TECHNICAL REPORT

Seasonal influenza vaccination and antiviral use in Europe Overview of vaccination recommendations and coverage rates in the EU Member States for the 2013–14 and 2014–15 influenza seasons

www.ecdc.europa.eu

ECDC TECHNICAL REPORT

Seasonal influenza vaccination and antiviral use in Europe Overview of vaccination recommendations and coverage rates in the EU Member States for the 2013–14 and 2014–15 influenza seasons

This report was commissioned by the European Centre for Disease Prevention and Control (ECDC), coordinated by Suzanne Cotter, Darina O’Flanagan (both Health Protection Surveillance Centre, Ireland), Svetla Tsolova and Kari Johansen (both ECDC); and produced by Jolita Mereckiene

Author

Jolita Mereckiene, Health Protection Surveillance Centre, Ireland

Note

This report is based on data from a seasonal influenza vaccination survey for the 2013–14 and 2014–15 influenza seasons in EU/EEA countries. The survey was conducted by the Vaccine European New Integrated Collaboration Effort III (VENICE), in collaboration with the European Centre for Disease Prevention and Control (ECDC).

Suggested citation: European Centre for Disease Prevention and Control. Seasonal influenza vaccination and antiviral use in Europe – Overview of vaccination recommendations and coverage rates in the EU Member States for the 2013–14 and 2014–15 influenza seasons. Stockholm: ECDC; 2016. Cover photo: AJC1, licensed under Creative Commons CC BY-SA 2.0

Stockholm, July 2016 ISBN 978-92-9193-896-4 doi 10.2900/956547 Catalogue number TQ-01-16-673-EN-N © European Centre for Disease Prevention and Control, 2016 Reproduction is authorised, provided the source is acknowledged

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TECHNICAL REPORT

Seasonal influenza vaccination and antiviral use in Europe

Contents Abbreviations ................................................................................................................................................ v Summary ...................................................................................................................................................... 1 Introduction .................................................................................................................................................. 3 Results.......................................................................................................................................................... 5 Response rate .......................................................................................................................................... 5 Seasonal influenza vaccination recommendations ........................................................................................ 5 Influenza vaccination policy ................................................................................................................... 5 Age groups recommended for influenza vaccination ................................................................................. 5 Chronic medical conditions .................................................................................................................... 6 Vaccination and pregnancy .................................................................................................................... 7 Occupational groups ................................................................................................................................. 8 Healthcare workers ............................................................................................................................... 8 Other occupations ................................................................................................................................ 9 Population groups in closed communities .................................................................................................. 10 Household contacts or caretakers ............................................................................................................. 10 Vaccination coverage rates ...................................................................................................................... 11 Older age groups ................................................................................................................................ 11 Individuals with chronic medical conditions ........................................................................................... 12 Pregnant women ................................................................................................................................ 13 Healthcare workers ............................................................................................................................. 13 Residents of long-term care facilities .................................................................................................... 14 Payment mechanisms for vaccines and vaccine administration .................................................................... 14 Adults (older population) ..................................................................................................................... 14 Children and adolescents ..................................................................................................................... 15 Chronic medical conditions .................................................................................................................. 15 Pregnant women ................................................................................................................................ 15 Healthcare workers ............................................................................................................................. 15 Use of antiviral agents for the treatment and prophylaxis of influenza ......................................................... 17 Treatment .......................................................................................................................................... 17 Post-exposure prophylaxis ................................................................................................................... 18 Control of influenza outbreaks ............................................................................................................. 18 Limitations ............................................................................................................................................. 19 Conclusions ............................................................................................................................................ 20 The way forward .................................................................................................................................... 21 References .................................................................................................................................................. 22 Annex Annex Annex Annex Annex

1. 2. 3. 4. 5.

Availability of national action plans .................................................................................................. 23 Recommendations for children, adolescents and adults...................................................................... 24 Recommendations for specific groups .............................................................................................. 26 Vaccination coverage rates and method of monitoring by countries .................................................... 28 Use of antiviral agents for the treatment and prophylaxis of influenza ................................................. 32

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Seasonal influenza vaccination and antiviral use in Europe

TECHNICAL REPORT

Figures and maps Figure 1. Proportion of Member States recommending seasonal influenza vaccine by chronic medical condition, 2012–13 and 2014–15 influenza seasons ......................................................................................................... 7 Map 1. Member States recommending seasonal influenza vaccine for pregnant women, 2014–15 influenza season 8 Map 2. Member States recommending seasonal influenza vaccine for healthcare workers, 2014–15 influenza season ... 9 Figure 2. Proportion of Member States recommending seasonal influenza vaccine, by occupational group, 2012–13 and 2014–15 influenza seasons ..................................................................................................................... 10 Figure 3. Proportion of Member States recommending seasonal influenza vaccine for household contacts or caretakers of those at risk for influenza, 2012–13 and 2014–15 influenza seasons ............................................. 11 Figure 4. Seasonal influenza vaccination coverage rates in older age groups, 25 EU/EEA Member States, 2013–14 and 2014–15 influenza seasons ..................................................................................................................... 12 Figure 5. Seasonal influenza vaccination coverage rates among individuals with chronic medical conditions, seven EU/EEA Member States, 2013–14 and 2014–15 influenza seasons .................................................................... 13 Figure 6. Seasonal influenza vaccination coverage rates in pregnant women, five EU/EEA Member States, 2013–14 and 2014–15 influenza seasons ..................................................................................................................... 13 Figure 7. Seasonal influenza vaccination coverage rates among healthcare workers, 13 EU/EEA Member States, 2013–14 and 2014–15 influenza seasons ....................................................................................................... 14 Figure 8. Payment mechanisms for vaccine in population groups recommended for seasonal influenza vaccination, 2014–15 influenza season ............................................................................................................................. 16 Figure 9. Payment mechanisms for vaccine administration for population groups recommended for seasonal influenza vaccine, 2014–15 influenza season .................................................................................................. 16 Figure 10. Proportion of Member States recommending antiviral agents for the treatment of inpatients with suspected or laboratory-confirmed influenza, 2014–15 influenza season, EU/EEA .............................................. 17 Figure 11. Proportion of Member States recommending antiviral agents for the treatment of outpatients with suspected or laboratory-confirmed influenza, 2014–15 influenza season, EU/EEA .............................................. 18 Figure 12. Proportion of Member States recommending antiviral agents for post-exposure prophylaxis following exposure to suspected or laboratory-confirmed influenza, 2014–15 influenza season, 24 Member States, EU/EEA 18 Figure 13. Proportion of Member States recommending antiviral agents for pre-exposure prophylaxis following exposure to suspected or laboratory-confirmed influenza during outbreaks, 2014–15 influenza season, EU/EEA ... 19 Map 3. Member States recommending seasonal influenza vaccine for children and adolescents, 2014–15 influenza season ........................................................................................................................................................ 24 Map 4. Member States recommending seasonal influenza vaccine for older age groups, 2014–15 influenza season .................................................................................................................................................................. 25

Tables Table 1. Member States recommending seasonal influenza vaccination for children, adolescents and adults, 2014– 15 influenza season ....................................................................................................................................... 5 Table 2. Availability of national action plan to improve vaccination coverage for seasonal influenza in the EU/EEA, 2014–15 influenza season ............................................................................................................................. 23 Table 3. Influenza vaccine recommendations for people with chronic medical conditions, EU/EEA Member States, 2014–15 influenza season ............................................................................................................................. 26 Table 4. Influenza vaccine recommendations for various occupational sectors, EU/EEA Member States, 2014–15 influenza season .......................................................................................................................................... 27 Table 5. Seasonal influenza vaccination coverage rates for targeted population groups by method of monitoring, EU/EEA Member States, 2013–14 and 2014–15 influenza seasons .................................................................... 28 Table 6. Recommendations for treatment and prophylaxis following exposure to suspected or laboratory-confirmed influenza, 2014–15 influenza season, EU/EEA countries ................................................................................... 32

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Abbreviations ECDC

European Centre for Disease Prevention and Control

EEA

European Economic Area

EU

European Union

HCWs

Healthcare workers

NAP

National action plan

ILI

Influenza-like illness

VENICE

Vaccine European New Integrated Collaboration Effort

CINECA

Consortium at the University of Bologna, Italy

GP

General practitioners

VCR

Vaccination coverage rates

WHO

World Health Organization

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Seasonal influenza vaccination and antiviral use in Europe

Summary In Europe, influenza occurs in regular annual epidemics in the winter season. Annual influenza epidemics are associated with high morbidity and mortality. Severe illness and complications are more common in certain risk groups. These include those with chronic medical conditions (e.g. cardiovascular, respiratory, renal and hepatic diseases, diabetes mellitus, immunosuppression due to disease or treatment, obesity, children and teenagers on long-term aspirin therapy) and individuals 65 years of age and above. The main public health intervention to prevent influenza is vaccination. To protect vulnerable individuals and reduce transmission, vaccination is also recommended for healthcare workers (HCWs). The aim of this survey was to provide an update on seasonal influenza immunisation policies and obtain vaccination coverage rates in European Union (EU) and European Economic Area (EEA) Member States for the 2013–14 and 2014–15 influenza seasons. A standardised questionnaire was developed and made available as an online survey. The survey was rolled out in December 2015. Experts in each Member State entered data directly online. Of 31 Member States invited to participate in the survey, 30 responded. Luxembourg did not respond to the survey. The United Kingdom provided data separately for England, Northern Ireland, Scotland and Wales. Of 30 responding Member States, all recommended seasonal influenza vaccination to older age groups. Nineteen of them had influenza vaccine recommendations for those aged ≥65 years. Hungary, Germany, Greece, Iceland, the Netherlands and Portugal recommended vaccination for those aged ≥60 years; Malta and Poland recommended vaccination for those aged ≥55 years; in Austria and Ireland, vaccine was recommended for those aged ≥50 years; in Slovakia vaccine was recommended for those aged ≥59 years. Nine countries recommended vaccination for children/adolescents