For National Influenza Vaccination Week, I had the pleasure of interviewing Dalton G. Paxman, PhD, FCPP, Regional Health Administrator for the mid-Atlantic region, where he oversees public health initiatives for the Office of the Assistant Secretary for Health (OASH), U.S. Department of Health and Human Services (HHS). Dr. Paxman is a Fellow here at The College of Physicians of Philadelphia. His biographical information is below.
Influenza season has begun – has there been much influenza nationally yet? What kind of activity are we seeing in HHS Region 3?
Flu activity is beginning to increase in parts of the United States and CDC is getting reports of flu illnesses, flu hospitalizations, and flu deaths. Influenza A (H3N2) viruses are most common so far. H3N2 predominant seasons are associated with more severe illness and mortality, especially in older people and young children, than during H1N1- or B-predominant seasons. If H3N2 viruses continue to predominate, this season could be severe. More than half of the influenza A (H3N2) viruses analyzed since October 1 are antigenically or genetically different from the H3N2 vaccine virus component this season.
As of the week ending November 29, 2014, elevated levels of outpatient visits for influenza–like illness (ILI) have been reported in Region III, meaning the percent of visits for ILI is at or above the national or region-specific baseline.
How did our HHS region 3 do in terms of influenza vaccine uptake in the 2013-14 influenza season?
In the 2013-2014 flu season flu vaccine coverage estimates for all people 6 months of age and older in HHS Region 3 was 49%, which is about 3 percentage points higher than the national average estimates for the same time period (46%). More specific information is available at www.cdc.gov/flu/fluvaxview.
Are supplies of influenza vaccine plentiful this year – in all its formulations?
Seven influenza vaccine manufacturers projected that as many as 151 million to 156 million doses of influenza vaccine would be available for use in the United States during the 2014-2015 influenza season. This projection is similar to that provided by manufacturers before influenza vaccine distribution began for this season, with the difference being that the high end of the range is reduced by approximately 4 million doses. In September, some manufacturers, including those who develop flu vaccines approved for children in the United States, reported delays in shipments that were originally anticipated for early fall. These early season shipping delays impacted certain vaccine products more than others, thus impacting some providers more than others. While there may have been spot shortages of some formulations, there was no national shortage of vaccine. Despite these early season shipping delays, approximately 85% of the total doses projected for the season were distributed by the end of October. As of November 28, 2014, manufacturers reported having distributed 144.5 million doses of vaccine despite these early season shipping delays. While there may have been spot shortages of some formulations, there was no national shortage of vaccine. Comparative information about doses distributed during previous seasons is available here: http://www.cdc.gov/flu/professionals/vaccination/vaccinesupply.htm
Last week, CDC published reports that a key antigen in one of the influenza A viruses targeted by the 2014-15 vaccine has changed and that the vaccine might not be as effective as we’d expect. What is the perspective of HHS on this development? Is there anything federal government agencies can do to try to avoid this problem in the future?
Influenza viruses are constantly changing – they can change from one season to the next or they can even change within the course of the same season. This kind of gradual change is called “antigenic drift.” In order for any vaccine to be delivered in the fall, the viruses in the vaccine must be chosen in February. When the vaccine viruses for 2014-2015 were selected, A/Texas/50/2012 (the influenza A (H3N2) component of the 2014-2015 Northern Hemisphere quadrivalent and trivalent influenza vaccine) was the most common circulating influenza H3N2 virus. The drifted H3N2 viruses that currently account for the majority of circulating H3N2 viruses had NOT yet been detected through virologic surveillance. Drifted H3N2 viruses were first collected in March 2014, and appeared only sporadically at first. Early on, there is no way to predict in advance if a given antigenic variant will circulate widely.
As of the week ending November 29, 58% of H3N2 viruses isolated in the United States since October 1, 2014 were drifted from the H3N2 vaccine virus component.
It’s possible that vaccine effectiveness against these viruses may be reduced, however, seasonal influenza vaccination can sometimes induce antibodies and/or T cells capable of cross-reacting with antigenically distinct viruses. Influenza vaccination still offers the best protection we have against seasonal flu. In the context of reduced vaccine effectiveness, the use of influenza antiviral drugs as a second line of defense against the flu becomes even more important, especially for high risk people and people who are very sick (hospitalized).
What activities is your office involved with for this year’s National Influenza Vaccination week?
For the fifth consecutive year, Walgreens is offering more than $10 million worth of flu shot vouchers free to those without health insurance coverage and the Department of Health and Human Services is assisting in the voucher distribution effort to help improve flu vaccination rates across the country.
Since 2010, more than half a million individuals have received flu shots through this innovative partnership. Individuals who are eligible can call 1-800-925-4733 to find the nearest Walgreens location with flu shot vouchers available.
Getting a flu shot is the best way to protect against the flu virus, a potentially life threatening disease. For more information, please visit http://www.vaccines.gov/.
Adult African Americans lag behind whites in influenza vaccine uptake. In the past, you’ve described ways that your office worked to increase influenza vaccination among our region’s African American residents. Can you give me an update on those efforts and the results you’re seeing?
During National Flu Vaccination Week (December 7-13, 2014), the Office of Minority Health is raising awareness about disparities in flu vaccination rates among racial and ethnic minority groups (particularly African American and Latino adults), the barriers that exacerbate these disparities, and how the Affordable Care Act is removing many of those barriers.
Getting a flu shot is the best way to protect against the flu virus, a potentially life threatening disease. While flu vaccination rates among adults are increasing, many African American and Latino adults are still not getting a yearly flu vaccine.
It’s important to know that the flu vaccine cannot give you the flu. The most common side effects are a sore arm and maybe a low fever or achiness. The nasal-spray flu vaccine might cause congestion, runny nose, sore throat, or cough. If you do experience these side effects, they are usually mild and short-lived. And that’s much better than getting sick and missing several days of school or work or getting a severe illness and needing to go to the hospital.
It is important that we make the flu vaccine affordable and accessible in our communities. Thanks to the Affordable Care Act, flu shots are now a free preventive benefit. Health Insurance open enrollment is available until February 15. If you don’t have insurance, please visit www.healthcare.gov to see which plans are available in your state.
Dr. Paxman, did you get influenza vaccine this year?
Yes, I did. I received the vaccine and made sure my entire family did the same, as we have done for many years.
Many thanks to Dr. Paxman and to Mahak Nayyar, MPA, FCPP, Deputy Regional Health Administrator, for her coordination.
NIVW is a national observance that was established to highlight the importance of continuing influenza vaccination, as well as fostering greater use of flu vaccine after the holiday season into January and beyond.
About Dalton G. Paxman, PhD, FCPP
Dalton Paxman is the Regional Health Administrator for the mid-Atlantic region (Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia), where he oversees public health initiatives for the Office of the Assistant Secretary for Health (OASH), U.S. Department of Health and Human Services (HHS). He administers regional public health programs in Minority Health, Population Affairs, Women’s Health, Medical Reserve Corps, and the HIV/AIDS Regional Resource Network.
From 1996-2000, Dr. Paxman served as the Senior Environmental Health Advisor, Office of Disease Prevention and Health Promotion, providing advice to the Assistant Secretary for Health/Surgeon General on environmental health issues. He was the senior staff on key multi-agency environmental health and science policy initiatives, including the President’s Food Safety Initiative and the President’s Task Force on Children’s Environmental Health and Safety. He also served as the Department’s liaison to the National Science and Technology Council for the White House Office of Science and Technology Policy.
Dr. Paxman was a Senior Policy Analyst in the Environment Program at the Office of Technology Assessment in the U.S. Congress, where he directed congressional studies in the areas of health risk assessment research, comparative risk assessment, and environmental regulations. He was a research toxicologist and a post-doctoral scholar for the UC Berkeley, School of Public Health. He received his PhD in Environmental Health Sciences from the Johns Hopkins University, School of Hygiene and Public Health, where he received the Kruze Award for Excellence in Environmental Health Research.