The Impact of COVID-19 on Immunization Services: Experts in Public - PowerPoint PPT Presentation

Welcome to the Webinar! Attendees are in listen only mode; Please use the chat box for technical difficulties and questions for the presenters. The Impact of COVID-19 on Immunization Services: Experts in Public Health and Primary Care Respond from the Field Wednesday, June 10 th , 2020 Presen ented ed b by: Edwi win A Asturias , MD - Professor of Pediatric Infectious Diseases, University of Colorado School of Medicine Bernadette A e Albanese , MD, MPH - Medical Epidemiologist, Tri-County Health Department Shen en N Nagel el , MD, FAAP - Pediatrician, Pediatrics West

Housekeeping • Attendees will be automatically mute ted for the presentation. • If you have any technical difficulties, use the chat box and a staff member will assist you. • We will be conducting Q& Q&A i A in n the s he sec econd ha half of the presentation, but please add y your q questions t to the ch chat b box throughout. • Please take time after the presentation to fill out the post-event ev evalua uation. n. • This meeting will be be rec ecorded ed and made available on our website within the next week.

Partnering to KEEP COLORADO COMMUNITIES HEALTHY OUR MISSION Founded in 1991, Immunize Colorado (formerly the Colorado Children’s Immunization Coalition) is a statewide 501(c)3 nonprofit that serves to protect Colorado families, schools and communities from vaccine-preventable diseases.

• Welcome/ e/Anno Announc uncem emen ents s (12:30 – 12:35pm) • Panel elist I Introduc ductions ns (12:35-12:40pm) • Panel elist P Presen entations ns (12:40 – 1:40pm) • Edwi win A Asturias, MD - Professor of Pediatric Infectious Diseases, University of Colorado School of Medicine Virtu rtual Town Hall • Bernadette A e Albanese, MD, MPH - Medical Epidemiologist, Tri-County Health Department Schedule • Shen en N Nagel el, MD, FAAP - Pediatrician, Pediatrics West • Moderated Q ed Q & & A (1:40 – 2:30pm) • Moder erator: S Ste tephanie e Wasser erman, MSPH - Executive Director, Immunize Colorado • Participants c can s submit q questions i in the Z Zoom chat b box

Welcome Colorado Immunity Corps VISTA Members! • Clara The Colorado Immunity Corps - • B.S. in Nutrition Studies from the University Immunize Colorado’s statewide of Minnesota AmeriCorps VISTA program – • Serving in Chaffee County at Chaffee County welcomed its first two members into Public Health in Salida service last week. VISTA members will • Ellie provide capacity building services at • B.A. in Kinesiology: Health Sciences and their host sites to support local Ecology from Rice University immunization activities. • Serving the Denver Metro area at Immunize Colorado in Aurora

Join us for the 11 th S.O.U.P! (Shots Offer Unrivaled Protection) on October 22, 2020 (exact time TBD) for an evening of celebrating and raising critical funds and awareness for immunizations. In-person and virtual attendance options will be available. Visit immunizecolorado.org for more information. Tickets on sale soon! For sponsorship opportunities, contact Emily.Clancy@childrenscolorado.org.

• Policy upd Updates from update e – SB163 • Just r released sed - Colorado Pediatric Provider our Executive Toolkit: Caring for Children During the COVID- Director 19 Pandemic

Toolkit from Immunize Colorado, AAP Colorado and CDPHE now available! Toolkit includes: • Template letter to families • Provider office poster • Template postcard • Sample social media messages and graphics • Template media pitch • Template letter to the editor • Additional resources Access today at bit.ly/COPedToolkit

• Panelists ts • Edwi win A Asturias, MD - Professor of Pediatric Infectious Diseases, University of Colorado School of Medicine • Bernadette A e Albanese, MD, MPH - Medical Epidemiologist, Tri-County Health Department Introduc uctions ns • Shen en N Nagel el, MD, FAAP - Pediatrician, Pediatrics West • Moderator • Step tephanie W e Wasser erman, MSPH - Executive Director, Immunize Colorado

Effects of COVID-19 on routine immunization, interim guidelines and population immunity Edwin J. Asturias, MD Professor of Pediatrics and Epidemiology UNIVERSITY OF COLORADO | COLORADO STATE UNIVERSITY | UNIVERSITY OF NORTHERN COLORADO

Total confirmed COVID-19 cases per million population, June 10, 2020

Mortality of COVID-19 compared to other epidemics COVID19 Influenza SARS 2013 MERS 2012 Fatalidades Recuperados Fatalidades Recuperados Fatalidades Recuperados Fatalidades Recuperados Infected 1 billion 8,098 2,494 >500,000 10% population ~50-60% population

Total confirmed COVID-19 cdeaths per million population, June 10, 2020

Daily total confirmed deaths COVID-19 in the United States Jan-Jun 2020

Relationship between Ro and population immunity

Immunity and correlates of protection • Antibodies against spike protein most likely to be protective • Most serological test measuring Ab to spike protein or N protein • Different sensitivities and specificities depending on test

Longitudinal profile of antibodies against nucleocapsid and spike proteins in immunocompetent adults with COVID-19 J Infect Dis , jiaa273, https://doi.org/10.1093/infdis/jiaa273.

Population immunity acquired in affected Cities measured as positive serology vs. cases reported by June 2020 21% 20% Immune by serology Porcentaje de la Poblacion Cases % Population 15% 12% 10% 7% 6% 5% 5% 5% 4% 3.1% 3% 1.2% 1.0% 0.6% 0.6% 0.6% 0.3% 0.1% 0% Santa Clara, Los Angeles, Miami Dade, New York Westchester, Spain Stockholm, Wuhan, CA CA FL City NY Sweden China

At least 80 million children under one at risk of diseases such as diphtheria, measles and polio as COVID-19 disrupts routine vaccination efforts, warn Gavi, WHO and UNICEF

• VPD surveillance should be maintained and reinforced • Design strategies for catch-up vaccination for the period post COVID-19 outbreak and make plans which anticipate a gradual recovery • Suspend and reconsider mass vaccination campaigns (risk-benefit) • Influenza vaccination of health workers, older adults, and pregnant women is advised.

Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration — United States, 2020 • Substantial reduction in VFC- funded pediatric vaccine ordering after the COVID-19 emergency declaration • Smaller decline in measles- containing vaccine administration among children aged ≤24 months MMWR May 15, 2020 / 69(19);591–593

Social distancing and % mobility in Colorado Feb-Jun 2020 150 Percent mobility from baseline 100 50 0 -50 -100 2/15/20 2/22/20 2/29/20 3/7/20 3/14/20 3/21/20 3/28/20 4/4/20 4/11/20 4/18/20 4/25/20 5/2/20 5/9/20 5/16/20 5/23/20 5/30/20 retail_and_recreation_percent_change_from_baseline grocery_and_pharmacy_percent_change_from_baseline parks_percent_change_from_baseline transit_stations_percent_change_from_baseline workplaces_percent_change_from_baseline residential_percent_change_from_baseline Global Mobility Report - Google

Colorado children 2 months of age susceptible to Rotavirus, by decrease in estimated vaccination, 2020 30,000 Number of children left susceptible 25,000 20,000 15,000 10,000 5,000 0 January February March April May June July August September October November December CumSuscep CumSuscep+15% incr. CumSuscep+25% incr. CumSuscep+35% incr. Asturias, Armon, Cataldi, Todd. Unpublished 2020

Summary • Immunizations are an essential public health strategy that is being impacted by COVID-19 • Expected increase in the number of susceptible likely to result in higher incidence of rotavirus disease in the winter of 2020 - 21, outbreaks of pertussis and resurgence of polio worldwide. • Catch-up immunization will be challenging and require innovative ways of doing home-based immunization while tracing COVID-19 contacts

COV OVID-19 U 19 Upda pdates es Bernadette Albanese, MD, MPH Medical Epidemiologist

PRIMARY CARE DURING COVID-19 Continuing to provide necessary well child care and immunizations safely June 10, 2020 Dr. Shen Nagel

 Parental fears  Office staff safety issues  Stay-at-home orders  Pediatric care in larger systems (KP, DHMC) had to be adjusted or curtailed to conserve resources for adult care INITIAL BARRIERS

 50% or more drop in patient volumes  (our practice) 50% decrease in IZs given in first month of COVID  Managed to get 80% of IZs in <2yo  Michigan data showed declining IZ rates  <50% children <2yo were UTD (MMWR 69(20), May 22, 2020) INITIAL IMPACT

 Separate offices for WCC and sick (if available)  Segregate well and sick by time  Clean and dirty sides of offices  Keep “clean” office by using telemed for all sick  Initially few practices/systems seeing WCC >2; some even more drastic  ? Telemed for well care—still need to bring in separately for IZs NEW WORKFLOWS

 Increased recall efforts for lapsed IZs, well care  EHR messaging  Practice website, social media GETTING PATIENTS IN

 Communications from practices—flyers re safety of office  Local/State/National guidance from CDPHE, AAP, etc PUBLICIZING THE NEW NORMAL

Q&A Please add your questions to the chat box