*

A Strategic Global Vision

Clin Infect Diseases 2007;44:1529-31

How heavy is the burden of vaccine preventable diseases?

The Burden of Vaccine Preventable Diseases

Hepatitis B1
2 billion people have been infected 450 million people are chronic carriers 1 million people die each year from hepatitis B and its complications

Hepatitis

A2,3

1.5 million cases worldwide per year Estimated cost 1.5 to 3 billion 30 days of work lost per patient

Typhoid4
1.

16 million cases per year 600,000 deaths each year 4 percent mortality rate
3. 4. WHO, Hepatitis A, WHO/CDS/CSR/EDC/2000.7 WHO Wkly Epidemiol Rec 2000; 75:257-64

http://www.hepb.org/hepb/statistics.htm. Accessed June 21, 2011 2. WHO, Hepatitis A vaccine, 2003

The Burden of Vaccine Preventable Diseases

Pneumococcal disease1
> 40,000 cases and > 4,400 deaths per year in the US alone Case-fatality rate among adults - 20% Case fatality among elderly patients - 60%

HPV2

Worldwide, every 2 minutes a woman dies of cervical cancer Every year in Asia, 266000 women are diagnosed with cervical cancer and 143000 will die from the disease

Varicella3
1. 2. 3.

Rate of complications is highest in those aged >15 yrs Mortality rate in adults ia 25.2/100,000 cases compared with only 1/100,000 cases in children

http://www.vaccineinformation.org/pneumchild/qandadis.asp. Accessed on July 6, 2011 Ferlay J, et al. GLOBOCAN 2002 Cancer Incidence, Mortality and Prevalence Worldwide . Lyon: IARC CancerBase, 2004 Gershon A, Takakashi M, Seward J. Varicella vaccine. In: Plotkin SA, Orenstein WA, Oxfitt PA, eds. Vaccines. Pennsylvania: WB Saunders, 2004: 784 823.

The Burden of Influenza

3 - 5 million cases of severe illness per year1,2,3
600 Hospitalizations for Influenza Per 100,000 Person Years4 500 400 300 200 114 100 28 0 0 - 4 Yrs 5 - 49 Yrs 50 - 64 Yrs Age Group > 65 Yrs 0 <1 111 120

250,000 - 500,000 deaths/yr1,2,3

Influenza associated Deaths Per 100,000 Person Years5

472

100 80 60 40 20 0.6 7.5 0.4 1-4 0.5 5 49 50 64 Age Group (yrs)

98.3

>65

1. WHO 2003; A56/23 2. Rose GW. Expert Opin. Biol. Ther. 2006; 6(3): 301-10 3. WHO. Weekly Epidemiol Rec 2005, 80(33): 27788 4. Thompson WW, et al. JAMA 2004; 292 (11): 1333-1340 Thompson WW, et al. 5. JAMA 2003; 289 (2): 179-186.

simple: ERADICATE vaccine preventable diseases!

*Our MISSION is

*
Effectiveness of and cost-benefits of influenza vaccination of healthy working adults
Illness Visits to physicians Prescribed medications Lost work days due to illness Lost work days due to physician visits 0 Placebo (N = 596) 0.1 Vaccinated (N = 582) 0.2

Bridges CB, Thompson WW, Meltzer MI. Effectiveness of and cost-benefits of influenza vaccnation of healthy working adults: a randomized controlled trial. JAMA 2000; 284: 1655-63

Vaccination Rates are still low

Schiller JS, Euler GL. National Health Interview Survey. Available at: http://www.cdc.gov/ncha/data/hestat/vaccine_coverage.htm

Why are adult vaccination rates so low? What can we do about it?

Patients Reasons for Not Getting Vaccinated

Medicare Benificiary Survey

Shot doesnt work Shot causes side effects Shot causes disease Didnt think of it Influenza Vaccine Pneumococcal Vaccine

Physician did not recommend

Did not know it was needed

10

20

30 Percent

40

50

60

CDC. MMWR Morb Mortal Wkly Rep. 1999;48:886-890

Provider Related Barriers

Not prevention oriented /Competing Demands Urgent concerns dominate visits Focus on acute and chronic problems Difficulty identifying eligible patients

Not knowing patient immunization history

Many Prevention Recommendations Adult Immunization is not a significant part of training or culture Ignorance and apathy about vaccine preventable disease Clinician is not immunized himself Clinician questions about vaccine efficacy and safety
Nichol KL, Zimmerman RK. Arch Intern Med. 2001 Silverman , et al. J cross Cult Gerontology. 2004;19:47-76 Nowalk MP et al. J Natl Med Assoc. Kimura AC., et al. Am J Public Health. 2007; 97:684-690 Prev. Med. 2005 ; 40 : 152-61

System or Organization Related Barriers

Poor or inconvenient vaccine availability
Inability to track, remind, or recall patients needing vaccinations Lack of routine screening of immunization status Lack of patient-oriented vaccine information materials Inadequate access to health services among some adults
Nichol KL, Zimmerman RK. Arch Intern Med. 2001 Silverman , et al. J cross Cult Gerontology. 2004;19:47-76 Nowalk MP et al. J Natl Med Assoc. Prev. Med. 2005 ; 40 : 152-61

What can we do about to improve adult vaccination rates?

Strategies to Increase Adult Immunization 1. Patient Barriers Increase Awareness and break down misconceptions Education programs Patient information materials Enhance Access Reduce costs

Bring the vaccines where the patients are

The Power of a Doctors Recommendation

Provider Recommendation and Influenza Immunization Rates

A physicians recommendation is the most important reason why people get vaccinated
Graph from Nichol KL et al. J Gen Intern Med 1996;11:673-767

Educating Patients

Strategies to Increase Adult Immunization

2. Provider Barriers Set an example get vaccinated Physician educational materials

Training for physicians, nurses and office staff

Be the Change Vaccinate yourself

Educating Doctors

Strategies to Increase Adult Immunization

3. Organization or System Barriers

Establish a culture of immunization in your clinics Standing orders

Improved tracking system/Routine Screening of vaccination

Immunization registries

Reminders to eligible patients

Changes in the System

Shared roles between nurse and physician

Standing orders
written order stipulating that all persons meeting certain criteria (i.e., age or underlying medical condition) should be vaccinated, thus eliminating the need for individual physicians orders for each patient.

Routine screening of vaccination status by nurses (part of getting vital signs)

*
Vaccine Business Growth and Development

*
Whats there outside?

*
Vaccine to fight INFECTIOUS DISEASES

*
Vaccine to fight DEGENERATIVE DISEASES

*
Medical Alternative Preventive CLINIC

Feb 2012: Website prelaunch

Sept 2011: Soft Opening & Incorporated In Harmony Baby & Kiddy

Aug 2011: In Harmony Charity Program

July 2011: 2nd clinic opened, VACCINE business introduced January 2011: 1st clinic opened Medical Alternative clinic

*
The Grow of a New Business!

April 2012 Feb 2012 Des 2011

Seminar Vaksin Flu & Hepatitis & penyuntikan 70 Pegawai Kejaksaan Tinggi Penyuntikan 80 karyawan Soewarna Biz Park CKG Golf Club Launching program IHIC EXPAND Penandatanganan kerjasama dg 3 rekanan baru: CKG SMG NTT Penandatanganan kerjasama dg Klinik Nurdin Rencana penandatanganan dg rekan di Bandung & KF

Nov 2011
Penyuntikan 26 karyawan PT Menjangan Sakti Trial Internet Marketing

Oct 2011
Penyuntikan 264 karyawan PT Bayer

*
IN HARMONY IMMUNITY CLINIC

* Klinik vaksinasi dan imunisasi utama di

Indonesia

* Partner dari berbagai institusi dan korporasi

terkemuka dalam penyediaan layanan vaksinasi dan imunisasi

vaksinasi dan imunisasi di Indonesia

* Menjadi pusat pengembangan dan penelitian

* 2012: Menyelesaikan infrastruktur

* Juni 2012 * Juli 2012
Office) * Agustus 2012 : Vaccinology Training komersial pertama & Grand Launching IHIC : Milestone 1st 1000 vial : Pembukaan Kantor Pusat (Head

* 2013: IHIC Expand II

* Target:
: Seluruh kota di Indonesia

* 2014: Sub-distributor khusus vaksinasi * 2015: Sertifikasi KAN dan ISO

Jakart a Barat Jakart a Pusat Bogor Bandung Semarang NTT

* Adult Immunizations:

We can overcome the