Influenza Vaccination Update for 2006-07

Jeanne M. Santoli, MD, MPHDeputy Director, Immunization Services Division

National Center for Immunization and Respiratory Diseases

Centers for Disease Control and Prevention June 2006

Outline•Expanded Recommendations

•Supply Projections

• Important Challenges

•Key Strategies

Expanded Recommendations: Annual Vaccination of 24-59

month old children• Beginning with the 2006-07 season

• Based upon increased risk of clinic and ED visits– Includes household contacts and out-of-home

caregivers

• Timing of the recommendation and limited supply of vaccine for young children will impact implementation

0

50

100

150

200

250

300

1964 1974 1984 1994 2004 2006

Year

Millio

ns

24-59 mos. of age

6-23 mos. of age

50-64 years

Household contacts

Health care workers

Nursing home residents

Pregnant women

<65 years with a highrisk condition

>65 years

Estimated Size of ACIP Recommended Groups

Projected Production

# manufacture

rs

# formulations

# doses

Current (as of 6/2006)

4 7 ~100 million doses

Potential 4 8 Up to 120 million doses

What is reason for these promising projections for

2006-07?•Four manufacturers in the market

•DHHS efforts to enhance production capacity for seasonal and pandemic influenza vaccine– Contracts to secure a year round egg

supply– Contracts to increase capacity, including

cell-culture capacity– Enhanced guidance for influenza vaccine

manufacturers from FDA

Are supply problems anticipated?

Yes and No

Yes, because . . . • CDC anticipates that providers may be

unable to obtain sufficient vaccine for their 3 year old patients– Single supplier of vaccine for this age-group– Timing of expanded recommendation (occurred

after pre-booking period)

• For providers without sufficient vaccine for all 6-59 month olds, CDC recommends providers consider prioritizing 6-23 months olds.

No, because . . .

•At present, we have no information to suggest that production problems will result in a delay of vaccine that has been ordered.

And, of course . . .

•Influenza vaccine production is unpredictable, particularly in a year when 2 of 3 vaccine strains are new.

Important Challenges

• Unpredictability of production

• Multiple products and formulations

• Importance of timing of vaccine availability

• Inherent challenge in balancing supply and demand/utilization

Cumulative Monthly Influenza Vaccine Distribution

70.4

57.1

0

10

20

30

40

50

60

70

80

90

July Aug Sept Oct Nov Dec Jan Feb

2000 2002 2004-05 2005-06Doses (Millions)

8381.2

Influenza Vaccine Production and Distribution, US, 1980-

2005Doses Produced

(millions)Doses Distributed

(millions)

1980 15.7 12.4

1985 23.1 20.1

1990 32.3 28.3

1995 71.5 54.9

1999 77.2 76.8

2000 77.9 70.4

2001 87.7 77.7

2002 95.0 83.0

2003 86.9 83.1

2004 61.0 56.5

2005 86.0 81.2

Balancing Supply and Demand/Utilization

1. We must have contingency plans in place in the event that vaccine is delayed or the supply is insufficient.

2. We want to promote influenza vaccine utilization to optimize health protection of the US population and minimize waste of vaccine.

**Sometimes work done to address one of these goals may seem to contradict the other goal.

Key Strategies for the 2006-07 Influenza Season

• No tiered vaccination

• More information about distribution– Enhanced communication to/from distributors– Data for state/local public health officials

• 2nd 2006 National Influenza Vaccine Summit

• Optimizing vaccine use for 2006-07 by targeting selected venues

Enhanced Communication

Distribution Data for Public Health

• Data have been supplied to CDC for use by state/local health officials since 2004

• Meeting in April 2006 to prepare for 2006-07, determine if additional data might be made available– Pre-book data, anticipated shipment dates– Current status: Some distributors willing to share pre-

book data; inability to provide anticipated shipment dates; concerns about provider-level data. Final decisions pending.

• Data are proprietary and sharing them is voluntary

• Conceived in response to delays in 2000-01

• Co-sponsored by AMA and CDC; annual meetings since 2001 and ongoing workgroup efforts

• 140+ individuals representing ~70 key private and public stakeholders involved in influenza vaccination, including: professional organizations; state/local/federal public health agencies; manufacturers; distributors; payers; community vaccinators; representatives from hospitals, long term care facilities, quality improvement organizations, consumer groups, and advocacy organizations.

National Influenza Vaccine Summit

Second 2006 National Influenza Vaccine Summit

MeetingObjective Discuss, develop, and implement

a plan to increase utilization of influenza vaccine for the 2006-07 season

Focus– Vaccination of priority groups, contacts, and

the general public– Helping health care providers to better promote

influenza vaccination– Communication strategies to facilitate

increased utilization of influenza vaccine

Potential Venues for Focus in 2006-07, I

•Workplace vaccination – Many adults do not make regular doctor visits– Convenience as a key factor– Has been shown to reduce physician visits

and lost work days (Nichol 1995, Bridges 2000)

– Includes healthcare settings

Potential Venues for Focus in 2006-07, II

•Colleges/universities– Mumps outbreaks in 2005-06 have

demonstrated potential for widespread transmission in this setting

– New vaccines for young adults (Meningococcal conjugate, Tdap) may provide an opportunity for a “platform” in this venue•College entry requirements for these

vaccines offer opportunities to educate, schedule return visits for influenza vaccine

Acknowledgments

•Gary Euler•Lance Rodewald•Abigail Shefer•Nicole Smith•Raymond Strikas•Litjen Tan•Greg Wallace

•Extra slides

Healthcare Distributor Locations

Source: Influenza Vaccine Production & Distribution Market Brief, HIDA, 2006