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Alberta’s Influenza Immunization Program

Alberta’s Influenza Immunization Program. TARRANT Workshop Elaine Sartison AHW March 24 2007. Partners. AHW participates in a bulk purchase program with all jurisdictions in Canada facilitated by PHAC AHW then distributes this vaccine to Regional Health Authorities (RHAs)

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Alberta’s Influenza Immunization Program

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  1. Alberta’s Influenza Immunization Program TARRANT Workshop Elaine Sartison AHW March 24 2007

  2. Partners • AHW participates in a bulk purchase program with all jurisdictions in Canada facilitated by PHAC • AHW then distributes this vaccine to Regional Health Authorities (RHAs) • Physicians are important partners in the delivery of publicly funded influenza vaccine in Alberta • Physicians can order influenza vaccine from RHAs for patients eligible for publicly funded vaccine

  3. Partners • The proportion of publicly funded vaccine delivered by physicians varies between RHAs in Alberta. • Approx. 50% delivered by PH staff • Approx 50% delivered by physicians who see patients with a chronic illness

  4. Process • Purchased 800,000 doses (2006/07 season) • Vaccine is distributed to all public health centers in Alberta to manage • RHAs accountable for all doses distributed within their region • Follow AHW eligibility criteria and adverse event surveillance guidelines

  5. Influenza Vaccine • Goal: To reduce morbidity, mortality and the impact of illness associated with influenza • NACI Statement • The two main areas of focus: • Those at high risk for influenza-related complications • Those capable of transmitting influenza to individuals at high risk for complications

  6. Influenza Predominant Strain

  7. 2006-2007 Vaccine Strains • A/New Caledonia/20/99 (H1N1) • A/Wisconsin/67/2005 (H3N2) • B/Malaysia/2506/2004

  8. Target Groups 1. People at high risk for influenza related complications: • Persons with chronic pulmonary and cardiac disorders • LTC residents • Persons 65 years of age and older • Those with specific chronic conditions • Adults and children with any condition that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk of aspiration. • HIV positive persons • Pregnant women who are at high risk for influenza-related complications as listed above • Persons 6 months to 18 years of age on long-term ASA therapy • Healthy children age 6 to 23 months • The chronically disadvantaged • People in direct contact with avian influenza-infected poultry during culling operations

  9. Target Groups, continued • People capable of transmitting influenza to those at high risk: • Health care workers (HCW) and other personnel who have significant contact with those at high risk***HCW and their employers have a DUTY to actively promote, implement and comply with influenza immunization recommendations*** • ALL household contacts of persons at high risk for influenza-related complications • Pregnant women expected to deliver during influenza season • Those providing regular childcare to children age zero to 23 months, whether in or out of the home

  10. Provincial Targets • 75% of all individuals 65 years and older • 70% of all persons under 65 years of age with chronic health conditions • 90% of all residents of long-term care facilities • 60% HCW moving towards 90% • 60% of healthy children 6-23 months of age moving towards 95%

  11. Achievement 2000 to 2006

  12. 2000-2006 Immunization Ratesby Select Groups 92% 93% 92% 91% 90% 91% Percentage 67% 69% 67% 667% 68% 68% 60% 40%

  13. 2006-2007 Vaccines • FluviralTM • VaxigripTM • VaxigripTM (T-free) Three vaccines were be publicly funded in Alberta

  14. FluviralTM • Split trivalent vaccine • Manufacturer GSK (formerly ID Biomedical) • 10 dose vial • No latex • Thimerosal content 50 µg/0.5 mL • Discard opened vial after 28 days • For general use in at risk persons, 9 years and older

  15. VaxigripTM • Split trivalent vaccine • Manufacturer Sanofi Pasteur • Multi-dose vial • No latex • Reduced thimerosal: 2µg/0.5 mL • Discard opened vial after seven days • For use with children age: < 9 years of age, pregnant women (if requested), and those with a severe sensitivity to thimerosal • 3 ml syringes most often used in dosages 0.5 ml • 1 ml syringes used in dosages 0.25 ml

  16. VaxigripTM (T-free) • Split trivalent vaccine • Manufacturer Sanofi Pasteur • No thimerosal used at any point in production • Pre-loaded 5/8 inch syringe • 6-23 month olds pending muscle size in the 6-11 month old children • 0.25 mL • No latex in the syringe

  17. Reporting Adverse Reactions • Surveillance of ALL influenza vaccine-associated events with no enhanced surveillance of ORS • Use Report of Adverse Reaction to Immunizing Agentsform (Jan. 2004) • Physicians would either complete this form or direct their patients to public health for follow-up

  18. NACI Statement on ORS • It is safe to re-immunize individuals who have experienced • Mild or moderate ORS symptoms • Severe ORS symptoms without lower respiratory symptoms • Consultation with the local MOH for those who experienced severe ORS symptoms with lower respiratory symptoms within 24 hours of receiving influenza vaccine.

  19. Communication • Letter/guidelines to MOH/CD contacts • Physicians through AMA newsletter • Press release by AHW this fall pending key messages from PHAC • Health Link Alberta

  20. Hot Issues • Why thimerosal-reduced and thimerosal-free used even though not considered a risk? • Theoretical risk – follow the precautionary principle to reduce exposure • Maintain public confidence in vaccines • What other jurisdictions in Canada are providing

  21. Hot Issues, continued • Vaccine supply for the private market • Solvay Pharma Inc • Belgian based pharmaceutical • Provided to some provinces last flu season • Influvac • Some product confusion – licensed for adults only • Vaccine supply for provincially funded programs • late two consecutive years • Delayed influenza program to November 1st

  22. Future Considerations • provision of information for physicians to give to patients • timely delivery of vaccine to physician’s offices • availability of vaccine for the whole influenza season pending vaccine supply issues • provincial electronic health record so physicians’ can access immunization information (influenza may not be included for all regions)

  23. Possible Best Practices: • consider the physician’s office as an important access site • provide annual information on the vaccine and vaccination program for physicians • provide multiple/additional public health clinic sites • other providers of influenza vaccine should be connected to public health

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