A summary of presentations from the weekly Summit partner webinars
August 12, 2021 – The latest Summit summary
- 2021–2022 Influenza Vaccination Campaign – Erin Burns (CDC)
- 2021–2022 ACIP Influenza Update – Lisa Grohskof (CDC)
- National Immunization Awareness Month and Catch-Up Vaccination Promotions in August – Michelle Graham (OASH, DHHS)
2021–2022 Influenza Vaccination Campaign – Erin Burns (CDC)
Erin Burns, associate director for communications science, in the Influenza Division at the CDC, gave a presentation on the 2021–22 influenza vaccine campaign.
The main platform CDC is again using for the 2021–22 influenza vaccine campaign, and that will also be emphasized during the National Influenza Vaccination Week to be held December 5–11, is the “take three” platform. There are three main messages:
- Take time to get a flu vaccine. It is the best way to protect yourself and your loved ones
- Take antiviral drugs if your doctor prescribes them
- Take every day preventative measures to prevent the flu
However, each influenza season has its own campaign-specific issues. For the upcoming season, CDC in collaboration with Weber-Shandwick, has designed a digital media campaign aimed at people age 40–64 years with chronic medical conditions, people age 65+ years and older, pregnant individuals, and parents. The campaign will also include a second year of collaboration between the Ad Council, CDC, and American Medical Association (AMA), resuming a campaign targeting the general population, particularly African Americans, Hispanic populations, and a generally younger and uncommitted demographic. These efforts will all take place against a background of ongoing activities that happen every year, such as media outreach, press releases, matte articles, clinician outreach, COCA calls, resources for clinicians, social media, audio podcasts, and partner outreach and coordination.
Key dates to note for the upcoming season include:
- August 27: Publication of annual influenza R&R/MMWR
- Mid-September: A soft launch of CDC digital media campaign
- October 7: NFID press conference
- October 12: Ad Council campaign launch
- October 15: Weekly FluView Reports start with associated social media and media outreach
- December 5: National Influenza Vaccination Week
- TBD – Around the start of flu season: Web spotlight/media outreach and communication rollouts around key studies
CDC had a publication in MMWR that looked at flu virus circulation in the wake of the SARS-CoV-2 pandemic. Among most of the common respiratory viruses, particularly the flu, activity plummeted in the previous season. However, in the past few weeks, there has been a resurgence of RSV, which is an atypical time for it to circulate. There are signs that other respiratory viruses are beginning to circulate as they have in the past. In anticipation of the re-emergence of the flu, CDC is doing everything it can to prepare for the season.
The media is picking up the messages that CDC is concerned about the upcoming flu season being more severe than usual. CDC is already laying the groundwork and re-emphasizing the fact that flu vaccination is the best way to protect yourself and your loved ones against the flu.
Examples of media coverage:
- CNBC: Health Experts are Anxious to Prevent a ‘Catastrophic’ Winter Flu Season (7/7/21)
- Contagion Live: Is There Risk of Flu Outbreaks in the 2021–22 Season? (7/29/21)
CDC Focus Group Testing Results on its Digital Campaign – Summary
CDC conducted six virtual focus groups among mostly unvaccinated and undecided adults age 40–64 years with at least one chronic health condition. These people weren’t for or against the vaccine; instead, they were hesitant to get it. CDC focused on convincing some of the people who may or may not be aware that they were at higher risk of severe flu.
The campaign that tested the best in these focus groups is called “I Get It,” which is a campaign that tested very well last season, but did not end up getting used. This campaign may be used this upcoming season, however the leadership at CDC has not made the decision as of yet. This campaign can be directed toward different populations and demographics.
CDC, AMA, Ad Council Collaboration
This is the second year for the collaboration between CDC, AMA, and the Ad Council. Last season, the Ad Council put out a whole array of materials and promotion in support of the campaign. They have re-tested the “No Time for Flu” messaging to see if it’s still relevant and impactful. It continues to test well and the campaign will be re-released with the bulk of the creative and focus implemented via digital outreach.
We are seeing other respiratory viruses spreading again and the CDC is preparing for respiratory viruses, flu, and SARS-CoV-2 to circulate together. The season could be severe due to reduced population immunity and a potentially early and possibly severe flu season. This may lead to a potentially renewed burden on our healthcare system.
Every day preventive measures can help stop all respiratory viruses such as the flu. And we need to continue to reinforce these behaviors at the local level. We all need to hammer home the benefits of flu vaccination. The vaccine not only reduces risk of flu illness but can make flu illness milder or non-existent. With the vaccine, the burden of hospitalizations is lower. The vaccine is beneficial to pregnant women and to the baby as well. The vaccine lowers rates of some cardiac events among people with heart diseases and has shown to be associated with reduced hospitalizations related to diabetes and chronic lung disease. Nine out of ten people hospitalized from flu have had at least one underlying health condition.
CDC reported record-breaking pediatric deaths––199 children dying from flu during the 2019–20 season––with 80% of those in unvaccinated children. It’s important to also put out the message that flu can be serious for children and that the best way to protect your children is to get them vaccinated.
Frequently asked questions
There are always questions about the match and how well the vaccine is going to work. There were few viruses to look at this season, but the viruses that were used for the vaccines were very representative, so experts are optimistic going into the season that we have the right viruses in the vaccine. CDC will have final vaccine coverage estimates from the 2020–21 flu season by October 2021.
There are a few things that are new this season.
- The flu vaccine can be co-administered with the COVID-19 vaccine.
- All of the vaccines have been updated with the most recent vaccine antigens and all will be quadrivalent this year.
- The R&R coming out on August 27 will clarify timing of vaccinations for different audiences.
Do you find that you are using the same messaging being used around the COVID-19 vaccines (that they chiefly prevent severe disease, hospitalization, and death)? Do you think that could prove helpful, provided the public concern around the potential mismatch between circulating strains and the ones the vaccine protects against?
There is a widespread misconception that flu vaccination doesn’t work. For people not planning to get vaccinated, that was their number one fear, along with the fear that the vaccine will make them sick. They need to understand the potential benefits: the vaccine may not prevent illness, but it may prevent hospitalizations and deaths. That’s worth getting a shot for. It’s preventing more serious outcomes and protecting people who are more vulnerable to those more serious outcomes.
Will there be any emphasis in the messaging on the idea that flu and COVID-19 vaccines may be co-administered?
Yes. In terms of materials, we are still pending some thoughtful deliberations but it’s going to be very important to build awareness around the fact that co-administration is okay at this point. In the focus groups there is still the widespread misconception that there is a waiting period between the two vaccines.
Is there going to be some emphasis on getting people vaccinated through the holiday season?
That’s the hope. It’s important to promote late season vaccination because of the potential for flu to still emerge.
Is CDC going to be emphasizing pediatric (age 6 months and over) flu vaccines? Will this be helpful because COVID-19 vaccinations will not be for children under 12. Is it a priority?
Reaching out to parents is a priority. There is not an approved vaccine for COVID-19 for younger kids, so this is an important point to make.
2021-2022 ACIP Influenza Update – Lisa Grohskopf (CDC)
Lisa Grohskof, MD, MPH, medical officer, Influenza Division, National Center for Immunization and Respiratory Diseases (NCIRD) at the CDC, gave a presentation summarizing influenza policy recommendations from the June ACIP meeting.
The June ACIP meeting discussed the policy changes that were proposed for this coming season flu season. The changes discussed are draft until they become official and published in the MMWR, which is anticipated to be near the end of August.
Updates discussed include:
- Influenza vaccines expected to be available for 2021–22 season
- S. influenza vaccine viral composition for the 2021–22 season
- Change in age indication for Flucelvax Quadrivalent from ≥4 years to ≥2 years
- Timing of vaccination language
- Co-administration of influenza and COVID-19 vaccines
- Contraindications and precautions concerning persons with previous severe allergic reaction to influenza vaccines
Influenza Vaccines Expected to Be Available for the 2021–22 Season
There are a total of nine vaccines anticipated to be available for 2021–22 season, including vaccines we have used in the past few years: inactivated (IIVs), recombinant (RIV), and live attenuated (LAIV) vaccines. Everything is expected to be quadrivalent this year and most are egg-based except Flucelvax Quadrivalent (culture-based) and Flublok Quadrivalent (recombinant).
The 2021–22 Influenza Vaccine Composition
Two of the four strains of influenza viruses were updated for this season, the H1N1 and H3N2 strains. Egg-based vaccines and cell-culture-based vaccines have slightly different quadrivalent vaccine compositions. These two differ in terms of taxonomy and name, but do not differ in antigenicity.
The two compositions are as follows:
- Egg-based IIV4s and LAIV4:
- An A/Victoria/2570/2019 (H1N1)pdm09-like virus;
- An A/Cambodia/e0826360/2020 (H3N2)-like virus;
- A B/Washington/02/2019 (Victoria lineage)-like virus; and
- A B/Phuket/3073/2013 (Yamagata lineage)-like virus.
- Cell-culture-based IIV4 and RIV4:
- An A/Wisconsin/588/2019 (H1N1)pdm09-like virus;
- An A/Cambodia/e0826360/2020 (H3N2)-like virus;
- A B/Washington/02/2019 (Victoria lineage)-like virus; and
- A B/Phuket/3073/2013 (Yamagata lineage)-like virus.
Change in Age Indication for Flucelvax Quadrivalent
The Flucelvax Quadrivalent is a cell-based inactivated influenza vaccine (ccIIV4). This vaccine is now licensed for age ≥2 years. This change was supported by a randomized trial conducted with over 4,000 children age ≥2 years through <18 years over three influenza seasons from 2017–19. The overall vaccine efficacy was 54.6% against RT-PCR or culture-confirmed influenza-associated CDC-defined influenza-like illness.
Co-Administration of Influenza Vaccines with COVID-19 Vaccines
Last season the COVID-19 vaccines weren’t available until mid-December, so co-administration of influenza and COVID-19 vaccines is new this year. Last season the guidance was that COVID-19 vaccines needed to be administered 14 days from other vaccines being administered, but now CDC guidance indicates that COVID-19 vaccines and other vaccines may be administered without regard to timing of other vaccines. This means that flu vaccine can be given at the same time as the COVID-19 vaccine. However, injectable vaccines should be given in separate limbs, especially for vaccines that are more likely to cause more localized side-effects such as adjuvanted vaccines.
Providers need to be checking the current CDC COVID-19 vaccine guidance for updates concerning co-administration.
Timing of influenza Seasons
The timing of the onset of the peak of the influenza season varies from season to season and it’s hard to tell when the best time will be to get vaccinated. The timing also changes geographically, however, and localized areas of increased activity generally occur around the month of October. The most common peak month for flu is February, but some seasons peaked as early as December or as late as March.
Language for timing of flu vaccination has been similar the last two seasons, which is to get the vaccine by the end of October and until the flu stops circulating locally. July and August considered too early for most seasons, particularly for older adults, with the exception of children age 6 months–8 years that require two doses. The first dose needs to be given once vaccine is available and second needs to be four weeks later so that they get their second dose before the start of the flu season.
Factors Relevant for Timing of Vaccination
The draft statement contains discussion of evidence for waning protection following vaccination, as declines in efficacy have been observed over the seasons. This appears to be more pronounced in older adults and less evident in children. The other considerations related to timing that were discussed included unpredictability of timing of onset and peak of the influenza season, the need and desire to avoid missed opportunities to vaccinate, and programmatic constraints.
Draft Timing Language and Early Vaccination (July/August)
Much of the language in the draft recommendations remains the same as last year. People should be immunized by the end of October and children who need two doses of the vaccine (age 6 months–8 years who haven’t had a flu vaccine previously) should get the vaccine as soon as it becomes available. The draft states that all children and pregnant individuals in their third trimester should be vaccinated as soon as possible. For others,, July and August should be avoided unless there is a concern that later vaccination might not be possible. Vaccination should continue throughout the season as long as influenza viruses are circulating, and unexpired vaccine is available.
Allergic Reactions to Influenza Vaccines––Background
The flu vaccine includes multiple components that can trigger potentially severe allergic reactions (anaphylaxis), however serious allergic reactions to the flu vaccine are rare. A study in the Vaccine Safety Datalink (VSD) estimated rates of post-vaccination anaphylaxis among cases that involved administration of a single vaccine were 1.31 cases/million doses for all vaccines and 1.35 cases/million doses for IIV3 (inactivated). These findings show that the incidence of allergic reactions as a result of flu vaccination is very rare.
Influenza Vaccine Package Insert Language Concerning Previous Allergic Reactions to Influenza Vaccines
Language previously stated that a severe allergic reaction to any influenza vaccine was a contraindication to all influenza vaccines. But in recent seasons there have been newer vaccines that have slightly different language. Egg-based IIV4s and LAIV4 are contraindication for people with history of severe allergic reaction to any component of the vaccine or to a previous dose of any influenza vaccine. The language reads different on the cell-culture vaccines; ccIIV4 and RIV4 language says a history of severe allergic reaction to any component of the vaccine is a contraindication.
Contraindications and Precautions Related to Previous Severe Allergic Reaction to Influenza Vaccines
For any egg-based IIV4s and LAIV4: Severe allergic reaction to a previous dose of any influenza vaccine is a contraindication. For these vaccines it’s similar to what it’s been previously and is consistent to what is in the insert.
For ccIIV4: Severe allergic reaction to any ccIIV is a contraindication; a severe allergic reaction to any other influenza vaccine (any egg-based IIV, RIV, or LAIV) is a precaution. This also applies to the trivalent version that’s no longer available.
For RIV4: Allergic reaction to any RIV is a contraindication; allergic reaction to any other influenza vaccine (any egg-based IIV, ccIIV, or LAIV) is a precaution. This applies to the current quadrivalent or if someone had a reaction to a trivalent formulation of the recombinant.
Where a precaution is present, if potential benefit of vaccination is thought to outweigh potential risk of a severe allergic reaction, vaccination should occur in a medical setting supervised by a provider who can recognize and manage a severe allergic reaction. Providers can also consider consulting an allergist to help identify the vaccine component responsible for the previous reaction. This can be helpful in terms of choosing a suitable vaccine.
While CDC interim clinical guidance says that co-administration is not a problem with the COVID-19 vaccine, can you restate the response providers should use to the question that flu vaccine was not studied for co-administration with authorized COVID-19 vaccines?
Last year COVID-19 and flu didn’t overlap very much. The current CDC guidance for co-administration of flu and COVID-19 vaccines is based on increasing clinical experience with and they are okay to be given with the caveats mentioned today.
National Immunization Awareness Month and Catch-Up Vaccination Promotions in August – Michelle Graham (OASH, DHHS)
Michelle Graham, MPH, Office of the Secretary of Health, DHHS, presenting on behalf of Ann Aikin, MA, gave a presentation on National Immunization Awareness Month and catch-up vaccination promotions in August.
During National Immunization Awareness Month (NIAM) in August, CDC needs your help in promoting vaccination and getting both children and adults up to date on recommended vaccines by sharing frequent and consistent messages on the importance of immunization.
The theme for NIAM this year is Get Back on Track with Routine Vaccines, and for this campaign they offer many resources for healthcare personnel, parents, and patients on their website. CDC has NIAM graphics that are sized for various social media platforms, websites, newsletters, and other materials. All of the materials are available for your use.
CDC encourages you to use the popular hashtags when you use the graphics and messages provided. Hashtags include: #NIAM, #NIAM2021, #ivaxtoprotect, #VaccineReady, #VaccinesWork, #CatchUpGetAhead, #PowertoProtect, #ThePowertoProtect, #VaxFacts, #WellChildWednesdays, #GetVaccinated, #GetVaccinatedNow, and #Vaccines.
Other great resources to share:
- Adult Vaccine Quiz – a popular online quiz that helps adults find the vaccines that are recommended for them
- CDC COVID-19 Chat Bot – a new tool CDC is using to answer common questions about covid-19 vaccines. Questions are asked and answered from both the public and healthcare professionals.
- GIFs, including this animated GIF – Office of Infectious Disease and HIV/AIDS’s (OIDP) GIFs provide entertaining and engaging content to promote vaccination and educate the public
Catch-Up to Get Ahead Messaging
The COVID-19 pandemic has caused a significant decline in routine immunizations for both adults and children, with greater gaps in ethnic and racial minority groups who already suffer a greater disease burden when compared to non-Hispanic whites. This decline in children, adolescents, and adults makes the nation vulnerable to more vaccine-preventable illnesses, hospitalizations, deaths, and subsequent economic costs associated with diseases. The Office of Infectious Disease and HIV/AIDS (OIDP) responded to this by creating the Catch-Up to Get Ahead toolkit and a call to action last year. This year, they’ve expanded it and are providing messaging and materials to encourage catch-up immunization in children and adults.
The Catch-Up to Get Ahead Toolkit provides messages and graphics to help spread awareness about catching up on childhood immunizations during NIAM. The toolkit provides talking points, social media graphics and banners, as well as more resources from partners.
To encourage well-child visits and immunizations, Health Resources and Services Administration (HRSA) launched a social media campaign with the hashtag #WellChildWednesdays. Each Wednesday during NIAM, messages will address well-child visits, immunizations, adolescent and young adult care, and nutrition, safety, and mental health as topics to be discussed with pediatric providers.
Will there be a flu vaccine finder this season?
CDC has taken over the widget so they will be responsible for the vaccine finder information, which should be online by mid-September.
Is there an opportunity to exchange the words “ask your doctor” on the website tool for patients regarding vaccinations they may need? There are other health care providers that patients speak to and ask questions about vaccinations, nurses, nurse practitioners, pharmacists, or dentists?
We are changing the messaging throughout the site and using “healthcare worker.”