INFLUENZA AND INFECTIOUS DISEASE FORUMOctober 17 , 2012

Andrew Res ignato , MSDirector, San Franc isco Immunizat ion Coal i t ion

Flu Season 2012-2013 Vaccine Update

www.sfcdcp.org/flu

Preventing Influenza

Why Influenza Vaccination?

On average, more than 200,000 people in the United States are hospitalized each year for respiratory and heart condition illnesses associated with seasonal influenza virus infections.

Over a period of 30 years, between 1976 and 2006, estimates of flu-associated deaths in the United States range from a low of about 3,000 to a high of about 49,000 people.“Influenza-Associated Hospitalizations in the United States 1979 Through the 2000-2001 Respiratory Seasons .” Journal of

American Medical Association’s September 14, 2004 issue (volume 292, no. 11). Source: http://www.cdc.gov/flu/keyfacts.htm

Why Universal Vaccination?

Source: CMAJ September 20, 2011 183:E1025-E1032; doi:10.1503/cmaj.110241 Effect of expanded US recommendations for seasonal influenza vaccination: comparison of two

pediatricemergency departments in the United States and Canada Anne Gatewood Hoen, PhD, David L.

Buckeridge, MDPhD, Katia M.L. Charland, PhD, Kenneth D. Mandl, MD MPH, Caroline Quach, MD MSc, John S.

Brownstein, PhD

• Flu hospital admissions for influenza among two- to four-year-olds declined 34 percent following changes in U.S. vaccine policy 2006/2007 influenza season; study is first to use real time hospital data to evaluate policy change after immunizing children 2 to 4 y.o.

• Smaller declines were seen in other age groups as well.

Who Is High Risk for Flu-Related Complications?

• People younger than 19 years of age who are receiving long-term aspirin therapy

• People who are morbidly obese (Body Mass Index, or BMI, of 40 or greater)

• Children younger than 5, but especially children younger than 2 years old

• Adults 65 years of age and older

• Pregnant women

• American Indians and Alaskan Natives seem to be at higher risk of flu complications

Source: http://www.cdc.gov/flu/about/disease/high_risk.htm

Who Is High Risk for Flu-Related Complications?

• Chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis)

• Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)

• Blood disorders (such as sickle cell disease)

• Endocrine disorders (such as diabetes mellitus)

• Kidney disordersSource: http://www.cdc.gov/flu/about/disease/high_risk.htm

Who Is High Risk for Flu-Related Complications?

• Liver disorders

• Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)

• Weakened immune system due to disease or medication (such as people with HIV or AIDS, or cancer, or those on chronic steroids)

• Asthma

• Neurological and neurodevelopmental conditions [including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders), stroke, intellectual disability (mental retardation), moderate to severe developmental delay, muscular dystrophy, or spinal cord injury].Source: http://www.cdc.gov/flu/about/disease/high_risk.htm

Vaccine Coverage Rates 11-12 Season

Age Rate

6 months – 17 y.o. 51%18-64 y.o. 34%

18–64 years high-risk 47%

≥65 years66.6%

Health Care Workers 64%

Source: Estimates from the Behavioral Risk Factor Surveillance System (BRFSS), National Immunization Survey NIS, Influenza Vaccination Coverage Among Health-Care Personnel --- United States, 2010--11 Influenza Season Weekly August 19, 2011 / 60(32);1073-1077 http://www.cdc.gov/flu/professionals/vaccination/trends/age-groups.htm

2012-2013 Flu Season Update

ACIP Recommendations published 8/17/2012 General recommendations are similar to the

2011-2012 influenza seasonhttp://www.cdc.gov/flu/protect/vaccine/vaccines.htm

Vaccination continues to be recommended for all persons >6 months of age

Strains in the 2012/2013 formulationA/California/7/2009 (H1N1)pdm09-like virusA/Victoria/361/2011 (H3N2)-like virusB/Wisconsin/1/2010-like virus (from the B/Yamagata lineage of

viruses).

Source: Prevention and Control of Influenza with Vaccines: Recommendations of the ACIP, 2012 ; http://www.cdc.gov/flu/about/season/flu-season-2012-2013.htm

Who needs 2 doses for 2012-2013?

Source: MMWR August 17, 2012 / 61(32);613-618

‘New’ Influenza Vaccines

Fluzone Intradermal® (Sanofi-Pasteur) licensed by FDA in May 2011 for use in persons aged 18 through 64 years

Fluzone High-Dose® (Sanofi-Pasteur) licensed by FDA on December 23, 2009 for use in persons ages 65 years and older

*ACIP expresses no preference for any given TIV formulation over another.

Source: Prevention and Control of Influenza with Vaccines: Recommendations of the ACIP, 2011 ; http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6033a3.htm

New Influenza Vaccines

Quadravalent Flu Vaccine? – two common circulating B strains (Victoria & Yamagata)

Quadravalent LAIV licensed in February 2012 - Flumist ® Quadravalent but not expected to be ready for this season

TIV quadravalent vaccines are in the pipeline

Source: Prevention and Control of Influenza with Vaccines: Recommendations of the ACIP, 2012 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6132a3.htm

4 444 4 4444 4 4 44

CDC: Situation Update

http://www.cdc.gov/flu/weekly/summary.htm

Flu Season Peaks

Peak Month of Flu Activity (United States)1976-77 through 2010-11

http://www.cdc.gov/flu/about/season/flu-season.htm

H3N2v

H3N2v is a variant of H3N2 influenza virus that infected 319 people in the United States in 2011 and 2012.

The virus does not usually infect people or spread among people.

It is very different from human seasonal H3N2 viruses.306 of the cases occurred from July-September 2012.

Symptoms of H3N2v are similar to seasonal flu symptoms.

There has been limited person-to-person transmission and one death.

Avoid close contact with pigs especially ones that look sick.

Health Care Worker Immunization – How are we doing?

Nationally, many facilities do not achieve Healthy People 2020 goals Target is 90%, reached 63.5% during 2010-2011 flu

seasonHow can we improve this?

Mandates demonstrate 90+% coverage Make influenza immunization a condition of employment Children’s Hospital of Philadelphia – 99.6% coverage

Encourage masking policies for HCWs who do not get vaccinated

Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6032a1.htm Presentation - What’s New With the Flu? Tan, Litjen 9/2011

Mandatory Vaccination of Health Care Workers for Influenza or Masking During Flu Season

The memo can be accessed here: http://sfcdcp.org/fluproviders.html

• Health care workers (HCWs) are required to get an influenza vaccine or wear a mask in patient care areas during influenza season.

• Applies to hospitals, skilled nursing, and other long-term care facilities

• Influenza Season is defined as December 15 to March 31 (could be extended depending on influenza surveillance)

• GOAL: To reduce HCW to patient transmission of influenza, increase HCW influenza vaccination, and reduce employee absenteeism.

Health Care Provider Recommendation – the key to getting patients vaccinated

The health care worker recommendation to a patient is the most influential reason why a patient gets vaccinated Pregnant women whose providers recommended flu

vaccine were: 1

5 times more likely to be vaccinated More likely to have positive attitudes about

Effectiveness and safety of flu vaccine Safety of flu vaccine for their fetus

For parents who immunize their children, one of the most important factors is a physician’s recommendation2

1. MMWR, August 19, 2011 / 60(32), 1073-1077.2. Daley MF, Crane LA, Chandramouli V, et al. Pediatrics 2006; 117(2): e268-e277.

Everyday Flu Prevention

• Cover your nose and mouth with a tissue when you cough or sneeze or crux of your elbow.

• Wash your hands often with soap and water or alcohol-based hand rub.

• Avoid touching your eyes, nose and mouth.

• Try to avoid close contact with sick people.

• If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities.

• While sick, limit contact with others as much as possible to keep from infecting them.

Where is the best place to find updated Flu Vaccine information? www.sfcdcp.org/flu

www.sfcdcp.org/flu

Questions?

Erin Bachus, MPHAdult Immunization Coordinator Communicable Disease Prevention UnitSan Francisco Department of Public Health101 Grove Street, Room 408San Francisco, CA 94102Tel: (415) 554-2798Fax: (415) 554-2579erin.bachus@sfdph.org http://www.sfcdcp.org/flu

www.sfcdcp.org/flu