Which is responsible for its caption content and accuracy. Visit ncicap. Org] good morning, everyone. Im dr. Bill shatner for the nfid, im professor for Preventive Medicine in the department of policy and Infectious Diseases at Vanderbilt School of medicine. Im pleased to welcome you all here this morning to talk about influenza, better known as the flu. Two quick announcements before we get started. Hashure tweeting, use the tag, fightflu. Theres still time to join the c. D. C. Thunder clap. The list is available at www. Nfib. Org. Now for more than 20 years, nfid has gathered partners in the medical and public communities to address the challenges of each flu season and as they say if youve seen one flu season, youve seen one flu season. Every year, the flu season may vary but one thing remains consistent. Weve all come together to advocate strongly for influential and influenza and pneumococcal disease prevention. This year is no different. Joining us today is dr. Thomas price, the secretary of health and human service, our keynote speaker. Its a pleasure to have him with us to discuss the latest on the Vaccination Efforts and what to expect this season. Id also like to welcome our disting westerned panelists. A nurse who specializes in vaccine preventable diseases at childrens in minnesota. Patsy is also a member of the nfid board of directors and served as the first nurse Voting Member of the centers for Disease Control and prevpk Advisory Committee on immunization practices. Dr. Kathleen neusel is director at the center for Vaccine Development and Deputy Director at the institutes for Global Health at the university of Maryland School of medicine. Shes also a member of the nfid board of directors and serves as acip liaison on behalf of the Infectious Diseases society of america. My colleagues here are all experts in their field and are as passionate as i am about the importance of Public Health and disease prevention through vaccination. Dr. Price will begin by addressing Vaccination Coverage in the United States and influne shah Vaccines Available for this season. Llowing dr. Price, ms. Stenchfield will talk talk about why flu sachs nation is particularly important for children. Dr. Neusel will discuss the impact of flu on older adult, why and when to get vaccinated and specific influenza vaccines designed to boost immunity in the 65plus population. Shell also discuss the importance of pneumococcal vaccination in protecting vulnerable populations. Were pleased to have a strong show of support from our partners who represent government, consumer advocacy and other organizations. Influenza Vaccination Coverage is substantially higher today than it was 20 or even 10 years ago. And we know produce an ample supply of vaccine and vaccination options. If youre at least six months of age in the United States, theres a flu vaccine for you. However, the despite all this, were still not meeting u. S. Public health goals for inflew vaccine nfluenza coverage for individual age and risk groups so we must keep working hard to enhance coverage rates. Influenza is an unpredictable Infectious Disease. I like to say flu is fickle. During any given season, millions of people are sickened, hundreds of thousands are hospitalized and thousands or tens of thousands of people die from flu and its complications. Im often asked, how severe will the season be . It will be severe and there will always be a flu season. Annual flu vaccination is our first and best line of defense top prevent flu. Id like to be the first today to urge to urge everyone to get vaccinated against flu. You dont have to think about it, c. D. C. Recommendations are very straightforward. If youre older than 6 years of age you should get vaccinated against flu each and every year. And for Health Care Professionals, its critically important that we lead by example. By getting vaccinated to protect our patients and ourselves. I also want to remind everyone of the c. D. C. Take three approach to flu prevention. In addition to annual vaccination, this includes practicing everyday preventive actions to help prevent the spread of flu, such as hand washing and avoiding contact with sick people as well as the use of antivirals in treating flu. Following the panelist presentations, there will be a q a session for the media. And its now my pleasure to welcome dr. Price. [applause] dr. Price thank you, dr. Schafter, for the introduction, for allowing me to join you today. Its a great pleasure to join you all for what is an incredibly important topic. I want to thank you so much for your work at nfid. Its always an honor to be introduced by a veteran of the United StatesPublic Health ver sis Service Commission corps. Its also an honor as a physician and h. H. S. Secretary to join this event today and to raise awareness about a key Public Health issue. Vaccines are among the greatest Public Health achievements of modern times. But theyre only as useful as we, as a society, take advantage of them. So im thankful for the work of c. D. C. And nfid and our panelists today in shedding some sunlight on this topic. That has a major impact on the health of our nation every single year and that is as dr. Schafter mentioned, influenza. Id like to remind everyone about the burden that flu puts on the American People and our families and our communities. Id like to discuss the Current Situation with regard to flu vaccines, explain a little bit about the larger context of influenza and the potential for pandemics, and most importantly, as the doctor mentioned as well, encourage everyone six months and older to make flu vaccination part of their yearly routine. Lets start with what influenza is. Its not a simple couple of days at home with a runny nose. It can be a lot worse than just a few days away from school or work. It is a potentially serious respiratory illness that can lead to hospitalization and sometimes death. This is especially true for certain groups of people, specifically older adults, pregnant women, and people with certain longterm medical conditions and young children. But even young and healthy adults can suffer complications from influenza. The Public Health consensus very straightforward. Its important for everyone six months and older to get a flu vaccine every year. By the end of these remarks, my remarks and those of the folks in the panel, well all join together and say, six months and older for everyone to get a flu vaccine. It is remarkably easy. There are thousands upon thousands of places across the country where you can get your flu shot. If you go to c. D. C. Gov go to cdc. Gov flu, theres a flu vaccine finder to plig in your zip code and choose from many, many places. Again, the stakes are very serious. Each flu season, flu causes millions of illnesses, hundreds of thousands of hospitalizations, and thousands or sometimes tens of thousands of deaths. The seriousness of each years flu varies significantly. Since 2010, hospitalizations ranged from a low of 140,000 to a high of 710,000. During that same time, the c. D. C. Estimates that the flu has killed between 12,000 and 56,000 people each year. But whatever it looks like in a given year, these numbers are far too high. Especially when we consider that theres a vaccine that could prevent the significant portion of these of this disease. Unfortunately, crrment d. C. s annual look at the number of c. D. C. s annual look at the number of people who get the flu vaccine shows the numbers are pla toad. Among those 6 months and older, flu Vaccination Coverage in the 20162017 flu season was 46. 8 , leaving more than half of all americans unprotected from the flu. Even when vaccine effectiveness is on the lower end it still prevents a great deal of suffering and illness. Vaccine effectiveness of 4 last season, c. D. C. Estimates that flu shot prevented 5. 4 million cases of the flu 2. 7 million doctors visits and 86,000 hospitalizations. With just a 5 increase, a 5 increase in vaccinations, the c. D. C. Estimates that another 490,000 illnesses and 7,000 hospitalizations could have been avoided. So weve got a lot of room for improvement. Because flu shots are produced by the private sector, by private sector manufacturers, supply does depend in part on demand. Manufacturers project that they will provide between 151 million and 166 million doses of vaccine for the u. S. Market this season. In different formulations. Last season, 146 million doses were distributed. This season, flu shots as opposed to the nasal spray vaccines are recommended. Beyond that, while there are vaccine options for consumers, theres no preference for one vaccine over another. One is just as good as another. We know that flu vaccines arent perfect, as i mentioned. Vaccine effectiveness ranges between 40 and 60 each year. That means a persons risk of getting sick with the flu and needing to see a doctor are 40 to 60 less than someone who didnt get vaccinated. Which is which are pretty good odds. We also know flu vaccine can prevent Serious Health challenges, including hospitalization. Now obviously, wed like to see even more effective vaccines and were working on that. Through investments through both the private sector and places like n. I. H. And c. D. C. And in the private sector, were making improvements to existing vaccines. Were also working on something very, very exciting at n. I. H. , something called the universal vaccine that would provide long lasting immunity against many different flu viruses, influiding bird flu viruses that have the potential to cause catastrophic pandemics. Id also like to mention vaccines that protect against pneumococcal e, disease as mentioned. Its a common and deadly complication of influenza. Eachier in the United States, about 520,000 adults, 65 or older, get pneumococcal disease and each year 18,000 of them will die. There are two types of vaccine recommended for use in adults. The c. D. C. Recommends vack nation for everyone age 65 and older and for adults with certain Chronic Health conditions like diabetes and Heart Disease and lung disorders as well as for people who smoke. When adults are getting their yearly flu vaccine, its a great time, its a great time to make re youre up to date on your pneumococcal vaccine and things like pneumonia, shingles and tetanus. The recommendations on these vary deponinged your health status, lifestyle and travel plans. Its important to talk to your doctor and discuss with him or her about the importance of vaccinations that you believe are important and that youd like to take part in. Vaccines including flu and pneumococcal vaccines are available in many places, so theres no reason not to get protected from these diseases. Adults can get the vaccines at doctors offices, pharmacies and so many other areas. Id like to touch briefly on understanding the seriousness of the flu that is sometimes aided by a little bit of historical perspective. Next year, 2018, is the 100th anniversary of the spanish flu. Thats a long time ago and a long time before all of us were born, my grandfather, who graduated from medical school in 1908, was 10 year in practice at the time of that deadly pan democrat ex. So its not ancient history. The spanish flu infected fully one third of the worlds population. Think about that one third of the worlds population. Infected. 50 Million People died worldwide, including 675,000 americans. Thats almost as many lives as were lost in the entire civil war in just a year. Catastrophic impact of the 1918 pandemic has left a Lasting Legacy and informs us as we prepare for another. Influenzas ability to jump from animals to people poses one of the worlds greatest Infectious Disease challenges. Our annual efforts to protect against seasonal flu are the foundation for our response to a pandemic. At h. H. S. , we take the work of pandemic preparedness extremely seriously. President trump and this administration are deeply committed to building relationships around the world to reinforce Global Health security. The United States and other countries have also invested deeply and strategically in National Vaccine preparedness and weve had the chance to see that firsthand that vaccine production and Research Facility heres at hem and abroad. H. H. S. And private partners have constantly researching new ways to generate more pandemic vaccines cheaper an faster and we aim to continue investing in those capabilities. So in closing, lets revisit how each and every one of us can take charge of our own health and prepare ourselveses for flu season. Again the three step approach. First and best defense is to get a flu vaccine. Everyone six months and older, say it together, six months and older, should get an annual flu vaccination. Its best to get vaccinated before flu activity starts, thats usually in october. So the time is now. Remember c. Cdc. Gov flu, you can look at that sight, cdc. Gov, to find out where vaccines are able to be provided near you. Doctors and other providers are incredibly important in this. Your recommendation as a physician, as providers, are crucial to motivating patients to get vaccinated. Its also important for physicians and other providers to get vaccinated themselves to protect yourself and to protect your patients. The flu vaccine that the flu viruses that circulate change from season to season so its important to get an influenza vaccine every single year. The second step we recommend for fighting the flu is to take everyday preventive actions to stop the spread of germs. Stay home if youre sick. Avoid people who are ill. And sick. An as always practice good hygiene. Washing your hands and covering for coughs an remember covering for coughs means you cough into your elbow, not your hand which is incredibly important. And last but not least, take the flu antiviral drugs if your physician prescribes them. We want those who are very sick and those at high risk of serious flu complications to get treated quickly. Taking antibiotic virals early if youre sick can prevent more serious outcomes. We dont want you to get to that point so make flu vaccinations a Healthy Habit each and every year, and the time is now. I want to thank you for the time today. I want to challenge you to spread the word about flu vaccines and not spread the flu and just as a demonstration of the importance of flu vaccination, im here to get my own flu vaccine today. So thank you so much. [applause] dr. Price, thank you very much for that good information and call to action. I just would like him to know that we are particularly pleased that an Orthopedic Surgeon is working to prevent flu, you know, surgeons are very incisive and youre making very incisive remarks. We thank sharon, from the visiting Nurses Association for administering the vaccine there ou go. [applause] thank you, dr. Price. Were grateful to him for eading by example. Well say our goodbye to dr. Price and several other folks. We know that hes heading off to many other important meetings today. So let me quickly focus on a few key data points that dr. Price mentioned. About 78 of Health Care Personnel reported receiving vaccination during the 20162017 season. Vaccination coverage continued to be higher among Health Care Personnel working in hospitals. These large institutions are really getting it done. Theyre getting all their personnel vaccinated. However, the rates are still lower among Health Care Personnel working in ambulatory and longterm care facilities. So we as Health Care Professionals still have work to do there. In addition, about 53 of pregnant women reported vaccination before or during pregnancy. Thats a great measure of progress, but you can see roughly half of pregnant women during the influenza season still did not get vaccinated so we all have to do more work there. That said, its now my pleasure o introduce ms. Patricia stinchfield. Nancy . Thank you. Im so pleased to be here today to talk about the importance of flu vaccine in children. The pediatric nurse practitioner, i often hear people say, oh, its just the flu. I think they might be confusing things with some more mild diseases such as the common cold or maybe a mild stomach flu. But if flu was just the flu a runny nose a cough that you got over quickly, we would not vaccinate. Unfortunately, flu is very severe and i have to remind everyone that children do die of influenza. In the u. S. Alone last year, 105 children died of influenza. And this is well below the number of average deaths per year, even back in the 20092010 season, we saw as many as 358 children die of influenza. In addition to pediatric deaths, c. D. C. Estimates that since 2010, flu related hospitalizations among children younger than 5 years of age have ranged from 7,000 to 26,000 children in the hospital every year. Working in a Childrens Hospital as i have for 30 years, we take care of the sickest of the sick and i can tell you i have seen way too many children in the i. C. U. On ventilators who have died that i ever care to remember. Its a very sad situation for everybody, those who care for them and their families. While severe influenza complications are most in those younger than 2 years age, bad outcomes can happen to anybody. It can be in all ages, in children with underlying chronic diseases such as asthma or a neurological problems where they will have difficulty with their secretions but also in healthy children with no chronic diseases, healthy adults as well. So i believe the word just and flu shouldnt be in the same sentence unless you say i just got my flu vaccine. [laughter] dr. Stenchfield so the flu vaccine is the first to protect children against influenza. Data that came out earlier this year adds to the strong body of evidence about the benefits of influenza vaccine for children. There was a recent publication in pediatrics that showed influenza reduced influenza the risk of flu associated death for those with underlying chronic diseases and by 65 in healthy children. It is the right thing to do to vaccinate our children. And we recently at childrens minnesota where i work completed a threeyear lookback of three seasons of influenza and we compared severe influenza disease for those with less severe and were waiting for publication notice but ill just tell you what we learned and its similar to what was in pediatrics, that kids of all ages we had 404 children over three seasons with influenza. Age 1 day to 18 years. They were healthy kids. They were kids with chronic illness but the three things that really stood out, the more severely ill children, 57 of them had not had a flu vaccine. We also know that those children who were more severely ill stayed home longer before they came to the hospital. So if you as a parent have that gut feeling that your child is ill and that youre worried, listen to that gut, bring them into the hospital sooner than later. Thats why were in clinics and hospitals, to care for you. If youre worried, its better to get them checked than not. And then also we also realize that we as clinicians play a role in more severe illness. Children who had one or more missed opportunity to vaccinate had more severe illness. So as you bring your child to a clinic, an e. R. , a hospital, make sure you ask as a parent, does my child need any vaccines, does my child need a flu vaccine . And we as a clinician, whether a a well child visit, sports visit, we need to make sure we dont have missed opportunity. Because the risk of severe outcomes among children is high but im pleased to see that 76. 3 of children in the u. S. Age 6 to 23 months old were vaccinated last season, exceeding the national Public Health goal of 70 Vaccine Coverage as outlined in the Healthy People 2020 goal. So that is great. However, this is the only age group of children, and in fact the only age Group Overall that met the goal. Influenza vaccination does the coverage decreases as children get older. So were good at vaccinating those younger kids but your teenager is just as important. Our goal is to increase coverage for children of all ages as every child deserves to be protected. Although their personal protection is reason enough, its not just about the kids. If your child gets the flu, they expose everyone around them. This may include babies in the household too young to be immunized, those less than 6 months of age. It may include grandparents who may be immune suppressed or have other chronic illnesses. It may include a pregnant woman. We must make sure that we vaccinate those that we can to protect the individual, the whole family as well as the public at large. Its our responsibility as parents to make sure that children are protected and as Health Care Professionals it is our responsibility to be clear, speak up loud and clear. The evidence shows that is the single most effective thing for someone to change their thoughts about flu vaccine is if they get a clear recommendation from their health care provider. That family will more likely be vaccinated. So i challenge all of us Health Care Professionals to make sure we give clear strong recommendations that influenza vaccination is the safest way to prevent a potentially lifethreatening disease. So we need to make every visit a vaccine visit. Ask, assess. I want to make sure that we dont miss an important detail about pediatric influenza vaccine. And that is if you are a child who has never had a flu vaccine and youre between the ages of 6 months through 8 years, this is your first season, you need two shots. One month apart. So one vaccine and then four weeks later a second vaccine in that same season. So thats a nuance just for young children, first time vaccinated. If you were vaccinated in the year prior youll only need one this year. And finally protection should start even before babies are born. Vaccinations of momstobe during any trimuster is important to protect both them and develop trimester is important to protect both them and the development of their babies. Fightflu, protect our community, our children and keep them health and safety. So lets make annual influenza vaccination a ruin teen part of our Childhood Health care. I challenge us as parents and Health Care Professionals tone sure as many children as possible get vaccinated this year. We ask and must do better. Thank you. [applause] dr. Schaffner thank you for your remarks. Cathy. So thanks, bill. And thanks to everyone who preceded me. They certainly made my job easy and im also very happy to be here to really advocate for a topic that im very passionate about and that is that everyone receives influenza vaccine. Dr. Neuzil i think you heard the message fairly loud and clear that influenza affects persons of all ages. So i will just address in the next few minutes really the particular concern and the Public Health burden of people 65 and over. Weve heard that everyone is susceptible to influenza. It is not a common cold. It is not a fun disease. Some of the terms ive heard from my patients are, i feel like ive been hit by a truck. It makes you feel terrible. You dont want to work. You dont want to go to school. You dont want to take care of your grandkids, whatever it might be. And while the illness is selflimited in most people, there are consequences that can last for weeks. You may have a cough for even months afterwards. But for certain segments of the population, influenza can be deadly. People 65 and over account for about 85 of the flurelated deaths that occur in this country. They also account for the majority of the hospitalizations that occur in this country. So, again, we know that older people are a very heterogeneous group but in general as your age increases and as your frailty increases, you are more likely to have the severe consequences of influenza. And thats true at the other age of the spectrum as well, as patsy clearly emphasized. This is why it was particularly concerning a couple years ago when we were actually seeing declining trends in coverage among people over 65. You know, the good news last year was that those trends appeared to be stabilizing and what wed like to see this year is a real increase. You know, even if were at a 65 level, that means a third of people 65 and over still arent getting influenza vaccine. Now, im an overachiever, as are most people in this room. 65 is a c or d in my book, so, again, we really need to try to vaccine or influenza coverage. So lets talk a little bit about influenza vaccine and, again, why me. You know, what if im the healthy older person whos traveling, whos working . We see more and more people working and are vibrant into their 80s and, again, theres certainly an increase with age that they end up in the hospital but as ive already pointed out, you know, influenza can effect their daytoday activities. It should be a powerful motivation for all of us to get our influenza vaccine. I think there are very few of us, maybe theres no one in this room that doesnt have Contact Contact on a daily or weekly basis with either grandparents or grandchildren or somebody with cancer or underlying lung or Heart Disease. You know, i very vividly remember a patient that i took care of who was brought in from an extended care facility with a severe influenza pneumonia. She had been there for months so she wasnt out circulating in the community exposing herself to influenza at the grocery store. We brought influenza to her. So either the Health Care Workers in that facility brought her influenza or her Family Member or friends brought her that influenza. So we all really need to think about that and for older people its especially important. You may be taking care of a spouse thats more frail than you are. You may be taking care of a 4monthold grandchild whos too young to receive influenza vaccine. Now, influenza vaccine does work in people 65 and over. It not only prevents illness but we have evidence, recent evidence that it also reduces the severity of illness. So even if you get flu its going to be less severe than if you hadnt received the flu shot. So youre less likely to be hospitalized with influenza. The other good news is that the influenza market has responded, and we actually now have two new influenza vaccines on the market in the last few years. To particularly address this issue of preventing influenza in the elderly. So as we get older, and i include myself in this group, we know that the agerelated declines in the immune system can start as early as 50. Im reluctant to admit. You know, our immune systems arent as robust in responding to influenza vaccine. And so in older people, again, we now have a high dose influenza vaccine which is exactly what it sounds like. Its the same content of the influenza vaccine that everybody else receives, but its four times the dose. Four times the antogen. And it has been shown to improve the immune response in people over 65 and prevent more illness and hospitalizations in people over 65. Similarly, with the vaccine its an additional ingredient that boosts the immune response. So we encourage people over 65 to talk to their physicians about what might be the best choice for them. I think the most Important Message is any flu vaccine is better than no flu vaccine. So we shouldnt wait to get a different vaccine but, again, if theres a choice we should encourage people to talk to their physicians about the choice. You know, bill used the term flu is fickle. I say flu is predictably unpredictable. It can occur at anytime. It takes about two weeks after you get the flu vaccine to get that immune response that you need to fight the flu. So, again, we dont want to wait. We want to get the flu vaccine now in case it hits in october, it hits in november. We will all be ready. Dr. Price mentioned the Resources Available on the c. D. C. Website. Ill just quickly mention that theres also Resources Available on the nfid website. And i believe that many of these are being distributed or, again, you can go to nfid. Org. So we really have a lot of information at our fingertips. And then finally, as dr. Price mentioned, you know new mexico cockal vaccination is critical for 65 and pneumococcal vaccination is critical for those 65 and olders. Those also with diabetes, people who smoke. Its a really good time. Were heading into flu season but were also heading into few monia season. In the winter its pneumonia season. In the winter its good to encourage people 65 and older who get their new mexico cockal vaccine pneumococcal vaccine. Again, i think we can make influenza vaccination a priority. By making pneumococcal vaccination a priority. Thats not an annual vaccine. Thats a onetime vaccination. We are all going to step up and get our flu vaccines today. Thank you. [applause] dr. Schaffner thank you very much, kathy. We are ready for our q a. To begin i am going to ask dan who is with the influenza unit here at the c. D. C. To come on up and join us here at the podium and microphone. Hell be able to answer some of your questions also. We are going to have two roving microphones. Please indicate if you have a question and these folks will find you. Please remember to identify yourself and the media outlet you represent. For the media participating by teleconference, the operator will come on the line momentarily to advise you how to submit your question. And finally, if you wish to schedule oneonone interviews with any of the panelists or members of the sporting organizations present, one of our staff here can arrange that for you immediately after the news conference. And now were happy to receive your questions. Laura. Laura with a. P. Is question is for dr. Gurnogen. What does it signal to us as we use the existing vaccine this year . How good do we expect it to be . It hat do we make it that was tough in parts of the Southern Hemisphere . There was the influenza season in australia, whether that was because of localized and happened very quickly in a lot of places may have been reason for a lot of Media Attention on it. But clearly it was a severe season in australia this summer. The season that we had last year in the 20162017 influenza season was also a moderate season. Dr. Jernigan it was a season where we had almost 600,000 hospitalizations. Thats almost as high as the 20142015 season. It was a very severe h3n2 season. Australia is having a bad season this summer. Does that mean well have a bad season this fall . We dont know exactly but we want to be prepared for that and thats one of the reasons why its important to get your vaccine. For the vaccine component decisions, w. H. O. Does make those decisions in february for the Northern Hemisphere the following fall. And the decisions theyre making right now are for the summer next year in the Southern Hemisphere. So theyre continually looking to see, are there ways they can make that vaccine better by updating it . So the decisions they made for the h3n2 component was really to address better performance of that particular vaccine virus, the h3n2 virus in egg manufacturing. Ok. Theres been a little bit of drift, some change but not a significant mutation in the h3n2. Its so the vaccine that cams out made in eggs is better. There is two vaccines which is made in cells and the flu block which is made with proteens, thonet arent affected by this change. Dr. Schaffner so basically, dan, as we were talking before the news conference, the proteens on the outside of that h3n2 virus are similar to whats in the current vaccine so we ought to be well prepared. This h3n2 strain is the one that usually causes, as kathy will say, more illness, more complications in older adults. So if you need it, another reason to be vaccinated, there it is. Best get that protection. Other questions, please . Phil with kaiser news. The lower states, nevada, has by the lowest rate in the country, whats going on in nevada . Have you talked to Health Officials there . Dr. Schaffner perhaps all those folks are in casinos. I dont know. Theres a frequency distribution obviously across and i have no insites. Perhaps my colleagues want insights. Perhaps my colleagues want to chip in, about the vaccine performance from state to state because theres substantial variation. Anybody have any good ideas . Dan . Dr. Jernigan different states handle things dimple. There are differences in race, ethnicity, who gets their vaccines. Why nevada i dont know. I am not going to comment on dr. Schaffners statement. I dont know. Dr. Schaffner my facetious remarks. Dr. Jernigan this is not an easy thing to do to get a vaccine every year. There are many places to get it but people are still very busy. We are trying to get part of the population that doesnt normally get vaccines which is people in older population, 18 to 49 years, they are not used to doing it. People seeing the benefits of getting vaccinate and just having them do it. Dr. Schaffner we as providers need to become more forceful. Its different to say to a patient, tom or jane, its that time to of the year, you should consider it. That opens the door to have the patient leave immunized. Its that time of the year. Were vaccinated everyone in our practice. Youll be vaccinated on the way out just as i have been vaccinated. Being a vaccine insistor than r than a rather a vaccine recommender. Other comments, please, suggestions, questions . Have one from the teleconference, right. So we have a question from kathleen with webb m. D. Please proceed with your question. Dr. Neuzil, there are statistics that doesnt preconvenient illness but also reduction in illness, can you give us a citation for that . R. Neuzil, the most one was in clinical Infectious Diseases. I have to give you the exact pmid afterwards. It was a citation out of a canadian network. And i think the other interesting aspect of that publication is that in certain adults over 65 years of age, at vaccine was up to 78 efficacious in preventing hospitalization. So flu may be like other vaccines where were used to hearing the 50 number and thats relatively mild disease. But in fact we have more evidence now that the protection is likely greater for more severe disease. And im happy to give you the citation. I think i can find it just with that. Clinical Infectious Diseases this year. Dr. Neuzil and look for the editorial by neu sdemrmbings il. Dr. Schaffner let me add to that. We all know that influenza vaccine is not a perfect vaccine but a pretty darn good vaccine. We see the effectiveness rates and we are always a little bit disappointed. Whats not in those effectiveness rates is the partial protection that is given to people who might have been vaccinated, gotten influenza but they didnt have to go to the hospital, be admitted into the intensive care unit. I like to say to my patients who said, but dr. Schaffner, you gave me the vaccine and i still got flu and i said, i am so pleased that youre still here with us to complain. Because you didnt die of influenza. So i think that thats very important. The flu vaccine i like to quote that is quote paraphrase voltaire who says waiting for perfection is the great enemy of the current good. With this pretty good vaccine we can do an awful lot of good. There is a question right here. Heidi. Internal medicine news. Thank you so much for doing this every year. Since its so important for Health Care Providers to be able to really insist and to make that push to their patients, what are some barriers that you are still finding as far as the Health Care Providers themselves getting vaccinated so when the patients ask, well, have you had yours, they can say that they have . Dr. Schaffner kathy, do you want to answer that or patsy . Sure. This is one of my tasks at childrens to get our 6,500 employees vaccinated so i think a lot about your question. I think its really about understanding the importance of it, about making it easy and accessible. No charge. Making it such that well come to you. Where is your staff meeting . We do so many different interventions at childrens. E dont have a mandate as some hospitals do. Even in a unionized nursing environment without a mandate, our staff are vaccinated 94 year after year. Dr. Stenchfield its making it easy and accessible. Dr. Schaffner support from the highest Level Administration all the way down to everage working in the hospital. Everyone working in the hospital. Vanderbilt is pleased to join you. Our vaccination rate is over 90 also. Dr. Neuzil nothing much to add. I agree with you. Its understanding the barriers and then removing those barriers and access a certainly one. Being able to provide multiple different types of vaccination is a vaccine is another. We do have a mandatory policy at maryland. We are also at the university of maryland medical center. We are also in the high 90 percentages. You know, its interesting. Its been shown that and dan could probably comment more specifically but the nurses, the physicians, the people in the hospitals who have regular contact were actually doing very well with those vaccination rates. Its some of the other workers that youre referring to, bill, who we probably havent done as good of job educating. The support staff sometimes in the hospitals that we arent doing quite as well on if you break down that Health Care Worker box. So, again, we need to take the same approaches. We need to educate them. We need to make it easy for them to get vaccine in the same way weve done it for the physicians and the nurses. Dr. Schaffner and just to make clear, its a Patient Safety issue. We dont want to give flu to the patients with whom for whom we are providing care. Another question, please. Dr. Stiveragefield its a shot. Stincfield its a shot. People dont like needles. And Health Care Professionals have needlephobia just like the general population does. So making that event the pain part of shots less is not just something to think about for children, its important to think approximate for adults. What can you do when you go get your flu shot which all of you will do, im certain . Breathe through your mouth. Just relax. Relax your arm. Let it hang down like a spaghetti noodle. Have it out just slightly from your body and then imagine your favorite place in the whole wide world. Just take yourself someplace else and before you know it ill be over. I am an independent writer here in d. C. Theres evidence that the vaccine is different in children and those over 65 but theres not the same evidence for healthy adults. That seems to be very little of that. Its modest. I want to know why is that and hats being done about that . Dr. Neuzil in terms of evidence about flu vaccine bout efficacy . For the efficacy or the burden . I think theres two issues. You know, first of all, is influenza a bad illness . So in otherwise Healthy People who, again, dont have underlying disease and young or middleaged adults, they are far less likely toned up in the hospital or die from influenza. As pantsy pointed out, it still happens every year in Young HealthyCollege Students and for healthy 40yearolds. For flu vaccine efficacy i would disagree with that. Theres placebo controlled trials in addition to our observational studies that support that influenza vaccines do work in the young and middleaged healthy population. Certainly immune responses are more robust in that population and thats most of our evidence now. Generally you randomize control trials are very expensive to do. And how many do you need to do to show that the vaccine works . But, again, i am very happy afterwards. I think its a very specific question for this audience to provide you with those papers and those trials that show the vaccine works in that population. Dr. Schaffner further questions, please . No questions . Not coming from the media . All right. Thank you very much. Well, then i thank you all for joining us as we do every year. Lets hope for a quiet flu season, but as weve heard from our panel of experts, the best defense is a good offense. We all invite you to get vaccinated to help fight flu. So our nurses in the back will be happy to accommodate you. We have plenty of vaccine, so you all should get vaccinated also to help fight the influenza and we thank you again for getting this message out to the general population of the United States. Youre doing a terrific Public Health service each and every year. Thanks to my colleagues and friends here that are panelists and thank you to thank you very much. [applause] [captions Copyright National cable satellite corp. 2017] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] heres a look at our primetime schedule on the cspan networks. Starting at 8 00 p. M. Eastern on cspan remarks from majority whip Steve Scalise who returned to the house floor for the First Time Since being shot in june at a congressional baseball practice. On cspan2, a discussion on president trumps first year in office. Focusing on the presidency, National Security issues and congress. And on cspan3, a hearing on the Scientific Research conducted during last months total Solar Eclipse by nasa. So this is what churchill faced when he came to power in those awful days in may, 1940. Practically from his first day in office he begged franklin off velt for help to stave hitler. Even though he wanted to help save britain he was very cautious. He didnt want to get involved in this war if he could help it. Besides, most people in washington, including him, were pretty much convinced that britain would be easily defeated. How could it possibly survive when no other european had . Former u. S. Secretary of tate madeleine albright, the foremost chronicler about world war ii politics and diplomacy. And sunday on in depth, lynne olson will be the guest. Her books called freedoms aughters, last hope island. During our live threehour conversation well take your calls, tweets and facebook questions. Watch in depth with lynne olson sunday live from noon to 3 00 p. M. Eastern on book tv n cspan2. Chester arthur ranks among the lesser known president s. The thing most people remember about him is of course his very distinctive facial hair, his side burns. Sunday night on