October 1, 2020

October 1, 2020

Influenza Vaccination Coverage for the 2019–2020 Season – Tammy Santibanez (CDC)

Tammy provided a summary of the just-published FluVaxView webpage report, Flu Vaccination Coverage, United States, 2019–20 Influenza Season. For children and adolescents, Information used for the report was compiled from the National Immunization Survey-Flu (NIS-Flu), while information for adults was obtained from the Behavioral Risk Factor Surveillance System (BRFSS). The time period covered was from July 2019 through May 2020.

The influenza vaccine coverage rate for persons age 6 months–17 years was 63.8%, a 1.2% increase from the 2018–19 season. The coverage rate was higher for younger children (6 months–4 years), with a reported rate of 75.5%, a 2.1% increase over the previous season. Rates were somewhat lower for children 5–12 years of age (64.6%) and adolescent 1  17 years of age (53.3%). There was wide variability in coverage between states, ranging from 59.1% to 78.3%. When compared by racial/ethnic group, flu vaccination coverage for Hispanic children (65.5%) and for non-Hispanic black children (58.0%) did not show a statistically significant change when compared to the previous season. Increases in coverage were seen for children who were non-Hispanic white (63.3%) or non-Hispanic other race (69.7%). Non-Hispanic black children had lower coverage rates than all the other racial/ethnic groups. Tammy noted that the online report contains additional information for other populations, such as American Indian/Alaska Native.

For adults age 18 years and older, the overall flu vaccination rate was 48.4%, a 3.1% increase over the 2018–2019 season. Coverage was higher for every age group when compared to the previous season. Consistent with previous seasons, coverage was higher for older adults compared to younger adults. Between states, coverage ranged from 41.4% to 56.8%. When compared by racial/ethnic group, flu vaccination coverage for Hispanic adults (38.3%) and for non-Hispanic black adults (41.2%) did not show an increase when compared to the previous season. Increases in coverage were seen for adults who were non-Hispanic white (52.8%) or non-Hispanic other race (45.9%). Tammy again pointed out that the online report contains additional information for other populations, including Excel reports that provide more detailed breakdowns such as coverage among persons with high risk conditions.

In conclusion, Tammy noted there were limitations to this data. For example, all information was based upon parental or self-reports which were not validated with medical records. In addition, in spite of weighting adjustments, some bias may remain for telephone surveys, which exclude households without telephone service.

Finally, Tammy reminded participants that more detailed information, such as individual state-level data, is available on FluVaxView’s interactive webpages.

Influenza Vaccination Coverage for Pregnant Women and Health Care Personnel – Hilda Razzaghi (CDC)

Hilda provided an overview of influenza vaccine coverage among pregnant women and health care personnel during the 2019–2020 season.

The report, Influenza and Tdap Vaccination Coverage Among Pregnant Women – United States, April 2020, has just been released in the MMWR. Estimates included in the report were based on an internet panel survey conducted during April 2–14, 2020. Participants included women who were pregnant during the peak vaccination period of October 2019 – January 2020. Vaccination coverage was measured from July 2019 to the time of the interview in April 2020.

Among 1,841 pregnant women included in the survey, 61.2% reported receiving influenza vaccine before or during their pregnancy. This was a 7.5% increase compared with the previous season. Coverage was lowest among those 18–24 years of age, Black women, women with a high school diploma or less education, those living below poverty, uninsured women, and those who did not receive a provider recommendation for vaccination. For those with an offer or referral who had 10 or more provider visits, flu vaccination was 64.3% in Black women compared with almost 83% in white women. Coverage was similar among white and Black women with an offer or referral and a condition other than pregnancy that put them at risk for influenza complications. Of note, increases in coverage were seen for all races in 2019–20 compared with earlier seasons, and the magnitude of coverage differences was reduced. Importantly, a provider recommendation continues to be a strong factor associated with vaccination coverage among pregnant women.

Hilda also presented findings from the recently published FluView report, Influenza Vaccination Coverage Among Health Care Personnel— United States, 2019–20 Influenza Season. Data for this report were collected from opt-in internet panel surveys of 2,401 health care personnel (HCP) conducted March 31–April 30, 2020.

Overall, 80.6% of HCP reported receiving flu vaccine. Although this similar to the previous season, it was still remarkably higher than the 63.5% level reported in the 2010–11 season. By occupation, lowest coverage was seen in the assistant/aide group, followed by non-clinical personnel. For the 2019–20 season, highest coverage levels were among physicians, followed by nurses and pharmacists. When examined by work setting, coverage has consistently been highest among hospital personnel (93%), followed by ambulatory care/physician offices (79%). Coverage was lowest among personnel in long term care facilities (69%).  Coverage was highest among HCP working in settings where vaccination was required by the employer (94%). Higher vaccination coverage was associated with employer vaccination requirements or promotions such as onsite vaccination.

Hilda noted that the findings for these reports for both pregnant women and HCP were subject to limitations. For example, the results of these non-probability samples might not be generalizable to these populations as a whole. In addition, vaccination status was self-reported. Despite these limitations, the opt-in panel surveys provide timely evidence of influenza vaccination coverage.

NVAC Meeting Summary – Ann Aiken (CDC)

Ann provided a summary of the National Vaccine Advisory Committee (NVAC) meeting held on September 23–24, 2020. The committee received a new charge from Admiral Giroir related to COVID-19 vaccine. This included three tasks related to supporting CVID-19 vaccine communications, enhancing vaccination of diverse populations, and examining lessons learned from COVID-19 vaccine development that can be used to promote innovation and shorten timelines for vaccine development in the future. (The full wording of these recommendations may be found under the “Background Slides” section of the summary linked above.) The group also voted on a letter containing five recommendations to build confidence in COVID-19 vaccine development. These included utilizing existing FDA processes for vaccine approval and using caution in approving vaccines via expedited processes, coordination of vaccine safety monitoring through a federal immunization safety task force, creating a unified and proactive communication structure for informing the American public, establishing an independent group of experts to conduct ongoing review of available data, and conducting community and stakeholder engagement.

Several expert speakers presented information at the meeting. On the first day, the group held sessions on COVID-19 vaccine equity, considerations for allocation and prioritization of COVID-19 vaccine, an overview of Operation Warp Speed (OWS), the “infodemic” revolving around COVID-19 immunization, and the importance of immunization information systems (IIS) and how they can be used to assist in COVID-19 vaccination efforts. The second day of the meeting focused on influenza and included an overview of flu vaccination coverage during COVID-19 and how to get back on track for overdue immunizations. Finally, the group discussed topics such as progress on using vaccines to prevent superbugs, as well as effective methods to decrease disparities in immunization.

The next NVAC meeting is scheduled for October 16, 2020.

Addressing Racial and Ethnic Disparities in Flu Vaccination – Tara Jatlaoui (CDC)

Tara provided a presentation on CDC’s efforts to address racial and ethnic disparities during the upcoming flu season, as well as in the broader scope of adult immunization. Coverage for all vaccines has been historically and consistently lower among racial and ethnic minority groups.

Disparities in flu vaccination in the 2017–18 and 2018–19 seasons were highlighted in a recent online JAMA publication. In both seasons, compared to non-Hispanic white adults, coverage was substantially lower among Black and Hispanic populations, as well as among American Indian/Alaska Natives. Data also show that vaccination disparities exist within a broad landscape of health inequities (e.g., higher rates of high blood pressure and diabetes), particularly among African Americans. Research shows that lower vaccination coverage is strongly linked to individual and interpersonal factors that impact vaccine confidence.

While these inequities have been recognized for some time, it has been unclear how they can best be alleviated. To better understand and act on these data, CDC’s National Center for Immunization and Respiratory Diseases (NCIRD) held an expert listening session in July to gather input on how to meaningfully address these disparities. The participants underscored the urgency of addressing these disparities, the importance of working with community organizations, and the need for sustained engagement to truly combat mistrust and misinformation. With this background, Tara pointed out how this impacts plans for the upcoming influenza season and vaccination efforts overall.

A record high of 194–198 million doses of flu vaccine are expected to be available for the 2020-21 season. As part of the focus on adults at higher risk of COVID-19, it will be important to reach out to disproportionately affected populations, including racial and ethnic minority groups. CDC has developed a wide variety of communication resources to help amplify messages for high risk populations. The clear message for this season is that flu vaccine is more important than ever. Tested messages focus on protecting loved ones and communities such as essential workers. Social media messages include #SleeveUp to #Fight Flu.

The flu vaccination campaign was kicked off with today’s (October 1) NFID press conference. Upcoming dates of importance are the launch of an Ad Council campaign on October 6, and National Influenza Vaccination Week is planned for December 6–12. A wide variety of helpful tools are available on the CDC website.

CDC also has been working to support expanded efforts for flu vaccine. An additional 9.3 million doses of adult flu vaccine will be available to jurisdictions later this season, and these areas have received $141 million in supplemental funding to support activities to increase flu vaccination coverage. To optimize use of federally procured vaccine, 36/54 jurisdictions report they will focus activities on disproportionately affected adult populations. The National Association of Community Health Centers has been collaborating with jurisdictions on their efforts to reach these groups.

Based on the results of the listening program, CDC is taking several approaches to address disparities. Specifically, CDC will deploy funding through its Racial and Ethnic Approaches to Community Health (REACH) program to implement priority actions focused on increasing flu vaccination coverage among racial and ethnic groups. The three priority actions are to support national and community organizations for immediate outreach to racial and ethnic groups experiencing disparities, rapidly establish a learning hub (in coordination with the Association of Immunization Managers) to provide resources to community partners, and rapidly establish a data hub to inform decisions on where to focus, segment populations, and track interventions and community-level progress. Thirty-one REACH programs are currently spread across 22 states and more than 200 regions and counties. These areas have identified more than 12 specific populations with whom they will be working. It is hoped these programs will help inform next steps to address vaccine confidence and racial/ethnic disparities for flu and other adult vaccinations.

CDC also is exploring ways to expand to more community level organizations. Resources will be available for these groups, and they will provide feedback to CDC to help improve efforts to address disparities. CDC also plans to collaborate with additional national partners on a national campaign. Tara expressed hopes to continue to collaborate with many Summit partners, as well as national pharmacy chains. CDC also is exploring new partnerships with groups experienced in racial justice and health equity.

Influenza Surveillance Update – Alicia Budd (CDC)

Alicia provided an update on influenza activity through Week 38, ending September 19, 2020. Influenza activity continues to be extremely low. The percentage of specimens testing positive at clinical labs has been at less than 1% since early April. There have been nearly equal numbers of influenza A and influenza B represented in this very small number of positives. Over the course of the summer, there have been a few influenza H1 and influenza B specimens at public health labs. Last week the first H3 specimen was reported since early May.

Outpatient visits for influenza-like illness (ILI) were also low, accounting for less than 1% of visits. This is well below the national baseline.

No new pediatric influenza-associated deaths have been reported, with the 2019–2020 season total at 188. Alicia reminded partners that the influenza season runs from Week 40 of one year through Week 39 of the next year. Therefore, the 2020–2021 season will begin with Week 40 on September 27. Any new pediatric deaths from that date forward will be counted in the new season.

Mortality from death certificates indicate 5.4% of deaths were due to pneumonia and influenza (P&I). This is slightly below the 5.5% epidemic threshold, but CDC expects this will increase as data continues to be reported for increased pneumonia deaths associated with COVID.

A Summit partner reported that information is circulating suggesting that COVID mitigation measures may delay the onset of the influenza season, and the question was raised about whether providers also should delay vaccinating until December or later. Alicia noted that we can never be sure of the timing or intensity of flu season. Although flu activity was extremely light in the Southern hemisphere, we cannot be assured the same thing will happen in the U.S. However, L.J noted that the experience in these areas was during a time of stringent restrictions and good compliance, which is not necessarily the case in this country. Tara added that CDC has made no changes to the recommendations. The message remains that October is a great time to be vaccinated against influenza.

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