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Press Briefing Transcript

CDC Telebriefing on Influenza Vaccination

Thursday, August 18, 2011

Operator:  Welcome.  And thank you for standing by.  At this time, all participants are in a listen-only mode until the question-and-answer session of today's conference.  At that time you may press star 1 to ask a question.  You will be prompted to record your name.  I'd like to inform all participants that today's conference is being recorded.  If you have any objections, you may disconnect at this time.  I would now like to turn the conference over to Mr. Tom Skinner.  Sir, you may begin.

Tom Skinner: Thank you, Jennifer.  And thank you all for joining us today.  Hopefully you have in front of you three pieces of information.  You have a couple of MMWR articles, one on influenza vaccination coverage among health-care personnel.  Another article from the MMWR on influenza vaccination coverage among pregnant women.  And finally, you should have the “2011 Prevention and Control of Influenza with Vaccines”, our recommendations from the Advisory Committee on Immunization Practices.  So I have with me today Dr. Carolyn Bridges, who is the associate director for adult immunization, Immunization Services Division in our National Center for Immunization and Respiratory Diseases. She’s going to provide opening remarks and provide a bottom line for each of the pieces of information. We'll then move to questions and answers.  Dr. Bridges will be answering questions.  We also have other subject matter experts on these various articles that we'll introduce if the need is for them to step up and answer the questions.  So without further delay, I want to turn this over to Dr. Bridges.

Carolyn Bridges: Thanks very much, Tom.  So I'm going to be talking about all three of these articles, and then we'll refer to everyone else for questions at the end, if there are things I can't answer.  So of the two coverage studies that we're going to be talking about today, one is on health-care personnel, and the other one is about influenza vaccination coverage among pregnant women.  But first I'm going to mention the ACIP's updated vaccine recommendations for this season.  This year's recommendations are issued in a shortened format because there are relatively few changes from 2010-11 recommendations.  We continue to recommend to all people six months and older be vaccinated.  The ACIP updated recommendations include information on the vaccine strains for this year, the vaccines schedule for children six months to eight years of age, and information about vaccination of people with egg allergies.  There is also information provided about a new formulation of the inactivated vaccine, and this vaccine is given intradermally.  I want to emphasize that the recommendation for annual vaccination remains in place, even though the strains of this year’s vaccine are the same as those in 2010-11.  Annual vaccination is recommended including people who were vaccinated last year. Because levels of protective antibodies against influenza viruses decline over the course of the year, particularly in elderly and people with compromised immune systems, and other people who may be susceptible to complications of flu.  So even people that got a flu vaccine last year should get vaccinated again this year to ensure that they are optimally protected. 

Next, I want to highlight some of the key issues regarding the articles on influenza vaccination rates.  First I'll discuss the article on health-care personnel vaccination.  Influenza vaccination for health-care personnel is important for the protection of both of the health-care worker against influenza and to reduce the likelihood that the patient may be exposed to an influenza-infected health-care worker.  Both the Advisory Committee on Immunization Practices and the Health-care Infection Control Practices Advisory Committee, called the HICPAC, recommends that all health-care personnel be vaccinated annually for influenza.  Influenza vaccination coverage among health-care personnel is important, both for patient safety, and health-care facilities should make vaccines readily available to all health-care personnel as a part of a comprehensive infection control program. 

The study on coverage published today reports information on coverage for the 2010-11 season.  For this study on health-care personnel, CDC worked with the RAND corporation to collect and analyze data from an internet panel survey which was conducted in April of this year.  The results of the panel survey are summarized in the report.  Influenza vaccination of health-care personnel has increased slowly over the past decade, and for this past season, reached 63.5 percent.  However, coverage is so well below the healthy people 2020 goal of 90 percent.  The 63.5 percent coverage for this past season is compared to 62 percent for the prior season.  Coverage was highest amongst physicians, among health-care personnel who worked in hospital settings, and among those who are 60 years of age and older.  Among the 13 percent of surveyed health-care personnel who have reported that their workplace required influenza vaccination, 98 percent were vaccinated.  Among the remaining health-care personnel surveyed that did not report having a workplace requirement, coverage was 58 percent.  In the absence of a workplace requirement, higher vaccination coverage was associated with vaccine being offered on site at the workplace, being offered free of charge, and being offered more than one day.  Offering vaccines in the work site was particularly important; coverage was 66 percent among health-care personnel who were offered vaccine at the workplace versus 38.5 percent among those not offered at the workplace.  And this is among health-care personnel who did not have a workplace requirement.  Making vaccination convenient for health-care personnel is a key strategy for raising vaccination rates. 

Next I want to mention a few key issues from the article on influenza vaccine coverage among pregnant women.  Pregnant women and children less than 6 months of age are known to be at higher risk of severe illness from influenza.  And vaccination during pregnancy has been shown to decrease the risk of illness in the mother as well as to decrease of the risk of influenza and influenza hospitalization in their infants during the first six months of life.  This is important because children under 6 months of age are the pediatric group at highest risk of flu-related hospitalization, but they are not old enough to get vaccinated.  The study reported in the MMWR today estimates influenza vaccine coverage among pregnant women for the 2010-11 season using data also from an internet panel survey conducted in April of 2011.  The survey included women who were pregnant anytime during October 2010 through January 2011.  The support found that for last season, 49 percent of pregnant women had received influenza vaccination; 32 percent during pregnancy and 17 percent before pregnancy or after delivery.  The overall coverage of 49 percent was comparable to the coverage for 2009-10 during the pandemic year. 

The results indicate that the vaccination level change among pregnant women during the previous season was sustained during the 2010-11 season.  A very important finding of the survey was that women whose medical providers offered them a flu vaccine were five times more likely to get vaccinated than women who didn't receive a provider offer.  This study is consistent with other studies that document the critical role providers in recommending and offering vaccine to their patients to increase coverage.  However, four out of ten women in the survey didn't receive a provider offer even though they visited a provider at least one time.  Survey also asked women about their attitudes and beliefs about influenza vaccination.  The top two concerns reported by pregnant women about influenza vaccine were possible safety risks to their baby if they got vaccinated, and concern that the vaccine would give the women the flu.  However, women who received a provider offer for influenza vaccine were more likely to have positive attitudes about the vaccine, its effectiveness and safety.  The study underscored the fact that continued efforts are needed to encourage providers to strongly recommend and to offer vaccination to their pregnant patients.  I would like now to open the phones for questions for myself and my colleagues. Thank you.

Tom Skinner:  Jennifer, we're ready for questions.

Operator:  If you would like to ask a question at this time, please press star 1 and record your name.  To withdraw your question, you may press star 2.  One moment for the first question.  Our first question comes from Lisa Schnirring, from CIDRAP News. 

Lisa Schnirring: Hi.  Thanks so much for being available to provide some good context for these three things.  I just wanted to drill down on what the main, newer things are in the ACIP recommendations.  I was reading through it, and it sounds like there's some -- a bit of it, extra information about kids age 6 months to 8 years, about ones that only got their first-ever dose. 

Carolyn Bridges:  Right.  Thank you for that question.  For children who are less than 9 years of age, we need to make sure that children have had the initial dose as well as a booster dose, for them to have an optimal immune response.  The recommendation currently is for children who had at least one prior dose of the 2010-11 vaccine, that those children only need one dose of this year's vaccine.  However, children whose vaccination status isn't known for last year or who are known not to have had a 2010-11 dose of influenza vaccine, those children should receive two doses.

Lisa Schnirring: That's kind of a unique situation, because the strains are the same, and that could change next year's, is that kind of what the status is in a nutshell? 

Carolyn Bridges:  Right.  Because the vaccine strength has not changed, they aren't required to have had two doses in the prior season.  But certainly things could change next year, depending on what the strains in the vaccine are.

 Lisa Schnirring: One quick question about the egg allergy items.  I'm -- lots of good guidance information in there.  How would you characterize it as more detailed information, so that more egg allergy people can get the vaccine, or how would you kind of characterize that? 

Carolyn Bridges:   I think it is -- more information has become available over the last, about a year and a half or two years, based on more studies that were done around the pandemic vaccine.  And so I think it provides more information on what the risks may or may not be for patients with egg allergy, and updates that data.  But the studies that were done with egg allergy patients with trivalent influenza vaccine suggested that even among those with egg allergies, the trivalent vaccine was very well tolerated.  That being said, for patients who have a known egg allergy, people who are administering vaccines certainly need to be prepared to handle any sorts of allergies or allergic reactions that occur during the vaccine administration.

Lisa Schnirring:  Thank you.

Tom Skinner:  Jennifer, next question, please? 

Operator:  Our next question comes from Timothy Martin of the Wall Street Journal.

Timothy Martin: Hi, guys, thanks for taking my call.  Two really quick questions.  First, how many doses of seasonal vaccine are going to be produced this flu season and how does it look versus last? 

Carolyn Bridges:   Thank you for that question.  We're anticipating based on reports from manufacturers that probably an estimated 166 million or so are likely to be produced this year.  That compares to about 157 million doses of vaccine that were distributed last year.

Timothy Martin: Do you have guys have any insights on how many were administered of the 157 million last year? 

Carolyn Bridges: We do collect data, of course, on vaccine coverage.  But it's a bit hard to very, very precisely estimate the number that were actually administered.  We do estimate that last season, about 49 percent of children, 6 months to 17 years, received vaccination, and almost 41 percent of all adults. 

Timothy Martin: I guess the sense that last year there were several million that went unused.  That transitions to my broader question, which is, what do you guys have in terms of plans to convince people to get the shot this year, given, you know, it's the same strain, people might think, well, I don't need it?  Is there anything in terms of marketing or advertising to get the message out? 

Tom Skinner:  Yeah, this is Tom Skinner.  We have a group here that does a lot of things around vaccine promotion each and every year working with our colleagues in the states to, you know, conduct public service announcements.  I can put you in touch with someone who can give you the nuances of all the things that we do to promote vaccination, or flu vaccination.  So if you want to follow up with me, I can put you in touch with someone who can really walk you through that.

Timothy Martin: Yeah.  I mean, I'll follow up, but are there any differences in the messaging this year versus last?  Or do you not know the answer to that? 

Tom Skinner:  The bottom line is, we really do encourage people to get vaccinated each and every year.  Particularly those 6 months of age and older.  So whether our efforts have changed or not this year, I can put you in touch with somebody who can walk you through that.  You know, what we did last year, what we're going to do this year, and what we do every year around promotion of influenza vaccination. 

Carolyn Bridges: This is Carolyn.  I might just add one other thing, which is that the Department of Health and Human Services has a seasonal influenza vaccination task force and there are a number of groups trying to reduce barriers to vaccination and various segments.  And to raise awareness, and to reduce disparities.  We know we still have disparities in vaccine coverage among adults and lower rates in certain racial/ethnic groups.  There are community outreach efforts that are being planned to try and reduce those disparities, and also to try and target particular groups that are higher risk, pregnant women for example, people with chronic medical conditions, et cetera.  There's a large effort at HHS as well. 

Tom Skinner:  If you want to send me an e-mail for more, send it to tskinner@cdc.gov.  And I can connect you with somebody.  Jennifer, next question, please? 

Operator:  Our next question comes from Mike Stobbe from the Associated Press. 

Mike Stobbe: Hi.  Thanks for taking my call.  Dr. Bridges, I wanted to ask you about Table 1 in the first report, the one about health-care personnel, it gives a breakdown of different types of health professionals.  And not all of them got vaccinated at the same rate, physicians the highest, and it went down from there.  I was wondering why that is?  Is that a function of education?  Or something else? 

Carolyn Bridges: I'm going to refer to my colleague, Dr. Black.

Carla Black: My name is Carla Black.  I'm an epidemiologist in the National Center for Immunization and Respiratory Diseases.  We don't have the exact answer to that question.  I think part of it is education.  I think also a lot of it is the belief that people who need to be vaccinated are those who have more hands-on care of patients.  So the people in more administrative type roles, or nonclinical support roles like housekeeping and food services don't feel that they're a part of the recommendation, even though they are.  So I think that's probably most of it. 

Mike Stobbe: Thank you.  Was there anything in there that surprised you all in terms of which health-care workers, or which health-care settings had the highest rates versus the lowest? 

Carla Black:  The settings, I don't think so.  The hospitals have the highest coverage.  But also, hospitals are the ones that are more likely to have vaccination available onsite.  And, you know, have it available free to their employees onsite.  You know, for more than one day.  And if you actually control those things, hospitals don't have higher rates than other settings.  So I think it's more, you know, the settings that have the highest coverage are those that have vaccine more available.  And those who work in, say, home health-care who don't go to an office every day, have to get vaccine on their own, have lower coverage. 

Tom Skinner:  Next question, Jennifer? 

Operator:   Our next question comes from Denise Mann from HealthDay. 

Denise Mann: Hi.  So my question is the same exact formulation as last year, so that means it would also contain the H1N1?  That's the first part of the question.  And then last year, there seemed to be a little bit of backlash about getting the flu vaccine, at least in the beginning of the vaccination season, because of what happened the year before, during the pandemic year.  Are there concerns that that might happen again, especially because the vaccine is exactly the same as it was last year?  And what are the risks, if it should happen to a person, as well as to society? 

Carolyn Bridges:  This is Carolyn Bridges.  To answer your first question, yes, the same strain, the 2009 H1N1 strain is included in the seasonal flu vaccine last year as it was in the previous influenza season.  I think there was some concern last year about, you know, “flu fatigue”.  However, you know, we saw that vaccination rates stayed high last year.  And we anticipate the same thing this year.  So vaccination coverage for last year for children was 43 percent -- I'm sorry, was 49 percent, and for all adults 18 and older was 41 percent.  So I think that was actually quite tremendous in the seasonal year that followed a pandemic year, a year where we had tremendous amounts of coverage about influenza, and to have the seasonal year following it had essentially seasonal increases in coverage, I think it's actually quite remarkable. 

Tom Skinner:  Next question, Jennifer? 

Operator:   Our next question comes from Richard Knox of National Public Radio. 

Richard Knox: Hi.  Thank you very much.  A couple of things.  The fellow from Wall Street Journal asked some of my questions.  I wanted to follow up with one of his. I gather that from the manufacturers that have started to ship this summer, there's said to be lots of vaccine out there at the beginning of the school year, I just wonder whether you feel at this point that there will be plenty of vaccine for all comers this year.  And secondly, well, I can ask it after you answer that one. 

Carolyn Bridges:  Oh, sure.  Yes, we believe that there is plenty of vaccine for anyone who wants to get vaccinated this year. 

Richard Knox: Thanks.  Secondly, I noticed that there's no recommendation for people over 65 to take the high dose vaccine instead of the normal one, even though it seems there's plenty of information that people may need more, in order to get adequate antibody response.  I just wonder why there isn't any recommendation for people over 65 to get the higher dose?  And if you're saying that people over 65 should be asking their providers, if they should be? 

Lisa Grohskopf:  Hi, this is Lisa Grohskopf.  I'm a medical officer in the influenza division and I do some of the work with the Advisory Committee on Immunization Practice surrounding influenza vaccine.  Thank you for that question.  The high dose vaccine being relatively new, really last year was the first season of use.  There are ongoing data being collected, and there are currently going to be collected on how well it works in that population.  It's anticipated that there will be some data on whether or not it works better than a standard trivalent inactivated vaccine at some point within the next year or so.  But to date, the Advisory Committee on Immunization Practice did not feel a preferential recommendation would be warranted.  It is something that will be revisited, however. 

Tom Skinner:  Next question, Jennifer? 

Operator:   The next question comes from Michele Marill, Hospital Employee Health Newsletter. 

Michele Marill: Thank you very much.  I had a question about the issue of egg allergy, and, you know, there's an increase in hospitals that are mandating influenza vaccination, that they allow for exemptions for medical contraindications.  So I wanted to have some better understanding of what this means. Should they not be granting as many medical contraindications, what would be the proper steps to follow to make sure that someone actually does have the medical contraindications? 

Lisa Grohskopf:  This is Lisa Grohskopf again.  The current package inserts, many of which have been revised for this coming season, no longer state the broad term of hypersensitivity, which would really pull in any kind of allergy to egg as a contraindication.  We are recommending in these guidelines that essentially only individuals who have hives, specifically only hives as a symptom as their allergy, go ahead and receive vaccine without some further risk stratification.  It's possible for a health-care worker to be stratified for the risk.  As far as whether -- you know, how they would be labeled to have a contraindication or not, it's sort of beyond the scope of the ACIP recommendation, at least of this document to go into detail of how that could be done.  But one alternative would be to consult with their own health-care provider and assess their individual risk. 

Michele Marill: Okay.  So the employer should basically accept the recommendation of the individual's health-care provider as to whether or not they would need to be exempted from a flu vaccine mandate?  Is that what you're saying? 

Lisa Grohskopf: That would be one way to verify whether or not there is a contraindication there, and support that.  It is really beyond the scope of this recommendation to go into how individuals do that, though. 

Tom Skinner:  Okay.  Next question, Jennifer? 

Operator:   The next question comes from Elaine Grant of New Hampshire Public Radio. 

 Elaine Grant: Yes, I have a question, and then a follow-up.  Thanks for taking my question.  The Cochrane collaboration has done a review of a tremendous number of studies, and very well publicized skepticism about scientific evidence about the flu vaccine.  I'm particularly interested in knowing what's the scientific evidence to support the idea that vaccinating health-care workers actually prevents morbidity and mortality among patients?  The scientific studies I have seen come from long-term care facilities, not hospitals or doctors' offices. 

Carolyn Bridges: This is Carolyn Bridges.  As you say, probably the best studies are randomized control trials have been done in long-term care facilities and show that vaccination coverage of health-care workers in the 40 percentile ranges decreases the risk of mortality in nursing home patients.  Now, it's more difficult -- of course, nursing home patients are in those facilities for longer periods of time.  And it is easier to do studies in those sorts of settings as opposed to following patients in outpatient clinics, or in hospital settings where the duration of stay and contact is substantially shorter.  But certainly we know from many studies that influenza vaccination decreases the risk of influenza, in healthy adults, including health-care workers.  And when we vaccinate people, they're less likely to get sick, less likely to be shedding virus and less likely to be infecting other people.

 Elaine Grant: But have there been any studies that follow up on hospitals with very high rates of vaccination to see whether that has actually reduced morbidity and mortality among patients? 

Carolyn Bridges:  Those are very, very difficult studies to do.  There was one study done at the University of Virginia, and they did show decrease in nosocomial influenza when they really increased their vaccination program.  There was another study that was done in Thailand, also working in a hospital setting.  And both of those showed -- you know, demonstrated that influenza vaccination can reduce -- was associated with the reduction of illness in patients.  But as I said, they are technically very difficult studies to do, because of the duration of exposure to patients in those settings.  And they're usually occurring at the time where there's community spread of influenza going on.  Nursing homes are, if you will, a, quote, “cleaner setting” to try and do those studies because you limit the kinds -- different kinds of exposures that those patients have.  Versus patients in other settings, where, you know, their exposure to the health-care setting is a much shorter duration.

Tom Skinner: Next question, Jennifer? 

Operator:   The next question comes from Stacey Singer of the Palm Beach Post.

Stacey Singer: Hi.  Thanks.  I appreciate it.  Could you spell out a little bit more for seniors the case for why they should go ahead and get vaccinated again this year, even though the strains are the same?  Can you quantify it at all?  Or help me paint a picture? 

Lisa Grohskopf:  Hi.  Thanks, this is Lisa Grohskopf again.  If you're looking at it on an individual basis, it's not really possible to tell for any given individual exactly how quickly their antibodies will decay after they get the vaccine.  We know studies of populations of people, a number of studies that the immune response will drop over time.  Over the course of a year.  And quite possibly not protect throughout a second -- the full second season.  Exactly how much that will happen in any individual case really isn't possible to tell.  Which is why our recommendation is to be optimally protected, annual vaccination would be recommended. 

Stacey Singer: How about seniors compared to younger people? 

Lisa Grohskopf:  There's still going to be some individual differences based on their previous immunization history and perhaps which flu viruses they may have been exposed to in the past.  There are so many things that do influence that, that it's really difficult to tease out on an individual level. On a population level the recommendation is still that in most cases, you're not going to be able to count on that vaccine protecting you throughout a second season. 

Tom Skinner:  Okay.  Jennifer, next question? 

Operator:   Our last question comes from Lorna Benson, Minnesota Public Radio.

Lorna Benson: Hello, Dr. Bridges, I'm wondering if you can tell me what kind of a flu season you're even anticipating in terms of illness, especially just given the fact that the strains that are circulating do appear to be the same? 

Carolyn Bridges: Thank you for that question.  As always, it's impossible really to predict what the next influenza season is going to be like, and so our recommendation is to be vaccinated to be optimally protected so that you're prepared.  We're happy to say that the strains that are circulating now look at the vaccine strains that will cover them well.  So that's good.  How severe the season is going to be, which strains exactly will be circulating, it's something we're going to have to wait and find out.  But we have a very extensive surveillance system that will continue to monitor both disease occurrence, as well as the viruses over the season. 

Tom Skinner: Okay. Any more questions, Jennifer? 

Operator: There are no other questions at this time. 

Tom Skinner: Thank you all for joining us.  We'll have a transcript from this telebriefing posted to our media relations website in a few hours.  And if you have any follow-up questions, you can call 404-639-3286.  So thank you all for joining us. 

Operator: That concludes today's conference.  Thank you for your participation.  You may disconnect at this time. 

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