Download - Low influenza A(H1N1)2009 population
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Low influenza A(H1N1)2009 population and high risk group vaccination coverage during the 2009-2010 pandemic, France
ESCAIDELisbon, 11-13 November 2010
JP Guthmann, A Bone, J Nicolau, D Lévy-Bruhl
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• 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 (1)
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• 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
Background (2)
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• 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
Analysis
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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
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
Week
43
(19-
25/1
0/200
9)
Week
45
Week
47
Week
49
Week
51
Week
53
Week
2
Week
4
Week
6
Week
8
Week
10
Week
12
Week
14
Week
16
Week
18
(3-9
/5/2
010)
Epidemiological week
Vac
cin
atio
n c
ove
rag
e
Epidemic peak (week 49)
VC=7.95%
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A(H1N1) vaccination coverage by age and sex, France, June 2010
0%
5%
10%
15%
20%
25%
30%
6-23
mont
hs
2-5
year
s
6-10
yea
rs
11-1
7 ye
ars
18-2
4 ye
ars
25-2
9 ye
ars
30-3
4 ye
ars
35-3
9 ye
ars
40-4
4 ye
ars
45-4
9 ye
ars
50-5
4 ye
ars
55-5
9 ye
ars
60-6
4 ye
ars
65-6
9 ye
ars
70-7
4 ye
ars
75-7
9 ye
ars
80-8
4 ye
ars
85-8
9yea
rs
90-9
4 ye
ars
95+ y
ears
Age group
Vac
cin
atio
n c
ove
rag
e
Female
Male
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A(H1N1) vaccination coverage by region, France, June 2010
0%
4%
8%
12%
16%
20%
Breta
gne
Corse
Champag
ne
Limousi
n
Auvergne
Bourgogne
Picar
die
Pays
de la
Loire
Ile d
e Fra
nce
Poitou-
Charente
s
Centre
Basse-
Norman
die
Franch
e Com
té
Lorrain
e
Aquitain
eNord
Rhône-Alp
es
Alsace
Haute -
Norman
die
Mid
i-Pyr
énées
Prove
nce-A
lpes
-Côte
d'A
zur
Langued
oc
Region
Vac
cin
atio
n c
ove
rag
e
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A(H1N1) vaccination coverage in other groups, France, June 2010
0%
5%
10%
15%
20%
25%
Pregnant women Persons with chronic illness excludingthose associated with increased risk of
influenzae
Vac
cin
atio
n c
ove
rag
e
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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
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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
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Discussion (3)
• Important implications for future pandemics and give some insight on how these campaigns should be conducted
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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
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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%)
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CV enquêteCV (%) 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
Couverture vaccinale grippe A (H1N1) 2009 par groupe cible, enquête InVS/CSA, France métropolitaine
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Personnels de santé de réa néonatale et pédiatriquePersonnels médical et para-médical des Etb de santé et secteur ambulatoire exposéFemmes enceintes 2ème trimestreEntourage nourrissons < 6 moisPersonnels chargés de l’accueil de la petite enfanceNourrissons 6-23 mois avec FDRSujets de 2-64 ans avec FDRAutres professionnels de santé, de secours, de transport sanitaireNourrissons 6-23 mois sans FDRPersonnels d’accueil des pharmaciesAutres Personnels des établissements médico-sociaux> 65 ans avec FDR2-18 ans sans FDR> 18 ans sans FDR
Recommandations de Stratégie Vaccinale (Arbitrage 1er Ministre-24/9/09)
6/10/09 16