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A summary of presentations from the weekly Summit partner webinars

January 6, 2022 – The latest Summit summary

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 December 25, 2021 (week 51).

Influenza Virologic Surveillance – United States, October 3, 2021–December 25, 2021 (week 51)

The percent positive flu specimens from clinical labs has been increasing through the end of December with 6.2% of specimens testing positive in the most recent week. Of those positive specimens, most of them are influenza A H3N2 viruses. There have been very few influenza B viruses detected in clinical labs. There’s a slight drop in the number of positives for week 51, however, this is probably due to the holiday.

The amount of flu activity depends on the location in the country. The eastern and central parts of the country are seeing the most flu activity at this point. The western areas are still reporting relatively low levels of flu at this point, but flu activity is expected to increase in all areas across the country in the coming weeks.

The public health labs have identified more than 5,000 flu positives most of which are influenza A viruses. Of those influenza A viruses that have been subtyped almost all are H3N2 viruses. The majority of these H3N2s are coming from the age 5–24 group, but as the season has progressed, there has been an increase in the amount of flu positives seen in other age groups, as well.

Influenza Virologic Surveillance – United States, October 3, 2021–December 25, 2021

There are very few influenza B Victoria viruses and influenza A H1 viruses, and there have been no influenza B Yamagata viruses. However, there have been about 200 H3 influenza A subtypes viruses genetically characterized. All the subtypes belong to a single clade––3C.2a1b. Nearly all of those viruses are in the 2a.2 subclade.

The H3N2 strain found in the vaccine is also in the same clade as the viruses that have been characterized, which is the same clade that’s circulating in the U.S. However, the vaccine strain is slightly different genetically and found in a different subclade. The H3N2s are also showing some antigenic differences in addition to the genetic differences to the H3 found in the vaccine. The vaccine may be less effective in protecting against infection, however, there is still some cross-reactivity between the vaccine and circulating H3N2 strains so some protection against more severe disease is expected.

As far as antiviral resistance, about 200 viruses have been tested for all four of the antivirals typically used for the flu and so far, there has been no resistance to the viruses that have been identified.

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.

In nine out of the ten HHS regions, the percent of visits for respiratory illness are above baseline and increasing, except for region six in the southern part of the country, which is still below baseline. Flu is contributing to the increasing levels of respiratory illness now, however, there are a lot of other respiratory viruses circulating right now that are at very high levels and contributing to illness. The relative contribution of flu to this larger body of respiratory illness can vary quite a bit from one location to another.

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.

Nineteen jurisdictions were seeing high or very high levels of respiratory illness last week. Twelve jurisdictions were seeing moderate levels of respiratory illness.

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 low levels of facilities reporting positive flu cases, but this has been slowly increasing in recent weeks.

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. From October 1–December 25 535 flu hospitalizations were reported, which is a rate of 1.8 people per 100,000. The rate is low but compared to the extremely low flu season last year, this rate has more than doubled.

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.

There were over 1,800 flu admissions last week, which has increased and is increasing. There are, however, many fewer flu admissions than COVID-19 admissions.

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 51, 19.2% of deaths had pneumonia, flu, or COVID-19 listed as the cause of death, however, the vast majority of deaths were due to COVID-19.

Influenza-Associated Pediatric Mortality Surveillance System: This system monitors flu-related deaths of children under the age of 18 years. Unfortunately, since the last update there have been two pediatric deaths reported. Both deaths were associated with influenza A viruses.

International Influenza Activity – Influenza Positives Reported to WHO’s FluNet 

There is finally enough flu activity data to report from WHO’s FluNet. Internationally, in recent weeks flu activity has been increasing, but relative to where we typically are at this time of year, flu activity is much lower than it has been in the past. The majority of the flu viruses circulating worldwide are H3 and influenza B Victoria viruses, mostly coming out of China.

Summary

In summary, influenza activity is increasing, but the level of activity varies by region. Most viruses detected are A(H3N2) and are genetically closely related to the vaccine virus but have some antigenic differences. There is no antiviral resistance identified for these viruses.

The percentage of outpatient visits for respiratory illness is increasing and is above the national baseline. Influenza is contributing to these visits, but so are other respiratory viruses. The contribution of other viruses along with the flu varies by location in the country. Flu hospitalizations are beginning to increase. The flu season is just getting started so there is still time to get vaccinated.

Additional Information

Influenza Activity

Other Respiratory Virus Activity

Questions

Question

What can you tell us about people getting flu and COVID-19 testing at the same time? Are there concerns about flu cases being masked because of the focus on COVID-19?

Alisha Budd

We may be missing some flu cases. In our laboratory systems we are seeing more testing for flu than we did in the previous season, so the trends are telling us what’s happening––activity is increasing. Whether a person with respiratory symptoms gets tested only for COVID-19 or for both COVID-19 and flu really depends on where they go for the tests and what the lab has available to preform those tests.

Question

Are there discussions about recommending serial testing? For example, COVID-19 first followed by flu or is that just happening based on clinical decision making?

Alisha Budd

The decision is primarily based on clinical decision making. There are guidelines on the CDC website, however they have not changed recently. A lot of the decision comes from local flu activity, which may influence which tests patients are getting, as well as where the tests are performed. So there are different factors at play.

Question

Are you aware of any issues with accessing flu test kits this year?

Alisha Budd

I have not heard of any issues so I would be interested to hear if others are experiencing that.

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NFID National Survey Findings Update – Dana Olson (NFID)

Dana Olson, Senior Director of Strategic Communications, NFID, gave an update presentation on the NFID National Survey Findings.

Annual flu vaccination is important for everyone but especially for adults with certain chronic health conditions such as heart disease, lung disease, and diabetes, who are at increased risk for serious flu-related complications including hospitalization and death. During recent flu seasons, 9 out of 10 people hospitalized with flu had at least one underlying health condition.

2021 Chronic Health Conditions Surveys: Gaps between Healthcare Professionals and Adult Patients

To better understand knowledge, attitudes, and behaviors around flu vaccination, as well as communication about flu between healthcare professionals and patients with chronic health conditions, NFID recently commissioned two national surveys. These surveys were conducted online from October 28–November 8, 2021, and included 300 adult patients and 400 physicians.

Disconnect on Flu Vaccine Recommendations

The surveys revealed that while nearly 100% of healthcare professionals say they recommend flu vaccines to their patients with chronic health conditions at least some of the time, only 45% of U.S. adults with chronic health conditions say they were vaccinated against flu as of early November.

HCPs Are Not Recommending Flu Vaccines Consistently

Healthcare professionals are not recommending flu vaccines consistently. Less than a third (31%) of healthcare providers (HCPs) said that they recommend the annual flu vaccine every year to all patients with chronic health conditions. For patients with chronic health conditions, 44% of HCPs said they recommend the flu vaccine to most of the patients, 20% said they recommend to about half of their patients, and 5% said they recommend it to about a quarter of their patients.

Inconsistency in Vaccine Recommendations by Specialty 

86% of the surveyed patients said an HCP recommended they get a flu vaccine in the past year. Of those patients, 56% received this recommendation from a primary care physician (PCP).  There are differences among specialties. Cardiologists are leading in recommending the flu vaccine.

  • 72% of patients with heart disease said that a cardiologist recommended they get a flu vaccine
  • 32% of patients with lung disease said a pulmonologist recommended a flu vaccine
  • And only 10% of patients with diabetes said an endocrinologist recommended flu vaccine

Perceptions of Risk Conversation Varies between Patients and HCPs

The flu vaccine recommendation is most important, but interestingly, 48% of patients with chronic health conditions say that they have never been advised by a HCP that the flu can increase their risk for serious complications and can make their health condition harder to manage. However, 77% of HCPs say that they advised their patients that their chronic health condition will put them at a greater risk of serious flu complications. 71% of HPCs reported that they tell their patients that flu can make their health condition harder to manage. There are different perceptions of the conversation happening around the flu and its risks to people with chronic health conditions.

HCP Recommendations Matter

Patients are more likely to get the flu vaccine if a HCP recommends they get it. Among patients unsure or not planning to get a flu vaccine, 47% said that they would consider getting one if a HCP recommended getting it and about 25% of those not planning on getting vaccinated, or who were unsure said they would be more likely to get vaccinated if they received a referral from a HCP to a local pharmacy or a prescription for the vaccine.

Many HCPs Do Not Offer Flu Vaccination

Among the 67% of HCPs who recommended the flu vaccines to their patients with chronic health conditions, say that the location where they practice offers flu vaccines.

  • 75% of cardiologists report that their office offers flu vaccines
  • 71% of PCPs report that their office offers flu vaccines
  • 61% of endocrinologists report their practice offers flu vaccines
  • 60% of pulmonologists report their practice offers flu vaccines

A majority of specialists who do not offer flu vaccines at their location believe the patient’s PCP should be responsible for recommending the flu vaccine. This is problematic because less than 65% of patients with chronic conditions report seeing a PCP at least once a year.

Survey Implications

The survey findings reinforce the importance of HCPs and patient conversations about flu vaccination for adults with chronic health conditions. HCPs need to strongly recommend the flu vaccine to all patients with chronic conditions. Specialists also need to be informing their patients of their increased risk of complications from getting the flu. Ensuring flu vaccine is offered or vaccine referral is made during routine visits might help increase vaccination rates among patients with chronic health conditions.

Dissemination of NFID Survey Findings

The NFID issued a press release and released the survey results during National Influenza Vaccination Week in order to help increase awareness about the importance of flu prevention for adults with chronic health conditions. NFID has developed tools and resources for HCPs and their patients with chronic health conditions which are available at: www.nfid.org/LowerYourFluRisk.

Other resources include:

Top-Tier Media Coverage

The NFID’s efforts generated a lot of attention among the media with over 235 stories secured in print, online, and TV outlets, resulting in more than 619 million impressions. Media placements were secured in several top-tier outlets including CBS News, Healthline, Medscape, and Breaking Med.

PSA Videos Help Drive Awareness

Videos were digitally distributed to about 1,900 TV stations across the U.S. The Flu Is Not a Game videos included brief interviews with 4 patients who are living with heart disease, lung disease, and diabetes, who talked about the importance of annual flu vaccination. The NFID is launching a social media campaign to extend the reach of the videos even further.

There are two videos that will give you a glimpse into the NFID’s efforts:

Additional Information

For additional information, videos, and other tools, you can visit: www.nfid.org/LowerYourFluRisk.

Questions

Question

What can the Summit partners do to reach out to some of the specialty providers, and what is NFID doing to reach out to these providers?

Dana Olson

NFID is sharing the resources with the partner organizations and many of the organizations are in support and have stepped up in their own efforts. Many in the NAIIS have taken part in the “Leading by Example” campaign where they take pictures of themselves getting vaccinated and share them on social media.

Organizations can keep pushing the message out that it’s not too late to get vaccinated because it’s important for all of us, and adults with chronic health conditions really need to be aware of the serious complications that they face due to flu.

All of the NFID resources are readily accessible, and we encourage the partners to use and share them. And we continue to improve these efforts and expand the partnerships.

Question

Do you think what we are seeing is the impact solid data showing the impact of flu on people with chronic heart disease and the impact of vaccination of preventing flu? If that’s the case, do you think that means what we really need to do is generate more data for other specialties as well?

Dana Olson

I can’t say for certain the reason why we are seeing this difference in the number of specialists recommending flu vaccine. You are right; the more data that we can have that shows the impact on patient populations, the more compelling the argument is. The more evidence we have, the stronger our message is.

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Announcements

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

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 actionand 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.

5. There is new zoom login information this year. Please check your emails with the call agendas from NAIIS for the new zoom link and password information.

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