October 12, 2018

HIGHLIGHTS

NILE Webinar: How to Make a Strong Flu Vaccine Recommendation

Immunize Nevada is pleased to host this training via a toll-free web-conference. This program offers one free nursing or pharmacy CEU credit (CEU credit requires completion of the post-webinar survey).

Program:
Many people believe flu is just a bad cold, rather than a serious, potentially life-threatening disease. Research shows that a strong recommendation for flu vaccination from a healthcare professional is an important factor to improving vaccine uptake.

In this webinar, Serese Marotta, Chief Operating Officer of Families Fighting Flu, will give participants the tools they need to discuss flu vaccination with confidence and compassion. Specific evidence-based resources and approaches will be reviewed, such as the CDC’s step-wise SHARE method, and Families Fighting Flu’s Healthcare Professional Toolkit, developed in partnership with the National Association of Pediatric Nurse Practitioners (NAPNAP) and HealthyWomen. As a mother who lost her son to influenza, Serese will also provide her unique perspective regarding ways providers can share personal flu stories to highlight the dangers of flu and motivate patients to protect themselves and their families through vaccination.

Learning objectives include:

Participants will learn how to implement CDC’s SHARE method to make strong flu vaccine recommendations to patients.
Participants will learn how to utilize the resources in Families Fighting Flu’s Healthcare Professional (HCP) Toolkit.
Participants will gain a better understanding of the value of Families Fighting Flu’s personal flu stories and learn how to use these stories to highlight the potential dangers of flu and the critical importance of annual flu vaccinations.

Featured Presenter: Serese Marotta, Chief Operating Officer. Families Fighting Flu
Serese Marotta is the Chief Operating Officer for Families Fighting Flu, a national non-profit 501(c)(3) organization dedicated to saving lives and reducing hospitalizations by protecting children and their families against influenza through education and advocacy. Serese originally came to Families Fighting Flu in 2010 following the loss of her five-year old son, Joseph, to the flu in 2009. Serese served on the Board of Directors for the organization for six years before coming on-staff in May 2016 as the COO. Prior to joining Families Fighting Flu, Serese worked as an environmental scientist for 16 years at a consulting firm conducting ecological and human health risk assessments for hazardous waste sites. She now works tirelessly to raise awareness about the seriousness of flu and the critical importance of annual flu vaccination for everyone six months and older.

For questions or more info, contact Breanne at Immunize Nevada.

FDA Approves Expanded Use of Gardasil 9 to Include Individuals 27 through 45 Years Old

The U.S. Food and Drug Administration has approved a supplemental application for Gardasil 9 (Human Papillomavirus [HPV] 9-valent Vaccine, Recombinant), expanding the approved use of the vaccine to include women and men aged 27 through 45 years. Gardasil 9 prevents certain cancers and diseases caused by the nine HPV types covered by the vaccine.

Comprehensive Study Indicates that Influenza Vaccination Reduces Risk of Hospitalization for Pregnant Women

Dr. Mark Thompson presented on a study that was published October 11, 2018 in the journal Clinical Infectious Diseases. This major study demonstrated that over the course of six flu seasons, getting a flu shot reduced a pregnant woman’s risk of being hospitalized from flu by an average of 40 percent.

The findings come from a multi-country, CDC-coauthored study and is the first study to show flu vaccination protected pregnant women against flu-associated hospitalization.

For this study, CDC partnered with a number of other public health agencies and health care systems in Australia, Canada, Israel, and the United States through the Pregnancy Influenza Vaccine Effectiveness Network (PREVENT), which consists of health care systems with integrated laboratory, medical, and vaccination records. Sites retrospectively examined medical records of more than two million women who were pregnant from 2010 through 2016 to identify those who were hospitalized with laboratory-confirmed flu.

Key findings include:

More than 80 percent of pregnancies overlapped with flu season, underscoring the likelihood that pregnant women will be exposed to flu at some point during their pregnancy.
Flu vaccine was equally protective for pregnant women with underlying medical problems such as asthma and diabetes, which also increase the risk of serious medical complications including a worsening of those chronic conditions.
Flu vaccine was equally protective for women during all three trimesters.

CDC has issued a press release and talking points on this article.

IDSA Launches Leadership Institute

The Infectious Diseases Society of America (IDSA) has announced the launch of its 2019 Leadership Institute. Designed for mid-career, infectious diseases specialists, this leadership and management training program begins with a two-and-a-half-day intensive investigation into the skills and practices of effective leaders in medical and nonmedical contexts.

Up to 30 participants will be selected through a competitive application process launching Monday, Oct. 22. All Institute participants must meet the following criteria at the time of application:

Active IDSA membership
Engaged in clinical practice of infectious diseases, clinical or basic research, administration, teaching in infectious diseases, public health, or a related field as primary professional activity
History of substantive service to the profession locally, regionally, or nationally
Minimum of five years relevant professional experience
Evidence of deep intellectual curiosity and growth mindset

Individuals interested in learning more should contact Colin Dixon, IDSA Educational Program Manager.

Clinical Vaccinology Course Sponsored by the National Foundation for Infectious Diseases and Emory University School of Medicine, November 9–10, 2018

The 2-day Clinical Vaccinology Course (CVC) sponsored by the National Foundation for Infectious Diseases (NFID) and Emory University School of Medicine focuses on new developments and issues related to the use of vaccines across the lifespan. Poster presentations and interactive sessions led by expert faculty provide the latest information on updated vaccine recommendations and innovative and practical strategies for ensuring timely and appropriate immunization. The 2018 course is scheduled for November 9-10, 2018 in Bethesda, MD.

ANNOUNCEMENTS

Mandate Flu Vaccination for Long-term Care Workers and Residents, Group Recommends

Assisted living organizations and other long-term care employers should mandate flu vaccination for staff members and make vaccination a condition of employment for workers, according to experts convened by the Gerontological Society of America’s National Adult Vaccination Program.

“Immunization in long-term care is critical, as we are dealing with individuals at great risk for getting the flu, pneumonia, shingles and associated complications,” said GSA Past President Barbara Resnick, Ph.D., RN, CRNP, FGSA, who is a member of the NAVP Workgroup. Long-term care residents are living close to one another and can easily pass along infections once they get them, she added.

The group’s findings were released Thursday in a white paper, Charting a Path to Increase Immunization Rates in the Post-Acute and Long-Term Care Settings. “The expectation for providers to be fully vaccinated should be covered by written policies, and renewable consent should be obtained during hiring and orientation processes,” according to the report.

Public Health Informatics Institute (PHII) is Offering a FREE Email Course on the Basics of IIS

The Welcome to IIS email course delivers a broad foundation of knowledge on immunization information systems (IIS) in an easy, accessible format: one email a day delivered to your inbox for 18 weekdays. Each email takes five to ten minutes to read and contains a brief lesson, resources for further study, and interactive activities so you can apply what you’ve learned to your system and jurisdiction. Over the course of the training, you’ll learn what IIS are, how they work and how they’re staffed and supported.

Families Fighting Flu Releases Updated Influenza Resource for 2018

Families Fighting Flu (FFF) has partnered with the National Association of Pediatric Nurse Practitioners (NAPNAP) and HealthyWomen to develop a Do You Know the Flu? comprehensive toolkit for pediatric healthcare professionals in an effort to increase annual flu vaccination rates in the pediatric population.

FFF realizes that as healthcare professionals, you have a lot of responsibilities when it comes to your patients, only one of which is flu prevention. However, we know you understand how serious the flu can be, even for healthy people. And we want to help you make a difference in the fight against flu.

In this toolkit, you will find the following educational resources:

A personal note from a pediatric nurse practitioner that highlights why healthcare professionals are so important for flu prevention
Family stories that illustrate just how serious flu can be for children, even healthy children
Benefits of flu vaccination to share with your patients
A Do You Know the Flu? quiz to test your flu knowledge
Key flu messages for patient/parent conversations
A conversation road map on how to address tough flu-related questions
Flu facts
A public service announcement called Play It Safe
Resources to share with parents, including two infographics

NEWS

CDC Influenza Updates

The FluView report for Week 40 (ending October 6, 2018) is available on CDC’s website. A synopsis of this report follows below:

Influenza activity in the United States remained low throughout the summer months and early October.

Viral Surveillance: While influenza B viruses were more commonly detected from May until late June, influenza A viruses have predominated from the beginning of July onward. The percentage of respiratory specimens testing positive for influenza in clinical laboratories is low.

- Virus Characterization: The majority of tested influenza viruses were characterized antigenically and genetically as being similar to the cell-grown reference viruses representing the 2018–2019 Northern Hemisphere influenza vaccine viruses.
- Antiviral Resistance: All tested viruses showed susceptibility to antiviral drugs.
Outpatient Illness Surveillance: The proportion of outpatient visits for influenza-like illness (ILI) remained low and was 1.4%, which is below the national baseline of 2.2%. All 10 regions reported ILI below region-specific baseline levels.

- ILI State Activity Indictor Map: New York City, the District of Columbia, and 49 states experienced minimal ILI activity, and Puerto Rico and one state had insufficient data.

Geographic Spread of Influenza: The geographic spread of influenza in two states was reported as local activity; the District of Columbia, the U.S. Virgin Islands and 35 states reported sporadic activity; 12 states reported no activity; and Guam, Puerto Rico and one state did not report.
Pneumonia and Influenza Mortality: The proportion of deaths attributed to pneumonia and influenza (P&I) was below the system-specific epidemic threshold in the National Center for Health Statistics (NCHS) Mortality Surveillance System.
Influenza-associated Pediatric Deaths: Two influenza-associated pediatric deaths were reported that occurred during the 2017-2018 season. No influenza-associated pediatric deaths for the 2018-2019 season have been reported to CDC.

Also available are CDC’s influenza summary and technical key points from October 12, 2018 and CDC’s 2018–2019 influenza technical key points issued on September 28, 2018. Frequently asked questions for the upcoming season may be found online.

Full FluView reporting for the 2018–2019 season resumed on October 12, 2018.

CDC Guidance to Providers Regarding Shingrix™ Vaccine Supply

CDC has issued guidance (see below) to providers who are experiencing difficulty receiving sufficient supplies of the Shingrix™ vaccine to meet demand.

SHINGRIX™ DELAYS. As you are aware there are some limits and delays with the Shingrix™ vaccine due to high demand. CDC has prepared the following statement for health care providers related to reminding them on considerations during this time as well as the importance of the 2^nd dose. The information is provided for your information and use as appropriate.

There are currently ordering limits and intermittent shipping delays for GlaxoSmithKline’s Shingrix™ vaccine (Recombinant Zoster vaccine) due to high demand. Until demand can be met, it is particularly important that vaccine providers educate patients about the importance of completing the series. In addition, CDC reminds health care professionals of proven strategies to help patients receive all their needed vaccinations on time, including Shingrix™:

Implement a vaccine reminder and recall system using phone, e-mail, or text messages to contact patients when you have Shingrix™ supply. Give first consideration to patients due for their second dose of Shingrix™. (The Community Guide – Vaccination Programs: Client Reminder and Recall Systems)
If you are out of Shingrix™ and a patient needs a second dose, refer the patient to another provider in the community (e.g., a pharmacy) that has Shingrix™ so the patient can complete the series. The immunization program at your state or local health department or vaccine finder can help identify other immunization providers. (HealthMap Vaccine Finder)
Be sure to enter your patients’ current vaccination information into your state’s immunization information system (IIS). This will ensure that every provider can access your patients’ immunization record, and it may help facilitate patient reminders to complete the Shingrix™ series.
As supply becomes less constrained, be sure to notify eligible patients so they can come in to get their first dose of Shingrix™.

Timely series completion is key to the success of any vaccination program and critical to ensuring patients receive the full benefit of their vaccinations.

Percentage of Young U.S. Children Who Don’t Receive Any Vaccines Has Quadrupled Since 2001

A small but increasing number of children in the United States are not getting some or all of their recommended vaccinations. The percentage of children under 2 years old who haven’t received any vaccinations has quadrupled in the last 17 years, according to federal health data released Thursday.

Overall, immunization rates remain high and haven’t changed much at the national level. But a pair of reports from the Centers for Disease Control and Prevention about immunizations for preschoolers and kindergartners highlights a growing concern among health officials and clinicians about children who aren’t getting the necessary protection against vaccine-preventable diseases, such as measles, whooping cough and other pediatric infectious diseases.

Adjuvanted Flu Vaccine More Likely to Keep Nursing Home Residents Out of the Hospital, Study Finds

Brown University researcher Stefan Gravenstein, M.D., and his team looked at more than 800 nursing homes to determine whether a standard, seasonal flu shot was as effective as the aTIV, Infectious Diseases News reported out of IDWeek. Researchers randomly assigned homes to offer either shot in the 2016-2017 season, and then studied those who had been in a nursing home for more than 100 days.

Stories about this research are available in the Infectious Disease News and McKnight’s Long Term Care Weekly.

Strain Selection for Annual Influenza Vaccines Should Consider Preexisting Immunity

Long-stay skilled nursing residents who receive an adjuvanted trivalent influenza vaccine (aTIV) may be at a lower risk for hospitalization compared to a non-adjuvanted trivalent influenza vaccine, according to study findings presented this week. Brown University researcher Stefan Gravenstein, M.D., and his team looked at more than 800 nursing homes to determine whether a standard, seasonal flu shot was as effective as the aTIV, Infectious Diseases News reported out of IDWeek. Researchers randomly assigned homes to offer either shot in the 2016-2017 season, and then studied those who had been in a nursing home for more than 100 days. Stories about this research are available in the Infectious Disease News and McKnight’s Long Term Care Weekly.

MF59-aduvanted Flu Vaccine Improves Immune Response in Children

Young children who were revaccinated with an MF59-adjuvanted, quadrivalent influenza vaccine, or aQIV, continued to show enhanced immunogenicity against strains that were contained in the vaccine and even those that were not, researchers reported at IDWeek.

Hospitalization Rates Among Older Adults Peaked Several Weeks Earlier than Children In 2017–2018 Influenza Season, Compared with Previous Seasons

According to surveillance numbers presented at IDWeek, among the season’s unique characteristics, researchers found that hospitalization rates among older adults peaked several weeks earlier than children compared with previous influenza seasons.

The study, performed by CDC, included all patients in the Influenza Hospitalization Surveillance Network (FluSurv-NET) who were hospitalized with laboratory-confirmed influenza during the 2017–2018 season, calculating influenza rates by type/subtype per 100,000 population and comparing results to the four most recent influenza seasons.

During the 2017–2018 season, hospitalization rates in adults aged 65 years and older peaked 3 weeks before they peaked in children aged 0 to 4 years. During the four prior seasons, rates in adults peaked the same week or 1 week after they peaked in children. Additionally, during the 2017–2018 season, the distribution of influenza types or subtypes varied significantly by age group. For example, the authors said, the proportion of patients with H1N1 ranged from 19% to 29% in those younger than age 65 years to only 7% in those aged 65 years and older.

Cell-Culture and Egg-Based Flu Vaccines Similarly Uneffective Against Influenza A

According to a new study, both cell-culture and egg-based IIV vaccines showed relatively low vaccine effectiveness (VE) during the 2017–2018 influenza season in which the A(H3N2) virus strain dominated.

“The relative vaccine effectiveness of cell culture-based IIV versus egg-based IIV against influenza A was 8%, but the difference between the two was non-significant,” said Nicola Klein, MD, of Kaiser Permanente.

An additional story is available online.

Seasonal Flu Vaccine Does Not Significantly Impact Efficacy of Pandemic Vaccine

The seasonal influenza vaccine had no significant clinical impact on the effectiveness of the 2009 pandemic influenza vaccine in patients who received both, according to findings from a recently published study.

The authors say there was no clinically significant difference in influenza-like illness, influenza or pneumonia attack rates among those receiving the pandemic vaccine with or without the presence of the seasonal vaccine.

An additional story is available online.

Timing of Third-trimester Maternal Tdap Immunization Associated with Levels of Whooping Cough Antibodies in Newborns

This observational study included 626 pregnancies and compared pertussis antibody concentrations in umbilical cord blood among newborns whose mothers received Tdap immunization in the third trimester, as is recommended by the U.S. Centers for Disease Control and Prevention, with those whose mothers didn’t receive the Tdap vaccine during pregnancy. Maternal immunization with the Tdap vaccine during the third trimester of pregnancy was associated with higher concentrations of pertussis antibodies in infants at birth, with immunization early in the third trimester associated with the highest concentrations of antibodies.

Early Oseltamivir Use Linked to Clinical Benefits in Influenza Complicating ARDS

People with acute respiratory distress syndrome (ARDS) and a confirmed influenza diagnosis treated ≤6 hours with oseltamivir had reduced length of hospital stay and a lower mortality rate, according to the results of a study presented at the CHEST Annual Meeting, held from October 6 through October 10, in San Antonio, Texas.

An additional news article is available online.

Novel Intranasal Influenza Vaccine Shows Tolerability, Safety, and High Immune Response

NasoVAX, a replication-deficient adenovirus-based nasal spray flu vaccine, has demonstrated tolerability and safety as well as higher cellular immune response compared with a common injectable vaccine. This research was presented at IDWeek 2018, held October 3-7, 2018, in San Francisco, California.

This study included 60 healthy adult participants who were randomly assigned to receive either an A/California 2009-based monovalent NasoVAX in 109, 1010, or 1011 doses of viral particles or a saline-based placebo. NasoVAX demonstrated tolerability without serious adverse events or fever. Placebo and all doses of treatment experienced similar rates of solicited symptoms, including headache, sore throat, and nasal congestion. Immune measures of hemagglutination inhibitor titers of >1:40 were set as delineation for development of seroprotection. At day 29, the seroprotection rate of NasoVAX 109 was 80% (95% CI, 51.9%-95.7%), doses of 1010 viral particles were 100% (95% CI, 78.2%-100%) protective, and doses of 1011 viral particles were also 100% (95% CI, 78.2%-100%) protective.

An additional news story is available online.

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:

Providing a strong recommendation (with video vignettes)
Assessing the patient for adult vaccines

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

Weekly Summit calls resumed on October 11, 2018. Calls are held weekly on Thursday at 3PM Eastern time throughout the influenza season unless cancelled. Call information and an agenda generally are sent the morning of the call. Call summaries are available shortly after each call on the Summit website.

Please email L.J Tan or LaDora Woods if you have any updates on activities to provide to the Summit.

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