Getting the shots!Let’s get all kids immunized

Lawrence J. Losey, MD, FAAPBrunswick Pediatrics, CMMG

Maine vs rest=worse!4:3:1:3 rate from national Immunization survey

Shot Schedule, 1979

2 Month DTP Oral Polio

4 Month DTP Oral Polio

6 Month DTP Oral Polio

12 Month MMR

18 Month DTP Oral Polio

5 Year DTP Oral Polio

Every 10 yrs Tetanus or Td booster

Shot Schedule, 2011(ignoring combo vaccines)

Birth Hep B1 Month Hep B2 Month DTaP IPV PN13 HIB Rota4 Month DTaP IPV PN13 HIB Rota6 Month DTaP PN13 (HIB) (Rota)9 Month Hep B IPV

12 Month

HIB PN13 Hep A

15 Month

DTaP MMR VZV

18 Month

Hep A

5 Year DTaP IPV MMR VZV11 Year TdaP MCV4 HPV16 Year MCV4

YearlyInfluenz

a

New focus--Teens

Maine not a leader

SkyrocketingCost

19819800

19961996 20002000 20062006 20092009

DTaP/DTaP/DTwPDTwP

37 96 114 105 152

Td/TdaPTd/TdaP 2 6 17 36 56

PolioPolio 5 51 68 91 125

MMRMMR 15 93 90 81 125

HepBHepB 42 51 64 100

VZVVZV 64 59 104 251

PCVPCV 0 219 277 333

MCV4MCV4 0 0 82 123

HepAHepA 0 0 61 78

Flu <3Flu <3 0 0 52 52

Flu >3Flu >3 0 0 22 167

RotaRota 0 0 190 296

HPVHPV 0 0 360 478

TotalTotal 59 352 618 1525 2554

Hepatitis A in US

Hep A vaccine available Vaccine for High Risk States

Vaccine for All States

Hep A ImmunizationChildhood rates, not teen

How have we paid?In 80’s cost was minimal

In 90’s developed “Gentlemen’s Agreement” with MCO’s for universal coverage--about $1M/yr

Fell apart for multiple reasonsMore Vaccines

More expensive

More “self-funded”

Less “317” money from CDC

For brief period, only VFC children

State funding allowed “universal select” for school mandated

Solving the Cost

PL595 Passed last year, established Maine Vaccine Board

Provides funding mechanism to immunize ALL Maine children through insurance/TPA assessments

Vaccines to be available January 1, 2012

Vaccines for ALL diseases recommended by ACIP

Assessment budgeted at $6.98/PMPM (<19)

How will it work?

Maine Vaccine Board--10 members (3 Insurers, 3 providers, 1 from self-insured [employers], 1 from industry, one each from DHS & state treasurer)

Establish vaccine list, budget, assessment

Collect money from insurers and TPA and send to Maine Immunization Program

How do you join?

Same as current vaccine for VFC

Will need to use ImmPact2 for ordering

Can be simply aggregate reporting, not by dose (lose biggest benefit of registry then)

Will need to anticipate for ordering in fourth quarter (from Maine Immunization Program and private sources)

Unsure what insurance company will do in interim for payment for purchased vaccines

How do we prepare?

Aim for zero stock of privately purchased vaccine on 1/1/12--realistically need some to assure full vaccines until then

Participate in Maine Immunization Program--if currently using for VFC, you are all set

Use ImmPact for ordering and inventory (also use for full registry if possible)

Decide which vaccines and what schedule you will use