1. Seasonal Influenza Vaccine Update Jeanne M. Santoli, MD, MPH National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention September 2006 jsantoli@cdc.gov

2. Outline Recommendations Supply Vaccine Distribution Tracking Communications Update from the National Influenza Vaccine Summit

3. 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

4. Estimated Size of ACIP Recommended Groups

5. Projected Production # manufacturers # presentations # doses Current (as of 9/2006) 47~100 million doses Potential48Up to 115 million doses

6. Timing of Vaccine Distribution (Products Currently Licensed) Majority of doses to be distributed by the end of October –75 million doses by end of October –This is ~15 million doses more than were delivered by the end of October in 2005 –Goal: Provide some vaccine to all who ordered it (by the end of October) Virtually all doses distributed by the end of November

7. Anticipated Supply Problem: Vaccine for 3 Year Old Cohort 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.

8. ACIP Priority Groups for Influenza Vaccination, 2006-07 1a: >65 years with medical conditions Nursing home residents 1b: Persons 2-64 years with high risk conditions Pregnant women Persons without high risk conditions >65 years Children 6-23 months old 1c: Children 24-59 months old Health care workers Close contacts to children <6 months of age 2: Contacts of all other high risk persons Healthy persons 50-64 years 3: Healthy persons 5-49 years of age (everybody else)

9. Influenza Vaccine Distribution Tracking Activities Weekly updates of influenza vaccine distribution data available via CDC’s Secure Data Network Meeting in April 2006 with key stakeholders to plan for this season What is new this season? –Application up and running on September 8, 2006 –Access for up to 5 public health officials per jurisdiction –One time report of pre-book data at the beginning of the season from a small number of distributors

10. Example Summary Report 05-06

11. Communication Campaign Core Elements Web Content, www.cdc.gov/fluwww.cdc.gov/flu Media Outreach and Activities –Radio and television PSAs, video and audio news releases, radio news tours, matte articles for small daily and weekly papers, magazine and newspaper ads, web banners Print Campaign –Web-based “gallery” at www.cdc.gov/flu/gallerywww.cdc.gov/flu/gallery Education and Outreach to Clinicians Audience Research and Message Testing

12. Free Posters and Flyers www.cdc.gov/flu/gallery

13. Early September Communication About Supply and Distribution Timing

14. Key Concepts in the Development of Messages about Supply/Distribution Talk about distribution in terms of actual timing, rather than using terms like “delay” –What is a “normal” or “good season” is ambiguous –Setting realistic expectations –Don’t want to deter the public from seeking vaccination Address the misconception that it is too late to be vaccinated in December and beyond, while still emphasizing the benefits of October/November vaccination

15. Optimizing Influenza Vaccine Utilization in 2006-07: Efforts of the National Influenza Vaccine Summit

16. Second 2006 National Influenza Vaccine Summit Meeting (June) 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

17. Meeting Outcomes Six teams identified to develop plans for the short-term goal of increasing utilization for this upcoming season –Team One: Targeting Healthcare Workers –Team Two: Targeting children aged 6 mos. through 18 years –Team Three: All Contacts of High-Priority Populations with an eye towards “Universal" –Team Four: Extending the Vaccination Season –Team Five: Unifying/Creating Provider Toolkit –Team Six: Utilizing Partnerships (to improve education, reduce barriers for immunizing, and sharing fiscal risk of influenza vaccine)

18. Team 1 - HCWs Objective –Develop tools and resources to encourage HCWs to get vaccinated, address common misperceptions Activities –Joint AMA/CDC letters to administrators of health care facilities and individual HCWs –Tools on summit website –Full-page advertisement in JAMA

19. Team 2 - Pediatrics Objective –Increase utilization of influenza vaccine in children aged 6-59 months and in those attending kindergarten through eighth grade (5 to 14 yr olds) Activities –Toolkit to providers serving 24-59 month olds –Flashcards and other educational materials to distribute to providers serving 5-14 y olds, as well as school and day care classes –Reach children through grandparents (AARP tool)

20. Team 3 – ‘Universal ‘ Objective –Target high-risk persons and general population who wish to decrease risk of influenza Activities –Target certain settings/populations: Colleges and university students – joint CDC/American Health Association letter to all ACHA members Employees in their worksites – Webinar conducted to National Business Group on Health members Faith-based groups – developing network and plans

21. Team 4 – Extending Vaccination Season Objective –Address the misperception that flu vaccination season end in December Activities –Recognition award for provider or organization with innovative approach to deliver vaccine throughout season –“Vaccination day” in January to promote vaccination

22. Team 5 – Provider Tool Kit Objective –Develop a ‘model’ tool kit for health care providers to address: vaccine ordering, vaccine storage, vaccine distribution, vaccine payment, vaccine clinics Activities –Collect existing tool kits from health depts, vaccine manufacturers, and other stakeholder organizations –Unify and customize existing materials into a ‘model’ tool kit

23. Team 6 – Partnerships Objective –Utilize partnerships to improve education, reduce vaccination barriers, and investigate ways of sharing fiscal risks of healthcare providers offering vaccinations Activities –Co-sponsor 3 educational conference calls with partner organizations to target adult and child health care providers, and promotion of late season vaccination –Sharing fiscal risk being discussed

25. Extra slides

26. Influenza Vaccine Production and Distribution, US, 1980-2005 Doses Produced (millions) Doses Distributed (millions) 198015.712.4 198523.120.1 199032.328.3 199571.554.9 199977.276.8 200077.970.4 200187.777.7 200295.083.0 200386.983.1 200461.056.5 200586.081.2

27. Cumulative Monthly Influenza Vaccine Distribution Doses (Millions) 83 81.2