1. 1 Alberta’s Influenza Immunization Program TARRANT Workshop Elaine Sartison AHW March 24 2007

2. 2 Partners AHW participates in a bulk purchase program with all jurisdictions in Canada facilitated by PHAC AHW then distributes this vaccine to Regional Health Authorities (RHAs) Physicians are important partners in the delivery of publicly funded influenza vaccine in Alberta Physicians can order influenza vaccine from RHAs for patients eligible for publicly funded vaccine

3. 3 Partners The proportion of publicly funded vaccine delivered by physicians varies between RHAs in Alberta. Approx. 50% delivered by PH staff Approx 50% delivered by physicians who see patients with a chronic illness

4. 4 Purchased 800,000 doses (2006/07 season) Vaccine is distributed to all public health centers in Alberta to manage RHAs accountable for all doses distributed within their region Follow AHW eligibility criteria and adverse event surveillance guidelines Process

5. 5 Influenza Vaccine Goal: To reduce morbidity, mortality and the impact of illness associated with influenza NACI Statement The two main areas of focus: Those at high risk for influenza-related complications Those capable of transmitting influenza to individuals at high risk for complications

6. 6 Influenza Predominant Strain Predominant Sub-Type 2001 2002 2003 2004 2005 2006 2006 2007 B/Hong Kong/330/2001  B/Malaysia/2506/2004)  A/New Caledonia/20/99(H1N1)  A/California/7/2004 (H3N2)  A/Wisconsin/67/2005)  A/Fujian/411/2002 

7. 7 2006-2007 Vaccine Strains A/New Caledonia/20/99 (H1N1) A/Wisconsin/67/2005 (H3N2) B/Malaysia/2506/2004

8. 8 Target Groups 1. People at high risk for influenza related complications: Persons with chronic pulmonary and cardiac disorders LTC residents Persons 65 years of age and older Those with specific chronic conditions Adults and children with any condition that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk of aspiration. HIV positive persons Pregnant women who are at high risk for influenza-related complications as listed above Persons 6 months to 18 years of age on long-term ASA therapy Healthy children age 6 to 23 months The chronically disadvantaged People in direct contact with avian influenza-infected poultry during culling operations

9. 9 Target Groups, continued 2. People capable of transmitting influenza to those at high risk: Health care workers (HCW) and other personnel who have significant contact with those at high risk ***HCW and their employers have a DUTY to actively promote, implement and comply with influenza immunization recommendations*** ALL household contacts of persons at high risk for influenza-related complications Pregnant women expected to deliver during influenza season Those providing regular childcare to children age zero to 23 months, whether in or out of the home

10. 10 Provincial Targets 75% of all individuals 65 years and older 70% of all persons under 65 years of age with chronic health conditions 90% of all residents of long-term care facilities 60% HCW moving towards 90% 60% of healthy children 6-23 months of age moving towards 95%

11. 11 Achievement 2000 to 2006 Doses Administered  65+  Immunized Rate % #LTC Residents Rate % 2000 2001 381,475201,41267%14,71693% 2001 2002 397,797205,29767%13,69292% 2002 2003 390,144206,96266%13,86390% 2003 2004 492,412220,33068%13,50891% 2004 2005 610,733229,21869%13,42091% 2005 2006 662,409232,56668%13,19992%

12. 12 2000-2006 Immunization Rates by Select Groups Percentage 91% 69% 91% 68% 90% 667% 92% 67% 93% 67% 40% 68%60% 92%

13. 13 2006-2007 Vaccines Fluviral TM Vaxigrip TM Vaxigrip TM (T-free) Three vaccines were be publicly funded in Alberta

14. 14 Fluviral TM Split trivalent vaccine Manufacturer GSK ( formerly ID Biomedical ) 10 dose vial No latex Thimerosal content 50 µg/0.5 mL Discard opened vial after 28 days For general use in at risk persons, 9 years and older

15. 15 Vaxigrip TM Split trivalent vaccine Manufacturer Sanofi Pasteur Multi-dose vial No latex Reduced thimerosal: 2µg/0.5 mL Discard opened vial after seven days For use with children age: < 9 years of age, pregnant women (if requested), and those with a severe sensitivity to thimerosal 3 ml syringes most often used in dosages 0.5 ml 1 ml syringes used in dosages 0.25 ml

16. 16 Vaxigrip TM (T-free) Split trivalent vaccine Manufacturer Sanofi Pasteur No thimerosal used at any point in production Pre-loaded 5/8 inch syringe 6-23 month olds pending muscle size in the 6-11 month old children 0.25 mL No latex in the syringe

17. 17 Reporting Adverse Reactions Surveillance of ALL influenza vaccine- associated events with no enhanced surveillance of ORS Use Report of Adverse Reaction to Immunizing Agents form (Jan. 2004) Physicians would either complete this form or direct their patients to public health for follow- up

18. 18 NACI Statement on ORS It is safe to re-immunize individuals who have experienced Mild or moderate ORS symptoms Severe ORS symptoms without lower respiratory symptoms Consultation with the local MOH for those who experienced severe ORS symptoms with lower respiratory symptoms within 24 hours of receiving influenza vaccine.

19. 19 Communication Letter/guidelines to MOH/CD contacts Physicians through AMA newsletter Press release by AHW this fall pending key messages from PHAC Health Link Alberta

20. 20 Hot Issues Why thimerosal-reduced and thimerosal- free used even though not considered a risk? Theoretical risk – follow the precautionary principle to reduce exposure Maintain public confidence in vaccines What other jurisdictions in Canada are providing

21. 21 Hot Issues, continued Vaccine supply for the private market Solvay Pharma Inc Belgian based pharmaceutical Provided to some provinces last flu season Influvac  Some product confusion – licensed for adults only Vaccine supply for provincially funded programs late two consecutive years Delayed influenza program to November 1st

22. 22 Future Considerations provision of information for physicians to give to patients timely delivery of vaccine to physician’s offices availability of vaccine for the whole influenza season pending vaccine supply issues provincial electronic health record so physicians’ can access immunization information (influenza may not be included for all regions)

23. 23 Possible Best Practices: consider the physician’s office as an important access site provide annual information on the vaccine and vaccination program for physicians provide multiple/additional public health clinic sites other providers of influenza vaccine should be connected to public health