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.

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

The Impact of COVID-19 on Immunization Services: Experts in Public Health and Primary Care Respond from the Field

Wednesday, June 10th, 2020

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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.

Virtu rtual Town Hall Schedule

• 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

• Bernadette A

e Albanese, MD, MPH - Medical

Epidemiologist, Tri-County Health Department

• 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

• Clara
• B.S. in Nutrition Studies from the University
• f Minnesota
• Serving in Chaffee County at Chaffee County

Public Health in Salida

• Ellie
• B.A. in Kinesiology: Health Sciences and

Ecology from Rice University

• Serving the Denver Metro area at Immunize

Colorado in Aurora

Welcome Colorado Immunity Corps VISTA Members!

The Colorado Immunity Corps - Immunize Colorado’s statewide AmeriCorps VISTA program – welcomed its first two members into service last week. VISTA members will provide capacity building services at their host sites to support local immunization activities.

Join us for the 11th 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.

Updates from

• ur Executive

Director

• Policy upd

update e – SB163

• Just r

released sed - Colorado Pediatric Provider Toolkit: Caring for Children During the COVID- 19 Pandemic

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

Toolkit from Immunize Colorado, AAP Colorado and CDPHE now available! Access today at bit.ly/COPedToolkit

Introduc uctions ns

• 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

• Shen

en N Nagel el, MD, FAAP - Pediatrician, Pediatrics West

• Moderator
• Step

tephanie W e Wasser erman, MSPH - Executive Director, Immunize Colorado

UNIVERSITY OF COLORADO | COLORADO STATE UNIVERSITY | UNIVERSITY OF NORTHERN COLORADO

Effects of COVID-19 on routine immunization, interim guidelines and population immunity

Edwin J. Asturias, MD

Professor of Pediatrics and Epidemiology

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

Mortality of COVID-19 compared to other epidemics

Influenza

Fatalidades Recuperados

SARS 2013

Fatalidades Recuperados

MERS 2012

Fatalidades Recuperados

COVID19

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

J Infect Dis, jiaa273, https://doi.org/10.1093/infdis/jiaa273.

Longitudinal profile of antibodies against nucleocapsid and spike proteins in immunocompetent adults with COVID-19

5% 4% 6% 21% 12% 5% 7% 3% 0.1% 0.3% 0.6% 1.0% 3.1% 0.6% 1.2% 0.6% 0% 5% 10% 15% 20%

Santa Clara, CA Los Angeles, CA Miami Dade, FL New York City Westchester, NY Spain Stockholm, Sweden Wuhan, China

Porcentaje de la Poblacion Immune by serology Cases % Population

Population immunity acquired in affected Cities measured as positive serology vs. cases reported by June 2020

At least 80 million children under one at risk

• f 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
• utbreak 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

• n Routine Pediatric Vaccine

Ordering and Administration — United States, 2020

• Substantial reduction in VFC-

funded pediatric vaccine

• rdering 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

• 100
• 50

50 100 150 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

Percent mobility from baseline

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

5,000 10,000 15,000 20,000 25,000 30,000

January February March April May June July August September October November December

Number of children left susceptible 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,

• utbreaks 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

Bernadette Albanese, MD, MPH

Medical Epidemiologist

COV OVID-19 U 19 Upda pdates es

PRIMARY CARE DURING COVID-19

Continuing to provide necessary well child care and immunizations safely June 10, 2020

• Dr. Shen Nagel

INITIAL BARRIERS

 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 IMPACT

 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)

NEW WORKFLOWS

 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

GETTING PATIENTS IN

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

PUBLICIZING THE NEW NORMAL

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

Q&A

Please add your questions to the chat box