seasonal influenza vaccination: looking ahead toward the 2007-08 season

Seasonal Influenza Seasonal Influenza Vaccination: Vaccination:

Looking Ahead Toward the Looking Ahead Toward the 2007-08 Season2007-08 Season

Seasonal Influenza Seasonal Influenza Vaccination: Vaccination:

Looking Ahead Toward the Looking Ahead Toward the 2007-08 Season2007-08 Season

Jeanne M. Santoli ([email protected])Jeanne M. Santoli ([email protected])Immunization Services DivisionImmunization Services Division

National Center for Immunization and National Center for Immunization and Respiratory DiseasesRespiratory Diseases

June 7, 2007June 7, 2007

OutlineOutline

RecommendationsRecommendations

Anticipated supplyAnticipated supply

Promotional activitiesPromotional activities– Annual campaignAnnual campaign

– National Influenza Vaccination WeekNational Influenza Vaccination Week

Highlights of the 2007 Highlights of the 2007 RecommendationsRecommendations

Change to vaccine composition (new H1N1 component)Change to vaccine composition (new H1N1 component)

Continue to recommend against the use of adamantanes (amantadine, Continue to recommend against the use of adamantanes (amantadine, rimantadine)rimantadine)

No change in the groups recommended for vaccinationNo change in the groups recommended for vaccination

Change in recommendations for children ages 6 months to <9 years Change in recommendations for children ages 6 months to <9 years who received a single dose during their first (previous) year of who received a single dose during their first (previous) year of vaccinationvaccination– New: recommended to receive 2 doses in second year of vaccinationNew: recommended to receive 2 doses in second year of vaccination

Emphasize the need to continue vaccination beyond the traditional Emphasize the need to continue vaccination beyond the traditional months of October and Novembermonths of October and November

Emphasize the importance of vaccinating healthcare workersEmphasize the importance of vaccinating healthcare workers



Continue to recommend against the use of adamantanes Continue to recommend against the use of adamantanes (amantadine, rimantadine)(amantadine, rimantadine)





Recommended Groups, IRecommended Groups, IEfforts should target these groups Efforts should target these groups if vaccine supply is limitedif vaccine supply is limited::

Children aged 6–59 months Children aged 6–59 months

All persons aged All persons aged >>50 years50 years

Household contacts (including children) and caregivers of infants who Household contacts (including children) and caregivers of infants who are younger than 6 months oldare younger than 6 months old

Children and adolescents on long-term aspirin therapyChildren and adolescents on long-term aspirin therapy

Pregnant womenPregnant women

Adults and children who have chronic diseasesAdults and children who have chronic diseases

Immunosuppressed adults and children Immunosuppressed adults and children

Adults and children with a condition that can compromise respiratory Adults and children with a condition that can compromise respiratory function, handling of respiratory secretion, or increase the risk for function, handling of respiratory secretion, or increase the risk for aspirationaspiration

Residents of nursing homes and other chronic-care facilities.Residents of nursing homes and other chronic-care facilities.

Recommended Groups, IIRecommended Groups, II

In addition, In addition, to prevent transmissionto prevent transmission to persons such as to persons such as those at increased risk of complications, the following those at increased risk of complications, the following groups are recommended for annual influenza groups are recommended for annual influenza vaccination with TIV or LAIV unless contraindicated:vaccination with TIV or LAIV unless contraindicated:

Healthcare WorkersHealthcare Workers

Healthy household contacts (including children) and Healthy household contacts (including children) and caregivers ofcaregivers of– Children 6-59 months of age, adults Children 6-59 months of age, adults >>50 years 50 years – Children and adults with medical conditions that put Children and adults with medical conditions that put

them at increased risk for severe complications from them at increased risk for severe complications from influenzainfluenza

Emphasizing the Permissive Emphasizing the Permissive Component of the Seasonal Component of the Seasonal

Recommendations Recommendations

Vaccination is recommended for Vaccination is recommended for persons, including school-age persons, including school-age children, children, who want to reduce the who want to reduce the likelihood of becoming ill with likelihood of becoming ill with influenza or transmitting influenza to influenza or transmitting influenza to othersothers should they become infected. should they become infected.





Change in recommendations for children ages 6 months to <9 years Change in recommendations for children ages 6 months to <9 years who received a single dose during their first (previous) year of who received a single dose during their first (previous) year of vaccinationvaccination– New: recommended to receive 2 doses in second year of New: recommended to receive 2 doses in second year of

vaccinationvaccination



Recommendations for Recommendations for Childhood VaccinationChildhood Vaccination

Longstanding recommendation: first time vaccinees less Longstanding recommendation: first time vaccinees less than 9 years of age should receive two doses, spaced 4-than 9 years of age should receive two doses, spaced 4-6 weeks apart6 weeks apart– Those who only received one dose in the first year should Those who only received one dose in the first year should

receive only one dose the following yearreceive only one dose the following year

New data suggests that these children have less benefit New data suggests that these children have less benefit (when strains change and when they don’t)(when strains change and when they don’t)

Beginning with 2007-08 season: Children who didn’t Beginning with 2007-08 season: Children who didn’t receive two doses during their initial year of vaccination, receive two doses during their initial year of vaccination, should receive two doses the next year. should receive two doses the next year.

Month of Peak Influenza Month of Peak Influenza Activity, US 1976-2006Activity, US 1976-2006

0

5

10

15

20

25

30

35

40

45

50

Month of Peak Influenza Activity

% o

f se

aso

ns

November

December

January

February

March

April

May

US WHO Collaborating Centers (CDC, unpublished data). Peak week defined as week with greatest % of positive specimens for influenza on basis of three-week moving average.





Change in recommendations for children ages 6 months to <9 years who Change in recommendations for children ages 6 months to <9 years who received a single dose during their first (previous) year of vaccinationreceived a single dose during their first (previous) year of vaccination– New: recommended to receive 2 doses in second year of vaccinationNew: recommended to receive 2 doses in second year of vaccination



Recommendations for the Recommendations for the Prevention and Control of Prevention and Control of Influenza are NOT StaticInfluenza are NOT Static

Recommendations for the Recommendations for the Prevention and Control of Prevention and Control of Influenza are NOT StaticInfluenza are NOT Static

Recommendation Changes for Influenza Recommendation Changes for Influenza Vaccination: Recent MilestonesVaccination: Recent Milestones

2000: 2000: All adults 50 and olderAll adults 50 and older

2004: 2004: All children aged 6--23 monthsAll children aged 6--23 monthsAll contacts of children aged 0--23 monthsAll contacts of children aged 0--23 months

All women who will be pregnant during All women who will be pregnant during influenza influenza season season

2005: 2005: All persons with any condition that can All persons with any condition that can compromise respiratory function or the handling compromise respiratory function or the handling of of respiratory secretionsrespiratory secretions

2006: 2006: All children aged 24---59 months and their All children aged 24---59 months and their household contacts and out-of-home caregivershousehold contacts and out-of-home caregivers

Potential Time-Frame for Modifying Potential Time-Frame for Modifying RecommendationsRecommendations

2007-2008:2007-2008: Consider expanding recommendations to include all Consider expanding recommendations to include all children (6 months-18 years)children (6 months-18 years)– Address scientific and implementation issuesAddress scientific and implementation issues– Summarize results for the October 2007 ACIP meetingSummarize results for the October 2007 ACIP meeting

2010-2011:2010-2011: Possible expansion of recommendations to include Possible expansion of recommendations to include household contacts and caregivers of school-aged childrenhousehold contacts and caregivers of school-aged children

2012-2013:2012-2013: Possible expansion to universal vaccination (extend Possible expansion to universal vaccination (extend recommendations to persons 19-49 years) recommendations to persons 19-49 years)

Each time recommendations are changed: Each time recommendations are changed: – need to assist manufacturers, immunization programs, and public need to assist manufacturers, immunization programs, and public

health communication experts in planning implementationhealth communication experts in planning implementation

Meeting to Examine Issues Around Meeting to Examine Issues Around Vaccination of School-age ChildrenVaccination of School-age Children

September 10-11 in Atlanta, GASeptember 10-11 in Atlanta, GA

ObjectivesObjectives

– Review the evidence base supporting expansion Review the evidence base supporting expansion of recommendations of recommendations

– Identify key data gapsIdentify key data gaps

– Discuss implementation strategiesDiscuss implementation strategies

Meeting summary to be presented to the ACIP in Meeting summary to be presented to the ACIP in October 2007October 2007

Projected Production of Influenza Projected Production of Influenza Vaccine for 2007-08, USVaccine for 2007-08, US

ManufacturerManufacturer Doses Projected*Doses Projected*

GSKGSK 30-35 million30-35 million

MedImmuneMedImmune 7 million7 million

NovartisNovartis Up to 40 millionUp to 40 million

sanofi pasteursanofi pasteur 50 million50 million

CSLCSL No estimate providedNo estimate provided

TotalTotal Up to 127-130 millionUp to 127-130 million

*These estimates are based on presentation made at the National Influenza Vaccine Summit Meeting, Atlanta, GA, April 19, 2007 by the manufacturers listed and reflect upper estimates of production contingent upon consumer demand.

More on Supply for 2007-08More on Supply for 2007-08

Projections from the 4 currently licensed Projections from the 4 currently licensed manufacturers exceed the 2006-07 manufacturers exceed the 2006-07 production by approximately 10 million production by approximately 10 million dosesdoses

An additional manufacturer has applied for An additional manufacturer has applied for licensurelicensure

In terms of vaccine for young childrenIn terms of vaccine for young children– Likely to be a similar amount of injectable, p-free Likely to be a similar amount of injectable, p-free

vaccine for young children this seasonvaccine for young children this season– An increased amount of LAIV projected, An increased amount of LAIV projected,

MedImmune has applied for a lower age indicationMedImmune has applied for a lower age indication

Overall Campaign Goals for Overall Campaign Goals for the 2007-08 Seasonthe 2007-08 Season

Promote vaccination to ACIP recommended Promote vaccination to ACIP recommended groups groups

Generate vaccine demand and encourage Generate vaccine demand and encourage anyone in the general population who wants anyone in the general population who wants to be protected against influenza to be to be protected against influenza to be vaccinatedvaccinated

Continue to work toward changing public Continue to work toward changing public and provider attitudes and behaviors related and provider attitudes and behaviors related to vaccination in December, January, and to vaccination in December, January, and beyond.beyond.

Target Audiences: Priority Target Audiences: Priority GroupsGroups

Persons 50 and olderPersons 50 and older Hispanic/Latino and African Hispanic/Latino and African

American seniorsAmerican seniors Persons with chronic diseasePersons with chronic disease Moms of preschool age childrenMoms of preschool age children Close contactsClose contacts

Target Audiences: Growing Target Audiences: Growing Market ShareMarket Share

Working adultsWorking adults– Work through CEOs, CFOs and HR Work through CEOs, CFOs and HR

professionalsprofessionals

Commuters and travelersCommuters and travelers Mothers Mothers

Annual Campaign Core ElementsAnnual Campaign Core Elements

Media outreach and activitiesMedia outreach and activities– NFID press “kick-off” in DC on Sept. 19NFID press “kick-off” in DC on Sept. 19

– Radio and television PSAs, matte articles, print Radio and television PSAs, matte articles, print ads, media toursads, media tours

Print materialsPrint materials PartnershipsPartnerships Education and outreach to cliniciansEducation and outreach to clinicians Web content Web content www.cdc.govwww.cdc.gov/flu/flu and new and new

media outreachmedia outreach Communications researchCommunications research

http://www.cdc.gov/flu

http://www.cdc.gov/flu

Formative ResearchFormative Research

Explore new late season messages Explore new late season messages Encourage the public to get their Encourage the public to get their

vaccination later without implying they vaccination later without implying they should put it offshould put it off

Assess messages related to vaccine Assess messages related to vaccine mismatch mismatch

Test new print materials targeted to Test new print materials targeted to healthy adults who have household healthy adults who have household contact s at high riskcontact s at high risk

Preliminary Focus Group Preliminary Focus Group ResultsResults

Participants heard and remember our past messages Participants heard and remember our past messages

Messages about vaccination in December and later and about Messages about vaccination in December and later and about timing of the peak of disease raised several unexpected timing of the peak of disease raised several unexpected questions questions

Emphasis on the permissive component of the seasonal Emphasis on the permissive component of the seasonal recommendations raised skepticism among many participantsrecommendations raised skepticism among many participants

Draft posters with messages about getting vaccinated to Draft posters with messages about getting vaccinated to protect vulnerable loved ones (particularly babies and children) protect vulnerable loved ones (particularly babies and children) were highly motivating were highly motivating

In the event of a mismatch - as always - simple and straight-In the event of a mismatch - as always - simple and straight-forward recommendations from CDC and providers for people forward recommendations from CDC and providers for people to continue to seek vaccination will be importantto continue to seek vaccination will be important

National Influenza Vaccination National Influenza Vaccination Week (NIVW)Week (NIVW)

Goal: Annual event to help raise Goal: Annual event to help raise awareness of the importance of awareness of the importance of influenza vaccination and the influenza vaccination and the importance of continuing vaccination importance of continuing vaccination throughout November and beyond throughout November and beyond

Planning for 2007-08 NIVW is now Planning for 2007-08 NIVW is now underwayunderway– Designated dates are Nov 26-Dec 2, 2007Designated dates are Nov 26-Dec 2, 2007

NIVW ActivitiesNIVW Activities

Flu-mobile stopsFlu-mobile stops Arrange public clinics/media events Arrange public clinics/media events

at malls, airports,etc.at malls, airports,etc. Audio, video news releases; media Audio, video news releases; media

tours for CDC spokespersonstours for CDC spokespersons NIVW on-line toolkit and calendar of NIVW on-line toolkit and calendar of

eventsevents

Summing Up, ISumming Up, I

Primary changes to the annual Primary changes to the annual recommendations includerecommendations include– Emphasis on permissive recommendationEmphasis on permissive recommendation– Changes to 2-dose recs for children not Changes to 2-dose recs for children not

fully vaccinated the first yearfully vaccinated the first year– Changes in language about timing of Changes in language about timing of

vaccinationvaccination

Meeting in September 2007 to examine Meeting in September 2007 to examine issues around expanding childhood issues around expanding childhood vaccination recommendations vaccination recommendations

Summing Up, IISumming Up, II

Vaccine supply for 2007-08 is projected at Vaccine supply for 2007-08 is projected at record high levels (if demand remains high)record high levels (if demand remains high)

CDC’s campaign will continue to emphasize CDC’s campaign will continue to emphasize and promote late season vaccination to make and promote late season vaccination to make optimal use of available vaccine to protect optimal use of available vaccine to protect children, adolescents, and adultschildren, adolescents, and adults

seasonal influenza vaccination: looking ahead toward the 2007-08 season

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rimantadineno change