Guidance for Immunization Grantees about the Influenza Vaccine Distribution Data Available in FluFinder:  2007-08 Influenza Season
September 15, 2008

Objective
The objective of this document is to provide information about CDC’s influenza vaccine distribution data tracking system for state and local pubic health officials, including:  a brief history of the tracking system; a discussion about the confidentiality requirements for users of the tracking system; a description of the type of data available as well as instructions for gaining access to the tracking system; a summary of the ways in which immunization grantees used vaccine distribution data during the 2006-07 season; tips for using Excel to analyze vaccine distribution data; and a listing of CDC contacts when additional information is needed.

Background
CDC began tracking seasonal influenza vaccine in October 2004, to provide state and local public health officials with information about influenza vaccine distribution.  This system was developed following a dramatic shortfall of seasonal influenza vaccine precipitated by Chiron’s announcement that the company would be unable to deliver any of the 50 million previously anticipated doses to the U.S. market due to regulatory issues.  Tracking during the 2004-05 season focused on inactivated (injectable) influenza vaccine produced and distributed by sanofi pasteur (formerly Aventis Pasteur), which represented approximately 95 percent of the doses available that season.  In addition to vaccine tracking, this application also had an ordering capacity.  Access to the system was provided for a limited number of state/local health officials per jurisdiction and was accomplished by placing the application (FluFinder) on CDC’s Secure Data Network (SDN).   

In response to a significant delay in vaccine distribution by Chiron in the 2005-06 season, FluFinder was activated late in the influenza season, without an ordering capacity.  In addition to data from sanofi pasteur, CDC reached out to Chiron’s major influenza vaccine distributors to enlist their participation.  Data were updated a limited number of times throughout the season as new information was submitted to CDC.   A key lesson learned during this season was the need for public health officials to have access to vaccine distribution data as early in the distribution process as possible. 

Since that time, FluFinder has evolved to include all US-licensed influenza vaccine products (intranasal vaccine as well as injectable vaccine) and the provision of distribution data beginning in mid-September through the end of January with updates posted by CDC each week.  

Confidentiality of Data
Influenza vaccine distribution data included in FluFinder are proprietary data that are voluntarily submitted to CDC by the six US-licensed manufacturers of influenza vaccine as well as the six major influenza vaccine distributors to support state and local health officials in their responsibilities around managing influenza vaccine supply problems.  It is because of the proprietary nature of the data that access to the system is limited to state and local health officials designated by CDC’s immunization grantees who must access the information via CDC’s SDN after applying and receiving an approved digital certificate.  Grantees may identify as many as five individuals within their health department for access to FluFinder.  The ability to see and use raw data from FluFinder is limited to these individuals.  

Grantees may use summaries of these data to communicate with immunization providers, the public, and the media about vaccine availability within their jurisdictions, but they should not permit direct access to these data outside of their public health agency.  Requests to share vaccine distribution data with individuals or agencies outside the public health department cannot be honored.  Assistance in handling these requests is available from Jeanne Santoli at NCIRD (jsantoli@cdc.gov). 

Although public health officials may carry out any analyses of these data that they deem appropriate, only analyses of aggregate information (i.e., analyses in which data about all influenza vaccine product types are combined) should be shared publicly.  In addition, analyses of these data are not to be submitted for publication.

FluFinder Data
The following data elements about individual influenza vaccine shipments are included within FluFinder:
•	Vaccine type
•	Presentation
•	Manufacturer
•	Distributor (if applicable)
•	Number of doses
•	Recipient’s state
•	Recipient’s zip code
•	Recipient’s provider type

Manufacturer/distributor information about the recipient’s provider type is classified into one of the following twelve categories by CDC: corporation/occupational health; corrections; distributors; federal government; hospitals/emergency departments/dialysis centers; long term care; military; other private; other public; pharmacy; private providers/outpatient clinics and facilities/HMOs/surgery centers; state/local health departments and governments.

FluFinder is operational during the influenza vaccine distribution season, beginning on Monday, September 15, 2008 for the 2008-09 season and running through the end of January 2009.  Data are updated by CDC on a weekly basis, each Wednesday by 12 noon EST.  

Influenza vaccine distribution data for the 2008-09 season are provided by the following manufacturers and distributors
  
Vaccine Distributors 
ASD Healthcare/Besse
•	Cura Script
•	FFF Enterprises
•	Henry Schein/GIV
•	McKesson Medical Surgical (Note:  This is a separate entity from McKesson Specialty, who holds the CDC contract for centralized distribution.)
•	Seacoast Medical

Vaccine Manufacturers
•	CSL Biotherapies
•	GSK
•	ID Biomed (GSK subsidiary)
•	MedImmune
•	Novartis
•	sanofi pasteur

The following is a sample of what the data will look like when you access FluFinder for your jurisdiction.  The screen shot shows the name of the state, zip code, manufacturer, distributor, vaccine type, presentation, doses, order number, and provider type.  It is a screen shot of an excel spreadsheet.

Acss to FluFinder
Grantees may identify as many as five individuals within their health department for access to FluFinder.  Information about the individuals for whom access is requested should include name and state health department affiliation and sent via email to Jim Harrisonat NCIRD (jharrison@cdc.gov ) NCIRD will then communicate with SDN staff at CDC to approve access to these individuals.

Each individual for whom access is requested will also need to obtain a digital certificate.  An application for obtaining a digital certificate is available at the SDN enrollment website https://ca.cdc.gov and by contacting Jim Harrison at NCIRD (jharrison@cdc.gov) for the SDN enrollment password.

Specific Data Considerations:  Flu Finder 2008-09

This section outlines some key issues to keep in mind as you review influenza vaccine distribution data in FluFinder:

Subdistribution   Since participation in FluFinder is limited to the manufacturers and major distributors of influenza vaccine, FluFinder does not provide information about the end user/recipient of doses that go through additional levels of distribution (i.e., subdistribution).  Previously, this has represented about 15 percent  of doses nationally, but may be larger for individual grantees, such as the territories. 
 
Doses Distributed via CDC’s Centralized Distributor (includes  those doses purchased via the CDC Influenza Vaccine Contracts or any other mechanism) Although these doses have a wide variety of end users/recipients, including private providers, all doses purchased via the CDC influenza vaccine contracts will appear in the provider category “state/local health departments and governments.” 

Grantee Use of Influenza Vaccine Distribution Data during 2006-07

In order to understand how influenza vaccine distribution data in FluFinder were used, CDC conducted an email survey of immunization grantees in March 2007.  The survey was developed following a workshop at the National Immunization Conference at which three grantees (two states and one large urban area) made presentations about use of influenza vaccine distribution data.  Survey questions included how frequently FluFinder was accessed during the influenza season; the sort of analyses carried out; use of distribution data to support efforts; comparison of vaccine distribution data with other data sources; communication with public health departments, providers, and the media; and use of limited amount of prebook data included in FluFinder.

Results During the 2006-07 influenza season, 40 grantees requested and were given access to FluFinder.  Among those grantees provided access to the system, 25 (63 percent ) responded to the survey.  Of those who responded, 23 (92 percent ) used FluFinder data, and the information provided by those grantees is summarized in this report.

•	Frequency of access Grantees most commonly reported accessing FluFinder more than once (52 percent ) or weekly (39 percent ); 9 percent  of grantees reported accessing the system only one time.  
•	Type of analyses The level of analysis varied by grantee.  The majority of grantees (74 percent ) carried out provider-level analyses; other commonly reported analyses include product-type analysis (49 percent ); zip code-level analysis (39 percent ); county-level analysis (35 percent ).  
•	
One grantee reported comparing distribution data from FluFinder with order data from the prior season.  In addition, although we did not ask the question directly, we are aware of several grantees who imported the data into GIS software to enable them to visualize the data more easily.  
•	Use of data to support redirection of doses or patients Two grantees reported using data to redirect patients and one grantee reported using data to redistribute doses.  None of these respondents provided descriptive information about how this was accomplished.
•	Comparison of SDN data with other sources of information Ten grantees (44 percent ) reported that their analyses of vaccine distribution data included comparison with other sources of data including the census (50 percent ), BRFSS high risk data (40 percent ), and the number of long term care beds (30 percent ).  Other comparison data sources submitted by a single respondent included an annual long term care survey, insurer’s payment data, pediatric vaccine distribution data, and a comparison between local health department doses and hospital doses within jurisdictions.
•	Communication with selected groups Grantees indicated using vaccine distribution data and analyses to communicate with local health departments (65 percent ), providers (61 percent ), and the media (61 percent ).  Ten grantees (45 percent ) also reported using the data to communicate with other groups, including coalitions, medical advisory boards, infection control practitioners, public health information officers, state medical societies, state professional society chapters, and the state legislature.  
•	Level of data sharing The level of information shared varied, depending on the audience.
o	Among grantees using distribution data to communicate with local health departments, 20 percent  shared only summary data (qualitative information without specific estimates), 53 percent  shared state-level information, and 43 percent  shared jurisdiction-level information with local health departments.
o	Among grantees using distribution data to communicate with providers, 29 percent  shared only summary data (qualitative information without specific estimates) and 53 percent  shared state-level information. 
o	Little descriptive information was provided about how information was shared with local health departments and providers.  Responses included issuing reports; sponsoring press conferences; and holding teleconferences.  
o	Among grantees using distribution data to communicate with the media, most provided summary data (qualitative information without specific estimates) or state level data. One grantee reported information about vaccine by provider type with the media.

This survey indicated that fewer than half of CDC’s immunization grantees accessed FluFinder.  Of those who did access the system, most used the data more than one time throughout the season and many used it on a weekly basis.  The most common analysis was vaccine distributed by provider type, but product-level, county-level, and zip code-level analyses were also carried out.  About half of the grantees who used the data compared it with other data sources and used it to communicate with other providers and the media.  Information about how grantees have used influenza vaccine distribution data may help to increase the value of this tool for immunization grantees to assist in their management of the seasonal influenza.  

While this evaluation did not provide information about the reasons that grantees may have decided not to request access to FluFinder, it is likely that some grantees were unaware of what information was contained in FluFinder, the timeline over which the data would be available, or how the data might be helpful to them.  Strategies to ensure grantees are aware of this resource include the dissemination of this guidance document as well as discussion about FluFinder on routine calls with immunization grantees.

Tips for using Excel to analyze vaccine distribution data
    Steps for sorting and grouping FluFinder data:

1.	In order to sort by a specific column first choose your column than highlight.
2.	Find the sort button on the Excel tool bar and choose ascending or descending.  The screen shot here is the exact same as described above, however in this situation, the author has highlighted the provider type column as a way to sort.
3.	After clicking on the sort button a window will pop up asking to expand the sort; click the “Sort” button.  
4.	After the sort is complete the subtotals can be calculated for each provider type.
5.	Highlight the Doses, Order ID and Provider Type columns.
6.	Click on “Data” “Subtotals”
7.	In the pop up window for subtotals set up like the screen by selecting:
“Provider Type” from “At each change in:”; 
“Sum” from the “Use function”; 
“Doses” from the “Add subtotal to” 
Replace current subtotals
Summary below data
8.	After subtotal information is set up click on the “OK” button.
9.	The provider type in bold is where the subtotal is calculated in the Doses column.
10.	You can use this technique to sort and subtotal on any of the columns.

Further Assistance
To submit names for access to the FluFinder application or obtain an application for a digital certificate, please contact Jim Harrison at NCIRD (jharrison@cdc.gov or 404.639.8577).

For technical assistance with the SDN, please contact the SDN Helpdesk at 800-532-9929.  The Helpdesk is available 8 am – 8 pm EST, Monday-Friday.

For other questions about influenza vaccine distribution data/tracking, please contact 
Jeanne Santoli (jsantoli@cdc.gov or 404.639.8208) or Jim Harrison (jharrison@cdc.gov)

This document can be found on the CDC website at:
http://www.cdc.gov/vaccines/programs/vmbip/downloads/agm/grant-guid-find.rtf