February 15, 2018

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February 15, 2018

Influenza Surveillance Update – Alicia Budd (CDC)

Alicia provided highlights of the influenza surveillance report from week 5, ending February 3, 2018. Although influenza activity has continued to increase nationally, we are beginning to see some signs that activity may be declining in the western and central parts of the country. The percentage of respiratory specimens testing positive for influenza in clinical laboratories was 26.3%. This level has been relatively stable for the last 4 weeks. The percentage of specimens testing positive for influenza A (69.2%) is beginning to decrease, while the percentage of influenza B specimens (30.8%) is on the rise. Data from public health laboratories indicates 79.3% of tested viruses were influenza A and 20.7% were influenza B. Of the subtyped influenza A viruses, 88.2% were of the H3 variety, and 68.2% of the B viruses for which lineage information was available were B Yamagata. When compared with previous weeks, these percentages indicate that the amount of B viruses and H1 viruses are continuing to increase as the season progresses. Specimens characterized since May continue to be antigenically and genetically similar to the reference virus for this season’s vaccine. The antigenic similarity is lower for egg-grown virus (64%) than cell-grown virus (98%). Of the several hundred viruses that have been tested, only 4 have shown any antiviral resistance. All of these virus samples were H1N1, which is not the predominant strain this season.

Nationwide, influenza-like illness (ILI) activity was at 7.7%, well above the baseline of 2.2% This is the 11th consecutive week that we have been at or above baseline ILI levels. This is the highest ILI level we have seen since the 2009 pandemic. All 10 HHS regions are above their region-specific baselines. ILI information also is available on a state level, with activity summarized as high, moderate, low, or minimal. Last week, 43 states, New York City, the District of Columbia, and Puerto Rico reported high ILI activity, 3 states reported moderate ILI activity, 2 states reported low ILI activity, and 2 states reported minimal ILI activity. For context, in the past 5 seasons the largest number of jurisdictions reporting high ILI activity in a single week was 31.

Information from the Influenza Hospitalization Surveillance Network (FluSurv-NET) indicates an overall hospitalization rate of 59.9 per 100,000 population. The highest rate (263.6 per 100,000) was among adults aged >65 years, followed by adults aged 50–64 (63.1 per 100,000 population) and children aged 0–4 years (40.0 per 100,000 population). This cumulative rate for week 5 exceeded the rate for the same week during the 2014–2015 season, our most recent H3 predominant season, It is too early to say whether this represents a true increase in the intensity of this season’s activity or whether this reflects the timing of the activity early in the season.

Based on reports from the National Center for Health Statistics (NCHS) surveillance system available for the week ending January 13, 10.1% of deaths were due to pneumonia and influenza (P&I). This system has been above the epidemic threshold for five consecutive weeks.

Ten (10) influenza-associated pediatric deaths were reported during week 5. For the 2017–2018 season, the total number of reported pediatric deaths is 63. Approximately one-third of these deaths were associated with influenza B viruses, Of the deaths associated with influenza A viruses, about ½ were associated with H1. Information on prior medical history was available for 53 of the 64 deaths. Just over ½ of the children had an underlying medical condition that put them at increased risk for complications from influenza. Among the 54 children who were vaccine-eligible and for whom vaccine status was known, 26% had been vaccinated prior to illness onset.

In terms of geographic spread of influenza within a state (characterized as regional, local, sporadic, or no activity) as reported by state and territorial epidemiologists, 48 states and Puerto Rico reported widespread activity, 2 states (Oregon and Hawaii) reported regional activity, 0 states, the District of Columbia, and Guam reported local activity, and 0 states and the U.S. Virgin Islands reported sporadic activity.

Alicia noted a couple of recent publications that might be of interest to Summit members.

  • What Have We Learned About Influenza Deaths in Children and How Can We Do Better? (Edwards) is in this week’s issue of Pediatrics. Alicia highlighted key points from the article, including information that the highest mortality rate was in children <6 months of age, followed by children 6–23 months of age. The mortality rate in children >6 months of age was 6 times greater than the rate for children who were 13–17 years of age. For children 6–23 months of age, the rate was 3 times higher than the older age group. About half of the deaths occurred in children who were otherwise healthy. Of the children who were eligible for vaccination and for whom vaccination status was known, 31% had been vaccinated.

HEDIS Public Comment Period Open for Adult and Prenatal Immunization Status Measures – Angela Shen (NVPO)

Angela announced that the public comment period is open on two HEDIS measures the Quality and Performance Measures Workgroup has been working on for several years. The proposed new measures are for the Adult Immunization Status composite measure for routinely recommended vaccines and the Prenatal Immunization Status for influenza and Tdap for pregnant women. The web page that includes the instructions, materials, and submission platform is available online. The public comment period is open until 11:59pm (ET), Tuesday, March 13.

2018 Adult Immunization Schedule Updates – David Kim (CDC)

David provided a presentation on the recently released 2018 Adult Immunization Schedule. Changes for 2018 include information on:

  • Recommended use of recombinant zoster vaccine, RZV (Shingrix, GSK);
  • Recommended use of MMR in a mumps outbreak setting;
  • Updated ACIP recommendations for prevention of hepatitis B.

Details about these changes are summarized in the presentation. However, selected highlights include:

  • 2 doses of RZV are recommended for adults >50, regardless of past herpes zoster or receipt of zoster vaccine live (ZVL). For adults >60, either RZV or ZVL may be used, though RZV is preferred.
  • 1 dose of MMR is recommended for persons who previously received <2 doses mumps-containing vaccine and who are identified by public health authorities to be at increased risk during a mumps outbreak.
  • Hepatitis B is recommended for adults with chronic liver disease. The 2018 schedule provides specific examples of chronic liver disease to assist providers in determining persons who should be vaccinated.

David also provided a brief update on the status of ACIP recommendations for conjugate 1018-adjuvanted hepatitis B vaccine (HEPLISAV-B, Dynavax). Because this new vaccine did not receive FDA licensure until November 2017, it was not discussed at the October ACIP meeting. However, it is scheduled for discussion and a vote at next week’s February meeting. This recombinant vaccine is recommended as a 2 dose regimen given 1 month apart.

Announcements – Amy Parker Fiebelkorn

Amy reminded participants to be sure to register for National Immunization Conference (May 15–17) and the 2018 Summit Meeting (May 17–18). Individuals needing the password to register for the Summit may contact L.J Tan.

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