A summary of presentations from the weekly Summit partner webinars
March 7, 2024 – The latest Summit Summary
- Important Announcements
- Respiratory Virus Surveillance Update – Katie Tastad (CDC)
- Respiratory Virus Vaccination Coverage Update – Carla Black (CDC)
- Announcements
Important Announcements
L.J Tan (Immunize.org)
Summit will host two webinars for its Virtual Flu days, May 16 and 23, to help partners plan for the respiratory virus season ahead of August, when the Summit’s in-person meeting will follow the National Immunization Conference (NIC). For information on these webinars and to register for one or BOTH, see: Setting the Stage for 2024–2025 Respiratory Virus Season.
Please also put on your calendars this Summit in person meeting that has been moved to August to accommodate the 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). Registration is being coordinated with the NIC registration and should be available soon.
Susan Farrell (DHHS)
We have a Medicare presentation planned for March 21 as part of our Summit weekly updates. If you have any Medicare questions, please get those to Susan so that shecan get them to the speakers: Susan.Farrall@hhs.gov
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 8, ending February 24.
Surveillance of Outpatient Respiratory Illness (See: FluView)
- Influenza-like Illness (ILI), which monitors fever plus cough or sore throat
- 4% of outpatient visits were for ILI
- High for the last four weeks and is now stable compared to the past week
- ILI by age
- The 0-ge 0–4-year age group has the highest percent visits due to ILI
- All age groups remain stable compared to the past week
Surveillance of Outpatient Respiratory Illness Activity by Jurisdiction
- There are 27 jurisdictions with high or very high activity
- The Southeast still has high activity
Virologic surveillance
- Surveillance from Clinical labs
- The percent of specimens tested positive for influenza in clinical labs has been decreased over past several weeks
- Influenza A percent positivity has been steadily declining over past several weeks
- Influenza B percent positivity has leveled off but remains stable
- HHS region 7 central region (Iowa, Kansas, Missouri, and Nebraska)
- Still seeing increases in percent positivity
- Surveillance from Public health labs
- The viruses that have been tested are antigenically similar to the vaccine reference strains
Surveillance of Hospitalizations
- Hospitalizations have been decreasing and have leveled off nationwide
- Looking at the cumulative hospitalizations level for this season
- Showing hospitalizations this season are similar to prior seasons
- Hospitalization rate is highest among older adults over age 65
Surveillance of Mortality
- Has now decreased sharply from previous weeks, and is at 2.7% of all deaths
- Currently, this season has 93 reported influenzas-associated pediatric deaths
- 49 are from influenza A
- 43 are from influenza B
- There was one A and B co-infection
Summary
- Seasonal influenza activity remains elevated nationally with increases in some parts of the country
- Outpatient respiratory illness has been above baseline nationally since November and is above baseline in all 10 HHS regions
- Nationally, percent positivity for influenza decreased slightly overall, with percent positivity for influenza A decreasing and percent positivity for influenza B remaining stable. Trends in percent positivity for influenza A and B vary by geographic region.
- The number of weekly flu hospital admissions remained stable compared to last week
- CDC estimates that there have been at least 26 million illnesses, 290,000 hospitalizations, and 18,000 deaths from flu so far this season
- CDC recommends that everyone 6 months and older get an annual flu vaccine as long as influenza viruses are spreading. Vaccination can still provide benefit this season
Questions
Q: Is there any information you can provide on why there are differences in the flu strains chosen for the egg-based versus the cell-cultured vaccines?
Katie Tastad (CDC): I’m not the best person to answer this, but I can get the answer and provide that to the group.
Sabrina Martinez (MSL with CSL Seqirus): The different strains are due to growth. Not all strains grow readily in eggs so sometimes the original strain that’s selected by the WHO,if it doesn’t grow well in the eggs, they have to go to a second or third iteration to find one that does. That’s why there is a different strain for the egg and recombinant vaccine production compared to the egg-based.
Q: Were any of the influenza B related pediatric deaths due to the Yamagata strain?
Katie Tastad (CDC): We haven’t seen any deaths due to Yamagata since early in 2020. That would be the reason for the removal of Yamagata, which has been recommended now by the WHO and FDA.
Q: Do you have any information on the proportion of pediatric deaths that were from influenza B compared to A?
Katie Tastad (CDC): I don’t have that information, but off the top of my head, I don’t think we noticed anything like that, where it’s standing out that only the younger children are having flu B.
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.
Weekly Cumulative Flu, COVID-19, and RSV Vaccination Coverage, Adults ≥18 Years, 2023–24 Season, National Immunization Survey Adult COVID Module (as of February 24, 2024)
- Adult vaccination coverage for flu vaccine as of the end of December was about 47.7%
- Adult vaccination coverage for COVID-19 vaccine was at about 22.2%
- Adult vaccination coverage for RSV vaccine was at about 22.4% (age 60+)
Weekly Cumulative Flu and COVID-19 Vaccination Coverage, Children 6 Months–17 Years, 2023–24 Season, NIS-Flu and NIS-Child COVID Module (as of February 24, 2024)
- Child flu vaccination coverage was about 51%
- Child COVID-19 vaccination coverage was about 13%
Place of Flu, COVID-19, and RSV† Vaccination among Vaccinated Adults, National Immunization Survey-Adult COVID Module
- For Flu: 43.2% of vaccinations occurred in the medical setting, 48% happened in the pharmacy setting
- COVID-19: 23.5% vaccinations occurred in the medical setting, 71.7% happened in the pharmacy setting
- RSV: 17.9% vaccinations occurred in the medical setting, 81% happened in the pharmacy setting
INFLUENZA
Weekly Cumulative Influenza Vaccination Coverage, Children 6 months–17 Years, 2022–2023 and 2023–24 Seasons, National Immunization Survey-Flu
- As of mid-February, vaccination coverage rates in children 6 months–17 Years are about 3 percentage points lower than last season
- Coverage rates in children have been decreasing since the pandemic
Influenza Vaccination Status and Intent to receive vaccination among Children Age 6mo–17yrs, NIS-Flu
- Parental intent to get their child vaccinated for flu
- 30% reported that they would definitely not get their child vaccinated
- 51% of children age 6mo–17yrs have received their flu vaccine since 7/1/23
- White and Black children have lower coverage rates than Hispanic children and children of multiple or other races
- Children from rural areas have much lower coverage than children from urban and suburban areas
Weekly Cumulative Influenza Vaccination Coverage, Adults ≥18 Years, 2022–2023 and 2023–24 Seasons, National Immunization Survey Adult COVID Module
- Flu vaccination coverages rates are about the same as last season at 48%
- Vaccination coverage rates have been trending downward the past few seasons and are well below where we want them to be
Influenza Vaccination Status and Intent to receive vaccination among Adults ≥18 Years of Age, NIS-ACM
- Coverage rates are lower in rural areas, but there is not quite as big of a difference as seen for children
- Asian and white adults have higher coverage than adults of other race ethnicities
- Hispanic adults have lower coverage rates, but have less hesitancy towards receiving a flu vaccine
- There is a much higher coverage rate among adults with health insurance compared to uninsured adults
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 February 10, 2024)
- This is based on IQVIA data which represents claims for vaccines given in pharmacies and physician offices
- Looking at claims data, about 6 million fewer doses were administered compared to last season
- For adults, this is similar or a little lower than last season
- Coverage rates are not increasing when compared to last season
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 February 10, 2024)
- This is based on IQVIA data – which represents claims for vaccines given in pharmacies and physician offices
- A total of 62 million doses of flu vaccine were given
- 37 million doses were administered in pharmacies
- 25 million doses were administered in physician offices
Weekly Cumulative Estimated Number of Flu Vaccinations Administered in Pharmacies Versus Physician Medical Offices, 2019–20 Flu Season, Adults 18 years and older, United States
- Pharmacies did not have a higher proportion of flu vaccines given compared to pre-pandemic levels
Monthly Cumulative Flu Vaccination Coverage by Flu Season, Pregnant Persons 18–49 Years, United States
- This is data, through January, from the Vaccine Safety Datalink, which comprises 8 managed healthcare systems therefore providing a nationally representative sample
- There has been a big decreasein flu vaccination of pregnanat persons since pandemic
- This season the vaccination coverage rate in pregnant women is about 3 percentage points lower than last season; and about 18 percentage points lower than coverate rates pre-pandemic
- Coverage in pregnant women is not recovering from the impact of the pandemic
Place of Influenza Vaccination among Vaccinated Adults, 2014–15 Through 2023–24 Seasons
- For the 2014-2015 season
- 58% of influenza vaccines were given in medical settings
- About 22% of influenza vaccinations were given in pharmacies
- And about 20% of flu vaccinations were given in other settings
- Since 2021, the trend has shifted to most flu vaccines being given in pharmacies
COVID-19
COVID-19 Vaccination Status and Intent to receive vaccination among Children 6mo–17yrs of Age, NIS-CCM
- COVID-19 vaccination coverage for children is low at 13.1%
- Coverage is lower in rural areas
- Coverage is low among all demographic subgroups
COVID-19 Vaccination Status and Intent to receive vaccination among Adults ≥18 Years of Age, NIS-ACM
- COVID-19 vaccination coverage is at 22.2%
- Coverage is slightly lower in rural areas
- Coverage is lower among Black, Hispanic populations than white and Asian
RSV
RSV Vaccination Status and Intent to receive vaccination among Adults ≥60 Years of Age, NIS-ACM
- There is a “movable middle” who are not opposed to vaccination
- Current coverage rate is at 22%
- Coverage is lower among rural adults
Websites
All of the coverage data are available on RespVaxView, which contains:
Summary
- By February 24, coverage for adults was 47.7% for flu, 22.2% for COVID-19, and 22.4% for RSV (age 60+)
- For all vaccines, intent to receive vaccination was lowest among uninsured adults and those living in rural areas
- Coverage rates, but not the intent to receive vaccination, was highest among White adults and children
- Flu vaccination coverage rates among children and pregnant people lags behind last season and remains below pre-pandemic coverage levels
- In more recent flu seasons, the proportion of flu vaccines given in medical settings is decreasing and going up in pharmacy setting
Questions
Q: While our percentage of age 65+ continues to stay stable at 65–70% for flu, through the course of the last few years what it doesn’t take into account is that we have a rapidly increasing age demographic so that percentage means that less people over 65 are getting vaccinated. Do you see that as something that’s real and a concern?
Carla Black (CDC): You’re saying that basically that in in terms of actual numbers of people, the unvaccinated are getting larger. I don’t really know what it translates to into real world in terms of prevention or transmission dynamics.
Q: With the vaccine fatigue and the data that you just provided, what potential actions can the Summit take if people are overwhelmed, and providers only want to stock a limited number of vaccines? Are there any suggestions?
Carla Black (CDC): I will say that in some of our surveys we ask about concerns about vaccination and reasons for vaccination and vaccine fatigue. It doesn’t really come up that much, although I believe it must be a factor. If the people get vaccines when it’s easier—if the provider stocks them all and recommends them all, they’re more likely to get them all.
Q: Do you think there’s a collateral damage from the fact that these providers are no longer giving flu vaccines and no longer talking about flu vaccines?
Carla Black (CDC): Yes, I think so. I don’t know if we have data to support that. I’ll try to show more of these data when I present in May. We do have data asking people about their preferred place of vaccination. More people say that they prefer to get vaccinated in provider offices. I don’t know from the provider perspective if they’re stocking them less and recommending less, but I think it probably is having an effect. Even if they’re still recommending, and people have to take an extra step to go somewhere else to get vaccinated, that decreases the chance that they’re going to get vaccinated.
Q: The drop in flu vaccination for pregnant women (although maybe not truly representative) is not recovering and is significantly lower compared to pre-pandemic. Any thoughts as to why, assuming that providers are continuing to encourage vaccination in their pregnant patients? Is it fatigue? Are they not being offered flu vaccine? Or are these patients saying “no”?
Carla Black (CDC): The data that I showed weren’t nationally representative. We do a survey at the end of the year for pregnant women, which also shows the same patterns of decline. I think some of the very large pattern of decrease you see in the VSD data (which comes from medical records) is because as vaccines are shifting to pharmacies. The data are less likely to capture them but we also see not as huge, but still a worrisome enough drop. In surveys among pregnant women, we also see with these data (published in MMWR at end of September), an increase in pregnant women reporting vaccine hesitancy. There’s a figure in a related online report that shows the decrease in coverage and decrease in vaccine hesitancy. The data line up, although it also shows that there is a decrease in coverage even among women who said they were not hesitant. There is something else going on too, but we have not really teased out yet what that is.
Comment from Sabrina Martinez (CSL Seqirus): OBGYNs do not stock and offer vaccines in clinic in all states. It would be interesting to see the uptake in pregnant persons stratified by region.
Carla Black (CDC): That is hard to know, because we don’t really have state specific data on pregnant people.
L.J Tan (Immunize.org): Any speculation as to whether that might be true about the stocking, or if there are differences at state levels?
Carla Black (CDC): I know ACOG is very involved in promoting vaccination. I’ve not heard that there are differences. There may be differences by states and OBGYNs, as well as Medicaid. Knowing what Medicaid will reimburse may contribute to it also.
Q: Many 65+ persons have not received updated COVID-19 vaccine because they have had COVID infection recently. Is there any way to estimate how often that occurs? Only way that comes to mind is perhaps follow up with people registered in v-safe who received all doses until 2023–2024 formulation? Maybe not feasible. Just curious about your thoughts on this.
Carla Black (CDC): I do think that we have asked in the past about reasons for not receiving vaccination and if it was because people think that they’re already immune, and it does come up sometimes.
L.J Tan (Immunize.org): There are people who were sick and don’t end up getting vaccinated because they don’t come back and then, they are also people who got sick and then say they don’t need to get vaccinated. Both result in suppression of that “vaccinated” number. Or maybe that’s an optimistic way of looking at things.
Q: Do you have longitudinal data on vaccine hesitancy for flu has that changed over the course of the seasons? Will CDC be conducting a healthcare worker coverage survey this year?
Carla Black (CDC): The answer to the second question is: yes, we will be. It’s surveying the healthcare workers about their own vaccinations. It’s not limited to just physicians and people who are providing vaccines. However, it’s not asking about their practice for recommending vaccination to patients. But we will be doing the healthcare worker survey and have those data for flu again. We don’t really have a general population survey of adults. Now we have the COVID module, but most of the attitude-type questions are related to COVID. We do have questions like that in our Omnibus Surveys that have been going on for a few years, so we probably have some longitudinal data about that. But it doesn’t go back very far.
Q: What can you tell us about the disparities that you pointed out, particularly between rural versus urban?
Carla Black (CDC): For children, the disparity is increasing. The decrease in children coverage rates is mostly among rural children. There was a decrease in coverage for everyone after the pandemic, but the continued decrease has mostly been in rural children. The disparity between urban and rural coeverage rates is getting bigger for adults, but it’s just not as pronounced as in children. For children, there was an initial decline in that first year after the pandemic, but the continued decline is mainly in rural and in white children.
Q: Some of our populations have gone to federally qualified health clinics (FQHC), so that’s who received Bridge funding. They’re still being charged for administering vaccines. Do you know anything about this?
Carla Black (CDC): I’m not an expert in the Bridge Program, but my understanding is that that is not supposed to be happening. I will follow up.
Announcements
- Summit will host two webinars for its Virtual Flu days, May 16 and 23, to help partners plan for the respiratory virus season ahead of August. For information on these webinars and to register for one or BOTH, see: Setting the Stage for 2024–2025 Respiratory Virus Season.
- Please also put on your calendars that the Summit in person meeting 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). Registration is being coordinated with the NIC registration and should be available soon.
- The Summit workshop developed tools to address challenges in providing multiple adult vaccines along with COVID-19, flu, and RSV vaccines. See the Summit’s Operationalizing Adult Immunizations in the 2023 Fall Season and Beyond Workshop web page for the deliverables.
- There is a new zoom link for the 2024 Summit meetings. If you do not have the new link, please contact info@izsummitpartners.org.
- If you have agenda items you are interested in sharing with the Summit, please tell us and we can add you to an upcoming call as a speaker or panelist. Contact information: info@izsummitpartners.org
