Federal officials launch new vaccine strategy, get flu immunization update

Feb 16, 2011 (CIDRAP News) – A federal vaccine advisory group meeting in Washington, DC, today unveiled a new national vaccination strategy for the next decade and reviewed the latest information on influenza vaccination in the first year of a new universal recommendation.

The first day of the 2-day National Vaccine Advisory Committee (NVAC), which advises the US Department of Health and Human Services (HHS), mainly focused on the release of the new vaccine plan and influenza vaccine updates. The meeting was broadcast live in HHS Web video and audio links.

Committee members heard from several groups involved in flu immunization activities, who said uptake rates seem to be maintaining a rise seen during the 2009 H1N1 pandemic months, while raising concerns about what will happen next flu season without federal economic stimulus money to help support vaccine purchase and administration.

The 43-page vaccine plan, the first since 1994, spells out goals for improving the nation's vaccine system by addressing research and development, supply, financing, distribution, safety, global cooperation, and decision making among consumers and healthcare providers. It incorporates input from public health and medical experts, officials from different levels of government, and the public.

It also lists 10 implementation priorities, which include items such as prioritizing domestic and global vaccine targets, strengthening the scientific base for developing and licensing new flu vaccines, and enhancing the vaccine safety system.

A series of regional stakeholder meetings scheduled for spring and summer is designed to flesh out strategies to implement the goals, the HHS said today in a press release.

Bruce Gellin, MD, MPH, who is HHS assistant secretary for health and director of its National Vaccine Program Office, said in the press release that the plan sets out a 10-year vision for more effectively preventing infectious diseases and reducing adverse vaccine reactions. "The plan is national in scope. Implementation will require a well-organized effort among stakeholders, including federal, state and local policymakers, health care providers, manufacturers, academia, philanthropic organizations, and the public," he said in the statement.

The HHS said the strategy's final implementation plan will be completed by the end of 2011.

During the part of the NVAC meeting that focused on this season's flu vaccination activities, Cindy Weinbaum, MD, MPH, associate director of immunization services at the US Centers for Disease Control and Prevention (CDC), said a record 163 million doses have been distributed this season and manufacturers produced and shipped it quickly, which has smoothed the road for immunization activities.

Federal health officials are watching flu vaccine uptake closely this year to see if rates achieved during a pandemic season will carry over to a more traditional flu season and if a more simplified universal immunization recommendation will have an effect on vaccination rates.

The CDC's internal weekly surveys so far show that rates for the seasonal flu vaccine are trending higher than last year among children. Preliminary data also show that last year's gains are being maintained with adults, healthcare workers, and pregnant women.

Weinbaum said that as of early January, it appears that physician billing claims for flu vaccination are above the last two seasons and that Medicare part A and B claims for the vaccine are higher than for the past 5 years.

She said surveys suggest that about 80% of children are getting their flu immunizations at doctors' offices, with adults getting theirs in a greater variety of settings, including about 20% at pharmacies, grocery stores, and super stores and 20% at the workplace.

Litjen (L.J.) Tan, PhD, the American Medical Association's director of medicine and public health and chairman of the National Influenza Vaccine Summit, told the group that pharmacy chains started aggressively marketing the flu vaccines after Labor Day, which health officials say is a boon for flu vaccination, though he said officials worry that the trend could pull flu immunizations away from doctors' offices.

However, he said flu vaccinations at both venues show signs of increasing.

An AMA internet survey of physicians to gauge their immunization experiences so far this flu season suggests that nearly 31% provided more vaccine because of the new universal immunization recommendation, Tan said. Respondents estimated that 68% of patients were very familiar or somewhat familiar with the CDC's new recommendation.

He said doctors see patient concerns about vaccine safety and efficacy as the top two obstacles to flu immunization. "That's probably good news. If you would have asked the same question 4 years ago, vaccine supply would be way up there," he said.

Tan said that recent data from members of the National Influenza Vaccine Summit, a partnership of 130 stakeholder groups, suggested that the public's overall demand for and awareness about the flu vaccine is still lukewarm, but he added that almost half said their efforts to promote the universal recommendation were showing benefits for providing more seasonal flu vaccine.

Kathy Talkington, director of immunization for the Association of State and Territorial Health Officials (ASTHO), said one site where traffic for flu vaccination seemed lighter is at local health departments. Though access vaccine at pharmacies is helpful for adult uptake, less immunization at health departments makes it hard for officials to project how much vaccine to order for the next season.

Talkington and others said federal stimulus money has helped buy flu vaccine for school immunization clinics, for example, and has helped health departments pay for staff to administer the vaccine. But they worried that state revenue cuts and the declining stream of federal money for vaccine initiatives could slow some of the immunization gains. "It's hard to tease out what the impacts are on the flu season. I almost feel like next season will be more telling," she said.

Claire Hannan, MPH, a representative of the Association of Immunization Managers, said a big challenge this season was the late delivery of flu vaccines to the Vaccines for Children (VFC) program, in which healthcare providers work with public health agencies to provide vaccines to certain groups of children. Many providers didn't get their supplies until well into October, which delayed vaccination and shortened the window of time for some kids to receive the second recommended dose. She said she hoped lessons learned from the delays will help drive better tracking of the vaccine and more equitable distribution across the VFC depots.

Laura Riley, MD, an NVAC member and medical director for labor and delivery at Massachusetts General Hospital in Boston, said the flu vaccine uptake rates in pregnant women look good but should be better. She said publicity about pandemic flu morbidity and mortality in pregnant women last season helped push vaccination levels higher, but keeping levels high this year is a challenge, given fewer reports of severe illness and death.

She said the safety message about flu vaccines seems to be getting through to pregnant women that it has been a slow process. Reilly said she expected newer messages about maternal flu vaccine benefits on babies to also gain traction slowly among patients, despite increased efforts by professional organizations to encourage the vaccines for pregnant women.

Federal vaccine safety officials updated the group on their activities. David Martin, MD, MPH, with the US Food and Drug Administration's Center for Biologics Evaluation and Research, reviewed postmarketing data on this season's flu vaccines, including the reports announced on Jan 20 on febrile seizures in young children who received Snafu's Fluzone vaccine. He projected that further analysis on the findings that are under way through the VSD may be ready in time for the CDC's vaccine advisory committee's Feb 23 meeting.

Marie McCormick, MD, ScD, professor and chair of maternal and child health at Harvard School of Public Health and chair of the Vaccine Safety Risk Assessment Working Group (VSRAWG), presented the group's interim report on the 2009 H1N1 vaccine. The VSRAWG is an independent panel put in place in October 2009 to monitor the safety of the 2009 H1N1 vaccine. She said the group explored weak signals for three conditions, thrombocytopenia/idiopathic thrombocytopenic purpura (TP/ITP), Bell's palsy, and Guillain-Barre syndrome (GBS). The probes found no link between 2009 H1N1 vaccination and ITP and Bell's palsy. More chart reviews though other systems are in progress to look at GBS rates, which if real would be 1 case per 1 million doses, she said.

More analysis is under way on allergic reactions to the vaccine and experiences in pregnant women who received the vaccine. McCormick said the group hopes to have its final safety report for the 2009 H1N1 vaccine completed within the next 6 months.

See also:

NVAC meeting materials

Feb 16 HHS press release

2010 HHS National Vaccine Plan

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