February 6, 2018

UPCOMING EVENTS

CDC Clinical Outreach and Communication Activity (COCA) Call: Update on the 2017–2018 Influenza Season for Clinicians – February 8, 2018, 2–3 pm (ET)

Influenza-related hospitalization rates so far in the 2017–2018 season are exceeding milestones set during the 2014–2015 season—a high severity, H3N2-predominant season.

During this COCA call, CDC flu experts will address clinical issues for influenza patients, including those with severe disease, and provide the latest updates on the 2017–2018 influenza season. The recordings (audio, slides, and transcript) for this call will be posted on the webpage a few days after the COCA Call.

Free Continuing Education (CE) is available for this COCA Call.

Date: Thursday, February 8, 2018
Time: 2–3 pm (ET)

At the time of the call, join the webinar

Or iPhone one-tap: US: +1-646-876-9923, 772478726## or +1-669-900-6833, 772478726##

Or Telephone: Dial (for higher quality, dial a number based on your current location):
US: +1-646-876-9923 or +1-669-900-6833 or +1-408-638-0968

Webinar ID: 772 478 726

International numbers available

For information about this update or other clinical issues, or to send your feedback, please contact CDC COCA.

Current Issues in Immunization NetConference Features New ACIP Schedules and RZV

The next Current Issues in Immunization NetConference (CIINC) will be on updates to the 2018 immunization schedules, as well as the new shingles vaccine recommendations. Information on the CIINC schedule is available online.

Registration Open for Both the National Immunization Conference (NIC) and the Summit In-Person Meeting

Intending to go to the NIC? Registration is still open.

The Summit in-person meeting is also open for registration. The password to register for this invitation-only meeting is available by contacting L.J Tan. Please consider booking your hotel room through the Summit to help us meet our lodging contractual agreement.

Call for Nominations: NAIIS Immunization Excellence Awards – Nominations Close FEBRUARY 8

The National Adult and Influenza Immunization Summit (NAIIS) is soliciting candidates for the 2018 NAIIS Immunization Excellence Awards. The 2018 awards recognize individuals and organizations that have made extraordinary contributions towards improving vaccination rates within their communities during 2017. 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 (VPDs)). 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 National Adult and Influenza Immunization Summit meeting (to be held in Atlanta, Georgia on May 17-18, 2018 (awards ceremony will be held May 18). The national winner in each category will be invited to present their program at the Summit meeting.

NFID-sponsored Interview with Penny Heaton, MD: A Vision for Accelerating Translational Science to Combat Disease

Join William Schaffner, MD, NFID Medical Director, and Penny M. Heaton, MD, Chief Executive Officer at the Bill and Melinda Gates Medical Research Institute, for a lively discussion featuring a preview of the closing keynote presentation at the 2018 Annual Conference on Vaccinology Research (ACVR) scheduled for April 25, 2018.

National HPV Roundtable to Hold Annual Meeting February 27–28, 2018

Please visit the National HPV Roundtable’s website to learn more about the organization and its efforts to improve HPV immunizations in the United States.

American College of Obstetricians and Gynecologists (ACOG) Webinar on Maternal Immunization – March 1, 2018 at 5 PM ET

The American College of Obstetricians and Gynecologists (ACOG), in partnership with American College of Nurse-Midwives (ACNM) and the Centers for Disease Control and Prevention (CDC), is presenting a webinar, Maternal Immunization: Understanding Safety and Efficacy and Making a Strong Recommendation on Thursday, March 1, 2018 at 5 PM ET (2 PM PT). This free, 1 CME credit webinar will provide information on the safety and efficacy of maternal information and will give example of how to address these topics with patients by making a strong recommendation. The webinar will also identify resources for providers and patients regarding maternal immunizations. Continuing Medical Education credit is provided through joint providership with The American College of Obstetricians and Gynecologists. Registration is available online.

ANNOUNCEMENTS

GSK Urges Proper Storage, Reconstitution, and Administration of RZV

GSK is seeking assistance from partners to reinforce important education and communication about the storage, reconstitution, and administration of recombinant zoster vaccine (RZV).

RZV was approved for use by the US Food and Drug Administration (FDA) on October 20, 2017. As this new vaccine begins to reach clinics and pharmacies, and ultimately patients, GSK has received a small number of reports from the field of maladministration of RZV. These reports of observed usage of RZV suggest that the root cause of maladministration has been the utilization of the storage requirements and route of administration established for Zoster Vaccine Live (ZVL). Since ZVL and RZV have different storage requirements and routes of administration, GSK is asking that Summit partners include in your communications regarding RZV the specific storage and administration requirements of RZV.

This will help ensure that the storage and administration of RZV is executed according to the instructions outlined in the FDA approved product labeling. Please include and emphasize the following information in your education and communications on RZV to reinforce its proper storage, reconstitution and administration:

Storage, Reconstitution and Administration of RZV

RZV is to be stored in the REFRIGERATOR ONLY. RZV must be discarded if frozen.
RZV MUST BE reconstituted with the ADJUVANT LIQUID SUSPENSION (AS01) provided.
RZV is to be administered INTRAMUSCULARLY ONLY. It is NOT to be administered subcutaneously.

CDC Releases ACIP 2018 Immunization Schedules

The MMWR early release (announcing the 2018 adult and child/adolescent immunization schedules) was posted on February 6. The actual adult schedule and child/adolescent schedule were released at the same time online.
The American Academy of Pediatrics published a policy statement regarding the release of the 2018 child/adolescent immunization schedule and schedule changes in Pediatrics. A story on this AAP action is available online.
The ACP published information on the adult schedule in the Annals of Internal Medicine.
The 2018 schedules will be formally announced in the MMWR on February 8.

ECBT Releases 2018 State of the ImmUnion Report

Every Child By Two (ECBT) is pleased to release its second annual State of the ImmUnion report. It examines how strong our defenses truly are against vaccine-preventable diseases and what we can do as public health advocates and legislators to make our country stronger and more resilient in the face of emerging health threats.

While the report contains national-level data, ECBT knows legislators like to hear how these issues affect their own states. They have therefore prepared a template that will allow you to share important state-level data. They have provided links to the data wherever possible to make your life a little easier, but the final box is open-ended for you to complete with issues or bragging rights that are unique to your state. All ECBT asks is that you share the final fact sheet with them so they can keep track of which states are complete.

ECBT has also prepared a few sample messages (see below) and an image in case you’d like to promote the 2018 State of the ImmUnion report through your social media platforms. Please feel free to use these in their entirety or alter them as you see fit:

Preventable diseases cost the U.S. economy billions each year! Legislators (tag key state/federal legislators) can help reduce these costs by ensuring all citizens have access to life-saving and cost-saving #vaccines. Get the facts from Vaccinate Your Family in their 2018 #StateoftheImmUnion report. http://vaccinateyourfamily.org/soti#SOTI2018
What should legislators be doing to make the #SOTU more resilient in the face of emerging health threats? Strengthen the #StateoftheImmUnion with suggestions found in Vaccinate Your Family’s #SOTI2018 report. http://vaccinateyourfamily.org/soti
Disease outbreaks like seasonal flu cost money and lives. Find out how policymakers can help ensure a strong #StateoftheImmUnion in Vaccinate Your Family’s #SOTI2018 report. http://vaccinateyourfamily.org/soti

Eliminating the Prevention & Public Health Fund #PPHF would have a devastating impact on our state and negatively impact the #StateoftheImmUnion. Find out how you can support strong immunization policies in the #SOTI2018 report from Vaccinate Your Family. http://vaccinateyourfamily.org/soti

CMS Releases Its Draft 2019 Medicare Advantage and Part D Advance Notice Part II and Draft Call Letter

CMS released its draft 2019 Medicare Advantage and Part D Advance Notice Part II and Draft Call Letter, and it once again includes encouraging language around immunizations. In addition to language on “improving access to Part D vaccines,” it incorporates a new line in the table around immunizations, a new HEDIS measure on pneumococcal vaccination, and lays the groundwork for CMS to determine the use of this new composite measure for the display page and Star Ratings for the future.

Comments are due on March 5; the Adult Vaccine Access Coalition will be preparing a response.

Additional Background
Since 2012, the CMS call letter has included language similar to the following, “We encourage Part D sponsors to consider offering $0 or low cost-sharing for vaccines to promote this important benefit.” Last year, this language was relegated to a footnote. AVAC sent a memo and held meetings with CMS and the Hill urging CMS to reinstate the language.

Immunization Language: Improving Access to Part D Vaccines
According to the Center for Disease Control and Prevention’s (CDC) Surveillance of Vaccination Coverage among Adult Populations — United States, 2015, vaccination rates remain low for tetanus and diphtheria with acellular pertussis (Tdap). While the Healthy People 2020 herpes zoster target vaccination rate has been achieved, approximately 70% of adults for whom the vaccine is recommended remain unprotected. In an effort to improve access to these and other Part D vaccines, AVAC encourages Part D sponsors to either offer a $0 vaccine tier, or to place vaccines on a formulary tier with low cost-sharing.

Potential New Measures for 2020 and Beyond: Quality
Adult Immunization Measure (Part C). For HEDIS 2018, NCQA added the Pneumococcal Vaccination Coverage for Older Adults measure to the ECDS reporting domain. Measures in the HEDIS ECDS domain are calculated using electronic data from administrative claims, electronic medical records, case management systems and registries. For HEDIS 2019, NCQA will build off the pneumococcal measure and evaluate the relevance, scientific soundness, and feasibility of a composite measure for HEDIS that assesses the receipt of routine adult vaccinations. The measure developer is focusing on four specific vaccines: influenza vaccine; tetanus, diphtheria, and pertussis (Tdap) or tetanus and diphtheria (Td) booster vaccine; herpes zoster vaccine; and pneumococcal vaccine. If approved, the new measure would be included in HEDIS 2019. CMS would welcome feedback on the feasibility, value of, and burden/reduction in burden of this change in data source. Depending on results of implementation, CMS will determine the use of this new composite measure for the display page and Star Ratings for the future.

Don’t Forget CDC’s Public Health and Health Care Professionals’ Resources for Influenza

CDC offers public health and health care professionals key information about vaccination, infection control, prevention, treatment, and diagnosis of seasonal influenza related to the 2017-2018 season. It also includes information about recommendations from the Advisory Committee on Immunization Practices (ACIP) for the prevention and control of seasonal influenza for the 2017-18 influenza season. Other resources, such as the link to the full presentation of the January 16 session of CDC Grand Rounds: Public Health Response to Severe Influenza, the transcript for CDC Telebriefing on Widespread Flu Activity on January 12, links to the latest Morbidity and Mortality Weekly Reports (MMWRs) about influenza, videos as part of the CDC Expert Commentary Series on Medscape, and a link to the CDC Health Advisory: Seasonal Influenza A(H3N2) Activity and Antiviral Treatment of Patients with Influenza are also provided.

CDC’s seasonal flu vaccination campaign materials are available to assist partners in communicating about the importance of vaccination. This digital toolkit includes details on events/activities, sample social media and newsletter content, graphics, web assets, and media prep material. This material is downloadable, shareable, and some of the material is customizable.

INFORMATION FROM CDC

Seasonal Influenza Surveillance

CDC has released Seasonal Flu Key Points for February 1, 2018. In addition, the FluView report for Week 4 (ending January 27, 2018) has been published. Partners can also sign up for the seasonal influenza key points. In addition, State/jurisdiction level ILI and virologic data are now available on FluView Interactive for areas that have given CDC approval to display their data.

INFORMATION OF INTEREST

Vaccination Without Litigation — Addressing Religious Objections to Hospital Influenza-Vaccination Mandates

A perspective published in the New England Journal of Medicine concludes that “Influenza-vaccination mandates for health care workers represent good policy, but heavy-handed, context-free implementation does not. Hospitals that pursue an inflexible approach to minimize religious exemptions are likely to find that the juice isn’t worth the squeeze. In contrast, well-drafted and reasonably applied policies should avoid or withstand legal challenge, while also protecting patients.”

Vaccines Could Prevent 36 Million Deaths by 2030

Vaccines could save as many as 36 million lives and avert roughly 24 million cases of medical impoverishment in 41 low- and middle-income nations by 2030, a new study finds.

The report, published Monday in the journal Health Affairs, examines the potential impact of immunization programs in nations eligible for support from Gavi, the Vaccine Alliance.

Flu Is A Tough Diagnostic Problem Even Now

Flu season is well underway, as anyone looking at the nightly news is aware. According to the CDC, pneumonia and influenza mortality in this last period exceeds our epidemic threshold. Since October there have been nearly 9,000 laboratory-confirmed hospitalizations for influenza, the highest rate is among adults over age 65 (136.5/100,000 population), patients who frequently (75%) have other medical problems (co-morbidities). While the diagnosis of influenza seems rather straight-forward based on these numbers, the reality is that physicians misdiagnose influenza a lot. But does it matter?

Population-Based Surveillance of Birth Defects Potentially Related to Zika Virus Infection — 15 States and U.S. Territories, 2016

A new CDC report shows Zika is still a threat to mothers and babies in U.S. areas with local transmission. CDC researchers found a 21% increase in birth defects most strongly linked to Zika virus infection in pregnancy during the last half of 2016.

The report, published on January 26, 2018 in the Morbidity and Mortality Weekly Report (MMWR), provides the first comprehensive data on the prevalence of birth defects (3.0 per 1,000 live births) potentially related to Zika virus infection in a birth cohort of nearly 1 million births in 2016. A significant increase in birth defects strongly related to Zika virus during the second half of 2016 compared with the first half was observed in jurisdictions with local Zika virus transmission. Only a small percentage of birth defects potentially related to Zika had laboratory evidence of Zika virus infection, and most were not tested for Zika virus.

Can You Get the Flu Twice in One Season?

This flu season is a particularly severe one, and it’s not over yet—health officials say flu activity will likely remain elevated for at least several more weeks. But if you already caught the flu, are you in the clear for the rest of the season?

Unfortunately, no. Experts say it is possible to catch the flu twice in one season. That’s because there are multiple strains of flu viruses circulating at any one time, said Dr. William Schaffner, an infectious-disease specialist at Vanderbilt University Medical Center in Nashville. So getting sick with one strain of flu won’t necessarily protect you from a different strain.

Some Flu Vaccines May Work Better Than Others — But Guidance to the Public is Scant

Last fall some people in the know about influenza science got picky when it came time to get their flu shots. They didn’t want to roll up their sleeve for any old vaccine on offer at their doctor’s office or workplace clinic. They sought specific products, the ones licensed for older adults that contain a performance-boosting compound called an adjuvant or more notably one of the two brands of vaccine not made — as most flu vaccines are — in eggs.

“My colleagues who are over age 65, everybody wanted basically the Fluad or the Protein Sciences vaccine, Flublok,” said Dr. Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota. (Fluad, made by Seqirus, contains an adjuvant; Flublok is produced in insect cells.)

The pickiness of flu experts underlines a truth not widely known to the general public: There are a host of different kinds of flu shots, and not all are created equal.

Unusual Symptoms Being Linked to the Flu; Kentucky, Indiana Influenza Outbreak Makes National News

As the flu spreads like wildfire, unusual symptoms are making it harder to treat patients. Kentucky and Indiana are both making national news as each state is reporting more than 100 flu-related deaths, and doctors fear it will only get worse before it gets better.

Part of the problem is that two different strains are affecting patients and some of the symptoms are not typical signs of influenza.

Study: Getting Influenza Raises Heart Attack Risk, Especially in Seniors

Having flu appears to increase the risk of having a heart attack, especially among those aged 65 and older, an Ontario study suggests.

“What we found is that you’re six times more likely to have a heart attack during the week after being diagnosed with influenza, compared with a year before or a year after the infection,” said Dr. Jeff Kwong, lead author of the study published Wednesday in the New England Journal of Medicine.

United States Influenza Vaccination Program Has Caused Meaningful Reductions in Outpatient Visits for Influenza

In a recent publication in Vaccine, researchers show that in addition to preventing hospitalizations and deaths due to influenza, influenza vaccination programs can reduce the burden of outpatient visits for influenza.

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 scheduled every Thursday at 3 PM ET, unless cancelled. Call summaries are posted to the Summit website shortly after each call. Please email L.J Tan or LaDora Woods if you have any updates on activities to provide the Summit.

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Information Of Interest