Transcript Texas Immunization Branch Influenza Update July 24th, 2008 Influenza Update • ACIP Recommendation • Influenza Vaccine – Strains – Types/Indications – Manufacturing/Supply • Texas Influenza Program – Vaccines For.

Texas Immunization Branch
Influenza Update
July 24th, 2008
Influenza Update
• ACIP Recommendation
• Influenza Vaccine
– Strains
– Types/Indications
– Manufacturing/Supply
• Texas Influenza Program
– Vaccines For Children
– Adult Program
– Legislation
• Links to Influenza Websites
http://www.cdc.gov/mmwr/PDF/rr/rr57e717.pdf
Influenza Recommendations For
Children 6 Months – 18 Years of Age
Advisory Committee on Immunization Practices (ACIP)
recently revised the influenza recommendations to include
all children 6 months – 18 years beginning before or during
the 2008-2009 influenza season if feasible, but not later
than the 2009-2010 influenza season. Previously, children
5-18 years of age were only recommended to receive the
influenza vaccine if they were at higher risk for influenza
complications.
In addition, annual vaccination of all children aged 6 months
through 4 years (59 months) continue to be a primary focus
of vaccination efforts because these children are at higher
risk for influenza complications compared with older
children
Children and Adolescents at
High-risk For Influenza
•Aged 6 months to 4 years;
•chronic pulmonary (including asthma), cardiovascular
(except hypertension), renal, hepatic, hematological or
metabolic disorders (including diabetes mellitus);
•who are immunosuppressed (including
immunosuppression caused by medications or by
human immunodeficiency virus);
Children and Adolescents at
High-risk For Influenza
•who have any condition (e.g., cognitive dysfunction,
spinal cord injuries, seizure disorders, or other
neuromuscular disorders) that can compromise
respiratory function or the handling of respiratory
secretions or that can increase the risk for aspiration;
•who are receiving long-term aspirin therapy who
therefore might be at risk for experiencing Reye
syndrome after influenza virus infection;
•who are residents of chronic-care facilities; and,
•who will be pregnant during the influenza season.
Adult Recommendations For
Influenza
Annual vaccination against influenza is recommended
for any adult who wants to reduce the risk for becoming
ill with influenza or of transmitting it to others.
Vaccination also is recommended for all adults in the
following groups, because these persons are either at
high risk for influenza complications, or are close
contacts of persons at higher risk:
•persons aged >50 years;
•women who will be pregnant during the influenza
season;
Adults at High-risk For
Influenza
•persons who have chronic pulmonary (including
asthma), cardiovascular (except hypertension), renal,
hepatic, hematological or metabolic disorders (including
diabetes mellitus);
•persons who have immunosuppression (including
immunosuppression caused by medications or by
human immunodeficiency virus);
•persons who have any condition (e.g., cognitive
dysfunction, spinal cord injuries, seizure disorders, or
other neuromuscular disorders) that can compromise
respiratory function or the handling of respiratory
secretions or that can increase the risk for aspiration;
Adults at High-risk For
Influenza
•residents of nursing homes and other chronic-care
facilities;
•health-care personnel;
•household contacts and caregivers of children aged
<5 years and adults aged >50 years, with particular
emphasis on vaccinating contacts of children aged <6
months; and,
•household contacts and caregivers of persons with
medical conditions that put them at high risk for
severe complications from influenza.
Vaccine Strains
Vaccines containing the 2008–09 trivalent
vaccine virus strains include:
• A/Brisbane/59/2007 (H1N1)-like,
• A/Brisbane/10/2007 (H3N2)-like, and
• B/Florida/4/2006-like
All 3 vaccine virus strains were changed for
the 2008-2009 season
2007-2008 Vaccine Strains:
A/Solomon Islands/3/2006 (H1N1)-like,
A/Wisconsin/67/2005 (H3N2)-like, and
B/Malaysia/2506/2004-like viruses
Vaccine Composition
2 types of vaccines (same strains in both)
• Trivalent Inactivated Influenza Vaccine (TIV)
– Multiple Products Available
– Intramuscular Injection
– Licensed between 6 months to +85 yrs.
• Live, Attenuated Influenza Vaccine (LAIV)
– Single Product (FluMist®) from MedImmune
– Intranasal Spray
– Licensed between 2* and 49 yrs.
* the previous recommendation was to administer LAIV to person aged 5–49 years
Vaccine Supply
• During the 2007–08 influenza season,
113 million doses of influenza vaccine
were distributed in the United States
(est. 141 million were produced).
• Total production of influenza vaccine for
the United States is anticipated to be
>140 million doses for the 2008–09
season, depending on demand and
production yields
Flu Vaccines Licensed in the US
Vaccine
Brandname/ Tradename
Influenza (Age 6 months and older)
Fluzone®
Influenza (Age 6-35 months)
Fluzone® Pediatric dose
Preservative-free
Influenza (Age 36 months and older)
Fluzone® No-Preservative
Manufacturer
38,000,000
Sanofi Pasteur
Influenza (Age 18 years and older)
28,275,000
Novartis
Fluvirin® Preservative-free
15,225,000
Fluarix™
13,000,000
FluLaval™
Influenza (Age 18 years and older)
Afluria
Influenza Live, Intranasal (Age 2-49
years)
FluMist®
CDC US VFC Allocation: 22,000,000
6,000,000
7,000,000
Fluvirin®
Influenza (Age 4 years and older)
Total Projected
Doses
Manufactured
GlaxoSmithKline
23,000,000
CSL Biotherapies
6,000,000
MedImmune
12,500,000
TOTAL
149,000,000
Flu Vaccine Age Indications
6 months
24 mo.
35 mo.
36 mo.
48 mo. …18 yrs…….49 yrs……+85 yrs
Fluzone®
Sanofi .25 mL
Fluzone®
Sanofi .5mL
Fluzone®
Sanofi .5 mL(no pres.)
FluMist®
Medimmune LAIV
Fluvirin®
Norvatis .5mL
FluLaval™
GSK .5mL
Fluarix™
GSK .5mL
Afluria
CSL Biotherapies .5mL
Note: Children < 9 years of age need 2 doses of influenza vaccine (administered 1 month apart) the first time they
receive the vaccine. If they only received 1 dose the first year, they need to receive 2 doses the following year.
Flu Season
• The Flu Season generally runs from early
September to late May
• CDC encourages ‘flu campaigns’ to
continue until the vaccines expires (June)
Influenza Disease
• Influenza viruses causes disease among
all age groups
– Rates of infection are highest among children
– Risk of complications, hospitalizations, and
death are highest among person aged > 65
years, young children, and persons with
medical conditions that increase risk
• Children deaths due to flu-associated
complications
2003-04: 153
2004-05: 47
2005-06:
2006-07:
46
76
2007-08: 83
Texas Immunization Branch
Influenza Programs
• Texas Vaccines For Children Program
– Federal funded program for eligible children 0-18
years of age
– Projected 809,270 doses (20% increase from
2007-2008 year)
• State purchased vaccine
– Used by HSRs for high-risk adults
– Projected 110,000 doses for 2007-2008
• Local Health Departments
– Can purchase direct from manufacturer, from a 3rd
party distributor, and off State of Texas Contract
Texas VFC Population
• Children 0-18 in Texas: 6,899,555
– VFC Eligible Children : 4,091,148
– Non-eligible VFC: 2,367,118
• VFC Doses for Texas (2008-2009)
– 289,500 (.25 mL)
– 519,770 (.5 mL)
809,270 total doses for +4,000,000
children
Influenza Coverage Levels
• The 2006 NIS estimated 30.5% of children (6 to
23 months) within Texas has received one or
more doses of Influenza Vaccine (US 32.2%)
• Texas 2007 Bi-Annual Childcare Assessment
Survey estimated 18.1% of children
surveyed,19-59 months of age, received one or
more doses Influenza Vaccine
• The 2007 Texas Behavioral Risk Factor
Surveillance System estimated 66.7%, adults 65
and older had received a flu shot
Influenza Coverage Levels
• 2007 NIS-Adult Survey currently estimated national
percent vaccinated against the flu
– 37.3 % of High Risk Adults, 18-49 years of age,
– 42.2 % of all adults, 50-64 years of age
– 68.8 % of all adults 65+
• Adolescent Immunization Rates* (one of the new
influenza target population) for 13-17 year olds
– MMR (2 doses): 86.9%
– Hepatitis B (3 doses): 81.3%
– Td/Tdap: 49.4% (higher in older age group)
– Meningococcal Conjugate: 11.7%
•2006 National Immunizatio
•Survey (13-17 year olds)
Texas Influenza Legislation
• House Bill (HB) 3184, which requires the DSHS
to publish information about the benefits of
annual vaccination against influenza; and,
together with the Department of Family &
Protective Services (DFPS), ensure the
information is annually distributed to parents of
children attending child-care in August or
September. A newly created Flu Fact Sheet for
Child-Care Settings will be mailed in September
to child-care facility centers in Texas for
distribution to all enrolled children.
Texas Influenza Legislation
• Senate Bill (SB) 811, which requires the DSHS
to allow each health care provider participating
in the vaccines for children program to:
1. select influenza vaccines from the list of all influenza
vaccines that:
• (i) within the limits of the vaccines annually
allocated by the CDC to the department for the
vaccines for children program; or
• (ii) not offered in the annual allocation under
Subparagraph (i), but are available from the
Centers for Disease Control and Prevention of the
United States Public Health Service and for which
the Centers for Disease Control and Prevention
awards to the department additional funds; and
2. use both inactivated influenza vaccines and live,
attenuated influenza vaccines.
Challenges
• Vaccine Supply (annual uncertainty)
• Universal Recommendation vs. prioritization of highrisk groups
• Vaccine Distribution (pre-booking)
• Vaccine delivery and reimbursement systems
• Vaccine uptake (especially in new recommended
groups
• Vaccine coverage levels (13 additional cohorts
added to annual campaign with existing resources)
• Vaccine Funding and over-reliance on public health
Links To Influenza Websites
•
CDC Influenza webpage www.cdc.gov/flu
•
DSHS Immunization Branch Website
www.dshs.state.tx.us/immunize/flu.shtm
•
MMWR Recommendations for Health Care Personnel
Influenza Vaccination of Health-Care Personnel: Recommendations of the
Healthcare Infection Control Practices Advisory Committee (HICPAC) and
the ACIP. February 24, 2006.
www.cdc.gov/mmwr/preview/mmwrhtml/rr5502a1.htm
•
Vaccine Information Statements (VIS)
The 2008-2009 Vaccine Information Statements are not available at this
time. Refer to the following website for updates
www.cdc.gov/vaccines/pubs/vis/default.htm
•
CDC’s Flu Gallery contains educational materials for promoting influenza
vaccination. The Gallery contains printed materials such as flyers and
posters, in color and black and white, English and Spanish. It is available at:
www.cdc.gov/flu/professionals/flugallery/index.htm.