Influenza Vaccination Update for 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 month old children Beginning with the 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

Projected Production # manufacturers # formulations # doses Current (as of 6/2006) 47~100 million doses Potential48Up to 120 million doses

What is reason for these promising projections for ? 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 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)

Influenza Vaccine Production and Distribution, US, Doses Produced (millions) Doses Distributed (millions)

Balancing Supply and Demand/Utilization 1.We must have contingency plans in place in the event that vaccine is delayed or the supply is insufficient. 2.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 Influenza Season No tiered vaccination More information about distribution –Enhanced communication to/from distributors –Data for state/local public health officials 2 nd 2006 National Influenza Vaccine Summit Optimizing vaccine use for 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 , 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 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 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 , 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 , II Colleges/universities –Mumps outbreaks in 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