National Vaccine Advisory Committee (nvac)

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September -December 2002 Baseline NIS Data on Influenza Vaccine Coverage among Children Aged 6-23 Months – Dr. Steven Cochi

Dr. Cochi noted that he would be discussing the 2002-2003 influenza season baseline coverage data for 6- to 23-month-old children and CDC’s internal operational plan for the upcoming season, which was developed in collaboration with NIP and the National Center for Infectious Diseases (NCID).

He noted that children under 2 years of age are at increased risk for influenza-related hospitalizations. Beginning with the 2002-2003 influenza season, ACIP recommended influenza vaccination of children 6 to 23 months of age, as well as for household contacts and out-of-home caregivers of children under 2 years of age.

The 2002-2003 coverage estimates were published in MMWR on September 24, 2004 and were based on the 2003 National Immunization Survey (NIS). Beginning with the 2003 NIS, children’s complete influenza immunization histories were obtained from immunization providers. This was also the first year ACIP encouraged immunization of this age group. The study included only children who were 6 to 23 months of age during the entire span of September 2002 to December 2002.

Dr. Cochi discussed the limitations of the analyses. First, since analyses were limited to vaccinations obtained between September 2002 and December 2002 and 2003 NIS interviewing began in January 2003, vaccinations received later in the season were not counted, resulting most likely in a decrease in coverage estimates. Second, the results were restricted to children 6 to 23 months of age only during the entire September 2002 to December 2002 period, resulting most likely in an increase in the coverage estimates. There were also the usual NIS limitations, such as the fact that it is a telephone survey, it relies on provider-reported vaccination histories, and there is a larger sampling uncertainty for state and urban area estimates.

Dr. Cochi summarized the findings. Influenza vaccination coverage for children 6 to 23 months of age was very low during the first year of the ACIP encouragement (2002-2003 season). The ACIP recommendations should result in increased coverage for the 2004-2005 influenza season. Substantial work is needed to fully implement the recommendation for children 6 to 23 months of age and household contacts of children under 2 years of age to reduce the number of preventable influenza-related hospitalizations and deaths among these children.

Dr. Cochi then discussed their internal operational plan for the upcoming season. The Coordinating Center for Infectious Diseases, which coordinated the three infectious disease centers at CDC (NCID, NIP, HIV/AIDS/TB/STD Center) convened a working group to develop an operations plan for the 2004-2005 influenza season. The plan is a guide for integrated approach to activities that will improve coordination among the participating programs to foster a seamless response. The plan relies on a core strategy of partnerships with all participating centers and CDC’s partners.

The general categories of functional operations that they want to coordinate and collaborate more effectively include surveillance, vaccine supply, vaccine safety, and policy coordination. Surveillance involves monitoring virus activity, morbidity (ILI), and mortality (reported weekly) and pediatric hospitalizations (reported bi-weekly). Vaccine supply, involving monitoring vaccine supply among manufacturers and distributors, will be reported weekly. Vaccine safety, involving monitoring adverse events, will be reported daily. Policy coordination, involving consultation with key advisory bodies and stakeholders would also be included. Other functional operations include healthcare impact (i.e., conducting rapid assessments of the impact of influenza on healthcare delivery), the strategic national stockpile, and communications (i.e., providing timely, accurate, comprehensive, audience-tailored information about influenza activity, vaccine supply, and other topics of importance to the public).
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