November 11, 2014

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Summit Call Recap – November 6, 2014
Information from CDC
Announcements

SUMMIT CALL RECAP – NOVEMBER 6, 2014


Influenza Surveillance Update – Sophie Smith (CDC)

Sophie provided a summary of the published reports for week 43, ending October 25. For week 43, all seasonal influenza indicators remain below baseline levels. Approximately 4.3% of specimens submitted for testing were positive, with a mixture of both A and B. The ILI-Net national data indicated 1.4% of total patient visits were for ILI, well below the baseline of 2% and slightly above the level reported during the previous week. There has been 1 pediatric death reported so far during the 2014–2015 season; no new pediatric deaths were reported during week 43.

As shown in CDC’s weekly influenza summary map, the geographic spread for influenza for week 43 is:

  • Widespread – Guam
  • Regional – Alaska
  • Local – 8 states and Puerto Rico
  • Sporadic – 32 states and the Virgin Islands
  • No activity – 9 states and the District of Columbia

Since October 1, antigenic testing has determined 10 samples as influenza A (H3N2). Of these, 7 were characterized as A/Texas/50/2012-like, the influenza A (H3N2) component of the 2014–2015 Northern Hemisphere influenza vaccine. Three viruses showed reduced titers with antiserum raised against A/Texas/50/2012 but were antigenically similar to A/Switzerland/9715293/2013, the H3N2 virus selected for the 2015 Southern Hemisphere influenza vaccine. Antiviral testing has not yet been conducted this season.


Administering Afluria Influenza Vaccine via PharmaJet Stratis Needle-Free Injection – Charles Altman (bioCSL)

Charles provided a short presentation on a newly approved system for delivering Afluria via needle-free injection. A survey published in Vaccine in 2012 indicated that 24% of adults report a fear of needles (“trypanophobia”), and needle fear was the primary reason for immunization non-compliance for 7% of adults. Healthcare personnel also have concerns about needle use. Approximately 800,000 needle-stick injuries are reported annually in the U.S. Additionally, it can be difficult to properly dispose of needles in some parts of the world.

To help overcome these barriers, bioCSL partnered with PharmaJet to study administration of Afluria with a needle-free, jet injection system. The vaccine is administered by holding the needle-free syringe at a 90o angle against the deltoid. The spring-loaded mechanism inserts the fluid stream into the deltoid in less than one-tenth of a second. Because no needle is involved, the used cartridge may be disposed without the use of a sharps container. This technique received FDA approval in August and is now included in the Afluria package insert.

The results of the Jet Infection for Influenza (JIFY) clinical trial were published in the Lancet in May 2014. The primary objective of the study was to show the noninferiority of the jet injector technique in terms of immunogenicity. A secondary objective was to compare the safety and tolerability of the vaccine administered by the injector versus needle and syringe. The study included 1,250 subjects who were randomly assigned to each study arm. Solicited and unsolicited reports of adverse events were followed for 28 days post-vaccination. The study endpoints were established to determine immunogenicity through comparison of geometric mean titers (GMTs), seroconversion rates, and selected safety endpoints. The results indicated the GMTs. seroconversion rates, and seroprotection rates were nearly identical in both groups. Immediate complaints post-vaccination were mild or moderate, with pain and tenderness within 30 minutes of vaccination, and there was no difference in bruising or swelling. Systemic adverse events were almost identical between the two methods. Eighty-nine percent of patients stated they would be willing to repeat the jet injector method, and post-marketing research showed a 90% satisfaction rate.

The cost of using the PharmaJet technology has not been announced. However, Charles reminded partners that the cost of needle disposal with the current needle and syringe technique should be factored into any cost comparison considerations. Summit partners with additional questions may send an email to Chip Altman.


Families Fighting Flu Activities and Initiatives – Laura Scott (FFF)

Laura provided information on two educational campaigns launched by Families Fighting Flu (FFF) over the last month.

  • Theraflu Fluprint program – FFF has partnered with Novartis, the maker of Theraflu, to launch the Theraflu Fluprint program. The campaign features a five-step action plan (learn, vaccinate, prepare, treat, and share) to help persons be flu-ready this season. Nick Cannon of America’s Got Talent announced the launch of the program. Novartis will donate $1 up to $100,000 to FFF for every Like on the Theraflu Facebook page.
  • Teach Flu a Lesson – FFF has established a new partnership with Healthy Schools LLC to Teach Flu a Lesson during the 2014–2015 season. The campaign, which was established in 2013 in Florida, is meant to raise awareness about the importance of annual flu vaccination and to increase the vaccination rates of children. Teach Flu a Lesson brings school-located flu vaccination clinics to more than 200,000 elementary through high school students. The program offers FluMist to students at no cost, as well as providing the staff for vaccine administration. It also includes valuable resources for schools to educate parents about the critical need for annual flu vaccination. The program plans to expand to other states in the future.


ACOG’s Practice Advisories and Ebola Web Page – Debra Hawks (ACOG)

Debra highlighted new ebola information now available on the ACOG website. The group has added information to its wide-ranging Ebola and Women’s Health site, including ebola guidance on caring for patients during an outbreak. ACOG also has issued two ebola-related practice advisories – Ebola: Joint ACOG/CDC Considerations for Ob-Gyns and Their Patients and Care of Ebola Patients During an Outbreak. ACOG will continue to feature ebola information on its homepage and issue periodic updates as warranted.


October ACIP Meeting Summary – Carolyn Bridges (CDC)

Carolyn briefly reported on several adult vaccine related issues discussed at the October ACIP meeting.

  • HPV9 – The group discussed the potential licensure of HPV9 vaccine, and they are expected to address the vaccine’s use during the February meeting.
  • VAERS – A new VAERS reporting form is now available online. Among other items, the form now contains space to indicate whether the patient was pregnant and the ability to identify the location where the vaccination occurred.
  • LAIV – ACIP members discussed new data from CDC, the Air Force, and MedImmune on the effectiveness of LAIV in children and adolescents. The data indicate low effectiveness of the H1N1 component during the 2013–2014 season. CDC has now posted an updated statement on this issue, CDC Statement on LAIV Effectiveness and Vaccination of Children.


Other Items – Carolyn Bridges (CDC)
  • Carolyn Bridges pointed out that CDC has announced that 132 million of the projected 150-155 million doses of flu vaccine have been distributed to date.
  • Cindy Alvarez provided a brief update on plans for National Influenza Vaccine Week (NIVW) scheduled for December 7–13. Because many staff members have been diverted to the ebola response, CDC is adapting its plans to reduce the time demands from subject matter experts while increasing the use of digital media for vaccine promotion. CDC will host a live Twitterchat on December 9, and NIVW specific tweets will be shared at #NIVW2014. A press update will occur on December 11.
  • Kaiser Permanente of Northern California is planning a live Twitter discussion on November 14 from 12-1 pm PT (3-4 pm ET). Also see below for announcement.

INFORMATION FROM CDC


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

The CDC weekly influenza surveillance report for week 44 (ending November 1, 2014) and region specific data are now available. During week 44, 5.7% 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 6.2% for week 44.

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.

No influenza-associated pediatric deaths were reported to CDC during week 44. To date, one influenza-associated pediatric death has been reported for the 2014–2015 season.

Nationwide during week 44, 1.5% 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. 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 November 1, 2014.

The FluView report for week 44 and archives of previous Fluviews are available from CDC. CDC also has released seasonal influenza key points for November 7, 2014, as well as overall 2014–2015 Influenza Season Key Points. Archives of previous FluViews are available.


More Information from CDC

National Influenza Vaccination Week

CDC has issued the following letter to its influenza immunization partners.

Dear National Influenza Vaccination Campaign Partners,

As we continue to prepare for National Influenza Vaccination Week (NIIW), scheduled for December 7–13, 2014, we’d like to extend our appreciation for your continued efforts to promote influenza vaccination. Your leadership and passion in raising awareness about the importance of influenza vaccination and its benefits have made a significant impact over the years. We look forward to increases in flu vaccination coverage across the United States which means that ongoing collaborations remain critical in the fight against this serious disease.

CDC is very concerned about influenza and the toll it takes on the United States each year. While many Americans may be focused on Ebola right now, CDC and public health and health care professionals who understand the risks from influenza continue to work to ensure people are vaccinated this season. As your organization prepares for NIVW, we want to share CDC’s plans with you with the hope that we can find synergies and ways to collaborate on activities that are mutually beneficial.

Our efforts to promote influenza vaccination this season thus far have been very similar to past seasons. However, CDC’s response to the Ebola epidemic is the agency’s largest international outbreak response ever. Because many CDC staff who work on influenza also are supporting the response to Ebola, we are adapting our flu vaccination promotion plans for NIVW to minimize  the time demanded from our subject matter experts. For instance, we will be placing more focus on vaccination promotion activities using digital media platforms. If flu activity warrants or if our early-season vaccination coverage estimates (to be released in December) indicate that vaccine uptake is lagging we are prepared to adapt and increase vaccination promotion activities accordingly. This year’s NIVW activities are listed below.

Participate

  • A CDC-hosted live Twitter chat on Tuesday, December 9 from 1–2pm EST featuring a CDC influenza subject matter expert. Participate or follow this event on Twitter: @CDCFlu, #NIVW2014. The chat will:

– Emphasize that getting vaccinated in December, January and beyond may still provide protective benefit against influenza.

– Remind parents and providers of the need for certain children to receive a second dose of flu vaccine for optimal protection.

– Provide an opportunity for people to ask questions about the flu and flu vaccines.

  • NIVW-specific tweets will be distributed to partners, who will be encouraged to share these messages with their Twitter followers. All messages will include the hashtag #NIVW2014.
  • We encourage you to share any flu vaccination events or activities you may be planning on http://www.cdc.gov/flu/nivw/activities.htm. We will post these events to the CDC website and promote some of them on CDC’s social media channels.

 Stay Informed

  • On Thursday, December 11, CDC will provide a media update. The update will include:

– Discuss flu vaccine impact during 2013-2014.

– Provide an update on influenza activity in the US during 2014-2015.

– Present early-season 2014-2015 flu vaccination coverage estimates (reports will be posted at cdc.gov/flu/fluvaxview).

 Other Activities

  • CDC will utilize Google keyword search to raise awareness that everyone 6 months of age and older should get vaccinated. Keyword search will trigger CDC messages to be featured at the top of Google searches that are relevant to flu vaccination. CDC messages will link consumers to the CDC flu website. This can also be accessed through mobile devices.
  • CDC will launch a Promoted Tweets campaign on Twitter to reach broad and diverse audiences nationwide.
  • Twitter promoted tweets will target networks directly with flu messages from the @CDCFlu twitter handle.
  • Flu Public Service Announcements (PSAs) will play between songs on Spotify, a digital radio platform.

Resources

  • Digital tools such as NIVW-specific web buttons and animated images will be available to link to from web and social media sites.
  • We have begun updating the CDC NIVW website so please check it regularly for resources, including NIVW-specific key points, the partner calendar of events, print and web tools, and other helpful planning materials.
  • Also included here for your convenience are a copy of the NIVW key points and 2-page flyer with CDC’s plans; these will be posted online this week.

Once again, thank you for your efforts, and we look forward to another successful National Influenza Vaccination Week!

Updated Key Points on EV-D68 Infections and Disease

The United States has been experiencing a nationwide outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness.  CDC has released updated EV-D68 key points, current as of November 6, 2014, including the weekly update of EV-D68-like illness activity in states, and specimens that tested positive for EV-D68 from patients who died.

Updated Information on Neurologic Disease with Limb Weakness of Unknown Etiology

Up-to-date key points from November 6, 2014 are now available about the investigation of neurologic illness with limb weakness of unknown cause in children, including the weekly update of CDC-verified neurologic illness cases reported by states that meet the case definition.

CDC Influenza Division posts Q & A on Ebola and influenza

CDC Influenza Division has posted a Q&A related to seasonal influenza and Ebola virus infection. The Q&A may be used to answer inquiries related to influenza and Ebola.


ANNOUNCEMENTS


SAVE THE DATE – CDC Vital Signs Hot Topic Town Hall Teleconference – November 12, 2014, 2:00–3:00pm (EST)

Join CDC subject matter experts and other public health professionals for a town hall teleconference, Cervical Cancer Prevention: State Perspectives on Screening and HPV Vaccination, on Wednesday, November 12, 2014, 2:00–3:00 pm (EST).

Each month’s Vital Signs teleconference provides a forum for state, tribal, local and territorial health, policy, and communication officials to broaden the conversation, build momentum, and ensure active implementation of evidence-based, effective programs within the public health areas covered by Vital Signs.

The Vital Signs report is available on the CDC website the first Tuesday of every month. Speakers and topics are subject to change. Always check the Vital Signs town hall teleconference website to get the most up-to-date information.

Dial in (USA only): 800-857-0764
Passcode: 795-4413


Kaiser Permanente Flu Prevention TweetChat

Get the facts about the flu: Join a live Twitter discussion with Kaiser Permanente physicians Randy Bergen, MD, Margaret Khoury, MD, and Eric France, MD, as they talk about prevention and treatment this flu season. The tweetchat takes place from noon-1 p.m. (Pacific time) on Friday, November 14. To participate, go to twubs.com and enter #fluchat.

Times in various time zones
Hawaii        10 – 11 AM
Pacific        noon – 1 PM
Mountain    1 – 2 PM
Central       2 – 3 PM
Eastern      3 – 4 PM

If you have questions, please contact: Vince Golla, Director of Social Media, Kaiser Permanente, at 510-271-6007 (office), 510-301-3387 (mobile), Twitter @vincegolla.


NFID and Rite Aid Announce Results of Joint Survey

The National Foundation for Infectious Diseases (NFID) is pleased to share the results of a new survey recently conducted through a partnership between NFID and Rite Aid.  Not surprisingly, the national survey reveals that most US adult women do not believe they are up to date on vaccinations to protect against many preventable diseases.

A press release and accompanying infographic were issued on November 10. NFID encourages you to share this information with your constituents and help spread the message about the importance of adult vaccination. Follow NFID on Twitter at @NFIDvaccines and Facebook at www.facebook.com/nfidvaccines.

Please feel free to contact Marla Dalton directly if you have any questions or need additional information.


American Medical Association Adopts New Policy on Pharmacy Immunizations

Today, at its interim 2014 meeting, the American Medical Association adopted as formal policy the following statements:

Our American Medical Association believes that:

  • Physicians and medical professional organizations should support state and federal efforts to engage pharmacists in vaccinating target populations that have difficulty accessing immunizations in a medical home. Before administration of a vaccine, pharmacists should assess the immunization status of the patient, which includes checking an immunization registry when one exists. Pharmacists should ensure that a record of vaccine administration is transmitted to the patient’s primary care physician and documented in the immunization registry, and that written or electronic documentation is provided to the patient. (New HOD Policy)
  • Vaccination programs in pharmacies should promote the importance of having a medical home to ensure appropriate and comprehensive preventive care, early diagnosis, and optimal therapy. Physicians and pharmacists should work together in the community to: (a) establish referral systems to facilitate appropriate medical care if the patient’s conditions or symptoms are beyond the scope of services provided by the pharmacies; and (b) encourage patients to contact a primary care physician to ensure continuity of care. (New HOD Policy)
  • State educational requirements for pharmacists who administer vaccines should be based on ACIP recommendations and recognized standards and guidelines derived with input from physicians and pharmacists with demonstrated expertise in immunization practices. (New HOD Policy)
  • Policy H-440.877, “Distribution and Administration of Vaccines,” should be amended by addition and deletion to read as follows:

AMA policy is that:

(1) it is optimal for patients to receive vaccinations in their medical home to ensure coordination of care. This is particularly true for pediatric patients and for adult patients with chronic disease and co-morbidities. If a vaccine is administered outside the medical home, all pertinent vaccine-related information should be transmitted back to the patient’s primary care physician and entered into an immunization registry when one exists to provide a complete vaccination record.

(2) all physicians and other qualified health care providers who administer vaccines should have fair and equitable access to all ACIP recommended vaccines. However, when there is a vaccine shortage, those physicians and other health care providers immunizing patients who are prioritized to receive the vaccine based upon medical risks/needs according to ACIP recommendations must be ensured timely access to adequate vaccine supply.

(3) physicians and other qualified health care providers should: (a) incorporate immunization needs into clinical encounters, as appropriate; (b) strongly recommend needed vaccines to their patients in accordance with ACIP recommendations and consistent with professional guidelines; (c) either administer vaccines directly or refer patients to another qualified health care provider who can administer vaccines safely and effectively, in accordance with ACIP recommendations and professional guidelines and consistent with state laws; (d) ensure that vaccination administration is documented in the patient medical record and an immunization registry when one exists; and (e) maintain professional competencies in immunization practices, as appropriate.

(4) all vaccines should be administered by a licensed physician, or by a qualified health care provider pursuant to a prescription, order, or protocol agreement from a physician licensed to practice medicine in the state where the vaccine is to be administered or in a manner otherwise consistent with state law.

(5) patients should be provided with documentation of all vaccinations for inclusion in their medical record, particularly when the vaccination is provided by someone other than the patient’s primary care physician.

(6) physicians and other qualified health care providers who administer vaccines should seek to use integrated and interoperable systems, including electronic health records and immunization registries, to facilitate access to accurate and complete immunization data and to improve information-sharing among all vaccine providers.

(7) vaccine manufacturers, medical specialty societies, electronic medical record vendors, and immunization information systems should apply uniform bar-coding on vaccines based on standards promulgated by the medical community. (Modify HOD Policy).

  • That Policy H-440.899, “Immunization Registries,” should be amended by addition to read as follows:

Our AMA encourages:

(1) physicians to participate in the development of immunization registries in their communities and use them in their practices for patients of all ages;

(2) electronic health record (EHR) vendors to add features to automate the exchange of vaccination information in the patient EHR to state immunization registries to improve and help ensure completeness and accuracy of vaccination records. EHR vendors and registry administrators need to work with physicians and other health professionals to facilitate the exchange of needed vaccination information by establishing seamless, bidirectional communication capabilities for physicians, other vaccine providers, and immunization registries; and

(3) all states to move rapidly to provide comprehensive lifespan immunization registries that are interfaced with other state registries. (Modify HOD Policy)

  • That Policy H-160.921, “Store-Based Health Clinics,” should be reaffirmed. (Reaffirm HOD Policy).


November 18 CIIC Webinar: Flu Care in Day Care

The National Foundation for Infectious Diseases (NFID) Childhood Influenza Immunization Coalition (CIIC) would like to invite partners to participate in an upcoming webinar, “Flu Care in Day Care” scheduled for Tuesday, November 18, 2014 at 11:00 AM–12:00 PM ET.

The webinar program will include guest speakers from Connecticut, New Jersey, and New York City who will share their experiences, challenges, and successes in implementing preschool and day care center mandates in their respective states/municipalities. Carol J. Baker, MD, professor of Pediatrics, Molecular Virology and Microbiology, Baylor College of Medicine, CIIC chair and NFID past-president, will moderate the session.

Flu vaccination coverage estimates for 2013-2014 demonstrate a continued rise in national childhood influenza vaccination rates over the past few years. Coverage is highest among children age 6 months to 5 years old; however, vaccination rates vary widely across states. It is important to address remaining gaps and continue to work together to ensure that all children are protected from influenza.

CIIC hopes that you or a representative of your organization will be able to join them. The webinar agenda is available. The registration process includes a brief online survey which will help inform the webinar discussion.

Please contact Sandra Plasse with any questions or call (212) 886-2219. Thank you for your continued support of CIIC.


November 12 is World Pneumonia Day!

November 12 is World Pneumonia Day. Pneumonia, including pneumococcal pneumonia, is a leading cause of death in the U.S., the day does deserve some attention.

Everyone is at risk for contracting pneumonia; however, certain people are at greater risk, including adults 65+, people living with certain chronic health problems (e.g., diabetes, heart disease, COPD), and people with a suppressed immune system (e.g., people with certain cancers, people living with HIV/AIDS).

In recognition of World Pneumonia Day—and in an effort to educate people about their individual risks—Pfizer has developed a handful of educational tools and requested that they be made available for free use.

  • An infographic about the risk of contracting pneumococcal pneumonia for use in current communications efforts.
  • A fun and educational animated video that dispels some common misperceptions is available on Pfizer’s YouTube


Team taps Wikipedia for flu forecasting data

A team from the Los Alamos National Laboratory is the latest to publish details of its model, which uses Wikipedia access logs to predict the spread of influenza. By combining the access logs for Wikipedia articles related to flu with CDC data, the team has created a model which it claims can accurately predict the incidence of influenza. The model goes one step further than Google Flu Trends by trying to predict the future, instead of just giving a real-time estimate of the spread of the virus.


New research in Clinical Infectious Diseases: Impact of Repeated Vaccination on Vaccine Effectiveness Against Influenza A (H3N2) and B During 8 Seasons

Patients presenting with acute respiratory illness were prospectively enrolled during the 2004–2005 through 2012–2013 influenza seasons. There were 7,315 enrollments during 8 seasons; 1,056 (14%) and 650 (9%) were positive for influenza A (H3N2) and B, respectively. Vaccination during current only, previous only, or both seasons yielded similar protection against H3N2 (adjusted VE range, 31%–36%) and B (52%–66%). In the analysis using 5 years of historical vaccination data, current season VE against H3N2 was significantly higher among vaccinated individuals with no prior vaccination history (65%; 95% confidence interval [CI], 36%–80%) compared with vaccinated individuals with a frequent vaccination history (24%; 95% CI, 3%–41%; P = .01). VE against B was 75% (95% CI, 50%–87%) and 48% (95% CI, 29%–62%), respectively (P = .05). Similar findings were observed when analysis was restricted to adults 18–49 years.

Additional studies are needed to understand the long-term effects of annual vaccination. An observed protection was seen among individuals vaccinated during the previous (but not current season), which could indicate some residual protection. Regardless of whether the influenza vaccine offers long-term protective effects, it is still recommended for all persons ages ≥6 months each and every year.


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 can also find archived copies of the Summit Buzz there.


Reminder

Summit calls are scheduled every Thursday at 3 pm ET, unless cancelled. Please email L.J Tan or LaDora Woods if you have any updates on activities to provide to the Summit.

 

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