Transcript Anne Schuchat, M.D. - Association of Immunization Managers

Immunization Program Managers Meeting
Atlanta, GA—January 20, 2010
Immunization in the
Time of H1N1
Anne Schuchat, MD
Rear Admiral, US Public Health Service
Director, National Center for Immunization
and Respiratory Diseases
Centers for Disease Control and Prevention
Atlanta, GA
Responsibility
Responsibilities Galore
 Presidential, State, CDC Transitions
 American Recovery and Reinvestment
Act (ARRA)
 Vaccine Management and Business
Improvement Project (VMBIP)
 Health Reform deliberations
April 23, 2009
1st press
conference
(N=7 cases)
CDC Emergency Operations Center
Uncertainty
Decision-Making in
Setting of Uncertainty
 Severity in Mexico vs. US
– Trinational team deploys to Mexico
– Field teams assist affected areas in US
 Frequent public and media
communication
– Risk communication principles
– Acknowledge uncertainty
Immunization Planning in
Setting of Uncertainty
 Would there be vaccine?
 Would it be safe?
 Would it work?
 Would people come to
public venues?
 One dose or two?
 Would it arrive ‘in time’?
 Would there be enough?
 Would anybody want it?
 Would providers be too busy
caring for the ill to vaccinate
the well?
 Would the H1N1 vaccination
program affect future
seasonal vaccine use?
Anxiety
Guiding Principles
 Minimize illness and death
 Limit societal disruption
 Direct greatest effort in ways that will
have most impact
Severity
60 Minutes Episode on H1N1
High School Athlete Luke Deval: H1N1 complicated by MRSA pneumonia
Teens and young adults
disproportionately affected
Few cases among elderly
Seasonal 2007-08
2009 H1N1 (April - Jun)
0-4 yrs
5-9 yrs
10-17 yrs
18-49 yrs
50-64 yrs
65+ yrs
N=3,930
0-4 yrs
5-9 yrs
10-17 yrs
18-49 yrs
50-64 yrs
65+ yrs
N=312
*April 12-June 30
Proportionality
School and student dismissals related to 2009H1N1, US, 2009
Updated school
recs
700000
1200
1000
500000
800
Schools Dismissed
400000
600
300000
400
200000
1st school recs
200
Date
Students Affected
Schools Closed
Source: ED and CDC Confirmed School Closing Reports
12-Jun
11-Jun
10-Jun
9-Jun
8-Jun
5-Jun
4-Jun
3-Jun
2-Jun
1-Jun
29-May
28-May
27-May
26-May
22-May
21-May
20-May
19-May
18-May
15-May
14-May
13-May
12-May
11-May
8-May
7-May
6-May
5-May
4-May
30-Apr
29-Apr
28-Apr
0
1-May
100000
27-Apr
Students Dismissed (Yellow)
600000
0
Toolkits: K-12, Higher Education,
Childcare Institutions
Capacity
Preparing for Fall
 Strengthen monitoring systems
– EDs, ICUs, Labs, schools, Southern Hemisphere
 Prepare for medical care surge
– Self-triage, protect EDs, prepare ICUs
 Plan for multiple scenarios (severity, supply)
 Communication & media
Preparing for Voluntary H1N1
Vaccination Program
 Production
 Clinical trials
 Planning (enrolling
providers, organizing
mass & school clinics)
 Vaccine distribution and
administration
 Strengthening safety,
efficacy monitoring
 Communication planning
Cumulative Number of Provider Agreements,
H1N1 Vaccine Program,
Sept 2009-Jan 2010
Prelaunch
22
Predictability
Scarcity
Flexibility
Place of Vaccination
Seasonal
NHFS, Interviews Conducted November 2009
H1N1
50
45
40
35
30
25
20
15
10
5
0
Doctor's
Office
Clinic or
Health
Center
Hospital
Other
MedicallyRelated
Place
Medical Location
Seasonal 61%, H1N1 65%
Health
Department
Pharmacy
or Drug
Store
Workplace
School
Non-Medical Location
Seasonal 39%, H1N1 35%
Other
NonMedical
Place
• Est. 61 million vaccinated in first three months
• Highest coverage in children, pregnant women
• Most doses went to target populations
Humility
Learning from the 1976 Experience
Pandemic
H1N1 Influenza Disease Burden
Estimates for Apr -Dec 18, 2009
2009 H1N1
Mid-Level
Estimated Range
Cases
~55 million
~39 M to ~80 M
Hospitalizations
~246,000
~173,000 to ~362,000
Deaths
~ 11,160
~7,880 to ~16,460
Bumps in the Road
 Vaccine strains grew slowly in eggs
 Messaging about vaccine supply
 Supply/demand imbalances
 Perceived equity of allocations
 Potency declines  2 product recalls
 Others to come…? ?
Pandemic H1N1 Influenza Status
• H1N1 decreased but not disappeared
• Immunization coordinated at state and local levels
– Mix of private and public venues
– Preparedness and immunization leadership
– School-located and other mass vaccination,
also traditional medical and pharmacy settings
– Evaluation for best practices critical
• Vaccination and surveillance continue this winter…
Pneumonia and Influenza Deaths, United States,
108 Cities: 1957-58
Where Will Immunization and
Pandemic Preparedness Go
From Here?
 Build on school- assoc vaccination
 New norms for pregnant & other adults
 Altered communication environment
 Sustain stronger links w/ health care
 Investments in vaccine development,
public health infrastructure?
Thank you!