Tag Archives: Flu

2015-2016 Flu Season Update

Fall has arrived and along with the shorter days, colder weather and rain comes the season for influenza-like-illnesses (ILI) and pneumonia. This article includes updates from the Oregon Health Authority (OHA), Centers for Disease Control and Prevention (CDC), and flu-related highlights from the Advisory Committee on Immunization Practices’ (ACIP) final meeting of 2015.

OHA Flu Season Activity Findings

The OHA monitors flu activity in Oregon and reports weekly on the number of incidents and spread of ILI throughout the state from the first day of the 40th week of the year through the last day of 20th week of the following year. This year flu activity reporting began on September 28, 2015 and will end May 22, 2016.

The FluBites report for week 44, ending November 7, 2015, reported no positive influenza tests, a minimal level of ILI activity, and no reported outbreaks.

CDC Flu Season Activity Findings

The CDC monitors flu and pneumonia activity in the United States all year long but they report weekly on the incidents and spread of these illnesses throughout flu season.  There is a lot of good news this flu season. Here are a few of the highlights from the CDC weekly report as of week 44, ending November 7, 2015.

  • This year’s flu vaccine offers significantly more protection than last year’s vaccine because it includes two or three additional flu strains in the vaccine mix and those strains are similar to the circulating strains of flu this year.
  • The percentage of respiratory specimens testing positive for influenza in clinical laboratories is low. Of the 10,271 specimens tested in week 44, only 1.2% of the specimens were positive for influenza viruses.
  • None of the 2015 tested influenza viruses in circulation were found to be resistant to the three major anti-viral medications.

Flu graphic



ACIP Meeting Highlights Related to Flu

The October ACIP meeting included a presentation on the cost-effectiveness of high-dose influenza vaccine in adults aged 65 years and older.  The presenters concluded that high-dose flu vaccine is more cost effective than standard doses of flu vaccine based on the reduction in cardiovascular complications seen in patients 65 years and older who received the high-dose vaccine versus those who received the standard flu vaccine dose.1,2

A new influenza vaccine currently under FDA review was discussed.  The new vaccine, an adjuvanted trivalent vaccine, is expected to enhance immune response and have a safety profile similar to other licensed vaccines.


1 DiazGranados C A, et al: Efficacy of high–dose versus standard–dose influenza vaccine in older adults. New England Journal of Medicine: 2014;371:635–45. Available at:  http://www.nejm.org/doi/full/10.1056/NEJMoa1315727?query=featured_home&  Accessed 5 November 2015.

2CDC. Fluzone High-Dose Seasonal Influenza Vaccine. Questions and answers. Available at http://www.cdc.gov/flu/protect/vaccine/qa_fluzone.htm  Accessed 5 November 2015.

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Flu Season Update

The 2014-2015 flu season brought a new, drifted A strain of influenza that was not in the virus selection for the season’s vaccine. As a result, the effectiveness of the vaccine was lower than expected.  This has many people asking, “Why bother with a flu shot each season?”

Each year  the A strains that begin on the East Coast die out over the Mid-West allowing the B strains to take the lead somewhere over the Rockies en route to the West Coast. Every year the Centers for Disease Control and Prevention (CDC) begins tracking the influenza (flu) season in early October and select the vaccine strains that will be used to manufacture vaccine around February. If  a strain drifts into a new influenza virus after the vaccine manufacturing process begins, the new strain will not be included in the current season’s vaccine, but the  vaccine will still protect against the other most deadly strains identified during the winter season in the southern hemisphere.

The CDC reported that among the 2014-2015 seasonal influenza A viruses, 52,518 (50.1%) were subtyped; 52,299 (99.6%) were influenza A (H3N2) viruses, and 219 (0.2%) were A (H1N1) pdm09 viruses. In addition, three variant influenza A viruses (one H3N2v and two H1N1v) were identified.  In response to the CDC findings, this year the 2015-2016 flu vaccine mix has two or three new strains included.


Vaccine Strains included
FluMist® (live) nasal

flu vaccines

·A/Bolivia/559/2013 (H1N1)
(an A/California/7/2009 (H1N1)pdm09-like virus)·A/Switzerland/9715293/2013 (H3N2)-like virus

·B/Phuket/3073/2013-like (B/Yamagata lineage) virus

·B/Brisbane/60/2008 (B/Victoria/2/87 lineage)

Inactivated (injectable)

trivalent vaccines

·A/California/7/2009 (H1N1)pdm09- like virus

·A/Switzerland/9715293/2013 (H3N2)-like virus

·B/Phuket/3073/2013-like (B/Yamagata lineage) virus

Inactivated (injectable)

quadrivalent vaccines

·Same three strains as the injectable trivalent, plus:

·B/Brisbane/60/2008-like (B/Victoria lineage) virus

Here at the Oregon Immunization Program our flu season takes off with the delivery of the first available flu vaccines, sometime in late summer or early fall. The CDC recommends an annual flu vaccine for all individuals without contraindications ages 6 months and older.  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6421a5.ht

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Got a Cold or the Flu? Antibiotics won’t work for you!

by Tessa Jaqua, AWARE Program Coordinator

Colds and the flu are hitting the northwest particularly hard this year. We are all seemingly surrounded by a cacophony of sniffling, sneezing, and yes, even some snorting. Individuals are eager to have everyone feel better and calm restored to immune systems everywhere. Out of all remedies that people try there is one often requested remedy not only that won’t help anyone feel better faster, but could also put you at risk of a more serious illness later: antibiotics. 



(Image Courtesy of http://weknowmemes.com/2013/01/batman-on-flu-season/)

It’s true that antibiotics are miracle drugs, capable of battling once fatal or crippling bacterial infections. Yet, antibiotics are only good for just that: bacterial infections. Antibiotics do not work for viral infections and colds and the flu are both caused by viruses. Yet, providers continue to prescribe antibiotics for these infections and patients continue to ask for them even though they will have little to no effect on their symptoms. In fact, flu researchers in Boston found that from 1995 through 2002, a 26 percent of patients who were diagnosed with flu were prescribed antibiotics (Linder et al. 2005). This excluded people whose diagnosis could include a bacterial infection, such as pneumonia, the only plausible reason to prescribe antibiotics when they have the flu. While these numbers may not seem huge by themselves, if you do the math there are anywhere from 2 to 4 million people who visit doctors’ offices for flu every year. That means when you add these together that there are 500,000 to 1 million antibiotic prescriptions every year with no possible benefit to patients.

This many unnecessary antibiotic prescriptions for cold or flu patients each year puts a strain on our already weakened antibiotic efficacy.  Each time an antibiotic is used improperly there is a risk of killing important “commensal” or healthy bacteria. This leaves the body open to  resistant bacterial strains multiplying if/when bacterial infections, like pneumonia, actually do strike.

There are ways to combat antibiotics overuse, starting with individuals. No one enjoys being sick and our schedules don’t allow us a lot of time to recover, but the best ways to prevent and lessen the duration of colds and the flu start at home.

How do I stop a cold or the flu from starting?

  • Wash your hands!  Remember to wash for 20 seconds and dry hands thoroughly. 
  • Get your flu vaccination every year.
  • Avoid close contact with others with colds and the flu.

How can I treat my cold or the flu?

  • TIME! Colds last 7 to 14 days
  • Drink plenty of fluids (water, juice, clear broth, warm water with honey)
  • 8 hours or more of sleep a night
  • Breathe steam from shower or bath to loosen mucus
  • Rinse inside of nose with saline nasal rinse
  • Avoid cigarette smoke
  • Take acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) as directed for fever or pain
  • If necessary, take a decongestant to relieve cold symptoms (only for those over 6 years of age)

Every time antibiotics are used incorrectly it puts all at risk of developing a resistant infection and diminishes antibiotic effectiveness in the future.  We all have a role to play in preserving our antibiotic resources. Patients, healthcare providers, hospital administrators, industry, policy makers and the general public can work together to promote appropriate antibiotic use – ultimately saving lives. So this cold and flu season, think twice before asking for or prescribing antibiotics, so we can all feel better today, tomorrow, and in the future.  


For more information on antibiotic resistance or cold and flu prevention visit: www.healthoregon.org/antibiotics  or flu.oregon.gov.



Gelband, Helen. “http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2009/rwjf64483.”Robert Wood Johnson Foundation. Extending The Cure, 01 Oct 2009. Web. 18 Feb 2014.


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There’s No Such Thing as “Flu Season”

by Amanda Timmons




We all know that flu activity in Oregon varies from month-to-month with cases peaking in January or February of most years. In the news media, and in many clinics, the winter months are collectively called “flu season.”  This reinforces the belief that you can’t get the flu in the spring or summer. 

Oregon sees a baseline number of flu cases all year long.  Plus, Oregonian travelers visit locations around the globe. In the temperate regions of the southern hemisphere, flu activity increases in May and continues during our summer, peaking around September. Flu cases in the tropics peak during the rainy season, usually in June or July. Cruise ships are frequently in the news for disease outbreaks. Recently, the culprit appears to be gastroenteritis-causing norovirus, but influenza is also a commonly carried passenger.

Centers for Disease Control and Prevention (CDC) data shows that flu isn’t just a winter virus.  Between May 19 and September 28, 2013, the United States saw 2,013 cases of laboratory-confirmed influenza.  It isn’t too late to protect your patients with flu vaccine, even if the numbers of cases in our area are decreasing. Most flu vaccine doesn’t expire until June 30 and it’s important not to waste it. Now is the perfect time to administer the second dose of flu vaccine to children who need two doses but have only had one this year.  Plus, this is an opportunity to vaccinate and educate anyone who hasn’t had a flu shot yet.  The CDC recommends that everyone six months and older receive an annual flu shot -even if they tell you that “flu season” is over. 


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2013-14 influenza nomenclature
By Jeanine Whitney

Back in 2005 (and revisited in 2009), the Department of Health and Human Services made an offer. They would provide funds to businesses that could produce a recombinant influenza vaccine, build a manufacturing plant within the contiguous United States, meet a surge capacity of 50 million doses in six months and have vaccine lot releases within 12 weeks of a pandemic declaration. Well, four years later, they’ve done just that! 1

What does this mean for us? It means that the 2013-2014 influenza season will have some new vaccines available to choose from and a whole new nomenclature for us to learn.2

It all started when FluMist3 added a second B-strain to their live attenuated influenza vaccine making the first quadrivalent influenza vaccine for the U.S., LAIV-4.

There won’t be any LAIV-3.

Say good-by to TIV.

The previous TIV family of vaccines is now Inactivated Influenza Vaccine (IIV). There will be a mix of trivalent and quadrivalent injectable influenza vaccines available; IIV-3 and IIV-4.

Not only have we added a second B-strain but we have added the first two non-chicken based vaccines: recombinant influenza vaccine RIV-3 and the first non-chicken cell culture vaccine: ccIIV-3
What does this mean for right now? Unless your vaccine buyer made purchases last fall for these new formulations you may well only carry IIV-3. Just keep in mind that these and others may be available later this year and available for ordering for the 2014-2015 season.

See the table for the 2013-2014 season here.

• There are seven (7) IIV-3 regular vaccines from chicken eggs.
• There is one (1) RIV-3 recombinant vaccine and
• There is one (1) ccIIV-3 cell culture vaccine.
• There are (2) IIV-4 vaccines from chicken eggs. [Fluzone IIV-4 was just approved4.]
• Keep in mind that influenza vaccine is recommended for all individuals’ ≥6 months of age with at least 17 different presentations from which to choose.

Happy shopping!

1. Donabedian, A. 2012, United States Department of Health and Human Services. Prospects for sustainable influenza pandemic preparedness.
2. Interim Recommendations: Prevention and control of influenza with vaccines: Recommendations of the Advisory Committee on Immunizations Practices, (ACIP) 2013.
3. Vaccines, Blood & Biologicals. February 29, 2012 approval letter – FluMist®Qudarivalent.
4. Vaccines, Blood & Biologicals. June 7, 2013 approval letter – Fluzone Quadrivalent.


Pneumonia vaccine said to reduce U.S. hospitalizations (Reuters)

Maternal Tdap vaccine increases pertussis antibodies in infants (Healio)

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H7N9 and the 3 Ps of Pandemic Flu Preparedness


By Tessa Jaqua
H1N1 will forever live in infamy in the minds of public health professionals and healthcare providers alike. It stands as the pinnacle of pandemic preparedness and lessons learned. When it was over and the dust had settled, state and county public health departments put all those quickly developed plans on the shelf to—hopefully—sit, unused for a good long while.

Then, in March of 2013, rumors started crossing the seas, whispers of H7N9 and human infection grew louder, and by April the World Health Organization announced that avian influenza A (H7N9), a type of flu usually seen in birds, has been identified in a number of people in China. Human infections with a new avian influenza A (H7N9) virus continue to be reported in China, with 131 cases and 36 deaths as of May 17. There was some mild illness in humans, however most patients have had severe respiratory distress. There have been no cases of H7N9 reported outside of China, and the CDC is not sounding the alarm quite yet, but this is an excellent time to dust off those plans and review the lessons we learned from the H1N1. If for no other reason, it’s always good to be prepared, just in case.

3 Ps of pandemic flu preparedness:
Plan Review: Remember all those notebooks, excel documents, word files, etc. that were filled to the brim with pressing and important preparedness and response information during H1N1 and possibly H1N5? Get them out, open them up, and review them. H7N9 may become pandemic in the fall, or maybe in 2015, or possibly never, but when you’ve planned and prepared for this before, it’s always important to review and update regularly.
Partner Check-up: We have lists and lists of push partners and community resources, but when was the last time they were updated? Are you sure that Tracy Smith is still the administrator of that residential care facility? Refresh the list, update numbers, addresses, and add or delete partners. These lists hold the key to true community response so it is integral that they be as current and as useful as possible.
Public Prevention: The best time to prepare for a pandemic outbreak is before it happens. Redouble your efforts to communicate disease prevention strategies to the public and communicate regularly with partners. Provide health literate, continual, easy access to preparedness tips and flu facts in redundant locations. Remember there is no such thing as being over-prepared.

H7N9 might not be a big bad pandemic flu strain yet, but the risk reminds us that preparation is our best defense.

For more information about the H7N9 strain visit the CDC website HERE.

    Second 2013 coalition roundtable scheduled

Immunize Oregon is excited to announce their second 2013 Round Table. This free, full day event will be held in La Grande, Oregon on Wednesday, June 19th from 9-4:30. Immunization updates including ALERT IIS, statewide immunization rates, and VFC developments will be covered. Dr. Jay Rosenbloom will give his keynote presentation: “Addressing Vaccine Resistance.”

The roundtable event is a wonderful opportunity for providers and interested stakeholders to learn more about immunizations. For more information, please visit our website, http://www.healthoregon.org/immunizeoregon or click here to register.

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Immunize Oregon: Improving community immunity


Immunize Oregon, OIP’s lifespan coalition,  is excited to announce we are restructuring the way we offer our FLU  (Free, Local, Underserved) Clinics. The coalition partners with area clinics, health systems, non-profits, and nursing and pharmacy schools to provide immunization clinics that offer no-cost vaccines to uninsured individuals. We work in conjunction with nursing or pharmacy students as vaccinators if necessary, and with partners who host the clinic and do outreach to people who need vaccines. 

If you are interested in hosting a FLU Clinic during the 2013-2014 season (September-April) please click here or contact Alison.alexander@state.or.us 

 We are also elated to announce a notable expansion of our mini-grants–one of OAIC’s most popular programs.  This year we are able to offer $30,000 of grant funds, with a maximum award of $4,000!  These grants are for organizations looking to improve immunization rates in Oregon.  Last year, OAIC had $48,000 in requests for mini-grants with a budget of only $14,000. This year the coalition hopes to make a greater impact on the health of our communities by expanding this wildly successful program.

Immunization projects that focus on populations across the lifespan will be considered for grants, with special consideration to those that work to raise adult immunization rates (which are the lowest).

If you are interested in applying, please look at our website, www.healthoregon.org/immunizeoregon for the request for proposals and application materials. If you have any questions, please contact Katherine.h.mcguiness@state.or.us

If you are interested in getting involved in Immunize Oregon, have any general questions about the coalition’s work or have an idea for a project, we would love to hear from you! Please email either Alison or Katherine at the addresses listed above.

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Children’s Clinic takes an extra step to protect newborns

The CDC recommends that everyone over the age of 6 months get immunized for influenza. But what about newborns who are too young to get vaccinated? Providers at The Children’s Clinic, a century-old Portland-metro area pediatric practice, are looking for a way to take care of those infants. “The most vulnerable children are too young to be vaccinated, so we looked for another way to protect them,” says Heather O’Leary, RN, BSN, Manager of Clinical Services at The Children’s Clinic. Their solution is to immunize the parents and caregivers of newborns by making flu vaccines available at the infant’s newborn – 4 month visits. The challenge is how to handle immunizing adults within the constraints of a pediatric practice.

Vaccines for Children can provide immunizations for parents and caregivers who are younger than 19 and uninsured, Medicaid, or American Indian/Alaskan Native. But Phyllis Layton, The Children’s Clinic’s Purchasing Coordinator says “We are still working on the billing part as we are not their primary care provider.  However, we feel that if pharmacies can do it, we can too.”

The Children’s Clinic has 24 pediatricians and one pediatric nurse practitioner who work at two sites:  one in Southwest Portland near Providence St. Vincent Medical Center and another in Tualatin, near Legacy Meridian Park Hospital. Last year they provided about 14,000 flu shots to children. This year, they hope to protect even more kids by making sure their parents and caregivers don’t give them the flu.


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Flu vaccine: let’s use it until we lose it!

By Kate Parker-Shames, VFC Health Educator

It’s the end of flu season. Often it seems like a lost cause, vaccinating patients against flu at this time of year. Many clinics around the state have a small amount of short-dated flu vaccine in their refrigerator, and in some clinics, that vaccine will just fill space until they expire.  It is still possible to administer flu vaccine, even this late in the season! Last week, while on a visit to Samaritan Pediatrics, I was reminded of how we should still encourage families to get immunized for flu- even though it is late in the season. When I asked the clinic how they were doing getting through their short-dated flu stock, I was told that the clinic was having no problem using up their flu stock; as they were still immunizing for flu. While the clinic’s rate of administering flu vaccine had slowed down a little since the winter months, they were still giving quite a few doses per day. The clinic told me that they thought they would probably use all their doses before the end of the month. Wow, I thought, I wonder how they do this. So many of our providers around the state have difficulty getting flu vaccines into patients this late in the season; so, how does this clinic do it?

My curiosity piqued, I asked clinic staff, and they told me:

Clinic staff said that it was almost a non-issue for them. Their attitude towards administering flu vaccine is straightforward:  it is still flu season, we have flu vaccine available, and anyone who is eligible should get the vaccine. Any eligible patient who sets foot in their clinic should get flu vaccine. 

First reason: children should get the flu vaccine every year. If they have not gotten their vaccine for this flu season, they should get it. The clinic screens every kid who comes to the clinic to see if they have yet received their flu vaccine for this season. Just because flu season is ending doesn’t mean that, (1) a kid can’t still get the flu, or (2) that they shouldn’t have access to the long-term immunity against this year’s flu strain for protection in future flu seasons. 

Second reason: a lot of pediatric patients require two doses of flu (children under 9 years old getting flu vaccine for the first time should have two doses in their first season of being immunized), so every kiddo fitting this category is screened when they come to the clinic to see if they have had their second dose of the season, and if they haven’t had their second dose already this year, they get it….even in June. 

Keys to successful late-season flu vaccine administration:

Attitude: the clinic treats late season immunization as a non-issue. People need the flu vaccine, should get it, and therefore, the clinic offers it whenever patients are eligible. 

Screening: the clinic is screening every patient who comes into their office to see if they are due for a flu vaccine

We can all learn a little from Samaritan Pediatrics! Let’s use these last few days of flu season 2010/11: screen all patients who walk through your doors for flu eligibility. Let’s use these flu doses before we lose them!




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