Seasonal influenza vaccination in Europe: vaccination policy and vaccination coverage. Summary of VENICE surveys

Seasonal influenza vaccination in Europe:

vaccination policy and vaccination

coverage.

Summary of VENICE surveys

S.Cotter, J.Mereckiene On behalf of VENICE Project

ECDC and WHO EURO Annual Influenza Meeting

VENICE Project

• VENICE - Vaccine European New Integrated Collaboration Effort – Launched in 2006 continued to 2008

– Supported by EC-DG SANCO

• VENICE II started in late December 2008 – still in progress – Supported by ECDC

– Involve all 27 EU member states

– Two EEA/EFTA countries (Iceland and Norway)

– Created a network of experts (gatekeepers) working in immunisation programmes

– Project leading countries (France, Italy, Poland, Ireland, Denmark) – The objective of this project to promote and share knowledge and

best practices in vaccination among European states – https://venice.cineca.org

Influenza surveys conducted by

VENICE

• December 2007/January 2008

– The first seasonal influenza survey conducted – Provided baseline information

• On influenza vaccination policy among MS

• Collected available data on vaccination coverage

• July 2009 and April 2011

– The second and third seasonal influenza surveys conducted

• To follow up policy changes among countries • To collect the latest vaccination coverage data

• August 2010

– Pandemic influenza vaccination survey conducted

• November 2011

– To identify policy changes after pandemic – To collect vaccination coverage results

Why seasonal influenza important

• Large economic impact

• Mild to moderate cases

– Result in time off work and losses to production

– Pressure and costs on the health and social care services

• Severe acute respiratory illness and increased

all cause mortality

• Disease burden varies from year to year among

countries

• The estimated excess of deaths in the EU

European Council Recommendation

on seasonal influenza vaccination

22 December 2009

• Member States are recommended

– To adopt and implement national plans aimed to

improve vaccination coverage

– To achieve vaccination coverage in older age groups

and risk groups of individuals suffering from chronic

diseases and conditions

• 75% by the winter season of 2014/2015

– To mitigate the impact of seasonal influenza among

health care workers

The same methodology for all

surveys

• Collaborative study between

– Member States – ECDC – VENICE • Participating countries – 27 EU – 2 EEA (Norway/Iceland) • Data collection – Standardised questionnaire • Administration – On-line questionnaire

– Accessed on secure VENICE website

• Completion

– Gatekeepers/national experts in each MS

• In this presentation

Action plan development to improve seasonal

influenza vaccination coverage among

Action plan development Pandemic influenza season 2009-10 (n=28) Post pandemic influenza season 2010-11 (n=28)

Updated previously developed plan 5 7 Plan was developed 0 2 Plan under development 1 0 Plan was not developed 18 18 Vaccination coverage meet EC targets 1 1

Countries recommending seasonal

influenza vaccine for children (n=28)

>6 months - 2 years

>6 months - 18 years >6 months - 12 years >6 months - 4 years*

Not recommended

Data refers to 2010-11 influenza season

Countries recommending seasonal influenza

vaccine for older age groups (n=28)

> 50 years*

> 65 years > 59 years > 60 years > 55 years **

Data refers to the 2010-11 influenza season

** In Malta vaccine is recommended for those > 55 years

Clinical risk groups recommended seasonal

influenza vaccine

Chronic diseases, disorders or underlying conditions Pre pandemic 2008-09 influenza season (n=27) Pandemic 2009-10 influenza season* (n=28) Post pandemic 2010-11 influenza season (n=28) Respiratory (pulmonary) 27 28 28 Cardiovascular 27 28 28 Renal 25 28 28 Haematologic /metabolic 26 28 28

Immunosuppression due to disease or treatment 25 28 28

HIV/AIDS 24 24 25

Any condition compromising respiratory function 12 18 19

Hepatic diseases 15 17 19

Neurologic /neuromuscular - - 19

Children on long-term aspirin therapy 18 17 16

Morbid obesity (Body Mass Index >40kg/m2) - - 9

Pregnancy related seasonal influenza

vaccine recommendations

Postpartum if not vaccinated during pregnancy

- - ₁

*Data refers to seasonal influenza vaccine recommendations in 2009-10 pandemic influenza season **Recommended for all pregnant women in 19 countries; for those with clinical risk in 3 countries

Occupational groups recommended

seasonal influenza vaccine

Occupational groups Pre pandemic 2008-09 influenza season (n=27) Pandemic 2009 -10 influenza season* (n=28) Post pandemic 2010-11 influenza season (n=28) HCWs 22 23 25

Essential services (police & firemen) 5 8 8

Military 6 9 10

Poultry industry 13 11 12

Families that raise poultry, pigs or waterfowl 4 9 9

Educational - - 5

Public transport - - 6

Energy sector - - 3

Finance /banking sector - - 4

Border control/Immigration/custom staff - - 4

Pig industry - - 8

Reported seasonal influenza vaccination coverage

in older population in EU/EEA countries (n=22)

EU target for influenza season 2014-15

*Norway- 2008-09 and 2009-10 coverage results calculated for those >65 and clinical risk groups together All countries recommend vaccination of older population

0 10 20 30 40 50 60 70 80 90 V accin at io n co v er a g e (% ) 2008-09 2009-10 2010-11

Reported seasonal influenza vaccination coverage

in clinical risk groups in EU/EEA countries (n=7)

EU target for influenza season 2014-15

Norway- 2008-09 and 2009-10 coverage results calculated for those >65 and clinical risk groups together

0 10 20 30 40 50 60 70 80 V accin at io n co v er a g e (% ) 2008-09 2009-10 2010-11

Reported seasonal influenza vaccination coverage

among health care workers in EU/EEA countries (n=8)

0 10 20 30 40 50 60 70 80 90 100

Romania Germany England France Hungary Portugal Spain Norway

V accin at io n co v er a g e (% ) 2008-09 2009-10 2010-11

Reported seasonal vaccination coverage

among residents of long-term stay care

facilities (n=2)

25 countries recommend vaccine to residents of long-term care facilities

0 10 20 30 40 50 60 70 80 90 Slovakia Portugal* V accin at io n co v er a g e (% ) 2008-09 2009-10 2010-11

Reported seasonal vaccination coverage

among pregnant women (n=2)

0 10 20 30 40 50 60 Healthy At risk England Romania V accin at io n co v er a g e (% )

Data refers to the 2010-11 influenza season

Survey limitations

• Comparison of vaccination coverage difficult

– Different not only denominator, also numerator data

• Denominator data for clinical risk groups

– Difficult accurately estimate

– Lack of information systems (disease registers) or other standardised methodologies

•

Population surveys to estimate

– Vaccination coverage – At risk population

• Variety of methodologies used

Summary of policy changes comparing pandemic

and post pandemic influenza seasons

• Changes in age recommendations

– Hungary

• recommended vaccine for >65 instead to >60 years old

– Poland

• recommended vaccine to children aged >6 months -18 years

• Changes in pregnant women recommendations

– 16 countries vs. 22 countries

• New clinical risk groups recommendations

– Neurologic disease 0 countries vs. 19 – Morbid obesity 0 countries vs. 9

• Vaccination coverage

– Slight decrease in coverage among age and risk groups – Two countries provided uptake among pregnant women

Conclusions (1)

• Action plan development

– Those countries that did not have plan develop should follow EC recommendation and develop plan

– Those countries that had developed should adopt it in order to increase VC

• Recommendations for influenza vaccination

– Exist in most of the countries for the main clinical and occupational risk groups in addition to the elderly

• Discrepancies between recommendations and

real vaccination coverage

Conclusions (2)

• Vaccination coverage

– For the elderly

• Lagging in most of the countries • Except Netherlands

• Do not meet EU target

– Clinical risk groups and HCWs

• Only one third of countries collect these data • Substantial or low for these groups of individuals • Should be increased

• All countries should strive to collect information

– On vaccine coverage for the older population, clinical risk

groups, pregnant women and HCWs

Acknowledgments

• Vaccine European New Integrated Collaboration Effort (VENICE)

– Project gatekeepers/national experts

• HPSC colleagues • CINECA

– Consortium of University, Bologna, Italy • ECDC

– European Centre for Disease Prevention and Control, Stockholm, Sweden

• VENICE collaborators

– Istituto Superiore di Sanita’, Rome, Italy

– Institut de Veille Sanitaire, Saint-Maurice, France

– National Institute of Public Health - National Institute of Hygiene, Poland