November 24, 2014

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Summit Call Recap – November 20, 2014
Information from CDC
Announcements

SUMMIT CALL RECAP – NOVEMBER 20, 2014


Influenza Surveillance Update – Sophie Smith (CDC)

Sophie provided a summary of the published reports for week 45, ending November 8. For week 45, all seasonal influenza indicators remain well below baseline levels. Approximately 7.4% of specimens submitted for testing were positive, with a mixture of both A and B. The ILI-Net national data indicated 1.6% of total patient visits were for ILI, well below the baseline of 2% and slightly higher than the level reported during the previous week. Of the ILI-related deaths reported during week 45, 6.0% were attributed to pneumonia and influenza (P&I), below the 6.3% baseline level for week 45. No new pediatric deaths were reported during the week; 1 pediatric death has been reported so far during the 2014–2015 season.

As shown in CDC’s weekly influenza summary map, the geographic spread for influenza for week 45 is:

  • Widespread – Guam
  • Regional – 3 states
  • Local – 13 states, Puerto Rico, Virgin Islands
  • Sporadic – 31 states, District of Columbia
  • No activity – 3 states

Since October 1, CDC has antigenically characterized 19 influenza viruses; one 2009 H1N1 virus, 13 influenza A (H3N2) viruses, and five influenza B viruses. The 2009 H1N1 virus tested was characterized as A/California/7/2009-like, the influenza A (H1N1) component of the 2014–2015 Northern Hemisphere influenza vaccine. Of the 13 influenza A (H3N2) viruses tested, seven were characterized as A/Texas/50/2012-like, which also is included in this season’s Northern Hemisphere vaccine. Six 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. Both B/Victoria and B/Yamagata-lineage viruses are circulating in the U.S., but results of antigenic characterization are available only for B/Victoria lineage viruses. All five B/Victoria viruses were characterized as B/Brisbane/0/2008-like, a component of the 2014–2015 Northern Hemisphere quadrivalent influenza vaccine.

None of the specimens tested this season has shown resistance to oseltamivir or zanamivir.


LAIV Effectiveness among Children and Adolescents – Brendan Flannery (CDC) & Jessie Clippard (CDC)

Brendan joined the call to provide an overview of the data presented at the October ACIP meeting on influenza vaccine effectiveness in the U.S. over the last three seasons. He began by acknowledging the 5 facilities that constitute the U.S. Flu Vaccine Effectiveness (VE) Network and the principal investigators at each location.

The objectives of the data review were to compare LAIV and IIV VE among children and adolescents during the 2011–2012, 2012–2013, and 2013–2014 influenza seasons, as well as summarize data from observational studies evaluating LAIV and IIV among children in 2013–2014. The analysis, which included children who were age 2–18 years who had received only one type of vaccine within the season, was developed to include: VE of LAIV vs no vaccine; VE of IIV vs no vaccine; and the relative effectiveness of LAIV to IIV.

Based on clinical trial data collected before the 2009 H1N1 epidemic and head-to-head trials, in 2013 the ACIP made a preferential recommendation for use of LAIV in children age 2–8 years. At the time, several countries and a few states already had made a similar recommendation.

Brendan noted that the VE analysis included children who were at least 6 months old who had a cough with a duration of 7 days or less. Influenza was confirmed via PCR testing, and the patient’s vaccination status also was confirmed. Models were adjusted to consider a wide variety of variables such as age, sex, and study site.

Surveillance data of viruses circulating by season indicate that the 2013–2014 season was the first season since 2009 in which H1N1 was the predominant strain in circulation. The relative effectiveness of LAIV to IIV in children age 2–18 years was relatively high until the 2013–2014 season, when the vaccine showed almost no effect. When stratified by age group, the vaccine was more effective in the age 9–18 years group than at younger ages. In contrast, IIV vaccine appeared to have a similar VE over all three seasons. Extensive data is available on the ACIP site noted above.

Brendan pointed out the limitations of the analysis, including: the difficulty of distinguishing whether the findings were a single season aberration or due to the H1N1 vaccine virus; the challenge of measuring VE among children by vaccine type being dependent on vaccine uptake and the need for a large sample size; and limited ability to control for potential confounding variables.

In summary, during the first few seasons, the relative effectiveness data favored use of LAIV. However, during the 2013–2014 season, when H1N1 was the predominant strain, relative effectiveness favored IIV in young children. These findings appeared to be confirmed by similar results from observational studies conducted by MedImmune as part of its post-licensure work and by the armed forces.

In response to questions, Brendan noted that three possibilities were speculated for why these findings have been seen. (1) The manufacturer is examining whether there might have been a general problem with the vaccine that affected H1N1 more than the other vaccine strains. (2) There possibly could be an issue resulting from the combination of the virus with the live “backbone”, though this seems less likely since the construct of the vaccine hasn’t really changed since the monovalent vaccine used in 2009. (3) There may have been some change to the circulating virus below the level of drifted or antigenic change. However, CDC has not seen this in the laboratory.

As noted in a recently released statement, CDC does not recommend changes to its previous preferential recommendation because there is substantially more circulation of influenza A (H3N2) and B viruses and very little circulating H1N1 so far this season, and LAIV has provided good protection against these strains in the past. In addition, LAIV may offer better protection than IIV against antigenically drifted viruses that may circulate this season. Finally, vaccine providers have received their vaccine for the 2014–2015 season and likely have administered a good proportion of it.


Report from GSK and AADE on Hep B Vaccination and Diabetes – Andrew Trofa (GSK) & Deb Filman (AADE)

Andrew provided a brief update on the new report, Hepatitis B Vaccination in Diabetes Care: Awareness, Priorities and Action among Diabetes Educators and Adults with Diabetes, published through a partnership between the American Association of Diabetes Educators (AADE) and GlaxoSmithKline (GSK).   A new infographic also was issued in conjunction with the report.

In 2011 the ACIP issued recommendations for hepatitis B vaccination of unvaccinated adults age 19–59 years with diabetes, and a discretionary recommendation for those age >60 years. In spite of this recommendation, a 2014 MMWR report on vaccination coverage in adults in 2012 indicated only ~29% of persons age 19–49 with diabetes had received >3 doses of hepatitis B vaccine.

During the fall of 2014, the AADE, with support from GSK, surveyed their membership to assess: (1) their patients’ perception of risk and (2) their own knowledge and practices related to diabetes and vaccination. The educators estimated that less than half of their patients were aware they had an increased risk of developing hepatitis B and should receive hepatitis B vaccination. When asked about their top priorities for patients, the educators stressed the importance of goal setting and improving healthcare. Only 7% selected vaccination among their top 3 priorities. When asked about which vaccinations they recommend to their adult patients, the educators mentioned HBV least often, behind influenza, pneumococcal, zoster, and Tdap. They also mentioned time limitations and competing priorities during patient visits among barriers to educating their adult patients about hepatitis B vaccination. The vast majority of educators said that doctors and other healthcare professionals should proactively discuss vaccinations with their patients. More than half of educators also felt that a broad public service or other awareness campaign directed to adult patients with diabetes would be helpful.

The AADE has issued a call to action recommending that everyone in the diabetes community is responsible for encouraging patients to stay up to date on recommended vaccinations, including hepatitis B. As outlined in the report cited above, the AADE proposes a variety of strategies to address this issue, including stakeholder outreach, awareness building, and resource creation.

Deb added that the AADE believes this important report should help encourage vaccination conversations between healthcare providers and their patients. She noted that providers feel this is an important issue, but often are challenged by time constraints. L.J stated that the Summit is ready to help in this endeavor and will share the materials through the Summit Buzz and other available venues.


Vaccines Facts and Policy Website – Katelyn Wells (AIM)

Katelyn announced the launch of an important resource, VaccineFactsAndPolicy.org. This new project, which is the result of a collaboration between George Washington University (GWU), the Association of Immunization Managers (AIM), and the Immunization Action Coalition (IAC), is designed to be a comprehensive database of U.S. immunization information. The project was initially funded by Pfizer, which has no input into the information. Katelyn shared a Frequently Asked Questions handout, as well as a one-page flyer highlighting the key features of the project.

The purpose of VaccineFactsAndPolicy.org is to catalogue information obtained from various sources about 64 local, state, and territorial jurisdictions in the U.S. The data is divided into five major areas of interest: demographics and rates; fiscal environment, law and policy; strategies and initiatives; and structure of the immunization program. One subcategory is specifically related to adult immunizations, but Katelyn noted that additional adult information is spread across other subcategories.

The goal of the project is to provide a searchable website of consolidated information that will be useful to a wide variety of users. The site will allow users to identify immunization programs with specific characteristics or those that have undertaken certain activities. The information is available in both table and map form, and users can save and print reports. All data areas are linked to applicable source information.

Katelyn provided a demonstration of the two major features of the site are that are now active, allowing users to view information by a specific topic or for a selected jurisdiction. She noted that, if additional funding can be obtained, project partners hope to expand the scope of the available information and add new features such as “search” capability and other functionality improvements. The partners also hope to add data from other partners such as AIRA and ASTHO.

The organizers would appreciate Summit partners sharing information about the project with their constituents. Groups wishing to receive a presentation about the website features should contact one of the partners or send an email to the project.


INFORMATION FROM CDC


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

The CDC weekly influenza surveillance report for week 46 (ending November 15, 2014) and region specific data are now available. During week 46, 5.0% 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 6.4% for week 46.

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 46. To date, one influenza-associated pediatric death has been reported for the 2014-2015 season.

Nationwide during week 46, 1.6% 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 15, 2014. At this time, no state is reporting widespread influenza activity.

The FluView report for week 46 and archives of previous FluViews are available from CDC. CDC also has released seasonal influenza key points for November 21, 2014. Archives of previous FluViews are available.


National Influenza Vaccination Week

Don’t forget to check the NIVW website, as materials have been recently updated, with more expected next 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. Updated EV-D68 key points, current as of November 20, 2014, include the weekly update of EV-D68-like illness activity in states and specimens that tested positive for EV-D68 from patients who died. Due to the Thanksgiving holiday, there will be no EV-D68 update or key points on November 27.


Updated Information on Neurologic Disease with Limb Weakness of Unknown Etiology

Up-to-date key points from November 20, 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 Develops Social Media Messages for Influenza

Per requests from partners, 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 disseminated on other social media platforms. We will share suggested social media messages every two weeks.

  • #FluFact: Most circulating #flu viruses so far this season are influenza A (H3N2) and influenza B viruses. http://1.usa.gov/1dgiUJY
  • FluView: Seasonal #flu activity remains low, but there are early signs that flu activity is increasing. http://1.usa.gov/17AHK
  • Get a #flu vaccine now if you haven’t yet this season. It takes 2 wks for #fluvax to provide protection. #fightflu
  • Don’t delay getting vaccinated if a certain type of #flu vaccine isn’t available. The most important thing is to get vaccinated.
  • #FluTip: If you’re at high risk for #flu complications, seek medical care quickly if you think you have the #flu  http://1.usa.gov/1enjDvN


Recent CDC COCA Calls

ANNOUNCEMENTS


CDC Emergency Response – CDC Response to 2014 Ebola in the United States and West Africa


Meningitis Angels Launches New Public Service Announcement

Meningitis Angels has just released a new PSA that they wrote and produced. Please share this widely with your constituents!


SAVE THE DATE: ACOG Immunization Webinar – December 3, 2014

The American College of Obstetricians and Gynecologists (ACOG) is presenting a webinar, Give It Your Best Shot – Adult Vaccinations for Ob-Gyn Providers, on Wednesday, December 3, 2014, from noon –1 p.m. ET. This free, 1 CME credit webinar will give an overview of general immunization recommendations and explain the importance of immunizing patients for all necessary vaccines, particularly those who are pregnant. The presentation will detail ACOG and CDC’s immunization recommendations, address the most common concerns and misconceptions around vaccines, and explain the importance of immunizations for adults and pregnant women. Continuing Medical Education credit is provided through joint providership with The American College of Obstetricians and Gynecologists.

Registration information is now available. Please contact Valerie Echeveste of ACOG if you have questions.


Two Annual Reports Related to Quality of Care Released by Secretary of Health and Human Services – Interesting Data on Immunization Measurement

The fifth Annual Secretary’s Report on the Quality of Care for Children in Medicaid and CHIP discusses the status of federal and state efforts for quality measurement and reporting, summarizes state-specific findings on FFY 2013 reporting on the Child Core Set, and summarizes information on the quality measures and performance improvement projects reported in the external quality review (EQR) technical reports provided to CMS by states for the FFY 2013–2014 reporting cycle. The report also features detailed analysis of data on the 16 Child Core Set measures reported by at least 25 states (including percentiles, trends, and geographic variation) in the Appendix: State-Specific Outcomes.

Complementing the Secretary’s report on children is the first Annual Secretary’s Report on the Quality of Health Care for Adults Enrolled in Medicaid. This report discusses the status of the first year of state reporting on the Medicaid Adult Core Set, and summarizes information on managed care performance measures and performance improvement projects (PIPs) reported in EQR technical reports submitted to CMS by states.

Additional information about quality initiatives related to children and adults in Medicaid and CHIP is available on the Medicaid website.


Order FREE VA Influenza Posters by December 2, 2014

The Department of Veterans Affairs has offered to share some current surplus educational posters they have in stock. The materials are available free of charge to outside groups in order to prevent them from going to waste. A full listing of available materials may be seen on the Poster Order Form, and the posters may be viewed online. All materials are on a “first come, first served” basis, and may be ordered through December 2. Any questions should be directed to Troy Knighton with the VA.


CMS MLN Matters featuring Influenza Vaccine Payment Allowances – Annual Update for 2014–2015 Season – Implementation Date is No Later than November 24

This recurring update notification provides the payment allowances for the seasonal influenza virus vaccines, when payment is based on 95 percent of the Average Wholesale Price (AWP).


CDC and FDA Revising VAERS Form – Seeking Public Input until January 23, 2015

The US Centers for Disease Control and Prevention (CDC) and US Food and Drug Administration (FDA) are calling for comments on a new adverse event reporting form for vaccines meant to replace the current paper-based reporting form. The request for comments was published in the Federal Register on November 24.


Merck, BioProtection Systems Sign Ebola Vaccine Licensing Deal

Merck announced on November 24, 2014, that it has entered a global partnership with a small U.S. drug developer to research and manufacture a potential Ebola vaccine now in initial patient testing. The exclusive deal involves rVSV-EBOV, a vaccine candidate under early development by BioProtection Systems, the vaccine-development subsidiary of NewLink Genetics Corp. of Ames, Iowa.


Reports of Drift in this Year’s H3N2 Strain Appearing

As discussed during a recent Summit call, it is likely that a drifted H3N2 strain will be in circulation this influenza season. Already, the news media are beginning to report on this. A recent story from Canada contained the headline Flu vaccine less effective against mutant strain. The story states that this year’s flu shot may prove less effective than usual because the dominant virus now circulating has mutated significantly in the months since the vaccine was devised.


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. The call scheduled for November 27 is cancelled due to the Thanksgiving holiday. Please email L.J Tan or LaDora Woods if you have any updates on activities to provide to the Summit.

 

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