February 2, 2015

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Summit Call Recap – January 29, 2015

Special Announcement

Nominations Now Open for 2015 NAIIS Immunization Excellence Awards (Deadline – February 13, 2015)

Information from CDC

Announcements

SUMMIT CALL RECAP – JANUARY 29, 2015

Influenza Surveillance Update – Sophie Smith (CDC)

Sophie provided a summary of the published reports for week 2, ending January 17, 2015. A variety of measures indicate influenza activity is continuing to increase in the U.S.

The ILI-Net national data indicated 4.5% of total outpatient visits were for influenza-like illness (ILI), which is above the national baseline. Approximately 19.5% of specimens submitted for testing were positive, which is slightly lower than the level of the previous week. Of the deaths reported through the 122 Cities Mortality Reporting System during week 2, 9.3% were attributed to pneumonia and influenza (P&I), above the 7.1% epidemic threshold for the week. Reports indicated there were 36.3 laboratory-confirmed influenza-associated hospitalizations per 100,000 population.

Eleven influenza-associated pediatric deaths were reported to CDC during the week 2, though some of these reports were for deaths which had occurred in earlier weeks. Three deaths were associated with an influenza A (H3) virus and eight deaths were associated with an influenza A virus for which subtyping was not performed. A total of 56 pediatric deaths have been reported during the 2014–2015 season. Of the 46 for whom vaccination status was known, three were ineligible for vaccination, and only three were fully vaccinated.

As shown in CDC’s weekly influenza summary map, the geographic spread for influenza for week 2 is:

Widespread – 44 states
Regional – 5 states, Guam. Puerto Rico, Virgin Islands
Local – 1 state and District of Columbia
Sporadic – no states
No activity – no states
No report – no states

Since October 1, CDC has antigenically characterized 508 influenza viruses; 10 2009 A (H1N1) virus, 395 influenza A (H3N2) viruses, and 103 influenza B viruses. All 10 of the 2009 H1N1 viruses tested were characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2014–2015 Northern Hemisphere influenza vaccine. Of the 395 influenza A (H3N2) viruses tested, 141 (35.7%) were characterized as A/Texas/50/2012-like, which also is included in this season’s Northern Hemisphere vaccine. Two hundred fifty-four (64.3%) of viruses tested showed either 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. Among viruses that showed reduced titers with antiserum raised against A/Texas/50/2012, most 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 69 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. Thirty (88.2%) of the 34 B/Victoria viruses were characterized as B/Brisbane/60/2008-like, a component of the 2014–2015 Northern Hemisphere quadrivalent influenza vaccine. Four (11.8%) of the B/Victoria lineage viruses tested showed reduced titers to B/Brisbane/60/2008.

One of the 865 specimens tested this season showed resistance, none of the 865 showed resistance to zanamivir, and one of 730 specimens tested showed resistance to peramivir.

Sophie provided a brief update on the December 2014 reports of parotitis in patients with laboratory confirmed influenza. Parotitis is rare with influenza, but the majority of patients did not have mumps. CDC has now learned of >100 cases in the U.S. this season, usually in young adults. Investigation into the cases is ongoing.

CDC staff will be available on next week’s call to discuss the results of any strain typing conducted on the three pediatric cases who died from influenza and who were fully vaccinated. Knowing whether these children died from infection with a strain not covered by the vaccine could assist in our communication efforts with parents and others. In addition, CDC will provide information on the first case of H7N9 avian influenza reported from British Columbia and reports of highly pathogenic H5 found in birds in Washington State.

Other Items – Litjen Tan (IAC)

CDC has just released Medical Office Telephone Evaluation of Patients with Possible Influenza. This new tool was developed for medical office staff as they conduct telephone triage for patients who call with flu-like symptoms to help them identify when it might be appropriate to initiate antiviral treatment before an office visit. The tool may be accessed directly though the link above or via the January 28 Summit Buzz.

Registration is now open for the 2015 NAIIS meeting to be held May 12–14 in Atlanta. A draft agenda and information on reserving a hotel room through the Summit block are also on the website. (Note: The password needed for registration to this invitation-only meeting has been shared directly with Summit members or may be obtained by contacting LaDora Woods.) Participants needing a federal government rate should contact LaDora Woods. Please be sure to follow the links to reserve a room using the hotel rooming block.

Nominations are open now through February 13 for the 2015 NAIIS Immunization Excellence Awards. The nomination form and additional information are available online. The six categories for this year’s awards are shown on the website and include the NEW category of Adult Immunization Publication Award. This award was established to encourage publication of some of the great work being done by Summit members which may not have made it into the literature. The Summit wants to encourage publication of these types of activities so that persons who were unable to attend the meeting would still be able to learn about them.

SPECIAL ANNOUNCEMENT

Nominations Now Open for 2015 NAIIS Immunization Excellence Awards (Deadline – February 13, 2015)

Give national recognition to those working to improve public health! The National Adult and Influenza Immunization Summit (NAIIS) is soliciting candidates for the 2015 NAIIS Immunization Excellence Awards. The 2015 awards recognize individuals and organizations that have made extraordinary contributions towards improving vaccination rates within their communities during 2014. The awards focus on individuals and organizations that exemplify the meaning of the “immunization neighborhood” (collaboration, coordination, and communication among immunization stakeholders dedicated to meeting the immunization needs of the patient and protecting the community from vaccine-preventable diseases). Unless an award criteria is specifically focused on influenza, it is the intent of the Summit to recognize broader adult immunization activities.

A National Winner will be selected for each award category, and where appropriate an Honorable Mention recipient. The winners will be presented with their awards at the NAIIS meeting which is being held on May 12–14, 2015 in Atlanta, GA. The national winner in each category will be invited to present their programs at the meeting.

The six categories of recognition are:

Influenza Season Campaign
Healthcare Personnel Campaign
“Immunization Neighborhood” Champion
Adult Immunization Champion
Corporate Campaign
NEW! Adult Immunization Publication Award

Additional information and the nomination submission form may be found online. (Note: The nomination deadline is February 13, 2015.)

INFORMATION FROM CDC

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

The CDC weekly influenza surveillance report for week 3, 2015 (ending January 24, 2015) and region specific data are now available. During week 3, 9.1% of all deaths reported through the 122 Cities Mortality Reporting System were due to pneumonia and influenza (P&I). This percentage was above the epidemic threshold of 7.1% for week 3.

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 P&I mortality.

About 159 (33.3%) of the 478 H3N2 viruses tested have been characterized as A/Texas/50/2012-like, the influenza A (H3N2) component of the 2014–2015 Northern Hemisphere influenza vaccine. 319 (66.7%) of the 478 viruses tested showed either 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. Among viruses that showed reduced titers with antiserum raised against A/Texas/50/2012, most were antigenically similar to A/Switzerland/9715293/2013, the H3N2 virus selected for the 2015 Southern Hemisphere influenza vaccine. A/Switzerland/9715293/2013 is related to, but antigenically and genetically distinguishable, from the A/Texas/50/2012 vaccine virus. A/Switzerland-like H3N2 viruses were first detected in the United States in small numbers in March of 2014 and began to increase through the spring and summer.

Sixty-nine (67.0%) of the influenza B viruses tested belong to B/Yamagata/16/88 lineage and the remaining 34 (33.0%) influenza B viruses tested belong to B/Victoria/02/87 lineage.

Five influenza-associated pediatric deaths were reported to CDC during week 3. Four deaths were associated with an influenza A (H3) virus and occurred during weeks 53, 1, 2, and 3 (weeks ending January 3, January 10, January 17, and January 24, 2015, respectively). One death was associated with an influenza A virus for which no subtyping was performed and occurred during week 1.

A total of 61 influenza-associated deaths have been reported during the 2014-2015 season from New York City [1] and 24 states (Arizona [1], Colorado [2], Florida [2], Georgia [1], Indiana [1], Iowa [3], Kansas [2], Kentucky [3], Louisiana [2], Michigan [1], Minnesota [4], Missouri [1], North Carolina [2], Nevada [3], New York [1], Ohio [5], Oklahoma [4], Pennsylvania [1], South Carolina [1], South Dakota [1], Tennessee [4], Texas [7], Virginia [3], and Wisconsin [5]). More detail is available on the FluView website.

Between October 1, 2014 and January 24, 2015, 11,077 laboratory-confirmed influenza-associated hospitalizations were reported. The overall hospitalization rate was 40.5 per 100,000 population. The highest rate of hospitalization was among adults aged ≥65 years (198.4 per 100,000 population), followed by children aged 0–4 years (38.2 per 100,000 population). Among all hospitalizations, 10,690 (96.6%) were associated with influenza A, 290 (2.6%) with influenza B, 29 (0.3%) with influenza A and B co-infection, and 62 (0.5%) had no virus type information. Among those with influenza A subtype information, 3,016 (99.7%) were A(H3N2) virus and nine (0.3%) were A(H1N1)pdm09. Additional virus characterization is available on FluView.

Nationwide during week 3, 4.4% 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 January 24, 2015. At this time, the majority of states are reporting widespread influenza activity.

The FluView report for week 3 (ending January 24, 2015) and archives of previous FluViews are available from CDC. CDC also has released seasonal influenza key points for January 30, 2015.

CDC Issues Call-to-Action on Antiviral Use for Influenza Infection

On January 29, 2015, CDC and partners issued a joint Dear Colleague letter calling on health care professionals to promptly treat young children and people age 65 and older with flu antiviral drugs.

CDC Releases Algorithm for Phone Triage of Patients for Antiviral Use

CDC has provided an algorithm for medical offices to use to evaluate patients for possible influenza over the telephone.

CDC Released Key Points on HPAI H5 in Birds and First H7N9 North American Infection

CDC has released key points related to reports of: highly pathogenic avian influenza (HPAI) H5 in domestic and wild birds in the United States and the first case of human infection in North America with avian influenza A (H7N9) virus.

Updated Information on Acute Flaccid Myelitis

Up-to-date key points (through January 30, 2015) 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, are available.

CDC Measles Telebriefing

On January 29, 2015, CDC held a media telebriefing featuring Dr. Anne Schuchat providing information on the current U.S. measles outbreak and guidance for health protection.

Latest Social Media Messages

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 adapted for use on other social media platforms.

#Flu activity in the U.S. is widespread and likely to continue for weeks. http://1.usa.gov/1dgiUJY

Aches? Fever? Fatigue? You may have the #flu. Know what to do if you get sick http://1.usa.gov/1b4LGNv #fightflu

#FluTip: While sick, limit contact with others as much as possible to keep from infecting them. http://1.usa.gov/IKbYts

Who should get treated with antivirals? Get answers here: http://1.usa.gov/1dXjzOM

Prompt use of antivirals is key this #flu season. Learn more about this impt step: http://1.usa.gov/1dXjzOM

Children and older adults are being harder hit this #flu season. Protect your loved ones: http://1.usa.gov/1cGv6jr

#Clinicians: What’s your #flu antivirals I.Q.? Find out with this new quiz: http://1.usa.gov/1EaNBPs

Upcoming and Recent CDC COCA Calls

2014–2015 Influenza Activity and Antiviral Recommendations

The latest FluView report indicates that flu activity remains high in the United States and is now widespread in 46 states and Guam. It has been recognized for many years that people 65 years and older are at higher risk of serious complications from the flu, and this flu season the hospitalization rates in this age group are climbing steeply. CDC recommends that all hospitalized and high risk patients (either hospitalized or outpatient) with suspected influenza should be treated as soon as possible with one of three available influenza antiviral medications, without waiting for confirmatory influenza testing. During this COCA Webinar, 2014–2015 Influenza Activity and Antiviral Recommendations, clinicians learned about 2014–2015 influenza activity, heard a summary of CDC’s current antiviral recommendations, and discussed data that inform the antiviral recommendations.

ANNOUNCEMENTS

New Publication: Oseltamivir Treatment Reduces Severity and Duration of Influenza Infection!

New analysis of efficacy data confirms that timely administration of the antiviral influenza drug oseltamivir considerably reduces the impact of an influenza infection in adults. The study results, Oseltamivir treatment for influenza in adults: a meta-analysis of randomized controlled trials, have now been published in The Lancet.

The study was conducted by an independent research group led by Arnold Monto, Professor of Epidemiology at the University of Michigan School of Public Health, USA, and Stuart Pocock, Professor of Medical Statistics at the London School of Hygiene and Tropical Medicine. The team had been given access to individual patient data from all the published and unpublished adult treatment trials in seasonal influenza from oseltamivir’s manufacturer Roche, hence not only clinical trial study reports, the basis of an earlier meta-analysis on this subject.

A total of nine randomized trials comparing the licensed 75mg twice daily dose of oseltamivir to placebo in 4328 adults were included in the meta-analysis. The trials had similar inclusion criteria, intervention protocol and primary outcome. The primary outcome was defined as time to alleviation of all the following influenza symptoms: nasal congestion, sore throat, cough, aches and pains, fatigue, headaches and chills/sweats. Two of the clinical trials were carried out in elderly populations and one in individuals with chronic cardiac or respiratory illness.

Analysis of the clinical data clearly showed significant reductions in the duration of influenza virus infection. In patients with proven influenza infection, time to alleviation of all symptoms was shortened by an average of 25.2 hours (or 21%, from 123 hours to 98 hours) and lower respiratory tract complications requiring antibiotics more than 48 hours after study entry were reduced by an estimated 44% (4.9% vs 8.7%) compared with placebo. Concomitantly, the timely use of oseltamivir reduced the number of hospital admissions for any cause by an estimated 63% (0.6% vs 1.7%) in adults with laboratory confirmed-influenza. The only clear side effects attributed to drug therapy were the previously known ones of vomiting (absolute increase 4.7%) and nausea (3.7%).

Legal Resources on Vaccines

Many thanks to Dorit Rubinstein Reiss, Professor of Law at the UC Hastings College of the Law, for putting together this list of articles about law and vaccines, so if anyone wants to find them, they can find them in one place. It’s sorted by categories, and it provides links to the wonderful blogs that agreed to host these articles. She has agreed that this can be shared with the Summit.

NFID Announces New Resources on Adult Immunization

The Summit is pleased to present this announcement from the National Foundation for Infectious Diseases. Thanks to NFID!

On behalf of the National Foundation for Infectious Diseases (NFID), I am pleased to share updated adult vaccination and pneumococcal vaccination resources developed to support healthcare professionals and public health officials. We hope you will encourage your members and constituents to use the resources in their efforts to help prevent adult vaccine-preventable diseases, including pneumococcal disease. For your convenience, sample language that can be used to share the new resources via email, newsletters, or other announcements from your organization is available.

Note that the NFID pneumococcal resources reflect the latest recommendations from the Advisory Committee on Immunization Practices (ACIP) for administering PCV13 and PPSV23 in people age 65 years and older and in adults age 19 to 64 years with risk factors such as diabetes, and heart, liver and kidney disease, among others.

We appreciate your continued commitment to educating others about this important topic and sharing these resources. Let me know if you have any questions or need additional information.

Marla Dalton, PE, CAE
Executive Director

TFAH Announces Congressional Briefing on Their Outbreaks Report

Trust for America’s Health (TFAH) is pleased to announce a congressional briefing, Outbreaks: Protecting Americans from Infectious Diseases. The briefing will be held on Tuesday, February 10th at 12:00 pm ET in the U.S. Capitol Visitor Center, Room SVC 203-02. A boxed lunch will be served. Use the following links to RSVP and/or add the briefing to your calendar.

The Outbreaks report, released by TFAH and the Robert Wood Johnson Foundation, found that the Ebola outbreak exposed serious underlying gaps in the nation’s ability to manage severe infectious disease threats. The report also found that half of states scored five or lower out of 10 key indicators relating to preventing, diagnosing and responding to outbreaks. The briefing will expand on the report’s findings and discuss the real-world impact of ignoring infectious disease threats.

Speakers include:

Jeffrey Levi, PhD, Executive Director of Trust for America’s Health

Paul Kuehnert, DNP, RN, Director, Bridging Health and Health Care, Robert Wood Johnson Foundation

Umair A. Shah, MD, MPH, Executive Director, Harris County (TX) Public Health & Environmental Services

If you have questions about attending the briefing, or wish to receive a detailed briefing on the report, please contact Dara Lieberman, TFAH’s Senior Government Relations Manager, via email or by phone at 202-864-5942.

Syndicate CDC Immunization Schedules on Your Website

Easy-to-read formats of the recommended immunization schedules are now available for syndication. These schedules, more visual and less documented than those intended for immunization providers, were previously available only as PDFs. You can now display one or more schedules (infants and children, preteens and teens, adults by age, and/or adults by health condition) on your website.

Not familiar with syndicating CDC schedules? It’s a one-time task: your web developer copies and places code for each schedule you want to display on your web pages. Once you save the code, you’re done; no additional maintenance is needed. Updates are automatic. For instructions, see Display Immunization Schedules on Your Website.

AIRA Annual Meeting, New Orleans, April 21–23

Registration is now open for the AIRA Annual Meeting on April 21st-23^rd, 2015 in New Orleans. Drs. Paul Offit and David Ross are keynote speakers.

2nd Asia-Pacific Influenza Summit, June 11–12, 2015

The Asia-Pacific Alliance for the Control of Influenza (APACI) is pleased to announce the 2nd Asia-Pacific Influenza Summit, to take place June 11 & 12, in Hanoi, Vietnam. Please mark the dates on your calendar.

APACI continues to develop new initiatives to promote influenza awareness in the region, and will again be presenting a unique opportunity to meet with key influenza experts and stakeholders from within the region, and from around the world. The summit follows the success of the inaugural Asia-Pacific Influenza summit held in Bangkok in 2012.

The summit will take place immediately prior to the 2015 Asian Vaccine Conference.

H7N9 Avian Influenza in China: 2 More Cases in Guangdong Province, One Death

The Hong Kong Centre for Health Protection (CHP) of the Department of Health (DH) is today (January 31) closely monitoring two additional human cases of avian influenza A (H7N9) notified by the Health and Family Planning Commission of Guangdong Province (GDHFPC), and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

New Biologic Approach May Protect Against Any Influenza Strain

A new biologic drug prevented death when administered to mice a week in advance of lethal challenge with influenza H7N9, a disease that has shown a roughly 30 percent mortality rate in humans. The biologic had previously proven protective in mice against the pandemic 2009 H1N1 and the highly pathogenic H5N1 influenza viruses. “This suggests that our approach could work for any strain of the influenza virus,” says corresponding author Elena Govorkova, of St. Jude Children’s Research Hospital, Memphis, Tennessee. The research is published ahead of print in Antimicrobial Agents and Chemotherapy.

Influenza Vaccination Rates Low Among Nursing Home HCWs

Researchers from the Rollins School of Public Health at Emory University have found low rates of influenza vaccination among health care workers at nursing homes. “Vaccination rates would be higher if staff held accurate beliefs about vaccination and influenza,” the researchers wrote in American Journal of Infection Control. “Low vaccination rates among employees place vulnerable populations (e.g., older adults), in whom the vaccine is not as effective, at risk of contracting the virus. Our findings support the need for additional research on the use of incentives and educational strategies targeted at staff.”

Clinical Efficacy Study of Flublok® Quadrivalent Compares Flublok to a Traditional Egg-based Flu Vaccine

Protein Sciences Corporation announced today that results from a double-blinded comparative efficacy study of Flublok Quadrivalent in adults over 50 are expected in June. The study is designed to demonstrate whether Flublok’s higher antigen content and its modern production process that avoids the introduction of egg-based mutations into the vaccine’s active ingredients will result in better efficacy than the recently announced flu vaccine efficacy of 14% in adults older than 50.

From Super Bowl Champ to Shingles Harbinger

Terry Bradshaw isn’t a doctor, and I am not inclined to take medical advice from TV personalities… “You don’t want to be tackled by shingles,” he says.

Terry Bradshaw probably now is known more for his co-hosting duties on “Fox NFL Sunday,” playing the funny guy second from the left. And this is a man who has clinical depression, showing again that, with treatment, mental illnesses do not have to be disabling. People can flourish with them if they take care of themselves.

Lately, Terry Bradshaw has been seen on TV doing commercials about shingles, a painful skin rash caused by the same virus that causes chicken pox. And Terry Bradshaw says you have a 1-in-3 chance of getting shingles if you have had the chicken pox.

According to the Incredible Internet, the Centers for Disease Control and Prevention modifies that: If you are older than 60, you have a 1-in-3 chance of contracting shingles.

The complete story is available in an article by Dick Peterson published in the Northwest Herald.

Nevada Becomes Sixth State to Report Bird Flu

Nevada agricultural officials reported a case of H5N8 avian influenza in a mallard duck in Lincoln County, making Nevada the sixth state to confirm an H5 avian flu—Washington, Oregon, Utah, Idaho and California have all previously reported cases.

European Society of Clinical Microbiology and Infectious Diseases (ESCMID) holds 3rd Conference on Vaccines

The ESCMID 3^rd Conference on Vaccines – Vaccines for Mutual Protection will be held from 6 – 8 March 2015 in Lisbon, Portugal. The abstract submission for young fellows is still open until 25 January 2015, and the current program and registration page are available online.

The conference is accredited with 15 CME points by the European Accreditation Council for Continuing Medical Education (EACCME), and provides an opportunity to meet with top-experts and participants to discuss the multiple aspects of direct and indirect protective effects of vaccination as well as novel approaches for vaccination in all ages.

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 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.