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Story from the Field

Name of Health Department/Agency: Sedgwick County Health Department
State: KS
Date Added: 12/21/2009
Themes: Vaccine Supply and Distribution
Issue Summary: Seven LHDs in Neighboring Kansas Counties Coordinate H1N1 Response
Description of Issue(s): We gathered the following information this week and last, primarily to help inform our own decision to open vaccination to the entire public. These seven counties represent our regional neighbors, working closely together for the last four or five years on preparedness, planning, and response. There have been challenges coordinating the H1N1 response among these counties, but we're still trying to stick together when it comes to allocation of vaccine, decision-making re: distribution, and consistency of public media information. Sedgwick is the largest of the seven counties. Populations range from ~13,000 (Marion) to ~500,000 (Sedgwick), and geographic sizes range from second smallest in the state (Harvey) to the largest (Butler). Commuting to and from Sedgwick is common, probably mostly from those residing in Butler to work in Sedgwick. All answers were as of 12/9 except for Reno (12/15), Marion (12/16), and Sedgwick (12/16).
Reno: We have distributed through two local Hospitals, three Primary Clinics, the Correctional Facility, TECH, one Specialty Clinic, the Hutchinson Area Student Health Center (HASH), three Adult Care Facilities, the Health Department with one Targeted H1N1 Saturday Clinic (very successful in part due to taking appointments), to all First Responders, Horizons Mental Health, with two Afternoon/Evening School clinics and used targeted campaigns to bring in Priority individuals such as School Staff/Medical Staff, and arranged to make home visits to those with severe underlying health issues.
Sumner: We are distributing through the Health Dept. office, School clinics, and Community clinics. In Sumner County the private providers preferred to have the Health Dept. dispense H1N1 vaccinations which is okay for us. We started doing the general public last week when someone came into the office and asked for the H1N1 vaccine - we didn't turn anyone down. Since then we have announced that we are doing H1N1 for the general public and will hold a clinic next Monday for this also.
Cowley: We utilized all of the avenues you listed to distribute vaccine.
Butler: We are sending vaccine to the health care providers who see the priority groups. We are now scheduling school clinics beginning next week and continuing next year.
Harvey: We continue to give our physicians accounts what they want and doing some of our own clinics. Can say that almost every week Wendy has been successful at getting all doses into people via distribution and in-house clinics.
Marion: We have gone to the schools in the County to administer to the students and will be finishing up our second trip to the schools on Dec. 21. The 4 physicians offices have been administering to the priority groups and were going to open it up to others once they felt they had served their priority patients. We have also had special clinics for health care providers and EMT's one of the hospitals received vaccine to vaccinate their priority people. We are also immunizing priority people by appointment at the Health Dept.
Sedgwick: We started with direct shipments to hospitals and major clinics (e.g., Wichita Clinic) for their direct care health care workers, EMS staff (they did their own), etc. They didn?t get their total requests due to inadequate supply. Then to medical providers who cared for target groups for their staff (OB's, family practice, pediatricians). From there we moved to providers for their priority group patients. Our own H1N1 Vaccine Clinic opened first only to priority groups. Then we started school clinics, soon followed by several mobile sites in farther reaches of the county. By last weekend, we?d held mobile clinics in both large malls. Even though demand is down, we?re continuing to hold our big clinic five hours a day/six days a week, and we?re still holding school clinics (by Christmas break we?ll have done all of our 190 schools except 6).
Reno: We are planning three more Afternoon/Evening School Clinics, with several Targeted sites (business, Early Education), we will continue to have people come to the Health Department (using increased staffing for flu vaccinations), the Primary Clinics will continue to be supported as will the Hospitals, TECH, HASH Center, additional support will be given to the Correctional Facility and Pharmacies will be added. This is all relative to the amount of vaccine available.
Sumner: Finalize plans for January to do clinics for second dose and coordinate doing another community clinic at the same time for each town in the county; contacting larger employers for clinics; Hopefully wind down H1N1 vaccination clinics by the end of January and just do them at the Health Dept. office until we have no more vaccine to give out or demand for stops.
Cowley: We are currently completing the 2nd dose clinics for school children under 9 years and will be completing our general public Drive-Thru clinics on the 16th.
Butler: If vaccine supply continues we will open up to all who request.
Harvey: We will be ready to distribute larger amounts of vaccine to Wichita Clinic and pharmacies that are willing to run clinics in other setting. At the same time, we will be doing H1N1 open clinics at the HD on Wednesday and provide vaccine to physician's offices.
Marion: We will probably by opening it up to the general public after we have been in the schools, providing we have vaccine.
Sedgwick: We hope to finish the schools and survive and rest over the holiday break! As stated, we opened to the general public on Dec. 3, and encouraged private providers to do the same. At that time, we started direct shipments to major retail pharmacies (e.g., Walgreens, etc).
Reno: The vaccine supply was initially sporadic, particularly due to the type available. At this time the supply is adequate, in part due to the relatively late arrival date of the vaccine in relation to the onset of increased illness when school reconvened, and the decreased sense of urgency in the public. We have been able to work with our local partners to allocate the vaccine in what has been a balanced approach within the priority guidelines. The vaccine supply may be excessive as the end of the year approaches, if we don't have a rise in H1N1 or a seasonal flu that will spark more interest.
Sumner: Yes at the present time.
Cowley: Following the general public Drive-Thru clinics we will hold on to enough vaccine to: provide immunizations during normal clinic hours, restock our private providers and provide 1st shipment vaccine to our private pharmacies. Per week, we plan to then relinquish any additional supply allocation to other counties.
Butler: Would like additional vaccine.
Harvey: Yes.
Marion: Don't know if you have heard but in the beginning we were actually getting McPherson's allocation, when the state figured this out, they have adjusted our allocations, and for the past month we have received very little vaccine. With the help of regional orders we have been able to cont. vaccinating the schools and the providers also have vaccine. Thanks to Sumner, Cowley and Sedgwick we have put an order in for more 200 more doses of mist, which will definitely help! Thank you all! We seem to have people requesting mist. Believe we will be getting 90 doses of mist from Butler County also, Thanks!!
Sedgwick: Yes. Now we do.
Outcomes that resulted from actions taken:
Reno: It may have been practical for CDC/KDHE to emphasize the vaccination of children as early as possible when vaccine arrived, rather than other individuals that have been much less affected by this flu. It may have been more effective to set up a weekly Saturday clinic as a regular part of the H1N1 campaign, possibly offsite, to reduce the load on our regular clinic. Overall there have been few instances of concern among the public which is due in part to the balanced approach and the vast amount of information that has come from all sides.
Sumner: Would not have been as restrictive with the vaccine priority groups.
Cowley: Personally (instead of blast fax) lobby physicians regarding vaccine safety.
Butler: I think I might do schools first but that was not possible with smaller amounts of vaccine. I would also do more publicity locally.
Harvey: We feel like we have been very successful keeping our medical community well informed and providing vaccine to them. We have not had any complaints. Our success in using volunteer help indeed was an overwhelming assistance enabling us to keep our lines very short with wait times not to exceed 20 minutes at the most. Our in-house clinics and school clinics were numbered between 200 and over 550 participants. What worked out especially well was keeping our school clinics after school hours so parents could bring their children and completed paperwork instead of relying on paperwork sent home and returned. We thank our past experience with the schools and our dental/flu mist clinics to have contributed to that success.
Marion: We probably would not have released so much to the providers as they are not using it very fast. However, were running out of room in the refrigerator. Am certainly glad we did the schools when we did because that is where we were able to get more people vaccinated. I agree that we need to get more physician buy in about the safety of the vaccine, so more would have taken the opportunity to get vaccinated. I did have one mom tell me just yesterday that her pediatrician was not originally for the vaccination but is now recommending it.
Reno: If we had more vaccine earlier, such as in August, we could have made a concerted effort to blunt the illness by targeting children first. At this time additional vaccine will be effective in getting the second vaccine in young children, adding to those older adults who were missed and to those Counties that were missed. Any increase in vaccine in the near future will allow us to open up to those who may have been restricted during the previous weeks (Incarcerated, well clients), and market more strongly to the remaining public.
Sumner: Nothing at present since we are already giving it to anyone who wants the H1N1 vaccine.
Cowley: Reach the college student targets quicker. Need federal (weekly) estimated availability schedules to be more accurate; production change notices.
Butler: I would open to everyone who wants it.
Harvey: Maybe just do more of the same. It does not seem that the local need is requiring more doses of vaccine at this time.
Marion: if we had more vaccine we would open it up to the public.
Sedgwick: Nothing different now. Have plenty.

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