Slide 1

Seasonal influenza vaccination
in the WHO European Region
preliminary results
WHO workshop on sentinel influenza surveillance,
16-17 November, 2011 Istanbul, Turkey

Pernille Jorgensen | Influenza and other Respiratory Pathogens
WHO Regional Office for Europe
In partnership with the VENICE Collaboration and ECDC


Slide 2

Background influenza vaccines
 Influenza vaccines introduced 1940s
 Vaccination is primary means of
preventing influenza today
 Excellent safety record
 High efficacy:70-90% in healthy adults
…but lower in the elderly...
- 60% in persons >60 years
- 30-40% in persons >85 years


Slide 3

Priority groups for influenza vaccination
 Individuals >6 months with underlying chronic
medical conditions
 Elderly
 Health care workers
 Pregnant women
 Residents of institutions
for older persons and
the disabled
Reference: WHO/Europe recommendations on influenza vaccination during the 2011-2012 winter season
www.euro.who.int/__data/assets/pdf_file/0008/152297/EURO_2011_2012_flu_vacc_rec.pdf


Slide 4

First VENICE survey on seasonal
influenza vaccination in WHO
European Region


Slide 5

Aims and objectives
Aim
 To assess progress toward the WHO goal of 75%
influenza vaccine coverage in elderly by 2010

Specific objectives
 Identify country specific vaccine recommendations
 Describe influenza vaccine coverage in 2008/2009
and 2009/2010
 Describe influenza vaccination implementation
 Provide a baseline from which to measure future
improvements in seasonal influenza vaccine uptake


Slide 6

Methods
 Self-administered questionnaire to national
vaccination focal points, 53 WHO Member States
in August 2011


Slide 7

Preliminary results
 Response from 46/53 (87%)
R e s p o n s e (1 .1 1 .2 0 1 1 )
No
Y es


Slide 8

National influenza vaccination
programmes
 43/46 (93%) countries had access to seasonal
influenza vaccines in 2008/2009 season
S e as o n a l v a cc in e 20 0 8/2 0 09
N o va c ci n e p u rc h a s ed
V a cc in e av a ila b l e
N o res p o n se


Slide 9

Seasonal influenza vaccine doses
available relative to total population
 Range from <1% to 23%
% d o s e s r ela tiv e to p o p u la t io n , 2 00 8 /20 0 9
0
>0
15 15

<1
5
15
- 30

V ac c in e av a ila b le
N o re s p o n s e

 Note: Limited vaccine
availability may
reflect risk group
vaccination policies


Slide 10

National recommendations
for vaccination seasonal influenza
Clinical risk
groups

HCW hospital
+ outpatient

Elderly

Pregnancy


Slide 11

National recommendations
clinical risk groups


Slide 12

National recommendations
for vaccination seasonal influenza

Children


Slide 13

Principal outlets for administration of
seasonal influenza vaccine & cost
Cost of single dose vial or prefilled syringe (€)

Primary health care
clinics are most
important site for
seasonal influenza
vaccination in 90%
of countries

Median: 5.1 EUR


Slide 14

Vaccine uptake in elderly
EU/EEA countries, 2008/2009
80

75% coverage target
60

40

20

0
NL UK ES IT BE FR DE IE LX DK NO PT FI SE IS MT SK HU RO SI PO LT EE


Slide 15

Influenza vaccination coverage
Clinical risk groups, 2008-2009
100

80

60

40

20

0
Netherlands

N=6

Germany

Croatia

Israel

Spain

Belarus


Slide 16

Influenza vaccination coverage
Health care workers, 2008-2009
100

80

60

40

20

0
Belarus

N=9

Armenia

Uzbekistan

Albania

Croatia

Hungary

Spain

Germany Montenegro


Slide 17

Seasonal influenza vaccination
campaigns
 81% produced specific information for
public and health professionals
 73% made use of media campaigns
– 93% TV
– 93% News paper adds
– 87% Radio
– 73% Posters


Slide 18

Conclusions
 Most countries in the Region have access to
seasonal influenza vaccine
 Similar recommendations for “traditional” risk
groups in the Region
 Only, 1 country reached WHO 2010 target of
coverage >75% among elderly
 Low coverage in health care workers
 Cost of influenza vaccine very similar
 Frequent use of media campaigns to promote
influenza vaccination


Slide 19

Key challenges
 Limited vaccine uptake monitoring
– Difficult to monitor progress
– Difficult to monitor impact

 Low vaccine uptake
 Limited vaccine access in some
countries


Slide 20

Suggested readings

www.who.int/wer/2004/wer7903.pdf
 Hollmeyer HG et al: Influenza vaccination of health care workers in
hospitals- a review of studies on attitudes and predictors.
Vaccine. 2009 Jun 19;27(30):3935-44.
 Babcock H et al: Mandatory Influenza Vaccination of Health Care Workers:
Translating Policy to Practice Clin Infect Dis. (2010) 50 (4): 459-464.
 Mereckiene J et al: Differences in national influenza vaccination policies
across the European Union, Norway and Iceland 2008-2009.
Euro Surveill. 2010;15(44)


Slide 21

Next steps - country plans
 Change seasonal vaccine recommendations and
include pregnant women and persons with
morbid obesity
 Prioritization of risk groups in settings with
limited quantity of vaccines
 Assessing cost-benefit of influenza vaccination
programme in different settings
 Evaluating vaccine uptake
 Improve perception of influenza vaccines in
the public


Slide 22

Sincere thanks to
 All national focal points who provided the data
 VENICE
– Jolita Mereckiene
– Suzanne Cotter
– Luca Dematte

 ECDC
– Angus Nicoll

 WHO
– Anna Bolokhovets
– Annemarie Wasley
– Guido Maringhini

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