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A summary of presentations from the weekly Summit partner webinars

May 2, 2024 – The latest Summit Summary

Preliminary Vaccine Effectiveness for Flu – Sascha Ellington, PhD, MSPH, CPH, Centers for Disease Control and Prevention

Sascha Ellington, PhD, MSPH, CPH, Lead, Influenza Prevention and Control Team, Epidemiology and Prevention Branch, Influenza Division, Centers for Disease Control and Prevention gave the update for 2023-24 seasonal influenza vaccine effectiveness.

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Preliminary Estimates of 2023-24 Seasonal Influenza Vaccine Effectiveness (VE)

CDC maintains four surveillance networks for data and evaluation

  • In combination, the four networks provide vaccine effectiveness estimates against laboratory-confirmed influenza in all ages across settings.
    • Investigating Respiratory Viruses in the Acutely Ill (IVY): adults, hospitalization
    • New Vaccine Surveillance Network (NVSN): children and adolescents, all settings
    • U.S. Flu Vaccine Effectiveness Network (US Flu VE): children and adolescents, outpatient clinic and ED/UC; adults, outpatient clinic and ED/UC
    • Virtual SARS-CoV-2, Influenza, and Other respiratory viruses Network (VISION): children and adolescents, ED/UC and hospitalization; adults, ED/UC and hospitalization
  • CDC influenza VE networks include patients from 22 states.
  • 2023-2024 influenza VE methods include test-negative design.
  • Analysis was adjusted for geographic region, age, calendar time of illness, and – for some networks – sex, race, ethnicity, and timing (i.e., days between illness onset, enrollment, and self-reported general health status).
  • Estimates calculated for influenza A subtypes: A(H1N1)pdm09 and A(H3N2), when possible.

VE by age group

  • Pediatric VE
    • Prevalence of vaccination among test-negative controls: 25-45% across settings.
    • Overall, VE for children and adolescents against any influenza ranged from 53-57% in the outpatient setting and 53-55% in the inpatient setting.
    • Pediatric VE against influenza by type and subtype:
      • VE against influenza A ranged from 36-52% in the outpatient setting and 41-48% in the inpatient setting.
      • VE against influenza A(H1N1)pdm09 ranged from 46-52% in the outpatient setting and was 61% in the inpatient setting.
      • VE against influenza A(H3N2) was 55% in the outpatient setting.
      • VE was higher against influenza B this year, ranging from 68-75% in the inpatient setting and 72% in the outpatient setting.
    • For children and adolescents, VE estimates were consistent across the networks.
  • Adult VE
    • Prevalence of vaccination among test-negative controls was 43-56% across settings.
    • VE against any influenza ranged from 39-47% in the outpatient settings and was 41% in both of the inpatient settings assessed.
    • VE against influenza by type and subtype:
      • VE against influenza A ranged from 25-42% in the outpatient setting and was 39% in both inpatient settings.
      • VE against influenza A (H1N1) was 21% in the outpatient setting and 41% in the inpatient setting.
      • VE against influenza A (H3N2) was 41% in the outpatient setting and 27% in the inpatient setting.
      • VE against influenza B was 76-82% in the outpatient setting and 63-67% in the inpatient settings.
  • Adult (ages 65 and older) VE
    • The following numbers separate out the age group of 65 years and older.
    • Prevalence of vaccination among controls ranged from 62-76%; higher than other age groups, as expected.
    • VE against any influenza ranged from 39-54% in outpatient settings and 33-40% in inpatient settings; this held across networks and was similar to the VE seen for all adults.
    • VE against influenza by type (subtypes of influenza A was not available owing to small sample sizes):
      • Influenza A ranged from 38-51% in outpatient settings and 36-40% in inpatient settings.
      • Influenza B was 68% in both outpatient and inpatient settings.

Overall, vaccination with a 2023-24 influenza vaccine reduced the risk for medically attended influenza outpatient visits and hospitalizations among children, adolescents, and adults across 22 U.S. states. Vaccination was effective against both influenza A – mostly subtype A(H1N1pdm09) and B (lineage Victoria) viruses. Results were consistent across networks.

 
QUESTIONS

Q: Did the VE in the 65+ population seem fractionally better than in the general adult population?

Sascha Ellington (CDC): Yes, particularly in one of our networks, we did see that the VE did seem to be better in older adults. We’ve had small numbers, so we’re hoping to dig deeper into that with the final data for the season. But, one of our networks showed that we might have seen higher VE in the older adults than we did in adults 18-64. We’re investigating some possible birth cohort effects there. So, we’re digging deeper into that right now, but we’re not exactly sure what the answer is, because we didn’t see it necessarily across all our networks.

 
Q: Could this be, finally, the effect of moving toward the preferential recommendation for some of the more “effective” vaccines for older adults.

Sascha Ellington (CDC): It certainly would be nice if that were the answer. But, we’re not sure, yet, because I don’t think we observed that in our large VHR network, VISION, and we’re trying to figure out why we’ve seen it in some and not others and based on what populations they covered. If that is the answer, that would be a great message to provide. But we at least saw as good, if not better, VE among older adults.

 
Q: About the inpatient versus the outpatient: we have the wild to mild campaign and I think that’s been our mantra for quite a long time, that vaccination is important to prevent those severe outcomes. But here, we really see very little difference in the outpatient versus the inpatient. Is one potential explanation that people who are hospitalized have more underlying conditions? We should probably see higher VE in the more severe outcomes, but that’s not necessarily the case.

Sascha Ellington (CDC): Yes, the data don’t necessarily show that here. Obviously, the populations presenting for the outpatient care are different than the populations presenting for the inpatient care and the test-negative design may not be the best approach to look at progression of disease from that mild illness to the more sever illness. So, all of these estimates are from a test-negative approach; whereas a cohort model could probably provide better data where you could look at some of these risks by their vaccine status on whether they progressed from mild to moderate to severe illness. These data don’t necessarily support that message, but I wouldn’t say they contradict it because of the study design and how the hospitalized cohorts work: they tend to have more underling conditions sicker people, so internally the comparisons are really valid and with little bias, given the design, but not necessarily showing that progression of disease.

 
Q: Will the final results be released at the media event in September?

Sascha Ellington (CDC): That will probably be based on each network’s ability to get those out, but we are aiming for that.
 

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Empowering Vaccine Advocates at the Community Level – Grisel Cisneros, MPH, Education Coordinator, and Serese Marotta, Advocacy and Education Director, Vaccinate Your Family

Grisel Cisneros, MPH, Education Coordinator, and Serese Marotta, Advocacy and Education Director, Vaccinate Your Family, gave updates on Vaccinate Your Family and SQUAD.

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Grisel Cisneros

Vaccinate Your Family

  • Vaccinate Your Family (VYF) informs, empowers, and activates people through communication, policy, and community.
  • The core community programs are Vaccine Community Navigator Training and SQUAD (SQuaring Up Against Disease).

Vaccine Community Navigator Training (VCN)

  • This is a continuing education curriculum created by Community Health Workers (CHWs) for CHWs to build capacity to engage their communities in vaccine conversation and navigate people to vaccination services.
  • The training was piloted with 200+ Promotores and CHWs and Instructors in Texas in March – April 2022
  • It was launched nationally February 2023
  • There are four core areas
    • Online Courses
    • Online Community
      • Free, online space for Community Health Workers (CHWs) and anyone who wants to network, in English and Spanish
      • A space for questions, resource sharing, and announcements about events and training
      • Connect at tinyurl.com/vcn-community
    • Virtual Community of Practice Meetings
      • Live, virtual, quarterly meetings for sharing information and connecting over resources and best practices – in English with live interpretation for Spanish-speakers
      • Register at https://tinyurl.com/VCN2024
    • In-Person Facilitation
      • Technical support for CHW sites interested in offering the VCN curriculum in-person, available in English and Spanish
      • More information at tinyurl.com/vcn-community
    • VCN Program Results 700+ students enrolled, ~100 attendees per meeting, 470+ members active
  • Next Steps for the program include updating of and continued promotion of VCN modules, continued management of online community, ongoing quarterly Community of Practice meetings, continued data collection for metrics and improvement, expanding reach through partnerships with community-based organizations, adding cohorts of in-person facilitation

Serese Marotta
SQUAD:

  • Member advocates SQuaring Up Against Disease (SQUAD) are passionate about protection against vaccine-preventable disease and many members have been personally impacted through loss or survivorship. Studies have shown that stories change vaccination behavior.
  • SQUAD provides a platform with four pillars:
    • Connect: Identify and engage impacted people, through a variety of community building efforts, including support groups
    • Train: Provide training to empower members for future advocacy and activities at community, state, and national levels
      • Vaccinate Your Family University is a new education platform, with a suite of educational services, that will have a soft launch in spring 2024.
        • Will begin with 5 courses: History of Vaccination, Vaccines 101, How to Debunk Online Misinformation, How Do We Talk with People About Vaccines, What Are the Barriers to Vaccination
    • Engage: Mobilize advocates through storytelling and community-level advocacy
    • Support: Invest in sustainable relationships with advocates through touchpoints and tracking, including with a SQUAD Advisory Committee which informs the program and the work more holistically
  • SQUAD members are activated through a variety of mechanisms, including but not limited to speaking engagements; Op-eds; satellite media tours; meetings with policymakers; community events, such as tabling at a local health fair; and Vaccination Collaborative
  • SQUAD has a library of personal stories on the website; call to action: contact VYF with any needs for speakers and advocates

 
QUESTIONS

Q: Can you provide some information about how you are going to figure out how well you are doing with this (i.e., metrics and evaluation)?

Serese Marotta (VYF): Excellent question. Our colleague, Robin, who is not here with us today, is our director of impact and evaluation. We measure everything. We understand that we want to come up with these models, these programs and we want to prove that they work and how do we prove that they work without collecting qualitative as well as quantitative data. So that’s really something that is embedded in each of our programs. With the VCN we have pre- and post-tests, we’re measuring increases in knowledge, increases in confidence. So, we are always measuring things and I think that helps us, at periodic points in time, stop and evaluate: is this working? Is this doing what we need it to do? So that’s a really important part of it and I’m glad you mentioned it. Grisel, did you want to add anything from the impact and evaluation end of it?

Grisel Cisneros (VYF): I’d like to add that, since this is a community-based program, this is critical to us to continue doing throughout the duration of the program. So, as we go further, we are constantly collecting data from our users. We want to make sure that we maintain the original intent of the program, which is, like Serese said, made by CHWs by CHWs, so when we hear back from them, “This is working great,”; or “This may not be working as well,”; we definitely listen, and we adapt to that. So, evaluation was built into the program from its very inception, and we plan to keep it like that.

Serese Marotta (VYF): And one other thing I’ll mention that I didn’t touch upon, when we think about community-based organizations and we think about CHWs as well as the SQUAD members, one of the things with the SQUAD members that we are doing, which is like the VCN and the CHWs, is the in-person facilitation. We’re kind of supporting the amplification of the VCN program by empowering other organizations to bring that to their communities. We’re doing the same thing with SQUAD members: the intention is to put them in the position where they might find themselves…they might be an individual, they might not have their own foundation; but they may have their own foundation or nonprofit, they may work with another community-based organization that’s not vaccine forward (and what I mean by that is that CBO is serving other needs in the community). The wonderful thing about that is there’s an opportunity to piggyback on top of that. I think that’s what makes it successful. Sometimes it’s like, Ooh, vaccines, people get a little bit hesitant about…what are you approaching me with? But if we can embed these efforts into other services that CBOs are providing, that’s a wonderful opportunity and that’s where we’re moving into, as well.
 

Q: With limited funding available for uninsured adults and for our most vulnerable groups, we’ve heard a lot of that from folks who have been working on improving equity and vaccine access. Do you have any recommendations or other community organizations, other people trying to maintain the kind of services and community outreach that we saw during the pandemic, given we’re in a different space right now? What are some of the CHWs you’re working with are doing or other suggestions that other grassroots groups could use?

Serese Marotta (VYF): I’m going to start and then I’d like Grisel to weigh in. One of the things…the part of the VCN where we are doing the in-person facilitation, part of that is coming along with funding. VYF took very seriously that, if we are going to support people, we need to do so in a monetary way, as well. So that is something that, with Cohort 1, as Grisel mentioned, for those organizations that needed funding support, we were able to provide that. And we will do the same with SQUAD members. Obviously, the amount of funding that we get, and then can support, is fluctuating as well, and certainly we try to be equitable with that. That, for us, was very important, because we can’t ask people to go out and do this work without supporting them, both in a technical way as well as in a monetary way.

Grisel Cisneros (VYF): I will add that CHWs, by definition, are very well positioned to understand navigation into services. And how do we do it with limited funding? How do we do it with underserved populations, underinsured populations? We have instances where CHWs know more than we do. And they’re the ones who come in and tell us, “Well, there is this or that available here or there.” So, they really are an untapped resource. And, along those lines, we work with organizations that already integrate CHWs into their workforce. And that’s the other thing that we are making sure that we remain very aware of. So, the fact that these people know their communities, know how to navigate them into resources…they also need jobs and they need to be compensated properly and recognized for their work. So that’s the other side of what we do. And, going back to that intersection where we started this conversation, we also look at that. We look at policy. We look at whether these people are considered under Medicaid reimbursement? Are their hours and their work something that is official, so to speak. Because, in many circumstances, they worked essentially underground. So that’s the other thing that we’re trying to work closely with our partners towards: workforce integration and job development for CHWs.
 

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Announcements
  • Registration is now available for the National Immunization Conference being held August 12-14, 2024 in Atlanta, GA.
  • May 16 and May 23 are virtual May Days used to talk about respiratory viral seasons. CLICK HERE FOR REGISTRATION.

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