February 24, 2014

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Summit Call Recap – February 20, 2014

Announcements

News Highlights

SUMMIT CALL RECAP – February 20, 2014

**Influenza Surveillance Update and Influenza Articles in Today’s MMWR – Scott Epperson (CDC)**

Scott reported that we are continuing to see declining levels of influenza across most of the country. However, ILI activity remains above baseline levels both nationally and in all 10 regions. Preliminary data to be reported on February 21 may show slight differences, with at least 1 region expected to be below baseline.

The 2009 H1N1 virus remains this year’s overwhelmingly predominant strain, although minimal levels of A(H3N2) and B strains also have been reported. There has been no substantial change in reported trends for hospitalization and mortality. Persons wishing to obtain more detailed information should refer to CDC’s FluView.

This week’s MMWR contains several important influenza reports, including:

Also this week, the World Health Organization recommended that the components of the 2014–2015 seasonal influenza vaccine for the northern hemisphere remain the same as those included in this season’s vaccine. Later this year, these recommendations will be considered by the FDA Advisory Committee as they select the specific strains to be included in U.S. influenza vaccines.

Interim Seasonal Influenza Vaccine Effectiveness Estimates for 2013–14 – Brendan Flannery (CDC)

As noted in Scott’s report (above), today’s MMWR included the interim seasonal influenza vaccine effectiveness estimates for the current season. These estimates are based on data collected by the Influenza Vaccine Effectiveness (Flu VE) Network. The 5 sites included in the Flu VE Network are located in Wisconsin, Michigan, Pennsylvania, Texas, and Washington State. Each facility has been collecting data since they began seeing widespread influenza circulation in their area (generally in early December) through January 23, 2014.

Data was collected from 2,319 outpatients >6 months of age who were seeking care for any acute respiratory illness with a cough. (Details of the study design are contained in the MMWR article.) Of the 784 (34%) study participants who tested PCR positive for influenza, 778 (99%) had influenza A and 6 (1%) had influenza B. Among the 775 subtyped influenza A viruses, 742 (98%) were 2009 H1N1. The proportion vaccinated with 2013-14 seasonal vaccine was 29% among influenza cases compared with 50% among influenza-negative controls. After adjusting for co-founders among the negative controls, VE was 61% (CI = 52%–68%) against acute respiratory illness and 62% (CI = 53%–69%) against 2009 H1N1 infection.

As noted during the media briefing conducted earlier today by Drs. Freiden and Schuchat, this year’s influenza has been particularly hard on younger and middle-aged persons. However, the good news from this study is that VE was similar across all age groups. It also is similar to the VE measured in the last several seasons for people infected with influenza H1N1. This data will be presented at next week’s ACIP meeting and will be updated at the end of the influenza season.

Call participants questioned whether data is available to assess duration of vaccine immunity, but Brendan noted that data from the 5 survey sites is limited in regard to whether participants had received H1N1 vaccine in prior seasons. Scott Epperson added that this is a limitation of the majority of our surveillance systems, with the exception of pediatric mortality.

The bottom line interpretation of the study is that vaccination appeared to have reduced the risk of a person with lab-confirmed illness receiving medical care by about 61% for all age groups. It is important that we explain these results as a reduction of risk, rather than actual outpatient visits. More detailed information is available in the MMWR.

Other Items – L.J Tan (IAC)

L.J announced that the new NAIIS website officially launched today. This coincides with today’s publication of the Adult Standards of Practice in Public Health Reports. The new website contains information and resources on adult and influenza vaccination, as well as NAIIS-specific materials related to the upcoming meeting and the activities of the Summit workgroups.

The 2014 NAIIS face-to-face meeting will be held May 13–15 in Atlanta, Georgia. Registration information will be posted on the NAIIS website as soon as it is available.

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

The CDC weekly influenza surveillance report for week 7 (ending February 14, 2014) and region specific data are now available. Of all deaths reported through the 122 Cities Mortality Reporting System, 8.2% were due to P&I. This percentage was above the epidemic threshold of 7.4% for week 7.

Two influenza-associated pediatric deaths were reported to CDC during week 7. One death was associated with a 2009 H1N1 virus and occurred during week 6 (week ending February 8, 2014), and one death was associated with an influenza A virus for which no subtyping was performed and occurred during week 5 (ending February 1, 2014).

A total of 52 influenza-associated pediatric deaths have been reported during the 2013–2014 season from New York City [1] and 24 states (AR [3], AZ [1], CA [4]; FL [3], GA [1]; IA [1]; KS [1], KY [1]; LA [4]; MA [2]; MI [2], MS [1], NC [3]; NE [1], NV [1], OK [2]; OR [1], PA [1], TN [4]; TX [9]; UT [2]; VA [1]; WI [1]; and WV [1]).

Nationwide during week 7, 2.5% 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. On a regional level, the percentage of outpatient visits for ILI ranged from 1.3% to 3.8% during week 7. Nine of 10 regions reported a proportion of outpatient visits for ILI above their region-specific baseline level. 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 7, seven states (Arkansas, Delaware, Hawaii, Maryland, New Mexico, Texas, and Virginia) experienced moderate ILI activity; sixteen states (Alaska, Connecticut, Kansas, Louisiana, Minnesota, Mississippi, Missouri, Nevada, New Jersey, New York, North Carolina, Oklahoma, South Dakota, Tennessee, Utah, and Washington and New York City) experienced low ILI activity; and twenty-seven states (Alabama, Arizona, California, Colorado, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Maine, Massachusetts, Michigan, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Vermont, 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 21, 2014 are available for review.

ANNOUNCEMENTS

CDC February 20, 2014 Media Briefing

On February 20, 2014, CDC held a media briefing reporting that people age 18−64 years represented 61% of all hospitalizations from influenza—up from the previous three seasons, when this age group represented only about 35% of all such hospitalizations. Influenza deaths followed the same pattern; more deaths than usual occurred in this younger age group. Also, CDC reported that that influenza vaccination offered substantial protection against influenza this season, reducing a vaccinated person’s risk of having to go to the doctor for influenza illness by about 60% across all ages.

Finally, CDC reported that, in its interim influenza vaccine effectiveness (VE) study, they examined data from 2,319 children and adults enrolled in the U.S. Influenza Vaccine Effectiveness (Flu VE) Network from December 2, 2013 to January 23, 2014. They found that influenza vaccine reduced the risk of having to go to the doctor for influenza illness by an estimated 61% across all ages. The study also looked at VE by age group and found that the vaccine provided similar levels of protection against influenza infection across all ages. VE point estimates against influenza A and B viruses by age group ranged from 52 percent for people 65 and older to 67 percent for children 6 months to 17 years. Protection against the predominant H1N1 virus was even slightly better for older people; VE against H1N1 was estimated to be 56 percent in people 65 and older and 62 percent in people 50 to 64 years of age. All findings were statistically significant.

The interim VE estimates this season are comparable to results from studies during other seasons when the viruses in the vaccine have been well-matched with circulating influenza viruses and are similar to interim estimates from Canada for 2013-14 published recently.

CDC has issued talking points on the 3 MMWR articles discussed during the media briefing. (Shown above in the “Summit Call Summary”.)

CDC Letter to Providers of Care to Pregnant Women

CDC recently posted a “Dear Colleague” letter to providers, specifically those who 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 CDC influenza pages for pregnant women and health professionals.

Confirmed A(H7N9) in Malaysia

On February 13, CDC released updated key points regarding a confirmed case of human infection with avian influenza A (H7N9) in Malaysia,/a>. Additional information on A (H7N9) is available on the CDC website.

Pfizer Announces Positive Top-Line Results Of Landmark Community-Acquired Pneumonia Immunization Trial In Adults (CAPiTA) Evaluating Efficacy Of Prevnar 13

Pfizer Inc. today announced that the Community-Acquired Pneumonia Immunization Trial in Adults (CAPiTA), the study of approximately 85,000 subjects evaluating the efficacy of Prevnar 13 (pneumococcal polysaccharide conjugate vaccine [13-valent, adsorbed]) in adults 65 years of age and older, achieved its primary clinical objective and both secondary clinical objectives.

“Dear Colleague” Letter Urges Strong Provider Recommendation for HPV Vaccination

HPV vaccine is cancer prevention. However, HPV vaccine is underutilized in our country, despite the overwhelming evidence of its safety and effectiveness. While vaccination rates continue to improve for other vaccines, HPV vaccination rates have not. Missed opportunities data suggest that providers are not giving strong recommendations for HPV vaccine. The healthcare provider recommendation is the single best predictor of vaccination. Recent studies show that a patient who receives a provider recommendation is 4-5 times more likely to receive the HPV vaccine.

Members of the immunization neighborhood have an important role to play in improving HPV vaccination rates. What providers say, and how they say it, matters. Consistency in delivered messages is also important. A half-hearted recommendation to a patient may not only result in the patient leaving a practice unvaccinated, but may lead the patient to believe that HPV vaccine is not as important as the other vaccines. Whether you actually administer the vaccine or refer the patient to a provider who will administer the vaccine, you have an influence on patients’ beliefs.

As the first step in improving HPV immunization coverage rates, a “Dear Colleague” letter has been released focusing on the importance of a strong provider recommendation. This letter provides key facts about HPV vaccine safety and effectiveness, with the hope that they will lead providers to recommend HPV vaccination – firmly and strongly – to their patients. It is clear that in order for adolescents and adults to be properly protected against HPV infection, the effort of the entire immunization neighborhood will be required.

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, 2014 in Atlanta, Georgia). 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 September 14–17, 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.

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. Persons planning to attend should schedule their travel to arrive on the evening of May 12 and depart no earlier than 5 p.m. on May 15. 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!

New Summit Website Ready for Viewing

Please visit the Summit’s new and revised website! The site now includes home pages for each Summit workgroup. It also highlights the new NVAC Standards for Adult Immunization Practices, including listings of supporting organizations and their supportive action items.

NEWS HIGHLIGHTS

Influenza Vaccine Cuts Stroke Risk by Nearly 25%, Researchers Say

People who are vaccinated against the seasonal influenza are 24% less likely to suffer a stroke during that flu season, according to recently published research out of the United Kingdom. These findings could be cited as one more reason for long-term care professionals and residents to receive flu vaccinations.

The “highly significant association” between reduced stroke risk and vaccination was strongest among those who received the shot early in the flu season, the researchers found. They did not discover any link between flu vaccination and reduced risk for transient ischemic attacks, or “mini-strokes.”

The analysis was not designed to explain why vaccination is connected to stroke risk, and further investigation is needed, the authors wrote.

U.S. News & World Report: Get the Flu Shot; polyDNA Recommends Adding Gene-Eden-VIR

Health authorities continue to urge the public to get the flu shot. This is seemingly good advice since a new study from Duke University Medical Center found that virtually all of the people with influenza who ended up in intensive care earlier this flu season had chosen not to get the annual flu vaccine.

Nine More Cases of Avian Influenza Reported in China: WHO

The United Nations World Health Organization (WHO) said Monday it has been notified by China’s National Health and Family Planning Commission of nine new laboratory-confirmed cases of human infection with avian influenza A (H7N9) virus.

The agency urged travelers to countries with known outbreaks of avian influenza to avoid poultry farms, or contact with animals in live bird markets, or entering areas where poultry may be slaughtered, or contact with any surfaces that appear to be contaminated with faeces from poultry or other animals. The UN agency also urged travelers to wash their hands often with soap and water, and to follow good food safety as well as good food hygiene practices.

Lack of Vaccination a Threat to Population

With the flu season still going strong in the Northern Hemisphere, it’s necessary for people to understand the paramount importance of vaccinations and immunization campaigns. Winter officially ends mid-March, but that does not mean the flu season is also nearing completion. According to a 31-year study by the U.S. Centers for Disease Control and Prevention, 45 percent of flu seasons peaked in February, and 16 percent peaked in March. This means it’s still prime time to contract and spread the flu.

We never think we’re the one who’s going to get sick, and on a national scale this mentality may lead to larger problems. According to a review from the non-profit groups Trust for America’s Health and the Robert Woods Johnson Foundation, most American states receive a failing grade in their public health emergency plans. As a nation, we’re completely unprepared for an infectious disease disaster — partly due to ignorance, sequestration and anti-vaccination campaigns.

The Rights of the Unvaccinated Child: The Legal View

In light of what’s starting to look like a surge of measles cases spread by unvaccinated carriers, Hastings Law professor Dorit Rubinstein Reiss offers some welcome insights into the legal rights of unvaccinated children. The first two installments of Reiss’ five-part series are up at the Shot of Prevention website, with the rest due over the next couple of weeks. Reiss provides a tour of the legal landscape via case law and legal principles, but her core finding is that parents are responsible for weighing the pros and cons of vaccination for their children, and the pros far outweigh the cons.

Soon, More Efficient Vaccines for Meningitis and Pneumonia

Researchers have discovered the presence of a novel subtype of innate lymphoid cells in human spleen essential for the production of antibodies.

This work was done by the B cell Biology research group at IMIM (Institut Hospital del Mar d’Investigacions Mediques) in Barcelona, directed by Dr. Andrea Cerutti, ICREA research professor and leader in the field of B lymphocyte biology.

Dr. Giuliana Magri, member of the research group of B Cell Biology at IMIM and first author in the paper, said that for the first time it has been described both their presence and function in human spleen. We have discovered how these cells regulate the innate immune response of a subset of splenic B lymphocytes that are responsible to fight against encapsulated bacteria, causative agents of meningitis or pneumonia.

Additional stories on this discovery may be found in Business Standard and Science Codex.

Oregon Vaccine Law Begins Next Month

With a new law going into effect next month that requires parents to speak with a medical provider or watch an interactive online video before they can opt out of vaccinating their kindergartners, Oregon is joining its West Coast neighbors in making nonmedical exemptions harder.

The current law was still in effect last Wednesday, this year’s school exclusion day when schoolchildren must show documentation that they are up-to-date on their immunizations or show a medical or religious exemption. In order to claim a religious exemption, parents had to sign a form, which a recent study of state immunization laws characterized as a relatively easy exemption procedure.

MERS Coronavirus Tally: ECDC

As of 21 February 2014, 186 laboratory-confirmed cases of MERS-CoV have been reported by local health authorities worldwide, including 81 deaths. Coronaviruses are a cause of the common cold. A coronavirus also was the cause of the severe respiratory illness called SARS (severe acute respiratory syndrome). SARS caused a global epidemic in 2003, but there have not been any known cases of SARS since 2004. MERS-CoV is not the same coronavirus that caused SARS.

MERS-CoV is different from any other coronavirus that has been previously found in people. Symptoms of MERS have included fever, cough, and shortness of breath.

The World Health Organization says MERS-CoV infections that may be acquired in health-care facilities illustrate the need to continue to strengthen infection prevention and control measures. Health-care facilities that provide care for patients suspected or confirmed with MERS-CoV infection should take appropriate measures to decrease the risk of transmission of the virus to other patients, health-care workers and visitors.

In addition, they recommend that people at high risk of severe disease due to MERS-CoV should avoid close contact with animals when visiting farms or barn areas where the virus is known to be potentially circulating.

HPV Vaccine: Conversations Between Pediatricians and Parents Key To Ensuring Daughters Get Vaccinated

The Centers for Disease Control and Prevention (CDC) says that despite the availability of protective vaccines against human papillomavirus (HPV) since 2006, HPV vaccine uptake in the US is relatively low.

In 2012, a national survey found that 54% of girls aged 13–17 years had received at least 1 dose of the HPV vaccine series, but only 33% had received all 3 doses in the series. Vaccine uptake is very low among boys. However, recently published research in Clinical Pediatrics says the communication between pediatrician and parent is key to encourage and educate apprehensive parents who delay or refuse the vaccination for their adolescent daughters.

Public Health Ontario Releases Annual Report on Vaccine Safety in Ontario, 2012 – Results Show Vaccines to be Safe with Few Cases of Adverse Reaction

Vaccines are safe and have a low risk of adverse reactions, according to the Annual Report on Vaccine Safety in Ontario, 2012, released today. An adverse reaction, or event, is an unwanted or unexpected health effect that happens after someone is vaccinated. It may or may not be caused by the vaccine. Of the 7.8 million doses of vaccine distributed in Ontario in 2012, only 631 adverse reactions were reported.

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