Influenza Vaccination National Perspective · Influenza Specimens 2015-2017 . ... •Chronic...
Transcript of Influenza Vaccination National Perspective · Influenza Specimens 2015-2017 . ... •Chronic...
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Influenza Vaccination
National Perspective
Dr. Anna Clarke
National Immunisation Office
April 2017
www.immunisation.ie
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Outline
• Influenza as a disease
– epidemiology
• Seasonal influenza vaccination programme 2016/2017
• Influenza vaccine
– Safety and efficacy
• Risk groups
– Healthcare worker
– Pregnant women
• Planning for next season
• Key messages
www.immunisation.ie
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Influenza (Flu)
• Infection caused by flu virus
• Symptoms can range from classic influenza to
mild illness or asymptomatic infection
• Spreads by aerosol or touching
• Most at risk include
– Risk groups
– Healthcare workers
– Pregnant women
• Flu is dangerous
www.immunisation.ie
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Influenza Sentinel GP Consultation Rates per
100,000 population and Number of Positive
Influenza Specimens 2015-2017
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Risk Groups
• Chronic illness requiring medical follow-up
e.g. CF and other chronic respiratory
diseases, CHD; Immunosuppression,
asplenia or splenic dysfunction; ≥65yrs,
Children and teenagers on long-term
aspirin therapy, Residents of nursing
homes and long stay facilities, HCW,
Pregnant women
www.immunisation.ie
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2016/2017 Annual campaign
• Risk groups
•Pregnant women
• Health care workers
• Season continues until end of April
Seasonal Influenza Vaccination Programme
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Influenza Vaccine
2016/2017 season
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Influenza Vaccine
• Contraindication – Anaphylaxis to any of the vaccine components or a
previous dose
• Precautions – Acute severe febrile illness; defer until recovery
– Egg allergy
• Adverse Reactions – Local – redness and swelling.
– General – fever, malaise, myalgia
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Vaccine Safety
• Vaccine is safe
• Most common side effect is redness and
soreness at injection site
• Less common – fever, malaise, muscle
pain
• Rare – Neurological reactions
www.immunisation.ie
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Vaccine Efficacy
• 70-90%- in healthy individuals <65
• Lower in the elderly and in those
individuals with underlying medical
conditions although immunisation has
been shown to reduce incidence of severe
disease including pneumonia,
hospitalisation and mortality
www.immunisation.ie
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Factors Influencing Vaccine Efficacy
• Closeness of the match between the vaccine strain and the circulating virus
• Age of vaccinee: – older people do not respond as well
• Health of the vaccinee: – people with chronic illnesses and immune system disorders do
not respond as well as healthy individuals
• Number of vaccinations: – in children under 9 two doses are required in the first year of use
• Type of vaccine used; – adjuvanted vaccines can give better immune response
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HealthCare Workers
• HealthCare Workers (HCWs) are recommended annual seasonal influenza vaccination
Vaccination:
• – Reduces risk of influenza transmission between patients and HCWs
• – Protects against influenza and complications (including death) associated with disease
• – Is an important infection control intervention
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Uptake by Hospital HCW Staff Category by Season 2
4.4
27
.9
21
.0
22
.6
13
.4
24
.9
17
.7 2
1.2
19
.7
18
.4
19
.3
11
.2
20
.1
14
.6
28
.3
28
.5
23
.9
34
.0
16
.7
23
.5
21
.5
25
.4
25
.8
24
.6
31
.9
16
.6
23
.5
21
.3
28
.2
29
.4
22
.5
38
.2
16
.7
22
.4
22
.5
0
10
20
30
40
GeneralSupport Staff
Health &Social Care
Professionals
Management& Admin
Medical &Dental
Nursing Other Patient& Client Care
All Staff
Avera
ge %
Up
take
HSE Staff Category
2011-2012 2012-2013 2013-2014 2014-2015 2015-2016
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Uptake by LTCF HCW Staff Category by Season 1
7.0
11
.7 1
7.0
5.2
14
.3
13
.6
16
.0
16
.4
13
.0 1
8.5
6.7
15
.3
8.3
16
.6
28
.4
35
.5
36
.7
48
.6
26
.2
27
.0
26
.0 30
.5
43
.3
40
.1
55
.1
27
.2
30
.6
28
.1
31
.1
32
.4
39
.0 43
.4
25
.7
26
.7
26
.6
0
10
20
30
40
50
60
GeneralSupport Staff
Health &Social Care
Professionals
Management& Admin
Medical &Dental
Nursing Other Patient& Client Care
All Staff
Avera
ge %
Up
take
HSE Staff Category
2011-2012 2012-2013 2013-2014 2014-2015 2015-2016
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“I know the symptoms and
would stay at home if I got sick
so I wouldn’t infect
my colleagues or patients.”
“I’m very healthy so my immune
system will protect me from flu.”
Why Should Health Care Workers Be Vaccinated?
• healthy people can get seriously ill from flu
• >20% HCWs get flu every year
• may only have mild symptoms and continue to work
• highly transmissible 1 day before & 5-7 days after symptoms
• vaccine contains killed viruses so cannot cause flu
http://www.immunisation.ie/en/HealthcareProfessionals/Influenza
“I got the vaccine
and it gave me the flu.”
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Transmission of Influenza by
HCW • In a neonatal intensive care unit1
– 19/54 infants were infected and one died
– 15% of staff were vaccinated against influenza
– Only 29% of staff who reported influenza-like illness took time off work
• In an organ transplant unit: attack rate 33%2 – Each patient was in an individual room and 3/4 had no visitors to account
for the spread
– 3/27 (11%) HCWs on the ward had influenza; not vaccinated
• In long-term facility3 – 65 residents developed influenza
– Over half developed pneumonia, 19 hospitalised, 2 died
– 10% of HCW were vaccinated
1Cunney et al. Infect Control Hosp Epidemiol. 2000;21:449–51 2Malavaud S, et al. Transplantation. 2001;72:535–7 3CDC. MMWR 1991;4:129-131
4Elder G, et al. BMJ. 1996;313:1241–2
Influenza infection can remain asymptomatic but infectious4
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www.immunisation.ie
Pregnant Women
Why Vaccinate?
Maternal influenza associated with an increased risk of – hospitalisation and maternal death (1 in 11 in the UK 2009-2012)
– congenital abnormalities • cleft lip
• neural tube defects
• hydrocephaly
• congenital heart defects
– spontaneous abortion
– preterm delivery
– birth of a small-for-gestational age infant
– foetal death
Infants under 6 months have the highest rate of hospitalisation and death from influenza
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www.immunisation.ie
Influenza Vaccine and Pregnancy
1960s Administered to pregnant women in the US
1997 Included in high risk groups
2004 At any stage in pregnancy
2009/2010 Recommended in Ireland since 2009/10
2012 Highest priority group (WHO)
Trivalent or quadrivalent inactivated vaccine
Recommended for consecutive seasons if needed
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www.immunisation.ie
Influenza Vaccine Efficacy in Pregnancy
Effective
• Disease reductions of 41-91%
• 70% reduction in 2009/10
• Vaccination during pregnancy provides passive immunity to infants up to 6 months of age
• incidence of confirmed influenza reduced by 63%
• 40% reduction in pre term births (as effective as smoking cessation)
• 57% reduction in small for gestational age infants
• Into adulthood
• ? reduce long term effects of pre term/ small for gestational age births
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Uptake In Those Aged ≥ 65 years
www.immunisation.ie
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Vaccine for 2017/2018 Season
• A/Michigan/45/2015 (H1N1)pdm09-like virus;
• an A/Hong Kong/4801/2014 (H3N2)-like virus;
• A B/Brisbane/60/2008-like virus.
www.immunisation.ie
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Planning
• Lessons Learnt from last season
• Procurement
• Who needs to be targeted?
• Communication Campaign
• Implementation
• Education
• Vaccine deliveries
• Monitoring flu activity
• Monitoring vaccine distribution
www.immunisation.ie
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Key Messages
• Flu is dangerous
• Flu vaccine is important public health
initiative
• Uptake less than optimal
• People in risk groups must be vaccinated
• Flu vaccine is safe
• Need to plan now for next season
www.immunisation.ie
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Thank You
Further information
www.immunsation.ie
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Uptake in Hospitals by Hospital Group & Season
19
.0 2
7.1
19
.9
9.4
11
.9
26
.4
26
.0
19
.0
21
.6
19
.8
9.4
11
.0
22
.8
5.3
23
.6 3
1.6
27
.6
11
.6
12
.1
16
.7
27
.3
29
.7
17
.5
30
.6
22
.9
23
.4
17
.9
11
.2 17
.9
26
.9
31
.4
34
.1
30
.9
27
.1
23
.9
15
.5
14
.7
15
.7
37
.6
23
.1
24
.2
0
10
20
30
40
50
Avera
ge %
Sta
ff U
pta
ke
Hospital Group
2011-2012 2012-2013 2013-2014 2014-2015 2015-2016
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Uptake in LTCFs by CHO & Season 1
4.3
18
.0
13
.8
5.1
14
.7
37
.1
21
.9
14
.9
22
.6
12
.5 1
8.0
15
.7
10
.8
8.7
26
.4
19
.0
27
.1
28
.6
29
.2
27
.4
33
.2
13
.0 17
.4
47
.6
20
.9
23
.5
41
.6
26
.1
22
.9
38
.9
18
.6
15
.5
40
.4
28
.4
22
.8
52
.1
27
.1
18
.7
44
.1
21
.1
15
.2
33
.3
29
.4
22
.2
48
.1
0
10
20
30
40
50
60
CHO 1: DL;SO/LM;CN/MN
CHO 2: G;RN; MO
CHO 3: CE;L; TN/EL
CHO 4: KY;NC; NSL;
WC
CHO 5: TS;CW/KK;WD; WX
CHO 6: WW;DS; DSE
CHO 7: KE;DW; DSC;
DSW
CHO 8:S/OY;
LD/WH;LH/MH
CHO 9: DN;DNC; DNW
Avera
ge %
Sta
ff U
pta
ke
Community Health Organisation
2011-2012 2012-2013 2013-2014 2014-2015 2015-2016