics opened. The very first day we had no problems with having excess or leftover vaccine but the second day we did have problems with there being wasted vaccine. We tried to minimize waste of vaccine by administering vaccine to people that were waiting around or came late to get vaccine but there is potential for wasting vaccine if that vaccine is pre-drawn. We are modifying our processes so we don?t do that in the future.
o LAIV vaccine is not in as great demand as the injectable form of the vaccine. In a mass vaccination setting, it is very easy for a nurse to just administer the vaccine because the patients will just sit down and roll up their sleeve and say I want the shot. It actually takes a little bit of work to talk to them about whether or not they are a candidate for the live attenuated vaccine and address their concerns or questions. We are working with our nurses and other staff on our site to make sure people are aware that this is an option and the safety of that vaccine but it?s not something people walk in the door demanding as much as the injectable vaccine.

o We have issues because the demand is far exceeding our capacity to administer the vaccine. We have had to modify our processes so we don?t have an appointment system. What we?re doing is distributing numbers and telling people when to come back by the hour so they don?t stand around waiting. The first couple of days, we would have large groups of children with parents sitting around in the hallways of this community college, which was somewhat disruptive to the college itself and also not necessarily the most convenient thing for these families. So our system is now being slightly modified based on concerns for the college as well as concerns for the people waiting in line. In addition, we tried to allow people who were clearly pregnant or in late-term pregnancy or otherwise had other medical problems that didn?t allow them to tolerate standing or waiting in line to move to the front of the line so they could get vaccinated quickly and leave.
o Training issue: We are using a lot of contract nurses to do our vaccination and we may not have realized how much training they needed. We prefer that our nurses who do a lot of mass vaccinations for us in seasonal influenza campaigns are skilled and knowledgeable but the contract nurses don?t necessarily come in with the knowledge or experience that is required so training is very important and should not be minimized. A substantial amount of training is probably appropriate

LESSONS LEARNED: COMMUNICATION PERSPECTIVE?-There are a lot of challenges. I know that we are not unique in these. In the beginning, we decided that we would broadly advertise our clinics for Chicago residents who were within the ACIP recommended priority groups. We didn?t do the subset for those groups?we kept the broad categories. The media has taken a big interest in our how much we are enforcing those ACIP recommendations, as well as city residency. So we?ve been criticized for not screening people out and not turning people away. On the other hand, I have seen media criticize other areas for screening people and turning people away. So I?m not sure what the right answer is but I think that anyone who is thinking of doing mass vaccinations should make it clear what they are going to do and be able to justify it and hopefully it?s defensible from your perspective so when the media comes after you, you?re prepared for it. I think that?s a very important thing to know whether you are going to be turning people away based on residency or priority group. Consistency of messaging is very important. At a local level in Chicago, we decided what we?re going to do but different areas around us may not do the same thing so that allows the media to really pick us apart. So, if you can work together with other local jurisdictions that may be helpful as well. Those are the key messages that we?ve learned. We still have another three weeks of clinics scheduled. We?re hopeful that we can get this vaccine out to the priority groups. I?ve been at clinics both days and what I saw was a lot of pregnant women and families with young children in the waiting room. So I was glad to see that and feel like the message is getting out there. There are also those who are not in the priority groups who are coming to get vaccinated as well.

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