1. Introduction Director’ s Welcom e INFLUENZA Department of Defense Influenza Vaccination Program Briefing 2009-10 UNCLASSIFIED

2. 2 Outline 1. ACIP Recommendations 2. Vaccines 3. Screening and Documentation 4. Administration 5. Adverse Events PURPOSE: To discuss details of the 2009-10 DoD Influenza Vaccination Program.

3. 3 Influenza Season 2009-10 “Annual influenza vaccination is the most effective method for preventing influenza virus infection and its complications” “Influenza viruses can cause disease among persons in any age group, but rates of infection are highest among children. Rates of serious illness and death are highest among persons aged >65 years, children aged <2 years, and persons of any age who have medical conditions that place them at increased risk for complications from influenza. An annual average of approximately 36,000 deaths during 1990–1999 and 226,000 hospitalizations during 1979–2001 have been associated with influenza epidemics.” ACIP Recommendations for Prevention and Control of Seasonal Influenza with Vaccines MMWR, July 2009 The 2009-10 trivalent influenza vaccine strains are A/Brisbane/59/2007 (H1N1)-like virus A/Brisbane/10/2007 (H3N2)-like virus B/Brisbane/60/2008-like antigens Only the influenza B component represents a change from the 2008-09 vaccine

4. 4 2009-10 ACIP Influenza Guidelines All children 6 mo – 18 yrs All adults ≥50 yrs of age Adults or children who have  Chronic pulmonary, cardiovascular, renal, hepatic, hematological or metabolic disorders  Immuno-suppressed  Any conditions that compromise respiratory functions  Residents of chronic care facilities  Women who are or may become pregnant during the influenza season Healthcare personnel Household contacts and caregivers of children aged < 5 yrs Household contacts and caregivers of people with medical conditions 2009-10 Season Advisory Committee on Immunization Practices released the recommendations for Prevention and Control of Influenza

5. 5 Vaccine Manufacturers DoD contracted with three manufacturers Injectable  Sanofi-Pasteur - Fluzone  CSL Biotherapies - Afluria Intranasal  MedImmune - Flumist 3.69 Million doses of influenza vaccine contracted for DoD 1.83 Million - U.S. Army 866K - U.S. Air Force 953K - U.S. Navy 64K - U.S. Coast Guard

6. 6 VaccineAgeDosageUnique Contraindications Flumist (Live) 2-49 yrs0.2ml (0.1ml per nostril) Intranasal Pregnant, immune suppressed, Children on chronic aspirin therapy, Asthmatics, Reactive airway disease, Chronic pulmonary disease, hypersensitivity to gentamicin, gelatin or arginine Fluzone (Inactivated) 6-35 mo 3 and older 0.25ml IM 0.5ml IM Afluria (Inactivated) 18yrs and older0.5ml IMAllergy to neomycin or polymixin READ PACKAGE INSERTS Vaccine Comparison Table

7. 7 Prioritization Should an unexpected vaccine shortage occur, directions will be provided by ASD (HA) and will be consistent with recommendations published in subsequent issues of the Morbidity and Mortality Weekly Report. In accordance with (IAW) HA Policy 08-005, “Policy for Mandatory Seasonal Influenza Immunization for Civilian Health Care Personnel Who Provide Direct Patient Care in Department of Defense Military Treatment Facilities”, military treatment facilities are directed to require all civilian health care personnel (HCP) who provide direct patient care in DoD MTFs be immunized against seasonal influenza infection each year as a condition of employment, unless there is a documented medical or religious reason not to be immunized. No vaccine shortage is anticipated this year Every effort should be made to swiftly complete seasonal influenza vaccinations and begin preparing for the impending Novel A(H1N1) Influenza Vaccine Immunization Program (NIVIP). A vaccine that can potentially prevent infection by the H1N1 virus is currently being developed and further guidance will be published detailing its use in DoD.

8. 8 Expected Shipment Dates Injectable vaccines (Fluzone) (Afluria) - 45% AUG - 25% SEP - 20% OCT - 10% NOV Intranasal (Flumist) - 35% AUG - 25% SEP - 30% OCT - 10% NOV

9. 9 Storage and Handling Requirements Fluzone  Shipped and stored at 2-8ْ C  Shelf life 12 months Afluria  Shipped and stored at 2-8ْ C  Shelf life 12 months Flumist  Shipped from manufacturer frozen and stored locally in refrigerator at 2-8ْ C  18 week shelf life

10. 10 Screening Read package inserts for contraindications, precautions and warnings Pay particular attention to AApproved age ranges of product IIndividual allergies (eggs, thimerosal, vaccine components, latex) IIndividual medical conditions (pregnancy, history of Guillain-Barre Syndrome, asthma, immune-compromised) Choose the best product for your patient

11. 11 Proper Documentation Electronic and paper documentation should include  Patient name, rank and SSN  Date of vaccination  Vaccine name/code  Manufacturer  Lot #  Volume  Administration route and anatomic site  Name, rank and SSN of prescriber  Vaccinator name  Date patient given Vaccine Information Statement (VIS) and VIS version date

12. 12 Immunization Tracking and Reporting Service members should receive influenza vaccination by 1 December 2009 Services will monitor influenza immunization compliance through their respective Immunization Tracking Systems beginning in October 2009 On 1 December 2009, DoD will include influenza compliance in FMR calculations for all components MILVAX will report influenza vaccination compliance during the OTSG Operations Update Compliance will be categorized as GGreen (≥ 90% vaccinated) AAmber (80-90% vaccinated) RRed (<80% vaccinated)

13. 13 Administration

14. 14 Flumist Administration Video

15. 15 Adverse Event after Vaccination Most common adverse reactions with influenza vaccinations  Injectable: soreness, tenderness, pain and swelling at the injection site. Malaise, headache and myalgia  Intranasal: runny nose or nasal congestion in all ages, fever >100ºF in children 2-6 yrs of age and sore throat in adults Vaccine Adverse Event Reporting System (VAERS)  www.vaers.hhs.gov www.vaers.hhs.gov  Contact VAERS 1-800-822-7967 Vaccine Healthcare Centers (VHC) Network  1-866-210-6469 (24 hrs)  www.vhcinfo.org www.vhcinfo.org

16. 16 Use Intranasal vaccine for healthy 2-49 year olds without contraindications Administer injectable vaccine for those in whom the intranasal vaccine is contraindicated or where the intranasal vaccine is unavailable due to logistical constraints Remain cautious – read all packaging Initiate vaccination campaigns once adequate vaccine has arrived to avoid unnecessary waste of vaccine Unless significant local shortages occur, no eligible beneficiary should be denied vaccination when requested Screen for other vaccine needs, such as pneumococcal or Tdap vaccine at time of influenza vaccine screening Use seasonal influenza immunization program to test installation-based processes that might be used in a Pandemic Key Points

17. 17 Contact Us For more information about DoD Influenza Vaccination Program, or if you have any vaccine related questions please contact the MILVAX Agency. www.vaccines.mil/flu vaccines@amedd.army.mil (877) GET-VACC (877-438-8222)

18. 18 www.vaccines.mil www.vaccines.mil