CDC Science Ambassador Workshop
CDC Science Ambassador Workshop2015 Lesson PlanSeasonal Flu Costs How Much?!Developed byVirginia R. Chapman, MATTampa Preparatory SchoolTampa, FloridaMatthew HutchinsonSebring High SchoolSebring, FloridaJason T. Croteau, MANorwich Free AcademyNorwich, ConnecticutKaren C. Merritt, MSNorth Caddo Magnet High SchoolVivian, LouisianaThis lesson plan was developed by teachers attending the Science AmbassadorWorkshop. The Science Ambassador Workshop is a career workforce trainingfor math and science teachers. The workshop is a Career Paths to Public Healthactivity in the Division of Scientific Education and Professional Development,Center for Surveillance, Epidemiology, and Laboratory Services, Office of PublicHealth Scientific Services, Centers for Disease Control and Prevention.
AcknowledgementsThis lesson plan was developed by teachers in consultation with subject matter experts from theNational Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control andPrevention:Rui Li, PhD, MPHGabrielle Miller, PhD, MSHealth EconomistHealth EconomistDivision of Diabetes TranslationDivision of Population Healthand from the Division of Scientific Education and Professional Development, Center for Surveillance,Epidemiology, and Laboratory Services, Office of Public Health Scientific Services, Centers for DiseaseControl and Prevention:Adam G. Skelton, PhD, MPHLead, Steven M. Teutsch Prevention Effectiveness FellowshipDivision of Scientific Education and Professional DevelopmentScientific and editorial review was provided by Ralph Cordell, PhD and Kelly Cordeira, MPH fromCareer Paths to Public Health, Division of Scientific Education and Professional Development, Centerfor Surveillance, Epidemiology, and Laboratory Services, Office of Public Health Scientific Services,Centers for Disease Control and Prevention.Suggested citationCenters for Disease Control and Prevention (CDC). Science Ambassador Workshop— Seasonal FluCosts How Much?!. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2015.Available at: .Contact InformationPlease send questions and comments to scienceambassador@cdc.gov.DisclaimersThis lesson plan is in the public domain and may be used without restriction.Citation as to source, however, is appreciated.Links to nonfederal organizations are provided solely as a service to our users. These links donot constitute an endorsement of these organizations nor their programs by the Centers forDisease Control and Prevention (CDC) or the federal government, and none should beinferred. CDC is not responsible for the content contained at these sites. URL addresses listedwere current as of the date of publication.Use of trade names and commercial sources is for identification only and does not implyendorsement by the Division of Scientific Education and Professional Development, Centerfor Surveillance, Epidemiology, and Laboratory Services, CDC, the Public Health Service, orthe U.S. Department of Health and Human Services.The findings and conclusions in this Science Ambassador Workshop lesson plan are those ofthe authors and do not necessarily represent the official position of the Centers for DiseaseControl and Prevention (CDC).
ContentsSummary . 1Learning Outcomes . 2Duration . 3Procedures . 3Day 1: Calculating the cost of influenza disease, Duration 45 minutes . 3Preparation . 3Materials . 3Online Resources . 3Activity . 4Day 2: Tailoring a vaccination program at school, Duration 45 minutes . 5Preparation . 5Materials . 5Online Resources . 5Activity . 6Conclusions . 7Assessments . 7Educational Standards . 9Appendices: Supplementary Documents . 11Worksheet 1A: Seasonal Flu Costs How Much?! . 13Worksheet 1B: Seasonal Flu Costs How Much?!, Guide . 27
Seasonal Flu Costs How Much?!SummarySeasonal influenza (flu) can be a serious disease that leads tohospitalization and occasionally death. Every flu season isdifferent because the types and subtypes of influenza virusescan change each year. Although persons with underlyingillness are more likely than others to have severeconsequences of flu, even otherwise healthy persons can getsick and spread it to others. During 31 flu seasons (1976–2007) estimates of flu-associated annual deaths in the UnitedStates range from a low of approximately 3,000 to a high ofapproximately 49,000 persons dying from a conditionassociated with flu each year.Figure 1: CDC's Spread Music. Not Flu. posterpromoting the 2015 flu vaccine to young adults.Everyone aged 6 months and older should get a seasonal flu vaccination every year. Thisrecommendation has been in place since February 24, 2010, when CDC’s Advisory Committee onImmunization Practices voted to expand protection against the flu to more persons in the United States.The traditional flu vaccine is trivalent, developed to protect against three different flu viruses (whichvary from year to year). In addition, there are quadrivalent vaccines, developed to protect against fourdifferent flu viruses that change year-to-year. The majority of vaccines are made from inactivatedinfluenza virus. In 2003, a live attenuated influenza vaccine in nasal spray form became available 1.Attenuation takes an infectious agent and alters it so it is viable (or live), but harmless or less virulent.This lesson examines the economic effects associated with seasonal flu and vaccination decisions. It isbased on a study by the Centers for Disease Control and Prevention 2, published in the journal Vaccine 3,that estimated an average dollar figure for visits to doctor’s offices and emergency departments (EDs)for treatment of children ill with flu, and examined the amount of time parents have to miss from workto care for children while they recover. The study examined the experience of 282 children under the ageof 5 in 3 U.S. cities, and reported that parents had medical expenses ranging from approximately 300 toapproximately 4,000, and missed 11–73 hours of work, depending on whether their child was able torecover at home or was hospitalized. Students will be presented with a scenario regarding vaccination.They will examine three vaccination decision options. For each, they will consider direct and indirecteconomic costs associated with influenza. They will perform mathematical calculations for each optionto evaluate and determine the most cost-effective course of action.The target grade level for this lesson is high school grades 9 or 10. Students need only basic priorknowledge of influenza and vaccines, although the teacher can choose to provide prior instruction aboutviruses and vaccinations.1CDC. Seasonal Flu. CDC. CDC. http://www.cdc.gov/flu/index.htm. Updated October 2, 2015. Accessed April 14, 2016.CDC. CDC Study Treating Children’s Flu Illness Costly. CDC. CDC. tly.htm. Updated May 21, 2012. Accessed April 14, 2016.3Ortega-Sanchez IR, Molinari NM, Fairbrother G, et al. Indirect, out-of-pocket and medical costs from influenza-relatedillness in young children. Vaccine. June 13, 2012;30(28):4175-4181. e/pii/S0264410X12005932.21
Learning OutcomesAfter completing this lesson, students should be able to Describe scientific, social, and economic considerations that affect the choice of interventionstrategies; Mathematically analyze data to determine cost effectiveness of vaccination program options; and Construct an argument to make a decision about implementing a vaccination strategy by usingevidence.DurationThis lesson can be conducted as one 90-minute lesson or divided into two 45-minute lessons.2
ProceduresDay 1: Calculating the cost of influenza (45 minutes)PreparationBefore Day 1, Print copies of Worksheet 1A: Seasonal Flu Costs How Much?! (Appendix 1A), one copy perstudent. Each part will be handed out separately. Review Worksheet 1B: Seasonal Flu Costs How Much?! Guide (Appendix 1B). Review cdc.gov/flu/ about the flu for the first part of day one. Review the other online resources used in Worksheet 1A, including, the CDC study, TreatingChildren’s Flu Illness Costly ostly.htm) and thejournal article titled “Indirect, out-of-pocket and medical costs from influenza-related illness inyoung children” (Ortega-Sanchez RI, Molinari NA, Fairbrother G, et al. Vaccine. 2012 Jun13;30(28):4175–81.)Materials Worksheet 1A: Seasonal Flu Costs How Much?! (Appendix 1A)Description: Students explore the costs of receiving an influenza diagnosis. Students analyze thedirect medical costs of getting sick as well as indirect costs (e.g., parent time-cost and student timecost). Students will also review the costs associated with a vaccination program. Then, studentsconsider the trade-offs of having a vaccination program by using two vaccination options. Worksheet 1B: Seasonal Flu Costs How Much?! Guide (Appendix 1B)Description: The guide provides answers and additional information that will help guide studentsthrough this exercise. CalculatorDescription: Students will perform basic mathematical calculations.Online Resources CDC InfluenzaURL: http://www.cdc.gov/flu/Description: This website provides background information regarding seasonal flu. Use this websiteto help answer any questions or to review any misconceptions about the flu. CDC Study: Treating Children’s Flu Illness CostlyURL: stly.htm.Description: CDC provides a summary of the journal article published in the journal Vaccine titled“Indirect, out-of-pocket and medical costs from influenza-related illness in young children.” Journal article titled “Indirect, out-of-pocket and medical costs from influenza-related illness inyoung children.”URL: 0264410X12005932.Description: This journal database provides a free, downloadable copy of the journal article above.The study objective was to determine indirect, out-of-pocket, and direct medical costs of laboratoryconfirmed medically attended influenza among young children.3
Activity1. Ask students what they know about seasonal flu. Write student responses on the board under theheadings as follows: Virus, Transmission, Symptoms, Prevention, Vaccination, and Patterns. Reviewany concepts that students are unclear on. Use http://cdc.gov/flu to answer any questions or reviewany misconceptions.2. Hand out Part 1 of Worksheet 1A: Seasonal Flu Costs How Much?! (Appendix 1A). Instruct avolunteer to read the first two paragraphs. Reiterate that students will be exploring the question,How much does it cost you and your family if you get the flu? Split students into group of no morethan 4 students per group. Tell students to answer Question 1 with their group and to be prepared toshare their answers with the class.3. Regroup to a larger class discussion when students have completed Part 1. Ask for a studentvolunteer from each group to suggest what types of costs they came up with. Write the costs on theboard in three categories: Medical Costs, Indirect Costs, and Out-of-pocket Costs.4. Hand out Part 2 of Worksheet 1A: Seasonal Flu Costs How Much?! (Appendix 1A). Instruct avolunteer to read the paragraph. As a class, ask students to consider what they come up with andwhat studies have been used to estimate costs. Ask students what other factors they might considerwhen estimating costs. Use this as an opportunity to suggest that severity might influence influenzacosts directly.6. Hand out Part 3 of Worksheet 1A: Seasonal Flu Costs How Much?! (Appendix 1A) as studentgroups complete Question 3. Explain to each group that they are to complete Part 3 as a group and tobe prepared to share their answers.7. Draw Table 2 on the board. With approximately 10 minutes remaining, ask for a student volunteerfrom each group to fill in two items with the respective values that their group came up with. Afterall groups have contributed, regroup for a larger class discussion. Discuss the costs that studentsdescribed. Ask students to agree on each cost and to add any other costs that did not make it on theboard. As a class, calculate the total cost (i.e., medical facility costs, parent time-cost, out-of-pocketexpenses, and student expenses) of having the flu, from hospitalizations, emergency departmentvisits, and outpatient (office) visits. Have students discuss which scenario they think is mostcommon. Present the information provided for Question 4.4
Day 2: Tailoring a vaccination program at school, 45 minutesPreparationBefore Day 2, Review CDC Influenza Prevention for the first part of Day 2. Review CDC Flu Vaccine Effectiveness and the two Morbidity Mortality Weekly Report (MMWR)articles concerning the 2013–14 flu season. Review Parts 4-5 of Worksheet 1A: Seasonal Flu Costs How Much?! Guide (Appendix 1A).Materials Worksheet 1A: Seasonal Flu Costs How Much?! (Appendix 1A)Description: Students explore the costs of getting influenza. Students analyze the direct medicalcosts of getting sick as well as indirect costs (e.g., parent time-cost and student time-cost). Studentswill also review the costs associated with a vaccination program. Then, students consider the tradeoffs of having a vaccination program using two vaccination options. Worksheet 1B: Seasonal Flu Costs How Much?! Guide (Appendix 1B)Description: The guide provides answers and additional information that will help guide studentsthrough this exercise. CalculatorDescription: Students will perform basic mathematical calculations.Online Resources CDC Influenza PreventionURL: ription: This website provides background information for seasonal flu prevention. Use thiswebsite to help answer any questions or to review any misconceptions about the flu prevention. CDC Flu Vaccine EffectivenessURL: ffectivenessqa.htm.Description: This resource provides information on the effectiveness of the flu vaccine. Reviewingthis information in advance might be helpful. CDC. Interim estimates of 2013–14 seasonal influenza vaccine effectiveness — United StatesURL: htm.Description: The resource provides information on the 2013–14 seasonal flu. Part 4 refers to thisstudy. Reviewing this information in advance might be helpful. CDC. Update: Influenza activity — United States, September 29, 2013–February 8, 2014.URL: htm.Description: The resource provides information on the 2013–14 seasonal flu. Part 4 refers to thisstudy. Reviewing this information in advance might be helpful.5
Activity1. Review Worksheet 1A: Seasonal Flu Costs How Much?! (Appendix 1A), Parts 1–3 from Day 1.2. Ask students how the flu can be prevented. On the board, write down their suggestions. Havestudents rank the ideas from most effective to least effective.3. Hand out Part 4 of Worksheet 1A: Seasonal Flu Costs How Much?! (Appendix 1A). Suggest tostudents that you will focus on flu vaccination to prevent the flu. Explain that preventioneffectiveness is a way to measure how well a flu vaccination program works to make decisions aboutthe future of the program. Ask for volunteers to read the paragraphs. Ask Question 7 out loud andanswer the question as a class.4. Hand out Part 5 of Worksheet 1A: Seasonal Flu Costs How Much?! (Appendix 1A). Direct studentsto answer Question 8 on their own. Ask a few volunteers to read their answers out loud. Write abasic definition on the board for students to refer to. For example, “efficacy controlled situation,ideal” and “effectiveness real-world”.4. Ask Question 9 aloud. Have students turn to a neighbor to discuss. After a few minutes, ask forstudent volunteers to answer the question. Take this opportunity to review bias. See the guide formore information on bias.5. Rearrange student into their groups from Day 1. Instruct students to compete Part 5. Walk around tomake sure student are staying on track. The formulas for the calculations for Table 3 are provided inthe guide. When all groups have completed their calculations, show students the answers to Table 3on the board.6. Regroup for a class discussion with approximately 5–10 minutes remaining. Pose Questions 14–16to the class. Ask for volunteers to share their responses.7. For homework, assign students to write a 1–2 page proposal for a vaccination program at yourschool. Students should present the information from the cost analysis to present the “best” option.Both direct and indirect costs should be considered. This product can be used as a summativeassessment.6
ConclusionsThrough this lesson, students will use a systematic, public health approach to learn about influenza andprevention effectiveness, also called public health economics. By using data and scientific estimates ofthe direct and indirect cost of the flu, students refine mathematical skills and apply them to a real-worldscenario. Analyzing scientific evidence through the eyes of students provides them with the insight as tohow social and economic factors can often substantially influence decision making and oftentimesoutweigh scientific evidence. Developing a tailored vaccination program for their school helps studentsthink strategically about how to construct a winning argument.Assessment Assessment 1: Homework for Worksheet 1: Seasonal Flu Costs How Much?! (Appendix 1A)Learning Outcomes Assessed- Describe scientific, social, and economic considerations that impact the choice ofintervention strategies.- Mathematical
North Caddo Magnet High School . Vivian, Louisiana . This lesson plan was developed by teachers attending the Science Ambassador Workshop. The Science Ambassador Workshop is a career workforce training for math and science teachers. The workshop is a Career Paths to Public Health . The target grade level for this lesson is high school grades .
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