H1N1 Vaccine Implementation Overview Carol Friedman, D.O. Vaccine Implementation Team CDC 1
Laboratory-confirmed cases by age group novel influenza A(H1N1) 24 JUL 2009 (n=43,771) 25000 20000 Percentages represent proportion of total cases 22,080 50% Cases 15000 10000 5000 0 4,816 11% 7,434 17% 2,187 5% 1% 513 6,741 15% 0-4 Yrs 5-24 Yrs 25-49 Yrs 50-64 Yrs 65 Yrs Unknown Age Groups 2
Distribution by Age Group of Persons Hospitalized with Laboratory- Confirmed Seasonal Influenza or novel Influenza A(H1N1), Emerging Infections Program 50 45 40 35 Seasonal 2007-08 Pandemic 2009* Percent 30 25 20 15 10 5 0 < 6 mo 6mo-4 yrs 5-9 yrs 10-17 yrs 18-29 yrs 30-49 yrs 50-64 yrs 65+ yrs Age group *April 12 June 30 3
Percentage with underlying medical risk condition Frequency of underlying medical condition among persons hospitalized with laboratory confirmed novel influenza A (H1N1), by age group (n=268*) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 20% 40% 50% 85% 62% 76% 87% 100% 0-6 m 6m-23m 2-4y 5-9y 10-17y 18-49y 50-64y 65+y Age Groups Similar to seasonal influenza, many have underlying medical conditions (~70% among cases hospitalized during April-May) *Note: S Jain et al, CDC unpublished data. Case series of patients with confirmed novel H1N1 infection who were hospitalized during April-May 2009 4
Deaths by age group of laboratory-confirmed novel influenza A(H1N1), 24 JUL 2009 (n=302) Number of deaths 140 120 100 80 60 40 48 16% 124 41% 71 24% 26 26 20 0 7 2% 0-4 Yrs 5-24 Yrs 25-49 Yrs 50-64 Yrs 65 Yrs Unknown Age Groups 9% 9% 5
Confirmed and probable cases per 100,000 population Incidence of confirmed or probable influenza A(H1N1) by age group, United States, March 15-May 16, 2009 (n=2672)* 3 2.5 2 1.5 1 0.5 0 0.44 1.07 1.64 1.58 1.65 0-11M 1Y 2Y 3Y 4Y 5-11Y 12-18Y 19-49Y 50-64Y 65+ *C Reed et al. CDC, provisional unpublished data 2.60 Age Groups 2.56 0.60 0.20 0.06 6
Hospitalizations by age group of laboratory-confirmed novel influenza A(H1N1), by age group, 24 JUL 2009 (n=5,011) Hospitalizations (n) 1800 1600 1400 1200 1000 800 600 400 200 0 Percentages Represent Proportion of Total Hospitalizations 1,718 34% 35% 1,184 953 24% 19% 658 13% 273 225 4% 5% 0-4 Yrs 5-24 Yrs 25-49 Yrs 50-64 Yrs 65 Yrs Unknown Age Groups 7
Summary of key epidemiologic findings Distribution of cases/hospitalizations/deaths Highest incidence of lab confirmed infections in school age children Highest hospitalization rates among 0-4 year olds Hospitalization rates for Apr-Jul 2009 similar to annual cumulative hospital rates for seasonal influenza among school age children and 18-49 year old adults Fewest cases but highest case-fatality ratio in older adults Distribution of cases by age group is markedly different compared to seasonal influenza Higher proportion of hospitalized cases in children and young adults Few cases in older adults No reports of outbreaks among residents in long term care facilities 70% of hospitalized cases have an underlying medical condition that confers higher risk for complications 8
Workgroup Conclusion: Five target population groups should be initial focus of immunization efforts Primary target groups for vaccination programs are Pregnant women (4M) Household contacts and caregivers for children younger than 6 months of age (5M) Health-care and emergency medical services personnel (14M) Persons 6 months through 24 years of age (102M) Persons aged 25 through 64 years who have medical conditions associated with a higher risk of influenza complications (34M) Total: Initial target group = ~159 million Seasonal influenza vaccine coverage in these groups is only 20-50% 9
Summary vaccination of population groups over time Increasing vaccine availability and demand met by immunization programs Consult local public health authorities Proportion of population 1 0.5 Primary target groups* Pregnant women Infant contacts HCP/EMS Persons 6m 24y Adults high risk <65y (159 million) Healthy adults 25-64 (103 million) Adults 65+ (38 million) 0 Population groups *Note prioritization of ~42 million persons within primary target groups if vaccine demand exceeds availability: 10 1)pregnant women; 2) contacts and care providers for infants <6 months old; 3) HCP/EMS with direct contact with patients or infectious material; 4) children aged 6m through 4 y; and, 5) children aged 5y through 18 y with chronic medical conditions
ACIP Recommendations: Novel Influenza A(H1N1) Vaccine Use Vaccinate as many as possible in initial target groups Pregnant women Household and caregiver contacts of children younger than 6 months of age Health-care and emergency medical services personnel Persons from 6 months through 24 years of age Persons aged 25 through 64 years who have medical conditions associated with a higher risk of influenza complications 11
ACIP Recommendations: Novel Influenza A(H1N1) Vaccine Use Prioritization within these target groups might be necessary if initial vaccine availability is insufficient to meet demand Pregnant women Household and caregiver contacts of children younger than 6 months of age Health-care and emergency medical services personnel wit direct patient contact Children from 6 months through 4 years of age Children and adolescents aged 6 months through 18 years who have medical conditions associated with a higher risk of influenza complications 12
ACIP Recommendations: Novel Influenza A(H1N1) Vaccine Use (2) Once immunization programs are meeting demand from initial target groups, begin providing vaccine to all adults aged 25 through 64, after consultation with local public health Vaccination can be offered to persons 65 years old and older once demand is being met among younger age groups Decisions about when to begin offering vaccination to persons outside of initial target groups should be made in consultation with local public health authorities 13
Public Health planning efforts Planning large scale clinics and schoollocated clinics Reaching out to other vaccinators (defined broadly) to assess interest and capacity to provide H1N1 vaccine in a variety of settings 14
Vaccine planning assumptions: Vaccine available starting mid-october Initial amount: At least 45 million doses will be available by Oct 15, followed by 20 million doses per week (up to the 195 million doses already purchased) Likely 2 doses required, 3-4 wks apart 15
Vaccine products Five manufacturers Majority of vaccine will be inactivated (TIV) and some live, intranasal (LAIV) Storage identical to seasonal vaccine Ancillary supplies will be provided syringes, needles, sharps containers, alcohol swabs 16
Vaccine purchase, allocation, and distribution Vaccine and Ancillary supplies: procured and purchased by US government and made available at no cost for vaccinators will be allocated across states proportional to population will be sent to state-designated receiving/vaccination sites: mix of local health departments and private settings (e.g. provider offices, workplaces, retail settings) 17
Worksite H1N1 vaccination Given that State/Local Public Health Departments will designate where vaccine will be shipped and who can serve as H1N1 vaccinator: Vaccine can be shipped directly to worksite if employer is designated as a vaccinator OR Employers can hire a commercial community vaccinator (must be designated by public state/local) who would bring vaccine with them Vaccination Fee and Billing Employees can be charged an administration fee For insured employees, administration fee will likely be covered by Medicare and Medicaid and most members of AHIP 18
Useful Information to Assist With Planning for 2009-2010 Flu Season http://www.flu.gov http://www.cdc.gov/h1n1flu/general_info.htm http://www.cdc.gov/h1n1flu/vaccination/ 19
H1N1 Business Resources http://www.cdc.gov/h1n1flu/business Communication Guide for Influenza How-to guide for preparing and protecting your business and employees from H1N1 flu General Business and Workplace Guidance for Prevention of H1N1 Help employers with employees who have minimal occupational contact with general public and other coworkers (e.g., office workers) Health Information for Employees/Employers with Children H1N1Flu PowerPoint Presentation Provide information about H1N1 flu to employees, constituents andother partrners 20
Questions/Comments Please forward questions and comments to Tess Benham at NSC. 21