A summary of presentations from the weekly Summit partner webinars
December 9, 2021 – The latest Summit summary
- Flu Surveillance Update – Alisha Budd (CDC)
- Midseason Flu Vaccination Coverage Estimates – Suchita A. Patel (CDC)
- National Vaccine Implementation Plan Update – Maria Huynh (OASH)
- American College of Physicians Video Series Update – Selam Wubu (ACP)
Flu Surveillance Update – Alisha Budd (CDC)
Alicia Budd, MPH, Influenza Division, CDC, gave an influenza surveillance update presentation based on data through the week ending November 27, 2021 (week 47).
Influenza Virologic Surveillance – United States, May 23, 2021–November 27, 2021
Clinical laboratories are seeing 1.5% positive test results for influenza among 630 out of about 43,000 tests. In the public health laboratories, the number of positive tests is 300 out of 14,000 tested. These numbers show that nationally there is a slow but consistent increase in flu activity. The majority of these cases tested are influenza A (H3N2), which is what has been seen in previous weeks. Most of the cases are in the 5–24 year-old age group, however increases in other age groups now as well.
Putting this data in perspective, compared to the same week in the 2019–2020 season (the last active flu season), the activity is still very low. In the 2019–2020 season, week 47, clinical labs were reporting 8% of specimens were positive for flu compared to 1.5% this year. This season there has been an increase in respiratory illness due to COVID-19 and other illnesses, as well, so there have been more tests conducted. Despite the larger number of testing this year, there are still fewer cases of flu positives.
There still haven’t been enough viruses characterized anagenetically and genetically to give a good picture of what is going on. As soon as there is enough data on virus characterization, the data will be reported in FluView.
Percentage of Outpatient Visits for Respiratory Illness [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 data can highlight potential hot spots and can help the CDC know where to dig deeper. In week 47, 2.4% of visits were for respiratory illness, which is a slight increase from the prior week and just below baseline level. There are two regions above their region-specific baseline levels. Those regions are region 3, mid-Atlantic, and region 7, which is in the central part of the country. There is a general upward trend in most of the age groups, with one exception. Those age 65 and over are at a stable level for respiratory illness visits.
ILI Activity Level, Determined by Data Reported to ILINet Week Ending November 27, 2021 (Week 47)
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 increases in 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.
New Mexico is experiencing high respiratory illness activity; however, lab data is showing that this increase is not likely due to flu activity at this time. Georgia and Mississippi have moderate respiratory illness activity currently with flu contributing to this increase.
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 28, 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’s (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.
The data coming from LTC facilities for confirmed flu cases is still quite low for week 47. For the 14,000 facilities reporting, 30 (0.2%) had at least one positive flu test in a resident.
Influenza Hospitalizations in the United States – May 23, 2021–November 27, 2021
There are two influenza hospitalization components reported in FluView:
Influenza Hospitalization Surveillance Network (FluSurv-Net): This component conducts population-based surveillance for laboratory-confirmed flu-related hospitalizations. This data will start to be reported later in the season when there are enough cases to get stable rates.
NEW! HHS Protect National Summary: This effort piggybacks off of some work that was set up for the COVID-19 response. All hospitals are required to report data on COVID-19 and flu and because of this, the CDC is getting information on previous admissions with lab-confirmed cases of flu, hospital admissions due to lab-confirmed flu, and ICU information on patients with lab-confirmed flu. This is a new system as of March of 2020, so there is no historical data to compare to.
For week 47, there were 495 flu admissions reported. This number is still low, but there has been a slight increase in the last couple of weeks.
Influenza-Related Mortality in the United States as of December 2
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.
For week 47, 15.5% of deaths had pneumonia, flu, or COVID-19 listed as the cause of death, which is a slight increase from the previous week and remains well above the epidemic threshold. There have been 2,5000 deaths reported for the week with only 4 that listed flu as the cause of death. These deaths are primarily due to COVID-19 and not influenza.
Influenza-Associated Pediatric Mortality Surveillance System: This system monitors flu-related deaths of children under the age of 18 years. There have not been any pediatric deaths reported this season.
International Influenza Activity – Influenza Positives Reported to WHO’s FluNet
The data from WHO’s FluNet shows that internationally there has been a slow but steady increase in flu positive cases. However, the activity is much lower than is typical for this time of year. The northern hemisphere is seeing a mix of influenza A (H3) and influenza B (Victoria lineage), while the southern hemisphere is mostly seeing influenza A (H1N1) and influenza B (Victoria lineage).
In summary, flu activity is still low nationally, but it is increasing. The number of influenza viruses detected by clinical and public health labs has been increasing over the past few weeks. The majority of viruses detected in the U.S. are influenza A (H3N2), and the percentage of outpatient visits from respiratory illness is trending upwards in the recent weeks, however, still remains below baseline nationally. Flu is being seen in 8 of the 10 HHS regions.
Other Respiratory Virus Activity
- COVID Data Tracker Weekly Review
- COVID Data Tracker
- National Respiratory Virus Surveillance System (NREVSS)
Midseason Flu Vaccination Coverage Estimates – Suchita A. Patel (CDC)
Suchita A. Patel, DO, MPH, Lead for Data Science and Innovation, Assessment Branch, Immunization Services Division, NCIRD, CDC, gave a presentation on midseason flu vaccination coverage estimates.
Overview of CDC’s Weekly Flu Vaccination Dashboard
CDC has been exploring and assessing data sources to share “real-time” flu vaccination estimates through their Weekly Flu Vaccination Dashboard (FluVaxDash), which was launched in December of 2019. The FluVaxDash is part of the larger dashboard called VaxViews (Child, Teen, School, Adult, Flu, & COVID-19). This October, FluVaxDash was re-launched for the 2021-2022 season and the data is now updated every 1–2 weeks for the season, based on data availability and other factors.
The goal of this dashboard is to be able to share preliminary data within the season estimates to help inform CDC, partners, jurisdictions, etc. The dashboard contains both long-standing and new data sources that estimate coverage by age, race/ethnicity, and risk factors. For the last season, only national estimates were shared. This last week there were child jurisdiction-level estimates shared. The adult jurisdiction-level estimates will not be shared until early January. All estimates for each week or month will change over time as additional data is uploaded and updated.
Child Flu Vaccination Coverage by Week and Season
Currently the flu vaccination coverage for kids 6 months–17 years is 40%, while at this time last season it was 47%. We are down by 7% percentage points compared to last year.
Child Flu Vaccination Coverage by Race/Ethnicity and Season
For this season, vaccination coverage is 14% points lower for Black and non-Hispanic children compared to While non-Hispanic children. When compared to the same time last season, there has been an 8% point drop for White non-Hispanic children, a 5% point drop for Hispanic/Latino children, and a 4% point drop for Black non-Hispanic children.
Child Flu Vaccination Coverage by Jurisdiction and Season
When looking at coverage by jurisdictions among the 50 states and DC, the child vaccination coverage is between 20% to 64%. Nationally, the coverage level is 40%. Findings show that coverage for all jurisdictions is the same statistically as last season or a lower this season. There aren’t any states with higher coverage than last season.
Pregnant Persons Flu Vaccination Coverage
Vaccine Safety Datalink shows that vaccination coverage for pregnant people (age 18–49) this season is 48%, compared to last season which was 62%. This is 14% percentage point (23%) lower coverage this season.
Pregnant Persons Flu Vaccination Coverage by Race/Ethnicity and Season.
The vaccination coverage for pregnant people by race/ethnicity is also lower this season. Vaccination coverage for Black and non-Hispanic pregnant people is 23% point lower compared to White non-Hispanic pregnant people. To compare to last season, for pregnant person coverage there was a 16% point drop for Hispanic/Latinos, a 16% point drop for Asian non-Hispanics, a 14% point drop for White non-Hispanics, and a 10% point drop for Black non-Hispanics.
Flu Vaccinations Administered in Pharmacies
This season there have been 33 million doses of flu vaccines administered in pharmacies as of November 20. Last season there were 44 million doses given. This season’s numbers are close to pre-pandemic 2019–2020.
Flu Vaccinations Administered in Physician Medical Offices
This year we are seeing the same trend in the number of vaccinations given in physician medical offices. In this season there have been 22 million doses given. Last season there were 28 million doses given at this same point in the year.
Adult Flu Vaccination Coverage for 2021–2022
Based on a survey (of 2,013 adults) from the CDC, as of the end of November, 44% of adults are already vaccinated, 14% plan to get the vaccines, 15% are not sure if they will receive it, and 28% do not plan to receive it. This yields a projected flu vaccination coverage for the 2021–2022 season of 58%. However, people who plan to get vaccinated may not get vaccinated.
Survey age group data shows that for those age 18–49 years, 34% are vaccinated. For those age 50–64 years, 45% are vaccinated. And for those age 65+, 66% are vaccinated.
The survey looked at race/ethnicity data, which is showing some statistical differences. About 48% of White non-Hispanic people are already vaccinated, 36% of Black non-Hispanic people, and 34% of Hispanic/Latino people.
For last season 55% reported getting the vaccine, but this season it’s projected that for all adults, 58% will get vaccinated based on current vaccination and report of intent to get vaccinated. Therefore, the projected coverage is expected to be higher at the end of this season than it was at the end of last season. The survey data is showing that coverage may be 3% higher for all adults, 3% higher for adults age 18–49, 5% higher for adults age 50–64, and 8% higher for Black non-Hispanic adults.
Among the 1,616 adults that were already vaccinated for COVID-19 or plan to get vaccinated, 55% have already gotten a flu vaccine, 16% plan to get the flu vaccine, 12% are not sure about getting the flu vaccine, and 17% do not plan to get the flu vaccine. Among the 301 adults who say they will not get the COVID-19 vaccine, 10% have gotten the flu vaccine and only 3% plan to get the flu vaccine.
Flu Vaccination Coverage for CMS Medicaid Free-for-Service Beneficiaries 65 and Older
Another data source specifically for CMS Medicaid Free-for-Service Beneficiaries 65 and Older shows that as of October 2, 2021, there was 11% flu vaccine coverage based on claims data. At the same time last year there was 29% coverage.
Possible Reasons for Drop in Coverage
The drops in flu vaccination coverage are unknown but could be related to:
- The lower flu activity last season
- Fatigue of hearing about COVID-19 vaccination efforts
- Confusion about the need for the flu vaccine, as some people think the COVID-19 vaccine will also protect them from the flu
- People making fewer visits to healthcare providers
- A drop in flu vaccination clinics compared to previous years.
Limitations to The Survey
Limitations to vaccine coverage data include:
- The survey estimates are subject to non-response bias and error in self-vaccination status, which would skew the data higher than is showing
- The projected coverage estimates for adults who plan to get vaccinated may not be correct, as many may not get vaccinated
- Estimates for pregnant persons from the Vaccine Safety Datalink may not be nationally representative
- Pharmacy and physician medical office claims do not include vaccinations administered in other settings such as workplaces and community settings
- Data for Flu Vaccination Dashboard will be updated on Fridays––the last refresh for this year will be 12/17/21
- Coverage data for adult coverage by jurisdiction will be added on 1/7/22
- There will be a continuation of estimates from data sources to explore if/how these estimates can be integrated
- The coverage for children and pregnant people is lower this season than last season.
- Coverage for Black/non-Hispanic children and pregnant people is lower than for White non-Hispanic children and pregnant people.
- There have been fewer adults getting vaccinated at pharmacies and physician medical offices this season.
- The CMS claims data for Medicare fee-for-service beneficiaries age 65 and older is showing less coverage as of October.
- The survey data including intent to get flu vaccination, suggests the flu vaccination coverage in adults may be similar to last season.
National Vaccine Implementation Plan Update – Maria Huynh (OASH)
Maria Huynh, MA, MPH, Office of Infectious Disease & HIV Policy (OIDP), Office of the Assistant Secretary for Health (OASH), gave an update presentation on the Vaccines Federal Implementation Plan.
Vaccines National Strategic Plan, 2021–2022
The Vaccines National Strategic Plan was released in January of 2021. This is a comprehensive strategic framework that promotes vaccines and vaccinations and is comprised of five goals, objectives, and strategies. The five goals include research and development, vaccine safety and monitoring, public knowledge and confidence, access and use across the lifespan, and global cooperation.
This plan was developed in partnership with the Summit members, external nongovernmental stakeholders, and the Federal Interagency Vaccine Work Group (IVWG), which serves as the Steering Committee for the Federal Implementation Plan and Strategy.
Vaccines Federal Implementation Plan
The Implementation Plan is an accompanying document that aligns with the Vaccines National Strategic Plan, and it has the same goals, objectives, and strategies. It continues the National Planning Effort by HHS to ensure that vaccines deliver the optimum public health benefit to the American people. It details current activities from member agencies and contributes to the National Strategic Plan. This includes recommended activities that were collected in last year’s public comment period.
The IVWG collected all of the comments from the last and previous years’ public comment period and analyzed and evaluated the comments to identify agencies within the IVWG that are best suited to accommodate the public recommendations.
Also, within the past year, OASH has been reengaging with the IVWG since the summer to develop the Implementation Plan. There is now an updated roster with 14 departments and agencies, and 25 individual members, with one new member, HHS Office of Global Affairs (OGA).
Since the members are over-taxed with the pandemic, OASH developed a more efficient and streamlined process to make it easier on the members. OASH developed and sent customized data collection tools to each of the IVWG member agencies. This includes customized spreadsheets for each IVWG agency that allows them to add current activities and recommended activities based on the public comment periods, departmental clearance process, and the previous National Vaccine Implementation Plan. This all was done in the spirit of partnership, collaboration, and transparency.
Currently, the Vaccine Federal Implementation Plan is being finalized and will move on to the IVWG. It will then be posted on the federal register. OASH will wait until after the holidays to do this to be sure that everyone has the full 30 days to comment on the Implementation Plan.
American College of Physicians Video Series Update – Selam Wubu (ACP)
Selam Wubu, MPH, Director, Center for Quality, American College of Physicians, gave an update presentation on the American College of Physicians (ACP) Video Series that was recently launched as part of their partnership with YouTube.
Misinformation and COVID-19
The significant impact of misinformation and the spread of false information online has impacted the ability to get ahead of the pandemic. Based on a Kaiser Family Foundation survey, 67% of unvaccinated adults believe at least one myth related to COVID-19 vaccines (source).
With the nature of social media, false news stories spread faster and wider than those with accurate information. These stories are 70% more likely to be shared on social media (source) compared to science-based information.
Exposure to misinformation decreases intent to vaccinate against COVID-19 (source). We are in the position of needing to do something to confront this head-on.
Confronting Health Misinformation
In July of this year the Surgeon General issued an advisory on the importance of confronting health misinformation. This served as a call to action and highlighted the important role of every person in stopping the spread of misinformation. The advisory called the epidemic of the spread of misinformation a “public health threat” and stressed the importance of not only combating vaccine information now, but combating misinformation in the future to address public health issues moving forward.
ACP is partnering with YouTube on educational content to counter misinformation around COVID-19 treatment and vaccines.
In response to the call to action, ACP was given the opportunity to partner with YouTube on two video series: Ask Your Internist, and Physician-to-Physician Conversations.
These videos provide educational, science-based information to combat misinformation and improve trust in vaccines. At around the time this partnership was announced, YouTube made the announcement that they were going to make the effort to withdraw and take down any content with inaccurate information as it relates to COVID-19 vaccines and treatments. ACP recognizes that it’s important to remove misinformation, but also important to fill that gap with accurate, trusted information, and a great way to do that is by using trusted messengers such as doctors, scientists, and public health authorities.
Video Series: Ask Your Internist – New Patient-Facing Series
This video series is oriented toward the public and patients, with the goal being to provide credible, accurate information, answering top vaccine-related questions from the trusted physician voice. This series is designed to address questions rooted in misconceptions without using the myth-busting approach. In clear and concise language, the videos show that vaccines are safe, effective, have been well-studied, and that they work. The videos are available in both English and Spanish.
Video Series: Physician-to-Physician Conversations
This video series is applicable to any clinician who has conversations with patients about vaccines. The videos offer practical strategies on how to address medical misinformation with patients whose thoughts and opinions are not rooted in science-based information. The focus of the series is on building trust between physicians and their patients and leveraging that trust to promote confidence in vaccines, with the emphasis in meeting patients with empathy and respect. Physicians will get to the root of what’s causing people to not want to get vaccinated and techniques to combat vaccine hesitancy and dispel misinformation.
Upcoming Videos (through February 2022)
Ask Your Internist: Comes out every other Monday at 3:00 p.m. (ET)
- COVID-19 Q&A
- Why trust vaccines? (English and Spanish)
- How to access trusted, accurate health information online (English and Spanish)
Physician to Physician Conversations: Comes out every other Friday at 3:00 p.m. (ET)
- Recommending flu vaccine
- Addressing misinformation with patients
- Team approaches to addressing misinformation
- Creating space for conversation
- Reinforcing public health messages
How you can help combat misinformation:
- Subscribe to ACP’s YouTube Channel
- Share videos on your social media
- Stay tuned for the next videos:
- Physician to Physician Conversations: Flu Vaccine Recommendations – December 17, 2021, at 3:00 p.m. (ET)
- Ask Your Internist: Q&A on COVID-19 vaccines – December 20, 2021, at 3:00 p.m. (ET)
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.
2. IAC hosted two influenza webinars in September that can now be viewed online.
- The Continued Threat of Influenza and How to Sustain Influenza Vaccination Efforts
- Translating COVID-19 Strategies to Improve Influenza Seasonal Flu Vaccination Efforts
3. We would welcome having even more NAIIS member organizations 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 firstname.lastname@example.org to your list of email contacts to keep receiving the NAIIS emails.