November 2, 2017

Announcement: 2018 Summit In-Person Meeting – L.J Tan

L.J reminded callers that the 2018 Summit in-person meeting will be held in conjunction with the National Immunization Conference (NIC) in Atlanta, Georgia. The NIC will be May 15–17, and the Summit will be May 17–18. Registration instructions and other Information about the meeting will be posted on the Summit website as the Summit Organizing Committee finalizes the agenda and other details about the meeting.

L.J reported that poster abstracts will be accepted for the Summit. However, because the Summit is being held in collaboration with the NIC, Summit organizers are hoping that abstracts will be submitted to both the NIC and the Summit. The NIC poster abstract submission deadline is December 31, but the deadline for the Summit has not yet been established. Amy Parker Fiebelkorn with CDC mentioned that presenters will be allowed to submit the same abstract for both meetings. The poster session for the Summit will be held on Thursday evening, May 17. Attendees are encouraged to participate in both the NIC and the Summit. NIC will include an adult immunization track, with two adult featured speakers presenting on Thursday.

Influenza Surveillance Update – Alicia Budd (CDC)

Alicia provided highlights of the influenza surveillance report from week 42, ending on October 21, 2017. Overall, we continue to see low levels of influenza throughout the country, but activity is slowly beginning to increase.

The percentage of respiratory specimens testing positive for influenza in clinical laboratories was 2.5%, a slight increase from the 2.1% reported during the previous week. The majority of specimens (89%) tested at public health laboratories during the first three weeks of the 2017–2018 season were influenza A, with the majority of these (91%) being influenza A(H3N2). The remaining specimens tested were reported as influenza B. For the influenza B specimens for which lineage information was available, 96% were B Yamagata. Almost all specimens tested by CDC since May have been similar to the vaccine strains. (B Yamagata is included in this year’s quadrivalent vaccine, but not the trivalent vaccine.)

Nationwide, influenza-like illness (ILI) activity was at 1.3%, well below the national baseline of 2.2. ILI information also is available on a state level, with activity summarized as minimal, low, medium, or high. Last week all 47 states, New York City, and the District of Columbia reported minimal ILI activity. However, 3 states (South Carolina, Louisiana, and Alaska) reported low ILI activity last week.

Based on reports from the National Center for Health Statistics (NCHS) surveillance system available for the week ending October 7, 5.4% of deaths were due to pneumonia and influenza (P&I). This percentage is below the epidemic threshold of 6.1% for the week.

Two influenza-associated pediatric deaths were reported during week 42. One report was for an influenza B positive death that actually occurred last season, bringing the total number of pediatric deaths occurring during the 2016–2017 season to 108. The second report was in a child reported with H1pdm09. This is the first reported pediatric death for the 2017–2018 season.

The geographic spread of influenza is reported weekly by state and territorial epidemiologists. For week 42, 5 states reported no activity, 33 states and the District of Columbia reported sporadic activity, 12 states and Puerto Rico reported local activity, and Guam reported regional activity.

One human infection with novel influenza A virus (H1N2v) was reported during week 42, but the case actually occurred in August. As is often the case, the report was for a child under 18 years of age who had contact with swine in an agricultural fair setting. No human-to-human transmission was identified.

ACIP Meeting Summary – Carolyn Bridges (Berry Technology Solutions)

Carolyn reported on the votes and a few other discussions that took place during the October ACIP meeting. Slides from the meeting should be available on the general ACIP meeting information web page within a few weeks.

Shingles vaccine:
Following a robust discussion, ACIP recommended that Shingrix, the newly-licensed herpes zoster subunit vaccine, be used for the prevention of herpes zoster in immunocompetent persons 50 years of age and above. It also is recommended the subunit vaccine for persons who previously have received herpes zoster live vaccine (Zostavax). In the closest vote, ACIP voted to prefer the subunit vaccine over the live vaccine. Carolyn stressed that the votes were taken for immunocompetent persons only, but being immunocompromised is not considered to be a contraindication to receipt of the subunit vaccine. ACIP will take up this issue during a future meeting. The new zoster vaccine recommendation is being incorporated into the adult immunization schedule, which will be published in February 2018.

Hepatitis A and B:
ACIP reviewed information about recent outbreaks of hepatitis A, as well as discussing the epidemiology of hepatitis B and a new hepatitis B vaccine (Heplisav-B) awaiting FDA licensure.

Influenza vaccine:
There were no substantive changes to the current influenza recommendations.

ACIP voted that people who previously have received two doses of mumps-containing vaccine (typically this is MMR or MMRV) who are identified by public health as being at increased risk of infection due to an outbreak should receive a third dose of mumps-containing vaccine. This recommendation will be included in the adult and child/adolescent schedules released in February 2018.

Adult and Child/Adolescent Immunization Schedules:
The 2018 immunization schedules will include the recommendations voted upon at the October meeting, specifically herpes zoster and mumps. The new schedules are slated for publication in February, 2018.

Shoulder Injury Associated with Vaccine Administration (SIRVA)
L.J provided an overview on the discussion related to shoulder injury associated with vaccine administration (SIRVA). This is believed to occur due to the unintentional injection of vaccine into the tissues/structures that are underlying or around the deltoid muscle. ACIP received information on the fairly dramatic increase in SIRVA over the past several years. This is a compensatible event on the Vaccine Injury Compensation Table. From 2011–2014, 59 cases of SIRVA received compensation of approximately $9.6 million. The number of reported cases in recent years is 98 in 2015, 202 in 2016, and 163 to date in 2017. In 2016, the compensatible amount was almost $30 million. HRSA will now be conducting increased education and outreach on this subject to help providers recognize the consequences of SIRVA and help reduce the incidence of this adverse event. Dr. Narayan Nair is the main HRSA contact on this subject. In addition, CDC has developed several educational resources that are available on the CDC resource library website, including a short video on intramuscular injection that was made specifically in response to SIRVA issues. In addition, CDC encourages clinic supervisors to use the Checklist of Best Practices for Vaccination Clinics Held at Satellite, Temporary, or Off-Site Locations. This can be particularly helpful during influenza vaccination clinics which may be staffed by personnel who are not accustomed to administering vaccines on a frequent basis.

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