Search:

A summary of presentations from the weekly Summit partner webinars

January 11, 2024 – The latest Summit Summary

Announcements – L.J Tan (Immunize.org)

On January 18 at 3:00 p.m. (ET), the Summit’s Sustaining Community Organizations Task Group will provide a presentation focusing on rural immunization disparities. The presentation will feature Megan Lindley,PhD, MPH, Lead of the Adult Vaccination Team at NCIRD. Ms. Lindley will present the latest data on immunization disparities in these communities and answer the question: Are these disparities widening? The presentation will be about 15 minutes followed by questions from Summit partners.

There will be a second part to this presentation.

On January 24 at 3:00 p.m. (ET), the Task Group will do a deeper examination of the topic. At that time, the Task Group will hear from Michelle Rodgers of the Excite Program, which works in rural communities through 644 local partnerships and the land grant universities network.  There will be opportunity for more discussion to develop further the large potential action items for the Summit. If you would like an invitation to join the discussion session on rural immunization disparities on January 24, please contact Susan Farrall at susan.farrall@hhs.gov.

Please also put on your calendars the Summit in person meeting that has been moved to August to accommodate the National Immunization Conference (NIC), which is being held in Atlanta, GA, on August 12–14. The Summit in person meeting, focusing on adult immunizations, will be held August 15 (full day) and August 16 (half day). Stay tuned for further information.

BACK TO TOP

Respiratory Virus Vaccination Coverage Update – Carla Black (CDC)
 

Carla Black, PhD, epidemiologist, Influenza Division Immunization Services Division, CDC, gave an update on flu, COVID-19, and RSV vaccination coverage for the 2023–2024 season.

VIEW SLIDES

Weekly Cumulative Influenza, COVID-19, and RSV Vaccination Coverage, Adults ≥18 Years, 2023–24 Season, National Immunization Survey Adult COVID Module

  • Adult coverage for flu vaccine as of the end of December was about 45%
  • Adult coverage for COVID-19 vaccine was at about 19%
  • Adult coverage for RSV vaccine was at about 18%

Weekly Cumulative Influenza and COVID-19 Vaccination Coverage, Children 6 Months– 17 Years, 2023–24 Season, NIS-Flu and NIS-Child COVID Module

  • Child infuenza vaccine coverage was about 44%
  • Child COVID-19 vaccine coverage was about 8%

INFLUENZA

Weekly Cumulative Influenza Vaccination Coverage, Children 6 months-17 Years, 2022–2023 and 2023–24 Seasons, National Immunization Survey-Flu

  • Flu vaccine coverage for children is about 5 percentage points lower than what it was at the end of December last season
  • Flu vaccine coverage for children was about 10 percentage points lower than at this same time in the 2019–2020 season (pre-pandemic)
  • Child flu vaccine coverage has been decreasing since the pandemic

Influenza Vaccination Status and Intent among Children Age 6mo–17yrs, NIS-Flu​

  • Parental intent to get their child vaccinated for flu
    • Definitely will not get their child vaccinated – 33%
    • Probably or unsure if will get child vaccinated – 13.4%
    • Probably or definitely will get child vaccinated – 9.7%
    • Percentage of children who have received their flu vaccine since 7/1/23 – 43.9%
  • Black children have lower coverage than other race/ethnicity groups, but parents do not have lower intent or more opposition to vaccination
  • Children in rural areas have the lowest coverage lowest intent for vaccination

Weekly Cumulative Influenza Vaccination Coverage, Adults ≥18 Years, 2022–2023 and 2023–24 Seasons, National Immunization Survey Adult COVID Module

  • Coverage this season among adults is comparable to last season in mid-December
  • Coverage is low among adults at about 45%
  • Coverage has most likely leveled off for this season

Influenza Vaccination Status and Intent Among Adults ≥18 Years of Age, NIS-ACM

  • Adult intent
    • Definitely will not get vaccinated – 28.5%
    • Probably or unsure if will get vaccinated – 20.1%
    • Definitely will get vaccinated – 6.5%
    • Adults who have received their flu vaccine since 7/1/23 – 44.9%
  • Coverage and intent lowest among rural adults
  • Coverage increases with age
  • Hispanic adults have lower coverage than white adults, but not lower intent
  • Adults without health insurance have lowest coverage

Weekly Cumulative Estimated Number of Flu Vaccinations Administered in Pharmacies and Physician Medical Offices by Flu Season, Adults 18 years and older, United States (through week ending December 23, 2023)

  • IQVIA data – represents claims for vaccines given in pharmacies and physician offices
  • Trending about 8 million doses lower (compared to pre-pandemic levels) this season for adults
  • The 2020–2021 season (first season after pre-pandemic) had higher coverage

Weekly Cumulative Estimated Number of Flu Vaccinations Administered in Pharmacies Versus Physician Medical Offices, 2023–24 Flu Season, Adults 18 years and older, United States (through week ending December 23, 2023)

  • IQVIA data – represents claims for vaccines given in pharmacies and physician offices
  • Among 58 million vaccines given, a little more than half were given in pharmacies and less than half given in physician offices

Flu Vaccination Concerns and Issues Among Adults ≥18 Years of Age by Status/Intent, Omnibus Surveys, November 30-December 21, 2023 (N=4,012)

  • Ampng those who said they would probably, or were unsure if they will, get vaccinated
    • Most common reason for not getting the vaccine is that they haven’t gotten around to it or haven’t had time
    • About 13% say that they aren’t worried about the flu or are worried about the side effects of the vaccine
    • 34% had no concerns
  • 78% of adults who have received their flu vaccine since 7/1/23 said they have no concerns about flu vaccination

Monthly Cumulative Flu Vaccination Coverage by Flu Season, Pregnant Persons 18–49 Years, United States

  • Data comes from the Vaccine Safety Datalink – about 8 managed healthcare organizations (thus it may not be nationally representative data)
  • Dropped in coverage for pregnant women to below where we were pre-pandemic and coverage rates haven’t caught up
  • This season is about 2 percentage points below where we were last season at this same time
  • Big decrease after the pandemic
  • Pregnant people are trending a little farther behind this season

COVID-19

COVID-19 Vaccination Status and Intent Among Children 6mo-17yrs of Age, NIS-CCM​

  • Parental intent to get child vaccinated for COVID-19
    • Definitely will not get their child vaccinated – 37.1%
    • Probably or unsure if will get child vaccinated – 41.5%
    • Probably or definitely will get child vaccinated – 13.4%
    • Children who have received their COVID-19 vaccine since 7/1/23 – 8%
  • Coverage for children is universally low among all race/ethnicity groups

COVID-19 Vaccination Status and Intent Among Adults ≥18 Years of Age, NIS-ACM

  • Adult intent
    • Definitely will not get vaccinated – 39.4%
    • Probably or unsure if will get vaccinated – 28%
    • Definitely will get vaccinated – 13.2%
    • Adults who have received their COVID-19 vaccine since 7/1/23 – 19.4%
  • White adults have higher coverage than other race/ethnicity groups
  • White adults have higher opposition than many other race/ethnicity groups that have lower coverage
  • Coverage very low among those who are not insured
  • Coverage is lower in rural areas
  • Coverage increases with age

Weekly Cumulative Estimated Number of Updated 2023–2024 COVID-19 Vaccinations Administered in Pharmacies Versus Physician Medical Offices, Adults 18 years and older, United States (through week ending December 16, 2023)

  • IQVIA data – represents claims for vaccines given in pharmacies and physician offices
  • About 26 million does given in pharmacies compared to 1.6 million does given in physician offices
    • Numbers in physician offices expected to increase as claims come in

COVID-19 Vaccination Concerns and Issues Among Adults ≥18 Years of Age by Status/Intent, Omnibus Surveys, November 30–December 21, 2023 (N=4,003)

  • Adult concerns
    • Among those who said they definitely will not get vaccinated
      • There were concerns about unknown side effects, heart-related issues, mild side effects, and some concerns about the effectiveness of vaccine
    • Among those who said probably, or were unsure if , they will get vaccinated, a about 39% said they didn’t have any concerns

RSV

RSV Vaccination Status and Intent Among Adults ≥60 Years of Age, NIS-ACM

  • Intent among age 60+ years
    • Definitely will not get vaccinated – 24.1%
    • Probably or unsure if will get vaccinated – 41.4%
    • Definitely will get vaccinated – 16.7%
    • Adults who have received their RSV vaccine – 17.7%
  • Lowest coverage in rural areas
  • Highest coverage among white adults
  • Very low coverage among uninsured
  • Very low sample size for that last week in December

Weekly Cumulative Estimated Number of RSV Vaccinations Administered in Pharmacies Versus Physician Medical Offices, Adults 60 years and older, United States (through week ending December 16, 2023)

  • IQVIA data – represents claims for vaccines given in pharmacies and physician offices
  • About 7.8 million does given in pharmacies and 0.2 million doses given in physician offices

RSV Vaccination Concerns and Issues Among Adults ≥60 Years of Age, by Status/Intent, Omnibus Surveys, November 30–December 21, 2023 (N=1,376)

  • Concerns among those who were probably going to get vaccinated, or were unsure if they will get vaccinated
    • About 25% did not get provider recommendation
    • About 29% don’t know enough about the vaccine or about RSV disease

All of the data are available on RespVaxView, which contains:

Summary

  • By the end of December, coverage among adults was 44% for flu, 19.4% for COVID-19, and 17.7% for RSV (age 60+ years)
  • By the end of December, coverage among children was 43.9% for flu and about 8% for COVID-19
  • For all vaccines, coverage and intent was lowest among those uninsured and those living in rural areal
  • Coverage was highest among white adults and children
  • Flu vaccination among children and pregnant women lags behind last season and remains substantially lower than pre-pandemic coverage
  • Among those who said they probably would get vaccinated or were unsure, the main concerns about vaccination were:
    • Flu: Haven’t had the time or hadn’t gotten around to it
    • COVID-19: Too busy or keep forgetting, and long-term side effects
    • RSV: no provider recommendation or not knowing enough about RSV or RSV vaccine
Questions

Q: Are you getting any feedback about how the shared clinical decision making has been impacting the pharmacist’s ability to give vaccinations?

Carla Black (CDC): I don’t have that information, but I think it’s a good thing that people are able to get the vaccine from pharmacists given it’s a shared clinical decision making vaccine. I know there is a lot of interest in ACIP work groups about how the shared clinical decision making is impacting uptake and what providers are doing, as well as to find out more information from providers about how they’re implementing that recommendation.

L.J Tan (Immunize.org): The numbers are interesting but also suggests this idea that the patient is that they’re not getting a provider recommendation. That kind of suggests that there is something there that can be leveraged.

 

Q: Are you aware of why providers may not be recommending the RSV vaccine for age 60+ years? I know the recommendation is still new, but is there hesitancy there?

Carla Black (CDC): No, I think there are some surveys that providers planned. I don’t know that we can say that providers are not recommending. Hopefully they are recommending it. At least in this survey people were more likely to give that as a reason for vaccination. Those could be people who haven’t gone to a provider, but if you’ve never heard of an RSV vaccine, and I think for flu and COVID everybody knows that they’re out there, and that they need providers to provide a recommendation to help for those vaccines, too. But you can get it without a provider recommendation, whereas for RSV, if your provider hasn’t told you’re probably not going to get vaccinated.

L.J Tan (Immunize.org): I’d be curious to as we come out of the RSV season to see the data points on all of this on the patient side as well as the provider side, to find out exactly where this is coming from. We have a comment from a pharmacist in Arkansas that says, “I am seeing physicians not recommending RSV vaccines because the physicians are uncomfortable with recommending; they say it’s too new.”

Carla Black (CDC): A lot of providers are not talking about it. They should still be recommending and referring, but I think we know that when they don’t stock vaccines, they’re less likely to recommend them.

L.J Tan (Immunize.org): There’s another comment from the same person, “they’re seeing a lot of scripts for RSV vaccines for patients under the age of 60.” It’s going to get to be a little bit challenging getting the payers to cover that, I will bet. Coverage remains the question that we want to address, so with the first season I think coverage is something that we’re going to figure out as we go forward.

Carla Black (CDC): I think she’s talking about insurance coverage. I know that that is also an issue with RSV. Insurers are supposed to cover it but they have up to a year to add it to their formulary, so not everyone is covered by their insurance yet.

L.J Tan (Immunize.org): I think that’s the challenge. Also, some payers are faster than others. And then we have local differences where one patient will be covered, and another won’t because they have different health plans. We are hearing anecdotally that that’s creating a lot of problems on the ground, as well. I think it’s the first season and we’ll continue to work on it. That’s what we’re here for at the Summit, to hear about these things and then try to figure out ways to make it better for the next season.

 

Q: Would you say that this intent to vaccinate is one of our best measures for vaccine confidence, as well?

Carla Black (CDC): I I think of it as a measure of vaccine confidence. I always say I like to interpret those orange portions of the bars as people who are opposed to vaccination. The other thing that I didn’t point out is that dark blue portion of the bar, which is “definitely will” group to get vaccinated, shrinks over time. The people who say that they’re probably or unsure are less likely to shrink over time. It’s like they’re not opposed to vaccination but they’re just not getting it. At least for flu, it’s mostly apathy so that’s the low hanging fruit group. You can see for RSV vaccine that the light blue unsure portion is much bigger than the other vaccines, and again, I think it’s just a lot of people who haven’t heard of RSV vaccine—They don’t know about it and they don’t know if they need it.

 

Q: Have you gotten any kind of feedback yet from any other focus groups or data regarding what seems to be the reason for the emerging disparities?

Carla Black (CDC): I think a lot of it is political. If you look at county political affiliation, it skews very much towards one political group than the other. I think part of it is probably access. Although, a lot of people do not report access issues even in rural areas. It’s mostly just attitudes. They report more vaccine hesitancy, less concern about disease, and are more likely to say they don’t trust the government.

 

Q: Some of the concerns that providers on the ground have stipulated to many of us as partners in the Summit is this idea that inventory management is easier for pediatric providers? Adult vaccine inventory tends to turn over slowly. On the other hand, the pediatric vaccines come in and out really fast because they’re giving a lot of vaccines . With the adult providers they are not turning over doses that quickly and so inventory management, how do you stock multiple adult vaccines, is going to be something that as we will have to address as more and more adult vaccines become available.  I wonder if many providers have expressed that inventory management is as a barrier?

Carla Black (CDC): I agree with that. I don’t have much more information, but I think it is an issue.

 

Q: What are you thinking about the issues of promoting one single vaccine at a time versus promoting the full array of all adult vaccines? Even focusing on just respiratory viral season right now, what’s CDC’s thinking regarding how to promote flu vaccine outside COVID-19 vaccine to improve coverage rates?

Carla Black (CDC): This is more of a question for Erin Burns. I know that there was hesitation before for promoting them together. I don’t know if I can say which is best. You saw that the uptake of COVID-19 and RSV is much lower, but for the people who do usually get a flu vaccine, there is a lot of coadministration.

 

Resource given during Q&A: RSV job aid from CDC: www.cdc.gov/vaccines/vpd/rsv/downloads/provider-job-aid-for-older-adults-508.pdf. This is a great tool for providers, but concern is that there is a need for it to be printed in other languages.

BACK TO TOP

Respiratory Virus Surveillance Update – Katie Tastad (CDC)

Katie Tastad, PhD, MPH, Influenza Division – Domestic Surveillance Team, CDC, gave an update on respiratory virus surveillance through week 52.

VIEW SLIDES

Outpatient Respiratory Illness (See: FluView)

  • Influenza-like Illness (ILI), fever plus cough or sore throat
    • Steep increases
    • Above national baseline for the last nine weeks
    • About 6.9% of all outpatient visits were due to a respiratory illness
  • ILI by age
    • All age groups have been steadily increasing over the course of the season
    • Age group 5–24 years declined slightly possibly due to holidays

Outpatient Respiratory Illness Activity by Jurisdiction

  • Most jurisdictions are seeing high or very high activity
  • Increasing in the middle of the country

Virologic surveillance

  • Clinical labs
    • Percent of specimens tested in clinical labs has been increasing steadily for the past few weeks
    • About 17.5% of tests performed in clinical labs were positive for flu during week 52
    • Increases in both influenza A and B
  • Public health labs
    • Mostly influenza A, mostly H1N1
    • Seeing some influenza A H3N2 and influenza B
    • So far this season, CDC has genetically characterized 776 flu viruses collected in the U.S. since 10/1/23
      • Majority express A/H1 genes, genetically similar to vaccine virus
      • Antigenic analysis of 137 viruses show reference viruses for current season react well with, or inhibit all of, the H1N1, H3N2, and B Victoria viruses

Hospitalization

  • Steep increases
    • Around 20,000 hospital admissions for flu for week 52
    • During week 52, cumulative rate was 22.3% per 100,000 hospitalizations for flu
  • Lagging behind last season, but approaching pre-pandemic seasons
  • Hospitalizations by age group
    • Age 65+ years have highest rates of hospitalization for flu, followed by age 50–64 years
    • Age 0–4 years have the third highest rates of hospitalization

Mortality

  • Starting to see bigger increases in flu-associated mortality
  • During week 52, 0.9% of all deaths were associated with flu
  • Pediatric deaths
    • There have been 27 pediatric deaths reported so far this season
    • Caused by a mix of influenza A and B viruses

Summary

  • Influenza activity is elevated and continues to increase in most parts of the country
  • Outpatient respiratory illness has been above baseline nationally since November and is above baseline in all 10 HHS Regions
  • Influenza A(H1N1) is the predominant influenza virus circulating although influenza A(H3N2) and influenza B viruses are also being reported
  • CDC estimates that there have been at least 10 million illnesses, 110,000 hospitalizations, and 6,500 deaths from flu so far this season

Resources

For questions, contact Katie Tastad at qwu5@cdc.gov.

Questions

Q: Respiratory illness is still going up and if looking at peaks from previous years, this looks like it could be a nasty season. Is that correct?

Katie Tastad (CDC): Last season was fairly severe and was early, but this year could come back with a bit of a vengeance. However, coverage rates are a little bit lower than what we would like. We’re still anxiously waiting to see what’s going to happen after the holidays to see if that’s going to continue.

L.J Tan (Immunize.org): Carla obviously showed us the significant decline in the pediatric coverage rates; hopefully that won’t translate to pediatric deaths, but right now the deaths are not as high as they’ve been in previous seasons. That might also go up after the holidays.

Katie Tastad (CDC): I think any mortality tends to lag behind other systems to begin with so we’re usually several weeks behind when you see the outpatient visit start to uptick and when the hospitalizations begin to increase. Mortality is sort of a little bit behind the curve to begin with. So, I think it’s tough to say how high that will peak or how many pediatric deaths we will see at the end of the season.

BACK TO TOP

Announcements

BACK TO TOP

Print Friendly, PDF & Email

Search: