Kevin Kunzmann

 vaccinations during the 2020-21 season, pediatric vaccination against the flu remains underwhelming in the US.

A new analysis of 11 national jurisdictions with relevant flu vaccination data for last year shows that administered doses for children aged 6 months to 4 years old in September-December 2020 actually declined from the previous 2 years, despite heightened awareness campaigns and advocacy for immunization against influenza during surging new COVID-19 cases.

The data from investigators at the Centers for Disease Control and Prevention (CDC) reinforce the need for education and awareness campaigns on the availability and recommendation of flu vaccination in children as young as 6 months old—especially headed into another winter season with COVID-19 outbreak risks.

Led by Patricia Castro Roman, MPH, the CDC investigators sought to interpret the percentage change between administration of ≥1 flu vaccine dose during the first half of last year’s flu season, compared with averages from the corresponding periods in 2018 and 2019. The team used data from 11 US jurisdictions with high-performing state immunization information systems.

Roman and colleagues believed this finding would provide a more clear understanding of how COVID-19 impacted influenza vaccination coverage in the US. As they noted, approximately 9 to 41 million annual flu cases occurred between 2010 and 2020; up to 52,000 persons have died each year from the preventable virus.

“As the United States enters the 2021–22 influenza season, the potential impact of influenza illnesses is of concern given that influenza season will again coincide with the ongoing COVID-19 pandemic, which could further strain overburdened health care systems,” they wrote.

Investigators stratified jurisdiction data reported to the CDC by vaccinated patient age groups:

The team observed 16,872,970 flu vaccine doses administered in the 11 study jurisdictions in September-December 2020. Comparatively, a mean 15,513,428 doses were reported in the same time period and jurisdictions in 2018 and 2019—indicating a 9% increase in flu doses in 2020 across all age groups versus the last 2 years.

Among children aged 6-24 months and 2-4 years, however, flu vaccine administration decreased 13.9% and 11.9%, respectively. Doses administered to children aged 5-12 years stayed consistent in 2020 as to averages reported for 2018 and 2019. Interestingly, doses administered to adolescents aged 13-17 years increased by 12.9% in 2020—the lone pediatric age group to report an increase in flu vaccination during COVID-19.

Each adult age group reported a significant increase in flu vaccinations in 2020 versus 2018 and 2019; persons aged 50-64 years increased by 15.3%; persons aged 18-49 years increased 14.6%; and persons aged ≥65 years increased 9.5%.

Roman and colleagues noted the findings are consistent with a national survey data assessment from this year that showed that influenza vaccination coverage was lower among persons aged 6 months to 17 years than in adults aged ≥18 years during the 2020-21 flu season, compared to the previous year.

The factors influencing this dip in pediatric vaccination, such as immunization awareness campaigns, remains unclear to investigators.

“These campaigns emphasized the importance of receiving the annual influenza vaccine to help reduce the spread of influenza viruses,” they wrote. “Although the flu vaccine does not protect against COVID-19, influenza vaccination was part of a public health strategy to flatten the curve of respiratory illnesses overall, protect essential workers from influenza, and preserve medical resources for care of COVID-19 patients.”

As they noted, the 2020-21 flu season was atypically minimal in the US; the implementation of public health measures against COVID-19, such as face-masking, social distancing, and remote working and education, most likely mitigated the effect of the flu. But the experts now worry that the effect of these measures may have misled parents to believe their children are at lower risk of contracting influenza.

Parents may have also been impacted by barriers to health and flu vaccination brought on by the pandemic. But now that COVID-19 vaccinations and therapies have progressed a gradual lift of public health mandates and practices, children are likely again at a heightened risk of flu this season.

“Influenza vaccination in 2020 was part of a comprehensive public health strategy to reduce the prevalence of respiratory illnesses overall, to help protect essential workers from influenza, and preserve medical resources for patients with COVID-19,” they concluded. “Influenza vaccination among all age groups could help reduce the spread of influenza this fall and winter, and reduce the potential burden that influenza cases could place on health care systems already overburdened by COVID-19.”

Influenza Vaccinations During the COVID-19 Pandemic — 11 U.S. Jurisdictions, September-December 2020

Articles

A CDC analysis shows more doses were administered adults and adolescents than in previous years, while COVID-19 factors may have influenced the dip in shots among children.

US Pediatric Flu Vaccinations Decreased in 2020

 Opportunities to detect non-cancer diseases


 Translating diagnostic findings to actual care


This November 2021 episode of Lungcast commemorates Lung Cancer Awareness Month with as apt a conversation topic one could have on the subject: improving lung cancer screening.

James Mulshine, MD, Professor of Internal Medicine and Associate Director at the Institute of Translation Medicine at Rush University, joins Lungcast to discuss a bevy of lung cancer screening topics, including low-dose CT scans, quantitative imaging, artificial intelligence, age-eligibility, and national guidance on priority.

Lungcast is a monthly respiratory health podcast series from the American Lung Association (ALA) produced by 

ALA Chief Medical Officer Al Rizzo, MD, talks with Mulshine on the matters of better implementing pivotal, supporting low-dose CT scan data into actual clinical practice, and what the benefits of a better aware patient population may mean for opportune lung cancer prevention in the US.

Rizzo also highlights the seminal work of British epidemiologist Sir Richard Doll, a pivotal investigator into the clinical links between smoking, cessation, lung and heart disease, and death.

Subscribe or listen to Lungcast on your favorite platforms:

https://open.spotify.com/show/1F3u1hKrwxi9snSQ0q3nti

https://podcasts.apple.com/us/podcast/lungcast/id1524712350

Podcasts

In recognition of Lung Cancer Awareness Month, this episode featuring Dr. James Mulshine at Rush University explains the ins and outs of the improved 2021 lung cancer screening guidelines.

Lung Cancer Screening: Trials, Tribulations & Triumphs with Dr. James Mulshine

 Thoughts on the ranbizumab PDS approval


US Food and Drug Administration (FDA) approved the Port Delivery System (PDS) with anti-VEGF therapy ranibizumab

 for the treatment of wet age-related macular degeneration (AMD) last month, a decision which introduced a novel ophthalmic treatment delivery product to the US and capped off a 2-decade research venture into PDS.

The historic approval granted to Roche could implicate long-term benefits in treatment adherence and efficacy—and therefore, retention of vision and quality of life—in the burdened retina disease patient population. The permanent eye implant is designed to provide patients a continuous administration of formulary anti-VEGF therapy—the gold standard for AMD treatment—through a vitreous cavity that does not require intravenous injections, nor refills for months at a time.

The late-October timing of the approval could not be more apt, as clinicians gathered to highlight and review PDS-relevant data at the American Society of Retina Specialists (ASRS) 2021 Meeting and American Academy of Ophthalmology (AAO) 2021 Meeting shortly prior to and after the FDA decision, respectively. Many ophthalmologists talked with 

 on the promising implication of PDS, as well as the anticipated early hurdles of application and monitoring in patients.

But one expert was able to speak fully to the long-term history and future potential of the novel product.

Carl Regillo, MD, Director of Retina Service at Wills Eye Hospital in Philadelphia, joined DocTalk to discuss ranibizumab PDS, his experiences with port delivery research that spans 15 years, what the application of the new anti-VEGF delivery method could mean for wet AMD, and where he thinks PDS may also serve ophthalmologists.

The Director of Retina Services at Wills Eye Hospital joins to discuss the historic FDA approval granted for a novel method of ophthalmic care: a permanent implant that allows for vision-saving formula therapy to treat the eye continually.

Port Delivery System 101 with Carl Regillo, MD

 clinical trial sites may differ by region, according to new study findings that highlight the disparity of health care access among patients burdened with ophthalmic disease.

American Academy of Ophthalmology (AAO) 2021 Meeting

 in New Orleans this week, a team of investigators reported that patients in the Northeast may have better access to phase 3 clinical trial sites for ophthalmic care than other regions. The findings could implicate the validity and value of late-stage clinical trial findings—especially when considering the unique demographic and clinical factors impacting different regions of the US.

Led by Rebecca R. Soares, MD, MPH, the Wills Eye Hospital investigators sought to determine the geographic distribution of ophthalmologic clinical studies across the US. They also aimed to define the predictors of such accessibility for the different regions—an outcome that could help identify at-risk populations less frequently included in late-stage trials.

As they noted, more than 4200 ophthalmologic clinical trials have been conducted in the past decade.

Soares and colleagues sought to define patient travel time to ophthalmologic clinical trial sites for different disease states via data from the US Department of Agriculture Economic Research Service and the Census Bureau. They observed that patients with retina disease had the shortest mean time to clinical trial sites (mean 33.7 minutes; range, 18.7 – 70.1), while neuro-ophthalmology patients had the longest time (mean 119.8 minutes; range, 48.7 – 240.4).

Key region predictors of >60 minute driving times to nearest clinical trial sites included:

Rural census tracts (adjusted odds ratio [aOR], 7.60; 95% CI, 5.66 – 10.20; 

Midwest region (aOR, 1.84; 95% CI, 1.15 – 2.96; 

South region (aOR, 2.57; 95% CI, 1.38 – 4.79; 

West region (aOR, 2.52; 95% CI, 1.52 – 4.17; 

Higher poverty levels (aOR vs first quartile, 2.26; 95 CI, 1.72 – 2.98; 

Lower education levels (high school aOR vs college Bachelor’s degree or higher, 1.02; 95% CI, 1.00 – 1.03; 

High visual impairment (aOR, 1.07; 95% CI, 1.03 – 1.10; 

Though rural location was the most significant predictor of travel distance to ophthalmology clinical trial sites, investigators stressed the significant disparities in access to such sites for census tracts with greater self-reported rates of visual impairment. They noted that clinical trial access is critical for the recruitment, retention, and generalizability of study outcomes.

“It is imperative that clinical trial investigators expand efforts to provide access to patients from rural and other demographically disadvantaged communities,” Soares and colleagues concluded.

The study, “Geographic Access Disparities to Phase 3 Clinical Trials in Ophthalmology in the United States,” was presented at AAO 2021.

A geographical study shows patients in areas with lower income, education, and higher rates of ophthalmic disease may be a greater distance from a trial site.