seasonal influenza vaccination: looking ahead toward the 2007-08 season
DESCRIPTION
Seasonal Influenza Vaccination: Looking Ahead Toward the 2007-08 Season. Jeanne M. Santoli ([email protected]) Immunization Services Division National Center for Immunization and Respiratory Diseases June 7, 2007. Outline. Recommendations Anticipated supply Promotional activities - PowerPoint PPT PresentationTRANSCRIPT
Seasonal Influenza Seasonal Influenza Vaccination: Vaccination:
Looking Ahead Toward the Looking Ahead Toward the 2007-08 Season2007-08 Season
Seasonal Influenza Seasonal Influenza Vaccination: Vaccination:
Looking Ahead Toward the Looking Ahead Toward the 2007-08 Season2007-08 Season
Jeanne M. Santoli ([email protected])Jeanne M. Santoli ([email protected])Immunization Services DivisionImmunization Services Division
National Center for Immunization and National Center for Immunization and Respiratory DiseasesRespiratory Diseases
June 7, 2007June 7, 2007
OutlineOutline
RecommendationsRecommendations
Anticipated supplyAnticipated supply
Promotional activitiesPromotional activities– Annual campaignAnnual campaign
– National Influenza Vaccination WeekNational Influenza Vaccination Week
Highlights of the 2007 Highlights of the 2007 RecommendationsRecommendations
Change to vaccine composition (new H1N1 component)Change to vaccine composition (new H1N1 component)
Continue to recommend against the use of adamantanes (amantadine, Continue to recommend against the use of adamantanes (amantadine, rimantadine)rimantadine)
No change in the groups recommended for vaccinationNo change in the groups recommended for vaccination
Change in recommendations for children ages 6 months to <9 years Change in recommendations for children ages 6 months to <9 years who received a single dose during their first (previous) year of who received a single dose during their first (previous) year of vaccinationvaccination– New: recommended to receive 2 doses in second year of vaccinationNew: recommended to receive 2 doses in second year of vaccination
Emphasize the need to continue vaccination beyond the traditional Emphasize the need to continue vaccination beyond the traditional months of October and Novembermonths of October and November
Emphasize the importance of vaccinating healthcare workersEmphasize the importance of vaccinating healthcare workers
Highlights of the 2007 Highlights of the 2007 RecommendationsRecommendations
Change to vaccine composition (new H1N1 component)Change to vaccine composition (new H1N1 component)
Continue to recommend against the use of adamantanes Continue to recommend against the use of adamantanes (amantadine, rimantadine)(amantadine, rimantadine)
No change in the groups recommended for vaccinationNo change in the groups recommended for vaccination
Change in recommendations for children ages 6 months to <9 years Change in recommendations for children ages 6 months to <9 years who received a single dose during their first (previous) year of who received a single dose during their first (previous) year of vaccinationvaccination– New: recommended to receive 2 doses in second year of vaccinationNew: recommended to receive 2 doses in second year of vaccination
Emphasize the need to continue vaccination beyond the traditional Emphasize the need to continue vaccination beyond the traditional months of October and Novembermonths of October and November
Emphasize the importance of vaccinating healthcare workersEmphasize the importance of vaccinating healthcare workers
Highlights of the 2007 Highlights of the 2007 RecommendationsRecommendations
Change to vaccine composition (new H1N1 component)Change to vaccine composition (new H1N1 component)
Continue to recommend against the use of adamantanes (amantadine, Continue to recommend against the use of adamantanes (amantadine, rimantadine)rimantadine)
No change in the groups recommended for vaccinationNo change in the groups recommended for vaccination
Change in recommendations for children ages 6 months to <9 years Change in recommendations for children ages 6 months to <9 years who received a single dose during their first (previous) year of who received a single dose during their first (previous) year of vaccinationvaccination– New: recommended to receive 2 doses in second year of vaccinationNew: recommended to receive 2 doses in second year of vaccination
Emphasize the need to continue vaccination beyond the traditional Emphasize the need to continue vaccination beyond the traditional months of October and Novembermonths of October and November
Emphasize the importance of vaccinating healthcare workersEmphasize the importance of vaccinating healthcare workers
Recommended Groups, IRecommended Groups, IEfforts should target these groups Efforts should target these groups if vaccine supply is limitedif vaccine supply is limited::
Children aged 6–59 months Children aged 6–59 months
All persons aged All persons aged >>50 years50 years
Household contacts (including children) and caregivers of infants who Household contacts (including children) and caregivers of infants who are younger than 6 months oldare younger than 6 months old
Children and adolescents on long-term aspirin therapyChildren and adolescents on long-term aspirin therapy
Pregnant womenPregnant women
Adults and children who have chronic diseasesAdults and children who have chronic diseases
Immunosuppressed adults and children Immunosuppressed adults and children
Adults and children with a condition that can compromise respiratory Adults and children with a condition that can compromise respiratory function, handling of respiratory secretion, or increase the risk for function, handling of respiratory secretion, or increase the risk for aspirationaspiration
Residents of nursing homes and other chronic-care facilities.Residents of nursing homes and other chronic-care facilities.
Recommended Groups, IIRecommended Groups, II
In addition, In addition, to prevent transmissionto prevent transmission to persons such as to persons such as those at increased risk of complications, the following those at increased risk of complications, the following groups are recommended for annual influenza groups are recommended for annual influenza vaccination with TIV or LAIV unless contraindicated:vaccination with TIV or LAIV unless contraindicated:
Healthcare WorkersHealthcare Workers
Healthy household contacts (including children) and Healthy household contacts (including children) and caregivers ofcaregivers of– Children 6-59 months of age, adults Children 6-59 months of age, adults >>50 years 50 years – Children and adults with medical conditions that put Children and adults with medical conditions that put
them at increased risk for severe complications from them at increased risk for severe complications from influenzainfluenza
Emphasizing the Permissive Emphasizing the Permissive Component of the Seasonal Component of the Seasonal
Recommendations Recommendations
Vaccination is recommended for Vaccination is recommended for persons, including school-age persons, including school-age children, children, who want to reduce the who want to reduce the likelihood of becoming ill with likelihood of becoming ill with influenza or transmitting influenza to influenza or transmitting influenza to othersothers should they become infected. should they become infected.
Highlights of the 2007 Highlights of the 2007 RecommendationsRecommendations
Change to vaccine composition (new H1N1 component)Change to vaccine composition (new H1N1 component)
Continue to recommend against the use of adamantanes (amantadine, Continue to recommend against the use of adamantanes (amantadine, rimantadine)rimantadine)
No change in the groups recommended for vaccinationNo change in the groups recommended for vaccination
Change in recommendations for children ages 6 months to <9 years Change in recommendations for children ages 6 months to <9 years who received a single dose during their first (previous) year of who received a single dose during their first (previous) year of vaccinationvaccination– New: recommended to receive 2 doses in second year of New: recommended to receive 2 doses in second year of
vaccinationvaccination
Emphasize the need to continue vaccination beyond the traditional Emphasize the need to continue vaccination beyond the traditional months of October and Novembermonths of October and November
Emphasize the importance of vaccinating healthcare workersEmphasize the importance of vaccinating healthcare workers
Recommendations for Recommendations for Childhood VaccinationChildhood Vaccination
Longstanding recommendation: first time vaccinees less Longstanding recommendation: first time vaccinees less than 9 years of age should receive two doses, spaced 4-than 9 years of age should receive two doses, spaced 4-6 weeks apart6 weeks apart– Those who only received one dose in the first year should Those who only received one dose in the first year should
receive only one dose the following yearreceive only one dose the following year
New data suggests that these children have less benefit New data suggests that these children have less benefit (when strains change and when they don’t)(when strains change and when they don’t)
Beginning with 2007-08 season: Children who didn’t Beginning with 2007-08 season: Children who didn’t receive two doses during their initial year of vaccination, receive two doses during their initial year of vaccination, should receive two doses the next year. should receive two doses the next year.
Highlights of the 2007 Highlights of the 2007 RecommendationsRecommendations
Change to vaccine composition (new H1N1 component)Change to vaccine composition (new H1N1 component)
Continue to recommend against the use of adamantanes (amantadine, Continue to recommend against the use of adamantanes (amantadine, rimantadine)rimantadine)
No change in the groups recommended for vaccinationNo change in the groups recommended for vaccination
Change in recommendations for children ages 6 months to <9 years Change in recommendations for children ages 6 months to <9 years who received a single dose during their first (previous) year of who received a single dose during their first (previous) year of vaccinationvaccination– New: recommended to receive 2 doses in second year of vaccinationNew: recommended to receive 2 doses in second year of vaccination
Emphasize the need to continue vaccination beyond the traditional Emphasize the need to continue vaccination beyond the traditional months of October and Novembermonths of October and November
Emphasize the importance of vaccinating healthcare workersEmphasize the importance of vaccinating healthcare workers
Month of Peak Influenza Month of Peak Influenza Activity, US 1976-2006Activity, US 1976-2006
0
5
10
15
20
25
30
35
40
45
50
Month of Peak Influenza Activity
% o
f se
aso
ns
November
December
January
February
March
April
May
US WHO Collaborating Centers (CDC, unpublished data). Peak week defined as week with greatest % of positive specimens for influenza on basis of three-week moving average.
Highlights of the 2007 Highlights of the 2007 RecommendationsRecommendations
Change to vaccine composition (new H1N1 component)Change to vaccine composition (new H1N1 component)
Continue to recommend against the use of adamantanes (amantadine, Continue to recommend against the use of adamantanes (amantadine, rimantadine)rimantadine)
No change in the groups recommended for vaccinationNo change in the groups recommended for vaccination
Change in recommendations for children ages 6 months to <9 years who Change in recommendations for children ages 6 months to <9 years who received a single dose during their first (previous) year of vaccinationreceived a single dose during their first (previous) year of vaccination– New: recommended to receive 2 doses in second year of vaccinationNew: recommended to receive 2 doses in second year of vaccination
Emphasize the need to continue vaccination beyond the traditional Emphasize the need to continue vaccination beyond the traditional months of October and Novembermonths of October and November
Emphasize the importance of vaccinating healthcare workersEmphasize the importance of vaccinating healthcare workers
Recommendations for the Recommendations for the Prevention and Control of Prevention and Control of Influenza are NOT StaticInfluenza are NOT Static
Recommendations for the Recommendations for the Prevention and Control of Prevention and Control of Influenza are NOT StaticInfluenza are NOT Static
Recommendation Changes for Influenza Recommendation Changes for Influenza Vaccination: Recent MilestonesVaccination: Recent Milestones
2000: 2000: All adults 50 and olderAll adults 50 and older
2004: 2004: All children aged 6--23 monthsAll children aged 6--23 monthsAll contacts of children aged 0--23 monthsAll contacts of children aged 0--23 months
All women who will be pregnant during All women who will be pregnant during influenza influenza season season
2005: 2005: All persons with any condition that can All persons with any condition that can compromise respiratory function or the handling compromise respiratory function or the handling of of respiratory secretionsrespiratory secretions
2006: 2006: All children aged 24---59 months and their All children aged 24---59 months and their household contacts and out-of-home caregivershousehold contacts and out-of-home caregivers
Potential Time-Frame for Modifying Potential Time-Frame for Modifying RecommendationsRecommendations
2007-2008:2007-2008: Consider expanding recommendations to include all Consider expanding recommendations to include all children (6 months-18 years)children (6 months-18 years)– Address scientific and implementation issuesAddress scientific and implementation issues– Summarize results for the October 2007 ACIP meetingSummarize results for the October 2007 ACIP meeting
2010-2011:2010-2011: Possible expansion of recommendations to include Possible expansion of recommendations to include household contacts and caregivers of school-aged childrenhousehold contacts and caregivers of school-aged children
2012-2013:2012-2013: Possible expansion to universal vaccination (extend Possible expansion to universal vaccination (extend recommendations to persons 19-49 years) recommendations to persons 19-49 years)
Each time recommendations are changed: Each time recommendations are changed: – need to assist manufacturers, immunization programs, and public need to assist manufacturers, immunization programs, and public
health communication experts in planning implementationhealth communication experts in planning implementation
Meeting to Examine Issues Around Meeting to Examine Issues Around Vaccination of School-age ChildrenVaccination of School-age Children
September 10-11 in Atlanta, GASeptember 10-11 in Atlanta, GA
ObjectivesObjectives
– Review the evidence base supporting expansion Review the evidence base supporting expansion of recommendations of recommendations
– Identify key data gapsIdentify key data gaps
– Discuss implementation strategiesDiscuss implementation strategies
Meeting summary to be presented to the ACIP in Meeting summary to be presented to the ACIP in October 2007October 2007
Projected Production of Influenza Projected Production of Influenza Vaccine for 2007-08, USVaccine for 2007-08, US
ManufacturerManufacturer Doses Projected*Doses Projected*
GSKGSK 30-35 million30-35 million
MedImmuneMedImmune 7 million7 million
NovartisNovartis Up to 40 millionUp to 40 million
sanofi pasteursanofi pasteur 50 million50 million
CSLCSL No estimate providedNo estimate provided
TotalTotal Up to 127-130 millionUp to 127-130 million
*These estimates are based on presentation made at the National Influenza Vaccine Summit Meeting, Atlanta, GA, April 19, 2007 by the manufacturers listed and reflect upper estimates of production contingent upon consumer demand.
More on Supply for 2007-08More on Supply for 2007-08
Projections from the 4 currently licensed Projections from the 4 currently licensed manufacturers exceed the 2006-07 manufacturers exceed the 2006-07 production by approximately 10 million production by approximately 10 million dosesdoses
An additional manufacturer has applied for An additional manufacturer has applied for licensurelicensure
In terms of vaccine for young childrenIn terms of vaccine for young children– Likely to be a similar amount of injectable, p-free Likely to be a similar amount of injectable, p-free
vaccine for young children this seasonvaccine for young children this season– An increased amount of LAIV projected, An increased amount of LAIV projected,
MedImmune has applied for a lower age indicationMedImmune has applied for a lower age indication
Overall Campaign Goals for Overall Campaign Goals for the 2007-08 Seasonthe 2007-08 Season
Promote vaccination to ACIP recommended Promote vaccination to ACIP recommended groups groups
Generate vaccine demand and encourage Generate vaccine demand and encourage anyone in the general population who wants anyone in the general population who wants to be protected against influenza to be to be protected against influenza to be vaccinatedvaccinated
Continue to work toward changing public Continue to work toward changing public and provider attitudes and behaviors related and provider attitudes and behaviors related to vaccination in December, January, and to vaccination in December, January, and beyond.beyond.
Target Audiences: Priority Target Audiences: Priority GroupsGroups
Persons 50 and olderPersons 50 and older Hispanic/Latino and African Hispanic/Latino and African
American seniorsAmerican seniors Persons with chronic diseasePersons with chronic disease Moms of preschool age childrenMoms of preschool age children Close contactsClose contacts
Target Audiences: Growing Target Audiences: Growing Market ShareMarket Share
Working adultsWorking adults– Work through CEOs, CFOs and HR Work through CEOs, CFOs and HR
professionalsprofessionals
Commuters and travelersCommuters and travelers Mothers Mothers
Annual Campaign Core ElementsAnnual Campaign Core Elements
Media outreach and activitiesMedia outreach and activities– NFID press “kick-off” in DC on Sept. 19NFID press “kick-off” in DC on Sept. 19
– Radio and television PSAs, matte articles, print Radio and television PSAs, matte articles, print ads, media toursads, media tours
Print materialsPrint materials PartnershipsPartnerships Education and outreach to cliniciansEducation and outreach to clinicians Web content Web content www.cdc.govwww.cdc.gov/flu/flu and new and new
media outreachmedia outreach Communications researchCommunications research
Formative ResearchFormative Research
Explore new late season messages Explore new late season messages Encourage the public to get their Encourage the public to get their
vaccination later without implying they vaccination later without implying they should put it offshould put it off
Assess messages related to vaccine Assess messages related to vaccine mismatch mismatch
Test new print materials targeted to Test new print materials targeted to healthy adults who have household healthy adults who have household contact s at high riskcontact s at high risk
Preliminary Focus Group Preliminary Focus Group ResultsResults
Participants heard and remember our past messages Participants heard and remember our past messages
Messages about vaccination in December and later and about Messages about vaccination in December and later and about timing of the peak of disease raised several unexpected timing of the peak of disease raised several unexpected questions questions
Emphasis on the permissive component of the seasonal Emphasis on the permissive component of the seasonal recommendations raised skepticism among many participantsrecommendations raised skepticism among many participants
Draft posters with messages about getting vaccinated to Draft posters with messages about getting vaccinated to protect vulnerable loved ones (particularly babies and children) protect vulnerable loved ones (particularly babies and children) were highly motivating were highly motivating
In the event of a mismatch - as always - simple and straight-In the event of a mismatch - as always - simple and straight-forward recommendations from CDC and providers for people forward recommendations from CDC and providers for people to continue to seek vaccination will be importantto continue to seek vaccination will be important
National Influenza Vaccination National Influenza Vaccination Week (NIVW)Week (NIVW)
Goal: Annual event to help raise Goal: Annual event to help raise awareness of the importance of awareness of the importance of influenza vaccination and the influenza vaccination and the importance of continuing vaccination importance of continuing vaccination throughout November and beyond throughout November and beyond
Planning for 2007-08 NIVW is now Planning for 2007-08 NIVW is now underwayunderway– Designated dates are Nov 26-Dec 2, 2007Designated dates are Nov 26-Dec 2, 2007
NIVW ActivitiesNIVW Activities
Flu-mobile stopsFlu-mobile stops Arrange public clinics/media events Arrange public clinics/media events
at malls, airports,etc.at malls, airports,etc. Audio, video news releases; media Audio, video news releases; media
tours for CDC spokespersonstours for CDC spokespersons NIVW on-line toolkit and calendar of NIVW on-line toolkit and calendar of
eventsevents
Summing Up, ISumming Up, I
Primary changes to the annual Primary changes to the annual recommendations includerecommendations include– Emphasis on permissive recommendationEmphasis on permissive recommendation– Changes to 2-dose recs for children not Changes to 2-dose recs for children not
fully vaccinated the first yearfully vaccinated the first year– Changes in language about timing of Changes in language about timing of
vaccinationvaccination
Meeting in September 2007 to examine Meeting in September 2007 to examine issues around expanding childhood issues around expanding childhood vaccination recommendations vaccination recommendations
Summing Up, IISumming Up, II
Vaccine supply for 2007-08 is projected at Vaccine supply for 2007-08 is projected at record high levels (if demand remains high)record high levels (if demand remains high)
CDC’s campaign will continue to emphasize CDC’s campaign will continue to emphasize and promote late season vaccination to make and promote late season vaccination to make optimal use of available vaccine to protect optimal use of available vaccine to protect children, adolescents, and adultschildren, adolescents, and adults