Influenza Prevention Update

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1 Influenza Prevention Update Dean A. Blumberg, MD, FAAP Disclosure speakers bureau: sanofi pasteur, Merck Discussion off label use of FDA approved vaccines

2 Influenza Prevention Update Seasonal influenza epidemiology Vaccine new recommendations new formulations new egg allergy guidelines focus on specific patient groups Immunization rates Current status of influenza activity

3 Influenza A Virus: Schematic Diagram Hemagglutinin (HA) Neuraminidase (NA) M2 Nucleoprotein (NP) M1 Polymerase (P) Proteins Adapted from: Hayden FG, Palese P. Clinical Virology

4 Influenza Annual Burden of Disease, US Influenza respiratory disease: million cases 5-20% of US population infected yearly Clinic visits: million Hospitalizations: 110, ,000 Deaths: 5,300-39,000 Reed C: 2015 NAIIS: May 12 14

5 Burden of Influenza in Children Annual attack rates 10%-40% in the pediatric population Hospitalization <24 months of age at higher risk Risk of complications increases with chronic underlying conditions acute otitis media concurrent viral, secondary bacterial common Outpatient visits times more common than hospitalizations in children <5 years of age

6 Annual average excess # of hospitalizations/100,000 children Hospitalization Rates in Children <15 Years of Age <6 mos 6 to <12 mos 1 to <3 yrs 3 to <5 yrs 5 to <15 yrs Age

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9 Pediatrics 2013;132:796

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14 Influenza Vaccines Trivalent or quadrivalent 2 A antigens, 1-2 B antigen» changes yearly Contains egg antigen most

15 Influenza Vaccine Composition A/California/7/2009 (H1N1)pdm09-like A/Hong Kong/4801/2014 (H3N2)-like B/Brisbane/60/2008-like (B/Victoria lineage) [B/Phuket/3073/2013-like (B/Yamagata lineage)]

16 Inactivated Influenza Vaccine >6 months of age Intramuscular Some formulations: thimerosal Adverse events local reactions

17 Inactivated Influenza Vaccine Contraindication history of severe allergic reaction to any vaccine component or previous dose Precaution moderate-severe illness history of Guillain-Barré syndrome within 6 weeks of prior influenza vaccine

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23 ACIP 6/16

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28 Influenza Vaccination Rationale Routine vaccination of children Influenza 6-23 months of age» high rates of hospitalization and complications months of age» significant morbidity 5-18 years of age» adverse impact on school-aged children school absenteeism, increased antibiotic use, medical care visits, parental work loss

29 Influenza Vaccine: Routine Indication Recommendations 6 months and older Timing initiate in Fall» as soon as available» administer throughout influenza season vaccinate yearly

30 Influenza Vaccine Dose Inactivated Vaccine Age Number of Doses (dose) 6-35 mo 1 or 2* (0.25 ml) 3-8 yrs 1 or 2* (0.50 ml) >9 yrs 1 (0.50 ml) *2 doses 1 month apart if vaccinated for the first time; if only 1 dose received the initial season, should receive 2 doses the following season

31 Per 100,000 population Older Adults: Influenza-related Deaths & Hospitalizations Influenza-related mortality Influenza-related hospitalizations Age group (yrs) Mortality rates are for Hospitalization rates are for Thompson WW, et al. J Infect Dis. 2006;194(suppl 2):S82-S91.

32 Influenza: Older Adults Disproportionate disease burden ~15% of US population >90% influenza-related deaths Influenza vaccine decreased immunologic response decreased antibody responses more vulnerable to influenza infection and severe complications

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34 % Subjects Seroconversion Rates, >65 Years 80 High-dose Standard-dose H1N1 H3N2 B Falsey AR, et al. J Infect Dis. 2009;200(2):

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41 Relative Vaccine Effectiveness

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46 Influenza-Related Illness in the Elderly vs County-Wide Nonelderly Adult Vaccination Coverage

47 >65 years of age

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50 Influenza B-Lineage Vaccine Strain Mismatch Season % B % Yamagata % Victoria Vaccine Yamagata Yamagata Victoria Victoria Yamagata Yamagata Victoria Victoria Yamagata Victoria Victoria Victoria Red indicates B-lineage mismatch between vaccine strain and predominant circulating strain. References: 1. Reed C, et al. Vaccine. 2012;30(11): CDC. MMWR. 2010;59(29): CDC. MMWR. 2011;60(21): CDC. MMWR. 2011;61(22):

51 Influenza B Virus: Disease Burden ~25%-30% of circulating strains Epidemics every 2 to 4 years Hospitalization and mortality rates < A(H3N2), > A(H1N1) Influenza B is a significant cause of absenteeism, clinic visits, hospitalizations, and deaths across all ages 25% of all influenza deaths

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61 50.4% efficacy 48.8% efficacy

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75 National Influenza Vaccine Summit 2012

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79 Flu Near You 9/21/16

80 Influenza Prevention Update: Summary Routine influenza vaccine for all >6 months old Vaccine choice Children» IIV, trivalent or quadrivalent egg-free option Adults» IIV, trivalent or quadrivalent egg-free option» intradermal» older adults HD-IIV3 aiiv3

Talkin Flu Mid-America Immunization Coalition August 18, William Atkinson, MD, MPH Immunization Action Coalition

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