Introduction Director’ s Welcom e INFLUENZA Department of Defense Influenza Vaccination Program Briefing 2009-10 UNCLASSIFIED.

IntroductionDirector’

s Welcom

e

INFLUENZA

Department of DefenseInfluenza Vaccination Program Briefing2009-10

2009-10

UNCLASSIFIED

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Outline

1. ACIP Recommendations

2. Vaccines

3. Screening and Documentation

4. Administration

5. Adverse Events

PURPOSE: To discuss details of the 2009-10 DoD Influenza Vaccination Program.

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Influenza Season 2009-10

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

“Influenza viruses can cause disease among persons in any age group, but rates of infection are highest among children. Rates of serious illness and death are highest among persons aged >65 years, children aged <2 years, and persons of any age who have medical conditions that place them at increased risk for complications from influenza.

An annual average of approximately 36,000 deaths during 1990–1999 and 226,000 hospitalizations during 1979–2001 have been associated with influenza epidemics.”

ACIP Recommendations for Prevention and Control of Seasonal Influenza with Vaccines MMWR, July 2009

The 2009-10 trivalent influenza vaccine strains are• A/Brisbane/59/2007 (H1N1)-like virus• A/Brisbane/10/2007 (H3N2)-like virus• B/Brisbane/60/2008-like antigens

Only the influenza B component represents a change from the 2008-09 vaccine

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2009-10 ACIP Influenza Guidelines

• All children 6 mo – 18 yrs• 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

2009-10 Season2009-10 Season

Advisory Committee on Immunization Practices released the recommendations for Prevention and

Control of Influenza

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Vaccine Manufacturers

DoD contracted with three manufacturers

• Injectable

Sanofi-Pasteur - Fluzone

CSL Biotherapies - Afluria

• Intranasal

MedImmune - Flumist

3.69 Million doses of influenza vaccine contracted for DoD

• 1.83 Million - U.S. Army

• 866K - U.S. Air Force

• 953K - U.S. Navy

• 64K - 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 mo

3 and older

0.25ml IM

0.5ml IM

Afluria

(Inactivated)

18yrs and older

0.5ml IM Allergy to neomycin or polymixin

READ PACKAGE INSERTS

Vaccine Comparison Table

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Prioritization

• Should an unexpected vaccine shortage occur, directions will be provided by ASD (HA) and will be consistent with recommendations published in subsequent issues of the Morbidity and Mortality

Weekly Report.

• In accordance with (IAW) HA Policy 08-005, “Policy for Mandatory Seasonal Influenza Immunization for Civilian Health Care Personnel Who Provide Direct Patient Care in Department of Defense Military Treatment Facilities”, 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

Every effort should be made to swiftly complete seasonal influenza vaccinations and begin preparing for the impending Novel A(H1N1) Influenza Vaccine Immunization Program (NIVIP). A vaccine that can potentially prevent infection by the H1N1 virus is currently being developed and further guidance will be published detailing its use in DoD.

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Expected Shipment Dates

• Injectable vaccines (Fluzone) (Afluria)

- 45% AUG - 45% AUG

- 25% SEP - 25% SEP

- 20% OCT - 20% OCT

- 10% 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

• 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 1 December

2009

• Services will monitor influenza immunization compliance through their

respective Immunization Tracking Systems beginning in October 2009

• On 1 December 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 as

Green (≥ 90% vaccinated)

Amber (80-90% vaccinated)

Red (<80% vaccinated)

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Administration

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Flumist Administration Video

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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

[email protected]

(877) GET-VACC

(877-438-8222)

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www.vaccines.mil

www.vaccines.mil