March 02, 2015

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Special Announcement
Information from CDC
Announcements

SPECIAL ANNOUNCEMENT


Public Comment Deadline for the National Adult Immunization Plan Extended

The public comment process for the National Adult Immunization Plan ends March 23, 2015 at 5:00 p.m. EDT.  The notice soliciting input is available in the Federal Register. The National Vaccine Program Office (NVPO) thanks you for your participation in this process.


INFORMATION FROM CDC


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

The CDC weekly influenza surveillance report for week 7, 2015 (ending February 21, 2015) and region specific data are now available. During week 7, 7.4% of all deaths reported through the 122 Cities Mortality Reporting System were due to pneumonia and influenza (P&I). This percentage was above the epidemic threshold of 7.2% for week 7.

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 P&I mortality.

Two hundred twenty-eight (30.3%) of the 752 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. 524 (69.7%) of the 752 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. 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.

For week 7, 107 (69.5%) of the influenza B viruses tested belong to B/Yamagata/16/88 lineage and the remaining 47 (30.5%) influenza B viruses tested belong to B/Victoria/02/87 lineage. One hundred (93.5%) of the 107 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. Seven (6.5%) of the B/Yamagata-lineage virses tested showed reduced titers to B/Massachusetts/2/2012. Forty-three (91.5%) of the 47 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. Four (8.5%) of the B/Victoria-lineage viruses tested showed reduced titers to B/Brisbane/60/2008.

Eleven influenza-associated pediatric deaths were reported to CDC during week 7. Three deaths were associated with an influenza A (H3) virus and occurred during weeks 51, 4, and 5 (weeks ending December 20, 2014, January 31, and February 7, 2015, respectively). Two deaths were associated with an influenza A virus for which no subtyping was performed and occurred during weeks 5 and 6 (weeks ending February 7 and February 14, 2015, respectively). One death was associated with an influenza B virus and occurred during week 53 (the week ending January 3, 2015).

A total of 92 influenza-associated pediatric deaths have been reported during the 2014-2015 season from New York City [2] and 31 states (Arizona [2], California [1], Colorado [3], Florida [3], Georgia [1], Indiana [1], Iowa [3], Kansas [2], Kentucky [3], Louisiana [2], Maryland [1], Massachusetts [1], Michigan [1], Minnesota [5], Missouri [1], Nebraska [1], New Jersey [1], North Carolina [2], Nevada [6], New York [2], Ohio [6], Oklahoma [6], Pennsylvania [3], South Carolina [2], South Dakota [1], Tennessee [5], Texas [12], Utah [2], Virginia [4], Washington [1], and Wisconsin [6]).  More detail is available on the FluView website.

Between October 1, 2014 and February 21 2015, 14,162 laboratory-confirmed influenza-associated hospitalizations were reported. The overall hospitalization rate was 51.7 per 100,000 population. The highest rate of hospitalization was among adults aged ≥65 years (258.0 per 100,000 population), followed by children aged 0–4 years (45.7 per 100,000 population). Among all hospitalizations, 13,416 (94.8%) were associated with influenza A, 625 (4.4%) with influenza B, 46 (0.3%) with influenza A and B co-infection, and 67 (0.5%) had no virus type information. Among those with influenza A subtype information, 4,000 (99.7%) were A(H3N2) virus and 10 (0.2%) were A(H1N1)pdm09. Additional virus characterization is available on FluView.

Clinical findings are preliminary and based on 3,118 (22.0%) cases with complete medical chart abstraction. The majority (92.9%) of hospitalized adults had at least one reported underlying medical condition; the most commonly reported were cardiovascular disease, metabolic disorders, and obesity. There were 432 hospitalized children with complete medical chart abstraction, 169 (39.1%) had no identified underlying medical conditions. The most commonly reported underlying medical conditions among pediatric patients were asthma, neurologic disorders, and immune suppression. Among the 253 hospitalized women of childbearing age (15-44 years), 67 were pregnant.

Nationwide during week 7, 3.0% 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 February 21, 2015. At this time, 21 states and territories are still reporting widespread influenza activity.

The FluView report for week 7 (ending February 21, 2015) and archives of previous FluViews are available from CDC. CDC also has released seasonal influenza key points for February 27, 2015.


CDC Provides Measles Information to its Partners

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, develop new materials for your members, post to social media, etc.  Let CDC know if you have any additional questions or would like to request resources from them.

CDC has posted an updated map which indicates the U.S. is currently experiencing a large, multi-state outbreak of measles linked to an amusement park in California. Check out CDC’s Measles Webpage to find resources for each of your audiences.

Here are some recently developed resources for various audiences that are now available online:

What can you do?

  • Pin the Pinterest pins (pin 1 and pin 2) on your boards for parents to link them to CDC’s “Top 4 Things Parents Need to Know about Measles”
  • Follow @CDCIZLearn on Twitter to stay up-to-date on measles information for healthcare professionals
  • Continue to link to CDC’s measles infographic (now co-branded with the American Academy of Pediatrics and American Academy of Family Physicians)
  • Post on social media about measles and the importance of on-time MMR vaccine and link to Dr. Frieden’s op-ed

Please let CDC know if you have any questions or additional requests for information.  Also, CDC would like to know what you are doing to promote MMR vaccination and education your membership about measles.  Please send CDC an email and let them know.  Thank you for your continued support and assistance!


CDC Study Published in the New England Journal of Medicine

CDC issued a press release about a CDC Etiology of Pneumonia in the Community (EPIC) study published in the New England Journal of Medicine. The study highlights the burden of pneumonia hospitalizations on U.S. children. The press release and key points related to the study are available. CDC also has launched a new website that provides an overview of the EPIC study’s scope and purpose and will provide links to all future publications based on EPIC data.


Updated Information on Acute Flaccid Myelitis

Up-to-date key points (through February 26, 2015) 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, are available. There have been no changes to the situation during the last two weeks.


CDC Social Media Messages

CDC’s Influenza Division has developed the following social media messages that your organization may use to help communicate about influenza and flu activity. These can be tweeted using your organization’s Twitter handle or adapted for use on other social media platforms.


Upcoming and Recent CDC COCA Calls

Protecting Children: Influenza Updates for Clinicians
This COCA call occurred on Thursday February 26, 2015.

A recent analysis by the Centers for Disease Control and Prevention (CDC) has found influenza A (H3N2) viruses are the predominant strain this year, and a little more than half of samples analyzed were found to be antigenically different (drifted) from the H3N2 vaccine strain. During this COCA Webinar, clinicians learned about the current state of flu activity related to children, the importance of continued vaccination despite the mismatch and low vaccine effectiveness, and strategies for using antiviral therapy early to prevent and treat influenza.

Presenters were:

Joseph Bresee, MD, FAAP
Chief, Epidemiology and Prevention Branch
Influenza Division
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention

Henry (Hank) Bernstein, DO, MHCM, FAAP
Professor of Pediatrics
Hofstra North Shore-LIJ School of Medicine

John S. Bradley, MD, FAAP
Director, Division of Infectious Diseases
Children’s Hospital San Diego
Rady Children’s Specialists.


ANNOUNCEMENTS


ACOG Presents Webinar on HPV on March 4, 2015

The American College of Obstetricians and Gynecologists (ACOG) is presenting a webinar, The Power to Prevent Cancer: Important Updates on the HPV Vaccine, on Wednesday, March 4 from 12:00–1:00 ET. This free, 1 CME credit webinar will detail ACOG and ACIP’s HPV immunization recommendations, describe the safety and common side effects of HPV vaccination, and explain the importance of and optimal timing for HPV immunization. Continuing Medical Education credit is provided through joint providership with The American College of Obstetricians and Gynecologists. Registration information is available on the ACOG website.


Update from the February 2015 ACIP Meeting

Influenza
On Thursday, February 26, 2015, CDC’s Advisory Committee on Immunization Practices (ACIP) voted on its annual influenza vaccine recommendations for the 2015–2016 influenza season. CDC issued a media statement on the ACIP vote.

Meningococcal B
The ACIP also voted that a serogroup B meningococcal vaccine (MenB) vaccine series should be administered to persons 10 years of age and older who are at increased risk of meningococcal disease. These include:

  • Persons with persistent complement component deficiencies including inherited or chronic deficiencies in C3, C5-9, properdin, factor D, factor H, or taking eculizumab
  • Persons with anatomic or functional asplenia, including sickle cell disease
  • Microbiologists routinely exposed to isolates of Neisseria meningitides
  • Persons identified to be at increased risk because of a meningococcal B outbreak

HPV
The ACIP also voted to recommend routine HPV vaccination at age 11 or 12 years. The vaccination can be started beginning at 9 years of age. Vaccination is also recommended for females 13–26 years of age and for males 13–21 years of age who have not been vaccinated previously or who have not completed the three-dose series. Males 22–26 years of age may also be vaccinated. Vaccination of females is recommended with 2vHPV, 4vHPV, or 9vHPV. Vaccination of males is recommended with 4vHPV or 9vHPV.

The ACIP also recommended that if providers do not know or do not have available the HPV vaccine product previously administered, or are in settings transitioning to 9vHPV, for protection against HPV 16 and 18, any HPV vaccine product may be used to continue or complete the series for females. 4vHPV or 9vHPV may be used to continue or complete the series for males.

The ACIP noted that future policy considerations include the use of 9vHPV for a person who has received the complete series of 4vHPV and alternative dosing schedules.

Yellow Fever
The ACIP voted that a single dose of yellow fever vaccine provides long-lasting protection and is adequate for most travelers.  ACIP also stated that additional doses of yellow fever vaccine may be indicated for certain populations:

  • Women pregnant when they received their initial dose of yellow fever vaccine should receive one additional dose prior to their next travel that puts them at risk for yellow fever virus infection
  • Individuals who received a hematopoietic stem cell transplant after receiving a dose of yellow fever vaccine and who are sufficiently immunocompetent to be safely vaccinated should be revaccinated prior to their next travel that puts them at risk for yellow fever virus infection
  • Individuals who were HIV-infected when they received their last dose of YF vaccine should receive a dose every ten years if they continue to be at risk for yellow fever infection

Finally, a booster dose of YF vaccine may be considered for travelers who received their last dose of YF vaccine at least 10 years previously and who will be in a higher-risk setting based on season, location, activities, and duration of their travel. This would include travelers who plan to spend a prolonged period of time in endemic areas or those traveling to highly endemic areas such as rural West Africa during peak transmission season or areas with ongoing outbreaks.


Influenza Antivirals Are Underutilized – New Study

A new study published on February 26, 2015 in Clinical Infectious Diseases highlights that influenza antiviral drugs continue to be underutilized in patients at high risk for flu complications. A Flu Spotlight related to this article also is available.


Survey: Parents Increasingly Ask Doctors to Delay Vaccines

Parents have increasingly pressured doctors to delay vaccines for young children, making their kids and others vulnerable to preventable diseases, a study suggests.

The findings are in a national survey of pediatricians and family doctors asked about parents wanting to postpone some of the many shots recommended for children younger than age 2. Nearly all doctors said that at least some parents had requested vaccine delays in a typical month; and 1 in 4 said those numbers had increased since the previous year. The full report is available in Pediatrics.


WHO Warns of Pandemics Worse Than 2009 Swine Flu Outbreak

The world is highly vulnerable to a severe flu pandemic and governments should increase surveillance, vigilance and preparedness, the World Health Organization (WHO) has said in a recently released report.

“Nothing about influenza is predictable – including where the next pandemic might emerge and which virus might be responsible,” the United Nations health agency warned while noting the next pandemic could be worse than the 2009 swine flu outbreak that killed over 284,000.

A news article about the report is available in the International Business Times.


Register for the 2015 Preparedness Summit

Don’t forget to register for the 2015 Preparedness Summit at the early-bird rate April 14–17, 2015 in Atlanta. The summit is the premier national conference for public health preparedness and provides one of the only cross-disciplinary learning opportunities in the field.


NACCHO Expresses Concern Over Budget Cuts to Immunization Funding during Measles Outbreak

In a recent press release, NACCHO expressed concern that the Obama Administration is proposing to cut discretionary funding for immunization and other programs that are key to preventing disease outbreaks and other disasters, especially while the country is in the midst of a measles outbreak.


Traveling to India? Swine Flu Death Toll Rises to 1,041

Swine flu has claimed 36 more lives, raising the toll to 1,041 even as the number of people affected by the H1N1 virus in India breached the 19,000 mark today. As per data collated by the Health Ministry, the total number of deaths due to swine flu was 1,041 till yesterday, while the number of people affected was 19,046.


CDC: Flu Vaccine Less Effective Than Expected

Does it seem like everyone you know is getting sick this winter? That may be because this year’s flu vaccine isn’t as strong as expected, according to the U.S. Centers for Disease Control and Prevention. The vaccine has an 18 percent effectiveness against the dominant H3N2 flu strain, the CDC reports. Earlier in the season, flu shot protection level was estimated at 23 percent.

“There’s more data that’s come in now, given how much of the flu is caused by this mutated strain of H3N2,” ABC News’ Chief Health and Medical Editor Dr. Richard Besser told ABC News today. “It turns out the vaccine is even less effective than they thought.”


Grant Opportunity from the National Vaccine Program Office

NVPO is sponsoring a pilot vaccine safety grant (cooperative agreement) Research, Monitoring and Outcomes Definitions for Vaccine Safety. Here is some information about the FOA:

Funding Opportunity for Vaccine Safety Research
NVPO announces a unique opportunity to partner with us on research that will strengthen the current U.S. vaccine safety enterprise. With the potential for two awardees to receive up to $250,000 in funds ($500,000 total available funds), we encourage your participation—and look forward to reviewing applications following the April 15, 2015 closing date.

Types of Vaccine Safety-Related Research
Our objective is to conduct research in vaccine safety that

  • determines the safety profile of new vaccines during the early development stage,
  • develops or modifies existing vaccines to improve their safety,
  • directly impacts the current vaccine safety monitoring system, and/or
  • produces consensus definitions of vaccine safety outcomes that could be utilized to collect consensus data in clinical research conducted globally.

Projects Related to Pregnant Women and Newborns
Of particular interest are projects related to researching, establishing or testing the vaccine safety profile of vaccines that are either currently recommended for, or are expected to be, routinely administered to pregnant women and/or newborns. Topics of research may cover establishing the safety of a vaccine in either the pregnant woman, her newborn or both, at any stage of the vaccine development, testing and/or pre-clinical or clinical research and monitoring of vaccine safety.


VICNetwork Webinar on Wednesday, March 4, 2015 – 11am PT / 2pm ET

While this is for infants, please feel free to pass it around to your colleagues. The CDC will be presenting information on a new campaign, “Born with Protection.”

This webinar will provide an overview of National Infant Immunization Week (NIIW) and available planning resources, as well as introduce a new campaign, Born With Protection, aimed at protecting babies from pertussis, or whooping cough.  Pertussis can cause serious illness in young infants; however, babies cannot start their own DTaP vaccination series until they are two months old. Tdap vaccination of women during the third trimester of pregnancy can help protect infants when they are most vulnerable, yet coverage with this vaccine during pregnancy remains low.

Objectives:

  • Provide background on National Infant Immunization Week (NIIW)
  • Highlight CDC resources available to help plan NIIW events
  • Review the recommendation for Tdap vaccination during the 3rd trimester of every pregnancy
  • Share findings from CDC research about Tdap vaccine during pregnancy, including how those research findings have informed our communication efforts
  • Discuss how to access and share educational materials available from CDC

SPEAKERS:

Jenny Mullen is the Lead for the Childhood Immunizations Communication Team in NCIRD’s Health Communication Science Office. In this role, Jenny leads efforts to develop research-based messages and materials and conduct communications activities to raise awareness among parents and healthcare professionals about the value and benefits of vaccinating children according to the CDC’s recommended immunization schedule. More recently, she collaborated with NCIRD’s Division of Bacterial Diseases to lead the development of the Born with Protection Against Whooping Cough campaign.

Allison Kennedy Fisher is a health communications specialist with CDC’s National Center for Immunization and Respiratory Diseases. She has been at CDC since 2002, first in the Immunization Safety Office before joining the Immunization Services Division in 2006 and the Health Communication Science Office in 2013. Her areas of research interest include: adolescent vaccines, health and risk communication, health care decision-making behavior, and vaccine acceptance and hesitancy.  Allison’s experience includes conducting communication and epidemiologic research; writing scientific manuscripts; and writing health education and health communication materials. She has authored or co-authored articles on parent and health care provider immunization attitudes and behaviors, and has presented at national conferences and meetings on various aspects of childhood and pre-teen immunization and communication research.


2nd Asia-Pacific Influenza Summit, June 11–12, 2015

The Asia-Pacific Alliance for the Control of Influenza (APACI) is pleased to announce the 2nd Asia-Pacific Influenza Summit, to take place June 11 & 12, in Hanoi, Vietnam. Please mark the dates on your calendar.

APACI continues to develop new initiatives to promote influenza awareness in the region, and will again be presenting a unique opportunity to meet with key influenza experts and stakeholders from within the region, and from around the world. The summit follows the success of the inaugural Asia-Pacific Influenza summit held in Bangkok in 2012.

The summit will take place immediately prior to the 2015 Asian Vaccine Conference.


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. The next call will be on March 5, 2015. Please email L.J Tan or LaDora Woods if you have any updates on activities to provide to the Summit.

 

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