Influenza Vaccination

National Perspective

Dr. Anna Clarke

National Immunisation Office

April 2017

www.immunisation.ie

Outline

• Influenza as a disease

– epidemiology

• Seasonal influenza vaccination programme 2016/2017

• Influenza vaccine

– Safety and efficacy

• Risk groups

– Healthcare worker

– Pregnant women

• Planning for next season

• Key messages

www.immunisation.ie

Influenza (Flu)

• Infection caused by flu virus

• Symptoms can range from classic influenza to

mild illness or asymptomatic infection

• Spreads by aerosol or touching

• Most at risk include

– Risk groups

– Healthcare workers

– Pregnant women

• Flu is dangerous

www.immunisation.ie

Influenza Sentinel GP Consultation Rates per

100,000 population and Number of Positive

Influenza Specimens 2015-2017

Risk Groups

• Chronic illness requiring medical follow-up

e.g. CF and other chronic respiratory

diseases, CHD; Immunosuppression,

asplenia or splenic dysfunction; ≥65yrs,

Children and teenagers on long-term

aspirin therapy, Residents of nursing

homes and long stay facilities, HCW,

Pregnant women

www.immunisation.ie

2016/2017 Annual campaign

• Risk groups

•Pregnant women

• Health care workers

• Season continues until end of April

Seasonal Influenza Vaccination Programme

Influenza Vaccine

2016/2017 season

Influenza Vaccine

• Contraindication – Anaphylaxis to any of the vaccine components or a

previous dose

• Precautions – Acute severe febrile illness; defer until recovery

– Egg allergy

• Adverse Reactions – Local – redness and swelling.

– General – fever, malaise, myalgia

Vaccine Safety

• Vaccine is safe

• Most common side effect is redness and

soreness at injection site

• Less common – fever, malaise, muscle

pain

• Rare – Neurological reactions

www.immunisation.ie

Vaccine Efficacy

• 70-90%- in healthy individuals <65

• Lower in the elderly and in those

individuals with underlying medical

conditions although immunisation has

been shown to reduce incidence of severe

disease including pneumonia,

hospitalisation and mortality

www.immunisation.ie

Factors Influencing Vaccine Efficacy

• Closeness of the match between the vaccine strain and the circulating virus

• Age of vaccinee: – older people do not respond as well

• Health of the vaccinee: – people with chronic illnesses and immune system disorders do

not respond as well as healthy individuals

• Number of vaccinations: – in children under 9 two doses are required in the first year of use

• Type of vaccine used; – adjuvanted vaccines can give better immune response

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HealthCare Workers

• HealthCare Workers (HCWs) are recommended annual seasonal influenza vaccination

Vaccination:

• – Reduces risk of influenza transmission between patients and HCWs

• – Protects against influenza and complications (including death) associated with disease

• – Is an important infection control intervention

Uptake by Hospital HCW Staff Category by Season 2

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10

20

30

40

GeneralSupport Staff

Health &Social Care

Professionals

Management& Admin

Medical &Dental

Nursing Other Patient& Client Care

All Staff

Avera

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Up

take

HSE Staff Category

2011-2012 2012-2013 2013-2014 2014-2015 2015-2016

Uptake by LTCF HCW Staff Category by Season 1

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20

30

40

50

60

GeneralSupport Staff

Health &Social Care

Professionals

Management& Admin

Medical &Dental

Nursing Other Patient& Client Care

All Staff

Avera

ge %

Up

take

HSE Staff Category

2011-2012 2012-2013 2013-2014 2014-2015 2015-2016

“I know the symptoms and

would stay at home if I got sick

so I wouldn’t infect

my colleagues or patients.”

“I’m very healthy so my immune

system will protect me from flu.”

Why Should Health Care Workers Be Vaccinated?

• healthy people can get seriously ill from flu

• >20% HCWs get flu every year

• may only have mild symptoms and continue to work

• highly transmissible 1 day before & 5-7 days after symptoms

• vaccine contains killed viruses so cannot cause flu

http://www.immunisation.ie/en/HealthcareProfessionals/Influenza

“I got the vaccine

and it gave me the flu.”

Transmission of Influenza by

HCW • In a neonatal intensive care unit1

– 19/54 infants were infected and one died

– 15% of staff were vaccinated against influenza

– Only 29% of staff who reported influenza-like illness took time off work

• In an organ transplant unit: attack rate 33%2 – Each patient was in an individual room and 3/4 had no visitors to account

for the spread

– 3/27 (11%) HCWs on the ward had influenza; not vaccinated

• In long-term facility3 – 65 residents developed influenza

– Over half developed pneumonia, 19 hospitalised, 2 died

– 10% of HCW were vaccinated

1Cunney et al. Infect Control Hosp Epidemiol. 2000;21:449–51 2Malavaud S, et al. Transplantation. 2001;72:535–7 3CDC. MMWR 1991;4:129-131

4Elder G, et al. BMJ. 1996;313:1241–2

Influenza infection can remain asymptomatic but infectious4

17

www.immunisation.ie

Pregnant Women

Why Vaccinate?

Maternal influenza associated with an increased risk of – hospitalisation and maternal death (1 in 11 in the UK 2009-2012)

– congenital abnormalities • cleft lip

• neural tube defects

• hydrocephaly

• congenital heart defects

– spontaneous abortion

– preterm delivery

– birth of a small-for-gestational age infant

– foetal death

Infants under 6 months have the highest rate of hospitalisation and death from influenza

www.immunisation.ie

Influenza Vaccine and Pregnancy

1960s Administered to pregnant women in the US

1997 Included in high risk groups

2004 At any stage in pregnancy

2009/2010 Recommended in Ireland since 2009/10

2012 Highest priority group (WHO)

Trivalent or quadrivalent inactivated vaccine

Recommended for consecutive seasons if needed

www.immunisation.ie

Influenza Vaccine Efficacy in Pregnancy

Effective

• Disease reductions of 41-91%

• 70% reduction in 2009/10

• Vaccination during pregnancy provides passive immunity to infants up to 6 months of age

• incidence of confirmed influenza reduced by 63%

• 40% reduction in pre term births (as effective as smoking cessation)

• 57% reduction in small for gestational age infants

• Into adulthood

• ? reduce long term effects of pre term/ small for gestational age births

Uptake In Those Aged ≥ 65 years

www.immunisation.ie

Vaccine for 2017/2018 Season

• A/Michigan/45/2015 (H1N1)pdm09-like virus;

• an A/Hong Kong/4801/2014 (H3N2)-like virus;

• A B/Brisbane/60/2008-like virus.

www.immunisation.ie

Planning

• Lessons Learnt from last season

• Procurement

• Who needs to be targeted?

• Communication Campaign

• Implementation

• Education

• Vaccine deliveries

• Monitoring flu activity

• Monitoring vaccine distribution

www.immunisation.ie

Key Messages

• Flu is dangerous

• Flu vaccine is important public health

initiative

• Uptake less than optimal

• People in risk groups must be vaccinated

• Flu vaccine is safe

• Need to plan now for next season

www.immunisation.ie

Thank You

Further information

www.immunsation.ie

Uptake in Hospitals by Hospital Group & Season

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Hospital Group

2011-2012 2012-2013 2013-2014 2014-2015 2015-2016

Uptake in LTCFs by CHO & Season 1

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CHO 1: DL;SO/LM;CN/MN

CHO 2: G;RN; MO

CHO 3: CE;L; TN/EL

CHO 4: KY;NC; NSL;

WC

CHO 5: TS;CW/KK;WD; WX

CHO 6: WW;DS; DSE

CHO 7: KE;DW; DSC;

DSW

CHO 8:S/OY;

LD/WH;LH/MH

CHO 9: DN;DNC; DNW

Avera

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Community Health Organisation

2011-2012 2012-2013 2013-2014 2014-2015 2015-2016