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Country Perspectives: Brazil – experience in increasing influenza coverage
José Ricardo Pio Marins
- Ministry of Health Brazil -
SECOND WHO CONSULTATION ON A GLOBAL ACTION PLAN FOR INFLUENZA VACCINES (GAP-II)
12-14 July 2011
WHO/HQ, Geneva, Switzerland
Country Perspectives: Brazil – experience in increasing influenza coverage
� Largest country in South America
� Surface: 8,5 million Km2 area
� Border with 10 countries in South
America (all except Chile and
Ecuador);
� Population: ~191 million (2009
estimates)
� Federal republic – 26 states and the
Federal Capital District – 5 macro
regions
� 5,564 municipalities
� GDP: US$1.3 trillion
� Gross National Income (per capita):
US$ 5,910
Brazil: administrative divisions and population
Source: http://data.un.org
Country Perspectives: Brazil – experience in increasing influenza coverage
Brazil: administrative divisions and population
Geographical
Region
Population (2010)
N %
Southeast 80.915.637 42
Northeast 53.591.299 28
South 27.718.997 14
North 15.359.645 8
Center west 13.895.467 7
Brazil 191.481.045 100
� ~15 million children < 5 years old and 15 million elderly (more
frequently focus of health care actions);
� Heterogeneous population distribution with average population density of 18,4
persons/km2 (municipalities vary from 7 children <1 year of age to 179.343 children <1
year of age in Sao Paulo);
� 75% of the population lives in urban areas;
MEN WOMEN
Population pyramidYear - 2010
Country Perspectives: Brazil – experience in increasing influenza coverage
Brazilian Surveillance Influenza System
Country Perspectives: Brazil – experience in increasing influenza coverage
SARI cases reported and confirmed Pandemic Influenza (H1N1) 2009, geographical regions.
Brazil, EW 16 to 52/2009
0
1000
2000
3000
4000
5000
6000
7000
16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52
Centro-oeste Sul Sudeste Nordeste Norte
SE de início dos sintomas
Nº de casos N=50.482
0
50
100
150
200
250
300
350
400
16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52
Centro-oeste Sul Sudeste Nordeste Norte
SE de início dos sintomas
Nº de óbitos N=2.060
Cases Deaths
Source: Sinan/SVS/MS.
Cases Dead
EW symptomsEW symptoms
Country Perspectives: Brazil – experience in increasing influenza coverage
Confirmed
Country Perspectives: Brazil – experience in increasing influenza coverage
Country Perspectives: Brazil – experience in increasing influenza coverage
Decision for vaccination in 2010
� Priority Groups to immunization:
<2 years old; pregnants; old people; health
workers; indigeous; people with chronic
disease.
� Total People:
� 95.636.744 people
� Goal 80% of total
Country Perspectives: Brazil – experience in increasing influenza coverage
Goal
80%
Vaccine coverage by prioritys groups in influenza campaign
Brazil , 2010
Country Perspectives: Brazil – experience in increasing influenza coverage
Incidence pandemic influenza (H1N1) 2009 by geographical regionsand symptoms epidemiologic week. Brazil, 2010.
Immunization
EW symptoms
Source: Sinan/SVS
Incidence /1 million hab.
Country Perspectives: Brazil – experience in increasing influenza coverage
Country Perspectives: Brazil – experience in increasing influenza coverage
2007, change the metodology to estimate population. 2008, change the goal 70% to 80% from target population.2007, change the metodology to estimate population. 2008, change the goal 70% to 80% from target population.
65y
Country Perspectives: Brazil – experience in increasing influenza coverage
Annual hospitalization for inluenza causes in ≥ 60 years old.
Brazil, 1992 - 2006
Source: Daunfebach et al, 2009
Group of causes Immunization
Ho
spit
ali
zati
on
/1
.00
0 h
ab
Country Perspectives: Brazil – experience in increasing influenza coverage
Country Perspectives: Brazil – experience in increasing influenza coverage
Source: http://pni.datasus.gov.br/consulta_influenza_11_selecao.asp
Influenza coverage - 2011
Children 6m <2 years
Adults ≥ 60 years
All groups
indigenous
Health Workers
Pregnants
Country Perspectives: Brazil – experience in increasing influenza coverage
Goal
80%
Source: pni.datasus.gov.br *data until 06/27/2011
Children Health workers Pregnants Indigenous
≥ 60 years old All groups
Country Perspectives: Brazil – experience in increasing influenza coverage
Source: pni.datasus.gov.br *data until 06/27/2011
Country Perspectives: Brazil – experience in increasing influenza coverage
Increasing the capacity of production
Institute Butantan
� 2006 - Sanofi Pasteur technology transfer influenza vaccine;
� 2010 - Qualified Plan;
� 2011 - Production of 3 million doses of influenza seasonal
vaccine included pH1N1;
� Expected ultimate capacity
� 20 million without adjuvant
� 40 – 80 million with adjuvant
Country Perspectives: Brazil – experience in increasing influenza coverage
Perspectives - 2012
PROGRAMMING PURCHASE 2012
Immunobilogy Calculation Sheet Total Doses
Influenza
A - Children � 2 years old - 4.402.637
36.900.000
C - Goal 2012 - 8/12 Pregnants 2011 - 2.009.126
D - Goal 2012 - health workers applied doses H1N1 - 2.985.774
E - Goal - Indigenous 2011 - 598.797
F - ≥ 60 years old - 19.498.086
G - Prision population - 496.251
Total Partial : - A+B+C+D+E+G = 32.934.360
Total Partial + (32.934.360) strategic reserve 12% = 36.886.483
Source: IBGE/DATASUS estimation 2009 and SINASC to � 1 year old and estimation IBGE to � 2 years old
Country Perspectives: Brazil – experience in increasing influenza coverage
www.saude.gov.br/svs