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Alberta’s Influenza Immunization Program

TARRANT WorkshopElaine Sartison

AHWMarch 24 2007

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Partners

AHW participates in a bulk purchase program with all jurisdictions in Canada facilitated by PHAC

AHW then distributes this vaccine to Regional Health Authorities (RHAs)

Physicians are important partners in the delivery of publicly funded influenza vaccine in Alberta

Physicians can order influenza vaccine from RHAs for patients eligible for publicly funded vaccine

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Partners

The proportion of publicly funded vaccine delivered by physicians varies between RHAs in Alberta. Approx. 50% delivered by PH staff Approx 50% delivered by physicians who see

patients with a chronic illness

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Purchased 800,000 doses (2006/07 season) Vaccine is distributed to all public health centers in

Alberta to manage RHAs accountable for all doses distributed within

their region Follow AHW eligibility criteria and adverse event

surveillance guidelines

Process

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Influenza Vaccine

Goal: To reduce morbidity, mortality and the impact of illness associated with influenza

NACI Statement The two main areas of focus:

Those at high risk for influenza-related complications

Those capable of transmitting influenza to individuals at high risk for complications

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Influenza Predominant StrainPredominant Sub-Type

2001

2002

2002

2003

2003

2004

2004

2005

2005

200620062007

B/Hong Kong/330/2001

B/Malaysia/2506/2004)

A/New Caledonia/20/99(H1N1)

A/California/7/2004 (H3N2)

A/Wisconsin/67/2005)

A/Fujian/411/2002

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2006-2007 Vaccine Strains

A/New Caledonia/20/99 (H1N1)

A/Wisconsin/67/2005 (H3N2)

B/Malaysia/2506/2004

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Target Groups 1. People at high risk for influenza related

complications:Persons with chronic pulmonary and cardiac disorders LTC residentsPersons 65 years of age and olderThose with specific chronic conditions Adults and children with any condition that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk of aspiration. HIV positive personsPregnant women who are at high risk for influenza-related complications as listed abovePersons 6 months to 18 years of age on long-term ASA therapyHealthy children age 6 to 23 monthsThe chronically disadvantaged People in direct contact with avian influenza-infected poultry during culling operations

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Target Groups, continued

2. People capable of transmitting influenza to those at high risk:

Health care workers (HCW) and other personnel who have significant contact with those at high risk

***HCW and their employers have a DUTY to actively promote, implement and comply with influenza immunization recommendations***

ALL household contacts of persons at high risk for influenza-related complications

Pregnant women expected to deliver during influenza season

Those providing regular childcare to children age zero to 23 months, whether in or out of the home

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Provincial Targets

75% of all individuals 65 years and older 70% of all persons under 65 years of age with

chronic health conditions 90% of all residents of long-term care facilities 60% HCW moving towards 90% 60% of healthy children 6-23 months of age

moving towards 95%

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Achievement 2000 to 2006

Doses

Administered

65+Immunized

Rate%

#LTC

ResidentsRate

%

20002001

381,475 201,412 67% 14,716 93%

2001

2002397,797 205,297 67% 13,692 92%

2002

2003390,144 206,962 66% 13,863 90%

2003

2004492,412 220,330 68% 13,508 91%

2004

2005610,733 229,218 69% 13,420 91%

2005

2006662,409 232,566 68% 13,199 92%

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0

10

20

30

40

50

60

70

80

90

100

2000-2001 2001-2002 2002-2003 2003-2004 2004-2005 2005-2006

65 years and over immunizedLTC Residents Immunized6-23 months old immunized

2000-2006 Immunization Ratesby Select Groups

Percentage

91%

69%

91%

68%

90%

667%

92%

67%

93%

67%

40% 68%

60%

92

%

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2006-2007 Vaccines

FluviralTM

VaxigripTM

VaxigripTM (T-free)

ThreeThree vaccines were be publicly funded in vaccines were be publicly funded in AlbertaAlberta

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FluviralTM

Split trivalent vaccine

Manufacturer GSK (formerly ID Biomedical) 10 dose vial No latex Thimerosal content 50 µg/0.5 mL Discard opened vial after 28 days For general use in at risk persons, 9 years and

older

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VaxigripTM

Split trivalent vaccine Manufacturer Sanofi Pasteur Multi-dose vial No latex Reduced thimerosal: 2µg/0.5 mL Discard opened vial after seven days For use with children age: < 9 years of age, pregnant

women (if requested), and those with a severe sensitivity to thimerosal

3 ml syringes most often used in dosages 0.5 ml 1 ml syringes used in dosages 0.25 ml

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VaxigripTM (T-free) Split trivalent vaccine Manufacturer Sanofi Pasteur No thimerosal used at any point in production Pre-loaded 5/8 inch syringe 6-23 month olds pending muscle size in the 6-11

month old children 0.25 mL No latex in the syringe

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Reporting Adverse Reactions

Surveillance of ALL influenza vaccine-associated events with no enhanced surveillance of ORS

Use Report of Adverse Reaction to Immunizing Agents form (Jan. 2004)

Physicians would either complete this form or direct their patients to public health for follow-up

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NACI Statement on ORS

It is safe to re-immunize individuals who have experienced Mild or moderate ORS symptoms Severe ORS symptoms without lower respiratory

symptoms Consultation with the local MOH for those

who experienced severe ORS symptoms with lower respiratory symptoms within 24 hours of receiving influenza vaccine.

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Communication

Letter/guidelines to MOH/CD contacts

Physicians through AMA newsletter

Press release by AHW this fall pending key messages from PHAC

Health Link Alberta

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Hot Issues

Why thimerosal-reduced and thimerosal-free used even though not considered a risk? Theoretical risk – follow the precautionary

principle to reduce exposure Maintain public confidence in vaccines What other jurisdictions in Canada

are providing

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Hot Issues, continued

Vaccine supply for the private market Solvay Pharma Inc Belgian based pharmaceutical Provided to some provinces last flu season Influvac

Some product confusion – licensed for adults only

Vaccine supply for provincially funded programs late two consecutive years Delayed influenza program to November 1st

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Future Considerations

• provision of information for physicians to give to patients

• timely delivery of vaccine to physician’s offices

• availability of vaccine for the whole influenza season pending vaccine supply issues

• provincial electronic health record so physicians’ can access immunization information (influenza may not be included for all regions)

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Possible Best Practices:

• consider the physician’s office as an important access site

• provide annual information on the vaccine and vaccination program for physicians

• provide multiple/additional public health clinic sites

• other providers of influenza vaccine should be connected to public health