July 27, 2015

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Summit Call Recap – July 16, 2015

Information from CDC

Announcements

SUMMIT CALL RECAP – JULY 16, 2015

Influenza Surveillance Update – Sophie Smith (CDC)

Sophie provided a summary of the published reports for week 26, ending July 4, 2015. Influenza activity in the U.S. continues to remain low.

The ILI-Net national data indicated 1.0% of total outpatient visits were for influenza-like illness (ILI), which is below the national baseline. Approximately 1.6% of specimens submitted for testing were positive. Of the deaths reported through the 122 Cities Mortality Reporting System during week 26, 5.5% were attributed to pneumonia and influenza (P&I), below the 6.1% epidemic threshold for the week.

One influenza-associated pediatric death was reported to CDC during the week 26. This death was associated with an influenza B virus. A total of 143 pediatric deaths have been reported during the 2014–2015 season. Of the 121 for whom vaccination status was known, 14 were ineligible for vaccination, and only 16 were fully vaccinated.

Additional routine influenza surveillance methods will be reinstated in the fall. In response to a question, L.J stated we will discuss the current influenza situation in the southern hemisphere during a future call. Following the call, Warner Hudson supplied information about the World Health Organization Influenza Update website, which contains updated information about current influenza activity in the southern hemisphere.

ACIP Influenza Update – Lisa Grohskopf (CDC)

Lisa provided an update on the influenza topics discussed at the June ACIP meeting, which included an influenza vaccine effectiveness update, discussions on quadrivalent intradermal influenza vaccine, and updates on influenza vaccine safety and high dose influenza vaccine. Finally, a vote was taken on the 2015–16 influenza vaccine recommendations.

Lisa focused her comments on the recommendations for the 2015–16 season. There are few changes from the previous season. As in previous years, the 2015–16 recommendations will be published in a Policy Note in the MMWR; the last full Recommendations and Reports on influenza was published in 2013. The Policy Note will incorporate votes previously taken at the truncated February ACIP meeting, including a reiteration of the core guidance for influenza vaccine for all persons >6 months of age and removal of the preferential recommendation for LAIV in healthy persons 2–49 years. At the June meeting the ACIP also added a brief overview of the 2015–16 vaccine composition which includes changes in both the influenza A H3N2 and B components. The group also discussed updated new product approvals after last season, including the full availability of Fluzone quadrivalent, an expanded age indication for Flublok to >18 years of age, and the use of jet injectors for vaccine administration.

ACIP also discussed the 1 vs 2 dose algorithm for children, which has changed slightly each year since the 2009 H1N1 epidemic. Since that time, doses of H1N1 have been considered separately in the algorithm. However, next season’s algorithm will be simpler, including 2 or more doses in any prior season.

In response to a question, Lisa reported that a vaccine efficacy (VE) update typically is reported to ACIP once each year. However, this year ACIP has received an update at each meeting due to the low VE for the H1N1 component of LAIV and the poor match with this season’s H3N2 component. At the June meeting, ACIP received a preliminary estimate of 66–67% VE for influenza B in children and adolescents; there were insufficient reports to make a determination of VE against H1N1.

At this time, it is unclear whether there will be a delay in release of next season’s vaccine information statement due to last minute changes in FluMist. L.J will follow up on this and provide an update to Summit partners.

June ACIP Meeting Summary – L.J Tan (IAC)

L.J provided a brief summary of the non-influenza adult vaccine discussions from the ACIP meeting. The group voted that either of the available vaccines now licensed for meningococcal B may be used in high risk patients. The ACIP considered a broader recommendation, but lack of sufficient data made a GRADE evaluation difficult. In addition, the two vaccines use different adjuvants, complicating the ability to make direct comparisons. Annually, meningococcal disease from serogroup B is responsible for 55–65 cases and 5–10 deaths, with a cost of $100,000–$400,000 per case prevented. However, the consequences of meningococcal infection are severe. ACIP voted to give a grade B (permissive) recommendation for use of this vaccine in all adolescents. A Category B designation does not denote an inferior recommendation; rather, it simply means use of the vaccine is based on the individual and clinical decision making. The preferred age for vaccine administration is 16–18 years.

ACIP also voted to harmonize the interval recommendations for use of PCV13 and PPSV23 in persons >65 years of age. The interval is now one year, regardless of which vaccine is given first.

ACIP discussed use of HPV9 vaccine in persons who had previously received a complete HPV series. HPV9 may be used to complete an HPV series that is in progress. However, no recommendation was made regarding use of HPV9 in persons who had previously completed a full series with HPV2 or HPV4.

Finally, ACIP discussed the importance of providing Tdap vaccine to close contacts of infants versus use of vaccine in pregnant women. The group noted that vaccination of pregnant women had greater effect in protecting the infant.

Other Items – L.J Tan (IAC)

The next Summit call will be held in 2 weeks. The focus of the call will be on partner efforts to promote the upcoming National Immunization Awareness Month.

INFORMATION FROM CDC

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

Summer reporting

The CDC weekly influenza surveillance report for week 28, 2015 (ending July 18, 2015) and region specific data are now available. During week 28, 5.5% of all deaths reported through the 122 Cities Mortality Reporting System were due to pneumonia and influenza (P&I). This percentage was below the epidemic threshold of 5.9% for week 28.

One influenza-associated pediatric deaths were reported to CDC during week 28. This death was associated with an influenza B virus and occurred during week 17 (the week ending May 2, 2015). A total of 144 influenza-associated pediatric deaths have been reported during the 2014–2015 season. Additional data may be found on CDC’s Influenza-Associated Pediatric Mortality webpage.

Nationwide during week 28, 0.8% 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.

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 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.

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 appear in the weekly influenza surveillance report, FluView. Seasonal key points will likely become available again shortly thereafter.

Novel Influenza A Infection

One human infection with a novel influenza A virus was reported by the state of Minnesota. The person was infected with an influenza A (H3N2) variant (H3N2v) virus and was hospitalized as a result of 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 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 on the CDC webpage, Information on Swine Influenza/Variant Influenza Viruses.

The CDC Influenza Division has released key points regarding this first human infection with influenza A (H3N2) variant (H3N2v) virus in the United States in 2015.

CDC Issues National Immunization Awareness Month Resources

To promote childhood immunization during National Immunization Awareness Month in August and year round, the National Center for Immunization and Respiratory Diseases (NCIRD) at CDC has printed additional copies of several childhood immunization posters. Limited quantities of these materials are available to order for free from the CDC warehouse. These materials were developed based on formative research with parents and are co-branded with the American Academy of Pediatrics and the American Academy of Family Physicians. Copies of these materials may be ordered at CDC-INFO On Demand – Publications.

Additionally, the National Public Health Information Coalition, in collaboration with NCIRD, has developed communication toolkits including sample key messages, ready-to-publish articles, sample news releases, sample social media messages, logos and banners, FAQs, web links, and more to help promote vaccinations. Each toolkit focuses on a different stage of the lifespan:

Preteens and teens (August 2-8)
Pregnant women (August 9-15)
Adults (August 16-22)
Infants and children (August 23-29)

More information about National Immunization Awareness Month is available online.

CDC Provides Measles Information to its Partners (July 8, 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’s 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 Emergency Response – CDC Response to 2014 Ebola in the United States and West Africa

NEW: The Road to Zero: CDC’s Response to the West African Ebola Epidemic, 2014–2015

UPDATE: CDC Ebola Response Update

UPDATE: Case Counts

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

CDC’s Anne Schuchat Is Moving On!

Please see the following message sent out by Anne Schuchat. She will be missed.

My colleagues and friends:

The time has come for transition in the leadership of the National Center for Immunization and Respiratory Diseases (NCIRD) and for me to take on a new professional challenge. In mid-September, I will become CDC’s Principal Deputy Director. Dr. Rima Khabbaz (Director, Office of Infectious Diseases) will become Acting Director of NCIRD, while a search for the next permanent NCIRD director proceeds.

As NCIRD Director, I have always felt I had the best job at CDC. Our people, programs, impact, and prospects for the future are tremendous. We have accomplished so much together with our partners:

Standing up a new center in 2006 bringing together the National Immunization Program and components of the National Center for Infectious Diseases

Sustaining vaccine acceptance and high coverage rates for childhood vaccines while introducing new vaccines –Rota, HPV, Zoster, PCV13– and new recommendations — universal flu

Tackling the 1st pandemic of the 21st century and strengthening seasonal and avian influenza efforts

Intensifying polio eradication and facilitating a smooth transfer of the Global Immunization Division to the Center for Global Health

Detecting and responding to respiratory threats – H5 & H7N9 influenza, Middle East Respiratory Syndrome, EnterovirusD-68, and resurgent pertussis

Accelerating uptake of pentavalent, pneumococcal conjugate, rotavirus in resource poor countries

Helping end epidemics of meningococcal A meningitis through MenAfriVac campaigns reaching >200M

Strengthening the evidence-informed processes, transparency, and accessibility of the Advisory Committee on Immunization Practices

Modernizing the US immunization system with central distribution, VTrckS (vaccine ordering and distribution tracking system), fiscal stewardship, and Immunization Information System-Electronic Medical Record interoperability initiatives

Celebrating the 20th year of the US Vaccines for Children Program, with >300 million illnesses prevented, >730,000 early deaths averted, and ~1.4 trillion dollars saved

Implementing the Sierra Leone Trial to Introduce a Vaccine against Ebola (STRIVE), in partnership with SL’s College of Medicine and Allied Health Sciences and Ministry of Health and Sanitation

Working with the immunization and respiratory diseases community these past ten years has been a joy.

I am confident that NCIRD’s next decade will be as rewarding – as CDC helps implement the Global Health Security Agenda, realizes the promises of Advanced Molecular Detection, and completes the IT transformation of immunization practice.

I will continue to serve as CDC’s executive sponsor for STRIVE after the transition, working closely with the Ebola response Vaccine task force which will continue to be based in the NCIRD’s Office of the Director.

I will always treasure the extraordinary opportunity to help establish such an awesome center and to get the chance to collaborate with so many of you. Thank you for the partnership and support for our important shared goals. I look forward to the opportunity to continue our partnerships from my new position.

Anne Schuchat
Director, National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention

Gerontological Society of America (GSA) Announces New Adult Immunization Initiative!

ICAMP Academy (Immunization Champions, Advocates, and Mentors Program) is a 1 and 1⁄2-day multidisciplinary program for healthcare professionals who are committed to increasing adult vaccination rates and improving their patients’ health, as well as improving quality metrics in their organization. Experts who have achieved success increasing immunization rates in their practices and communities designed the Academy’s agenda. The program will provide insights on how to implement the National Vaccine Advisory Committee (NVAC) Standards for Adult Immunization Practice through the use of practical tools and sharing of best practices.

GSA is also soliciting assistance from Summit partners to share information about the Academy and encourage healthcare professionals to attend. Sample templates for this outreach are available for potential applicants, organizational leaders and partner organization newsletters.

Register for NFID CME Webinar (8/5/15, noon Eastern) on Vaccines for Young Adults

At NFID’s complimentary webinar, Vaccines for Young Adults, Carol J. Baker, MD, NFID past-president and professor of pediatrics and molecular virology and microbiology at Baylor College of Medicine, will discuss important vaccines recommended for young adults, including meningococcal and human papillomavirus (HPV). Dr. Baker will answer questions about the new meningococcal B and 9-valent HPV vaccine recommendations.

Sanofi Pasteur Has Begun to Ship Influenza Vaccine

Sanofi Pasteur has started shipping Fluzone influenza vaccines for the 2015–2016 influenza season. Please feel free to share this information with those who may be interested. Questions may be directed to Cristine Schroeder.

Novartis Has Begun to Ship Influenza Vaccine for the Upcoming Influenza Season

Novartis began shipping influenza vaccine for the upcoming 2015–2016 season on July 23, 2015. Novartis estimates that they will deliver at least 36 million doses of vaccines, comprising Flucelvax® [Influenza Vaccine] and Fluvirin® [Influenza Virus Vaccine]. For more information, please contact Aaron Rak.

The State of the National Vaccine Plan

On July 7, the National Vaccine Advisory Committee announced the release of the Annual Report of the State of the National Vaccine Plan (2014). It features accomplishments across the vaccination system in regards to development, safety, communications, access and global vaccination, and reflects new opportunities and challenges presented by the 21st century immunization landscape.

MedImmune/AstraZeneca Announces Delay in FluMist™shipping

Live attenuated influenza vaccine (LAIV) will be shipping later than usual, with doses anticipated to arrive at offices/pharmacies in early September. LAIV will continue to ship through November due to a slow growing strain. MedImmune remains committed to manufacturing the projected 15 million doses of vaccine this flu season.

Is a Universal Flu Vaccine at Our Doors?

A new study conducted on mice has just brought researchers at the United States’ National Institute of Allergy and Infectious Diseases (NIAID) one step closer to this achievement. By presenting a cocktail of flu proteins to the immune system, the team found out that they can induce immunity to strains that the animals have never encountered. Additional information is available online.

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.

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.

During the July 30 call, we will be hearing about plans for the upcoming National Immunization Awareness Month (NIAM). Please feel free to inform other Summit partners of any planned NIAM activities during the call.

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