Seasonal Influenza Vaccine Update

Jeanne M. Santoli, MD, MPHNational Center for Immunization and Respiratory

Diseases Centers for Disease Control and Prevention

September 2006

jsantoli@cdc.gov

Outline

•Recommendations•Supply•Vaccine Distribution Tracking•Communications•Update from the National Influenza

Vaccine Summit

Expanded Recommendations: Annual Vaccination of 24-59

month old children• Beginning with the 2006-07 season

• Based upon increased risk of clinic and ED visits– Includes household contacts and out-of-home

caregivers

• Timing of the recommendation and limited supply of vaccine for young children will impact implementation

0

50

100

150

200

250

300

1964 1974 1984 1994 2004 2006

Year

Millio

ns

24-59 mos. of age

6-23 mos. of age

50-64 years

Household contacts

Health care workers

Nursing home residents

Pregnant women

<65 years with a highrisk condition

>65 years

Estimated Size of ACIP Recommended Groups

Projected Production

# manufacture

rs

# presentation

s

# doses

Current (as of 9/2006)

4 7 ~100 million doses

Potential 4 8 Up to 115 million doses

Timing of Vaccine Distribution (Products Currently Licensed)

• Majority of doses to be distributed by the end of October– 75 million doses by end of October– This is ~15 million doses more than

were delivered by the end of October in 2005

– Goal: Provide some vaccine to all who ordered it (by the end of October)

• Virtually all doses distributed by the end of November

Anticipated Supply Problem: Vaccine for 3 Year Old Cohort

• CDC anticipates that providers may be unable to obtain sufficient vaccine for their 3 year old patients– Single supplier of vaccine for this age-group– Timing of expanded recommendation (occurred

after pre-booking period)

• For providers without sufficient vaccine for all 6-59 month olds, CDC recommends providers consider prioritizing 6-23 months olds.

ACIP Priority Groups for Influenza Vaccination, 2006-07

1a:

•>65 years with medical conditions

•Nursing home residents

1b:

•Persons 2-64 years with high risk conditions•Pregnant women•Persons without high risk conditions >65 years•Children 6-23 months old

1c:

•Children 24-59 months old

•Health care workers

•Close contacts to children <6 months of age

2:  •Contacts of all other high risk persons

•Healthy persons 50-64 years

3:•Healthy persons 5-49 years of age (everybody else)

Influenza Vaccine Distribution Tracking Activities

• Weekly updates of influenza vaccine distribution data available via CDC’s Secure Data Network

• Meeting in April 2006 with key stakeholders to plan for this season

• What is new this season?– Application up and running on September 8,

2006– Access for up to 5 public health officials per

jurisdiction– One time report of pre-book data at the

beginning of the season from a small number of distributors

Example Summary Report 05-06

State Zip Code Vaccine Type Presentation Doses Order ID Provider TypeST ID 99507 PRESERVATIVE-FREE 0.25ML 900 745780 DistributorsST ID 99577 PRESERVATIVE-FREE 0.25ML 2000 745769 DistributorsST ID 99517 PRESERVATIVE-FREE 0.25ML 600 745768 DistributorsST ID 99504 PRESERVATIVE-FREE 0.25ML 400 745775 DistributorsST ID 99502 PRESERVATIVE-FREE 0.25ML 600 745773 DistributorsST ID 99503 PRESERVATIVE-FREE 0.25ML 400 746078 DistributorsST ID 99701 PRESERVATIVE-FREE 0.25ML 500 655473 DistributorsST ID 99669 PRESERVATIVE-FREE 0.25ML 400 745739 DistributorsST ID 99645 PRESERVATIVE-FREE 0.25ML 300 670541 DistributorsST ID 99503 PRESERVATIVE-CONTAINING 0.5ML 150 1312317 PharmacyST ID 99508 PRESERVATIVE-CONTAINING 10 DOSE VIAL 100 000091419 PharmacyST ID 99669 PRESERVATIVE-CONTAINING 0.5ML 200 1324757 PharmacyST ID Total 6550Grand Total 22380

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Preservative-Free or Preservative Containing

Volume per dose

Total number of distributed doses reported to the CDC for this week, for this jurisdiction

Total number of distributed doses reported to the CDC for the 05-06

season, for this jurisdiction

Distributor “Provider Types” mapped to a common data set to enable reporting. Options are:§ State/Local HD/Govt§ Federal Government§ Other Public§ Corrections§ Military§ Private providers, oupatient clinics/facilities, HMO, Sugery Centers

§ Hospitals/Eds/dialysis centers§ Long term care§ Other Private § Corporation/OCC health§ Distributors Pharmacy

Communication Campaign Core Elements

• Web Content, www.cdc.gov/flu • Media Outreach and Activities

– Radio and television PSAs, video and audio news releases, radio news tours, matte articles for small daily and weekly papers, magazine and newspaper ads, web banners

• Print Campaign– Web-based “gallery” at www.cdc.gov

/flu/gallery

• Education and Outreach to Clinicians• Audience Research and Message Testing

Free Posters and Flyerswww.cdc.gov/flu/gallery

Early September Communication About Supply and Distribution

Timing

Key Concepts in the Development of Messages about Supply/Distribution

• Talk about distribution in terms of actual timing, rather than using terms like “delay”– What is a “normal” or “good season” is

ambiguous– Setting realistic expectations– Don’t want to deter the public from seeking

vaccination• Address the misconception that it is too late to be

vaccinated in December and beyond, while still emphasizing the benefits of October/November vaccination

Optimizing Influenza Vaccine Utilization in 2006-07: Efforts of the National

Influenza Vaccine Summit

Second 2006 National Influenza Vaccine Summit

Meeting (June) • Objective Discuss, develop, and

implement a plan to increase utilization of influenza vaccine for the 2006-07 season

• Focus– Vaccination of priority groups, contacts,

and the general public– Helping health care providers to better

promote influenza vaccination– Communication strategies to facilitate

increased utilization of influenza vaccine

Meeting Outcomes• Six teams identified to develop plans for the

short-term goal of increasing utilization for this upcoming season

– Team One: Targeting Healthcare Workers  – Team Two: Targeting children aged 6 mos. through 18

years  – Team Three: All Contacts of High-Priority Populations

with an eye towards “Universal"  – Team Four: Extending the Vaccination Season  – Team Five: Unifying/Creating Provider Toolkit  – Team Six: Utilizing Partnerships (to improve education,

reduce barriers for immunizing, and sharing fiscal risk of influenza vaccine)

Team 1 - HCWs

• Objective– Develop tools and resources to encourage

HCWs to get vaccinated, address common misperceptions

• Activities– Joint AMA/CDC letters to administrators of

health care facilities and individual HCWs– Tools on summit website– Full-page advertisement in JAMA

Team 2 - Pediatrics • Objective

– Increase utilization of influenza vaccine in children aged 6-59 months and in those attending kindergarten through eighth grade (5 to 14 yr olds)

• Activities– Toolkit to providers serving 24-59 month

olds– Flashcards and other educational materials

to distribute to providers serving 5-14 y olds, as well as school and day care classes

– Reach children through grandparents (AARP tool)

Team 3 – ‘Universal ‘ • Objective

– Target high-risk persons and general population who wish to decrease risk of influenza

• Activities– Target certain settings/populations:

• Colleges and university students – joint CDC/American Health Association letter to all ACHA members

• Employees in their worksites – Webinar conducted to National Business Group on Health members

• Faith-based groups – developing network and plans

Team 4 – Extending Vaccination Season

•Objective– Address the misperception that flu

vaccination season end in December•Activities

– Recognition award for provider or organization with innovative approach to deliver vaccine throughout season

– “Vaccination day” in January to promote vaccination

Team 5 – Provider Tool Kit

•Objective– Develop a ‘model’ tool kit for health

care providers to address: vaccine ordering, vaccine storage, vaccine distribution, vaccine payment, vaccine clinics

•Activities– Collect existing tool kits from health

depts, vaccine manufacturers, and other stakeholder organizations

– Unify and customize existing materials into a ‘model’ tool kit

Team 6 – Partnerships

• Objective– Utilize partnerships to improve education,

reduce vaccination barriers, and investigate ways of sharing fiscal risks of healthcare providers offering vaccinations

• Activities – Co-sponsor 3 educational conference calls

with partner organizations to target adult and child health care providers, and promotion of late season vaccination

– Sharing fiscal risk being discussed

Extra slides

Influenza Vaccine Production and Distribution, US, 1980-

2005Doses Produced

(millions)Doses Distributed

(millions)

1980 15.7 12.4

1985 23.1 20.1

1990 32.3 28.3

1995 71.5 54.9

1999 77.2 76.8

2000 77.9 70.4

2001 87.7 77.7

2002 95.0 83.0

2003 86.9 83.1

2004 61.0 56.5

2005 86.0 81.2

Cumulative Monthly Influenza Vaccine Distribution

70.4

57.1

0

10

20

30

40

50

60

70

80

90

July Aug Sept Oct Nov Dec Jan Feb

2000 2002 2004-05 2005-06Doses (Millions)

8381.2