A summary of presentations from the weekly Summit partner webinars
January 13, 2022 – The latest Summit summary
- Hepatitis B Universal Recommendation Implementation Update – Mark Weng (CDC)
- Omicron Variant Surveillance Update – Heather Scobie (CDC)
Hepatitis B Universal Recommendation Implementation Update – Mark Weng (CDC)
LCDR Mark K. Weng, MD, MSc, Division of Viral Hepatitis, CDC presented on the new universal adult hepatitis B vaccine changes to recommendation and implementation.
The hepatitis B immunization recommendation strategy has evolved over the past four decades that resulted in large declines in new hepatitis B infections in children and adolescents and younger adults, however incidence has plateaued over the past ten years. The past decade illustrated that risk-based screening among adults has gotten us as far as it can take. Currently, rates of infection are highest among age 30–59 and have increased in adults over age 40. There are now approximately 20,000 new infections every year in the U.S.
ACIP approved the following recommendations in a unanimous vote on November 2, 2021, which was signed off by CDC director on December 20, 2021:
The ACIP recommends that the following groups should receive hepatitis B vaccination:
- Adults age 19–59 years
- Adults age 60+ with risk factors for hepatitis B infection
The ACIP recommends the following groups may receive a hepatitis B vaccine:
- Adults age 60+ without known risk factors for hepatitis B infection
Dates on the hepatitis B timeline:
- Late February 2022 (tentatively 2/18/22): Release of the adult immunization schedule (along with the childhood schedule)
- February 23–24 ACIP meeting: Discussion of newly FDA approved 3-antigen hepatitis B vaccine
- Early spring 2022: The MMWR policy associated with the new recommendations should be published and CDC pages will be updated with the new recommendations
- Late summer or fall 2022: Consideration of universal screening recommendations for adults and updating risk groups for recommended testing
This year marks the 40th year of hepatitis B vaccine recommendations in the U.S.
Public health, and healthcare personnel need to be made aware of these new recommendations. Provider education is key to making the vaccine work effectively and as intended to reduce and eliminate hepatitis B in the U.S. Updating and leveraging electronic medical records, revising standing orders, and increasing the vaccine infrastructure is vital to reducing and eliminating hepatitis B. It’s important to keep trying to pinpoint and articulate the remaining barriers to hepatitis B prevention until there aren’t any left.
Given that the MMWR won’t be out until early spring, should the programs and immunization coalitions be updating their materials now or should they wait for the ACIP publication?
My purpose today is to come to you to lay down the groundwork for when the MMWR gets published. The recommendations will be on the adult vaccine schedule when that gets published in February so programs can begin to prepare for the recommendations on the schedule.
Do you have information you can share on what the risk factors are or what’s behind some of this increase in hepatitis B that is occurring in middle-aged adults?
One big factor driving the uptick in middle-aged adults is the opioid epidemic.
The risk factors have not changed from the 2018 recommendations. One challenge is that many people with acute hepatitis B do not report any known risk factors. The limitations of the previous risk-based hepatitis B vaccine recommendations make it difficult for the providers to implement. We have a safe vaccine that has been used for decades, so given that risk-based recommendations have reached a plateau in their ability to reduce hepatitis B, the universal vaccine recommendation for adults younger than 60 is now made to further reduce and eliminate hepatitis B.
Omicron Variant Surveillance Update – Heather Scobie (CDC)
CDR Heather Scobie, PhD, MPH, Deputy Team Lead, Surveillance and Analytics, Epidemiology Task Force, COVID-19 Emergency Response, CDC gave a surveillance update presentation on the omicron variant.
Omicron variant SARS-CoV-2 (B.1.1529) was first reported to WHO on November 24, 2021, based on specimens collected in Botswana and South Africa. In late November, omicron was designated as a variant of concern by WHO and then later by U.S. SARS-CoV-2 Interagency Group (SIG). The first omicron case was confirmed in the U.S. on December 1, 2021.
Omicron was defined a variant of concern due to the detection of cases in multiple countries, new mutations in the spike gene, potential for increased transmissibility, reduction in efficacy of some antibody treatments, and reduction in neutralization by sera from vaccinated or convalescent individuals.
A case study was published in MMWR of the first 43 Omicron cases (as of December 8, 2021), identified in 22 states. Of those cases, 33% had an international travel history, 79% were fully vaccinated, 32% were fully vaccinated with a booster dose, and 14% had been previously infected.
Another MMWR described a cluster in Nebraska which was part of the initial case series. This index case (previously infected In November 2020) had a history of travel to Nigeria and contact with a coughing person. In the household of the index case there were five other likely infected members. The study found that reinfected patients had less severe illness than the previous infection and fewer symptoms. For the cluster, there was a median incubation period of three days compared to four days for the Delta variant and five days for ancestral SARS-CoV-2.
The CDC response to omicron has been monitoring genomic surveillance and vaccine breakthrough, as well as vaccine administration and effectiveness. CDC has been working with partners on studies to answer questions about the variant. They’ve also been supporting state, local, tribal, and territorial health departments and drafting recommendations for travel, prevention strategies, and activities.
Genomic surveillance data comes from three different systems: National SARS-CoV-2 Strain Surveillance, CDC-supported contracts with commercial laboratories, and partners who deposit and tag viral sequences in public repositories (GISAID and NCBI). The CDC estimates that if a variant is circulating with 0.1% frequency, there is greater than 99% chance it will be detected by the national genomic surveillance. There was enhanced surveillance through PCR tests for omicron from November 28–December 10 to identify the first cases.
COVID-19 Data Tracker: From mid-December to the week ending January 8, omicron is the variant responsible for 98.3% of all infections (Delta is 1.7%). Over a four-week period, omicron went from 1% of all infections to over 95%, which happened much more rapidly than with the delta variant. Omicron accounts for >90% of variants in all US HHS regions.
A study from South Africa shows that the Pfizer-BioNTech COVID-19 vaccine offers 70% protection from COVID-19-related hospitalizations with omicron, verses 93% reduction in hospitalization with delta. Even though lower, there is still substantial protection from the vaccine from omicron-related hospitalization. The same group showed that the risk of hospitalization among adults with COVID-19 was 29% lower with the omicron variant compared to the ancestral mid-2020 variant.
A study done in the U.K. on Pfizer-BioNTech COVID-19 vaccine effectiveness showed decreased protection against omicron with increasing time from the second dose. There was increased waning of immunity for omicron (35%) verses delta (64%) at 25+ weeks. There was 76% vaccine effectiveness against omicron two weeks after the 3rd dose, compared to 93% with delta.
Prevention strategies can slow the spread of omicron:
- Vaccination for everyone age five and over
- Boosters for all people age 12 and older (both Moderna and Pfizer vaccines are recommended at 5 months post primary series)
- Increased use of masking and improved ventilation
- Wider and more frequent testing, including self-testing
- Adherence to guidance on quarantine and isolation
Is there any information to help people understand the changes in symptoms with omicron vs. delta or previous variants?
There was a study conducted by Kaiser Health System that included CDC co-authors on the omicron severity compared to other variants. Omicron has potential for reduced severity, however it’s very contagious and maxing out the health systems. And greater vaccination and higher rates of prior SARS-CoV-2 infections also contributing to reducing severity of infections from omicron.
Is there guidance on testing after exposure with no symptoms?
Testing should be done 5 days post exposure.
1. Kelly Moore of Immunize.org:
As part of a comprehensive organization rebranding originally envisioned by our founder and executive director emerita, Dr. Deborah Wexler, IAC has taken the name of our flagship website, Immunize.org. By rebranding with the name most familiar to the healthcare professionals we serve, we hope to make it easier for more frontline vaccinators to find us and our resources.
You will find the new look of Immunize.org on our social media pages on Facebook, Instagram, Twitter, LinkedIn, and YouTube. In coming months, you’ll also see our new look on a redesigned website with improved searchability to keep accurate, up-to-date resources at the fingertips of vaccinators and the public. We look forward to increasing our visibility and expanding our reach to serve even more frontline vaccinators through these changes planned for 2022.
2. 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.
3. 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
4. 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.
5. If you are not getting emails, please add firstname.lastname@example.org to your list of email contacts to keep receiving the NAIIS emails.
6. 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.