A summary of presentations from the weekly Summit partner webinars
September 22, 2022 – The latest Summit Summary
- Flu Surveillance Update and Introduction to FluView – Alicia Budd (CDC)
- 2022–23 Influenza Season Key Points and Communications Update – Erin Burns (CDC)
Flu Surveillance Update and Introduction to FluView – Alicia Budd (CDC)
Alicia Budd, MPH, Influenza Division, CDC gave an update on influenza activity in the United States.
CDC’s FluView shows that compared to the pre-pandemic seasons, the 2021–22 season was mild; however, it was the first “real” flu season that the United States had since the pandemic was declared. This past season, the numbers were either below or at the low end of the range that has been seen historically from 2010–2020. There were two peaks of activity, the second lasting longer and much later in the year than usual, leading to the FluSurv-NET running longer than usual. Both peaks were due to influenza A H3N2.
There were many respiratory viruses circulating last year beyond COVID-19 and the flu. Data from the public health labs show that the majority of the specimens tested positive for COVID-19. The majority of hospitalizations were also due to COVID-19 and not the flu or other respiratory viruses. COVID-19 was also the predominant respiratory virus in long-term care facilities and the main cause of death.
The United States had a much later flu season with 5% positivity at the end of May and into early June. The activity is starting to pick back up now, but it is still low. Currently, the predominant virus is influenza A H3N2, but influenza A H1N1 has been showing up in recent weeks. Although the number is case number is low, the country is seeing more in the last several weeks than had been seen in the fall season so far.
There have been 35 influenza-associated pediatric deaths reported for this past season. The majority (all but one) of those cases were associated with influenza A H3N2.
The number of visits from people with fever, cough, and/or sore throat is starting to increase in areas across the country, and there are larger numbers of people with influenza-like Illness (ILI) that are testing positive for COVID-19, flu, and other respiratory viruses. This does not mean we are seeing increases in flu cases, however, flu is contributing to the cases, currently with a rate of 1% positivity. COVID-19 is still the predominant virus for cause of ILI in the United States.
In the southern hemisphere, activity more closely resembled a “normal” flu season, however, the timing of viral activity was much different. There was a mix of influenza A H3N2 and H1N1 viruses, which predominated in different regions, and much lower influenza B activity. Influenza B Victoria was predominately found in east Asia, particularly coming out of China.
- Australia’s flu season started early, slowed, and dropped very quickly. They had predominately influenza A H3 season.
- Southern Africa’s data tracked similarly to what they have seen before with a mix of influenza A H1 and H3 viruses circulating. Toward the end of the season, they saw some influenza B start to circulate.
- Argentina had very different timing with their flu activity this year, with a sharper, earlier incline in activity
- Chile had two peaks of activity, the second of which lined up with what they would normally see in a traditional flu season, however the first wave of activity occurred at a time when they don’t normally see flu activity. Chile had predominant influenza A H3 season this year.
It’s important to keep up with what the activity looks like in the southern hemisphere, however, their activity is not a predictor of what the upcoming season will look like in the United States. These places are not all seeing the same thing. The take-home is that we really have to be prepared for anything this fall.
Novel influenza A viruses in 2022 in the United States
There were eight novel influenza viruses reported to the CDC in 2022.
- 3 H3N2v (West Virginia)
- 4 H1N2v (Oregon, Ohio, Michigan, Wisconsin)
- 1 Avian A(H5N1) virus (Colorado)
These are viruses that don’t normally circulate among people; however, some do circulate from year to year. There have been seven cases of human infection (in children under age 18) with viruses that normally circulate in pigs and one that circulated in poultry. All of the cases were mild illnesses, and the individuals were not hospitalized. The country is relatively low with the number of infections so far, but it’s only September so that could change.
The variant influenza A viruses typically found in swine are often associated with summer and related to exposure at agricultural fairs. Much work is being done with state and local partners, especially in jurisdictions with agricultural fairs, to raise awareness of the risk of variant influenza viruses. Clinicians are also being made aware of what they should be looking for. CDC has issued guidance for the reduction of the risk of influenza transmission at fairs.
Swine contact/agricultural fair attendance was identified for six of the seven cases of swine flu, the other had no known reported exposure, however, this may be due to recall bias. No person-to-person transmission was associated with any of the cases.
Domestic HPAI (H5) Outbreak
HPAI (H5) had been infecting wild birds, domestic birds, and poultry across the country. This started in January and picked up in the early summer, following a decrease for a few months. As birds are migrating south for the winter, more cases are being detected. Commercial poultry is being monitored, as well as the individuals exposed to the birds. CDC is working with state and local partners to continue to monitor the situation. There has been one individual identified with an influenza H5 infection back in April who was working in a culling operation at a commercial facility. This is the only known case of this virus in the United States.
What to expect for the 2022–23 influenza season
CDC expects COVID-19 and flu to circulate this fall and winter along with other respiratory viruses. The country can expect to see a mix of influenza A (H3N2), influenza A (H1N1), and some influenza B Victoria lineage viruses.
There have been no influenza B Yamagata lineage viruses confirmed by a WHO Collaborating Center since March 2020.
The country can expect to see some novel flu virus variants and possibly HPAI H5 sporadic cases.
Q: A new influenza VIS has not been released for a while now. Will it be updated this year?
Erin Burns (CDC): They will not be putting up a new VIS this year so use the one that is up now.
Q: Were the 35 pediatric deaths in children that were vaccinated or not?
Alicia Budd: What we are seeing this year is following along with what we have seen historically. About 20% of the children were vaccinated and about 80% are not. I don’t have the specific percentages but it’s falling within that
Carolyn Bridges (Immunize.org): Typically, about half of the children have some significant health issues. The influenza division published a paper looking at vaccine effectiveness against pediatric deaths: Vaccine Effectiveness Against Life-Threatening Influenza Illness in US Children
2022–23 Influenza Season Key Points and Communications Update – Erin Burns (CDC)
Erin Burns, Associate Director for Communications Science Influenza Division, CDC gave a presentation on the 2022–23 influenza season key points and the campaign activities summary.
The CDC puts out flu campaigns every year to target audiences across the lifespan, targeting people of varying ages, pregnant women, people with chronic health conditions, clinicians, and frontline vaccinators.
Take 3 Communications Platform
No matter where the country is during the flu season, there are three things people can do to protect themselves: get the vaccine, take preventative actions, and take any prescribed antiviral medications. Depending on where the country is in the season, emphasis will be on one or more of these recommendations. Currently, going into the season, most of the messaging revolves around getting the vaccine.
The Current Environment
Currently, we have seen lower flu vaccination rates last year, there are ongoing COVID-19 and catch-up vaccination efforts, there is a new preferential flu vaccine recommendation for people age 65+, there has been low flu activity for the last two seasons, and the flu vaccine was not well matched in last few seasons.
2022–23 Flu Vaccination Campaign
This year there will be a strong emphasis on health equity with two campaigns (both bilingual: English and Spanish). Two campaigns include:
- A CDC campaign with a primary audience to parents with children ages 6 months–12 years and a sub-audience with people with chronic conditions, people age 65+ years, and pregnant people
- An Ad Council collaboration campaign (to be discussed at a later date) with a primary audience of the general public, emphasizing Black and Hispanic audiences age 18–64 years who are ambivalent about the flu vaccine
Formative Research Methods
CDC conducted in-depth interviews with parents and providers about flu vaccine attitudes and behaviors. The focus groups provided feedback on three draft concepts.
Not only were the concepts tested, but the interviewers also looked at the barriers and facilitators to flu vaccination. Conclusions showed that barriers and facilitators were the same as what they were 10–20 years ago.
Barriers included the belief that the flu is not serious, the recommended doesn’t apply to them, the flu vaccine isn’t effective/can cause the flu, and that other measures are more effective such as vitamins and natural infection.
Facilitators to vaccination included “I am susceptible,” a negative experience with the flu, awareness of the risk of getting the flu, belief that the vaccination is safe, and the recommendation of their healthcare provider.
CDC’s “Help Them Fight Flu”
Based on the research the CDC settled on a campaign focusing on children, called “Help Them Fight Flu.” This campaign’s motto is “Help them fight flu so they can do what they do.”
2022–23 Flu Vaccine Campaign in collaboration with Ad Council and AMA
The CDC campaign in collaboration with Ad Council and AMA, encourages vaccination through earned and donated media. Campaigns include “No Time for Flu,” “Flu FOMO,” micro-influencer outreach, and a new campaign: Doctor’s Orders. The Ad Council will update the previous ads and re-release them.
The new campaign called “Doctor’s Orders” will include a new video in a doctor/interviewer format, will focus on the barriers to flu vaccination, and will be straightforward and factual. The placement will be the same as the previous ads and will focus more on micro-influencer outreach, as the rate of return is found to be much higher using social media influencers.
Ad Council placements for all of these ads will include digital media, broadcast TV, Outdoor printed material, other media types such as ratio PSAs, print, and influencer marketing.
2022–23 Flu Vaccine Campaign Key Dates
- Mid-September – was the soft launch of the digital flu campaign and activities
- October 4 – Flu vaccine campaign kickoff
- October 10 – Ad Council campaign launch
- October 12 – Ad Council radio media tour
- October 18 – Flu Vital Signs publication
- Mid-October – CDC Director NFID flu blog/first FluView report
- Ongoing – Weekly distribution of key points/surveillance updates/burden estimates
- End October First 2022–23 vaccine uptake estimates
- November 18 – COCA calls
- December 5–9 – National Influenza Vaccination Week (NIVW)
- Difficult to predict the timing of flu, but expect flu and COVID-19 to circulate this season
- Low flu activity in the past two seasons means we can expect a country ripe for a severe flu season
- CDC is concerned about flu vaccine drop in coverage; people are at risk
- Critical for public health that we use flu vaccines to prevent flu
- The flu vaccine has many health benefits
- Important to be up to date on flu vaccine
- Annual flu vaccine for everyone age 6 months and over with rare exceptions
- Get vaccinated by end of October
- Preferential recommendation this year for people age 65+
Co-Administration of Flu and COVID-19 Vaccines
Co-administration is the best practice if a patient is due for both COVID-19 and Flu vaccines at the same visit. The recommended schedule should be followed for both vaccines, be sure to follow CDC’s extensive guidance. There is safety data on the co-administration of flu and COVID-19 vaccines. It’s shown that people getting both vaccines at the same time had similar safety profiles than just getting one at a time.
Q: FEMA funding restrictions on COVID-19 vaccine providers have created a barrier to co-administration of flu and COVID19 vaccines at the same time at events like mobile clinics and community pop-up events. For teams serving underserved communities in rural and urban areas, is there any word on lowering this barrier? Otherwise, we are promoting having individuals getting flu and COVID-19 vaccines at the same time this season (with the concurrent rollout of the flu campaigns and updated bivalent COVID-19 boosters), but there’s a barrier to administering both at these events.
Susan Farrell: There are two different systems for vaccines, so that’s making it difficult
Q: Arizona is having an unanticipated flu vaccine issue to keep on the radar. We have the Vaccines for Adults program using the 317 funds, so typically we get around 9,100 doses of flu vaccine. It stays in the county health departments and they are able to give to the uninsured patients. During COVID-19 they did the supplemental flu doses which took the numbers up to 150,000 doses to avoid the “twindemic” at the beginning of COVID-19. They brought it back for the second year. We have had staff turnover and they ordered their private doses based on the last two years of inventory using the supplemental doses as a guide. They have now almost no flu vaccine for adults because they were counting on getting other flu vaccine doses from the state health department through CDC. They are worried they will miss the flu season for most of their high-risk patients.
L.J Tan (Immunize.org): We can raise awareness with some FQHC partners and the national health centers. There might still be flu vaccines available for purchase. However, a lot of the doses that would be ordered now won’t come in until late November. You must do what you can to get doses ordered so you have doses to give to your high-risk patients. We need to work with some community health center partners, distributors, and manufacturers to see what we can do to help. This is something that the Summit should take a look at.
Carolyn Bridges (Immunize.org): I hope our CDC colleagues can raise the issue there, as well, and have the health centers work with their state and local health departments.
Lana Hudanick (Missouri DHHS): We were able to order more flu doses in Missouri, however, it will count against us for the next flu season. Whatever we ordered additionally they would take out of our funding for the next season.
Luke Noll (FFF): There are still flu vaccine doses available for sale from some of the distribution networks.
- NAIIS will be back to our regular weekly scheduled calls beginning October 6, which is our next call. Our calls start right after the NFID media conference on the national kickoff for flu vaccination. There will be an update from Marla Dalton about that event.
- If you have not registered for the summit in-person meeting please do so The 2022 National Adult and Influenza Immunization Summit (NAIIS) will be held on November 2–3, 2022 at the Crowne Plaza Atlanta Perimeter at Ravinia in Atlanta, Georgia. While registration is free, once the meeting registration hits max capacity, registration will be closed. If you have registered and can’t make it, please let us know so that we can offer that spot to someone else. You need a password to register. For the password and for more information and to register visit izsummitpartners.org/2022-naiis-adult.
- The Summit released Get Adults’ Vaccinations Back on Track, a 2-page clinician tip sheet on new CDC recommendations and tools to help adults catch up on needed vaccinations. NAIIS is a large coalition of public and private organizations dedicated to increasing immunization rates, co-led by Immunize.org, CDC, and the Health and Human Services Office of Infectious Disease and HIV/AIDS Policy.
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