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A summary of presentations from the weekly Summit partner webinars

December 2, 2021 – The latest Summit summary

Flu Immunization Uptake Update – Julian Ritchey (Sanofi)

Julian Ritchey, VP, Head of Public Affairs and Patient Advocacy, U.S. Vaccines, Sanofi Pasteur, gave an update presentation on flu immunization uptake.

The U.S. has the lowest influenza vaccine immunization rates since 2016. Anticipated extension of the season has not materialized.

 Looking at claims data, there has been a little increase in the uptake of flu vaccines since the prior update 2 weeks ago, which means that the increased attention and focus on engagement with providers may be yielding a better outcome. The country is still significantly behind where it was last year with flu vaccine uptake, as well as behind where we were pre-COVID-19.

Claims remain down across all age groups, most notably pediatrics.

The decrease in flu vaccine uptake this year is seen across all age groups, but most notably and most concerning among children. This is an area of significant concern, but also when looking at the HCP components, there is a strong base of established immunization that can continue later into the season.

CDC has issued an early HAN on influenza.

There was a recent Health Alert Network (HAN) from CDC:  Increasing Seasonal Influenza A (H3N2) Activity, Especially Among Young Adults and in College and University Settings, During SARS-CoV-2 Co-Circulation (11/24/21), that was an important vehicle for increasing awareness of flu vaccination recommendations. Many people are not aware of the immunization gap in flu vaccine this year compared to prior years. One particularly important point is reprinted below.

Remind public health practitioners and clinicians to recommend and offer the current seasonal influenza vaccine to all eligible persons aged six months and older (Flu vaccine and COVID-19 vaccine can be given at the same visit).

There is still time to immunize patients this season as flu activity begins to rise. 

 During the last 38 years, flu activity is known to peak generally between December–March, and most often in February. Knowing this offers the opportunity to stay ahead of the disease and its peak season and continue to urge vaccination.

Encourage providers to stay engaged.

The most important message is that it’s not too late to immunize and to get immunized, so keep offering the flu shot. Reach out to patients who have not received influenza this year and remind them why getting influenza vaccine this year is important for their health. Also, use COVID-19 vaccination and booster appointments to co-administer influenza per the ACIP recommendation, or, if the patient declines, schedule a visit in the very near future for their influenza immunization and follow-up with them to ensure they are immunized. There are also many tools available to help providers, staff, and patients on sites such as CDC.org and Immunize.org. 

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Flu Surveillance Update – Katie Tastad (CDC)

Katie Tastad, MPH, Influenza Division – Domestic Surveillance Team, CDC gave an updated presentation on flu surveillance for week 46, ending on November 20, 2021.

Influenza Virologic Surveillance – United States, May 23, 2021–November 20, 2021

There is starting to be more lab-confirmed influenza identified over the past few weeks, in both clinical and public health labs. However, relative to other flu seasons, the activity is still low than what is historically seen for this time of year.

Public health labs are mostly seeing influenza A (H3N2) in about 80% of specimens tested and these cases are mostly occurring in the 5–24-year-old age group this season.

Percentage of Outpatient Visits for Influenza-Like Illness (ILI), ILINet, U.S.

The outpatient Influenza-like Illness Surveillance Network (ILINet) monitors outpatient visits for influenza-like illness (ILI). ILI is not strictly related to influenza virus activity, but refers to someone who has a fever and cough or sore throat. These are symptoms that are found with many respiratory illnesses that are often circulating at the same time of year. ILI cases are not laboratory-confirmed cases of influenza.

This season is tracking lower than most seasons so far. The ILI activity is still below baseline (2.5%), but there is starting to be a rise in cases, which might indicate the start of flu season.

ILI Activity Level, Determined by Data Reported to ILINet Week Ending November 20, 2021 (Week 46)

The ILI activity level map is based off the same ILI outpatient data but reflects intensity of ILI activity and not the extent of the geographic spread. This compares data from the providers that reported that week to baseline data for the same providers to compare and see whether they are seeing gradations of ILI activity. The ILI Activity Indicator Map displays state-specific and core-based statistical area (CBSA) specific activity levels by week for multiple seasons and allows a visual representation of relative levels of ILI activity from state to state.

During week 46 there was one jurisdiction that had high ILI, which was New Mexico, and one with moderate activity, which was Georgia. The ILI increase was driven by COVID-19 activity.

The CBSA activity shows any high case spots around the country, and a lot of those line up with parts of the country where there are colleges/universities. Currently, there are some influenza outbreaks on campuses, which is concerning because winter travel may increase spread.

Percent of Long-Term Care Facilities (LTCF) with at least One Confirmed Influenza Case among Residents, Reported to CDC National Healthcare Safety Network (NHSN), National Summary, May 24, 2021 – November 21, 2021

A new component of FluView is the percentage of LTCFs with at least one confirmed influenza case among residents, which is reported to CDC’s National Healthcare Safety Network (NHSN). This model supports the COVID-19 response but contains several flu questions related to lab-confirmed flu cases among residents and personnel in the reporting facilities. Currently, there are more than 15,000 LTCFs across the country reporting to this network each week.

There is nothing concerning on this new component as of right now, and it’s hard to expect what the data will look like as this is the first year the system is reporting.

Influenza Hospitalizations in the United States

There are two influenza hospitalization components reported in FluView:

National Center for Health Statistics (NCHS) Mortality Surveillance Data: This looks at the death certificate data from state vital statistics offices for all the deaths in the U.S. with pneumonia, flu, or COVID-19 listed as the cause of death. Currently, many of the deaths are due to COVID-19, as the percentage of COVID-19 deaths is very high. Not many deaths are driven by flu at this point in the season.

Influenza-Associated Pediatric Mortality Surveillance System: This system monitors flu-related deaths of children under the age of 18 years. Currently, there have not been any pediatric deaths with flu as the cause of death so far this flu season and only 1 last season.

Influenza-Related Mortality in the United States

The two mortality-related components of FluView have not been changed.

National Center for Health Statistics (NCHS) Mortality Surveillance Data: This looks at the death certificate data from state vital statistics offices for all the deaths in the U.S. with pneumonia, flu, or COVID-19 listed as the cause of death. Many of the deaths are due to COVID-19 currently, as the percentage of COVID-19 deaths is very high. Not many deaths are driven by flu currently this season.

Influenza-Associated Pediatric Mortality Surveillance System: This system monitors flu-related deaths of children under the age of 18 years. Currently, there have not been any pediatric deaths with flu as the cause of death so far this flu season and only 1 last season.

Summary

In summary, flu activity is still low, but there are indications that flu season is beginning due to increases in positive flu tests in clinical and public health labs, as well as possibly the upward trend of ILI reports. Currently, there is mostly influenza A (H3N2) being seen and most of the cases are among children and young adults. There are anecdotal reports of college and university campuses experiencing outbreaks of flu, which is not unusual for this time of year, however, it is concerning as winter break travel is near.

Additional Information

Influenza Activity

Other Respiratory Virus Activity

Questions

Question

Will you be having LTC healthcare personal vaccination data reported in addition to NHSN outbreaks?

Katie Tastad

Long-term care facilities can track weekly influenza vaccination data for residents and healthcare personnel through NHSN. The reporting is optional. Information is available here: https://www.cdc.gov/nhsn/ltc/vaccination/index.html.

Question

Can you talk a little bit about how the LTC facility data is gathered?

Katie Tastad

This is not nationwide; only some facilities are reporting.

See: Nursing Home COVVID-19 Vaccination Data Dashboard

Question

Will you have race/ethnicity data for this year?

Katie Tastad

We don’t start reporting rates until about 300 cases are confirmed. It takes time to get enough information where there would be a stable rate. We do collect race/ethnicity data for the other surveillance programs, such as for pediatric mortality. Here is the link to the data on influenza burden by race and ethnicity: www.cdc.gov/flu/highrisk/disparities-racial-ethnic-minority-groups.html

Question

Are you doing sequencing for the flu samples as well as for COVID-19? Do you have resistance information yet? Can you describe the process for surveillance for antiviral resistance for flu?

Katie Tastad

The lab is doing normal sequencing and looking for antiviral resistance. However, there is not going to be any published data on FluVIew until there are more specimens.

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Vaccination Coverage Rate and National Influenza Vaccination Week Prep Update – Erin Burns and Bess Davenport (CDC)

Bess Davenport, MPH, Health Communication Specialist, Influenza Division, NCIRD, CDC, and Erin Burns, Associate Director for Communications Science, Influenza Division, CDC, gave an update presentation on vaccination coverage rate and national influenza vaccination week preparation.

Bess Davenport

2021–2022 Flu Vaccine Campaigns

This year there are two flu vaccine campaigns running in parallel:

“I Get It” is a digital media campaign (collaboration with Weber-Shandwick), which targets people age 40-64 living with certain chronic health conditions (asthma, heart disease/stroke, diabetes), with secondary audiences: pregnant people, parents of young children, and adults 65+.

“No Time for Flu” is in year two of collaboration with the Ad Council and AMA, with comprehensive TV, digital, OOH campaign (collaboration with Ad Council, AMA) aimed at the general population, with additional focus on Black/Hispanic audiences of age  25-54 years. This campaign has a secondary social media campaign called “Flu FOMO” (fear of missing out).

Seasonal Flu Vaccination Campaign Timeline

The CDC digital media campaign, “I Get It,” soft-launched in mid-September. The Ad Council campaign, “No Time for Flu,” launched in mid-October, along with the NFID press conference and weekly FluView reports. The Ad council secondary campaign, “Flu FOMO,” launched in November. Heading into National Influenza Vaccination Week (December 5–11), the campaign efforts are ongoing and will run through December and into January.

“I Get It” Flu Vaccination Paid Campaign Results At-a-Glance

Overall, the campaign is performing well across display, paid social, paid search, and boosted organic social posts. Garnering 18.9 million impressions (estimated number of people who have seen the ad), 25,000 clicks, and a 26.74% conversion rate (represents the percentage of users that interacted further with the content––clicking a sub-link on the page).

“I Get It” Campaign Metrics

As part of the “I Get It” campaign, media efforts launched with vaccination messaging targeting the primary audience­­––parents of young kids, pregnant people, and those with chronic health conditions, and those age 65+. The media efforts resulted in 4,000 placements across all ten of the U.S. designated marketing areas.

There were four matte article releases for this campaign. The “Five Truths about Flu Vaccines” focused on adults with chronic health conditions that place them at higher risk for serious complications from flu. This went live on October 11. The “Flu Can Still Make Children Sick” release focused on parents of young children. This went live on October 14. The “Flu Shots for Two” highlighted messaging for pregnant people and went live on October 21. Finally, the “Flu Shot Recommended for People 65 and Older” release highlighted the criticality for older adults to get the flu shot as soon as possible. This final release went live on October 25.

Ad Council Flu Vaccination Campaign Results Report – November 2021

The Ad Council kicked off their “No Time for Flu” campaign with virtual, national satellite, and radio media tour on October 12. This performed well and is outperforming other recent Ad Council media tours. There have been 1.5 million total broadcast impressions, 5.5 million total digital impressions, and 78 total placements so far.

Initial Campaign Highlights

Through mid-November there has been over $200,000 preliminary donated media including (Telemundo, NBC stations, Facebook, Fox stations, Univision, ABC stations, and CBS stations) and 17,500 unique visitors to the campaign site.

Influencer Engagement – Main Street One

The “No Time for Flu” also ran a micro-influencer campaign on Instagram which is driving strong reach and engagement. Of the 40 pieces from the effort, 27 are active and exceeding engagement rate benchmarks (1–2%). To date, it has exceeded the reach achieved through last year’s influencer campaign. There have been 27 live micro-influencer posts, a 361,000 total reach, and a 3.37% engagement rate (viewed and interacted with the post).

Ad Council Toolkit

The materials can be accessed through the campaign toolkit web page and are available in both English and Spanish. These include radio, TV, out-of-home, and web PSAs. There are also key messages and social media graphics.

English web site: https://getmyflushot.org/

Spanish web site: https://vacunatecontralainfluenza.org/

National Influenza Vaccination Week (NIVW)

National Influenza Vaccination Week (NIVW) runs from December 5–11. NIVW is an annual observance in early December to remind everyone 6 months and older that there’s still time to get vaccinated against flu to be protected during the upcoming holidays and winter months.

As of November 19, 2021, preliminary of flu vaccine coverage suggest that flu vaccine uptake is lower this season than last. These preliminary estimates show drops in vaccine coverage among children and pregnant people and are concerning because both groups are at higher risk of developing potentially serious flu complications.

With flu activity just picking up, there is still time to benefit from a flu vaccine this season. It’s important for healthcare personnel to explain that COVID-19 vaccine can be co-administered with flu vaccine for everyone eligible, including everyone age 5 and older. Those 6 months and older can get a flu shot. Both vaccines are necessary this year.

Weekly Cumulative Influenza Vaccination Coverage by Flu Season and Race/Ethnicity for Children 6 months–17 years (NIS-Flu data through November 6)

For the 2021–22 season, coverage is 34%, which is lower than for the prior season number of 40% at this same time.

Monthly Cumulative Influenza Vaccination Coverage by Flu Season and Race/Ethnicity for pregnant persons 18–49 (Vaccine Safety Datalink data through November 6)

There was a 17% drop in flu coverage as of October compared with last season at the end of October (41% vs 58%).

Leveraging NIVW to Reach Core Audiences

Building on the momentum from current campaign efforts, CDC is leveraging National Influenza Vaccination Week (NIVW) starting on December 5 as a moment to elevate flu as a significant public health concern and make a critical push for patient reminder communications. The key message is that there is still time to get vaccinated.

Driving Conversation on Owned Channels

Throughout NIVW, owned content is being deployed across CDC flagship channels. All social graphics were developed within the “I Get It” campaign branding align with NIVW content shared with partners to extend messaging reach.

Engaging Partner Networks

Partners can spotlight the urgency of flu vaccination amid NIVW with digital tools. Assets available for partners in the toolkit equipped with and offer key messages throughout the week of NIVW.

Where to Find CDC Resources

Campaign and Social Media Toolkits:

Key Consumer Web Resources:

Videos:

Multi-Language Resources:

Healthcare Provider and Partner Resources

Additional Factsheets

Questions

Question

The engagement rate for your influencers was 3.7%; what’s typical or average?

Bess Davenport

We are seeing higher than expected engagement rates, especially with Instagram content. This number is a percentage or two higher than expected. Normally there are 1-2% engagement rates on posts. This is a little lower with Facebook, so it depends on the channel.

Question

Why did you choose adults with chronic conditions as the target audience? How did you determine your target audience?

Bess Davenport

This audience is the same as last year, and a group we think of as the “movable middle.” These people have at least one underlying health condition and are between the age of 40–64. We know that in the past flu seasons, 9 out of 10 people hospitalized for flu had at least one underlying health condition. We also have secondary audiences for the “I Get It” campaign––pregnant people, parents of young children, and those age 65+. That’s the nice thing about this campaign is that it’s customizable to focus on these secondary groups, as well.

Question

Can you describe what kind of outreach that is going out specifically to colleges and universities and how might people be able to help with that?

Erin Burns

We haven’t reached out directly to colleges and universities, but have been relying on digital and social media to try to get the message out to those groups. We’ve often seen that flu starts first in kids and young adults and they take it home with them. There is some great work being done by Families Fighting Flu with outreach to this group of people.

Families Fighting Flu:

 We have a group of about fifteen 13–23-year-olds who are working on their high school and college campuses to talk about flu vaccination. We are hoping to use the momentum of NIVW to talk about the importance of flu vaccination, especially knowing that finals are coming up and that that’s a time when people don’t want to be sick because it could prevent them from having a fun winter break. We are all on the same page which is what’s important.

Carolyn

Alana’s Foundation hosts a College/University Flu Challenge: https://www.alanasfoundation.org/outreach-flu-vax-challenges that might be of interest to some of you looking to get involved.

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ANNOUNCEMENTS

Carolyn Bridges (IAC)

1. The Immunization Action Coalition (IAC), with funding support from Seqirus, is offering a limited quantity of FREE Flu Vaccine buttons and stickers in English and Spanish to support your flu vaccine promotion efforts this season. IAC also offers free COVID-19 buttons and stickers. To receive these supplies at no cost, please order now.

Order the free flu buttons and stickers.

Order the free COVID-19 buttons and stickers.

2. IAC hosted two influenza webinars in September that can now be viewed online.

3. We would welcome having even more NAIIS member organizations to add their support to the Call to Action on adult immunization. Access the call to action and click on the top righthand button to add your organization.

4. If you are not getting emails, please add info@izsummitpartners.org to your list of email contacts to keep receiving the NAIIS emails.

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