July 05, 2016

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Summit Call Recap – July 5, 2016

Announcements

Register for Free NFID CME/CNE Webinar on July 7, 2016: Updates from June 2016 ACIP Meeting
Adult Vaccine Access Coalition Issues Its Response to MACRA (informational)

Information from CDC

Other News

SUMMIT CALL RECAP – JUNE 30, 2016

Influenza Surveillance Update – Sophie Smith (CDC)

Sophie provided a summary of the published reports for week 24, ending June 18, 2016.

During the summer CDC’s reporting is abbreviated from the amount of data provided during the height of the influenza season. Therefore, data is not available on several of the reports routinely provided by Sophie, including geographic spread, hospitalization rates, antiviral resistance, and antigenic characterization.

Influenza activity in the U.S. continues to decrease. The ILI-Net national data indicated 1.2% of total outpatient visits were for influenza-like illness (ILI), which is below the national baseline of 2.1%. Approximately 2.4% of specimens submitted for testing were positive. Of the deaths reported through the 122 Cities Mortality Reporting System during week 24, 5.9% were attributed to pneumonia and influenza (P&I), below the 6.2% epidemic threshold for the week.

No influenza-associated pediatric deaths were reported to CDC during week 24. A total of 77 pediatric deaths have been reported during the 2015–2016 season. Of the 67 for whom vaccination status was known, 4 were ineligible for vaccination due to age, and only 7 were fully vaccinated.

ACIP Vote on Use of LAIV for 2016–2017 Influenza Season – Lisa Grohskopf (CDC)

Lisa provided a brief update on the influenza vaccine votes from the ACIP’s February and June meetings.

In February the ACIP reviewed data on use of influenza vaccine in egg-allergic patients. The Committee voted to remove the special algorithm for vaccination of these patients, as well as the recommendation that egg-allergic patients be observed for a 30-minute waiting period after vaccination. (Note: The General Recommendations on Immunization will continue to suggest a 15-minute waiting period after vaccination due to potential syncope.) The Committee also voted that live attenuated influenza vaccine (LAIV) could be an acceptable vaccine option for these individuals, although this recommendation was impacted by the subsequent discussions at the June meeting.

The June ACIP meeting covered eight presentations on influenza-related topics, including a vaccine safety update and manufacturer presentations from Seqiris and GSK. However, the primary topic for the meeting was LAIV.

CDC has been following LAIV vaccine effectiveness (VE) closely, particularly since June 2014 when ACIP stated a preference for use of this vaccine in healthy children. However, the final VE data released in the fall of 2014 indicated the vaccine had no statistically significant impact on prevention during the previous season. H1N1 was the predominant circulating strain during 2013–2014 season, and it was thought the viral construct of the H1N1 vaccine component may have contributed to the low VE. As a result, the H1N1 component of the vaccine was changed for the 2015–2016 season. But FluNet data presented at the June 2016 ACIP meeting indicated that there had been no statistically significant impact on the prevention of H1N1 infection in children age 2 through 17 years. VE data presented by MedImmune/AstraZeneca differed from the FluNet result.

As a result of the CDC data indicating poor VE of LAIV during the past three influenza seasons, ACIP voted to recommend that LAIV should not be used in any setting during the 2016–2017 influenza season. ACIP also voted to remove LAIV from the VFC program for the 2016–2017 influenza season.

Information from AstraZeneca on LAIV – Brianne Murphy (AstraZeneca)

Brianne Murphy, Public Health Manager of AstraZeneca’s Specialty Care Division, joined the Summit call to report on AstraZeneca’s response to the ACIP action. Joining her on the call were Allyn Bandell, Serior Director, Medical Affairs – Infectious Disease; Brian Gregoire, Director, Public Health Vaccine; and Joel Batten, Government Affairs Manager.

Ms. Murphy stressed that AstraZeneca wants to continue to be a good public health partner, and they will continue to promote annual vaccination against influenza. The company feels strongly about LAIV, and they will work diligently to understand the issues that led to this point. Ms. Murphy noted that the company fully anticipates seeking ACIP approval for the 2017–2018 season. However, as explained in AstraZeneca’s letter to healthcare providers, the company recognizes that the recommendation has placed providers in a difficult situation. Therefore, AstraZeneca will release all U.S. providers from their pre-book commitments at no penalty. At this point, AstraZeneca has not established a specific website containing this information; rather, providers are being informed of this policy through the letter. Joel Batten noted that AstraZeneca uses third parties for vaccine distribution of LAIV, so the actual cancellation of orders will take place between distributors and individual providers. (Distributors have been instructed to allow cancellation of orders at no penalty.)

A Summit partner asked whether the data showed the low VE was restricted only to the H1N1 component of the vaccine. Dr. Bandell responded that it would be best to review the various data sets presented at the ACIP meeting as soon as they are posted on the ACIP website. Carolyn Bridges noted that she will share the key points distributed by CDC, and she also will determine if this vote will cause CDC to issue a new influenza vaccine information statement (VIS) for the upcoming season. (Note: Following the meeting, Carolyn reported that, during the upcoming season, all providers may use the currently available influenza VIS.

In response to a question, AstraZeneca reported that LAIV distribution is still planned for the 2016–2017 season in countries other than the U.S. This may provide additional experience on VE that could be examined by ACIP in future years.

Early Launch of Influenza Vaccine Availability Tracking System – L.J Tan (IAC)

Due to the unique nature of this season’s influenza vaccine supply, the Immunization Action Coalition has provided an early launch of the 2016–2017 Influenza Vaccine Availability Tracking System (IVATS.)

IVATS serves as a resource for healthcare settings wishing to purchase influenza vaccine. The voluntary system contains information from approved, enrolled, and participating wholesale vaccine distributors or manufacturers of U.S. licensed influenza vaccine. Ongoing updates are being made and will continue to be made throughout the 2016–2017 season.

L.J provided kudos to Diane Peterson and CDC partners for their rapid response to the LAIV situation and the early release of IVATS for this year.

2016 National Immunization Awareness Month – Ian Branam (CDC)

Ian provided a presentation on plans for National Immunization Awareness Month (NIAM), scheduled for August 2016.

Background
NIAM is observed each August to highlight the importance of immunization for people of all ages. It is sponsored by the National Public Health Information Coalition (NPHIC) and CDC. The objectives of the month are to: (1) highlight the value of immunization for people of all ages; (2) disseminate consistent, coordinated messages across national, state, and local levels; and (3) utilize social and digital media to reach target audiences with tailored messages and resources.

Communication Toolkits
The 2016 NIAM Communication Toolkit has just been launched. It contains key messages, vaccine information, sample news releases and articles, sample social media messages, links to web resources from CDC and other organizations, and logos, web banners, posters and graphics to use with social media. It also includes a media outreach toolkit and a place for you to share your NIAM activities and view what other are doing for NIAM. (#NIAM16) Suggested themes are available for each of the target audiences, i.e., school-age children; babies and young children; preteens and teens; and adults, including pregnant women. The themes can be highlighted throughout the month and/or used all year. Four central messages of the campaign are:

Vaccines protect against serious diseases.
These diseases still exist and outbreaks do occur.
Vaccines are recommended throughout our lives.
Vaccines are very safe.

The toolkits can be used to help with a variety of communications activities. Messages can be combined or adapted to fit the needs of the user.

Resources and Activities
A wide variety of resources from NPHIC and CDC may be found on the NIAM website. Users are asked to use #VaxWithMe within social media posts both during and after NIAM. A #VaxWithMe Thunderclap is scheduled for August 17. The goal of the thunderclap will be to have 500 participants and more than 6 million impressions. The entire website has been optimized for use with mobile devices. New motion graphics will be available by August for children and teens, and adult vaccine information will be available on videos. Some items will include Spanish translations.

Developing an Outreach Plan
A new resource for 2016 is a Media Outreach Toolkit. The toolkit includes valuable tips and checklists on activities such as preparing a spokesperson, pitching a PSA to media outlets, updating your web presence to highlight immunization, promoting through social media, and sharing posters and fact sheets. Users are asked to share their activities on the NIAM website to document their actions and to serve as an inspiration to others.

Persons with questions may contact Ian Branam (CDC) or John Stieger (NPHIC).

Other Items – L.J Tan (IAC)

L.J reminded Summit members that the 47^th National Immunization Conference will be held at the Hilton Hotel in Atlanta on September 13–15, 2016.

ANNOUNCEMENTS

Register for Free NFID CME/CNE Webinar on July 7, 2016: Updates from June 2016 ACIP Meeting

The National Foundation for Infectious Diseases (NFID) offers a variety of continuing education activities designed to provide healthcare professionals with practical knowledge, tools, and resources, led by key opinion leaders in infectious diseases.

NFID’s next webinar, Updates from the June 2016 ACIP Meeting, will take place on Thursday, July 7, at 12:00 p.m. ET. The webinar will be conducted by William Schaffner, MD, NFID Medical Director and liaison to the Advisory Committee on Immunization Practices (ACIP). Dr. Schaffner’s discussion will include updated recommendations for adult vaccination and votes taken regarding influenza, meningococcal, and cholera vaccines.

At the conclusion of the webinar, participants will be able to:

Describe current ACIP recommendation for adult immunization
Explain how recent changes to guidelines will impact vaccination programs
Discuss information on new and/or future vaccines for potential use in practice

Registration information is available on the NFID website, which also contains information about the availability of Continuing Medical Education (CME) credits are for physicians and Continuing Nursing Education (CNE) credits for nurses.

The webinar is supported by an unrestricted educational grant from Merck & Co., Inc. NFID policies restrict funders from controlling program content.

Adult Vaccine Access Coalition Issues Its Response to MACRA (informational)

The Adult Vaccine Access Coalition (AVAC) has issued a response to the MACRA proposed rule. The response is focused on improving the priority of adult vaccinations in the final rule. Please contact Abby Bownas at AVAC if you would like to obtain a copy of the response.

INFORMATION FROM CDC

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

The CDC weekly influenza surveillance report for week 25 (ending June 26, 2016) and region specific data are now available.

NCHS mortality surveillance data for week 23 (ending June 1, 2016, but available June 30, 2016) indicate 5.7% of deaths were due to pneumonia and influenza (P&I). This percentage is below the epidemic threshold of 6.6% for week 23. Region and state-specific NCHS data are available online. During week 25, 5.8% of all deaths reported through the 122 Cities Mortality Reporting System were due to P&I. This percentage was above the epidemic threshold of 6.1% for week 25.

May 15–21, 2016 marks the final full influenza surveillance report for the 2015–2016 influenza season in the United States. Influenza surveillance in the U.S. will continue through the summer months with condensed reports available on the FluView website. Full publication of the complete FluView resumes on October 14, 2016.

No influenza-associated pediatric deaths were reported to CDC during week 25. A total of 77 influenza-associated pediatric deaths have been reported during the 2015–2016 season. More detail is available on CDC’s Influenza-Associated Pediatric Mortality webpage.

The Influenza Hospitalization Surveillance Network (FluSurv-NET) conducts population-based surveillance for laboratory-confirmed influenza-related hospitalizations in children younger than 18 years of age (since the 2003–2004 influenza season) and adults (since the 2005–2006 influenza season). Influenza hospitalization rates and virus characterization are available on the FluSurv-NET website.

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 May 21, 2016. Resumption of this reporting will occur in October 2016.

CDC Influenza Division seasonal influenza key points for May 27 are now available, as is the FluView report for week 20 ending May 21. This is the final issue of the seasonal key points for the 2015–2016 season. These key points will no longer be released on a fixed schedule, but will be issued as they are warranted, such as in conjunction with the release of important influenza-related publications or guidance, or unexpected increases in influenza activity. Full reporting for the 2016–2017 season will begin in mid-October 2016 and will appear in FluView. Archives of previous FluViews also may be found online.

CDC Public Health Grand Rounds

The Public Health Grand Rounds is a series created to further strengthen CDC’s common scientific culture and foster discussion and debate on major public health issues.

Special Grand Rounds Presentation: Seven Decades of Firsts—With Seven CDC Directors Tuesday, July 12, 2016: 11:00 a.m.–12:00 p.m. ET Registration is not required. Watch live and archived broadcasts

Dengue and Chikungunya in Our Backyard: Preventing Aedes Mosquito-Borne Disease –Encore Presentation Tuesday, July 19, 2016: 1:00 p.m.–2:00 p.m. ET Registration is not required. Watch live and archived broadcasts

CDC Learning Connection

The CDC Learning Connection is your source for information about public health training developed by CDC, CDC partners, and other federal agencies. Through website features, social media, and an e-newsletter, CDC Learning Connection keeps you informed about training opportunities, including many that offer free continuing education (CE).

CDC Clinician Outreach and Communication Activity (COCA) Information

CDC Science Clips: Volume 8, Issue: 26 – (CDC)
Each week select science clips are shared with the public health community to enhance awareness of emerging scientific knowledge. The focus is applied public health research and prevention science that has the capacity to improve health now.

Seasonal Influenza Information for Healthcare Professionals
In addition to multiple topics of interest to healthcare professionals, this site contains CDC’s Toolkit for Long-Term Care Employers.

Recent COCA webinars/calls
Identification and Care of Patients with Hantavirus Disease During this COCA Call, clinicians learned about the epidemiology, diagnosis, and clinical care of patients with hantavirus disease in the United States. Earn free continuing education.

Archived COCA conference calls are available, and free continuing education credits (CME, CNE, ACPE, CEU, CECH, and AAVSB/RACE) are available for most calls.

OTHER NEWS

ACIP Votes Not to Recommend LAIV for the 2016–2017 Season at its June 2016 Meeting

On June 22, 2016, the ACIP voted to recommend against the use of LAIV in the upcoming 2016-2017 influenza season and also completed a vote to remove LAIV from VFC eligibility for the upcoming influenza season. ACIP is aware of the impact of this recommendation on school-located immunization clinics and on private sector vaccine.

Here are links to five stories that have more detail:

AAP Backs New ACIP Recommendation on Influenza Vaccine (AAP)

ACIP Votes Down Use of LAIV for 2016–2017 Flu Season (CDC)

AstraZeneca Provides Update on Flumist Quadrivalent Vaccine in the US for the 2016–17 Influenza Season (AstraZeneca)

CDC Advises Against Using AstraZeneca’s FluMist Next Season (Bloomberg)

Flu Vaccines: CDC says FluMist “Nasal Spray” Should Not Be Used This Upcoming Flu Season (Outbreak News Today)

Novel Influenza A Viruses

Two human infections with novel influenza A viruses were reported to CDC during week 25.

One human infection with a novel influenza A virus was reported by the state of Wisconsin. The person was infected with an influenza A (H1N2) variant (H1N2)v virus. The patient was hospitalized as a result of their illness, and continues to recover. Direct contact with swine in the week preceding illness onset was reported. No ongoing community transmission has been detected.

One human infection with a novel influenza A virus was reported by the state of Minnesota. In April 2016, the person was infected with an H1N2v virus. The patient was not hospitalized and has fully recovered from their illness. No human-to-human transmission has been identified and the case reported close contact with swine in the week prior to illness onset.

Early identification and investigation of human infections with novel influenza A viruses are critical so that the risk of infection can be more fully appreciated and appropriate public health measures can be taken. Additional information on influenza in swine, variant influenza infection in humans, and strategies to interact safely with swine can be found at http://www.cdc.gov/flu/swineflu/index.htm.

CDC Influenza Division key points regarding human infections with influenza A H1N2 variant (H1N2v) virus in the United States in 2016 are available.

CDC Begins Reporting Pregnancy and Birth Outcomes of Women Affected by Zika Virus During Pregnancy

CDC began reporting poor outcomes of pregnancies with laboratory evidence of possible Zika virus infection.

CDC will report two types of outcomes:

Live-born infants with birth defects
Pregnancy losses with birth defects

Screening of Blood Donations for Zika Virus

Zika virus screening of locally collected blood donations was implemented on April 3, 2016, using a newly developed, FDA-authorized nucleic acid test. A total of 68 (0.5%) presumptive viremic donors in Puerto Rico were identified from 12,777 donations tested during April 3–June 11, 2016.

IDSA Announces Three Research Awards Available in 2016

The deadline to apply for the 2016 IDSA Research Awards is fast approaching. The IDSA Education and Research Foundation is pleased to offer the following Research Awards in 2016. Its goal is to support promising young researchers who may not otherwise find funding as federal and other institutional research support becomes more difficult to obtain.

Who should apply:

Candidates who have completed an ID fellowship within the last four years
Candidates currently enrolled in an accredited ID fellowship

2016 Young Investigator Awards

Pfizer Young Investigator Award in Vaccine Development
IDSA Young Investigator Award in ID
IDSA Postdoctoral Fellowship Award in ID

Application Deadline: July 15, 2016

Maternal Vaccination Against Influenza Associated with Protection for Infants

Infants born to women who participated in a randomized clinical trial of trivalent inactivated influenza vaccine (IIV3) when they were pregnant were followed up to determine the vaccine’s efficacy against influenza and infant antibody levels during their first six months of life. Analysis of the vaccine’s efficacy included 1,026 infants born to women immunized with IIV3 and 1,023 infants born to women given placebo. The vaccine’s efficacy against influenza illness was highest when infants were 8 weeks or younger at 85.6 percent but decreased as the infants grew to 25.5 percent among infants 8 to 16 weeks and to 30.3 percent among infants 16 to 24 weeks, according to the results.

An additional story is available from the American Association for the Advancement of Science.

‘Ineffective’ FluMist Vaccine Blamed by Utah Parents for Daughter’s Death Due to Influenza

The parents of an 8-year-old girl who died from influenza are claiming that the nasal spray vaccine FluMist failed to protect their daughter from the virus. This came after the U.S. Centers for Disease Control and Prevention warned against nasal spray vaccines and advised health officials to administer flu shots in its place instead.

Low Prices for Vaccines Can Come at a Great Cost

A $30,000 price tag for cancer drug therapy that extends life only a few weeks is understandably alarming. But a $2,000 price tag for all childhood vaccines — credited with eradicating smallpox, preventing a million or more cases of other diseases and averting thousands of deaths each year — is a bargain. In fact, the price of childhood vaccines may be too low for our own good because it contributes to shortages.

HPV Resource Center for Pharmacists has Information, Practice Tools, and Resources

The American Pharmacists Association (APhA) and the National Association of Chain Drug Stores (NACDS) have partnered to create a resource for pharmacists seeking guidance in speaking to patients about the benefits of immunizing children and adolescents against HPV.

Please Help the Summit, AIRA, and CDC Engage EHR Vendors in Immunization IT

The Summit has been active and interested in improving interoperability and utilization of EHRs and immunization information systems (IIS) for several years. Indeed, for the past two years, there has been a lot of prioritization of IIS and health information technology (HIT) activity within the Summit workgroups.

However, engagement by vendors of EHRs remains difficult. We hope that, with the Summit’s support, we can begin to change that in little steps. If you are connected with an EHR vendor, perhaps you can start by encouraging them to simply join in two activities in the IIS community that are not demanding on their time.

The first is the AIRA Standards & Interoperability Steering Committee (SISC). SISC provides technical support and guidance to interoperability efforts of AIRA members and the IIS community. They act as a liaison between national organizations involved with interoperability, such as the Office of the National Coordinator (ONC) and others, and serve as a technical resource for AIRA members and the IIS community. SISC meets the 2nd Wednesday of every month from 1–2 pm ET. Participation of EHR, pharmacy, health information exchange (HIE), and other IIS partners trading perspectives is welcomed to help drive forward increased interoperability. For more information, please connect with Mary Beth Kurilo.

The second is the CDC Clinical Decision Support for Immunization (CDSi) project. This project provides a single, authoritative, implementation-neutral foundation for development and maintenance of CDS engines. It captures ACIP recommendations in an unambiguous manner and improves the uniform representation of vaccine decision guidelines, as well as the ability to automate vaccine evaluation and forecasting. Interested parties can reach out to Eric Larson.

Three Slide Decks Available to Support New Standards for Adult Immunization Practice

The Summit’s Access and Collaboration workgroup has developed three separate slide decks with talking notes to support partners and others who wish to present on the Standards to their peers and colleagues. The three audiences targeted by the decks are: healthcare providers; patients/public; and public health. These are now available, along with tips and tools on how to use them, at the Summit website.

Also do not forget that Medscape has produced two modules to support the implementation of the Standards:

Providing a strong recommendation (with video vignettes)
Assessing the patient for adult vaccines.

Every Child By Two (ECBT) Compiles Media Information on Its Website

On a daily basis, ECBT assembles significant news media coverage on immunizations in their “Daily Clips.” Summit partners may find this effort useful.

Summit Website Offers Wonderful Resources on Influenza Vaccination

Remember to visit the Summit website for the latest on influenza immunization resources. You also can find archived copies of The Summit Buzz there.

Reminder

Summit calls are now scheduled every Thursday at 3 p.m. Eastern time, unless cancelled. The call scheduled for July 7 has been cancelled. Please email L.J Tan or LaDora Woods if you have any updates on activities to provide to the Summit.