Report to/Rapport au :
Ottawa Board of Health
Conseil de santé
d’Ottawa
Monday
19 Septermber, 2011/le lundi 19 septembre 2011
Submitted by/Soumis
par :
Dr./Dr Isra
Levy,
Medical Officer of
Health/Médecin chef en santé publique
Contact
Person/Personne-ressource :
Brenda
MacLean, Program Manager/ Gestionnaire de programmes
Environment,
Health Protection and Outbreak Management Branch/Environnement, Protection de
la santé et Gesion des éclosions
Ottawa Public Health/Santé publique
Ottawa
613-580-2424,
ext./poste 24342
brenda.maclean@ottawa.ca
|
ACS2011-OPH-VPD-0001 |
|
SUBJECT: |
INFLUENZA Immunization PROGRAM 2010-2012 |
|
OBJET : |
PROGRAMME DE VACCINATION CONTRE LA GRIPPE 2010-2012 |
That the Board of
Health for the City of Ottawa receive this report for information.
Que le Conseil de santé de la circonscription
sanitaire de la ville d’Ottawa prenne connaissance du présent rapport à titre
d’information.
This report summarizes Ottawa Public Health’s (OPH) Influenza Immunization Program. Influenza (the flu) is a serious respiratory disease that is highly contagious and spreads rapidly from person to person, usually by a simple cough or sneeze. The best defence against influenza is an annual influenza vaccination, which reduces health care utilization and deaths due to influenza.
During the 2010-2011 influenza season, approximately 38% of Ottawa residents received the influenza vaccine. The same year, OPH distributed approximately 363,000 doses of influenza vaccine. The majority (64%) of these doses were distributed to 341 physician’s offices; 11% were distributed to nursing agencies; OPH nurses administered 8% of the vaccines at OPH community influenza vaccine clinics and the remaining vaccine was distributed to hospitals (7%), long-term care homes (5%), retirement homes (2%) and others (3%), including workplaces, Community Care Access Centre (CCAC) and community health centres (CHCs).
This year, OPH’s influenza program will begin in late October and finish in December. OPH will provide 33 community influenza immunization clinics and nine clinics at seniors’ apartment buildings, as well as distribute vaccine to local shelters and facilities for pregnant teenagers. During the 2010 influenza campaign, OPH piloted an on-line appointment booking system which will be run again in 2011. Public Health Nurses from all OPH programs will have the opportunity to work in the influenza immunization clinics. OPH will continue to expand its use of web and social media communications to promote influenza immunization.
BACKGROUND
OPH Influenza
Immunization Program
In 2001, Ontario became the first jurisdiction in Canada to adopt a Universal Influenza Immunization Program (UIIP) providing influenza immunization to all residents. In addition, the Ontario Ministry of Health and Long-Term Care (MOHLTC) directs public health units to plan and implement vaccine delivery strategies.
OPH participates in the UIIP in a variety of ways, such as:
· Receiving influenza vaccines from the MOHLTC pharmacy and distributing the vaccine and reference material to physician’s offices, hospitals, long term care homes, paramedics, retirement homes, workplaces, and nursing agencies.
· Conducting free influenza immunization clinics throughout the city.
·
Conducting routine vaccine
refrigerator inspections and investigating all reported incidents involving
proper storage of vaccines, which helps ensure health care providers, who receive
the influenza vaccines, maintain proper storage of vaccines (i.e. maintaining
the vaccine in a storage compartment with a temperature of 2 – 8 degrees Celsius).
·
Promotion
of immunization and OPH influenza immunization clinics through
local advertising, earned media, social media and OPH’s website.
Table 1: Vaccine distribution 2010
|
Agency |
Doses |
% of total doses |
|
Physicians |
230,250 |
64% |
|
Nursing agencies who administer the vaccine to a
variety of sites including workplaces. |
38,330 |
11% |
|
OPH community influenza clinics |
30,440 |
8% |
|
Hospitals |
26,090 |
7% |
|
Long-Term Care Facilities (residents and staff) |
16,650 |
5% |
|
Retirement Homes (residents and staff) |
8,730 |
2% |
|
Workplaces |
5,530 |
2% |
|
Other (CHC, schools, CCAC) |
6,680 |
1% |
|
Total |
362,700 |
100% |
Free influenza immunization
clinics throughout the city
OPH will launch the 2011 influenza immunization clinics on October 29, 2011. The OPH clinics will run until December 12, 2011. There are enough clinics, distributed throughout the city, to vaccinate between 30,000 and 35,000 people, which is the expected attendance based on last year’s data. The majority of Ottawa residents whom seek the vaccine will, however, receive the influenza vaccine from their physician. The distribution of vaccine to physicians is scheduled to begin the first week of October.
Targeting high risk
groups
Although the program is universal, OPH aims to maximize coverage in specific target populations, which follows the national and provincial guidelines. The target groups for each year’s influenza program are announced by the National Advisory Committee on Immunization (NACI) (1) and the Ontario Ministry of Health and Long Term Care (MOHLTC) in the fall, but have not been announced yet for 2011/2012. The targeted groups for 2010/2011 were:
Communications Plan
The annual influenza communications campaign is supported by the MOHLTC. OPH’s complimentary locally-specific influenza campaign focuses on local advertising, earned media, social media and the OPH website to provide information on clinic location, dates and times and information about immunization (www.ottawa.ca/influenza). A growing number of residents are turning to OPH’s website for information on influenza immunization. In a survey of OPH clinic clients in 2010, 47% said they received their information about the influenza clinics from the OPH website, up from 33% in 2004/2005.
DISCUSSION
Challenges to uptake
of the vaccine
In 2011, approximately 38% of adult Ottawa residents reported receiving an influenza vaccination in 2010. Similar to other communities, there has been a decrease in the number of people receiving the vaccine after the H1N1 pandemic campaign. The highest rate of uptake in Ottawa was recorded during the 2004/2005 influenza season, with approximately 54% of Ottawa’s residents receiving the vaccine.
Uptake of the influenza vaccine for high priority groups for 2010/2011 was as follows:
· 69% of Ottawa adults aged 65 and older, and
· 39% of Ottawa adults under the age of 65 with a high-risk chronic condition
The uptake of the influenza vaccine in Ottawa is higher than the provincial average, but declined in 2010 compared to previous years. Rates of uptake among health care workers in hospitals declined from 55% in 2008/2009 to 39% in 2010/2011. Rates among staff of long term care (LTC) homes decreased from 66% to 54% over the same two year period (Table 2). Rates are consistently high among LTC and retirement home residents but were lower in 2010/2011 compared to the previous years. The 2009/2010 year was not typical due to the mass administration of the H1N1 Vaccine. OPH facilitates the uptake of the vaccine by directly supplying vaccine and the supporting resources to these facilities.
Table 2 Influenza immunization
rates health care workers and residents of long-term care and retirement homes
|
|
2007-2008 |
2008-2009 |
2009-2010 |
2010-2011 |
|||
|
Seasonal |
H1N1 |
||||||
|
Staff |
|
|
|
|
|
||
|
Hospitals |
58% |
57% |
20% |
62% |
39% |
||
|
LTC facilities |
73% |
69% |
38% |
42% |
54% |
||
|
Retirement homes |
75% |
69% |
40% |
50% |
54% |
||
|
Residents |
|
|
|
|
|
||
|
LTC facilities |
95% |
94% |
92% |
80% |
90% |
||
|
Retirement homes |
92% |
89% |
86% |
71% |
79% |
||
Outbreaks of influenza
The number of laboratory-confirmed influenza cases in Ottawa was significantly higher in 2010/2011 compared to 2009/2010. By March 2011, 170 cases of Influenza A and 11 cases of Influenza B were reported. Twenty-six of these influenza cases were hospitalized. Most of the hospitalized cases were children with only 4 cases being over the age of 17. The average age for hospitalized cases is approximately 2 years old.
Over the past 5 years, an average of 71 cases of Influenza A and 26 cases of Influenza B were reported per year. A new strain of H3N2 virus emerged last season, which caused an increased number of influenza cases in most of Canada, which particularly affected the elderly, with the peak of activity around the holiday season. Later in the influenza season, there was increased activity of a strain of Influenza B which particularly affected children. Laboratory-confirmed case reports are an indicator of the influenza activity in the community, but do not provide an accurate reflection of the morbidity and burden of influenza.
Program Improvements
Emergency preparedness is part of OPH programming and a critical requirement is having a pool of nurses ready to provide mass immunizations. During the 2009 pandemic H1N1, almost all OPH nursing staff were deployed to assist with the mass vaccination campaign. Feedback from nurses, following the H1N1 clinics, included a desire to continue working at the immunization clinics on an annual basis to maintain their skills.
In 2010, OPH introduced a pilot project to enable all Public Health Nurses in all programs to work at OPH’s influenza immunization clinics. At the end of the clinics, nurses were surveyed about the experience and suggestions for improvement were invited. As a result of this project, 200 public health nurses had an opportunity to upgrade their knowledge and skills in immunization and a booking system was created to schedule large volumes of staff. Operational costs of the influenza immunization clinics were also reduced through the use of existing staff.
OPH Clinic evaluation
In 2010, OPH’s influenza immunization program was evaluated with input from clients who attended the influenza clinics. Client satisfaction for the clinics was very high (over 90%) and clients were especially satisfied with the courtesy, knowledge and competency of the nurses and reception staff at the clinics. In addition, clients indicated that they preferred clinics close to their residence and a variety of times for clinics (day time, weekend and weeknights).
Therefore, OPH will continue to vary the times of clinics.
Clients’ main source of information about the clinics was the OPH website, though some clients prefer community newspapers. Francophone and allophone populations are underrepresented in our clientele compared to the Ottawa population. In the future, OPH will continue to work with community partners in relation to these under-represented populations.
Online clinic
appointment booking system
Clients have identified wait times at clinics as an important issue, especially during H1N1 in 2009/2010. To address this challenge, in 2010, OPH piloted an online appointment booking system at four clinics. Approximately 2,100 people used the appointment booking system. Clients who attended the clinics by appointment said they waited an average of 4.5 minutes compared to 8.3 minutes reported by walk-in clients. In addition, 99% of appointment clients surveyed stated they would use the appointment booking system again. Based on these results, OPH will implement a mixed online and appointment-booking system for the 2011 influenza season with the intent to continue to monitor client preference for appointments and adjust the services offered accordingly. In collaboration with IT services, OPH plans to expand the appointment service to eight clinics at eight different locations across the City in 2011 through a hosted solution alternative.
Physician vaccinators
As part of program improvements in 2010, physicians were asked to pre-order the vaccine before it was delivered to OPH. In January 2011, physicians were surveyed about their experience with the vaccine distribution process. Physicians made a number of suggestions including streamlining the ordering, improving the distribution of vaccine information, and enhancing communication to health care providers. The pre-ordering system will be used again in 2011.
Since 2001, OPH has offered influenza immunization clinics in the rural communities of Richmond, Kinburn, North Gower, Metcalfe and Manotick. OPH will continue to offer clinics in these areas, especially given lower physician availability in these communities.
OPH surveyed Ottawa residents and physicians in 2010 to identify areas for enhancement of OPH’s influenza immunization program.
LEGAL IMPLICATIONS
There are no legal
implications related to this report.
IT will be supporting the use of a staff scheduling system. A private sector vendor will be providing and
hosting the appointment booking software application.
Ottawa Public Health staff will carry out the activities stated in this report, specifically disseminating influenza vaccine to physician’s offices and other community partners, providing influenza immunization clinics and expanding its use of web and social media communications to promote influenza immunization.
References
Public Health Agency of Canada. Canada Communicable Disease Report. Statement on Seasonal Trivalent Inactivated Influenza Vaccine for 2010-2011. August 2010 (http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/10vol36/acs-6/index-eng.php).