When influenza vaccine manufacturer Chiron announced on October 5, 2004, that none of the company's flu vaccine would be available for the 2004–2005 flu season, the shortage caused a nationwide crisis. With supplies of the vaccine scarce, the state of Nebraska relied on cutting edge technology to track and distribute the vaccine. Two days after Chiron's announcement, Nebraska activated its Health Alert Network (HAN) to survey physicians, hospitals, nursing homes, rural health clinics, health departments, university health centers, and pharmacies to find out how much vaccine they had ordered from manufacturers Aventis Pasteur and Chiron, along with how much vaccine they already had on hand.

This map shows the number of doses of flu vaccine interpolated by the amount of population by health district. The result is the number of doses per 100 residents of the health districts.

Nebraska began implementing its HAN several years ago as part of a federal mandate and ramped up the development in 2001 through a bioterrorism grant program from the Centers for Disease Control. HAN is an electronic network that enables the Nebraska Health and Human Services System (HHSS) to communicate with health care providers across the state via e-mail and fax during urgent situations and for informational purposes. Health alerts, advisories, and updates go out over HAN.

David Lawton, Nebraska Health Alert Network coordinator, says that part of the standards the network follows is to have every data point in the database geocoded. "The key is that whenever we collect data, it gets geocoded before we deposit it into our database. It's fully integrated with GIS."

Within days after the Chiron announcement, Nebraska had a snapshot of the current vaccine supply across the state and anticipated need. That data, integrated into the GIS, showed the number of flu vaccine doses available compared to the entire population per health district. Analysis by public health professionals was done using ArcView 9 software's ArcMap application and population data from the Esri 2003 population estimates for Nebraska.

The numbers tell Nebraska HHSS where gaps in coverage exist and make it easier for state employees to redistribute vaccine and ensure that it's getting into the arms of those who need it most. Local health departments can enter and access vaccine information on a secure Web site.

A State of Preparedness

When the current flu vaccine shortage occurred, officials at Nebraska HHSS weren't caught off guard. In December 2003, there was also a shortage, and Lawton says they moved quickly to develop a vaccine survey for the entire state. The survey collected data from the field concerning influenza vaccine supply and demand. Data for that initial effort was taken from faxes sent in by health care providers.

"Dealing with all those faxes was a major effort," says Lawton. To alleviate some of that work, the Nebraska Bioterrorism Response Section developed a Web-based survey tool for the Health Alert Network system. "Health care providers responding to the survey can go to the URL and populate the database for us," continues Lawton. The results are automatically tabulated into a common separator value file for sorting and printing, whichever is required. Lawton attributes having this automated system already in place to Nebraska's success in quickly getting the flu vaccine to everyone who qualified and wanted it in 2004. "We have a very complete picture," he says.

Following the 2004 shortage, the initial plan was to survey weekly. That was changed to every other week. Every survey is different in some way, depending on the data required at the time of the survey. "At first we wanted to know what had been ordered by practitioners and vaccine providers in Nebraska," says Chris Chalmers, Nebraska HHSS GIS coordinator. "Subsequent surveys were more concerned about vaccine on hand and need. Follow-up to the surveys was conducted by an influenza team, which met at least weekly and often more frequently."

The weekly snapshots of the influenza vaccine status for Nebraska helped to reallocate and vaccinate all citizens who were on the priority list and wanted the vaccine. Lawton says they have become facilitators, making good use of the local and district public health departments to verify need, set up clinics, and receive and deliver vaccine supplies where needed.

The HAN surveys will continue to go out throughout flu season. So far, more than 400,000 flu shots have been distributed throughout Nebraska, covering 100 percent of all those in the high-risk category who wanted them. "I don't think we'll waste more than a handful of doses," predicts Lawton. In fact, Nebraska HHSS was able to ship 6,000 doses to Missouri's high-risk patients and has 6,000 more doses available to ship to another state.

Chalmers says that Nebraska HHSS has embraced GIS technology. In less than two years, the department has positioned Nebraska in the forefront of other states in addressing health-related issues. When Chalmers came to the department in early 2003, there were a few GIS users operating ArcView 3.2. After doing a needs assessment, he recommended that the agency move to a more integrated style of GIS. First, they migrated to ArcGIS 8.2 and earlier this year upgraded to 9.0.

Nebraska HHSS was the recipient of a 2004 Esri Special Achievement Award for its GIS Seeding project, which provides local health departments with GIS tools. Chalmers is also working toward expanding the department's work with ArcIMS.

For more information, contact Chris Chalmers, GIS coordinator, Nebraska Health and Human Services (tel.: 402-471-4598, e-mail: chris.chalmers@hhss.ne.gov).