Low influenza A(H1N1)2009 population and high risk group vaccination coverage during the 2009-2010 pandemic, France

ESCAIDELisbon, 11-13 November 2010

JP Guthmann, A Bone, J Nicolau, D Lévy-Bruhl

• Mass vaccination campaign, October 20, 2009• Free of charge to the entire population

• At vaccination centres and mobile teams

• Enough vaccine ordered to vaccinate all the French population, but

gradually available

• Invitations sent by post by the State Health Insurance Fund (CNAM)

• According to an order of priority Health care workers Pregnant women Other risk groups targeted by seasonal influenza vaccination Healthy population

Background (1)

• Data management• Invitation database

Administrative data for each person to whom vaccination was offered All recorded in a central invitation database by the CNAM

• Vaccination database Demographic and vaccination data collected for each person vaccinated

All recorded in a central vaccination database

• Data matched in one single database

• Recoding and cleaning by contractor in collaboration with InVS/CNAM

• InVS received a final anonymised extract of this database

Background (2)

• Definition of vaccine uptake (coverage) Number of persons who received at least one dose of A(H1N1)

vaccine/Number of persons invited

• Uptake by priority group calculated using date of invitation as a proxy

• 10% of vaccination records could not be matched to invitations in the database

These were allocated proportionally by district, using age-sex distribution in the database

Analysis

Overall A(H1N1) vaccination coverage, France, June 2010

• 64.9 million invitations – denominator, comparable to the French population by age, sex and « département »

• 5.2 million who had received at least one vaccination

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

Week

43

(19-

25/1

0/200

9)

Week

45

Week

47

Week

49

Week

51

Week

53

Week

2

Week

4

Week

6

Week

8

Week

10

Week

12

Week

14

Week

16

Week

18

(3-9

/5/2

010)

Epidemiological week

Vac

cin

atio

n c

ove

rag

e

Epidemic peak (week 49)

VC=7.95%

A(H1N1) vaccination coverage by age and sex, France, June 2010

0%

5%

10%

15%

20%

25%

30%

6-23

mont

hs

2-5

year

s

6-10

yea

rs

11-1

7 ye

ars

18-2

4 ye

ars

25-2

9 ye

ars

30-3

4 ye

ars

35-3

9 ye

ars

40-4

4 ye

ars

45-4

9 ye

ars

50-5

4 ye

ars

55-5

9 ye

ars

60-6

4 ye

ars

65-6

9 ye

ars

70-7

4 ye

ars

75-7

9 ye

ars

80-8

4 ye

ars

85-8

9yea

rs

90-9

4 ye

ars

95+ y

ears

Age group

Vac

cin

atio

n c

ove

rag

e

Female

Male

A(H1N1) vaccination coverage by region, France, June 2010

0%

4%

8%

12%

16%

20%

Breta

gne

Corse

Champag

ne

Limousi

n

Auvergne

Bourgogne

Picar

die

Pays

de la

Loire

Ile d

e Fra

nce

Poitou-

Charente

s

Centre

Basse-

Norman

die

Franch

e Com

té

Lorrain

e

Aquitain

eNord

Rhône-Alp

es

Alsace

Haute -

Norman

die

Mid

i-Pyr

énées

Prove

nce-A

lpes

-Côte

d'A

zur

Langued

oc

Region

Vac

cin

atio

n c

ove

rag

e

A(H1N1) vaccination coverage in other groups, France, June 2010

0%

5%

10%

15%

20%

25%

Pregnant women Persons with chronic illness excludingthose associated with increased risk of

influenzae

Vac

cin

atio

n c

ove

rag

e

Discussion (1)• First time in France a system is put in place where in the

context of a possible health emergency, the entire population is registered in one single database and contacted individually by mail

• Comparisons with other sources is in favour of the reliability of our vaccination coverage estimates

• Major limitation of our study is the lack of information on priority groups, i.e. persons affected by chronic illnessess associated with an increased risk of influenza

• Will be soon overcome by the adjunction of information on other high risk groups in this database

Discussion (2)• Vaccine uptake low

Overall, and more importantly in pregnant women which represent a high risk group

• French population not very receptive to recommendations

• This could reflect Negative impact of controversies concerning the safety and effectiveness

of the vaccine

Public perception of a low risk from the infection

The decision to set up vaccination centres rather than involving General

Practitioners

Invitations were sent late in the epidemic

Discussion (3)

• Important implications for future pandemics and give some insight on how these campaigns should be conducted

Acknowledgements• We thank the CNAM and the contractor EMC for

their assistance in managing and cleaning the database, and for furnishing us with the data for our analyses

Discussion (1)• Compared to other countries

Similar to that of other countries from the EU (Belgium 7%, Germany 10%, UK 20% in healthy under 5’s)

Lower than the USA (median of 24%) and some countries from northern Europe (Sweden 64%, Netherlands 32%, Norway 45%)

CV enquêteCV (%) IC95%

Prof. de santé 29.8 21.7 – 39.4

Sujets à risque 12.2 9.8 - 15.1

Sujets à risque < 65 ans 16.3 11.4 – 22.8

Femmes enceintes 12.8 5.7 – 26.1

Couverture vaccinale grippe A (H1N1) 2009 par groupe cible, enquête InVS/CSA, France métropolitaine

Personnels de santé de réa néonatale et pédiatriquePersonnels médical et para-médical des Etb de santé et secteur ambulatoire exposéFemmes enceintes 2ème trimestreEntourage nourrissons < 6 moisPersonnels chargés de l’accueil de la petite enfanceNourrissons 6-23 mois avec FDRSujets de 2-64 ans avec FDRAutres professionnels de santé, de secours, de transport sanitaireNourrissons 6-23 mois sans FDRPersonnels d’accueil des pharmaciesAutres Personnels des établissements médico-sociaux> 65 ans avec FDR2-18 ans sans FDR> 18 ans sans FDR

Recommandations de Stratégie Vaccinale (Arbitrage 1er Ministre-24/9/09)

6/10/09 16