April 25, 2016

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Summit Call Recap
Announcements
Upcoming Deadlines
Information From CDC
Other News

SUMMIT CALL RECAP

(Although a Summit call was not held on April 21, the updated surveillance summary is provided below.)


Influenza Surveillance Update – Sophie Smith (CDC)

This summary is from data for week 14 ending April 9, 2016. During week 14, flu activity decreased slightly, but remained elevated in the U.S.

For week 14, of the viruses tested in clinical labs, 14.0% were positive for influenza. Of these, 58.2% were influenza A and 41.8% were influenza B. In public health labs, there were 955 specimens tested during week 14, 379 of which were positive for influenza. Of these, 240 were influenza A viruses, and 139 were influenza B viruses.

CDC has characterized 1,604 influenza viruses [606 A (H1N1) pdm09, 411 A (H3N2), and 587 influenza B virus] collected by U.S. laboratories since October 1, 2015. All 606 H1N1 pdm09 viruses were antigenically characterized as A/California-like. All 411 H3N2 viruses were genetically sequenced and were similar to genetic groups for which a majority of viruses antigenically characterized were similar to A/Switzerland; a subset of 193 H3N2 viruses were antigenically characterized with 185 of the 193 viruses being A/Switzerland-like. 358 of the B viruses were of the Yamagata lineage, and were antigenically characterized as B/Phuket-like, and there were 229 B viruses of the Victoria lineage, with 223 of the 229 antigenically characterized as B/Brisbane-like.

To date this season, 2,691 viruses (including 1,469 influenza A H1N1 pdm09, 485 influenza A H3N2, and 737 influenza B viruses) have been tested for antiviral resistance. There were 11 influenza A H1N1 pdm09 virus that were resistant to oseltamivir and peramivir. All of the other viruses tested were sensitive to all three inhibitors.

Based on the most up to date NCHS mortality surveillance data available on April 14, 7.1% of the deaths occurring during the week ending March 26 (week 12) were due to pneumonia and influenza (P&I), which is below the NCHS specific epidemic threshold of 7.5% for week 12.

Based on the 122 Cities Mortality Reporting System, during week 14, 7.5% of all deaths reported through this system were due to P&I, which is above the 122-cities specific epidemic threshold of 7.1% for week 14.

Ten influenza-associated pediatric deaths were reported to CDC during week 14. A total of 50 influenza-associated pediatric deaths have been reported during the 2015–2016 season. Of the 50 deaths, six had unknown vaccination history, three were ineligible for vaccination due to age, four were fully vaccinated, and 37 were unvaccinated.

Hospitalization data showed that for week 14, the cumulative hospitalization rate was 26.6 lab-confirmed flu associated hospitalizations per 100,000 population. The highest hospitalization was among adults aged >65 years (69.6 per 100,000), followed by adults aged 50–64 (38.6 per 100,000) and children aged 0–4 (36.8 per 100,000). The majority of hospitalizations were associated with flu A at 77.9%, among which the majority were A(H1N1)pdm09. Hospitalizations were also associated with flu A/H3, flu B, and flu A/B coinfections.

For week 14, the proportion of outpatient visits for ILI reported to ILINet was 2.1%, which is lower than the previous week and at the national baseline of 2.1%. On a regional level, the percentage of outpatient visits for ILI ranged from 1.5% to 2.9% during week 14. Six of 10 regions (Regions 1, 2, 3, 4, 8, and 10) reported a proportion of outpatient visits for ILI at or above their region-specific baseline levels.

The geographic spread of influenza as assessed by state and territorial epidemiologists indicates the following levels of influenza activity during week 14:

  • Widespread – 18 states and Puerto Rico
  • Regional – 19 states and Guam
  • Local – 10 states and the District of Columbia
  • Sporadic – 3 states and the Virgin Islands

ANNOUNCEMENTS


Various Announcements
  • The 2016 National Adult and Influenza Immunization Summit is scheduled for May 10–12, 2016 in Atlanta, GA. The password-protected registration site is now available online. Persons needing the password for this invitation only event may contact L.J Tan or LaDora Woods. Persons needing a hotel room are asked to go through the Summit website when making hotel reservations and to request a room soon, as the rooming block is filling up quickly.

UPCOMING DEADLINES


Adult Vaccine Access Coalition (AVAC) Hosts Thunderclap

AVAC is hosting its first Thunderclap campaign on April 27 at 10 am ET to mark National Minority Health Month and World Immunization Week. April is a great opportunity to talk about how vaccines remain beyond the reach of far too many Americans – particularly minorities, for whom immunization rates are significantly lower on average than the general population.  If enough people say they support AVAC, the Thunderclap will blast out a timed and automatic Facebook post and/or Tweet from all of you and your supporters to create a wave of attention about minorities receiving fewer vaccines.

In order for Thunderclap to disseminate the shared message, we need at least 100 supporters to sign up by April 26.  The good news is that it takes 5 minutes to join! All you have to do is sign on so that we can all share one consistent message simultaneously and show strong support for AVAC. Additional Thunderclap information is available with suggested social media, newsletter, email, and website language to make it easy for you to promote joining the Thunderclap to your networks.


Every Child by Two Hosting Vaccine Twitter Chat on April 26

Dr. Richard Besser, ABC’s Chief Health and Medical Editor, will be hosting a Vaccine Twitter Chat along with Every Child By Two (ECBT) and the American Academy of Pediatrics on April 26, in celebration of Global Immunization Week. ECBT is reaching out to you as a critical immunization partner to encourage your participation in the chat. This will allow you to increase the reach of your immunization materials, resources, and messaging, while also sharing your expertise with ABC’s followers.

Each week Dr. Besser encourages researchers, clinicians, bloggers, and especially patients themselves to participate in his chats, which often generate millions of impressions.  Since we will be discussing vaccines (global and domestic) on this chat, we seek your help in publicizing the event and encouraging participation among your colleagues and social media followers.

Dr. Besser is eager to engage with immunization partners. If you or your organization is willing to participate, please reply directly to Amy Pisani at ECBT. We are happy to provide more details in advance and include your Twitter account in our promotional messaging leading up to the chat.

Details:
Tuesday, April 26
1–2 pm ET
#abcDRBchat
Moderator @abcDRBchat


Help IAC Promote Its June Workshops in the Northeast to Improve Implementation of Standing Orders for Adult Vaccines

Please help IAC get the word out to Massachusetts, New York, Pennsylvania, and Maryland medical practices on the availability of workshops to help them implement standing orders for adult vaccinations. These workshops are part of a national initiative to put standing orders into action. IAC is also delighted to announce that immunization thought leaders such as Dr. Susan Lett will be presenting at the different workshops.

Additional information, including workshop locations and how to register, is available on the project website. As part of the initiative, IAC is offering a full year of free follow up support to medical practices that participate in the workshop and implement standing orders for adult vaccines.


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 16, 2016) and region specific data are now available.

NCHS mortality surveillance data for week 13 (ending April 2, 2016, but available April 21, 2016) indicate 6.8% of deaths were due to pneumonia and influenza (P&I). This percentage is below the epidemic threshold of 7.5% for week 13. Region and state-specific NCHS data are available online. During week 15, 7.7% of all deaths reported through the 122 Cities Mortality Reporting System were due to P&I. This percentage was above the epidemic threshold of 7.0% for week 15.

CDC has characterized 1,707 influenza viruses [688 A (H1N1)pdm09, 431 A (H3N2), and 588 influenza B viruses] collected by U.S. laboratories since October 1, 2015. All 431 influenza A (H3N2) viruses were genetically sequenced and all viruses belonged to genetic groups for which a majority of viruses antigenically characterized were similar to the cell-propagated A/Switzerland/9715293/2013, the influenza A (H3N2) reference virus representing the 2015–2016 Northern Hemisphere vaccine component. A subset of 193 influenza A (H3N2) viruses also were antigenically characterized; 185 of 193 (95.9%) H3N2 viruses were A/Switzerland/9715293/2013-like by HI testing or neutralization testing.

All 688 (100%) influenza A (H1N1)pdm09 viruses were antigenically characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2015-2016 Northern Hemisphere vaccine. All 359 (100%) influenza B/Yamagata-lineage viruses were antigenically characterized as B/Phuket/3073/2013-like, which is included as an influenza B component of the 2015–2016 Northern Hemisphere trivalent and quadrivalent influenza vaccines. Two hundred twenty-three of 229 (97.4%) influenza B/Victoria-lineage viruses were antigenically characterized as B/Brisbane/60/2008-like, which is included as an influenza B component of the 2015–2016 Northern Hemisphere quadrivalent influenza vaccines.

Six influenza-associated pediatric deaths were reported to CDC during week 15. Three deaths were associated with an influenza A (H1N1)pdm09 virus and occurred during weeks 13 and 14 (the weeks ending April 2 and April 9, 2016), and two deaths were associated with an influenza A virus for which no subtyping was performed and occurred during week 14 (the week ending April 9, 2016). One death was associated with an influenza B virus and occurred during week 12 (the week ending March 26, 2016).

A total of 56 influenza-associated pediatric deaths have been reported during the 2015–2016 season from Puerto Rico [1], Chicago [1], and 25 states (Arizona [3], California [9], Colorado [1], Florida [7], Illinois [1], Indiana [2], Louisiana [1], Maine [1], Maryland, [1], Massachusetts [2], Michigan [1], Minnesota [3], Mississippi [1], Montana [2], Nebraska [1], Nevada [3], New Jersey [1], New York [3], North Carolina [1], Ohio [1], Tennessee [2], Texas [4], Virginia [1], Washington [1], and Wisconsin [1]). More detail is available on CDC’s Influenza-Associated Pediatric Mortality webpage.

The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in children younger than 18 years of age (since the 2003–2004 influenza season) and adults (since the 2005–2006 influenza season) in select counties in the Emerging Infections Program (EIP) states and Influenza Hospitalization Surveillance Project (IHSP) states.

Between October 1, 2015 and April 16, 2016, 7,850 laboratory-confirmed influenza-associated hospitalizations were reported. The overall hospitalization rate was 28.4 per 100,000 population. The highest rate of hospitalization was among adults aged ≥65 years (75.0 per 100,000 population), followed adults aged 50-64 (41.1 per 100,000 population) and children aged 0-4 years (38.8 per 100,000 population). Among all hospitalizations, 6,049 (77.0%) were associated with influenza A, 1,723 (21.9%) with influenza B, 39 (0.5%) with influenza A and B co-infection, and 40 (0.5%) had no virus type information. Among those with influenza A subtype information, 1,895 (88.6%) were A(H1N1)pdm09 and 243 (11.4%) were A(H3N2) virus.

Clinical findings are preliminary and based on 1,798 (21.4%) cases with complete medical chart abstraction. The majority (91.4%) of hospitalized adults had at least one reported underlying medical condition; the most commonly reported were obesity, cardiovascular disease, metabolic disorders and chronic lung disease. There were 264 hospitalized children with complete medical chart abstraction; 136 (52.1%) had at least one underlying medical condition. The most commonly reported underlying medical conditions among pediatric patients were asthma and neurologic disorders. Among the 183 hospitalized women of childbearing age (15-44 years), 44 (24.0%) were pregnant.

Nationwide during week 14, 2.1% 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 above the national baseline of 2.1%. ILI is defined as fever (temperature of 100°F [37.8°C] or greater), and cough and/or sore throat.

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. This currently reflects data from April 16, 2016. Currently 15 states are reporting widespread activity, 20 states are reporting regional activity, and the remaining states are reporting local or sporadic activity.

CDC Influenza Division seasonal influenza key points for April 22 are now available, as is the FluView report for week 15, ending April 16. Archives of previous FluViews also may be found online.


CDC Concludes Zika Causes Microcephaly and Other Birth Defects

Scientists at the Centers for Disease Control and Prevention (CDC) have concluded, after careful review of existing evidence, that Zika virus is a cause of microcephaly and other severe fetal brain defects. In the report published in the New England Journal of Medicine, the CDC authors describe a rigorous weighing of evidence using established scientific criteria. Additional information may be found in CDC’s Media Statement.


MMWR: Patterns in Zika Virus Testing and Infection, by Report of Symptoms and Pregnancy Status — United States, January 3 – March 5, 2016

As reported in the MMWR, a low proportion of persons who had testing for Zika virus in the United States had confirmed Zika virus infection. Approximately 99% of asymptomatic pregnant women who were tested had no laboratory evidence of Zika virus infection. Given the potential for adverse pregnancy and infant outcomes associated with Zika virus, healthcare providers can continue to offer Zika virus testing to asymptomatic pregnant women with potential exposure. However, these data suggest that in the current U.S. setting, the likelihood of Zika virus infection among asymptomatic persons is low.


CDC Measles Update

CDC has new measles information and resources available for you to share with your membership, including key points that can be obtained upon request. These key points are meant to be a resource for increasing awareness of measles activity, other pertinent information, and communicating measles-related messages.

Contact Jill Woodard at the CDC if you have any questions or additional requests for information.  Also, CDC would like to know what you are doing to promote MMR vaccination and measles education to your membership..


CDC Clinician Outreach and Communication Activity (COCA) Information

CDC Science Clips: Volume 7, Issue: 49 – (CDC)

Each week select science clips are shared with the public health community to enhance awareness of emerging scientific knowledge. The focus is applied public health research and prevention science that has the capacity to improve health now.

Seasonal Influenza Information for Healthcare Professionals
The CDC’s Long Term Care toolkit is also available at his website.

Upcoming and Recent COCA Webinars/Calls

Updated Interim Zika Clinical Guidance for Reproductive Age Women and Men, Sexual Transmission of Zika, and the U.S. Zika Pregnancy Registry

Date: Tuesday, April 12, 2016
During this COCA call, clinicians learned about:

  • Updated CDC interim guidance for on caring for reproductive age women and men with possible Zika exposure
  • CDC interim guidance for prevention of sexual transmission of Zika
  • Preventing transmission of Zika virus in labor and delivery settings
  • Interpreting pediatric testing guidance
  • US Zika Pregnancy Registry

Archived COCA conference calls are available, and free continuing education credits (CME, CNE, ACPE, CEU, CECH, and AAVSB/RACE) are available for most calls.


OTHER NEWS


From the Adult Vaccine Access Coalition (AVAC)

A Congressional sign-on letter regarding the burden of cost sharing for immunizations under the Medicare Part D program was circulated by Representatives Eddie Bernice Johnson (D-TX-30), Ami Bera (D-CA-07) and Michelle Lujan Grisham (D-NM-01) and sent to CMS Acting Administrator Slavitt. Representative Johnson has issued a press release about this effort.

An AVAC-spearheaded op-ed on adult vaccine access from Rep. Gene Green (D-TX-29) and Litjen (L.J) Tan was published in The Hill last week. AVAC asks if you all could share the op-ed far and wide among your networks, so they have included some suggested language to promote it.


2016–2017 Influenza Season – U.S. Influenza Vaccine Composition

The World Health Organization (WHO) has recommended vaccine viruses for the 2016–2017 influenza season Northern Hemisphere vaccine composition, and the Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) has made the vaccine composition recommendation to be used in the United States. Both agencies recommend that trivalent vaccines contain an A/California/7/2009 (H1N1)pdm09-like virus, an A/Hong Kong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008-like (B/Victoria lineage) virus. It is recommended that quadrivalent vaccines, which have two influenza B viruses, contain the viruses recommended for the trivalent vaccines, as well as a B/Phuket/3073/2013-like (B/Yamagata lineage) virus. This represents a change in the influenza A (H3) component and a change in the influenza B lineage included in the trivalent vaccine compared with the composition of the 2015–2016 influenza vaccine. The vaccine viruses recommended for inclusion in the 2016–2017 Northern Hemisphere influenza vaccines are the same vaccine viruses that were chosen for inclusion in 2016 Southern Hemisphere seasonal flu vaccines. These vaccine recommendations were based on several factors, including global influenza virologic and epidemiologic surveillance, genetic characterization, antigenic characterization, antiviral resistance, and the candidate vaccine viruses that are available for production.


ASCO Publishes Statement Urging Aggressive Efforts to Increase HPV Vaccination

The American Society of Clinical Oncology (ASCO) has published a statement urging aggressive efforts to increase HPV vaccination and prevent cancer. The group also has developed an infographic on this topic.


Why Partnerships Are Crucial for Pushing Vaccine R&D Forward

The amount of time, money, and effort expended to develop a new dengue vaccine demonstrates the challenging cost calculus required to bring a new vaccine to market. Sanofi Pasteur spent 20 years working on its dengue vaccine, enrolling over 40,000 volunteers in 25 clinical studies. On top of this heavy investment burden, vaccines typically command lower prices than other drugs, making the commercial case for vaccine development less compelling for pharmaceutical companies. From a public health standpoint, however, vaccines are vital for large, at-risk populations.

This combination of need and challenging economics leads Dr. Jim Tartaglia, global vice president of new vaccine projects at Sanofi Pasteur, to believe novel partnerships between companies are vital to continue pushing R&D money into new disease areas.


“Mesa Consortium” Becomes Research Hub for New Human Vaccines Project

Four scientific institutions – University of California, San Diego, J. Craig Venter Institute, La Jolla Institute for Allergy and Immunology and The Scripps Research Institute – have teamed up to create the “Mesa Consortium,” a new scientific hub for the Human Vaccines Project. Under a collaborative agreement, the Mesa Consortium and the Human Vaccine Project aim to transform current understanding of the human immune system and expedite development of vaccines and biologics to prevent and treat many global diseases.


The First Dengue Vaccine and Fight against “Breakbone Fever”

The Philippines this week launched the world’s first public dengue immunisation program, vaccinating 600 children at a school in the capital Manila with the goal of reaching 1 million students across the country this year. Dengue, also known as “breakbone fever”, has spread rapidly around the world in recent decades, and about half the world’s population is now at risk. Scientists have been working on a vaccine for decades, and the first one received market approval in December in Mexico.


NFID Publishes Call To Action on Adolescent Vaccination

The National Foundation for Infectious Diseases (NFID) has announced the publication of the final Call to Action: Addressing New and Ongoing Adolescent Vaccination Challenges. Vaccines are one of the most effective public health interventions available to protect individuals of all ages. Persistent gaps in vaccination coverage leaves adolescents at risk for HPV-related cancers, meningitis, and annual outbreaks of influenza among other infectious diseases. Read more about the risks and ways to improve vaccination rates in the Call to Action.

We encourage you to share this widely with your members and constituents. Additionally, for those of you using social media, please share the following message with the attached image:

Adolescent #vaccination rates are below US public health goals. Read more: http://ow.ly/ZjVll and #RaiseVaxRates.

A companion webinar and consumer tool will also be developed in August 2016, in conjunction with National Immunization Awareness Month. NFID thanks you for your continued support.


WHO Stays Positive as Dose of Reality Hits Malaria Vaccine Hopes

Malaria still kills more than 400,000 people a year, most of them children in Africa. But new weapons are arriving to aid the fight against it, most notably a vaccine that could eventually protect millions from infection. So why, with so much good news, is the mood not more celebratory? For decades, a malaria vaccine was seen as the holy grail of tropical medicine. Yet, now one has arrived, it is causing fraught debate.

After 30 years of development by GlaxoSmithKline and its predecessor companies, the Mosquirix vaccine — also known as RTS, S — was endorsed last year by the European drugs regulator and the World Health Organization. On the face of it, the rulings were a vindication of the hundreds of millions of dollars invested in the project by GSK and donors led by the Bill & Melinda Gates Foundation.

The recommendations came with strong caveats and conditions, however, because the clinical data in favor of the vaccine were far from overwhelming. Malaria cases were reduced by between a third and a half in children aged 5–17 months — much lower than most vaccines. Moreover, the WHO concluded that four separate doses were required to provide enduring protection.


Did Flu Kill Pop Icon Prince? What You Should Know About Influenza

Singer-songwriter Prince passed away on Thursday in his Minnesota home at the age of 57, following reports that he had been suffering from the flu in the past few days. While it remains uncertain what exactly caused the pop superstar’s death, doctors said it wouldn’t be surprising if his passing was connected to his recent respiratory infection. Dr. Amesh Adalja, an expert on infectious diseases from the University of Pittsburgh Medical Center, said that many people tend to underestimate how life-threatening the flu can be.


Race for Universal Flu Vaccine Gathers Pace

One of the highest priorities in medical virology is to develop a “universal vaccine” that would protect against any strain of the disease. A breakthrough like that would cut out the expensive and time-consuming process of preparing vaccines against seasonal flu, which kills an estimated 250,000-500,000 people a year. It would also be a lifesaver should a virulent new strain of pandemic flu emerge, perhaps through the mutation of a porcine or avian flu virus.


Please Help the Summit, AIRA, and CDC Engage EHR Vendors in Immunization IT

The Summit has been active and interested in improving interoperability and utilization of EHRs and immunization information systems (IIS) for several years. Indeed, for the past two years, there has been a lot of prioritization of IIS and health information technology (HIT) activity within the Summit workgroups.

However, engagement by vendors of EHRs remains difficult. We hope that, with the Summit’s support, we can begin to change that in little steps. If you are connected with an EHR vendor, perhaps you can start by encouraging them to simply join in two activities in the IIS community that are not demanding on their time.

The first is the AIRA Standards & Interoperability Steering Committee (SISC). SISC provides technical support and guidance to interoperability efforts of AIRA members and the IIS community. They act as a liaison between national organizations involved with interoperability, such as the Office of the National Coordinator (ONC) and others, and serve as a technical resource for AIRA members and the IIS community.  SISC meets the 2nd Wednesday of every month from 1–2 pm ET. Participation of EHR, pharmacy, health information exchange (HIE), and other IIS partners trading perspectives is welcomed to help drive forward increased interoperability. For more information, please connect with Mary Beth Kurilo.

The second is the CDC Clinical Decision Support for Immunization (CDSi) project. This project provides a single, authoritative, implementation-neutral foundation for development and maintenance of CDS engines. It captures ACIP recommendations in an unambiguous manner and improves the uniform representation of vaccine decision guidelines, as well as the ability to automate vaccine evaluation and forecasting. Interested parties can reach out to Eric Larson.


Three Slide Decks Available to Support New Standards for Adult Immunization Practice

The Summit’s Access and Collaboration workgroup has developed three separate slide decks with talking notes to support partners and others who wish to present on the Standards to their peers and colleagues. The three audiences targeted by the decks are: healthcare providers; patients/public; and public health. These are now available, along with tips and tools on how to use them, at the Summit website.

Also do not forget that Medscape has produced two modules to support the implementation of the Standards:


Every Child By Two (ECBT) Compiles Media Information on Its Website

On a daily basis, ECBT assembles significant news media coverage on immunizations in their “Daily Clips.” Summit partners may find this effort useful.


Summit Website Offers Wonderful Resources on Influenza Vaccination

Remember to visit the Summit website for the latest on influenza immunization resources. You also can find archived copies of The Summit Buzz there.


Reminder

Summit calls are now scheduled every Thursday at 3 p.m. Eastern time, unless cancelled. Please email L.J Tan or LaDora Woods if you have any updates on activities to provide to the Summit.