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INFLUENZA

Department of DefenseInfluenza Vaccination Program Briefing2008-09

2008-2009

UNCLASSIFIED

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Outline

1. ACIP Recommendations2. Vaccines3. Screening and Documentation4. Administration5. Adverse Events

PURPOSE: To discuss details of the 2008-2009 DoD Influenza Vaccination Program.

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Influenza Season 2008-2009

• Rates of infection are highest among children• Illness and death are highest

Among persons aged >65 years Children aged <2 years Those at increased risk

“Annual influenza vaccination is the most effective method for preventing influenza virus infection and its complications”

“In the United States, annual epidemics of influenza occur typically during the late fall through early spring seasons. Influenza viruses can cause disease among persons in any age group, but rates of infection are highest among children.”

ACIP Recommendations for Prevention and Control of Influenza MMWR, August 2008

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2008-09 ACIP Influenza Guidelines

• All children 6 mo – 18 yrs (5 -18 year olds is a new recommendation)• All adults ≥50 yrs of age• Adults or children who have

Chronic pulmonary, cardiovascular, renal, hepatic, hematological or metabolic disorders

Immuno-suppressed Any conditions that compromise respiratory functions Residents of chronic care facilities Women who are or may become pregnant during the influenza

season• Healthcare personnel• Household contacts and caregivers of children aged < 5 yrs• Household contacts and caregivers of people with medical conditions

2008 – 2009 Season

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Vaccine Manufacturers

DoD contracted with four manufacturers

• Injectable Sanofi-Pasteur - Fluzone CSL Biotherapies - Afluria ID Biomedical (MFR) / McKesson (distributor) - Flulaval

• Intranasal MedImmune - Flumist

3.53 Million doses of influenza vaccine contracted for DoD

• 1.64 Million - U.S. Army

• 854K - U.S. Air Force

• 1 Million - U.S. Navy

• 63K - U.S. Coast Guard

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Vaccine Age Dosage Unique Contraindications

Flumist(Live)

2-49 yrs 0.2ml (0.1ml per nostril) Intranasal

Pregnant, immune suppressed, Children on chronic aspirin therapy, Asthmatics, Reactive airway disease, Chronic pulmonary disease, hypersensitivity to gentamicin, gelatin or arginine

Fluzone(Inactivated)

6-35 mo3 and older

0.25ml IM0.5ml IM

Afluria(Inactivated)

18yrs and older

0.5ml IM Allergy to neomycin or polymixin

FluLaval(Inactivated)

18 yrs and older

0.5ml IM

READ PACKAGE INSERTS

Vaccine Comparison Table

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Prioritization

• Should shortages occur, DoD will vaccinate in the following manner

Deployed/deploying Forces Critical Support Staff/COOP Medical High Risk beneficiaries (as defined in ACIP recommendations)

• No significant changes to DoD vaccination priority list

• In accordance with (IAW) HA Policy 08-005, military treatment facilities are directed to require all civilian health care personnel (HCP) who provide direct patient care in DoD MTFs be immunized against seasonal influenza infection each year as a condition of employment, unless there is a documented medical or religious reason not to be immunized.

No vaccine shortage is anticipated this year

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Expected Shipment Dates

• Injectable vaccines (Fluzone) (Afluria & Flulaval)

- 20-40% SEP - 60% SEP

- 20-40% OCT - 30% OCT

- Balance % NOV - 10% NOV

• Intranasal (Flumist)

- 35% AUG

- 25% SEP

- 30% OCT

- 10% NOV

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Storage and Handling Requirements

• Fluzone Shipped and stored at 2-8 ْ C Shelf life 12 months

• Afluria Shipped and stored at 2-8 ْ C Shelf life 12 months

• Flulaval Shipped and stored at 2-8 ْ C Shelf life 12 months

• Flumist Shipped from manufacturer frozen and stored locally in refrigerator at 2-8 ْ C 18 week shelf life

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Screening

• Read package inserts for contraindications, precautions and warnings

• Pay particular attention to Approved age ranges of product Individual allergies (eggs, thimerosal,

vaccine components, latex) Individual medical conditions (pregnancy,

history of Guillain-Barre Syndrome, asthma, immune-compromised)

• Choose the best product for your patient

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Proper Documentation

• Electronic and paper documentation should include Patient name, rank and SSN Date of vaccination Vaccine name/code Manufacturer Lot # Volume Administration route and anatomic site Name, rank and SSN of prescriber Vaccinator name Date patient given Vaccine Information Statement

(VIS) and VIS version date

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Immunization Tracking and Reporting

• Service members should receive influenza vaccination by 31 December 2008

• Services will monitor influenza immunization compliance through their respective Immunization Tracking Systems beginning in October 2008

• On 1 January 2009, DoD will include influenza compliance in FMR calculations for all components

• MILVAX will report influenza vaccination compliance during the OTSG Operations Update

• Compliance will be categorized asGreen (≥ 90% vaccinated)Amber (80-90% vaccinated)Red (<80% vaccinated)

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Administration

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Adverse Event after Vaccination

• Most common adverse reactions with influenza vaccinations Injectable: soreness, tenderness, pain and swelling at the injection

site. Malaise, headache and myalgia Intranasal: runny nose or nasal congestion in all ages, fever >100ºF

in children 2-6 yrs of age and sore throat in adults

• Vaccine Adverse Event Reporting System (VAERS) www.vaers.hhs.gov Contact VAERS 1-800-822-7967

• Vaccine Healthcare Centers (VHC) Network 1-866-210-6469 (24 hrs) www.vhcinfo.org

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• Use Intranasal vaccine for healthy 2-49 year olds without contraindications

• Administer injectable vaccine for those in whom the intranasal vaccine is contraindicated or where the intranasal vaccine is unavailable due to logistical constraints

• Remain cautious – read all packaging

• Initiate vaccination campaigns once adequate vaccine has arrived to avoid unnecessary waste of vaccine

• Unless significant local shortages occur, no eligible beneficiary should be denied vaccination when requested

• Screen for other vaccine needs, such as pneumococcal or Tdap vaccine at time of influenza vaccine screening

• Use seasonal influenza immunization program to test installation-based processes that might be used in a Pandemic

Key Points

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Contact Us

For more information about DoD Influenza Vaccination Program, or if you have any vaccine related questions

please contact the MILVAX Agency.

www.vaccines.mil/flu

vaccines@amedd.army.mil

(877) GET-VACC

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www.vaccines.mil

www.vaccines.mil