February 10, 2014


Summit Call Recap: February 6, 2014
News Highlights

SUMMIT CALL RECAP – February 6, 2014

Influenza Vaccine Distribution Update – Erin Kennedy (CDC)

Erin provided a brief overview of influenza vaccine distribution for the 2013– 2014 influenza season and utilized a graph to compare this to seasonal influenza vaccine distribution during the last decade. For the current season, approximately 133.9 million doses of vaccine had been distributed through January 24. This total appears to be in line with the 135–139 million doses vaccine manufacturers had estimated would be produced at the beginning of the season. This is on par with vaccine distribution during the 2011– 2012 and 2012– 2013 seasons, when 134.9 million and 132 million doses were distributed, respectively. At this time, CDC is unaware of any vaccine shortages. (Note: In response to a question, Erin reported after the call that distribution data for quadrivalent vaccine is not available at this time.) Erin also announced that CDC has just published a letter from Anne Schuchat encouraging providers caring for pregnant women to offer their patients vaccines and antiviral treatments, when indicated. The letter was co-signed by leaders from a wide range of major medical organizations, including: American Academy of Pediatrics; American Academy of Family Physicians; American College of Nurse-Midwives; American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine; National Hispanic Medical Association; National Foundation for Infectious Diseases; American Pharmacists Association; Association of Women’s Health, Obstetric and Neonatal Nurses; March of Dimes Foundation; and National Medical Association. Other CDC links related to this letter include:

Influenza Surveillance Update – Scott Epperson (CDC)

Scott reported that the data through week 4, ending January 25, indicates that influenza activity may have peaked nationally. However, a good bit of activity is still occurring in northeast and western states, where influenza transmission began a little later in the season. Influenza 2009 H1N1 continues to be the predominant strain for this season. There has been a small increase in type B virus transmission, but this still accounts for <10% of the number of specimens tested. No significant changes have been observed in influenza-related hospitalizations. Nine (9) new pediatric deaths were reported during week 4, bringing the total for the season to 37. Of these, 23 were eligible for vaccination and had a known vaccination history. Two of the 23 (8.7%) were fully vaccinated for this season, but information is not available to differentiate whether the remaining 21 were partially vaccinated or unvaccinated. The age breakdown of the 37 cases is: 0–5 mos, 6 (16.2%); 6–23 mos, 10 (27%); 2–4 yrs, 5 (13.5%); 5–11 yrs, 10 (27%); and 12-17 yrs, 6 (16.2%). This is a slightly higher proportion of cases for children <2 years of age than has been seen in previous seasons. However, CDC is still receiving reports, so these percentages are subject to change. Resistance to antiviral medications has been minimal, with <1% of tested specimens showing resistance to oseltamivir. Testing also indicates specimens are similar to the stains included in the seasonal vaccine. Only one 2009 H1N1 specimen has differed from the vaccine strain, while all H3N2 results were similar to the vaccine. Influenza B specimens remain split between Yamagata and Victoria lineages. Scott reminded callers that the FluView interactive site is a great tool for visualizing influenza surveillance data collected by CDC.

Adult Immunization Publications – LaDora Woods (CDC)

LaDora gave a quick overview of the important adult immunization information being released this week and throughout February. On February 3, the Annals of Internal Medicine included the 2014 recommended immunization schedule for adults and an article by Laura Hurley MD describing a survey of U.S. physicians regarding adult vaccine delivery. Also on February 3, a Notice to Readers was published in the MMWR highlighting changes in this year’s schedule and referencing the schedule publication in the Annals of Internal Medicine. Unlike previous years, the figures, footnotes, and tables are not being published in MMWR, but will be posted and maintained on the CDC website to facilitate updating the schedule during the year, if needed. On February 6, the MMWR included a report of Non-Influenza Vaccination Coverage of Adults – United States, 2012. This information, which was developed through the National Health Interview Survey (NHIS), indicates small gains in Tdap, zoster, and HPV coverage. However, overall coverage is still low, indicating work remains to be done. On February 6–7, a national media tour highlighting the NHIS results will be conducted by Drs. Carolyn Bridges, Walter Williams, and Melinda Wharton. CDC continues to support NVAC’s Standards for Adult Immunization Practice, which will be formally released in Public Health Reports on February 20. The major message of the Standards is that all healthcare providers should assess the status of all patients at every clinical encounter, administer recommended vaccines (or refer the patient to a provider who can administer them), and document vaccines given in the patient’s medical record and with appropriate immunization registries.

Announcements – L.J Tan (CDC)

L.J reminded call participants that the 2014 National Adult and Influenza Immunization Summit Meeting is scheduled for May 13–15, 2014 in Atlanta, Georgia. Registration and hotel details will be available soon. Persons making travel plans should plan to arrive on the evening of May 12 and depart on May 15 sometime after 5 p.m.

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

The CDC weekly influenza surveillance report for week 5 (ending February 1, 2014) and region specific data are now available. Of deaths reported through the 122 Cities Mortality Reporting System, 8.6% were due to P&I. This percentage was above the epidemic threshold of 7.3% for week 5.

Three influenza-associated pediatric deaths were reported to CDC during week 5. All three deaths were associated with an influenza A virus for which no subtyping was performed and occurred during weeks 1, 3 and 4 (weeks ending January 4, January 18, and January 25, 2014). A total of 40 influenza-associated pediatric deaths have been reported during the 2013-2014 season from New York City [1] and 19 states (AR [3], CA [4], FL [3], GA [1], IA [1], KY [1], LA [2], MA [1], MI [1], MS [1], NC [1], OK [2], OR [1], TN [4], TX [9], UT [1], VA [1], WI [1], and WV [1]).

Nationwide during week 5, 3.2% 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. During week 5, seven states (Alabama, Arkansas, Kansas, Louisiana, Oklahoma, Texas, and Virginia) experienced high ILI activity; 12 states (California, Delaware, Hawaii, Minnesota, Mississippi, Missouri, New Jersey, New Mexico, North Carolina, South Dakota, Tennessee, and Vermont) experienced moderate ILI activity; . Fourteen states and New York City experienced low ILI activity (Alaska, Arizona, Colorado, Connecticut, Florida, Indiana, Kentucky, Nebraska, Nevada, New York, Pennsylvania, South Carolina, Utah, and Washington); and 17 states (Georgia, Idaho, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, Montana, New Hampshire, North Dakota, Ohio, Oregon, Rhode Island, West Virginia, Wisconsin, and Wyoming) experienced minimal ILI activity. Data were insufficient to calculate an ILI activity level from the District of Columbia.

Archives of previous FluViews and CDC’s seasonal influenza key points for February 7, 2014 are available for review.

More information from CDC

On February 7, CDC released key points regarding the first confirmed case of human infection with avian influenza A (H5N1) virus in North America.

CDC recently posted a letter to providers, specifically those that serve and have the potential to reach pregnant women. We hope that you’ll read and share it with your membership/constituents. The following organizations have cosigned the letter: AAP, AAFP, ACOG, SMFM, NHMA, NFID, APhA, AWHONN, March of Dimes, NMA, and CDC. The letter also is available on various CDC influenza web pages, including Pregnant Women and Influenza and Information for Health Professionals.

Updated key points related to recent human infections with avian influenza A (H7N9) virus in China were released on January 31.


2014 NAIIS Immunization Excellence Awards Call for Nominations (Deadline: COB March 25, 2014)

The National Adult and Influenza Immunization Summit (NAIIS) is soliciting candidates for the 2014 NAIIS Immunization Excellence Awards. The 2014 awards recognize individuals and organizations that have made extraordinary contributions towards improving vaccination rates within their communities during 2013. 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 specifically indicated in the award description, the immunization activities should be broader than influenza activity. A National Winner and possibly an Honorable Mention recipient will be selected for each award category, including:

  • Overall Flu Season Activities
  • Healthcare Personnel Campaign
  • “Immunization Neighborhood” Champion
  • Adult Immunization Champion
  • Corporate Campaign

The winners will be presented with their awards at the National Adult and Influenza Immunization Summit meeting (to be held on May 12-15/Atlanta, GA). The national winner in each category will be invited to present their programs at the National Adult and Influenza Immunization Summit meeting.

Invitation to Attend the Fifth ESWI Influenza Conference; Travel Grants Available

The European Scientific Working group on Influenza (ESWI) invites partners of the U.S. National Adult and Influenza Immunization Summit to join other scientists and public health officials at the Fifth ESWI Influenza Conference in Riga, Latvia, on 14 –17 September 2014. The aim of the conference is to discuss the most recent advances in influenza research, control, prevention and treatment, while a tailor-made program for public health officials will cover the entire spectrum of influenza policy making. This program represents the 2014 European edition of their Flu Summit, which is modeled from the successes of our own Summit.

Registration is now open. To encourage the participation of outstanding students and young, promising researchers, ESWI will provide some 50 travel and accommodation grants through the ESWI Young Scientist Fund. Application for these grants opened on February 1, 2014. Please feel free to forward this information to anyone you think may be interested in applying for a Young Scientists travel and accommodation grant.

CDC releases Adult Immunization Schedule and Coverage Data

New national adult immunization coverage data and the updated ACIP adult immunization schedule were published in the MWWR on February 7, 2014. There were only very modest gains for Tdap and HPV vaccines and coverage for other vaccines and risk groups did not improve from the previous year. Additionally, racial/ethnic disparities persist for routinely recommended adult vaccines and for some vaccines, actually became worse. Coverage for all vaccines for adults remains low.

Check out the University of Pittsburgh’s 4 Pillars Toolkit to Increase Adult Immunizations 

The 4 Pillars Toolkit to Increase Adult Immunizations is an evidence-based collection of techniques for increasing adult influenza, pneumococcal and Tdap vaccinations, grouped into the 4 strategic “pillars” of Convenience/Easy Access, Patient Notification, Enhanced Office Systems, and Motivation.

This toolkit has undergone an evolution of revision and testing. Initially developed as a toolkit peer-reviewed by national experts designed to assist practices in implementing standing orders protocols (SOPs) for adult immunizations, the toolkit was revised and expanded to include additional pillars to support SOPs and further increase adult influenza and pneumococcal polysaccharide (PPSV) vaccination. This successful toolkit was then digitized and made available online. It has been revamped further to become a web-based, step-by-step program which includes a Practice Transformation Dashboard that guides practices through the process of implementing the strategies outlined in this toolkit. 

SAVE THE DATE! 2014 Summit Face-to-Face Meeting Information

The 2014 face-to-face annual meeting of the National Adult and Influenza Immunization Summit will be held in Atlanta, Georgia, at the Hyatt Regency hotel on May 13-15, 2014. As details are finalized, we will continue to inform the Summit partners on the agenda, rooming block, etc. Thank you all for your continued support and participation!

Early Registration for the National Conference on Immunization and Health Coalitions Ends February 14, 2014!

Partnering for Prevention from Sea to Summit is the theme of the 11th National Conference on Immunization and Health Coalitions (NCIHC), which will take place in Seattle, WA from May 21-23, 2014. NCIHC is the only conference solely dedicated to collaboration and partnership as a way to improve the health status of communities. Keynote speakers will include Drs. David Williams, William Foege, Wendy Sue Swanson (Seattle Mama Doc), and Sara Rosenbaum, JD.

More than 400 Organizations Are Now Represented on IAC’s Influenza Vaccination Honor Roll for Mandatory Healthcare Worker Vaccination!

IAC urges qualifying healthcare organizations to apply for its Influenza Vaccination Honor Roll. The honor roll recognizes hospitals, medical practices, professional organizations, health departments, and government entities that have taken a stand for patient safety by implementing mandatory influenza vaccination policies for healthcare personnel. More than 400 organizations are now enrolled.

Summit Website Offers Wonderful Resources on Influenza Vaccination!

Remember to visit the Summit website for the latest on influenza immunization resources and to view archived copies of the weekly Updates.


Bill Seeks Committee to Study Cost, Availability of Vaccines in Arizona

A bill has been advanced that would establish a committee to study the cost and availability of vaccines in Arizona. HB 2101, authored by Rep. Kate Brophy McGee, won a unanimous endorsement from the House Health Committee.

The bill would have lawmakers, state and local health officials, health professionals, representatives of insurers and pharmaceutical companies and others study the financing and availability of childhood and adolescent vaccines and the costs associated with those vaccines across Arizona.

The panel would have to submit its findings by Dec. 15, 2014.

Major Breakthrough For Vaccine Design

Vaccines are the safest, cheapest and most effective way to protect against infectious diseases, but to make a good one remains a challenge. Traditional approaches are now stretched to the limit while fatal diseases, like HIV and malaria, remain without vaccine. But a major breakthrough that turns vaccine design on its head was published in Nature on February 6 – a new computational method that, from the protective antibodies of patients, can design the vaccine specific to induce them (and protect against the disease).

CDC: Adults Vaccination Rates ‘Depressingly Low’

A recent survey revealed that many adults in the U.S. are not taking recommended vaccinations that could protect them from serious diseases. In the 2012 National Health Interview Survey, which included a national representative sample of the U.S. population, the Centers for Disease Control and Prevention (CDC) found that adult vaccination rates are significantly low, especially among vaccines that could prevent serious diseases.

H7N9 Cases Show No Epidemiologic Link – Four Family Clusters Remain Suspicious

Researchers with the Chinese CDC reported that most people with influenza A(H7N9) infection had severe lower respiratory tract illness and a history of recent exposure to poultry, but they were otherwise epidemiologically unrelated. In an article in the New England Journal of Medicine, researchers in China said that the risk for human-to-human transmission of the virus is still low, but that they could not rule out limited human-to-human transmission in four family clusters.

Why Some Flu Viruses May Be More Contagious

Some influenza viruses can survive and remain infectious on the fingertips for at least 30 minutes, long enough to transmit the flu to oneself or others, says a study in the January issue of Clinical Microbiology and Infection. Researchers sought to find out if the type or size of the flu virus affects its survival. Experiments in Geneva involved two common influenza viruses: H3N2 and H1N1, the virus that triggered a global flu pandemic in 2009. H1N1 appeared to be hardier than H3N2, the researchers said.

Sinovac Seeks Approval For H7N9 Vaccine Clinical Trials

Sinovac Biotech has submitted a clinical trial application (CTA) with the China Food and Drug Administration (CFDA) to commence human clinical trials for its vaccine against Avian influenza A (H7N9) virus. The CTA was officially accepted by CFDA on January 29, 2014.

Incidence rates for H7N9 continue to increase in China, with 153 H7N9 Human infectious cases reported in 2013 according to the World Health Organization (WHO). In January 2014, 96 H7N9 cases were reported in China, including 20 fatalities.

The H7N9 vaccine was developed using Sinovac’s existing flu vaccine development and production platform that includes its seasonal influenza vaccine, its pandemic influenza vaccine against H5N1, and its pandemic A (H1N1) vaccine.

Data Maps Use Queries to Predict the Influenza Season

Cruising the Internet, we ran across a couple of novel data maps that attempt to chart the trajectory and severity of the flu season. According to these maps, the U.S. is in the throes of the flu season, which appears pretty severe in California and Texas compared to much of the rest of the country. The story goes on to detail two data systems from Google FluTrends and from Columbia University.

Reminder: Please email L.J or LaDora if you have any updates on activities to provide to the Summit.

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