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A summary of presentations from the weekly Summit partner webinars

March 3, 2022 – The latest Summit summary

Flu Surveillance Update – Alicia Budd (CDC)

Alicia Budd, MPH, Influenza Division, CDC, gave a presentation on CDC’s flu surveillance from FluVIew ending on February 19, 2022 (week 7).

Influenza Virologic Surveillance – U.S., 10/4/21–2/20/22:

There has been a slight increase over the last few weeks in the number of specimens testing positive for flu. This is occurring over many areas of the country, however not nationwide.

The CDC is now reporting antigenic characterization of the viruses in addition to genetic characterization. The genetic data remains the same––mostly influenza A H3N2 viruses belonging to the 3C.2a1b clade and the 2a.2 subclade. The subclades have been characterized to see if they are antigenically similar to the cell- and egg-grown vaccine viruses. For the H3 viruses, the percent similarity is quite low, which suggests that the vaccine is likely to provide reduced protection against infection from most circulating H3 viruses. The small numbers of influenza B (Victoria) viruses circulating are somewhat antigenically similar to the vaccine version, so vaccine antigenic match is better for this virus. All of the viruses have been tested for antiviral resistance and so far there have been no issues identified with susceptibility to the antiviral agents.

Some of the vaccine viruses that are antigenically different from the circulating viruses offer lower protection against infection, however, there is some protection against severe disease. There is preliminary vaccine efficacy (VE) estimate data in the MMWR. [Published March 11. 2022].  This data is looking at the VE against medically attended respiratory illness in an outpatient setting.

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 by a number of respiratory viruses, including flu and COVID-19. After declining for several weeks, the number of ILI visits has remained stable. This pattern is similar for most age groups except for a slight increase in the 5–24 years age group. The contribution of flu to the ILI visits varies by location.

ILI Activity Level, Determined by Data Reported to ILINet, Week ending February 19, 2022 (Week 7): During week 7, there have been lower levels of flu activity with some hot spots across the nation.

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, 10/4/21–2/20/22:  The number of LTCF reporting at least one flu positive case among their residents has been stable at very low levels for the past couple of weeks.

Influenza hospitalizations in the U.S.: HHS Protect shows that this week that there has been a slight increase in the number of flu-positive admissions that have been reported. The cumulative influenza-associated hospitalization rate from FluServNet shows that flu activity is above the point that it was at last season. The rate for the current season is lower than for the 2015–2016 and 2011–2012 seasons, which were both mild.

Influenza-related mortality data, U.S.: The percentage of death certificates that list pneumonia, influenza, or COVID-19 (PIC) as the cause of death has been decreasing for the last few weeks. This is most likely driven by COVID-19 activity. There are currently 6 pediatric deaths this season, all of which were tested positive for influenza A H3N2 viruses.

International Influenza Activity, Number of Influenza Positives Reported to WHO’s FluNet, 10/2018–1/8/22: Flu positive activity reported to the WHO remains lower in both hemispheres than is typically reported in a flu season. Influenza A H3 is still the predominant virus worldwide, except for China where they are reporting influenza B (Victoria) as the dominant virus.

WHO Influenza Vaccine Strain Recommendations for 2022–2023: WHO is making strain recommendations for the northern hemisphere 2022–2023 flu vaccine. They have come to the decision to update influenza A H3N2 virus and the influenza B Victoria virus. There will be no change to influenza A H1N1 virus or the influenza B Yamagata virus. FDA met on these recommendations on March 3, 2022. The meeting information can be found at: Vaccines and Related Biological Products Advisory Committee March 3, 2022, Meeting Announcement.

Highly Pathogenic Avian Influenza (HPAI) A(H5N1): Current Situation in the U.S.

There has been detection of Eurasian lineage highly pathogenic avian influenza (HPAI) A(H5N1) from the 2.3.4.4b clade for the first time in birds in the U.S. this year.  The first detected infected birds were on the east coast. Wild birds in 13 states have tested positive for the virus, as have commercial poultry and backyard flocks in nine states. Wild birds can carry the virus without becoming sick and domestic poultry that get infected often become very sick and die from the infection. The risk to the general public is low and it is safe to eat properly handled and cooked poultry.

To date, there have not been any confirmed human cases in the U.S., however, there have been occasional human infections across the world. The human cases have been sporadic and have occurred after close, prolonged, and unprotected exposure to infected birds and/or their environment. The human disease ranges from asymptomatic to severe illness and death. There has not been evidence of human-to-human transmission.

There’s been an ongoing multi-agency and multi-jurisdictional response since the identification of the virus in wild birds. USDA and the Department of Interior are the leads for investigation and the response to the birds, while the CDC is the response for human health.

CDC is working closely with the USDA and Department of Interior to exchange information and be sure to get out accurate information to all partners involved. CDC is updating existing guidance and working with partners in states with confirmed infections, primarily in commercial and backyard flocks. There is frequent sharing of information with public health partners––CSTE, APHL–– and the public. Affected states are involved in managing the response in their state. Department of Agriculture and Department of Health are monitoring exposed people, arranging testing, and informing clinicians, veterinarians, backyard flock owners, etc.

CDC is also looking at the viruses coming out of the birds to see if there is potential concerning changes that could have implications for greater transmission to people. CDC is looking for potential infections and testing those exposed people such as farmers, investigators, cullers, and anyone with contact and respiratory symptoms. There has not been any human HPAI H5N1 infection in the U.S. to date.

There are ongoing pandemic influenza planning and preparedness activities that put U.S. in a good position to respond to a more serious situation. There are existing diagnostic tests that can detect H5 viruses, as well as mechanisms to report lab data and test results to CDC electronically, as influenza A is a nationally notifiable condition.

There is an existing candidate vaccine H5 virus that can be matched to the HPAI H5N1 virus and this virus is susceptible to antiviral agents. There is also a licensed H5 vaccine strain that is related to this virus, however, it’s much easier to switch this strain with one that is well matched for the HPAI H5N1 virus-like we do with the seasonal influenza vaccine. This is helpful as the vaccine manufacturing process does not need to be started from scratch.

CDC is using IRAT, a tool to assess the potential pandemic risk of the novel influenza A viruses based on the risk of emergence, transmission, and public health impact in terms of severity. However, the U.S. is nowhere near needing a vaccine now.

For more information:

Questions

Question

I read that Canadian geese may be highly susceptible to the H5N1 strain. Many northeast states have Canadian geese. Has there been any reporting of this in the eastern part of the country?

Alicia Budd

I don’t recall seeing them on the list of positives in wild birds. Maine has reported H5 in ducks but not Canadian geese.

Question

Will this be as pathogenic in humans as the previous H5N1 viruses have been?

Alicia Budd

Some similar viruses have caused sporadic infections in humans in other countries. There was a report of an individual in the U.K. who was infected with this strain, however, was asymptomatic. There is a procedure in place where they test even if the exposed individual is asymptomatic. There has been a range of severity of illness and people are being monitored who have close contact with birds. There is no human-to-human transmission at this point in time.

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Families Fighting Flu: Key Messages and Takeaways – Shoshana Fishbein (Families Fighting Flu)

Shoshana Fishbein, MPH, Communications & Marketing Director, Families Fighting Flu, gave a presentation on key messages and takeaways from the current flu season that partners can use to begin planning for the 2022–2023 season.

For the 2021–2022 flu messing and communication, Families Fighting Flu (FFF) worked to get ahead of the flu season by sharing a new message with its community: “Vaccinate, Test, and Treat.” This language is being used for the 2022–2023 season, as well as will be used for future seasons. FFF continues to focus on prominent language about testing and treatment, which is very important and reiterated by families who have lost loved ones due to flu.

This messaging was put into blog posts, social media, fact sheets, and educational materials, some of which were specially created for the 2022–2023 season and will be used for the upcoming season. These materials are intended to help people understand that vaccination is the number one way to prevent flu for those 6 months and older, as well as what to do when you get sick with the flu. The message is that if you do get sick, to be proactive and connect with a provider when necessary.

This season, FFF is also working on some materials for back to school. Many kids are behind on their routine vaccinations due to the pandemic, and partnering with school districts, school nurses, counties, states, and health departments, is a way to get information out about routine vaccinations as well as the flu when children start going in for their school physicals. These visits offer clinicians an opportunity to offer a strong reminder that flu vaccines are needed by the end of October. The materials are easy to understand and will be sustainable without mention of ages with vaccines such as the COVID-19 vaccine.

FFF also revised key pieces to include more information about flu testing and treatment. With these materials, FFF is happy to co-brand and partner with organizations, as well as to get the materials out to communities for free. FFF offers durable postcards that include warning signs for flu and FAQs with answers without using too many statistics so that they will be valid for several seasons.

Family stories are critical to these messages and are what brought FFF into existence. During the past flu season, FFF added five new families whose stories garnered significant engagement on social media and earned media. Putting a face to the flu is critical to the message as to why the vaccine is so necessary and that the flu is a serious disease.

Youth and adolescent education (junior board) are also critical to sharing the importance of vaccination and the importance of taking this disease seriously. Many people on the junior board have been affected in some way by the flu, and therefore are motivated to help others through local efforts. Young voices bring a fresh perspective and it’s a great way to channel a loss or tragic event into advocacy.

The University YMCA in Minneapolis, MN, offers a 5-week educational program for grades K-8. The InFLUencer program has been running from fall 2021 and will run into spring of 2022. This program includes FFF comic books, quizzes, worksheets, and other educational materials. The thought is that children who learn this information at a young age will be less susceptible to pseudoscience and misinformation about vaccines as they grow into adults.

The University of Iowa biology department and the Iowa City Booster Club of past and current students in the field of biology offered their expertise on vaccination and pandemics to create a game called Flu’s Clues. This virtual game for older elementary students and middle school students allows the player to assist an epidemiologist in an outbreak. The game takes the player to different countries to learn how a vaccine is created.

FFF is currently making plans for the 2022–2023 season, which include:

  • Continued collaboration with key leaders, trustworthy messengers, and partners
  • Virtual library of quizzes, webinars, and video modules for people of all ages
  • Patient videos on the importance of maternal vaccines
  • Collaborating with school nurses
  • Focus on targeted advertising to U.S. cities with low vaccination rates and health disparities
  • Launch a back-to-school vaccination campaign and partnership with school nurses
  • Create new materials with health literacy and health equity focus
  • Translating materials to Spanish
  • Expand blogs to include the most current and relevant trending topics
  • Continue to build our stories and emphasize flu severity through family stories

In planning for the upcoming season, FFF stresses that it’s important to make resources accessible and understandable.

For information on collaboration and co-branding, contact Shoshana Fishbein at: sfishbein@familiesfightingflu.org.

Questions

Question

Are your families still available for future in-person presentations and meetings to continue to provide the face to influenza?

Shoshana Fishbein

Yes, there are always families that would like to share their stories. We can work with your organization on what’s best for your audience. There are lots of virtual events, as well, so please reach out if you are interested, even if your organization is not completely flu-focused.

For information contact Shoshana Fishbein at: sfishbein@familiesfightingflu.org.

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Announcements

1. The NAIIS Annual meeting will be split into two segments The NAIIS Flu Day will be virtual this year. The tentative day for the virtual flu session is May 19 from 2:00–4:30 p.m. (ET). The adult vaccination component will hopefully be in person, COVID-19 permitting, in September or October of 2022.

2. Vaccinate Your Family has released their State of the ImmUnion report, which is available at: https://vaccinateyourfamily.org/wp-content/uploads/2022/01/SOTIReport_2022_R5.pdf

3. The Duke-Margolis Center for Health Policy, the Association of Immunization Managers, and the Brown University School of Public Health article, Priorities and Policy Levers to Support School-Located Vaccination, published in Health Affairs Forefront, which is available at: https://www.healthaffairs.org/do/10.1377/forefront.20220228.651782

4. The HHS Office of Infectious Disease and HIV/Policy announced a public comment period for the updated: “Vaccines Federal Implementation Plan”. This new draft document talks about federal agency actions in support of our overall national vaccination goals. You can review the draft and provide comments up to 5 pm Eastern Time on March 29. You can find the Vaccines Federal Implementation Plan, a companion document to the Vaccines National Strategic Plan 2021-2025, at: https://www.hhs.gov/vaccines/vaccines-national-strategic-plan/vaccines-federal-implementation-plan/index.html. You may send comments to nvp.rfi@hhs.gov.

 

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