1. Seasonal influenza vaccination in the WHO European Region preliminary results WHO workshop on sentinel influenza surveillance, 16-17 November, 2011 Istanbul, Turkey Pernille Jorgensen | Influenza and other Respiratory Pathogens WHO Regional Office for Europe In partnership with the VENICE Collaboration and ECDC

2. Background influenza vaccines Influenza vaccines introduced 1940s Vaccination is primary means of preventing influenza today Excellent safety record High efficacy:70-90% in healthy adults …but lower in the elderly... -60% in persons >60 years -30-40% in persons >85 years

3. Priority groups for influenza vaccination Reference: WHO/Europe recommendations on influenza vaccination during the 2011-2012 winter season www.euro.who.int/__data/assets/pdf_file/0008/152297/EURO_2011_2012_flu_vacc_rec.pdf Elderly Health care workers Pregnant women Residents of institutions for older persons and the disabled Individuals >6 months with underlying chronic medical conditions

4. First VENICE survey on seasonal influenza vaccination in WHO European Region

5. Aims and objectives Aim To assess progress toward the WHO goal of 75% influenza vaccine coverage in elderly by 2010 Specific objectives Identify country specific vaccine recommendations Describe influenza vaccine coverage in 2008/2009 and 2009/2010 Describe influenza vaccination implementation Provide a baseline from which to measure future improvements in seasonal influenza vaccine uptake

6. Methods Self-administered questionnaire to national vaccination focal points, 53 WHO Member States in August 2011

7. Preliminary results Response from 46/53 (87%)

8. National influenza vaccination programmes 43/46 (93%) countries had access to seasonal influenza vaccines in 2008/2009 season

9. Seasonal influenza vaccine doses available relative to total population Range from <1% to 23% Note: Limited vaccine availability may reflect risk group vaccination policies

10. National recommendations for vaccination seasonal influenza Elderly Pregnancy Clinical risk groups HCW hospital + outpatient

11. National recommendations clinical risk groups

12. National recommendations for vaccination seasonal influenza Children

13. Principal outlets for administration of seasonal influenza vaccine & cost Cost of single dose vial or prefilled syringe () Median: 5.1 EUR Primary health care clinics are most important site for seasonal influenza vaccination in 90% of countries

14. Vaccine uptake in elderly EU/EEA countries, 2008/2009 75% coverage target

15. Influenza vaccination coverage Clinical risk groups, 2008-2009 N=6

16. Influenza vaccination coverage Health care workers, 2008-2009 N=9

17. Seasonal influenza vaccination campaigns 81% produced specific information for public and health professionals 73% made use of media campaigns – 93% TV – 93% News paper adds – 87% Radio – 73% Posters

18. Conclusions Most countries in the Region have access to seasonal influenza vaccine Similar recommendations for traditional risk groups in the Region Only, 1 country reached WHO 2010 target of coverage >75% among elderly Low coverage in health care workers Cost of influenza vaccine very similar Frequent use of media campaigns to promote influenza vaccination

19. Key challenges Limited vaccine uptake monitoring – Difficult to monitor progress – Difficult to monitor impact Low vaccine uptake Limited vaccine access in some countries

20. Suggested readings www.who.int/wer/2004/wer7903.pdf Hollmeyer HG et al: Influenza vaccination of health care workers in hospitals- a review of studies on attitudes and predictors. Vaccine. 2009 Jun 19;27(30):3935-44. Babcock H et al: Mandatory Influenza Vaccination of Health Care Workers: Translating Policy to Practice Clin Infect Dis. (2010) 50 (4): 459-464. Mereckiene J et al: Differences in national influenza vaccination policies across the European Union, Norway and Iceland 2008-2009. Euro Surveill. 2010;15(44)

21. Next steps - country plans Change seasonal vaccine recommendations and include pregnant women and persons with morbid obesity Prioritization of risk groups in settings with limited quantity of vaccines Assessing cost-benefit of influenza vaccination programme in different settings Evaluating vaccine uptake Improve perception of influenza vaccines in the public

22. Sincere thanks to All national focal points who provided the data VENICE – Jolita Mereckiene – Suzanne Cotter – Luca Dematte ECDC – Angus Nicoll WHO – Anna Bolokhovets – Annemarie Wasley – Guido Maringhini --