Vaccination against seasonal and pandemic influenza ?· Vaccination against seasonal and pandemic influenza…

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  • Inmunizacin Integral de la Familia

    Salud Familiar y Comunitaria

    Vaccination against seasonal

    and pandemic influenza

    Alba Mara Ropero Alvarez

    Geneva , 12-14 July 2011

  • Inmunizacin Integral de la Familia

    Salud Familiar y Comunitaria

    Outline

    Introduction and use of seasonal influenza vaccine in the Americas

    Review of vaccination against pandemic influenza

    Conclusions

  • Inmunizacin Integral de la Familia

    Salud Familiar y Comunitaria

    Introduction and use of

    seasonal influenza vaccine

    in the Americas

  • Inmunizacin Integral de la Familia

    Salud Familiar y Comunitaria

    TAG 2004 and 2006

    All countries should strengthen their surveillance systems in order to determine:

    influenza disease burden

    cost-effectiveness of influenza vaccine introduction

    best vaccination strategy to use, formulation and when (especially in tropical countries)

    All countries should establish a seasonal influenza vaccination policy that seeks to vaccinate:

    individuals with chronic illness, the elderly and pregnant womenchildren 6-23 months of agehealth workers

    Countries using the vaccine should document experiences and lessons learned from targeting high-risk groups.

    Resolution WHA.56 (2003)

    Coverage of >50% of older adults by 2006

    Coverage of >75% of older adults by 2010

    Influenza Vaccine Recommendations

  • Inmunizacin Integral de la Familia

    Salud Familiar y Comunitaria

    Influenza Vaccine Recommendations

    TAG July 2011

    Reiterates previous recommendations that countries vaccinate older adults, children, those with underlying conditions, and healthcare workers.

    Urges countries to increase vaccine uptake of pregnant women given their vulnerability to complications from influenza infection.

    Urges countries to document influenza vaccination coverage in high-risk populations. As more countries in the Region are introducing influenza vaccine, it becomes more important to assess the impact of influenza and conduct vaccine effectiveness studies in high-risk populations

    Urges PAHO to continue to promote the transfer of technology for influenza vaccine production in the Region, in order to increase its availability.

  • Inmunizacin Integral de la Familia

    Salud Familiar y Comunitaria

    Number of Countries and Territories in the Americas

    with Vaccination Policies for Seasonal Influenza

    393835

    33

    25

    17

    1013

    0

    5

    10

    15

    20

    25

    30

    35

    40

    45

    1940-

    2003

    2004 2005 2006 2007 2008 2009 2010

    Out of 45

    countries and

    territories

    reporting in the

    Americas

    Pending

    introduction:

    Dominica

    Guyana

    Haiti

    St Kitts

    St Maarten

    St Vincent

    Source: Country Reports to PAHO, MOH web pages, PAHO/WHO Surveys

    Note: Data was not collected from the French Departments (French Guiana, Guadeloupe, Martinique)

  • Inmunizacin Integral de la Familia

    Salud Familiar y Comunitaria

    Case study: Costa Rica

  • Inmunizacin Integral de la Familia

    Salud Familiar y Comunitaria

    Number of countries with: 2004 2008 2010

    - Public policies for influenza vaccination 13 35 39

    - Vaccination of children 6 22 29

    - Vaccination of elderly 12 33 39

    - Vaccination of persons with chronic diseases 9 24 26

    - Vaccination of health workers 3 32 34

    - Vaccination of pregnant women 3 7 17

    Source: Country Reports to PAHO, MOH web pages, PAHO/WHO Surveys

    Note: Data was not collected from the French Departments (French Guiana, Guadeloupe, Martinique)

    Seasonal Influenza Vaccination in Countries

    and Territories

  • Inmunizacin Integral de la Familia

    Salud Familiar y ComunitariaSource: Country and territory reports to PAHO, MOH websites, WHO survey

    Use of seasonal influenza vaccine and formulations in the

    Americas 2011

    Northern HemisphereNorthern HemisphereNorthern HemisphereNorthern HemisphereSouthern HemisphereSouthern HemisphereSouthern HemisphereSouthern HemisphereVaccine not yet introduced Vaccine not yet introduced Vaccine not yet introduced Vaccine not yet introduced in the public sectorin the public sectorin the public sectorin the public sector

    Belize

    Honduras

    El Salvador

    Nicaragua

    Panama

    Costa Rica

    Brazil

    Paraguay

    Uruguay

    Argentina

    Chile

    Peru

    Ecuador

    Colombia Venezuela

    Cuba Bahamas

    Turks & Caicos

    Jamaica Haiti Dominican

    Republic

    Anguilla

    Barbados

    Trinidad & Tobago

    Antigua &

    Barbuda

    St. Lucia

    Guatemala

  • Inmunizacin Integral de la Familia

    Salud Familiar y Comunitaria

    Quality of information system

    Coverage rates for all targeted populations groups are not routinely

    available

    WHO/UNICEF joint reporting form does not capture vaccine coverage

    among pregnant women

    Two-dose schedule for children

  • Inmunizacin Integral de la Familia

    Salud Familiar y Comunitaria

    0

    20

    40

    60

    80

    100

    120

    Brazil Chile Ecuador El Salvador Honduras Mexico Panama Paraguay Uruguay

    2005 2006 2007 2008 2009

    Source: Country and territory reports to PAHO

    Seasonal Influenza Vaccination Coverage Among

    the Elderly in Selected Countries

    WHO Goal of 75%

  • Inmunizacin Integral de la Familia

    Salud Familiar y Comunitaria

    PERU 86% (2009)*

    EL SALVADOR 79% (2009)*

    PANAMA 74% (2009)*

    USA 62% (2009)

    MEXICO 53% (2008)

    PARAGUAY 47% (2009)*

    GUATEMALA 38* (2009)**Source: Country and territory reports to PAHO

    Source: Paredes-Solis et al. Vaccination coverage against seasonal influenza in

    workers from four hospitals of Guerrero Mexico Gac Med Mex 2010 Sep-Oct

    146(5):318-25

    Source: CDC. Interim results: Influenza A (H1N1) 2009 monovalent and

    seasonal influenza vaccination coverage among health-care personnelUS, Aug

    2009-Jan 2010. MMWR 2010;59:357-62

    Seasonal Influenza Vaccination of

    Health Care Workers

  • Inmunizacin Integral de la Familia

    Salud Familiar y Comunitaria

    Review of vaccination against

    Pandemic Influenza

  • Inmunizacin Integral de la Familia

    Salud Familiar y Comunitaria

    Recommendations for Progressive Vaccination

    Against Pandemic Influenza

    SAGE (WHO)7 July 2009

    1. Health workers

    2. Pregnant women

    3. Population >6 m with history of chronic diseases

    4. Healthy young adults (>15 and 6 m with history of chronic diseases

    4. Healthy population:*6 m- 4 y*school-age (>5 &

  • Inmunizacin Integral de la Familia

    Salud Familiar y Comunitaria

    Immediate support of seasonal influenza vaccination

    for countries not yet using the vaccine

    Technical cooperation in planning for pandemic vaccination campaigns

    (development of technical guidelines)

    Support in pandemic vaccine acquisition

    Monitoring vaccine use and surveillance of adverse events

    Documenting and disseminating information in real time

    PAHO Technical Cooperation in Influenza

    Vaccination during the pandemic

  • Influenza A (H1N1) Vaccine Access in Latin

    America and the Caribbean

    Vaccine source:

    Revolving Fund-RF (PAHO)

    WHO Donation*

    Direct Purchase (DP)

    RF-PAHO and WHO Donation

    DP and WHO Donation

    Mixed Purchase

    Vaccine source:

    Revolving Fund-RF (PAHO)

    WHO Donation*

    Direct Purchase (DP)

    RF-PAHO and WHO Donation

    DP and WHO Donation

    Mixed Purchase

  • 348,890,000 pop.

    348,890,000 pop.

    49.9%

    October November December January February March April May June

    340,410,000 pop.340,410,000 pop.

    44.3%

    *213,126,000 pop.*213,126,000 pop.

    5.0%

    78,025,000 pop.

    12.8%

    78,025,000 pop.

    USA and Canada Argentina, Brazil, Mxico Revolving Fund WHO donation USA and Canada Argentina, Brazil, Mxico Revolving Fund WHO donation

    More than 224 million doses applied in the RegionMore than 224 million doses applied in the RegionMore than 224 million doses applied in the RegionMore than 224 million doses applied in the Region144 million in LAC144 million in LAC144 million in LAC144 million in LAC81 million in USA81 million in USA81 million in USA81 million in USA

    Differential Access to Pandemic Vaccine in the Region

  • Inmunizacin Integral de la Familia

    Salud Familiar y Comunitaria

    0.0%

    10.0%

    20.0%

    30.0%

    40.0%

    50.0%

    60.0%

    70.0%

    80.0%

    90.0%

    100.0%

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