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A summary of presentations from the weekly Summit partner webinars

January 20, 2022 – The latest Summit summary

Flu Vaccination Coverage for 2021-22 Season: Are we there yet? – 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 flu vaccination coverage for the 2021–2022 season.

The data presented comes from CDC’s Weekly Flu Vaccination Dashboard (FluVaxDash), which was launched in December of 2020 and sits within the FluVaxView website. The purpose of the dashboard is to share preliminary estimates for general public health purposes. During the season, the data is updated about every 2 weeks based on data availability.

Child flu vaccination coverage is 3% lower this season (50.3%) than last season (53.1%) at this same time for children age 6 months–17 years. In the 2019–2020 season the coverage was at 56.5%. Coverage for children based on race/ethnicity shows 11% lower coverage for Black, non-Hispanics compared to white, non-Hispanics. When looking at this season versus last, there is 5% lower coverage for white, non-Hispanic children. Jurisdictional data shows that coverage levels among states and DC are between 28–72%, with a national average of 50%. These numbers are lower this season than for the previous season, however over the last month they have been increasing.

Pregnant person flu vaccination coverage is 11% lower this season (50%) than last season (61%). Coverage, however, has increased over the last month. Coverage for pregnant persons based on race/ethnicity shows 23% lower coverage in Black, non-Hispanics compared to white, non-Hispanics. There has been an 8–13% drop in vaccination coverage among all races/ethnicities.

Flu vaccines administered in pharmacies and medical offices has dropped this season for adults when compared to the last season. There have been 8.6 million fewer vaccinations in pharmacies, with 38.4 million vaccinations given this season so far and 47 million vaccinations given at this same time the previous season. There have also been 3.4 million fewer vaccinations given in medical offices this season, with 27.6 million given this season and 31 million given at the same time last season.

Adult flu vaccination coverage: This season’s data can be viewed with a new table on the dashboard of national estimates by age group and race/ethnicity. As of mid-December, overall coverage for adults age 18 and older is 40%. Coverage for white, non-Hispanic adults (45.6%) is 14–17% higher than for all other races/ethnicities. Coverage for adults age 18–49 is 29%, for adults age 50–64 is 43%, and for adults age 65 and older is 65%.

Jurisdictional adult vaccination coverage as of mid-December for all states and DC ranges from 29.6%–54.8%. The national average, including Puerto Rico and the U.S. Virgin Islands, is 40%. Survey data that ask about flu vaccination intent suggest the possibility that coverage in adults by the end of this season may be similar to last season.

Flu vaccination coverage for CMS Medicare fee-for-service beneficiaries 65 years of age and older based on claims data.  CMS is currently reporting data based from October 30, 2021, with coverage of 37%.  Coverage is 11.8% lower than last season (42.4%) at the same time.

For data on Influenza Vaccination Coverage, Adults 65 Years and Older, United States, visit: https://www.cdc.gov/flu/fluvaxview/dashboard/vaccination-coverage-adults-65-over.htm

Possible Reasons for drop in flu vaccine coverage:

  • Lower than usual flu activity during the 2020–21 flu season
  • Vaccine fatigue caused by ongoing COVID-19 vaccination efforts
  • Confusion about the need for a flu vaccine this season or a belief that the COVID-19 vaccine will protect against flu
  • Changes in healthcare-seeking behavior that result in people making fewer visits to vaccine providers
  • Fewer flu vaccination clinics compared to previous years

Limitations

  • Survey-based estimates subject to non-response bias and error in parental or self-reported vaccination status; may be too high
  • Survey-based estimates of projected coverage for adults assume those who report they plan to get vaccinated actually will 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

All of this data and more can be found at CDC’s Weekly Flu Vaccination Dashboard (FluVaxDash). The next update to the dashboard will occur in mid-February.

Questions

Question

We are seeing even larger, widening vaccination gaps by race/ethnicity in the coverage data. Can you discuss what’s being done to encourage patient reminders and outreach to reduce the gap?

Question:

Do we generally see higher uptake with NIVW?

Carolyn Bridges

Yes, however, this year is different because of COVID-19 and it’s much harder to get the public’s attention.

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Flu Surveillance Update – Alicia Budd (CDC)

Alicia Budd, MPH, Influenza Division, CDC, gave an update presentation on CDC’s flu surveillance from FluVIew ending on January 8, 2022 (week 1).

Influenza Virologic Surveillance – U.S., 10/3/21–1/8/22: All ten of the U.S. regions have seen a decrease in flu-positive specimens in the last 2–4 weeks. Prior to this period of decrease, most of the flu-positive cases were in age 5–24 years, which was also the group of people most likely to be out of school/college/university for the holidays, which may have led to the decrease in flu transmission. This is something that has been seen in prior seasons, and there may be a rebound of flu activity once this age group goes back to normal activities.

Public health laboratories are reporting that a majority of the viruses circulating in the U.S. are Influenza A(H3N2). Most of these belong to the 3C.2a1b clade and the 2a.2 subclade. So far there has been no antiviral resistance or reduction in susceptibility identified.

Outpatient Visits for Respiratory Illness, Reported by the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet):   Influenza-like illness (ILI) refers to someone who has a fever and cough or sore throat and could be caused from a number of respiratory viruses, including flu and COVID-19. These are not lab-confirmed cases. There has been a decrease in the percentage of visits for ILI in all age groups except for those age 65+, where the percentage has remained stable. The decrease is not unusual around the holidays, as it can be seen in past seasons. There may also be a drop in ILI cases due to a decline in some areas of COVID-19 activity.

ILI Activity Level, Determined by Data Reported to ILINet, Week ending January 8, 2022 (Week 1): There has been a slight decrease in ILI nationally, but there are 21 jurisdictions that are seeing high or very high levels of respiratory illness, and 14 seeing moderate levels.

Percent of Long-Term Care Facilities (LTCF) with at least One Confirmed Influenza Case among Residents, Reported to CDC’s National Healthcare Safety Network (NHSN), National Summary, 10/4/21–1/9/22: The percent of all facilities with at least one resident with a lab-confirmed flu positive test is generally low; this number had been increasing, however over the last few weeks it’s been relatively stable.

Influenza hospitalizations in the U.S.:

HHS Protect shows that this week there were 1,800 lab-confirmed flu hospital admissions reported, which is a decrease from the prior week (2,600 admissions).

Cumulative influenza-associated hospitalization rate from FluServNe shows a lower rate (3.4/100,000) than was seen this time during the four seasons preceding the COVID-19 pandemic but is slightly higher than the rate seen in the 2015–16 season.

Influenza-related mortality data, U.S.: The percentage of death certificates that list pneumonia, COVID-19, or flu (PIC) as the cause of death continues to increase in week one to 23%. This is driven almost entirely by COVID-19 and not the flu. There have been more than 4,000 PIC deaths in week one, more than 3,500 of the deaths were listed as COVID-19 and 42 were listed as flu. There have been 3 pediatric deaths so far this season, all three of which had influenza A infections.

International Influenza Activity, Number of Influenza Positives Reported to WHO’s FluNet, 10/2018–1/8/22: Flu positive activity reported to the WHO (in both hemispheres) looks to be holding steady over the past few weeks. The southern hemisphere is reporting flu activity outside the time when there would typically be flu activity, however, it’s not happening across the board. There has been an increase in flu activity in the northern hemisphere over the last month or so, however activity is still lower than expected at this time of year. Both Influenza A(H3)––the predominant virus everywhere except for China––and influenza B (Victoria) have been reported worldwide. Most of the influenza B viruses are coming out of China.

It’s not too late to get your flu vaccine!

Additional Information

Influenza Activity

Other Respiratory Virus Activity

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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National Influenza Vaccination Week Results Update – Erin Burns (CDC) and Bess Davenport (CDC)

Erin Burns, Associate Director for Communications Science Influenza Division, CDC, and Bess Davenport, MPH, Health Communication Specialist, Influenza Division, NCIRD, CDC, gave a presentation on the National Influenza Vaccination Week (NIVW) (first week of December) 2021–22 Influenza Vaccination Campaign results.

The 2021–22 Flu Vaccination Campaign:

  • “I Get It” campaign (collaboration with Weber-Shandwick) is a digital media campaign targeting people age 40–65 with chronic medical conditions, people 65+, pregnant people, and parents. This campaign focuses on the different reasons why people get the flu vaccine and is customized for various audiences. Results from the campaigns:
    • Six matte release articles were distributed for use in media across the country––three for NIVW with the message, “There’s still time to protect from the flu,” and three aimed at target audiences. These articles did very well with a total reach of one billion.
    • The “I Get It” campaign supplemental audiences (people 65+, pregnant people, and parents) was successful in outreach for these groups through development of targeted social media.
    • This campaign has had better results than last season.
  • Year 2 of CDC, AMA, and Ad Council collaboration targeted vaccine uncommitted adults age 25–54 years, with a focus on Black/Hispanic audiences. There were two campaigns associated with this collaboration: 1) “No Time for Flu” is in its second season and this season the campaign was refreshed with resources available to all. 2) “Flu FOMO” had new assets for this season including out-of-home, billboard, tv, and digital assets, to spread the message about “flu fear of missing out.” Results from the campaigns:
    • The Ad Council works with a partner to create assets and the placements of the assets is entirely donated media. As of December 8, the two campaigns had received placements in equivalent of $865,000.
    • Digital media impressions: Facebook (6.8M impressions), programmatic (TV and digital banners) (34.8M impressions), and digital out-of-home (23.6M impressions).
    • Influencer engagement: There are 40 active Instagram posts from micro-influencers that are exceeding engagement rates at 3.58% (benchmark rates are 1-2%). Some engagement rates are as high as 13% for these campaigns.

“Baseline” communication activities include media, clinician resources and outreach, COCA Calls, partner outreach and coordination, and social media outreach.

Useful links for public content: getmyflushot.org and vacunatecontralainfluenza.org

Recap of NIVW:

  • Earned social media:
    • Two matte releases (English and Spanish) encouraging people to get their flu shots this season
    • Conducted positive, targeted outreach to national consumer and trade outlets
    • Matte articles for NIVW had lower engagement this season. The English articles had similar engagement to last season with a reach of 200M people in some of the largest media outlets in the country.
  • Social media:
    • Posted organic social content and graphics to CDC flagship handles
    • Hosted “flu-etting” social activation on Instagram Reels
    • Teamed up with Coalition to Stop Flu for a Twitter chat
    • Results: Instagram Reel had nearly 400,000 views within a day.
  • Partner activations:
    • Launched refreshed NIVW landing page and partner toolkit

All of the campaign activities will run through the end of January. The in-house social media and the Ad Council campaigns will continue into March. If flu activity continues, the campaigns may run longer.

CDC is reaching out to partners to see if they would like to participate in the Instagram reels. Please reach out if you are interested.

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

How do you know who looks at the social media posts to figure out audiences?

Erin Burns

It’s hard to tell who is seeing and interacting with these digital pieces. We may be able to get more data from Instagram.

Bess Davenport

We are looking into doing a comment analysis of who is interacting with the posts. We are in the early stages but are hoping to get some more information on those exact questions. There will be more to come.

Question

We are seeing even larger, widening vaccination gaps by race/ethnicity in the coverage data. Can you discuss what’s being done to encourage patient reminders and outreach to reduce the gap?

Erin Burns

We are committed to a third year with the Ad Council so we will continue to reach out with ads that are meant to target Black and Hispanic audiences. We are conducting follow-up research to try to assess which campaigns moved the needle in terms of awareness.

We have also been partnering with the vaccine equity program at CDC’s Immunization Services Division where they have allocated $150M to local community centers and communities that have high proportions of underserved minority populations. The programmatic approach of marketing is being taken to try to reach those areas as well.

One of the first things we need to do is get out there and read the public on what barriers we might have this season. We are hearing anecdotally that some people are saying that the pharmacists are being told to focus on COVID-19 or that the pediatrician isn’t doing vaccinations. Things like that. There may be vaccine fatigue or other things that we might not be aware of. This will be helpful in formulating out next steps.

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Announcements

1. From 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 the 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. Immunize.org, 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. Immunize.org also offers free COVID-19 buttons and stickers in English and Spanish. To receive these supplies at no cost, please order now.

3. Immunize.org hosted two influenza webinars in September that can now be viewed online.

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 action and click on the top righthand button to add your organization.

5. If you are not getting emails, please add info@izsummitpartners.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.

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