A summary of presentations from the weekly Summit partner webinars
October 13, 2022 – The latest Summit Summary
- Flu Surveillance Update – Alicia Budd (CDC)
- NFID Media Conference Update – Marla Dalton (NFID) and Diana Olson (NFID)
Flu Surveillance Update – Alicia Budd (CDC)
Alicia Budd, MPH, Influenza Division, CDC, gave an update on influenza activity for week 39, ending October 1, 2022. (View presentation slides.)
Week 39 is the last week of the surveillance season for October 2021–September 2022 flu season. Week 40 will be the beginning of the 2022–2023 flu season surveillance reports.
Influenza Virologic Surveillance: Clinical Laboratories
In recent weeks there has been an uptick in the percent flu positivity, predominately influenza A. The percent positivity is still low at 2.5% nationally. The upward trajectory is being driven primarily by activity in region 4 (southeast) and region 6 (south-central). There are small increases in most of the country but these two parts of the country have the most significant levels of flu virus circulation currently.
Influenza Virologic Surveillance: Public Health Laboratories
The 2021–2022 season was predominately influenza A (H3) with some influenza A viruses not subtyped and a small amount of influenza B virus circulating, which carried on through the summer. While the U.S. is still A/H3 predominant, there is also some A/H1 and a little bit of influenza B showing up. Data from the last three weeks shows there is more variability so far this year in the circulating viruses.
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.
Respiratory illness has been increasing in recent weeks and is being driven by young children ages 0–4 years. It’s also being seen in some school-age children and young adults with less in the older age groups. This activity corresponds with where influenza is increasing. Flu is contributing, and in some areas, pretty significantly, to increases in ILI. There are also reports of high levels of RSV and rhinovirus and enteroviruses. While COVID-19 activity is declining, this is still contributing to respiratory disease. The proportion of ILI due to one virus or another depends on location.
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
The percentage of LTCFs with at least one confirmed influenza case among residents has remained stable at quite low levels in recent weeks. There is starting to be a slight uptick in the number of lab-confirmed flu-positive cases among patients admitted to the hospital.
Influenza-Related Mortality in the United States as of October 6, 2022
Deaths from pneumonia, influenza and COVID-19 (PIC) has been declining for several weeks. Deaths currently appear to be driven almost exclusively by COVID-19 activity, with very few flu deaths.
There have been 40 influenza-associated pediatric deaths during the 2021–2022 flu season, and there continue to be a few pediatric deaths reported every couple of weeks. Not much has changed in terms of the virus causing the deaths, which is predominately H3. The proportion of children who have died that were vaccinated is around 20%, which is similar to other years.
Novel influenza A viruses
There have been nine novel influenza A virus infections in people reported in 2022. There were eight variant viruses (5 H1N2v, and 3 H3N2v) and one H5N1 virus, found in birds, and only one person has been infected. Fair season has ended, which is good to keep variant viruses down that are caused by pig-to-human transmission. Wild birds are now migrating south for the winter, which may not bode well for commercial poultry, backyard flocks, and wild birds. There has been an increase in identification of the virus in birds of all populations. In September, there were more than 6 million infected birds, while the month earlier there were only one million. State and public health officials are monitoring people who have had exposure to these birds and they are being tested when respiratory illness has been detected.
What’s happening worldwide
After peaking in July, the activity in the Southern Hemisphere declined, but they are now seeing a rise in September, which is atypical. Both South Africa and Argentina are reporting second waves of activity.
The activity in the Northern Hemisphere is similar to what has been seen in the past, with low levels throughout the summer and into the early fall. Activity is slow but increasing, especially in Europe and Canada.
2022–2023 Influenza season
The 2022–2023 season officially started Sunday, October 2. For the 2022–2023 flu season surveillance, there will be some virus characterization data (summer through present), and later in the season there will be FluServNet hospitalization data.
Activity is still low in the U.S. but is increasing in some parts of the country. The virus that is most predominant is still H3 with a little bit of B and H1.
It’s a great time to get vaccinated.
Q: Can you comment a little on the B Yamagata situation? It hasn’t been around since March 2020 globally. How long will you be looking for that virus before you decide if it may have gone away entirely? What’s the plan for looking for B when we haven’t seen it in so long?
Alicia Budd: I don’t know when or if there would ever be the statement that B Yamagata is no longer around. There are a lot of places that don’t do the lineage typing that we do in the U.S. and it’s important to continue to lineage type to be sure that it’s not hiding out somewhere. It may be at low levels somewhere and not getting picked up. We have seen that in the past with B Victoria viruses. We will be continuing to look for it.
Q: Is there any subtyping going on in the Southern Hemisphere? Is the increase there travel related? Are they the same subclades?
Alicia Budd: It’s hard to know if the viruses are travel related. In South Africa, they had an early wave which was H1 and now they are having a wave which is H3 and some B. In South America, they peaked earlier in the spring and summer with H3 and are continuing to see H3 predominately. Now they are seeing increases in H1 and B that they hadn’t seen earlier. Whether travel-related or not, they are seeing additional viruses circulating now that they didn’t see in the first wave.
NFID Media Conference Update – Marla Dalton (NFID) and Diana Olson (NFID)
Marla Dalton, NFID Executive Director and CEO, and Diana Olson, NFID Senior Director, Strategic Communications gave an update on the National Foundation for Infectious Disease (NFID) Media Conference. (View presentation slides.)
The 2022 NFID Influenza/Pneumococcal Disease News Conference, held in collaboration with CDC, took place on October 4, 2022, as a hybrid event this year. The news conference is the official kick-off to flu season and an opportunity to share critical public health messages around flu and pneumococcal disease prevention and treatment.
The expert panel included moderator NFID president, Patsy Stinchfield, RN, MS, CPNP; William Schaffner, MD, NFID Medical Director; Tamika C. Auguste, MD, ACOG Fellow and Chair, Women’s and Infants’ Services, MedStar Washington Hospital Center; Rochelle P. Walensky, MD, MPH, CDC Director; and Jeb S. Teichman, MD, retired pediatrician and healthcare executive. The panelists shared the final CDC flu vaccination coverage data for the 2021–2022 season, the results from a new natural survey by NFID, and focused on the impacts of the pandemic on vaccination rates overall. An impactful message came from Dr. Teichman who lost his 29-year-old unvaccinated son to the flu in 2019. And an onsite flu clinic was offered where some participants showed themselves getting vaccinated for news outlets and social media.
Watch the conference at: www.nfid.org/2022flunews.
NFID National Survey
The NFID National Survey is a survey of U.S. adults conducted in August that revealed 69% of U.S. adults agree that flu vaccination is the best way to prevent flu-related hospitalizations and deaths. But only 49% said they planned to get vaccinated in the 2022–2023 season. Nearly one in five of those at higher risk for flu-related complications (including older adults and those with chronic health conditions) said that they were not planning on getting vaccinated this season. Among adults at higher risk for pneumococcal disease, only one in three reported they had been advised to get vaccinated against pneumococcal disease. For those who had been advised, 75% received the vaccine. This underscores the importance of a strong recommendation from a healthcare provider. The survey also highlighted some misconceptions about flu vaccination that needed to be addressed, as well as the fact that people are still underestimating the serious complications of flu and underappreciating the effectiveness of flu vaccines.
All of the survey results were translated into a fact sheet and infographic that can be found at: www.nfid.org/2022flusurvey.
Top-Tier Media Coverage
The news conference generated a lot of attention among the media and the immunization community. There were 300 attendees both virtually and in person. Media placements were secured in top-tier print, online, TV, and radio outlets, resulting in 4.8 billion impressions to date. All of the media coverage included at least one of the key messages with a strong call to action that annual flu vaccination is the best way to prevent flu, especially for older adults and people with chronic health conditions.
Partners, the immunization community, and healthcare professionals helped spread the messages through social media using the hashtags #FightFlu and #PreventPneumo. There were 819 social media posts by 514 unique authors that generated an estimated 24.5 million impressions. Media outlets helped extend the reach of the messaging on social media.
NFID #FightFlu Campaign: Leading by Example
NFID hosted an in-person flu clinic at the conference where panelists and participants got vaccinated on camera. Pictures and videos were shared on social media. We encourage you to join the Leading by Example mission by doing the same and using the hashtag #FightFlu and tagging @NFIDvaccines.
NFID has developed social posts and graphics to be used throughout the season. You can find these social media assets HERE.
Building Awareness and Sustaining Strong Momentum throughout 2022–2023 U.S. Respiratory Season
The news conference was the kickoff to flu season, but these resources will continue to be shared throughout flu season. There is a webinar on October 24 on the importance of annual flu vaccination for all adults you may register for HERE. There are also plans for paid media integrations focused on reaching older adults and those with chronic health conditions. Additionally, there will be research focused on knowledge and attitudes about flu and flu vaccines by U.S. Black adults and eventually the development of a toolkit.
Additional information, including news conference recording can be found HERE.
Q: What was the kind of feedback that you were getting from some of the outlets you talked to or the feedback that they were getting from the posts? I’m concerned that there may be some backlash that public health is crying wolf since we haven’t had flu in a couple of years. What are you seeing in social media from the conference?
Marla Dalton: That’s the concern we always have when we talk about flu. It’s early and the media clearly understood the importance of flu vaccines in preventing flu and flu-related complications. The results of the survey added to the alarm that half the pop says they Until we see the activity come it’s going to continue to be an uphill battle communicating with the media and public.
Diana Olson: We were really pleased by the media perspective this year. They understood the importance of getting vaccinated and the concern about the large percentage of people at greater risk who are not planning to get vaccinated. As Marla said, we did something different this year by featuring Dr. Teichman. His personal story put a human face on the message. Expertise and data from CDC, our research findings, and a human story made for a very compelling package, and that was what contributed to a lot of the great coverage that we received this year.
Q: Did you get a sense when talking to the media after the press conference about any interest in the media to address the issue of spillover from COVID-19 vaccine to flu/pneumococcal coverage rates in terms of declining confidence with regards to the vaccines?
Diana Olson: We have been getting a lot of questions related to that and we are continuing to get those questions. We have NFID medical director, Bill Schaffner, on the internal medicine side, and this year Patsy Stinchfield, President of NFID, on the pediatric side. So, there are some great spokespeople who are good at putting this all in context based on the data and experience they have in clinical practice.
Q: For COVID-19, children are much less impacted than older adults, but for flu you see much more hospitalization and severity in the less than 2 year olds especially which is more comparable to flu hospitalization in older adults. Have you tried to emphasize the severity of the flu to young children for those thinking that COVID-19 is the same as flu in terms of impact in young children?
Diana Olson: One of the biggest misconceptions that we found in our survey research, and we didn’t specifically tease out children vs adults, but people think that flu isn’t that serious. That is something we try to repeatedly stress: the flu is very serious. That’s a big part of the messaging. Having a pediatric nurse practitioner as one of our key messengers is helpful in addressing that.
Marla Dalton: Patsy had a good quote where she said that “just” and “flu” should never be in the same sentence. That’s a key part of the messaging platform. We also talk about the long-standing history of the safety of flu vaccines so some of the concerns that we hear in the surveys are around the COVID-19 vaccines and the short time frame in which they were developed and the lack of long-term safety data. We point to the years and billions of doses of flu vaccines that have been administered to combat this.
Q: Is there any insight that you gained about how to bridge the gap between the 69% of adults who agree that the flu vaccine is the best way to protect you against the flu and the 49% that plan to get a flu shot? That seems like a real disconnect. Any insights on bridging that gap?
Diana Olson: One thing is the importance of the unified, strong, collective voice. It’s important for all of us to continue to make the case for annual flu vaccination for everyone 6 months and older and to continue to address those misconceptions that people have about flu not being serious and the effectiveness of flu vaccine. With COVID-19 one of the things people have learned is that vaccines for COVID-19 and flu, even when they don’t prevent infection entirely, can make a huge difference in preventing hospitalization and death. Those are important messages. We need to be a unified voice reiterating those messages, showing research from NFID, CDC, and others, and reiterating that health care professionals play a vital role in messaging. Everyone you encounter in the healthcare system plays a role in the importance of annual flu vaccination. Those are the ways that we bridge that gap.
- 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 the meeting registration has hit max capacity. If you have registered and can’t make it, please let us know so that we can offer that spot to someone else. We have sent an email to the registrants and based on their confirmation or cancelation; we may be able to add more people. If you are interested in coming, please still go on and register; we will try to get you a spot. 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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