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MDHHS Update: Preventing Influenza During the 2019-2020 Flu Season

 

By. Michelle Doebler, MPH, Influenza Epidemiologist, Michigan Department of Health and Human Services Division of Immunization

Each year influenza infections are estimated to cause millions of illnesses and thousands of hospitalizations and deaths nationally. The 2018-2019 flu season (September 30, 2018 – May 18, 2019) was moderately severe with two distinct waves of influenza activity corresponding to two different influenza A viruses circulating throughout the season. Influenza-like illness (ILI) activity began increasing in November 2018, peaked during mid-February 2019, and returned to below national baselines in mid-April 2019. Nationwide, the 2018-2019 flu season saw 21 weeks of elevated flu activity, making it the longest flu season in a decade.1 Flu activity in Michigan reflected the patterns of activity seen on a national level.

Preliminary estimates indicate that influenza burden from the 2018-2019 flu season was significant.2 Influenza infections caused approximately 42 million illnesses, up to 647,000 hospitalizations, and up to 61,000 deaths.2 Nationally, as of September 27, 2019, 135 influenza-associated pediatric deaths have been confirmed for the 2018-2019 flu season, and 3 of these deaths were from Michigan.3

The most effective way to prevent flu is with an annual influenza vaccination. The Advisory Committee on Immunization Practices recommends that all persons aged 6 months and older, without contraindications, receive an influenza vaccination every year. However, influenza vaccine coverage across the country is below the Healthy People 2020 goal of 70 percent. According to data from the Centers for Disease Control and Prevention (CDC), nationally only 49.2% of all persons aged 6 months and older received an influenza vaccination for the 2018-2019 flu season.4 The influenza vaccine coverage estimate in Michigan, utilizing data from the Michigan Care Improvement Registry (MCIR), for everyone aged 6 months and older was 30.4% for the 2018-19 season.

Influenza is not the “stomach flu” and not just a “bad cold” but rather is a highly contagious respiratory illness that can lead to extreme sickness and even death. Young children can be especially susceptible to severe complications from the flu. Children aged 6 months through 8 years may require two doses of influenza vaccine to be fully protected for a season. Last season according to MCIR data, Michigan’s flu vaccination coverage for children recommended to receive two doses was only 12.5%. Children that do not receive their second dose may still be at risk from developing illness from influenza infection. Providers are encouraged to communicate the importance of the second dose of influenza vaccine to parents. We need to do better in Michigan to protect our most vulnerable children.

Annually, CDC and the Michigan Department of Health and Human Services encourages providers to utilize the plethora of resources available to educate patients and increase influenza vaccine coverage rates. Many of these resources provide sample messaging to address the misconceptions preventing people from choosing to get an influenza vaccine. Educational materials are available at www.cdc.gov/flu and www.michigan.gov/flu.

To address vaccine effectiveness concerns, the World Health Organization reviews surveillance, laboratory, and clinical study data every year to make recommendations on the composition of the influenza vaccine.5 The Northern Hemisphere’s 2019-2020 flu vaccine composition includes an A/Brisbane/02/2018 (H1N1)pdm09–like virus, an A/Kansas/14/2017 (H3N2)–like virus, and a B/Colorado/06/2017–like virus (Victoria lineage). Quadrivalent vaccines include these three strains plus a B/Phuket/3073/2013–like virus (Yamagata lineage) virus.1

While influenza viruses are detected year-round in the United States, typically influenza infections are most common in the fall and winter months, with activity peaking between December and February.6 National Influenza Vaccination Week (December 2-8, 2019) highlights the importance of continuing flu vaccination through the holiday season and beyond. Providers are encouraged to assess their patients through the winter for flu vaccination status and continue to offer flu vaccine for the entire season!

References:

1Xu X, Blanton L, Elal AI, et al. (2019). Update: Influenza Activity in the United States During the 2018–19 Season and Composition of the 2019–20 Influenza Vaccine. MMWR Morb Mortal Wkly Rep 2019;68:544–551. DOI: http://dx.doi.org/10.15585/mmwr.mm6824a3

2Centers for Disease Control and Prevention (CDC). (2019). 2018-2019 U.S. Flu Season: Preliminary Burden Estimates. Retrieved from https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm

3CDC. (2019). Weekly U.S Influenza Surveillance Report. Retrieved from https://www.cdc.gov/flu/weekly/index.htm#ILIMap

4CDC. (2019). FluVaxView, 2018-2019 Flu Season. Retrieved from https://www.cdc.gov/flu/fluvaxview/1819season.htm

5CDC. (2018). Selecting Viruses for the Seasonal Influenza Vaccine. Retrieved from https://www.cdc.gov/flu/prevent/vaccine-selection.htm

6CDC. (2018). The Flu Season. Retrieved from https://www.cdc.gov/flu/about/season/flu-season.htm

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AMA
As part of CCB, and having become known in the HOD as a trusted and respected parliamentarian and advisor, he has been actively sought out by sections and delegations for his expertise and counsel, to ensure their concerns are met and can be adopted by the House. His commitment to open, fair and unbiased discussion and debate empowers colleagues wherever he leads, including in our House of Delegates.

ACEP
In addition to his commitments to MSMS, the AMA and CCB, Pino participates in the American College of Emergency Physicians (ACEP) Section Council. This allows him to stay informed about the latest issues facing their specialty and the broader medical landscape across the country. The council comprises representatives from all over the US, who bring unique perspectives and experiences to the table, and gain a better understanding of the challenges and opportunities facing emergency medicine in different regions, and work collaboratively to develop solutions and best practices. This also allows him to build relationships across the country, which are key to getting the House to “yes.”

MSMS
Dr. Colone has been an active member of the AMA since his first year of medical school. He served as Chair of the Medical Student Section, Resident and Fellows Section, and the Young Physician Section of the Michigan State Medical Society, as well as representing each of those sections as delegate from MSMS to the AMA. He has served on the Michigan Delegation to the AMA for almost 30 years, and on the MSMS Board of Directors for 11 years during that time. He is also a recipient of the AMA Foundation Leadership Award.

In addition to influencing the national debate, Dr. Colone served as president of his county and state medical societies during times of crisis. He led his county medical society during the Flint water crisis and MSMS during the COVID pandemic from 2021-2022, standing up to outside efforts by lay persons and legislators and standing by science for the safety and betterment of the public. During his presidency he led a coalition of 50 patient and health care organizations to achieve comprehensive prior authorization reform removing barriers and improving the health of all Michiganders.

President of MSMS: Pino took the helm of MSMS as President during a tumultuous time. The COVID pandemic was entering its second year. Effective and, more importantly, ineffective treatments, were becoming better known, better understood, as physicians were learning every day how to best save lives. He stood by science and resisted pressures and endorsed science based treatments based on what we’d learned, over unproven, and even dangerous, treatments.

Health Can’t Wait Initiative: Pino advanced the Health Can’t Wait Initiative as President of MSMS, a coalition of over 50 health-focused groups that saw the successful passage of comprehensive prior authorization reform into law.

Read more about the coalition here

Organizations involved in the coalition 

PA Reform Signed into Law

“Today is a wonderful day for Michigan patients who can now rest easy knowing insurance company prior authorization practices will no longer prove to be an impassable roadblock between them and the timely care and treatment they too often desperately need," said MSMS President Pino Colone, MD. “Speaking on behalf of providers, patient advocacy groups and patients across the state, I want to thank Governor Whitmer and Michigan’s lawmakers for recognizing the need for reform in this area and then working to craft and enact legislation that delivers. In signing SB 247, Governor Whitmer has ushered in a new era where transparency, clinical validity and fairness to patients will all be factored into the prior authorization process, protecting Michigan patients from costly and dangerous delays in access to health care. Officially signing this bill into law is a tremendous—and much needed—win for countless Michigan patients and the providers who serve them.”

Scope of Practice: He has testified on scope of practice helping legislators understand that nonphysician practitioners (NPPs) do not have the training or education to safely care for our families, and that medical school matters. (include the graphic from the article) and link the article: https://www.mha.org/newsroom/tag/pino-colone/

Pino spent six years as chair of the MSMS Task Force on Opioid Stewardship, advocating for naloxone to be available to residents of Michigan without a prescription, collaborating with colleagues and state officials, and disseminating timely and accurate information to MSMS members. In this role, he was pivotal in shaping MSMS’s strategic plan to reduce opioid-related overdose, eliminate stigma, and support harm reduction efforts by fighting to make naloxone available over the counter.

He was also a member of the MSMS Executive Task Force on Health Care Disparities. 

Genesee County Medical Society
Pino was also president of the GCMS during the water crisis of its largest city, Flint. He led efforts by the Society to disseminate accurate information about lead in drinking water and its effects on health. With the city and state in the national spotlight, Pino stood firm against pressure from government officials to endorse what would later prove to be flawed information, putting the expertise of his physician colleagues and the safety of local residents first.
Read more about Pino’s service as county medical society president below: 

§  November 2020 GCMS Bulletin 

§  December 2020 GCMS Bulletin

§  January 2020 GCMS Bulletin

§  February 2020 GCMS Bulletin

§  March 2020 GCMS Bulletin 

§  April 2020 GCMS Bulletin

§  May 2020 GCMS Bulletin

§  June 2020 GCMS Bulletin

§  July 2020 GCMS Bulletin

§  August 2020 GCMS Bulletin

§  September 2020 GCMS Bulletin

§  October 2020 GCMS Bulletin

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§  Twindemic – 2021-2022

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