high-level hearing on the implementation of the council...

High-level hearing on the implementation of the Council Recommendation on seasonal influenza vaccination, Luxembourg, 29-30 April 2015

Implementation of seasonal influenza vaccination programme in the United Kingdom (UK) Dr Richard Pebody Respiratory Diseases Department, Public Health England I have no conflicts of interest to declare

Seasonal influenza vaccination

programme, UK

Vaccine policy decision-making;

Current influenza vaccine policy;

Implementation of influenza vaccine programme;

Influenza vaccine programme monitoring

2 High level hearing on flu vaccine implementation, Luxembourg, April 2015

High level hearing on flu vaccine implementation, Luxembourg, April 2015

Recommendations to ministers

Presentation of surveillance data

PHLS

Vaccine

quality Economic

analyses

Licensing

regulations

Academia/scientific

literature

Investigation of policy options

Determining vaccine policy in the UK

JCVI

Vaccine

Coverage

Clinical

Trials

Monitoring

safety & efficacy

Disease

surveillance

Serological

surveillance

Mathematical

modeling

PHE


Joint Committee of Vaccination

and Immunisation (JCVI)

The JCVI is an independent expert advisory committee (=NITAG).

Its role is:

“To advise the Secretaries of State for Health, Scotland, Wales and

Northern Ireland on matters relating to communicable diseases,

preventable and potentially preventable through immunisation”

Taken from JCVI website:http://www.advisorybodies.doh.gov.uk/jcvi/

JCVI reviews all available evidence and make recommendations to the

Dept Health……

…who then decide on, fund and make UK vaccine policy

4

Current UK seasonal influenza

immunisation policy

Target groups for 2014/15 season:

Aged 65 years or more

Aged 6 months – 65 years in risk group: chronic heart disease, chronic respiratory disease including asthma, chronic renal disease, chronic liver disease, stroke patients, immunosuppression due to disease or treatment, diabetes mellitus

All pregnant women (since 2009)

People living in long stay residential care

Health care workers directly involved in patient care

All children aged 2-4 yrs (ultimately all 2-16 yr olds)

High level hearing on flu vaccine implementation, Luxembourg, April 2015 5

Current UK seasonal influenza

immunisation policy

Target groups for 2014/15 season

Aged 65 years or more

Aged 6 months – 65 years in risk group: chronic heart disease, chronic respiratory disease including asthma, chronic renal disease, chronic liver disease, stroke patients, immunosuppression due to disease or treatment, diabetes mellitus

All pregnant women (since 2009)

People living in long stay residential care

Health care workers directly involved in patient care

All children aged 2-4 yrs (ultimately all 2-16 yr olds)

Recommendations for 2015/16 season

Extend to all children of age years 1 and 2 (in England)

Morbid obesity (BMI >40)


Annual WHO vaccine composition

meeting: the annual cycle

N Hemisphere Vaccine component decision by WHO February/March

Vaccine manufacture purchase and release to NHS/PHE

Immunisation campaign in UK Oct/Nov/Dec


Programme steps each year


Annual CMO letter and Annual Flu Plan;

Green book update;

Publicity campaigns for public and health

professionals e.g. NHS employers;

Immunisation targets e.g. 75% for >65 year old and

HCW programmes;

Letter recommending GPs prescribe antivirals once

flu circulating based on surveillance

Annual Flu Plan – each Spring


Tripartite holistic prevention and control plan:

Department of Health; NHS-England and PHE

- policy decisions in relation to the flu season

- oversight of supply of antiviral medicines

- procurement and distribution of flu vaccine

- oversight of vaccine supply and strategic reserve

- delivery of vaccine programme

- monitoring and reporting of key indicators related

to flu, including flu activity, vaccine uptake and

vaccine effectiveness

- respiratory hygiene campaign

ImmForm

Set Policy Implement Monitor

Department of Health Flu Immunisation Policy - Over 65s - Under 65 At-Risk - Children

Store and manage centrally procured vaccine

Vaccine Ordering and Delivery to

~10,000 locations

Collection data on Cohort Size

and Uptake

Report / Analyse Uptake

Identify areas for remedial

action

ImmForm

General Practice

Computer

PHE Vaccine

Management

Vaccine Distributor

PHE Surveillance

Central and Local

Data Collection

Central Vaccine Stock Mgt

Vaccine Ordering

Portal for latest news, reference

Reporting and Analysis

Vaccine Orders Automatic extracts of Uptake Data

Uptake Data Ordering Data

Stock Levels Ordering Levels

Order Status Deliveries Stock Levels

Orders

News, Alerts, Reference Material

Schools / Hospitals

Uptake data Vaccine Orders

Monitoring delivery of programme in

real-time: web-based surveillance


<65yrs high risk, >65yrs,

pregnant women, children Health Care Workers

8155 General Practices

25 Area Teams

PHE

Weekly/monthly report

267 Hospital Trusts

25 Area teams

PHE

Monthly report

Weekly vaccine uptake monitoring


Influenza vaccine uptake, 2000/1-2014/15

(England): 65 plus and <65 at risk


65,4% 67,5% 68,5%

71,0% 71,4% 75,3% 73,9% 73,5% 74,1%

72,4% 72,8% 74,0% 73,4% 73,2% 72,8%

39,9%

48,0%

42,1% 45,3% 47,1%

51,6% 50,4% 51,6% 51,3% 52,3% 50,3%

0,0%

10,0%

20,0%

30,0%

40,0%

50,0%

60,0%

70,0%

80,0%

90,0%

100,0%

% V

accin

e U

pta

ke

Flu Season

65 and Over Under 65 at Risk

WHO/EC 2010 target

Flu vaccine uptake by clinical risk group in

2014/15


Age Six months to

under two years

Two years to

under five

years

Five years to

under sixteen

years

Sixteen

years to

under sixty

five

Total number

under sixty five

years

Risk Group % Vaccine Uptake

Patients with Chronic Heart Disease 21.4 47.5 31.6 51.6 50.1

Patients with Chronic Respiratory Disease 24.4 56.7 44.6 49.8 49.2

Patients with Chronic Kidney Disease 34.9 46.9 36.3 55.9 55.6

Patients with Chronic Liver Disease 24.5 45.4 40.5 43.9 43.9

Patients with Diabetes 24.7 63.5 60.5 68.2 68.1

Patients with Immunosuppression 29.6 55.4 47.6 55.7 55.4

Patients with Chronic Neurological Disease (including

Stroke/ TIA, Cerebral Palsy or MS) 17.9 47.3 33.1 51.5 50.4

Patients with Asplenia or dysfunction of the spleen. 32.8 47.2 31.3 37.3 36.8

Flu vaccine uptake rates 2012/13 – 2014/15


2014/15 2013/14 2012/2013

Patients aged 65 years or older 72.8% 73.2% 73.4%

Patients aged six months to under 65 years in risk groups (excluding

pregnant women without other risk factors) 50.3% 52.3% 51.3%

Pregnant women 44.1% 39.8% 40.3%

Health care workers 54.9% 54.8% 45.6%

Carers 45.1% 44.8% 46.3%

Children aged two years old (including those in risk groups) 38.5% 42.6% N/A

Children aged three years old ( including those in risk groups) 41.3% 39.5% N/A

Children aged four years old ( including those in risk groups) 32.9% N/A N/A

Influenza Vaccine Effectiveness

(VE) monitoring

To develop a system to monitor on a routine and

timely basis influenza VE

- have early estimates during the influenza season and at end

of season;

- have system ready to assess and monitor flu VE during a

pandemic

Part of European network – i-MOVE


Evidence of flu VE (TIV and LAIV)

Lancet ID Osterholm 2012

TIV in

adults

LAIV in

children

Implementation of flu vaccine

programme: conclusions

Influenza vaccination central component of national flu prevention and control

programme;

On-going evolution of programme based on best available evidence;

Introduction of universal child-hood flu vaccine programme with newly licensed

live attenuated influenza vaccine aimed at providing both direct and indirect

population protection;

Importance of central organisation in delivery and management of programme

Value of near-real time vaccine uptake and effectiveness monitoring each year;

Work continues to increase vaccine uptake in key target groups – in particular

health care workers, at-risk groups and children;

Importance of pro-active communication as an integral part of the programme


Acknowledgements

M Ramsay, H Green, C Tsang, S Steinberger, N Boddington, N Andrews, F

Warburton, M Zambon, J Ellis, M Baguelin, N Phin, J Yarwood (PHE)

J McMenamin, A Reynolds, B von Wissmann (Health Protection Scotland)

S Cottrell, D Rys Thomas (Public Health Wales)

J Johnston (Public Health Agency Northern Ireland)

Tim Hopson (Info-Max Ltd)

All participating stakeholders responsible for flu programme management and

delivery in Department of Health and NHS England


high-level hearing on the implementation of the council...

Documents