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Influenza Vaccination Update for 2006-07
Jeanne M. Santoli, MD, MPHDeputy Director, Immunization Services Division
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention June 2006
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Outline•Expanded Recommendations
•Supply Projections
• Important Challenges
•Key Strategies
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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
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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
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Projected Production
# manufacture
rs
# formulations
# doses
Current (as of 6/2006)
4 7 ~100 million doses
Potential 4 8 Up to 120 million doses
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What is reason for these promising projections for
2006-07?•Four manufacturers in the market
•DHHS efforts to enhance production capacity for seasonal and pandemic influenza vaccine– Contracts to secure a year round egg
supply– Contracts to increase capacity, including
cell-culture capacity– Enhanced guidance for influenza vaccine
manufacturers from FDA
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Are supply problems anticipated?
Yes and No
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Yes, because . . . • 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.
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No, because . . .
•At present, we have no information to suggest that production problems will result in a delay of vaccine that has been ordered.
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And, of course . . .
•Influenza vaccine production is unpredictable, particularly in a year when 2 of 3 vaccine strains are new.
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Important Challenges
• Unpredictability of production
• Multiple products and formulations
• Importance of timing of vaccine availability
• Inherent challenge in balancing supply and demand/utilization
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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
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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
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Balancing Supply and Demand/Utilization
1. We must have contingency plans in place in the event that vaccine is delayed or the supply is insufficient.
2. We want to promote influenza vaccine utilization to optimize health protection of the US population and minimize waste of vaccine.
**Sometimes work done to address one of these goals may seem to contradict the other goal.
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Key Strategies for the 2006-07 Influenza Season
• No tiered vaccination
• More information about distribution– Enhanced communication to/from distributors– Data for state/local public health officials
• 2nd 2006 National Influenza Vaccine Summit
• Optimizing vaccine use for 2006-07 by targeting selected venues
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Enhanced Communication
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Distribution Data for Public Health
• Data have been supplied to CDC for use by state/local health officials since 2004
• Meeting in April 2006 to prepare for 2006-07, determine if additional data might be made available– Pre-book data, anticipated shipment dates– Current status: Some distributors willing to share pre-
book data; inability to provide anticipated shipment dates; concerns about provider-level data. Final decisions pending.
• Data are proprietary and sharing them is voluntary
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• Conceived in response to delays in 2000-01
• Co-sponsored by AMA and CDC; annual meetings since 2001 and ongoing workgroup efforts
• 140+ individuals representing ~70 key private and public stakeholders involved in influenza vaccination, including: professional organizations; state/local/federal public health agencies; manufacturers; distributors; payers; community vaccinators; representatives from hospitals, long term care facilities, quality improvement organizations, consumer groups, and advocacy organizations.
National Influenza Vaccine Summit
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Second 2006 National Influenza Vaccine Summit
MeetingObjective 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
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Potential Venues for Focus in 2006-07, I
•Workplace vaccination – Many adults do not make regular doctor visits– Convenience as a key factor– Has been shown to reduce physician visits
and lost work days (Nichol 1995, Bridges 2000)
– Includes healthcare settings
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Potential Venues for Focus in 2006-07, II
•Colleges/universities– Mumps outbreaks in 2005-06 have
demonstrated potential for widespread transmission in this setting
– New vaccines for young adults (Meningococcal conjugate, Tdap) may provide an opportunity for a “platform” in this venue•College entry requirements for these
vaccines offer opportunities to educate, schedule return visits for influenza vaccine
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Acknowledgments
•Gary Euler•Lance Rodewald•Abigail Shefer•Nicole Smith•Raymond Strikas•Litjen Tan•Greg Wallace
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•Extra slides
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Healthcare Distributor Locations
Source: Influenza Vaccine Production & Distribution Market Brief, HIDA, 2006