Transcript Titre

Low influenza A(H1N1)2009 population
and high risk group vaccination coverage
during the 2009-2010 pandemic, France
ESCAIDE
Lisbon, 11-13 November 2010
JP Guthmann, A Bone, J Nicolau, D Lévy-Bruhl
Background (1)
• Mass vaccination campaign, October 20, 2009
• Free of charge to the entire population
• At vaccination centres and mobile teams
• Enough vaccine ordered to vaccinate all the French population, but
gradually available
• Invitations sent by post by the State Health Insurance Fund (CNAM)
• According to an order of priority
 Health care workers
 Pregnant women
 Other risk groups targeted by seasonal influenza vaccination
 Healthy population
Background (2)
• Data management
• Invitation database
 Administrative data for each person to whom vaccination was offered
 All recorded in a central invitation database by the CNAM
• Vaccination database
 Demographic and vaccination data collected for each person vaccinated
 All recorded in a central vaccination database
• Data matched in one single database
• Recoding and cleaning by contractor in collaboration with InVS/CNAM
• InVS received a final anonymised extract of this database
Analysis
• Definition of vaccine uptake (coverage)
 Number of persons who received at least one dose of A(H1N1)
vaccine/Number of persons invited
• Uptake by priority group calculated using date of
invitation as a proxy
• 10% of vaccination records could not be matched to
invitations in the database
 These were allocated proportionally by district, using age-sex
distribution in the database
Overall A(H1N1) vaccination coverage,
France, June 2010
• 64.9 million invitations – denominator, comparable to the French population by age,
sex and « département »
• 5.2 million who had received at least one vaccination
9%
Vaccination coverage
8%
Epide mic pe a k (we e k 49)
7%
6%
5%
4%
VC=7.95%
3%
2%
1%
W
ee
k
43
(1
925
/1
0/
20
09
)
W
ee
k
45
W
ee
k
47
W
ee
k
49
W
ee
k
51
W
ee
k
53
W
ee
k
2
W
ee
k
4
W
ee
k
6
W
ee
k
8
W
ee
k
10
W
ee
k
12
W
ee
k
W
14
ee
W
k
ee
18
k
(3
16
-9
/5
/2
01
0)
0%
Epidemiological week
m
o
2- nth
5
s
6- yea
10 r
11 ye s
-1 a
7 r
18 ye s
-2 ar
25 4 ye s
-2 a
r
30 9 ye s
-3 a
r
35 4 ye s
-3 a
9 r
40 ye s
-4 ar
45 4 ye s
-4 a
r
50 9 ye s
-5 a
r
55 4 ye s
-5 a
9 r
60 ye s
-6 ar
65 4 ye s
-6 a
r
70 9 ye s
-7 a
r
75 4 ye s
-7 a
9 r
80 ye s
-8 ar
4
s
85 ye
-8 ar
90 9ye s
-9 a
4 rs
y
95 e a
+ rs
ye
ar
s
623
Vaccination coverage
A(H1N1) vaccination coverage by age and sex,
France, June 2010
30%
25%
20%
15%
Female
Male
10%
5%
0%
Age group
Br
et
ag
Ch C ne
a m or
pa s e
Li gn
m e
Au ous
i
Bo v er n
ur gn
go e
Pa
ys P gn
de ic a e
rd
Po Ile la L ie
it o de oir
u- Fra e
Ch n
ar ce
Ba
en
ss
e
C tes
Fr - No e n
an rm tr
ch a e
e nd
C ie
o
Lo mté
r
Aq rai
ui ne
ta
in
Rh
e
ôn No
Ha
e- rd
Pr
Al
ut
ov
e
p
en
- N A es
ce M o lsa
-A id rm ce
lp i-P an
es y d
- C ré ie
ôt né
e
e
La d'A s
ng z
ue ur
do
c
Vaccination coverage
A(H1N1) vaccination coverage by region,
France, June 2010
20%
16%
12%
8%
4%
0%
Region
A(H1N1) vaccination coverage in other groups,
France, June 2010
25%
Vaccination coverage
20%
15%
10%
5%
0%
Pregnant women
Persons with chronic illness excluding
those associated with increased risk of
influenzae
Discussion (1)
• First time in France a system is put in place where in the
context of a possible health emergency, the entire population
is registered in one single database and contacted
individually by mail
• Comparisons with other sources is in favour of the reliability
of our vaccination coverage estimates
• Major limitation of our study is the lack of information on
priority groups, i.e. persons affected by chronic illnessess
associated with an increased risk of influenza
• Will be soon overcome by the adjunction of information on
other high risk groups in this database
Discussion (2)
• Vaccine uptake low
 Overall, and more importantly in pregnant women which represent a high
risk group
• French population not very receptive to recommendations
• This could reflect
 Negative impact of controversies concerning the safety and effectiveness
of the vaccine
 Public perception of a low risk from the infection
 The decision to set up vaccination centres rather than involving General
Practitioners
 Invitations were sent late in the epidemic
Discussion (3)
• Important implications for future pandemics
and give some insight on how these
campaigns should be conducted
Acknowledgements
• We thank the CNAM and the contractor EMC for
their assistance in managing and cleaning the
database, and for furnishing us with the data for our
analyses
Discussion (1)
• Compared to other countries
 Similar to that of other countries from the EU
(Belgium 7%, Germany 10%, UK 20% in healthy
under 5’s)
 Lower than the USA (median of 24%) and some
countries from northern Europe (Sweden 64%,
Netherlands 32%, Norway 45%)
Couverture vaccinale grippe A (H1N1) 2009 par groupe cible,
enquête InVS/CSA, France métropolitaine
CV enquête
CV (%) IC95%
Prof. de santé
29.8
21.7 – 39.4
Sujets à risque
12.2
9.8 - 15.1
Sujets à risque < 65 ans
16.3
11.4 – 22.8
Femmes enceintes
12.8
5.7 – 26.1
Recommandations de Stratégie Vaccinale (Arbitrage
1er Ministre-24/9/09)
Personnels de santé de réa néonatale et pédiatrique
Personnels médical et para-médical des Etb de santé et secteur ambulatoire exposé
Femmes enceintes  2ème trimestre
Entourage nourrissons < 6 mois
Personnels chargés de l’accueil de la petite enfance
Nourrissons 6-23 mois avec FDR
Sujets de 2-64 ans avec FDR
Autres professionnels de santé, de secours, de transport sanitaire
Nourrissons 6-23 mois sans FDR
Personnels d’accueil des pharmacies
Autres Personnels des établissements médico-sociaux
> 65 ans avec FDR
2-18 ans sans FDR
> 18 ans sans FDR
6/10/09
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