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A summary of presentations from the weekly Summit partner webinars

March 9, 2023 – The latest Summit Summary

The 2023 Adult Immunization Schedule and other CDC Resources Update – Neil Murthy (CDC)

Neil Murthy, MD, MPH, MSJ, LCDR, United States Public Health Service, Immunization Services Division, NCIRD, CDC gave an update on the 2023 Adult Immunization Schedule and other CDC Resources. VIEW SLIDES

There are two separate Immunization Schedules that are updated each year: the Adult schedule (age 19+) and the Child and Adolescent Schedule (Birth to age 18). These schedules represent current, approved ACIP policy and are designed to implement ACIP policy. Schedules are published in February in MMWR and Annals of Internal Medicine.

Major Updates to the 2023 Adult Immunization Schedule

Cover Page

  • Box in the upper right-hand corner
    • Added American Pharmacists Association as a partner organization that’s now approving the adult schedule this year
  • Injury Claims Section
    • Includes information about COVID-19
    • Countermeasures Injury Compensation Program
  • Vaccines in the Adult Immunization Program
    • COVID-19 vaccines added to the list
      • Added some abbreviations for each vaccine product: monovalent mRNA vaccine, bivalent mRNA vaccine, and the monovalent protein subunit vaccine
    • Hepatitis B row
      • PreHevbrio added as a new vaccine product
    • MMR row
      • Priorix added as a new product
    • Pneumococcal conjugate vaccine all collapsed into one row with PCV15, PCV20, and PPSV23

Table 1 – Routine vaccination schedule by age

  • Addition of COVID-19 as a row
    • The entire row is yellow, indicating that COVID-19 vaccination is recommended across the adult lifespan
    • Includes overlaying text prompting providers to look at the notes section for guidance for primary series and recommended booster doses
  • MMR row
    • Includes overlaying text to the age ≥65+ column
    • Refers to the notes section to read about vaccination considerations for healthcare personnel for age 65+
  • Pneumococcal row
    • Age ≥65+
      • Yellow box and blue box show two vaccines in this age group are recommended based on the adult’s previous history
      • Refers providers to look at the notes section
    • Hepatitis A row
      • Two, three, or four doses of vaccine to include the four doses accelerated Twinrix schedule that can be used for hepatitis A

Table Two – Routine vaccination schedule by medical indication

  • Addition of COVID-19 as a row to the table
    • For the immunocompromised and HIV infection column, there are overlaying text notes since different patients may have different primary series requirements and may have additional considerations for preexposure prophylaxis to complement COVID-19 vaccinations
    • Refers providers to the note section for specific guidance

Notes Section 

  • COVID-19 vaccines
    • COVID-19 is now formally incorporated as a section
    • Routine vaccination section describes primary series for the general population
    • Booster dose recommendations are changing, so a hyperlink to the latest recommendations is included
    • The special situation section talks about the primary series for people who are moderately or severely immunocompromised. This section has a hyperlink for booster dose recommendations for immunocompromised persons.
    • A bullet has been added reminding providers to consider preexposure prophylaxis for those moderately or severely immunocompromised
    • Link included with recommendations for Janssen vaccine recipients
    • Note refers providers to additional resources on COVID-19 schedules and EUA indications
  • Hepatitis B vaccines
    • Now routinely recommended for all adults age ≥19–59
    • Revised descriptions of the 2-, 3-, and 4-dose series
    • Includes PreHevbrio in the dosing regimens
    • Note states Heplisav-B and PreHevbrio are not recommended in pregnancy due to lack of safety data
    • For those age ≥60 with known risk factors for hepatitis B virus infections should complete a hepatitis B vaccination series
    • For those age ≥60 without known risk factors for hepatitis B virus infections may complete a hepatitis B vaccination series
    • Risk factors for hepatitis B virus infection are listed
    • Special section included for patients on hemodialysis including details for a four-dose regimen
  • Influenza vaccines
    • Sub bullet states that any one of the quadrivalent high-dose inactivated influenza vaccine, quadrivalent recombinant influenza vaccine, or quadrivalent adjuvanted inactivated influenza vaccine is preferred in age ≥65. If none of these three vaccines are available, then any other age-appropriate influenza vaccine should be used.
    • A hyperlink to the 2022–23 recommendations is included
    • There is a placeholder for a link to the 2023–24 recommendations that are released later this year
    • Special Situations section
      • Includes influenza recommendations for people with an egg allergy who experienced any symptom other than hives
      • Includes a bullet that describes guidance for people who are in close contact of patients who are severely immunosuppressed
    • MMR vaccines
      • Special Situations section has a new bullet highlighting the guidance that describes administering an additional dose of MMR during a mumps outbreak setting
      • Change in language to the MMR vaccination to indicate that MMR vaccination for healthcare providers born before 1957 who do not have any evidence of immunity to measles, mumps, or rubella can be considered
    • Meningococcal vaccines
      • Change in guidance to indicate that if a third dose of Trumenba is administered earlier than four months after the second dose, a fourth dose should be administered at least four months after dose three
    • Pneumococcal vaccines
      • Routine vaccine recommendations for all adults age ≥65
      • Special Situation section for adults age 19–64 with certain underlying medical conditions or other risk factors
      • List of all medical conditions and risk factors is at the end of the section
      • Incorporates new guidance ACIP voted on in October 2022 for persons who previously received any pneumococcal vaccine
      • A bullet has been added to both the routine and special situation sections that refers providers to the CDC app that providers can use as a resource that can help determine a person’s pneumococcal vaccine needs
    • Polio vaccines
      • A new polio vaccination section added
      • Routine polio vaccination of adults residing in the U.S. is not necessary
      • In the Special Situations section recommendations for adults at increased risk of exposure to poliovirus are provided
        • Adults without evidence of a complete polio vaccination series can complete a three-dose series
        • Adults with completed polio vaccination series may administer one lifetime IPV booster
      • Tetanus, diphtheria, and pertussis vaccination
        • Minor edits made to the guidance in the Special Situation section to improve clarity
          • For persons who did not receive primary vaccination series for tetanus, diphtheria, and pertussis, one dose Tdap, they should receive 1 dose f Tdap followed by 1 dose of Td or Tdap at least 4 weeks later, and then a third dose of Td or Tdap 6–12 months later
        • Zoster vaccines
          • Note added at the end of the routine vaccination section providing background on serologic evidence of prior varicella
            • Serologic evidence of prior varicella is not necessary for zoster vaccination.
            • If serologic evidence of varicella susceptibility becomes available, providers should follow ACIP guidelines for varicella vaccination first
            • RZV is not indicated for the prevention of varicella, and there are limited data on the use of RZV in persons without a history of varicella or varicella vaccination
          • Special Situations section, the language in the immunocompromising conditions includes persons with HIV regardless of CD4+ count. Link is provided for providers to learn more.
          • Note added at end of Special Situations section to provide some guidance for persons with no documented history of prior varicella infection, varicella vaccination, or prior herpes zoster infection, referring providers to the clinical considerations for use of RZV in immunocompromised adults age ≥19 and the ACIP varicella vaccine recommendations for further assistance. The resource is hyperlinked.

Appendix (includes contraindications and precautions for all vaccines)

  • Hyperlink added at the top of page one for providers to view the contraindications and precautions to COVID-19 vaccines
  • Rest of Page one – Entirely Influenza Vaccines
    • Header has been changed from “Contraindication” to “Contraindicated or Not Recommended”
    • The precautions column no longer lists having an “egg allergy” with symptoms other than hives
  • Page two – All other vaccines
    • In the hepatitis B row – language regarding pregnancy changed to say Heplisav-B and PreHevbria are not recommended for pregnanat persons due to lack of safety data – other hepatitis B vaccines should be used. Links to registries to report the use of these vaccines while pregnant are included.
    • Language for pregnancy in the HPV row has also changed to state that in pregnancy, HPV vaccine is not recommended

Vaccination resources for healthcare providers

Questions

Q: Is there information included under the notes for COVID-19 vaccination regarding the Novavax vaccine?

Neil Murthy: If you look at the COVID-19 notes section and the routine vaccination section there is dosing information on Novavax. It says it is a two-dose series with doses 3–8 weeks apart.

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Flu Surveillance Update – Alicia Budd (CDC)

Alicia Budd, MPH, Influenza Division, CDC, gave a flu surveillance update for week ending February 25, 2023. VIEW SLIDES

Virologic Surveillance

Virologic Surveillance – Percent Positive for Influenza

  • Not a lot has changed in the last month
  • Flu activity is decreasing a little bit but staying at low levels
  • Percent positive for influenza B is increasing slightly but not amounting to anything yet

Virologic Surveillance – Virus Characteristics

  • Predominately influenza A season
    • 75% H3
    • 25% H1
  • Influenza B – 0.7%; 100% Victoria lineage
  • The vast majority are similar to the vaccine reference strains
  • One virus has been identified with resistance to oseltamivir
  • Subclade names for influenza A to track the evolution of the virus
    • A/H1: 99.4% – 6B.1A.5a.2
    • A/H3: 100% – 3C.2a1b.2a.2

Outpatient Respiratory Illness – people presenting to outpatient urgent care, primary practice, or emergency department for fever and cough or sore throat

  • There has been a plateau for the last month and a half
  • See the same pattern across all age groups
  • Most of country seeing low to minimal respiratory illness activity
    • Some regions seeing higher levels, but not due to flu

Long-term Care Facilities (LTCF) and Hospitals

HHS Protect – Percent of LTCF that reported at least one influenza positive test among residents

  • Steady decline in recent weeks
  • Hospitalizations declining

FluSurv-NET – Age-specific information

  • Current rates are not surprising

Mortality – Percent of deaths from pneumonia, influenza, and COVID-19 (PIC) 

  • Flu activity has significantly dropped off
  • PIC is reflecting primarily COVID-19 activity
  • Influenza-associated pediatric deaths at 117 for the season

Preliminary In-Season Flu Burden Estimates, 2022–2023

  • 26–49 million illnesses
  • 12–24 million medical visits
  • 290–620 thousand hospitalizations
  • 18–54 thousand deaths

Interim Influenza Vaccine Effectiveness Estimates, 2022–2023 Season

3 CDC networks for measuring vaccine effectiveness

  • Flu vaccination provided substantial protection against flu illness and serious flu-related outcomes

Marshfield Clinic VE estimates

MMWR: Interim Estimates of 2022–23 Seasonal Influenza Vaccine Effectiveness—Wisconsin, October 2022–February 2023 (2/24/23)         

2023-2024 Northern Hemisphere Influenza Vaccine Strain Selection Decisions: WHO and VRBPAC

  • A/H1 – updated
    • A/Victoria/4897/2022 (H1N1) pdm09-like virus (egg)
    • A/Wisconsin/67/2022 (H1N1) pdm09-like virus (cell/recombinant)
  • A/H3 – no change
    • A/Darwin/9/2021 (H3N2)-like virus (egg)
    • A/Darwin/6/2021 (H3N2)-like virus (cell/recombinant)
  • B/Victoria – no change
    • B/Austria/1359417/2021 (B/Victoria lineage)-like virus (egg/cell/recombinant)
  • B/Yamagata – no change
    • B/Phuket/3073/2013 (B/Yamagata lineage)-like virus (egg/cell/recombinant)

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#ShowUp and #FightFlu Toolkit Update – Marla Dalton and Diana Olson (National Foundation for Infectious Diseases, NFID)

Marla Dalton, CAE, NFID Executive Director and CEO, and Diana Olson, NFID Senior Director, Strategic Communications gave an update on the #ShowUp and #FightFlu Toolkit. VIEW SLIDES

NFID kicks off each flu season encouraging everyone 6 months and older to get a flu vaccine. Of particular concern are those at higher risk for complications from flu. Data show that Black adults are more likely to be hospitalized from flu-related complications and less likely to get vaccinated. To help address the disparities, NFID has been working closely with targeted partner organizations to increase awareness of the importance of flu vaccination with the new #ShowUp and #FightFlu campaign.

2020 NFID National Survey: U.S. Black Adults

In December of 2020, NFID conducted a national survey to better understand knowledge, attitudes, and practices among U.S. Black adults regarding COVID-19 vaccination

  • 55% of U.S. Black adults were worried about getting or someone in their family getting COVID-19
  • 49% planned to get a COVID-19 vaccine
  • Higher resistance among younger Black adults and Black women
  • Safety and effectiveness of COVID-19 vaccines was the top concern expressed among all age groups

Flu vaccines

  • 54% of U.S. Black adults had been vaccinated, or planned to get vaccinated, during the 2021–22 flu season
  • Reasons for hesitancy
    • Worry about side effects
    • Getting the flu from the vaccine
    • Vaccine doesn’t work well
    • Never get sick with flu

2021 NFID National Survey: U.S. Black Adults (18–49 years)

  • A greater number reported getting vaccinated against flu and COVID-19 during the 2021–22 season vs the prior season
  • Top reason to get vaccinated was to protect family and themselves
  • Reasons for hesitancy regarding flu vaccination
    • Concerns about side effects
    • Never get sick with flu
    • Vaccine efficacy

 Partner Consultations

In March­–April 2022, NFID conducted consultations with partners who had deep connections to U.S. Black audiences to share the 2021 survey results, obtain feedback, and discuss collaboration. (Consultation Report.) Multiple organizations stated that engaging community leaders as trusted messengers of high importance is important

Partners agreed with NFID survey findings:

  • Healthcare professionals, with the most trusted source being Black healthcare professionals, are most likely to be understood
  • Focus on whole health for the Black community
  • Vaccination as a holistic conversation, as whole health
  • Message that the flu vaccine is something you do to stay healthy

Empowering Trusted Messengers

NFID developed a campaign and toolkit with culturally-relevant messaging to encourage Black audiences to get a flu vaccine

  • Materials to address misconceptions and misinformation about flu vaccines
  • Messages aligned with CDC recommendations
  • Creative images, taglines, hashtags, and messages shared with partner organizations

#ShowUp and #FightFlu Toolkit

Messages:

  • Focusing on individuals and family
  • Not missing work or events
  • Pointing to accurate information for people wanting to learn more about effectiveness, efficacy, side effects
  • Addressed common misconceptions head-on
    • Even when flu vaccination doesn’t prevent infection entirely, it can be helpful in preventing serious flu-related complications including hospitalization and death
    • Flu vaccines are safe
    • Most people don’t experience serious side effects from flu vaccines
  • Working with healthcare professionals to amplify messages

Toolkit includes:

  • Key messages
  • Sample email and newsletter language and banners
  • Social media graphics and language
  • Banners and graphics

All materials are accessible and can be co-branded

Dissemination: NIVW and Beyond

  • The initial campaign elements rolled out via social media during National Influenza Vaccination Week in December 2022
  • Full toolkit shared with all NFID partners in February 2023
  • Collaborated with BlackDoctor.org on a Facebook Live event
  • All of the materials and programs included strong calls to action
    • Get a flu vaccine to protect you and your family
    • Talk to a healthcare professional about any questions
    • Go to trusted sources for accurate information

Next Steps: Get Involved

  • Download the co-brandable toolkit
  • Share messaging
  • Help build momentum for the 2023–24 respiratory season
  • Contact NFID for more information at communications@nfid.org
Questions

Q: Can you provide a link to the downloadable toolkit?

Diana Olson: #ShowUp and #FightFlu Partner Toolkit: www.nfid.org/wp-content/uploads/2023/01/NFID-ShowUp-Flu-Vaccine-Partner-Toolkit.pdf

 

Q: In New York State we are having trouble recommending the flu vaccine at this point in the season. Any advice?

Diana Olson: We always tell people that it’s not too late to get vaccinated if flu viruses are still circulating in your community.

Alicia Budd: When we have had one wave of flu activity, we don’t know whether another wave is coming. Ever since COVID-19 came, the seasonality of all the other respiratory viruses has been off. It’s still worth it because we don’t know what’s going to happen in the coming months.

 

Q: Is there a Spanish version of the toolkit?

Diana Olson: There is not, but we are exploring ways to translate our materials. If there are any partners who would like to work with us on this, we would love to hear from you.

 

Q: Did any of the NFID survey data suggest that vaccine hesitancy surrounding COVID-19 vaccines has spilled over into overall vaccine confidence?

Marla Dalton: That was not an objective of this survey, but we have seen this in all vaccine rates. It was interesting to see the disparities between the responses as to why they were hesitant to flu, COVID-19, and pneumococcal vaccine depending on the population—race, ethnicity, and age. Side effects and efficacy concerns were higher with the flu vaccine, but with the COVID-19 vaccine,  the lack of safety data and long-term data was highest concern in hesitant people.

Diana Olson: The survey findings are all accessible on the NFID website.

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Announcements
  • The 2023 NAIIS Adult Vaccine meeting will be held on May 9–11, 2023, at the Atlanta Marriott Perimeter Center in Atlanta, GA.  Persons needing the password to register for this invitation-only event may contact info@izsummitpartners.org.
  • If you are registered for the Summit, and you are not getting our emails, please add info@izsummitpartners.org to your contact list.
  • If you have any agenda items that you are interested in sharing with the Summit, please let us know and we can add you to an upcoming call as a speaker or panelist. Contact information: info@izsummitpartners.org.

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