Low influenza A(H1N1)2009 population and high risk group vaccination coverage during the pandemic, France ESCAIDE Lisbon, November 2010 JP Guthmann, A Bone, J Nicolau, D Lévy-Bruhl

Mass vaccination campaign, October 20, 2009 Free of charge to the entire population At vaccination centres and mobile teams Enough vaccine ordered to vaccinate all the French population, but gradually available Invitations sent by post by the State Health Insurance Fund (CNAM) According to an order of priority Health care workers Pregnant women Other risk groups targeted by seasonal influenza vaccination Healthy population Background (1)

Data management Invitation database Administrative data for each person to whom vaccination was offered All recorded in a central invitation database by the CNAM Vaccination database Demographic and vaccination data collected for each person vaccinated All recorded in a central vaccination database Data matched in one single database Recoding and cleaning by contractor in collaboration with InVS/CNAM InVS received a final anonymised extract of this database Background (2)

Definition of vaccine uptake (coverage) Number of persons who received at least one dose of A(H1N1) vaccine/Number of persons invited Uptake by priority group calculated using date of invitation as a proxy 10% of vaccination records could not be matched to invitations in the database These were allocated proportionally by district, using age-sex distribution in the database Analysis

Overall A(H1N1) vaccination coverage, France, June million invitations – denominator, comparable to the French population by age, sex and « département » 5.2 million who had received at least one vaccination

A(H1N1) vaccination coverage by age and sex, France, June 2010

A(H1N1) vaccination coverage by region, France, June 2010

A(H1N1) vaccination coverage in other groups, France, June 2010

Discussion (1) First time in France a system is put in place where in the context of a possible health emergency, the entire population is registered in one single database and contacted individually by mail Comparisons with other sources is in favour of the reliability of our vaccination coverage estimates Major limitation of our study is the lack of information on priority groups, i.e. persons affected by chronic illnessess associated with an increased risk of influenza Will be soon overcome by the adjunction of information on other high risk groups in this database

Discussion (2) Vaccine uptake low Overall, and more importantly in pregnant women which represent a high risk group French population not very receptive to recommendations This could reflect Negative impact of controversies concerning the safety and effectiveness of the vaccine Public perception of a low risk from the infection The decision to set up vaccination centres rather than involving General Practitioners Invitations were sent late in the epidemic

Discussion (3) Important implications for future pandemics and give some insight on how these campaigns should be conducted

Acknowledgements We thank the CNAM and the contractor EMC for their assistance in managing and cleaning the database, and for furnishing us with the data for our analyses

Discussion (1) Compared to other countries Similar to that of other countries from the EU (Belgium 7%, Germany 10%, UK 20% in healthy under 5s) Lower than the USA (median of 24%) and some countries from northern Europe (Sweden 64%, Netherlands 32%, Norway 45%)

CV enquête CV (%)IC95% Prof. de santé – 39.4 Sujets à risque Sujets à risque < 65 ans – 22.8 Femmes enceintes – 26.1 Couverture vaccinale grippe A (H1N1) 2009 par groupe cible, enquête InVS/CSA, France métropolitaine

Personnels de santé de réa néonatale et pédiatrique Personnels médical et para-médical des Etb de santé et secteur ambulatoire exposé Femmes enceintes 2ème trimestre Entourage nourrissons < 6 mois Personnels chargés de laccueil de la petite enfance Nourrissons 6-23 mois avec FDR Sujets de 2-64 ans avec FDR Autres professionnels de santé, de secours, de transport sanitaire Nourrissons 6-23 mois sans FDR Personnels daccueil des pharmacies Autres Personnels des établissements médico-sociaux > 65 ans avec FDR 2-18 ans sans FDR > 18 ans sans FDR Recommandations de Stratégie Vaccinale (Arbitrage 1 er Ministre-24/9/09) 6/10/0916