August 09, 2016

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Summit Call Recap – Month 04, 2016

Special Announcements

Information from CDC

Announcements

SUMMIT CALL RECAP – MONTH 09, 2016

Influenza Surveillance Update – Stacy Davlin (CDC)

L.J welcomed Stacy Davlin to the call. Stacy will now be providing the surveillance updates from CDC. She is replacing Sophie Smith, who has left CDC to pursue her degree in nursing.

Sophie provided a summary of the published reports for week 30, ending July 30, 2016.

Influenza activity in the U.S. continues to remain low. Overall clinical lab percent positives were similar to the previous week, with 0.9% of specimens submitted found to be positive. Influenza B viruses predominated during week 30, but H1N1 viruses were predominant for the overall season. Influenza-like illness (ILI) activity also was well below the national baseline as of August 4.

The proportion of deaths attributed to pneumonia and influenza (P&I) was below the system-specific epidemic threshold for both the NCHS and 122 Cities Mortality Reporting System.

One influenza-associated pediatric death was reported to CDC during week 30 for a death that occurred earlier in the season. A total of 85 pediatric deaths have been reported during the 2015–2016 season. Of the 71 for whom vaccination status was known, 5 were ineligible for vaccination due to age and 18 were fully vaccinated according to ACIP recommendations.

ILI-Net national data indicated 0.9% of total outpatient visits were for influenza-like illness (ILI), which is below the national baseline of 2.1%.

During the summer CDC’s reporting is abbreviated from the amount of data provided during the height of the influenza season. Therefore, data is not available on several of the reports routinely provided, including geographic spread, hospitalization rates, antiviral resistance, and antigenic characterization.

One Summit partner asked about influenza strains being seen in the Southern hemisphere. Stacy did not have that information available, she will check on this and forward an update to be shared with the Summit. (See below.) During a brief discussion on this topic, it became apparent that this information is helpful in projecting how well the Northern hemisphere vaccine might be a match for circulating strains. It also is helpful when dealing with travelers who want to determine their level of protection if they are traveling to the Southern hemisphere, but are vaccinated in the United States.

Text4baby: Influenza Module Findings – Jessica Bushar and Amy Pirretti (Text4baby/ZERO TO THREE)

Jessica is a senior research analyst at ZERO TO THREE (ZTT), a non-profit organization working to ensure that babies and toddlers benefit from early connections that are critical to their well-being and development. Text4baby is jointly operated by ZERO TO THREE and Voxiva, their technology partner.

Text4Baby is a free text messaging program for pregnant women and mothers of infants up to one year of age. The organization sends out three messages/week that are timed to a mother’s due date or her birth day. They also send out modules of messages focused on different topics, such as influenza vaccination.

Jessica reviewed Evolution of influenza Text4Baby Influenza Vaccine Messaging. This factsheet provides an overview of four years of Text4baby activities, including the messaging that is included and its effectiveness. Influenza messaging was the first major topic area implemented by the group in 2011–2012. The project was the result of partnerships with CDC’s Division of Reproductive Health and the National Center for Immunization and Respiratory Diseases (NCIRD). Other partners include Johns Hopkins, the University of South Florida, and RiteAid.

During the pilot year (2011–2012), it was determined that users were engaged and responsive to the questions. The data collected also was similar to results from CDC’s internet panel surveys. In 2012–2013, more work was conducted to evaluate the effective components of messaging using (1) text-based reminders and (2) tailored messages based on user-reported concerns that resulted in them not getting the vaccine. They found that reminders were effective and that tailored messages on costs were effective, while those related to safety were not effective. At this time CDC also added questions to their survey about Text4baby participation. In 2013-2014, the messaging was changed to include information on where to obtain free/low-cost influenza vaccine, as well as sending a separate reminder to enrolled participants to seek out vaccination. A partnership with RiteAid was added to provide texted coupons for free flu shots. Approximately 13% of these coupons were redeemed. The educational content also was expanded to focus on vaccination of infants greater than six months of age. In 2014–2015, the RiteAid component was expanded. In addition, a feature was added to allow participants to opt out of continued reminders once vaccine had been received. The group also began to look at how the data collected through the program could assist with surveillance.

Jessica also reviewed a second factsheet, Text4baby as a Surveillance Tool for Influenza Vaccination. This factsheet provides background indicating the data collected from Text4baby is similar to data collected through other national surveys, such as the CDC internet panel surveys of pregnant women. The data also compared favorably with PRAMS. One surveillance tool available from the data is a map of state-specific vaccine coverage among pregnant women. Currently the group is considering how the Text4baby tool can be used for surveillance in other areas in the future.

Mothers wishing to enroll in the program can text “baby” or “bebe” (Spanish) to 511-411. Three questions are asked of potential participants, including their zip code, due date, and what type of user they are, i.e., pregnant, new mom, or other.

Jessica encouraged Summit partners to promote Text4baby as a tool to promote influenza vaccination during the upcoming season. Persons wishing to get more information about the program may contact Jessica Bushar.

L.J asked about whether the group’s data indicated influenza vaccination among users has increased over the years since the project began. Jessica referred to the summary chart in the surveillance document. Users are contacted three times during the season to determine if they have been vaccinated. Unfortunately, the coverage levels have remained relatively stable over the years and do not indicate a great deal of growth.

Some of the questions initially asked by Text4baby have changed over the years. The group no longer asks participants if they want a text reminder; this is just done automatically. They also no longer ask whether you plan to receive the vaccine as a criteria point for inclusion in messaging. More information about the surveillance methodology may be found in the endnotes.

Persons wishing to obtain more information about Text4baby are encouraged to attend a presentation on this subject at the National Immunization Conference.

Other Items – L.J Tan (IAC)

J reminded members that registration is open for the 47^th National Immunization Conference, which will be held at the Hilton Hotel in Atlanta on September 13–15.

Summit calls are scheduled weekly, unless cancelled.

SPECIAL ANNOUNCEMENTS

Updates on the Summit Working Groups and Upcoming Calls

With the agreement of the Working Group co-leads, the Summit has combined the Provider WG and the Access and Collaboration WG into a single Access and Provider WG. The co-leads for this group will be Laura Lee Hall (ACP), Debra Hawks (ACOG), Mitch Rothholz (APhA), Kimberly Martin (ASTHO), Carolyn Bridges (CDC), and L.J Tan (IAC).

Additionally, as the Patient Education WG’s work has reached a natural stopping point, the Summit will be transitioning down that WG. However, some of the ongoing activities of the WG will continue, and the we will do so by improving the way the Summit continues to share communications, new happenings, and opportunities on the weekly Summit calls.

As new action items emerge, the Summit will form specific sub-task forces to advance those issues.

Upcoming Working Group Calls

Access and Provider WG – August 17, 2:00 pm ET.
Quality Measures WG – August 22, 12:00 pm ET.
Influenza WG – No call currently scheduled, as this group is finalizing documents discussed at the Summit in-person meeting.

Follow up from August 4 Summit Call on Southern Hemisphere Surveillance

In response to a question on the August 4 Summit call regarding influenza activity in the Southern hemisphere, Stacy forwarded summary data from the World Health Organization’s (WHO) Global Influenza Surveillance and Response System (GISRS). This information was developed from WHO’s FluNet system, a global tool for influenza virological surveillance.

INFORMATION FROM CDC

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

The CDC weekly influenza surveillance report for week 30 (ending July 30, 2016) and region specific data are now available.

NCHS mortality surveillance data for week 28 (ending July 16 2016, but available August 4, 2016) indicate 5.3% of deaths were due to pneumonia and influenza (P&I). This percentage is below the epidemic threshold of 6.2% for week 28. Region and state-specific NCHS data are available online. During week 30, 4.9% of all deaths reported through the 122 Cities Mortality Reporting System were due to P&I. This percentage was below the epidemic threshold of 5.8% for week 30.

May 15–21, 2016 marks the final full influenza surveillance report for the 2015–2016 influenza season in the United States. Influenza surveillance in the U.S. will continue through the summer months with condensed reports available on the FluView website. Full publication of the complete FluView resumes on October 14, 2016.

One influenza-associated pediatric deaths were reported to CDC during week 30. This death was associated with an influenza B virus and occurred during week 11 (ending March 19, 2016). A total of 85 influenza-associated pediatric deaths have been reported during the 2015–2016 season. 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). Influenza hospitalization rates and virus characterization are available on the FluSurv-NET website.

Nationwide during week 30, 0.9% 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 2.1%. 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 May 21, 2016. Resumption of this reporting will occur in October 2016.

The final CDC/Influenza Division Weekly Influenza Surveillance Report (FluView) was issued on Week 20, and the final seasonal influenza key points document for the 2016–2017 influenza season was provided on May 27, 2016. After that point, seasonal influenza key points will no longer be released on a fixed schedule, but will be issued as they are warranted, such as in conjunction with the release of important flu-related publications or guidance or unexpected increases in flu activity. Full reporting for the 2017–2018 influenza season will begin in mid-October 2017, and will appear in FluView. Archives of previous FluViews are available online.

CDC NIAM Maternal Vaccination Week Resources

The National Immunization Awareness Month week of August 9–15 will highlight maternal vaccinations. The theme for the week is “Protect yourself and pass protection on to your baby.” To help you with your planning efforts, CDC wanted to remind you of the resources they have available for this audience.

The Centers for Disease Control and Prevention (CDC), in partnership with the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Nurse-Midwives (ACNM), and the American College of Obstetricians and Gynecologists (ACOG), recently launched a new campaign to educate pregnant women about the importance of Tdap vaccine during pregnancy. The campaign is based on extensive formative research with pregnant women and prenatal care providers.

In addition to Tdap resources, CDC also has a variety of materials about the importance of flu vaccine during pregnancy. You can find all of Tdap and flu resources online (links and descriptions below). CDC hopes that they will be useful as you plan your NIAM outreach and beyond.

Access resources for healthcare professionals:

Tdap
- Pregnancy recommendation fact sheets covering both the importance of prenatal Tdap vaccination and how to make a strong referral if an office does not stock the vaccine
- Updated continuing education webcast that reviews the clinical presentation of whooping cough (pertussis), how to test and treat appropriately, and who to vaccinate and when
- Additional materials including Vaccine Information Statements, instructional videos, and more

Flu
- Infographic with latest flu vaccination coverage estimates among pregnant women, from 2013-2014 season
- Letter to providers about the importance of vaccinating pregnant women
- Customizable cards to help ob-gyns remind pregnant women to get vaccinated
  - 2 English versions available for Caucasians and African Americans, similar to prescription pads
  - Spanish customizable posters are also available
- Podcast discussing why pregnant women need the flu vaccine

Share resources for pregnant women:

Tdap
- Posters featuring the new “Born with Protection against Whooping Cough” message, in English and Spanish, encouraging women to talk with their doctor or midwife about Tdap vaccination during their 3^rd trimester of pregnancy
- Protect Your Baby from the Start (also available in Spanish)
- Protect your Baby Starting at Her First Breath (English only)
- Mom, You’ll Always Protect Your Little Miracle (Spanish Only)
- A fact sheet, in English and Spanish, explaining that when pregnant women receive the Tdap vaccine during their 3^rd trimester they can pass antibodies to their babies before birth, providing them with protection from whooping cough until they are old enough to receive their own vaccination
- A radio PSA (also available in Spanish) encouraging women to get the Tdap vaccine during their 3^rd trimester
- “Born with Protection against Whooping Cough” podcast (also available in Spanish) featuring a CDC medical officer who is also a pediatrician and mom of a new baby girl

Flu
- Pregnant women and the flu fact sheet in English and Spanish
- Posters and flyers showing the risks associated with getting the flu while pregnant
- An animated image for pregnant women that can be shared on social media
- Other pregnancy and flu web tools including buttons and eCards

Use Social Media to Promote the Messages

Please help CDC get the word out about what they have available. They have prepared some social media messages to assist you:

For healthcare professionals:

CDC recommends 3^rd trimester #whoopingcough vaccine for women during each of their pregnancies. Learn more: http://1.usa.gov/1N7YCmC
CDC recommends the #flu shot (not the nasal spray) for pregnant women at any point during their pregnancy. http://go.usa.gov/37Cmc
Ob-gyns & midwives: Don’t carry Tdap in your office? See CDC’s tips for making a strong vaccine referral http://1.usa.gov/1xdml0S
Ob-gyns & midwives: Encourage your patients to get the 3^rd trimester Tdap vaccine with new posters & fact sheets http://1.usa.gov/1CPbvin
You are your patients’ most trusted source of vaccine info. Here’s info you can trust when you talk to them: http://1.usa.gov/1l92LXR
Pregnant women can receive the #flu shot at any time, during any trimester, while pregnant http://1.usa.gov/1lVNXPl
#Flu is more likely to cause severe illness in pregnant women than in women who are not pregnant http://1.usa.gov/1lVNXPl
Pediatricians: Encourage 3rd trimester Tdap during each pregnancy to protect babies until DTaP at 2 mos. http://1.usa.gov/1CPbvin

For pregnant women:

Get vaccinated and your baby can be born with protection against #whoopingcough and the #flu
3^rd trimester #whoopingcough vaccine passes antibodies to your baby, helping protect her until she gets vaccinated http://1.usa.gov/1N7XgIs
#Whoopingcough can be deadly for babies. Learn how to help protect your baby with a vaccine in your 3^rd trimester http://1.usa.gov/1N7XgIs
Vaccine protection starts before birth. Make sure to get #whoopingcough and #flu vaccines http://1.usa.gov/1N7XgIs
When pregnant women get #flu shots, they and their babies (after birth) get the flu less often.
Studies show that the #fluvax helps protect women and their babies during pregnancy and up to 6mos after they’re born. #getafluvax

Use CDC’s website to stay up-to-date

You can visit CDC’s new Pregnancy and Whooping Cough Webpage to see all of the new content reorganized by audience to make it easier for you to access the resources you need.

On CDC’s Flu Vaccine Resources for Pregnant Women webpage, you can quickly access, download, and print flu materials.

CDC also encourages you to syndicate its content on your website. Syndication gives you the ability to add CDC content directly to your website. When CDC updates content, those updates will automatically appear on your site. This will save you valuable time and ensure that your site is as up to date as possible. Below are links to syndicated content related to pertussis, flu, and pregnant women:

Pertussis Syndicated Content

Pertussis Vaccine (Tdap) Syndicated Content

Pregnancy Syndicated Content

Please let us know if you have any questions or additional requests for information. Also, we’d like to know what you are doing to promote maternal vaccination and to educate your membership about whooping cough (pertussis) and the flu. Please send us an e-mail and let us know. Thank you for your continued support and assistance!

CDC Clinician Outreach and Communication Activity (COCA) Information

CDC Science Clips: Volume 8, Issue 32, August 9, 2016

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.

Upcoming and Recent COCA Webinars/Calls

Updated Interim Zika Clinical Guidance for Pregnant Women and Data on Contraceptive Use to Decrease Zika-affected Pregnancies

During this COCA Call, clinicians were advised about the updated CDC interim guidance for caring for pregnant women with possible Zika virus exposure, and learned about strategies for increasing access to contraceptive methods and services to minimize the number of pregnancies affected by Zika.

Archived COCA conference calls are available. Free continuing education credits (CME, CNE, ACPE, CEU, CECH, and AAVSB/RACE) are available for most calls. For more information about free CE is available online.

CDC Learning Connection

The CDC Learning Connection is your source for information about public health training developed by CDC, CDC partners, and other federal agencies. Through website features, social media, and an e-newsletter, CDC Learning Connection keeps you informed about training opportunities, including many that offer free continuing education (CE).

ANNOUNCEMENTS

New Film Educates Seniors on Adult Vaccination

In recognition of National Immunization Awareness Month (NIAM), the Alliance for Aging Research released a new “pocket film” to urge seniors to get their recommended vaccines and to encourage their loved ones to do the same.

This short, animated film gives an overview of how vaccines work, highlights the importance of vaccination, and debunks common myths. It addresses the need for vaccination later in life, encourages communication with health care professionals, and reminds older adults of their influential role in increasing the immunity of their families and social circles.

Please feel free to share this resource through your website, newsletter, and social media accounts. For more information, please visit the website of the Alliance for Aging Research.

In-Pharmacy Availability of Influenza Vaccine Increases Uptake

Canadians living in provinces where pharmacists may administer influenza vaccines are more likely to report annual immunization than residents in areas with administration limited to health care providers, according to data recently published in CMAJ. A news story about this research also is available.

FDA Advisors Schedule Meeting to Review Hepatitis B Vaccine

The FDA’s Vaccines and Related Biological Products Advisory Committee (VBRPAC) will review the biologics license application for Heplisav-B (hepatitis B vaccine, recombinant [adjuvanted], Dynavax Technologies Corporation) at a meeting scheduled for November 16. Heplisav-B is a vaccine candidate for immunization against infection caused by all known subtypes of hepatitis B virus in adults (18 years of age and older). The vaccine is currently under FDA review, with a Prescription Drug User Fee Act (PDUFA) action date of December 15, 2016.

Why Black and Hispanic Adults 65 and Older Should Get Vaccinated

Discussions surrounding health disparities within minority communities continuously focus on two issues: high percentages of heart disease and diabetes rates. The gaze is usually offset from a silent killer for Black and Hispanic adults age 65 and older – pneumococcal pneumonia. According to the CDC, pneumococcal disease kills about 18,000 adults 65 years or older.

On Friday morning, over 100 journalists gathered at the joint conferences for the National Association of Black Journalists and the National Association of Hispanic Journalists to listen to three leading health professionals of color.

Dr. Freda Lewis-Hall, Pfizer’s Chief Medical Officer; Dr. Jorge Rodriguez, a certified internist and regular contributor on The Doctors; and Dr. Regina Benjamin, a former U.S. Surgeon General and chair of the National Prevention Council, addressed the crowd about the importance of vaccinations to protect older adults in disenfranchised communities from contracting serious, but preventable diseases.

Death Reported as Meningitis Outbreak Grows

Three new cases, including one additional death, have been reported in the Southern California Outbreak of Invasive Meningococcal Disease. In its press release Orange County immediately urges all gay men to get vaccinated against the disease, leading some to speculate that the death and or the new cases involved gay men..

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:

Providing a strong recommendation (with video vignettes)
Assessing the patient for adult vaccines.

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. The next call is scheduled for August 18. Please email L.J Tan or LaDora Woods if you have any updates on activities to provide to the Summit.