July 11, 2019

July 11, 2019

Influenza Surveillance Update – Alicia Budd (CDC)

Alicia reported that flu activity in the United States is minimal, which is to be expected for July. The percent of specimens testing positive at clinical laboratories over the last month is 2–3%. Public health laboratories are seeing a little bit of all the viruses, with H3 being slightly predominant.

Outpatient visits for influenza-like illness are low, accounting for less than 1.5% of visits. Similarly, mortality data related to pneumonia and influenza (P&I) as low and below epidemic thresholds for this time of year.

Influenza-associated pediatric deaths continue to be reported. However, some of these deaths occurred earlier in the season and are just now being reported. A total of 122 influenza-associated pediatric deaths have been reported to CDC during the current season.

CDC continues to monitor influenza activity in the temperate zones of the world, where the influenza season is currently occurring. The 2019 influenza season seems to have begun earlier than usual in Australia, Chile, New Zealand, and South Africa. However, it is still too early to determine the severity of the season. Influenza A H3 viruses are predominant in the Oceania region (Australia, New Zealand, South Africa), but most countries in South America are seeing H1 as the predominant strain. There is no way to know if the upcoming U.S season will reflect what is being seen in these regions.

A Summit member pointed out that influenza vaccine effectiveness (VE) during the past season for H3 was relatively low and wondered if we know how many flu deaths were due to H3 as opposed to other strains. Alicia noted that CDC does have information on the virus strains that caused reported influenza deaths, but receipt of vaccination status is usually delayed. Of the 122 pediatric deaths reported, 27 were influenza A H3 viruses. A number of influenza A specimens received were not sub-typed. Adult numbers are harder to determine because they are developed from death certificates, which do not include virologic data.

Update from ACIP on Influenza Vaccine Supply

L.J provided an update from the ACIP meeting on the anticipated influenza vaccine supply for the upcoming season. The WHO decision to postpone its influenza vaccine strain selection to March in order to have more data regarding potential drift in the H3N2 strain has impacted vaccine manufacturing with regards to the timing of delivery of influenza vaccine this upcoming season. As of June 2019, capacity has not been impacted (except for LAIV), and we are anticipating about 162–169 million doses this year. Delivery of these doses will be spread out over time with start times for delivery according to this table taken from the ACIP June meeting.

Manufacturer Distribution estimated to begin
AstraZeneca Early September
GSK Mid-August
Sanofi Pasteur Late August/Early September
Seqirus Mid-August

It is important to note that while this information was first presented at the National Adult and Influenza Immunization Summit and validated as of June 2019, it can change based on production yield and other manufacturing factors.

Update on June 2019 ACIP Meeting – David Kim (CDC)

David provided an overview of the extremely busy ACIP June meeting, which included detailed discussions and multiple votes, as outlined below.

Human Papillomavirus (HPV) Vaccine
ACIP now recommends HPV catch-up vaccination for all persons through age 26 years. This harmonizes the recommendations for both males and females. In addition, ACIP recommends vaccination based on shared clinical decision making for all persons age 27–45 years. The new terminology of “shared clinical decision making” defines the relationship between the healthcare provider and the patient, and it replaces the previously used “individual clinical decision.” The new term will be reflected in both the childhood and adult 2020 immunization recommendation schedules.

Pneumococcal Vaccine
ACIP now recommends use of pneumococcal conjugate vaccine (PCV13) based on shared clinical decision making for immunocompetent adults age 65 years and older. The committee also reiterated that all adults in this age group should receive a dose of pneumococcal polysaccharide vaccine (PPSV23). The PCV13 decision was based on data showing minimal direct impact of PCV13 in this age group. Although this was not a unanimous decision, the majority of ACIP members approved this modification of the recommendation.

Influenza Vaccine
ACIP reiterated its recommendation that annual influenza vaccination is recommended for all persons age 6 months and older who do not have contraindications. During the meeting a presentation was made on the changes for the 2019–2020 vaccine composition. The B strains remain the same as the 2018–2019 vaccine, but the A H1N1 strains have been updated to A Brisbane and the A H3N2 strains have been updated to A Kansas.

Meningococcal Vaccine
ACIP now recommends a booster dose of MenB vaccine for persons age 10 years and older who are at increased risk of meningococcal disease (i.e., persons with asplenia, complement deficiency, complement inhibitor use, or who are microbiologists) and who have completed the primary series of MenB vaccine. The booster should be given 1 year after completion of the primary series. If the risk remains, a booster should be given every 1–3 years thereafter. In addition, ACIP recommends that persons determined by public health officials to be at increased risk of meningococcal B disease during an outbreak should be vaccinated with a one-time booster dose if it has been more than 1 year since they completed the primary series of MenB.

Hepatitis A
ACIP recommends routine catch-up hepatitis A vaccination for all persons age 2–18 years who have not been previously vaccinated. The committee also recommends that all HIV-infected persons age 1 year or older should be vaccinated with hepatitis A vaccine. This is added to the current recommendation for vaccination of persons traveling internationally to hepatitis A endemic countries, persons in close contact with an international adoptee from a hepatitis A endemic country, men who have sex with men (MSM), individuals who use drugs, persons with chronic liver disease, persons who are homeless, and persons at occupational risk, such as healthcare workers.

ACIP also updated a policy guideline from approximately 10 years ago. This was not discussed during the meeting itself.

  • Vaccination of persons with chronic liver disease – The definition of persons with chronic liver disease will now be added to the guidance, as was done previously for hepatitis B vaccine.
  • Vaccination of pregnant women – Pregnant women will now be specifically identified as being at increased risk of hepatitis A virus infection.
  • Environmental settings – Hepatitis A vaccine will now be recommended in certain high-risk settings providing services to adults, such as healthcare settings targeting services to persons using drugs and group homes/non-residential day care facilities for developmentally disabled persons.
  • Vaccination during outbreaks – Hepatitis A vaccine will be recommended for persons age 1 year or older during outbreaks in specific settings (as determined by public health officials).
  • Persons with clotting factor disorders – The previous recommendation that persons with clotting factor disorders should receive hepatitis A vaccine will be removed. Development of new clotting factor products has eliminated the risk of infection for these persons.

Other Items – L.J Tan (IAC)
  • Summit/AMGA Health Care Systems White Paper Has Been Published – The white paper A roadmap to better population management through improved adult immunization has now been published in Becker’s Hospital Review. The paper details best practices and provides a step-by-step roadmap on how health care systems can implement adult immunizations to improve population health management.
  • 2020 Child and Adult Core Set Review Workgroup Draft Report Now Open for Comments – The Quality and Performance Measures Workgroup reminds Summit partners that the Recommendations for Improving the Core Sets of Health Care Quality Measures for Medicaid and CHIP report is now available for public comment. Comments may be submitted by 8 pm ET on Monday, August 5 to Public Comments or via email which includes the subject line “2020 Core Set Review Public Comment.
  • Webinar on June 2019 ACIP Meeting – The National Foundation for Infectious Diseases (NFID) will provide a webinar, Updates from the June 2019 ACIP Meeting, on July 18, 2019 at 12:00 pm ET. Speakers for the webinar will be William Schaffner, MD, NFID Medical Director and liaison to the ACIP, and H. Keipp B. Talbot, MD, MPH, NFID Secretary and ACIP member.
  • AVAC Congressional Briefing – The Adult Vaccine Access Coalition (AVAC) will be holding a briefing for congressional staffers on July 24 at 12:00 pm ET in the Russell Senate Office Building. The briefing will provide a chance to educate on the importance of immunizations across the lifespan and also will cover the Protecting Seniors Through Immunizations Act, S. 1872.
  • Announcement from the American Nurses Association (ANA) – Holly Carpenter announced that the ANA recently voted to strengthen its statement on vaccination compliance, removing the religious exemption and requiring annual recertification for medical exemption.
  • Summit Call Schedule Reduced During the Summer – Summit calls will be held on a monthly basis until the beginning of the next flu season this fall.
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