February 9, 2015

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SPECIAL ANNOUNCEMENT

National Vaccine Program Office releases National Adult Immunization Plan – Seeks Public Comment

Summit Call Recap – February 5, 2015

Information from CDC

Announcements

SPECIAL ANNOUNCEMENT

National Vaccine Program Office releases National Adult Immunization Plan – Seeks Public Comment

The long-awaited National Adult Immunization Plan from the national Vaccine Program Office (NVPO) was released on February 6 and is now open for public comment.

NVPO asks for your participation in the public comment process for the Plan (see solicitation in the Federal Register notice) by the deadline of March 9, 2015 at 5:00 p.m. EDT. We invite you to pay special attention to Table 3: Indicators for the Goals of the NAIP and Appendix 5: Non-Federal Roles and Responsibilities. NVPO thanks you for your participation in this process.

SUMMIT CALL RECAP – FEBRUARY 5, 2015

Announcements – L.J Tan (IAC)

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.

Someone You Love: The HPV Epidemic is a powerful new feature length documentary about HPV and its impact on the lives of five women. The film’s creators are seeking partners interested in screening the film in local venues. Anyone interested in hosting a screening can contact the film’s director, Frederic Lumiere. He can assist with details and also can help match groups with a local sponsor to cover the modest license fee.

Avian Influenza A (H5N2), (H5N8), and (H5N1) MMWR – Michael Jhung (CDC)

Michael provided a brief update on the current status of avian influenza activity in the United States, as reported in the February 6 MMWR article, Outbreaks of Avian Influenza A (H5N2), (H5N8), and (H5N1) Among Birds – United States, December 2014–January 2015.

Since mid-December the U.S. Department of Agriculture (USDA) has identified more than 20 detections of highly pathogenic avian influenza in birds in six different states, largely in the Pacific Northwest. Although some of these detections may be an artifact of enhanced surveillance, CDC feels we actually are seeing something new. This is concerning not only for animal health practitioners, because these viruses kill birds, but also for public health, due to the potential for human infection with viruses that have exhibited a high mortality rate in other parts of the world.

To date, approximately 25 people have been exposed to infected birds, resulting in two persons who have developed influenza-like illness (ILI). Upon testing, one of these individuals was found to be negative for influenza. The other person, who was not able to be tested, is currently recovering.

CDC recently posted two documents to provide interim guidance on testing and influenza antiviral prophylaxis for persons possibly infected with highly pathogenic avian influenza A viruses. These guidance documents can help healthcare personnel determine who and how to test for human infection, as well as how to monitor and provide prophylaxis for potentially infected persons. Essentially, anyone with recent (within 10 days) contact with sick or dead birds who has an acute fever or respiratory infection should receive prompt medical evaluation, antiviral treatment, and testing for infection. Persons who have been exposed but who are not symptomatic should be monitored for 10 days. Prophylaxis for these asymptomatic individuals should be considered based on their baseline health status and the extent of their exposure. CDC has a team ready to respond quickly in the event a human case is identified.

When asked whether serology studies are planned in persons exposed to birds, Michael reported that some state and local health departments have collected acute and convalescent sera, but this has not been systematically conducted. Exposed individuals sometimes are reluctant to provide specimens. At this time, laboratory assays can detect H5 virus in birds, and the USDA is developing assays to conduct full subtyping for all 3 types of H5 viruses.

Michael also offered a brief overview of (low pathogenic) influenza H7N9 which was recently identified in two travelers returning from China to British Columbia. These traveling companions were confirmed to have H7N9 infection, and both have fully recovered after experiencing uncomplicated illness. The Canadian government has not identified any additional cases resulting from spread from the two persons.

Michael plans to return to a Summit call within the next few weeks in order to provide a more comprehensive update on avian influenza.

Influenza Surveillance Update – Sophie Smith (CDC)

Sophie provided a summary of the published reports for week 3, ending January 24, 2015. A variety of measures indicate influenza activity remains elevated in the U.S.

The ILI-Net national data indicated 4.4% of total outpatient visits were for influenza-like illness (ILI), which is above the national baseline. Approximately 19.9% of specimens submitted for testing were positive, which is slightly higher than the level of the previous week. Of the deaths reported through the 122 Cities Mortality Reporting System during week 2, 9.1% were attributed to pneumonia and influenza (P&I), above the 7.1% epidemic threshold for the week. Reports indicated there were 40.5 laboratory-confirmed influenza-associated hospitalizations per 100,000 population.

Five influenza-associated pediatric deaths were reported to CDC during the week 3, though some of these reports were for deaths which had occurred in earlier weeks. Four deaths were associated with an influenza A (H3) virus and one death was associated with an influenza A virus for which subtyping was not performed. A total of 61 pediatric deaths have been reported during the 2014–2015 season. Of the 51 for whom vaccination status was known, five 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 3 is:

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

Since October 1, CDC has antigenically characterized 602 influenza viruses; 21 2009 A (H1N1) virus, 478 influenza A (H3N2) viruses, and 103 influenza B viruses. All 21 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 478 influenza A (H3N2) viruses tested, 159 (33.3%) were characterized as A/Texas/50/2012-like, which also is included in this season’s Northern Hemisphere vaccine. Three hundred nineteen (66.7%) 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 1,103 specimens tested this season showed resistance to oseltamivir, none of 1,100 showed resistance to zanamivir, and one of 895 specimens tested showed resistance to peramivir.

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 4, 2015 (ending January 31, 2015) and region specific data are now available. During week 4, 8.5% 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 7.2% for week 4.

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 78 (31.3%) of the 569 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. 391 (68.7%) of the 569 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.

Ninety-nine (68.7%) of the influenza B viruses tested belong to B/Yamagata/16/88 lineage. Ninety-two (92.9%) of the 99 B/Yamagata-lineage viruses were characterized as B/Massachusetts/2/2012-like, which is included as an influenza B component of the 2014–2015 Northern Hemisphere trivalent and quadrivalent influenza vaccines. The remaining 45 (31.3%) influenza B viruses tested belong to B/Victoria/02/87 lineage. Forty-one (91.1%) of the 45 B/Victoria-lineage viruses were characterized as B/Brisbane/60/2008-like, the virus that is included as an influenza B component of the 2014–2015 Northern Hemisphere quadrivalent influenza vaccine.

Eight influenza-associated pediatric deaths were reported to CDC during week 4. Four deaths were associated with an influenza A (H3) virus and occurred during weeks 1, 2, and 4 (weeks ending January 10, January 17, and January 31, 2015, respectively). Four deaths were associated with an influenza A virus for which no subtyping was performed and occurred during weeks 50, 51, 52, and 4 (weeks ending December 13, December 20, December 27, 2014 and January 31, 2015).

A total of 69 influenza-associated pediatric deaths have been reported during the 2014-2015 season from New York City [1] and 27 states (Arizona [2], Colorado [2], Florida [2], Georgia [1], Indiana [1], Iowa [3], Kansas [2], Kentucky [3], Louisiana [2], Massachusetts [1], Michigan [1], Minnesota [4], Missouri [1], Nebraska [1], New Jersey [1], North Carolina [2], Nevada [3], New York [1], Ohio [5], Oklahoma [6], Pennsylvania [1], South Carolina [1], South Dakota [1], Tennessee [4], Texas [9], Virginia [3], and Wisconsin [5]). More detail is available on the FluView website.

Between October 1, 2014 and January 31, 2015, 11,897 laboratory-confirmed influenza-associated hospitalizations were reported. The overall hospitalization rate was 43.5 per 100,000 population. The highest rate of hospitalization was among adults aged ≥65 years (213.8 per 100,000 population), followed by children aged 0–4 years (40.2 per 100,000 population). Among all hospitalizations, 11,449 (96.2%) were associated with influenza A, 355 (3.0%) with influenza B, 40 (0.3%) with influenza A and B co-infection, and 53 (0.4%) had no virus type information. Among those with influenza A subtype information, 3,423 (99.7%) were A(H3N2) virus and 10 (0.3%) were A(H1N1)pdm09. Additional virus characterization is available on FluView.

Nationwide during week 4, 4.1% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is above the national baseline of 2.0%. 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 31, 2015. At this time, all but 11 states and territories are reporting widespread influenza activity.

The FluView report for week 4 (ending January 31, 2015) and archives of previous FluViews are available from CDC. CDC also has released seasonal influenza key points for February 6, 2015.

CDC Provides Measles Information to Its Partners

CDC thanks its partners for their continued assistance and support as CDC works to keep all of its audiences informed about the current measles outbreak. As you may know, CDC has a webpage that is updated weekly (on Mondays). CDC has also developed corresponding information (available to Summit Buzz partners) to assist you as you get questions about measles, develop new materials for your members, post to social media, etc. Let CDC know if you have any additional questions or would like to request resources from them.

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.

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.

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 the 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.

CDC Emergency Response – CDC Response to 2014 Ebola in the United States and West Africa

NEW: Q&A’s about the Transport of Pediatric Patients (< 18 years of age) Under Investigation or with Confirmed Ebola

Updated: Case Counts

NEW: Guidance for U.S. Laboratories for Managing and Testing Routine Clinical Specimens When There is a Concern About Ebola Virus Disease

NEW: Non-CDC Laboratory Resources

NEW: Interim Guidance for U.S. Businesses, Employers, and Business Travelers to Prevent Exposures to Ebola

ANNOUNCEMENTS

2015 Healthy Aging Summit Welcomes Abstracts

The U.S. Department of Health and Human Services’ Office of Disease Prevention and Health Promotion is seeking abstracts addressing the science of healthy aging for presentation at the 2015 Healthy Aging Summit, to be held July 27 and 28, 2015, in Washington, DC. The agency is calling for “innovative presentations” from a wide array of subject matter experts across a multitude of disciplines, both federal and non-federal. The submission deadline is Monday, February 9.

Authors are encouraged to submit abstracts that demonstrate relevance and alignment with national prevention and health initiatives such as Healthy People 2020, the National Action Plan to Improve Health Literacy, the National Action Plan to Eliminate Health Care-Associated Infections, the National Action Plan to Prevent Adverse Drug Events, and the Affordable Care Act.

Energy and Commerce Committee’s Subcommittee on Oversight and Investigations Flu Hearing Recap

Thanks to APCO Worldwide for this recap!

The Energy and Commerce Committee’s Subcommittee on Oversight and Investigations held a hearing this morning on the preparedness and treatment efforts surrounding this year’s flu. Witnesses included:

Anne Schuchat, director, CDC’s National Center for Immunization and Respiratory Diseases

Karen Midthun, director, FDA Center for Biologics Evaluation and Research

Robin Robinson, director, Biomedical Advanced Research and Development Authority, Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services

Anthony Fauci, director, National Institute of Allergy and Infectious Diseases, National Institutes of Health

Chairman Tim Murphy (R-PA) opened the hearing. He explained its purpose was to examine how U.S. public health agencies are working to improve the seasonal flu response and to learn about the progress of federal efforts into new vaccine technologies, including a universal flu vaccine. Mr. Murphy clearly stated there is no scientific evidence linking vaccines and autism. He asked all the witnesses if they had or would have their children vaccinated and all responded yes.

Many committee members, including Michael Burgess (R-TX) and David McKinley (R-WV), expressed concern as to why the CDC did not work to develop a new monovalent vaccine for the drifted influenza strain as soon as it learned of the current vaccine’s low effectiveness. Dr. Schuchat responded that manufacturers would not have been able to produce large quantities of a new vaccine quickly enough. She assured the committee that CDC closely monitored the drifted strain and, after assessing the situation, determined developing a new vaccine would not have been a feasible or effective response.

The hearing shifted at one point to address the current measles outbreak. Committee members, especially Marsha Blackburn (R-TN), expressed concern about the outbreak and asked the witnesses what Congress can do to encourage the public to vaccinate. Dr. Schuchat responded that most parents who do not vaccinate do not realize measles is still a dangerous threat. She stressed the importance of providing parents with accurate information and resources. Ms. Blackburn asked Dr. Schuchat if parents should be more concerned by measles or by the measles vaccine and Dr. Schuchat responded that the measles vaccine is very safe and effective.

Many questions focused on the universal flu vaccine, which Dr. Anthony Fauci said has been approved for Phase 1 clinical trials in humans. The committee members and witnesses agreed a universal flu vaccine will be a valuable tool to improve future influenza responses.

Ebola Vaccine Trial Opens in Liberia

A large clinical trial to assess the safety and efficacy of two experimental vaccines to prevent Ebola virus infection is now open to volunteers in Liberia. The trial is being led by a recently formed Liberia-U.S. clinical research partnership and is sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

Update on the Epidemiology of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection, and Guidance for the Public, Clinicians, and Public Health Authorities — January 2015

CDC continues to work with the World Health Organization (WHO) and other partners to closely monitor Middle East respiratory syndrome coronavirus (MERS-CoV) infections globally and to better understand the risks to public health. The purpose of this report is to provide a brief update on MERS-CoV epidemiology and to notify health care providers, public health officials, and others to maintain awareness of the need to consider MERS-CoV infection in persons who have recently traveled from countries in or near the Arabian Peninsula.

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 10 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.

Researchers Develop Model To Predict and Track Flu Activity

UCSD researchers have developed a model to predict the spread of influenza up to a week in advance, with as much accuracy as Google Flu Trends (GFT) can estimate current infections. The study, published on January 29, combined “big data” compiled from GFT and traditional data from the Center for Disease Control to assess real-time flu activity with better accuracy and to make valid predictions about future spread.

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.

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 was 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.