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Low influenza A(H1N1)2009 population and high risk group vaccination coverage during the 2009-2010 pandemic, France ESCAIDE Lisbon, 11-13 November 2010 JP Guthmann, A Bone, J Nicolau, D Lévy-Bruhl. Mass vaccination campaign, October 20, 2009 Free of charge to the entire population - PowerPoint PPT Presentation
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Low influenza A(H1N1)2009 population and high risk group vaccination coverage during the 2009-2010 pandemic, France
ESCAIDELisbon, 11-13 November 2010
JP Guthmann, A Bone, J Nicolau, D Lévy-Bruhl
• Mass vaccination campaign, October 20, 2009• Free of charge to the entire population
• At vaccination centres and mobile teams
• Enough vaccine ordered to vaccinate all the French population, but
gradually available
• Invitations sent by post by the State Health Insurance Fund (CNAM)
• According to an order of priority Health care workers Pregnant women Other risk groups targeted by seasonal influenza vaccination Healthy population
Background (1)
• Data management• Invitation database
Administrative data for each person to whom vaccination was offered All recorded in a central invitation database by the CNAM
• Vaccination database Demographic and vaccination data collected for each person vaccinated
All recorded in a central vaccination database
• Data matched in one single database
• Recoding and cleaning by contractor in collaboration with InVS/CNAM
• InVS received a final anonymised extract of this database
Background (2)
• Definition of vaccine uptake (coverage) Number of persons who received at least one dose of A(H1N1)
vaccine/Number of persons invited
• Uptake by priority group calculated using date of invitation as a proxy
• 10% of vaccination records could not be matched to invitations in the database
These were allocated proportionally by district, using age-sex distribution in the database
Analysis
Overall A(H1N1) vaccination coverage, France, June 2010
• 64.9 million invitations – denominator, comparable to the French population by age, sex and « département »
• 5.2 million who had received at least one vaccination
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
Week
43
(19-
25/1
0/200
9)
Week
45
Week
47
Week
49
Week
51
Week
53
Week
2
Week
4
Week
6
Week
8
Week
10
Week
12
Week
14
Week
16
Week
18
(3-9
/5/2
010)
Epidemiological week
Vac
cin
atio
n c
ove
rag
e
Epidemic peak (week 49)
VC=7.95%
A(H1N1) vaccination coverage by age and sex, France, June 2010
0%
5%
10%
15%
20%
25%
30%
6-23
mont
hs
2-5
year
s
6-10
yea
rs
11-1
7 ye
ars
18-2
4 ye
ars
25-2
9 ye
ars
30-3
4 ye
ars
35-3
9 ye
ars
40-4
4 ye
ars
45-4
9 ye
ars
50-5
4 ye
ars
55-5
9 ye
ars
60-6
4 ye
ars
65-6
9 ye
ars
70-7
4 ye
ars
75-7
9 ye
ars
80-8
4 ye
ars
85-8
9yea
rs
90-9
4 ye
ars
95+ y
ears
Age group
Vac
cin
atio
n c
ove
rag
e
Female
Male
A(H1N1) vaccination coverage by region, France, June 2010
0%
4%
8%
12%
16%
20%
Breta
gne
Corse
Champag
ne
Limousi
n
Auvergne
Bourgogne
Picar
die
Pays
de la
Loire
Ile d
e Fra
nce
Poitou-
Charente
s
Centre
Basse-
Norman
die
Franch
e Com
té
Lorrain
e
Aquitain
eNord
Rhône-Alp
es
Alsace
Haute -
Norman
die
Mid
i-Pyr
énées
Prove
nce-A
lpes
-Côte
d'A
zur
Langued
oc
Region
Vac
cin
atio
n c
ove
rag
e
A(H1N1) vaccination coverage in other groups, France, June 2010
0%
5%
10%
15%
20%
25%
Pregnant women Persons with chronic illness excludingthose associated with increased risk of
influenzae
Vac
cin
atio
n c
ove
rag
e
Discussion (1)• First time in France a system is put in place where in the
context of a possible health emergency, the entire population is registered in one single database and contacted individually by mail
• Comparisons with other sources is in favour of the reliability of our vaccination coverage estimates
• Major limitation of our study is the lack of information on priority groups, i.e. persons affected by chronic illnessess associated with an increased risk of influenza
• Will be soon overcome by the adjunction of information on other high risk groups in this database
Discussion (2)• Vaccine uptake low
Overall, and more importantly in pregnant women which represent a high risk group
• French population not very receptive to recommendations
• This could reflect Negative impact of controversies concerning the safety and effectiveness
of the vaccine
Public perception of a low risk from the infection
The decision to set up vaccination centres rather than involving General
Practitioners
Invitations were sent late in the epidemic
Discussion (3)
• Important implications for future pandemics and give some insight on how these campaigns should be conducted
Acknowledgements• We thank the CNAM and the contractor EMC for
their assistance in managing and cleaning the database, and for furnishing us with the data for our analyses
Discussion (1)• Compared to other countries
Similar to that of other countries from the EU (Belgium 7%, Germany 10%, UK 20% in healthy under 5’s)
Lower than the USA (median of 24%) and some countries from northern Europe (Sweden 64%, Netherlands 32%, Norway 45%)
CV enquêteCV (%) IC95%
Prof. de santé 29.8 21.7 – 39.4
Sujets à risque 12.2 9.8 - 15.1
Sujets à risque < 65 ans 16.3 11.4 – 22.8
Femmes enceintes 12.8 5.7 – 26.1
Couverture vaccinale grippe A (H1N1) 2009 par groupe cible, enquête InVS/CSA, France métropolitaine
Personnels de santé de réa néonatale et pédiatriquePersonnels médical et para-médical des Etb de santé et secteur ambulatoire exposéFemmes enceintes 2ème trimestreEntourage nourrissons < 6 moisPersonnels chargés de l’accueil de la petite enfanceNourrissons 6-23 mois avec FDRSujets de 2-64 ans avec FDRAutres professionnels de santé, de secours, de transport sanitaireNourrissons 6-23 mois sans FDRPersonnels d’accueil des pharmaciesAutres Personnels des établissements médico-sociaux> 65 ans avec FDR2-18 ans sans FDR> 18 ans sans FDR
Recommandations de Stratégie Vaccinale (Arbitrage 1er Ministre-24/9/09)
6/10/09 16