2017 2018 Influenza Season Highlights Next Season RANDI

2017 -2018 Influenza Season Highlights & Next Season RANDI PEDERSEN, MPH EPIDEMIOLOGY PROGRAM Presented on 5/25/18 at Intermountain APIC Meeting

Influenza Media Presented 5/25/18

National Surveillance Highlights Presented 5/25/18

Idaho Surveillance Highlights Presented 5/25/18

Idaho - ILI Outpatient Visits Presented 5/25/18

Idaho - Mortality Idaho Public Health Districts

Idaho - Virologic Surveillance Presented 5/25/18

Looking Forward to 2018 -2019 Season Presented 5/25/18

100 th Anniversary 1918 Influenza Pandemic In Presented 5/25/18

U. S. Influenza Vaccine Influenza vaccine production technologies: 1) Egg-based vaccine 2) 3) Dependent on large number of hen eggs Takes ~6 months Cell-based vaccine Egg-free, grown in mammalian cells Shorter time, no egg-adapted changes Recombinant vaccine Egg-free HA protein + other viruses Shortest time, no egg-adapted changes Presented 5/25/18 replicate in insect cells HA purified

Vaccine Effectiveness Enroll patients in US Flu Vaccine Effectiveness (VE) Network > 6 months of age, with acute respiratory illness with cough <7 days Presented 3/25/18

Vaccine Effectiveness Interim VE estimates Between 11/2/17 through 2/3/18 ~4, 500 enrollees in U. S. Flu VE Network Overall 36% effective against Influenza A & B VE was 59% in children aged 6 months through 8 years VE varies by type and subtype A (H 3 N 2) - 25% in all age groups Presented 3/25/18 51% children 6 months - 8 years A (H 1 N 1)pdm 09 – 67% in all age groups B (no lineage breakdown) – 42% in all age groups

Genetic Diversity

2018 -2019 U. S. Influenza Vaccine In U. S. vaccine composition determined by FDA Vaccines and Related Biological Products Advisory Committee (VRBPAC) Decision made in March 2018 Composition: A/Michigan/45/2015 (H 1 N 1)pdm 09 -like virus A/Singapore/INFIMH-16 -0019/2016 (H 3 N 2)-like virus NEW B/Colorado/06/2017 -like (B/Victoria/2/87 lineage) virus NEW B/Phuket/3073/2013 -like (B/Yamagata/16/88 lineage) virus Trivalent and Quadrivalent formulations Flu. Mist® Intranasal Live vaccine is back Presented 5/25/18

Vaccine Challenges Why low efficacy for influenza vaccines? Challenges with A(H 3 N 2) Host factors Age, health, immune status Imprinting H 3 N 2 evolves rapidly Egg-adapted changes Presented 3/25/18 H 3 N 2 difficult to get to grow in eggs Slight genetic changes affect vaccine efficacy

Universal Influenza Vaccine Safe, effective, long-lasting immunity Effective against seasonal and novel influenza Target conserved regions of virus HA stem Leading vaccine candidates: Protein ferritin Subtypes of H protein DNA-based “prime”, seasonal influenza vaccine “boost” Antigenic peptide, M-001 Presented 3/25/18

2018 -2019 Influenza Season Idaho Routine statewide influenza surveillance Conducted October-May Participation is voluntary Snapshot of what is happening around the state Communication Weekly surveillance update at http: //flu. idaho. gov Traditional and social media E-mail updates to local epidemiologists Health Alert Network (HAN) Presented 5/25/18

2018 -2019 Influenza Season Idaho Your public health partners Epidemiologists at your local health department After hours call State Communications, 800. 632. 8000 One-on-one consultation, ask for a epidemiologist to be paged Bridge call, coordinate call with multiple facilities/ agencies How can we support you? Presented 5/25/18

Questions? Randi Pedersen, MPH Idaho Influenza Surveillance Coordinator Ph: 208. 334. 5939 Randi. Pedersen@dhw. idaho. gov Presented 5/25/18