Service Area Strategic Plan
11/23/2009   4:42 am
Department of Health (601)
Biennium: 2008-10
Service Area 1 of 1
Immunization Program (601 405 02)
Description

This service area has responsibility for the support and oversight of statewide immunization activities. Through a variety of activities, the service area strives to maintain and distribute an adequate and viable vaccine supply. The program also conducts quality assurance site visits, oversees the investigation of suspected cases of vaccine preventable disease and assesses immunization coverage statewide. These and other program activities are effective in protecting the health of all Virginians.
Background Information
Mission Alignment and Authority
  • Describe how this service supports the agency mission
    This service area directly aligns with the VDH mission of promoting and protecting the health of Virginians. The Immunization Program ensures that an adequate and viable inventory of vaccine is available to local health departments and private physicians participating in the Vaccines for Children (VFC) program. This is essential to protecting the public from the spread of communicable disease.
  • Describe the Statutory Authority of this Service
    Section 32.1-46 authorizes the State Board of Health, the State Health Commissioner and the State Department of Health to administer this service area.
    Section 32.1-46 also provides for the immunization of children against certain diseases in accordance wih regulations established by the Board of Health and the implementationof a statewide immunization registry.
    Section 23-7.5 requires full-time students enrolling in public institutuions to be immunized against certain diseases.
Customers
Agency Customer Group Customer Customers served annually Potential annual customers
Birthing Hospitals 71 71
Community Health Centers 93 93
Department of Education 1 1
Department of Medical Assistance Services 1 1
Laboratories 1 183
Legislators 140 140
Local health departments 119 119
Local Health Departments 119 119
Pediatricians & Family Physicians 1,800 4,000
Project Immunize Virginia Coalition 1 1
Virginia Health Quality Center 1 1

Anticipated Changes To Agency Customer Base
Implementation of the immunization registry will expand customer base to include health plans, insurers, managed care organizations, and emergency preparedness and response agencies and organizations.
Partners
Partner Description
[None entered]
Products and Services
  • Factors Impacting the Products and/or Services:
    Poverty and unemployment: Increased rates of poverty and unemployment could result in a large number of citizens presenting to health departments for immunization services.

    Vaccine supply and demand: Insufficient vaccine supply or radically increased demand could cause delays in the on-time administration of vaccine causing more persons to be unimmunized or incompletely immunized.

    Acts of Bioterrorism: Responding to acts of bioterrorism will reduce the number of staff available for the delivery of routine health department services. This could result in an increasing number of unimmunized or incompletely immunized children and adults.

    Health Insurance and access to care: Failure of insurance companies to cover the cost of new vaccines or added doses of vaccine would cause some citizens to delay/or defer immunizations.

    Immigration Policies: More comprehensive health care requirements and an increasing number of immigrants presenting to health departments for vaccinations could rapidly deplete the vaccine budget and result in gaps in vaccine suply.

    Anti vaccine movement: Increased activities of anti vaccine groups and widespread distribution of anti vaccine material could result in decreased demand for vaccination services. This would result in an increased number of susceptible children and adults.

    Legislative changes at the Federal and State Level: Legislative changes that have fiscal impact but no additional funding appropriation will adversely affect program operations and could reduce vaccine availability and access to vaccination services.
  • Anticipated Changes to the Products and/or Services
    Increased focus on emergency preparedness.

    Greater need for services to be ethnically and linguistically diverse.

    Addition of new vaccines [adolescent/adult tetanus,diphtheria and pertussis (Tdap), human papillomavirus (HPV), meningococcal conjugate vaccine (MCV4)].

    Increased usage of more costly combination vaccines. [measles,mumps,rubella and varicella (MMRV)]
  • Listing of Products and/or Services
    • Vaccine Supply: Maintain and appropriately ship an inventory of viable vaccine to public and private health care providers statewide.
    • Statewide Policy Development: Develop and implement statewide policy on vaccine preventable diseases in accordance with the harmonized recommendations of the CDC Advisory Committee on Immunization Practices, the American Academy of Pediatrics and Academy of Family Physicians.
    • Grants Management and Resource Allocation: Develop and manage annual federal grant and allocate resources to districts for support of immunization services. Perform quarterly evaluation of program fiscal activity.
    • Quality Assurance: Conduct annual quality assurance reviews in all local health department sites to ensure compliance with State and Federal program guidelines. Conduct quality assurance reviews in all Vaccines for Children Program (VFC) private provider sites to ensure compliance with State and Federal program guidelines.
    • Statewide Assessment and Program Evaluation: Conduct annual assessment of the immunization records of kindergarten students to determine immunization coverage, medical and religious exemptions and school regulatory compliance. Conduct annual assessment of day care and Head Start centers to determine immunization coverage and regulatory compliance. Conduct quarterly assessment of the immunization coverage rates in health districts. Conduct quarterly evaluation of program objectives.
    • Adverse Event Reporting: Manage the statewide vaccine adverse event reporting system.
    • Immunization Registry: Implement and manage the statewide immunization registry.
    • Technical Assistance: Provide vaccine preventable disease related technical assistance to public and private health care providers statewide. Maintain the statewide Smallpox Emergency Response plan. Provide technical guidance on Pandemic Influenza Preparedness planning and operations. Provide guidance and support to local health department staff on investigation of suspected cases of vaccine preventable diseases. Perform statewide oversight and provide guidance to district health department staff on the identification and follow-up of cases of perinatal hepatitis B.
    • Education and Training: Ensure availability of CDC and other vaccine preventable disease satellite training courses to public and private health care providers. Develop and distribute patient and provider educational material. Provide computer based assessment training for health department staff. Support off-site, job related training for program staff.
Finance
  • Financial Overview
    The total budget for the service area has two funding streams consisting of general and non-general funds. Non-general funds are received in a federal, categorical, cooperative agreement from the Centers for Disease Control and Prevention.
  • Financial Breakdown
    FY 2009    FY 2010
      General Fund     Nongeneral Fund        General Fund     Nongeneral Fund  
    Base Budget $4,093,904 $5,563,956    $4,093,904 $5,476,622
    Change To Base $-1,215 $-1,411    $-518,421 $-1,411
               
    Service Area Total   $4,092,689  $5,562,545     $3,575,483  $5,475,211 
Human Resources
  • Human Resources Overview
    [Nothing entered]
  • Human Resource Levels
    Effective Date      
    Total Authorized Position level Ø    
    Vacant Positions Ø    
    Current Employment Level 0.0    
    Non-Classified (Filled)    
    Full-Time Classified (Filled)    breakout of Current Employment Level
    Part-Time Classified (Filled)    
    Faculty (Filled)    
    Wage    
    Contract Employees    
    Total Human Resource Level 0.0   = Current Employment Level + Wage and Contract Employees
  • Factors Impacting HR
    [Nothing entered]
  • Anticipated HR Changes
    [Nothing entered]
Service Area Objectives
 
  • Achieve and maintain maximum immunization coverage rates in Virginia’s children.
    Objective Description
    The occurrence of most vaccine-preventable diseases in children is at or near record low levels. However, the organisms that cause these diseases have not disappeared. Rather, they have receded and will reemerge if the vaccination coverage drops. Continuing to improve immunization coverage and sustaining high coverage is critical to achieving on-going reductions in vaccine-preventable disease morbidity and mortality.
    Alignment to Agency Goals
    • Agency Goal: Provide strong leadership and operational support for Virginia's public health system.
    • Agency Goal:
    Objective Strategies
    • Improve the quality and quantity of vaccination delivery services. Provide an adequate and viable vaccine supply to public and private providers. Provide up-to-date Vaccination Information Statements to all providers. Regularly update VDH policies to reflect the most recent recommendations of the CDC Advisory Committee on Immunization Practices (ACIP). Conduct annual quality assurance site visits at all public and private health care provider sites. Monitor and report all suspected adverse events to vaccination. Target program resources to “Pockets of Need”. Implement an immunization registry in the public and private sectors.
    • Minimize financial burdens to needy persons. Increase private provider enrollment in the Vaccines for Children Program.
    • Increase community participation, education and partnership. Support the infrastructure needs of the Project Immunize Virginia statewide immunization coalition. Regularly update division website to include the most up-to-date information on vaccines, policies and regulations. Continue partnerships with the Department of Medical Assistance Services (DMAS), the Department of Education and the Department of Social Services.
    • Improve and expand monitoring of vaccination coverage. Quarterly assessment of immunization coverage in health districts. Annual assessment of immunization status of students at middle school entry (6th grade). Annual assessment of immunization coverage in at least 25% or private provider sites enrolled in VFC. Annual assessment of the immunization coverage at school entry, Head Start facilities and day care centers.
    • Improve vaccine use. Ensure availability of resources to support the provision of new vaccines and combination vaccines.
    Objective Measures
    • Immunization coverage rates of children at school entry.
      Measure Class:
      Other
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Up
      Measure Baseline Value:
      93.5
      Date:
      6/30/2004

      Measure Baseline Description: Percent for coverage rate

      Measure Target Value:
      97
      Date:
      6/30/2010

      Measure Target Description: Percent for coverage rate

      Data Source and Calculation: Data are from the VDH Immunization Survey of Kindergarten, Head Start and Day Care programs. The statistical function known as probability proportional to size is used to select assessment sites. This function provides all students, regardless of geographic location, with an equal chance of being selected. Data collected by district health department staff are forwarded to the central office where they are imported into the Clinic Assessment Software Application (CASA). CASA analyzes the data taken from the student immunization records and provides vaccine coverage rates at school entry, retrospectively at 2 years of age and produces a listing of students with medical and religious exemptions to immunization.

  • Increase the influenza and pneumococcal vaccination coverage rates in adults 65 years of age and older.
    Objective Description
    Historically the annual influenza and pneumococcal vaccination coverage rates in persons 65+ years of age has been below 70 percent. The risks of complications and hospitalizations from influenza and pneumococcal disease are higher among persons in this age group and nursing home attack rates may be as high as 60 percent, with fatality rates as high as 30 percent. Increasing the number of persons 65 and older who receive an annual influenza vaccination and at least one pneumococcal vaccination will reduce morbidity and mortality and medical costs associated with these diseases and improve the quality of life for older Virginians.
    Alignment to Agency Goals
    • Agency Goal: Prevent and control the transmission of communicable diseases.
    Objective Strategies
    • Improve the quality and quantity of vaccination delivery services. Maintain an adequate and viable supply of vaccine. Maintain current vaccine procurement contracts. Maintain current vaccine distribution contract. Develop a vaccine prioritization plan for implementation during periods of vaccine shortages. Provide up-to-date Vaccine Information Statements to all providers. On-going education of providers on the need to increase vaccine coverage, persons to be vaccinated and appropriate use of available vaccines. On-going support for Standing Order policies.
    • Minimize financial burdens for needy persons. Educate providers on Medicare reimbursement and encourage roster billing in mass clinic settings.
    • Increase community participation, education and partnership. Support the Project Immunize Virginia annual flu and pneumococcal campaigns. Partner with the American Lung Association of Virginia in the annual flu and pneumococcal statewide media campaign. Partner with the Virginia Health Quality Center on the annual influenza and pneumococcal educational campaigns directed at hospitals and nursing homes. Develop annual VDH press release at the beginning of flu season. Partner with the Virginia Pharmacy Association in educating pharmacists statewide on issues regarding influenza and pneumococcal vaccines.
    Objective Measures
    • The percentage of adults 65 years of age and older in Virginia who are appropriately immunized against influenza
      Measure Class:
      Governor's Key
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Up

      Key Summary: We will increase the percentage of adults 65 years of age and older who are appropriately immunized against influenza to 80% by June 30, 2009.

      Measure Baseline Value:
      66.8
      Date:
      6/30/2006

      Measure Baseline Description: Percent of adults

      Measure Target Value:
      80
      Date:
      6/30/2010

      Measure Target Description: Percent of adults

      Data Source and Calculation: Data are taken from the Behavioral Risk Factor Surveillance Survey (BRFSS). BRFSS is a series of telephone interviews with people in all 50 states plus Washington, D.C. and several U.S. Territories. In Virginia, the data are collected and analyzed by the Survey and Evaluation Research Laboratory at Virginia Commonwealth University. Coverage rates are calculated by determining the number and percentage of persons contacted who are 65 + years of age and who have received an influenza vaccination within the previous 12 months.

    • The percentage of adults 65 years of age and older in Virginia who are appropriately immunized against pneumonia
      Measure Class:
      Governor's Key
      Measure Type:
      Outcome
      Measure Frequency:
      Annual
      Preferred Trend:
      Up

      Key Summary: We will increase the percentage of adults 65 years of age and older who are appropriately immunized against pneumonia to 80% by June 30, 2009.

      Measure Baseline Value:
      66.5
      Date:
      6/30/2006

      Measure Baseline Description: Percent of adults

      Measure Target Value:
      80
      Date:
      6/30/2010

      Measure Target Description: Percent of adults

      Data Source and Calculation: Data are taken from the Behavioral Risk Factor Surveillance Survey (BRFSS). BRFSS is a series of telephone interviews with people in all 50 states plus Washington, D.C. and several U.S. Territories. In Virginia, the data are collected and analyzed by the Survey and Evaluation Research Laboratory at Virginia Commonwealth University. Coverage rates are calculated by determining the number and percentage of persons contacted who are 65 + years of age and who have received a pneumonia vaccination within the previous 12 months.


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