April 23, 2014

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Summit Call Recap – April 10, 2014
Information from CDC
Announcements

Reminders:

  • Summit calls are scheduled every Thursday at 3 p.m. ET, unless cancelled.
  • Persons intending to participate in the National Adult and Influenza Immunization Summit (NAIIS) should register as soon as possible. Also, please be sure to book your hotel room through the Summit website before the rooming block closes on April 30, 2014.
  • Please email L.J or LaDora if you have any updates on activities to provide to the Summit.

SUMMIT CALL RECAP — April 10, 2014


Announcements – L.J Tan (IAC)

L.J opened the call by reminding participants to be sure to register for the upcoming Summit meeting. The meeting will take place from May 13–15 in Atlanta, Georgia. Persons who have not yet reserved a room at the conference hotel (Hyatt Regency Atlanta) are urged to use the secured Hyatt rooming block link to make a reservation as soon as possible, before the rooming block closes on April 30.


Influenza Surveillance Update – Scott Epperson (CDC)

Scott provided an update on seasonal influenza surveillance for week 13, which incorporates data available through March 29. In general, influenza is declining throughout the country. However, some areas, particularly Regions 1 (New England) and 2 (Mid-Atlantic), continue to have reports of influenza A(H3N2) and B. Although overall reports are decreasing, influenza B has become the predominant strain in the country. This type of change is not unusual, as we often see a “spring wave” of influenza B in the U.S. Data from CDC’s surveillance of 122 cities indicates the proportion of deaths attributed to P&I is below the epidemic threshold. ILI surveillance shows levels below baseline in all regions except the Northeast and Mid-Atlantic. Five states in these areas still indicate “widespread” influenza activity.

Three (3) new pediatric deaths were reported during week 13, bringing the seasonal total to 82. Sixty-two (62) of these children were eligible for vaccination and had a known vaccination history. Of these, 8 (13%) had been vaccinated. The vast majority of cases were either 2009 H1N1 or A non-subtyped. Fifty-two percent (52%) of pediatric deaths have occurred in children who had underlying medical conditions that put them at high risk for complications from influenza. This was similar in both vaccinated and unvaccinated children, with 4 of the 8 vaccinated children having an underlying condition. The age distribution of pediatric deaths is: <6 mos (19.5%); 6–23 mos (25.8%); 2–4 yrs (9.8%); 5–11 yrs (25.6%); and 12–17 yrs (18.3%). Additional information is available on CDC’s FluView Interactive website. When Scott was asked how pediatric deaths this season compared to prior years, he noted they were on the higher end of the scale. Reported pediatric deaths during previous seasons were: 2010–11, 123; 2011–12, 35; 2012–13, 171. This season’s 82 reports fall somewhat in the middle of this scale. This is the first year since 2009 that H1N1 has been the predominant strain.


Novel Influenza Virus Overview – Mike Young and Eduardo Azziz-Baumgartner (CDC)

L.J introduced Mike and Eduardo by emphasizing that inclusion of this topic on the Summit call does not indicate something new is occurring with novel influenza. Rather, the update is being provided because this topic has not been covered during Summit calls for several months. A slide presentation is available for the information discussed below.

Mike began the presentation by reminding callers that during 2011 we began using the term “variant” to describe influenza A cases of swine origin. He provided a high level overview of reported cases from 2005 through December 2013. The epidemic curve for this time period shows that we have been plagued with a handful of subtypes of variants and that during the earlier years we saw more influenza H1. H3N2 is now the predominant strain. There has been a sharp increase in cases reported since 2011, with a large spike occurring in 2012, when over 300 cases of H3N2v were reported. There was a dramatic decline during 2013. CDC speculates that this variation has to do with the circulating viruses in the swine population. So far during 2014, no variant cases have been reported in the U.S. However, Mike reminded call participants that there is a definite seasonality to these reports; the overwhelming majority of cases occur during the summer, typically during July and August.

The epidemiology of H3N2v indicates that most cases are young, with a median age of 7 years. Approximately 90% of cases occur in persons <18 years of age. Although this may be partially due to pre-existing cross protection in older persons, it mostly is the result of the type of exposures occurring with children. Symptoms are mostly mild, with few hospitalizations and only 1 death being reported. The majority of cases occur in the same populations as persons who are at increased risk for complications from seasonal influenza. Person-to-person transmission is limited, with no evidence of sustained or community transmission. There is a definite association of cases with prolonged, close contact with swine. During the 2012 outbreak, over 90% of cases had attended a fair, and 98% of cases had contact with swine. More than half of cases reported multiple days of contact, with approximately 30% indicating at least 7 days of contact. As we approach the 2015 fair season, CDC anticipates receiving additional reports. The agency recommends enhanced surveillance, PCR testing, prompt reporting, and prompt contact investigation of confirmed cases. Precautions should be taken to encourage social distancing (in this case, from pigs), particularly for persons at high risk for complications from influenza. No association has been found between duration of contact and the level of disease severity. Interestingly, no cases have been reported among persons working at commercial swine farms. H3N2v transmission occurs almost exclusively through fairs. It is hypothesized that prolonged exposure may have resulted in increased immunity, but there is not reasonable mechanism for proving this hypothesis.

Eduardo provided information on the international surveillance for influenza H7N9. CDC continues to work with the Chinese government and WHO to monitor transmission of this virus. China has reported approximately 400 cases, 35% of whom have died. There has been no sustained human-to-human transmission. The only case occurring outside China was in a traveler from China to Malaysia. CDC has developed an H7N9 candidate virus in order to ramp up vaccine production if needed. Providers are urged to consider the possibility of H7N9 in persons appearing with severe respiratory illness who report recent travel from infected areas of China or contact with infected persons. If indicated, they should notify CDC and being treatment with oseltamivir or inhaled zanamivir within 48 hours of symptom onset. Additional information is available at Avian Influenza: Information for Health Professionals and Laboratorians and Interim Guidance on the use of Antiviral Agents for Treatment of Human Infections with Avian Influenza A (H7N9) Virus.

From 2003–2013, influenza H5N1 was been reported from 52 countries. There have been over 600 human cases, 59% of whom have died. There has been no sustained human-to-human transmission beyond the 3rd generation. In January 2014, Canada reported a case in a traveler who died. CDC has developed H5N1 vaccine candidate viruses in case they are needed. Similar to the discussion above (on H7N9), providers should consider H5N1 among persons from affected countries with severe respiratory illness and begin treatment with oseltamivir or inhaled zanamivir within 48 hours of symptom onset.

CDC provides Advice for Travelers to countries where H5N1 poultry outbreaks have occurred. Travelers with symptoms should be sure to inform their healthcare provider(s) about their recent travel history.


INFORMATION FROM CDC


CDC/Influenza Division Weekly Influenza Surveillance Report and CDC Key Points 

The CDC weekly influenza surveillance report for week 15 (ending April 12th, 2014) and region specific data are available. Of all deaths reported through the 122 Cities Mortality Reporting System, 6.4% were due to P&I. This percentage was below the epidemic threshold of 7.2% for week 15.

One influenza-associated pediatric death was reported to CDC during week 15. This death was associated with an influenza B virus and occurred during week 14 (week ending April 5, 2014).

A total of 86 influenza-associated pediatric deaths have been reported during the 2013-2014 season from Chicago [1], New York City [4] and 29 states (AR [4]; AZ [1]; CA [8]; FL [4]; GA [1]; IA [1]; IL [1]; KS [2]; KY [1]; LA [5]; MA [2]; MD [1]; ME [1]; MI [2]; MS [1]; NC [6]; NE [1]; NJ [1]; NV [1]; OK [2]; OR [1]; PA [3]; SC [2]; TN [4]; TX [18]; UT [2]; VA [1]; WI [2]; and WV [2]).

Nationwide during week 15, 1.5% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is below the national baseline of 2.0%. ILI is defined as fever (temperature of 100°F [37.8°C] or greater, and cough and/or sore throat.  On a regional level, the percentage of outpatient visits for ILI ranged from 0.6% to 3.6% during week 15. Two of 10 regions reported a proportion of outpatient visits for ILI at or above their region-specific baseline level. An Influenza Summary Update of the influenza activity reported by state and territorial epidemiologists, which indicates geographic spread of influenza viruses but does not measure the intensity of influenza activity, is available.

During week 15, three states (New Jersey, New York, and Texas) and New York City experienced moderate ILI activity. Four states (Connecticut, Delaware, Massachusetts, and Rhode Island) experienced low ILI activity. Forty-three states (Alabama, Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming) experienced minimal ILI activity. Data were insufficient to calculate an ILI activity level for the District of Columbia.

Archives of previous FluViews and CDC’s seasonal influenza key points for April 18, 2014 are available.


More Information from CDC

Current seasonal influenza vaccine distribution

CDC has published recent distribution numbers for all influenza vaccines. As of February 28, 2014, 134.5 million doses have been distributed. This represents the final weekly update of influenza vaccine supply for this season.

Continuing Education Courses for Immunization Providers

Low HPV vaccination rates are leaving another generation of boys and girls vulnerable to devastating HPV cancers. Vaccination could prevent most of these cancers. CDC encourages doctors, nurses and other health professionals to make a strong recommendation for HPV vaccination when kids are 11 and 12 years old. However, that can be difficult considering the number of competing priorities that need be addressed in a single visit. CDC has developed two new CME courses in an effort to assist doctors, nurses and other health professionals in effectively speaking with patients and their parents about HPV vaccine.

  • Continuing Education Opportunity: You Are the Key to HPV Cancer Prevention

CE credit for the web-on-demand video, You Are the Key to HPV Cancer Prevention, was posted on February 26, 2014 and will remain available until February 26, 2016. Credit is available for Immunization Providers such as Physicians, Nurses, Nurse Practitioners, Pharmacists, Physician’s Assistants, DoD Paraprofessionals, Medical Students, etc. The course is approximately one hour in length

  • COMING SOON: “Framing the Conversation with Parents about the HPV Vaccine”

This Medscape CME activity is intended for pediatricians, family physicians, nurses, and other healthcare providers who care for adolescent patients in their practice or clinic. The goal of the CME is to enhance decision-making skills and knowledge, building both confidence and competence in the care of adolescent patients. Included in this CME are Skill-Building Video Vignettes, custom-developed videos illustrating provider-patient encounters that demonstrate educational gaps that cannot be as effectively achieved with text alone, such as clinician/patient communication.

  • CDC Partner Update: Girlology & Guyology

Girlology & Guyology is a growing national brand with the voice that parents trust for age-appropriate, medically accurate, engaging, and cringe-free messages about growing up safe, healthy, and informed — especially when it comes to sexuality. Girlology & Guyology also is changing the culture of sexuality education by bringing parents and kids together to have honest, real world conversations covering topics ranging from puberty and sexuality to body image, media literacy, digital safety, pornography, risk taking, healthy relationships, and pregnancy and STI prevention. Additional nformation about Girlology & Guyology is available on their Facebook page.


ANNOUNCEMENTS


NAIIS Announces 2014 Immunization Excellence Award Winners

The National Adult and Influenza Immunization Summit (NAIIS) is proud to announce the recipients of its 2014 Immunization Excellence Awards. The awards will be presented during the NAIIS meeting in Atlanta, Georgia, May 14, 2014. There are five categories of recognition including overall influenza season activities, healthcare personnel campaign, “immunization neighborhood” champion, corporate campaign, and adult immunization champion.  Nominees were evaluated based on the areas of impact, originality, challenges, opportunities, collaboration, coordination and communication with partners and stakeholders.

Many packets describing innovative programs were received this year.

The Summit applauds all stakeholders who are working towards improving the health of their communities. Complete descriptions are contained within the Summit Awards booklet that will be available after the awards presentation at www.izsummitpartners.org/immunization-excellence-awards.

The 2014 Immunization Excellence Award winners are as follows:

Overall Influenza Season Activities

National Winner:  Immunize Nevada (Reno, NV)

National Winner:  Universal Kidney Foundation (Grand Blanc, MI)

Honorable Mention:  National Foundation for Infectious Diseases (NFID; Bethesda, MD)

Healthcare Personnel Campaign

National Winner: Da Vita HealthCare Partners, Inc. (Denver, CO)

Honorable Mention: Partnership for Quality Care (New York, NY)

“Immunization Neighborhood” Champion

National Winner: Hispanic Institute for Blindness Prevention (Falls Church, VA)

Honorable Mention: Osterhaus Pharmacy (Maquoketa, IA)

Corporate Campaign

National Winner: Safeway Pharmacy (Pleasanton, CA)

Honorable Mention: Sanofi Pasteur (Swiftwater, PA)

Honorable Mention: Walgreen Co. (Deerfield, IL)

Adult Immunization Champion 

National Winner: American College of Obstetricians & Gynecologists (ACOG) (Washington, DC)

National Winner: Eric Crumbaugh, PharmD (Little Rock, AR)

Honorable Mention: Jenny S. Arnold, PharmD (Renton, WA)


Public Health and Faith Community Partnerships: Model Practices

On Tuesday, April 29, 2014, 11:00 a.m. – 12:30 p.m. EDT, the Emory University Interfaith Health Program, in partnership with the Association of State and Territorial Health Officials (ASTHO), the Centers for Disease Control and Prevention (CDC), and the Society for Public Health Education (SOPHE), invite you to join the webinar, Public Health and Faith Community Partnerships:  Model Practices.

PURPOSE:  The purpose of this learning event is to disseminate knowledge and promote replication of model practices known to contribute to the reach of seasonal influenza prevention to vulnerable, at-risk, and minority populations. The focus is on a new toolkit and case examples that demonstrate these model practices and partnership capacity in action. This event will be embedded in a live meeting being held at Emory.

LEARNING OBJECTIVES:  After participating in this webinar, participants will be able to:

  • Describe the characteristics of faith-based and community organizations likely to be strong partners in reaching hard-to-reach, vulnerable, at-risk, and minority populations.
  • Describe effective strategies for establishing and/or strengthening partnerships between public health and local trusted networks of faith-based and community partners for the purposes of planning and implementing interventions to reach priority populations.

SPEAKERS:

  • Moderator:  Connie Jorstad, Director of Emerging Infections at ASTHO, the Association of State and Territorial Health Officials
  • Project Overview:  Mimi Kiser, Interfaith Health Program, Emory University?
  • Discussion and Response Panel:  Model Practices “Wisdom from the Field” — Faith and Health leaders from four community-based collaboratives

CONTINUING EDUCATION CREDITS:  This session has been approved for 1.5 Entry and Advanced-level Category I continuing education contact hours (CECHs) for Certified Health Education Specialists (CHES) and Master Health Education Specialists (MCHES).  SOPHE, including its chapters, is a designated multiple event provider of CECHs by the National Commission for Health Education Credentialing (NCHEC).  This session also has been approved for 1.5 CPH Renewal Credits by the National Board of Public Health Examiners.   Visit the SOPHE website to create a free SOPHE CORE account to access and manage all continuing education opportunities.

REGISTRATION:  Register for this webinar now.


CDC Flu Update: Antiviral Key Points

On April 10, 2014, the Cochrane Collaboration published an updated review of randomized clinical trial data for the influenza neuraminidase inhibitor antiviral medications. The review is accompanied by a series of editorials and analyses posted on the British Medical Journal website. In the review, they raise questions about the value of influenza antiviral medications for the prevention and treatment of influenza.

Based on all available data, including both randomized control trials and observational studies, CDC continues to recommend the use of the neuraminidase inhibitor antiviral drugs (oral oseltamivir and inhaled zanamivir) as an important adjunct to influenza vaccination in the treatment of influenza.

CDC has published a “Have You Heard” article highlighting current influenza antiviral recommendations. A PDF version also is available. CDC’s Influenza Division has released CDC Influenza Division Antiviral Key Points April 10. Additional information on flu antiviral drugs may be found on the CDC website.

An article on the controversy regarding this Cochrane publication is available.


National Infant Immunization Week 2014 is Fast Approaching

Scheduled for April 26–May 3, National Infant Immunization Week (NIIW) is an annual observance to promote the benefits of immunizations and to improve the health of young children. Since its establishment in 1994, hundreds of communities across the country have joined together to highlight NIIW and its core messages through a variety of activities, including health fairs, media outreach, vaccines clinics, provider education events, Grand Rounds, and other grassroots efforts.  There are plenty of opportunities to utilize NIIW to raise awareness among health care professionals and parents about the positive impact of vaccination, not just for infants and young children, but also for preteens and teens. For example, HPV vaccine communications will be highlighted during this year’s NIIW activities in Indiana.

Whether you’re already deep in the planning process or just starting to think about how you can participate in NIIW, feel free to reach out to the CDC with any questions or to share your plans and activities. You can email Brian Katzowitz or visit the NIVW website for more information.


From GSK: New Transaction to Strengthen Vaccine Portfolio

Today, GSK announced a proposed three-part transaction with Novartis involving their mutual Consumer Healthcare, Vaccines and Oncology businesses. Under the terms of the agreement, GSK and Novartis would combine their consumer healthcare and OTC businesses, respectively, to form a new joint venture; GSK would acquire Novartis’ global Vaccines business (excluding influenza vaccines); and GSK would divest its oncology business comprising the rights to marketed oncology assets to Novartis. A presentation summarizing the details of the transaction is available.

Per GSK, the transaction would enable the company to substantially strengthen two of their core businesses – Vaccines and Consumer Healthcare – through scale and focus, release further value to shareholders and deliver far-reaching benefits to patients and consumers.

The transaction is anticipated to occur during the first half of 2015, subject to shareholder approval and clearance from certain regulatory and tax authorities, as well as appropriate employee consultation requirements.

In the meantime, it’s business as usual for GSK with the manufacture and sale of their consumer healthcare and oncology products and vaccines.


Summit Website Offers Wonderful Resources on Influenza Vaccination!

Remember to visit the Summit website for the latest on influenza immunization resources and to find archived copies of the Summit Buzz.


Reminder: Please email L.J or LaDora if you have any updates on activities to provide to the Summit.


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