March 9, 2018 Volume 8

It's Still Not Too Late to Get Vaccinated!

Local Influenza Activity:  Based on voluntary healthcare facility reporting, influenza appears to have peaked during week 52 (week ending 12/30/2017). But significant influenza B activity continues; a slight increase in overall influenza reports was seen between week 8 (ending 2/24/2018) and 9 (ending 3/3/2018). Influenza activity is expected to continue through May and Orange County residents are encouraged to be vaccinated if they still haven’t received the 2017-18 vaccine. Influenza A(H3) overall has been the most frequently identified influenza virus but A(H1N1) and B strains have also been reported. Influenza B has for the past three weeks accounted for 60-70% of reported cases.

Healthy children remain at risk for severe influenza-related complications: A study published by the Centers for Disease Control and Prevention (CDC) in the journal Pediatrics showed that half of pediatric flu-related deaths from 2010 to 2016 occurred in otherwise healthy children, of whom 69% were not vaccinated against influenza. Antiviral treatment was reported in only about half of the pediatric deaths. CDC recommends that flu antiviral drugs be started as soon as possible when people with high-risk conditions, including healthy young children, are suspected of having influenza.   Of note, 43% of the pediatric deaths had at least one bacterial coinfection, of which beta-hemolytic Streptococcus (e.g., Group A Strep) and Staphylococcus aureus were the most common.   Link:  http://pediatrics.aappublications.org/content/early/2018/02/09/peds.2017-2918 .

Recommendations for 2018-19 Influenza vaccine:   The United States Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee has chosen the influenza vaccine strains for the 2018-2019 season in the Northern Hemisphere: A/Michigan/45/2015 (H1N1)pdm09-like virus (same as the 2017-2018 vaccine) A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus (new) B/Colorado/06/2017-like virus (B/Victoria lineage) (new) B/Phuket/3073/2013-like virus (B/Yamagata lineage) (same as in 2017-2018; in quadrivalent only) Earlier this year, the CDC Advisory Committee on Immunization Practices voted to restore the nasal live attenuated influenza vaccine (LAIV; FluMist) to the list of recommended influenza vaccines in the 2018-19 season, citing recent data in US children showing improved effectiveness against H1N1 than was seen with previous formulations in the past 2 years.

Promising results for new one-dose antiviral influenza drug: A new one-dose influenza antiviral called baloxavir marboxil (Xofluza) has been approved for use in Japan. Data from clinical trials in Japan and the United States demonstrated the antiviral shortened the duration of flu symptoms by about 1 day (to 53 hours) compared to placebo, and decreased duration of shedding to a median time of 24 hours, compared to 72 hours for oseltamivir (Tamiflu) and 96 hours for placebo. A clinical trial is still underway in the United States.  See Open Forum Infect Dis 2017 Falll: 4(Suppl 1) S734 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5631501/ .

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