Country Perspectives: Brazil – experience in increasing influenza coverage

José Ricardo Pio Marins

- Ministry of Health Brazil -

SECOND WHO CONSULTATION ON A GLOBAL ACTION PLAN FOR INFLUENZA VACCINES (GAP-II)

12-14 July 2011

WHO/HQ, Geneva, Switzerland

Country Perspectives: Brazil – experience in increasing influenza coverage

� Largest country in South America

� Surface: 8,5 million Km2 area

� Border with 10 countries in South

America (all except Chile and

Ecuador);

� Population: ~191 million (2009

estimates)

� Federal republic – 26 states and the

Federal Capital District – 5 macro

regions

� 5,564 municipalities

� GDP: US$1.3 trillion

� Gross National Income (per capita):

US$ 5,910

Brazil: administrative divisions and population

Source: http://data.un.org

Country Perspectives: Brazil – experience in increasing influenza coverage

Brazil: administrative divisions and population

Geographical

Region

Population (2010)

N %

Southeast 80.915.637 42

Northeast 53.591.299 28

South 27.718.997 14

North 15.359.645 8

Center west 13.895.467 7

Brazil 191.481.045 100

� ~15 million children < 5 years old and 15 million elderly (more

frequently focus of health care actions);

� Heterogeneous population distribution with average population density of 18,4

persons/km2 (municipalities vary from 7 children <1 year of age to 179.343 children <1

year of age in Sao Paulo);

� 75% of the population lives in urban areas;

MEN WOMEN

Population pyramidYear - 2010

Country Perspectives: Brazil – experience in increasing influenza coverage

Brazilian Surveillance Influenza System

Country Perspectives: Brazil – experience in increasing influenza coverage

SARI cases reported and confirmed Pandemic Influenza (H1N1) 2009, geographical regions.

Brazil, EW 16 to 52/2009

0

1000

2000

3000

4000

5000

6000

7000

16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52

Centro-oeste Sul Sudeste Nordeste Norte

SE de início dos sintomas

Nº de casos N=50.482

0

50

100

150

200

250

300

350

400

16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52

Centro-oeste Sul Sudeste Nordeste Norte

SE de início dos sintomas

Nº de óbitos N=2.060

Cases Deaths

Source: Sinan/SVS/MS.

Cases Dead

EW symptomsEW symptoms

Country Perspectives: Brazil – experience in increasing influenza coverage

Confirmed

Country Perspectives: Brazil – experience in increasing influenza coverage

Country Perspectives: Brazil – experience in increasing influenza coverage

Decision for vaccination in 2010

� Priority Groups to immunization:

<2 years old; pregnants; old people; health

workers; indigeous; people with chronic

disease.

� Total People:

� 95.636.744 people

� Goal 80% of total

Country Perspectives: Brazil – experience in increasing influenza coverage

Goal

80%

Vaccine coverage by prioritys groups in influenza campaign

Brazil , 2010

Country Perspectives: Brazil – experience in increasing influenza coverage

Incidence pandemic influenza (H1N1) 2009 by geographical regionsand symptoms epidemiologic week. Brazil, 2010.

Immunization

EW symptoms

Source: Sinan/SVS

Incidence /1 million hab.

Country Perspectives: Brazil – experience in increasing influenza coverage

Country Perspectives: Brazil – experience in increasing influenza coverage

2007, change the metodology to estimate population. 2008, change the goal 70% to 80% from target population.2007, change the metodology to estimate population. 2008, change the goal 70% to 80% from target population.

65y

Country Perspectives: Brazil – experience in increasing influenza coverage

Annual hospitalization for inluenza causes in ≥ 60 years old.

Brazil, 1992 - 2006

Source: Daunfebach et al, 2009

Group of causes Immunization

Ho

spit

ali

zati

on

/1

.00

0 h

ab

Country Perspectives: Brazil – experience in increasing influenza coverage

Country Perspectives: Brazil – experience in increasing influenza coverage

Source: http://pni.datasus.gov.br/consulta_influenza_11_selecao.asp

Influenza coverage - 2011

Children 6m <2 years

Adults ≥ 60 years

All groups

indigenous

Health Workers

Pregnants

Country Perspectives: Brazil – experience in increasing influenza coverage

Goal

80%

Source: pni.datasus.gov.br *data until 06/27/2011

Children Health workers Pregnants Indigenous

≥ 60 years old All groups

Country Perspectives: Brazil – experience in increasing influenza coverage

Source: pni.datasus.gov.br *data until 06/27/2011

Country Perspectives: Brazil – experience in increasing influenza coverage

Increasing the capacity of production

Institute Butantan

� 2006 - Sanofi Pasteur technology transfer influenza vaccine;

� 2010 - Qualified Plan;

� 2011 - Production of 3 million doses of influenza seasonal

vaccine included pH1N1;

� Expected ultimate capacity

� 20 million without adjuvant

� 40 – 80 million with adjuvant

Country Perspectives: Brazil – experience in increasing influenza coverage

Perspectives - 2012

PROGRAMMING PURCHASE 2012

Immunobilogy Calculation Sheet Total Doses

Influenza

A - Children � 2 years old - 4.402.637

36.900.000

C - Goal 2012 - 8/12 Pregnants 2011 - 2.009.126

D - Goal 2012 - health workers applied doses H1N1 - 2.985.774

E - Goal - Indigenous 2011 - 598.797

F - ≥ 60 years old - 19.498.086

G - Prision population - 496.251

Total Partial : - A+B+C+D+E+G = 32.934.360

Total Partial + (32.934.360) strategic reserve 12% = 36.886.483

Source: IBGE/DATASUS estimation 2009 and SINASC to � 1 year old and estimation IBGE to � 2 years old

Country Perspectives: Brazil – experience in increasing influenza coverage

www.saude.gov.br/svs

gripe@saude.gov.br