December 8, 2014

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Summit Call Recap – December 4, 2014
Information from CDC
Announcements

SUMMIT CALL RECAP – DECEMBER 4, 2014


Vaccine Facts and Policy – Katelyn Wells (AIM)

Because time was short during the November 20 Summit call when Katelyn gave a presentation on the Vaccine Facts and Policy website, she returned to the call today to offer partners an opportunity to ask questions. She also noted that the project partners (GWU, AIM, and IAC) have received some great feedback via email on additional topics partners would like to see incorporated, as well as ideas for future functionalities. She encouraged Summit members to review the website to provide additional feedback. She also reminded them that staff are available to provide webinars or other presentations on the use of this resource. Carolyn Bridges suggested that information about the site should be shared with academic groups (e.g., teachers of preventive medicine) that work on vaccine.


Influenza Surveillance Update – Sophie Smith (CDC)

Sophie provided a summary of the published reports for week 47, ending November 22. Approximately 12.6% of specimens submitted for testing were positive, with a mixture of both A and B. The ILI-Net national data indicated 2.0% of total patient visits were for ILI, which is at the national baseline level for this week. Of the ILI-related deaths reported during week 47, 5.3% were attributed to pneumonia and influenza (P&I), below the 6.4% baseline level for week 47. The first week of reported hospitalizations indicated 1.1 laboratory-confirmed influenza-associated hospitalizations per 100,000 population.

Four new pediatric deaths were reported during the week. Of the 3 deaths reported for week 46, 2 were influenza A (H3) and 1 was influenza B. An additional pediatric death reported from week 43 was not subtyped. A total of 5 pediatric deaths have been reported so far during the 2014–2015 season.

As shown in CDC’s weekly influenza summary map, the geographic spread for influenza for week 47 is:

  • Widespread – 2 states
  • Regional – 9 states, Puerto Rico
  • Local – 20 states
  • Sporadic –  17 states, District of Columbia, Virgin Islands
  • No activity –  2 states
  • No report – Guam

Since October 1, CDC has antigenically characterized 103 influenza viruses; one 2009 H1N1 virus, 85 influenza A (H3N2) viruses, and 17 influenza B viruses. The 2009 H1N1 virus tested was characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2014–2015 Northern Hemisphere influenza vaccine. Of the 85 influenza A (H3N2) viruses tested, 41 were characterized as A/Texas/50/2012-like, which also is included in this season’s Northern Hemisphere vaccine. Forty-four viruses tested showed reduced titers with antiserum raised against A/Texas/50/2012, but were antigenically similar to A/Switzerland/9715293/2013, the H3N2 virus selected for the 2015 Southern Hemisphere influenza vaccine. Both B/Victoria and B/Yamagata-lineage viruses are circulating in the U.S. All 10 B/Yamagata-lineage viruses were characterized as B/Massachusetts/2/2012-like, a component of both the trivalent and quadrivalent vaccines for the Northern Hemisphere. All seven B/Victoria viruses were characterized as B/Brisbane/0/2008-like, a component of the 2014–2015 Northern Hemisphere quadrivalent influenza vaccine.

None of the specimens tested this season has shown resistance to oseltamivir or zanamivir.


CDC Health Advisory – Angela Campbell (CDC)

Angela followed up on Sophie’s report to provide additional information on the H3N2 laboratory results, which indicated 52% of H3N2 viruses tested were antigenically drifted from the H3N2 component of this season’s vaccine. On December 3, CDC issued a Health Advisory reminding clinicians of the benefits of influenza antiviral medications and urging continued influenza vaccination of unvaccinated patients this influenza season. This was followed by a December 4 press briefing conducted by Drs. Tom Frieden and Joe Bresee. Dr. Frieden noted that during past seasons in which the H3N2 strain has been predominant, we have seen higher rates of hospitalization and mortality.

Because of the virus drift, the 2014–15 vaccine may see reduced effectiveness of this year’s vaccine. Even so, Dr. Frieden stressed that vaccination continues to be our first line of defense. There may be some cross-protection against the drifted virus which might reduce the likelihood of severe outcomes such as hospitalization and death. Additionally, the vaccine can offer protection against other circulating strains that might become more significant later in the season.

The two-pronged message emphasizes that: (1) clinicians should continue to vaccinate and (2) persons at high risk for complications should seek medical attention as soon they show symptoms of illness. Early treatment with antivirals can help shorten the duration of symptoms and reduce the risk of complications and deaths. Early use of antivirals is particularly important for persons with underlying health conditions. CDC’s Influenza Antiviral Medications: Summary for Clinicians offers more specific information on antiviral use and indications.

Angela stressed that a major point for clinicians is that they should “think flu,” providing appropriate treatment for high risk persons even in the absence of laboratory confirmation. She stated that several institutional outbreaks already have been reported this season. In an institutional setting, an outbreak is likely when at least two residents are ill within 72 hours, and at least one has laboratory confirmed influenza. Chemoprophylaxis may be considered for all employees.

CDC recommends a three-pronged approach of:

  1. Vaccination;
  2. Use of neuraminidase inhibitor medications when indicated for treatment or prevention;
  3. Use of other preventive health practices (e.g., respiratory hygiene, cough etiquette, social distancing, handwashing) to help decrease spread.

In response to questions, Angela pointed out that the Southern Hemisphere vaccine, which contains the drifted H3N2 strain, is not available in the United States. However, it is reasonable to suggest that international travelers to the Southern Hemisphere could receive the vaccine during their travels. Carolyn Bridges noted that earlier studies indicate there are no safety issues associated with receiving two doses of vaccine during one influenza season. In response to an additional question, Angela noted that the last season in which the U.S. experienced a significant drift in influenza strains was 2007–2008.

Partners wishing to receive influenza talking points or who want to be recipients of Health Alert Network advisories should contact CDC.


National Influenza Vaccination Week – Cindy Alvarez (CDC)

Cindy provided a presentation on plans for the upcoming National Influenza Vaccination Week (NIVW) to be conducted December 7–13. The goals of this annual event are to promote continued influenza vaccination throughout the season; highlight the importance of the universal recommendation for everyone age >6 months and 2 doses from some children; provide special focus on persons at high risk for complications; and address disparities in vaccination coverage.

CDC sees NIVW as an opportunity to capitalize on partnerships to boost immunization levels, particularly among underserved populations. Some of the planned activities include a Digital Ambassador Relay during the week of December 1, in which 7 partners will host information about influenza vaccine for one day of the week and then “hand-off” to another partner. CDC will host a Twitter Chat on December 9, and four partners will co-host an additional Twitter Chat on December 11. CDC also plans to conduct a media update on December 11 that will highlight the impact of influenza vaccine and provide early season coverage data.

Planned digital media outreach includes display ads that appear during Google searches, as well as promoted tweets for general and high risk audiences. These can be targeted to users based on their interest or search terms. Outreach is planned through “mommy blogs” to reach pregnant women and child caregivers. Social gaming activities include insertion of CDC PSAs between levels of select games, as well as the opportunity to receive game points as an incentive for watching the PSAs. PSAs also will be aired on digital radio sites.

Many influenza promotion events (e.g., mayoral proclamations) are being coordinated by local partners. Cindy encouraged Summit partners to view the NIVW Calendar of Events and submit information about their own events.

A wide variety of NIVW resources, many of which also are available in Spanish, may be found on the NIVW website. Newly developed animated images also may be embedded on websites or social media. Cindy noted that many CDC influenza efforts continue long after NIVW, and partners should take advantage of CDC’s websites for information that can be used at whatever level is best for your organization. She highlighted that a new Toolkit for Long-Term Care Employers was posted today.


Other Items – Carolyn Bridges (CDC)
  • The National Foundation for Infectious Diseases (NFID) and the Council of State and Territorial Epidemiologists (CSTE) are partnering to provide a webinar on Five Key Steps to Improve HPV Vaccination Rates in Your Practice. The event will take place on December 9 at 11 a.m. ET. Additional information on speakers and registration is available on the NFID professional education website.
  • The 2015 National Adult and Influenza Immunization Summit is planned for May 12–14, 2015, in Atlanta, Georgia. Additional information will be available soon on the Summit website.

INFORMATION FROM CDC


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

The CDC weekly influenza surveillance report for week 48 (ending November 29, 2014) and region specific data are now available. During week 48, 5.4% of all deaths reported through the 122 Cities Mortality Reporting System were due to P&I. This percentage was below the epidemic threshold of 6.5% for week 48.

For the 2014–2015 influenza season, CDC/Influenza Division and the National Center for Health Statistics (NCHS) are collaborating on a pilot project to use NCHS mortality surveillance data for the rapid assessment of pneumonia and influenza (P&I) mortality.

No influenza-associated pediatric deaths were reported to CDC during week 48. To date, five influenza-associated pediatric deaths have been reported for the 2014-2015 season.

Nationwide during week 48, 2.6% 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 2.0%. 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 November 29, 2014. At this time, 6 states and Puerto Rico are reporting widespread influenza activity.

The FluView report for week 48 and archives of previous FluViews are available from CDC. CDC also has released seasonal influenza key points for December 5, 2014.


National Influenza Vaccination Week

National Influenza Vaccination Week (NIVW) is a national observance that was established to highlight the importance of continuing influenza vaccination. This year, CDC is placing more focus on vaccination promotion activities using digital media platforms, and these activities are listed below.

  • An @CDCFlu-hosted live Twitter chat on Tuesday, December 9 from 1–2pm EST featuring CDC influenza subject matter expert, Dr. Mike Jhung. Participate or follow this event on Twitter by using #NIVW2014. The chat will:

– Emphasize that getting vaccinated in December, January and beyond can still provide protective benefit against influenza. As long as flu viruses are circulating, it’s not too late to get vaccinated!

– Remind parents and providers of the need for certain children to receive a second dose of flu vaccine for optimal protection.

– Provide an opportunity to ask questions about the flu and flu vaccine.

  • A National Influenza Vaccination Campaign Partner-Led Twitter Chat will take place on Thursday, December 11, from 2–3 pm EST. The co-hosts of this event will be: American Hospital Association – @ahahospitals, Easter Seals – @Easter_Seals, Long-Term Living – @LongTermLiving, and Men’s Health Network – @MensHlthNetwork. The focus of the chat will be about what caregivers need to know about the flu and flu vaccines. This is a new event this year, and it is led by CDC’s national flu vaccination campaign partners! Please show your support by promoting it and participate if you are able!
  • A media update on December 11, which will include influenza vaccination impact data from the 2013-2014 season as well as early season coverage estimates for the 2014–2015 season.
  • NIVW-specific tweets, in English and Spanish – for partners to utilize this week and next week to promote NIVW. All messages will include the hashtag #NIVW2014. Most prepared tweets in English are followed by a Spanish-translated version of that tweet, highlighted in grey.


Updated Key Points on EV-D68 Infections and Disease

The United States has been experiencing a nationwide outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness.  Updated EV-D68 key points, current as of December 4, 2014, include the weekly update of EV-D68-like illness activity in states and specimens that tested positive for EV-D68 from patients who died.


Updated Information on Acute Flaccid Myelitis

Up-to-date key points from December 4, 2014 are now available about the investigation of acute flaccid myelitis in children, including the weekly update of CDC-verified neurologic illness cases reported by states that meet the case definition.


CDC Develops Social Media Messages for Influenza – Updated December 5, 2014

Per requests from partners, CDC’s Influenza Division has developed the following social media messages that your organization may use to help communicate about influenza and flu activity. These can be tweeted using your organization’s Twitter handle, or disseminated on other social media platforms. We will share suggested social media messages every two weeks.

  •  #Flu activity has increased in the U.S. #H3N2 flu viruses have been found in almost all states. http://1.usa.gov/1zo8UYa
  • #Fluvax still offers the best protection against #flu, even when there r circulating flu viruses that are different from #vax viruses.
  • #Antiviral meds are a second line of defense to treat the flu. Learn more about #flu treatment: http://1.usa.gov/1nn0lqP
  • #FluFacts: Antibodies created through vaccination with one #flu virus can cross-protect against different #flu viruses.


Message from CDC

Dear Influenza Prevention Partners,

As always, flu is unpredictable and every season is different with different flu viruses spreading and causing illness. So far this season influenza A (H3N2) viruses have been detected most frequently and have been detected in almost all states. We tend to have more severe seasons when H3N2 viruses predominate. Unfortunately, about half of the H3N2s that we have analyzed since October are different from the H3N2 virus that is included in this season’s flu vaccine. They are different enough that we are concerned protection from vaccination against these drifted H3N2 viruses may be reduced. CDC continues to recommend:

  • Flu vaccination as the best way to protect against the flu. Vaccination may provide partial protection against the drifted viruses and should better protect against other non-drifted flu viruses that may circulate this season, including influenza B viruses
  • Antiviral medications as an important second line of defense against the flu. Treatment with antiviral drugs is especially important for people at high risk of serious flu complications or people who are very sick with flu. It’s especially important to get antiviral medicines quickly – as they work best when started within two days of the beginning of flu symptoms.
  • Everyday actions like covering your cough, staying away from sick people, and washing your hands often. If you get the flu, stay home from work or school. If you are sick, do not go near other people so that you don’t make them sick too.

Below are some key resources to assist and support your ongoing efforts to prevent influenza illness and promote prompt treatment when influenza illness occurs. We welcome you to use and share these guidance and education resources in your efforts and with other partners or constituents. Your efforts are critical and greatly appreciated in helping us fight this serious disease this and every flu season.


Key Points

CDC Health Alert Network, Health Advisory: Regarding the Potential for Circulation of Drifted Influenza A (H3N2) Viruses

CDC Media: Update on Flu Season 2014–15 December 4, 2014 (telebriefing transcript and press release)

Tweets

General Antiviral Messaging

  • Quick antiviral treatment can mean the difference b/w life and death in high risk people.

HAN-specific tweets

  • #Flu vaccination should be offered now & as long as flu viruses are circulating.
  • #Flu is starting to increase in some parts of the U.S. #H3N2 viruses has been detected in almost all states. http://go.usa.gov/687W
  • #H3N2 predominant seasons typically have higher hosp. & death rates, esp in seniors, young children, & ppl with high risk cond. http://go.usa.gov/687W
  • So far we’re seeing more #H3N2 viruses, which tends to affect young kids & older ppl more.
  • Half of the H3N2 viruses analyzed are different from #H3N2 vax virus. Flu vax still best way to prevent flu. http://go.usa.gov/687W
  • A Health Alert Network (HAN) has been issued to stress the importance of #antiviral meds.  http://go.usa.gov/687W
  • Antiviral meds can make illness shorter & milder, reduce risk of complications, & reduce risk of death in hospitalized patients
  • New online toolkit helps long-term care facilities protect staff & prevent spread of flu: http://go.usa.gov/6jMj #NIVW2014

Q&As: What You Should Know for the 2014-2015 Influenza Season

Antiviral information on the CDC website: Including general information, information for health care professionals, and other information for people who are sick with flu

CDC Expert Commentaries on Medscape: Antivirals, Not Antibiotics, for Influenza (October 2014), When to Give Antiviral Drugs for the Flu (March 2014), Influenza in Pregnancy: Prevention and Treatment (November 2014)

CDC Flu Mobile Apps – with information on flu activity and CDC recommendations


NEW! Toolkit for Long-Term Care Employers

The National Vaccine Program Office and the Centers for Disease Control and Prevention, with support from the Office of Disease Prevention and Health Promotion in the Department of Health and Human Services, created a web-based toolkit to provide easily accessible tools and resources for managers in long-term care (LTC) facilities to improve influenza vaccination coverage among their personnel.

  • This  new comprehensive toolkit includes a number of useful resources, tools and information to help close the gap in vaccination of healthcare personnel  in LTC facilities such as:

– guidance documents, campaign materials, and educational resources to share with managers and staff

– community best practices for achieving high influenza vaccination among staff

– a chart of common barriers to influenza vaccination in these settings with recommended strategies for overcoming specific barriers

– an easy to follow guide on the Affordable Care Act role in increasing access to influenza vaccination in this population, and so much more.


NEW! Resources on Influenza Specimen Collection

Desk Reference Guide (8.5”x11”)
Poster (11”x17”)


Upcoming and Recent CDC COCA Calls

EMS and Ebola: Field Experience with Transporting Patients
Date: Monday, December 15, 2014
Time: 2:00 – 3:00 pm (EDT)
Dial In Number: 888-972-6898 (U.S. Callers); 630-395-0194 (International Callers)
Passcode: 5076538
Healthcare systems across the United States are actively preparing to treat patients with Ebola. Emergency Medical Services (EMS) play an important role in the identification, assessment, and transportation of suspected or confirmed patients with Ebola. As designated treatment facilities, Emory University Hospital and the University of Nebraska Medical Center have received patients with confirmed Ebola. During this COCA Call, clinicians will learn about the field experiences of EMS personnel in the two jurisdictions and discuss unique planning considerations for EMS.

Caring for Patients with Ebola in U.S. Hospitals: A Nursing Perspective
Date: Monday, November 24, 2014
Archived at: emergency.cdc.gov/coca/calls/2014/callinfo_112414.asp


ANNOUNCEMENTS


NFID Announces Free CME Webinar on HPV – December 9 at 11AM ET

On behalf of the National Foundation for Infectious Diseases (NFID) and the Council of State and Territorial Epidemiologists (CSTE), Summit partners are invited to a complimentary CME webinar on Tuesday, December 9, 2014 at 11:00 AM ET.

Five Key Steps to Improve HPV Vaccination Rates in Your Practice

will be presented by Joseph A. Bocchini, Jr., MD and Noel Brewer, PhD. They will discuss HPV vaccination barriers and opportunities and will present five key steps that healthcare professionals (HCPs) can take to improve HPV vaccination rates in their practices, based on the NFID Call to Action, HPV Vaccination as a Public Health Priority. Additional information and online registration is available at the NFID Online Education site.

NFID is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. NFID designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM.


USA Today and MediaPlanet Launches the “Fight Against The Flu” Campaign

Through USA Today, targeted distribution and endless online/social media outlets, both in print and digitally, the Fight Against the Flu campaign will reach around 3 million readers. To help raise awareness of the cause, please feel free to share the campaign with your followers and audience by posting a link to the campaign on your company blog, website, or newsletter, as well as across your social media platforms.


Follow-Up on Question Received During December 4, 2014 Summit Call

During the Summit call on December 4, there was a question regarding the upcoming Southern Hemisphere vaccine and its match to the drifted H3N2 strain in the United States.

To clarify, the H3N2 component selected for the Southern Hemisphere vaccine in September 2014 and for their 2015 influenza season which begins in May 2015, is a closer match to the H3N2 variant that emerged in the spring of 2014. This vaccine is not yet available in the Southern Hemisphere, and Southern Hemisphere vaccine is not available in the United States.

The information on the match issue is included in the weekly surveillance report with the relevant section copied below:

“The remaining 44 (52%) influenza A (H3N2) viruses tested showed reduced titers with antiserum produced against A/Texas/50/2012 or belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. The majority of these 44 influenza A (H3N2) viruses were antigenically similar to A/Switzerland/9715293/2013, the influenza A (H3N2) component of the 2015 Southern Hemisphere influenza vaccine.”

Finally, while older studies do not show an increase risk to getting vaccinated twice in a year, ACIP does not recommend vaccination twice in a year. These studies were mainly done to look at potential benefits to the elderly mostly in nursing homes. There is no information on potential benefits of twice a year vaccination for other groups.


New PSA Reminds College Students That Vaccination Is the Best Form of Protection Against Dangerous Flu Virus

Although college students might be soaking up a lot of knowledge in school, there’s one piece of information that may not be sinking in: the importance of getting vaccinated against the flu. While the CDC recommends that everyone 6 months of age and older get a flu vaccine every season, college-aged adults have low vaccination rates of just 8 to 30 percent. To help educate college-aged adults and encourage vaccination against the flu, Families Fighting Flu has partnered with bioCSL Inc. and Alana’s Foundation to launch a new Public Service Announcement (PSA). Watch the PSA and please share it with a college student you know. The press release is below:

Although the Centers for Disease Control and Prevention (CDC) recommends that everyone six months of age and older get a flu vaccine every season, college-aged adults have documented vaccination rates of just 8 to 30 percent. To help educate this vulnerable group and encourage vaccination, a collaboration of flu stakeholders launched a new Public Service Announcement (PSA) to broach a serious topic with college-aged adults. bioCSL Inc. has partnered on the PSA with Families Fighting Flu and Alana’s Foundation, two nonprofit organizations of families who have lost children to, or whose children have suffered serious health complications due to the flu, that work to increase vaccination rates.

College students are at a particularly high risk of getting and spreading the flu because of exposure to high-touch areas like common living spaces and classrooms, and through social activities. Flu vaccination is associated with reductions in illness, use of health care services, and work and school absenteeism, and a lower risk for impaired academic performance. The new PSA reminds this vulnerable population to get vaccinated.

The PSA was inspired by research showing that college students’ parents are key influencers in their decision to get a flu vaccine.  “A recommendation from someone is the biggest reason college students get a flu vaccine, and mom’s voice is one of the most influential they hear,” said Dr. Charles Altman, Head of U.S. Medical Affairs at bioCSL Inc. “We hope this campaign will be one more reminder to college students of what mom and public health officials are already telling them — that a flu vaccine is the best form of protection against this dangerous disease.”

The PSA follows Seth, a college student whose mom shadows him throughout his daily routine. As Seth prepares for a big night out, mom shakes off some of his bad habits, but when his date appears at the door with the sniffles, mom puts her foot down, asking Seth, “Did you get your flu vaccine?”

Seasonal influenza is a serious, contagious respiratory illness caused by flu viruses. Approximately 5 to 20 percent of Americans get the flu each year, more than 200,000 are hospitalized, and tens of thousands die from flu-related complications. The flu is transmitted via respiratory droplets spread through coughing, sneezing and talking. Flu can also be contracted by touching a surface or object that has the flu virus on it, and then touching the mouth, eyes or nose. Getting the flu vaccine is the best protection against the flu.

Laura Scott, Executive Director of Families Fighting Flu, commented: “Family members can play an important role in the health of their loved ones. A simple reminder can be the difference between a successful school year and a trip to the hospital.”

“As college students, it’s easy to feel invincible — like we’ll never get sick,” added 18-year-old Nicholas Yaksich, brother to Alana Yaksich of Alana’s Foundation. “My family learned firsthand the dangers of flu, and we’re committed to educating others that vaccination is the best way to protect themselves and their family members from the flu.”

Visit HealthMap Vaccine Finder to find where you can get a flu vaccination in your area. For additional media assets, please visit the FFF’s Digital Newsroom.


CDC Telebriefings: Update on Flu Season 2014–15

The transcript of CDC December 4, 2014 Media Briefing is now available. Remember, CDC will be holding a media briefing on December 11, 2014 to announce early season coverage results.


CDC and FDA Revising VAERS Form – Seeking Public Input Until January 23, 2015

As announced in the Federal Register, the US Centers for Disease Control and Prevention (CDC) and US Food and Drug Administration (FDA) are calling for comments on a new adverse event reporting form for vaccines meant to replace the current paper-based reporting form.


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 can also find archived copies of the Summit Buzz there.


Reminder

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

 

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