May_23_Santoli.ppt

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May_23_Santoli.ppt

  1. 1. Annual Influenza Vaccination of Children: Recommendations and Coverage Jeanne M. Santoli (jsantoli@cdc.gov) Immunization Services Division National Center for Immunization and Respiratory Diseases May 23, 2007
  2. 2. Outline  Recommendations for seasonal vaccination – Evolution of recommendations for children  What do we know about uptake among children recommended for vaccination?  How does this compare with influenza vaccination in adults? With routine childhood vaccination rates?
  3. 3. Highlights of the 2007 Recommendations  Change to vaccine composition (new H1N1 component)  Continue to recommend against the use of adamantane antivirals (amantadine, rimantadine)  No change in the groups recommended for vaccination  Change in recommendations for children ages 6 months to <9 years who received a single dose during their first (previous) year of vaccination – New: recommended to receive two doses in second year of vaccination  Emphasize the need to continue vaccination beyond the traditional months of October and November  Emphasize the importance of vaccinating healthcare workers
  4. 4. Highlights of the 2007 Recommendations  Change to vaccine composition (new H1N1 component)  Continue to recommend against the use of adamantane antivirals (amantadine, rimantadine)  No change in the groups recommended for vaccination  Change in recommendations for children ages 6 months to <9 years who received a single dose during their first (previous) year of vaccination – New: recommended to receive two doses in second year of vaccination  Emphasize the need to continue vaccination beyond the traditional months of October and November  Emphasize the importance of vaccinating healthcare workers
  5. 5. Highlights of the 2007 Recommendations  Change to vaccine composition (new H1N1 component)  Continue to recommend against the use of adamantane antivirals (amantadine, rimantadine)  No change in the groups recommended for vaccination  Change in recommendations for children ages 6 months to <9 years who received a single dose during their first (previous) year of vaccination – New: recommended to receive two doses in second year of vaccination  Emphasize the need to continue vaccination beyond the traditional months of October and November  Emphasize the importance of vaccinating healthcare workers
  6. 6. Recommended Groups, I Efforts should target these groups if vaccine supply is limited:  Children aged 6–59 months  All persons aged >50 years  Household contacts (including children) and caregivers of infants who are younger than 6 months old  Children and adolescents on long-term aspirin therapy  Pregnant women  Adults and children who have chronic diseases  Immunosuppressed adults and children  Adults and children with a condition that can compromise respiratory function, handling of respiratory secretion, or increase the risk for aspiration  Residents of nursing homes and other chronic-care facilities.
  7. 7. Recommended Groups, II In addition, to prevent transmission to persons such as those at increased risk of complications, the following groups are recommended for annual influenza vaccination with TIV or LAIV unless contraindicated:  Healthcare workers  Healthy household contacts (including children) and caregivers of – Children 6-59 months, adults >50 years of age – Children and adults with medical conditions that put them at increased risk for severe complications from influenza
  8. 8. Emphasizing the Permissive Component of the Seasonal Recommendations Vaccination is recommended for persons, including school-age children, who want to reduce the likelihood of becoming ill with influenza or transmitting influenza to others should they become infected.
  9. 9. Highlights of the 2007 Recommendations  Change to vaccine composition (new H1N1 component)  Continue to recommend against the use of adamantane antivirals (amantadine, rimantadine)  No change in the groups recommended for vaccination  Change in recommendations for children ages 6 months to <9 years who received a single dose during their first (previous) year of vaccination – New: recommended to receive two doses in second year of vaccination  Emphasize the need to continue vaccination beyond the traditional months of October and November  Emphasize the importance of vaccinating healthcare workers
  10. 10. Recommendations for Childhood Vaccination  Longstanding recommendation: first-time vaccinees less than 9 years of age should receive two doses, spaced four to six weeks apart – Those who only received one dose in the first year should receive only one dose the following year  New data suggests that these children have less benefit (when strains change and when they don’t)  Beginning with 2007-08 season: Children who didn’t receive two doses during their initial year of vaccination should receive two doses the next year
  11. 11. Highlights of the 2007 Recommendations  Change to vaccine composition (new H1N1 component)  Continue to recommend against the use of adamantane antivirals (amantadine, rimantadine)  No change in the groups recommended for vaccination  Change in recommendations for children ages 6 months to <9 years who received a single dose during their first (previous) year of vaccination – New: recommended to receive 2 doses in second year of vaccination  Emphasize the need to continue vaccination beyond the traditional months of October and November  Emphasize the importance of vaccinating healthcare workers
  12. 12. Month of Peak Influenza Activity, US 1976-2006 50 45 Feb 40 35 % of seasons 30 25 Jan 20 15 Dec Mar 10 5 Nov Apr May 0 Month of Peak Influenza Activity US WHO Collaborating Centers (CDC, unpublished data). Peak week defined as week with greatest % of positive specimens for influenza on basis of three-week moving average.
  13. 13. Highlights of the 2007 Recommendations  Change to vaccine composition (new H1N1 component)  Continue to recommend against the use of adamantane antivirals (amantadine, rimantadine)  No change in the groups recommended for vaccination  Change in recommendations for children ages 6 months to <9 years who received a single dose during their first (previous) year of vaccination – New: recommended to receive 2 doses in second year of vaccination  Emphasize the need to continue vaccination beyond the traditional months of October and November  Emphasize the importance of vaccinating healthcare workers
  14. 14. Recommendations for Vaccinating Young Children against Seasonal Influenza  1964 Recommendation to vaccinate high risk persons < 65, including children  2002 “Encouragement” for all children 6-23 months and their household contacts  2004 Recommendation for all children 6-23 months and their household contacts  2006 Recommendation for all children 24-59 months and their household contacts  200? Potential expansion to include all school-aged children
  15. 15. Influenza Vaccination Coverage among Children 6-23 Months of Age, National Immunization Survey, 2002-05 1 or more doses Fully vaccinated 100 Coverage Level (%) 90 80 First season of “vaccinate all 6-23 month olds” 70 recommendation 60 50 40 33.4 30 17.5 17.6 20 7.4 4.4 8.4 10 0 2002-2003 2003-2004 2004-2005 Influenza Season National Immunization Survey data available at: http://www.cdc.gov/nip/coverage/default.htm#NIS
  16. 16. Vaccination of Children with High- Risk Medical Conditions Year Age Setting Coverage 1998 6-48 mos Allergy-immunology 25% (moderate-severe clinic asthma) 2000 1-6 yrs 4 large HMOs 9-10% (asthma) (61% with missed opportunity) 2000 2-13 yrs State CHIP plan 7-9% (asthma) 2001 6mos-18 yrs Children’s hospital 31% (hospitalized with HR conditions) 2002 6 mos-18 yrs Cystic fibrosis 79% (CF) center 2007 2-17 yrs National sample 29-36% (asthma) 1. Chung EK, et al. Ann Allergy Asthma Immunol 1998;80(4):318-22. 2.Kramarz P, et al. Vaccine 2000;18(21):2288-94. 3. Szilagyi PG, et al. Pediatrics 2000; 105:e719. 4. Poehling K, et al. Pediatrics 2001:108:e99. 5. Marshall BC, et al. Pediatrics 2002;109(5):e80. 6. Brim SN, et al. MMWR 2007; 56:193-96.
  17. 17. Increasing Coverage  Implementation of reminder-recall in a pediatric clinic raised rates of coverage among children with asthma from 5% to 32%1  Provider recommendation associated with higher rates of vaccination among – 6-23 month olds2 – Children with asthma,3 and/or other HR conditions 4 1. Gaglani M, et al. Pediatric Infect Disease Journal 2001;20(12):1155. 2. Nowalk MP et al. Am Journal Prev Med; 2005; 29:210-214. 3. Gnanasekaran S, et al. PHR 2006;121:181-7. 4. Poehling K, et al. Pediatrics 2001;108:e99.
  18. 18. Influenza Vaccination Coverage among Children 6-23 Months of Age, National Immunization Survey, 2002-05 1 or more doses Fully vaccinated 100 Coverage Level (%) 90 80 First season of “vaccinate all 6-23 month olds” 70 recommendation 60 50 40 33.4 30 17.5 17.6 20 7.4 4.4 8.4 10 0 2002-2003 2003-2004 2004-2005 Influenza Season National Immunization Survey data available at: http://www.cdc.gov/nip/coverage/default.htm#NIS
  19. 19. Self-Reported Influenza Vaccination Coverage Levels Among Selected US Adult Populations 1989-2005, National Health Interview Survey 100 90 Coverage Level (%) All 65+ yrs 80 70 High-risk 50- 64 yrs 60 Healthy 50-64 50 yrs 40 High-risk 18- 49 yrs 30 Pregnant 20 women 10 Health-care workers 0 19 9 19 0 19 1 19 2 19 3 19 4 19 5 19 6 19 7 19 8 20 9 20 0 20 1 20 2 20 3 20 4 05 8 9 9 9 9 9 9 9 9 9 9 0 0 0 0 0 19 Year Vaccine shortage: 2004-05 season National Health Interview Survey data available at: http://www.cdc.gov/nip/coverage/default.htm#NHIS
  20. 20. Increasing Vaccine-Specific Coverage Rates Among Preschool- Percent Aged Children 100 2010 Target 80 DTP(3+)† Hep B (3+) 60 PCV 7 (3+) MMR(1+) Polio (3+) 40 20 Hib (3+) Varicella (1+) 0 1967 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 2005 † DTP(3+) is not a Healthy People 2010 objective. DTP(4) is used to assess Healthy People 2010 objectives. Note: Children in the USIS and NHIS were 24-35 months of age. Children in the NIS were 19-35 months of age. Source: USIS (1967-1985), NHIS (1991-1993) CDC, NCHS, and NIS (1994-December 2003), CDC, NIP and NCHS; No data from 1986-1990 due to cancellation of USIS because of budget reductions.
  21. 21. Conclusions  Influenza vaccination recommendations for 2007-08 include further guidance about vaccination of young children, emphasize a longer vaccination season  Coverage among children is low, particularly among risk-based groups with a long standing recommendation  Traditional interventions should be employed  Expanded recommendations are under consideration and may impact uptake

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