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Immunization Program Managers Meeting Atlanta, GA—January 20, 2010. Anne Schuchat, MD Rear Admiral, US Public Health Service Director, National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention Atlanta, GA. Immunization in the Time of H1N1.
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Immunization Program Managers Meeting Atlanta, GA—January 20, 2010 Anne Schuchat, MD Rear Admiral, US Public Health ServiceDirector, National Center for Immunization and Respiratory Diseases Centers for Disease Control and PreventionAtlanta, GA Immunization in the Time of H1N1
Responsibilities Galore • Presidential, State, CDC Transitions • American Recovery and Reinvestment Act (ARRA) • Vaccine Management and Business Improvement Project (VMBIP) • Health Reform deliberations
April 23, 2009 1st press conference (N=7 cases)
Decision-Making in Setting of Uncertainty • Severity in Mexico vs. US • Trinational team deploys to Mexico • Field teams assist affected areas in US • Frequent public and media communication • Risk communication principles • Acknowledge uncertainty
Would there be vaccine? Would it work? One dose or two? Would it arrive ‘in time’? Would there be enough? Would anybody want it? Would it be safe? Would people come to public venues? Would providers be too busy caring for the ill to vaccinate the well? Would the H1N1 vaccination program affect future seasonal vaccine use? Immunization Planning in Setting of Uncertainty
Guiding Principles • Minimize illness and death • Limit societal disruption • Direct greatest effort in ways that will have most impact
60 Minutes Episode on H1N1 High School Athlete Luke Deval: H1N1 complicated by MRSA pneumonia
Teens and young adults disproportionately affectedFew cases among elderly 0-4yrs 0-4 yrs 5-9 yrs 5-9 yrs 10-17 yrs 10-17 yrs 18-49 yrs 18-49 yrs 50-64 yrs 50-64 yrs 65+ yrs 65+ yrs Seasonal 2007-08 2009 H1N1 (April - Jun) N=312 N=3,930 *April 12-June 30
School and student dismissals related to 2009-H1N1, US, 2009 Updated school recs 1st school recs Source: ED and CDC Confirmed School Closing Reports
Preparing for Fall • Strengthen monitoring systems • EDs, ICUs, Labs, schools, Southern Hemisphere • Prepare for medical care surge • Self-triage, protect EDs, prepare ICUs • Plan for multiple scenarios (severity, supply) • Communication & media
Preparing for Voluntary H1N1 Vaccination Program • Production • Clinical trials • Planning (enrolling providers, organizing mass & school clinics) • Vaccine distribution and administration • Strengthening safety, efficacy monitoring • Communication planning
Cumulative Number of Provider Agreements, H1N1 Vaccine Program, Sept 2009-Jan 2010 Pre-launch 22
Est. 61 million vaccinated in first three months • Highest coverage in children, pregnant women • Most doses went to target populations
H1N1 Influenza Disease Burden Estimates for Apr -Dec 18, 2009
Bumps in the Road • Vaccine strains grew slowly in eggs • Messaging about vaccine supply • Supply/demand imbalances • Perceived equity of allocations • Potency declines 2 product recalls • Others to come…? ?
Pandemic H1N1 Influenza Status • H1N1 decreased but not disappeared • Immunization coordinated at state and local levels • Mix of private and public venues • Preparedness and immunization leadership • School-located and other mass vaccination, also traditional medical and pharmacy settings • Evaluation for best practices critical • Vaccination and surveillance continue this winter…
Pneumonia and Influenza Deaths, United States, 108 Cities: 1957-58
Where Will Immunization and Pandemic Preparedness Go From Here? • Build on school- assoc vaccination • New norms for pregnant & other adults • Altered communication environment • Sustain stronger links w/ health care • Investments in vaccine development, public health infrastructure?