what’s new in flu? an update on influenza prevention and …27s new in... · 2018. 12. 18. ·...
TRANSCRIPT
Whatrsquos New in Flu An Update on Influenza Prevention and
Treatment
Kathryn M Edwards MDSarah H Sell and Cornelius Vanderbilt Professor of Pediatrics
Vanderbilt University Nashville TN USA
Disclosures
bull I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) discussed in this CME activity
bull I do not intend to discuss an unapproved investigative use of a commercial productdevice in my presentation
Objectives
bull To provide an update on influenza disease burden in the US
bull To understand current influenza vaccine recommendations
bull To review the characteristics of currently available influenza vaccines
bull To understand antivirals directed to influenza and their recommended use
bull To review future influenza vaccine approaches5132013
Page 3
Source AS Fauci
Influenza A Virus
Hemagglutinin (H) ndash 17 subtypes (attachment penetration)
Neuraminidase (N) ndash 10 subtypes (release)
M2 Protein (replication)
8 viral genes (assembly replication)
5132013Page 4
Clinical Manifestations of Influenza
bull Acute febrile respiratory illness- Many ldquoinfluenza-like illnessrdquo definitions
- Fever or feverish- Cough andor sore throat otitis
- More serious manifestations- Primary or secondary pneumonia
croup bronchiolitis- Non-specific febrile illness particularly in
infants- Extra-pulmonary manifestations
- Neurologic ndash Encephalitis seizures- Myositis- Cardiac
5132013Page 5
0
1
2
3
4
5
0-5 months 6-23months
24-59months
Total lt5years
Age
Hosp
italiz
ation
s per
1000
Poehling KA et al NEJM 200635531-40
Discharge Diagnoses ForChildren lt5 years With Influenza
0
10
20
30
0-5 months 6-59 months
Poehling KA et al NEJM 200635531-40
Influenza Outpatient Visit Rates Per 1000 Children
0
20
40
60
80
100
120
140
160
180
lt 6mos 6-23 mos 2-4 yrs 5-12 yrs
2002-3
2003-4
2006-7
Poehling KA et al NEJM 200635531-40
Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
0
50
100
150
200
lt1 1- lt2 2-lt5
Rat
e pe
r 100
0 ch
ildre
n
Age (years)
Ill visits AOM LRI
Neuzil et al J Infect Dis 2002185147-52
Influenza Burden in US
bull Infection rates are highest among children with complications and hospitalizations from seasonal influenza being greatest among persons aged ge65 years children aged lt2 years and persons of any age who have medical conditions that confer increased risk for complications from influenza
bull Highly variable from year-to-yearbull Approximately 100 pediatric deaths reported yearly bull Approximately 55000 to 431000 hospitalizations per
year with a mean of 226000
Page 10
2017-2018 Was a Bad Influenza Year
MMWR June 8 2018 Vol 67 No 22
High Number of Hospitalizations Noted
MMWR June 8 2018 Vol 67 No 22
httpswwwcdcgovfluweekly
Shang M Blanton L Brammer L et al Influenza Associated Pediatric Deaths in the United States 2010ndash 2016Pediatrics2018141(4)e20172918
US ACIP Influenza Vaccine Recommendations
bull Historically recommended for all high-risk children ge6 months Two doses recommended
bull In 2005 recommended for all children aged 6-23 months to prevent hospitalizations and deaths
bull In 2006 recommended for all children aged 24-59 months to prevent outpatient visits and indirect costs
bull In 2008 recommended for all persons ge6 monthsbull In 2014 preferential recommendation for LAIV
for healthy children (2-17 years of age) since LAIV consistently more effective than trivalent IIV in this population in comparative trials
NEJM 2007356685-96
Pediatric Trial of LAIV vs IIV
bull Randomized double-blind trial in 8492 children (6-59 months of age) from 249 sites in 3 continents
bull Primary endpoint culture-confirmed influenza illness most strains were H3N2 and influenza B
bull LAIV associated with 55 reduction in culture confirmed influenza compared to IIV
LAIV IIV p-value
Confirmed influenza 39 86 lt00001
NEJM 2007356685-96
Summary of comparative studies
Influenza Other Respi Viruses 2011567-75
Observational Study dagger Challenge Study others randomized controlled trials
US ACIP Influenza Vaccine Recommendations
bull In 2015 preferential recommendation for LAIV removed
bull LAIV4 not recommended in the US for 2016-7 and 2017-8 seasons
bull Studies in other areas of the world were ongoing
21
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Disclosures
bull I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) discussed in this CME activity
bull I do not intend to discuss an unapproved investigative use of a commercial productdevice in my presentation
Objectives
bull To provide an update on influenza disease burden in the US
bull To understand current influenza vaccine recommendations
bull To review the characteristics of currently available influenza vaccines
bull To understand antivirals directed to influenza and their recommended use
bull To review future influenza vaccine approaches5132013
Page 3
Source AS Fauci
Influenza A Virus
Hemagglutinin (H) ndash 17 subtypes (attachment penetration)
Neuraminidase (N) ndash 10 subtypes (release)
M2 Protein (replication)
8 viral genes (assembly replication)
5132013Page 4
Clinical Manifestations of Influenza
bull Acute febrile respiratory illness- Many ldquoinfluenza-like illnessrdquo definitions
- Fever or feverish- Cough andor sore throat otitis
- More serious manifestations- Primary or secondary pneumonia
croup bronchiolitis- Non-specific febrile illness particularly in
infants- Extra-pulmonary manifestations
- Neurologic ndash Encephalitis seizures- Myositis- Cardiac
5132013Page 5
0
1
2
3
4
5
0-5 months 6-23months
24-59months
Total lt5years
Age
Hosp
italiz
ation
s per
1000
Poehling KA et al NEJM 200635531-40
Discharge Diagnoses ForChildren lt5 years With Influenza
0
10
20
30
0-5 months 6-59 months
Poehling KA et al NEJM 200635531-40
Influenza Outpatient Visit Rates Per 1000 Children
0
20
40
60
80
100
120
140
160
180
lt 6mos 6-23 mos 2-4 yrs 5-12 yrs
2002-3
2003-4
2006-7
Poehling KA et al NEJM 200635531-40
Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
0
50
100
150
200
lt1 1- lt2 2-lt5
Rat
e pe
r 100
0 ch
ildre
n
Age (years)
Ill visits AOM LRI
Neuzil et al J Infect Dis 2002185147-52
Influenza Burden in US
bull Infection rates are highest among children with complications and hospitalizations from seasonal influenza being greatest among persons aged ge65 years children aged lt2 years and persons of any age who have medical conditions that confer increased risk for complications from influenza
bull Highly variable from year-to-yearbull Approximately 100 pediatric deaths reported yearly bull Approximately 55000 to 431000 hospitalizations per
year with a mean of 226000
Page 10
2017-2018 Was a Bad Influenza Year
MMWR June 8 2018 Vol 67 No 22
High Number of Hospitalizations Noted
MMWR June 8 2018 Vol 67 No 22
httpswwwcdcgovfluweekly
Shang M Blanton L Brammer L et al Influenza Associated Pediatric Deaths in the United States 2010ndash 2016Pediatrics2018141(4)e20172918
US ACIP Influenza Vaccine Recommendations
bull Historically recommended for all high-risk children ge6 months Two doses recommended
bull In 2005 recommended for all children aged 6-23 months to prevent hospitalizations and deaths
bull In 2006 recommended for all children aged 24-59 months to prevent outpatient visits and indirect costs
bull In 2008 recommended for all persons ge6 monthsbull In 2014 preferential recommendation for LAIV
for healthy children (2-17 years of age) since LAIV consistently more effective than trivalent IIV in this population in comparative trials
NEJM 2007356685-96
Pediatric Trial of LAIV vs IIV
bull Randomized double-blind trial in 8492 children (6-59 months of age) from 249 sites in 3 continents
bull Primary endpoint culture-confirmed influenza illness most strains were H3N2 and influenza B
bull LAIV associated with 55 reduction in culture confirmed influenza compared to IIV
LAIV IIV p-value
Confirmed influenza 39 86 lt00001
NEJM 2007356685-96
Summary of comparative studies
Influenza Other Respi Viruses 2011567-75
Observational Study dagger Challenge Study others randomized controlled trials
US ACIP Influenza Vaccine Recommendations
bull In 2015 preferential recommendation for LAIV removed
bull LAIV4 not recommended in the US for 2016-7 and 2017-8 seasons
bull Studies in other areas of the world were ongoing
21
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Objectives
bull To provide an update on influenza disease burden in the US
bull To understand current influenza vaccine recommendations
bull To review the characteristics of currently available influenza vaccines
bull To understand antivirals directed to influenza and their recommended use
bull To review future influenza vaccine approaches5132013
Page 3
Source AS Fauci
Influenza A Virus
Hemagglutinin (H) ndash 17 subtypes (attachment penetration)
Neuraminidase (N) ndash 10 subtypes (release)
M2 Protein (replication)
8 viral genes (assembly replication)
5132013Page 4
Clinical Manifestations of Influenza
bull Acute febrile respiratory illness- Many ldquoinfluenza-like illnessrdquo definitions
- Fever or feverish- Cough andor sore throat otitis
- More serious manifestations- Primary or secondary pneumonia
croup bronchiolitis- Non-specific febrile illness particularly in
infants- Extra-pulmonary manifestations
- Neurologic ndash Encephalitis seizures- Myositis- Cardiac
5132013Page 5
0
1
2
3
4
5
0-5 months 6-23months
24-59months
Total lt5years
Age
Hosp
italiz
ation
s per
1000
Poehling KA et al NEJM 200635531-40
Discharge Diagnoses ForChildren lt5 years With Influenza
0
10
20
30
0-5 months 6-59 months
Poehling KA et al NEJM 200635531-40
Influenza Outpatient Visit Rates Per 1000 Children
0
20
40
60
80
100
120
140
160
180
lt 6mos 6-23 mos 2-4 yrs 5-12 yrs
2002-3
2003-4
2006-7
Poehling KA et al NEJM 200635531-40
Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
0
50
100
150
200
lt1 1- lt2 2-lt5
Rat
e pe
r 100
0 ch
ildre
n
Age (years)
Ill visits AOM LRI
Neuzil et al J Infect Dis 2002185147-52
Influenza Burden in US
bull Infection rates are highest among children with complications and hospitalizations from seasonal influenza being greatest among persons aged ge65 years children aged lt2 years and persons of any age who have medical conditions that confer increased risk for complications from influenza
bull Highly variable from year-to-yearbull Approximately 100 pediatric deaths reported yearly bull Approximately 55000 to 431000 hospitalizations per
year with a mean of 226000
Page 10
2017-2018 Was a Bad Influenza Year
MMWR June 8 2018 Vol 67 No 22
High Number of Hospitalizations Noted
MMWR June 8 2018 Vol 67 No 22
httpswwwcdcgovfluweekly
Shang M Blanton L Brammer L et al Influenza Associated Pediatric Deaths in the United States 2010ndash 2016Pediatrics2018141(4)e20172918
US ACIP Influenza Vaccine Recommendations
bull Historically recommended for all high-risk children ge6 months Two doses recommended
bull In 2005 recommended for all children aged 6-23 months to prevent hospitalizations and deaths
bull In 2006 recommended for all children aged 24-59 months to prevent outpatient visits and indirect costs
bull In 2008 recommended for all persons ge6 monthsbull In 2014 preferential recommendation for LAIV
for healthy children (2-17 years of age) since LAIV consistently more effective than trivalent IIV in this population in comparative trials
NEJM 2007356685-96
Pediatric Trial of LAIV vs IIV
bull Randomized double-blind trial in 8492 children (6-59 months of age) from 249 sites in 3 continents
bull Primary endpoint culture-confirmed influenza illness most strains were H3N2 and influenza B
bull LAIV associated with 55 reduction in culture confirmed influenza compared to IIV
LAIV IIV p-value
Confirmed influenza 39 86 lt00001
NEJM 2007356685-96
Summary of comparative studies
Influenza Other Respi Viruses 2011567-75
Observational Study dagger Challenge Study others randomized controlled trials
US ACIP Influenza Vaccine Recommendations
bull In 2015 preferential recommendation for LAIV removed
bull LAIV4 not recommended in the US for 2016-7 and 2017-8 seasons
bull Studies in other areas of the world were ongoing
21
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Source AS Fauci
Influenza A Virus
Hemagglutinin (H) ndash 17 subtypes (attachment penetration)
Neuraminidase (N) ndash 10 subtypes (release)
M2 Protein (replication)
8 viral genes (assembly replication)
5132013Page 4
Clinical Manifestations of Influenza
bull Acute febrile respiratory illness- Many ldquoinfluenza-like illnessrdquo definitions
- Fever or feverish- Cough andor sore throat otitis
- More serious manifestations- Primary or secondary pneumonia
croup bronchiolitis- Non-specific febrile illness particularly in
infants- Extra-pulmonary manifestations
- Neurologic ndash Encephalitis seizures- Myositis- Cardiac
5132013Page 5
0
1
2
3
4
5
0-5 months 6-23months
24-59months
Total lt5years
Age
Hosp
italiz
ation
s per
1000
Poehling KA et al NEJM 200635531-40
Discharge Diagnoses ForChildren lt5 years With Influenza
0
10
20
30
0-5 months 6-59 months
Poehling KA et al NEJM 200635531-40
Influenza Outpatient Visit Rates Per 1000 Children
0
20
40
60
80
100
120
140
160
180
lt 6mos 6-23 mos 2-4 yrs 5-12 yrs
2002-3
2003-4
2006-7
Poehling KA et al NEJM 200635531-40
Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
0
50
100
150
200
lt1 1- lt2 2-lt5
Rat
e pe
r 100
0 ch
ildre
n
Age (years)
Ill visits AOM LRI
Neuzil et al J Infect Dis 2002185147-52
Influenza Burden in US
bull Infection rates are highest among children with complications and hospitalizations from seasonal influenza being greatest among persons aged ge65 years children aged lt2 years and persons of any age who have medical conditions that confer increased risk for complications from influenza
bull Highly variable from year-to-yearbull Approximately 100 pediatric deaths reported yearly bull Approximately 55000 to 431000 hospitalizations per
year with a mean of 226000
Page 10
2017-2018 Was a Bad Influenza Year
MMWR June 8 2018 Vol 67 No 22
High Number of Hospitalizations Noted
MMWR June 8 2018 Vol 67 No 22
httpswwwcdcgovfluweekly
Shang M Blanton L Brammer L et al Influenza Associated Pediatric Deaths in the United States 2010ndash 2016Pediatrics2018141(4)e20172918
US ACIP Influenza Vaccine Recommendations
bull Historically recommended for all high-risk children ge6 months Two doses recommended
bull In 2005 recommended for all children aged 6-23 months to prevent hospitalizations and deaths
bull In 2006 recommended for all children aged 24-59 months to prevent outpatient visits and indirect costs
bull In 2008 recommended for all persons ge6 monthsbull In 2014 preferential recommendation for LAIV
for healthy children (2-17 years of age) since LAIV consistently more effective than trivalent IIV in this population in comparative trials
NEJM 2007356685-96
Pediatric Trial of LAIV vs IIV
bull Randomized double-blind trial in 8492 children (6-59 months of age) from 249 sites in 3 continents
bull Primary endpoint culture-confirmed influenza illness most strains were H3N2 and influenza B
bull LAIV associated with 55 reduction in culture confirmed influenza compared to IIV
LAIV IIV p-value
Confirmed influenza 39 86 lt00001
NEJM 2007356685-96
Summary of comparative studies
Influenza Other Respi Viruses 2011567-75
Observational Study dagger Challenge Study others randomized controlled trials
US ACIP Influenza Vaccine Recommendations
bull In 2015 preferential recommendation for LAIV removed
bull LAIV4 not recommended in the US for 2016-7 and 2017-8 seasons
bull Studies in other areas of the world were ongoing
21
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Clinical Manifestations of Influenza
bull Acute febrile respiratory illness- Many ldquoinfluenza-like illnessrdquo definitions
- Fever or feverish- Cough andor sore throat otitis
- More serious manifestations- Primary or secondary pneumonia
croup bronchiolitis- Non-specific febrile illness particularly in
infants- Extra-pulmonary manifestations
- Neurologic ndash Encephalitis seizures- Myositis- Cardiac
5132013Page 5
0
1
2
3
4
5
0-5 months 6-23months
24-59months
Total lt5years
Age
Hosp
italiz
ation
s per
1000
Poehling KA et al NEJM 200635531-40
Discharge Diagnoses ForChildren lt5 years With Influenza
0
10
20
30
0-5 months 6-59 months
Poehling KA et al NEJM 200635531-40
Influenza Outpatient Visit Rates Per 1000 Children
0
20
40
60
80
100
120
140
160
180
lt 6mos 6-23 mos 2-4 yrs 5-12 yrs
2002-3
2003-4
2006-7
Poehling KA et al NEJM 200635531-40
Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
0
50
100
150
200
lt1 1- lt2 2-lt5
Rat
e pe
r 100
0 ch
ildre
n
Age (years)
Ill visits AOM LRI
Neuzil et al J Infect Dis 2002185147-52
Influenza Burden in US
bull Infection rates are highest among children with complications and hospitalizations from seasonal influenza being greatest among persons aged ge65 years children aged lt2 years and persons of any age who have medical conditions that confer increased risk for complications from influenza
bull Highly variable from year-to-yearbull Approximately 100 pediatric deaths reported yearly bull Approximately 55000 to 431000 hospitalizations per
year with a mean of 226000
Page 10
2017-2018 Was a Bad Influenza Year
MMWR June 8 2018 Vol 67 No 22
High Number of Hospitalizations Noted
MMWR June 8 2018 Vol 67 No 22
httpswwwcdcgovfluweekly
Shang M Blanton L Brammer L et al Influenza Associated Pediatric Deaths in the United States 2010ndash 2016Pediatrics2018141(4)e20172918
US ACIP Influenza Vaccine Recommendations
bull Historically recommended for all high-risk children ge6 months Two doses recommended
bull In 2005 recommended for all children aged 6-23 months to prevent hospitalizations and deaths
bull In 2006 recommended for all children aged 24-59 months to prevent outpatient visits and indirect costs
bull In 2008 recommended for all persons ge6 monthsbull In 2014 preferential recommendation for LAIV
for healthy children (2-17 years of age) since LAIV consistently more effective than trivalent IIV in this population in comparative trials
NEJM 2007356685-96
Pediatric Trial of LAIV vs IIV
bull Randomized double-blind trial in 8492 children (6-59 months of age) from 249 sites in 3 continents
bull Primary endpoint culture-confirmed influenza illness most strains were H3N2 and influenza B
bull LAIV associated with 55 reduction in culture confirmed influenza compared to IIV
LAIV IIV p-value
Confirmed influenza 39 86 lt00001
NEJM 2007356685-96
Summary of comparative studies
Influenza Other Respi Viruses 2011567-75
Observational Study dagger Challenge Study others randomized controlled trials
US ACIP Influenza Vaccine Recommendations
bull In 2015 preferential recommendation for LAIV removed
bull LAIV4 not recommended in the US for 2016-7 and 2017-8 seasons
bull Studies in other areas of the world were ongoing
21
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
0
1
2
3
4
5
0-5 months 6-23months
24-59months
Total lt5years
Age
Hosp
italiz
ation
s per
1000
Poehling KA et al NEJM 200635531-40
Discharge Diagnoses ForChildren lt5 years With Influenza
0
10
20
30
0-5 months 6-59 months
Poehling KA et al NEJM 200635531-40
Influenza Outpatient Visit Rates Per 1000 Children
0
20
40
60
80
100
120
140
160
180
lt 6mos 6-23 mos 2-4 yrs 5-12 yrs
2002-3
2003-4
2006-7
Poehling KA et al NEJM 200635531-40
Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
0
50
100
150
200
lt1 1- lt2 2-lt5
Rat
e pe
r 100
0 ch
ildre
n
Age (years)
Ill visits AOM LRI
Neuzil et al J Infect Dis 2002185147-52
Influenza Burden in US
bull Infection rates are highest among children with complications and hospitalizations from seasonal influenza being greatest among persons aged ge65 years children aged lt2 years and persons of any age who have medical conditions that confer increased risk for complications from influenza
bull Highly variable from year-to-yearbull Approximately 100 pediatric deaths reported yearly bull Approximately 55000 to 431000 hospitalizations per
year with a mean of 226000
Page 10
2017-2018 Was a Bad Influenza Year
MMWR June 8 2018 Vol 67 No 22
High Number of Hospitalizations Noted
MMWR June 8 2018 Vol 67 No 22
httpswwwcdcgovfluweekly
Shang M Blanton L Brammer L et al Influenza Associated Pediatric Deaths in the United States 2010ndash 2016Pediatrics2018141(4)e20172918
US ACIP Influenza Vaccine Recommendations
bull Historically recommended for all high-risk children ge6 months Two doses recommended
bull In 2005 recommended for all children aged 6-23 months to prevent hospitalizations and deaths
bull In 2006 recommended for all children aged 24-59 months to prevent outpatient visits and indirect costs
bull In 2008 recommended for all persons ge6 monthsbull In 2014 preferential recommendation for LAIV
for healthy children (2-17 years of age) since LAIV consistently more effective than trivalent IIV in this population in comparative trials
NEJM 2007356685-96
Pediatric Trial of LAIV vs IIV
bull Randomized double-blind trial in 8492 children (6-59 months of age) from 249 sites in 3 continents
bull Primary endpoint culture-confirmed influenza illness most strains were H3N2 and influenza B
bull LAIV associated with 55 reduction in culture confirmed influenza compared to IIV
LAIV IIV p-value
Confirmed influenza 39 86 lt00001
NEJM 2007356685-96
Summary of comparative studies
Influenza Other Respi Viruses 2011567-75
Observational Study dagger Challenge Study others randomized controlled trials
US ACIP Influenza Vaccine Recommendations
bull In 2015 preferential recommendation for LAIV removed
bull LAIV4 not recommended in the US for 2016-7 and 2017-8 seasons
bull Studies in other areas of the world were ongoing
21
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Discharge Diagnoses ForChildren lt5 years With Influenza
0
10
20
30
0-5 months 6-59 months
Poehling KA et al NEJM 200635531-40
Influenza Outpatient Visit Rates Per 1000 Children
0
20
40
60
80
100
120
140
160
180
lt 6mos 6-23 mos 2-4 yrs 5-12 yrs
2002-3
2003-4
2006-7
Poehling KA et al NEJM 200635531-40
Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
0
50
100
150
200
lt1 1- lt2 2-lt5
Rat
e pe
r 100
0 ch
ildre
n
Age (years)
Ill visits AOM LRI
Neuzil et al J Infect Dis 2002185147-52
Influenza Burden in US
bull Infection rates are highest among children with complications and hospitalizations from seasonal influenza being greatest among persons aged ge65 years children aged lt2 years and persons of any age who have medical conditions that confer increased risk for complications from influenza
bull Highly variable from year-to-yearbull Approximately 100 pediatric deaths reported yearly bull Approximately 55000 to 431000 hospitalizations per
year with a mean of 226000
Page 10
2017-2018 Was a Bad Influenza Year
MMWR June 8 2018 Vol 67 No 22
High Number of Hospitalizations Noted
MMWR June 8 2018 Vol 67 No 22
httpswwwcdcgovfluweekly
Shang M Blanton L Brammer L et al Influenza Associated Pediatric Deaths in the United States 2010ndash 2016Pediatrics2018141(4)e20172918
US ACIP Influenza Vaccine Recommendations
bull Historically recommended for all high-risk children ge6 months Two doses recommended
bull In 2005 recommended for all children aged 6-23 months to prevent hospitalizations and deaths
bull In 2006 recommended for all children aged 24-59 months to prevent outpatient visits and indirect costs
bull In 2008 recommended for all persons ge6 monthsbull In 2014 preferential recommendation for LAIV
for healthy children (2-17 years of age) since LAIV consistently more effective than trivalent IIV in this population in comparative trials
NEJM 2007356685-96
Pediatric Trial of LAIV vs IIV
bull Randomized double-blind trial in 8492 children (6-59 months of age) from 249 sites in 3 continents
bull Primary endpoint culture-confirmed influenza illness most strains were H3N2 and influenza B
bull LAIV associated with 55 reduction in culture confirmed influenza compared to IIV
LAIV IIV p-value
Confirmed influenza 39 86 lt00001
NEJM 2007356685-96
Summary of comparative studies
Influenza Other Respi Viruses 2011567-75
Observational Study dagger Challenge Study others randomized controlled trials
US ACIP Influenza Vaccine Recommendations
bull In 2015 preferential recommendation for LAIV removed
bull LAIV4 not recommended in the US for 2016-7 and 2017-8 seasons
bull Studies in other areas of the world were ongoing
21
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Influenza Outpatient Visit Rates Per 1000 Children
0
20
40
60
80
100
120
140
160
180
lt 6mos 6-23 mos 2-4 yrs 5-12 yrs
2002-3
2003-4
2006-7
Poehling KA et al NEJM 200635531-40
Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
0
50
100
150
200
lt1 1- lt2 2-lt5
Rat
e pe
r 100
0 ch
ildre
n
Age (years)
Ill visits AOM LRI
Neuzil et al J Infect Dis 2002185147-52
Influenza Burden in US
bull Infection rates are highest among children with complications and hospitalizations from seasonal influenza being greatest among persons aged ge65 years children aged lt2 years and persons of any age who have medical conditions that confer increased risk for complications from influenza
bull Highly variable from year-to-yearbull Approximately 100 pediatric deaths reported yearly bull Approximately 55000 to 431000 hospitalizations per
year with a mean of 226000
Page 10
2017-2018 Was a Bad Influenza Year
MMWR June 8 2018 Vol 67 No 22
High Number of Hospitalizations Noted
MMWR June 8 2018 Vol 67 No 22
httpswwwcdcgovfluweekly
Shang M Blanton L Brammer L et al Influenza Associated Pediatric Deaths in the United States 2010ndash 2016Pediatrics2018141(4)e20172918
US ACIP Influenza Vaccine Recommendations
bull Historically recommended for all high-risk children ge6 months Two doses recommended
bull In 2005 recommended for all children aged 6-23 months to prevent hospitalizations and deaths
bull In 2006 recommended for all children aged 24-59 months to prevent outpatient visits and indirect costs
bull In 2008 recommended for all persons ge6 monthsbull In 2014 preferential recommendation for LAIV
for healthy children (2-17 years of age) since LAIV consistently more effective than trivalent IIV in this population in comparative trials
NEJM 2007356685-96
Pediatric Trial of LAIV vs IIV
bull Randomized double-blind trial in 8492 children (6-59 months of age) from 249 sites in 3 continents
bull Primary endpoint culture-confirmed influenza illness most strains were H3N2 and influenza B
bull LAIV associated with 55 reduction in culture confirmed influenza compared to IIV
LAIV IIV p-value
Confirmed influenza 39 86 lt00001
NEJM 2007356685-96
Summary of comparative studies
Influenza Other Respi Viruses 2011567-75
Observational Study dagger Challenge Study others randomized controlled trials
US ACIP Influenza Vaccine Recommendations
bull In 2015 preferential recommendation for LAIV removed
bull LAIV4 not recommended in the US for 2016-7 and 2017-8 seasons
bull Studies in other areas of the world were ongoing
21
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
0
50
100
150
200
lt1 1- lt2 2-lt5
Rat
e pe
r 100
0 ch
ildre
n
Age (years)
Ill visits AOM LRI
Neuzil et al J Infect Dis 2002185147-52
Influenza Burden in US
bull Infection rates are highest among children with complications and hospitalizations from seasonal influenza being greatest among persons aged ge65 years children aged lt2 years and persons of any age who have medical conditions that confer increased risk for complications from influenza
bull Highly variable from year-to-yearbull Approximately 100 pediatric deaths reported yearly bull Approximately 55000 to 431000 hospitalizations per
year with a mean of 226000
Page 10
2017-2018 Was a Bad Influenza Year
MMWR June 8 2018 Vol 67 No 22
High Number of Hospitalizations Noted
MMWR June 8 2018 Vol 67 No 22
httpswwwcdcgovfluweekly
Shang M Blanton L Brammer L et al Influenza Associated Pediatric Deaths in the United States 2010ndash 2016Pediatrics2018141(4)e20172918
US ACIP Influenza Vaccine Recommendations
bull Historically recommended for all high-risk children ge6 months Two doses recommended
bull In 2005 recommended for all children aged 6-23 months to prevent hospitalizations and deaths
bull In 2006 recommended for all children aged 24-59 months to prevent outpatient visits and indirect costs
bull In 2008 recommended for all persons ge6 monthsbull In 2014 preferential recommendation for LAIV
for healthy children (2-17 years of age) since LAIV consistently more effective than trivalent IIV in this population in comparative trials
NEJM 2007356685-96
Pediatric Trial of LAIV vs IIV
bull Randomized double-blind trial in 8492 children (6-59 months of age) from 249 sites in 3 continents
bull Primary endpoint culture-confirmed influenza illness most strains were H3N2 and influenza B
bull LAIV associated with 55 reduction in culture confirmed influenza compared to IIV
LAIV IIV p-value
Confirmed influenza 39 86 lt00001
NEJM 2007356685-96
Summary of comparative studies
Influenza Other Respi Viruses 2011567-75
Observational Study dagger Challenge Study others randomized controlled trials
US ACIP Influenza Vaccine Recommendations
bull In 2015 preferential recommendation for LAIV removed
bull LAIV4 not recommended in the US for 2016-7 and 2017-8 seasons
bull Studies in other areas of the world were ongoing
21
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Influenza Burden in US
bull Infection rates are highest among children with complications and hospitalizations from seasonal influenza being greatest among persons aged ge65 years children aged lt2 years and persons of any age who have medical conditions that confer increased risk for complications from influenza
bull Highly variable from year-to-yearbull Approximately 100 pediatric deaths reported yearly bull Approximately 55000 to 431000 hospitalizations per
year with a mean of 226000
Page 10
2017-2018 Was a Bad Influenza Year
MMWR June 8 2018 Vol 67 No 22
High Number of Hospitalizations Noted
MMWR June 8 2018 Vol 67 No 22
httpswwwcdcgovfluweekly
Shang M Blanton L Brammer L et al Influenza Associated Pediatric Deaths in the United States 2010ndash 2016Pediatrics2018141(4)e20172918
US ACIP Influenza Vaccine Recommendations
bull Historically recommended for all high-risk children ge6 months Two doses recommended
bull In 2005 recommended for all children aged 6-23 months to prevent hospitalizations and deaths
bull In 2006 recommended for all children aged 24-59 months to prevent outpatient visits and indirect costs
bull In 2008 recommended for all persons ge6 monthsbull In 2014 preferential recommendation for LAIV
for healthy children (2-17 years of age) since LAIV consistently more effective than trivalent IIV in this population in comparative trials
NEJM 2007356685-96
Pediatric Trial of LAIV vs IIV
bull Randomized double-blind trial in 8492 children (6-59 months of age) from 249 sites in 3 continents
bull Primary endpoint culture-confirmed influenza illness most strains were H3N2 and influenza B
bull LAIV associated with 55 reduction in culture confirmed influenza compared to IIV
LAIV IIV p-value
Confirmed influenza 39 86 lt00001
NEJM 2007356685-96
Summary of comparative studies
Influenza Other Respi Viruses 2011567-75
Observational Study dagger Challenge Study others randomized controlled trials
US ACIP Influenza Vaccine Recommendations
bull In 2015 preferential recommendation for LAIV removed
bull LAIV4 not recommended in the US for 2016-7 and 2017-8 seasons
bull Studies in other areas of the world were ongoing
21
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
2017-2018 Was a Bad Influenza Year
MMWR June 8 2018 Vol 67 No 22
High Number of Hospitalizations Noted
MMWR June 8 2018 Vol 67 No 22
httpswwwcdcgovfluweekly
Shang M Blanton L Brammer L et al Influenza Associated Pediatric Deaths in the United States 2010ndash 2016Pediatrics2018141(4)e20172918
US ACIP Influenza Vaccine Recommendations
bull Historically recommended for all high-risk children ge6 months Two doses recommended
bull In 2005 recommended for all children aged 6-23 months to prevent hospitalizations and deaths
bull In 2006 recommended for all children aged 24-59 months to prevent outpatient visits and indirect costs
bull In 2008 recommended for all persons ge6 monthsbull In 2014 preferential recommendation for LAIV
for healthy children (2-17 years of age) since LAIV consistently more effective than trivalent IIV in this population in comparative trials
NEJM 2007356685-96
Pediatric Trial of LAIV vs IIV
bull Randomized double-blind trial in 8492 children (6-59 months of age) from 249 sites in 3 continents
bull Primary endpoint culture-confirmed influenza illness most strains were H3N2 and influenza B
bull LAIV associated with 55 reduction in culture confirmed influenza compared to IIV
LAIV IIV p-value
Confirmed influenza 39 86 lt00001
NEJM 2007356685-96
Summary of comparative studies
Influenza Other Respi Viruses 2011567-75
Observational Study dagger Challenge Study others randomized controlled trials
US ACIP Influenza Vaccine Recommendations
bull In 2015 preferential recommendation for LAIV removed
bull LAIV4 not recommended in the US for 2016-7 and 2017-8 seasons
bull Studies in other areas of the world were ongoing
21
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
High Number of Hospitalizations Noted
MMWR June 8 2018 Vol 67 No 22
httpswwwcdcgovfluweekly
Shang M Blanton L Brammer L et al Influenza Associated Pediatric Deaths in the United States 2010ndash 2016Pediatrics2018141(4)e20172918
US ACIP Influenza Vaccine Recommendations
bull Historically recommended for all high-risk children ge6 months Two doses recommended
bull In 2005 recommended for all children aged 6-23 months to prevent hospitalizations and deaths
bull In 2006 recommended for all children aged 24-59 months to prevent outpatient visits and indirect costs
bull In 2008 recommended for all persons ge6 monthsbull In 2014 preferential recommendation for LAIV
for healthy children (2-17 years of age) since LAIV consistently more effective than trivalent IIV in this population in comparative trials
NEJM 2007356685-96
Pediatric Trial of LAIV vs IIV
bull Randomized double-blind trial in 8492 children (6-59 months of age) from 249 sites in 3 continents
bull Primary endpoint culture-confirmed influenza illness most strains were H3N2 and influenza B
bull LAIV associated with 55 reduction in culture confirmed influenza compared to IIV
LAIV IIV p-value
Confirmed influenza 39 86 lt00001
NEJM 2007356685-96
Summary of comparative studies
Influenza Other Respi Viruses 2011567-75
Observational Study dagger Challenge Study others randomized controlled trials
US ACIP Influenza Vaccine Recommendations
bull In 2015 preferential recommendation for LAIV removed
bull LAIV4 not recommended in the US for 2016-7 and 2017-8 seasons
bull Studies in other areas of the world were ongoing
21
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
httpswwwcdcgovfluweekly
Shang M Blanton L Brammer L et al Influenza Associated Pediatric Deaths in the United States 2010ndash 2016Pediatrics2018141(4)e20172918
US ACIP Influenza Vaccine Recommendations
bull Historically recommended for all high-risk children ge6 months Two doses recommended
bull In 2005 recommended for all children aged 6-23 months to prevent hospitalizations and deaths
bull In 2006 recommended for all children aged 24-59 months to prevent outpatient visits and indirect costs
bull In 2008 recommended for all persons ge6 monthsbull In 2014 preferential recommendation for LAIV
for healthy children (2-17 years of age) since LAIV consistently more effective than trivalent IIV in this population in comparative trials
NEJM 2007356685-96
Pediatric Trial of LAIV vs IIV
bull Randomized double-blind trial in 8492 children (6-59 months of age) from 249 sites in 3 continents
bull Primary endpoint culture-confirmed influenza illness most strains were H3N2 and influenza B
bull LAIV associated with 55 reduction in culture confirmed influenza compared to IIV
LAIV IIV p-value
Confirmed influenza 39 86 lt00001
NEJM 2007356685-96
Summary of comparative studies
Influenza Other Respi Viruses 2011567-75
Observational Study dagger Challenge Study others randomized controlled trials
US ACIP Influenza Vaccine Recommendations
bull In 2015 preferential recommendation for LAIV removed
bull LAIV4 not recommended in the US for 2016-7 and 2017-8 seasons
bull Studies in other areas of the world were ongoing
21
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Shang M Blanton L Brammer L et al Influenza Associated Pediatric Deaths in the United States 2010ndash 2016Pediatrics2018141(4)e20172918
US ACIP Influenza Vaccine Recommendations
bull Historically recommended for all high-risk children ge6 months Two doses recommended
bull In 2005 recommended for all children aged 6-23 months to prevent hospitalizations and deaths
bull In 2006 recommended for all children aged 24-59 months to prevent outpatient visits and indirect costs
bull In 2008 recommended for all persons ge6 monthsbull In 2014 preferential recommendation for LAIV
for healthy children (2-17 years of age) since LAIV consistently more effective than trivalent IIV in this population in comparative trials
NEJM 2007356685-96
Pediatric Trial of LAIV vs IIV
bull Randomized double-blind trial in 8492 children (6-59 months of age) from 249 sites in 3 continents
bull Primary endpoint culture-confirmed influenza illness most strains were H3N2 and influenza B
bull LAIV associated with 55 reduction in culture confirmed influenza compared to IIV
LAIV IIV p-value
Confirmed influenza 39 86 lt00001
NEJM 2007356685-96
Summary of comparative studies
Influenza Other Respi Viruses 2011567-75
Observational Study dagger Challenge Study others randomized controlled trials
US ACIP Influenza Vaccine Recommendations
bull In 2015 preferential recommendation for LAIV removed
bull LAIV4 not recommended in the US for 2016-7 and 2017-8 seasons
bull Studies in other areas of the world were ongoing
21
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
US ACIP Influenza Vaccine Recommendations
bull Historically recommended for all high-risk children ge6 months Two doses recommended
bull In 2005 recommended for all children aged 6-23 months to prevent hospitalizations and deaths
bull In 2006 recommended for all children aged 24-59 months to prevent outpatient visits and indirect costs
bull In 2008 recommended for all persons ge6 monthsbull In 2014 preferential recommendation for LAIV
for healthy children (2-17 years of age) since LAIV consistently more effective than trivalent IIV in this population in comparative trials
NEJM 2007356685-96
Pediatric Trial of LAIV vs IIV
bull Randomized double-blind trial in 8492 children (6-59 months of age) from 249 sites in 3 continents
bull Primary endpoint culture-confirmed influenza illness most strains were H3N2 and influenza B
bull LAIV associated with 55 reduction in culture confirmed influenza compared to IIV
LAIV IIV p-value
Confirmed influenza 39 86 lt00001
NEJM 2007356685-96
Summary of comparative studies
Influenza Other Respi Viruses 2011567-75
Observational Study dagger Challenge Study others randomized controlled trials
US ACIP Influenza Vaccine Recommendations
bull In 2015 preferential recommendation for LAIV removed
bull LAIV4 not recommended in the US for 2016-7 and 2017-8 seasons
bull Studies in other areas of the world were ongoing
21
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
NEJM 2007356685-96
Pediatric Trial of LAIV vs IIV
bull Randomized double-blind trial in 8492 children (6-59 months of age) from 249 sites in 3 continents
bull Primary endpoint culture-confirmed influenza illness most strains were H3N2 and influenza B
bull LAIV associated with 55 reduction in culture confirmed influenza compared to IIV
LAIV IIV p-value
Confirmed influenza 39 86 lt00001
NEJM 2007356685-96
Summary of comparative studies
Influenza Other Respi Viruses 2011567-75
Observational Study dagger Challenge Study others randomized controlled trials
US ACIP Influenza Vaccine Recommendations
bull In 2015 preferential recommendation for LAIV removed
bull LAIV4 not recommended in the US for 2016-7 and 2017-8 seasons
bull Studies in other areas of the world were ongoing
21
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Pediatric Trial of LAIV vs IIV
bull Randomized double-blind trial in 8492 children (6-59 months of age) from 249 sites in 3 continents
bull Primary endpoint culture-confirmed influenza illness most strains were H3N2 and influenza B
bull LAIV associated with 55 reduction in culture confirmed influenza compared to IIV
LAIV IIV p-value
Confirmed influenza 39 86 lt00001
NEJM 2007356685-96
Summary of comparative studies
Influenza Other Respi Viruses 2011567-75
Observational Study dagger Challenge Study others randomized controlled trials
US ACIP Influenza Vaccine Recommendations
bull In 2015 preferential recommendation for LAIV removed
bull LAIV4 not recommended in the US for 2016-7 and 2017-8 seasons
bull Studies in other areas of the world were ongoing
21
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Summary of comparative studies
Influenza Other Respi Viruses 2011567-75
Observational Study dagger Challenge Study others randomized controlled trials
US ACIP Influenza Vaccine Recommendations
bull In 2015 preferential recommendation for LAIV removed
bull LAIV4 not recommended in the US for 2016-7 and 2017-8 seasons
bull Studies in other areas of the world were ongoing
21
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
US ACIP Influenza Vaccine Recommendations
bull In 2015 preferential recommendation for LAIV removed
bull LAIV4 not recommended in the US for 2016-7 and 2017-8 seasons
bull Studies in other areas of the world were ongoing
21
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
What were the reasons for the poor H1N1 effectiveness in the US
bull Chance methodology programmatic issuesbull Poor replicative fitness of H1N1bull Viral interference between four LAIV strainsbull Repeat immunization leading to a more
restricted ldquoadult-typerdquo response
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
The Way ForwardModifications Made to LAIV-Ann
Arbor Backbone Strain
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Presented at the ACIP February 2018
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Presented at the ACIP February 2018
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Presented at the ACIP February 2018
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
ACIP Recommendations
bull On February 21 2018 the ACIP voted in favor of a reinstated recommendation for LAIV4
bull For the 2018-2019 season immunization providers may choose to administer any licensed age appropriate influenza vaccine including Live Attenuated Influenza Vaccine (LAIV) and Injectable Influenza Vaccine (IIV)
bullbull The recommendation follows the presentation of positive results from a US study in
children between the ages of 2 to lt4 years evaluating the shedding and antibody responses of the H1N1 strain in LAIV4
bull Study demonstrated new 2017-2018 H1N1 LAIV post-pandemic strain (ASlovenia) performed significantly better than the 2015-2016 H1N1 LAIV post-pandemic strain (ABolivia)
bull The antibody response induced with the new H1N1 LAIV strain was comparable to earlier data seen with the highly effective H1N1 LAIV strain included in the vaccine before the 2009 influenza pandemic
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
httpsassetspublishingservicegovukgovernmentuploadssystemuploadsattachment_datafile726342Influenza_vaccine_effectiveness_in_primary_care_2017_2018pdf
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
45 Received Oseltamivir
Antiviral Use in Hospitalized Patients is Low
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Recommended Use of Antiviral Agents in Influenza
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Proportions of High-risk outpatients prescribed antivirals
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Infections in Children website
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
FG Hayden et al N Engl J Med 2018379913-923
KaplanndashMeier Curves of the Time to Alleviation of Influenza Symptoms with Baloxavir versus Placebo in the Phase 3 Trial
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Kaplan Meier Curves for Alleviation of Symptoms in RCT
FG Hayden et al N Engl J Med 2018379913-923
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
New Approaches to Influenza Vaccine
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-
Summarybull Influenza is a common respiratory illness accounting for
substantial morbidity and some mortality annuallybull Influenza vaccines are safe and effective
ndash Absolute efficacy varies by year and influenced by circulating virus vaccine administered host characteristics and previous influenza experience
bull Antivirals are indicated in hospitalized patients and those with co-morbiditiesndash Antivirals are uncommonly used in children ndash New antivirals are under development
12182018 Page 65
- Whatrsquos New in Flu An Update on Influenza Prevention and Treatment
- Disclosures
- Objectives
- Influenza A Virus
- Clinical Manifestations of Influenza
- Slide Number 6
- Discharge Diagnoses ForChildren lt5 years With Influenza
- Influenza Outpatient Visit Rates Per 1000 Children
- Culture-confirmed Influenza over 25 years in Primary Care Clinic at Vanderbilt University
- Influenza Burden in US
- Slide Number 11
- Slide Number 12
- Slide Number 13
- Slide Number 14
- US ACIP Influenza Vaccine Recommendations
- Slide Number 16
- Pediatric Trial of LAIV vs IIV
- Summary of comparative studies
- Slide Number 19
- Slide Number 20
- US ACIP Influenza Vaccine Recommendations
- What were the reasons for the poor H1N1 effectiveness in the US
- The Way ForwardModifications Made to LAIV-Ann Arbor Backbone Strain
- Slide Number 24
- Slide Number 25
- Slide Number 26
- Slide Number 27
- Slide Number 28
- Slide Number 29
- Slide Number 30
- ACIP Recommendations
- Slide Number 32
- Slide Number 33
- Slide Number 34
- Slide Number 35
- Slide Number 36
- Slide Number 37
- Slide Number 38
- Slide Number 39
- Slide Number 40
- Slide Number 41
- Slide Number 42
- Slide Number 43
- Slide Number 44
- Slide Number 45
- Slide Number 46
- Slide Number 47
- Slide Number 48
- Slide Number 49
- Slide Number 50
- Slide Number 51
- Slide Number 52
- Slide Number 53
- FG Hayden et al N Engl J Med 2018379913-923
- Kaplan Meier Curves for Alleviation of Symptoms in RCT
- Slide Number 56
- Slide Number 57
- Slide Number 58
- Slide Number 59
- Slide Number 60
- Slide Number 61
- Slide Number 62
- Slide Number 63
- Slide Number 64
- Summary
-