Influenza vaccination guidelines and vaccine sales in southeast Asia: 2008-2011.

BACKGROUND: Southeast Asia is a region with great potential for the emergence of a pandemic influenza virus. Global efforts to improve influenza surveillance in this region have documented the burden and seasonality of influenza viruses and have informed influenza prevention strategies, but little information exists about influenza vaccination guidelines and vaccine sales. METHODS: To ascertain the existence of influenza vaccine guidelines and define the scope of vaccine sales, we sent a standard three-page questionnaire to the ten member nations of the Association of Southeast Asian Nations. We also surveyed three multinational manufacturers who supply influenza vaccines in the region. RESULTS: Vaccine sales in the private sector were <1000 per 100,000 population in the 10 countries. Five countries reported purchasing vaccine for use in the public sector. In 2011, Thailand had the highest combined reported rate of vaccine sales (10,333 per 100,000). In the 10 countries combined, the rate of private sector sales during 2010-2011 (after the A(H1N1)2009pdm pandemic) exceeded 2008 pre-pandemic levels. Five countries (Indonesia, Malaysia, Singapore, Thailand and Vietnam) had guidelines for influenza vaccination but only two were consistent with global guidelines. Four recommended vaccination for health care workers, four for elderly persons, three for young children, three for persons with underlying disease, and two for pregnant women. CONCLUSIONS: The rate of vaccine sales in Southeast Asia remains low, but there was a positive impact in sales after the A(H1N1)2009pdm pandemic. Low adherence to global vaccine guidelines suggests that more work is needed in the policy arena

Characteristics of seasonal influenza vaccine use among the nine Southeast Asian countries that responded to study survey<b>.</b>

*<p>Due to chronic metabolic diseases (including diabetes mellitus), renal dysfunction, haemoglobinopathies or immunosuppression (including by medication or HIV).</p>†<p>High risk conditions: Malaysia (chronic cardiovascular, pulmonary, metabolic or renal disease, or who are immunocompromised); Philippines (chronic pulmonary or cardiovascular disorders); Singapore (diseases of the pulmonary or cardiovascular systems, including asthma); Thailand (chronic obstructive pulmonary disease, asthma, heart disease, stroke, kidney failure, cancer, diabetes, thalassemia, immunosuppression including persons infected with HIV); Vietnam (COPD, congenital heart disease, heart failure, diabetes, immunodeficiency).</p>**<p>Only includes elderly with >1 more of the following chronic conditions: chronic cardiovascular, pulmonary, metabolic or renal disease, or who are immunocompromised.</p

Selected health, budgetary, and immunization statistics of the ten Southeast Asian countries surveyed.

<p>GNI: Gross National Income; DGP: Gross Domesitc Product; USD: United States Dollars.</p>1<p>Total gross national income per-capita, total expenditure on health, percent of deaths among children <5 years caused by pneumonia and ranking of pneumonia as the cause of childhood mortality updated May 2012 and found at: levels for each country found at: <a href="http://www.who.int/countries/en/" target="_blank">http://www.who.int/countries/en/</a>.</p>2<p>World Bank country classification can be found at: <a href="http://data.worldbank.org/about/country-classifications/country-and-lending-groups" target="_blank">http://data.worldbank.org/about/country-classifications/country-and-lending-groups</a>.</p>3<p>Routine childhood vaccinations are tuberculosis (BCG), diptheria, tetanus, pertussis (DTP), oral polio vaccine (OPV), hepatitis B, and measles-containing vaccine (MCV).</p>4<p>Percent of routine vaccinations funded by government and under 5-year mortality rates updated Oct 2012 and found at: <a href="http://apps.who.int/immunization_monitoring/en/globalsummary/countryprofileselect.cfm" target="_blank">http://apps.who.int/immunization_monitoring/en/globalsummary/countryprofileselect.cfm</a>.</p

Influenza vaccine sales per 100,000 population; shaded areas are aggregate data from several countries. Dashed line (–) indicates data were not available.

†<p>Private sales data in this row are from Thailand Food and Drug Administration.</p>*<p>Excludes Brunei.</p