A summary of presentations from the weekly Summit partner webinars
December 8, 2022 – The latest Summit Summary
- Vaccine Safety and Use of COVID-19 Vaccine Coadministration Update – John R. Su (CDC)
- Influenza Vaccination Coverage Update – Suchita Patel (CDC)
- Insights Into the PAs Experience with Influenza Vaccines Update — Noel Smith (AAPA)
Vaccine Safety and Use of COVID-19 Vaccine Coadministration Update – John R. Su (CDC)
John R. Su, M.D., Ph.D., M.P.H., CAPT, U.S. Public Health Service, Acting Deputy Director, Immunization Safety Office, CDC, gave a presentation on vaccine safety and use of COVID-19 vaccine coadministration update.
Bivalent mRNA COVID-19 Vaccines (Originally presented to the Global Advisory Committee on Vaccines Safety on 11-29-22)
VAERS, a national passive safety surveillance system, is a reporting system for the United States for anyone to report a vaccine adverse event that occur after vaccination
- Rapidly detects potential safety problems
- Can detect rare adverse events
- No unvaccinated comparison group
- Generally, can’t use the data to determine long term cause and effect
- Passive surveillance
- Inconsistent quality and completeness of information that is reported to VAERS
- Reporting biases
- Demographic summary of 5,542 VAERS reports (as of 10-23-22) among persons 12 years and older following bivalent booster dose:
- Most reports from non-Hispanic white females or those not reporting race/ethnicity
- Data reported is consistent with what has been seen after other COVID-19 vaccines
- Most (96%) of VAERS reports were nonserious
- Vaccination errors were the most (35%) common events reported
- Events that under Federal law are designated as serious are those meeting the following criteria:
- Hospitalization or prolongation of existing hospitalization
- Life threatening illness
- Permanent disability
- Among serious adverse events reported after bivalent vaccination included five reports of myocarditis and four reports pericarditis following administration were reported among 22.6 million doses of bivalent vaccine administered.
- Among reported deaths, the causes of morality for the effected age group were not different from expected in the general population, so there was nothing concerning.
v-safe is a more active surveillance system where vaccinated people can receive periodic text messages asking them to check in to report any adverse events to the vaccine
- If a severe event prompts patient to seek medical attention
- As of 10-23-22, there were 212,000 v-safe participants, age 12 years and older
- Found about a third of the participants got a flu vaccine at the same time as their COVID-19 booster
- Over 211, 959 v-safe registrants reported a bivalent booster dose—reporting frequencies of reactions and health impacts similar to those described after first and second booster
- Vaccination characteristics of 211,959 v-safe participants age 12 years and older who reported at least once 0–7 days post bivalent booster dose shows trend of declining proportions of people reporting negative health outcomes as age increases
Coadministration of mRNA COVID-19 and Inactivated Influenza Vaccines – VAERS
As of June 2022, there have been nearly 2,500 reports (median age 48) to VAERS, the majority of reports are among females
- Reports mostly not serious
- Most flu vaccines were coadministered with Pfizer COVID-19 vaccine
- Most reports are not serious and consistent with what is seen after COVID-19 vaccination alone
- Adverse events often relate to COVID-19 disease-associated symptoms
- Reports of mortality are consistent with age-related causes of mortality
Preliminary reports of adverse events of special interest to VAERS after coadministration
- Bell’s palsy: 19
- Myocarditis/pericarditis: 16
- Anaphylaxis: 6
- Multisystem Inflammatory Syndrome in children: 2
- Guillain Barre Syndrome: 1
- Deaths: 47, median age 73 years
v-safe data (originally presented to the National Vaccine Advisory Committee, Sept. 23, 2022)
Reactions and health impacts reported to v-safe in the week following coadministration of flu and COVID-19 vaccines and COVID-19 vaccine administration alone, from Sept. 20, 2021, and May 1, 2022, were compared.
- Even split between Pfizer-BioNTech and Moderna
- Moderna, regardless of being administered alone or coadministered, tends to be a more reactogenic and slightly more so after coadministration
- Most reports are mild to moderate in severity
- About 10% reported not being able to work or go to school
- Few patients reported needing medical care (<3%)
Vaccine Safety Data
There have been 230,000 does of bivalent vaccine coadministered with influenza vaccine under active surveillance.
Influenza Vaccination Coverage Update – Suchita Patel (CDC)
Suchita Patel, DO, MPH, Lead for Data Science and Innovation, Assessment Branch, Immunization Services Division, NCIRD, CDC, gave an update on influenza vaccination coverage.
The Weekly Flu Vaccination Dashboard was launched during COVID-19 pandemic in December 2020. The goal of the dashboard is to share preliminary estimates during the season to help with program decisions. These are not final season estimates. This is updated weekly or monthly. Estimates change over time as data gets updated.
Weekly Cumulative Doses (in Millions) of Influenza Vaccines Distributed
The first figure on the dashboard shows the number of doses that have been distributed in the United States in millions. As of November 20, there have been 155 million doses distributed.
Weekly Cumulative Influenza Vaccination Coverage by Flu Season and Race Ethnicity – Children age 6 months– 17 years, U.S. (From National Organization Survey for Kids
Estimated U.S. 2022-2023 season coverage
- This season, as of November 20, coverage for children is 42.5%.
- This season is statistically similar to the same time last November (40.9%)
- Compared to November 2020, this season is 4.2 percentage points lower
- Compared to November 2019 (pre-pandemic), this season is 3.9 percentage points lower
Coverage by race/ethnicity
- Coverage for non-Hispanic black children is 5.4 percentage points lower than non-Hispanic other race children
- Comparing this season to lasts, this season is 8 percentage points higher for non-Hispanic black children and 6.1 percentage points higher for Hispanic children
Comparison between 2022–2023 and the three previous seasons
- National coverage is 42.5%, ranging from 24.4% to 54.6% among the US state/city immunization programs
- Coverage for children in rural settings is 27.7%, 15.5 percentage points lower than kids in suburban settings, and 18.3 percentage points lower for kids in urban settings
- The coverage for rural kids this season is 6.4 percentage points lower than the same time last season
Monthly Cumulative Influenza Vaccination Coverage by Age Group, Race/Ethnicity, Urbanicity, and Jurisdiction for Adults age 18 years and older, U.S., 2022–2023 and 2021–2022 (Data Source: National Immunization Survey-Adult COVID Module)
Coverage by State
- For most states, the coverage is similar to last season at this point. As of mid-October 2022, overall coverage this season among 50 states, DC, and Puerto Rico is 26.3%
- Coverage among U.S. states and DC ranges from 18.9% to 35.6%
- For adults, this year is 3.3 percentage points higher than last season
Coverage by race/ethnicity and location
- This year coverage is lower for Hispanic adults than for non-Hispanic black adults and non-Hispanic adults and other multiple
- The coverage for adults in rural areas is lower, but not as big of a disparity as for children
Monthly Cumulative Influenza Vaccination Coverage by Flu Season and Race/Ethnicity, Medicare Fee-For-Service Beneficiaries age 65 years and older, U.S. (Data Source: Medicare & Medicaid Services Chronic Conditions Warehouse)
14.6% of Medicare fee-for-service beneficiaries, age 65+ were vaccinated as of the end of September 2022.
Intent for vaccination for adults as of mid-November
- 4% of adults said they already got the vaccine
- 6% say they probably or definitely will get the vaccine
- 5% are unsure if they will get the vaccine
- 5% probably or definitely will not get the vaccine
- 7% pf non-Hispanic white adults don’t plan to get the vaccine
- This is 10.7 percentage points higher than Hispanic adults (22%)
- This is 12 percentage points higher than adults in the non-Hispanic, other race/ethnicity group (20.7%)
- 7% pf non-Hispanic white adults don’t plan to get the vaccine
The data is related to where people are getting vaccinated this year compared to 2021-22 season
- Medical offices have 4.4 million fewer doses this year
- Pharmacies had 2 million more doses administered this year
Monthly Cumulative Influenza Vaccination Coverage by Flu Season and Race/Ethnicity, Pregnant Persons age 18–49 years, (Data Source: Vaccine Safety Datalink (through December 3)
- The coverage for pregnant people is 12.4 percentage points lower this season than last season
- This year, pregnant people coverage is 22 percentage points lower compared with October 2020
- This year there is 20.4% coverage for black non-Hispanic pregnant people so far at the end of October
- Seeing lower coverage in all ethnicities
- So far this season, coverage is similar to last season, but about 4 percentage points lower than the same time in 2019 and 2020.
- Seeing trends of lower coverage for non-Hispanic Black children
- There’s a huge disparity for kids living in rural versus urban areas
- Coverage is 3 percentage points higher compared to last season
- Coverage is lower for non-Hispanic Black adults and Hispanic adults
- Coverage this season is lower for adults in rural areas
- So far this season, coverage for pregnant people is 12 percentage points lowered compared to the same time last year
- Compared to 2020, coverage is 22 percentage points lower
- Coverage for all race/ethnicity groups is lower this year than last season
- Subject to non-response bias and error in parental or self-reported vaccination may lead to overestimate of coverage
- Estimates for pregnant persons from Vaccine Safety Datalink may not be nationally representative
- Claims data for medical offices and pharmacies are incomplete because there aren’t comparable numbers from other settings
Starting in January, updates to the Weekly Flu Vaccination Dashboard will be on Fridays.
Insights Into the PAs Experience with Influenza Vaccines Update — Noel Smith (AAPA)
Noel Smith, MA, American Academy of Physician Associates gave an update on the insights Into the PAs experience with influenza vaccines.
Disclosures: The research was sponsored by Sanofi. AAPA wrote and had final approval for all questions included in the Survey.
- The survey was run from September 12–20, 2022
- Sample was a random selection of nearly 1,200 PAs within in select specialties.
- Within those, there were 348 responses (29%)
- Margin of error is +/- 5.5% at 95% confidence interval
Benefit: Do PAs know the benefit of receiving a flu vaccine?
- 95% of PAs are extremely likely or very likely to get the flu vaccines
- PAs identified themes on the benefits of receiving the flu vaccines
- Prevents illness and death from influenza
- PAs said that development of acquired immunity of a particular strain of flu decreases probability of mortality
- Flu vaccine helps others
- Helps decrease community spread by providing herd immunity
- Helps keep you and your loved ones from getting severe infection and requiring hospitalization
- Prevents illness and death from influenza
Targeted: Do PAs know about influenza vaccine recommendations for different age groups? Are they making recommendations based on this?
- 71% educate or counsel patients on the differences between influenza vaccines and influenza vaccines for people age 65+
- 84% are confident in their abilities to counsel patients in flu vaccine
- ACIP released the current recommendations on August 26 for flu vaccination (16 days before the start of the survey)
- 43% were moderately to extremely familiar with the new recommendations for age 6 months and older
- 56% were moderately to extremely familiar with the new recommendations for age 65+
- 42% were slightly or somewhat familiar with the new recommendations for age 6 months and older
- 36% 42% were slightly or somewhat familiar with the new recommendations for age 65+
- PAs are more familiar this season, but are not as confident in their ability to counsel and in knowing the recommendations
Equity: What are PAs’ experiences with access issues with influenza vaccinations? What are the barriers to patients being vaccinated?
- For the 2021–22 season, 56% of PAs recommended a specific influenza vaccine based on their patient’s needs
- 48% had access to more than one flu vaccine in their clinic, and 76% would recommend a specific vaccine to their patients
- 47% only had access to one vaccine and therefore, only 36% recommended a specific flu vaccine to their patients
- Having access to more than one formulation makes a big difference in ensuring patients get the right vaccine.
- Barriers to administering flu vaccine:
- 47% of patients are resistant
- 13% are concerned with efficacy
- 11% outside the scope of practice
- 8% are concerned about safety
- Reasons patients refuse the flu vaccine:
- 58% don’t think vaccines work very well
- 49% say they never get the flu
- 48% say they are concerned about getting the flu from the vaccine
- 39% say they are concerned about potential side effects
- 20% don’t trust the system
- 16% say there are harmful ingredients in the vaccine
- 11% say that vaccines are political
- Responses may be impacted by bias
- Survey timing – recent ACIP recommendations released just prior to the survey
Q: Are you seeing a higher proportion of vaccine administration errors with coadministration than you are of errors reported with just one vaccine? And are you seeing any trends with vaccine administration errors being reported?
John Su: I have not looked directly at vaccine errors in coadministration. The impression I get is that it is no greater than by administering COVID-19 vaccine alone in terms of trends in vaccination errors. Looking at the data we find that the most frequently reported adverse events among children age 5–11 and 6 months–5 years appear to be vaccination errors. I don’t know about trends, but it seems to be that those younger population where we see a lot of vaccination errors. They often tend to be a dilutional error where they’re not introducing enough, as well as administering a formulation meant for an older population and giving it to a younger patient in error.
Q: Do you know if providers are giving two shots in one arm? Are you able to segregate that data at all?
John Su: VAERS is a passive surveillance system, so if they don’t designate then you don’t know. There are some guidelines on how to coadminister: https://www.immunize.org/catg.d/p2030.pdf.
Q: Is there any data on whether there is more hesitancy this year over last year?
Marie-Michèle Lèger: This is early in the season. The survey was conducted in September. So, patients may not have been rushing to get a flu shot yet. But data from now shows uptake numbers still lower than last season. It would be interesting if Noel could look at the PA population again to see if there has been an uptick compared to previous seasons.
- We are trying to settle on dates for the Summit in person meeting in May in Atlanta. We have decided to settle on the dates for the meeting on May 9–11 and not May 16–18, which were the original dates.
- 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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