USA - Media Advisory - CDC Update: Flu Season and Vaccine Effectiveness Today 11:30am

[sharon sanders]

Please Note: Attached are CDC?s latest FluView, MMWR article on vaccination effectiveness, as well as the media advisory for today?s telebriefing at 11:30 am. Please dial in to the telebriefing to have your questions answered about this year?s flu season. We will respond to requests for interviews after the telebriefing.


Media Advisory
For Immediate Release
Friday, January 11, 2013

Contact: CDC Division of News & Electronic Media
(404) 639-3286


CDC Update: Flu Season and Vaccine Effectiveness

WHAT: CDC will host a telephone-only media availability to provide an update on influenza in the United States and to provide update on effectiveness of the influenza vaccine for 2012-2013 season.

WHO: Tom Frieden, M.D., M.P.H., Director, Centers for Disease Control and Prevention

Joseph Bresee, M.D., Chief of the Epidemiology and Prevention Branch, Influenza Division, CDC


WHEN: Friday, January 11, 2013 at 11:30 a.m. ET

DIAL-IN:
Media: 888-795-0855
Non-Media: 877-917-7132
INTERNATIONAL: 1- 210-234-0090
PASSCODE: CDC MEDIA

Important Instructions
If you would like to ask a question during the call, press *1 on your touchtone phone. Press *2 to withdraw your question. You may queue up at any time. You will hear a tone to indicate your question is pending.

TRANSCRIPT
A transcript of this media availability will be available following the briefing at the CDC web site at www.cdc.gov/media.

[gsgs]

Re: USA - Media Advisory - CDC Update: Flu Season and Vaccine Effectiveness Today 11:30am

11:30 ET = 17:30 MET = in 1h.20min
ask for sequences, all 8 segments, partials, low quality, is enough.
OK, I sent email, asking about reassortment

[sharon sanders]

Re: USA - Media Advisory - CDC Update: Flu Season and Vaccine Effectiveness Today 11:30am

I am on hold for now. They just released the Flu View

2012-2013 Influenza Season Week 52 ending December 29, 2012

http://www.cdc.gov/flu/weekly/

[sharon sanders]

Re: USA - Media Advisory - CDC Update: Flu Season and Vaccine Effectiveness Today 11:30am

My notes on twitter:

#USA - Media Advisory - CDC Update: #Flu Season and Vaccine Effectiveness Today Conference Call 11:30 am http://www.flutrackers.com/forum/sho...514#post480514 ? #fb

#USA - CDC - FluView 2012-2013 Influenza Season Week 52 ending December 29, 2012 http://www.cdc.gov/flu/weekly/ #flu

#USA -CDC Conf w/Tom Frieden,M.D.M.P.H.,Director,& Joseph Bresee,M.D.,Chief of Epidemiology & Prevention Branch,Influenza Division #flu #fb

Tom Skinner w/ CDC introducing conference attendees #flu

Frieden: It is #flu season and an early start. Elevated in most of #USA #fb

Frieden: #Flu activity ebbs and flows geographically. 2 more pediatric deaths last week. Total =20 for this season. #fb

Frieden: Trends are hard to predict with recent holidays. 24 states report high activity - down from 29. #flu #fb

Frieden: #Flu is unpredictable. Expects a few more weeks of flu outbreaks. #fb

Frieden: Overall #flu vaccine effectiveness is 66%. #fb (note - The MMWR says 62%. Either I heard him wrong or Frieden misspoke).

Frieden: You can do a lot to protect yourself. Consider #flu vaccine.Some shortages. Cover your cough.Stay home if sick.Wash hands ---> #fb

Frieden:If sick contact medical practitioner. Anti-virals need 2 b started early 2 b effective.Keep sick children home from school #flu #fb

#USA - Written - MMWR says overall #flu vaccine effectiveness is 62% http://www.flutrackers.com/forum/sho...529#post480529 ? #fb

#USA - #Flu vaccine against flu A is 55% and against influenza B is 70% per written MMWR http://www.flutrackers.com/forum/sho...529#post480529 ? #fb

The question and answer period is ongoing. Mostly covered in the MMWR already. http://www.flutrackers.com/forum/sho...529#post480529 ? @ironorehopper #flu #fb

#USA CDC recommends that persons in risk groups especially consider taking #flu shot even w/low effectiveness rate overall. #fb

Frieden: Closing remarks - We do not know if we are over the peak. Some areas indicate maybe - need to establish a trend. #flu #fb

Bresee: Some issues finding pediatric tamiflu fluid. Probably will use adult tablets to make more. #flu #fb

Tom McNeil w/NY Times asks about other illnesses circulating. Bresee says lots r out there incl,norovirus crowding emergency rooms #flu #fb

Most questions and comments are about #flu vaccine and how to make more effective. #fb

Bresee basically said that yes we need better effectiveness rates. People working on this for the future. Problem is #flu changes. #fb

Bresee: Getting the vaccine might give you a milder #flu disease if you still get infected but data is "sparse" on this issue. #fb

The conference is over.

[Missouriwatcher]

Re: USA - Media Advisory - CDC Update: Flu Season and Vaccine Effectiveness Today 11:30am

Flu Vaccine Effectiveness: Questions and Answers for Health Professionals CDC 0ct. 2011 (Some of the questions and answers)

Which outcomes provide the best estimates of vaccine effectiveness?
Studies that use more specific outcomes, such as laboratory-confirmed influenza outcomes (e.g., culture positive or reverse-transcriptase polymerase chain reaction (RT-PCR) positive results), provide the best and most specific estimates of the impact of influenza vaccines in preventing influenza. In general, when non-laboratory-confirmed outcomes are used (e.g., all pneumonia hospitalizations or influenza-like illness, which include many non-influenza illnesses), vaccine effectiveness estimates are lower. For example, a study by Bridges et al (2000) among healthy adults found that the inactivated influenza vaccine was 86% effective against laboratory-confirmed influenza, but only 10% effective against all respiratory illnesses in the same population and season.

Why do estimates of influenza vaccine effectiveness vary widely?

Estimates of influenza vaccine effectiveness are affected by several factors, including the specific study biases discussed above, the match between the vaccine influenza strains and the circulating strains, host factors and the sample size of a specific study...However, vaccine effectiveness will always vary from season to season, based upon the degree of similarity between the viruses in the vaccine and those in circulation, as well as other factors. In years when the vaccine strains are not well-matched to circulating strains, vaccine effectiveness is generally lower. In addition, host factors also affect vaccine effectiveness. In general, influenza vaccines are less effective among people with chronic medical conditions and among people age 65 and older, as compared to healthy young adults and older children.

How well do influenza vaccines work in people with chronic high-risk medical conditions?
The presence of chronic medical conditions may also affect the effectiveness of influenza vaccines. For example, in an observational study of people 50?64 years of age, the vaccine was 60% effective in preventing laboratory-confirmed influenza among otherwise healthy adults 50?64 years of age, but only 48% effective among those who had high-risk medical conditions (Herrera et al., 2006). In general, vaccine efficacy and effectiveness estimates among people with high-risk conditions may be somewhat lower than among people of similar age without high-risk conditions. However, because the risk of influenza-related complications among this group is much higher, vaccination still provides important benefits.

Adults 65 years or older
Only one large randomized, controlled trial of influenza vaccine has been conducted among an elderly population. During the 1991-1992 influenza season, a group of Dutch people 60 years of age and older not living in long-term care facilities (e.g., nursing homes) was studied (Govaert et al., 1994). In this study, vaccine efficacy was 58% in preventing clinically-defined influenza with serologic confirmation of infection. There are no published studies of the efficacy or effectiveness of influenza vaccines in preventing laboratory-confirmed, serious outcomes of influenza such as hospitalization, primarily because the size of the study would be large, and therefore, such a study is very expensive to conduct. Published observational studies conducted among people 65 and older not living in long-term care facilities have used non-specific outcomes, such as pneumonia hospitalizations or all-cause mortality. These studies may be subject to substantial confounding and selection bias, and they use outcomes in which the proportion of illness associated with influenza virus infections vary by season (as other respiratory viruses can cocirculate). As a result, it is difficult to interpret the results of these studies.

Adults 65 years or older in long-term care facilities
All residents of long-term care facilities s (e.g., nursing homes) should receive annual influenza vaccination, as outbreaks of influenza can be explosive and result in substantial morbidity and mortality among residents of such facilities. There is evidence that vaccination prevents respiratory illnesses during periods of influenza circulation for elderly nursing home residents. For example, one study conducted during the 1991-1992 influenza season found that vaccination was associated with a 34% reduction in total respiratory illnesses and a 55% reduction in pneumonia during the two-week peak of influenza activity (Monto, 2001). In addition, one study conducted in UK nursing homes found that vaccinating health care workers decreased deaths during periods of influenza activity during one season with substantial influenza circulation, but not during the next year, when influenza activity was low throughout the winter (Hayward, 2006).

Children
In a four-year randomized, placebo-controlled study of inactivated and live influenza vaccines among children aged 1?15 years, vaccine efficacy was estimated at 77% against influenza A (H3N2) and 91% against influenza A (H1N1) virus infection (Neuzil et al., 2001). A two-year study of children aged 6?24 months found that the vaccine was 66% effective in preventing laboratory-confirmed influenza in one year of the study (Hoberman et al., 2003). Only children who were fully vaccinated (i.e., had either two doses if not previously vaccinated, or one dose if previously vaccinated) versus unvaccinated children were included in the analysis. In the other year of this study, few cases of influenza occurred, making it difficult to assess the vaccine's efficacy (Hoberman et al., 2003). Children younger than 9 years of age who have not been vaccinated previously are recommended to receive two doses of vaccine the first year they get vaccinated. In subsequent years, they need only one dose. This recommendation was made because many children younger than 9 years of age have not been infected with influenza viruses previously, and a booster dose is needed for them to produce a protective immune response.

Questions and answers continue.

http://www.cdc.gov/flu/professionals/vaccination/effectivenessqa.htm

[Pathfinder]

Re: USA - Media Advisory - CDC Update: Flu Season and Vaccine Effectiveness Today 11:30am

Press Briefing Transcript

<!--Content-->CDC Update: Flu Season and Vaccine Effectiveness



Friday, January 11, 2013 at 11:30 a.m. ET

• Audio recording [MP3, 9.17MB]

**This transcript is a DRAFT only. The final, edited transcript will be available on Monday, January 14**

Excerpts:

Thank you. This question comes from Jonathan Serrie with Fox News.

>> Good afternoon, gentlemen. If you could explain the vaccine effectiveness of 62 percent, help me to understand does that mean a 62 percent chance you will not get the flu if you're exposed to the flu or how do you come up with that figure?

>> Basically, that says that if you've gotten the flu vaccine, you're 62 percent less likely to need to go to your doctor to get treated for flu.
...
next question comes from Maryhelen Campa from CBS Network News.

>> Hi, thanks for taking my call. You mentioned that the area of the country that's relatively lower with flu numbers is the far west. Can you talk a little bit more about that? Maybe provide some numbers? Is there anything that quantifies the spread west other than the usual?

>> I will -- I'll begin. I'll turn it over to Dr. Bresee and then I have to sign off the call. The -- generally we do see flu essentially roll across the country as it rolls across the globe. So it's not unexpected to see it start in the south, southeast and then spread sporadically to the west. That would be a common pattern. Though again you can't predict. Sometimes it skips areas of the country for reasons we don't understand. I want to reiterate a couple of messages before I turn it over to Dr. Bresee because I do have to drop off the call now. We're in flu season. Most of the country has seen or is seeing a lot of flu. This may continue for a few more weeks. We don't yet know whether we are over the peak. It does appear that in some of the south and southeast we are seeing that we are past the peak and declines in cases. But only the next couple of weeks will make that trend clear. You can't really make a line with two points. You need multiple points to see where that line is going, particularly when you have the holiday season which can sometimes skew some of the data...
...
Thank you. Next question comes from Erica Edwards with NBC news. You may ask your question.

>> Hey, there, I was wondering if you could talk more about the specific kinds of strains we're seeing and whether they're included in the vaccine. And specifically a reported fourth strain that popped up and may be not included in the vaccine?

>> Sure. About 90 percent of all of the strains circulating are included in the vaccine. In fact, they're the most -- the three most common strains and the current vaccines have only -- have space for only three strains. So the pick of vaccine strains was as good as it could have been this year. The other close to 10 percent are a second influenza B. And within a year or two, we do expect manufacturers to have on the market vaccines that have space for four different vaccines including two influenza Bs. So that's the explanation of that. Dr. Bresee, anything to add?

>> No, sir. That's great.
>> If I could ask a quick follow-up, is there any evidence that that particular strain is more severe or less severe or about the same as the flu we're seeing?
>> Dr. Bresee?
>> No, there's not. The two B strains, I think the fourth strain you're talking about is the B that is of a genetic lineage that's not included in the vaccine. There's no evidence that that strain is more or less severe than the other strains.
...
Next question comes from Robert Lowes from Medscape Medical News.
>> Thanks for taking my call.

...Second question, apparently, the pandemic virus is a very minor player in this year's season. What do you conclude from that?

>> I'll take the second question first, because I think it's an interesting question. We're not seeing much of the 2009 H1 virus yet so far this year, though it should be said that Europe and other places in the world are. And so that virus continues to circulate in the world. We know that influenza viruses in a given country, in a given city, in a given region will vary from year to year and in unpredictable ways. So I'd say we are seeing less of that virus now, but it doesn't mean we'll see less of it all during the season and it doesn't mean that it's gone from its vantage...
...
>> Thank you. Next question comes from Donald McNeill with "the New York Times." You may ask your question.

>> Thank you. I was hoping Tom Frieden would be here to handle this, but can you talk about the other viruses that are circulating? Lots of people are sick. Clearly not everybody has the flu this year. They have a whole constellation of symptoms, other things are going on. Can you just discuss that?

>> Thanks for the question. This is Joe. I'll try to answer this question. We are seeing an early flu year as we talked about, but at this time of the year we also see lots of other respiratory viruses like respiratory syncytial virus, metapneumovirus, parainfluenza virus and those are circulating now too. We are seeing a norovirus, which causes vomiting and diarrhea. So I think a lot of the calls that we have gotten anecdotally and a lot of the news reports that talk about clinics being very busy and ERs being very busy may in part be due to a confluence of a lot of these winter-time viruses occurring at the same time in some communities.
...

Full text:

http://www.cdc.gov/media/releases/2013/t0111_flu_season.html

[gsgs]

Re: USA - Media Advisory - CDC Update: Flu Season and Vaccine Effectiveness Today 11:30am

noone asked about sequences or reassortment.
And noone asked about the vax increasing ARI in the vaccination study

> Each year since 2004 and 2005, CDC has estimated the effectiveness of this seasonal influenza vaccine

do we have an overview about the results somewhere ?

> far the best tool we have to prevent influenza

no. Staying away from others, from infected people is far more efficient.
E.g. move to Australia or lock into your house/room when there is a wave.

> You can still protect yourself through vaccination

at this point I think it's not much useful. You only get ~50% (my estimate) of the
protection that you usually get.

> Basically, that says that if you've gotten the flu vaccine, you're 62 percent less likely to
> need to go to your doctor to get treated for flu.

no, it means that the doctor is 62% less likely to get a positive flu test.

> The geographic spread of flu is unpredictable

it comes regularly each winter to USA. Much more predictable than other epidemics

> And so I suspect that over the next couple of weeks the west coast will have more
> flu than they do now and some of the other areas will have less.

I agree that this is a reasonable prediction of the geographic spread of flu in the next 5 weeks.

> We have seen a lot of vaccination happening in the last couple of weeks, so I don't know
> where we'll end up this year. But hopefully we'll end up much higher than 37 percent
> and close to 50 percent. [vaccination coverage]

so, maybe all that vaccination talk made google-flu-trends go up

[Missouriwatcher]

Re: USA - Media Advisory - CDC Update: Flu Season and Vaccine Effectiveness Today 11:30am

Active duty military vaccination rates are ~95% each year and yet the overall vaccine effectiveness was only 43% in 2011-12 (preliminary results). http://www.afhsc.mil/viewDocument?fi...RBPAC_2012.pdf

So does it matter how many are vaccinated?

Media attention has increased around KCMO. Consequently, the Health Dept had only 100 flu shots left as of yesterday. So it has helped sell the vaccine.

http://www.kshb.com/dpp/news/health/kansas-city-health-deparment-facing-shortfall-of-flu-vaccine

[jeffrey]

Re: USA - Media Advisory - CDC Update: Flu Season and Vaccine Effectiveness Today 11:30am

Here in California, it is starting to pick up, but I will say that people that never got the vaccine, now have got due to the media! Some places are sold out of pediatric doses, but none the less, we will see how many who got the vaccine this week, which is late will help in California!
There is no flu mist anywhere in Sacramento County!

[gsgs]

Re: USA - Media Advisory - CDC Update: Flu Season and Vaccine Effectiveness Today 11:30am

http://www.cdc.gov/mmwr/pdf/wk/mm6207.pdf

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6207a2.htm?s_cid=mm6207a2_w

n=2697, VE=56&#37; VE=47%(H3),VE=67%(B)
1115 tested positive
~45% vaccinated
32% of positives were vaccinated
50% of negatives were vaccinated

The adjusted,
age-stratified VE point estimates were 58% for persons aged
6 months–17 years, 46% for persons aged 18–49 years, 50%
for persons aged 50–64 years, and 9% for persons aged ≥65
years (Table 2).

> Overall, influenza vaccination reduced the
> risk for medical visits resulting from influenza A and B by 56%,
> from influenza A (H3N2) by 47%

no, only when tested positive. We don't know how many people who had influenza
did indeed test positive.

I can't find it explicitely in that study, but it seems that the negative controls were
those that presented with ILI but tested negative,

So, 43%(71%) of those)elderly) that presented with ILI were vaccinated.
This is probably above the vaccination coverage of the
included sites . National average = 35.2% (59.2%) per Nov.2012

http://www.cdc.gov/flu/fluvaxview/index.htm

You could argue, that those who get vaccinated also
more likely present when they have ILI.(urban ?)
(this doesn't seem to happen in Europe)

all  |neg. pos.| sum
-----+-----------+-----
vacc.|0793 0367| 1160
nvac.|0789 0748| 1537
-------+-------+----
tot,  |1582 1115| 2697

>65  |neg. pos.|sum
-----+-------+-----
vacc.|0119 0086|0205
nvac.|0046 0039|0085
-----+---------+-----
sum  |0165 0125|0290

[gsgs]

Re: USA - Media Advisory - CDC Update: Flu Season and Vaccine Effectiveness Today 11:30am

https://www.grippenet.fr/fr/le-projet/

5876participants, 6541 comptes

> Toutes les semaines, les participants rapportent les sympt&#244;mes qu’ils ont &#233;ventuellement
> eus depuis leur derni&#232;re connexion

http://www.influenzanet.eu/results/?page=results&season=all&country=compare&casedef=ilit&type=rrr__vaccin_now_later&group=vaccin&baseline=samples_baseline

Vaccine efficacy against ILI:

NL:-5,-19,-10,3,42,30,36,54,27,-4
B:43,32,48,42,45,-30,80,40,70
P:-13,-70,63,46,50,30,-
I:70,-4,35,33,-
UK:60,15,-
S:25,55
F:42
E:12

average: 28&#37;(35 country-years)



so the vaccination decreases your risk of ILI for that season
from ~20% to ~14%
8 vaccinations for one prevented ILI

4.5M French ILI-doctor-visits instead of 4M without vaccination


however, of the 287 severe confirmed flu-cases in France this season
so far only 41 had been vaccinated

[gsgs]

Re: USA - Media Advisory - CDC Update: Flu Season and Vaccine Effectiveness Today 11:30am

http://www.ncbi.nlm.nih.gov/pubmed/23413420

328 households with 1,441 members,
2010-2011
Influenza was identified in 78 (24%) households and 125 (9%) individuals;
the infection risk was 8.5% in the vaccinated and 8.9% in the unvaccinated (P=.83).
Adjusted vaccine effectiveness in preventing community-acquired influenza was 31%
In vaccinated subjects with no evidence of prior season vaccination,
significant protection (62%, 95% CI: 17 to 82%) against community-acquired influenza
was demonstrated
Substantially lower effectiveness was noted among subjects who were vaccinated
in both the current and prior season. There was no evidence that vaccination prevented
household transmission once influenza was introduced; adults were at particular risk
despite vaccination

--------------------------------------------
Low vaccine effectiveness against influenza A(H3N2) virus among elderly
people in Denmark in 2012/13

[Emily]

Re: USA - Media Advisory - CDC Update: Flu Season and Vaccine Effectiveness Today 11:30am

the infection risk was 8.5% in the vaccinated and 8.9% in the unvaccinated (P=.83). Adjusted vaccine effectiveness in preventing community-acquired influenza was 31%

That's quite a statistical adjustment! 31% effectiveness sounds a lot better vs 8.9 - 8.5 = .4% I don't have the background in statistics to know how that is done.

Substantially lower effectiveness was noted among subjects who were vaccinated in both the current and prior season.

Original antigenic sin effect?

[gsgs]

Re: USA - Media Advisory - CDC Update: Flu Season and Vaccine Effectiveness Today 11:30am

they distinguish "community introduced" and "household introduced"

but how does the vaccine or the virus know that ?

[gsgs]

Re: USA - Media Advisory - CDC Update: Flu Season and Vaccine Effectiveness Today 11:30am

http://www.ncbi.nlm.nih.gov/pubmed/23442587

South of France,>64y,2004 Oct-Dec
1.79%died,n=21303,pneumovax+fluvax
2.08%died,n=18651,fluvax
2.25%died,n=3769,pneumovax
2.47%died,n=25164,no vax
4.21%died,risk-group,2vax
5.81%died,risk-group,no vax