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Advisory Committee on Immunization Practices June 2018 Meeting Update

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The Advisory Committee on Immunization Practices (ACIP) held their second of three annual meetings at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA last week.  ECBT staff took advantage of the opportunity to view the meeting via webcast, and strongly encourage members of the public to take advantage of this technology in order to gain a better understanding of the deliberations that take place to ensure the ongoing safety and effectiveness of the vaccines licensed for use in the U.S.

The CDC sets the recommended immunization schedules for people of all ages in the U.S. based on recommendations from the ACIP. The ACIP establishes, updates and continually evaluates all the vaccine recommendations that are made in the United States for infants, adolescents and adults. These guidelines are considered the gold standard among healthcare providers. The ACIP consists of 15 voting members, 8 ex officio members and 30 non-voting representatives who participate voluntarily. In addition to the three meetings per year, which are open to the public, ACIP members serve on various work groups that are active throughout the year. Work groups review the latest studies on specific vaccines (including safety and efficacy reports), in order to provide recommendations to the larger committee.

Last week the ACIP voted on recommendations for influenza (flu) and anthrax vaccinations, and discussed HPV, mumps, shingles (herpes zoster), Japanese encephalitis, and pneumococcal vaccines. Votes and highlights from the discussions are detailed below.

 

Influenza (Flu) Vaccination Discussion and Vote

It will come as no surprise to our readers that the flu virus hit a brutal blow to people of all ages during the very severe 2017-18 flu season in the U.S., striking at nearly the same time nationwide.

 

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Influenza A (H3N2) was the predominant circulating strain and this year the effectiveness of the vaccine against this strain was approximately 24% (similar to the previous flu season). Effectiveness against the influenza A (H1N1) strain was 65% and 49% against the influenza B (Yamagata) strain.

 

 

 

Now the good news – vaccination reduced flu-related visits to healthcare providers (outpatient) by 40% among all people ages 6 months and older. Among adults, the vaccine reduced outpatient visits and hospitalizations by 22%.

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The ACIP listened to vaccine safety reports provided by representatives from the Food and Drug Administration (FDA), vaccine manufacturers, and the vaccine safety surveillance systems in the U.S. – the Vaccine Adverse Event Reporting System (VAERS) and Vaccine Safety Datalink (VSD) which is a collaboration between CDC and nine healthcare organizations that began in 1990 and analyzes up to 10 million immunization records per year to ensure ongoing safety.  After an extensive review of the safety of this season’s flu vaccines, the ACIP confirmed that there were no vaccine safety signals of concern including anaphylaxis, narcolepsy and Guillian-Barre Syndrome, each of which received increased scrutiny due to a number of news and anecdotal reports in recent years.

The ACIP approved the following influenza recommendations for the 2018-19 season:

Everyone 6 months of age and older should be vaccinated with any licensed, age-appropriate influenza vaccine (IIV, recombinant influenza vaccine [RIV], or LAIV), as indicated. No preference is given for any one vaccine over another. In its February meeting, the ACIP once again recommended LAIV (the nasal spray vaccine known as FluMist) for healthy, non-pregnant people 2 through 49 years old during the 2018-19 season. This recommendation was made after ACIP reviewed effectiveness data presented by the manufacturers of FluMist.

Of Note: The Redbook Committee of the American Academy of Pediatrics, who typically endorses the recommendations of the ACIP, have stated a preference for the flu shot (IIV or RIV) over the nasal spray vaccine (LAIV), recommending that pediatricians only give the nasal spray as a last resort. This decision by the AAP is not without controversy as it may lead to confusion among parents and their providers. ECBT Board Member Dr. Paul Offit recently created a Medscape video explaining why he agrees with the ACIP’s decision to recommend the use of FluMist in children based on the effectiveness data.

 

Pneumococcal Vaccination Discussion

Two pneumococcal vaccines are currently recommended for all adults over the age of 65 – one dose of pneumococcal conjugate vaccine (PCV13) with a booster dose of pneumococcal polysaccharide vaccine (PPSV). ACIP is re-examining whether PCV13 should be routinely recommended for otherwise healthy older adults. Some experts believe the childhood recommendations for routine vaccination with PCV13 is sufficiently lowering the disease burden in adults by reducing the circulation of the disease in communities. In data presented to the ACIP, however, it seems there are persistent disparities in the rate of pneumococcal disease and vaccine uptake  pneumoacip062018

among minority populations and those in poverty, which puts into question whether it would be wise to eliminate the vaccine recommendation for adults.  The ACIP will continue to deliberate the data and have continued discussions into 2019.

 

Anthrax Vaccination Discussion and Vote

The anthrax vaccine is currently approved for use by the FDA for 18-65 year olds, and is usually given to select populations of adults (i.e. military). As the Department of Health and Human Services (HHS) and CDC review their plans for responding to an anthrax “mass event”, they have asked ACIP to offer guidance on how best to use the vaccine in the event of emergency. Specifically, they asked ACIP whether the anthrax vaccine would be equally effective and safe if they had to administer the vaccine in fewer or smaller doses to ensure there was enough vaccine for everyone affected.  Also under consideration was the utilization of different types of needles to be used in the event of a needle shortage. The current vaccine is given subcutaneously, not intramuscularly, like typical vaccines. Intramuscular needles are therefore more readily available.

After reviewing the data, the ACIP agreed unanimously that reduced dosing would still save lives, as would offering the vaccine intramuscularly instead of subcutaneously. There was no data, however, on whether reduced doses given intramuscularly would be equally effective. The Committee also offered their recommendations on the duration of antimicrobial treatment following vaccination. There is a new intramuscular anthrax vaccine on the horizon which may help federal agencies better plan for a possible emergency situation.

The ACIP made the following recommendations:

The intramuscular route of administration may be used if the subcutaneous route presents clinical, operational, or logistical challenges that may delay or prevent effective vaccination.

  • Should there be an inadequate supply of anthrax vaccine available for Post Exposure Prophylaxis (PEP), either 2 full doses or 3 half doses of AVA may be used to expand vaccine coverage.
  • In immunocompetent individuals 18-65 years of age, antimicrobials given in conjunction with vaccine may be discontinued at 42 days after the first vaccine dose or 2 weeks after the last vaccine dose, whichever comes later.

 

Japanese Encephalitis Vaccination Discussion

The cell culture-derived Japanese encephalitis vaccine (JE-VC) is both safe and effective, but given how few U.S. travelers contract the disease, ACIP is re-evaluating their recommendations. They are in the midst of re-evaluating the cost effectiveness of the vaccine and whether their recommendations should be more targeted. ACIP will continue deliberations at a future meeting.

 

Mumps Vaccination Discussion

Mumps outbreaks continue to crop up throughout the nation. From late 2016 through 2017, there were 56 outbreaks, which included 3,914 cases, and in 2018, there have already been 30 outbreaks, including 1,415 cases. The ACIP previously recommended the use of a 3rd dose of mumps virus-containing vaccine (MMR) for people identified at increased risk during a mumps outbreak. img_0681.pngDuring the June, 2018 ACIP meeting, the CDC provided guidance for public health officials to assist them on the use of a 3rd dose of MMR vaccine during an outbreak, including identifying groups of people at risk for acquiring mumps during an outbreak; assessing transmission in the settings to determine if groups are at increased risk; and how to implement a 3rd dose recommendation.

 

Shingles (Herpes Zoster) Vaccination Discussion

In October 2017, ACIP made recommendations for a new recombinant zoster vaccine (RZV) called Shingrix. The vaccine is recommended for the prevention of shingles and related complications for adults 50 years of age and older. It is also recommended for adults 50 and older who previously received zoster vaccine live (ZVL), and it is preferred over ZVL for the prevention of shingles and related complications.

GSK, the manufacturer of Shingrix, reported to the Committee that it is increasing the number of doses available due to high demand and shipping delays.  They are also continuing to study the safety and effectiveness of the vaccine.  The CDC also continues to monitor shingles vaccine coverage and vaccine supply. As it does with all vaccines, the CDC is using U.S. safety surveillance systems – VAERS and VSD – to monitor the shingles vaccine (RZV). VAERS is a passive system that is not designed to determine if a vaccine caused a health problem, but does help to detect unusual or unexpected patterns of adverse events that might indicate a possible safety problem with a vaccine. The CDC reported that were 680 reports to VAERS between October 20, 2017 and April 27, 2018, and the majority concerned females. There were no unusual patterns or unexpected adverse events. 48 (7%) of reports involved co-administration with 1 or more other vaccines, and the most commonly reported side effects from RZV were injection site pain and pyrexia (fever).

The CDC also reported to ACIP about VSD monitoring of the shingles vaccine.  The staff of the  VSD conducted vaccine safety studies based on questions and concerns raised from the medical literature and reports to VAERS. As of May 31, 2018, 37,303 total doses of RZV were administered at the participating VSD sites. The VSD monitoring for RZV includes high priority short-term outcomes (GBS, anaphylaxis, and acute myocardial infarction); lower priority short-term outcomes for descriptive analysis (gout, local and systematic reactions); and longer-term outcomes (potential immune-mediated diseases). Evidence of safety and effectiveness of shingles vaccine in immunocompromised is currently being reviewed.

The CDC has created a number of resources for RZV. For providers, the CDC developed a report published in MMWR on vaccine administrative errors, a Continuing Medical Education program (CME) called “You Call the Shots”, a Medscape video, web pages, webinars/conferences and fact sheets. For the public, the CDC created a vaccine information statement (VIS) on the RZV, web pages and a fact sheet.

Human Papillomavirus (HPV) Vaccination Discussion

In October 2018, the FDA is expected to complete a review of scientific studies to determine whether 9-valent HPV vaccine (GARDASIL®9) is safe and effective for use in adults ages 27 to 45. The vaccine will continue to serve as a prophylactic to prevent new infections, and is not expected to prevent progression of the disease among those who already have a HPV infection. The ACIP is also simultaneously reviewing the evidence that has been sent to the FDA and will determine whether to recommend the vaccine if and when the FDA approves the vaccine for use among mid-aged adults. Factoring into the ACIP decision will be the fact that the overall population-level benefit will be lower among mid-aged adults than among younger populations. This is due to the fact that this

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population may have already been exposed to HPV and thus already have an infection, or have immunity against some strains of the disease. In addition they tend to have fewer new sex partners and have several other factors that will make the vaccine less beneficial (but not without merit) for this older group than for those ages 11-12, who can be vaccinated prior to exposure.

The ACIP’s HPV work group is also continuing to review data in consideration of “harmonizing” the schedule for males and females so that both populations would be recommended up to the age of 26 instead of up to age 21 for males and up to age 26 for females and will report back to the full ACIP at a future meeting.

ECBT will keep you informed on this and other deliberations of this important committee.  

Learn more about each of these vaccines and the diseases they prevent on the Vaccinate Your Family website and Facebook page.

 

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What You Don’t Know About Hepatitis Can Hurt You

More than four million Americans are living with viral hepatitis, but most don’t know they’re infected.

HepABCs-cubeMany people can live with hepatitis for decades without feeling sick or exhibiting any symptoms.  But left untreated, there are three different types of viral hepatitis which can cause serious health problems, including liver damage, liver failure, liver cancer or even cirrhosis, a condition that causes permanent scarring of the liver.

In honor of Hepatitis Awareness Month, learn how the different types of viral hepatitis are spread, as well as how they can be prevented or treated. 

Hepatitis A

Hepatitis A can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months.

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It is usually spread by contact with people who are infected or from contact with objects, food, water or drinks contaminated by the feces of an infected person, which can easily happen if someone doesn’t properly wash his or her hands after using the toilet. It’s important to know that not all people with hepatitis A have symptoms, but it’s more likely for adults to have symptoms than children. If symptoms develop, they usually appear two to six weeks after being infected and may include:

  • Fatigue
  • Nausea and vomiting
  • Loss of appetite
  • Fever
  • Dark urine
  • Gray-colored stools
  • Joint pain
  • Yellowing of the skin and eyes (jaundice)
  • Severe stomach pains and diarrhea (mainly in children)

The good news is that hepatitis A is easily prevented with a safe and effective vaccine. For the best protection, it is recommended that children receive two  doses of Hep A vaccine with the first dose being administered between 12 and 23 months of age, and a second dose administered 6 to 18 months after the first dose. Adults who have not been previously vaccinated, or who are at risk due to their work or travel. should also be vaccinated.  Since the introduction of the vaccine, cases of hepatitis A have plummeted across the country.  However, outbreaks still do occur. 

Currently, there are reported outbreaks in West Virginia, Kentucky and California in which hundreds of cases have been identified and several deaths have occurred. This is why all everyone should ensure they are protected against hepatitis A.

Hepatitis B

People who get infected with the hepatitis B virus, especially young children, can go on to develop a chronic or lifelong infection which can cause serious liver damage, liver failure, liver cancer or cirrhosis.

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Hepatitis B virus can be spread through contact with an infected person’s blood, semen, or other body fluids.  This may happen when someone has a cut or sore, when someone is bitten by another person (as in the case of children in daycare), through the sharing of a toothbrush or food has been chewed (like in the case of young children), from an infected mother to her baby during childbirth, through sexual contact, or by sharing needles, syringes, or other drug-injection equipment.

Not all people with hepatitis B have symptoms. However, if they occur, they usually appear about three months after infection and can range from mild to severe, including:

  • Dark urine
  • Fever
  • Joint, muscle and stomach pain
  • Loss of appetite
  • Nausea, diarrhea and vomiting
  • Fatigue
  • Yellowing of your skin and the whites of your eyes (jaundice)

The best way to prevent hepatitis B is by getting vaccinated. The vaccine is recommended for: 

  • All infants, starting with the first dose of hepatitis B vaccine within 24 hours of birth.  This shot acts as a safety net, reducing the risk of a child getting hepatitis B from moms or family members who may not know they are infected with the disease. Additional doses of the vaccine should be given between 1 and 2 months, and between 6 and 18 months of age.Newborns who become infected with hepatitis B virus have a 90% chance of developing chronic Hepatitis B, which can eventually lead to serious health problems, including liver damage, liver cancer, and even death. This is why the birth dose has been an extremely effective way of reducing the risk of chronic Hepatitis B infection. 
  • All children and adolescents younger than 19 years of age who have not been fully vaccinated against hepatitis B
  • Unvaccinated adults at risk for hepatitis, in addition to any adult who wants to be protected from hepatitis B.

Unfortunately, many people got infected before the hepatitis B vaccine was widely available. That’s why the CDC recommends that anyone born in areas where hepatitis B is common (such as Asia, the Pacific Islands or Africa), or whose parents were born in these regions, get tested for hepatitis B.

You can learn more about who may be at increased risk of hepatitis B here. Fortunately, treatments are available that can delay or reduce the risk of developing liver cancer.

Hepatitis C

FACT: People born from 1945 - 1965 are 5 times more likely to be infected with Hepatitis C. Learn more: //www.cdc.gov/KnowMoreHepatitis/

For some people, hepatitis C is a short-term illness, but for 70%–85% of people who become infected, it becomes a long-term, chronic infection which can cause serious liver damage and even liver cancer over time. Unfortunately, the majority of infected people are not aware of their infection because they are not clinically ill.

In the past, hepatitis C was spread through blood transfusions and organ transplants. However, widespread screening of the blood supply began in 1990 and the hepatitis C virus was virtually eliminated from the blood supply by 1992. Today, most people become infected with hepatitis C by sharing needles, syringes, or any other equipment to inject drugs. For reasons that are not entirely understood, people born from 1945 to 1965 are five times more likely to have hepatitis C than other age groups.

Unfortunately, there is currently no vaccine to prevent hepatitis C. However, once diagnosed, most people can be treated and cured in just 8 to 12 weeks, reducing liver cancer risk by 75%. This is why awareness and testing is so critical.


The CDC has developed an online Hepatitis Risk Assessment to help people find out if they should get tested or vaccinated for viral hepatitis.

ARE YOU AT RISK? Millions of Americans have VIRAL HEPATITIS. Most don't know it. Take this online assessment to see if you're at risk. //www.cdc.gov/hepatitis/riskassessment/

The assessment, which takes only five minutes, will provide personalized testing and vaccination recommendations for hepatitis A, hepatitis B, and/or hepatitis C.  Take it today and protect yourself from these viruses that can so easily go undetected.  

Shingles Vaccine is the Silver Lining of Turning 50

April 19, 2018 7 comments

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Turning fifty is a milestone most people would rather avoid.  

Not me.  

After watching both my 73-year-old mother and my 18-year-old daughter suffer with shingles, I would do almost anything to avoid it. And last year, when a new and more effective shingles vaccines was licensed by the FDA, and recommended by the Advisory Committee on Immunization Practices (ACIP) for people age 50 and older, I began looking forward to my 50th birthday.

You see, now that I’ve witnessed shingles up close and personal, I am eager to prevent it and I feel compelled to encourage everyone to as well.  And here’s why…

Vaccination is the Only Way to Prevent Shingles

You can’t avoid shingles by washing your hands or avoiding sick individuals.  The only means of prevention is through vaccination.

That’s because shingles isn’t your typical contagion. It’s a virus, but not the kind that is spread from person to person through coughing or sneezing. It’s actually a virus (the herpes zoster virus), that is caused by another virus, (the varicella-zoster virus, more commonly known as chickenpox).

Over the past two years I’ve watched as both my mother and my daughter have suffered with shingles, and I’ve learned a few things along the way.   

Shingles Pain Is Excruciating, Debilitating and Can Be Long Lasting

ShinglesImageThe rash then developed into fluid-filled blisters that would break open, ooze out and eventually crust over.  She had to be careful to keep the rash covered and wash her hands frequently since she didn’t want to infect my newborn niece who was living in the same home at the time. Since my niece had not yet received her varicella vaccine, she was not immune to the virus and would be at risk of developing chickenpox.  As a premature infant, that could have been extremely dangerous for her.   Read more…

Updates from the Advisory Committee on Immunization Practices February Meeting

March 6, 2018 2 comments
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Photo Credit: James Gathany, Centers for Disease Control and Prevention

The Advisory Committee on Immunization Practices (ACIP) held its first meeting of 2018 on February 21st and 22nd.  The Committee consists of a panel of immunization experts that advise the Centers for Disease Control and Prevention (CDC).  Part of their charter is to continually evaluate new data and update or change vaccine recommendations as warranted. 

The agenda for the February 2018 meeting included presentations pertaining to several different diseases and vaccines, to include hepatitis, influenza, anthrax, HPV, pneumococcal, meningococcal and Japanese encephalitis.

A overview of the meeting is provided below, with details on presentations in the order they occurred: 

Hepatitis B

The committee voted unanimously to approve a non-preferential recommendation for a new Hepatitis B vaccine (Dynavax’s HEPISLAV-B™) to their list of recommended vaccines for adults 18 years and older against infections caused by all known subtypes of Hepatitis B.

This vote came following the presentation of data showing that the new two-dose vaccine generates a more rapid and higher antibody response than the standard 3 dose vaccine.

Hepatitis B is a viral disease of the liver that can become chronic and lead to cirrhosis, liver cancer and death. The hepatitis B virus is 50 to 100 times more infectious than HIV, and transmission is on the rise. In 2015, new cases of acute hepatitis B increased by more than 20 percent nationally and 850,000-2.2 million persons are estimated to be living with infection in the U.S.

Since there is no here is no cure for hepatitis B, vaccination is our best chance at preventing the disease. While about 90% of people are infected during infancy, in adults, hepatitis B is most often spread through contact with infected blood and through unprotected sex with an infected person. Some individuals who are especially susceptible include those who are immunosuppressed or living with diabetes. The CDC recommends vaccination for those at high risk for infection due to their jobs, lifestyle, living situations and travel to certain areas.

The Working Group summary suggested that this new vaccine option is likely to improve vaccine series completion and result in earlier protection, which is especially beneficial in persons with anticipated low adherence such as injection drug users.  Additionally, the improved immunogenicity in populations with typically poor vaccine response such as the elderly, diabetics and those on dialysis, is promising.  The ACIP will continue to review post-marketing surveillance studies and additional data to ensure safety and cost-effectiveness considerations.

Hepatitis A

The committee voted unanimously to pass three recommendations pertaining to Hepatitis A.

  • Hepatitis A vaccines should be administered for post-exposure prophylaxis for all persons 12 months of age or older.
  • Hepatitis A vaccine or immune globulin (IG) may be administered to persons 40 years of age or older, depending on the providers’ risk assessment.
  • Hepatitis A vaccine should be administered to infants age 6-11 months of age traveling outside the US when protection against hepatitis A is recommended. This recommendation takes into consideration the fact that infants under 12 months who will be traveling internationally will typically also need an MMR vaccine.  Since Hepatitis A immune globulin and MMR vaccine should not be administered simultaneously, these children should receive a single dose of HepA vaccine. It’s important to note that infants should then complete the full, 2 doses of MMR and HepA vaccines at 12 months of age as recommended.

Influenza

The Committee heard five presentations specific to influenza.

The first two were reports of current season data; one detailing flu surveillance, the other providing early influenza vaccine effectiveness data.

According to the update, the majority of circulating flu strains are similar to those contained in the 2017-2018 vaccine.  The only virus clearly showing antigenic drift was the B/Victoria lineage viruses which represents less than 1% of circulating viruses.  So far this season, influenza A (H3N2) has been dominant, with influenza B activity starting to increase more recently. Activity has been the highest we’ve seen since 2009, and while final severity can’t be determined until the end of the season, hospitalization rates and mortality could be similar to or exceed those send during the severe 2014-2015 season.

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Based on data from 4,562 children and adults with acute respiratory illness enrolled during November 2, 2017–February 3, 2018, at five study sites, the overall estimated effectiveness of the 2017–18 seasonal influenza vaccine for preventing medically attended, laboratory-confirmed influenza virus infection was 36%. The percentage differs by age group and by virus.  A detailed report can be found here.

The most notable news out of the Committee last week was the vote to restore the live attenuated influenza virus (LAIV) vaccine as an option for the 2018-19 season. LAIV is commonly known as the nasal spray flu vaccine or by its brand name, FluMist This renewed ACIP recommendation offers FluMist as one of several vaccine options for non-pregnant people who are 2-49 years of age during the 2018-2019 season, but does not indicate any preference for FluMist over injectable flu vaccines.

While FluMist has not been recommended for the past two flu seasons due to reduced effectiveness against the H1N1 flu strain in children, the Committee heard three presentations specific to LAIV vaccine efficacy in children prior to taking a vote on future recommendations for LAIV.  The first reported on the efficacy of Fluarix Quadrivalent in children 6-35 month of age. Another presented the results of a randomized trial of a new H1N1 LAIV strain in U.S. children. The third was a review LAIV in children 2-17 years of age.  

The possible root cause of the poor effectiveness of LAIV against H1N1 was discussed and poor replication of the H1N1 selected strain was thought to be the likely problem. A new strain selection process is now in place in cooperation with the Food & Drug Administration (FDA) and it suggested that the antibody responses of the latest reformulated version of the quadrivalent vaccine, which includes the new 2017-18 post-pandemic 2009 H1N1 LAIV strain (A/Slovenia), will perform significantly better than what was previously observed when the vaccine included the 2015-16 post-pandemic LAIV strain (A/Bolivia).  Immunogenicity and viral shedding data in small trials supported this notion, but no efficacy data is available at this time.

The Committee was therefore forced to a vote using only the science available to date. There was a lively discussion among members who expressed various concerns. While flu vaccine effectiveness is a serious issue, some committee members expressed concern that they may be holding FluMist to a higher standard than other influenza vaccines, yet all have efficacy challenges from year to year.  Other members were concerned with how the vaccine may perform in an H1N1 dominated season. Until the vaccine is used, further effectiveness assessments are performed, and a prominent H1N1 year occurs, a certain level of uncertainty will remain.

While members voted overwhelmingly (12-2) to reinstate LAIV on the immunization schedule, a second vote to give other flu vaccines a preferential recommendation over LAIV failed (11-3).  So, while the ACIP will not indicate a preference for any one type of flu vaccine over another, the public will ultimately determine whether there will be high uptake of this particular vaccine next season. Read more…

Is This Season’s Flu More Severe Than Usual or Just Highly Active?

January 13, 2018 10 comments

At this point in the flu season people often wonder if all the media hype is part of an orchestrated effort to panic people about flu, or if it is really signaling serious concern.

There are lots of flu stories in the news these days.  From reports of  74 Californian’s who’ve died from flu – five times the number seen at this point last year – to 13 school districts in TX closing due to the high number of flu cases among students, we’re left to wonder….

Is this year’s flu season more severe than usual or just highly active at the moment?

A recent CDC media briefing has helped clarify the following concerns regarding the latest flu activity in the U.S.: 

Right now, flu is widespread everywhere.  

One of the most notable differences between this season and others is in relation to the geographic spread of flu. This is the first time over the course of 13 years of surveillance data that the entire nation is experiencing widespread flu at the exact same time, as can be noted by the color of CDC’s flu surveillance map below.

FluWeeklyReportActivity is severe right now.

 

One of the ways the CDC tracks influenza activity is to record the number of lab confirmed cases of flu and hospitalizations by week. What they’ve noted is a very rapid increase in the number of people seeing their healthcare providers for flu diagnosis, along with a rapid rise in the numbers of people being hospitalized with lab confirmed flu. For instance, this week’s surveillance data indicates that there’s been 22.7 hospitalizations per 100,000 people in the U.S., which is up considerably from the 13.7 number recorded last week.

So far this season, influenza A (H3N2), has been the most prevalent strain in circulation. Unfortunately, historically it is often the strain linked to more severe illness, especially among children and older individuals above the age of 65. Interestingly enough, the current flu surveillance observations seem to be in line with two more previous H3N2 dominant seasons; the 2014-2015 and 2012-2013 seasons.WHOPHL02_small

Additionally the hospitalizations so far this season seem to be in line with other H3N2 predominant seasons, with the highest rates among those over the age of 65, those between 50-64, and children under 5 years of age.

Flu can cause mild disease in some, but severe disease and death in others.

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Sadly, there have been as many as 30 pediatric deaths so far this season. While children are at great risk, there are plenty of reports of otherwise healthy adults who have been hospitalized or died from flu this season.

Peak season may have started early, but there are many more weeks to go.

Speaking to the media on behalf of the CDC on Friday, Dr.  Jernigan explained,

“If we look at the timing of the season, even if we have hit the top of the curve or the peak of the seasonal activity, it still means we have a lot more flu to go.”

He went on to suggest that there will likely be at least 11 to 13 more weeks of elevated influenza activity this season, before activity begins to subside. Even though it can take about two weeks for protection from vaccination to set in, Dr. Jernigan explained that we still have a lot of flu season to get through and that vaccination efforts should continue as long as influenza viruses are circulating.

While we are seeing a lot of H3N2 circulating now, we are also seeing H1N1 show up in states that have already had H3N2 activity. And we know that B viruses also tend to show up later in the season. Each of these strains are covered in the vaccine, so flu vaccination now can still help to prevent, or lessen the severity of flu throughout the remainder of the season.

Vaccination is our best defense.  

While flu vaccination is far from perfect, it remains our best defense. Not only can it help prevent flu, but it can also help lessen the severity of symptoms if a vaccinated person does end up getting infected.  This can reduce the chances of an individual being hospitalized or dying from flu.

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In fact, a recent study showed that influenza vaccination reduced the risk of flu-associated death by 65% among healthy children and by 51% among children with underlying high-risk medical conditions. Another study indicated that many older adults benefit from repeated flu vaccination. When getting vaccinated in both the current and previous seasons, the study found flu vaccination was 74% effective in preventing ICU admissions in older individuals and 70% effective in preventing deaths among older adults.

Manufacturers are reporting that they’ve shipped more than 151 million doses of flu vaccine this season, so there shouldn’t be a problem finding a flu vaccine in your area.  Simply refer to the flu vaccine finder for assistance.

We won’t know preliminary flu vaccine effectiveness until February.  

Read more…

Most Popular Posts of 2017 Address Flu, Vaccine Safety, Disease Outbreaks and Maternal Vaccines

December 27, 2017 Leave a comment

As we look back at the success of the Shot of Prevention blog this past year, we’re especially grateful to our blog readers, contributors and subscribers.

Whether you’ve shared a post, shared your story, or shared your expertise, we recognize that our growth and success would not have been possible without your support. Thanks to you, our posts are helping people to make important immunization decisions for themselves and their families.

In these final days of 2017, we hope that you will revisit the top ten posts from the past year and share them with others in your social networks.  

1)  3 Things I’ve Learned Since Losing My Son To Flu

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It’s been eight years since Serese Marotta of Families Fighting Flu lost her five-year-old son, Joseph, to the flu. She’s not the same person she was eight years ago. Today, she sees things through a different lens as a bereaved parent. Losing a child is devastating, but she feels a responsibility to pass on some of the lessons she’s learned through her personal tragedy, which she does in her article here.

 

2)  10 Things Parents Who Don’t Vaccinate Their Kids Should Know

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In some cases, children who have suffered with a preventable disease were unvaccinated.  This could be the result of parents who did not have access to certain vaccines, parents who willfully refused a particular vaccine, or it could because they were too young to be fully vaccinated. After Riley Hughes passed away in the arms of his parents when he was just 32 days old, his parents made it their mission to educate people about the dangers of whooping cough, and promote the need for vaccination. In a plea to parents who still choose not to vaccinate, Riley’s mom posted the following list of “things to know” here.

 

3)  Even With All Our Modern Medicine I Watched My Sister Die From Flu

lizaLiza was healthy and only 49 years old when she contracted flu. She sought medical care early. She was cared for at a good hospital in a major city.  She had no other infections. And she was unvaccinated. To say that her death was a surprise to her brother is an understatement.  And yet her brother, Dr. Michael Northrop is a pediatric intensive care physician. His story traces the clinical course of Liza’s illness, and expresses the grief he felt as he helplessly watched his sister  succumbs to an illness that even modern medicine can’t always save us from. To read his story, click here.

 

4) Take It From This Mom, The Flu Is No Joke

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After her four-year old daughter is rushed to the emergency room, she writes a warning to others.  “The words just the flu need to be eradicated from our lexicon. Because this? This is the flu. There’s no ‘just’ about this. It was terrifying. It was the most helpless I’ve ever felt as a mommy. And it was potentially deadly.  All because I was too busy to get our flu shots.” Read the full story here.

 

5) Flu Vaccine Benefits Go Beyond Effectiveness of One Strain

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Amid speculation about how effective the flu vaccine will be this year, Dr. LJ Tan addresses some of the public’s most prominent concerns. He starts with a basic explanation of flu and flu vaccines, discusses the factors that play into vaccine effectiveness, and addresses rumors about this year’s flu vaccines. To gain a better understanding, read more here.

 

6) How My Sister Helped Save My Daughter From Whooping Cough

As a Medical Director responsible for Community Health and Prevention at Intermountain Healthcare in Salt Lake City, Utah, Tamara Sheffield is a huge advocate for SOTI_Pertussis_FBimmunizations. She is especially appreciative of maternal immunizations, which she considers one of today’s most promising new preventive health strategies. But her reasons go beyond her professional understanding of how maternal flu and Tdap vaccines pass on protective antibodies to newborns. Her surprising story ends with a twist involving her own daughter who nearly died from whooping cough when she was just three weeks old. Read it here.

 

7) Multiple Vaccine Oversight Committees Ensure Our Public Safety

While 2017 brought a lot of uncertainty about health services in this country, Dr. Dorit Reiss, Professor of Law at the University of California Hastings College of Law, explains 178_NFID_Vaccine_Safety_infograms_2_FINALwhy the public should remain confident in vaccine safety. In this post she reviews the specific ways in which vaccine safety is regulated in the U.S., and the oversight committees that monitor vaccines pre and post licensure. Her scrutiny explains that it would be hard to hide a problem if one existed, and that when problems do occur, they are quickly discovered and addressed. To learn more about vaccine safety oversight, read the full post here.

 

8) Why Should Vaccinated Individuals Worry About Measles Outbreaks

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With various measles outbreaks reported across the U.S. and the world in 2017, it’s important to understand why vaccinated individuals should be concerned. Many people mistakenly think that vaccinated individuals are not at risk during outbreaks. However, when it comes to infectious diseases like measles, one person’s decision not to vaccinate can negatively impact the health of others and this post explains how.

 

9) Five Things I’ve Learned About Vaccines Through 21 Years of Parenting

HowHerdImmunityWorksWe’ve all received plenty of unsolicited advice about how to care for our children. However, when making health decision for our families we should rely on evidence based research and credible information from reputable sources. In this post, I share five of the most important things I’ve learned about vaccines through my journey as a parent and immunization blogger. Spoiler alert: it begins with science and it ends with action.

 

10) Five Things Expectant Parents Need to Know About Vaccines in Pregnancy

SOTI-PregnancyCoverFBWhile well-meaning friends and family will provide a constant stream of advice on what to do and what to avoid while pregnant, all this information can be overwhelming. Expectant couples should rely on credible medical sources such as the CDC, the American College of Obstetricians and Gynecologists (ACOG), and the American College of Nurse Midwives. This blog post reviews the 5 things these trusted organizations say about the flu and Tdap vaccines routinely recommended during pregnancy. Learn more here.

 

We hope you have found our content to be engaging and informative.  We have exciting changes planned for Shot of Prevention in 2018 in hopes of engaging even more people in these important immunization conversations in the years to come.  

If you have suggestions for topics you would like us to address in 2018, or you would like to contribute a guest post for publication, please email shotofprevention@gmail.com.

Also, if you want to receive important immunization news and join in our online discussions, be sure to “Like” our Vaccinate Your Family Facebook page, follow our @ShotofPrev Twitter feed and subscribe to Shot of Prevention by clicking the link on the top right of this page.

Thanks again for your continued support and best wishes for a happy and healthy new year!

Flu Vaccine Benefits Go Beyond Effectiveness of One Strain

December 11, 2017 3 comments
LJ TanGuest post by Litjen (LJ) Tan, MS, PhD; co-chair and co-founder of the National Adult and Influenza Immunization Summit.

 

There seems to be a lot of speculation recently about how effective the influenza (flu) vaccine will be at preventing cases of influenza this season.

We have heard suggestions that the vaccine may only be 10% effective against flu this year, that there may be mismatches in the vaccine compared to the influenza strains that are circulating, and thus, that the vaccine is not worth getting.

To address these concerns I will start with a basic explanation of flu and flu vaccines, and then discuss the factors that play into vaccine effectiveness.

First, let me say that influenza is a serious respiratory infection that is responsible for about 30% of all the respiratory infections during the winter season. When I say serious, I mean that flu can keep you down for a week or more, and you will feel completely miserable. Additionally, each year thousands of people of all ages die from flu in the U.S.; it can be very dangerous. So, that office colleague who said that he was out with the flu yesterday very likely did not have influenza. Not fully understanding the dangers of flu is why some people fail to see the value of flu prevention.  

Flu is caused by multiple strains of influenza viruses that circulate during the winter season; specifically, we have influenza type A (with the H3N2 and H1N1 strains) and influenza type B (there are two type B strains that can circulate and currently 90% appear to be the Yamagata lineage, but since it is still so early in the season and sample sizes are small, this data point may not be statistically significant). Because these strains of flu viruses can switch every season in terms of dominance, and can also mutate, manufacturers need to develop a new influenza vaccine every year and people need to be re-vaccinated each year.

To be clear, the vaccine development process is the same every year, it is just that the starting, or “seed”, vaccine virus that we immunize against has to be identified before it can be used to develop our country’s annual vaccines.

When that seed virus is identified, it is then amplified (or passaged) to develop more seed virus. Then that seed virus is further amplified to create the large quantities of vaccine virus that we ultimately need to prepare an adequate supply of vaccines to protect our population. That amplification of the seed virus, and the making of large amounts of vaccine virus, can occur in eggs, which is the more traditional way, or it can also occur in cell cultures. So there needs to be four seed viruses developed and amplified to create influenza vaccines – an H3N2 seed, an H1N1 seed, and the two B seed viruses.

So why do we keep hearing people say that this year’s flu vaccine may only be 10% effective? Where did that suggestion come from?

When we say that a flu vaccine is 10% effective, what we usually mean is that it was effective in preventing 10% of cases of influenza in those who were vaccinated. This 10% number that you may have heard is actually a data point from Australia, and it’s not against all strains of flu, but specifically against the H3N2 strain that dominated the southern hemisphere this past flu season. If you look at the Australian data for all influenza, the vaccine effectiveness goes up to 33%. Agreed, that’s not great for Australians (although, it’s still better than no protection), but is looking at the Australian data truly reflective of what might happen in the US?

It’s unlikely, and here’s why. Read more…