Influenza Vaccination National Perspective Dr. Anna Clarke National Immunisation Office April 2017 www.immunisation.ie
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
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
Influenza Sentinel GP Consultation Rates per 100,000 population and Number of Positive Influenza Specimens 2015-2017
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
Seasonal Influenza Vaccination Programme 2016/2017 Annual campaign Risk groups Pregnant women Health care workers Season continues until end of April
Influenza Vaccine 2016/2017 season
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
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
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
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 11
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
Average % Uptake 13.4 11.2 14.6 16.7 16.6 16.7 21.0 18.4 17.7 19.7 19.3 21.2 22.6 24.4 23.9 24.6 22.5 24.9 20.1 23.5 23.5 22.4 21.5 21.3 22.5 25.4 25.8 28.3 28.2 27.9 28.5 29.4 34.0 31.9 38.2 Uptake by Hospital HCW Staff Category by Season 40 30 20 10 0 General Support Staff Health & Social Care Professionals Management & Admin Medical & Dental HSE Staff Category Nursing Other Patient & Client Care 2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 All Staff
5.2 6.7 8.3 11.7 13.0 17.0 16.4 14.3 15.3 13.6 Average % Uptake 17.0 18.5 16.0 16.6 28.4 30.5 31.1 26.2 27.2 25.7 27.0 30.6 26.7 26.0 28.1 26.6 32.4 35.5 36.7 40.1 39.0 43.3 43.4 48.6 55.1 Uptake by LTCF HCW Staff Category by Season 60 50 40 30 20 10 0 General Health & Support Staff Social Care Professionals Management & Admin Medical & Dental HSE Staff Category Nursing Other Patient & Client Care 2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 All Staff
Why Should Health Care Workers Be Vaccinated? I m very healthy so my immune system will protect me from flu. I know the symptoms and would stay at home if I got sick so I wouldn t infect my colleagues or patients. I got the vaccine and it gave me the flu. 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
Transmission of Influenza by HCW In a neonatal intensive care unit 1 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 facility 3 65 residents developed influenza Over half developed pneumonia, 19 hospitalised, 2 died 10% of HCW were vaccinated Influenza infection can remain asymptomatic but infectious 4 1 Cunney et al. Infect Control Hosp Epidemiol. 2000;21:449 51 2 Malavaud S, et al. Transplantation. 2001;72:535 7 3 CDC. MMWR 1991;4:129-131 4 Elder G, et al. BMJ. 1996;313:1241 2 17
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 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 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 www.immunisation.ie
Uptake In Those Aged 65 years www.immunisation.ie
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
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
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
Thank You Further information www.immunsation.ie
Average % Staff Uptake 5.3 9.4 9.4 12.1 11.2 14.7 19.0 19.0 23.6 27.1 21.6 31.6 22.9 27.1 19.9 19.8 11.6 17.9 15.5 11.9 11.0 16.7 17.9 15.7 17.5 27.6 23.4 23.9 26.4 22.8 27.3 26.9 23.1 26.0 24.2 30.6 30.9 29.7 31.4 34.1 37.6 Uptake in Hospitals by Hospital Group & Season 50 40 30 20 10 0 Hospital Group 2011-2012 2012-2013 2013-2014 2014-2015 2015-2016
5.1 Average % Staff Uptake 8.7 14.3 12.5 13.8 15.7 10.8 13.0 14.7 14.9 18.0 18.0 18.7 17.4 15.5 15.2 22.9 18.6 21.1 21.9 19.0 20.9 22.6 29.2 26.1 27.1 27.4 26.4 28.4 29.4 27.1 23.5 22.8 22.2 28.6 33.2 33.3 38.9 37.1 40.4 41.6 44.1 47.6 48.1 52.1 Uptake in LTCFs by CHO & Season 60 50 40 30 20 10 0 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 Community Health Organisation CHO 8: S/OY; LD/WH; LH/MH 2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 CHO 9: DN; DNC; DNW