1 csu mass_innoculation

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  • Our presentation today will focus on the activities surrounding 2 mass vaccination clinics that were held in Larimer County on the Colorado State University Campus. The vaccinations offered at the clinics were intended to enhance community immunity to meningococcal disease Meningococcal disease is a fairly rare condition, so to start out our presentation, I will give you a brief overview of the disease…
  • Meningococcal disease can present in several different ways…
  • not all meningitis conditions are a result of meningococcal disease—meningitis is an inflammation of the lining around the spinal cord and brain and can be caused by a number of different agents. Meningitis can be caused by viruses (WNV), bacteria, molds, or chemical exposure. This message became important when dealing with the media and when recruiting for clinic clients.
  • Can be treated with antibiotics; however, even early tx may not prevent death or complications in severe cases. We can also tx close contacts of cases with antibiotics to prevent them from becoming ill.
  • Certain people are more at risk for getting meningococcal disease… Bacteria are thought to be carried by ~10-15 % of the population
  • So how common is meningococcal disease?? In a years course of time, statewide, Colorado would normally see ~20-25 cases per year Larimer county ususally sees 1 or 2 cases per yr. In 2010, there were 8 cases of meningococcal disease reported for Larimer County. Much higher number than what would be expected in a year’s time.
  • To summarize the cases, in 2010, Larimer county had 8 reported cases of meningococcal disease. 7 of these cases were caused by Group C meningococcal bacteria. Our first case in Larimer County for 2010, occurred in a CSU student over Memorial Day week-end. The student was not in finished classes ~2 wks prior to his his illness, but was in process of relocating to a new residence. A roommate who was also moving into the same house, had stopped by the residence to drop off boxes and found the person lying on the floor and unresponsive. The student survived the illness, but faces a long recovery process. 9 News did a story about him last fall telling about his recovery process—this was an active, healthy, young adult that is now having to relearn many of the things we take for granted—such as learning how to walk. Our next 3 cases occurred among players in a Fort Collins adult hockey league. Cases were from 2 teams that had played against each other in a June 9 th hockey game. Once it was identified that our cases were connected to the hockey game, our HD staff offered antibiotics to hockey team members to prevent additional cases from becoming ill. Later on we also offered vaccinations to the entire adult league to provide more long term protection. All three of our cases from the hockey teams died from the illness. In August, a child from a different hockey player was diagnosed with mening; the child was treated and recovered. In October, another CSU student became ill and died from meningococcal sepsis. In December, a CSU student was noted ill and rushed to the emergency room by his roommates. Case survived and was released from hospital to private residence. All of the 7 group C cases were further tested at the CDPHE LSD; all seven were of the same genetic clone. A Metro State Student In addition to the 7 group C cases, Larimer County also had 1 case that was Group B. Case survived and recovered.
  • There is a vaccine to prevent meningococcal disease. The vaccines licensed in the US cover 4 of the 5 meningococcal serogroups: A,C, Y, and W-135. No vaccine is currently licensed in the US to prevent disease from Group B meningococcal infections. At the time of our clinic planning, the following recommendations were in place for meningococcal vaccine… The Advisory Committee on Immunization Practices has since reviewed the vaccination recommendations for meningococcal vaccine and has modified the recommendations to include a booster at ?????, since it was noted that vaccine protection waned after ~3-5 years.
  • Having had 7 cases of the same strain of meningococcal disease that had occurred in Larimer County within the span of several months, LCDHE consulted with CDPHE and CDC as to what steps could be taken to provide protection for the community. Our county has ~300,000 residents and vaccination of all of the residents was not doable—financially or logistically. So we had to determine a target group for vaccination. At the time prior to the clinic, two of the cases were students at CSU, an out-of-county case from earlier in the year had CSU students as contacts, and several of the hockey league members also indicated close connections to CSU population (students, workers, or had household contacts that were s/w). Also considered who would be most at risk for disease: age group (<29), life style, vaccination status. So, even though we could not establish direct transmission between CSU students/staff, due to cases occurring in the CSU population and possible links between CSU and the hockey league, and considering the population most at risk, it was decided to target the CSU student population. After discussions with CDPHE and CDC, the target population was defined as: …
  • Used Menactra—licensed for _______________________ Also used Menveo for those w latex allergy Vaccine provided through CDPHE EPR division. Vaccine cost=~1M
  • Arranged for delivery and storage of vaccine in warehouse that we had also used during H1N1 vaccination campaign. Not only did temperature have to be controlled, we also had to consider security and access for the site.
  • We had CSU rounding up clients, we had vaccine being shipped to the warehouse, NOW, needed to get clients signed up for the clinics. How to get clients into the clinics… During our Larimer County H1N1 clinics in 2009 and early 2010, we used an on-line registration system to get people into the clinics. This same system was modified and used again for the meningococcal clinics.
  • Had to be done fast. Decision to hold clinics was made October 29 th . CDPHE put out general alert on November 1 st about the need for volunteers to staff the clinics. The registration system was operational on November 2 nd . CDPHE put out a request for volunteers through CVM that day. Held first clinic on November 5 th .
  • General Clinic Staff = clinic set up and supply, floaters, worker check-in/check-out staff, food service, patient movement, history checking staff
  • You were given handouts that show the clinic site layout. You can follow along as we walk through the clinic.
  • The clinics were held in the Student Recreation Center. If you’re familiar with CSU, this is just east of Moby Gym.
  • There were numerous signs in the area, directing people to the clinic.
  • Here’s the clinic entrance.
  • Point out on layout. As you entered the student center lobby, you were directed where to go by patient movement staff. If you were a clinic worker, you were went to the worker check-in area. Point out on slide
  • Show on site layout
  • Here the check-in / check-out staff had rosters of scheduled workers. Each worker was asked to sign in. Then they signed a confidentiality agreement to comply with patient privacy laws. Every position was assigned a color-coded vest, so positions could be readily identified. For example, command wore purple vests patient movement was lime green vaccinators were royal blue safety officers were red You were given a vest and told where to report.
  • If you were media and entered the lobby, you were directed to our friendly Public Information Officers in side the front door. If you were a student who wasn’t sure if or when you had received a meningococcal vaccination, you were directed to the Vaccination Records Area.... Show on slide behind the media area.
  • Here, authorized staff with computer access to CSU medical records could provide look up your vaccination history. Show on layout
  • If you were a patient and had not registered for the clinic – or if you had registered, but did not have a copy of your “registration ticket” – you were directed to the registration area back here... Show on slide
  • Show on layout Here we had several computers and printers.....
  • Set up and staffed to help patients register or print a ticket. Once that was completed, the person was directed through a back hallway Show on layout To the vaccination area.
  • If you were pre-registered and had your ticket , you were directed to the “express lane” Show on layout And sent to the vaccination area.
  • We used a lot of pipe and drape to separate clinic traffic from regular student center traffic, since the facility was open during the clinics.
  • And we had a lot of traffic directors or patient movement staff – and signs - to keep the herd headed in the right direction.
  • The next stop was general screening. Show on Layout Here we had several stations where the information on the registration ticket slash vaccination form were checked for completeness and accuracy.
  • Anyone with medical questions was sent from general screening to medical screening. Show on layout This area was staffed with doctors and nurses who could answer questions and provide advice.
  • Once screening was completed, the patient was sent – along with the ticket / vaccination form – to one of five vaccination lines. Show on layout and slide This allowed us to spread the workload and prevent anyone from standing in line for a long time.
  • The queues fed into the vaccination area. Show on site layout We had ten “vaccination modules” fed by the five lines. A vaccination module consisted of two vaccination tables separated by a common supply table. There were two vaccinators and two assistants at each table, for a total of 40 shooters.
  • You can see here that we had each module of tables numbered Point out number on slide So patient movers could say, “There’s an opening at station 9 or station 5.”
  • Here’s a close-up shot of a vaccination table.
  • After each patient received their vaccination, they were directed to the medical observation area. Show on layout A few students who were feeling faint or sick were held for observation. Most were sent to the exit. We had snacks for students feeling faint, but almost all the students loaded up before they left.
  • Here’s the exit from the observation area. The table served as a “crash cart”, with blood pressure cuffs, medical supplies, ammonia ampules, etc.
  • And the exit from the building. Show on layout
  • We had several other ancillary areas set up around the building... In the gym was Command Show on layout
  • ITAC Show on layout Point out on slide EMS was located over here Situation status reports were kept here Communications was located here We used both 800 MHz radios , FRS radios, and cell phones for communication. These were assigned to key staff, who were in constant contact.
  • ITAC was also able to make real-time adjustments to the client registration system – Add or remove slots, extend hours, track counts, and so on.
  • Once the vaccination was given, the vaccination sheets were kept at the vaccination tables. These were collected every hour and taken to data entry. Show on layout – labeled as clinic check-out The information from each vaccination sheet was entered into the Colorado Immunization Information System – or CIIS – through the day.
  • Central Supply was located across the hall from the vaccination area. Show on layout
  • We had supply staff replenishing supplies throughout the day from these carts.
  • We had a worker break area upstairs. Show on layout We had food and drinks up there and a place to sit.
  • Here’s one of the just in time training rooms Show on layout
  • If you’ll refer to the lower left corner of your handout, you’ll see a site map of the clinic worker parking in relation to the clinic. Parking was just west of Moby Gym.
  • And it was a quarter of a mile walk to the clinic.
  • It was more like a ten mile walk the second clinic, with snow and cold!
  • For the first clinic, we had a couple of golf carts available to haul workers. For the second clinic, we resorted to school buses from Poudre School District. And that was pretty much the site layout and operations.
  • 1 csu mass_innoculation

    1. 1. <ul><li>Kim Meyer-Lee and Janelle Henderson </li></ul><ul><li>Larimer County Department of </li></ul><ul><li>Health and Environment </li></ul>
    2. 2. <ul><li>Acute, potentially severe illness </li></ul><ul><li>Caused by bacteria: Neisseria meningitidis </li></ul><ul><li>Almost all invasive disease from 1 of 5 serogroups: A, B, C, Y, W-135. </li></ul><ul><li>Sx: sudden onset of fever, headache, body aches </li></ul><ul><ul><li>Also, vomiting, nausea, photophobia, altered mental state, stiff neck, rash/skin changes. </li></ul></ul>
    3. 3. <ul><li>Manifestations: </li></ul><ul><ul><li>Meningococcal Meningitis </li></ul></ul><ul><ul><ul><li>Most common presentation </li></ul></ul></ul><ul><ul><ul><li>~47% of cases </li></ul></ul></ul><ul><ul><li>Meningococcal Sepsis </li></ul></ul><ul><ul><ul><li>~ 43% of cases </li></ul></ul></ul><ul><ul><li>Pneumonia, focal infections </li></ul></ul>
    4. 4. <ul><li>Meningococcal meningitis is most common presentation </li></ul><ul><ul><li>HOWEVER: </li></ul></ul><ul><ul><ul><li>not all meningitis conditions are a result of meningococcal disease </li></ul></ul></ul><ul><ul><ul><li>not all meningococcal disease cases present as meningitis </li></ul></ul></ul>
    5. 5. <ul><li>Case fatality rate </li></ul><ul><ul><li>9-12% overall for invasive disease </li></ul></ul><ul><ul><li>40% for septicemia </li></ul></ul><ul><li>20% of survivors have permanent sequelae </li></ul><ul><ul><li>Hearing loss </li></ul></ul><ul><ul><li>Neurologic damage </li></ul></ul><ul><ul><li>Limb loss </li></ul></ul>
    6. 6. <ul><li>Risk factors </li></ul><ul><ul><li>Immune deficiency </li></ul></ul><ul><ul><li>No or non-functioning spleen </li></ul></ul><ul><ul><li>HIV infection </li></ul></ul><ul><ul><li>Preceding upper respiratory infection (including influenza) may contribute to invasive infection </li></ul></ul><ul><ul><li>College freshmen in dorms </li></ul></ul>
    7. 8. <ul><li>Larimer County Meningococcal Disease Outbreak </li></ul><ul><li>8 Cases in 2010 </li></ul><ul><li>7+ group C </li></ul><ul><ul><li>(Metro State Student with connections to CSU) </li></ul></ul><ul><ul><li>CSU student Memorial Day week-end </li></ul></ul><ul><ul><li>June: 3 Hockey players from Ft Collins hockey league </li></ul></ul><ul><ul><li>Aug: Child of hockey player teammate </li></ul></ul><ul><ul><li>Oct: CSU student </li></ul></ul><ul><ul><li>Dec: CSU student </li></ul></ul><ul><li>1 group B (June) </li></ul>
    8. 9. <ul><li>Usual Vaccine Recommendations </li></ul><ul><ul><li>Children ages 11-12 through college entry </li></ul></ul><ul><ul><li>Adults if: </li></ul></ul><ul><ul><ul><li>college freshmen living in a dormitory </li></ul></ul></ul><ul><ul><ul><li>military recruit </li></ul></ul></ul><ul><ul><ul><li>damaged spleen or spleen has been removed </li></ul></ul></ul><ul><ul><ul><li>certain immune deficiencies </li></ul></ul></ul><ul><ul><ul><li>microbiologist who is routinely exposed to Neisseria meningitidis (the causal pathogen) </li></ul></ul></ul><ul><ul><ul><li>traveling or residing in countries in which the disease is common. </li></ul></ul></ul>
    9. 10. <ul><li>Clinics at Colorado State University </li></ul><ul><li>Target Population </li></ul><ul><ul><li>CSU student, faculty, staff </li></ul></ul><ul><ul><li>Household contact of CSU student, faculty, staff </li></ul></ul><ul><ul><li>AND 2-29 yrs of age </li></ul></ul><ul><ul><li>AND never vaccinated/vaccination > 3 yrs ago </li></ul></ul><ul><ul><li>Extended to Front Range CC </li></ul></ul><ul><li>12,000 vaccinations planned to be given over 2 clinics (11/5, 11/11) </li></ul><ul><li>Joint effort between CDPHE, LCDHE, Health District of Northern Larimer County, CSU </li></ul>
    10. 12. <ul><li>Command </li></ul><ul><li>PIO/JIS </li></ul><ul><li>Safety Officer </li></ul><ul><li>Staff recruiting </li></ul><ul><li>Staff registration, scheduling and communication </li></ul><ul><li>Clinic management for vaccinations </li></ul><ul><li>Medical safety officer </li></ul><ul><li>Data entry (patient records) </li></ul><ul><li>Patient movement </li></ul><ul><li>Patient registration </li></ul><ul><li>Patient general screening </li></ul><ul><li>Patient medical screening </li></ul><ul><li>Observation </li></ul><ul><li>Planning (situation unit, resource unit, documentation unit, demobilization unit) </li></ul><ul><li>Facilities </li></ul><ul><li>Supplies and equipment </li></ul><ul><li>Sanitation, including medical waste </li></ul><ul><li>Worker parking </li></ul><ul><li>Clinic set up and central supply </li></ul><ul><li>Security </li></ul><ul><li>Food (worker and patient) </li></ul><ul><li>EMS </li></ul><ul><li>ITAC (on-line patient registration system, on-site patient registration system, worker registration system, clinic communications systems) </li></ul><ul><li>Worker check-in / check-out </li></ul><ul><li>Risk management </li></ul><ul><li>Cost </li></ul><ul><li>Procurement </li></ul><ul><li>Vaccine management and transportation </li></ul><ul><li>Vaccine Information Statement distribution </li></ul><ul><li>History checking </li></ul><ul><li>Signage </li></ul><ul><li>Worker transportation </li></ul><ul><li>Worker training </li></ul><ul><li>CAD drawing </li></ul>
    11. 14. <ul><li>Television, Radio, Newspaper </li></ul><ul><li>Social Media (Facebook, Twitter) </li></ul><ul><li>Direct email to students, faculty, staff </li></ul><ul><li>and parents </li></ul><ul><li>Websites </li></ul><ul><li>Telephone Hotline (COHELP) </li></ul><ul><li>Informational Posters </li></ul><ul><li>Health Alert Network (HAN) </li></ul>
    12. 15. <ul><li>Television </li></ul><ul><li>Radio </li></ul><ul><li>Newspapers </li></ul>
    13. 18. <ul><li>PHEWR— P ublic H ealth E vent W eb R egistration </li></ul><ul><ul><li>Tested during H1N1 clinics </li></ul></ul><ul><ul><li>Allows clinic clients to be spread throughout the day </li></ul></ul><ul><ul><li>Enables client to select time slot for service </li></ul></ul><ul><ul><li>Clinic and vaccination information provided </li></ul></ul><ul><ul><li>Able to print out screening form and registration </li></ul></ul><ul><ul><li>Number of slots adjustable </li></ul></ul><ul><ul><ul><li>Open new slots </li></ul></ul></ul><ul><ul><ul><li>Limit slots to allow for staffing/flow/etc. </li></ul></ul></ul>
    14. 22. <ul><li>Volunteer registration managed by Health District of Northern Larimer County </li></ul><ul><ul><li>Sorted by task, number needed per shift </li></ul></ul><ul><ul><li>Credentialing </li></ul></ul><ul><ul><li>On-line training </li></ul></ul><ul><ul><li>Maps, clinic info </li></ul></ul><ul><ul><li>Email confirmation, notifications, updates </li></ul></ul><ul><li>473 unduplicated workers from 26 cities & counties and 43 other employers </li></ul>
    15. 23. Position Number Needed / Clinic General Clinic Staff 55 Screening (Gen & Med) 31 Patient Ck-in, Registration 18 Vaccination Administration 182 Patient Ck-out, Observation 24 Other (Clinic Setup, Safety, Security, EMS, Vaccine, JIS, Command, ITAC) 25 Total 335
    16. 64. <ul><li>November 5 th clinic from 10 am to 6 pm </li></ul><ul><li>8,085 registered </li></ul><ul><li>7,608 vaccinated </li></ul><ul><li>November 11 th clinic from 10 am to 5 pm </li></ul><ul><li>2,858 registered </li></ul><ul><li>2,560 vaccinated </li></ul><ul><li>Total 10,168 vaccinated at total cost of ~$1.2 million </li></ul>
    17. 65. <ul><li>What worked well… </li></ul><ul><ul><li>Experience with previous Mass Vaccination Clinics </li></ul></ul><ul><ul><li>Partnering agencies </li></ul></ul><ul><ul><li>Location </li></ul></ul><ul><ul><li>PHEWR </li></ul></ul><ul><ul><li>Volunteer management tool (HDNLC) </li></ul></ul><ul><ul><li>Volunteer requests </li></ul></ul><ul><ul><li>Clinic advertising/publicity </li></ul></ul>
    18. 66. <ul><li>Still needs work: </li></ul><ul><ul><li>Internal communications </li></ul></ul><ul><ul><li>Just-in-time training </li></ul></ul><ul><ul><li>Practice in ICS </li></ul></ul><ul><ul><li>Resource management </li></ul></ul><ul><ul><li>Rewrite of POD plan </li></ul></ul>
    19. 67. <ul><li>Still in the works… </li></ul><ul><ul><li>AAR </li></ul></ul><ul><ul><li>Final version of PHEWR </li></ul></ul>
    20. 68. <ul><li>Janelle Henderson </li></ul><ul><ul><li>970 498-6739 </li></ul></ul><ul><ul><li>[email_address] </li></ul></ul><ul><li>Kim Meyer-Lee </li></ul><ul><li>970 498-6786 </li></ul><ul><li>[email_address] </li></ul>

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