Influenza

 

FROM AN ACIP MEETING

New draft recommendations on influenza vaccines for children and pregnant women were unanimously passed by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) after a lengthy debate over specifics regarding recommendations for pregnant women.

The proposed recommendation that sparked the debate would change the wording of the previous recommendation for pregnant women to receive a seasonal inactivated vaccine (IIV) to “any licensed, recommended, and age-appropriate, trivalent or quadrivalent IIV or RIV [recombinant influenza vaccine] may be used.”

Steve Mann/Thinkstock

Members of the committee were hesitant to introduce this new wording, concerned that the language was too strong for the uncertainty some of the committee felt about the safety of including a recombinant influenza vaccine (RIV), Flublok, among those recommended.

“I think there’s a subtle, but important difference here between making what would appear to be an affirmative statement that RIV is safe in pregnant women, versus just staying silent on it, and saying ‘we’re not saying you shouldn’t use it, but we don’t have enough data to affirmatively say it is safe,’ ” said Cindy Pellegrini, senior vice president of Public Policy and Government Affairs at the March of Dimes Foundation.

In response, members of the committee pointed out that the responsibility of determining safety lies with the Food and Drug Administration, which has already licensed the Flublok trivalent vaccine with expectations that the quadrivalent vaccine soon will follow.

While Lisa Grohskopf, MD, MPH, medical officer of the influenza division of the CDC, did acknowledge that there were more data on the safety of inactivated influenza vaccines, she asserted to the committee that “the general overall safety profile of Flublok in comparison to inactivated vaccines is reassuring.”

“For example, one concern that arises is reactogenicity and inflammation. [In terms of] overall reactogenicity in the studies where Flublok and inactivated vaccines have been compared, rates of the adverse and systemic reactions were similar,” Dr. Grohskopf said.

A motion was made to change the wording of the recommendation; however, the motion was not passed, and the eventual vote on the approval was conducted.

The ACIP also voted unanimously to change the safe age limit noted in influenza guidelines for use of Afluria (IIV3) from 9 years and older to 5 years and older. A footnote saying that the ACIP recommends Afluria for children 9 years and older will be removed.

This change, which mirrors the licensing Afluria has with the FDA, was based on research conducted by Seqirus that showed fever levels were the same for Afluria trivalent and quadrivalent vaccines in children 5 to 9 years old, both of which were less than historical vaccine rates.

The approved recommendations will be sent to the director of the CDC and the U.S. Department of Health and Human Services. Once reviewed and approved, the final recommendations will be published in the CDC’s Morbidity and Mortality Weekly Report. The committee members had no relevant financial disclosures.

[email protected]

On Twitter @eaztweets

 

FROM AN ACIP MEETING

New draft recommendations on influenza vaccines for children and pregnant women were unanimously passed by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) after a lengthy debate over specifics regarding recommendations for pregnant women.

The proposed recommendation that sparked the debate would change the wording of the previous recommendation for pregnant women to receive a seasonal inactivated vaccine (IIV) to “any licensed, recommended, and age-appropriate, trivalent or quadrivalent IIV or RIV [recombinant influenza vaccine] may be used.”

Steve Mann/Thinkstock

Members of the committee were hesitant to introduce this new wording, concerned that the language was too strong for the uncertainty some of the committee felt about the safety of including a recombinant influenza vaccine (RIV), Flublok, among those recommended.

“I think there’s a subtle, but important difference here between making what would appear to be an affirmative statement that RIV is safe in pregnant women, versus just staying silent on it, and saying ‘we’re not saying you shouldn’t use it, but we don’t have enough data to affirmatively say it is safe,’ ” said Cindy Pellegrini, senior vice president of Public Policy and Government Affairs at the March of Dimes Foundation.

In response, members of the committee pointed out that the responsibility of determining safety lies with the Food and Drug Administration, which has already licensed the Flublok trivalent vaccine with expectations that the quadrivalent vaccine soon will follow.

While Lisa Grohskopf, MD, MPH, medical officer of the influenza division of the CDC, did acknowledge that there were more data on the safety of inactivated influenza vaccines, she asserted to the committee that “the general overall safety profile of Flublok in comparison to inactivated vaccines is reassuring.”

“For example, one concern that arises is reactogenicity and inflammation. [In terms of] overall reactogenicity in the studies where Flublok and inactivated vaccines have been compared, rates of the adverse and systemic reactions were similar,” Dr. Grohskopf said.

A motion was made to change the wording of the recommendation; however, the motion was not passed, and the eventual vote on the approval was conducted.

The ACIP also voted unanimously to change the safe age limit noted in influenza guidelines for use of Afluria (IIV3) from 9 years and older to 5 years and older. A footnote saying that the ACIP recommends Afluria for children 9 years and older will be removed.

This change, which mirrors the licensing Afluria has with the FDA, was based on research conducted by Seqirus that showed fever levels were the same for Afluria trivalent and quadrivalent vaccines in children 5 to 9 years old, both of which were less than historical vaccine rates.

The approved recommendations will be sent to the director of the CDC and the U.S. Department of Health and Human Services. Once reviewed and approved, the final recommendations will be published in the CDC’s Morbidity and Mortality Weekly Report. The committee members had no relevant financial disclosures.

[email protected]

On Twitter @eaztweets

 

FROM AN ACIP MEETING

New draft recommendations on influenza vaccines for children and pregnant women were unanimously passed by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) after a lengthy debate over specifics regarding recommendations for pregnant women.

The proposed recommendation that sparked the debate would change the wording of the previous recommendation for pregnant women to receive a seasonal inactivated vaccine (IIV) to “any licensed, recommended, and age-appropriate, trivalent or quadrivalent IIV or RIV [recombinant influenza vaccine] may be used.”

Steve Mann/Thinkstock

Members of the committee were hesitant to introduce this new wording, concerned that the language was too strong for the uncertainty some of the committee felt about the safety of including a recombinant influenza vaccine (RIV), Flublok, among those recommended.

“I think there’s a subtle, but important difference here between making what would appear to be an affirmative statement that RIV is safe in pregnant women, versus just staying silent on it, and saying ‘we’re not saying you shouldn’t use it, but we don’t have enough data to affirmatively say it is safe,’ ” said Cindy Pellegrini, senior vice president of Public Policy and Government Affairs at the March of Dimes Foundation.

In response, members of the committee pointed out that the responsibility of determining safety lies with the Food and Drug Administration, which has already licensed the Flublok trivalent vaccine with expectations that the quadrivalent vaccine soon will follow.

While Lisa Grohskopf, MD, MPH, medical officer of the influenza division of the CDC, did acknowledge that there were more data on the safety of inactivated influenza vaccines, she asserted to the committee that “the general overall safety profile of Flublok in comparison to inactivated vaccines is reassuring.”

“For example, one concern that arises is reactogenicity and inflammation. [In terms of] overall reactogenicity in the studies where Flublok and inactivated vaccines have been compared, rates of the adverse and systemic reactions were similar,” Dr. Grohskopf said.

A motion was made to change the wording of the recommendation; however, the motion was not passed, and the eventual vote on the approval was conducted.

The ACIP also voted unanimously to change the safe age limit noted in influenza guidelines for use of Afluria (IIV3) from 9 years and older to 5 years and older. A footnote saying that the ACIP recommends Afluria for children 9 years and older will be removed.

This change, which mirrors the licensing Afluria has with the FDA, was based on research conducted by Seqirus that showed fever levels were the same for Afluria trivalent and quadrivalent vaccines in children 5 to 9 years old, both of which were less than historical vaccine rates.

The approved recommendations will be sent to the director of the CDC and the U.S. Department of Health and Human Services. Once reviewed and approved, the final recommendations will be published in the CDC’s Morbidity and Mortality Weekly Report. The committee members had no relevant financial disclosures.

[email protected]

On Twitter @eaztweets

 

First-trimester maternal inactivated influenza vaccine (IIV) was not linked to an increased risk of major structural birth defects in singleton infants, said Elyse Olshen Kharbanda, MD, of HealthPartners Institute, Minneapolis, and her associates.

Data from seven participating Vaccine Safety Datalink sites in six states were used to identify 52,856 women who received IIV in the first trimester of pregnancy (12% of the study total) and 373,088 not exposed to the flu vaccine in the first trimester (88%). A total of 865 women in the IIV-exposed group had an infant with 1 of the 50 selected major structural defects (1.6 per 100 live births), versus 5,730 in the unexposed group (1.5 per 100 live births).

Piotr Marcinski/Thinkstock

The adjusted prevalence ratio for having one of the birth defects after being exposed to IIV in the first trimester was 1.02 (95% confidence interval, 0.94-1.10). There were no increased risks for any of the major structural birth defects after maternal first-trimester IIV, including cardiac defects, neural tube defects, microcephaly, or cleft lip and/or cleft palate.

Among the strengths of the study were the large population, which allowed the researchers to examine subgroups of major structural birth defects; their findings were consistent across all those subgroups. In addition, the investigators were able to exclude women at increased risk for major birth defects because of comorbidities such as diabetes, drug exposures, diagnosed chromosomal abnormalities, or congenital infections. Finally, the study authors were able to exclude women with potential exposure to teratogenic medications.

“Because IIV is currently recommended for all women who will be pregnant during periods of influenza circulation, these data should provide reassurance for women considering first trimester vaccination,” said Dr. Kharbanda and her associates.

Read more in the Journal of Pediatrics (2017 May 24. doi: 10.1016/j.jpeds.2017.04.039).

[email protected]

 

First-trimester maternal inactivated influenza vaccine (IIV) was not linked to an increased risk of major structural birth defects in singleton infants, said Elyse Olshen Kharbanda, MD, of HealthPartners Institute, Minneapolis, and her associates.

Data from seven participating Vaccine Safety Datalink sites in six states were used to identify 52,856 women who received IIV in the first trimester of pregnancy (12% of the study total) and 373,088 not exposed to the flu vaccine in the first trimester (88%). A total of 865 women in the IIV-exposed group had an infant with 1 of the 50 selected major structural defects (1.6 per 100 live births), versus 5,730 in the unexposed group (1.5 per 100 live births).

Piotr Marcinski/Thinkstock

The adjusted prevalence ratio for having one of the birth defects after being exposed to IIV in the first trimester was 1.02 (95% confidence interval, 0.94-1.10). There were no increased risks for any of the major structural birth defects after maternal first-trimester IIV, including cardiac defects, neural tube defects, microcephaly, or cleft lip and/or cleft palate.

Among the strengths of the study were the large population, which allowed the researchers to examine subgroups of major structural birth defects; their findings were consistent across all those subgroups. In addition, the investigators were able to exclude women at increased risk for major birth defects because of comorbidities such as diabetes, drug exposures, diagnosed chromosomal abnormalities, or congenital infections. Finally, the study authors were able to exclude women with potential exposure to teratogenic medications.

“Because IIV is currently recommended for all women who will be pregnant during periods of influenza circulation, these data should provide reassurance for women considering first trimester vaccination,” said Dr. Kharbanda and her associates.

Read more in the Journal of Pediatrics (2017 May 24. doi: 10.1016/j.jpeds.2017.04.039).

[email protected]

 

First-trimester maternal inactivated influenza vaccine (IIV) was not linked to an increased risk of major structural birth defects in singleton infants, said Elyse Olshen Kharbanda, MD, of HealthPartners Institute, Minneapolis, and her associates.

Data from seven participating Vaccine Safety Datalink sites in six states were used to identify 52,856 women who received IIV in the first trimester of pregnancy (12% of the study total) and 373,088 not exposed to the flu vaccine in the first trimester (88%). A total of 865 women in the IIV-exposed group had an infant with 1 of the 50 selected major structural defects (1.6 per 100 live births), versus 5,730 in the unexposed group (1.5 per 100 live births).

Piotr Marcinski/Thinkstock

The adjusted prevalence ratio for having one of the birth defects after being exposed to IIV in the first trimester was 1.02 (95% confidence interval, 0.94-1.10). There were no increased risks for any of the major structural birth defects after maternal first-trimester IIV, including cardiac defects, neural tube defects, microcephaly, or cleft lip and/or cleft palate.

Among the strengths of the study were the large population, which allowed the researchers to examine subgroups of major structural birth defects; their findings were consistent across all those subgroups. In addition, the investigators were able to exclude women at increased risk for major birth defects because of comorbidities such as diabetes, drug exposures, diagnosed chromosomal abnormalities, or congenital infections. Finally, the study authors were able to exclude women with potential exposure to teratogenic medications.

“Because IIV is currently recommended for all women who will be pregnant during periods of influenza circulation, these data should provide reassurance for women considering first trimester vaccination,” said Dr. Kharbanda and her associates.

Read more in the Journal of Pediatrics (2017 May 24. doi: 10.1016/j.jpeds.2017.04.039).

[email protected]

 

Outpatient visits for influenza were down again in the United States during the week ending April 1, and the number of states at the highest level of flu activity dropped from seven to four, according to the Centers for Disease Control and Prevention.

The national proportion of outpatient visits for influenza-like illness (ILI) was 2.9% for the week ending April 1, compared with 3.2% the week before, the CDC’s Outpatient Influenza-like Illness Surveillance Network reported. The national baseline level is 2.2%.

On the state level, Georgia, Kentucky, South Carolina, and Tennessee were at level 10 on the CDC’s 1-10 scale of ILI activity. Other states in the “high” range (8-10) were Alabama, New York, and North Carolina at level 9 and Rhode Island and Virginia at level 8. The “minimal” end of the scale (1-3) included 27 states and Puerto Rico, which was up from 24 states and Puerto Rico the week before, CDC data show.

There were 7 flu-related pediatric deaths reported for the week ending April 1 – six of the deaths occurred in previous weeks – which brings the total for the 2016-2017 season to 68, the CDC said. The largest share of those deaths by age group has been among 5- to 11-year-olds (36.8%), followed by those aged 12-17 years (26.5%), 6-23 months (16.2%), 2-4 years (14.7%), and 0-5 months (5.9%).

[email protected]

 

Outpatient visits for influenza were down again in the United States during the week ending April 1, and the number of states at the highest level of flu activity dropped from seven to four, according to the Centers for Disease Control and Prevention.

The national proportion of outpatient visits for influenza-like illness (ILI) was 2.9% for the week ending April 1, compared with 3.2% the week before, the CDC’s Outpatient Influenza-like Illness Surveillance Network reported. The national baseline level is 2.2%.

On the state level, Georgia, Kentucky, South Carolina, and Tennessee were at level 10 on the CDC’s 1-10 scale of ILI activity. Other states in the “high” range (8-10) were Alabama, New York, and North Carolina at level 9 and Rhode Island and Virginia at level 8. The “minimal” end of the scale (1-3) included 27 states and Puerto Rico, which was up from 24 states and Puerto Rico the week before, CDC data show.

There were 7 flu-related pediatric deaths reported for the week ending April 1 – six of the deaths occurred in previous weeks – which brings the total for the 2016-2017 season to 68, the CDC said. The largest share of those deaths by age group has been among 5- to 11-year-olds (36.8%), followed by those aged 12-17 years (26.5%), 6-23 months (16.2%), 2-4 years (14.7%), and 0-5 months (5.9%).

[email protected]

 

Outpatient visits for influenza were down again in the United States during the week ending April 1, and the number of states at the highest level of flu activity dropped from seven to four, according to the Centers for Disease Control and Prevention.

The national proportion of outpatient visits for influenza-like illness (ILI) was 2.9% for the week ending April 1, compared with 3.2% the week before, the CDC’s Outpatient Influenza-like Illness Surveillance Network reported. The national baseline level is 2.2%.

On the state level, Georgia, Kentucky, South Carolina, and Tennessee were at level 10 on the CDC’s 1-10 scale of ILI activity. Other states in the “high” range (8-10) were Alabama, New York, and North Carolina at level 9 and Rhode Island and Virginia at level 8. The “minimal” end of the scale (1-3) included 27 states and Puerto Rico, which was up from 24 states and Puerto Rico the week before, CDC data show.

There were 7 flu-related pediatric deaths reported for the week ending April 1 – six of the deaths occurred in previous weeks – which brings the total for the 2016-2017 season to 68, the CDC said. The largest share of those deaths by age group has been among 5- to 11-year-olds (36.8%), followed by those aged 12-17 years (26.5%), 6-23 months (16.2%), 2-4 years (14.7%), and 0-5 months (5.9%).

[email protected]

 

ATLANTA – In the opinion of John M. Kelso, MD, assessment of immunization status in older adults should be a routine part of all visits.

“Don’t assume that your patients are getting their vaccines someplace else,” he said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “We should be taking advantage of the fact that these patients are in our offices.”

Dr. Kelso, of the division of allergy, asthma, and immunology at Scripps Clinic, San Diego, discussed the importance of four vaccinations in particular.

Inactivated influenza vaccine (IIV3)

For adults aged 65 and older, the high-dose, trivalent version of the flu vaccine (60 micrograms of hemagglutinin per strain, or IIV3-HD) may be preferable to the standard dose of 15 micrograms of hemagglutinin per strain (IIV3-SD). A study of nearly 32,000 patients found that IIV3-HD induced significantly higher antibody responses and provided better protection against laboratory-confirmed influenza, compared with IIV3-SD (N Engl J Med. 2014;371:635-45). The relative efficacy of high dose vs. standard dose was 24.2%. “That means that one-quarter of all breakthrough influenza illnesses could be prevented if IIV3HD were used instead of IIV3-SD,” Dr. Kelso said.

Another approach is to use an adjuvanted influenza vaccine, which contains the standard 15 micrograms of influenza antigen but the adjuvant is MF59, a squalene-based oil-in-water emulsion. One small study of 282 patients aged 65 and older showed the adjuvanted vaccine to be more effective than the unadjuvanted vaccine (Vaccine. 2013;51:1622-8).

The Centers for Disease Control and Prevention does not express a preference for the high-dose or adjuvanted vaccine, but rather stresses the importance of influenza vaccination with whatever age-appropriate IIV formulation is available at the time of the patient’s visit.

The 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23)

All adults who turn 65 years of age should receive the PCV13, followed 1 year later by the PPSV23. For those who already received the PPSV23 after age 65 years of age, they should receive the PCV13 at least 1 year later. “The real bulk of hospitalizations and fatalities from invasive pneumococcal disease are happening to people over 65 year of age,” said Dr. Kelso, who is also a clinical professor of pediatrics and internal medicine at the University of California, San Diego “So there’s a real need here for vaccination.”

Tdap

This should be administered to all adolescents and adults regardless of interval since their last tetanus-diphtheria vaccine. “This includes those age 65 years of age and older in whom the vaccine has been found to be equally safe and immunogenic,” Dr. Kelso said. “This is important not only to prevent pertussis in older adults, but also to prevent them from spreading the disease to infants where it can be fatal.”

Zoster vaccine

One in three adults will develop zoster during their lifetime, he said, and one million episodes occur in the United States each year. Common complications include postherpetic neuralgia and eye involvement that can result in loss of vision. The CDC recommends routine vaccination of all immunocompetent persons over age 60 with one dose of zoster vaccine. “Persons who report a previous episode of zoster can be vaccinated but it is not indicated to treat acute zoster, to prevent persons with acute zoster from developing postherpetic neuralgia, or to treat ongoing postherpetic neuralgia,” Dr. Kelso said.

He reported having no relevant financial disclosures.

[email protected]

 

ATLANTA – In the opinion of John M. Kelso, MD, assessment of immunization status in older adults should be a routine part of all visits.

“Don’t assume that your patients are getting their vaccines someplace else,” he said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “We should be taking advantage of the fact that these patients are in our offices.”

Dr. Kelso, of the division of allergy, asthma, and immunology at Scripps Clinic, San Diego, discussed the importance of four vaccinations in particular.

Inactivated influenza vaccine (IIV3)

For adults aged 65 and older, the high-dose, trivalent version of the flu vaccine (60 micrograms of hemagglutinin per strain, or IIV3-HD) may be preferable to the standard dose of 15 micrograms of hemagglutinin per strain (IIV3-SD). A study of nearly 32,000 patients found that IIV3-HD induced significantly higher antibody responses and provided better protection against laboratory-confirmed influenza, compared with IIV3-SD (N Engl J Med. 2014;371:635-45). The relative efficacy of high dose vs. standard dose was 24.2%. “That means that one-quarter of all breakthrough influenza illnesses could be prevented if IIV3HD were used instead of IIV3-SD,” Dr. Kelso said.

Another approach is to use an adjuvanted influenza vaccine, which contains the standard 15 micrograms of influenza antigen but the adjuvant is MF59, a squalene-based oil-in-water emulsion. One small study of 282 patients aged 65 and older showed the adjuvanted vaccine to be more effective than the unadjuvanted vaccine (Vaccine. 2013;51:1622-8).

The Centers for Disease Control and Prevention does not express a preference for the high-dose or adjuvanted vaccine, but rather stresses the importance of influenza vaccination with whatever age-appropriate IIV formulation is available at the time of the patient’s visit.

The 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23)

All adults who turn 65 years of age should receive the PCV13, followed 1 year later by the PPSV23. For those who already received the PPSV23 after age 65 years of age, they should receive the PCV13 at least 1 year later. “The real bulk of hospitalizations and fatalities from invasive pneumococcal disease are happening to people over 65 year of age,” said Dr. Kelso, who is also a clinical professor of pediatrics and internal medicine at the University of California, San Diego “So there’s a real need here for vaccination.”

Tdap

This should be administered to all adolescents and adults regardless of interval since their last tetanus-diphtheria vaccine. “This includes those age 65 years of age and older in whom the vaccine has been found to be equally safe and immunogenic,” Dr. Kelso said. “This is important not only to prevent pertussis in older adults, but also to prevent them from spreading the disease to infants where it can be fatal.”

Zoster vaccine

One in three adults will develop zoster during their lifetime, he said, and one million episodes occur in the United States each year. Common complications include postherpetic neuralgia and eye involvement that can result in loss of vision. The CDC recommends routine vaccination of all immunocompetent persons over age 60 with one dose of zoster vaccine. “Persons who report a previous episode of zoster can be vaccinated but it is not indicated to treat acute zoster, to prevent persons with acute zoster from developing postherpetic neuralgia, or to treat ongoing postherpetic neuralgia,” Dr. Kelso said.

He reported having no relevant financial disclosures.

[email protected]

 

ATLANTA – In the opinion of John M. Kelso, MD, assessment of immunization status in older adults should be a routine part of all visits.

“Don’t assume that your patients are getting their vaccines someplace else,” he said at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. “We should be taking advantage of the fact that these patients are in our offices.”

Dr. Kelso, of the division of allergy, asthma, and immunology at Scripps Clinic, San Diego, discussed the importance of four vaccinations in particular.

Inactivated influenza vaccine (IIV3)

For adults aged 65 and older, the high-dose, trivalent version of the flu vaccine (60 micrograms of hemagglutinin per strain, or IIV3-HD) may be preferable to the standard dose of 15 micrograms of hemagglutinin per strain (IIV3-SD). A study of nearly 32,000 patients found that IIV3-HD induced significantly higher antibody responses and provided better protection against laboratory-confirmed influenza, compared with IIV3-SD (N Engl J Med. 2014;371:635-45). The relative efficacy of high dose vs. standard dose was 24.2%. “That means that one-quarter of all breakthrough influenza illnesses could be prevented if IIV3HD were used instead of IIV3-SD,” Dr. Kelso said.

Another approach is to use an adjuvanted influenza vaccine, which contains the standard 15 micrograms of influenza antigen but the adjuvant is MF59, a squalene-based oil-in-water emulsion. One small study of 282 patients aged 65 and older showed the adjuvanted vaccine to be more effective than the unadjuvanted vaccine (Vaccine. 2013;51:1622-8).

The Centers for Disease Control and Prevention does not express a preference for the high-dose or adjuvanted vaccine, but rather stresses the importance of influenza vaccination with whatever age-appropriate IIV formulation is available at the time of the patient’s visit.

The 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent pneumococcal polysaccharide vaccine (PPSV23)

All adults who turn 65 years of age should receive the PCV13, followed 1 year later by the PPSV23. For those who already received the PPSV23 after age 65 years of age, they should receive the PCV13 at least 1 year later. “The real bulk of hospitalizations and fatalities from invasive pneumococcal disease are happening to people over 65 year of age,” said Dr. Kelso, who is also a clinical professor of pediatrics and internal medicine at the University of California, San Diego “So there’s a real need here for vaccination.”

Tdap

This should be administered to all adolescents and adults regardless of interval since their last tetanus-diphtheria vaccine. “This includes those age 65 years of age and older in whom the vaccine has been found to be equally safe and immunogenic,” Dr. Kelso said. “This is important not only to prevent pertussis in older adults, but also to prevent them from spreading the disease to infants where it can be fatal.”

Zoster vaccine

One in three adults will develop zoster during their lifetime, he said, and one million episodes occur in the United States each year. Common complications include postherpetic neuralgia and eye involvement that can result in loss of vision. The CDC recommends routine vaccination of all immunocompetent persons over age 60 with one dose of zoster vaccine. “Persons who report a previous episode of zoster can be vaccinated but it is not indicated to treat acute zoster, to prevent persons with acute zoster from developing postherpetic neuralgia, or to treat ongoing postherpetic neuralgia,” Dr. Kelso said.

He reported having no relevant financial disclosures.

[email protected]

 

Outpatient visits for influenza-like illness (ILI) held steady for the week ending March 25, but the number of states at the “high” range of activity dropped from 12 from 10 the previous week, according to the Centers for Disease Prevention and Control.

The proportion of outpatient visits for ILI was 3.2% for the second consecutive week, which halted the slowdown in activity that began the week ending Feb. 18. That 3.2% represents just under 25,000 visits for ILI of the almost 747,000 total visits reported to the Outpatient Influenza-like Illness Surveillance Network (ILINet) for the week ending March 25. By age, the largest groups with ILI visits for the week were individuals aged 5-24 years (41%) and those aged 4 years and under (20%), the CDC reported.

A look at the map shows that ILI activity is still highest in the South, where all seven of the states at level 10 on the CDC’s 1-10 scale are to be found – Alabama, Georgia, Kentucky, North Carolina, Oklahoma, South Carolina, and Tennessee – as well as Arkansas, which was in the “high” range at level 8. The other two states in the high range were Minnesota at level 9 and Virginia at level 8, the ILINet data show.

There were six flu-related pediatric deaths reported during the week ending March 25, but all occurred in earlier weeks. The total number of such deaths is now 61 for the 2016-2017 season, the CDC said.

[email protected]

 

Outpatient visits for influenza-like illness (ILI) held steady for the week ending March 25, but the number of states at the “high” range of activity dropped from 12 from 10 the previous week, according to the Centers for Disease Prevention and Control.

The proportion of outpatient visits for ILI was 3.2% for the second consecutive week, which halted the slowdown in activity that began the week ending Feb. 18. That 3.2% represents just under 25,000 visits for ILI of the almost 747,000 total visits reported to the Outpatient Influenza-like Illness Surveillance Network (ILINet) for the week ending March 25. By age, the largest groups with ILI visits for the week were individuals aged 5-24 years (41%) and those aged 4 years and under (20%), the CDC reported.

A look at the map shows that ILI activity is still highest in the South, where all seven of the states at level 10 on the CDC’s 1-10 scale are to be found – Alabama, Georgia, Kentucky, North Carolina, Oklahoma, South Carolina, and Tennessee – as well as Arkansas, which was in the “high” range at level 8. The other two states in the high range were Minnesota at level 9 and Virginia at level 8, the ILINet data show.

There were six flu-related pediatric deaths reported during the week ending March 25, but all occurred in earlier weeks. The total number of such deaths is now 61 for the 2016-2017 season, the CDC said.

[email protected]

 

Outpatient visits for influenza-like illness (ILI) held steady for the week ending March 25, but the number of states at the “high” range of activity dropped from 12 from 10 the previous week, according to the Centers for Disease Prevention and Control.

The proportion of outpatient visits for ILI was 3.2% for the second consecutive week, which halted the slowdown in activity that began the week ending Feb. 18. That 3.2% represents just under 25,000 visits for ILI of the almost 747,000 total visits reported to the Outpatient Influenza-like Illness Surveillance Network (ILINet) for the week ending March 25. By age, the largest groups with ILI visits for the week were individuals aged 5-24 years (41%) and those aged 4 years and under (20%), the CDC reported.

A look at the map shows that ILI activity is still highest in the South, where all seven of the states at level 10 on the CDC’s 1-10 scale are to be found – Alabama, Georgia, Kentucky, North Carolina, Oklahoma, South Carolina, and Tennessee – as well as Arkansas, which was in the “high” range at level 8. The other two states in the high range were Minnesota at level 9 and Virginia at level 8, the ILINet data show.

There were six flu-related pediatric deaths reported during the week ending March 25, but all occurred in earlier weeks. The total number of such deaths is now 61 for the 2016-2017 season, the CDC said.

[email protected]

 

Influenza activity took another healthy step down as outpatient visits continued to drop, according to the Centers for Disease Control and Prevention.

The proportion of outpatient visits for influenza-like illness (ILI) was down to 3.2% for the week ending March 18, 2017, the CDC reported, compared with 3.6% the week before. (The figure of 3.7% previously reported for last week has been adjusted this week, so the halt in the decline in outpatient visits was actually more of a slowdown.) The national baseline for outpatient ILI visits is 2.2%.

On the regional level, flu activity was still high in most of the South, as Alabama, Georgia, Kentucky, Maryland, Oklahoma, and South Carolina were at level 10 on the CDC’s 1-10 scale of ILI activity. Other southern states in the high range (8-10) were Louisiana, Mississippi, and Virginia, and they were joined by Indiana, Kansas, and Minnesota.

Two flu-related pediatric deaths were reported during the week of March 18, but both occurred earlier: one during the week ending Feb. 18 and the other in the week ending Feb. 25, the CDC reported. The total number of pediatric flu deaths reported is now 55 for the 2016-2017 season.

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Influenza activity took another healthy step down as outpatient visits continued to drop, according to the Centers for Disease Control and Prevention.

The proportion of outpatient visits for influenza-like illness (ILI) was down to 3.2% for the week ending March 18, 2017, the CDC reported, compared with 3.6% the week before. (The figure of 3.7% previously reported for last week has been adjusted this week, so the halt in the decline in outpatient visits was actually more of a slowdown.) The national baseline for outpatient ILI visits is 2.2%.

On the regional level, flu activity was still high in most of the South, as Alabama, Georgia, Kentucky, Maryland, Oklahoma, and South Carolina were at level 10 on the CDC’s 1-10 scale of ILI activity. Other southern states in the high range (8-10) were Louisiana, Mississippi, and Virginia, and they were joined by Indiana, Kansas, and Minnesota.

Two flu-related pediatric deaths were reported during the week of March 18, but both occurred earlier: one during the week ending Feb. 18 and the other in the week ending Feb. 25, the CDC reported. The total number of pediatric flu deaths reported is now 55 for the 2016-2017 season.

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Influenza activity took another healthy step down as outpatient visits continued to drop, according to the Centers for Disease Control and Prevention.

The proportion of outpatient visits for influenza-like illness (ILI) was down to 3.2% for the week ending March 18, 2017, the CDC reported, compared with 3.6% the week before. (The figure of 3.7% previously reported for last week has been adjusted this week, so the halt in the decline in outpatient visits was actually more of a slowdown.) The national baseline for outpatient ILI visits is 2.2%.

On the regional level, flu activity was still high in most of the South, as Alabama, Georgia, Kentucky, Maryland, Oklahoma, and South Carolina were at level 10 on the CDC’s 1-10 scale of ILI activity. Other southern states in the high range (8-10) were Louisiana, Mississippi, and Virginia, and they were joined by Indiana, Kansas, and Minnesota.

Two flu-related pediatric deaths were reported during the week of March 18, but both occurred earlier: one during the week ending Feb. 18 and the other in the week ending Feb. 25, the CDC reported. The total number of pediatric flu deaths reported is now 55 for the 2016-2017 season.

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The decline in U.S. influenza activity that started in February paused during the week ending March 11, according to the U.S. Centers for Disease Control and Prevention.

The proportion of outpatient visits for influenza-like illness (ILI) stayed at 3.7% for a second consecutive week after declining for 3 weeks in a row. The peak for the season, 5.2%, came during the week ending Feb. 11, CDC data show. The national baseline is 2.2%.

The number of states at the highest ILI activity level on the CDC’s 1-10 scale decreased from 11 to 10 for the week ending March 11, but the number in the “high” range (8-10) increased from 14 to 18, the CDC’s Outpatient ILI Surveillance Network reported.

Five ILI-related pediatric deaths were reported to the CDC for the week – all of which occurred during previous weeks – bringing the total to 53 for the 2016-2017 season, the CDC said.

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The decline in U.S. influenza activity that started in February paused during the week ending March 11, according to the U.S. Centers for Disease Control and Prevention.

The proportion of outpatient visits for influenza-like illness (ILI) stayed at 3.7% for a second consecutive week after declining for 3 weeks in a row. The peak for the season, 5.2%, came during the week ending Feb. 11, CDC data show. The national baseline is 2.2%.

The number of states at the highest ILI activity level on the CDC’s 1-10 scale decreased from 11 to 10 for the week ending March 11, but the number in the “high” range (8-10) increased from 14 to 18, the CDC’s Outpatient ILI Surveillance Network reported.

Five ILI-related pediatric deaths were reported to the CDC for the week – all of which occurred during previous weeks – bringing the total to 53 for the 2016-2017 season, the CDC said.

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The decline in U.S. influenza activity that started in February paused during the week ending March 11, according to the U.S. Centers for Disease Control and Prevention.

The proportion of outpatient visits for influenza-like illness (ILI) stayed at 3.7% for a second consecutive week after declining for 3 weeks in a row. The peak for the season, 5.2%, came during the week ending Feb. 11, CDC data show. The national baseline is 2.2%.

The number of states at the highest ILI activity level on the CDC’s 1-10 scale decreased from 11 to 10 for the week ending March 11, but the number in the “high” range (8-10) increased from 14 to 18, the CDC’s Outpatient ILI Surveillance Network reported.

Five ILI-related pediatric deaths were reported to the CDC for the week – all of which occurred during previous weeks – bringing the total to 53 for the 2016-2017 season, the CDC said.

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The 2016-2017 U.S. influenza season appears to have peaked, as activity measures dropped for the third consecutive week, the Centers for Disease Control and Prevention reported.

For the week ending March 4, there were 11 states at level 10 on the CDC’s 1-10 scale of influenza-like illness (ILI) activity, with another three in the “high” range at levels 8 and 9. The previous week (Feb. 25), there were 22 states at level 10, with a total of 27 in the high range of ILI activity. At the peak of activity during the week of Feb. 11, there were 25 states at level 10, data from the CDC’s Outpatient ILI Surveillance Network show.

The nationwide proportion of outpatient visits for ILI was 3.6% for the week ending March 4, the CDC reported, which was down from 4.7% the previous week and 5.2% during the peak week of Feb. 11.

There were eight ILI-related pediatric deaths reported during the week ending March 4, although all occurred in earlier weeks. For the 2016-2017 season so far, 48 ILI-related pediatric deaths have been reported, the CDC said.

For the 70 counties in 13 states that report to the Influenza Hospitalization Surveillance Network, the flu-related hospitalization rate for the season is 43.5 per 100,000 population. The highest rate by age group is for those 65 years and over at 198.8 per 100,000, followed by 50- to 64-year-olds at 42.2 per 100,000 and children aged 0-4 years at 28.8 per 100,000, according to the CDC.

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The 2016-2017 U.S. influenza season appears to have peaked, as activity measures dropped for the third consecutive week, the Centers for Disease Control and Prevention reported.

For the week ending March 4, there were 11 states at level 10 on the CDC’s 1-10 scale of influenza-like illness (ILI) activity, with another three in the “high” range at levels 8 and 9. The previous week (Feb. 25), there were 22 states at level 10, with a total of 27 in the high range of ILI activity. At the peak of activity during the week of Feb. 11, there were 25 states at level 10, data from the CDC’s Outpatient ILI Surveillance Network show.

The nationwide proportion of outpatient visits for ILI was 3.6% for the week ending March 4, the CDC reported, which was down from 4.7% the previous week and 5.2% during the peak week of Feb. 11.

There were eight ILI-related pediatric deaths reported during the week ending March 4, although all occurred in earlier weeks. For the 2016-2017 season so far, 48 ILI-related pediatric deaths have been reported, the CDC said.

For the 70 counties in 13 states that report to the Influenza Hospitalization Surveillance Network, the flu-related hospitalization rate for the season is 43.5 per 100,000 population. The highest rate by age group is for those 65 years and over at 198.8 per 100,000, followed by 50- to 64-year-olds at 42.2 per 100,000 and children aged 0-4 years at 28.8 per 100,000, according to the CDC.

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The 2016-2017 U.S. influenza season appears to have peaked, as activity measures dropped for the third consecutive week, the Centers for Disease Control and Prevention reported.

For the week ending March 4, there were 11 states at level 10 on the CDC’s 1-10 scale of influenza-like illness (ILI) activity, with another three in the “high” range at levels 8 and 9. The previous week (Feb. 25), there were 22 states at level 10, with a total of 27 in the high range of ILI activity. At the peak of activity during the week of Feb. 11, there were 25 states at level 10, data from the CDC’s Outpatient ILI Surveillance Network show.

The nationwide proportion of outpatient visits for ILI was 3.6% for the week ending March 4, the CDC reported, which was down from 4.7% the previous week and 5.2% during the peak week of Feb. 11.

There were eight ILI-related pediatric deaths reported during the week ending March 4, although all occurred in earlier weeks. For the 2016-2017 season so far, 48 ILI-related pediatric deaths have been reported, the CDC said.

For the 70 counties in 13 states that report to the Influenza Hospitalization Surveillance Network, the flu-related hospitalization rate for the season is 43.5 per 100,000 population. The highest rate by age group is for those 65 years and over at 198.8 per 100,000, followed by 50- to 64-year-olds at 42.2 per 100,000 and children aged 0-4 years at 28.8 per 100,000, according to the CDC.

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ROCKVILLE, MD. – A committee of Food and Drug Administration advisers backed the World Health Organization’s influenza vaccine recommendations for the 2017-2018 season at a meeting March 9.

In a unanimous vote, members of the Vaccines and Related Biological Products Advisory Committee recommended that trivalent vaccines for the 2017-2018 season should contain the following vaccine strains: A/Michigan/45/2015(H1N1)pdm09-like, A/Hong Kong/4801/2014(H3N2)-like, and B/Brisbane/60/2008-like.

Quadrivalent vaccine should add the B/Yamagata lineage B/Phuket/3073/2013-like virus, the committee recommended.

These recommendations echo those from the 2016-2017 season, with the exception of a slight update to the H1N1 strain, which had previously been A/California/7/2009(H1N1)pdm09-like virus.

Regarding vaccine efficacy, the cell propagated A/Hong Kong strain was the strongest candidate, covering 93% of A(H3N2) viruses seen in the 2016-2017 season, according to Jacqueline Katz, PhD, director of the WHO Collaborating Center for Surveillance, Epidemiology and Control of Influenza at the Centers for Disease Control and Prevention. In comparison, the egg propagated version of the A/Hong Kong virus covered 59%.

For the influenza B virus, the Yamagata lineage and Victoria lineage strain cycled monthly as the predominant strain in the 2016-2017 season, with a split of “around 50/50,” leaning toward Yamagata in North America, Europe, and Oceana, Dr. Katz explained. The Victoria lineage, in some cases, accounted for nearly 75% of B viruses in Africa and South America.

Committee members expressed concern over the difference between strain prevalence in the United States and abroad and considered recommending a strain that did not coincide with the WHO recommendation, something that has not happened in the history of the advisory committee.

“I’m very aware of influenza vaccinations being a global enterprise, and companies manufacture vaccines for use in multiple countries,” said Committee Chair Kathryn Edwards, MD, professor of pediatrics at Vanderbilt University, Nashville, Tenn. “If we to select a B strain that differed from the WHO recommendation, would that adversely impact vaccine production for the U.S. market?”

Despite these questions, the committee continued to back the WHO recommendations.

Historically, the advisory committee has recommended flu vaccine strains earlier in the year, according to Beverly Taylor, PhD, head of influenza scientific affairs and pandemic readiness at Seqirus Vaccines. Dr. Taylor presented the vaccine manufacturers’ perspective. The delay has put added pressure on manufacturers.

“We haven’t seen impacts yet on start of vaccination dates,” said Dr. Taylor. “But the very clear message from manufacturers is if you keep squashing that manufacturing window, then there will reach a point where we are concerned we will see an impact on vaccine supply time.”

None of the committee members presented waivers of conflict of interest. While the FDA is not obligated to follow the recommendations of the advisory committee, it generally does.

[email protected]
On Twitter @EAZTweets

ROCKVILLE, MD. – A committee of Food and Drug Administration advisers backed the World Health Organization’s influenza vaccine recommendations for the 2017-2018 season at a meeting March 9.

In a unanimous vote, members of the Vaccines and Related Biological Products Advisory Committee recommended that trivalent vaccines for the 2017-2018 season should contain the following vaccine strains: A/Michigan/45/2015(H1N1)pdm09-like, A/Hong Kong/4801/2014(H3N2)-like, and B/Brisbane/60/2008-like.

Quadrivalent vaccine should add the B/Yamagata lineage B/Phuket/3073/2013-like virus, the committee recommended.

These recommendations echo those from the 2016-2017 season, with the exception of a slight update to the H1N1 strain, which had previously been A/California/7/2009(H1N1)pdm09-like virus.

Regarding vaccine efficacy, the cell propagated A/Hong Kong strain was the strongest candidate, covering 93% of A(H3N2) viruses seen in the 2016-2017 season, according to Jacqueline Katz, PhD, director of the WHO Collaborating Center for Surveillance, Epidemiology and Control of Influenza at the Centers for Disease Control and Prevention. In comparison, the egg propagated version of the A/Hong Kong virus covered 59%.

For the influenza B virus, the Yamagata lineage and Victoria lineage strain cycled monthly as the predominant strain in the 2016-2017 season, with a split of “around 50/50,” leaning toward Yamagata in North America, Europe, and Oceana, Dr. Katz explained. The Victoria lineage, in some cases, accounted for nearly 75% of B viruses in Africa and South America.

Committee members expressed concern over the difference between strain prevalence in the United States and abroad and considered recommending a strain that did not coincide with the WHO recommendation, something that has not happened in the history of the advisory committee.

“I’m very aware of influenza vaccinations being a global enterprise, and companies manufacture vaccines for use in multiple countries,” said Committee Chair Kathryn Edwards, MD, professor of pediatrics at Vanderbilt University, Nashville, Tenn. “If we to select a B strain that differed from the WHO recommendation, would that adversely impact vaccine production for the U.S. market?”

Despite these questions, the committee continued to back the WHO recommendations.

Historically, the advisory committee has recommended flu vaccine strains earlier in the year, according to Beverly Taylor, PhD, head of influenza scientific affairs and pandemic readiness at Seqirus Vaccines. Dr. Taylor presented the vaccine manufacturers’ perspective. The delay has put added pressure on manufacturers.

“We haven’t seen impacts yet on start of vaccination dates,” said Dr. Taylor. “But the very clear message from manufacturers is if you keep squashing that manufacturing window, then there will reach a point where we are concerned we will see an impact on vaccine supply time.”

None of the committee members presented waivers of conflict of interest. While the FDA is not obligated to follow the recommendations of the advisory committee, it generally does.

[email protected]
On Twitter @EAZTweets

ROCKVILLE, MD. – A committee of Food and Drug Administration advisers backed the World Health Organization’s influenza vaccine recommendations for the 2017-2018 season at a meeting March 9.

In a unanimous vote, members of the Vaccines and Related Biological Products Advisory Committee recommended that trivalent vaccines for the 2017-2018 season should contain the following vaccine strains: A/Michigan/45/2015(H1N1)pdm09-like, A/Hong Kong/4801/2014(H3N2)-like, and B/Brisbane/60/2008-like.

Quadrivalent vaccine should add the B/Yamagata lineage B/Phuket/3073/2013-like virus, the committee recommended.

These recommendations echo those from the 2016-2017 season, with the exception of a slight update to the H1N1 strain, which had previously been A/California/7/2009(H1N1)pdm09-like virus.

Regarding vaccine efficacy, the cell propagated A/Hong Kong strain was the strongest candidate, covering 93% of A(H3N2) viruses seen in the 2016-2017 season, according to Jacqueline Katz, PhD, director of the WHO Collaborating Center for Surveillance, Epidemiology and Control of Influenza at the Centers for Disease Control and Prevention. In comparison, the egg propagated version of the A/Hong Kong virus covered 59%.

For the influenza B virus, the Yamagata lineage and Victoria lineage strain cycled monthly as the predominant strain in the 2016-2017 season, with a split of “around 50/50,” leaning toward Yamagata in North America, Europe, and Oceana, Dr. Katz explained. The Victoria lineage, in some cases, accounted for nearly 75% of B viruses in Africa and South America.

Committee members expressed concern over the difference between strain prevalence in the United States and abroad and considered recommending a strain that did not coincide with the WHO recommendation, something that has not happened in the history of the advisory committee.

“I’m very aware of influenza vaccinations being a global enterprise, and companies manufacture vaccines for use in multiple countries,” said Committee Chair Kathryn Edwards, MD, professor of pediatrics at Vanderbilt University, Nashville, Tenn. “If we to select a B strain that differed from the WHO recommendation, would that adversely impact vaccine production for the U.S. market?”

Despite these questions, the committee continued to back the WHO recommendations.

Historically, the advisory committee has recommended flu vaccine strains earlier in the year, according to Beverly Taylor, PhD, head of influenza scientific affairs and pandemic readiness at Seqirus Vaccines. Dr. Taylor presented the vaccine manufacturers’ perspective. The delay has put added pressure on manufacturers.

“We haven’t seen impacts yet on start of vaccination dates,” said Dr. Taylor. “But the very clear message from manufacturers is if you keep squashing that manufacturing window, then there will reach a point where we are concerned we will see an impact on vaccine supply time.”

None of the committee members presented waivers of conflict of interest. While the FDA is not obligated to follow the recommendations of the advisory committee, it generally does.

[email protected]
On Twitter @EAZTweets

 

The overall national measure of outpatient flu activity was down for the week ending Feb. 18, and the number of states at the highest level of activity dropped from 25 to 24, according to the Centers for Disease Control and Prevention.

The national proportion of outpatient visits for influenza-like illness (ILI) decreased from 5.2% the previous week to 4.8% for the week ending Feb. 18, the CDC reported.

In addition to the 24 states at level 10 on the CDC’s 1-10 scale of ILI activity, three other states were in the “high” range (8-10): Alaska, Michigan, and Wyoming were all at level 8, data from the U.S. Outpatient Influenza-like Illness Surveillance Network show.

There were 5 ILI-related pediatric deaths reported during the week, bringing the total to 34 for the season so far, but none of the 5 occurred in the current week, the CDC said. There were 89 pediatric deaths reported during the 2015-2016 season, with the peak week occurring in late March/early April (11 deaths). During the 2014-2015 season, there were 148 deaths reported, and 111 were reported in 2013-2014.

[email protected]

 

The overall national measure of outpatient flu activity was down for the week ending Feb. 18, and the number of states at the highest level of activity dropped from 25 to 24, according to the Centers for Disease Control and Prevention.

The national proportion of outpatient visits for influenza-like illness (ILI) decreased from 5.2% the previous week to 4.8% for the week ending Feb. 18, the CDC reported.

In addition to the 24 states at level 10 on the CDC’s 1-10 scale of ILI activity, three other states were in the “high” range (8-10): Alaska, Michigan, and Wyoming were all at level 8, data from the U.S. Outpatient Influenza-like Illness Surveillance Network show.

There were 5 ILI-related pediatric deaths reported during the week, bringing the total to 34 for the season so far, but none of the 5 occurred in the current week, the CDC said. There were 89 pediatric deaths reported during the 2015-2016 season, with the peak week occurring in late March/early April (11 deaths). During the 2014-2015 season, there were 148 deaths reported, and 111 were reported in 2013-2014.

[email protected]

 

The overall national measure of outpatient flu activity was down for the week ending Feb. 18, and the number of states at the highest level of activity dropped from 25 to 24, according to the Centers for Disease Control and Prevention.

The national proportion of outpatient visits for influenza-like illness (ILI) decreased from 5.2% the previous week to 4.8% for the week ending Feb. 18, the CDC reported.

In addition to the 24 states at level 10 on the CDC’s 1-10 scale of ILI activity, three other states were in the “high” range (8-10): Alaska, Michigan, and Wyoming were all at level 8, data from the U.S. Outpatient Influenza-like Illness Surveillance Network show.

There were 5 ILI-related pediatric deaths reported during the week, bringing the total to 34 for the season so far, but none of the 5 occurred in the current week, the CDC said. There were 89 pediatric deaths reported during the 2015-2016 season, with the peak week occurring in late March/early April (11 deaths). During the 2014-2015 season, there were 148 deaths reported, and 111 were reported in 2013-2014.

[email protected]