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Implementing Expanded Seasonal Influenza Vaccination: Federal Perspective


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Title: Implementing Expanded Seasonal Influenza Vaccination: Federal Perspective

Implementing Expanded Seasonal Influenza
Vaccination Federal Perspective
  • Jeanne M. Santoli (
  • Immunization Services Division
  • National Center for Immunization and Respiratory
  • July 14, 2008

  • Vaccine supply
  • Vaccine financing
  • Vaccine coverage
  • Vaccine safety monitoring
  • Public health infrastructure
  • Supporting activities
  • New knowledge
  • CDCs annual campaign

Approved Influenza Vaccines and Supply
Projections, United States 2008-09 Season
Vaccine Trade name Manufacturer Presentation Age group Projected Production (Doses)
TIV Fluzone sanofi pasteur .25 mL prefilled syringe 0.5 mL prefilled syringe 0.5 mL vial 5.0 mL multi-dose vial 6-35 mo gt 36 mo gt 36 mo gt 6 mo 50 m
TIV Afluria CSL 5.0 multi-dose vial 0.5 mL prefilled syringe gt 18 years 6 m
TIV Fluvirin Novartis Vaccine 5.0 mL multi-dose vial 0.5 mL prefilled syringe gt 4 years 40 m
TIV Fluarix Glaxo SmithKline 0.5 mL prefilled syringe gt 18 years 35-38 m 1/3 Fluarix, 2/3 Flulaval
TIV Fluluval Glaxo SmithKline 5.0 mL multi-dose vial gt 18 years 35-38 m 1/3 Fluarix, 2/3 Flulaval
LAIV FluMist MedImmune 0.2 mL sprayer 2-49 years 12 m
Total Projected Production Total Projected Production Total Projected Production Total Projected Production Total Projected Production 143-146 m
As reported May 12, 2008 at the National
Influenza Vaccine Summit, Atlanta, GA.
Influenza Vaccine Production and Distribution,
US, 1980-2007
Doses Produced (millions) Dose Distributed (millions) Difference (millions)
1980 15.7 12.4 3.3
1990 32.3 28.3 4.0
1995 71.5 54.9 16.6
1999 77.2 76.8 0.5
2000 77.9 70.4 7.5
2001 87.7 77.7 10.0
2002 95.0 83.0 12.0
2003 86.9 83.1 3.8
2004 61.0 57.0 4.0
2005 86.0 81.2 7.0
2006 120.9 102.5 18.4
2007 140.6 112.8 27.8
Influenza Vaccine Production and Distribution,
US, 1980-2007
Sufficiency of Supply
  • 27 million doses of vaccine were not
    distributed in 07-08
  • A mismatch between supply and demand not
    surprising when both supply and recommendations
    are changing
  • There have been steady increases in doses
    distributed over past several years
  • 81 million doses (2005-06)
  • 103 million doses (2006-07)
  • 113 million doses (2007-08)
  • Given projected production for upcoming season
    and data about uptake of new vaccine
    recommendations, including uptake of recent
    expanded flu recommendations, we anticipate that
    supply will likely be sufficient to meet demand

Production Projections for Thimerosal-free or
Preservative-free Influenza Vaccines, United
2007-08 Season 2008-09 Season
Doses licensed for use in children 6-35 months of age 12 m 20 m
Total doses 30 m 50 m
Represents production capacity for products as
reported by the influenza vaccine manufacturers
prior to the 2007-08 season. Represents
production capacity, as reported on May 12, 2008
by influenza vaccine manufacturers at the
National Influenza Vaccine Summit in Atlanta, GA.
NOTE Translation of capacity into actual
production depends upon production yields, lot
release, and demand for product.
Financing for Flu Vaccine
  • VFC resolution adopted Feb 2008 to cover expanded
  • Vaccine available on CDC contracts has increased
  • Approximately 12.5 million doses across all
    products in 08-09
  • Issue of low administration fees for VFC impacts
    influenza vaccination as well as other routine
  • Section 317 Report calls for increased funding
    for underinsured children and adolescents to
    cover routine vaccines, including influenza
  • Private insurance coverage for flu vaccine
  • Time lag for new vaccines vs. expanded recs?

Influenza Vaccination Coverage Among Children
6-23 Months of Age, National Immunization Survey,
Vaccinate all 6-23 month olds recommendation
Encourage vaccination of 6-23 month olds
How do we measure seasonal flu coverage in
  • National Immunization Survey
  • Provider-verified
  • Routinely assesses
  • Children 19-35 months (state level)
  • Children 13-17 years (state level beginning 08)
  • National Health Interview Survey
  • All ages, national data, self reported
  • Self reported
  • Child flu vaccination module available in 2006
  • Immunization Information Systems
  • Provider verified
  • Small area/practice level estimates possible
  • Status of IIS varies by region

Vaccine Safety Monitoring
  • ACIP Influenza Working Group reviewed available
    vaccine safety data as part of deliberation
  • Available data suggest widespread use of TIV/LAIV
    would be safe
  • Existing systems are in place for initial safety
  • Additional efforts needed to optimize safety
    monitoring in non-traditional or non-healthcare

Public Health Infrastructure for Influenza
Vaccine Delivery
  • Broad interest in use of venues that are
    unrelated to vaccination or healthcare to capture
    school-aged children
  • In contrast to traditional or non-traditional
    medical settings, these venues will require staff
    to deliver vaccines
  • Delivery will likely either be public health
    staff or overseen by public health staff
  • Current public health infrastructure is likely
    insufficient to play these roles across the US

A Second Public Health Infrastructure Issue
  • Use of non-traditional and/or non-healthcare
    venues increases need for information- sharing to
    preserve continuity of care
  • Immunization information system (IIS) development
    in the US continues, traditional focus has been
    on younger children
  • In 2006, 65 of children lt 6 yrs participated in
    an IIS
  • 84 of grantees report maintaining vaccination
    data in IIS for persons 11-18 yrs

IIS ProgressUS, 2006, MMWR March 21, 2008
Vol57/N0 11, pp 289-91.
New Knowledge
  • Two RFAs focused on school-based vaccination were
    posted by CDC this year
  • One RFA focuses specifically on influenza
  • Goal was to identify sustainable projectsso
    involvement of billing entity was required
  • RFAs targeted toward state and local health
  • Another RFA focuses on strategies for private
    providers to use a longer vaccination season to
    vaccinate their patients

Promotion of the Expanded Seasonal Recommendations
  • CDCs traditional seasonal campaign enhanced with
    new materials for providers and public
  • Highlight benefits of decreased school
    absenteeism, more time for learning
  • Routine childhood and pre-teen/adolescent
    materials updated to include influenza
    recommendations for these children
  • NIVW to be sponsored December 8-14, 2008 more
    information is available at http//
  • Collaboration with Families Fighting Flu to
    sponsor Childrens Vaccination Day during NIVW

Summing Up
  • Manufacturers project a large supply of vaccine
    for 08-09 season
  • Vaccine financing issues similar to other
    childhood vaccines
  • Underinsured children/adolescents are the primary
  • Vaccine coverage is low in young children
  • Enhancements to current systems for monitoring
    vaccine coverage and safety are needed as current
    mechanisms are not optimized to the newly added
    agegroup and potential new venues
  • Increased public health infrastructure is needed
    to support implementation of expanded
  • Knowledge gaps around immunization delivery exist
    and efforts are being made to fill them

  • Karen Broder
  • Gary Euler
  • John Iskander
  • Lance Rodewald
  • Tammy Santibanez
  • Kris Sheedy
  • Abigail Shefer
  • Greg Wallace
  • Karen Wooten