March 07, 2016

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Summit Call Recap – February 25, 2016
Summit Call Recap – February 18, 2016
Summit Call Recap – February 11, 2016
Special Announcements
Information from CDC
Announcements

SUMMIT CALL RECAP – FEBRUARY 25, 2016


Influenza Surveillance Update – Sophie Smith (CDC)

Today’s report provides a summary of published reports for week 6, ending February 13, 2016. Influenza activity in the U.S. increased during this week.

CDC is now reporting separately on influenza specimens received from U.S. clinical laboratories and U.S. public health laboratories. For week 6, 12.0% of specimens submitted to clinical laboratories were positive for influenza. Of these, 73.0% were influenza A and 27.0% were influenza B. For public health laboratories, 580/1,531 (37.9%) specimens were positive, with 423 (72.9%) influenza A and 157 (27.1%) influenza B.

Five hundred thirty-two (532) influenza virus specimens have been characterized as of October 1. Of these, 181 were A(H1N1), 228 were A(H3N2), and 123 were influenza B. All 181 A(H1N1) viruses and all 228 A(H3N2) viruses were similar to their respective components of the 2015–2016 Northern Hemisphere vaccine. A subset of 107 H3N2 viruses also were antigenically characterized, with 100/107 (93.3%) being A/Switzerland/9715923/2013-like. Eighty-eight (88) of the B viruses were of the B/Yamagata lineage, and the remaining 35 were B/Victoria.

Since October 1, 793 influenza viruses have been tested for antiviral resistance, including 330 influenza A(H1N1), 261 influenza A(H3N2), and 202 influenza B. Of these, 2 influenza A(H1N1) were resistant to oseltamivir and peramivir. All the remaining samples tested were sensitive to oseltamivir, zanamivir, and peramivir.

Based on National Center for Health Statistics (NCHS) data available on February 18, 2016, 6.5% of deaths occurring during the week ending January 30 (week 4) were due to pneumonia and influenza (P&I.) (NCHS data has an approximate 2 week lag time for reporting.) This is below the epidemic threshold of 7.6% for week 4. Similarly, data from the 122 Cities Mortality Reporting System for week 6 indicate 6.9% of deaths were due to P&I. This is below the epidemic threshold of 7.3% for week 6.

Two influenza-associated pediatric deaths were reported to CDC during week 6. A total of 13 influenza-associated pediatric deaths have been reported during the 2015–2016 season. Of these 13 deaths, 3 had no vaccination history available, 1 was not eligible for vaccination due to age, and 9 were unvaccinated. A laboratory breakdown showed 4 A(H1N1), 3 A unsubtyped, 1 A(H3), 1 type not determined, and 4 B.

For week 6, the cumulative hospitalization rate was 4.1 laboratory-confirmed influenza-associated hospitalizations per 100,000 population. The highest rate of hospitalization was among adults aged >65 years (12.7 per 100,000 population), followed by children aged 0–4 years (6.0 per 100,000 population). Among all hospitalizations, 71.1% were associated with influenza A, the majority of which were influenza A(H1N1). Hospitalizations also were associated with influenza A(H3), B, and A/B co-infections.

During week 6, influenza-like Illness (ILI) activity levels, which are based on the percent of outpatient visits due to ILI, were at 3.1%, above the baseline of 2.1% for the week.

On a regional level, outpatient visits for ILI ranged from 1.4% to 4.5% during week 6. Nine public health regions (Regions 1, 2, 3, 4, 5, 6, 8, 9, and 10) reported outpatient visits for ILI to be at or above region-specific baseline levels. The geographic spread of influenza as assessed by state and territorial epidemiologists indicates the following levels of influenza activity during week 6:

  • Widespread – 12 states and Puerto Rico
  • Regional – 20 states
  • Local – 15 states, the District of Columbia, and Guam
  • Sporadic – 3 states and the Virgin Islands


ACIP Meeting Summary – Carolyn Bridges (CDC)

Carolyn reported on the short (one day only) ACIP meeting held in Atlanta on February 24. The only vote at the meeting was on the upcoming 2016–2017 influenza vaccine recommendations. Key presentations were given on the use of live attenuated influenza vaccine (LAIV) with patients who have egg allergies. After the Working Group and the Committee reviewed this information, a vote was taken to simplify the language related to vaccination of egg-allergic patients. The figure outlining use of LAIV, IIV, or recombinant vaccine in these patients, which is located in the current influenza recommendations, will be eliminated. The rationale for this was based on studies which have shown patients have not had reactions after receipt of these vaccines. This information will be published in the MMWR sometime this spring or early summer.

Information on 2015–2016 influenza vaccine effectiveness (VE) also was presented at the meeting. CDC has issued a press release summarizing this information. The current estimates of vaccine effectiveness are 51% against A(H1N1) and 76–79% against influenza B, for a combined estimate of 59% VE. This is a considerable increase over last year’s result, when there was a mismatch between the vaccine and circulating strains. Carolyn reminded Summit members that these early VE estimates are likely to change as the season progresses.

An additional presentation described the VE of Flublok quadrivalent compared to IIV quadrivalent. A study examining the prevention of PCR-confirmed influenza-like illness was conducted in 9,000 adults >50 years. The study indicated a relative VE that was 31% superior for Flublok compared to IIV. This result was driven by prevention of A(H3N2) strains.

Other topics reviewed (without votes) by the ACIP were the VE results when using 2 vs 3 doses of HPV vaccine, as well as updates on meningococcal vaccines, including the use of Men ACWY in HIV-infected persons. Additionally, the group reviewed information on the duration of protection of Japanese encephalitis vaccine and the potential need for booster doses. A brief update was given on Zika virus, and cholera vaccine was discussed.

Slides from the meeting should be available shortly on the ACIP website.


Announcements – Carolyn Bridges (CDC)
  • Don’t forget to submit nominations for the Summit’s Immunization Excellence Awards. The deadline for submission of nominations has been extended to February 26.
  • Guidelines for the Summit’s Adult Vaccine Video Contest are available online. Please be sure to share information about this unique opportunity.

SUMMIT CALL RECAP – FEBRUARY 18, 2016


Influenza Surveillance Update – Sophie Smith (CDC)

Today’s report provides a summary of published reports for week 5, ending February 6, 2016. Influenza activity in the U.S. increased slightly during this week.

CDC is now reporting separately on influenza specimens received from U.S. clinical laboratories and U.S. public health laboratories. For week 5, 9.1% of specimens submitted to clinical laboratories were positive for influenza. Of these, 72.6% were influenza A and 27.4% were influenza B. For public health laboratories, 443/1,233 (36.2%) specimens were positive, with 325 (73.4%) influenza A and 118 (26.6%) influenza B.

Four hundred eighty-three (483) influenza virus specimens have been characterized as of October 1. Of these, 188 were A(H1N1), 216 were A(H3N2), and 87 were influenza B. All 188 A(H1N1) viruses and all 216 A(H3N2) viruses were similar to their respective components of the 2015–2016 Northern Hemisphere vaccine. A subset of 105 H3N2 viruses also were antigenically characterized, with 98/105 (93.3%) being A/Switzerland/9715923/2013-like. Fifty-two (52) of the B viruses were of the B/Yamagata lineage, and the remaining 35 were B/Victoria.

Since October 1, 700 influenza viruses have been tested for antiviral resistance, including 301 influenza A(H1N1), 247 influenza A(H3N2), and 152 influenza B. Of these, 2 influenza A(H1N1) was resistant to oseltamivir and peramivir. All the remaining samples tested were sensitive to oseltamivir, zanamivir, and peramivir.

Based on National Center for Health Statistics (NCHS) data available on February 11, 2016, 6.9% of deaths occurring during the week ending January 23 (week 3) were due to pneumonia and influenza (P&I.) (NCHS data has an approximate 2 week lag time for reporting.) This is below the epidemic threshold of 7.6% for week 3. Similarly, data from the 122 Cities Mortality Reporting System for week 5 indicate 6.3% of deaths were due to P&I. This is below the epidemic threshold of 7.2% for week 5.

Two influenza-associated pediatric deaths were reported to CDC during week 5. A total of 11 influenza-associated pediatric deaths have been reported during the 2015–2016 season. Of these 11 deaths, 3 had no vaccination history available, 1 was not eligible for vaccination due to age, and 7 were unvaccinated.

For week 5, the cumulative hospitalization rate was 3.2 laboratory-confirmed influenza-associated hospitalizations per 100,000 population. The highest rate of hospitalization was among adults aged >65 years (10.2 per 100,000 population), followed by children aged 0–4 years (4.5 per 100,000 population). Among all hospitalizations, 69.6% were associated with influenza A, the majority of which were influenza A(H1N1). Hospitalizations also were associated with influenza A(H3N2), B, and A/B co-infections.

During week 5, influenza-like Illness (ILI) activity levels, which are based on the percent of outpatient visits due to ILI, were at 2.2%, above the baseline of 2.1% for the week.

On a regional level, outpatient visits for ILI ranged from 1.1% to 4.5% during week 5. Seven public health regions (Regions 1, 2, 3, 4, 6, 8, and 10) reported outpatient visits for ILI to be at or above region-specific baseline levels. The geographic spread of influenza as assessed by state and territorial epidemiologists indicates the following levels of influenza activity during week 5:

  • Widespread – 7 states and Puerto Rico
  • Regional – 17 states and Guam
  • Local – 16 states
  • Sporadic – 9 states and the District of Columbia
  • No activity – 1 state
  • No report – Virgin Islands


Health Alert Network Advisory – Angie Campbell (CDC)

Dr. Campbell provided information into the rationale behind the February 1 release of the Health Alert Network (HAN) Advisory on the appearance of severe influenza. She reiterated that the information just presented by Sophie indicates that at this time we are not having a high level of morbidity due to influenza. However, we are seeing more severe disease.

At the time the HAN was issued, ILI numbers were rising above baseline levels, and these were expected to continue to rise. Essentially, the HAN was released to mark the beginning of influenza season and to alert physicians that we were beginning to receive reports of severe illness, particularly with influenza A(H1N1). In addition, CDC wanted to alert providers that the agency was receiving reports of rapid tests coming back negative, while molecular tests were resulting in positives. Although this has been seen in the past, it is different than the previous year, and it also is reminiscent of the severe illness seen in young adults during previous A(H1N1) years.

In essence, the HAN noted that:

  • All types of influenza viruses were appearing early in the season, but now H1N1 viruses are beginning to predominate.
  • CDC has received several reports of severe illness in young and middle-aged adults.
  • Many tests were negative by rapid test, but positive by molecular assay.
  • Many of these patients were unvaccinated, so the HAN provided an opportunity to reinforce the need for vaccination.
  • Antiviral medications continue to be recommended.

A Summit member asked about recent reports indicating an 8-year-old girl in Park City, Utah, died from influenza A in spite of being vaccinated. Although CDC cannot discuss this individual child, Angie reiterated the importance of vaccination, even though it may not always be effective in each individual. Joe Bresee with CDC confirmed that this year’s vaccine appears to be a good match with circulating strains. The first vaccine effectiveness report for this season will be provided at next week’s ACIP meeting.


Immunization Measurements for Influenza and Pneumococcal – June Fisher (Sanofi Pasteur)

Ms. Fisher noted that a recent announcement from the Centers for Medicare and Medicaid Services (CMS) and America’s Health Insurance Plans (AHIP) indicated they had reached an agreement on seven core measure sets of healthcare quality. These measures were developed in an effort to harmonize reporting requirements for physicians and other clinicians, who currently must report multiple quality measures to different entities. As noted in the announcement, measure requirements are often not aligned among payers, which has resulted in confusion and complexity for reporting providers.

Measures related to the patient-centered medical home, physicians, and accountable care organizations (ACOs) are of interest to Summit members. In the past, quality measures were available for influenza and pneumococcal immunization. However, neither vaccine is included in the proposed quality measures. Both CMS and AHIP have agreed to transition into these measures for reporting, and they likely will be used to determine payments. This will be a transition year, but CMS has said they will be removing current measures.

In response to a question, Ms. Fisher noted that it is not clear if these are the only measures that ACOs and other health systems will use. Previously, ACOs reported on 21 measures. The goal was to reduce the number of quality measures requiring reporting.

Carolyn Bridges noted that the OB/GYN measure of Tdap vaccination of pregnant women will still be considered in the future if an appropriate data source is located. However, vaccines were not listed in the quality care measures for other types of providers, including cardiologists.

L.J stated that the Summit will follow this effort as additional information is made available, and he will notify all Summit members when an opportunity for public comment is announced. He also will share the currently available information to the Summit Quality Measures Workgroup and the Adult Vaccine Access Coalition.


Announcements – L.J Tan (CDC)
  • Don’t forget to submit nominations for the Summit’s Immunization Excellence Awards. The deadline for submission of nominations has been extended to February 26.

SUMMIT CALL RECAP – FEBRUARY 11, 2016


Influenza Surveillance Update – Sophie Smith (CDC)

Today’s report provides a summary of published reports for week 4, ending January 30, 2016. Influenza activity in the U.S. increased slightly during this week.

CDC is now reporting separately on influenza specimens received from U.S. clinical laboratories and U.S. public health laboratories. For week 4, 6.8% of specimens submitted to clinical laboratories were positive for influenza. Of these, 68.1% were influenza A and 31.9% were influenza B. For public health laboratories, 368/1,255 (29.3%) specimens were positive, with 273 (74.2%) influenza A and 95 (25.8%) influenza B.

Four hundred seven (407) influenza virus specimens have been characterized as of October 1. Of these, 130 were A(H1N1), 190 were A(H3N2), and 87 were influenza B. All 130 A(H1N1) viruses and all 190 A(H3N2) viruses were similar to their respective components of the 2015–2016 Northern Hemisphere vaccine. A subset of 93 H3N2 viruses also were antigenically characterized, with 92/93 (98.9%) being A/Switzerland/9715923/2013-like. Fifty-two (52) of the B viruses were of the B/Yamagata lineage, and the remaining 35 were B/Victoria.

Since October 1, 584 influenza viruses have been tested for antiviral resistance, including 229 influenza A(H1N1), 225 influenza A(H3N2), and 130 influenza B. Of these, 2 influenza A(H1N1) was resistant to oseltamivir and peramivir. All the remaining samples tested were sensitive to oseltamivir, zanamivir, and peramivir.

Based on National Center for Health Statistics (NCHS) data available on February 4, 2016, 7.0% of deaths occurring during the week ending January 16 (week 2) were due to pneumonia and influenza (P&I.) (NCHS data has an approximate 2 week lag time for reporting.) This is below the epidemic threshold of 7.6% for week 2. Similarly, data from the 122 Cities Mortality Reporting System for week 4 indicate 6.8% of deaths were due to P&I. This is below the epidemic threshold of 7.2% for week 4.

Two influenza-associated pediatric deaths were reported to CDC during week 4. A total of 9 influenza-associated pediatric deaths have been reported during the 2015–2016 season. Of these 9 deaths, 3 had no vaccination history available, 1 was not eligible for vaccination due to age, and 5 were unvaccinated.

During week 4, influenza-like Illness (ILI) activity levels, which are based on the percent of outpatient visits due to ILI, were at 2.2%, above the baseline of 2.1% for the week.

Between October 1, 2015 and January 30, 2016, 723 laboratory-confirmed influenza-associated hospitalizations were reported. The overall hospitalization rate was 2.6 per 100,000 population. The highest rate of hospitalization was among adults aged >65 years (8.5 per 100,000 population), followed by children aged 0–4 years (3.8 per 100,000 population). Among all hospitalizations, 490 (67.8%) were associated with influenza A, 203 (28.1%) with influenza B, 18 (2.5%) with influenza A and B co-infection, and 12 (1.7%) had no virus type information. Among those with influenza A subtype information, 115 (79.3%) were A(H1N1)pdm09 and 28 (19.3%) were A(H3N2) virus.

On a regional level, outpatient visits for ILI ranged from 1.7% to 2.4% during week 4. Five public health regions (Regions 1, 2, 4, 6, and 10) reported outpatient visits for ILI to be at or above region-specific baseline levels. The geographic spread of influenza as assessed by state and territorial epidemiologists indicates the following levels of influenza activity during week 4:

    • Widespread – 3 states and Puerto Rico
    • Regional – 18 states and Guam
    • Local – 16 states and the District of Columbia
    • Sporadic – 12 states and the Virgin Islands
    • No report – 1 state


Adult Vaccination Update – Walter Williams (CDC)

Dr. Williams provided a concise presentation summarizing CDC’s February 4 publication of Surveillance of Vaccination Coverage Among Adult Populations — United States, 2014. The article describes vaccine coverage results from the 2014 National Health Interview Survey (NHIS).

The NHIS sampled over 36,000 adults about health questions, including immunizations. Vaccines included in the survey included influenza, pneumococcal (PPSV or PCV13), Td/Tdap, hepatitis B, zoster, and HPV. Additional information was collected on specific high risk factors for pneumococcal disease and hepatitis A and B, and whether the respondent worked in health care as a direct patient care provider.

The following information provides only summary highlights on adult vaccination coverage in 2014. Be sure to check the actual presentation and the MMWR article (see above) for detailed information on individual vaccines and populations.

Summary (adapted from Dr. Williams’ presentation and MMWR article)

  • Overview: Although modest gains occurred for Tdap vaccine among adults >19 years of age and herpes zoster vaccine among adults >60 years of age, coverage for other vaccines and risk groups did not improve, and racial/ethnic disparities persisted for routinely recommended adult vaccines. Coverage for all vaccines for adults remained low, and missed opportunities to vaccinate adults continued.
  • Healthy People 2020: Overall coverage remains below HP2020 targets:
    • 70% for 19+ years for influenza vaccine
    • 90% for 65+ years for pneumococcal vaccine
    • 60% for high risk 19–64 years for pneumococcal vaccine
    • 30% for 60+ years for zoster vaccine
    • 90 for hepatitis B vaccine for healthcare personnel
  • Racial/ethnic disparities: Racial/ethnic differences in coverage persisted for all vaccines, with higher coverage generally for whites compared with most other groups.
  • Health insurance coverage: Adults without health insurance were significantly less likely than those with health insurance to report receipt of all vaccines.
  • Medical home: Regardless of whether they had health insurance, adults who reported having a usual place for health care generally were more likely to receive recommended vaccinations than those who did not have a usual place for health care. Similarly, vaccination coverage was significantly higher among persons reporting one or more physician contacts in the past year.
  • U.S.-born: Overall, vaccination coverage was significantly higher among U.S.-born repondents to the survey, compared with foreign-born respondents.
  • Conclusion: Much remains to be done to increase vaccine utilization among adults and to eliminate disparities.


Announcements – L.J Tan (IAC)
  • Don’t forget to submit nominations for the Summit’s Immunization Excellence Awards. Because February 15 is a federal holiday, the deadline for submission of nominations has been changed to February 16.

SPECIAL ANNOUNCEMENTS


Unity Consortium Extends Recruitment for Research Study Until March 18, 2016

The UNITY Consortium is inviting practices to apply for participation in an important new study, the “Pursuit of the Three Cs: Confident, Concise, and Consistent Health Care Provider Recommendations for Adolescent Vaccines”.  This study will evaluate the impact of a simple intervention that can be readily adopted by HCPs regardless of HCP type, geography, or location, designed to improve adolescent vaccination rates.

The following are the inclusion and exclusion practice criteria:

Inclusion

  • Single specialty pediatrics practice with moderate to high volume of adolescent visits
  • Practice has at least five providers, which may include NPs and/or PAs
  • At least 90% of the providers in the practice must agree to participate
  • Participating providers should work at least 60% FTE, spend ≥ 70% of time in direct patient care, and have been practicing for > 2 years and <25 years
  • Practice equipped with electronic health records that allow for generating blinded vaccination data/rates by provider.

Exclusion

  • Practice based in hospital/academic center
  • Practice cannot reside in Illinois, North Carolina, Rhode Island, or Utah as new adolescent vaccination mandates for these states are starting in the upcoming school year (2015–16).

Unity Consortium welcomes an opportunity to discuss this groundbreaking study with interested practices.  Applications are being accepted through March 18. There is no fee to participate, and practices will be provided a modest honorarium. Please email Denise Lewis at for additional information.


NFID Spring 2016 Clinical Vaccinology Course

The 2.5 day Clinical Vaccinology Course will be held March 18-20, 2016 in Phoenix, AZ. The course focuses on new developments and issues related to the use of vaccines. Expert faculty will provide the latest information on vaccines, including updated recommendations for vaccinations across the lifespan, and innovative and practical strategies for ensuring timely and appropriate immunization. Topics covered include:

  • Best practices to improve childhood, adolescent, and adult immunization rates
  • Current vaccine recommendations
  • Effective vaccine communication strategies
  • Vaccine administration, storage and handling, and reimbursement

Check online to view the agenda or to register.


Let All know about the Summit’s Video Contest and Encourage Submissions

The Summit has just opened a new NAIIS 2016 Adult Vaccine Video Contest. The contest asks the public to help raise awareness about the importance of adult vaccine by creating a short, creative video that promotes adult immunization. The video can be a rap, sketch, dance, slide show, or anything the developer wants it to be, as long as it is appropriate for all audiences and follows the contest guidelines outlined on the website.

The top videos will be posted on the Summit webpage and the public will be provided an opportunity to vote for their favorite. In addition to a monetary award of $750 (first place) and $350 (second place), the top three videos will receive recognition from NAIIS, the National Foundation for Infectious Diseases, the Immunization Action Coalition, and other partners.

Please share information about the contest through your professional networks. Attached is an e-blast example that can be used to help spread the word! The deadline for submission is March 21, 2016.


IAC Seattle Workshop to Improve Implementation of Standing Orders for Adult Vaccines is on March 15, 2016; Arizona Workshops are on March 17 and 18

Please help IAC get the word out to Washington and Arizona medical practices on the availability of a workshop to help them implement standing orders for adult vaccinations. This workshop is part of a national initiative to assist medical practices put standing orders into action. IAC is also delighted to announce that national immunization thought leaders, Drs. Jeff Duchin and Carlos Perez-Velez, will join other expert speakers who are presenting at the workshops.

As part of the initiative, IAC is offering a full year of free follow up support to medical practices that participate in the workshop and implement standing orders for adult vaccines.

Visit the project website to register for the workshops or to learn more about the initiative and see other workshop locations.


INFORMATION FROM CDC


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

The CDC weekly influenza surveillance report for week 8, 2016 (ending February 27, 2016) and region specific data are now available.

NCHS mortality surveillance data for week 2 (ending February 13, 2016, but available March 3, 2016) indicate 6.7% of deaths were due to pneumonia and influenza (P&I). This percentage is below the epidemic threshold of 7.7% for week 6. Region and state-specific NCHS data are available online. During week 8, 7.4% of all deaths reported through the 122 Cities Mortality Reporting System were due to P&I. This percentage was above the epidemic threshold of 7.2% for week 8.

CDC characterized 783 influenza viruses [331 A (H1N1)pdm09, 251 A (H3N2), and 201 influenza B viruses] collected by U.S. laboratories since October 1, 2015. All 251 H3N2 viruses were genetically sequenced, and all viruses belonged to genetic groups for which a majority of viruses antigenically characterized were similar to A/Switzerland/9715293/2013, the influenza A (H3N2) component of the 2015–2016 Northern Hemisphere vaccine. A subset of 109 H3N2 viruses also were antigenically characterized; 102 of 109 (93.6%) H3N2 viruses were A/Switzerland/9715293/2013-like by HI testing or neutralization testing.

All 331 (100%) influenza A (H1N1)pdm09 viruses were antigenically characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2015-2016 Northern Hemisphere vaccine. All 142 (100%) B/Yamagata-lineage viruses were antigenically characterized as B/Phuket/3073/2013-like, which is included as an influenza B component of the 2015–2016 Northern Hemisphere trivalent and quadrivalent influenza vaccines. Fifty-eight of 59 (98.3) B/Victoria-lineage viruses were antigenically characterized as B/Brisbane/60/2008-like, which is included as an influenza B component of the 2015–2016 Northern Hemisphere quadrivalent influenza vaccines.

Four influenza-associated pediatric deaths were reported to CDC during week 8. Two deaths were associated with an influenza A (H1N1)pdm09 virus and occurred during week 7 (week ending February 20, 2016). One death was associated with an influenza A virus for which no subtyping was performed and occurred during week 8 (week ending February 27, 2016), and one death was associated with an influenza B virus and occurred during week 7 (week ending February 20, 2016). A total of 18 influenza-associated pediatric deaths have been reported during the 2015–2016 season from Puerto Rico [1], Chicago [1], and 10 states (Arizona [2], California [3], Florida [4], Louisiana [1], Michigan [1], Mississippi [1], Nebraska [1], Nevada [1], Tennessee [1], and Washington [1]. 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) in select counties in the Emerging Infections Program (EIP) states and Influenza Hospitalization Surveillance Project (IHSP) states.

Between October 1, 2015 and February 27, 2016, 2,163 laboratory-confirmed influenza-associated hospitalizations were reported. The overall hospitalization rate was 7.8 per 100,000 population. The highest rate of hospitalization was among adults aged ≥65 years (21.3 per 100,000 population), followed by children aged 0–4 years 11.8 per 100,000 population) and adults aged 50–64 (10.6 per 100,000 population). Among all hospitalizations, 1,624 (75.1%) were associated with influenza A, 505 (23.3%) with influenza B, 23 (1.1%) with influenza A and B co-infection, and 11 (0.5%) had no virus type information. Among those with influenza A subtype information, 545 (89.3%) were A(H1N1)pdm09 and 65 (10.7%) were A(H3N2) virus.

Clinical findings are preliminary and based on 610 (28.2%) cases with complete medical chart abstraction. The majority (91.1%) of hospitalized adults had at least one reported underlying medical condition; the most commonly reported were cardiovascular disease, obesity and metabolic disorders. There were 81 hospitalized children with complete medical chart abstraction, 38 (46.9%) had no identified underlying medical conditions. The most commonly reported underlying medical conditions among pediatric patients were asthma, neurologic disorders and cardiovascular disease. Among the 56 hospitalized women of childbearing age (15–44 years),15 were pregnant.

Nationwide during week 4, 3.2% 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 2.1%. 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 27, 2016. Currently 34 states are reporting widespread activity, 15 states are reporting regional activity, and the remaining states are reporting local or sporadic activity.

CDC Influenza Division seasonal influenza key points for March 4 are now available, as is the FluView report for week 8, ending February 27. Archives of previous FluViews also may be found online.


CDC Has Released 2016 Immunization Schedules

The 2016 Birth–18 Years and Adult Immunization Schedules are now available online. Every year, the Advisory Committee on Immunization Practices (ACIP) develops recommendations for routine use of vaccines in children, adolescents, and adults. When approved by the CDC Director, they become official CDC/HHS policy. A summary of schedule changes on February 2 for persons aged 0–18 years and 19 years or older was published in the Morbidity and Mortality Weekly Report (MMWR) on February 2.

CDC has also updated the following easy-to-read schedules for patients and parents:

CDC encourages organizations to syndicate the schedules rather than post a PDF version of the schedule onto their websites to share with visitors. Content syndication allows other organizations’ websites to mirror CDC web content with automatic updates whenever changes are made on the CDC site. This helps ensure that all schedules are current across the Internet. Learn how to display the schedules on your site.


CDC Launches AdultVaxView

CDC has launched AdultVaxView, which will include the first release of AdultVaxView Interactive. The interactive tool features U.S. adult pneumococcal vaccination coverage trends from 2008–2014. Users can view the coverage data from the Behavioral Risk Factor Surveillance System (BRFSS) by state, HHS region, or nationally.


CDC introduces Immunization Communication Resources

To support your efforts to promote immunization in February and throughout the year, CDC has developed a range of communication products for immunization of different age groups.

Infants and young children:

  • National Infant Immunization Week is April 16–23 this year. We encourage you to highlight the importance of protecting infants from vaccine-preventable diseases during this annual observance.
  • Display posters in clinic waiting rooms, child care centers, and other community settings to reach parents of young children. Print materials, web banners, and an animated image are also available to address flu vaccination for children and families.
  • Run a print ad in community publications, parenting magazines, or your organizational newsletter.
  • Download these radio and video public service announcements (available in English and Spanish) to promote on-time infant immunizations.  Ask your local radio and televisions stations to play them at times of the day to reach parents of young children.

Preteens and Teens:

  • Receive continuing education credit to learn about HPV disease, HPV vaccine as a primary cancer prevention tool, effectively communicating with parents, and the most recent HPV vaccine recommendations.
  • Learn how immunization providers can have successful conversations with parents about HPV vaccination as a routine part of preteen vaccination.

Adults:

  • Share videos  online or in waiting rooms to help adults understand why vaccines are important for them and which ones may be recommended.
  • Display posters and flyers encouraging adult vaccination in healthcare offices, workplaces, and other community settings.
  • Share factsheets that can help adults understand why vaccination is important and which vaccines are recommended for them.
  • Use web buttons to link to CDC web pages and resources.
  • Share radio PSAs through your organization and by encouraging local radio stations and medical offices to play them.
  • Access materials to assist with vaccine recommendations with pregnant patients.  Download resources about both Tdap and flu vaccines during pregnancy.  Print materials, web banners, and an animated image are also available to address the importance of flu vaccination in pregnant women.


CDC Measles Update

CDC has new measles information and resources available for you to share with your membership, including key points that can be obtained upon request. These key points are meant to be a resource for increasing awareness of measles activity, other pertinent information, and communicating measles-related messages.

Contact Jill Woodard at the CDC 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 measles education to your membership.


CDC Clinician Outreach and Communication Activity (COCA) Information

CDC Science Clips: Volume 7, Issue: 49 – (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 Health Professionals
The CDC’s Long Term Care toolkit is also available at his website.

Upcoming and Recent COCA webinars/calls

Update on Interim Zika Virus Clinical Guidance and Recommendations
During this COCA Call, participants learned why CDC has updated the clinical guidelines and how they can use the guidelines for Zika virus evaluation and testing.

2015-2016 Influenza Activity and Clinical Recommendations
During this COCA Call, clinicians learned about 20152016 influenza activity, heard an overview of CDC’s current recommendations for vaccination and antiviral medications, and gained insight into data supporting the recommendations.


ANNOUNCEMENTS


WHO Announces Influenza Vaccine Composition for the 2016–2017 Season (Northern Hemisphere)

WHO has recommended that trivalent vaccines for use in the 2016–2017 influenza season (northern hemisphere winter) contain the following:

  • A/California/7/2009 (H1N1)pdm09-like virus;
  • A/Hong Kong/4801/2014 (H3N2)-like virus;
  • B/Brisbane/60/2008-like virus.

It is recommended that quadrivalent vaccines containing two influenza B viruses contain the above three viruses and a B/Phuket/3073/2013-like virus.


FDA Advisers Pick 2016–2017 Influenza Vaccine Strains

A US Food and Drug Administration (FDA) advisory committee has recommended two changes for the influenza vaccine for the 2016–2017 season. The Vaccines and Related Biological Products Advisory Committee today unanimously voted to adopt the World Health Organization’s (WHO) recommendations for the 2016-2017 influenza vaccine for the northern hemisphere.

The WHO recommendations are based on global surveillance of circulating influenza strains and on the effectiveness of the northern hemisphere vaccine for the 2015-2016 season.

The H3N2 strain and the B strain will be new for the US and northern hemisphere 2016-2017 trivalent vaccine. In 2015-2016, the trivalent vaccine included A/California/7/2009 (H1N1)pdm09-like virus, the A/Switzerland/9715293/2013 (H3N2)-like virus, and the B/Phuket/3073/2013-like virus.


Flu Vaccine Nearly 60 Percent Effective

The Centers for Disease Control and Prevention today reported preliminary overall influenza vaccine effectiveness (VE) of 59 percent this season. These data were presented at a meeting of the agency’s Advisory Committee for Immunization Practices (ACIP) in Atlanta. This finding is comparable to past estimates for seasons when most circulating flu viruses and vaccine viruses have been similar.


In Guelph, Canada, Students Face Suspension If Not Immunized

Wellington-Dufferin-Guelph Public Health is making sure Grade 12 students have their vaccines up to date. They recently sent a letter home to approximately 2,300 17-year-olds that required students to be fully vaccinated. The students also have to complete an immunization record to be on file with the health unit. If the teens don’t comply, they face suspension from school.


Influenza picking up across the country

Influenza is picking up across the country. Here are several news reports from across the United States.


US Vaccine Officials Weigh In at the Midpoint of the Decade of Vaccines

We’re at the midpoint of the Decade of Vaccines (subscription required to view article) — an intense period marked by efforts to ramp up and extend the benefits of immunization to all people, everywhere. Unfortunately, despite much progress, the world has fallen short. But there is still time to re-think our strategy.


Flu Shot Effectiveness Varies by Ethnicity, Researchers Find

The flu shot seems to protect some people better than others because of differences in immune response between ethnic groups, say researchers who hope to better tailor vaccines to an individual some day. Researchers at Dana-Farber Cancer Institute in Boston have studied stored blood samples from the 1,000 Genomes Project. They’ve investigated 14 slightly different forms of one gene with an eye to seeing what’s more effective at responding to a flu virus. An additional article is available online.


New Study Brings MERS Vaccine Strategy into Question

A new study published this week in the online open-access journal mBio suggests that the Middle East Respiratory Syndrome coronavirus (MERS-CoV) develops mutations that make the virus less virulent, rather than more virulent. An additional article is available online.


Summit’s IVATS Program Is Now Live for 2015–2016 to Assist Providers Locate Influenza Vaccine

The Influenza Vaccine Availability Tracking System (IVATS) has been a staple of the Summit for several years. The 2015–2016 iteration is now live. Distributors are encouraged to submit their latest data via the IVATS submission form. Submission is entirely voluntary. Providers can use IVATS to locate influenza vaccine supply.


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:


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 next Summit call is on Thursday, March 10, and will feature Angela Shen summarizing the recent National Adult Immunization Implementation Plan. Please email L.J Tan or LaDora Woods if you have any updates on activities to provide to the Summit.

 

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