Influenza Program 2018 - Presented by Angela Newbound SA PHN Immunisation Hub Coordinator - sapmea

Influenza
Program 2018
       Presented by Angela Newbound
    SA PHN Immunisation Hub Coordinator

The Immunisation Hub thanks the Immunisation Section – CDCB for
preparing this presentation

Objectives
Better understanding of:
• Influenza Vaccines Available for 2018
• Eligible Groups for Funded Vaccine Program
• How to Order Influenza Vaccines
• Vaccine Safety
• Influenza Resources

Influenza virus-review
•   Reservoir
     • Influenza A – may infect both humans and animals
     • Influenza B & C – humans the only known reservoir

•   Transmission
     • Direct contact with infected persons
     • Contact with contaminated objects e.g. doorknobs, toys
     • Inhalation of virus-laden aerosols (coughing, sneezing, and talking)

                     Image: Courtesy of Centres for Disease Control and Prevention

Incubation Period & Infectious
Period
•   Incubation period:
     • Typically 3 or 4 days, range 1 to 7 days

•   Infectious period:
     • 24 hours before onset to 7 days after onset
     • Low level of infectiousness after 5 days
     • Patients no longer infectious if well AND 24 hours after resolution of fever (usually 5
        to 7 days)
     • Also not infectious if 24 hours after resolution of fever AND 72 hours of antiviral
        medication
     • Infectious for longer in children and people with weakened immune systems

Influenza: Clinical Features
•   Influenza is more than a bad cold
•   Symptoms
      • Chills
      • Shakes
      • Headache
      • Muscle aches
      • Fever
      • Dry cough
      • Respiratory complaints
      • Sometimes abdominal complaints (such as pain and diarrhoea) and involvement of
         other body systems occurs

•   Flu is often ‘self-limiting’ but it can cause severe illness and life threatening complications

Complications
•   Complications can include
     • Pneumonia
     • Myocarditis
     • Neurological complications
     • Secondary bacterial infections, such as pneumonia

Influenza Occurrence in
Australia
  Annual statistics
  •   predominantly between late Autumn and early Spring
  •   all year round in the tropics
  •   5-20% of the population may be affected
  •   1500 to 2500 deaths
  •   18,000 hospitalisations
  •   300,000 GP consultations
  •   $85m in health system costs

Classification of subtypes
Naming is expressed in this order
•   Virus type
•   Geographic site where it was first isolated
•   Strain number
•   Year of isolation
•   Virus subtype

Influenza in South Australia

•   2016 there were 7,871 influenza notifications to CDCB

•   2017 saw the highest influenza notification rates in the last 10 years with
    27,655 confirmed influenza notifications reported to CDCB

•   2017 season saw a 250% increase in influenza cases from the previous year

Note: The 2009 Pandemic only reported 10,763 cases on influenza in South
Australia

NIP Influenza Vaccine Brands for
2018
          Vaccine Brand      6 months to less than 3 years   3+   18+   65+

FluQuadri™ Junior                         
Fluarix® Tetra                                                        
FluQuadri™                                                            
Afluria® Quad                                                          
Fluzone® High Dose Vaccine                                              
Fluad™ Adjuvanted Vaccine                                               

Strains Covered in 2018 QIV
vaccines
•    Influenza A/ Michigan H1N1
                  Singapore H3N2*
•    Influenza B/ Phuket
                  Brisbaneᵝ

*Was Hong Kong strain in 2017
ᵝThis strain is not in the trivalent vaccine

New 2018 Trivalent Influenza
Vaccines

Fluzone® - Sanofi Pasteur
   • High Dose Vaccine
   • Trivalent Influenza Vaccine
   • 0.5ml IM Injection

Fluad™ - Seqirus
  • Adjuvanted Vaccine
  • Trivalent Influenza Vaccine
  • 0.5ml IM Injection

Fluad™ and Fluzone®

• Fluad™ and Fluzone® can only be given to people ≥65

• Cannot be given to pregnant women and children

• People aged 65 and older can have the QIV instead of TIV if they
  choose

Immunogenicity of High Dose and
Adjuvanted TIV Influenza vaccines
•    Immune Systems become weaker with age which can be further compromised with
     medical conditions and medical therapies
•    High dose flu vaccines promote a better immune response in persons 65yrs and older

Studies* have shown that in a group that were given the high dose vaccine they showed:
     • Higher Antibody responses
     • Better protection against lab confirmed influenza illness
     • Reduced risk of respiratory-related hospital admissions from nursing home residents
       aged 65 years and older

*Efficacy of High-Dose versus Standard-Dose Influenza Vaccine in Older Adults
http://www.nejm.org/doi/full/10.1056/NEJMoa1315727?query=featured_home
Comparative effectiveness of high-dose versus standard-dose influenza vaccination on numbers of US nursing home residents
admitted to hospital: a cluster-randomised trial-Lancet Respiratory Medicine
http://www.thelancet.com/journals/lanres/article/PIIS2213-2600%2817%2930235-7/fulltext

Groups eligible to receive
funded vaccine

•    Pregnant Women

•    Aboriginal Children aged 6 months to less than 5 years

•    Aboriginal persons aged 15 years or older

•    Medical at risk* persons aged 6 months and older

•    Persons aged 65 years and older (Trivalent or
     Quadrivalent)

*For Medical at Risk groups see NCIRS Influenza fact sheet

Vaccine Ordering & Delivery
•   Providers can commence ordering from 9th April 2018

•   Deliveries will commence from 10th April 2018

•   Refer to your delivery schedule for your fortnightly delivery dates and order
    cut off times

•   Only order the number of vaccines that can be safely stored in your fridge
    without over crowding

•   Providers must estimate numbers of each vaccine brand required for
    different eligible groups

Weekly Ordering
•   After the first fortnight, weekly orders can be requested

•   Special delivery requests outside of scheduled delivery times due to running
    out of stock are considered on a case by case basis

•   Educate staff to plan their individual flu programs realistically in line with their
    vaccine
    • fridge capacity and VDC
    • delivery schedules

Vaccine Order Splits
•   Vaccine order form will split influenza vaccine into 3 different ordering
    categories

     • Influenza Junior (6mths to 3 yrs and over
          FluQuadri, Fluarix Tetra, Afluria Quad (from 18yrs)

     • Influenza from 65yrs and over
          Fluzone or Fluad

Providers will receive age appropriate available flu vaccines at time of order

Online Immunisation Handbook
10th Edition - Recommendations

•   Persons with known egg allergy can be safely vaccinated with influenza
    vaccines:
        *Anaphylaxis - Medical Facility
        *Sensitivity - Any Setting

•   Two doses are recommended for persons receiving influenza vaccine for the
    first time who are:
           *Immunocompromised
           *Children 6 months to less than 9 years

AIR Reporting

•   AIR – Whole of Life Register

•   Influenza vaccine doses are to be reported to the Australian Immunisation
    Register

•   Will reduce likelihood of inadvertently giving the vaccine again

Staff should check AIR before administering flu vaccine to all patients to avoid
program errors

Influenza Education

•   An influenza component is available in the Understanding Vaccines for
    Adult Vaccination Requirements for Workplace Programs online learning
•   https://immunisationeducation.sahealth.sa.gov.au/

Influenza Resources

• Posters and pamphlets can be ordered from the Commonwealth DOH website
  https://beta.health.gov.au/resources

• 2018 Influenza Program schedules, Vaccine safety leaflets and Record of
  immunisation cards are available from SA Health
  www.poscat.com.au

• Pharmaceutical companies have other promotional influenza materials available
   • http://au.gsk.com/
   • www.sequris.com.au
   • www.sanofi.com.au

Commonwealth Resources

References and Useful
Websites
•   Immunisation Section SA Health - Immunisation Providers
    http://www.sahealth.sa.gov.au/immunisationprovider

•   Australian Department of Health and Ageing
    - Immunise Australia Program
                                th
    - Immunisation Handbook 10 ed.
    www.health.gov.au/immunistion

•   Australian Government Department of Health
    https://beta.health.gov.au/topics/immunisation

•   National Centre for Immunisation Research & Surveillance (NCIRS)
    http://www.ncirs.edu.au

•   Immunisation Coalition
    http://www.immunisationcoalition.org.au/

SA PHN Immunisation Hub

SA PHN Immunisation Hub supports               Angela Newbound
immunisation providers and community           Immunisation Hub Coordinator (08) 8219 5900 or
through:                                       0421 168 367
                                               anewbound@adelaidephn.com.au

    •   Clinical advice (phone, text, email)   Alex Stevens
    •   Clinical support (planning catch-      Immunisation Hub Project Officer (08) 8219 5900 or
        ups, AIR issues)                       0401 620 440
    •   Champion Nurse support                 astevens@adelaidephn.com.au
    •   Immunisation Provider Network
        (IPN)                                  Tracy Maynard
                                               Nurse Consultant (Country SA PHN) (08) 8565 8909
    •   Education events (face to face and     or 0400 858 142
        webinars)                              Tmaynard@countrysaphn.com.au
    •   Resource development
    •   Attending community events             Champion Immunisation Nurses (HAIMS)
                                               (08) 8152 0363

Thank you, any Questions?