August 27, 2020

August 27, 2020

Influenza Surveillance Update – Alicia Budd (CDC)

Alicia provided an update for influenza activity through Week 33, ending August 15, 2020. Flu activity remains very low. Since early April, less than 1% of specimens have been testing positive for flu. For this small number, both H1 and B specimens have been reported. No H3 specimens have been reported since early May.

Reported influenza-like illness (ILI) also has been extremely low, with less than 1% of visits attributed to ILI. This is well below the baseline level and is a decline from the slight bump in activity seen in mid-July. Even though this is a very low level, it is higher than is typically seen at this time of year. This may represent some respiratory illness associated with COVID-19.

A total of 188 pediatric deaths from influenza have occurred during the 2019–2020 season. Unfortunately, this ties with the 2017–2018 season for the highest number of flu-related reported pediatric deaths during a regular influenza season. Nearly 2/3 of these deaths occurred in children who were infected with influenza B, and 43% of deaths occurred in children less than five years of age. Of those for whom information was available, 43% had an underlying medical condition. Approximately 80% of these pediatric deaths occurred in children who were not vaccinated.

NCHS data for pneumonia and influenza (P&I) mortality indicated 6.1% of deaths during the week were attributable to P&I. Although this is a decline, it is still well above the epidemic threshold. With no flu activity occurring now, it is felt some of this mortality is attributable to COVID-19.  Reinforcing that concept is the fact that two peaks in activity have occurred (early April and mid-to-late July), corresponding to increases in COVID-19.

Influenza in the Southern hemisphere has been quite low this year, and all types of influenza were reported.

COVID-19 Epi Update and ACIP Summary – Sara Oliver (CDC)

Sara provided a brief summary of COVID-19 epidemiology and an overview of the ACIP meeting which took place on August 26.

Through August 26, more than 5.7 million cases of COVID-19 had been reported in the U.S. Cases showed a sharp increase during March-April and again in June-July. Over the last month, there has been a steady decline, though the numbers of reported cases are still larger than they were during the April-May period.

For the last week, U.S. state and local public health labs have reported 6.6% of specimens tested were positive for COVID-19. Commercial labs reported 6.3% positive during the same period. COVID-like illness (CLI) was reported for 2.3% of visits to emergency departments for the week. Pneumonia, influenza, and COVID (PIC) accounted for 7.8% of death certificates submitted for the week. Additional surveillance information is available in COVIDView, which is published weekly.

Through August 26, there had been almost 178,000 deaths reported. During August, there were about 1,000 deaths per day.

Sara provided additional information on the epidemiology of disease in at-risk populations. She emphasized that the definition for healthcare personnel (HCP) is broader than many people realize; it  includes both paid and unpaid persons in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials. As of August 26, almost 145,000 persons known to be HCP had been reported with COVID-19. COVID-NET reports through mid-July indicates the bulk of cases were in HCP other than physicians and nurses. Cases have been increasing in long-term care facility (LTCF) workers, who predominantly are lower wage workers over the age of 50. In many instances, COVID-19 activity has increased among LTCF staff first, and then in residents. Similarly, in a separate analysis of 16 U.S. prisons and jails, more than half of these facilities identified their first case of COVID-19 was among staff members.

Data reported from 14 states during April and May indicated 9.1% of workers in meat and poultry processing plants were positive for COVID-19. Almost 90% of these cases were among racial and ethnic minorities. Unique risk factors for these workers included prolonged workplace exposure, shared transportation and/or housing, and lack of paid sick leave.

Sara concluded the epidemiology portion of her presentation by noting that higher hospitalization rates were seen in adults age 65 and older and among adults with underlying medical conditions, including obesity, chronic kidney disease, diabetes, and hypertension.

Sara highlighted key points from the August 26 ACIP meeting. Both Moderna and Pfizer provided results from Phase I trials of their respective mRNA COVID vaccines and their plans for ongoing Phase II and III studies. Immunogenicity and safety data reported from both companies was summarized on the presentation slides. (See link at beginning of this section.) Both companies are currently enrolling participants in Phase III trials. The primary endpoints of these trials will be to assess for symptomatic, virologically-confirmed COVID-19 disease. Both companies also are attempting to assure diversity among study participants, including racial and ethnic diversity, younger and older adults, and persons with underlying medical conditions.

Proposed scenarios for vaccine distribution and allocation were presented at the meeting. These scenarios took into account the amount of vaccine available, which initially is expected to be in limited supply, as well as vaccine storage and handling parameters. (For example, the Pfizer/BioNTech vaccine must be shipped and stored at -70o C.).

Groups under consideration for early phase vaccination include healthcare personnel, essential workers, persons age 65 years and older, and those with high risk medical conditions. If taken as a whole, this accounts to over one-half the U.S. population, so additional sub-prioritization will be needed. At this time, ACIP appears to be leaning toward priority vaccination of HCP. The workgroup is continuing to hold these discussions, and it is hoped a vote may be taken on this issue at the September ACIP meeting.

Following her presentation, Sara answered several questions from call participants. Although specific data is not available to report the percentage of deaths occurring in residents of long-term care facilities (LTCF), it is illuminating to note that adults 65 years of age and older account for 16% of U.S. cases but almost 80% of U.S. deaths. She noted that ACIP also will review the best ways to protect LTCF residents if, for example, they cannot be vaccinated with a vaccine approved under an Emergency Use Authorization. In that instance, vaccinating staff would be the best approach.

In response to another question, Sara explained that CDC and state health departments would work together to determine priority candidates for vaccines. CDC will provide guidance, but states will have the flexibility to adjust this prioritization to meet the needs of their specific population.

One call participant asked about obesity risk for COVID disease. Although COVIDNet classifies obesity as anyone with a BMI greater than 30, and severe obesity in those with a BMI over 40, it does not classify gradients of risk within these classifications. Sarah pointed out that the CDC webpage describes the systematic review of various high-risk conditions, including obesity, and suggested additional information might be available there.

Sarah reported that CDC hopes to have votes on COVID vaccine use during the September 22 meeting, and they will publish recommendations quickly after that. In addition, CDC is developing all information that will be needed if a vaccine is approved under an EUA.

Because the mRNA vaccines discussed at the meeting require two doses, one call participant asked if compliance is known for adults receiving routine vaccines that require more than one dose. Carolyn Bridges commented that some data is available for this in regard to Shingrix compliance, but she did not have that available at the time of the call. Sarah reminded callers that, if a vaccine is approved under an EUA, it would likely place greater emphasis on follow-up for receipt of the second dose. She also noted that ACIP does not consider vaccine mandates; these decisions are left up to individual states and facilities such as hospitals. Of note, if a vaccine is approved under EUA status, it is not allowed to be mandated.

HHS Updates – David Kim (OIDP)

Healthy People 2030 (HP2030) was launched on August 19. It contains 365 core objectives and 144 developmental objectives, a significant reduction of the number included in HP2020. Six objectives relate to vaccines; five relate to children and one concerns the general population. The latter relates to the goal of everyone 6 months of age and over receiving influenza vaccine. The three developmental objectives relate to women receiving Tdap during pregnancy, increasing the proportion of people whose records are included in immunization information systems (IIS), and increasing the proportion of adults age 19 years and older receiving recommended vaccines. All three developmental objectives were supported by the Summit.

The Public Readiness and Emergency Preparedness (PREP) Act now authorizes that, during the time of COVID-19, pharmacists may deliver vaccines to children 3–18 years of age.

The National Vaccine Advisory Committee (NVAC) met on June 9 to discuss COVID-19. The next meeting is scheduled for September 23–24.

Announcements – Carolyn Bridges (IAC)
  • Summit Webinar – Carolyn announced that on September 9 the Summit will be holding a webinar in which vaccine manufacturers will be providing an update on COVID-19 vaccine planning. Additional information about this will be shared with Summit members via email.


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