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U.S. Influenza Activity and Vaccine Effectiveness Update Lisa Grohskopf , MD MPH Vaccine and Related Biologic Products Advisory Committee Meeting 28 February 2014. National Center for Immunization and Respiratory Diseases. Influenza Division. - PowerPoint PPT Presentation
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U.S. Influenza Activity and Vaccine Effectiveness Update
Lisa Grohskopf, MD MPH
Vaccine and Related Biologic Products Advisory Committee Meeting28 February 2014
National Center for Immunization and Respiratory Diseases
Influenza Division
Influenza Activity Update
Lyn Finelli, DrPH, MSInfluenza Surveillance and Outbreak Response Team
Epidemiology and Prevention BranchInfluenza Division
ACIPFebruary 26, 2013
VIROLOGIC SURVEILLANCE
0
1,000
2,000
3,000
4,000
5,000
0
5
10
15
20
25
30
40 50 10 20 30 40 50 10 20 30 40 500
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
0
10
20
30
40
50
60
70
80
90
100H3N2v
A(2009 H1N1)
A(H3)
A(Subtyping not performed)
B
Percent Positive
Num
ber o
f Pos
itive
Spe
cim
ens
Per
cent
Pos
itive
2012 2013 2014
2011
14%
31%
U.S. World Health Organization and National Respiratory and Enteric Virus Surveillance System Collaborating Laboratories,
National Summary, 2010-14
Antiviral ResistanceOctober 1, 2013 – February 15, 2014
High levels of resistance to the adamantanes (amantadine and rimantadine) persist among pH1N1 and influenza A (H3N2) viruses currently circulating globally.
Neuraminidase Inhibitor Resistance Testing Results Samples Collected Since October 1, 2013
Oseltamivir ZanamivirVirus
Samples tested
(n)
Resistant Viruses, Number
(%)
Virus Samples tested
(n)
Resistant Viruses, Number
(%)Influenza A (H3N2) 186 0 (0.0) 186 0 (0.0)
Influenza B 73 0 (0.0) 73 0 (0.0)2009 H1N1 3,471 26 (0.7) 1,259 0 (0.0)
ILI SYNDROMIC SURVEILLANCE
Percentage of Visits for Influenza-like Illness (ILI) Reported by the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet),
Weekly National Summary, 2013-14 and Selected Previous Seasons
40
41
42
43
44
45
46
47
48
49
50
51
52
1 2 3 4 5 6 7 8 9 10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
0
1
2
3
4
5
6
7
8
2013-14 season
2012-13 season
2011-12 season
2009-10 season
2007-08 season
2002-03 season
National Baseline
Week
% o
f Vis
its fo
r IL
I
6.1%
4.6%
HOSPITALIZATION SURVEILLANCE
Rates of Lab-Confirmed Influenza Hospitalization FluSurvNet, October 1, 2013 –
February 15, 2014
55/100K
41/100K
38/100K
18/100K
7/100K
Overall Rate26.1/100K pop
MORTALITY SURVEILLANCE
40 50 10 20 30 40 50 10 20 30 40 50 10 20 30 40 500
5
10
15
20
25
30
35
40
Week of Death
Num
ber o
f dea
ths
2010-11Number of Deaths
Reported = 123
2011-12Number of Deaths
Reported = 35
2012-13Number of Deaths
Reported = 171
2013-14Number of Deaths
Reported = 52
Number of Influenza-Associated Pediatric Deaths
by Week of Death: 2010-11 to February 15, 2014
40 50 10 20 30 40 50 10 20 30 40 50 10 20 30 40 50 10 20 30 40 504
6
8
10
12
Weeks
% o
f All
Dea
ths
Due
to P
&I
Epidemic Threshold
Seasonal Baseline
Pneumonia and Influenza Mortality 122 U.S. Cities Surveillance System
National Summary, 2009-2014
2009 2010 2011 2012 2013 2014
8.7%
9.9%
Influenza Deaths by Age Group122 Cities Mortality Reporting System,
Number of Influenza Deaths by Age Group and Year
2009-10 2010-11 2011-12 2012-13 2013-140%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
16941 19 59 25
555
190 37
138
352
160
17566
556
194
>64 years25-64 years0-24 years
*
**Data as of week 6, 2014
***Data from week 15, 2009 – week 39, 2010
Influenza Activity Summary Influenza activity in the US during the 2013–14
season began approximately 4 weeks earlier than usual, and occurred at moderate levels Activity peaked in late December/early January Influenza A (H1N1) viruses predominated
There are higher rates of influenza-associated hospitalization in 2013-14 in persons 18-64 years of age than during the past several seasons
There were higher numbers of influenza deaths in the 122 Cities Mortality Surveillance System in 2013-14 in persons 25-64 years than during past several seasons
Acknowledgements
Joseph BreseeScott EppersonLenee BlantonKrista KnissRosaline DharaDesiree MustaquimAlejandro PerezMichelle LeonAndrea GiorgiCraig SteffensAshley FowlkesJulie VillanuevaSophie Smith
Michael JhungCarrie ReedAlicia FrySeema JainAnna BramleyVictoria JiangSandra Dos Santos ChavesDaniel JerniganJoe GreggLarissa GubarevaTerri WallaceXiyan XuNancy Cox
Interim Estimates of 2013-14 Seasonal Influenza Vaccine Effectiveness — United States,
February 2014
Data from the U.S. Flu VE NetworkDecember 2, 2013-January 23, 2014
Brendan Flannery, PhDInfluenza Division
Presentation to the ACIP Influenza Working GroupFebruary 18, 2014
National Center for Immunization & Respiratory DiseasesInfluenza Division
US Flu VE Network: Five Study Sites and Principal Investigators
Lisa JacksonMike Jackson
Ed Belongia
Arnold MontoSuzanne Ohmit
Rick ZimmermanPatricia Nowalk
Manju Gaglani
US Flu VE Network: Methods
Enrollees: All persons aged >6 months with medically attended acute respiratory illness (MAARI) – ambulatory care visits from Dec 2, 2013-Jan 23, 2014Methods : Prospective case-control study (test negative design) Influenza infection confirmed with CDC RT-PCR
Cases: Outpatient ARI and influenza PCR-positive Controls: Outpatient ARI and influenza PCR-negative
Vaccination status: receipt of ≥1 dose of 2013-14 seasonal flu vaccine confirmed by medical records and registries (2 sites) and self-report and medical records (3 sites)
Analysis: VE = (1 – adjusted OR) x 100% Adjustment for study site, age, sex, race/ethnicity,
self-rated health and days from illness onset to enrollment
US Flu VE Network: Results
Influenza test result No. (%)Influenza A 778 (99%) H1N1pdm09 742 H3N2 13 Not subtyped 23Influenza B 6 (1%)
• 2,319 enrolled from 2 December, 2013-23 January, 2014
• 1,535 (66%) influenza RT-PCR negative• 784 (34%) influenza RT-PCR positive
Adjusted VE* and 95% CIs against influenza A and B for ≥1 dose of 2013-14 seasonal influenza vaccine, by age
group
6 mos-17 yrs 18-49 yrs 50-64 yrs ≥65 yrs0
10
20
30
40
50
60
70
80
90
100
Age group
Vacc
ine
Effec
tive
ness
(%
)
* Vaccine effectiveness was estimated as 100% X (1 – odds ratio [ratio of odds of vaccination among flu-positive cases to odds of vaccination among flu-negative controls]) using multivariable logistic
regression including study site, age, sex, race/ethnicity, self-rated health status and days from illness onset to enrollment.
Comparison of adjusted VE estimates against H1N1pdm09 associated outpatient ARI over several
influenza seasons
* Adjusted VE and 95% CI for primary healthcare patients: 42% (-97%-83%). Source: Castilla J, Eurosurveillance 2014 .
US Flu V
E, 20
13-14
Canad
a, 20
13-14
Spain*,
2013
-14
US Flu V
E, 20
11-12
Canad
a, 20
11-12
US Flu V
E, 20
10-11
Marsh
field, W
I, 20
10-11
Euro
pe, 20
10-11
US Flu V
E, 20
09-10
Pregnan
t wom
en, U
S, 10-1
1/11-1
20
102030405060708090
100
Study, Influenza Season
Vacc
ine
Effec
tive
ness
(%
)
Conclusions 2009 H1N1pdm virus predominated among influenza
viruses identified from Dec 2, 2013-Jan 23, 2014 in U.S.
Interim adjusted VE against H1N1pdm09 associated medically attended ARI = 62% (95% CI: 53-69) Similar for all age groups Similar to VE estimates from previous seasons Consistent with laboratory data
Final analyses for 2013-14 season will investigate effects of prior vaccination
Ability to estimate VE for H3N2 or B infections will depend upon final sample size
US Flu VE Network• University of Michigan and Henry Ford Health System: Arnold S. Monto, MD, Suzanne E.
Ohmit, DrPH, Joshua G. Petrie, MPH, Emileigh Johnson, Rachel T. Cross, MPH, Casey Martens, Marcus Zervos, MD, Lois Lamerato, PhD, Mary Ann Aubuchon, William Fredrick;
• University of Pittsburgh Schools of the Health Sciences and UPMC: Richard K. Zimmerman, MD, Mary Patricia Nowalk, PhD, Jonathan M. Raviotta, MPH, Heather Eng, Stephen R. Wisniewski, PhD, Charles R. Rinaldo, Jr, MD, Arlene Bullotta, Joe Suyama, MD, Evelyn Reis, MD, Donald B. Middleton, MD, Rhett H. Lieberman, MD, Michael Susick, MPH, Krissy K. Moehling, MPH, Mallory Schaffer, BS;
• Baylor Scott and White Health, Texas A&M University Health Science Center College of Medicine: Manjusha Gaglani, Lydia Clipper, RN, Anne Robertson, AA, Kempapura Murthy, MPH, Monica Weir, Hope Gonzales, Martha Zayed, Teresa Ponder, Virginia Gandy, RN, Patricia Sleeth, RN, Sophia V James, MS, , Michael Reis, MD, Cathleen Rivera, MD, David Morgan, MD, and Baylor College of Medicine : Pedro Piedra, MD, Vasanthi Avadhanula, PhD;
• Group Health Research Institute : Michael L. Jackson, PhD, Lisa A. Jackson, MD, C. Hallie Phillips, MEd, Joyce Benoit, RN, Lawrence T. Madziwa, MS, Matt B. Nguyen, MPH, Julia P. Anderson, MA;
• Marshfield Clinic Research Foundation: Edward A. Belongia, MD, Huong Q. McLean, PhD, Deanna Cole, Donna David, Sarah Kopitzke, MS, Tamara A. Kronenwetter Koepel, Jennifer K. Meece, PhD, Carla Rottscheit, Sandra K. Strey, Maria E. Sundaram, MSPH, Laurel A. Verhagen;
• CDC: Alicia M. Fry, MD, Swathi N. Thaker, PhD, Jessie Clippard, MPH, Ivo Foppa, PhD, Jill Ferdinands, PhD, LaShondra Berman, MS, Angie Foust, MS, Wendy Sessions, MPH, Sarah Spencer, PhD, Erin Burns, MA, Joseph Bresee, MD, Nancy Cox, PhD.