In this dcument: Summary Key Pints Summary f Influenza Virus Labratry Data FluView Activity Update Early Influenza Vaccine Cverage Estimates fr 2016-17 Influenza Vaccine Prgram Impact Estimates fr 2015-16 Natinal Influenza Vaccinatin Week (NIVW) Summary Key Pints The mst recent FluView reprt indicates that flu activity remains lw in the United States but is beginning t increase. Influenza A (H3N2) viruses have been mst cmmn s far this seasn. Influenza A (H3N2)-predminant seasns are ften assciated with mre severe illness, especially in yung children and peple 65 and lder. Flu is unpredictable. It s nt pssible t say hw severe this flu seasn will be, what viruses will predminate r hw lng activity will cntinue. Each flu seasn, flu causes millins f illnesses, hundreds f thusands f hspitalizatins and thusands r smetimes tens f thusands f deaths. On December 9, CDC released new estimates n flu hspitalizatins and deaths in the States since 2010. Since 2010, CDC estimates that flu-related hspitalizatins since 2010 ranged frm 140,000 t 710,000, while flu-related deaths are estimated t have ranged frm 12,000 t 56,000. (See sectin Influenza Vaccine Prgram Impact Estimates fr 2015-16 fr mre infrmatin.) The Centers fr Disease Cntrl and Preventin (CDC) recmmends annual flu vaccinatin fr everyne 6 mnths and lder by the end f Octber, if pssible. Peple wh have nt yet gtten vaccinated against flu shuld get their vaccine as sn as pssible. This week is Natinal Influenza Vaccinatin Week and CDC urges anyne 6 mnths and lder wh had nt yet been vaccinated yet this seasn t get vaccinated. On December 9 CDC als released estimates f the number f peple wh had gtten their flu vaccinatin by early Nvember f this seasn. There was little change in flu vaccinatin cverage cmpared t this time last year, but there are sme grups we are cncerned abut. Despite the benefits f vaccinatin, mre than 60% f the U.S. ppulatin have nt yet been vaccinated against flu this seasn. (See sectin Early Influenza Vaccine Cverage Estimates fr 2016-17 fr mre infrmatin.) 1
This seasn nly injectable flu vaccines (flu shts) are recmmended. The nasal spray vaccine shuld nt be used. A flu vaccine is the best defense against getting the flu. While flu vaccine can vary in hw well it wrks, vaccinatin can reduce flu illnesses, dctrs' visits, and missed wrk and schl due t flu, as well as prevent flu-related hspitalizatins. On December 9, CDC als released infrmatin n hw many illnesses, hspitalizatins were prevented by flu vaccinatin last seasn. CDC estimates that fr the 2015-2016 influenza seasn, influenza vaccinatin prevented apprximately 5.1 millin influenza illnesses, 2.5 millin influenzaassciated medical visits, and 71,000 influenza-assciated hspitalizatins. (See sectin Influenza Vaccine Prgram Impact Estimates fr 2015-16 fr mre infrmatin.) Getting a flu vaccine yurself als can prtect peple arund yu wh are mre vulnerable t serius flu cmplicatins, like pregnant wmen, lder peple, yung children and peple with certain chrnic cnditins like asthma r diabetes. Flu can be mre serius fr these peple and yu can help prtect them by getting vaccinated yurself. The cmpsitin f this seasn s vaccine has been updated t better match circulating viruses. Bth fur-cmpnent (quadrivalent) and three-cmpnent (trivalent) flu vaccines are available this seasn. Trivalent flu vaccine is designed t prtect against three different flu viruses; quadrivalent prtects against thse three viruses plus an additinal influenza B virus. CDC has nt expressed a preference fr any ne flu sht ver anther. The imprtant thing is t get vaccinated. It takes abut tw weeks after vaccinatin fr prtectin t set in. Nw is a gd time t get vaccinated. There are still likely t be many weeks f flu activity this seasn, s getting vaccinated nw can still prvide imprtant prtectin this seasn. Manufacturers reprt having shipped mre than 133.3 millin dses f flu vaccine as f December 2, 2016. http://www.cdc.gv/flu/prfessinals/vaccinatin/vaccinesupply.htm The riginal ttal prjected supply f vaccine in the United States this seasn was between 157 millin and 168 millin dses f injectable flu vaccine. Early seasn supply prjectins can differ frm the actual number f vaccine dses distributed at the end f the seasn based n a number f factrs. 2
G t http://vaccine.healthmap.rg/ r www.cdc.gv/flu t find a lcatin near yu where yu can get vaccinated. CDC als issued a press release summarizing the current situatin n flu at this time and a web sptlight highlighting CDC s wrk with private flu frecasters. All reprts issued n December 9 are available at https://www.cdc.gv/flu/sptlights/flu-vaccine-prtected-millins.htm Summary f Influenza Virus Labratry Data Labratry data n flu viruses cllected and analyzed since Octber 2 shw that all circulating influenza viruses are similar t the reference vaccine viruses recmmended fr the prductin f 2016-2017 U.S. vaccines. N significant antigenic drift has been identified. This suggests that vaccinatin with Nrthern Hemisphere influenza vaccine shuld ffer prtectin against the majrity f circulating influenza viruses. CDC will cntinue t carefully review the results f labratry studies f currently circulating influenza viruses t lk fr any evidence that viruses are changing. Labratry results are published weekly in FluView, alng with surveillance infrmatin related t influenza activity. FluView is available at http://www.cdc.gv/flu/weekly/fluactivitysurv.htm. CDC als will cnduct vaccine effectiveness studies t tell hw well the vaccine is actually prtecting against illness. FluView Activity Update Accrding t the FluView reprt fr the week ending December 3, 2016 (week 48), flu activity increased slightly, but remains lw verall in the cntinental United States. Influenza A (H3) viruses were mst cmmnly reprted during week 48 and have been the predminant virus s far this seasn. While the timing f influenza activity varies and is unpredictable, flu activity is expected t increase in the cming weeks. CDC recmmends annual flu vaccinatin fr everyne 6 mnths f age and lder. Anyne wh has nt gtten vaccinated yet this seasn shuld get vaccinated nw. Belw is a summary f the key flu indicatrs fr the week ending December 3, 2016: Fr the week ending December 3, the prprtin f peple seeing their health care prvider fr influenza-like illness (ILI) was 1.8%. This is belw the natinal baseline f 2.2%. Tw regins (Regins 2 and 4) reprted ILI at r abve their reginspecific baseline level. 3
Puert Ric experienced high ILI activity. New Yrk City and fur states (Clrad, Gergia, Luisiana, and Nevada) experienced lw ILI activity. 46 states experienced minimal ILI activity. The District f Clumbia did nt have sufficient data t calculate an activity level. ILI activity data indicate the amunt f flu-like illness that is ccurring in each state. Widespread influenza activity was reprted by Puert Ric. Reginal influenza activity was reprted by Guam and tw states (Alabama and Nrth Carlina). Lcal flu activity was reprted by 19 states (Arizna, Cnnecticut, Delaware, Indiana, Kentucky, Luisiana, Maine, Maryland, Massachusetts, Minnesta, Nevada, New Hampshire, Ohi, Oklahma, Oregn, Pennsylvania, Texas, Virginia, and Washingtn). Spradic flu activity was reprted by the U.S. Virgin Islands and 28 states (Alaska, Arkansas, Califrnia, Clrad, Flrida, Gergia, Hawaii, Idah, Illinis, Iwa, Kansas, Michigan, Mississippi, Missuri, Mntana, Nebraska, New Jersey, New Mexic, New Yrk, Nrth Dakta, Suth Carlina, Suth Dakta, Tennessee, Utah, Vermnt, West Virginia, Wiscnsin, and Wyming). N flu activity was reprted by ne state (Rhde Island). The District f Clumbia did nt reprt. Gegraphic spread data shw hw many areas within a state r territry are seeing flu activity. Influenza-assciated hspitalizatin data frm the Influenza Hspitalizatin Surveillance Netwrk (FluSurv-NET) fr the 2016-2017 influenza seasn will be updated weekly starting later this seasn. Due t data prcessing prblems, the Natinal Center fr Health Statistics (NCHS) mrtality surveillance data fr the week ending Nvember 19, 2016 (week 46) will nt be published this week. N influenza-assciated pediatric deaths fr the 2016-2017 seasn have been reprted t CDC. Natinally, the percentage f respiratry specimens testing psitive fr influenza viruses in clinical labratries during the week ending December 3 was 3.5%. Reginally, the three week average percent f specimens testing psitive fr influenza in clinical labratries ranged frm 0.9% t 8.7%. The mst frequently identified influenza virus type reprted by public health labratries during the week ending December 3 was influenza A viruses, with influenza A (H3) viruses predminating. During the week ending December 3, 141 (91.6%) f the 154 influenzapsitive tests reprted t CDC by public health labratries were influenza A viruses and 13 (8.4%) were influenza B viruses. Of the 118 influenza A viruses that were subtyped, 112 (94.9%) were H3 viruses and 6 (5.1%) were (H1N1)pdm09 viruses. 4
Since Octber 1, 2016, antigenic and/r genetic characterizatin shws that the majrity f the tested viruses remain similar t the recmmended cmpnents f the 2016-2017 Nrthern Hemisphere vaccines. Since Octber 1, 2016, CDC tested 156 specimens (24 influenza A (H1N1)pdm09, 104 influenza A (H3N2), and 28 influenza B viruses) fr resistance t the neuraminidase inhibitrs antiviral drugs. Nne f the tested viruses were fund t be resistant t seltamivir, zanamivir, r peramivir. FluView (http://www.cdc.gv/flu/weekly/fluactivitysurv.htm) is available and past issues are archived (http://www.cdc.gv/flu/weekly/pastreprts.htm) n the CDC website. Nte: Delays in reprting may mean that data changes ver time. The mst up t date data fr all weeks during the 2016-2017 seasn can be fund n the current FluView(http://www.cdc.gv/flu/weekly/). Early Influenza Vaccine Cverage Estimates fr 2016-17 Summary Key Pints: Despite the benefits f vaccinatin, mre than 60% f the U.S. ppulatin have nt yet been vaccinated against flu this seasn. We have mre t d in getting adults, particularly pregnant wmen and health-care persnnel wrking in lng-term care (LTC) facilities fr whm vaccinatin is s imprtant, vaccinated. There was little change in flu vaccinatin cverage cmpared t this time last year, but there are sme grups we are cncerned abut. Children: Children are an imprtant fcus this seasn because the nasal spray vaccine is nt recmmended fr use during 2016-17. Because f this change, we re lking clsely at cverage amng children and are hpeful that we wn t see cverage decline. We want t remind parents abut the imprtance f flu vaccinatin t prtect their children. Adults 50+: Peple 65 and lder are at high risk f serius flu cmplicatins because f their age. Abut ne-third f peple 50-64 are at high risk f serius flu cmplicatins because they have an underlying health cnditin. Last seasn vaccinatin cverage amng bth grups f peple was abut 3 percentage pints lwer than cverage in the previus years. We hpe last seasn s decline was a dip, nt a trend. Peple wh wrk in LTC settings: While there has been sme increase in flu vaccinatin cverage amng peple wrking in lng term care facilities, their rates cntinue t lag behind thse in ther healthcare settings. Lwer cverage nt nly means they are at increased risk f flu, but they are putting themselves, their families, and their patients at increased risk. 5
Pregnant wmen: The early vaccinatin cverage estimate shws that mre than half f pregnant wmen remain unvaccinated. The best way fr pregnant wmen t prtect themselves and their babies frm the flu is t get a flu sht. Infants yunger than 6 mnths are at high risk f severe cmplicatins frm the flu, but they are t yung t be vaccinated. Infants whse mthers get the flu sht while pregnant have a lwer risk f flu illness during the first several mnths after birth. General Ppulatin Key Findings Only apprximately tw f every five children and adults in the United States were vaccinated by early Nvember 2016: 40% f the U.S. ppulatin 6 mnths and lder 37% f children 6 mnths thrugh 17 years 41% f adults 18 years and lder Early 2016 17 flu vaccinatin cverage was similar t cverage at the same time last flu seasn fr everyne 6 mnths and lder. Amng bth children and adults, early flu vaccinatin cverage estimates shwed n racial/ethnic differences. Amng bth adults and children, the mst cmmn places reprted fr receiving flu vaccinatin were medical lcatins like dctr s ffices (children: 85%, adults: 52%). Fr adults, retail settings like pharmacies (24%) and wrkplaces (18%) were als cmmn lcatins fr vaccinatin. Health Care Prfessinal (HCP) Key Findings Flu vaccinatin cverage amng HCP has imprved ver the past six flu seasns, but remains belw the natinal Healthy Peple 2020 target f 90%. By early Nvember 2016, flu vaccinatin cverage amng HCP was 69%, similar t early- cverage during the 2015 16 seasn (67%). During the previus tw seasns, flu vaccinatin cverage increased by 12 t 13 percentage pints frm early cverage estimates t the final cverage estimates. By ccupatin, early- flu vaccinatin cverage was highest amng physicians (83%), nurse practitiners/physician assistants (83%), pharmacists (81%), nurses (81%), and ther clinical prfessinals (72%). Flu vaccinatin cverage was lwest amng administrative and nnclinical supprt staff (65%) and assistants and aides (57%). 6
By wrk setting, early flu vaccinatin cverage was highest amng HCP wrking in hspitals (81%). Flu vaccinatin cverage cntinues t be lwest amng HCP wrking in lngterm care (LTC) settings (55%). Early flu vaccinatin cverage was higher amng HCP whse emplyers required (89%) r recmmended (69%) that they be vaccinated cmpared with HCP whse emplyer did nt have a requirement r a recmmendatin regarding flu vaccinatin (26%). Flu vaccinatin f HCP has been shwn t reduce the risk f flu and absenteeism in vaccinated HCP and reduce the risk f respiratry illness and deaths in nursing hme residents. Amng unvaccinated HCP wh did nt intend t get the flu vaccinatin during this flu seasn, the mst cmmn reasn reprted fr nt getting vaccinated was fear f experiencing side effects r getting sick frm the vaccine. The secnd mst cmmn reasn was that they dn t think that flu vaccines wrk. Pregnant Wmen Key Findings The early vaccinatin cverage estimate fr pregnant wmen shws that mre than half f pregnant wmen remain unvaccinated. By early Nvember 2016, flu vaccinatin cverage befre and during pregnancy amng pregnant wmen was 47%, apprximately 6 percentage pints higher cmpared with 2014 15 early seasn vaccinatin cverage (40%). In the previus tw flu seasns, vaccinatin cverage increased by apprximately 7 t 10 percentage pints frm the early cverage estimates t the final cverage estimates. While the early vaccinatin cverage estimate fr pregnant wmen is 6 percentage pints higher than it was arund this time last seasn, this year s estimate reflects data cllecting during a slightly later time perid (apprximately 5 days later than last seasn). Yunger pregnant wmen (18 24 years) had a vaccinatin cverage (42%) lwer than pregnant wmen 25 34 years (47%) and thse 35 49 years (52%). There were n differences in vaccinatin cverage by race/ethnicity amng pregnant wmen in early Nvember 2016. Vaccinatin cverage was lwer amng pregnant wmen with a high schl diplma r less (38%) r sme cllege (38%) cmpared with wmen with a cllege degree (49%) r mre than a cllege degree (60%). 7
Mst wmen (99%) reprted visiting a dctr r ther medical prfessinal at least nce since July 1, 2016. Amng these wmen, 60% reprted receiving a recmmendatin fr and ffer f vaccinatin frm a dctr r ther medical prfessinal, 14% received nly a recmmendatin fr and n ffer f vaccinatin, and 24% did nt receive a recmmendatin fr flu vaccinatin, similar t the prprtins in Nvember 2015 (62%, 15% and 23%, respectively). Wmen wh reprted receiving a prvider recmmendatin and ffer fr vaccinatin were mre than twice as likely t be vaccinated cmpared with wmen wh received nly a recmmendatin but n ffer f vaccinatin (66% vs. 30%) and six times mre likely t be vaccinated cmpared with wmen wh did nt receive a recmmendatin fr vaccinatin (66% vs. 11%). The best way fr pregnant wmen t prtect themselves frm the flu is t get a flu sht. Infants yunger than 6 mnths are at high risk f severe cmplicatins frm the flu, but they are t yung t be vaccinated. Infants whse mthers get the flu sht while pregnant have a lwer risk f flu illness and influenza related hspitalizatins during the first several mnths f life. Influenza Vaccine Prgram Impact Estimates fr 2015-16 CDC estimates f influenza disease burden (illnesses, medical visits and hspitalizatins) and disease-averted by influenza vaccinatin have been published annually, beginning in 2010. On, CDC released its estimates fr the 2015-2016 seasn. The reprt is available nline at https://wwwd.cdc.gv/flu/abut/disease/2015-16.htm. 2015-2016 Estimates CDC estimates that fr the 2015-2016 influenza seasn, influenza vaccinatin prevented apprximately 5.1 millin influenza illnesses, 2.5 millin influenzaassciated medical visits, and 71,000 influenza-assciated hspitalizatins. This represents a 19 percent reductin in the burden f influenza illness in the absence f vaccinatin; which is similar t what has been seen in estimates fr ther seasns. The nline reprt als prvides the estimated number f illnesses, medical visits and hspitalizatins assciated with influenza last seasn. CDC estimates that last seasn there were 25 millin illnesses, 11 millin medical visits and 310,000 flu-assciated hspitalizatins; a substantial amunt f illness. 8
The reprt underscres the benefits f the current vaccinatin prgram but it als highlights areas where imprvements in vaccine uptake and vaccine effectiveness culd deliver even greater benefits t the public s health. Range f Flu-Related Hspitalizatins A summary table f estimates generated using this mdel frm 2010-2011 t 2015-2016 is included. Based n this data: CDC estimates that frm 2010-2011 t 2015-2016, flu-related hspitalizatins in the United States ranged frm a lw f 140,000 (2011-2012) t 710,000 (2014-2015). CDC has previusly cited mre than 200,000 as an average fr annual flu-related hspitalizatins. That figure was based n data frm 1979-2001. CDC believes that prviding a range f flu-related hspitalizatins frm mre recent seasns is a mre cmplete representatin f the variability and severity f influenza than an average. Range f Flu-Related Deaths CDC als has added estimates f flu deaths and flu deaths prevented by vaccinatin t this reprt and will present thse numbers annually ging frward as well. CDC calculates flu-related deaths in tw ways: 1) using reprts f pneumnia & influenza (P&I) deaths, and 2) using reprts f respiratry & circulatry (R&C) deaths. P&I deaths represent nly a fractin f the ttal number f deaths frm influenza, which can als result frm respiratry and cardivascular cmplicatins. CDC believes that estimates f flu-related deaths using R&C reprts gives a mre cmplete estimate f the actual burden f influenza; hwever, P&I data is available in real-time whereas R&C data lags three years behind. CDC will prvide estimates f flu-related deaths based n P&I annually (befre R&C estimates are available). *Imprtant nte: Past cmparative data suggest that the ttal number f influenza-assciated deaths may be 2 t 4 times greater than estimated using nly reprted P&I deaths. Calculatins based n R&C will be prvided with a three-year delay. The nline reprt finds that: 9
CDC estimates that during the 2015-2016 influenza seasn, influenza vaccinatin prevented abut 3,000 P&I deaths.* CDC als is updating the range used t characterize flu-related deaths using data frm mre recent seasns. Since 2010 CDC has used a range ( 3,000 t 49,000 ) t describe flu-related deaths. These R&C-based influenza mrtality estimates were derived frm data frm 1976 t 2007. This range is being updated based n R&C deaths reprted frm 2010 t 2014. The nline reprt finds that: CDC estimates that frm 2010-2011 t 2013-2014, influenza-assciated deaths in the United States ranged frm a lw f 12,000 (during 2011-2012) t a high f 56,000 (during 2012-2013). Natinal Influenza Vaccinatin Week (NIVW) NIVW is a natinal bservance established in 2005 by the Centers fr Disease Cntrl and Preventin (CDC) t highlight the imprtance f cntinuing influenza vaccinatin after the hliday seasn and beynd. NIVW prvides an pprtunity fr public health and health care prfessinals, health advcates, cmmunities and families acrss the cuntry t wrk tgether t prmte flu vaccinatin. 10