January 12, 2015

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Special Announcement
Summit Call Recap – January 8, 2015
Information from CDC
Announcements

SPECIAL ANNOUNCEMENT


2015 NAIIS Immunization Excellence Awards – Nominations are now open! Nominations 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 will be named. The winners will be presented with their awards at the National Adult and Influenza Immunization Summit meeting (to be held on May 12–14, 2015 in Atlanta, GA). The national winner in each category will be invited to present their programs at the NAIIS meeting.

The six categories of recognition are:

  • Influenza Season Campaign
  • Healthcare Personnel Campaign
  • “Immunization Neighborhood” Champion
  • Adult Immunization Champion
  • Corporate Campaign
  • Adult Immunization Publication Award (new award!)

Nominations may be submitted by going directly online. The deadline for nominations is February 13, 2015.


SUMMIT CALL RECAP – JANUARY 8, 2015


Influenza Surveillance Update – Sophie Smith (CDC)

Sophie provided a summary of the published reports for week 52, ending December 27. A variety of measures indicate influenza activity is continuing to increase in the U.S.

The ILI-Net national data indicated 5.9% of total patient visits were for influenza-like illness (ILI), which is above the national baseline level of 2.0% for this week. Approximately 30.4% of specimens submitted for testing were positive, with a mixture of both A and B. Of the deaths reported through the 122 Cities Mortality Reporting System during week 52, 6.8% were attributed to pneumonia and influenza (P&I), below the 6.9% epidemic threshold for the week. Reports indicated there were 12.6 laboratory-confirmed influenza-associated hospitalizations per 100,000 population.

Six new pediatric deaths were reported during the week. Three deaths reported during week 51 were attributed to influenza H3N2. During weeks 51 and 52, 2 deaths were reported as influenza A, but no subtyping was performed. One death reported during week 51 was not typed. A total of 21 pediatric deaths have been reported so far during the 2014–2015 season. Of the 18 (of 21) for whom a vaccination history is known, only 1 was fully vaccinated.

As shown in CDC’s weekly influenza summary map, the geographic spread for influenza for week 52 is:

  • Widespread – 43 states
  • Regional – 6 states and Puerto Rico
  • Local – no states
  • Sporadic –  1 state
  • No activity –  no states
  • No report – District of Columbia, Guam, Virgin Islands

Since October 1, CDC has antigenically characterized 334 influenza viruses; 10 2009 H1N1 virus, 268 influenza A (H3N2) viruses, and 56 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 268 influenza A (H3N2) viruses tested, 85 were characterized as A/Texas/50/2012-like, which also is included in this season’s Northern Hemisphere vaccine. One hundred eighty-three 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 39 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. Fifteen of the 17 B/Victoria viruses were characterized as B/Brisbane/60/2008-like, a component of the 2014–2015 Northern Hemisphere quadrivalent influenza vaccine. Two of the B/Victoria lineage viruses tested showed reduced titers to B/Brisbane/60/2008.

None of the 386 specimens tested this season has shown resistance to oseltamivir or zanamivir.

Summit members discussed the communications challenge in promoting the use of influenza vaccine due to this year’s H3N2 virus drift from the vaccine component. But it is important to stress that the vaccine contains 3 strains. Therefore, the vaccine could still provide protection against 2 strains that might appear in greater numbers later in the season. Additionally, some published reports indicate there could be cross-reactivity between the H3N2 strains.


2014–15 Influenza Activity and Antiviral Recommendations – Angela Campbell (CDC)

Angela provided a presentation highlighting influenza activity for the 2014–15 season compared with prior seasons, and also discussed CDC’s recommendations on the use of antiviral medications.

Influenza-like illness (ILI) reports for this season closely parallel similar reports during the 2012–13 season, the last severe H3N2 season. As noted in the surveillance report Sophie provided earlier in the call, influenza activity is moderate to high in the majority of the country. As expected during a high H3N2 year, hospitalizations are high in the >65 years age group. It would not be surprising for hospitalizations to reach 181/100,000, the level seen in 2012–13. At this point, we cannot predict whether we have reached the peak of this year’s influenza activity.

Angela reminded Summit members that in early December CDC issued a message via the Health Alert Network (HAN) to call attention to the appearance of drifted H3N2 virus while still recommending vaccine as the first line of defense. CDC now plans to issue an additional HAN on January 9. The 3-fold goal of this HAN is to provide: (1) a summary of influenza antiviral drug treatment recommendations in direct language, (2) an update about approved antiviral drugs and drug supply this season, and (3) background information encouraging patients to seek early treatment, particularly if they are at high risk for complications. CDC will be issuing this new HAN to promote antiviral medications, which evidence suggests are severely underutilized. In particular, it is important for antiviral treatment to be started as soon as possible after illness onset, ideally within 48 hours of symptom onset. Treatment should not be delayed even for a few hours to wait for the results of influenza testing. Antiviral effectiveness drops over every 24 hour period. Even so, antivirals should still be offered for persons who present after the 48 hour window has passed. Some studies in pregnant women indicated treatment was still helpful on days 3 or 4, and studies in Bangladesh indicate antivirals were still helpful at 72 hours.

In addition to oral oseltamivir and inhaled zanamivir, a new antiviral medication, intravenous peramivir, was approved on December 19, 2014 for the treatment of acute uncomplicated influenza in persons >18 years. Peramivir may be an easily implemented option when a patient needing an IV for rehydration is seen as an outpatient.

Currently there are no national shortages of antiviral medications. However, local spot shortages have been reported for some formulations, and it may be necessary for patients to contact more than one pharmacy to fill a prescription. CDC is aware of this problem and is working with manufacturers and distributors to try to improve distribution. Staff within the Strategic National Stockpile (SNS) network are trying to increase access through improved management of the supply chain. This week the SNS group is establishing a central call center to facilitate groups that may need a large quantity of antiviral medications to respond to institutional outbreaks, where traditional supply chains are unable to meet the demand.

CDC also is reminding clinicians that antibiotics are not effective against influenza. However, bacterial infections can occur as a complication of influenza, so these should be considered and appropriately treated if suspected. The agency also is highlighting the new pneumococcal vaccine recommendations for adults.

Finally, CDC is providing simple messages to help providers educate their patients. These include:

  • If you get the flu, antiviral drugs are an option.
  • Persons should seek treatment early, particularly if they are hospitalized, have severe illness, or are at high risk for flu complications because of age or underlying medical conditions.

One caller noted that some clinics in Minnesota have begun rationing their antiviral supply by limiting it to persons who are immunocompromised, prompting L.J to ask if CDC anticipates providing guidance to local areas with spot shortages. Angela noted that so far CDC has been focusing their guidance on the meeting needs of outbreaks within institutional settings. However, they would like additional information on instances of rationing such as the one reported from Minnesota.

CDC has developed a website, Influenza Antiviral Medications: Summary for Clinicians, to provide a consolidated location for the latest information and recommendations. The site does not yet contain detailed information about the use of peramivir.


Other Items – Litjen Tan (IAC)

As announced in a supplemental Summit Buzz dated January 7, 2015, CMS has issued new guidance allowing Medicare Part B coverage for a second dose of pneumococcal vaccine, per ACIP recommendations. This is great news! However, L.J did call attention to the fact that the Medicare coverage is not in complete alignment with the ACIP recommendations. The Medicare regulations require one year between doses, while the ACIP recommendations state that if PCV13 is given first, PPSV23 should be given 6–12 months later. Additional information about pneumococcal vaccine coverage may be found in the official MLN Matters article on this new regulation.


INFORMATION FROM CDC


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

The CDC weekly influenza surveillance report for week 53, 2014 (ending January 3, 2015) and region specific data are now available. During week 53, 7.0% of all deaths reported through the 122 Cities Mortality Reporting System were due to P&I. This percentage was above the epidemic threshold of 6.9% for week 53.

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 pneumonia and influenza (P&I) mortality.

About 31.6% of the 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. About 68.4% of the H3N2 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.

Five influenza-associated pediatric deaths were reported to CDC during week 53. All five deaths were associated with an influenza A virus for which no subtyping was performed and occurred during weeks 50, 51, 52, and 53 (weeks ending December 13, December 20, December 27, 2014, and January 3, 2015, respectively).

A total of 26 influenza-associated deaths have been reported during the 2014-2015 season from New York City [1] and 13 states (Arizona [1], Colorado [1], Florida [2], Georgia [1], Kansas [1], Minnesota [3], North Carolina [2], Nevada [1], Ohio [2], Tennessee [3], Texas [5], Virginia [2], and Wisconsin [1]).  More detail is available at: http://gis.cdc.gov/GRASP/Fluview/PedFluDeath.html.

Between October 1, 2014 and January 3, 2015, 5,492 laboratory-confirmed influenza-associated hospitalizations were reported. The overall hospitalization rate was 20.1 per 100,000 population. The highest rate of hospitalization was among adults aged ≥65 years (91.6 per 100,000 population), followed by children aged 0–4 years (22.0 per 100,000 population). Among all hospitalizations, 5,332 (97.1%) were associated with influenza A, 138 (2.5%) with influenza B, 13 (0.2%) with influenza A and B co-infection, and nine (0.2%) had no virus type information. Among those with influenza A subtype information, 1,582 (99.6%) were A(H3N2) virus and six (0.4%) were A(H1N1)pdm09. Additional virus characterization is available on FluView.

Nationwide during week 53, 5.6% 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 3, 2015. At this time, most states are reporting widespread influenza activity.

The FluView report for week 53 and archives of previous FluViews are available from CDC. CDC also has released seasonal influenza key points for January 9, 2015.


CDC Holds Media Briefing on Influenza

On January 9, 2015, CDC held a telebriefing highlighting flu activity in the United States so far this season and reviewing the agency’s antiviral treatment recommendations. A transcript of the telebriefing is available from CDC.


CDC Issues HAN on Importance of Antiviral Treatment for Influenza

A CDC Health Update Regarding Treatment of Patients with Influenza with Antiviral Medications was distributed via the CDC Health Alert Network on January 9, 2015.


Updated Key Points on EV-D68 Infections and Disease

The United States has been experiencing a nationwide outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness.  Updated EV-D68 key points, current as of January 8, 2015, include the weekly update of EV-D68-like illness activity in states and specimens that tested positive for EV-D68 from patients who died.


Updated information on Acute Flaccid Myelitis

Up-to-date key points from January 8, 2015 are now available 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.

On January 9 CDC released an MMWR, Notes from the Field: Acute Flaccid Myelitis Among Persons Aged <21 Years – United States, August 1–November 13, 2014, that summarizes statistics about confirmed cases in this investigation as of Nov 13.


CDC Spotlight on Influenza Released

A CDC Flu Spotlight on current influenza activity, Flu Activity Expands: Severity Similar to Past H3N2 Seasons, is available online.


Upcoming and Recent CDC COCA Calls
  • CDC Response to 2014 Ebola in the United States and West Africa

NEW: 2014 Ebola Outbreak in West Africa – Cumulative Reported Cases Graphs

NEW: Considerations for U.S Healthcare Facilities to Ensure Adequate Supplies of Personal Protective Equipment (PPE) for Ebola Preparedness

UPDATED: 2014 Ebola Outbreak in West Africa – Case Counts

NEW: Interim Guidance for Ebola Virus Cleaning, Disinfection, and Waste Disposal in Commercial Passenger Aircraft

NEW: Questions and Answers about Ebola and Food Safety in the United States

NEW: 2014 Ebola Outbreak in West Africa – Cumulative Reported Cases Graphs

NEW: Frequently Asked Questions (FAQs) on Interim Guidance for Managers and Workers Handling Untreated Sewage from Suspected or Confirmed Individuals with Ebola in the U.S.

Date: Monday, December 15, 2014

Overview: Healthcare systems across the United States are actively preparing to treat patients with Ebola. Emergency Medical Services (EMS) play an important role in the identification, assessment, and transportation of suspected or confirmed patients with Ebola. As designated treatment facilities, Emory University Hospital and the University of Nebraska Medical Center have received patients with confirmed Ebola. During this COCA Call, clinicians will learn about the field experiences of EMS personnel in the two jurisdictions and discuss unique planning considerations for EMS.


ANNOUNCEMENTS


Pneumococcal Vaccination Algorithms from Dr. Robert Hopkins

On the January 8 Summit call, Dr. Robert Hopkins, a frequent participant in Summit activities, mentioned that he had developed pneumococcal vaccination algorithms. He put these together for his institution’s pediatric group and to support an adult standing order set on pneumococcal vaccination incorporating the new ACIP recommendations. He hopes that they are useful to Summit partners. Thank you Dr. Hopkins!


ACOG Presents a New Webinar – Tdap Vaccination in Pregnancy: A Mother’s Gift to Her Baby

The American College of Obstetricians and Gynecologists (ACOG) is presenting a webinar, Tdap Vaccination in Pregnancy:  A Mother’s Gift to Her Baby, on Wednesday, January 21st from 12:00-1:00 p.m. EST.

This free, 1 CME credit webinar will explain the importance of Tdap immunization, especially for pregnant women during the 3rd trimester. The presentation will detail ACOG and ACIP’s Tdap immunization recommendations, describe the safety and common side effects of Tdap vaccination, and explain the importance of and optimal timing for Tdap immunization during pregnancy.

Continuing Medical Education credit is provided through joint providership with The American College of Obstetricians and Gynecologists.

Following the live presentation, the webinar will be archived on ACOG’s Immunization for Women website for convenient viewing.


Support Families Fighting Flu (FFF) by Using and Posting Their New Twibbon!

FFF has created a Twibbon, which is a badge for Facebook and Twitter profile pictures, to help spread awareness about the seriousness of flu and the importance of vaccination. Summit partners can add the Twibbon to your social media profile pictures and help FFF spread the word. The more people who add the Twibbon, the more people are going to be curious about what it means and will click on it to learn more, and hopefully get vaccinated if they haven’t already. Many thanks for the Summit partners’ help in spreading awareness!


FDA Clears Molecular Flu Test for Wider Use

On January 6 the US Food and Drug Administration (FDA) announced that it has granted the first waiver to allow a nucleic acid–based test to be used in a broader selection of clinical settings. Before the FDA’s waiver, the Alere influenza A & B test was allowed only for use in certain laboratories. Additional information is available in an article published in CIDRAP.


Comment Period Open for Proposed Revised Vaccine Information Materials

CDC has posted Proposed Revised Vaccine Information Materials for Multiple Pediatric Vaccines (“Your Baby’s First Vaccines”) on regulations.gov, the federal eRulemaking portal. The comment period is open until March 10, 2015, in case Summit partners want to submit comments or provide input. The original Federal Register notice is available for review.


Check Out Meningitis Angels’ New PSA!

Please take a look at the Meningitis Angels new PSA, Meningitis Angels (The ABC & Y of Meningitis), which was released in November, 2014. The PSA features several children who are meningitis survivors. Between them, they have multiple amputations, kidney transplants, learning disabilities, hearing loss, severe anemia and other health problems. All from meningococcal meningitis. All preventable.


NFID Holding Clinical Vaccinology Course

The National Foundation for Infectious Diseases (NFID) will be holding its Spring 2015 Clinical Vaccinology Course on March 13–15, 2015, in Denver, Colorado. This 2-1/2 day course focuses on new developments and issues related to the use of vaccines. Expert faculty will provide the latest information on both current and prospective vaccines, updated recommendations for vaccinations across the lifespan, and innovative and practical strategies for ensuring timely and appropriate vaccination.

The course is specifically designed for physicians (family, infectious disease specialists, internists, and pediatricians), nurse practitioners, nurses, physician assistants, pharmacists, public health professionals, vaccine program administrators, and other healthcare professionals interested in clinical aspects of vaccine delivery.

Attendees will leave the course with:

  • Skills to communicate effectively with patients and parents about vaccine concerns
  • Resources to educate patients and colleagues
  • Knowledge to administer vaccines appropriately
  • Best practices to improve childhood, adolescent, and adult immunization rates


Pharmacist.com Story on CMS Payment for Two Different Pneumococcal Vaccines

On January 8, 2015, pharmacist.com published Medicare will cover a second dose of pneumococcal vaccine, which covers the new CMS payment guidance for two different pneumococcal vaccines.

The new CMS coverage requirements align with updated ACIP recommendations. Beginning February 2, 2015, CMS will cover a second dose of pneumococcal vaccine to align with updated recommendations from CDC’s Advisory Committee on Immunization Practices (ACIP).

In September 2014, ACIP issued a recommendation to use the existing vaccine (PPSV23) and a recently FDA-approved vaccine (PCV13) in adults 65 years and older for the prevention of pneumococcal disease. Until now, Medicare never paid providers—with the exception of an appropriate booster dose of the same vaccine (PPSV23)—who followed the recommendation to administer a second dose.


China Bans U.S. Poultry, Eggs Imports Amid Avian Flu Fears: USDA

China has banned all imports of U.S. poultry, poultry products and eggs amid recent reports of highly pathogenic strains of avian influenza found in the Pacific Northwest, the U.S. Department of Agriculture said January 12, 2015. All poultry and poultry related products shipped from the United States after Jan. 8 would be returned or destroyed, according to the agency and the U.S. trade group USA Poultry & Egg Export Council.


Multiple News Stories on Measles Transmission at Disneyland

There are multiple news reports on this incidence of measles transmission at Disneyland.

Measles outbreak at Disneyland linked to non-vaccinations (CBS News)

At least 20 confirmed measles instances connected to Disneyland (West Valley News)

Nineteen people have been confirmed with measles after visiting Disneyland (Morning Vertical)

Cases of Measles Linked to California Disney Parks (Youth Health Magazine)

Disneyland Measles Outbreak Highlights the Importance of Vaccines (Huffington Post)

At least 20 confirmed measles cases connected to Disneyland as recent outbreak continues to spread to 4 states (New York Daily News)

Is the Anti-Vaccination Movement to Blame for Disneyland Measles Outbreak? (TakePart)

Number of confirmed measles cases increased to nine; most are Disney-related (OCRegister)

19 measles cases reported with ties to Disneyland (Town Hall)

Orange County Measles Cases Increases to Nine (Santa Monica Mirror)

Disneyland measles outbreak: 19 fall ill after visiting theme parks (Mirror.co.uk)


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.

 

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