# Presentation: 933397

## Influenza Vaccination Update for 2006-07

**Jeanne M. Santoli, MD, MPH**
**Deputy Director, Immunization Services Division****National Center for Immunization and Respiratory Diseases **
**Centers for Disease Control and Prevention **
**June 2006**

## Outline

- Expanded Recommendations
- Supply Projections
- Important Challenges
- Key Strategies

## Expanded Recommendations:  Annual Vaccination of 24-59 month old children

- Beginning with the 2006-07 season
- Based upon increased risk of clinic and ED visits
- Includes household contacts and out-of-home caregivers
- Timing of the recommendation and limited supply of vaccine for young children will impact implementation

## Estimated Size of ACIP Recommended Groups

**Estimated Size of ****ACIP Recommended Groups**

**Notes:**
Annual influenza vaccination is recommended for high risk persons, their household contacts and caregivers, and health care personnel.  This slide depicts the changes in the estimated size of ACIP recommended target groups beginning in 1964 [79 M].  The total number of persons targeted for routine influenza vaccination in the US is now approximately 218 million persons or 73% of the population. 

As we strive to decrease influenza-associated morbidity and mortality, we are considering different options for recommendations:  Should we expand to have universal vaccination recommendations that include an additional 78 million people?  Should we strive toward better coverage levels among the existing target populations that already number 218 million?  Should we consider taking a more focused approach, such as vaccinating school children?  Or, some combination of these approaches.

I don’t have the answers to these questions for you today; but I hope that you’ll continue to be interested in these issues as we work toward improving the prevention and control of influenza.

Thank you.

## Projected Production

|  | # manufacturers | # 
formulations | # 
doses |
| --- | --- | --- | --- |
| Current 
(as of 6/2006) | 4 | 7 | ~100 million doses |
| Potential | 4 | 8 | Up to 120 million doses |

## What is reason for these promising projections for 2006-07?

- Four manufacturers in the market
- DHHS efforts to enhance production capacity for seasonal and pandemic influenza vaccine
- Contracts to secure a year round egg supply
- Contracts to increase capacity, including cell-culture capacity
- Enhanced guidance for influenza vaccine manufacturers from FDA

## Are supply problems anticipated?

- Yes and No

## Yes, because . . . 

- CDC anticipates that providers may be unable to obtain sufficient vaccine for their 3 year old patients
- Single supplier of vaccine for this age-group
- Timing of expanded recommendation (occurred after pre-booking period)
- For providers without sufficient vaccine for all 6-59 month olds, CDC recommends providers consider prioritizing 6-23 months olds.

## No, because . . .

- At present, we have no information to suggest that production problems will result in a delay of vaccine that has been ordered.

## And, of course . . .

- Influenza vaccine production is unpredictable, particularly in a year when 2 of 3 vaccine strains are new.

## Important Challenges

- Unpredictability of production
- Multiple products and formulations
- Importance of timing of vaccine availability
- Inherent challenge in balancing supply and demand/utilization

## Cumulative Monthly Influenza Vaccine Distribution

- Doses (Millions)

**83**

**81.2**

## Influenza Vaccine Production and Distribution, US, 1980-2005

|  | Doses Produced (millions) | Doses Distributed (millions)  |
| --- | --- | --- |
| 1980 | 15.7 | 12.4 |
| 1985 | 23.1 | 20.1 |
| 1990 | 32.3 | 28.3 |
| 1995 | 71.5 | 54.9 |
| 1999 | 77.2 | 76.8 |
| 2000 | 77.9 | 70.4 |
| 2001 | 87.7 | 77.7 |
| 2002 | 95.0 | 83.0 |
| 2003 | 86.9 | 83.1 |
| 2004 | 61.0 | 56.5 |
| 2005 | 86.0 | 81.2 |

**Notes:**
                         Produced           Distributed	
1980	15.7	12.4	79%
1985	23.1	20.1	87%
1990	32.3	28.3	88%
1995	71.5	54.9	77%
1999	77.2	76.8	99%
2000	77.9	70.4	90%
2001	87.7	77.7	89%
2002	95.0	83.0	87%
2003	86.9	83.1	96%
2004	61.0	56.5	93%
  	86.0	81.2 	94%

 	sanofi: 	50 m
		Chiron: 	40 m
		GSK:	7-9 m
		MedImmune:	3 m
			100-102 m
		IDB:	15-20 m

## Balancing Supply and Demand/Utilization

- We must have contingency plans in place in the event that vaccine is delayed or the supply is insufficient.
- We want to promote influenza vaccine utilization to optimize health protection of the US population and minimize waste of vaccine.
- **Sometimes work done to address one of these goals may seem to contradict the other goal.

## Key Strategies for the 2006-07 Influenza Season

- No tiered vaccination
- More information about distribution
- Enhanced communication to/from distributors
- Data for state/local public health officials
- 2nd 2006 National Influenza Vaccine Summit
- Optimizing vaccine use for 2006-07 by targeting selected venues

## Enhanced Communication

## Distribution Data for Public Health

- Data have been supplied to CDC for use by state/local health officials since 2004
- Meeting in April 2006 to prepare for 2006-07, determine if additional data might be made available
- Pre-book data, anticipated shipment dates
- Current status:  Some distributors willing to share pre-book data; inability to provide anticipated shipment dates; concerns about provider-level data.  Final decisions pending.
- Data are proprietary and sharing them is voluntary

## Conceived in response to delays in 2000-01

Co-sponsored by AMA and CDC; annual meetings since 2001 and ongoing workgroup efforts

140+ individuals representing ~70 key private and public stakeholders involved in influenza vaccination, including:  professional organizations; state/local/federal public health agencies; manufacturers; distributors; payers; community vaccinators; representatives from hospitals, long term care facilities, quality improvement organizations, consumer groups, and advocacy organizations.

- Co-sponsored by AMA and CDC; annual meetings since 2001 and ongoing workgroup efforts
- 140+ individuals representing ~70 key private and public stakeholders involved in influenza vaccination, including:  professional organizations; state/local/federal public health agencies; manufacturers; distributors; payers; community vaccinators; representatives from hospitals, long term care facilities, quality improvement organizations, consumer groups, and advocacy organizations.

**National Influenza Vaccine Summit**

## Second 2006 National Influenza Vaccine Summit Meeting

- _Objective_  Discuss, develop, and implement a plan to increase utilization of  influenza vaccine for the 2006-07 season
- _Focus_
- Vaccination of priority groups, contacts, and the general public
- Helping health care providers to better promote influenza vaccination
- Communication strategies to facilitate increased utilization of influenza vaccine

## Potential Venues for Focus in 2006-07, I

- Workplace vaccination
- Many adults do not make regular doctor visits
- Convenience as a key factor
- Has been shown to reduce physician visits and lost work days (Nichol 1995, Bridges 2000)
- Includes healthcare settings

## Potential Venues for Focus in 2006-07, II

- Colleges/universities
- Mumps outbreaks in 2005-06 have demonstrated potential for widespread transmission in this setting
- New vaccines for young adults (Meningococcal conjugate, Tdap) may provide an opportunity for a “platform” in this venue
- College entry requirements for these vaccines offer  opportunities to educate, schedule return visits for influenza vaccine

## Acknowledgments

- Gary Euler
- Lance Rodewald
- Abigail Shefer
- Nicole Smith
- Raymond Strikas
- Litjen Tan
- Greg Wallace

**Extra slides**

## Healthcare Distributor Locations

- Source:  Influenza Vaccine Production & Distribution Market Brief, HIDA, 2006