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UNIVERSAL INFLUENZA VACCINATION - Advisory committee on immunization practices


UNIVERSAL INFLUENZA VACCINATION


Presenters: Dr. Walter Orenstein, Emory University School of Public Health and Dr. Ben Schwartz, N.V.P.O.

Overview: Influenza vaccination strategies, information gaps, challenges to implementation of universal vaccination, Canadian data.

Emory University, C.D.C. and the N.V.P.O. called a meeting of government, professional medical societies, academia, school health, and industry to discuss the possibility of universal influenza vaccination. Although influenza vaccination coverage has improved, its mortality, hospitalizations and morbidity continue to be a burden. The present strategy is focused on persons at high risk of complications from influenza, particularly those ≥65 years, but this meeting discussed others aged 2 to 49 years. This group is not currently recommended for universal immunization, but 4 percent to 44 percent already are vaccinated, being household contacts and others of high-risk individuals.

Presentations were provided on the disease burden and program impact, information gaps and possible studies, and proposed potential strategies to phase in universal vaccination. Consideration of expanded influenza vaccination is being driven by the continued disease burden, particularly among the elderly and those at high risk; by low coverage among some of the recommended populations; and by the need to increase disease prevention and cost savings, strengthen the public health infrastructure, and improve pandemic preparedness.

The information gaps identified in the science of influenza and its prevention were:

Despite these gaps, several findings are well supported: the validity of a “U” shaped curve for hospitalization and mortality, significant illness burden throughout the population, higher rates in children than adults, a substantial role of children in transmission, reasonable V.E. in children and healthy adults, and better than reasonable V.E. among the elderly.

The challenges to implementation of universal influenza vaccination include a greater burden on the public health infrastructure and resources, since more doses of influenza vaccine would be delivered than all other vaccines combined. Universal vaccination may impose unintended opportunity costs to both current and new vaccines. The site of vaccine delivery was discussed, since this expansion would place a considerable burden on medical homes. Vaccinating in schools has its own set of challenges, as do other possible settings, and the role of public health in vaccine delivery is unclear.

Even without universal vaccination, there have been supply interruptions in the past, and the supply and demand issues are not likely to disappear in the time needed for manufacturers to build their production capacity. The public sector’s purchasing (or assured purchase) role continues to be debated. Public and health care sector acceptance will be essential to success, as will be settling the questions of financing. Ethical issues to ensure equitable distribution to all sectors of the population will require attention.

The experience was shared of Ontario’s universal influenza vaccination program, instituted in 2000. The program has increased vaccine coverage in all age groups surveyed (although there are no data on those aged less than 12 years) and lowered respiratory disease hospitalizations in all age groups. A media campaign facilitated its general acceptance. Further evaluations are being done. Still to be determined are the program’s impact on disease in children, its indirect effects, the potential of a coverage plateau, and the need for funding support and new delivery strategies. This program was implemented as part of their standard coverage without new funding.

In general, the expansion to universal vaccination was favored by all involved. Many of the latter at this meeting favored a stepwise approach to implementation, which could be more realistically consistent with vaccine supply. The approach would begin with universal vaccination of children, where there may be greater direct and indirect effects.

Several factors were acknowledged in the discussion of potential implementation strategies:

Discussion:


2014-07-19 18:44
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