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Vaccine Preventable Disease Epidemiology in Ireland and recent outbreaks

Suzanne Cotter, SPHM, National Immunisation Conference, RCPI, 23rd May 2019

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Impact of vaccines on Irish population, 1948‐2019*

• Successes – Eliminated, well controlled, for elimination/eradication

• Smallpox, Hib, measles, rubella and polio– Impact newer vaccines

• pneumococcal, meningococcal C (+B), rotavirus• Successes and re-emergence

• Pertussis, mumps, meningococcal• New vaccines in the pipeline

• Influenza (universal), Respiratory Syncytial Virus, Group B Streptococcus….

3

*2019 provisional data 22/5/2019

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4

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National Immunisation Guidelinesregularly updated 

National Immunisation Office: http://www.hse.ie/eng/health/immunisation/hcpinfo/guidelines/

Only available online

* Regular changes to online chapters of 2013 Immunisation Guidelines

5

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New Primary Childhood Immunisation Schedule December 2016

• Two new vaccines added to childhood immunisation schedule. Meningococcal B and rotavirus

6www.imunisation.ie

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7

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Reporting of National Immunisation Statistics

• Statistics calculated at the HSE regional level 

• Quarterly Reports collated at HPSC• http://www.hpsc.ie/

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Immunisation Uptake Statistics at 12 and 24  months –National, Q1 2000‐ Q3 2018

9

60

65

70

75

80

85

90

95

100

Q3

2000

Q1

2001

Q3

2001

Q1

2002

Q3

2002

Q1

2003

Q3

2003

Q1

2004

Q3

2004

Q1

2005

Q3

2005

Q1

2006

Q3

2006

Q1

2007

Q3

2007

Q1

2008

Q3

2008

Q1

2009

Q3

2009

Q1

2010

Q3

2010

Q1

2011

Q3

2011

Q1

2012

Q3

2012

Q1

2013

Q3

2013

Q1

2014

Q3

2014

Q1

2015

Q3

2015

Q1

2016

Q3

2016

Q1

2017

Q3

2017

Q1

2018

Q3

2018

% Im

mun

isat

ion

Upt

ake

Quarter/YearD3 P3 Hib3 Polio3 MenC3 HepB3

MenC2 MenC1 PCV2 BCG MenB2 Rota2

Uptake (%) at 12 months of age 

Source: local immunisation offices, collated by HPSC

Uptake (6in1 vaccine), Q3 2018N

EW

S

0 - 7980 - 8485 - 8990 - 9495 - 100No Data

G

L

DL

KY

MO

CE

TS

RN

NC

MH

NSL

WX

LS/OY

WC

SO/LM

WD

LD/WH

LHCN/MN

CW/KK

WWTN/EL

KE/WW

DN

DW

DNW

DSW DSDSE

DNC

DSC

DN

DW

DNW

DSW DSDSE

DNC

DSC

Uptake (%) at 24 months of age 

Uptake (6in1 vaccine), Q3 2018

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Polio endgame strategy

A hospital room in the US with patients in iron lungs in 1952*

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0

100

200

300

400

5001948

1953

1958

1963

1968

1973

1978

1983

1988

1993

1998

2003

2008

2013

2018

Num

ber o

f Cases Notified

Year

Polio vaccine, 1957

Last case reported, 1984

Polio notifications, Ireland, 1948‐2018

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Rubella notifications and rubella programme, by year 1948‐2018

0

1000

2000

3000

4000

5000

600019

48

1950

1952

1954

1956

1958

1960

1962

1964

1966

1968

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

2016

2018

Num

ber o

f Notificatio

ns

Year

1988 MMR1

1971 ,Rubella vaccine for girls, 

1992 MMR2MR campaign, 1995

MMR2, 4-5 yoa, 1999

*

Rubella vaccine 

MMR vaccine 

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Impact of vaccination on measles, Ireland, 1948‐2018

0

2000

4000

6000

8000

10000

12000

14000

16000

1948

1950

1952

1954

1956

1958

1960

1962

1964

1966

1968

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

2016

2018

Num

ber o

f not

ifica

tions

Year

MMR1 introduced in 1988

Measles vaccine,  introduced in 1985

MMR2 introduced in 1992 

MR campaign1995

MMR campaigns*  

2009,2012‐2014

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14http://www.euro.who.int/__data/assets/pdf_file/0014/401117/IRL.pdf?ua=1

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15http://www.euro.who.int/__data/assets/pdf_file/0014/401117/IRL.pdf?ua=1

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Pneumococcal Conjugate Vaccines (PCV), impact and changes in serotypes, by age group, 2008‐2017

PCV7 serotypes PCV13 serotypes

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0

5

10

15

20

25

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Incide

nce pe

r 100, 000

 of n

on‐

PCV 13

 serotype

s

Year

<2 2‐4 5‐14 15‐64 65+

Emergence of Non PCV 13 serotypes by age group, 2008‐2017

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050100150200250300350400450

Num

ber o

f notificatio

ns

Year B C W Y NG Unk

MenC introduced, plus catch up (< 23 years) 

MenC booster for adolescents Sept 2014 

MenB vaccine from Oct 2016, at 2,3,12 months 

Meningococcal cases by year and serogroup, 1999‐2019*

*CIDR: 19/02/2019

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Meningococcoal serogroup B notifcations, < 5 y.o.a. and total, 2012‐2019*

0

10

20

30

40

50

60

70

80

2012 2013 2014 2015 2016 2017 2018 2019*

Num

ber o

f notificatio

ns

year 

<1 yr1 yr2 yr3  yr4  yrGrand Total

MenB vaccine at 2,4 and 12 months

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Mumps notifications in Ireland, 2018-2019 (weeks 1-12 2019)

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Mumps notifications, 1988‐2019*

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0

500

1000

1500

2000

2500

3000

3500

40001988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019*

Num

ber o

f Notificatio

ns

Year

MMR1, 1988

MMR2, 1992 

MR campaign1995

MMR campaigns  2009,2012‐2014

*CIDR: 22/05/2019

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Mumps notifications, by age group and year (1988‐2019*)

22

0

500

1000

1500

2000

2500

3000

3500

4000

Num

ber n

otificatio

ns

Year 

Unknown65+ yrs55‐64 yrs45‐54 yrs35‐44 yrs25‐34 yrs15‐24 yrs5‐14 yrs0‐4 yrs

Age group begins to be reported, 2000

*CIDR: 22/05/2019

MMR campaigns  2009,2012‐2014

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MMR doses† as % no fica ons by age group Week 20, 2018‐ week 22 2019*

23*CIDR: 22/05/2019             †MMR doses includes self reported and some validated

0%

20%

40%

60%

80%

100%

All ages 15‐24 yo

% notificatio

ns 

Age group

ThreeTwoOneNoneUnknownBlank

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Notified influenza outbreaks and predominant influenza type/subtype by season, 2009/2010 to 

2017/2018, in Ireland 

24

0

5

10

15

20

25

30

35

40

Numb

er of

Influe

nza O

utbrea

ks

Influenza Season

A(H1)n=110

A(H1) & B; n=14 A(H3);

n=17

B, A(H3), A(H1);n=72 A(H3) & A(H1);

n=61

A(H3) & B; n=89

A(H1) & B;n=36

A(H3);n=91

2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

B, A(H3),A(H1); n=200

A(H1)n=110

A(H1) & B; n=14 A(H3);

n=17

B, A(H3), A(H1);n=72 A(H3) & A(H1);

n=61

A(H3) & B; n=89

A(H1) & B;n=36

A(H3);n=91

2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17 2017/18

Source: HPSC Influenza AER 2018 

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ASIR* confirmed influenza cases hospitalised and admitted to critical care during the 2017/2018 influenza season, in Ireland 

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*Age specific rate, based on CSO 2016 data  

Age (years) Number Age specific rate per 100,000 pop. Number Age specific rate per 100,000 pop.0-4 652 196.7 19 5.75-14 451 66.8 20 3.015-24 157 27.2 4 0.725-34 178 27.0 4 0.635-44 298 45.2 16 2.145-54 288 46.0 12 1.955-64 443 87.0 31 6.1≥65 2245 352.1 85 13.3Unknown Age 1 0Total 4713 99.0 191 4.0

Hospitalised Admitted to ICU

Source: HPSC Influenza AER 2018 

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ASIR* confirmed influenza cases hospitalised and admitted to critical care during the 2017/2018 influenza season, in Ireland 

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*Age specific rate, based on CSO 2016 data  

Age (years) Number Age specific rate per 100,000 pop. Number Age specific rate per 100,000 pop.0-4 652 196.7 19 5.75-14 451 66.8 20 3.015-24 157 27.2 4 0.725-34 178 27.0 4 0.635-44 298 45.2 16 2.145-54 288 46.0 12 1.955-64 443 87.0 31 6.1≥65 2245 352.1 85 13.3Unknown Age 1 0Total 4713 99.0 191 4.0

Hospitalised Admitted to ICU

Source: HPSC Influenza AER 2018 

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HCW influenza vaccine uptake, public hospitals, by HSE grade category and influenza season, Ireland*

22.1 25.0

21.0

21.9

12.4 19

.7

18.122.5

20.0

18.5 23.5

12.6 21

.7

17.626

.7 30.2

25.3 33

.4

18.4 24.2

24.1

25.1 29.7

23.1

36.6

17.2 24

.7

23.525.8 29.7

24.8

41.0

18.9 23.3

25.230.4

41.0

30.6

54.7

27.5 31.3 34.038.3

54.4

40.3

66.4

39.8

35.9 44

.8

0

10

20

30

40

50

60

70

GeneralSupport Staff

Health &Social CareProfessionals

Management& Admin

Medical &Dental

Nursing Other Patient& Client Care

All Staff

Overall % Uptake

HSE Staff Category

2011‐2012 2012‐2013 2013‐2014 2014‐2015 2015‐2016 2016‐2017 2017‐2018

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Key points 

• Vaccines have had a major positive impact on decreasing incidence VPDs in Ireland

• Vaccination policy and programme informed and influenced by – New information – Changes in epidemiology (Ireland and internationally) – New vaccines (products)

• Constant need to monitor epidemiology• Need to understand and address reasons for non-vaccination and missed

opportunities• HCWs most important and trusted sources of VPD information for public

– Being up-to-date invaluable!

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Thank you

Acknowledgements • All those involved in diagnosis, surveillance, control, prevention

– Clinicians/GPs/nurses– CHO staff (PMOs, PHNs, SMOs, IT and admin staff, management)– Infection control nurses and teams– Occupational health – Departments of Public health – Laboratories/NVRL/IMSPR, NPSRL– HPSC staff – NIO