March 15, 2018

March 15, 2018

Influenza Surveillance and ACIP Influenza Update – Alicia Budd (CDC)

Alicia provided highlights of the influenza surveillance report from week 9, ending March 3, 2018. Although we are still at relatively high levels compared to baseline, we are beginning to see a significant decline in influenza activity.

The percentage of respiratory specimens testing positive for influenza in clinical laboratories was 17.7%, representing a decline for the third week in a row. The percentage of specimens testing positive for both influenza A (49.1%) and influenza B (50.1%) is trending downward. All 10 public health regions now appear to be past their peak in terms of reported positives. For the season as a whole, data from public health laboratories indicates 21.7% of viruses have been influenza B. Looking at the last 2 weeks only, influenza B levels were 46% during week 8 and 53% during week 9. Seven of the 10 surveillance regions reported influenza B as being predominant during week 9. H1 viruses are increasing, but at much smaller levels than influenza B. Of the B viruses for which lineage information was available, approximately 90% were B Yamagata and 10% were B Victoria.

Specimens characterized since May continue to be antigenically and genetically similar to the reference virus for this season’s vaccine. For H3, H1, and B Yamagata viruses, 98–100% are similar to their respective cell-grown viruses. However, the egg-grown viruses have a lower similarity to the vaccine virus (~64%) for H3. In addition, a subset of the B Victoria viruses have a particular genetic change and amino acid deletion that affects their antigenic similarity to the vaccine. Currently, about 67% of B Victoria viruses have this deletion.

Three (3) new H1 specimens were found to be antiviral resistant, bring the season total to 8. This is still quite low, however, occurring with <2% of the H1 specimens tested. No antiviral resistance has been detected for H3 or B viruses.

Nationwide, influenza-like illness (ILI) activity was at 3.7%. Although we are still above the baseline of 2.2%, this is the fourth consecutive week we have seen a decline in this system. All 10 HHS regions now appear to have passed their peak ILI activity. ILI information also is available on a state level, with activity summarized as high, moderate, low, or minimal. Last week, 21 states and New York City reported high ILI activity; 15 states reported moderate ILI activity; 5 states, the District of Columbia, and Puerto Rico reported low ILI activity; and 9 states reported minimal ILI activity.

Information from the Influenza Hospitalization Surveillance Network (FluSurv-NET) indicates an overall hospitalization rate of 86 per 100,000 population. The highest rate (371 per 100,000) was among adults age >65 years, followed by adults age 50–64 (94 per 100,000 population) and children age 0–4 (63 per 100,000). Overall, the all ages combined rate and all adult rates are at the highest levels ever reported into the system.

Based on reports from the National Center for Health Statistics (NCHS) surveillance system available for the week ending February 17, 8.8% of deaths were due to pneumonia and influenza (P&I). This is the still above epidemic threshold levels, but represents the fourth week in which we have seen a decline in the percentage of deaths attributed to P&I.

Five (5) new influenza-associated pediatric deaths were reported during week 9. For the 2017–2018 season, the total number of reported pediatric deaths is 119. 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.

In terms of geographic spread of influenza within a state (characterized as widespread, regional, local, sporadic, or no activity) as reported by state and territorial epidemiologists, 34 states and Puerto Rico reported widespread activity; 12 states and Guam reported regional activity; 4 states and the District of Columbia reported local activity; and 0 states and the U.S. Virgin Islands reported no influenza activity.

Update on Adult Immunization Regional Stakeholder Meetings – Angela Shen (NVPO)

NVPO is convening Regional Stakeholder Meetings to discuss and spark action around the National Adult Immunization Plan (NAIP). The meetings are scheduled to be held in 6 of the 10 HHS Regions. The first meeting (for Region 6) was held in Dallas, Texas in January. Five additional workshops will be held next quarter, with the first scheduled for next week in Philadelphia, Angela wanted to ensure partners are aware of this unique opportunity to collaborate with other immunization stakeholders in their region.

The meetings are designed to galvanize action around adult immunizations at the state and local level. Topics discussed will vary among the meetings and will include areas such as communications and college health issues.

Angie Bricco commended NVPO on conducting these meetings and asked if any interesting insights were gleaned from the first session that could be applied to current or future influenza seasons. However, Angela pointed out that the first two meetings were not influenza-specific. For example, at the first meeting, states discussed action plans modeled around NAIP objectives. Angela offered to obtain permission from at least one state to share an action plan with Summit partners.

At the end of the series of meetings, NVPO hopes to have a compilation of best practices that can be widely shared. Persons wishing to obtain additional information should contact Angela Shen.

Announcements – Amy Fiebelkorn (CDC)

Amy reminded partners that today (March 15) is the deadline to submit an abstract for the poster session to be held at the annual Summit in-person meeting. In addition, persons should register for the Summit meeting itself. Individuals needing the password to register for the meeting should contact L.J Tan. Persons also are reminded to register for the National Immunization Conference (NIC) to be held immediately prior to the Summit meeting.

Angie Bricco announced that Sanofi Pasteur will be holding an educational program during NIC on Wednesday, May 16 from 6–8:30 pm. The meeting will consist of a panel discussion among a multi-disciplinary group of experts discussing their role in being champions for vaccination, particularly during this challenging influenza season. Panel members are Tracy Bieber, Sanford Health; Ruth Carrico, University of Louisville; Barbara Pahud, Children’s Mercy; and Serese Marotta, Families Fighting Flu. Additional information is available from Angie Bricco.

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