July 06, 2015

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Summit Call Recap – June 11, 2015

Information from CDC

Announcements

SUMMIT CALL RECAP – JUNE 11, 2015

Influenza Surveillance Update – Sophie Smith (CDC)

Sophie provided a summary of the published reports for week 21, ending May 30, 2015. This was the first week of CDC’s summer reporting. 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 2.0%. Approximately 2.6% of specimens submitted for testing were positive. Of the deaths reported through the 122 Cities Mortality Reporting System during week 21, 6.3% were attributed to pneumonia and influenza (P&I), below the 6.5% epidemic threshold for the week.

One influenza-associated pediatric death was reported to CDC during week 21. This death was associated with an influenza B virus. A total of 142 pediatric deaths have been reported during the 2014–2015 season. Of the 121 for whom vaccination status was known, 14 were ineligible for vaccination due to age, and only 15 were fully vaccinated. Following up on a question posed during the last Summit call about the distribution of subtypes among children who have died, Sophie reported that 42% were influenza A (H3), 35% were influenza A with an undetermined subtype, 21% were influenza B, 1% were influenza A and influenza B co-infection, and 1% were of a type not determined.

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.

GSK Unbranded Campaign Against Whooping Cough – Len Silverstein and Mick Stanley (GSK)

Dr. Silverstein, the Head of Medical Affairs North America Vaccine Development with GSK, provided a description of GSK’s new unbranded, direct-to-consumer education program to raise adult awareness about the need vaccination against pertussis. Adult Tdap coverage is very low (~15%), and pertussis outbreaks are occurring each year. Therefore, GSK feels there is a vital need for consumer education on the importance of Tdap vaccination.

GSK recognizes a new maternal immunization campaign has been conducted by CDC in conjunction with AAP, ACOG, AAFP, and the American College of Nurse Midwives. However, GSK does not have a maternal indication for their Tdap vaccine and therefore cannot join in this effort. But because the vaccines are indicated for adults in general, GSK is able to conduct general adult consumer immunization campaigns.

Mick Stanley, Director of GSK Vaccine Brands Strategy, followed up on Dr. Silverstein’s introductory comments by providing highlights of the campaign, which was launched on June 8 through television, print, and digital media outlets. It also incorporates pull-through at selected physician offices and retail pharmacies. The campaign, which will run through the end of 2015, is targeted to grandparents of infants. This group was chosen because it was determined they were extremely motivated to be vaccinated when they learned about the potential consequences of infection on their grandchildren. In particular, first-time grandparents were highly motivated in this area.

Mick reported that this is an innovative approach that was identified through several rounds of research. The research indicated that grandparents who viewed the materials were quickly educated and motivated to obtain pertussis vaccination. This is the company’s first approach with this type of campaign, and they hope to learn tactics that will be helpful in similar types of adult campaigns in the future.

L.J asked about the campaign’s duration. The soft launch in April was limited to print items, but the June 8 launch was a full launch that will run through 2015. Additionally, the medical community received information prior to the launch.

A Summit partner asked whether the tagline would also target other types of providers, such as physician assistants and nurse practitioners, even though the message says “talk to your doctor or pharmacist.” This was chosen because GSK’s research indicated this language worked best with patients. However, the company is looking at additional ways to be sure they are being inclusive of all the different types of providers for adult immunizations.

Other Items – L.J Tan (IAC)

L.J announced that the NAIIS Access and Collaboration Workgroup developed three slide sets in support of the Adult Standards. One set is for presentations to providers, another is for the general public, and the third is for public health. These have now been posted on the Adult Standards webpage of the Summit website.

INFORMATION FROM CDC

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

Final 2014-2015 season report

The May 17–23, 2015 FluView marks the final full influenza surveillance report for the 2014–2015 flu 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. Although this page will not be updated until publication of the full FluView resumes on October 16, 2015, FluView interactive will be updated over the summer months.

A total of 17,911 laboratory-confirmed influenza-associated hospitalizations have been reported through the Influenza Hospitalization Surveillance Network (FluSurv-NET) since October 1, 2014. This translates to a cumulative overall rate of 65.5 hospitalizations per 100,000 population. This is higher than the cumulative overall hospitalization rate during 2012–2013, which was 43.9 per 100,000 population.

The hospitalization rate in people 65 years and older is 322.8 per 100,000, which is the highest hospitalization rate recorded since data collection on laboratory-confirmed influenza-associated hospitalization in adults began during the 2005–2006 season. This is the highest rate of any age group. Previously, the highest recorded hospitalization rate was 183.2 per 100,000, which was the cumulative hospitalization rate for people 65 years and older for the 2012–2013 season. (The 2012-2013 season was the last H3N2-predominant season.)

The hospitalization rate for children 0–4 years is 57.2 per 100,000 population. During the 2012–2013 season, the overall cumulative hospitalization rate for that age group was 67.0 per 100,000.

Hospitalization data are collected from 13 states and represent approximately 9% of the total U.S. population. The number of hospitalizations reported does not reflect the actual total number of influenza-associated hospitalizations in the United States.

The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Mortality Reporting System was 6.4%, and remains below the epidemic threshold of 6.6%. The percentage of P&I attributed deaths was at or above the epidemic threshold for 12 consecutive weeks this season. The highest P&I percentage this season was 9.3% and occurred during week 2. During 2012–2013, P&I peaked at 9.9%. This is comparable to recorded percentages for past severe seasons, including the 2003–2004 season when P&I reached 10.4%.

Two influenza-associated pediatric deaths were reported to CDC during the week ending May 23. Both deaths were associated with an influenza B virus and occurred during week 19 (the week ending May 16, 2015). A total of 141 influenza-associated pediatric deaths have been reported for the 2014–2015 season at this time.

The 141 influenza-associated pediatric deaths reported thus far during the 2014-2015 season come from New York City [3] and 40 states (Alaska [1], Arizona [3], Arkansas [4], California [7], Colorado [6], Florida [3], Georgia [1], Illinois [3], Indiana [2], Iowa [3], Kansas [2], Kentucky [3], Louisiana [2], Maryland [1], Massachusetts [1], Michigan [3], Minnesota [10], Mississippi [1], Missouri [1], Nebraska [1], Nevada [8], New Jersey [1], New Mexico [1], New York [3], North Carolina [2], Ohio [6], Oklahoma [7], Oregon [1], Pennsylvania [3], Rhode Island [2], South Carolina [3], South Dakota [2], Tennessee [9], Texas [16], Utah [2], Virginia [5], Washington [1], Wisconsin [6], West Virginia [1], and Wyoming [1]). More detail is available on the FluView website.

From October 1, 2014 through May 23, 2015, 2,193 influenza viruses, including 59 influenza A (H1N1)pdm09, 1,324 influenza A (H3N2) viruses, and 810 influenza B viruses, were collected in the United States.

Two hundred and forty-six (18.6%) of the 1,324 influenza A (H3N2) viruses tested have been characterized as A/Texas/50/2012-like. This is the influenza A (H3N2) component of the 2014-2015 Northern Hemisphere quadrivalent and trivalent influenza vaccine. One thousand and seventy-eight (81.4%) influenza A (H3N2) viruses tested were different from A/Texas/50/2012. The majority of these 1,078 influenza A (H3N2) viruses were antigenically similar to A/Switzerland/9715293/2013, the influenza A (H3N2) component of the 2015 Southern Hemisphere influenza vaccine and 2015–2016 Northern Hemisphere influenza vaccine. A/Switzerland/9715293/2013 is related to, but antigenically and genetically distinguishable from, the A/Texas/50/2012 vaccine virus. A/Switzerland-like H3N2 viruses were first detected in the United States in small numbers in March of 2014 and began to increase through the spring and summer.

All 59 influenza A (H1N1)pdm09 viruses tested were characterized as A/California/7/2009-like. This is the influenza A (H1N1) component of the 2014-2015 Northern Hemisphere quadrivalent and trivalent influenza vaccine.

For week 23, five hundred and eighty-two (71.9%) of the influenza B viruses tested belong to B/Yamagata/16/88 lineage and the remaining 228 (28.1%) influenza B viruses tested belong to B/Victoria/02/87 lineage. Five hundred and seventy-one (98.1%) of the 582 B/Yamagata-lineage viruses were characterized as B/Massachusetts/2/2012-like, which is included as an influenza B component of the 2014–2015 Northern Hemisphere trivalent and quadrivalent influenza vaccines. Eleven (1.9%) of the B/Yamagata-lineage viruses tested showed reduced titers to B/Massachusetts/2/2012.

Two hundred and twenty-three (97.8%) of the 228 B/Victoria-lineage viruses were characterized as B/Brisbane/60/2008-like, the virus that is included as an influenza B component of the 2014–2015 Northern Hemisphere quadrivalent influenza vaccine. Five (2.2%) of the B/Victoria-lineage viruses tested showed reduced titers to B/Brisbane/60/2008.

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. Based on NCHS mortality surveillance data available on July 2, 2015, 5.9% of the deaths occurring during the week ending June 13, 2015 (week 23) were due to P&I. This percentage is below the epidemic threshold of 6.7% for week 23.

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 23, 2015.

Summer reporting

The CDC weekly influenza surveillance report for week 25, 2015 (ending June 27, 2015) and region specific data are now available. During week 25, 5.8% of all deaths reported through the 122 Cities Mortality Reporting System were due to P&I. This percentage was below the epidemic threshold of 6.1% for week 25.

No influenza-associated pediatric deaths were reported to CDC during week 25. A total of 142 influenza-associated pediatric deaths have been reported during the 2014–2015 season.

Nationwide during week 25, 1.1% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI). This percentage is below 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.

Archives of previous FluViews are available online. Seasonal influenza key points are no longer being released on a fixed schedule, but will be issued as they are warranted, such as in conjunction with the release of important flu-related publications or guidance or unexpected increases in flu activity. Full reporting for the 2015–2016 influenza season will begin in mid-October 2015, and will appear in FluView. Seasonal key points will likely become available again shortly thereafter.

2016 CDC Health Information for International Travel Now Available

CDC is pleased to announce the release of the new 2016 CDC Health Information for International Travel (more commonly known as the Yellow Book). The Yellow Book is written primarily for health professionals and offers the U.S. government’s most current health recommendations for international travel. The latest edition features comprehensive updates, new sections, and expanded disease maps (including country-level yellow fever vaccine recommendation maps).

The Yellow Book is available for sale from Oxford University Press, and will soon be available online and as an app for iOS and Android devices. To learn more about the Yellow Book and for ordering information, visit CDC’s Yellow Book homepage.

CDC Issues Seasonal Influenza Key Points on June 5, 2015

The seasonal influenza key points document (released on June 5, 2015) includes information summarizing the June 4, 2015, Morbidity and Mortality Weekly Report, “Influenza Activity – United States, 2014–15 Season and Composition of the 2015–16 Influenza Vaccine.”

CDC Provides Measles Information to its Partners (July 6, 2015)

CDC has new measles information and resources available which it invites you to share with your membership.

Current information about measles cases and outbreaks is available from CDC. The agency also has developed corresponding information (available to Summit partners) to assist you as you receive questions about measles, and/or education your membership. Let CDC know if you have any additional questions or would like to request resources from them.

On July 2, 2015, the Washington State Department of Health confirmed a measles-related death. The last reported measles infection that resulted in death in the U.S. was in 2003.

Visit CDC measles webpages to see information about measles cases and outbreaks, as well as measles complications. Also, CDC would like to know what you are doing to promote MMR vaccination and education to your membership about measles. Please send CDC an email, and let them know.

CDC Provides Key Points on Avian Influenza

The June 19, 2015 key points related to reports of highly pathogenic avian influenza (HPAI) A H5 in domestic and wild birds in the United States are available.

CDC HAN on Avian Influenza

On June 2, 2015 CDC issued a Health Alert Network (HAN) health advisory on highly pathogenic avian influenza that was featured in its entirety in a previous issue of The Summit Buzz. This HAN was released to raise awareness among U.S. clinicians and public health staff about CDC’s recommendations to protect human health during this outbreak. Key points related to this HAN are available.

Upcoming and Recent CDC COCA Calls

CDC’s Clinical Outreach and Community Activity (COCA) program recently held the following webinars:

Cyclosporiasis: Detecting, Investigating, and Preventing Cases and Outbreaks of this Foodborne Parasitic Disease
Date: Thursday, June 18, 2015

Ebola – Clinical Updates with a Global Perspective
Date: Wednesday, June 17, 2015

Updated Information and Guidelines for Evaluation for MERS
Date: Thursday, June 11, 2015

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

ANNOUNCEMENTS

American Nurses Association (ANA) joins the Summit. Please welcome them back!

The ANA has joined the Summit and most recently provided a presentation to the Summit’s Access and Collaboration Workgroup on their efforts in immunization. The ANA representatives to the Summit are Ruth Francis and Chad Rittle. They are open for potential collaborations on adult immunization, so please feel free to email them should you have opportunities to collaborate with the ANA on adult immunization activities.

CMS has Patient Education Resources Available for Summit Partners

During the last Access and Collaboration Workgroup call, Tracy Branch from the Center for Medicare and Medicaid Services (CMS) presented some web-based patient education resources that are available for use.

On the Outreach & Education website, you can search for the patient education materials by the targeted group (e.g., newly insured, special population, etc.)

And here are a few more links to help identify specific coverage information for patients:

Preventive Care Benefits (note that the vaccine has to be provided by a network provider)

Affordable Care Act and Immunization

Funding Announcement Opportunities in Adult Immunization

For your information and potential action, CDC has recently published three funding opportunity announcements that pertain to adult vaccination. The two funding opportunities that are still open listed below.

CDC-RFA-IP15-1502PPHF15: Increasing Awareness and Implementation of the Standards for Adult Immunization Practice Through Partnerships With State and Local Immunization Programs – Financed Solely by PPHF 2015 Prevention and Public Health Funds, with a closing date of July 27.

CDC-RFA-IP15-1504PPHF15: Improving Immunization Collaboration Among Pharmacists and Other Healthcare Providers – Financed Solely by PPHF 2015 Prevention and Public Health Funds, with a closing date of July 27.

Questions about these FOAs should be directed only to the individuals specified in the announcements.

Protein Sciences Corporation Issues Press Release on Recent Clinical Trial on Flublok®

In a recent press release, Protein Sciences Corporation presented the results of a clinical trial comparing Flublok® Quadrivalent to a traditional egg-based quadrivalent inactivated vaccine. According to the release, the data demonstrate superior performance of Flublok® based on a significantly lower number of people contracting the flu after vaccination with Flublok® Quadrivalent.

National Adult and Influenza Immunization Summit Follow-Up Survey on 2015–2016 Summit Activities and Priorities

The National Adult and Influenza Immunization Summit (NAIIS) would like to get your input on the direction the Summit should take in the coming year. This includes questions on behalf of the Summit and its workgroups to determine what the priorities moving forward should be. If you attended the 2015 NAIIS meeting in Atlanta on May 12–14, you may have received a meeting evaluation survey. Please note that we have received your feedback, and this is a separate set of questions. Click the link below to begin the survey, which will remain open until July 17, 2015. Thank you for your continued participation.

Three New Slide Sets Available to Support the Standards for Adult Immunization Practice

The Summit’s Access and Collaboration Workgroup has developed three new slide sets (including talking notes) to support partners and others who wish to provide presentations on the Standards for Adult Immunization Practice to their peers and colleagues. The target audiences for these slide sets are: healthcare providers; patients or consumers; and public health professionals. These are now available, along with tips and tools on how to use them, on the Summit website.

First Death from Measles In U.S. In 12 Years

A woman in Washington state has died from measles, marking the first measles death in the U.S. since 2003 and the first in the state since 1990. The woman lacked some of the measles’ common symptoms, such as a rash, so the infection was not discovered until an autopsy, according to Washington State Department of Health spokesman Donn Moyer.

Ansun BioPharma Publishes Effects of FluDase™ on Drug Resistant Flu

Ansun Biopharma announced the publication of the report “Treatment of resistant influenza virus infection in a hospitalized patient with cystic fibrosis with DAS181 (FluDase™), a host-directed antiviral” in the peer-reviewed journal Antiviral Research. The report describes a case of an ill cystic fibrosis patient who was first treated with Tamilfu and then with IV Relenza, but who continued to deteriorate clinically and shed influenza virus. The virus was tested by the CDC and had been shown to be resistant to Tamiflu. Under an emergency use IND, the patient was then treated with FluDase™ and clearance of the virus was achieved.

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 other Thursday at 3 p.m. Eastern time, unless cancelled. We will resume the regular weekly call schedule in fall. Please email L.J Tan or LaDora Woods if you have any updates on activities to provide to the Summit.