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Alumnus Article: Portland Public Health Initiative to Prevent Flu Among American Indians


By CAPT Thomas Weiser, MD ’95, MPH, Medical Epidemiologist Portland Area Indian Health Service

November 23, 2016

Thanksgiving is almost upon us. As we prepare to gather together with family and friends, let us be mindful that one guest is not invited–influenza! Influenza has been shown to have a greater impact on American Indians and Alaska Natives and people with chronic medical conditions. The Portland Area IHS and Tribal clinics have been hard at work this year in vaccinating our communities against the flu. One strategy that we focused on last year was to vaccinate as early as possible. Because flu vaccine supplies are sometimes delayed by production or distribution factors outside of our control, we needed to add to this strategy. This year, clinics are focusing on not only vaccinating as early as possible, they are taking it to the streets by vaccinating in multiple sites outside of the clinic’s four walls. Here are some examples of the great efforts our clinical sites are undertaking here in the Pacific Northwest:

  1. Yakama Service Unit: The clinic has scheduled weekly flu-shot clinics every afternoon. In addition, they have added one late evening clinic each week. On Thursday mornings, during Administrative Time when the clinic is closed, they are holding “drive-through flu shot clinics” where folks can get their flu shots without even getting out of their car. Flu vaccinations were also given during the Tribal Head Start screening clinic, which had about 50 children.

  2. Western Oregon Service Unit (Chemawa): Clinic staff have given about 500 flu shots so far to community members. Among Health Care Providers, 99 percent have received a flu shot this year, according to the new mandatory policy for annual flu vaccinations of Health Care Providers. Angela Zimmerman, Public Health Nurse, is gearing up to vaccinate all 400+ students at the nearby Chemawa Boarding School before they travel home for the Thanksgiving break.

  3. Colville Service Unit: The Colville Service Unit has been doing drive-through flu clinics for many years. The first one for this year was held at the main clinic location (Nespelem) on September 21 in which about 100 flu shots were given. A week later, they held another drive-through flu clinic at a smaller satellite clinic in Omak. This was the first time they had done this at Omak and they reported a good turn-out. Both clinics have a policy to vaccinate at all visits and anecdotally they report about 80 percent of those offered accepted the flu vaccine this year. According to Immunization coordinator Sadie Cano, over 90 percent of employees have been vaccinated for flu so far this year.

  4. Wellpinit Service Unit: The first ever drive-through flu clinic was held this week reaching 24 patients. CDR Elizabeth Sachse, Public Health Nurse, reports that many of the people she usually sees at home or in elder programs have already gotten their flu shots and observed that the clinic nurses seem to be more active in giving flu shots in clinic because many of the folks she has seen have already gotten their flu shots.

  5. Warm Springs Service Unit: Activities at the Warm Springs Health and Wellness Center have focused on making flu shots available at every visit throughout the clinic, including medical clinics, pharmacy and Community Health. In addition, flu shots have been offered at multiple locations and venues outside of clinic. These include many high traffic areas such as the Post Office, Administration Center, Community Center and Family Resource Center. They have also worked to coordinate with many tribal programs such as Corrections, Human Resources, Assisted Living and Children’s Group Home. In each location, flu shots are provided for both clients and tribal staff. Nearly all Warm Springs Health and Wellness Center employees have received their flu shots this year!

  6. Fort Hall Service Unit: The Ft. Hall Service Unit worked with Shoshone-Bannock Tribal Health Partners again this year to hold two successful drive-through flu clinics. Last year they gave 38 flu shots in just one hour, this year they gave 50! A second drive-through clinic was smaller (just 23 patients) but the Ft. Hall staff was dedicated, working outside in near freezing temperatures. Dr. Bernadette Corum, Acting Clinical Director, reports they have been increasing their use of media and advertising with messages in the clinic, Facebook and tribal newspaper. So far it has paid off with over 1,000 adults and 99 percent of employees vaccinated against influenza this year.

Tribal clinics in the area are also joining in the effort. One clinic reports starting to give flu shots earlier this year than before while another reports that they have vaccinated over 400 people so far. They held a flu clinic at the Elder’s Center over lunch two different days and even brought their Clinical Director, Dr. Allison Spencer, to discuss the differences between regular adult and high dose flu vaccines. As a result of these activities, 55 elders were vaccinated. Two of our Tribal clinics have also adopted mandatory employee flu shot policies to help protect staff and patients from influenza.

Across the Pacific Northwest, clinical providers employ a number of “best practices” to get people vaccinated. These include:

  1. Using Electronic Health Record reminders to help remind staff of who needs a flu shot.

  2. Checking for and offering a flu shot at every clinic visit, including eye clinic, dental clinic and the pharmacy refill window.

  3. Providing flu shots at out-of-clinic venues: elder meetings, day care and Head Start facilities, and drive-through flu clinics like the one pictured below at Ft. Hall Service Unit.

  4. Making flu shots available at special walk-in flu clinics staffed by nurses.

  5. Adopting extended-hour clinics on weekends and evenings specifically for providing flu shots.

  6. Utilizing pharmacists who are authorized in most states to provide a variety of immunizations, including flu shots.

  7. Providing community outreach through radio, newspaper and social media outlets to educate the community about the importance of getting a flu shot each year.

The Portland Area Office is extremely proud of the efforts being made by everyone across our three states. We believe that these efforts are important to prevent influenza morbidity and mortality among the patients that we serve. Learn more about influenza vaccination, prevention and disease surveillance.

CAPT Thomas Weiser, MD, MPH is the Medical Epidemiologist for the IHS Portland Area Office and is assigned to the NW Tribal Epidemiology Center at the Northwest Portland Area Indian Health Board.


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