# Presentation: 294011

## Influenza Prevention and Control in Canada

- Arlene King,  MD, MHSc, FRCPC
- Director, Immunization and Respiratory Infections Division, Health Canada
- Meeting of the
- National Vaccine Advisory Committee
- Washington DC, June 1-2, 2004

## Overview

- Context:  Canada’s National Immunization Strategy
- Surveillance
- Scientific recommendations
- Program and policy development
- Vaccine supply
- Public education
- Vaccine safety
- Influenza research

## The National Immunization Strategy (NIS) is ...

- A comprehensive, collaborative, progressive strategy to meet the current and future immunization needs of all Canadians
- A means for governments and other key stakeholders to work in partnership to address national immunization issues

***Meeting of the National Vaccine Advisory Committee***
***Washington DC, June 1-2, 2004***

## ... to achieve the following goals

- Ensure equitable and timely access to recommended vaccines by NACI for all Canadians
- Optimize program safety and effectiveness
- Improve coordination and efficiency of immunization programs
- Optimize cost-effectiveness/affordability of programs
- Ensure security of vaccine supply
- Provide rapid and effective national interventions in emergency situations and in response to international requests when required

***Meeting of the National Vaccine Advisory Committee***
***Washington DC, June 1-2, 2004***

## It has five Key Components ...

- National Goals and Objectives
- Equitable Access:  Collaborative Immunization Program Planning
- Vaccine Supply
- Immunization Registries
- Immunization Safety
- and five Supporting Activities...
- Immunization Research
- Public Education
- Professional Education
- Approaches to Special Populations
- Vaccine Preventable Disease Surveillance

***Meeting of the National Vaccine Advisory Committee***
***Washington DC, June 1-2, 2004***

## Slide 6

## Canada’s National Influenza Surveillance Program

## Early detection and monitoring of national/provincial influenza activity through real time:
surveillance of ILI
laboratory isolate reports
provincial/territorial influenza activity assessment
International monitoring of influenza activity
Information sharing (local, provincial/territorial, national, international)
Rapid dissemination of information

- surveillance of ILI
- laboratory isolate reports
- provincial/territorial influenza activity assessment
- International monitoring of influenza activity
- Information sharing (local, provincial/territorial, national, international)
- Rapid dissemination of information

***Meeting of the National Vaccine Advisory Committee***
***Washington DC, June 1-2, 2004***

- Activities

## Partners in FluWatch 

**Laboratories**

**Sentinel Physicians**

**Centre for Infectious Disease Prevention and Control (CIDPC)**

**Provincial and Territorial Ministries of Health**

***Meeting of the National Vaccine Advisory Committee***
***Washington DC, June 1-2, 2004***

**Notes:**
Notes for Arlene:  What do Partners Do?

Sentinel Physicians
Provide rates of influenza-like illness (ILI), by age group, for one practice day each week (based on a standard definition of ILI agreed to by all provincial/territorial FluWatch representatives)

 Provincial/Territorial Epidemiologist or Representative
Provide information on influenza activity level by health region each week (based on influenza reports from local health units, workplace and school absenteeism, and information from physicians)

 Laboratories (Provincial, Regional and Hospital)
Provide information on the number of confirmed specimens for influenza A and B

## FluWatch on the Web ...

*FluWatch* on the Web ...

## Influenza Surveillance 

- Other Activities:
- Ongoing exchange of information through the F/P/T Respiratory Illness Surveillance Committee
- Pilot project to collect real time data on influenza hospitalizations in children through the IMPAct program
- Estimating the impact of influenza on morbidity and mortality, including modeling

***Meeting of the National Vaccine Advisory Committee***
***Washington DC, June 1-2, 2004***

## Pediatric hospital-based surveillance program 

- Pediatric hospital-based surveillance program
- Part-time nurse monitor and a volunteer investigator communicate with a network of health centre contacts
- Identify and report vaccine-associated adverse events, vaccine failures and selected vaccine preventable infections in children

## Scientific Recommendations

- National Advisory Committee on Immunization (NACI) provides advice to Health Canada on vaccine use including recommendations on influenza vaccination prior to each influenza season
- The 2004-2005 NACI influenza vaccination statement will be released on June 15 with recommendations on:
- antigenic components of the influenza vaccine
- recommended recipients
- dosage and administration schedule
- contraindications and precautions
- strategies to reduce the impact of influenza.

***Meeting of the National Vaccine Advisory Committee***
***Washington DC, June 1-2, 2004***

## Scientific Recommendations - II

- Pandemic Influenza Committee
- Federal/Provincial/Territorial (F/P/T) committee
- Provides technical advice on annual and pandemic influenza prevention and control
- Continuum
- Provides overall guidance on the Canadian Pandemic Influenza Plan

***Meeting of the National Vaccine Advisory Committee***
***Washington DC, June 1-2, 2004***

## Program and Policy Development 

- Canadian Immunization Committee
- Mechanism for F/P/T collaboration to provide leadership in immunization through the analysis, development and recommendation of:
- National goals and objectives
- Effective and cost-effective immunization programs
- Frameworks and practices
- Guidelines and best practices

***Meeting of the National Vaccine Advisory Committee***
***Washington DC, June 1-2, 2004***

## Program and Policy Development - II

- The CIC moves scientific recommendations (e.g. NACI recommendations) to F/P/T influenza season vaccination program implementation
- Diversity in populations offered publicly funded vaccine
- Ontario:  publicly funded program to all residents 6 months of age and older
- Most others:  publicly funded programs for seniors, persons under 65 years at high risk, household contacts of persons at high risk, health care workers

***Meeting of the National Vaccine Advisory Committee***
***Washington DC, June 1-2, 2004***

## Influenza Vaccine Safety 

- Influenza vaccine-associated adverse event surveillance system (VAESS)
- Is the cornerstone of vaccine safety monitoring
- Has two major components: passive and active monitoring systems
- Allows rapid risk assessment and response to reported events (e.g. oculo-respiratory syndrome)

***Meeting of the National Vaccine Advisory Committee***
***Washington DC, June 1-2, 2004***

## Influenza Vaccine Safety - II - VAESS

**Active reporting**

**Passive reporting**

**Vaccine **
**manufacturer**

**Vaccine **
**providers**

**P/T health **
**ministries**

**Local health **
**authorities**

***Meeting of the National Vaccine Advisory Committee***
***Washington DC, June 1-2, 2004***

**Notes:**
IMPAct: adverse events that are potentially linked to immunization are monitored by 12 major pediatric hospitals across Canada on a timely basis, and reported to Health Canada.

## Influenza Vaccine Supply

- Vaccine Supply Working Group
- F/P/T, including other Federal Departments (PWGSC, DND, CSC) membership
- Involved in reviewing and assessing Canadian vaccine supply issues and making recommendations to vaccine manufacturers and Health Canada
- Bulk purchasing program in place through PWGSC

***Meeting of the National Vaccine Advisory Committee***
***Washington DC, June 1-2, 2004***

## Public and Professional Education

- Annual Influenza Awareness program
- Raises awareness of the need for annual influenza immunization by providing credible sources of information for the public, health professionals and the media

***Meeting of the National Vaccine Advisory Committee***
***Washington DC, June 1-2, 2004***

## Influenza Research

- Development of national research agenda
- Coordinated evaluation of the Ontario's Universal Influenza Immunization Program
-  Mock-up vaccine production and clinical trials with novel influenza vaccine strain to test pandemic vaccine production capacity

***Meeting of the National Vaccine Advisory Committee***
***Washington DC, June 1-2, 2004***

## Influenza Research - II

- National leadership and collaboration on the development of new vaccine technologies
- Vaccine coverage surveys – research that informs program planning
- Vaccine effectiveness studies

***Meeting of the National Vaccine Advisory Committee***
***Washington DC, June 1-2, 2004***

## Outbreak Detection and Response

- Rapid Alert Mechanism
- Canadian Integrated Outbreak Surveillance Centre (CIOSC) web-based reporting system
- Respiratory Infections Outbreak Response Protocol (RIORP)
- Avian Flu
- Pandemic Flu
- SARS

***Meeting of the National Vaccine Advisory Committee***
***Washington DC, June 1-2, 2004***

## Organized by

**Organized by**
**The Immunization and Respiratory Infections Division, Health Canada **
**and the Canadian Paediatric Society**