Flu Scan for Jan 14, 2014

News brief

TFAH calls for boosting flu vaccine coverage in adults

With the flu season hitting its stride and the 2009 H1N1 virus spreading, the public health advocacy group Trust for America's Health today called for greater efforts to increase flu vaccine coverage, saying only 35.7% of working-age adults were vaccinated last season.

"The trend of low vaccination rates among younger adults is particularly troubling this year, when they are more at risk than usual for the effects of the H1N1 strain of flu that's circulating," Jeffrey Levi, PhD, executive director of TFAH, said in a press release. The 2009 H1N1 virus is the dominant US strain this season.

TFAH said overall flu vaccination rates remain low in the United States, though coverage in children and the elderly is better than in working-age adults. Citing data from the Centers for Disease Control and Prevention (CDC), the group said 45% of Americans got a flu shot for the 2012-13 season, which was an increase from 41.8% in 2011-12.

Vaccination coverage last season was highest in Massachusetts, at 57.5%, and lowest in Florida, at 34.1%, TFAH reported. Only 12 states had 50% coverage or better: Delaware, Hawaii, Iowa, Maine, Maryland, Massachusetts, Minnesota, Nebraska, North Carolina, Rhode Island, South Dakota, and Tennessee.

The group recommended a number of steps to increase flu vaccine uptake, including supporting flu shots without copays for all Americans and requiring vaccination for all healthcare workers.

In other comments, TFAH said federal flu spending is slated to increase under a budget agreement reached by negotiators in the US House and Senate yesterday. The omnibus spending bill for fiscal 2014 allocates $156.7 million for flu planning and response, about a $6.6 million increase over last year, but $2.2 million lower than in 2012, the group said.

Also, the bill allocates $115 million for pandemic flu preparedness, which hadn't been funded since fiscal 2011, TFAH reported.
Jan 14 TFAH press release
Jan 14 TFAH full report
Dec 12, 2013, CIDRAP News story on flu vaccine impact and coverage
CDC FluVaxView page with vaccine uptake data

New Columbia Mailman Web site forecasts flu trends by city

A flu-forecasting Web site developed by the Columbia University Mailman School of Public Health in New York may help consumers take extra precautions to guard against the illness and may inform the public health sector on such decisions as vaccine and antiviral stockpiling and distribution, according to a Mailman news release yesterday.

"For the first time, people can see the outlook for seasonal flu in their area by going online," Mailman assistant professor Jeffrey Shaman, PhD, said in the release.

The site, called the Columbia Prediction of Infectious Diseases: Influenza Forecasts, or CPID (www.cpid.iri.columbia.edu), tracks influenza in 94 US cities and forecasts rates of seasonal flu in upcoming weeks "based on a scientifically validated system," according to the story. Updated every Friday afternoon during the flu season, it includes an interactive map, comparison charts of the four most recent flu seasons, and exportable data.

Among current predictions are these:

Texas, Tennessee, Louisiana, and Nevada have already seen the peak of flu cases
The current season will peak later and with fewer cases than the 2012-13 season but will be far more severe than the 2011-12 season
Cases in most of the cities tracked will peak in January (eg, Chicago, Jan 12 to 18; New York, Jan 19 to 25), but in several, including Miami and Providence, R.I., the worst will come in February (Feb 2 through 8 and Feb 16 through 22, respectively)

Jan 13 Columbia Mailman news release

Study: Text messages may boost flu vaccine uptake in pregnant women

Text messages provide an effective means of reminding urban, low-income pregnant women to get their flu shots, according to a study published in the American Journal of Public Health.

The authors, primarily from Columbia University, enrolled 1,187 obstetric patients from five New York community-based clinics in their randomized controlled trial during the 2011-12 flu season. Women were eligible if they had a first trimester visit between Feb 1 and Aug 31, 2011, had an estimated delivery date after Aug 31, and had a cell phone capable of receiving text messages. Messages were sent in English or Spanish, depending on patient preference.

Patients were randomized to receive five weekly text messages about flu vaccination beginning in mid September 2011 and two appointment reminder texts or to receive "usual" care. Messages were stopped after vaccination. Standard, automated appointment-reminder phone messages were sent to both groups.

After adjusting for gestational age and number of clinic visits, the women in the text-message group were 30% more likely to have been vaccinated by December 2011, with those early in the third trimester at the start of the intervention most likely to have been affected by the messages (61.9% versus 49.0% for the controls).

Pregnant women, while constituting only 1% of the population, are at increased risk for flu morbidity and mortality, note the authors.
February Am J Public Health abstract

News Scan for Jan 14, 2014

News brief

Slight rise in risk of intussusception seen with rotavirus vaccine

Rotavirus vaccination in infants slightly raises the risk of a specific intestinal disorder, researchers reported today in The New England Journal of Medicine.

US investigators assessed the effect of both the pentavalent (five-strain) RotaTeq vaccine and Rotarix, a monovalent formulation, on the risk intussusception in infants 5 to 37 weeks old. Intussusception is an inversion or "telescoping" of one segment of the intestine within another segment, which can block the passage of food or fluid and cut off blood supply. It has been noted in other countries as a risk with both vaccines.

Their analyses included 507,874 first doses and 1,277,556 total doses of RotaTeq and 53,638 first doses and 103,098 total doses of Rotarix.

For RotaTeq, they found the risk of the disorder to be slightly elevated after the first dose, with an attributable risk of 1.1 excess cases per 100,000 vaccinees within 7 days and of 1.5 excess cases within 21 days in their primary analysis, and an attributable risk of 1.2 excess cases within 21 days in a secondary analysis. The primary analysis included only vaccinated children, while the secondary analysis included exposed and unexposed infants.

The secondary analysis of Rotarix suggested a potential risk, but the authors said the study of that vaccine was underpowered.

An accompanying editorial calls the risk low and says the harm prevented by the vaccine outweighs the risk: "In the US cohort of 4.5 million babies born each year, vaccination is estimated to prevent approximately 53,000 hospitalizations and 170,000 emergency department visits for diarrhea, at the expense of causing 45 to 213 cases of intussusception nationwide."

The study was funded by the US Food and Drug Administration.
Jan 14 N Engl J Med study
Jan 14 N Engl J Med editorial

More chikungunya cases confirmed in Caribbean

Three cases of Chikungunya have been confirmed in the Virgin Islands in the midst of an ongoing and widespread outbreak on nearby St. Martin and other Caribbean islands, according to a story yesterday in the Virgin Islands Platinum News.

The infected patients, all on Jost Van Dyke island, have no history of travel, meaning the illnesses were locally acquired and the virus is in the mosquito population there, an official with the Ministry of Health and Social Development said.

Surveillance in the area was stepped up after reports of the St. Martin cases. Preventive efforts are also being enhanced, including fogging in mosquito-breeding areas by the Environmental Health Division and educational efforts for residents.

People are being urged to inspect their premises for potential mosquito-breeding areas such as uncovered water containers. Other measures include minimizing personal exposure by using insect repellent and covering baby cribs with netting and contacting a physician if symptoms such as fever, headache, and joint pain occur.
Jan 13 Platinum News story
Jan 10 CIDRAP News scan on St. Martin outbreak