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IHS Clinical Rounds Influenza Kick-Off
September 12th, 2013
Overview
• Overview of new influenza vaccine formulations and vaccine effectiveness
• Overview of influenza vaccine and antiviral treatment recommendations
• Recap of the IHS 2012-2013 Influenza Season• IHS Influenza Awareness System Reports for
2013-2014
Chart of FLUVIEW/CDC
Chart of FLUView CDC
2012-2013 Influenza Season
• Relatively early season– Influenza-like-illness peaked in December
• More severe than previous season• Predominantly H3N2• Higher hospitalization and mortality rates among
the elderly• 158 pediatric deaths
– Higher than the 2 previous seasons– 2009-2010 Pandemic
• 282 deaths
Recap of the 2012-2013 Influenza Season for IHS
Amy V. Groom, MPHIHS Immunization Program Manager/
CDC Public Health AdvisorIHS Division of Epidemiology and Disease Prevention
IHS Influenza Awareness System Reporting2012-2013
IHS Area # of RPMS Databases Reporting* # of Facilities Reporting**NATIONAL 160 356
ABERDEEN 18 32
ALASKA 10 72
ALBUQUERQUE 6 9
BEMIDJI 4 11
BILLINGS 13 25
CALIFORNIA 17 31
NASHVILLE 18 21
NAVAJO 8 38
OKLAHOMA 24 50
PHOENIX 19 34
PORTLAND 22 28
TUCSON 1 5
* Exporting databases may include data from multiple facilities.** Includes only facility categories: Hospital, Health Center, Health Station, Health Location, Alaska Village Clinic.
IHS Areas ILI Surveillance Years - Continuous
Ove
rall
ILI %
0
1
2
3
4
5
6
7
8
Year - Week
2009-10
2009-20
2009-30
2009-40
2009-50
2010-10
2010-20
2010-30
2010-40
2010-50
2011-10
2011-20
2011-30
2011-40
2011-50
2012-10
2012-20
2012-30
2012-40
2012-50
2013-10
2013-20
2013-30
All IHS AreasInfluenza-Like Illness (ILI) All Surveillance Years - Continuous
Percentage of Visits for ILI per week01/04/09 to 08/24/13
Percentage of ILI visits is number of ILI visits divided by total number of daily visits.
IHS ILI Surveillance % of VisitsP
erce
ntag
e IL
I
0
1
2
3
4
5
6
7
8
40
41
42
43
44
45
46
47
48
49
50
51
52
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
All IHS AreasInfluenza-Like Illness (ILI) for All Surveillance Years
Percentage of Visits for ILI per week01/04/09 to 08/24/13
ILI during non-influenza weeks for the previous three seasons plus two standard deviations. The horizontal line represents the 2012-2013 baseline. The baseline is the mean percentage of patient visits for
Percentage of ILI visits is number of ILI visits divided by total number of daily visits.
2008-2009 2009-2010 2010-2011 2011-2012 2012-2013
Proportion of outpatient visits for Influenza-like-Illness (ILI)2012-2013
40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 340
1
2
3
4
5
6
7
% ILI ILINet vs. IIAS
IIAS % ILI
ILINet % ILI
Perc
ent I
LI
ILINet – CDC Sentinel Surveillance System for Influenza-like-Illness IIAS – IHS Influenza Awareness System
Influenza Like Illness by IHS Region2012-2013
IHS INFLUENZA VACCINE COVERAGE FOR 2012-2013
IHS Influenza Vaccine Coverage1 dose, All Ages (> 6 months)
2010-11 2011-12 2012-130%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
IIASRPMS
IHS Influenza Awareness System (IIAS) vs. Quarterly Immunization Package reports from RPMS
IHS Influenza Vaccine Coverage2012 - 2013
All ages 6+ months
Children 6 mos - 17 yrs
Adults > 18 years
Adults 65+ yrs0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
IIASRPMS
IIAS – IHS Influenza Awareness System; RPMS – RPMS Quarterly Immunization Report
IHS Influenza Vaccine Coverage by IHS Area
Aberdeen
Alaska
Albuquerque
Bemidji
Billings
Californ
ia
Nashvil
le
Navajo
Oklahoma
Phoenix
Portland
Tucson
All Are
as0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
RPMS Quarterly Immunization Reports All Ages
Vaccinated
N = 852,168. Based on Active Clinical Users
IHS Healthcare Personnel (HCP) Influenza Vaccination Coverage
2008-09 2009-10 2010-11 2011-12 2012-130%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
71.30%
74.90%72.40%
75.30% 76.20%
% Vaccinated
HP 2020 Goal
IHS Influenza Vaccine Coverage reports available at: www.ihs.gov/flu
HCP Influenza Vaccine Coverage by Area2012-2013
Aberdeen
Alaska
Albuquerque
Bemidji
Billings
Californ
ia
Nashville
Navajo
Oklahoma
Phoenix
Portland
Tucson
National0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Vaccinated
HP 2020 Goal
IHS Influenza Awareness SystemReports
Michael Bartholomew, MDDirector
IHS Division of Epidemiology and Disease Prevention
Data in National IIAS reports• Influenza vaccine coverage by age group and risk
group– National and Area– Active Clinical and User population
• Cumulative influenza vaccine coverage• Codes used to document administered influenza
vaccines– Can be helpful to ensure sites are using the correct codes
• Proportion of visits with ILI– National, by flu season and cumulatively
• Map of ILI by Area• Number of exporting databases and facilities for
each Area
Area Level Report
• Same data as National report• Compares Area to National level data • Provides breakdown by facility for vaccine
coverage• List of exporting databases and facilities
Area Level Report - ILIO
vera
ll IL
I %
0
1
2
3
4
5
6
7
8
9
Year - Week
Area Level: PHOENIXInfluenza-Like Illness (ILI) All Surveillance Years - Continuous
Percentage of Visits for ILI per week01/04/09 to 08/31/13
Percentage of ILI visits is number of ILI visits divided by total number of daily visits.
NATIONAL PHOENIX
Area level Report – ILI by SeasonP
erce
ntag
e IL
I
0
1
2
3
4
5
6
7
8
9
40
41
42
43
44
45
46
47
48
49
50
51
52
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
Area Level: PHOENIXInfluenza-Like Illness (ILI) for All Surveillance Years
Percentage of Visits for ILI per week01/04/09 to 08/31/13
ILI during non-influenza weeks for the previous three seasons plus two standard deviations. The horizontal line represents the 2012-2013 baseline. The baseline is the mean percentage of patient visits for
Percentage of ILI visits is number of ILI visits divided by total number of daily visits.
2008-2009 2009-2010 2010-2011 2011-2012 2012-2013
Area Level Report - Vaccine CoverageArea Level: TUCSON
Seasonal Influenza Vaccine Coverage by Age Groups - All (6 months +)for National, Area, and Exporting Databases
07/01/12 to 06/29/13
37.1
60.3 60.1
Per
cent
0
10
20
30
40
50
60
70
80
90
100
2013-14Seasonal Influenza Vaccine and Antiviral Procurement
IHS- National Supply Service CenterPharmacy Support Branch
CDR Matthew Baker
NSSC 2013-14 Contract Vaccine
Product Name
Dosage Form NDC Price/Dose
Flulaval® Multi-Dose Vial (MDV) -10 doses/vial 19515-0890-07 $3.88*Fluzone® PFS - 0.25mL - 10 doses/package 49281-0113-25 $11.60*Fluzone® PFS – 0.5mL – 10 doses/package 49281-0013-50 $9.54*Fluzone® PFS - 0.5mL HD - 10 doses/package 49281-0393-65 $21.18*Fluzone PFS 0.1ml – 10 doses/package 49281-0707-55 12.70*
• NSSC submits total IHS Requirements to VA for contract
• Expect all shipments of contract vaccine to be completed by 9/15/13
*The NSSC reduced the NSSC Flu Vaccine Fee (the service charge added to the facilities total Flu bill) from 3.25% charged last year to 3% this year (in addition to Cost above).
Flu Vaccine Ordering Post-Solicitation
• Contact Ms. Christy Gay- [email protected]– She will forward a Form 413 for ordering
• Submit Seasonal Flu Form 413 to NSSC– NSSC may have stock of additional contract vaccine
• If not- NSSC will contact contractors to obtain and if authorized, will purchase additional vaccine
– If contract vaccine not available- NSSC will contact additional vendors to find best price
• Occasionally- FSS priced vaccine available through McKesson- but no guarantees
Seasonal VaccineProcurement Overview
2012-13 vs 2013-14 Season
0
50,000
100,000
150,000
200,000
250,000
300,000
5,660
68,270
7,910
253,490
2,340 6,9306,160
80,290
9,800
272,040
3,090 6,170
Total Contract Solicitation Doses Purchased
Sum of 2012 Total Doses Sum of 2013 Total Doses
2012 Total Doses 2013 Total DosesGrand Total 344,600 377,550
**Actual 2012 Doses-376K- includes all additional vaccine purchases
Antivirals
• Tamiflu 75mg Capsules & Relenza blocked from ordering through McKesson and must be purchased through the NSSC until stockpile depleted/expires– Contact Christy Gay and she will forward a 413– Complete 413 and submit to NSSC
• All other Tamiflu doses and dosage forms may be ordered through McKesson when available– Tamiflu 30mg production delays noted in McKesson– Tamiflu Suspension unavailable until late Oct 2013
Resources
• IHS Influenza Website – www.ihs.gov/flu– National IIAS reports posted weekly under “IHS Influenza
Surveillance Reports”– Area Flu points of contact to request facility reports and
guidance on IIAS exports, under “Facility Data Exports and Reports”
– Resources, webinars under “Educational Resources”
• CDC Influenza Website – www.cdc.gov/flu– Influenza vaccine and Antiviral treatment recommendations– FluView – weekly influenza surveillance reports– Free resources Print materials, PSAs, eCards, etc.