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A summary of presentations from the weekly Summit partner webinars

February 6, 2025 – The latest Summit Summary

IQVIA Respiratory Viral Vaccine Coverage Data – Anurag Sahu, MS, Consultant, Commercial Solutions & Insights Hub at IQVIA

Anurag Sahu, MS, Consultant, Commercial Solutions & Insights Hub at IQVIA.

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IQVIA Respiratory Viral Vaccine Coverage Data – Anurag Sahu, MS
A quick background of IQVIA was provided. Using clinical research data, analytics, and evidence generation, IQVIA, a Fortune 300 health services company, works across domains in the health care industry to provide insights that drive better health care decisions. This presentation focused on adult and maternal annual vaccination trends in the United States, including those for influenza, pneumococcal, shingles, maternal Tdap, and RSV.

IQVIA Analysis
The analysis of adult and maternal vaccination rate trends sought to determine how the COVID-19 pandemic affected routine adult vaccinations.

  • The analysis relied mostly on secondary patient level data under both private and public insurance across the 50 US states.
  • The study, which started with approximately 258M adults 18 years of age and older, had a final cohort of about 60M adults.

Vaccination Rates & Trends
For influenza, there was a sharp increase in vaccination rates during the peak of the COVID-19 pandemic.

  • Between June 2020 and May 2021, the rates surged to about 70%; the rates have since decreased and plateaued around 50%.
  • The vaccine rate has decreased and, in September 2024, was 53.8% for adults 65+ and 35.6% for adults 18+.

For shingles and pneumococcal, there has been a steady rate of vaccinations over time.

  • For shingles, the rate has not recovered post-pandemic, with a 10.1% rate in 2019 and a 7.5% rate in September 2024.
  • For pneumococcal vaccines, there was a slight increase in the vaccination rate in 2023, largely driven by age-based clinical recommendations and shared clinical decision making.

For Tdap, there was a plateauing trend with rates hovering just below 50%, with a slight increase trending in 2024 as compared to 2023.

For RSV, the data are being watched carefully, as it is a relatively new vaccine.

  • For adults 65 years of age and older, from October 2023 to September 2024, there was a vaccination rate of approximately 20%.
  • For pregnant women, the highest vaccination rate, from October 2023 to September 2024, was in the 35 to 49 years of age group, at 8.8%; the overall rate for those 18-49 years of age was 6.1%.

For COVID-19, the vaccination rate from October 2023 to September 2024 was highest among adults 65 years of age and older, at 49.5%; adults 18 years of age and older had a vaccination rate of 24.7%.

For all of these data, IQVIA breaks down the results by demographics, including by state, to provide insights into which populations may need more targeted interventions to improve vaccine uptake.

National Prescription Audit (NPA)
The NPA data shows what product was supplied to pharmacies and, then, what product was prescribed. The data reviewed were those up to January 24, 2025. Comparisons are made year over year.

  • There were decreases in the volume of administered vaccinations against
    • influenza (-2%)
    • shingles (-24%)
    • RSV (-66%)
    • COVID-19 (-11%), in the 2025 season versus the 2024 season.
  • There were increases in the volume of administered vaccinations against
    • pneumococcal (9%)
    • Tdap (36%)

QUESTIONS & ANSWERS

Q: Regarding the decline in RSV vaccinations administered in pharmacies from last year to this year, do you have any speculation or understanding as to why that decline might be there?
Anurag Sahu (IQVIA): We are still tracking that. There can be various factors. For example, it was recently launched, so we saw good uptake in the last season. There might be few other reasons for the decline, and we are still investigating as we get more data points for RSV. [This is for pharmacies only.]

Q: Any insight into why Minnesota, Michigan, and Georgia dropped in their vaccination rates?
Anurag Sahu (IQVIA): That is just the heat map of what we are trying to show. There are teams who have been investigating trends for different states. Although I don’t have the answer now, we can get back to you once we have more clarity.

Q: Regarding the RSV decline, the claims data is obviously based on administration data. Do you have any information on the total eligible population for the 2 seasons that you compare, 2023 and 2024? Because, for example, people who got vaccinated in 2023 are not eligible for 2024, and so, with the change in recommendations from ACIP, there there should have been a larger volume of people getting vaccinated. What are your thoughts on that?
Anurag Sahu (IQVIA): When we talk about the eligible population, say influenza, for example, that vaccine can be taken in every season. But there are certain vaccinations for which we have to drill down the cohort population. So we start with the initial cohort. We also look into the claims data to understand the patients we are trying to capture, those who are actually eligible, or not. So we track the longitudinal behavior of all those patients who present claim data. We apply different look-back periods for different vaccine types, and that is based on the sensitivity analyses performed to identify the ideal look-back period. Based on that, we track whether the patient is eligible and stable across the claims data, then we consider that for the eligible population. So those also might be a few factors why we see a declining trend in the RSV vaccine. But that is how we drill down from the initial cohort of patients to the final cohort on which we’ll be applying the business rules..
L.J Tan (Immunize): You’re suggesting that the way you do this, using eligibility data, the 2025/second year data would have excluded people who already got RSV the first year, correct?
Anurag Sahu (IQVIA): Yes.
L.J Tan (Immunize): Therefore, that decline is not because of people who got RSV the first year, but it was more likely because these are eligible patients who actually didn’t get vaccinated.
Anurag Sahu (IQVIA): Yes, that’s correct.

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H5N1 Flu USDA Update – Nailah Smith, DVM, MPH, Veterinary Medical Officer (Public Health), USDA/APHIS

Nailah Smith, DVM, MPH, Veterinary Medical Officer (Public Health), USDA/APHIS.

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The first detection of HPAI H5N1 clade 2.3.4.4b, genotype B2.13 occurred on March 25, 2024 in a Texas dairy herd. Phylogenetic analysis and epidemiology support a single introduction in a novel host, followed by onward transmission.

Clinical Picture
There is generally a decrease in production, dehydration, drop in feed consumption, fever, and some minor respiratory signs. In general, cattle are able to recover with treatment.

  • Milk carries a very high viral load, which presents opportunities for lateral transmission, through contamination via movement and shared equipment and tools.
  • Cattle seem to need a larger amount of virus (than poultry, for example) to become infected. The spillover from dairy cattle to poultry farms highlights the need for additional biosecurity on poultry premises.

Food Safety

  • Pasteurized milk and dairy products are safe.
  • Raw milk consumption remains a risk for HPAI and other reasons.
  • Cooking meat to appropriate temperatures inactivates the virus.
  • There have been recent detections of HPAI virus in raw pet foods.
  • Additional studies and testing are needed.

Human Health and Mitigating Disease
The CDC handles human health monitoring. Most cases have been farm workers with direct exposure to potentially infected animals.

  • Symptoms have included conjunctival infections, fatigue, and respiratory issues.
  • The key recommendation to mitigate spread between premises is having biosecurity practices.
  • The Secure Milk Supply Plan identifies those biosecurity measures:
    • Testing before movement of cattle and minimizing movement
    • Diligent monitoring and investigating of sick cattle
    • Identifying interconnections between operations
    • Identifying as many affected herds as possible to better assess the scope of the event

APHIS Response
The APHIS response since April 2024 has been robust and has included pre-movement testing for certain dairy cattle:

  • Mandatory result reporting
  • Financial support options for dairy producers
  • Acceptance of license applications for HPAI vaccines to use in livestock
  • Acceptance of submissions for field studies to support licensure of non-viable, non-replicating HPAI vaccines.
  • Federal order requiring unpasteurized milk samples to be collected and provided to USDA for HPAI testing, upon request.

The APHIS Action Strategy is to understand the virus and cattle, identify and respond to detection, control and eliminate circulating virus, and provide support to producers.

The National Milk Testing Strategy (NMTS)
NMTS is a structured, national testing strategy, which has enrolled 38 states to date. Its goals are to

  • Swiftly identify states and specific herds that are affected
  • Support rapid implementation of enhanced biosecurity measures to decrease transmission risk
  • Inform critical efforts to protect farmworkers

USDA Programs to Assist Farmers
Dairy Herd Status Program

  • This is a voluntary program that aims to ease the burden of pre-movement testing requirements. It allows farmers to establish herd status with 3 weeks of consecutive testing.

Support Options for Dairy Herd Producers

  • Financial support for PPE provision
  • Assistance with development of biosecurity plans
  • Funding for sick cow milk disposal
  • Reimbursement for veterinary costs and fees
  • Offset shipping costs for influenza A testing
  • [A program not through APHIS]: Milk loss offset through the Emergency Assistance for Livestock, Honeybees & Farm-Raised Fish Program (ELAP)

APHIS’ Ongoing Broad Response

  • Support states’ response actions in dairy and poultry and leverage national surveillance and response to minimize impacts
  • Collaborate with federal and state partners to coordinate research and response efforts across food safety, animal and public health, and vaccine development
  • Continue engagement and enrollment in the NMTS
  • Offer producer support options, emphasizing biosecurity

QUESTIONS & ANSWERS

Q: As it may differ from how a “human physician” might use the word “case,” how do you define a case? You mentioned 38 cases in the last 30 days: Is that 38 herds?
Nailah Smith (USDA): Yes, exactly. On the agriculture side, we are defining our epi unit as a herd. So, when you hear us talking about a case, we’re talking at the herd level rather than the individual cow level.
Q [follow-up]: The other word you used is a condemnation of infected cattle. Can you talk about what you mean by that?
Nailah Smith (USDA): I believe that was from the slide with the Food Safety and Inspection Service (FSIS) information. I’m with APHIS, so I can only speak a little bit to FSIS processes, but my understanding is when you have animals that are going to slaughter for meat production, FSIS is there inspecting those carcasses, and there are certain criteria that the carcasses have to meet, otherwise they are condemned or held, you know, not put into the human food chain for consumption.

Q: This is tough with H5N1 and wild bird populations. With influenza in swine populations, one of the issues, historically, has been the use of surface water. And they’ve tried to reduce the use of surface water. Is that something they’re also trying to do here with dairy herds: reduce the amount of surface water that they may be exposed to, which might have wild bird flu viruses in it?
Nailah Smith (USDA): I haven’t heard surface water come up as much as some of the other biosecurity measures. So, a lot of it has really been focused on the different movements that go from farm to farm, like on some of the shared trucks, equipment, things like that; but I haven’t heard the surface water mentioned.

Q: Can you talk a little about the spectrum of illness in cattle? Can they be apparently visually asymptomatic and yet shedding virus in their milk?
Nailah Smith (USDA): I think the spectrum is pretty wide. I think, when you have [an infected] herd, there are generally some animals that have shown clinical signs, but I would argue that not all of them show clinical signs. And then, of the clinical signs that are there, not all of them have the same extreme nature. So, some cows have gotten very sick, and we know that there’s a low mortality rate associated with this illness; and we have also seen herds test positive without showing clinical signs. So, there is definitely a range.

Q: Could you discuss any of the emerging evidence around reinfection of herds or the question of reinfection?
Nailah Smith (USDA): I will say it’s getting looked into. There are some ongoing research studies looking into what reinfection looks like and what’s going on with that. But I don’t have any concrete information, like ‘this definitely happens with reinfection’ right now.

Q: Can you talk about the new strain that was identified in the Nevada dairy herd?
Nailah Smith (USDA): In the news, they’re noting that the Nevada cases that have been most recently detected are not B3.13. They are associated with circulating wild bird strains. So, I should have said, “Our most recent understanding was that there was a single introduction and lateral spread of B3.13.” This kind of throws an interesting new twist on that information. As with all emergency response work, there’s always ongoing development. So, basically, APHIS’ response is that we’re working to tease out exactly what has been going on with that, and understanding what the nature of that introduction was, as well as what the nature of seeing multiple premises affected by it is. And so, we’re thinking, ‘Is this one introduction or have there been multiple introductions?’ trying to tease out some of those details?

Q: Regarding the fact that it was obviously from wild birds, D1.1, is the illness profile different? And are the transmission dynamics different, or is it too early for you to even be able to say anything about that?
Nailah Smith (USDA): At the time that they were detected, the dairy cattle were not showing clinical signs, but I think they’re digging in with their epi investigation to see if that herd had exhibited any clinical signs around the time that they would have been maybe incubating or associated with wild birds. So that that part is ongoing. And then we would also love to know the transmission dynamics. So that’s part of the ongoing investigation. Nevada has placed movement restrictions on all the affected dairies, following our usual recommendations if you find HPAI in a dairy herd, and their ongoing weekly testing of bulk, tank, milk, and dairy surrounding the affected premises, and that includes 22 of Nevada’s 23 dairies. So that testing is ongoing, and we’ll see what that yields..

Q: The other question that comes from Nevada, obviously, is does that change your strategies that you’ve described at all right now, again, early on in the investigation.?
Nailah Smith (USDA): I think it doesn’t change some of our broader biosecurity messaging, no matter what strain is circulating, we know that biosecurity, mitigating movement, those things are going to be our recommendations. I think it changes our understanding of what we thought introduction to dairy herds looked like. So, for a long time, it has looked like lateral spread between dairies, and now we have seen this new spillover event. And so we’re thinking how often things like this happen? It’s kind of changing our understanding of this, how this behaves, but not really our recommendations. Biosecurity is still going to be really important to mitigate spread. The one thing I wanted to highlight is that this herd was found through our national milk testing strategy. So because we’ve been doing broader screening and making sure that we are understanding where virus is, we were able to find this herd. And so I think it’s really a testament to having this broader testing strategy. It’s effective. It’s teaching us things that maybe we wouldn’t have learned otherwise.
L.J Tan (Immunize): That’s definitely a call to the improved and increased surveillance that’s necessary at the one health level in general.

Q: Do male and female cows have similar symptoms?
Nailah Smith (USDA): For the dairy industry, all the cows affected are female, by nature, they’re lactating. These are the cows that give us milk. So it’s very skewed to only representing female cows.

Q: Are those loss offset programs actually functioning now, for example, money for disposing milk?
Nailah Smith (USDA): Yes, they are.

Q: Could you describe a bit more of your prospective surveillance? And are all states that have already had lab-confirmed cases or outbreaks participating?

Nailah Smith (USDA): The national milk testing strategy has been what we been pushing for and focusing on. There are 5 stages in this strategy. And the goal is just to understand where virus is in this country and then get down to the herd level to be able to say, “We eliminated this virus. And we know we have because we’re doing this testing. And folks are testing clear.” So, Stage 1 is setting up mandatory USDA national plant silo monitoring. A milk silo is huge and where a lot of milk is stored. If you think about a grain silo, it’s a similar thing, where you just have a lot of the [milk] being stored. Milk silos represent a lot of herds. They can represent multiple states. And so, starting at that level, there are already programs where this milk is tested. And so, we’re leveraging those existing programs and those testing mechanisms to test for avian influenza.
If a state has all their milk in silos, and we find that the silos we’re testing are representative of a state’s dairy herds, they are enrolled in Stage 1. And, if they continue testing negative through the silos, they can eventually be cleared because all of their herds are represented in a silo. Ideally, states might go to Stage 2 if they are not represented by a silo, like if all their herds are not represented in what we’re testing through silos, and that is state-specific surveillance. So this would be at the state level, determining the amount of dairy herds that would need to be tested to be considered representative and then testing them on a regular basis to understand what’s going on in their herds. And then Stage 3 is detecting and responding to virus in affected states. If you’re a Stage 3 state, you have had a detection of avian influenza, you’re considered affected, and you’ll continue testing until you have demonstrated absence of the virus in your dairy herds. Whether that’s through a silo that represents your state’s herds, or you have state-specific herd level testing, that’s how that stage works.
And then Stage 4 is demonstrating ongoing absence in your unaffected state. This is like you’ve been testing and no positives came up for weeks to months, depending on your approach. So, for silo testing, it takes a lot longer. You have to test negative, I think, for 4 consecutive months in order to be Stage 4. If you are doing herd-level testing at the state level, it takes a little bit less time. But in any case, you’ve tested consecutive negative, you’ve demonstrated absence, and so now you are considered an unaffected state. And then Stage 5 is demonstrating freedom from H5 in US dairy cattle, so this is like the whole United States, we’ve testing our silos, we’ve got the state-level testing going on and we’re not seeing any positives for a period of time, and we can declare the US free. So that’s the progression through the different stages. And the goal is to get everyone to disease freedom, eventually.

Q: Now that we have this situation in Nevada, even after 4 months and someone’s negative, is there consideration for continuing this testing on a long-term basis [surveillance]?
Nailah Smith (USDA): I think they’re now writing more guidance; we’re having states move into Stage 4, so they’re writing more guidance about what that looks like for states. I think it will involve ongoing testing and monitoring herds for any clinical signs, as well, and just having that high index of suspicion to be on the lookout for HPAI in your herd. Those Stage 4 states are wanting to keep that status. So there’s definitely some ongoing monitoring that will be needed. I don’t think it’s something where we would say our country is unaffected and all the testing goes away. I think there’s going to be a long period of time when we’re really making sure everyone stays unaffected.

Q: Do you have any information on vaccine development for H5 for dairy cows?
Nailah Smith (USDA): Our colleagues in the Center for Veterinary Biologics oversee the vaccine side of things. I know that those discussions are happening. I think the last thing I heard was that they were working on something to consider licensure. The Center for Veterinary Biologics would approve the licensure. In August, they began accepting submissions for field studies to support licensure of a non-viable, non-replicating HPAI vaccines, and so I believe those are ongoing.

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Announcements
  • For those seeking current information, Immunize.org has vaccine information statements and current ACIP MMR recommendations that can be downloaded.
  • Registration is open for the Adult and Influenza Immunization: Looking Back, Moving Forward, May 13–15, 2025. This summit will be held at the Crowne Plaza Atlanta Perimeter at Ravinia.
  • 2025 NAIIS Immunization Excellence Awards: Submit a nomination to recognize individuals and organizations that made extraordinary contributions towards improving vaccination rates within their communities during 2024.
  • 2025 NAIIS Poster Session: The May 2025 NAIIS Meeting will include a poster session.

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