Influenza Immunisation Programme past and present Presentation to - - PowerPoint PPT Presentation

Influenza Immunisation Programme – past and present

Presentation to the 4 th New Zealand Influenza Sym posium 8 February 20 18 Diana Murfitt, Senior Advisor, Ministry of Health

Ov erv iew

• 1. Policy direction
• 2. Influenza Programme over the years
• 3. 2017 Influenza Immunisation Programme
• what we did differently?
• how did we do?
• 4. Focus for 2018

Review the policy evidence Inform the strategy Reach policy decisions Communicate the Strategy Implementation

Influenza Programme Strategy Building Blocks

• Ministry leads Influenza Immunisation

Programme strategy

• Install influenza champions
• Review influenza literature
• Confirm roles and

responsibilities

• Execute timely

messages

• Monitor and

disseminate information

• Establish a communications

network

• Develop a communications plan
• Apply a well thought out,

no surprise approach to decision making

• Develop and agree

processes and timelines that contain some flexibility

• Agree measurable
• utcomes
• Use forums to check

and articulate goals

• Engage with Maori

and Pacific community leaders

• Seek advice from
• ther local experts

and communities

Progra m m e p olicy questions

How do we ensure everyone is offered influenza vaccination? What is the aim of the Programme? Are the targets fit for purpose? How do we identify high risk individuals? When is the best time to start the Programme? What needs to change to improve coverage? How will the new vaccines impact on the Programme ?

The Progra m m e ov er the y ea rs…

• 20 years since influenza vaccine was funded for those aged 65+

years

• Targets:
• 1.2M doses distributed achieved since 2013
• 75% of those aged 65+ are immunised against influenza annually
• Pharmacist vaccinators started offering non-funded influenza

vaccine in 2012

• Vaccine availability – usually late Feb/ early March and until 31 July
• Ministry of Health Communications Strategy (in conjunction with

IMAC)

W ha t d id w e d o d ifferently in 20 17?

• Improving access - from 1 April community pharmacists have been

providing funded influenza vaccine to:

• those aged 65+
• pregnant women
• Extending availability for the funded vaccine until

31 December each year

• DHB performance measure introduced
• 2017/ 18 – 75% of 65+ years are immunised

against influenza

• Infrastructure support
• Influenza NIR DataMart reports available
• ImmuniseNow used by pharmacists

New Zea la nd Influenza Im m unisa tion Progra m m e

Aim : To protect those at higher risk of influenza morbidity and mortality 20 17 Goals:

• Improve influenza immunisation coverage for those aged:
• under 65 years at high risk (including pregnant women)
• 65+ (particularly Māori and Pacific)
• Achieve 1.2 million doses distributed annually
• Achieve 75% of those aged 65+ are immunised against influenza

20 17 Influenza Surv eilla nce

Com p a rison of 20 17 ra te w ith a v era ge sea sona l ra te, a nd historica l threshold s

Source: ESR

50 100 150 200 250 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Rate ILI presentations per 100,000 registered patients Week (2017) baseline seasonal level low seasonal level moderate seasonal level high seasonal level above seasonal level average seasonal rate 2017 rate Jan May Sep Dec

20 17 – how d id w e d o?

• 1.2 million doses distributed
• 3% of influenza vaccine distribution attributed to pharmacists
• Approximately 660 pharmacists have a contract with their DHB to

provide funded influenza vaccination - 250 claiming for funded influenza

• NIR Influenza Datamart 65+ coverage total – 54%
• DHB healthcare worker coverage – remains at 65 - 66%

Im m unisa tion Cov era ge a t a ge 65+ y ea rs

(rep orting p eriod 1/ 3/ 17 to 30 / 9 / 17)

Source: NIR Datamart

DHB NAME

• No. Eligible

Fully Immunised for Age %

• No. Eligible

Fully Immunised for Age %

• No. Eligible

Fully Immunised for Age %

• No. Eligible

Fully Immunised for Age %

• No. Eligible

Fully Immunised for Age %

Auckland 57,780 29,524 51.1. % 2,650 882 33.3. % 3,640 2,206 60.6. % 10,690 5,466 51.1. % 40,800 20,970 51.4. % Bay of Plenty 45,360 26,416 58.2. % 4,140 2,237 54.0. % 270 111 41.1. % 1,140 299 26.2. % 39,810 23,769 59.7. % Canterbury 87,490 53,943 61.7. % 3,040 1,279 42.1. % 710 390 54.9. % 3,360 1,423 42.4. % 80,380 50,851 63.3. % Capital and Coast 40,840 23,463 57.5. % 1,770 809 45.7. % 1,540 962 62.5. % 3,190 1,655 51.9. % 34,340 20,037 58.3. % Counties Manukau 63,490 29,356 46.2. % 4,460 1,797 40.3. % 7,280 3,278 45.0. % 11,260 5,220 46.4. % 40,490 19,061 47.1. % Haw kes Bay 30,310 17,922 59.1. % 2,700 1,520 56.3. % 340 175 51.5. % 620 229 36.9. % 26,650 15,998 60.0. % Hutt Valley 21,630 11,139 51.5. % 1,230 572 46.5. % 790 410 51.9. % 1,410 731 51.8. % 18,200 9,426 51.8. % Lakes 17,240 6,481 37.6. % 2,430 779 32.1. % 130 68 52.3. % 360 82 22.8. % 14,320 5,552 38.8. % MidCentral 31,340 18,800 60.0. % 2,050 983 48.0. % 310 175 56.5. % 980 485 49.5. % 28,000 17,157 61.3. % Nelson Marlborough 31,270 18,956 60.6. % 1,010 513 50.8. % 140 55 39.3. % 410 101 24.6. % 29,710 18,287 61.6. % Northland 33,800 17,524 51.8. % 4,770 2,422 50.8. % 270 93 34.4. % 390 132 33.8. % 28,370 14,877 52.4. % South Canterbury 13,085 7,847 60.0. % 350 146 41.7. % 35 18 51.4. % 190 42 22.1. % 12,510 7,641 61.1. % Southern 54,650 28,173 51.6. % 2,000 881 44.1. % 360 158 43.9. % 1,010 238 23.6. % 51,280 26,896 52.4. % Tairaw hiti 7,265 3,887 53.5. % 1,880 1,014 53.9. % 70 28 40.0. % 65 20 30.8. % 5,250 2,825 53.8. % Taranaki 20,700 10,935 52.8. % 1,470 622 42.3. % 100 31 31.0. % 420 76 18.1. % 18,710 10,206 54.5. % Waikato 64,310 34,044 52.9. % 5,470 2,607 47.7. % 820 397 48.4. % 2,180 939 43.1. % 55,840 30,101 53.9. % Wairarapa 9,385 5,839 62.2. % 560 289 51.6. % 50 27 54.0. % 125 32 25.6. % 8,650 5,491 63.5. % Waitemata 84,120 38,583 45.9. % 2,980 987 33.1. % 2,600 1,274 49.0. % 9,420 4,414 46.9. % 69,120 31,908 46.2. % West Coast 5,960 3,313 55.6. % 280 139 49.6. % 30 7 23.3. % 90 18 20.0. % 5,560 3,149 56.6. % Whanganui 12,275 7,718 62.9. % 1,130 774 68.5. % 100 47 47.0. % 165 67 40.6. % 10,880 6,830 62.8. % National 732,300 393,863 53.8. % 46,370 21,252 45.8. % 19,585 9,910 50.6. % 47,475 21,669 45.6. % 618,870 341,032 55.1. %

IMMUNISATION COVERAGE BY PRIORITISED ETHNICITY - Aged 65+ years Total Maori Pacific Asian Other

DHB hea lthca re w orker cov era ge

Source: District Health Boards

Focus for 20 18

• Vaccine strain change
• Funded quadrivalent vaccines
• Programme start date
• Improving coverage in:
• those aged 65+
• healthcare workers
• Goal of 75% of DHB healthcare workers vaccinated annually against

influenza

• Zoster vaccine introduction

The m ea ning of Flu?

20 18 influenza v a ccine com p osition

Two strain changes

• A/ Michigan/ 45/ 2015 (H1N1) pdm09-like virus
• A/ Singapore/ INFIMH-16-0 0 19/ 20 16 (H3N2)-like virus
• B/ Phuket/ 30 73/ 20 13-like virus
• B/ Brisbane/ 60/ 2008-like virus

20 18 fund ed qua d riv a lent v a ccines

Influvac Tetra – adults and those aged 3 years and over

• available in March

Fluarix Tetra – children aged under 3 years i.e. 6 to 35 mths

• available in mid April

Im p rov ing 65+ influenza cov era ge

• Older people may have a reduced immune response

to influenza vaccine

• A(H3N2) has historically been associated with higher

morbidity and mortality

• Number of those aged 65+ is increasing
• NIR coverage has remained steady at 54-55%
• Low coverage for Maori, Pacific and Asian

peoples What changes do we have to m ake to im prove coverage in this age group?

Im p rov ing hea lthca re w orker cov era ge

• We know an asymptomatic carrier can unknowingly expose their family, co-

workers and patients to the influenza virus without realising it

• Total DHB healthcare worker coverage - has remained at 65-66%

Provisional DHB coverage in 20 17

• Total DHB coverage ranges from 89 to 51%
• 4 DHBs have coverage over 70%
• 8 DHBs have coverage under 60%

What changes do we have to m ake to im prove coverage in this group?

Zoster v a ccine introd uction

• From 1 April 2018:
• those aged 65 years are eligible for one funded zoster vaccine from

their general practice

• Two year catch up until 31 March 2020 for those aged between 66 –

80 years

• Zoster vaccine may be administered at the same time as the influenza

vaccine

• Note: contraindication to zoster vaccination for those immune suppressed
• r immune deficient – refer to the Immunisation Handbook for more

information.

• New edition of the online Im m unisation Handbook 2017 (available late

Feb)

• Fact sheet and new resource are in development