Governors Influenza Vaccine Summit 2004 Influenza Season, Vaccine Supply

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Governors Influenza Vaccine Summit2004
Influenza Season, Vaccine Supply High Risk
Population Distribution in Arizona

• Will Humble
• David M. Engelthaler
• Arizona Department of Health Services
• March 4, 2005

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The 2004-2005 Influenza Season
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The Current Influenza Season
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Influenza-like Illness (ILI) TrackingArizona,
2002-2004
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National Influenza Surveillance, by month
2004-2005
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2004 Influenza Vaccine Supply High Risk
Population Distribution in Arizona
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Estimated Arizona High Risk Populations by
Category, 2004
n 2,177,657
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Composition of High Priority Groups by County
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Estimated National Influenza Vaccination Rates
for High Priority Groups 2004-2005
Behavioral Risk Factor Surveillance System
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Cumulative monthly influenza vaccination coverage
from September-December, 2004
HR High-risk conditions including asthma other
lung, heart, or kidney problems diabetes,
weakened immune system, anemia, pregnancy (adults
only) or aspirin therapy (children only). HCW
Health care worker. NPNon-priority group.
Does not include persons in households with
children aged lt6m, or out-of-home care givers of
children aged lt6m, or others with rare high-risk
conditions
Behavioral Risk Factor Surveillance System
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Arizona Influenza Vaccine Doses Purchased, 2004
n 629,640
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Estimated Percent Influenza Vaccine Coverage for
High Priority Groups by County, 2004
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Estimated Influenza Vaccine Coverage by Type
of Purchaser, 2004
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Recent Studies on Influenza Vaccine Efficacy
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Impact of Influenza Vaccination on Seasonal
Mortality in the US Elderly Population-
Simonsen, et al (NIAID and NIH) Arch Intern Med.
2005165265-272

• Writers use an ecological study approach to
  conclude that use of flu vaccine dos not decrease
  influenza mortality
• Study design does not follow who was vaccinated
  versus who wasnt, therefore, no direct
  conclusions on efficacy of vaccine can be made
• Study does bring up issues of the lack of herd
  immunity provided by elderly-centric vaccination
  strategies

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Assessment of the efficacy and effectiveness of
influenza vaccines in healthy children Systemic
review Jefferson, et al The Lancet (Feb 26,
2005)

• Writers review numerous previous studies
  involving influenza vaccine and pediatric
  populations, no new information is provided
• At least two key studies that dont support
  writers conclusion are left out of the study
• Other evidence of efficacy of flu vaccine in
  pediatric populations not included in final
  conclusions
• The Advisory Committee on Immunization Practices
  (ACIP) and CDC have determined that vaccination
  would help reduce serious illness from influenza
  among children at high risk

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Strategy for Distribution of Influenza Vaccine to
High-Risk Groups and Children - Longini and
Halloran, American J of Epidemiology (Feb 15,
2005)

• Writers comment on current U.S. strategy to
  target high-risk groups with flu vaccine versus a
  community transmission prevention based strategy
  that would focus on vaccination of children
• Writers cite previous studies that show children
  to be main source of community transmission and
  include the Japanese program that targeted only
  school children as being effective in decreasing
  flu mortality
• Writers maintain the importance of reaching high
  risk groups concurrently
• Note 57 of children 6 mo to 23 mo in 2004 were
  vaccinated compared to 8 of same age group in
  2002

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The Influenza Vaccine Business
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The Influenza Vaccine Market is Increasingly a
Private Purchase System
Source Aventis Pasteur Estimates
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Vaccine Supply/Demand Environment Recent
Trends

• In 2002, insufficient demand resulted in
  manufacturers discarding 12 million doses
  intended for US market
• Vaccine orders in 2003 were down significantly,
  indicating demand would be less than in the prior
  season
• In 2003, early influenza outbreaks created
  unanticipated vaccine demand after production was
  completed.
• Production based on pre-book vaccine orders plus
  at risk allowance

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2003-2004 Season Summary

• Ample supply existed in 3rd Quarter, 2003 (83-87M
  doses)
• Unanticipated demand late November/December
  exhausted supplies
• Aventis Pasteur proactively notified CDC of late
  surge
• Worked with CDC to reserve/allocate remaining
  vaccine to states

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Preparing for 2004-2005 Influenza Season

• Pre-orders drive vaccine production (2004-2005)
• -Demand drives supply over time
• -2004-05 Pediatric Recommendation (1st season)
• Pre-Book Vaccine Orders for 2004-2005 season
  began December 1st, 2003
• Planning early assists all stakeholders (Public
  and Private)
• -To increase immunization across all risk groups

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Key Lessons on Influenza Vaccine Supply(notes
from 2004 National Flu Summit)

• Build upon existing system Current
  private-public distribution system is efficient
• Promote provider and consumer education about
  influenza immunization recommendations
• Encourage health care providers to order vaccine
  early
• Develop innovative and sustainable initiatives to
  drive demand
• Urge Health Care workers to set an example for
  immunization
• Demand for influenza vaccine drives increased
  supply
• Steady, predictable annual increases in demand
  will ensure increased capacity to meet
  immunization goals

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Data Sources

• NHIS
• AIPO
• Division of Licensure Services
• BRFSS
• CDC
• Aventis-Pastuer

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Thank You