CDC SAYS FLU SEASON HARD FOR YOUNGER PEOPLE

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 
CDC Reports Flu Hit Younger People Particularly Hard This Season
Vaccination lowered risk of having to go to the doctor by about 60 percent for people of all ages

This influenza season was particularly hard on younger- and middle-age adults, the Centers for Disease Control and Prevention reported in today’s Morbidity and Mortality Weekly Report. People age 18-64 represented 61 percent of all hospitalizations from influenza—up from the previous three seasons when this age group represented only about 35 percent of all such hospitalizations. Influenza deaths followed the same pattern; more deaths than usual occurred in this younger age group.

A second report in this week’s MMWR showed that influenza vaccination offered substantial protection against the flu this season, reducing a vaccinated person’s risk of having to go to the doctor for flu illness by about 60 percent across all ages.
“Flu hospitalizations and deaths in people younger- and middle-aged adults is a sad and difficult reminder that flu can be serious for anyone, not just the very young and old; and that everyone should be vaccinated,” said CDC Director Tom Frieden, M.D., M.P.H. “The good news is that this season's vaccine is doing its job, protecting people across all age groups."

U.S. flu surveillance data suggests that flu activity is likely to continue for a number of weeks, especially in places where activity started later in the season. Some states that saw earlier increases in flu activity are now seeing decreases. Other states are still seeing high levels of flu activity or continued increases in activity.

While flu is responsible for serious illness and death every season, the people who are most affected can vary by season and by the predominant influenza virus. The currently circulating H1N1 virus emerged in 2009 to trigger a pandemic, which was notable for high rates of hospitalization and death in younger- and middle-aged people. While H1N1 viruses have continued to circulate since the pandemic, this is the first season since the pandemic they have been predominant in the U.S. Once again, the virus is causing severe illness in younger- and middle-aged people.

Approximately 61 percent of flu hospitalizations so far this season have occurred among persons aged 18-64 years. Last season, when influenza A (H3N2) viruses were the predominant circulating viruses, people 18 to 64 years accounted for only 35 percent of hospitalizations. During the pandemic season of 2009-2010, people 18 to 64 years old accounted for about 56 percent of hospitalizations.
Hospitalization rates have also been affected. While rates are still highest among people 65 and older (50.9 per 100,000), people 50 to 64 years now have the second-highest hospitalization rate (38.7 per 100,000), followed by children 0-4 years old (35.9 per 100,000). During the pandemic, people 50 to 64 years also had the second-highest hospitalization rate. Note that hospitalization rates are cumulative and thus will continue to increase this season.

Influenza deaths this season are following a pattern a similar to the pandemic.  People 25 years to 64 years of age have accounted for about 60 percent of flu deaths this season compared with 18 percent, 30 percent, and 47 percent for the three previous seasons, respectively. During 2009-2010, people 25 years to 64 years accounted for an estimated 63 percent of deaths.

"Younger people may feel that influenza is not a threat to them, but this season underscores that flu can be a serious disease for anyone," said Dr. Frieden. "It's important that everyone get vaccinated. It's also important to remember that some people who get vaccinated may still get sick, and we need to use our second line of defense against flu: antiviral drugs to treat flu illness. People at high risk of complications should seek treatment if they get a flu-like illness. Their doctors may prescribe antiviral drugs if it looks like they have influenza."

People at high risk for flu complications include pregnant women, people with asthma, diabetes or heart disease, people who are morbidly obese and people older than 65 or children younger than 5 years, but especially those younger than 2 years. A full list of high risk factors and antiviral treatment guidance is available on the CDC website. More information about flu vaccine and how well it works also is available.

Flu Vaccine Best Tool Available

In the flu vaccine effectiveness (VE) study, CDC looked at data from 2,319 children and adults enrolled in the U.S. Influenza Vaccine Effectiveness (Flu VE) Network from December 2, 2013 to January 23, 2014. They found that flu vaccine reduced the risk of having to go to the doctor for flu illness by an estimated 61 percent across all ages. The study also looked at VE by age group and found that the vaccine provided similar levels of protection against influenza infection across all ages. VE point estimates against influenza A and B viruses by age group ranged from 52 percent for people 65 and older to 67 percent for children 6 months to 17 years. Protection against the predominant H1N1 virus was even slightly better for older people; VE against H1N1 was estimated to be 56 percent in people 65 and older and 62 percent in people 50 to 64 years of age. All findings were statistically significant.

The interim VE estimates this season are comparable to results from studies during other seasons when the viruses in the vaccine have been well-matched with circulating influenza viruses and are similar to interim estimates from Canada for 2013-14 published recently.

While flu vaccine can vary in how well it works, vaccination offers the best protection currently available against influenza infection. CDC recommends that everyone 6 months and older get an annual flu vaccine.

“We are committed to the development of better flu vaccines, but existing flu vaccines are the best preventive tool available now. This season vaccinated people were substantially better off than people who did not get vaccinated. The season is still ongoing. If you haven’t yet, you should still get vaccinated," said Dr. Frieden.

CDC SAYS E-CIGARETTES, HOOKAHS GAINING POPULARITY WITH STUDENTS

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION
Press Release Emerging tobacco products gaining popularity among youth
Increases in e-cigarette and hookah use show need for increased monitoring and prevention

Emerging tobacco products such as e-cigarettes and hookahs are quickly gaining popularity among middle- and high-school students, according to a report in this week’s Morbidity and Mortality Weekly Report.

While use of these newer products increased, there was no significant decline in students’ cigarette smoking or overall tobacco use. Data from the 2012 National Youth Tobacco Survey (NYTS) show that recent electronic cigarette use rose among middle school students from 0.6 percent in 2011 to 1.1 percent in 2012 and among high school students from 1.5 percent to 2.8 percent. Hookah use among high school students rose from 4.1 percent to 5.4 percent from 2011 to 2012.

The report notes that the increase in the use of electronic cigarettes and hookahs could be due to an increase in marketing, availability, and visibility of these tobacco products and the perception that they may be safer alternatives to cigarettes. Electronic cigarettes, hookahs, cigars and certain other new types of tobacco products are not currently subject to FDA regulation. FDA has stated it intends to issue a proposed rule that would deem products meeting the statutory definition of a "tobacco product" to be subject to the Federal Food, Drug, and Cosmetic Act.

Another area of concern in the report is the increase in cigar use among certain groups of middle and high school students. During 2011-2012, cigar use increased dramatically among non-Hispanic black high school students from 11.7 percent to 16.7 percent, and has more than doubled since 2009. Further, cigar use among high school males in 2012 was 16.7 percent, similar to cigarette use among high school males (16.3 percent).

“This report raises a red flag about newer tobacco products,” said CDC Director Tom Frieden, M.D., M.P.H. “Cigars and hookah tobacco are smoked tobacco – addictive and deadly. We need effective action to protect our kids from addiction to nicotine.”

CDC TOUT BETTER, FASTER LAB RESULTS

FROM:  U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION 
Press Release Better, Faster Lab Reports Help States’ Outbreak Response
CDC Push for Electronic Lab Reports Showing Gains

Once labs detect dangerous infections, it’s crucial for the correct information to get to health departments quickly and in a format that allows them to recognize disease outbreaks. The Centers for Disease Control and Prevention’s (CDC) efforts to speed this process and ensure that the best and most complete information about disease cases is reported is paying off, according to new data released in today’s issue of Morbidity and Mortality Weekly Report (MMWR).

A key to speeding lab reports is widespread adoption of electronic laboratory reporting (ELR) by the approximately 10,400 labs that send reportable data to health agencies. ELR is an important tool that gives health officials vital information on infectious disease cases. Since 2010, CDC has provided funds to help 57 states, local and territorial health departments increase the use of electronic laboratory reporting (ELR).

The MMWR report shows that the number of state and local health departments receiving electronic reports from laboratories has more than doubled since 2005, when CDC last evaluated ELR reporting. In the past year, the number of individual reports received electronically increased by 15 percent. States and local health departments now estimate that nearly two-thirds (62 percent) of total lab reports were received electronically. The number of reports received through ELR varied by jurisdiction, the types of labs reporting and by disease reported.

“Infectious disease outbreaks will always be with us—and rapid recognition of an outbreak saves lives,” said CDC Director Tom Frieden, M.D., M.P.H. “Thanks to electronic laboratory reporting (ELR), we’re detecting outbreaks faster than ever. Unfortunately, only a quarter of the 10,000 labs across the country use ELR. We must keep expanding use of ELR to help CDC and our partners save lives and reduce healthcare costs.”

CDC REPORTS E-CIGARETTE USE BY HIGH SCHOOL, MIDDLE SCHOOL KIDS MORE THAN DOUBLES

FROM:  CENTERS FOR DISEASE CONTROL AND PREVENTION 
Press Release E-cigarette use more than doubles among U.S. middle and high school students from 2011-2012
More than 75 percent of youth users smoke conventional cigarettes too

The percentage of U.S. middle and high school students who use electronic cigarettes, or e-cigarettes, more than doubled from 2011 to 2012, according to data published by the Centers for Disease Control and Prevention.

The findings from the National Youth Tobacco Survey, in today’s Morbidity and Mortality Weekly Report, show that the percentage of high school students who reported ever using an e-cigarette rose from 4.7 percent in 2011 to 10.0 percent in 2012. In the same time period, high school students using e-cigarettes within the past 30 days rose from 1.5 percent to 2.8 percent. Use also doubled among middle school students. Altogether, in 2012 more than 1.78 million middle and high school students nationwide had tried e-cigarettes.

"The increased use of e-cigarettes by teens is deeply troubling," said CDC Director Tom Frieden, M.D., M.P.H. "Nicotine is a highly addictive drug. Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes."

The study also found that 76.3 percent of middle and high school students who used e-cigarettes within the past 30 days also smoked conventional cigarettes in the same period. In addition, 1 in 5 middle school students who reported ever using e-cigarettes say they have never tried conventional cigarettes. This raises concern that there may be young people for whom e-cigarettes could be an entry point to use of conventional tobacco products, including cigarettes.

“About 90 percent of all smokers begin smoking as teenagers,” said Tim McAfee, M.D., M.P.H., director of the CDC Office on Smoking and Health. “We must keep our youth from experimenting or using any tobacco product. These dramatic increases suggest that developing strategies to prevent marketing, sales, and use of e-cigarettes among youth is critical.”

CDC WARNS THAT HPV VACCINE IS UNDERUTILIZED IN GIRLS AGED 13-17

FROM:  CENTERS FOR DISEASE CONTROL
HPV vaccine: Safe, effective, and grossly underutilized

In a press conference held today, top officials from CDC and the American Academy of Pediatrics announced that HPV vaccination rates in girls aged 13-17 years failed to increase between 2011 and 2012, according to data from the Centers for Disease Control and Prevention (CDC). Three-dose coverage actually declined slightly from 2011 to 2012.

The article in CDC's Morbidity and Mortality Weekly Report (MMWR) drew on data from the 2012 National Immunization Survey-Teen (NIS-Teen).
Among girls unvaccinated for HPV, 84 percent had a healthcare visit where they received another vaccine (such as one aimed at meningitis or pertussis) but not HPV vaccine. If HPV vaccine had been administered, vaccination coverage for ≥1 dose could be nearly 93 percent rather than 54 percent.

"Progress increasing HPV vaccination has stalled, risking the health of the next generation.," said CDC Director Tom Frieden M.D., M.P.H. "Doctors need to step up their efforts by talking to parents about the importance of HPV vaccine just as they do other vaccines and ensure its given at every opportunity."

According to CDC, for each year the 3-dose HPV vaccine series coverage remains near the current level of 33 perccent instead of achieving the Healthy People 2020 goal of 80 percent coverage, an additional 4,400 women will be diagnosed with cervical cancer and 1,400 cervical cancer-attributable deaths will occur in the future.

The 2012 NIS-Teen data show that not receiving a healthcare provider's recommendation for HPV vaccine was one of the five main reasons parents reported for not vaccinating daughters. Healthcare providers are urged to give a strong recommendation for HPV vaccination for boys and girls aged 11 or 12 years.

The other responses parents provided indicate gaps in understanding about the vaccine, including why vaccination is recommended at ages 11 or 12.
"Parents need reassurance that HPV vaccine is recommended at 11 or 12 because it should be given well in advance of any sexual activity," said Dr. Frieden. "We don't wait for exposure to occur before we vaccinate with any other routinely recommended vaccine."
Parents also reported safety concerns as a reason for not vaccinating. In the seven years of post-licensure vaccine safety monitoring and evaluation conducted independently by federal agencies and vaccine manufacturers, no serious safety concerns have been identified. According to today's MMWR article, reports of adverse events after HPV vaccination to the Vaccine
Adverse Event Reporting System (VAERS) have steadily decreased from 2008 to 2012 and the numbers of serious adverse events reported has also declined since 2009.

Approximately 79 million Americans are currently infected with HPV. About 14 million people become newly infected each year. HPV is so common that nearly all sexually-active men and women will get at least one type of HPV at some point in their lives.

Parents and caregivers are encouraged to ask about vaccination every time they take children for a healthcare visit. If a preteen boy or girl (aged 11 or 12 years) has not started the HPV vaccine series, make an appointment to get him or her vaccinated. Teens who haven't started or finished the 3-dose series should do so—it's not too late for them to receive HPV vaccine.

For many, it's easier than ever to get the HPV vaccine. Because of the Affordable Care Act, most private health insurance plans must cover the HPV vaccine at no out-of-pocket cost, meaning no co-pay or deductible. Visit https://www.healthcare.gov/what-are-my-preventive-care-benefits/#part=3External Web Site Icon for more information.

CDC officials urge healthcare providers to increase the consistency and strength of how they recommend HPV vaccine, especially when patients are 11 or 12 years old. Reviewing vaccination status at every healthcare encounter and taking advantage of every visit, including acute care visits, can increase HPV vaccine coverage in the United States.

HPV vaccine is an anti-cancer vaccine. Preteen and teens are relying on the adults in their lives to help protect them.

National and state vaccination coverage data for adolescent immunization will be released late August 2013 in the MMWR and will include HPV vaccine coverage for both girls and boys.