Introduction

1. Introduction Department of Defense Influenza Vaccination Program Briefing 2008-09 Director’s Welcome INFLUENZA 2008-2009 UNCLASSIFIED

2. 1. ACIP Recommendations 2. Vaccines 3. Screening and Documentation 4. Administration 5. Adverse Events Outline PURPOSE: To discuss details of the 2008-2009 DoD Influenza Vaccination Program.

3. Influenza Season 2008-2009 “Annual influenza vaccination is the most effective method for preventing influenza virus infection and its complications” “In the United States, annual epidemics of influenza occur typically during the late fall through early spring seasons. Influenza viruses can cause disease among persons in any age group, but rates of infection are highest among children.” ACIP Recommendations for Prevention and Control of Influenza MMWR, August 2008 • Rates of infection are highest among children • Illness and death are highest • Among persons aged >65 years • Children aged <2 years • Those at increased risk

4. All children 6 mo – 18 yrs (5 -18 year olds is a new recommendation) All adults ≥50 yrs of age Adults or children who have Chronic pulmonary, cardiovascular, renal, hepatic, hematological or metabolic disorders Immuno-suppressed Any conditions that compromise respiratory functions Residents of chronic care facilities Women who are or may become pregnant during the influenza season Healthcare personnel Household contacts and caregivers of children aged < 5 yrs Household contacts and caregivers of people with medical conditions 2008-09 ACIP Influenza Guidelines 2008 – 2009 Season

5. DoD contracted with four manufacturers Injectable Sanofi-Pasteur - Fluzone CSL Biotherapies - Afluria ID Biomedical (MFR) / McKesson (distributor) - Flulaval Intranasal MedImmune - Flumist Vaccine Manufacturers 3.53 Million doses of influenza vaccine contracted for DoD • 1.64 Million - U.S. Army • 854K - U.S. Air Force • 1 Million - U.S. Navy • 63K - U.S. Coast Guard

6. Vaccine Comparison Table READ PACKAGE INSERTS

7. Prioritization No vaccine shortage is anticipated this year • Should shortages occur, DoD will vaccinate • in the following manner • Deployed/deploying Forces • Critical Support Staff/COOP • Medical High Risk beneficiaries (as defined in ACIP recommendations) • No significant changes to DoD • vaccination priority list • In accordance with (IAW) HA Policy 08-005, • military treatment facilities are directed to require • all civilian health care personnel (HCP) who • provide direct patient care in DoD MTFs be • immunized against seasonal influenza infection • each year as a condition of employment, unless • there is a documented medical or religious reason • not to be immunized.

8. Injectable vaccines (Fluzone) (Afluria & Flulaval) - 20-40% SEP - 60% SEP - 20-40% OCT - 30% OCT - Balance % NOV - 10% NOV Intranasal (Flumist) - 35% AUG - 25% SEP - 30% OCT - 10% NOV Expected Shipment Dates

9. Fluzone Shipped and stored at 2-8ْC Shelf life 12 months Afluria Shipped and stored at 2-8ْC Shelf life 12 months Flulaval Shipped and stored at 2-8ْC Shelf life 12 months Flumist Shipped from manufacturer frozen and stored locally in refrigerator at 2-8ْC 18 week shelf life Storage and Handling Requirements

10. Read package inserts for contraindications, precautions and warnings Pay particular attention to Approved age ranges of product Individual allergies (eggs, thimerosal, vaccine components, latex) Individual medical conditions (pregnancy, history of Guillain-Barre Syndrome, asthma, immune-compromised) Choose the best product for your patient Screening

11. Electronic and paper documentation should include Patient name, rank and SSN Date of vaccination Vaccine name/code Manufacturer Lot # Volume Administration route and anatomic site Name, rank and SSN of prescriber Vaccinator name Date patient given Vaccine Information Statement (VIS) and VIS version date Proper Documentation

12. Service members should receive influenza vaccination by 31 December 2008 Services will monitor influenza immunization compliance through their respective Immunization Tracking Systems beginning in October 2008 On 1 January 2009, DoD will include influenza compliance in FMR calculations for all components MILVAX will report influenza vaccination compliance during the OTSG Operations Update Compliance will be categorized as Green (≥ 90% vaccinated) Amber (80-90% vaccinated) Red (<80% vaccinated) Immunization Tracking and Reporting

13. Administration

14. Most common adverse reactions with influenza vaccinations Injectable: soreness, tenderness, pain and swelling at the injection site. Malaise, headache and myalgia Intranasal: runny nose or nasal congestion in all ages, fever >100ºF in children 2-6 yrs of age and sore throat in adults Vaccine Adverse Event Reporting System (VAERS) www.vaers.hhs.gov Contact VAERS 1-800-822-7967 Vaccine Healthcare Centers (VHC) Network 1-866-210-6469 (24 hrs) www.vhcinfo.org Adverse Event after Vaccination

15. Key Points • Use Intranasal vaccine for healthy 2-49 year olds without contraindications • Administer injectable vaccine for those in whom the intranasal vaccine is contraindicated or where the intranasal vaccine is unavailable due to logistical constraints • Remain cautious – read all packaging • Initiate vaccination campaigns once adequate vaccine has arrived to avoid unnecessary waste of vaccine • Unless significant local shortages occur, no eligible beneficiary should be denied vaccination when requested • Screen for other vaccine needs, such as pneumococcal or Tdap vaccine at time of influenza vaccine screening • Use seasonal influenza immunization program to test installation-based processes that might be used in a Pandemic

16. For more information about DoD Influenza Vaccination Program, or if you have any vaccine related questions please contact the MILVAX Agency. www.vaccines.mil/flu vaccines@amedd.army.mil (877) GET-VACC Contact Us

17. www.vaccines.mil www.vaccines.mil