November 10, 2016

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SUMMIT CALL RECAP – OCTOBER 27, 2016

Influenza Surveillance Update – Noreen Alabi (CDC)

Noreen provided highlights of the influenza surveillance report from week 41, ending on October 15, 2016. Influenza activity in the U.S. continues to remain low. Clinical lab percent positives have increased slightly in the past week, with 1.3% of specimens submitted found to be positive. Influenza A viruses were most common during week 41. Noreen reported that it is still a little early in the season to know whether we are seeing an H1 or H3 season.

CDC continues to collect hospitalization rates for influenza, but none have been reported to date. Based on reports for week 41 from the National Center for Health Statistics (NCHS) surveillance system, 5.4% of mortality was due to pneumonia and influenza (P&I). This is below the epidemic threshold of 6.4% for the week.

No influenza-associated pediatric deaths have been reported to CDC for the 2016–2017 season. At 1.2%, influenza-like illness (ILI) activity remained below the national baseline of 2.2% for the week.

Immunization Editorial Calendar – Aparna Ramakrishnan (CDC)

Aparna provided an overview of current items to highlight in the Immunization Editorial Calendar developed by the Summit’s Patient Education Workgroup. The calendar was developed to identify different themes and observances throughout the year that could be used to help highlight the importance of immunization and encourage vaccination.

Some of the items that can be highlighted over the next month include:

Halloween – help prevent “scary” diseases with immunizations
November – designated as several different months (American Diabetes Month, COPD Awareness Month, and Lung Cancer Awareness Month) which provide opportunities to highlight the importance of immunizations for persons with chronic conditions
Travel – Reminders to be vaccinated before travel and meet with family members at Thanksgiving get-togethers

Summit partners are encouraged to look at the calendar and inform LaDora Woods or L.J Tan if they have any additional suggestions.

October ACIP Meeting Summary – David Kim (CDC) and Laurel Wood (IAC)

David provided an overview of the changes to the Recommended Adult Immunization Schedule for Adults Age >19 as voted upon by ACIP at the October meeting.

The schedule consists of:

Cover letter – contains information on the content of the schedule, additional CDC resources, and acronyms used for vaccines
Figure 1 – Recommended schedule for adults by age group
Figure 2 – recommended schedule for adults by medical condition and other indications
Footnotes – contain important general information and considerations for special populations
Table of Contraindications and Precautions – This table is now incorporated into the schedule

The changes for the 2017 recommendations are found in influenza, HPV, HepB, and meningococcal vaccine.

Influenza

LAIV is not recommended for use during the 2016–2017 season
Egg allergy – Even if a patient has a history of hives or other symptoms, it is now acceptable to use age-appropriate IIV or RIV

HPV

Healthy adolescents may receive 2 doses of this vaccine; however, 3 doses continue to be recommended for adults who did not begin the series before age 15 (an adult who began the series before age 15 and who has a history of 2 doses at least 5 months apart may be considered adequately vaccinated)

Hepatitis B

Recommended for adults with chronic liver disease, including those with Hepatitis C infection (new addition), HIV, and those with diabetes (at the discretion of the treating physician)

Meningococcal

HIV-infected adults should receive 2 doses of MenACWY
MenB-FHbp (Trumenba) – healthy adolescents should receive 2 doses of this vaccine, though 3 doses continue to be recommended if the individual is at increased risk for meningococcal disease or during a serogroup B outbreak

The 2017 recommendations are scheduled for publication in early February.

Following David’s presentation, Laurel reviewed the remaining votes and discussions (i.e., other than the changes to the adult schedule) from the October ACIP meeting, as follows:

Hepatitis B Vaccine
ACIP voted to consolidate information from five previously released statements into a single document. Significant changes included:

Emphasis on the importance of the safety net against chronic HBV infection passed from a mother to her infant by recommending that all infants of HBsAg-neg women should be immunized with HepB within 24 hours of birth (rather than before hospital discharge.) This removes previous policy language that allowed for a delay in certain rare circumstances.
Prioritization of HBsAg-positive women for HBV management and therapy
Updated guidance on post-vaccination serologic testing for infants whose mother’s HBsAg status remains unknown indefinitely (e.g., in a confidential adoption)
Specific examples of chronic liver disease.

Tdap Vaccine

After reviewing new data showing the optimal timing for Tdap during pregnancy, ACIP recommended vaccination be given earlier in the 27 through 36 week “window” to maximize passive antibody transfer to the infant.
ACIP clarified that persons 7–10 years of age who receive Tdap as part of a catch-up series may be given an additional Tdap for the routinely recommended adolescent dose at 11–12 years of age.

Human Papillomavirus (HPV) Vaccine

On October 7 FDA approved adding a 2-dose schedule for 9v Gardasil for adolescents 9–14 years of age. After reviewing the immunogenicity data and efficacy trials of the 2-dose schedule, ACIP voted to recommend that younger adolescents 9–14 years of age receive two doses of HPV, with a minimum interval of 5 months between doses.
Persons initiating HPV vaccine (either 2-, 4-, or 9-valent) on or after the 15th birthday should still receive 3 doses.
According to CDC’s official press release, “CDC encourages clinicians to begin implementing the 2-dose schedule in their practice to protect their preteen patients from HPV cancers.”
Supplies – Gardasil 9 will soon be the only HPV vaccine available in this country, as 2v and 4v HPV vaccine will no longer be produced.

Meningococcal Vaccine

GSK’s Bexsero was already approved for 2 doses for age 10+ at increased risk and for healthy persons 16-23. Following FDA approval of Pfizer’s Trumenba for a 2 dose (0, 6 mos) or 3 dose (0, 1-2, 6 mos) schedule, ACIP voted to recommend that providers continue to use the 3-dose schedule of Trumenba when vaccinating persons at increased risk of meningococcal serogroup B disease (e.g., persons with persistent complement component deficiencies or anatomical or functional asplenia) or during serogroup B outbreaks. The 2-dose MenB-FHbp schedule may be used for healthy persons 16–23 years of age who are not at increased risk.

Child and Adolescent Immunization Schedule

The child and adolescent schedule, which will be published in February 2017, mainly just incorporates previously approved ACIP policies and has been revamped to improve readability and usability.
One important change: The vaccine recommendations for adolescents 16 years of age have been emphasized by placing them in a separate column from the recommendations for persons 17 and 18 years of age. ACIP is highlighting the importance of the 16-year-old visit to administer the Men-ACWY booster dose, as well as to provide the opportunity to deliver MenB vaccine and catch-up on other recommended adolescent vaccines such as HPV and Tdap.
A new “high-risk” graphic in table form will be included with the schedule which stresses that most young people with medical conditions can and should be vaccinated according to routine schedules.
Haemophilus influenza type B vaccine recommendations have been updated to indicate that Hiberix (GlasoSmithKline) may now be used as part of the primary series.
Comvax (Merck) Hib vaccine and 7-valent pneumococcal vaccine (PCV7, Pfizer) have been deleted from the recommendations because these vaccines are no longer being distributed.
A recommendation for use of live attenuated influenza vaccine (LAIV) has been removed for the 2016–2017 season.

ACIP also reviewed information that did not require votes, including discussion of a potentially more effective zoster vaccine in the future, yellow fever vaccine availability, an update from the pneumococcal working group about the research they are conducting related to the use of PCV13 in people 65 years of age and older, and early reports on influenza activity in the Southern hemisphere. Finally, the group discussed the epidemiology and impact of RSV in older adults.

Other Items – L.J Tan (IAC)

The 2017 National Adult and Influenza Immunization Summit is scheduled for May 9–11, 2017 in Atlanta, GA. Updates and registration information will be added to the website as they become available.

INFORMATION FROM CDC

Updated CDC Information on Influenza

CDC’s influenza talking points from November 4, 2016 and the FluView report for Week 43 (ending October 29) are now available online.

ANNOUNCEMENTS

Offit to Discuss “Current Issues in Vaccines”

On November 16 the Vaccine Education Center and the PA Chapter, AAP, will present a webinar, “Current Issues in Vaccines.” Dr. Paul Offit will be the speaker and will review:

HPV vaccine: The new two-dose schedule
Meningococcal B vaccines: Change in Trumenba® recommendation
Tdap: Change in emphasis in pregnancy recommendation
Herpes zoster vaccines: A new vaccine on the way
Pneumococcal vaccine (PCV13): Evidence for herd immunity

Persons interested in attending may register on the Children’s Hospital of Philadelphia website; click on the link over “Registration is now available.” Registration will close on Tuesday morning, November 15. The archived event will be available by November 18. Free continuing education credits will be available for both live and archived event.

NFID Announces Upcoming Presentations

On November 16 NFID will be hosting a free CME/CNE webinar covering updates from the October 2016 ACIP meeting, including updated recommendations for adults, children, and adolescents. A brief description of the webinar and registration information are available online. Presenters for the webinar will be William Schaffner, MD, NFID Medical Director and NFID liaison to the Advisory Committee on Immunization Practices (ACIP) and NFID Secretary, Patricia Stinchfield, MS, CPNP, CIC, Senior Director, Infection Prevention & Control and Pediatric Nurse Practitioner, Infectious Disease/Immunology at Children’s Minnesota and current liaison member to ACIP.

Other upcoming NFID events include:

Respiratory Syncytial Virus (RSV) in Older Adults: A Hidden Annual Epidemic (11/2/2016)
Fall 2016 Clinical Vaccinology Course, Philadelphia, PA (11/4–6/2016)
Vaccines to Mitigate Risk During Travel (12/7/2016)
Spring 2016 Clinical Vaccinology Course, Chicago, IL (3/10–12/2017)
20th Annual Conference on Vaccine Research, Bethesda, MD (4/24–26/2017)

Three Cases of Meningococcal Serogroup B Disease confirmed at the University of Wisconsin–Madison

In response to three case of meningococcal serogroup B, the University of Wisconsin-Madison Health Services recommends vaccination for all undergraduates through age 25.

Four Healthcare Organizations Join IAC’s Influenza Vaccination Honor Roll for Mandatory Healthcare Worker Vaccination

Six hundred organizations are now enrolled in IAC’s Influenza Vaccination Honor Roll. The honor roll recognizes hospitals, medical practices, professional organizations, health departments, and government entities that have taken a stand for patient safety by implementing mandatory influenza vaccination policies for healthcare personnel.

Since October 12, when IAC Express last reported on the Influenza Vaccination Honor Roll, four additional healthcare organizations have been enrolled:

Gallatin City-County Health Department, Bozeman, MT
Hebrew Senior Life, Boston, MA
North Oaks Health System, Hammond, LA
Norton County Hospital and Medical Clinic, Norton, KS

Mumps Cases Top 1,000 in Arkansas

The Arkansas Department of Health (ADH) now puts the number of suspected and lab confirmed mumps cases in the country’s largest outbreak at 1,028, according to data published on November 7, 2016. 2016.

Too Many People Are Missing Out on the HPV Vaccine

You’d think a shot that protects against the most common sexually transmitted disease would be in high demand, but many people who should be getting it are skipping the human papillomavirus (HPV) vaccine. The Centers for Disease Control and Prevention (CDC) recommends the HPV shot for boys and girls beginning at age 11 or 12. But the latest CDC data shows that just 42 percent of girls and 28 percent of boys age 13 to 17 are fully vaccinated against the disease.

Acute flaccid myelitis (AFM) in Oregon

A mystery illness that causes paralysis has popped up again in Oregon. State officials have tracked three cases of the disease, acute flaccid myelitis, since August. Two children younger than 10 and an adult over 50 were infected, and all were hospitalized. “This is not something that happens very often,” said Dr. Richard Leman of the Oregon Public Health Division. “But we want to detect it if it’s there.” Two of the patients live in eastern Oregon, including the adult. The other child is in the Willamette Valley.

HIDA has released its 2016 Flu Market Brief

HIDA’s 2016 Influenza Vaccine Production & Distribution Market Brief provides new insights into the flu products supply chain and key information from the sixth annual HIDA Flu Products Survey of distributors conducted in May 2016. The brief was released in October 2016, and is available online.

Ouch! Needles are Hurting Flu Vaccination Clinics at Schools

In June, the U.S. Centers for Disease Control and Prevention recommended against using the nasal spray, also known by the brand name FluMist, based on evidence that injectable vaccine offers better protection. As a result, fewer schools have agreed to sponsor school-based flu vaccine clinics this fall, and the number of New Mexico kids vaccinated at school is expected to decline by half or more from the 2015 tally, a program manager estimated.

Keep Flu Out of School Program

Families Fighting Flu has teamed up again this year with the CDC, the National Association of School Nurses, and the National Foundation for Infectious Diseases to help provide the tools you need to keep your schools healthy and flu-free. Check out the Keep Flu Out of School website for free downloadable materials and information.

Summit Call Recap – October 27, 2016

Information from CDC

Announcements