PHGR Influenza and Beyond: Responding to Vaccine-preventable Diseases

National Satellite Broadcast & Webcast: 1/30/04 2-3pm EDT

# Script [Version 3 SHORT]{.mark} 1/29/04

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|    | **VIDEO**             | # AUDIO                                 |
+====+=======================+=========================================+
|    | **13:30:00 SEGMENT    |                                         |
|    | 00**                  |                                         |
|    |                       |                                         |
|    | **Pre-program Test    |                                         |
|    | 30:00**               |                                         |
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| 1. | **14:00:00 SEGMENT    |                                         |
|    | 01**                  |                                         |
|    |                       |                                         |
|    | **5:00**              |                                         |
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| 2. | **TAPE:** Cut -- 1    |                                         |
|    | Pre-Con /Open         |                                         |
|    |                       |                                         |
|    | RT: **7:22**          |                                         |
+----+-----------------------+-----------------------------------------+
| 3. | CU BILL ROPER         | Roper:                                  |
|    |                       |                                         |
|    | CG:                   | Hello, I\'m Bill Roper. Welcome to      |
|    |                       | another session of Public Health Grand  |
|    | William Roper MD, MPH | Rounds, a collaboration of the Centers  |
|    |                       | for Disease Control and Prevention, and |
|    |                       | the School of Public Health at the      |
|    |                       | University of North Carolina at Chapel  |
|    |                       | Hill.  In these LIVE interactive forums |
|    |                       | we focus on CURRENT public health       |
|    |                       | issues. Today we find ourselves midway  |
|    |                       | through an unusually bad flu season.    |
|    |                       | And yet, as Public Health authorities   |
|    |                       | know, NOT ENOUGH PEOPLE, especially     |
|    |                       | those at HIGHEST RISK, are getting      |
|    |                       | vaccinated against this potentially     |
|    |                       | deadly disease.                         |
+----+-----------------------+-----------------------------------------+
| 4. | # SS:                 | Now here are some important CONTACT     |
|    |                       | numbers if you\'re having trouble       |
|    | [U.S. Technical       | receiving the program. For TECHNICAL    |
|    | Help]{.underline}:    | assistance call: 800 7-2-8 8-2-3-2.     |
|    |                       |                                         |
|    | \(800\) 728-8232      | That\'s 800 7-2-8 8-2-3-2               |
|    |                       |                                         |
|    | [International        | Or for INTERNATIONAL viewers, please    |
|    | Technical             | call:                                   |
|    | Help:]{.underline}    |                                         |
|    |                       | 4-0-4 6-3-9 1-2-8-9                     |
|    | \(404\) 639-1289      |                                         |
|    |                       | \[PAUSE\]                               |
+----+-----------------------+-----------------------------------------+
| 5. | CU BILL ROPER         | Roper:                                  |
|    |                       |                                         |
|    | CG:                   | Flu is a disease that\'s SO FAMILIAR    |
|    |                       | that many of us don\'t take it          |
|    | William Roper MD, MPH | seriously. Yet each year, about ONE     |
|    |                       | HUNDRED FOURTEEN THOUSAND people in the |
|    |                       | United States are hospitalized because  |
|    |                       | of influenza. And approximately         |
|    |                       | 36-thousand will DIE from this          |
|    |                       | vaccine-preventable disease. In CHICAGO |
|    |                       | this situation has spurred the Health   |
|    |                       | Department together with its community  |
|    |                       | partners to TAKE ACTION.                |
+----+-----------------------+-----------------------------------------+
| 6. | **TAPE:** Cut -- 2    | OUTCUE: \"... infants and young         |
|    | Tease                 | children.\"                             |
|    |                       |                                         |
|    | RT: **1:33**          |                                         |
+----+-----------------------+-----------------------------------------+
| 7. | CU BILL ROPER         | Roper:                                  |
|    |                       |                                         |
|    |                       | Treating influenza and other            |
|    |                       | vaccine-preventable illnesses like      |
|    |                       | pneumococcal disease costs Americans    |
|    |                       | more than 10 BILLION dollars each year. |
|    |                       | The key to REDUCING the burden of these |
|    |                       | diseases is INCREASING IMMUNIZATION     |
|    |                       | RATES, especially among those groups at |
|    |                       | increased risk for complications, such  |
|    |                       | as seniors; anyone with chronic heart   |
|    |                       | of lung problems; diabetes; or pregnant |
|    |                       | women. It\'s also important to reach    |
|    |                       | RACIAL and ETHNIC MINORITIES who        |
|    |                       | historically have had lower             |
|    |                       | immunization rates than whites. Joining |
|    |                       | us today to discuss ways of reaching    |
|    |                       | these goals is:                         |
+----+-----------------------+-----------------------------------------+
| 8. | CU WALTER ORENSTEIN   | Dr. Walter Orenstein, Assistant Surgeon |
|    |                       | General and Director of C-D-C\'s        |
|    |                       | National Immunization Program.          |
+----+-----------------------+-----------------------------------------+
| 9. | CU KRISTIN NICHOL     | We\'re also pleased to have with us Dr. |
|    |                       | Kristin Nichol, Professor of Medicine   |
|    |                       | at the University of Minnesota and      |
|    |                       | Chief of Medicine at the Minneapolis    |
|    |                       | Veterans Affairs Medical Center.        |
+----+-----------------------+-----------------------------------------+
| 10 | CU HUGH TILSON        | And as always, we have with us my       |
| .  |                       | colleague at                            |
|    |                       |                                         |
|    |                       | U-N-C, Dr. Hugh Tilson, Clinical        |
|    |                       | Professor of Epidemiology and Health    |
|    |                       | Policy. Hugh as usual will be keeping a |
|    |                       | close watch on our WEBSITE and will be  |
|    |                       | sifting through QUESTIONS you send us   |
|    |                       | on this timely subject.                 |
+----+-----------------------+-----------------------------------------+
| 11 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    | **SS:**               | One of the real values of a LIVE        |
|    |                       | INTERACTIVE program like this is        |
|    | **[United             | HEARING directly from YOU, so please    |
|    | S                     | write or call in your QUESTIONS and     |
|    | tates:]{.underline}** | COMMENTS.                               |
|    |                       |                                         |
|    | Voice (800) 793 --    | Our phone number is 800 7-9-3 --        |
|    | 8598                  | 8-5-9-8                                 |
|    |                       |                                         |
|    | Fax (800) 553 -- 6323 | Our fax number is 800 5-5-3 -- 6-3-2-3  |
|    |                       |                                         |
|    | TTY (800) 815 -- 8152 | And, you can also submit a question at  |
|    |                       | our website at www dot Public Health    |
|    | **SS:**               | Grand Rounds dot U-N-C dot E-D-U.       |
|    |                       | \[PAUSE\]                               |
|    | [www.PublicHealthGr   |                                         |
|    | andRounds.unc.edu](ht | And now let\'s take a look at our       |
|    | tp://www.PublicHealth | OBJECTIVES for today\'s program.        |
|    | GrandRounds.unc.edu/) |                                         |
|    |                       |                                         |
|    | CU BILL ROPER         |                                         |
+----+-----------------------+-----------------------------------------+
| 12 | **TAPE:** Cut -- 3    | OUTCUE: \".. also known as READII.\"    |
| .  | Objectives            |                                         |
|    |                       |                                         |
|    | RT: **:27**           |                                         |
+----+-----------------------+-----------------------------------------+
| 13 | **14:05:00 SEGMENT    |                                         |
| .  | 02**                  |                                         |
|    |                       |                                         |
|    | **Vaccine             |                                         |
|    | effectiveness 3:00**  |                                         |
+----+-----------------------+-----------------------------------------+
| 14 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | Let\'s begin with that FIRST objective, |
|    |                       | the EFFECTIVENESS of VACCINES. And for  |
|    |                       | perspective, let\'s remind ourselves    |
|    |                       | once again of our ATTITUDE toward the   |
|    |                       | flu, the main vaccine-preventable       |
|    |                       | disease faced by adults. Whether it\'s  |
|    |                       | through ignorance, denial or we\'re     |
|    |                       | just too blasé, data show the public    |
|    |                       | DOES NOT PERCEIVE INFLUENZA to be a     |
|    |                       | SERIOUS ILLNESS, and is                 |
|    |                       |                                         |
|    |                       | UN-SURE of the BENEFITS of vaccination. |
|    |                       | Walt, you\'ve been in the immunization  |
|    |                       | field a long time, WHY take this        |
|    |                       | disease so seriously?                   |
+----+-----------------------+-----------------------------------------+
| 15 | CU WALTER ORENSTEIN   | Orenstein:                              |
| .  |                       |                                         |
|    |                       | There are a number of really good       |
|    |                       | reasons to take influenza very          |
|    |                       | seriously.                              |
|    |                       |                                         |
|    |                       | -   We see outbreaks every winter       |
|    |                       |                                         |
|    |                       | ```{=html}                              |
|    |                       | <!-- -->                                |
|    |                       | ```                                     |
|    |                       | -   It\'s highly infectious. 10-20%     |
|    |                       |     infection rate                      |
|    |                       |                                         |
|    |                       | ```{=html}                              |
|    |                       | <!-- -->                                |
|    |                       | ```                                     |
|    |                       | -   It puts over 100,000 people in      |
|    |                       |     hospital a year. About 50% of them  |
|    |                       |     are people age 65 or older.         |
|    |                       |                                         |
|    |                       | -   Influenza is frequently associated  |
|    |                       |     with complications                  |
|    |                       |                                         |
|    |                       | -   It causes an average of 36,000      |
|    |                       |     deaths a year. 90% of them in       |
|    |                       |     people over 65.                     |
+----+-----------------------+-----------------------------------------+
| 16 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | So it\'s a disease which is MOST DEADLY |
|    |                       | for SENIORS but at the same time is     |
|    |                       | VACCINE-PREVENTABLE. How EFFECTIVE is   |
|    |                       | the vaccine?                            |
+----+-----------------------+-----------------------------------------+
| 17 | CU WALTER ORENSTEIN   | Orenstein:                              |
| .  |                       |                                         |
|    | CG:                   | The effectiveness depends on 3 things:  |
|    |                       |                                         |
|    | Walter A. Orenstein,  | -   Whether a person has ever been      |
|    | MD                    |     exposed to the virus before         |
|    |                       |                                         |
|    |                       | -   The match between the vaccine and   |
|    |                       |     circulating strains                 |
|    |                       |                                         |
|    |                       | ```{=html}                              |
|    |                       | <!-- -->                                |
|    |                       | ```                                     |
|    |                       | -   A person's age---the vaccine is 70  |
|    |                       |     to 90% effective in preventing      |
|    |                       |     influenza in healthy, young adults, |
|    |                       |     when there is a good match between  |
|    |                       |     the vaccine and the circulating     |
|    |                       |     strains. However in those who are   |
|    |                       |     65 or older or are frail, the       |
|    |                       |     effectiveness of the vaccine        |
|    |                       |     against illness decreases to 30 to  |
|    |                       |     40%. But for same group, the        |
|    |                       |     vaccine is 50-60% effective in      |
|    |                       |     preventing hospitalization and 80%  |
|    |                       |     effective in preventing death.      |
+----+-----------------------+-----------------------------------------+
| 18 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | So, given the facts about               |
|    |                       | effectiveness, why should people get    |
|    |                       | vaccinated?                             |
+----+-----------------------+-----------------------------------------+
| 19 | CU WALTER ORENSTEIN   | Orenstein:                              |
| .  |                       |                                         |
|    |                       | Number one...Influenza is a serious     |
|    |                       | disease associated with respiratory     |
|    |                       | illness and it can exacerbate           |
|    |                       | underlying health conditions such as    |
|    |                       | diabetes, heart disease, and asthma.    |
|    |                       |                                         |
|    |                       | Number two.. your flu vaccine not only  |
|    |                       | protects you, but it protect your loved |
|    |                       | ones as well                            |
|    |                       |                                         |
|    |                       | And three...influenza is transmitted    |
|    |                       | from people who are ill to people who   |
|    |                       | are susceptible.  By getting            |
|    |                       | vaccinated, you help break this chain   |
|    |                       | of transmission.                        |
+----+-----------------------+-----------------------------------------+
| 20 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | Thanks, Walt. Kristin, as an ex officio |
|    |                       | member of the Advisory Committee on     |
|    |                       | Immunization Practices, IMMUNIZATION    |
|    |                       | COVERAGE RATES are something you're     |
|    |                       | very familiar with. What can you ADD to |
|    |                       | what Walt said?                         |
+----+-----------------------+-----------------------------------------+
| 21 | CU KRISTIN NICHOL     | Nichol:                                 |
| .  |                       |                                         |
|    | CG:                   | -   Vaccine preventable deaths highest  |
|    |                       |     amongst adults. 99% versus 1% in    |
|    | Kristin L. Nichol,    |     children                            |
|    | MD, MPH, MBA          |                                         |
|    |                       | ```{=html}                              |
|    | [Is this correct for  | <!-- -->                                |
|    | general               | ```                                     |
|    | pop?]{.mark}**\       | -   Vaccination rates have become       |
|    | **                    |     stagnant in the past 5 years.       |
|    |                       |                                         |
|    |                       | -   Plateauing at just over             |
|    |                       |     [68%]{.mark} for people age 65 or   |
|    |                       |     older for the population as a       |
|    |                       |     whole.                              |
|    |                       |                                         |
|    |                       | -   When we look at African American    |
|    |                       |     and Hispanics the rate is           |
|    |                       |     significantly lower, around 50%     |
|    |                       |                                         |
|    |                       | So clearly there\'s a lot that needs to |
|    |                       | be done.                                |
+----+-----------------------+-----------------------------------------+
| 22 | **14:08:00 SEGMENT    |                                         |
| .  | 03**                  |                                         |
|    |                       |                                         |
|    | **Identifying the     |                                         |
|    | Problem 8:00**        |                                         |
+----+-----------------------+-----------------------------------------+
| 23 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | Thanks, Kristin. Now let\'s take a look |
|    |                       | at our CASE. In December Public Health  |
|    |                       | Grand Rounds went to CHICAGO and spoke  |
|    |                       | extensively with those Public Health    |
|    |                       | and community groups who are actively   |
|    |                       | engaged in trying to IMPROVE adult      |
|    |                       | immunization RATES in the city. Hugh,   |
|    |                       | what did you find out?                  |
+----+-----------------------+-----------------------------------------+
| 24 | CU HUGH TILSON        | Hugh:                                   |
| .  |                       |                                         |
|    | CG:                   | Bill, as you might expect it all began  |
|    |                       | with the key tools of Public Health,    |
|    | Hugh Tilson, MD, DrPH | surveillance and epidemiology. The      |
|    |                       | Chicago Health Department set out first |
|    |                       | of all to identify the size and scope   |
|    |                       | of the problem. They identified adult   |
|    |                       | immunization patterns throughout the    |
|    |                       | city and where the greatest gaps were,  |
|    |                       | primarily in the African American and   |
|    |                       | Hispanic communities. These needs       |
|    |                       | dovetailed neatly with the national     |
|    |                       | program C-D-C was launching known as    |
|    |                       | READII. Here\'s how it happened.        |
+----+-----------------------+-----------------------------------------+
| 25 | **TAPE:** Cut-4       | OUTCUE: \" to address this problem?\"   |
| .  | Identifying the       |                                         |
|    | Problem/Epidemiology  |                                         |
|    |                       |                                         |
|    | RT: **2:34**          |                                         |
+----+-----------------------+-----------------------------------------+
| 26 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | So LOCAL needs in Chicago converged     |
|    |                       | with a NATIONAL initiative to RAISE     |
|    |                       | adult immunization. Walt, tell us about |
|    |                       | the READII project that                 |
|    |                       |                                         |
|    |                       | C-D-C launched along with other federal |
|    |                       | partners.                               |
+----+-----------------------+-----------------------------------------+
| 27 | CU WALTER ORENSTEIN   | Orenstein:                              |
| .  |                       |                                         |
|    | **(BUILD)**           | As we heard in the objectives, READII   |
|    |                       | is short for Racial and Ethnic Adult    |
|    | **SS:**               | Disparities in Immunization Initiative. |
|    |                       | It\'s an initiative that C-D-C and its  |
|    | READII Project        | federal partners LAUNCHED in 2002.      |
|    |                       | We\'re trying to INCREASE VACCINATION   |
|    | -   2002 HHS/C-D-C    | RATES for influenza and pneumococcal    |
|    |     initiative in     | disease among Hispanics and African     |
|    |     collaboration     | Americans in FIVE communities.          |
|    |     with CMS, HRSA,   |                                         |
|    |     AoA & AHRQ        | The five READII sites are Chicago,      |
|    |                       | Milwaukee, Rochester, San Antonio, and  |
|    | **SS:**               | 19 counties in Mississippi.             |
|    |                       |                                         |
|    | -   Increase          |                                         |
|    |     vaccination rates |                                         |
|    |     among Hispanic-   |                                         |
|    |     Americans &       |                                         |
|    |     African Americans |                                         |
|    |                       |                                         |
|    | **SS:**               |                                         |
|    |                       |                                         |
|    | -   Chicago,          |                                         |
|    |     Milwaukee,        |                                         |
|    |     Rochester, San    |                                         |
|    |     Antonio and 19    |                                         |
|    |     counties in       |                                         |
|    |     Mississippi       |                                         |
+----+-----------------------+-----------------------------------------+
| 28 | **SS:** **(BUILD)**   | The READII Project has 4 goals:         |
| .  |                       |                                         |
|    | READII Objectives     | Mobilize community organizations        |
|    |                       |                                         |
|    | -   Mobilize          | Motivate Healthcare professionals       |
|    |     community         |                                         |
|    |     organizations     | Increase awareness of vaccine benefits  |
|    |                       |                                         |
|    | **SS:**               | Get more minority seniors immunized.    |
|    |                       |                                         |
|    | -   Motivate          |                                         |
|    |     Healthcare        |                                         |
|    |     professionals     |                                         |
|    |                       |                                         |
|    | **SS:**               |                                         |
|    |                       |                                         |
|    | -   Increase          |                                         |
|    |     awareness of      |                                         |
|    |     vaccine benefits  |                                         |
|    |                       |                                         |
|    | **SS:**               |                                         |
|    |                       |                                         |
|    | -   Get more minority |                                         |
|    |     seniors           |                                         |
|    |     immunized.        |                                         |
+----+-----------------------+-----------------------------------------+
| 29 |                       | One of the unique things about the      |
| .  |                       | Chicago READII Project is that it\'s    |
|    |                       | aimed at BOTH the African-American and  |
|    |                       | the Hispanic communities.               |
+----+-----------------------+-----------------------------------------+
| 30 | **14:16:00 SEGMENT    |                                         |
| .  | 04**                  |                                         |
|    |                       |                                         |
|    | **Providers/Delivery  |                                         |
|    | Service 10:00**       |                                         |
+----+-----------------------+-----------------------------------------+
| 31 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | Thanks, Walt. The READII Project in     |
|    |                       | Chicago is now just over a YEAR old.    |
|    |                       | Hugh, tell us what you discovered about |
|    |                       | HOW it\'s working.                      |
+----+-----------------------+-----------------------------------------+
| 32 | CU HUGH TILSON        | Tilson:                                 |
| .  |                       |                                         |
|    |                       | Certainly, Bill. Well, as Walt said,    |
|    |                       | one of the goals of READII is to        |
|    |                       | motivate healthcare professionals,      |
|    |                       | providers in particular, to find ways   |
|    |                       | to increase vaccination rates. We saw   |
|    |                       | how Chicago under the leadership of the |
|    |                       | Health Department is approaching that   |
|    |                       | challenge. Remember the lion share of   |
|    |                       | immunizations in this country is        |
|    |                       | administered by the private sector so   |
|    |                       | there\'s a tremendous need to educate   |
|    |                       | those private sector providers. And all |
|    |                       | providers need to know how to file for  |
|    |                       | reimbursement not through Medicaid but  |
|    |                       | through Medicare.                       |
|    |                       |                                         |
|    |                       | While in Chicago we also saw some of    |
|    |                       | the READII clinics operating in the 14  |
|    |                       | target communities. They\'re staffed by |
|    |                       | nurses from one of the community        |
|    |                       | partners, the American Lung             |
|    |                       | Association. So here\'s a look at what  |
|    |                       | we found out about providers and the    |
|    |                       | READII clinics.                         |
+----+-----------------------+-----------------------------------------+
| 33 | **TAPE:** Cut-5       | OUTCUE: \".. which we're happy about.\" |
| .  | Providers/ Service    |                                         |
|    | Delivery              |                                         |
|    |                       |                                         |
|    | RT: **3:51**          |                                         |
+----+-----------------------+-----------------------------------------+
| 34 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | So clearly PROVIDERS play a CRITICAL    |
|    |                       | ROLE in adult immunization rates.       |
|    |                       | Kristin, how do we make things better   |
|    |                       | in this area?                           |
+----+-----------------------+-----------------------------------------+
| 35 | CU KRISTIN NICHOL     | Nichol:                                 |
| .  |                       |                                         |
|    | **SS:**               | The first priority is of course turning |
|    |                       | PROVIDERS into BELIEVERS. Only 36       |
|    | (PP Slide #25)        | percent of healthcare workers report    |
|    |                       | that they have GOTTEN the vaccine.      |
|    | Disparities between   | It\'s critical that MORE healthcare     |
|    | Perception and        | workers get vaccinated against          |
|    | Performance           | influenza.  We need to remember that    |
|    |                       | healthcare workers see sick patients    |
|    |                       | who may have the flu and can transmit   |
|    |                       | it to the healthcare worker.            |
|    |                       | Healthcare workers can then TRANSMIT    |
|    |                       | the disease to their susceptible        |
|    |                       | patients.  By getting vaccinated,       |
|    |                       | healthcare workers are protecting       |
|    |                       | themselves, their patients, and their   |
|    |                       | communities.                            |
|    |                       |                                         |
|    |                       | Secondly, as the Chicago case shows,    |
|    |                       | there\'s often this gap between         |
|    |                       | PERCEPTION and PERFORMANCE among        |
|    |                       | providers in terms of numbers of        |
|    |                       | patients who receive an influenza       |
|    |                       | vaccination. It can be a dramatic one   |
|    |                       | as this chart demonstrates. On left, we |
|    |                       | see doctors reporting a better than     |
|    |                       | EIGHTY PERCENT vaccination rate.        |
|    |                       | However, on the right, when we conduct  |
|    |                       | an AUDIT of their charts we find an     |
|    |                       | ACTUAL rate of about FIFTEEN percent.   |
+----+-----------------------+-----------------------------------------+
| 36 | **SS:**               | So what this tells us is that there\'s  |
| .  |                       | a need for providers to get organized   |
|    | Strategies to Improve | and adopt a number of STRATEGIES to     |
|    | Vaccination Rates     | IMPROVE vaccination rates.              |
|    |                       |                                         |
|    | -   Increase demand\  | -   Increase demand                     |
|    |     Patient           |                                         |
|    |     reminders\        | > Patient reminders                     |
|    |     Multifaceted      | >                                       |
|    |     program including | > Multifaceted program including        |
|    |     education\        | > education                             |
|    |     Regulation        | >                                       |
|    |                       | > Regulation                            |
|    | **SS**                |                                         |
|    |                       | -   Enhance access                      |
|    | -   Enhance access\   |                                         |
|    |     Reduce cost\      | > Reduce cost                           |
|    |     Walk-in clinics   | >                                       |
|    |                       | > Walk-in clinics                       |
|    | **SS**                |                                         |
|    |                       | -   Address provider barriers           |
|    | -   Address provider  |                                         |
|    |     barriers\         | > Reminder/Feedback                     |
|    |                       | >                                       |
|    |    Reminder/Feedback\ | > Standing orders and policies.         |
|    |     Standing orders   | > (Standing orders can boost            |
|    |     and policies      | > immunization rates tremendously.)     |
+----+-----------------------+-----------------------------------------+
| 37 | **SS:**               | Finally I would like to stress that the |
| .  |                       | SINGLE MOST IMPORTANT STRATEGY for      |
|    | Slide #13 Provider    | IMPROVING immunization rates is for the |
|    | Recommendation        | provider to RECOMMEND getting a flu     |
|    |                       | shot. This chart of immunization rates  |
|    | (Highlight 2          | for influenza and pneumococcal disease  |
|    | \"Negative            | dramatically makes the case. Look at    |
|    | Attitudes\" columns)  | the NEGATIVE ATTITUDES columns. When a  |
|    |                       | provider recommends a flu shot even     |
|    |                       | when the patient has a negative         |
|    |                       | attitude we still see an EIGHTY PERCENT |
|    |                       | immunization rate. When the provider    |
|    |                       | gives NO RECOMMENDATION the             |
|    |                       | immunization rate DROPS way down to     |
|    |                       | TWENTY-SEVEN percent for INFLUENZA and  |
|    |                       | FIFTEEN percent for PNEUMOCOCCAL        |
|    |                       | disease.                                |
+----+-----------------------+-----------------------------------------+
| 38 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | Thanks, Kristin. Anything you\'d like   |
|    |                       | to add about PROVIDER EDUCATION, Walt?  |
+----+-----------------------+-----------------------------------------+
| 39 | CU WALTER ORENSTEIN   | Orenstein:                              |
| .  |                       |                                         |
|    |                       | Bill, Kristin emphasized there\'s this  |
|    |                       | tremendous GAP between provider         |
|    |                       | PERCEPTION and PERFORMANCE in terms of  |
|    |                       | immunization.                           |
|    |                       |                                         |
|    |                       | C-D-C has in fact developed a very      |
|    |                       | useful software package, called ACASA   |
|    |                       | which is specifically designed to allow |
|    |                       | providers to go to their records and    |
|    |                       | EVALUATE their immunization rates.      |
|    |                       | It\'s easy to use and you can download  |
|    |                       | it from C-D-C\'s website.               |
+----+-----------------------+-----------------------------------------+
| 40 | **14:26:00 SEGMENT    |                                         |
| .  | 05**                  |                                         |
|    |                       |                                         |
|    | **Community           |                                         |
|    | Outreach/Barriers     |                                         |
|    | 11:00**               |                                         |
+----+-----------------------+-----------------------------------------+
| 41 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | Thanks Walt, We\'re now going to move   |
|    |                       | on to look at the OTHER SIDE of the     |
|    |                       | equation, the PATIENTS THEMSELVES.      |
|    |                       | Hugh, what did you find out in the      |
|    |                       | Chicago case?                           |
+----+-----------------------+-----------------------------------------+
| 42 | CU HUGH TILSON        | Tilson:                                 |
| .  |                       |                                         |
|    |                       | Bill, as Walt mentioned mobilizing      |
|    |                       | community organizations and agencies is |
|    |                       | a key component of READII. And in       |
|    |                       | Chicago, as we discovered, it\'s        |
|    |                       | primarily these grassroots partners who |
|    |                       | are going out into the community, and   |
|    |                       | coming up with effect ways to overcome  |
|    |                       | the barriers and myths that prevent     |
|    |                       | seniors from getting shots. Let\'s take |
|    |                       | a look.                                 |
+----+-----------------------+-----------------------------------------+
| 43 | **TAPE:** Cut-6       | OUTCUE: \" result from these            |
| .  | Community             | illnesses.\"                            |
|    | Outreach/Barriers     |                                         |
|    |                       |                                         |
|    | RT: **4:46**          |                                         |
+----+-----------------------+-----------------------------------------+
| 44 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | Walt, the case shows that there are a   |
|    |                       | number of BARRIERS that PREVENT people  |
|    |                       | from \`getting vaccinated and they VARY |
|    |                       | among different communities. Could you  |
|    |                       | summarize for us the MAIN REASONS WHY   |
|    |                       | adults DON\'T get vaccinated against    |
|    |                       | flu and for pneumococcal disease?       |
+----+-----------------------+-----------------------------------------+
| 45 | CU WALTER ORENSTEIN   | Orenstein:                              |
| .  |                       |                                         |
|    | **SS:**               | Bill, research from the 1999 Medicare   |
|    |                       | beneficiary survey shows the FOUR       |
|    | PP Slide #25          | LEADING REASONS seniors do not to get a |
|    |                       | flu vaccination are:                    |
|    | Reasons for Not       |                                         |
|    | Getting Vaccinated    | First, people say they DID NOT KNOW     |
|    |                       | they needed the vaccination;            |
|    |                       |                                         |
|    |                       | second, people INCORRECTLY believe the  |
|    |                       | shot CAUSES flu;                        |
|    |                       |                                         |
|    |                       | third, they INCORRECTLY believe the     |
|    |                       | shot causes SERIOUS SIDE EFFECTS;       |
|    |                       |                                         |
|    |                       | and fourth they believe the shot DOES   |
|    |                       | NOT WORK.                               |
|    |                       |                                         |
|    |                       | And, as we saw in the Chicago case,     |
|    |                       | these barriers do vary between          |
|    |                       | populations.                            |
|    |                       |                                         |
|    |                       | In the case of pneumococcal disease the |
|    |                       | three leading reasons are slightly      |
|    |                       | different:                              |
|    |                       |                                         |
|    |                       | First, respondents said they DIDN\'T    |
|    |                       | KNOW they needed it; second, they       |
|    |                       | didn\'t think of it; and third, their   |
|    |                       | DOCTOR didn\'t recommend it.            |
+----+-----------------------+-----------------------------------------+
| 46 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | And HOW LARGE are the DISPARITIES in    |
|    |                       | coverage rates for different            |
|    |                       | communities?                            |
+----+-----------------------+-----------------------------------------+
| 47 | CU WALTER ORENSTEIN   | Orenstein:                              |
| .  |                       |                                         |
|    | **SS:**               | Bill, they\'re significant. If we take  |
|    |                       | a look at influenza vaccination rates   |
|    | PP Slide #18          | for those age 65 or older across racial |
|    | Influenza Vaccination | and ethnic lines, we can see that while |
|    | Coverage              | the white community is at SIXTY-EIGHT   |
|    |                       | PERCENT coverage for influenza vaccine, |
|    | **SS:**               | the African American and Hispanic       |
|    |                       | communities are just below FIFTY        |
|    | PP Slide #21          | percent. So clearly there\'s a long way |
|    |                       | to go across the board to reach our     |
|    | Pneumococcal          | Healthy People 2010 goal of NINETY      |
|    | Vaccination Coverage  | percent coverage for the population as  |
|    | Levels                | a whole.                                |
|    |                       |                                         |
|    |                       | Pneumococcal vaccination coverage       |
|    |                       | levels in those age 65 or older are     |
|    |                       | even lower. Whites have about a 60%     |
|    |                       | vaccination coverage level, while 37.2% |
|    |                       | of African Americans have received the  |
|    |                       | vaccine and only 27% of Hispanics.      |
+----+-----------------------+-----------------------------------------+
| 48 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | Aside from funding to the sites, C-D-C  |
|    |                       | also offers TECHNICAL ASSISTANCE to the |
|    |                       | READII sites. Tell us about that.       |
+----+-----------------------+-----------------------------------------+
| 49 | CU WALTER ORENSTEIN   | Orenstein:                              |
| .  |                       |                                         |
|    |                       | Staff from the National Immunization    |
|    |                       | Program, and from our contractor, the   |
|    |                       | Academy for Educational Development,    |
|    |                       | provide TRAINING and TECHNICAL          |
|    |                       | ASSISTANCE to the sites in many areas.  |
|    |                       | Some of these include how to mobilize a |
|    |                       | community, dealing with the media,      |
|    |                       | evaluating program effectiveness, using |
|    |                       | data for decision making, working with  |
|    |                       | faith communities, working with         |
|    |                       | provider communities, and methods for   |
|    |                       | conducting provider-based               |
|    |                       | interventions.                          |
+----+-----------------------+-----------------------------------------+
| 50 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | Thanks, Walt. Kristin, what about       |
|    |                       | improving immunization rates through    |
|    |                       | VACCINATING in NON-TRADITIONAL          |
|    |                       | SETTINGS? What can you tell us about    |
|    |                       | those approaches, particularly in the   |
|    |                       | context of MINORITIES?                  |
+----+-----------------------+-----------------------------------------+
| 51 | CU KRISTIN NICHOL     | Nichol:                                 |
| .  |                       |                                         |
|    |                       | As we saw in the case, going to where   |
|    |                       | the people are can be very effective.   |
|    |                       | So we need to discuss community         |
|    |                       | vaccination clinics, working with       |
|    |                       | community and faith leaders to build    |
|    |                       | trust, and promoting the vaccination to |
|    |                       | build consumer demand                   |
|    |                       |                                         |
|    |                       | Potential advantages                    |
|    |                       |                                         |
|    |                       | -   Cost                                |
|    |                       |                                         |
|    |                       | -   Access/convenience                  |
|    |                       |                                         |
|    |                       | -   Increased public awareness and      |
|    |                       |     demand                              |
|    |                       |                                         |
|    |                       | -   New providers and new strategies    |
+----+-----------------------+-----------------------------------------+
| 52 | **14:37:00 SEGMENT 06 |                                         |
| .  | Public Awareness      |                                         |
|    | 5:00**                |                                         |
+----+-----------------------+-----------------------------------------+
| 53 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | Thanks, Kristin. Let\'s return to our   |
|    |                       | Chicago case. One of the other key      |
|    |                       | strategies for improving adult          |
|    |                       | immunization rates is by INCREASING     |
|    |                       | PUBLIC AWARENESS as a whole. Hugh, what |
|    |                       | did CHICAGO do in this area?            |
+----+-----------------------+-----------------------------------------+
| 54 | CU HUGH TILSON        | Tilson:                                 |
| .  |                       |                                         |
|    |                       | Bill, as with any major public health   |
|    |                       | initiative enlisting the support of the |
|    |                       | local media, both large and small,      |
|    |                       | played a significant role in getting    |
|    |                       | their message out to the public at      |
|    |                       | large. Here\'s how they went about it.  |
+----+-----------------------+-----------------------------------------+
| 55 | **TAPE -** Cut #7:    | OUTCUE: \"... and they're going to      |
| .  | Public                | want.\"                                 |
|    | Awareness/Media       |                                         |
|    |                       |                                         |
|    | RT: **2:17**          |                                         |
+----+-----------------------+-----------------------------------------+
| 56 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | Walt, I believe YOU participated in the |
|    |                       | media event to launch Chicago\'s Adult  |
|    |                       | Immunization Awareness Week. Tell us    |
|    |                       | about that.                             |
+----+-----------------------+-----------------------------------------+
| 57 | CU WALTER ORENSTEIN   | Orenstein:                              |
| .  |                       |                                         |
|    |                       | That\'s correct Bill. I got MY SHOT     |
|    |                       | there in front of the television        |
|    |                       | cameras. I got my shot because          |
|    |                       | vaccination is recommended for me, and  |
|    |                       | because I believe it is a safe and      |
|    |                       | effective vaccine. I get vaccinated     |
|    |                       | annually and I recommend that my family |
|    |                       | members do as well. Another reason I    |
|    |                       | was vaccinated is that I am a doctor    |
|    |                       | and vaccine is recommended annually for |
|    |                       | health care workers to protect them     |
|    |                       | from developing influenza and to        |
|    |                       | prevent health care workers from        |
|    |                       | transmitting influenza to their         |
|    |                       | patients.  Remember, health care        |
|    |                       | workers frequently come in contact with |
|    |                       | flu patients who are infectious.        |
|    |                       | Infected health care workers can, in    |
|    |                       | turn, transmit the virus to patients    |
|    |                       | with underlying conditions that put     |
|    |                       | them at high risk of complications from |
|    |                       | influenza.                              |
+----+-----------------------+-----------------------------------------+
| 58 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | In WHAT OTHER WAYS has C-D-C supported  |
|    |                       | the READII communities in their effort  |
|    |                       | to get out the message?                 |
+----+-----------------------+-----------------------------------------+
| 59 | CU WALTER ORENSTEIN   | Orenstein:                              |
| .  |                       |                                         |
|    | **SS:**               | Bill, C-D-C has created a number of     |
|    |                       | POSTERS and BROCHURES which community   |
|    | PP Slide #42 &43      | partners can distribute. The materials  |
|    |                       | are designed specifically for the       |
|    | READII Communications | MINORITY SENIORS and their families.    |
|    | Materials             | All of the materials were PRE-TESTED    |
|    |                       | with seniors and use text and images    |
|    |                       | that resonate well with them. The       |
|    |                       | materials picture physicians, seniors,  |
|    |                       | and grandchildren and we have both      |
|    |                       | ENGLISH AND SPANISH versions.           |
+----+-----------------------+-----------------------------------------+
| 60 |                       | Roper:                                  |
| .  |                       |                                         |
|    |                       | Thanks Walt. Generating public          |
|    |                       | awareness is obviously key to raising   |
|    |                       | immunization rates to the NINETY        |
|    |                       | PERCENT level we\'re aiming for in our  |
|    |                       | Healthy People 2010 goals. Kristin,     |
|    |                       | what are YOUR THOUGHTS on USING the     |
|    |                       | MEDIA and educating the public?         |
+----+-----------------------+-----------------------------------------+
| 61 | CU KRISTIN NICHOL     | Nichol:\                                |
| .  |                       | Bill, the MOST IMPORTANT QUESTION we    |
|    |                       | have to address is \"What does the      |
|    |                       | PUBLIC KNOW about influenza and other   |
|    |                       | vaccine-preventable diseases?\" From    |
|    |                       | there we move to the important details. |
|    |                       |                                         |
|    |                       | Do people fully appreciate the RISKS of |
|    |                       | these diseases? Do they understand the  |
|    |                       | SAFETY of immunization?                 |
|    |                       |                                         |
|    |                       | WHERE can they go to get immunized?     |
|    |                       | What NON-TRADITIONAL IMMUNIZATION SITES |
|    |                       | are available to them?                  |
|    |                       |                                         |
|    |                       | In general we need to make sure the     |
|    |                       | public has access to ACCURATE and       |
|    |                       | UP-TO-DATE INFORMATION that is grounded |
|    |                       | in good audience research.              |
+----+-----------------------+-----------------------------------------+
| 62 | **14:42:00 SEGMENT 07 |                                         |
| .  | Lessons Learned       |                                         |
|    | 5:00**                |                                         |
+----+-----------------------+-----------------------------------------+
| 63 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | Thanks, Kristin. Let\'s go back to our  |
|    |                       | case once more. Hugh, what have the     |
|    |                       | Chicago Health Department officials and |
|    |                       | their community partners LEARNED from   |
|    |                       | this whole effort to raise adult        |
|    |                       | immunization rates?                     |
+----+-----------------------+-----------------------------------------+
| 64 | CU HUGH TILSON        | Tilson:                                 |
| .  |                       |                                         |
|    |                       | Bill, the lessons learned are always    |
|    |                       | the most fascinating part of any Public |
|    |                       | Health Grand Rounds case for me.        |
|    |                       | Here\'s what they had to say about      |
|    |                       | their experience so far.                |
+----+-----------------------+-----------------------------------------+
| 65 | **TAPE**: Cut-8       | OUTCUE: \"\... accomplish our           |
| .  | Lessons Learned       | mission.\"                              |
|    |                       |                                         |
|    | RT: **3:21**          |                                         |
+----+-----------------------+-----------------------------------------+
| 66 | # CU BILL ROPER       | # Roper:                                |
| .  |                       |                                         |
|    |                       | Walt, from your standpoint what are the |
|    |                       | KEY POINTS the audience should take     |
|    |                       | home from today's broadcast?            |
+----+-----------------------+-----------------------------------------+
| 67 | # CU WALTER ORENSTEIN | # Orenstein:                            |
| .  |                       |                                         |
|    |                       | Bill, I think it is important for the   |
|    |                       | audience to remember several key        |
|    |                       | points:                                 |
|    |                       |                                         |
|    |                       | -   Influenza and pneumococcal disease  |
|    |                       |     are SERIOUS. Both diseases cause    |
|    |                       |     UNNECESSARY hospitalizations and    |
|    |                       |     can cause death.                    |
|    |                       |                                         |
|    |                       | -   Influenza KILLS an average of 36    |
|    |                       |     thousand people per year and        |
|    |                       |     pneumococcal kills approximately    |
|    |                       |     5,700 people per year.              |
|    |                       |                                         |
|    |                       | -   The influenza and pneumococcal      |
|    |                       |     vaccines are both SAFE and          |
|    |                       |     EFFECTIVE and getting vaccinated is |
|    |                       |     the best way to PREVENT these       |
|    |                       |     diseases.                           |
|    |                       |                                         |
|    |                       | ```{=html}                              |
|    |                       | <!-- -->                                |
|    |                       | ```                                     |
|    |                       | -   We need to strive to INCREASE       |
|    |                       |     vaccination coverage rates among    |
|    |                       |     those at HIGHEST RISK for           |
|    |                       |     complications, such as seniors and  |
|    |                       |     those with chronic health problems. |
|    |                       |     Reminding people that getting a flu |
|    |                       |     shot not only protects them, but    |
|    |                       |     protects THEIR LOVED ONES can be    |
|    |                       |     very motivating.                    |
|    |                       |                                         |
|    |                       | -   We also need to ensure that more    |
|    |                       |     HEALTHCARE WORKERS get vaccinated.  |
|    |                       |                                         |
|    |                       | -   And last, I think we can learn a    |
|    |                       |     lot from the READII Project sites   |
|    |                       |     about how to ENGAGE community       |
|    |                       |     leaders, healthcare providers and   |
|    |                       |     others in activities that PROMOTE   |
|    |                       |     adult vaccination. and increase     |
|    |                       |     vaccination coverage rates.         |
+----+-----------------------+-----------------------------------------+
| 68 | # CU BILL ROPER       | # Roper:                                |
| .  |                       |                                         |
|    |                       | Thanks, Walt. Kristin, what are the KEY |
|    |                       | LESSONS for you?                        |
+----+-----------------------+-----------------------------------------+
| 69 | # CU KRISTIN NICHOL   | # Nichol:                               |
| .  |                       |                                         |
|    |                       | Bill, there\'s clearly an urgency to do |
|    |                       | better.                                 |
|    |                       |                                         |
|    |                       | -   VACCINE PREVENTABLE DEATHS are      |
|    |                       |     particularly HIGH among adults      |
|    |                       |                                         |
|    |                       | -   IMMUNIZATION RATES are TOO LOW      |
|    |                       |                                         |
|    |                       | -   We know a lot about FACTORS         |
|    |                       |     associated with LACK OF             |
|    |                       |     IMMUNIZATION                        |
|    |                       |                                         |
|    |                       | -   We know a lot about STRATEGIES to   |
|    |                       |     improve immunization rates          |
|    |                       |                                         |
|    |                       | -   Physicians must RECOMMEND           |
|    |                       |     vaccinations                        |
|    |                       |                                         |
|    |                       | -   We must take a SYSTEMS APPROACH to  |
|    |                       |     get organized and get serious.      |
+----+-----------------------+-----------------------------------------+
| 70 | # 14:47:00 SEGMENT 08 | #                                       |
| .  |                       |                                         |
|    | # Discussion 6:00     |                                         |
+----+-----------------------+-----------------------------------------+
| 71 | CU BILL ROPER         | # Roper:                                |
| .  |                       |                                         |
|    | **SS:**               | Thanks, Kristin. In a moment it\'ll be  |
|    |                       | YOUR turn to ask questions about ADULT  |
|    | **[United             | IMMUNIZATION and how to better reach    |
|    | S                     | your community. Please tell us too      |
|    | tates:]{.underline}** | about YOUR EXPERIENCES and BEST         |
|    |                       | PRACTICES. Again, you can TELEPHONE us  |
|    | Voice (800) 793 --    | at:                                     |
|    | 8598                  |                                         |
|    |                       | 800 7-9-3 -- 8-5-9-8                    |
|    | Fax (800) 553 -- 6323 |                                         |
|    |                       | Our FAX number is 800 5-5-3 -- 6-3-2-3  |
|    | TTY (800) 815 -- 8152 |                                         |
|    |                       | And, you can also submit a question at  |
|    | **SS:**               | our WEBSITE at www dot Public Health    |
|    |                       | Grand Rounds dot U-N-C dot E-D-U.       |
|    | [www.Public](ht       |                                         |
|    | tp://www.Public/)Heal |                                         |
|    | thGrandRounds.unc.edu |                                         |
+----+-----------------------+-----------------------------------------+
| 72 | **SS:**               | Also, I\'d like to remind you about our |
| .  |                       | Discussion Forum on the WEB. Content    |
|    | **[Discussion         | experts from C-D-C and U-N-C will       |
|    | Forum]{.underline}**  | facilitate the on-line discussion. THAT |
|    |                       | will start TODAY and run through        |
|    | [www.PublicHealthGr   | February six. That\'s another           |
|    | andRounds.unc.edu](ht | opportunity to ASK questions and SHARE  |
|    | tp://www.PublicHealth | your best practices. Just go to         |
|    | GrandRounds.unc.edu/) | **w**-w-w dot Public Health Grand       |
|    |                       | Rounds dot u-n-c dot e-d-u and click on |
|    |                       | the \"Discussion Forum\".               |
+----+-----------------------+-----------------------------------------+
| 73 | # SS:                 | You can also to access our ON-LINE      |
| .  |                       | Resources Page, which has LINKS to      |
|    | **[Res                | useful resources on the web.            |
|    | ources]{.underline}** |                                         |
|    |                       |                                         |
|    | [www.PublicHealthGr   |                                         |
|    | andRounds.unc.edu](ht |                                         |
|    | tp://www.PublicHealth |                                         |
|    | GrandRounds.unc.edu/) |                                         |
+----+-----------------------+-----------------------------------------+
| 74 |                       | Hugh you\'ve been checking our website. |
| .  |                       | Do you have ANY QUESTIONS for us?       |
|    |                       |                                         |
|    |                       | Tilson:                                 |
|    |                       |                                         |
|    |                       | \[QUESTION\]                            |
|    |                       |                                         |
|    |                       | Roper:                                  |
|    |                       |                                         |
|    |                       | We have a call from \[STATE\]. Go       |
|    |                       | ahead, please.                          |
+----+-----------------------+-----------------------------------------+
| 75 | **14:53:00 SEGMENT    |                                         |
| .  | 09**                  |                                         |
|    |                       |                                         |
|    | **Wrap-Up 7:00**      |                                         |
+----+-----------------------+-----------------------------------------+
| 76 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | Unfortunately that\'s all the time we   |
|    |                       | have now for our discussion. MANY of    |
|    |                       | you, I\'m sure, will have ADDITIONAL    |
|    |                       | questions and comments. So please join  |
|    |                       | us at our website discussion forum. If  |
|    |                       | you\'re looking for information, check  |
|    |                       | out our Resource Page. And now I\'d     |
|    |                       | like to ask each of our guests to share |
|    |                       | a few FINAL WORDS about our topic       |
|    |                       | today, responding to influenza and      |
|    |                       | other vaccine-preventable diseases. Let |
|    |                       | me start with you, Walt.                |
+----+-----------------------+-----------------------------------------+
| 77 | CU WALTER ORENSTEIN   | Orenstein:                              |
| .  |                       |                                         |
|    |                       | [BRIEF FINAL WORDS]{.mark}              |
+----+-----------------------+-----------------------------------------+
| 78 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | Kristin, what\'s your TAKE HOME         |
|    |                       | MESSAGE?                                |
+----+-----------------------+-----------------------------------------+
| 79 | CU KRISTIN NICHOL     | Nichol:                                 |
| .  |                       |                                         |
|    |                       | [BRIEF FINAL WORDS]{.mark}              |
+----+-----------------------+-----------------------------------------+
| 80 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | And Hugh, what words would you like to  |
|    |                       | leave us with?                          |
+----+-----------------------+-----------------------------------------+
| 81 | CU HUGH TILSON        | Tilson:                                 |
| .  |                       |                                         |
|    |                       | Well, Bill, I couldn\'t miss the chance |
|    |                       | to THANK our wonderful PUBLIC HEALTH    |
|    |                       | GRAND ROUNDS team. THANKS too to all    |
|    |                       | the good people in Chicago. They truly  |
|    |                       | are taking a community-based approach   |
|    |                       | to raising adult immunization rates and |
|    |                       | it\'s working. And I\'d like to give    |
|    |                       | THEM the FINAL WORD on this important   |
|    |                       | challenge for public health.            |
+----+-----------------------+-----------------------------------------+
| 82 | **TAPE:** Cut-9 Final | OUTCUE: \".. out there with the         |
| .  | Words                 | people.\"                               |
|    |                       |                                         |
|    | RT: **1:30**          |                                         |
+----+-----------------------+-----------------------------------------+
| 83 | CU BILL ROPER         | Roper:                                  |
| .  |                       |                                         |
|    |                       | We pay attention to the exotic -- SARS, |
|    |                       | MONKEY POX, WEST NILE VIRUS. But as for |
|    |                       | the perennial threats to our health,    |
|    |                       | like INFLUENZA and PNEUMOCOCCAL         |
|    |                       | disease, we often grow IMMUNE to the    |
|    |                       | warnings when we should be getting      |
|    |                       | immunized. As Public Health             |
|    |                       | professionals we need to aim for the    |
|    |                       | same level of success with ADULT        |
|    |                       | IMMUNIZATIONS as we have already        |
|    |                       | achieved with CHILDHOOD immunizations.  |
|    |                       | By doing so we can save many of the     |
|    |                       | 36-THOUSAND lives we currently lose to  |
|    |                       | the flu each year. We hope today\'s     |
|    |                       | case study from Chicago will help you   |
|    |                       | RAISE adult immunizations rates in YOUR |
|    |                       | community.                              |
+----+-----------------------+-----------------------------------------+
| 84 | **SS:**               | Before we go, my thanks to all our      |
| .  |                       | guests for joining us today. I\'d also  |
|    | **[Website            | like to thank you, our viewers, for     |
|    | A                     | being with us. We know you represent    |
|    | ddress]{.underline}** | the FULL SPECTRUM of community public   |
|    |                       | health partners, from grass roots       |
|    | www.PublicHeal        | community workers to public health      |
|    | thGrandRounds.unc.edu | directors. Let us know what YOU think   |
|    |                       | of today\'s program by going to our     |
|    | **SS:**               | website and filling out the online      |
|    |                       | evaluation form.                        |
|    | **[                   |                                         |
|    | E-mail]{.underline}** | If you want to receive continuing       |
|    |                       | education credit, you must complete an  |
|    | <Gra                  | on-line EVALUATION form.                |
|    | ndRounds@sph.unc.edu> |                                         |
|    |                       | If you have any difficulties, please    |
|    |                       | e-mail us at                            |
|    |                       |                                         |
|    |                       | GrandRounds at S-P-H dot U-N-C dot      |
|    |                       | E-D-U.                                  |
+----+-----------------------+-----------------------------------------+
| 85 | **SS:**               | Again, when you visit our WEBSITE, take |
| .  |                       | advantage of our Resource Page and the  |
|    | **[Website            | DISCUSSION FORUM where you can get      |
|    | A                     | additional questions answered and share |
|    | ddress]{.underline}** | your own ideas about our program. This  |
|    |                       | forum will be open between now and      |
|    | www.PublicHeal        | February sixth.                         |
|    | thGrandRounds.unc.edu |                                         |
+----+-----------------------+-----------------------------------------+
| 86 | **SS:**               | Public Health Grand Rounds will be back |
| .  |                       | on March 26th when examine the          |
|    | Public Health Grand   | important issue of HIGHWAY SAFETY. So   |
|    | Rounds                | please, be sure to mark that date on    |
|    |                       | your calendars.                         |
|    | Highway Safety        |                                         |
|    |                       |                                         |
|    | # March 26, 2004      |                                         |
|    |                       |                                         |
|    | 2:00pm -- 3:00pm ET   |                                         |
|    |                       |                                         |
|    | For more information  |                                         |
|    | visit:                |                                         |
|    |                       |                                         |
|    | www.PublicHeal        |                                         |
|    | thGrandRounds.unc.edu |                                         |
+----+-----------------------+-----------------------------------------+
| 87 |                       | On behalf of everyone at C-D-C, the     |
| .  |                       | Public Health Training Network and the  |
|    |                       | School of Public Health at the          |
|    |                       | University of North Carolina at Chapel  |
|    |                       | Hill, I\'m Bill Roper wishing you a     |
|    |                       | GOOD DAY from Atlanta.                  |
+----+-----------------------+-----------------------------------------+
| 88 | **SS:**               | Music                                   |
| .  |                       |                                         |
|    | Production Credits    |                                         |
|    |                       |                                         |
|    | **SS:**               |                                         |
|    |                       |                                         |
|    | Partners              |                                         |
|    |                       |                                         |
|    | **SS:**               |                                         |
|    |                       |                                         |
|    | A Special Thanks To:  |                                         |
|    | (1)                   |                                         |
|    |                       |                                         |
|    | **SS:**               |                                         |
|    |                       |                                         |
|    | A Special Thanks To:  |                                         |
|    | (2)                   |                                         |
|    |                       |                                         |
|    | **SS:**               |                                         |
|    |                       |                                         |
|    | A Good Day From       |                                         |
|    | Atlanta               |                                         |
+----+-----------------------+-----------------------------------------+