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Third European Influenza Conference Vilamoura 14-17 September 2008

Third European Influenza Conference Vilamoura 14-17 September 2008. INCREASING THE OVERALL EPIDEMIC VACCINATION COVERAGE: THE MACROEPIDEMIOLOGY OF INFLUENZA VACCINATION David S. Fedson dfedson@wanadoo.fr. WHO Recommendations for Influenza Vaccination - 2005.

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Third European Influenza Conference Vilamoura 14-17 September 2008

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  1. Third European Influenza Conference Vilamoura 14-17 September 2008 INCREASING THE OVERALL EPIDEMIC VACCINATION COVERAGE: THE MACROEPIDEMIOLOGY OF INFLUENZA VACCINATION David S. Fedson dfedson@wanadoo.fr

  2. WHO Recommendations for Influenza Vaccination - 2005 • Raise awareness about influenza vaccination among health care workers and the public • Increase vaccination coverage of all at-risk people (~ 25% of a country’s total population) elderly people 50% by 2006 75% by 2010

  3. Macroepidemiology of Influenza Vaccination Study Group • Voluntary unfunded network of individuals in 73 countries • Report on influenza vaccine distribution, recommendations and public reimbursement Population % not in Region2006 MIVSG North America, Europe 1,135 M 4 Latin America 562 12 Asia & Oceania 3,720 57 Middle East, Africa 1,111 82 World 6,500 49

  4. National Recommendations in 71 Countries - 2005 • Virtually all countries recommend vaccinating elderly people (≥ 60 or 65 yrs) and those with cardiopulmonary and renal diseases, diabetes mellitus and immunocompromise • A few countries vaccinate all people ≥ 50 yrs • Less agreement on pregnant women,household contacts and children on aspirin • Several countries vaccinate children 6-24 mos (Austria, Canada, Chile, Rep. of Korea, Taiwan and Mexico) • In 2008, US recommended vaccination up to 18 yrs

  5. Influenza Vaccination in 71 Countries, 1997-2005 / 637 MIVSG 2007

  6. Influenza Vaccination in 71 Countries, 2002-2005 / 637 MIVSG 2007

  7. Influenza Vaccination in 71 Vaccine-producing and Non producing Countries 2002-2005 Vaccine-producing / 637 Non producing MIVSG 2007

  8. Influenza Vaccination in Countries With and Without Public Reimbursement 2002-2005 With reimbursement No reimbursement MIV SG 2007

  9. Influenza Vaccination in Western Europe 1997-2002-2005 MIV SG 2007

  10. Influenza Vaccination inMalta, 1997-2005 MIV SG 2007

  11. Influenza Vaccination in Central and Eastern Europe 1997-2002-2005 MIV SG 2007

  12. Economic Development and Influenza Vaccination in Europe, 2005 Luxembourg Norway Switzerland Iceland Ireland Denmark Austria Belgium Netherlands Sweden Finland France Germany Italy Spain Greece Cyprus Slovenia Czech Rep. Portugal Malta Hungary Slovak Rep. Estonia Lithuania Poland Latvia Croatia Russian Fed. Romania Bulgaria Ukraine Albania Georgia Uzbekistan Kyrgyz Rep. GNI per capita ($), adjusted for PPP Vaccine doses distributed / 1000 pop. MIV SG 2007

  13. Influenza Vaccination in the Western Pacific, 1997-2002-2005 MIV SG 2007

  14. Economic Development and Influenza Vaccination in the Western Pacific, 2005 Japan Australia Singapore N. Zealand Rep. Korea Thailand Vaccine doses distributed / 1000 population GNI per capita ($) adjusted for PPP MIV SG 2007

  15. Influenza Vaccination in the Americas 1997-2002-2005 (1) MIV SG 2007

  16. Economic Development and Influenza Vaccination in Latin America, 2005 Chile Mexico Uruguay Costa Rica Brazil Colombia Panama Venezuela Peru El Salvador Guatemala Ecuador Honduras Bolivia Vaccine doses distributed / 1000 population GNI per capita ($) adjusted for PPP MIV SG 2007

  17. Influenza Vaccination in Countries With Recommendations for Children 6-23 Months, 2003-2004-2005 MIV SG 2007

  18. MIVSG Findings on Influenza Vaccine Distribution • Global distribution increased from 292 M doses in 2003 to >329 M doses in 2005 • Great differences persist in vaccine distribution among individual countries • A few countries increased distribution spectacularly while others decreased distribution, often due to supply shortages • Higher vaccine uptake in vaccine-producing countries and in those with publicreimbursement

  19. MIVSG Findings on Influenza Vaccine Distribution • Recommendations for childen 6-23 months of age in seven countries did not lead to higher uptake overall (no surprise) No information on vaccine use in specific age or high-risk groups Despite remergence of H5N1 in 2003, most countries showed little change in distribution between 2002 and 2005

  20. Monitoring Influenza Vaccination Across Europe • Currently most countries monitor vaccine uptake (especially in the elderly ) with methods unique to each country • Possible methods for monitoring uptake across Europe - population surveys - vaccine distribution data (MIVSG) - physician information networks • Other issues to be considered for cross-European monitoring - common set of variables - frequency of surveys - central coordination What would be the purpose of establishing a cross-European system for monitoring of influenza vaccination? Kroeneman M et al. Eurosurveill 2008; 13 (20): pii=18874.

  21. Comparison of ESWI (2006) and MIVSG (2005) Vaccination Rates Vaccination Rates (%) ESWI ≥ 65 yrsESWI ≥ 15 yrsMIVSG ≥ 15 yrs* Germany 53.1 27.4 29.8 UK 69.8 25.0 27.6 Italy 65.6 24.4 18.6 France 68.3 24.2 22.4 Portugal 53.3 23.6 16.7 Spain 71.1 21.8 27.9 Austria 36.8 17.8 16.8 Finland 63.1 16.2 18.5 Poland 25.3 14.1 9.1 Czech Rep. 30.2 13.8 7.6 Ireland 50.7 13.5 20.5 * MIVSG rates/total population adjusted to population ≥ 15 yrs

  22. Influenza Vaccination in Spain • Eligible population - 2006-2007 current recommendations - 410 doses/1000 pop. ≥ 65 yrs - 41% < 65 yrs HR - 16 % healthy contacts - 36% ACIP-like guidelines - 610 doses/1000 pop. Vaccine 2007; 25: 3249-53. vaccine distribution in 2005 - 233 doses/1000 pop. • Vaccination coverage - 2003 ≥ 65 yrs - 63.7% Eur J Public Health 2007;17:272-7. < 65 yr HR - 30.5% Infection 2006; 34: 135-41. HCWs - 19.7%

  23. Influenza Vaccination in Spain • Vaccination effectiveness -  65 yrs, 2002-2005 - 24 deaths (all causes) / 100,000 / week - 14% of deaths prevented by vaccination - 239 vaccinations  prevented one death (144-1748) Vaccine 2007; 25: 6699-707. • Cost effectiveness - 50-64 yrs - third party payor - € 14,919 / QALY; € 9731 / LYG - societal perspective - € 4149/ QALY; € 2706 / LYG Vaccine 2007; 25: 6900-10.

  24. Five Reasons Why People Choose to Receive Influenza Vaccine • Doctor/nurse recommended it 47 % • Not in very good health 47 % • Protects against influenza 39 % • Don’t want to infect others 23 % • It’s free and recommended 22 % Influenza Vaccine Supply Task Force presentation at the WHO/SEARO Workshop on Strengthing NCIPs in Pandemic Influenza Preparedness, 26-28 March 2008

  25. Physician Recommendation and Influenza Vaccination - US, 1988 Patient Physician Percent Attitude Recommendation Vaccinated Positive Yes 87 Negative Yes 70 Positive No 8 Negative No 7 MMWR 1988; 37: 657-61.

  26. Hospitalization and Death Among People Discharged from Hospital During the Flu Vaccination Season in Manitoba, 1982-83

  27. Improving the Delivery of Seasonal Influenza Vaccine Across Europe • Focus on improving individual national vaccination programs, not on cross-European efforts - consistent year-to-year monitoring - administrative features associated with higher vaccination rates, not individual patient characteristics - reimbursement A rising tide does not necessarily lift all boats • New targets for improving vaccine delivery - individuals at risk - hospital discharge programs - populations - childhood vaccination

  28. Western Europe Austria Michael Kunze Belgium Rene Snacken Cyprus Chrystalla Hadjianastassiou Denmark Ann E. Ottosen Finland Rose-Marie Olander France Jean-Marie Cohen Germany Peter Wutzler Greece Andreas Constantopoulos Iceland Thorolfur Gudnason Ireland Joan O’Donnell Italy Isabella Donatelli Malta Tanya Melillo Luxembourg Claude P. Muller Netherlands Ted van Essen Norway Lars Haaheim Portugal Helena Rebelo de Andrade Spain Agustin Portela Sweden Ake Ortqvist Switzerland Mark Witschi United Kingdom Jane Leese Eastern Mediterranean and Africa Algeria Fawzi Derrar Egypt Mostafa Orkhan Iran Abdoul reza Esteghamati Jordan Ali Muhaidat Oman Salah Al Awaidy South Africa Barry D. Schoub AcknowledgementMIV Study Group Investigators Central and South America Argentina Vilma Savy Bolivia Raul Artega Brazil Joao Toniolo-Neto Chile Leonardo Maggi Colombia Enrique Gutierrez Costa Rica Maritza Morena Singler Dominican Rep Jose Brea del Castillo Ecuador Greta Migno El Salvador Suarez Castaneda Guatemala Adib Rodriguez Panama Xavier Saez Peru Gordito Chaparro Uruguay Homero Bagnulo Venezuela Jaime Torres Western Pacific Australia Alan Hampson China not identified Hong Kong SAR Christina Maw Japan Kosaku Uchida New Zealand Lance Jennings Rep. of Korea Woo-Joo Kim Singapore Chan Kwai Peng Taiwan Shu-fong Chen Southeast Asia Thailand Piyanit Tharmaphornpilas Central and Eastern Europe Albania Miriam Xibinaku Bosnia & Herz. Prof. Puvacic Bulgaria Mira Kojouharova Croatia Ira Gjenero-Margan Czech Rep. Eva Vitkova Estonia Olga Sadikova GeorgiaL. Jabidze Hungary Zsuzsanna Molnar Israel I tamar Grotto Kyrgyz Republic Kalia Kasymbekova Latvia Inga Velicko Irina Lucenko Lithuania Arvydas Ambrozaitis Macedonia Blaze Nikolovski Moldova Peter G. Scofertsa Montenegro Dragan Lausevic Poland Lidia Brydak Romania Viorel Alexndrescu Russian Fed. Larisa Rudenko Serbia Mila Vucic-Jankovic Slovak Rep. Zuzana Kristufkova Slovenia Maja Socan Turkey Selim Badur Ukraine Anna V. Moiseeva Uzbekistan Dilorom Tursunova North America Canada Theresa Tam Mexico Augustin Lara Esqueda United States Greg Wallace MIVSG 2007

  29. Influenza Vaccination of Elderly and High-risk People

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