Fluarix Quadrivalent Influenza Vaccine

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Northern Hemisphere Flu Season Ending

Don Hackett — Sat, 11 Apr 2020 18:55:02 +0000

Reviewer:

Nationally, the U.S. Centers for Disease Control and Prevention (CDC) says the percent of laboratory specimens testing positive for one of the influenza viruses continued to decrease.

And, the flu season risk is now considered ‘low’.

Nationwide during week #14, 3.9% of patient visits reported through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI).

This is a decrease from week #13, which reported 5.2%

As of April 10, 2020, the CDC is now estimating that during the 2019-2020 influenza season in the USA, there have been at least 39 million flu illnesses, 410,000 hospitalizations and 24,000 deaths from flu.

And, the increased percentage of fatalities associated with pneumonia, rather than influenza, likely reflects COVID-19 disease activity reported in 2020.

Based on the mortality surveillance data available on March 26, 2020, 10.0% of the deaths occurring during the week ending March 28, 2020 (week 13) were due to pneumonia and influenza (P&I).

This percentage is significantly above the threshold of 7.1% for week #13.

And, based on death certificate data, the percentage of deaths attributed to COVID-19 disease increased from 4.0% during week #13 to 6.9% during week #14.

And the percentage of deaths due to pneumonia (excluding COVID-19 or influenza) decreased from 7.5% during week 13 to 7.2% during week #14.

‘These changes impact data from ILINet in ways that are difficult to differentiate from changes in illness levels, therefore ILINet data should be interpreted with caution’ said the CDC.

Furthermore, 166 influenza-associated deaths in children have been reported so far this flu season.

This amount remains lower than the 2017-2018 season during which 188 pediatric fatalities were reported by the CDC.

While influenza B/Victoria viruses predominated earlier in the season, during recent weeks, influenza A(H1N1)pdm09 viruses have been reported more frequently than B/Victoria viruses nationally and in all surveillance regions.

In the most recent 3-weeks, influenza A viruses are the most commonly reported influenza viruses in all age groups. For the entire flu season, A(H1N1)pdm09 viruses are the predominant virus nationally.

Additionally, the CDC says antiviral medications are an important adjunct to a flu vaccine in the control of influenza virus.

The CDC also assesses the susceptibility of influenza viruses to the antiviral medications, which includes the neuraminidase inhibitors (oseltamivir, zanamivir, and peramivir) and the PA endonuclease inhibitor baloxavir, using next-generation sequence analysis supplemented by laboratory assays.

Almost all (>99%) of the influenza viruses tested this season are susceptible to the four FDA-approved influenza antiviral medications recommended for use in the U.S. this season.

Precision Vaccination s publishes flu season news.

Sub Title:

Influenza reporting data influenced by SARS-CoV-2 coronavirus pandemic

Reference:

CDC: FluView

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Flu-Related US Fatalities May Exceed 24,000

Don Hackett — Sat, 28 Mar 2020 14:57:14 +0000

Reviewer:

CDC: FluView Key Updates for Week 12, ending March 21, 2020

The US Centers for Disease Control and Prevention (CDC) reported the overall influenza activity in the USA continues to decrease during the 2019-2020 flu season.

But, the overall influenza-like illness (ILI) activity is increasing due to more people seeking care for respiratory illness caused by SARS-CoV-2 resulting in COVID-19 disease.

The CDC announced on March 27, 2020, that they estimate so far this flu season there have been at least 39 million flu illnesses, 400,000 hospitalizations and 24,000 fatalities related to one of the various influenza viruses.

Nationally, influenza A(H1N1)pdm09 viruses are the most commonly reported influenza viruses this season. Previously, influenza B/Victoria viruses predominated nationally.

And, laboratory-confirmed influenza-associated hospitalization rates for the U.S. population overall are higher than in most recent seasons.

The rates for children 0-4 years and adults 18-49 years are the highest CDC has on record for these age groups, surpassing rates reported during the 2009 H1N1 pandemic.

Hospitalization rates for school-aged children (5-17 years) are higher than any recent regular season but remain lower than rates experienced by this age group during the 2009 pandemic.

However, 155 influenza-associated deaths in children have been reported so far this season.

This number is higher than recorded at the same time in every season since reporting began in 2004-05, except for the 2009 pandemic.

Of the 155 pediatric fatalities, 99 deaths were associated with influenza B viruses.

In past seasons, the proportion of influenza-related pediatric deaths associated with influenza B viruses has generally been higher than the proportion of influenza B among circulating viruses.

Furthermore, 56 deaths were associated with influenza A viruses, and 31 were subtyped; 30 were A(H1N1)pdm09 viruses, and one was an A(H3) virus.

Human influenza A and B viruses cause seasonal flu epidemics almost every winter in the USA.

Influenza B viruses generally change more slowly in terms of their genetic and antigenic properties than influenza A viruses, especially influenza A(H3N2) viruses.

Influenza surveillance data from recent years shows the co-circulation of influenza B viruses from both lineages around the world.

However, the proportion of influenza B viruses from each lineage that circulates can vary by geographic location.

As of March 16, 2020, in the temperate zone of the Northern Hemisphere, respiratory illness indicators and influenza activity appeared to decrease overall.

In Europe, influenza activity remained elevated overall, though appeared to have peaked in some countries.
In Central Asia, influenza activity decreased with detections of all seasonal influenza subtypes.
In Northern Africa, influenza activity continued to increase in Algeria and Tunisia, with detections of influenza A(H1N1)pdm09 and B viruses.
In Western Asia, influenza activity decreased in most countries, except in Armenia, Azerbaijan, and Qatar.
In East Asia, ILI and influenza activity decreased overall.

The CDC did report some good news.

Almost all (>99%) of the influenza viruses tested this season are susceptible to the 4 FDA-approved influenza antiviral medications recommended for use in the USA.

These medications block the viral neuraminidase enzyme and have activity against both influenza A and B viruses.

Three of these drugs are chemically related antiviral medications known as neuraminidase inhibitors: oral oseltamivir phosphate (available as a generic version or under the trade name Tamiflu®), inhaled zanamivir (trade name Relenza®), and intravenous peramivir (trade name Rapivab®).

The 4th medication is oral baloxavir marboxil (trade name Xofluza®), which is active against both influenza A and B viruses but has a different mechanism of action.

Influenza antiviral medications are most effective in reducing complications when treatment is started within 48 hours of illness onset.

For detailed flu medicine and vaccine information, it’s best to speak with a healthcare provider.

Influenza medication and vaccination development news published by Precision Vaccinations.

Sub Title:

Pediatric fatalities related to influenza reaches 155 during 2020

References:

WHO: Influenza Transmission Zones

Why is the Influenza B Virus So Fatal?

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‘Lab in a Backpack’ Expedites Test Results

Don Hackett — Wed, 04 Mar 2020 14:32:26 +0000

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CDC's Portable flu testing kit allows for faster, on-site detection of viruses that could cause the next pandemic

Experts in the Centers for Disease Control and Prevention (CDC) Influenza Division have developed a portable flu laboratory that can sequence the influenza genome and analyze flu A viruses in real-time and on-site.

The test kit, called Mobile Influenza Analysis (MIA), brings influenza sequencing technology out of the laboratory and into the field, said this CDC article published on February 6, 2020.

This reduces the time needed to genetically analyze viruses, producing actionable data that can be used in a public health response.

“MIA has the potential to transform influenza surveillance, accelerate vaccine production during an influenza pandemic and greatly enhances CDC’s responsiveness to influenza outbreaks for protecting public health”- John Barnes, Ph.D., Team Lead, Genomics, and Diagnostics, CDC.

During any virus outbreak, time is of the essence. For flu, the sooner researchers can understand the genetic composition of the emergent viruses, the sooner prevention and control measures can begin, including the development of a vaccine.

Dr. Barnes’ team estimates that had the viruses they detected caused a flu pandemic, their proactive surveillance and the time saved by using MIA would have provided an 8-week advantage for vaccine manufacturing.

The success of MIA’s use in the field at the site of a flu outbreak paves the way for future progress toward the decentralization of flu surveillance.

Influenza news published by Precision Vaccinations.

Sub Title:

Mobile Influenza Analysis brings influenza sequencing technology into the field

References:

Influenza A Virus Field Surveillance at a Swine-Human Interface

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Canadian Flu Shots Outperform the USA

Don Hackett — Fri, 21 Feb 2020 17:39:06 +0000

Reviewer:

CDC: Weekly US Influenza Surveillance Report

According to new reports, this season’s flu vaccines are more effective in Canada than in the USA.

According to a Eurosurveillance study published on February 20, 2020, the overall vaccine-effectiveness (VE) against any influenza strain was 58 percent, including 74 percent in children ages 1 to 19 years.

However, flu shot effectiveness for seniors has only been 18 percent this season in Canada.

All influenza vaccines used in Canada were manufactured in eggs and inactivated.

Overall and by province, 74 percent of publicly-funded doses were quadrivalent, except in British Columbia, where 16 percent of doses overall were quadrivalent and targeted to children.

In Ontario, the high-dose trivalent vaccine was publicly funded for seniors, 65+ years of age.

In the USA, the 2019–20 influenza season began early with predominant influenza B/Victoria virus circulation, followed by increasing A(H1N1)pdm09 virus activity, with ongoing detection of both viruses.

Through the week ending February 8, 2020, influenza vaccines were reported protecting about 45 percent of all of the recipients against the circulating strains, according to the Centers for Disease Control and Prevention's (CDC's) Morbidity and Mortality Weekly Report.

The beginning of the US flu season was dominated by influenza B/Victoria, but since December, cases of H1N1 flu have increased.

The study authors also noted that there have been a large number of influenza-associated, pediatric fatalities as of February 15, 2020.

The CDC reported 105 influenza-associated pediatric deaths occurring during the 2019-2020 season, with 72 deaths associated with influenza B viruses.

The CDC says persons aged ≥6 months who have not yet received the influenza vaccine during the current season should get vaccinated to protect against influenza.

In addition, influenza antiviral medications remain an important adjunct to influenza vaccination.

The CDC recommends antiviral treatment for any patient with suspected or confirmed influenza who is hospitalized, has a severe or progressive illness, or is at high-risk for complications from influenza, including children aged less than 2 years and seniors, regardless of vaccination status or results of point-of-care influenza diagnostic testing.

Antiviral treatment can also be considered for any previously healthy symptomatic outpatient not at high risk for complications, with confirmed or suspected influenza, if treatment can be started within 48 hours of illness onset.

In summary, the CDC strongly suggests people ask a healthcare provider about which medications and vaccines best meet their needs.

Influenza vaccine news is published by Precision Vaccinations.

Sub Title:

Northern hemisphere influenza season began early with predominant influenza B/Victoria virus circulation

References:

CDC: Interim Estimates of 2019-2020 Seasonal Influenza Vaccine Effectiveness

Interim estimates of 2019/20 vaccine effectiveness during early-season co-circulation of influenza A and B viruses, Canada

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Why is the Influenza B Virus So Fatal?

Don Hackett — Tue, 14 Jan 2020 00:53:03 +0000

Reviewer:

CDC: Official Health Advisory

Influenza B viruses circulate every year around the world, but they are generally seen more often at the end of each flu season.

But the 2019-2020 flu season in the Northern Hemisphere appears to be different.

The Centers for Disease Control and Prevention (CDC) recently issued a Health Advisory reminding clinicians that influenza B viruses can cause severe illness in people of all ages, including children.

This CDC Alert issued on January 10, 2020, said the Influenza B viruses accounted for half of the detections in Canada and influenza B/Victoria viruses were the predominant influenza type detected in the USA.

Furthermore, Influenza B is related to the increasing number of influenza-related pediatric fatalities confirmed during the 2019-2020 flu season.

As of January 4, 2020, the reported 21 of the 32 influenza-associated pediatric fatalities were associated with influenza B viruses.

And, so far this season, influenza B virus infections account for about half of all hospitalizations reported through CDC’s laboratory-confirmed influenza hospitalization surveillance network.

Unfortunately, the CDC’s influenza forecasts suggest that national influenza activity will remain elevated for several more weeks.

There are 4 types of influenza viruses: A, B, C, and D. Human influenza A and B viruses cause seasonal flu epidemics almost every winter in the United States.

Influenza B viruses are not divided into subtypes but instead are further classified into two lineages: B/Yamagata and B/Victoria.

Similar to influenza A viruses, influenza B viruses can then be further classified into specific clades and sub-clades.

Influenza B viruses generally change more slowly in terms of their genetic and antigenic properties than influenza A viruses, especially influenza A(H3N2) viruses.

Influenza surveillance data from recent years shows the co-circulation of influenza B viruses from both lineages in the USA and around the world.

However, the proportion of influenza B viruses from each lineage that circulates can vary by geographic location.

In past seasons, the proportion of influenza-related pediatric deaths associated with influenza B viruses has generally been higher than the proportion of influenza B among circulating viruses.

To reduce all influenza health issues, the CDC continues to recommend everyone 6 months of age and older get a flu shot.

All available vaccine formulations this season contain A(H3N2), A(H1N1)pdm09, and B/Victoria virus strains. The 2019-2020 U.S. quadrivalent influenza vaccines contain these and an additional influenza B/Yamagata virus.

The CDC does not recommend any specific influenza vaccine formulation over another.

The CDC also recommends antiviral medications for the treatment of influenza, because antiviral treatment has shown clinical and public health benefit in reducing illness and lessening severe outcomes of influenza.

Influenza antiviral medications are most effective in treating influenza and reducing complications when treatment is started within 48 hours of illness onset.

But if you do start taking flu antivirals on the 3rd day, a few clinical studies suggest there is clinical benefit from antivirals among hospitalized patients and young children with febrile illness even when treatment was started 3 to 5 days after illness onset.

There are 4 influenza antiviral medications approved by the U.S. Food and Drug Administration (FDA) for use in the USA during the 2019-2020 influenza season.

These medications block the viral neuraminidase enzyme and have activity against both influenza A and B viruses.

The 4th medication is oral baloxavir marboxil (trade name Xofluza®), which is active against both influenza A and B viruses but has a different mechanism of action.

Baloxavir is a cap-dependent endonuclease inhibitor that interferes with viral RNA transcription and blocks virus replication.

In October 2019, FDA approved an indication for baloxavir treatment of acute uncomplicated influenza within two days of illness onset in people 12 years and older at high risk of developing influenza-related complications, based upon the findings of a clinical trial.

Flu shots and antiviral medications are available at most pharmacies in the USA.

Last week’s Northern Hemisphere flu report can be found here.

Influenza antiviral and vaccine news is published by Precision Vaccinations.

Sub Title:

Influenza B virus is related to over 50 percent influenza-related pediatric fatalities and hospitalizations during the 2019-2020 flu season

References:

CDC: FluView

CDC: Types of Influenza Viruses

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Northern Hemisphere Flu News for 2020

Don Hackett — Fri, 10 Jan 2020 00:51:34 +0000

Reviewer:

WHO: Influenza Update January 6, 2020

As most of the Northern Hemisphere was celebrating the arrival of the New Year, many areas started to report increasing rates of influenza virus, according to the latest global flu update published by the World Health Organization (WHO).

On January 6, 2020, the WHO reported seasonal influenza A(H3N2) viruses accounted for the majority of detections around the globe.

In the temperate zones of the Northern Hemisphere respiratory illness indicators and influenza activity continued to increase, such as the following.

In the countries of North America, Influenza-Like-Illnesses (ILI) and influenza activity further increased:

All seasonal influenza subtypes co-circulate in Canada and the United States of America (USA), though the proportion of influenza B viruses was higher than in previous years for this period of the influenza season.
Influenza B viruses accounted for half of the detections in Canada and influenza B/Victoria viruses were the predominant influenza type detected in the US, followed by influenza A(H1N1)pdm09.
In Canada, the percentage of visits for ILI and pediatric hospitalizations increased and followed the average trend of previous seasons. For this season the majority of hospitalizations were associated with influenza A(H3N2). However, among sentinel pediatric hospitalizations with influenza, Influenza update approximately 55% were associated with influenza B.
In the USA, ILI activity raised sharply in the last weeks and reached the peak level of last influenza season. Hospitalization rates were similar to those reported during recent seasons. The percentage of deaths attributed to pneumonia and influenza increased but remained below the epidemic threshold.
Sixteen of the 22 influenza-associated pediatric deaths reported in the USA were associated with influenza B viruses.

In Europe, influenza activity continued to increase across the region:

In Northern Europe, influenza detections and syndromic surveillance indicators increased. Influenza A detections predominated in most reporting countries. Among the subtyped influenza A detections, influenza A(H3N2) predominated in Ireland and the United Kingdom of Great Britain and Northern Ireland (United Kingdom) while both influenza A(H1N1)pdm09 and A(H3N2) were reported in Finland and Iceland.
In Ireland, ILI activity was reported at moderate levels; in the United Kingdom, ILI activity was moderate in Northern Ireland and Wales, low in England and below baseline in Scotland in week 50.
In England, influenza hospitalizations and admissions to Intensive Care Units were at mid-levels. Respiratory syncytial virus activity increased in England and was reported as high in Ireland.
In Eastern and Southwestern Europe, influenza detections increased but remained low with influenza A and B viruses reported. Syndromic surveillance indicators increased following seasonal trends but were generally low.

In Central Asia, influenza activity increased with influenza A and B viruses co-circulating in all reporting countries except Uzbekistan where only influenza B viruses were reported:

In Northern Africa, influenza activity was low overall, though Morocco and Tunisia reported influenza B virus detections in recent weeks.
In Western Asia, influenza activity remained elevated overall. Influenza activity continued to increase in Iraq, Israel, Jordan, Turkey, and Yemen, with detections of predominately influenza A(H1N1)pdm09 and a small proportion of B viruses (except in Yemen reporting predominantly influenza A(H1N1)pdm09).
In Bahrain, influenza activity remained elevated with all seasonal influenza subtypes co-circulating. Detections of predominantly influenza B/Victoria lineage were reported as slightly increased in Lebanon.
In Oman, Qatar and Saudi Arabia, influenza activity was reported as decreased with co-circulation of influenza A and B viruses.
In East Asia, ILI and influenza activity continued to increase overall. In China, ILI activity continued to increase and was slightly earlier and higher than the levels of the three previous seasons; influenza activity also increased, with detections of predominately influenza A(H3N2), followed by a smaller proportion of influenza B/Victoria lineage viruses.
In Mongolia, respiratory illness indicators were above the seasonal threshold with increased detections of influenza B viruses reported. In the Republic of Korea, ILI and influenza activity continued to increase with influenza A(H1N1)pdm09 and A(H3N2) viruses co-circulating.
In Japan, influenza activity was detected slightly earlier than in previous seasons, with a continued increase in the number of influenza cases per sentinel site.

In related flu news, the following studies offered new insights:

January 7, 2020 – A new study from Australia revealed influenza vaccinations were 31 percent effective in reducing mortality for hospital-related flu cases.
December 31, 2019 – The UK’s Joint Committee on Vaccination and Immunisation recently issued advice on vaccines in the National Health Service annual seasonal flu vaccination program and reimbursement guidance for 2020-2021 flu season.
December 27, 2019 – The CDC FluView report confirmed there have been 16 pediatric fatalities associated with influenza B viruses during the 2019-2020 flu season. And, 5 of these 16 fatalities had the lineage determined and all were B/Victoria viruses.

The US Centers for Disease Control and Prevention (CDC) says ‘everyone 6 months of age and older should get a flu vaccine every season with rare exceptions. And, suggests patients discuss their vaccination options with a licensed healthcare provider.’

A more detailed explanation of the flu burden and burden averted by seasonal flu vaccines during 2019-2020 are available from CDC’s Flu Burden page.

Flu vaccine news is published by Precision Vaccinations.

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Temperate zone of the northern hemisphere reports respiratory illness indicators and influenza activity increasing

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Diabetics Need Flu Shots Too

Don Hackett — Fri, 03 Jan 2020 18:06:51 +0000

Reviewer:

* Diabetes, Heart, and Lung Associations Support Flu Shots

Diabetes is a complex, chronic illness requiring continuous medical care with risk-reduction strategies beyond glycemic control, says the American Diabetes Association (ADA).

And one of these risk-reduction suggestions from the ADA is for diabetics to get the annual flu shot.

The ADA published on January 1, 2020, its updated “Standards of Medical Care in Diabetes,” which offers both clinicians and patients enhanced vaccination suggestions regarding diabetes care.

Since diabetes can alter a person’s immune system, fighting off infections becomes more difficult. And conditions like influenza can increase blood glucose levels leading to serious complications.

As an example, during the 2018-2019 flu season, approximately 93 percent of US adults who were hospitalized for flu-related complications had an underlying medical condition, such as diabetes.

But, according to a study published by the ADA in 2018, diabetic vaccination rates are not optimized. This ADA study’s participants were only 17.6 percent protected from influenza viruses.

Furthermore, this study’s findings suggest influenza vaccinations in patients with diabetes significantly reduces flu and diabetes-related hospital admissions.

According to the US Centers for Disease Control and Prevention (CDC) latest flu season report on December 21, 2019, there is an elevated and even widespread flu activity in all regions of the country of flu-like illness.

People with diabetes (type 1, type 2, or gestational), even when well-managed, are at high risk of serious flu complications,

And, the CDC estimated that so far this flu season, there have been at least 4.6 million flu illnesses, 39,000 hospitalizations and 2,100 fatalities related to influenza viruses.

With the 2019-2020 influenza season soon to reach its peak infectious time, both the ADA and the CDC say ‘there is still time to get this flu season’s vaccination, since the peak time for flu-related illness is during January, February, and into March in the Northern Hemisphere.’

Diabetes vaccine development news

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* HPV Vaccination Did Not Increase Diabetes Risk

To clarify any questions, the CDC suggests everyone 6 months of age and older should get a flu vaccine every season, with rare exceptions.

This CDC suggestion includes pregnant women. But, the CDC suggests pregnant women not get the nasal spray influenza vaccine for this current flu season.

And, people who have diabetes also should be up to date with pneumococcal vaccination to help protect against pneumococcal disease, says the CDC.

There are various influenza vaccines available at most US pharmacies for the 2019-2020 flu season. Financial support programs for flu shots can be found at Vaccine Discounts.

As always, both the ADA and the CDC say 'vaccination decisions should be part of an ongoing discussion between a provider and patient.'

If you get flu symptoms, call your healthcare provider right away.

Flu symptoms can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. Some people may also have vomiting and diarrhea, though this is more common in children.

Moreover, if you do catch the flu, antiviral medications are an important adjunct to the flu vaccine in the control of influenza. Almost all of the influenza viruses tested this season are susceptible to the 4 FDA-approved influenza antiviral medications recommended for use in the USA for the 2019-2020 flu season.

Influenza vaccine news published by Precision Vaccinations.

Sub Title:

American Diabetes Association offers diabetics enhanced influenza vaccination suggestions for 2020

References:

Standards of Medical Care in diabetes—2020

The Alarming Inadequacy of Adult Vaccination—Vaccination Rates in Diabetic Patients

FluView: Key Updates for Week 52, ending December 28, 2019

This Is The Best Week For Flu Shots

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Universal Flu Shot Remains Elusive

Don Hackett — Sun, 22 Dec 2019 23:08:35 +0000

Reviewer:

New clues about why a universal flu vaccine is so elusive

‘Every year, we’re reminded why can’t we have a flu vaccine that offers long-term protection, like those for measles or polio?'

‘That’s because the influenza virus continuously evolves, so the immune response humans build up each year might not work the next year,’ said Gabriel D. Victora, Ph.D., an assistant professor at The Rockefeller University, in a December 20, 2019, press release.

Already in late 2019, the Centers for Disease Control and Prevention (CDC) estimated on December 14th that during this flu season, there have been at least 3.7 million flu illnesses, 32,000 hospitalizations, and 1,800 related fatalities.

And, the CDC has confirmed 19 pediatric fatalities related to 2019 flu viruses.

But, new findings recently published in Cell give an indication ‘why making a general-purpose vaccine that guards against all versions of the flu is so hard to produce.’

‘Instead of improving its memory of the previous version of the influenza virus, the immune system develops its response to the new virus variant from scratch, mostly using immune cells that have no memory of the virus.’

“If we can help the immune system to keep building on what it has already learned, we could develop better vaccines for highly evolving viruses like the flu, or HIV, or Hepatitis C,” says Dr. Vicora.

In this study, Dr. Victora and team explored the behavior of immune cells in mice after a 1st and 2nd exposure to a flu vaccine.

Specifically, they looked at B cells, white blood cells that release antibodies.

During an infection or immunization, B cells enter so-called germinal centers in the lymph nodes, where they mutate many times until they evolve to target the new invader.

“A germinal center is like a boot camp,” said Dr. Victora.

“They go in very bad, they come out very good, releasing better antibodies that bind more tightly to their targets.”

Those very good B cells are the immune system’s cellular memory and can release antibodies that latch on to one part of the virus.

Ideally, these B cells would return to the germinal centers the next time the body is faced with a virus or vaccine and evolve even more sophisticated antibodies to target the slightly different version of the virus even better, ultimately becoming able to produce the so-called broadly neutralizing antibodies that the virus can’t escape from.

And that’s what researchers need in order to make a universal vaccine.

“The idea is you would keep calling memory cells back into germinal centers by repeated vaccination,” Dr. Victora says, “in order to make them evolve several times until they become the super B cells that you need to give you a universal flu vaccine or an HIV vaccine.”

But instead of seeing the B cells return, the researchers found something different.

They genetically marked the mice’s germinal centers with fluorescent colors during the first vaccination so they could track the behavior of their descendants during the 2nd vaccination.

To their surprise, more than 90 percent of the B cells that entered the germinal centers on the 2nd vaccination were uncolored—a sign that they were newcomers.

Genetic analysis also revealed these cells hadn’t gone through the mutation process that germinal center B cells typically undergo, further suggesting they were present in that site for the first time.

The boot camp veterans, however, were mostly absent.

Out of the hundreds of types of B cells that entered the germinal centers on the first vaccination, only a few made it back the second time, despite many of them being able to bind to the virus. It appears that coming back a second time is reserved only for a chosen few B cells.

This finding, if further studies show is also the case in humans, has implications for vaccine design.

In order to arrive at strong B cells, researchers need to understand what is blocking the cells from returning to camp.

“If we can understand these bottlenecks that don’t allow these cells back in, that might help us to find a way to circumvent them, making it easier for repeated vaccination approaches to work,” Victora says.

This would give the cells the chance to undergo the many rounds of mutations they need in order to arrive at antibodies that target all variants of virus-like flu.

This data also suggests that, in order to be efficiently targeted by sequential immunization, an epitope must be rendered dominant from the very beginning.

Furthermore, the CDC says ‘It’s not too late to get vaccinated.’

‘Influenza vaccination is always the best way to protect yourself from the various flu viruses and its potentially serious complications.’

And, antiviral medications are an important adjunct to the flu vaccine in the control of influenza.

Almost all (>99%) of the influenza viruses tested this season are susceptible to the FDA-approved influenza antiviral medications recommended for use in the USA for the 2019-2020 flu season, said the CDC on December 20th.

This research work was funded by NIH/NIAID grants, with additional support from Gates Foundation grant and NIH grant, research grants from The Ministry of Education, Culture, Sports, Science, and Technology, by a Rockefeller University Helmsley Postdoctoral Fellowship, a Boehringer-Ingelheim Fonds Ph.D. fellow, a Cancer Research Institute-Irvington postdoctoral fellow, a Louis and Rachel Rudin Fellowship in Immunology and NIGMS Medical Scientist Training Program, a Burroughs-Wellcome Investigator in the Pathogenesis of Infectious Disease, a Pew-Stewart Scholar, and a MacArthur Fellow.

The authors declare no competing interests.

About: The world’s leading biomedical research university, Rockefeller draws top scientists and graduate students from around the world in pursuit of one mission: to conduct science for the benefit of humanity. In 1955, The Rockefeller Institute expanded its mission to include education and admitted its first class of graduate students. The Rockefeller Institute became The Rockefeller University, broadening its research mandate further.

Influenza news published by Precision Vaccinations.

Sub Title:

Rockefeller researcher says Super B cells are needed to produce a universal influenza vaccine

References:

Restricted Clonality and Limited Germinal Center Reentry Characterize Memory B Cell Reactivation by Boosting

CDC: Weekly US Influenza Surveillance Report (FluView)

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Trinidad & Tobago Flu-Related Fatalities Increase 300%

Danielle Reiter RN — Wed, 04 Dec 2019 14:49:51 +0000

Reviewer:

Ministry of Health: Advises Most Influenza Deaths from High-Risk Groups

Holly Lutmer PharmD

The Government of the Republic of Trinidad & Tobago Ministry of Health (MoH) issued an update from Port of Spain ‘sounding the alarm for high-risk members of the public to get the annual influenza vaccination.’

In a media release published on December 3, 2019, the MoH noted that ‘24 people have already died during the current flu season.’

During the last flu season, Trinidad & Tobago only confirmed 7 influenza-related fatalities.

“Influenza viruses are serious and are generally more severe than the common cold."

This increase in flu-related fatalities could be related to the ‘drifting’ of influenza viruses in the Southern Hemisphere.

A report from Eurosurveillance shows that within countries of the Southern Hemisphere, the timing, duration, and intensity of the predominant circulating influenza viruses all varied during the 2019 influenza season.

This variability was noted even between neighboring countries.

This Eurosurveillance report published on November 7, 2019, means that the ‘flu activity in one country was not indicative of activity in another country, even when influenza seasons are contemporaneous.’

The early Vaccine Effectiveness estimates for the 2019 influenza season in the Southern Hemisphere presented in this report were highest for influenza A(H1N1)pdm09 and lowest for A(H3N2).

‘To remove any financial barriers, the flu vaccine is available, at no cost, at all health centers in Trinidad & Tobago,’ said the MoH statement. And, members of the public are advised to contact their nearest health center to confirm when influenza vaccines will be distributed.

This new Trinidad & Tobago MoH statement says the majority of persons who have died from Influenza this season were in one of these high-risk categories:

65 years old or older
5 years old or less
Diabetic
Hypertensive
Obese
Smoked Tobacco Products

The Republic of Trinidad & Tobago is the southernmost island country of about 1.3 million residents in the Caribbean, consisting of the main islands Trinidad and Tobago, and numerous much smaller islands.

About 400,000 international travelers visit these islands annually, which are located south of Grenada and just off the coast of northeastern Venezuela.

The US Centers for Disease Control and Prevention (CDC) suggest various vaccinations, such as a flu shot, prior to visiting Trinidad & Tobago. The CDC’s August 2, 2019 update also includes a measles alert for Trinidad & Tobago.

The CDC says any vaccine can create a side effect, which should be reported to a healthcare provider asap.

Trinidad & Tobago vaccine news published by Vax Before Travel

Sub Title:

Southern Hemisphere influenza virus drifting can reduce flu shot effectiveness

References:

Ministry of Health: Weekly Infuenza Update

Ministry of Health: Influenza Vaccination Drive

CDC: Health Information for Travelers to Trinidad and Tobago

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Texas Reports 1st Pediatric Fatality This Flu Season

Don Hackett — Sun, 17 Nov 2019 02:44:50 +0000

Reviewer:

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Influenza activity is increasing and has exceeded the Texas-specific influenza-like illness (ILI) baseline for the first time this flu season, reported the Department of State Health Services (DSHS).

This Texas DSHS report published on November 15, 2019, also includes news of the 1st influenza-related pediatric fatality in the state of Texas this season.

During the 2018-2019 influenza season, the DSHS confirmed 17 influenza-associated pediatric fatalities in Texas.

Throughout the USA, the Centers for Disease Control and Prevention (CDC) has confirmed a total of 3 influenza-associated pediatric fatalities occurring during the 2019-2020 season.

One fatality was associated with an influenza A virus, for which no subtyping was performed and occurred the week ending February 16, 2019, in the 2018-2019 season.

This new information increases the total number of fatalities during the last flu season to 143 children in the USA.

During the 2017-2018 flu season, the CDC confirmed a total of 187 pediatric fatalities.

"Be very careful if you get the flu, as you can pass it on to someone with a weak immune system that can really become sick. Getting a flu shot not only protects yourself but also those you love," said Crockett Tidwell RPh, CDE, United Supermarkets Pharmacy.

An influenza-associated pediatric death is defined for surveillance purposes as a death resulting from a clinically compatible illness that was confirmed to be influenza by an appropriate laboratory diagnostic test.

During week 45, data collected in ILINet showed the following ILI activity levels throughout the USA:

High – Louisiana
Moderate – Puerto Rico and Alabama, Georgia, Mississippi, South Carolina, and Texas
Low – Arizona, Arkansas, Connecticut, Missouri, Nevada, New Mexico, Oklahoma, Tennessee, and Virginia
Minimal – the District of Columbia, New York City, and 35 states (Alaska, California, Colorado, Delaware, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Washington, West Virginia, Wisconsin and Wyoming)
Data were insufficient to calculate an ILI activity level from the U.S. Virgin Islands.

Nationally influenza B/Victoria viruses have been reported more frequently than other influenza viruses this season, however, influenza A(H3N2) and A(H1N1)pdm09 viruses are also circulating widely.

Nationally, influenza B/Victoria viruses are the most commonly reported influenza viruses among children age 0-4 years (45% of reported viruses) and 5-24 years (53% of reported viruses), while A(H3N2) viruses are the most commonly reported influenza viruses among persons 65 years of age and older (72% of reported viruses).

Among adults aged 25-64 years, approximately equal proportions of influenza A(H1N1)pdm09, A(H3N2) and B/Victoria viruses (31%, 30%, and 26%, respectively) have been reported to the CDC.

Most people who get sick with flu will have a mild illness, will not need medical care or antiviral drugs and will recover in less than 2 weeks. Some people, however, are more likely to get flu complications that can result in hospitalization and sometimes death, says the CDC.

Flu vaccination is always the best way to prevent flu and its potentially serious complications.

Furthermore, pregnant women remain the highest priority group for annual influenza vaccination, and a new study adds more evidence to that focus.

This new study published on November 11th in England found that when pregnant women receive an influenza vaccination, their future infants experience a reduced number of flu cases and related hospitalizations prior to reaching 6 months of age.

Also, getting vaccinated can help protect a baby after birth from flu, as the mother passes protective antibodies onto the developing baby during her pregnancy, says the CDC.

Most flu vaccines protect against 4 different influenza viruses for the 2019-2020 Northern Hemisphere season.

The CDC also suggests pregnant women get a flu shot and not the nasal spray influenza vaccine for the current flu season. The nasal spray flu vaccine is approved for use in non-pregnant individuals, 2 years through 49 years of age.

But, people with some certain medical conditions should not receive the nasal spray flu vaccine.

As always, vaccination decisions should be part of an ongoing discussion between a provider and patient.

Previously, the American Lung Association and the American Diabetes Association joined the American Heart Association on October 16, 2019, ‘urging 117 million adults living with chronic health conditions, including diabetes, heart disease, and lung diseases to prioritize annual flu shots within their practices.’

Influenza news published by Precision Vaccinations

Sub Title:

Texas DSHS confirmed 17 influenza-associated pediatric fatalities during 2018-2019 flu season

References:

2018-2019 Texas Influenza Surveillance Activity Report

CDC: FluView

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Southern Hemisphere Influenza Season Was Peculiar

Don Hackett — Thu, 07 Nov 2019 23:10:55 +0000

Reviewer:

Heterogeneity in influenza seasonality and vaccine effectiveness in Australia, Chile, New Zealand and South Africa

A new report from Eurosurvellance shows that within countries of the Southern Hemisphere, the timing, duration, and intensity of the predominant circulating influenza viruses all varied during the 2019 influenza season.

This variability was noted even between neighboring countries.

This Eurosurveillance report on November 7, 2019, includes data from Australia, Chile, New Zealand, and South Africa.

This means that the ‘flu activity in one country was not indicative of activity in another country, even when influenza seasons are contemporaneous,’ concluded this November 7, 2019 report.

The early Vaccine Effectiveness (VE) estimates for the 2019 influenza season in the Southern Hemisphere presented in this report were highest for influenza A(H1N1)pdm09 and lowest for A(H3N2).

However, the utility of these estimates for the Northern Hemisphere may be limited because the 2019 Southern Hemisphere vaccine differed from the 2019/20 Northern Hemisphere formulation in 3 of 4 components, A(H1N1)pdm09, A(H3N2) and B/Victoria.

Nevertheless, these estimates or earlier versions of them were included with other data reviewed at the WHO Consultation and Information Meeting on the Composition of Influenza Virus Vaccines for Use in the 2020 Southern Hemisphere Influenza Season.

There are many potential sources for this heterogeneity that affect not only the VE estimates but interpretation of weekly activity rates.

First, with random sampling, we should not expect estimates to be the same.
Second, when samples are small they may be vulnerable to statistical biases, such as sparse data bias, and bias due to measurement errors may be more profound.
Third, there were many differences in study design. Case ascertainment differed; for example, a SARI case definition was used in New Zealand and Chile, but not in Australian hospital surveillance. Exposure ascertainment also differed, with varying availability of registries to verify vaccination status and the use of different vaccines. In particular, the adjuvanted vaccines used among Australians ≥ 65 years of age might be expected to yield higher VE than standard vaccines.
Fourth, vaccine coverage varied. Low vaccination coverage, as observed in South Africa, affects power and precision and can exacerbate the bias induced by measurement errors. Higher coverage, as seen in Chile and among elderly patients in New Zealand and Australia, may mean that many more people in the sample are repeat vaccinees. Repeat vaccination may negatively impact VE and could result in lower VE estimates in highly vaccinated populations.
Fifth, although only limited virological data were available, we observed differences in circulating A(H3N2) virus clades and B lineages. This may impact both seasonality and VE, particularly as most A(H3N2) viruses sequenced appeared to be in different clades from the vaccine virus (3C.2a2). Notably, most A(H3N2) viruses were also in different genetic groups from the 2019/20 northern hemisphere vaccine.

In conclusion, this report attempted to briefly summarise and interpret the 2019 influenza season in 4 Southern Hemisphere countries and have presented early VE estimates.

We observed substantial variation in available data on influenza seasonality and VE within the southern hemisphere in 2019, which is unsurprising given the many differences in surveillance among these countries.

The US Centers for Disease Control and Prevention (CDC) suggests everyone 6 months of age and older should get a flu vaccine every season, with rare exceptions.

Different flu vaccines are approved for use in different groups of people. There are flu shots approved for use in children as young as 6 months of age and flu shots approved for use in adults 65 years and older.

Additionally, the CDC continues to recommend that pregnant women get an influenza vaccine during any trimester of their pregnancy because influenza poses a danger to pregnant women and a flu shot can prevent influenza in pregnant women.

As always, vaccination decisions should be part of an ongoing discussion between a provider and patient.

NOTE: Caution should be applied when attempting to infer the impending Northern Hemisphere influenza season based on these observations.

Various potential conflicts of interest were disclosed.

Influenza Vaccine news published by Precision Vaccinations

Sub Title:

Influenza seasonality and vaccine effectiveness varied substantially within the southern hemisphere during 2019

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The Flu Season Has Arrived in Louisiana and Puerto Rico

Don Hackett — Sat, 26 Oct 2019 22:29:40 +0000

Reviewer:

John Paul Sanchez, PharmD

According to new information from the Centers for Disease Control and Prevention (CDC), the seasonal influenza activity in the United States increased slightly but remains low, when compared to previous years.

This is good news since the Australian flu season in the Southern Hemisphere was reported to have started 2-months earlier than the 2018 flu season.

The flu season in the USA typically begins in October with a peak number of cases reported in February. And during the early part of 2019, the flu season continued into May.

As of October 25, 2019, the CDC reported the following highlights from its Week #42 FluView Report, with data up to October 19, 2019:

The initial influenza-associated pediatric deaths were reported to CDC. One death was associated with an influenza A virus for which no subtyping was performed and one death was associated with an influenza B/Victoria virus. During the 2018-2019 flu season, 138 pediatric deaths were confirmed.
Nationwide, 1.7% 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 2.4%.
During week 42, the following ILI activity levels were ‘High’ in Puerto Rico and Louisiana; and ‘Low’ in Alabama, Connecticut, Hawaii, and Missouri.
Influenza A (H3N2) viruses and influenza B/Victoria viruses have circulated at similar levels nationally this season. Influenza B/Victoria viruses have predominated in the south and southeast regions (regions 4 and 6) while influenza A (H3N2) viruses have predominated elsewhere.

While Australia isn’t always indicative of what the flu season may be like in the Northern Hemisphere, the CDC does pay close attention.

H3N2 was the predominant strain in the Southern Hemisphere for 2019—a strain that is known for more severe illness, especially among vulnerable populations such as the elderly.

This data lead the World Health Organization (WHO) advisory group to recommend exchanging the H3N2 component and one that covers the influenza B Victoria lineage in the Southern Hemisphere's 2020 flu vaccines.

This WHO announcement on September 27, 2019, recommends the following components for the 2020’s Southern Hemisphere influenza vaccines:

For H1N1, an A/Brisbane/02/2018-like virus
For H3N2, an A/South Australia/34/2019-like virus
For B Victoria, a B/Washington/02/2019-like virus
For Yamagata, a B/Phuket/3073/2013-like virus

Additionally, the WHO reported the new H3N2 component is A/South Australia/34/2019, which replaces A/Kansas/14/2017, which was the delayed component for the Northern Hemisphere's 2019-2020 influenza season.

The newly recommended H3N2 strain is also a change from the current Southern Hemisphere’s vaccine, which was A/Switzerland/8060/2017.

Also, the new influenza B Victoria lineage strain is B/Washington/02/2019, which replaces the B/Colorado/06/2017.

The group's pick for the 2009 H1N1 strain is the same as this season's Northern Hemisphere vaccine but is different than the one included in the current Southern Hemisphere vaccine, which is the A/Michigan/45/2015.

For egg-based trivalent versions that have only one B strain, the WHO experts recommended including the Victoria lineage vaccine virus.

These component changes could mean that what’s in the current Northern Hemisphere vaccine may not be the best match to protect people from the approaching Southern Hemisphere version circulating the globe.

The complete WHO report is available here.

Influenza Vaccine news

Additionally, the CDC says ‘all pregnant women and for each pregnancy, it is recommended that patients receive an influenza vaccine.’

However, vaccine uptake remains far below the CDC’s target goals.

During the 2017–18 influenza season, only 49 percent of pregnant women received influenza vaccination before or during pregnancy.

Jamie Nixon, Pharmacy Intern at Brookshire Grocery Company in Tyler, Texas, recently said "Getting a flu shot is just another way to ensure the health of the mother and baby is protected.”

“Talk with your doctor, nurse or pharmacist about which flu shot is best for you," shared Nixon.

In a previous CDC study published in 2018, the most commonly reported reason for not receiving influenza vaccination before or during pregnancy was the belief that the vaccine is not effective (20%).

The CDC’s FluView includes enhanced web-based interactive applications that can provide dynamic visuals of the influenza data collected and analyzed by the CDC.

These FluView Interactive applications allow people to create customized, visual interpretations of influenza data, as well as make comparisons across flu seasons, regions, age groups and a variety of other demographics. To access these tools, visit Flu View Interactive.

Influenza news published by Precision Vaccinations

Sub Title:

CDC confirmed 2 influenza-related pediatric deaths for the 2019-2020 flu season

Reference:

CDC: Weekly U.S. Influenza Surveillance Report

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Xofluza Approved for People at High Risk of Developing Influenza-Related Complications

Don Hackett — Thu, 17 Oct 2019 17:40:01 +0000

Reviewer:

Genentech Announces FDA Approval of Xofluza for People at High Risk of Developing Influenza-Related Complications

Genentech announced that the U.S. Food and Drug Administration (FDA) has approved a supplemental New Drug Application for Xofluza™ for the treatment of acute, uncomplicated influenza in people 12 years of age and older who have been symptomatic for no more than 48 hours, and who are at high risk of developing flu-related complications.

Although flu vaccines are an important first line of defense in preventing the flu, there is a need for new medical options for prophylaxis and treatment, said Genentech.

Xofluza (baloxavir marboxil) is a first-in-class, 1-dose oral medicine with a novel proposed mechanism of action that inhibits polymerase acidic endonuclease, an enzyme essential for viral replication.

In October 2018, Xofluza was first approved by the FDA for the treatment of acute, uncomplicated flu in otherwise healthy people 12 years of age and older who have been symptomatic for no more than 48 hours, representing the first new antiviral to treat the flu in the U.S. in 20 years.

This expanded indication for Xofluza was approved based on results from the Phase III CAPSTONE-2 study of a single dose of 40 mg or 80 mg of Xofluza compared to oseltamivir (75 mg twice daily for five days), or placebo in people 12 years of age or older who met the criteria for being at high risk of complications from the flu.

Xofluza significantly reduced the time to improvement of flu symptoms compared to placebo, including in people infected with the flu type B virus. Adverse events reported in at least 1% of adult and adolescent subjects treated with Xofluza included diarrhea (3%), bronchitis (3%), nausea (2%), sinusitis (2%) and headache (1%).

Levi Garraway, M.D., Ph.D., chief medical officer and head of Global Product Development, said in a October 17, 2019, press release, “People with chronic conditions such as asthma, heart disease, and diabetes are at higher risk of developing serious complications from the flu, so it is critical that these patients speak with their healthcare providers about possible treatment at the first signs and symptoms of the disease.”

Important Safety Information

Do not take XOFLUZA if you are allergic to baloxavir marboxil or any of the ingredients in XOFLUZA.
Before you take XOFLUZA, tell your healthcare provider about all of your medical conditions, including if you:
Are pregnant or plan to become pregnant. It is not known if XOFLUZA can harm your unborn baby.
Are breastfeeding or plan to breastfeed. It is not known if XOFLUZA passes into your breast milk.

The Centers for Disease Control and Prevention (CDC) defines people at high risk of serious flu complications as those who have conditions such as asthma, chronic lung disease, diabetes, heart disease, morbid obesity or adults 65 years of age or older.

Influenza, or flu, is one of the most common, yet serious, infectious diseases, representing a significant threat to public health. Since 2010, the CDC estimates that the flu has resulted annually in 9.3 to 49 million illnesses, 140,000 to 960,000 hospitalizations and 12,000 to 79,000 deaths.

Other antiviral medicines have limitations with respect to efficacy, the convenience of dosing and resistance. Genentech is committed to addressing the unmet need in this area through its agreement with Shionogi & Co., Ltd. to develop and commercialize Xofluza.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Genentech is a leading biotechnology company that discovers, develops, manufactures and commercializes medicines to treat patients with serious and life-threatening medical conditions. For additional information about the company, please visit Genentech.

Influenza news published by Precision Vaccinations

Sub Title:

Flu shots are an important first line of defense in preventing influenza

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In-Hospital Flu Shots Associated With a 6.5% Reduction in Re-admissions

Don Hackett — Mon, 14 Oct 2019 13:58:01 +0000

Reviewer:

Routine influenza vaccination for all adults hospitalized with pneumonia may save lives and reduce hospitalizations

A new study found that among adults admitted to a hospital with pneumonia, patients who received an influenza vaccination had a 6.5 percent lower chance of being readmitted.

"One striking fact that we also discovered in this study is that less than 2 percent of patients hospitalized with pneumonia received an influenza vaccine during their hospital stay, which indicates an underutilized service, with significant implications on hospital readmission and mortality," stated Kam Sing Ho, M.D., in a October 15, 2019, press release.

The co-occurrence of influenza and pneumonia has been well established, accounting for up to half of deaths during seasonal influenza in the United States.

"This study highlights the importance of implementing influenza vaccination, specifically in patients with a diagnosis of community-acquired pneumonia," commented Michelle Cao, M.D., Clinical Associate Professor at Stanford University.

"Influenza vaccination is considered a 'primary care-driven service,'" Dr. Cao continued.

"The question is how best to develop practices that would ensure successful vaccination in the inpatient setting, specifically for patients admitted for community-acquired pneumonia.”

The researchers conducted a retrospective study of 735,120 hospital admissions for community-acquired pneumonia to understand the role of influenza vaccinations in reducing health care spending.

They found that the in-hospital influenza vaccinations were given to 1.91% (13,983) of the patients admitted with pneumonia.

The investigators found that the overall 30-day rate of readmission was 11.9%.

Nearly all return patients (81%) were readmitted with pneumonia.

The readmitted patients had double the risk of dying (7.69%) than the index admissions (3.32%).

Furthermore, a total of 489,247 hospital days was associated with readmission, and the total healthcare in-hospital economic burden was $1 billion in costs and $3.67 billion in charges.

Further results from this study will be shared at CHEST Annual Meeting 2019 in New Orleans on Monday, Oct. 21, 2:48 p.m. to 2:51 p.m., in Poster Area 1 of the Ernest N. Morial Convention Center's Exhibit Hall. The study abstracts can be viewed on the journal CHEST® website.

The American College of Chest Physicians, publisher of the journal CHEST®, is the global leader in advancing best patient outcomes through innovative chest medicine education, clinical research, and team-based care. Its mission is to champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research.

Influenza news published by Precision Vaccinations

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Hospital readmissions for community-acquired pneumonia can be reduced with influenza vaccination

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