IHS Clinical Rounds Influenza Kick-Off

September 12th, 2013

Overview

• Overview of new influenza vaccine formulations and vaccine effectiveness

• Overview of influenza vaccine and antiviral treatment recommendations

• Recap of the IHS 2012-2013 Influenza Season• IHS Influenza Awareness System Reports for

2013-2014

Chart of FLUVIEW/CDC

Chart of FLUView CDC

2012-2013 Influenza Season

• Relatively early season– Influenza-like-illness peaked in December

• More severe than previous season• Predominantly H3N2• Higher hospitalization and mortality rates among

the elderly• 158 pediatric deaths

– Higher than the 2 previous seasons– 2009-2010 Pandemic

• 282 deaths

Recap of the 2012-2013 Influenza Season for IHS

Amy V. Groom, MPHIHS Immunization Program Manager/

CDC Public Health AdvisorIHS Division of Epidemiology and Disease Prevention

IHS Influenza Awareness System Reporting2012-2013

IHS Area # of RPMS Databases Reporting* # of Facilities Reporting**NATIONAL 160 356

ABERDEEN 18 32

ALASKA 10 72

ALBUQUERQUE 6 9

BEMIDJI 4 11

BILLINGS 13 25

CALIFORNIA 17 31

NASHVILLE 18 21

NAVAJO 8 38

OKLAHOMA 24 50

PHOENIX 19 34

PORTLAND 22 28

TUCSON 1 5

* Exporting databases may include data from multiple facilities.** Includes only facility categories: Hospital, Health Center, Health Station, Health Location, Alaska Village Clinic.

IHS Areas ILI Surveillance Years - Continuous

Ove

rall

ILI %

0

1

2

3

4

5

6

7

8

Year - Week

2009-10

2009-20

2009-30

2009-40

2009-50

2010-10

2010-20

2010-30

2010-40

2010-50

2011-10

2011-20

2011-30

2011-40

2011-50

2012-10

2012-20

2012-30

2012-40

2012-50

2013-10

2013-20

2013-30

All IHS AreasInfluenza-Like Illness (ILI) All Surveillance Years - Continuous

Percentage of Visits for ILI per week01/04/09 to 08/24/13

Percentage of ILI visits is number of ILI visits divided by total number of daily visits.

IHS ILI Surveillance % of VisitsP

erce

ntag

e IL

I

0

1

2

3

4

5

6

7

8

40

41

42

43

44

45

46

47

48

49

50

51

52

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

All IHS AreasInfluenza-Like Illness (ILI) for All Surveillance Years

Percentage of Visits for ILI per week01/04/09 to 08/24/13

ILI during non-influenza weeks for the previous three seasons plus two standard deviations. The horizontal line represents the 2012-2013 baseline. The baseline is the mean percentage of patient visits for

Percentage of ILI visits is number of ILI visits divided by total number of daily visits.

2008-2009 2009-2010 2010-2011 2011-2012 2012-2013

Proportion of outpatient visits for Influenza-like-Illness (ILI)2012-2013

40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 340

1

2

3

4

5

6

7

% ILI ILINet vs. IIAS

IIAS % ILI

ILINet % ILI

Perc

ent I

LI

ILINet – CDC Sentinel Surveillance System for Influenza-like-Illness IIAS – IHS Influenza Awareness System

Influenza Like Illness by IHS Region2012-2013

IHS INFLUENZA VACCINE COVERAGE FOR 2012-2013

IHS Influenza Vaccine Coverage1 dose, All Ages (> 6 months)

2010-11 2011-12 2012-130%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

IIASRPMS

IHS Influenza Awareness System (IIAS) vs. Quarterly Immunization Package reports from RPMS

IHS Influenza Vaccine Coverage2012 - 2013

All ages 6+ months

Children 6 mos - 17 yrs

Adults > 18 years

Adults 65+ yrs0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

IIASRPMS

IIAS – IHS Influenza Awareness System; RPMS – RPMS Quarterly Immunization Report

IHS Influenza Vaccine Coverage by IHS Area

Aberdeen

Alaska

Albuquerque

Bemidji

Billings

Californ

ia

Nashvil

le

Navajo

Oklahoma

Phoenix

Portland

Tucson

All Are

as0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

RPMS Quarterly Immunization Reports All Ages

Vaccinated

N = 852,168. Based on Active Clinical Users

IHS Healthcare Personnel (HCP) Influenza Vaccination Coverage

2008-09 2009-10 2010-11 2011-12 2012-130%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

71.30%

74.90%72.40%

75.30% 76.20%

% Vaccinated

HP 2020 Goal

IHS Influenza Vaccine Coverage reports available at: www.ihs.gov/flu

HCP Influenza Vaccine Coverage by Area2012-2013

Aberdeen

Alaska

Albuquerque

Bemidji

Billings

Californ

ia

Nashville

Navajo

Oklahoma

Phoenix

Portland

Tucson

National0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Vaccinated

HP 2020 Goal

IHS Influenza Awareness SystemReports

Michael Bartholomew, MDDirector

IHS Division of Epidemiology and Disease Prevention

Data in National IIAS reports• Influenza vaccine coverage by age group and risk

group– National and Area– Active Clinical and User population

• Cumulative influenza vaccine coverage• Codes used to document administered influenza

vaccines– Can be helpful to ensure sites are using the correct codes

• Proportion of visits with ILI– National, by flu season and cumulatively

• Map of ILI by Area• Number of exporting databases and facilities for

each Area

Area Level Report

• Same data as National report• Compares Area to National level data • Provides breakdown by facility for vaccine

coverage• List of exporting databases and facilities

Area Level Report - ILIO

vera

ll IL

I %

0

1

2

3

4

5

6

7

8

9

Year - Week

Area Level: PHOENIXInfluenza-Like Illness (ILI) All Surveillance Years - Continuous

Percentage of Visits for ILI per week01/04/09 to 08/31/13

Percentage of ILI visits is number of ILI visits divided by total number of daily visits.

NATIONAL PHOENIX

Area level Report – ILI by SeasonP

erce

ntag

e IL

I

0

1

2

3

4

5

6

7

8

9

40

41

42

43

44

45

46

47

48

49

50

51

52

01

02

03

04

05

06

07

08

09

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

Area Level: PHOENIXInfluenza-Like Illness (ILI) for All Surveillance Years

Percentage of Visits for ILI per week01/04/09 to 08/31/13

ILI during non-influenza weeks for the previous three seasons plus two standard deviations. The horizontal line represents the 2012-2013 baseline. The baseline is the mean percentage of patient visits for

Percentage of ILI visits is number of ILI visits divided by total number of daily visits.

2008-2009 2009-2010 2010-2011 2011-2012 2012-2013

Area Level Report - Vaccine CoverageArea Level: TUCSON

Seasonal Influenza Vaccine Coverage by Age Groups - All (6 months +)for National, Area, and Exporting Databases

07/01/12 to 06/29/13

37.1

60.3 60.1

Per

cent

0

10

20

30

40

50

60

70

80

90

100

2013-14Seasonal Influenza Vaccine and Antiviral Procurement

IHS- National Supply Service CenterPharmacy Support Branch

CDR Matthew Baker

NSSC 2013-14 Contract Vaccine

Product Name

Dosage Form NDC Price/Dose

Flulaval® Multi-Dose Vial (MDV) -10 doses/vial 19515-0890-07 $3.88*Fluzone® PFS - 0.25mL - 10 doses/package 49281-0113-25 $11.60*Fluzone® PFS – 0.5mL – 10 doses/package 49281-0013-50 $9.54*Fluzone® PFS - 0.5mL HD - 10 doses/package 49281-0393-65 $21.18*Fluzone PFS 0.1ml – 10 doses/package 49281-0707-55 12.70*

• NSSC submits total IHS Requirements to VA for contract

• Expect all shipments of contract vaccine to be completed by 9/15/13

*The NSSC reduced the NSSC Flu Vaccine Fee (the service charge added to the facilities total Flu bill) from 3.25% charged last year to 3% this year (in addition to Cost above).

Flu Vaccine Ordering Post-Solicitation

• Contact Ms. Christy Gay- christy.gay@ihs.com– She will forward a Form 413 for ordering

• Submit Seasonal Flu Form 413 to NSSC– NSSC may have stock of additional contract vaccine

• If not- NSSC will contact contractors to obtain and if authorized, will purchase additional vaccine

– If contract vaccine not available- NSSC will contact additional vendors to find best price

• Occasionally- FSS priced vaccine available through McKesson- but no guarantees

Seasonal VaccineProcurement Overview

2012-13 vs 2013-14 Season

0

50,000

100,000

150,000

200,000

250,000

300,000

5,660

68,270

7,910

253,490

2,340 6,9306,160

80,290

9,800

272,040

3,090 6,170

Total Contract Solicitation Doses Purchased

Sum of 2012 Total Doses Sum of 2013 Total Doses

2012 Total Doses 2013 Total DosesGrand Total 344,600 377,550

**Actual 2012 Doses-376K- includes all additional vaccine purchases

Antivirals

• Tamiflu 75mg Capsules & Relenza blocked from ordering through McKesson and must be purchased through the NSSC until stockpile depleted/expires– Contact Christy Gay and she will forward a 413– Complete 413 and submit to NSSC

• All other Tamiflu doses and dosage forms may be ordered through McKesson when available– Tamiflu 30mg production delays noted in McKesson– Tamiflu Suspension unavailable until late Oct 2013

Resources

• IHS Influenza Website – www.ihs.gov/flu– National IIAS reports posted weekly under “IHS Influenza

Surveillance Reports”– Area Flu points of contact to request facility reports and

guidance on IIAS exports, under “Facility Data Exports and Reports”

– Resources, webinars under “Educational Resources”

• CDC Influenza Website – www.cdc.gov/flu– Influenza vaccine and Antiviral treatment recommendations– FluView – weekly influenza surveillance reports– Free resources Print materials, PSAs, eCards, etc.