Influenza Vaccines

Recommendations for Prevention and Control of Influenza in Children, 2021–2022

The American Academy of Pediatrics (AAP) announced recommendations for the routine use of influenza vaccine and antiviral medications to prevent and treat influenza in children during the 2021–2022 influenza season.

The AAP stated on September 7, 2021, it recommends annual influenza immunization of all children without medical contraindications, starting at six months of age.

Excerpts from the AAP statement are discussed below:

Influenza vaccination is necessary to protect vulnerable populations and reduce the burden of respiratory illnesses during the circulation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is expected to continue during the 2021–2022 flu season.

According to the AAP, any licensed recommended age-appropriate influenza vaccine available can be administered without preference for one product or formulation over another.

Furthermore, antiviral treatment of influenza with any licensed, recommended, age-appropriate influenza antiviral medication is recommended for children with suspected or confirmed influenza who are hospitalized, have severe or progressive disease, or have underlying conditions that increase their risk of complications of influenza.

And, antiviral treatment may be considered for any previously healthy, symptomatic outpatient, not at high risk for influenza complications, in whom an influenza diagnosis is confirmed or suspected if treatment can be initiated within 48 hours of illness onset, and for children whose siblings or household contacts either are younger than six months or have a high-risk condition that predisposes them to complications of influenza.

Moreover, influenza vaccines may be administered simultaneously with or any time before or after administration of the current U.S. FDA Approved or Authorized COVID-19 vaccines.

Given that it is unknown whether reactogenicity of COVID-19 vaccines will be increased with coadministration of influenza vaccine, the reactogenicity profile of the vaccines should be considered, and providers should consult the most current CDC Advisory Committee on Immunization Practices (ACIP)/AAP guidance regarding coadministration of COVID-19 vaccines with influenza vaccines.

'No data are currently available concerning coadministration of currently Authorized COVID-19 vaccines and influenza vaccines,' stated Lisa Grohskopf, M.D., MPH, ACIP vaccine committee presentation on June 24, 2021.

However, children with acute moderate or severe COVID-19 should not receive the influenza vaccine until they have recovered. But children with mild illness may be vaccinated, says the AAP.

This APP policy statement summarizes updates and recommendations for the 2021–2022 influenza season. In addition, a detailed review of the evidence supporting these recommendations is published in the technical report.

Note: As of September 10, 2021, the U.S. CDC’s U.S. Influenza Surveillance Report confirmed one influenza-associated pediatric death occurring during the 2020-2021 season had been reported to CDC. This data contrasted with the 2019-2020 flu season when 199 influenza-associated pediatric deaths were confirmed.

PrecisionVaccinations publishes fact-checked research-based vaccine news.

Sub Title:

Pediatricians recommend annual flu shots of most children without medical contraindications

References:

CDC: Prevention and Control of Seasonal Influenza with Vaccines

CDC: Weekly US Influenza Surveillance Report (FluView)

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Tuesday, September 14, 2021 - 06:30

When Should We Get Flu Shots This Year?

Don Hackett — Sat, 26 Jun 2021 12:23:24 +0000

Reviewer:

Seasonal Influenza Vaccines

Since flu vaccines are most protective when the influenza season is intense, the timing of getting the annual vaccination is essential.

Unlike most flu seasons, predicting when the 2021-2022 flu season will reach the USA from the Southern Hemisphere is unknown, said the US Centers for Disease Control and Prevention (CDC) vaccine committee on June 24, 2021. The CDC recently reported influenza cases were lower this year than any flu season since 2005.

The CDC estimates the number of flu illnesses, medical visits, and hospitalization prevented depends on how protective vaccines are each year.

During the CDC’s Advisory Committee on Immunization Practices (ACIP) influenza presentation led by H. Keipp Talbot, M.D., MPH Chair, Influenza Work Group, developing a clear message regarding influenza vaccination timing is a top priority for 2021-2022.

The ACIP’s core message has not changed…. ‘Annual influenza vaccination is recommended for all persons aged six months and older who do not have contraindications,’ presented Lisa Grohskopf, M.D., MPH, Influenza Division, NCIRD, CDC.

And the ACIP confirmed what types of influenza vaccines would be available in the USA this flu season… ‘All vaccines expected for 2021-22 are quadrivalent (i.e., contain hemagglutinin derived from four viruses: one influenza A(H1N1), one influenza A(H3N2), one influenza B/Victoria and one influenza B/Yamagata.’

Most flu shots will be quadrivalent vaccine (99%) and thimerosal-free or reduced vaccine (87%). Additionally, about 20% will be egg-free.

Moreover, the question about COVID-19 and influenza vaccine coadministration was clarified on June 1, 2021... “COVID-19 vaccines were previously recommended to be administered alone, with a minimum interval of 14 days before or after administration of any other vaccines. This was out of an abundance of caution and not due to any known safety or immunogenicity concerns.’

‘However, actual data is now being collected regarding the safety of COVID-19 vaccine currently authorized by U.S. FDA for use under Emergency Use Authorizations…COVID-19 vaccines and other vaccines may now be administered without regard to timing.”

Furthermore, there should be ample flu shot availability this year since about 193 million influenza vaccines will be stocked by doctors, pharmacists, and nurses. Last flu season, 193.8 flu vaccines were distributed by vaccine manufacturers as of late February 2021.

This leads to the ‘when to get a flu shot during the 2021-2022 flu season’ question.

Over the past thirty-six flu seasons, peak influenza activity occurred around January and February, says the CDC.

Declines in influenza VE throughout each flu season have been noted in many observational studies. However, the influenza vaccine ‘waning’ appears to be more pronounced among older adults, and there is less evidence of waning among children.

The CDC’s proposed new language for children is a follows… “Children of any age who require only one flu shot for the season should ideally be vaccinated by the end of October; vaccination of these children may occur as soon as vaccines become available, as there is less evidence to suggest that early vaccination is associated with waning immunity among children as compared with adults.”

However, new reports from Southern Hemisphere countries indicate there is minimal detection of influenza viruses. The latest Pan American Health Organization (PAHO) report says, ‘Despite continued or even increased testing for influenza in some countries, influenza activity remained at lower levels than expected for this time of the year.’

In the temperate zone of the southern hemisphere, influenza activity remained at an inter-seasonal level. In Southern Asia, few influenza detections were reported from Bangladesh, India, Nepal, and Pakistan. And in Southeast Asia, no influenza detections were reported,’ said the PAHO report issued on June 23, 2021.

Furthermore, with the CDC discouraging international travel because of the ongoing COVID-19 pandemic, very few people are visiting the USA. The current US Transportation Security Agency data indicates overall travel volume remains about 30% less than pre-COVID-19 pandemic levels, which reduces the likelihood flu-infectious travelers will visit the USA during Fall 2021.

Since Dr. Grohskopf and the other ACIP members did not recommend modifying the current ‘when to get a flu shot guidance,’ the group suggested everyone rely on the U.S. influenza surveillance system to determine when and where influenza activity is occurring.

This system is a collaborative effort between CDC and its many partners in state and local health departments, public health and clinical laboratories, vital statistics offices, healthcare providers, clinics, and emergency departments.

For more information about CDC’s influenza surveillance activities, see the Overview of Influenza Surveillance in the United States.

PrecisionVaccination publishes research-based vaccine news.

Note: this article was updated for content style.

Sub Title:

Influenza vaccines become available during late summer annually

References:

CDC: WG Considerations and Proposed Influenza Vaccine Recommendations, 2021-22

CDC: COVID-19 Vaccines

CDC: Influenza (Flu)

PAHO: Influenza Situation Report

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Saturday, June 26, 2021 - 10:45

Pediatric Influenza Cases Increased Last Week

Don Hackett — Fri, 14 May 2021 17:19:07 +0000

Reviewer:

2021–2022 INFLUENZA SEASON

The US Centers for Disease Control and Prevention (CDC) reported today, the 2020-2021 influenza season has begun to accelerate in the pediatric population.

The CDC confirmed on May 14, 2021, the percentages of provider visits in Week #18 continued to increase for one age group (0–4 years) and remained stable for the remaining age groups compared with Week #17.

About 6% of provider visits for children were related to the seasonal flu.

However, there has not been an increase in influenza-associated pediatric deaths reported to CDC. As of Week #18, one influenza-associated pediatric death has been confirmed during the 2020-2021 flu season.

This is good news when compared with last flu season when 198 influenza-associated pediatric deaths were confirmed.

The CDC continues to recommend the annual flu shot for children older than six months of age. The most common flu shot for the 2020-2021 influenza season in the Northern Hemisphere is quadrivalent vaccines that protect people against four viruses.

Regarding the older populations, the CDC reported an equally positive trend.

The Influenza Hospitalization Surveillance Network (FluSurv-NET) confirmed between October 2020, and April 30, 2021, fourteen US states reported 226 laboratory-confirmed influenza hospitalizations for an overall cumulative hospitalization rate of 0.8 per 100,000 population.

This is lower than rates for any season since systematic data collection began in 2005. Due to low case counts, only overall cumulative influenza rates for the entire FluSurv-NET are reported this season.

Of the 22,487 specimens tested, 22 were found positive (.1%). Influenza B was confirmed in 54.5% of these specimens.

The CDC says ‘many people are accessing the health care system in alternative settings, which may or may not be captured in the data. Therefore, flu activity levels should be interpreted with caution.

It is essential to evaluate syndromic surveillance data in the context of other sources of surveillance data to obtain a complete and accurate picture of both influenza and COVID-19 activity.

The CDC is tracking the COVID-19 pandemic in a weekly publication called COVID Data Tracker Weekly Review.

As the 2021-2022 flu season in the Northern Hemisphere arrives in August, the CDC and the US Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) made the influenza vaccine composition recommendation for the USA.

The 2021–2022 U.S. influenza vaccines' composition includes updates to the influenza A(H1N1)pdm09 and influenza A(H3N2) components.

The VRBPAC vaccine recommendations are based on several factors, including global influenza virologic and epidemiologic surveillance, genetic characterization, antigenic characterization, and the candidate vaccine viruses for production.

An updated listing of available flu shots is posted on this webpage.

PrecisionVaccinations publishes research-based vaccine news.

Sub Title:

Influenza-associated pediatric deaths remain well below forecast

References:

CDC: FluView

CDC: FluView Interactive

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Saturday, May 15, 2021 - 05:15

Flu Vaccine Changes Confirmed for 2021-2022

Don Hackett — Sat, 27 Feb 2021 21:29:35 +0000

Reviewer:

The World Health Organization (WHO) announced that the influenza vaccine selection committee finalized its recommendations for the Northern Hemisphere's 2021-22 flu season.

These recommendations were made within the context of the ongoing COVID-19 pandemic. Overall, record-low levels of influenza detections were reported, and fewer viruses were available for characterization during September 2020 to January 2021 time period than in previous years, said the WHO.

Globally, since September 2020, influenza activity was mostly reported from countries in the tropics and subtropics and some countries in the temperate zone of the Northern Hemisphere.

Overall, the percent positivity for influenza viruses in all specimens tested was less than 0.2% during this period. In contrast, the average percent positivity during the same reporting period of the three previous seasons (2017-2020) was 17%.

On February 26, 2021, the WHO recommended that quadrivalent vaccines for use in the 2021 - 2022 northern hemisphere influenza season contain the following:

Egg-based Vaccines:

an A/Victoria/2570/2019 (H1N1)pdm09-like virus
an A/Cambodia/e0826360/2020 (H3N2)-like virus
a B/Washington/02/2019 (B/Victoria lineage)-like virus
a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus

Cell- or recombinant-based Vaccines:

an A/Wisconsin/588/2019 (H1N1)pdm09-like virus
an A/Cambodia/e0826360/2020 (H3N2)-like virus
a B/Washington/02/2019 (B/Victoria lineage)-like virus
a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus

It is recommended that trivalent influenza vaccines for use in the 2021 - 2022 Northern Hemisphere influenza season contain the following:

Egg-based Vaccines:

an A/Victoria/2570/2019 (H1N1)pdm09-like virus
an A/Cambodia/e0826360/2020 (H3N2)-like virus
a B/Washington/02/2019 (B/Victoria lineage)-like virus

Cell- or recombinant-based Vaccines

an A/Wisconsin/588/2019 (H1N1)pdm09-like virus
an A/Cambodia/e0826360/2020 (H3N2)-like virus
a B/Washington/02/2019 (B/Victoria lineage)-like virus

Compared with the Southern Hemisphere recommendation made in September 2020, the H3N2 recommendations were changed for the egg and other versions.

The WHO published updated FAQs, which are found on this WHO page.

The current flu vaccine recommendations from the U.S. CDC can be found on this webpage.

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Influenza vaccine selection committee recommendations for the Northern Hemisphere's 2021-22 flu season announced

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When Pregnant, Flu Shots Are Needed Sooner Than Later

Don Hackett — Mon, 02 Nov 2020 18:03:47 +0000

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CDC: Flu Vaccine Safety and Pregnant Women

A new study suggests that influenza infection during pregnancy may result in an increased risk of pregnancy loss and a reduction in birthweight.

This study published by The Lancet on October 29, 2020, provides data underscoring the potential importance of flu vaccination in pregnant women. The new study found women had a 0·7–0·9% risk of influenza per month of pregnancy during the influenza season.

And antenatal influenza was associated with increased risk for some adverse pregnancy outcomes.

Furthermore, flu illness during pregnancy was associated with a reduction in the average birth weight of full-term newborns and an increased risk of late pregnancy loss, which is defined as pregnancy loss after 13 weeks gestation.

In addition, women with respiratory illness symptoms who had fever were found to have an increased risk of preterm birth.

Another finding of this study was that pregnant women had the highest incidence of flu infection during their first trimester, and the risk of having influenza during pregnancy increased with each month that women were pregnant during the influenza season.

These findings suggest it is best for pregnant women to be vaccinated either before flu viruses begin circulating in places with distinct influenza seasons or as early in pregnancy as possible in places with year-round influenza circulation to maximize the protection of mothers and their babies throughout pregnancy.

It’s well established that pregnant women are at higher risk of severe illness associated with flu illness, there has been less information about the impact of flu illness in pregnant women on pregnancy outcomes, states the US Centers for Disease Control and Prevention (CDC).

This study included 11,277 pregnant women from India, Peru, and Thailand during the 2017 and 2018 flu seasons. Only 13% of study participants had been vaccinated against influenza.

In the USA last flu season, about 60% of pregnant women were vaccinated, but that proportion is much lower in some other parts of the world.

The CDC recommends pregnant women receive a flu shot during any trimester of pregnancy. But not the nasal spray flu vaccine. For more information on influenza vaccines and pregnancy, visit the CDC website.

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Sub Title:

Pregnant women have an increased risk of influenza per month of pregnancy during the influenza season

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Incidence of influenza during pregnancy and association with pregnancy and perinatal outcomes in three middle-income countries

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Southern Hemisphere Flu Season Fizzled Out Before Starting

Don Hackett — Sat, 19 Sep 2020 12:27:35 +0000

Reviewer:

According to the World Health Organization (WHO), influenza activity was reported at lower levels than expected for this time of the year.

As an example, in the temperate zones of the Southern Hemisphere, the influenza season has not started. Despite continued or even increased testing for influenza in some countries in the southern hemisphere, very few influenza detections were reported, reported the WHO on September 14, 2020.

However, the WHO says ‘the current influenza surveillance data should be interpreted with caution as the ongoing COVID-19 pandemic has influenced to varying extents health-seeking behaviors in the Member States.

And, the various hygiene and physical distancing measures implemented by Member States to reduce SARS-CoV-2 virus transmission have likely played a role in reducing influenza virus transmission.

Based on data as of September 1, 2020, the WHO reported the following highlights:

In the Caribbean and Central American countries, no influenza detections were reported.

In tropical South America, tropical Africa, and Southern Asia there were sporadic or no influenza detections across reporting countries.

In South East Asia, influenza A(H3N2) virus detections were reported in Cambodia.

Furthermore, of the very low numbers of detections reported, seasonal influenza A viruses accounted for the majority of detections worldwide.

The WHO’s laboratories tested specimens during the recent reporting time period: 34 were positive for influenza viruses, of which 19 (55.9%) were typed as influenza A and 15 (44.1%) as influenza B.

Of the sub-typed influenza A viruses, 11 (100%) were influenza A(H3N2).

And of the characterized B viruses, 3 (37.5%) belonged to the B-Yamagata lineage and 5 (62.5%) to the B-Victoria lineage.

The WHO’s summaries of global surveillance are based on data gathered through global and regional data-sharing platforms and direct reports from Member States.

‘Vaccination is the most effective way to prevent infection and severe outcomes caused by influenza viruses’ states the WHO. Moreover, selecting the most relevant influenza vaccines for the next flu season requires long term planning.

On September 16, 2020, the WHO announced its periodic review and update of viruses contained in influenza vaccines in order for the vaccines to be effective due to the constant evolving nature of influenza viruses, especially those circulating and infecting humans.

Twice annually, the WHO organizes consultations with an advisory group of experts to analyze influenza virus surveillance data generated by the WHO Global Influenza Surveillance and Response System, and issues recommendations on the composition of the influenza vaccines for the following influenza season. These recommendations are used by the national vaccine regulatory agencies and the pharmaceutical companies to develop, produce, and license influenza vaccines.

A list of U.S. FDA authorized influenza vaccines for the 2020-2021 flu season are published at PrecisionVaccinations.

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Sub Title:

Influenza surveillance data should be interpreted with caution during the COVID-19 pandemic

References:

WHO Consultation and Information Meeting on the Composition of Influenza Virus Vaccines for Use in the 2021 Southern Hemisphere

WHO: Influenza Update

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Gen X'ers Have Different Influenza Antibodies

Don Hackett — Sat, 12 Sep 2020 14:41:10 +0000

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Middle-aged individuals may be in a perpetual state of H3N2 influenza virus susceptibility

Penn Medicine researchers have found that those born in the late 1960s and the 1970s may be in a perpetual state of H3N2 influenza virus susceptibility, because their antibodies bind to H3N2 viruses, but fail to prevent infections.

According to a new study led by Scott Hensley, Ph.D., an associate professor of microbiology at the Perelman School of Medicine in Pennsylvania, it is possible that the presence of high levels of non-neutralizing antibodies in middle-aged adults has contributed to the continued persistence of H3N2 viruses in the human population.

These findings ‘shed light on the relatively low effectiveness of 3c2.H3N2-based vaccines over the past 3 years, which may partially be related to the inherent difficulties of preparing egg-based 3c2.A H3N2 antigens.

This is because 3c2.A H3N2 viruses cannot grow in fertilized chicken eggs without first acquiring an amino acid substitution that abrogates a key glycosylation site in HA antigenic site B, and this egg-adaptation can dramatically alter antigenicity.

This new finding published on September 11, 2020, might also relate to the unusual age distribution of H3N2 infections during the 2017-2018 season, in which H3N2 activity in middle-aged and older adults peaked earlier compared to children and young adults.

“We found that different aged individuals have different H3N2 flu virus antibody specificities,” Hensley said. “Our studies show that early childhood infections can leave lifelong immunological imprints that affect how individuals respond to antigenically distinct viral strains later in life.”

Most humans are infected with influenza viruses by three to four years of age, and these initial childhood infections can elicit strong, long-lasting memory immune responses. H3N2 influenza viruses began circulating in humans in 1968 and have evolved substantially over the past 51 years.

Therefore, an individual’s birth year largely predicts which specific type of H3N2 virus they first encountered in childhood.

Researchers completed a serological survey — a blood test that measures antibody levels — using serum samples collected in the summer months prior to the 2017-2018 season from 140 children (ages one to 17) and 212 adults (ages 18 to 90). They first measured the differences in antibody reactivity to various strains of H3N2, and then measured for neutralizing and non-neutralizing antibodies.

Neutralizing antibodies can prevent viral infections, whereas non-neutralizing antibodies can only help after infection takes place. Samples from children aged three to ten years old had the highest levels of neutralizing antibodies against contemporary H3N2 viruses, while most middle-aged samples had antibodies that could bind to these viruses but these antibodies could not prevent viral infections.

Dr. Hensley said his team’s findings are consistent with a concept known as “original antigenic sin” (OAS), originally proposed by Tom Francis, Jr. in 1960.

“Most individuals born in the late 1960s and 1970s were immunologically imprinted with H3N2 viruses that are very different compared to contemporary H3N2 viruses.

Upon infection with recent H3N2 viruses, these individuals tend to produce antibodies against regions that are conserved with older H3N2 strains and these types of antibodies typically do not prevent viral infections.”

According to the research team, ‘it will be important to continually complete large serological surveys in different aged individuals, including donors from populations with different vaccination rates. A better understanding of immunity within the population and within individuals will likely lead to improved models that are better able to predict the evolutionary trajectories of different influenza virus strains.’

“Large serological studies can shed light on why the effectiveness of flu vaccines varies in individuals with different immune histories, while also identifying barriers that need to be overcome in order to design better vaccines that are able to elicit protective responses in all age groups,” said Sigrid Gouma, Ph.D., a postdoctoral researcher of Microbiology and first author on the paper.

A better understanding of immunity within the population and within individuals will likely lead to improved models that are better able to predict the evolutionary trajectories of different influenza virus strains.

Other Penn authors include Madison Weirick and Megan E. Gumina. Additional authors include Angela Branche, David J. Topham, Emily T. Martin, Arnold S. Monto, and Sarah Cobey.

This work was supported by the National Institute of Allergy and Infectious Diseases, and the Center for Disease Control (CDC). No industry conflicts of interest were disclosed.

Vaccines authorized by the CDC for the 2020-2021 flu season in the Northern Hemisphere are be found here.

PrecisionVaccinations publishes research-based vaccine development news.

Sub Title:

H3N2 influenza viruses have evolved over the past 50 years

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Will This Year’s Seasonal Influenza Overtake Coronavirus?

Don Hackett — Thu, 10 Sep 2020 20:10:32 +0000

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Testimony on Vaccines: Saving Lives, Ensuring Confidence, and Protecting Public Health

‘The fight against the COVID-19 pandemic may become more difficult as we enter the fall and winter flu season,’ sate Francis S. Collins, M.D., Ph.D., Director, National Institutes of Health (NIH).

‘Each year influenza causes a surge in hospitalizations, and in combination with COVID-19, is a serious concern for healthcare systems across the USA,’ said Dr. Collins in a September 9, 2020 testimony.

‘In addition to the expected surge in patient numbers, the clinical symptoms for influenza and SARS-CoV-2 can overlap, and an increase in influenza infections will require testing for SARS-CoV-2 in order to determine if the patient has COVID-19 or influenza.’

Seasonal influenza co-circulation with SARS-CoV-2 has already been observed in the Southern hemisphere.

An increase in the vaccination rate for influenza will help to safeguard our healthcare systems against this surge, by reducing flu morbidity, to allow for COVID-19 surge capacity in hospitals, and reducing the number of sick individuals presenting to outpatient clinics.

During the 2018- 2019 fall and winter, the influenza vaccination rate for adults was 45.3 percent. It is imperative that we increase this vaccination rate to protect our healthcare systems.

Lastly, it is important to remind the public that childhood vaccinations are another way we can protect our communities and healthcare systems from avoidable illnesses and deaths.

The NIH is the world’s largest biomedical research funder, but we are also America’s research engine. Right now, our funded scientists are working around the clock to find the best ways to diagnose, prevent, and treat COVID-19. We won’t rest until this job is done,’ concluded Dr. Collins testimony.

When children were admitted to a hospital for COVID-19, they had no higher chance of serious complications than other children admitted with seasonal influenza, according to a retrospective study published by JAMA on September 8, 2020.

More patients hospitalized with COVID-19 had underlying medical conditions and reported fever, diarrhea or vomiting, headache, body ache or myalgia, or chest pain.

During the 2019-2020 flu season in the USA, there have been 188 pediatric fatalities related to influenza viruses reported to the U.S. CDC, as of September 4, 2020.

Furthermore, regarding new innovative diagnostics, North Carolina based LabCorp announced on September 8, 2020, the launch of the first testing method to simultaneously detect COVID-19, influenza A / B, and respiratory syncytial virus (RSV).

This single-panel test, which detects multiple types of infections, can help doctors diagnose patients and make decisions about treatment options.

The most common flu shot for the 2020-2021 influenza season in the Northern Hemisphere are quadrivalent vaccines that protect people against 4 viruses; influenza A (H1N1) virus, influenza A (H3N2) virus, and 2 influenza B viruses.

Most people over 6 months of age are encouraged to get vaccinated every flu season since influenza infections can create severe consequences.

An updated list of U.S. FDA authorized flu vaccines can be found at this link.

PrecisionVaccinations published research-based news focused on influenza and the SARS-CoV-2 virus pandemic.

Sub Title:

Influenza and SARS-CoV-2 clinical symptoms can overlap

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CDC: FluView

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Where Did Last Year’s Flu Season Go

Don Hackett — Fri, 28 Aug 2020 20:03:21 +0000

Reviewer:

CDC: 2019-2020 Influenza Season Week 34, ending August 22, 2020

In the USA during Week #34 of the U.S. CDC influenza reporting period, about 1% of patient visits reported through the Outpatient Influenza-like Illness Surveillance Network (ILINet) were due to influenza-like illness (ILI).

This percentage reported on August 28, 2020, is below the national baseline of 2.4%.

Additionally, based on the National Center for Health Statistics (NCHS) mortality surveillance data, 6.2% of the deaths occurring during the week ending August 22, 2020 (Week #34) were due to Pneumonia and Influenza (P&I).

And indicators that track ILI and COVID-19-like illness (CLI) and the percentage of laboratory tests positive for SARS-CoV-2 have continued to decrease nationally since mid-July.

Regionally, six of 10 regions reported decreasing or stable (change of ≤0.1%) ILI, CLI, and percentage of laboratory tests positive for SARS-CoV-2. However, two regions reported an increase in the percentage of specimens testing positive for SARS-CoV-2.

Nationally, the percentage of respiratory specimens testing positive for SARS-CoV-2 decreased from 6.2% during Week #33 to 5.7% during Week #34 and decreased or remained the same in eight of the 10 regions.

Furthermore, based on death certificate data, the percentage of fatalities attributed to pneumonia, influenza, or COVID-19 (PIC) for Week #34 is 7.9%. This is currently lower than Week #33 (12.3%), but will likely increase as more death certificates are processed, says the CDC.

Most importantly, there were no influenza-associated pediatric fatalities reported to CDC during Week #34. Unfortunately, a total of 188 pediatric fatalities have occurred during the 2019-2020 season.

Most people in the USA over 6 months of age are encouraged by the CDC to get vaccinated every flu season since influenza infections can create severe consequences.

Seasonal flu vaccines fight infection by inducing antibodies that target the virus’s HA head. This region varies season to season, which is why flu vaccines must be updated each year, says the U.S. NIH.

For more information about this flu season, the CDC suggests speaking with a healthcare provider.

PrecisionVaccinations publishes research-based flu shot news.

Sub Title:

Pneumonia, Influenza, and COVID-19 disease fatalities decreased for Week #34

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Influenza No-Showed For the Southern Hemisphere’s Flu Season

Don Hackett — Fri, 28 Aug 2020 19:25:26 +0000

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From Southern Hemisphere, Hints That U.S. May Be Spared Flu On Top Of COVID-19

This year's flu season in the Southern Hemisphere was weirdly mild, reported NPR.

As of August 29, 2020, a surprisingly small number of people in the Southern Hemisphere have gotten the flu this year, probably because the public health measures put in place to fight COVID-19 have also limited the spread of influenza viruses.

That makes public health experts hope that the USA and other northern countries might be spared the double whammy of COVID-19 and an intense 2020-2021 flu season.

Still, health leaders say people still need to get vaccinated against the flu.

Influenza vaccines, known as flu shots, protect people against the influenza viruses that research indicates will be most common during the upcoming season.

"We are sort of seeing very little influenza activity in the Southern Hemisphere, but that doesn't allow me to predict that that will be the case for the Northern Hemisphere,” said Kanta Subbarao, director of the World Health Organization's Collaborating Centre for Reference and Research on Influenza in Melbourne, Australia, in a statement.

The tropics around the globe's equator can have flu year-round. The temperate zones of the north and south, in contrast, see cases of seasonal influenza rise and peak during the winter.

That means doctors in the Southern Hemisphere typically start seeing flu in May or June. The number of infections there is greatest in July or August. In the Northern Hemisphere, cases start to rise in the fall and peak between December and February each year.

That's why, as COVID-19 started spreading earlier this year, public health officials in the southern parts of the world worried that their health care systems would soon be overwhelmed. Just when they were expecting to see the normal burden of hospitalizations of seasonal flu, this new respiratory illness could be upon them.

"The countries took it very, very seriously," says Sylvain Aldighieri, the incident manager for COVID-19 with the Pan American Health Organization. "They bought more vaccine, they vaccinated more people during the pre-flu season."

Flu hasn't totally disappeared, but it's way down.

For example, consider various clinical samples that were taken from patients with an acute respiratory illness during a 3-week period in the middle of winter in Chile.

"Zero were positive for influenza," Aldighieri says, explaining that he'd normally expect to see hundreds test positive for flu.

Chile isn't alone. Other countries are having a similar experience.

"Based on what we've seen in the Southern Hemisphere, and I would say this is true of all through the Southern Hemisphere — South America, Africa, Australia, New Zealand, all across this region — there's been very little influenza activity," Subbarao says.

Recently, the WHO's Influenza Update #374 indicated the Southern Hemisphere's flu season hasn't started yet. As of August 17, 2020, sporadic influenza outbreaks have been detected in the Caribbean, Central America, and tropical parts of South America and Africa.

According to the U.S. CDC, the most common flu shot for the 2020-2021 influenza season in the Northern Hemisphere are quadrivalent vaccines that protect people against 4 viruses; influenza A (H1N1) virus, influenza A (H3N2) virus, and 2 influenza B viruses.

Click here for detailed information about the various flu shot options.

Vax-Before-Travel publishes research-based international travel news.

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Flu shots are suggested prior to international travel

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Complex Vaccination Recommendations From the U.S. CDC

Don Hackett — Fri, 21 Aug 2020 17:31:21 +0000

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CDC: Prevention and Control of Seasonal Influenza with Vaccines

The US Centers for Disease Control and Prevention published an update to the Advisory Committee on Immunization Practices (ACIP) recommendations regarding the use of seasonal influenza vaccines for the 2020-2021 flu season.

This new CDC report, published on August 20, 2020, says this influenza season will coincide with the continued circulation of the SARS-CoV-2 coronavirus associated with the COVID-19 disease pandemic. The extent to which SARS-CoV-2, the novel coronavirus that causes COVID-19, will circulate during the 2020–21 influenza season, ‘is unknown.’

Unfortunately, the common symptoms of COVID-19 can also occur with an influenza illness.

To mitigate this confusion, the CDC suggests everyone over the age of 6-months get a flu shot.

Optimally, vaccination should occur before the onset of influenza activity in the community. However, because the timing of the onset, peak, and decline of influenza activity varies, the ideal time to start vaccinating cannot be predicted each season.

Moreover, more than 1 outbreak might occur in a given community in a single year.

In the United States, localized outbreaks that indicate the start of seasonal influenza activity can occur as early as October. However, in 27 (75%) of 36 influenza seasons from 1982–83 through 2017–18, peak influenza activity (which often is close to the midpoint of influenza activity for the season) has not occurred until January or later, says the CDC.

Because SARS-CoV-2 is a novel coronavirus, clinical experience with influenza vaccination of persons with COVID-19 is limited. For those who have acute illness with suspected or laboratory-confirmed COVID-19, clinicians can consider delaying influenza vaccination until they are no longer acutely ill.

If influenza vaccination is delayed, patients should be reminded to return for influenza vaccination once they have recovered from their acute illness.

Furthermore, with various coronavirus vaccine candidates in late-stage studies, there may be added confusion between vaccine efficacy.

The effectiveness of influenza vaccination varies depending on several factors, such as the age and health of the recipient; the type of vaccine administered; the types, subtypes, and lineages of circulating influenza viruses; and the degree of similarity between circulating viruses and those included in the vaccine.

During six previous influenza seasons, the overall estimated vaccine effectiveness was reported to be 38 percent (62% against influenza A[H1N1]pdm09 viruses, 22% against influenza A[H3N2] viruses, and 50% against influenza B viruses).

In recent years, several vaccines containing nonaluminum adjuvants have been licensed for use in the USA for the prevention of various infectious diseases, says the CDC.

These include Shingrix (recombinant zoster subunit vaccine); MF59 (in Fluad and Fluad Quadrivalent); and CpG 1018 (in Heplisav-B, recombinant hepatitis B surface antigen vaccine).

Data are limited regarding co-administration of these vaccines with other adjuvanted or nonadjuvanted vaccines. The immunogenicity and safety of simultaneous or sequential administration of two nonaluminum-adjuvant–containing vaccines has not been evaluated, and the ideal interval between such vaccines, when given sequentially, is not known.

In the study of Shingrix and IIV4, most reactogenicity symptoms resolved within 4 days.

Because of the limited data on the safety of simultaneous administration of two or more vaccines containing nonaluminum adjuvants and the availability of nonadjuvanted influenza vaccine options, selection of a nonadjuvanted influenza vaccine may be considered in situations in which influenza vaccine and another vaccine containing a nonaluminum adjuvant are to be administered concomitantly, says the CDC.

And as recommended for all vaccines, vaccines with nonaluminum adjuvants should be administered at separate anatomic sites from other vaccines that are given concomitantly.

These recommendations apply to U.S.-licensed influenza vaccines used within the Food and Drug Administration (FDA)–licensed indications.

CoronavirusToday publishes research-based news.

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Flu shots and coronavirus vaccination schedules may cause consumer confusion

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Massachusetts Requires Flu Shots For Most Students

Don Hackett — Thu, 20 Aug 2020 12:42:29 +0000

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Flu Vaccine Now Required for all Massachusetts School Students Enrolled in Child Care, Pre-School, K-12, and Post-Secondary

Massachusetts State public health officials announced that influenza immunization will be required for all children 6 months of age or older who are attending child care, pre-school, kindergarten, K-12, and colleges and universities.

This new vaccine requirement published on August 19, 2020, ‘is an important step to reduce flu-related illness and the overall impact of respiratory illness during the COVID-19 disease pandemic’ said the press release.

“Every year, thousands of people of all ages are affected by influenza, leading to many hospitalizations and deaths,” said Dr. Larry Madoff, Medical Director, DPH’s Bureau of Infectious Disease and Laboratory Sciences, in a press statement.

Last flu season, there were 4 confirmed pediatric (individuals under the age of 18) flu-related fatalities reported in Massachusetts.

And, throughout the USA, there were 187 pediatric fatalities related to the 2019-2020 flu season reported to the US Centers for Disease Control and Prevention (CDC).

Additionally, this announcement said Massachusetts students will be expected to have received a flu vaccine by December 31, 2020, for the 2020-2021 influenza season, unless either a medical or religious exemption is provided. Also exempted are K-12 students who are homeschooled and higher education students who are completely off-campus and engaged in remote learning only.

However, elementary and secondary students in districts and schools that are using a remote education model are not exempt.

“It is more important now than ever to get a flu vaccine because flu symptoms are very similar to those of COVID-19 and preventing the flu will save lives and preserve healthcare resources,” added Dr. Madoff.

This new flu immunization requirement to enter school in January is in addition to existing vaccine requirements for all those attending child care, preschool, K-12, and colleges and universities in Massachusetts. All children at least 6 months old who attend child care or preschool must be immunized in accordance with the ACIP Recommended Immunization Schedule.

All students in K-12 must receive the seasonal influenza vaccine annually by December 31. New students entering between January 1 and March 31st must have received a dose of flu vaccine for the current flu season, before entry.

Depending on the child’s age and flu vaccination history, a 2nd dose of flu vaccine in the same season may be recommended.

As of August 18, 2020, the CDC says some children 6 months through 8 years of age require 2 doses of flu vaccine for adequate protection from influenza. The child’s healthcare provider can tell if a child needs 2-doses.

For older students, the flu vaccine requirement applies to all full-time undergraduate and graduate students under 30 years of age and all full- and part-time health science students.

The requirement includes individuals from outside the USA attending or visiting classes or educational programs in Massachusetts as part of an academic visitation or exchange program. College students who attend any classes or activities on campus, even once, must be vaccinated by December 31st.

The only exception is for college and university students who exclusively attend classes online and never visit campus in person.

The updated table of immunization requirements for the upcoming Massachusetts school year can be found here.

The CDC recognizes that school administrators, teachers, staff, and parents are concerned about influenza viruses, particularly its effects on children. Educators and staff can help slow the spread of respiratory illnesses like colds, enterovirus D68, and influenza says the CDC.

The CDC suggests most people receive a flu shot during the early Fall each year.

The CDC has been working with researchers at universities and hospitals since the 2003-2004 flu season to estimate how well the flu vaccine works through observational studies using laboratory-confirmed flu as the outcome.

The overall, adjusted vaccine effectiveness estimates for influenza seasons from 2004-2018 are noted in this CDC chart.

For the 2019-2020 flu season in the USA, the CDC’s July 1, 2020 estimates indicate influenza vaccines were about 39 percent effective.

There are several types of flu shots available at most pharmacies and clinics.

PrecisionVaccinations publishes research-based influenza vaccine news.

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Massachusetts reported 4 influenza related fatalities last flu season

References:

Influenza Vaccine Requirement for School Attendance: Kindergarten through Grade 12

CDC: Influenza

CDC: Special vaccination instructions for children aged 6 months through 8 years of age Some children 6 months through 8 years

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Flatten Coronavirus and Flu Outbreaks With Dedicated Clinics

Don Hackett — Wed, 12 Aug 2020 18:07:45 +0000

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Study Finds Dedicated Clinics Can Reduce Impact of a Flu Pandemic

A new study concludes that opening clinics explicitly dedicated to treating influenza can limit the number of people infected and help to “flatten the curve,” or reduce the peak prevalence rate.

While this study focused on influenza, the findings are relevant for policymakers seeking ways to reduce the impacts of the ongoing COVID-19 pandemic.

“Dedicated clinics would have less of an impact than interventions such as vaccination, but at the statewide level, we’re talking about cutting the overall number of infections by six figures,” says Julie Swann, Ph.D., the corresponding author of a paper on the work, published on August 6, 2020.

Dr. Swann is the department head and A. Doug Allison Distinguished Professor of the Fitts Department of Industrial and Systems Engineering at North Carolina State University.

“And while our work here focused on the H1N1 strain of influenza, the findings are useful as we grapple with how best to respond to COVID-19,” Swann says. “COVID-19 is more infectious than H1N1 and has a higher mortality rate. So I would expect the effect of using dedicated clinics to be larger for COVID-19.”

Swann and her collaborators were inspired to do the study by the fact that some hospitals opened dedicated H1N1 clinics during the H1N1 influenza pandemic in 2009-2010. These clinics focused exclusively on treating patients who were exhibiting symptoms of H1N1.

There was some question at the time as to whether these clinics were a good use of limited resources. It was also unclear as to whether the clinics may have had unintended consequences, such as spreading H1N1 to patients who showed up at the dedicated clinic with flu-like symptoms but didn’t actually have the disease.

For this study, Swann and her collaborators at Purdue University, Georgia Tech, and Emory University used a simulation model to address questions related to the ultimate impact of dedicated clinics during an H1N1 pandemic.

The researchers found that opening clinics reduced disease spread and hospitalizations, particularly when open during the periods of peak prevalence – when most people are sick.

Specifically, the researchers found that if dedicated clinics were open for the entire duration of the pandemic, the clinics would have reduced the overall number of infections by 0.4-1.5%; reduced peak prevalence (or “flattened the curve”) by 0.07-0.32%; and reduced hospitalizations by 0.02-0.09%.

“For a state that has a population of 10 million, the difference in the baseline clinic case would be about 100,000 cases, with about 6,000 hospitalizations averted,” Swann says. “In other words, dedicated clinics certainly don’t make things worse, and can make things at least a little better.”

“And these are benefits that come on top of any benefits we’d see from other, behavioral changes – such as wearing masks – which may be more difficult to implement.”

The study on dedicated clinics is part of a larger research initiative that has already published work examining issues related to vaccine distribution for adults and children; the role of mass gatherings and travel in spreading influenza; and the impact of seasons and mutation in the spread of the disease.

The paper, “The impact of opening dedicated clinics on disease transmission during an influenza pandemic,” is published in the journal PLOS ONE. The paper was co-authored by Pengyi Shi of Purdue University; Jia Yan and Pinar Keskinocak of Georgia Tech; and by Dr. Andi Shane of Emory University and Children’s Healthcare of Atlanta. The work was done with support from Georgia Tech, Edward P. Fitts, and the A. Doug Allison Distinguished Professorship.

PrecisionVaccinations publishes influenza news.

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Opening vaccination and treatment clinics reduce virus spread and hospitalizations

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The impact of opening dedicated clinics on disease transmission during an influenza pandemic

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Cancer Patients Do Benefit From Flu Shots

Don Hackett — Mon, 16 Sep 2019 21:22:50 +0000

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