[inaudible conversations] im also the professor of medicine and the department of Health Policy and Infectious Diseases at Vanderbilt University school of medicine. On behalf of im pleased to welcome you all here this morning. Please use the hash tag fight the flu. Please still join before 10 30 a. M. Today. The list is available on the nsaid website at www. Dot n. S. I d. Weve gathered partners in the communities to address the unique challenges of each flu season and if youve seen juan, youve seen one. The department of health and Human Services who is our keynote speaker. It is an honor to have the doctor with us to share the latest data on how we are doing as a nation. Nurse practitioner and Infectious Disease of childrens minnesota the senior direction of Infection Prevention and control in minnesota. Patsy is also a member of the board of directors and served as the first verse Voting Member of the centers for Disease Control and Prevention Advisory Committee on immunization practices. Doctor kathleen is the director of the id also a member of the board of directors she serves as the asip liaison on behalf of the Infectious Disease society of america. My colleagues here are all experts in their fields and are as passionate as i am about the importance of Public Health and disease prevention through vaccination. We will talk more about why flu vaccinations are particularly important for children and then discuss the Significant Impact of the flu on older adults, why and when to get vaccinated and specific influenza vaccines designed to boost the immunity in the 65 plus population. She will also discuss the importance of the vaccination in protecting vulnerable populations. We are pleased to have a strong showing of support from the part where is representing Public Health, medical societies, government industry advocacy and consumer focused organizations. It is substantially higher today than it was 20 or ten years ago. And we now produce an ample supply of vaccine and vaccination options. If you are at least six months of age in the United States, there is a flu vaccine for you. We are still not meeting the public goals for the coverage among the individual age and risk groups. I would like to see that the flu is fickle. During any given season millions are second, hundreds of thousands are hospitalized and hundreds of tens of thousands die from the 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 the first and best line of defense. We dont have to think about it. The recommendations are very straightforward if you are older than six years of age. And for Healthcare Professionals it is critically important that we lead by example by getting vaccinated to protect our patients and ourselves. I also want to remind every one of the take three approached the flu prevention and in addition to the annual vaccination this includes practicing every day preventive actions to help prevent the spread of the flu such as hand washing and avoiding contact with sick people as well as the use of antivirals in treating the flu. Following the panelist presentations, there will be a two day session for the media and it is now my pleasure to welcome doctor price. [applause] thank you so much for the introduction and allowing me to join. Its a great privilege to join for this incredibly important topic and i want to thank you so much for your work its always an honor to be introduced by a veteran of the United StatesPublic Health and an honor as the secretary to joi secretary t and raise awareness about the key publichealth issue. Vaccines are among the greatest achievements of modern times but they are only as useful as we take advantage of them so im thankful for the work in our panelists today shedding some light on the topic that has a major impact on the health of the nation every single year and that is the issue of influenza. In my brief remarks i would like to remind everyone about the burden that the flu puts on the American People in our families and communities and i would like to discuss the Current Situation with regards to the vaccines and a little bit about the larger context of influenza and the potential for pandemics and most importantly as mentioned, encourage everyone six months and older take the flu vaccination a part of their yearly routine. Lets start with what the influenza is. Its not just a couple of simple couple days at home with a runny nose. It can be worse than a few days away from school or work. Its a potentially serious respiratory illness that can lead to hospitalization and sometimes a. This is especially true for certain groups of people, specifically older adults, pregnant women and people with longterm medical conditions and Young Children. But even the young and healthy adults can suffer from severe complications of influenza. The publichealth consensus is very straightforwar straightfors important for everyone six months and older to get a flu vaccine every year by the end of these remarks and those on the panel we will all join together and say six months and older for everyone to get a flu vaccine and it is remarkably easy there are thousands upon thousands of places you can get a flu shot. If you go to the cdc. Gov mac flu there is a finder you can put in your zip code and choose from many places. Again the stakes are very serious. Each season it causes millions of mrs. , hundreds of thousands of hospitalization and thousands were sometimes tens of thousands of death. The seriousness of each varies the complete. We estimate since 2010 that related hospitalizations in the United States ranged from the aw of 140,000 a high of 710,000. During the same time they estimate that it has killed between 12,00 told falsehoods to 56,000 people each year. But whatever it looks like, the numbers are far too high especially when we consider that there is a vaccine that could prevent significant portion of this disease. Unfortunately, the annual look at the numbers of people who report getting their flu vaccine shows the numbers have actually plateaued and leveled off among people sixmonth and older for coverage during the 2016 and 2017 flu season was 46. 8 leaving more than half of all americans unprotected from the flu. Even when the effectiveness is on the lower end it still presents a great deal of suffering and illness and with vaccine effectiveness of 42 last season at estimates a flu shot prevented about 5. 4 million cases of the flu come a 2. 7 million doctors visits and 86,000 hospitalizations with just a 5 increase in vaccination they estimate another 490,000 illnesses and 7,000 hospitalizations could have been avoided. So theres a lot of room for improvement because the flu shots are produced by private sector manufacturers and supplied us depend in part on demand. Manufacturers predict they will provide 151 to 166 million doses of vaccine for the u. S. Market this season in different formulations. Last season 146 million were distributed. This season afloat to decod fleu shots as opposed to the nasal vaccines are recommended. There are many options. There is no preference for one vaccine over another. One is just as good as another. We know that they are perfect as mentioned into the effectiveness ranges between 40 to 60 each year and that means that a persons risk of getting sick with the flu and needing to see a doctor or 40 to 60 less than someone who didnt get vaccinated which are pretty good odds. We also know that the vaccine can prevent Serious Health challenges including hospitalization. We would like to see even more effective vaccines and we are working on it through investments in the private sector at nih and cdc and in the private sector we are making improvements to existing vaccines. We are also working on something very exciting at the nih, something called the universal vaccine thauniversalvaccine thae longlasting immunity against many different flu viruses including bird flu virus but have the potential to cause catastrophic influenza pandemic. I would also like to briefly mention vaccines that protect against another serious disease and that is the pneumococcal disease was mentioned. It can cause a range of serious illnesses and is a common and deadly complication of influenza. He cheered about 520,000 adults 65 or older at the disease and about 18,000 of them will die. Theres two types of vaccines recommended. The cdc recommends a vaccination for everyone aged 65 and older in four 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 it is a great time to make sur sure youre uptodate on your vaccines and other recommended vaccinations, things like pneumonia, hepatitis and thickness. Fitness. The recommendations very depending on your Health Status and lifestyle and travel plans and the like so its important that you talk with your doctor and discuss the importance of vaccinations you believe are important to you would like to take part in. Vaccines including pneumococcal vaccines are everywhere so theres no reason not to get protected. Adults can get their vaccines to doctors offices, pharmacies, workplaces and Community Health centers and so many other areas. I would like to touch briefly on understanding the seriousness that is sometimes aided by historical perspective. Ask cheered 2018 is the 100th anniversary of the spanish flu. That is a long time ago in a long time before all of us were born. My grandfather who graduated medical school in 1908 was ten years in practice at the time of the deadly pandemic so it isnt ancient history. The spanish flu infected one third of the worlds population. Think about that, one third of the worlds population. 50 Million People died worldwide including 5,000 americans, almost as many as were lost in the entire civil war in just a year. Catastrophic impact of the 1918 pandemic left a legacy. The ability to jump from animals to people poses one of the worlds greatest Infectious Disease challenges and or annual efforts to protect against seasonal flu are the foundation for the response to the pandemic. We take the work of the pandemic prepared this extremely seriously and President Trump and the administration are committed to building relationships around the world to be in force security. Countries invested deeply in the National Vaccine preparedness and weve had a chance to see that firsthand both here at home and abroad. Hhs and private partners are constantly researching ways to generate more pandemic vaccines cheaper and faster than we aim to continue in those capabilities. In closing less revisit how each and every one of us can take charge of our own health and prepare ourselves for flu season. In the threestep approach first they flu vaccine. Every one to si of six months ad older should get an annual flu vaccination. Its best to get vaccinated before the activity starts so that is usually in october so the time is now. Remember cdc. Gov. You can look at the site to find where vaccines are able to be provided near you and other providers are incredibly important in this. Your recommendation is crucial to getting vaccinated and its also important for physicians and other providers to get vaccinated themselves to protect yourself and your patience. The vaccine viruses that circulate a chain from season to season isnt put into getting vaccine every single year. The second step we recommend is to take everyday preventive actions to stop the spread of germs, stay home if youre sick of weight people who are ill and as always, practice good hygiene. Washing your hands and covering for costs means you cough into your elbow not in your hand which is incredibly important and last but not least, take the antiviral drugs if your prescriptioproviderprescribes t. We want those that are sick and at high risk ohave higher risk f complications to get treated quickly. Taking antivirals can prevent more serious outcomes. We dont want you to get to that point so make the flu vaccination may Healthy Habit and as i mentioned that time is now so i want to thank you for your time today and challenge you to spread the word about the flu vaccines and not spread the flu. And just as a demonstration of the importance of the flu vaccinations, im here to get my own flu vaccine today. So thank you very much. [applause] thank you very much for that good information and call to action. I would liken to kno like him te are particularly pleased that an Orthopedic Surgeon is working to prevent the flu. Surgeons are very incisive and you are making very incisive remarks. And we thank for sharing for shr administering the vaccine. There you go [applause] thank you doctor price. We are grateful to him for leading by example. We will say goodbye to doctor price [inaudible] we know hes heading off to many other important meetings today. Let me focus on a few of the points that doctor price mentioned. About 78 of health care for somehow reported receiving vaccination during the 2016 to 2017 season. A Vaccination Coverage continued to be higher among healthcare personnel in hospitals. The large institutions are getting it done. They are getting all of their personnel vaccinated however, the rates are stil still low wee among healthcare person now working in ambulatory and longterm care facilities, so we as Health Care Professionals still have work to do. In addition about 53 of pregnant women reported vaccination before or during pregnancy. That is a great measure of progress that you can see roughly half of pregnant women during the influenza season still didnt get vaccinated, so we all have to do more work. It is now my pleasure to introduce patricia. Good morning. Thank you. I am so pleased to be here to talk about the importance of the flu vaccine in children. As a pediatric Nurse Practitioner i often hear people say its just the flu and i think they might be confusing things with more mild diseases such as the common cold or a mild stomach flu. But a runny nose and cough you got over quickly, we wouldnt vaccinated. Unfortunately the flu is very severe and i have to remind everyone that children do die of influenza. In the u. S. Open last year, 105 children died of influenza. And this is well below the number of average deaths per year. Even back in 09 and 2010, we saw as many as 358 children die of influenza. In addition to pediatric deaths, we estimate that since 2010, flu related hospitalizations among children younger than five years of age 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 that i see way too many children in the i icq. Its a situation for those who care for them and their families. While the complications are most common in children two years of age, i can remind us that bad outcomes can happen to anybody with underlining chronic diseases such as asthma or neurological problems with the difficulty. But also healthy children with no chronic diseases. Thats why i believe the words shouldnt be in the same sentence. Unless of course youre going to say i just got my flu vaccine. So they enable vaccination is the first and most important step protecting children against influenza. The data adds to the strong body of evidence about the benefits of influenza vaccines for children. It reduces the risk of flu associated deaths by 51 of children who have underlining chronic conditions and by 65 in healthy children. Its the right thing to do to vaccinate our children and we recently where i work completed a threeyear look back of the seasons of influenza and we compared the influenza disease for those with less severe and we are waiting for publication notice, but i will just tell you what he learned and its similar to what was in the pediatrics that the kids of all ages we have 400 for children over three seasons of influenza, age one they were healthy kids with chronic illness. Three things that stood out 57 of them had not had a flu vaccine. We also know that those children who were more severely ill stay at home longer before they came to the hospital. So if you as a parent have the feeling that youre child is ill and you are worried, listen to that and bring them to the hospital sooner than later. We realize as clinicians we play a role in more severe illness, children who have one or more missed opportunities to vaccinate would have more severe illness. So as you bring your child to a clinic and er in hospitals. As a clinician whether it is a healthy wellchild check, physical or broken wrist should see the flu vaccine season and i see yoandicuand isee you haven. Lets make sure as clinicians we dont have a missed opportunity. Because the risk of severe outcomes is high but im pleased to say 76. 3 of the children in the u. S. Age 23 months older vaccinated last season. As it is outlined. This is the only age group of children and the only age Group Overall thickness of the goal. Influenza vaccination does cover decrease as we get the person we are going to vaccinate but that teenager is dressed as important. The goal is to increase coverage for children of all ages as every child deserves to be protected. If your child gets the flu, they expose everyone around them. This may include babies in the household are too young to be immunized with less than six months of age and 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 they are protected. To speak up loud and clear the evidence shows that is the single most effective thing for someone to change their thoughts if they get a clear recommendation from their healthcare provider. We have clear recommendations that influence the vaccine is the best to prevent it potentially lifethreatening disease. We need to make every visit a vaccine visit. I want to make sure we dont miss a detail about the vaccines and that is if you are between the ages of six months through eight years, you need two shots. One month apart. So, one vaccine and then four weeks later a second vaccine in the same season. So that is a nuance just for Young Children firsttime vaccinated in it than you would only need one this year. And finally, the protection should start even before babies are born. Vaccinations of moms to be coming any time is important to protect both them and developing babies against influenza. Its our shared responsibility to fight the flu or should i say hash tag fights flu to protect children, communities to keep them safe and healthy so lets make annual vaccinations a routine part of Childhood Health care. We can and must do better. Thank you. [applause] theyve certainly made my job easy and im also very happy to be here to advocate for a topic that im very passionate about. And that is that everyone receives influenza vaccines. I think that youve heard the message very loud and clear that influenza affects persons of all ages. So i will just address in the next few minutes that particular concern and the Public Health burden of people 65 and over. Weve heard that everyone is susceptible to influenza. Its not a common cold. Its not a fun disease. Some of the terms ive heard from my patients or 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 or take care of your grandkids. Whatever it might be. And while the illness is a selflimited and most people, there are consequences that can last for the. You may have a cough event for months afterwards. But for certain segments of the population, influenza can be deadly. People 65 and over account for about 85 of the 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 wage increases and as your frailty increase is coming you are more likely to have the severe consequences of influenza. And that is true at the other spectrums as well as emphasized. This is why it was particularly concerning a couple of years ago when we were actually seeing the declining trends in coverage among people 65. Even if we are at the third of people 65 and over still are not getting influenza vaccine. We need to try to get an a for influenza vaccine coverage. Lets talk about the influenza vaccine. We are seeing more and more people working in our vibrant into their 80s and again theres certainly an increased aincreasethat they end up in thl that influenza can affect the daytoday activities. I think that there are very few of us, maybe there is no one in this room doesnt have contact on a daily or weekly basis with either grandparents or grandchildren or somebody with cancer or underlining long or Heart Disease. I very vividly remember a patient 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 was not out of circulating in the committee exposing herself to influenza at the grocery store. We brought influenza to her. So either the Healthcare Workers in that facility about her influenza were her family members and friends brought her that influenza so we need to think about that. And for older people it is especially important you may be taking care of a spouse that is more frail than you are or a four monthold grandchild who is too young to receive influenza vaccines. Influenza vaccines do work in people 65 and over. Not only prevents illness, but we have evidence that it also reduces the severity of illness. Even if you get the flu it is going to be less severe than if you havent received the flu shot so you are less likely to be hospitalized with influenza. The other good news is that the influenza market has responded. Two particularly addressed 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 decline in the system can start as early as 50. I am reluctant to admit our immune systems are not as robust to responding to the influenza vaccine. Vaccine. And so, in older people, we now have a high dose influenza vaccine which is exactly what it sounds like. Its the same content of the vaccine that everybody else receives. But it is four times the antigen. And its been shown to improve the response in people over 65 and prevent more elements and hospitalizations on people over 65. I think the most important messagemessage is any flu vaccis better than no flu vaccine. I use the term it is unpredictable and can occur at any time. It takes about two weeks after you get vaccine to give immune response that you need to fight the flu. So again, we dont want to wait. We want to get the vaccine now in case it gets in october, november. We will all be ready. Doctor price mentioned the Resources Available. I will quickly mention theres also Resources Available on the website and many are being distributed again. Finally, as doctor price mentioned, the pneumococcal vaccination is critical for adults 65 and older. For the younger couples with a number of medical conditions again from Heart Disease, lung disease, diabetes, people who smoke so this is a really good time. We are heading into flu season that we are alsbut we are also o pneumonia season. Its also a good time to encourage people 65 and over to get their pneumococcal vaccine. I think we can all help fight the flu by making annual influenza vaccination a priority by making this a priority. We are going to step up and get our vaccines today. Thank you. Please join us at the podium and you will be answering some of the questions also if you have a question these folks will find you please render to identify yourself and the media outlet that you represent. For the media participating by teleconference, the operator will come onto 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 were members of the supporting organizations present, one of our staff can arrange that for you immediately after the News Conference and now we are happy to receive your questions. How could we expect it to be and what do we make of the fact that its a tough year in parts of this. We had almost 600,000 hospitalizations thats almost as high as the 2014 and 2015 season so we had a bad season last year. In february from the Northern Hemisphere this following fall and the decisions we are making right now are for the summer in the Southern Hemisphere so they are continuously looking to see are there ways they can make that vaccine or by updating it so the decisions they make with this component was to address better performance of this particular vaccine virus so theres been a little bit of drift on change but not a significant mutation. The change is made so the vaccine that comes out is a better vaccine. Right now there are two vaccines in the flu block with proteins that are not affected by the change. As we were talking about before the News Conference, the proteins on the outside of the virus are still quite similar to whats in the current so we ought to be well prepared to. So if you need another reason to be vaccinated, there is a. Of nevada has the lowest rate in the country with regard to nevada have you talked to the officials there a. Does anybody have any good ideas here x. There is lots of different factors. We are trying to get a part of the population that doesnt normally get vaccines which is the Larger Population 18 to 49 those are the folks that are not used to doing it so its getting the folks to see the benefit of getting vaccinated. I think that as providers, we need to become even more forceful. Its one thing to say to a patient its that time of the year you ought to consider getting a flu vaccine as far as im concerned that opens the door for the patient to leave or maybe not. Its different say its that time of year we are vaccinating everyone in our practice you will be vaccinated on the way out just as ive been vaccinated, so being a vaccine and sister rather than recommender. Other comments, please. We have one from the teleconference. We have a question with web and the. You said its not only prevents illness but recent evidence suggests can you give a citation for that fact . Theres a few citations but the most recent was clinical Infectious Diseases i would have to give the exact number afterwards, but im happy to. It was a citation out of a Canadian Network and the interesting aspect of the publication is that certain adults over 65 years of age it was up to 78 advocation in preventing hospitalization. So it may be like others where we are used to hearing the 50 number and if its a relatively mild disease that we have more evidence now that perfection is likely greater for more severe disease, and im happy to give you the citation. I think i can find it just with that. Le carre the editorial. Thats good enough. We all know the influenza vaccine isnt perfect but its pretty darn good. Whats not in those effectiveness rates is partial protection that is given to people who might have been vaccinated, gotten influenza but they didnt have to go to the hospital and be admitted to the intensive care unit and as i like to say. They say im so pleased you are still here with us to complain because you didnt die of influenza so i think that is very important. The flu vaccine i like to quote or paraphrase that old french philosopher who said waiting for perfection is the great enemy of the current good and which is ws pretty good vaccine, we can do in awful lot of good. Theres a question right here. Since its so important for Healthcare Providers to be able to insist and make that the push to their patients what are some barriers that you are still finding as far as Healthcare Providers getting vaccinated so when the patient asks have you had yours, they can say that they have. Do you want to talk to that first . This is one of my tasks to get the 6500 employees vaccinated and i think a lot about the question. I think that its about understanding the importance about making it easy and accessible making it such where is your staff meeting we do so many different interventions and we dont have a mandate that some hospitals do. Its at 94 year over year so it really emphasizes the importance of making it easy and accessib accessible. I would also say support from the highest level of the administration all the way down. I agree with you i think the issue is understanding the barriers. Its certainly one being able to provide multiple different types of vaccinations is a vaccine and another at the Maryland Medical Center we are in the high 90 percentages. Its been shown more specifically the nurses and physicians and people in the hospitals who have regular contact are actually doing very well with those vaccination rates. We probably havent done as good a job as educating the support staff sometimes in the hospitals that we are not doing quite as well if you break down the Healthcare Worker box so again we need to take the same approach as and educate them. We need to make it easy for them to get a vaccine in the same way that weve done it for the physicians and nurses. It is a Patient Safety issue. We dont want to give the flu to their patients for whom we are providing care. Another question please. Im going to add it as a shock and even grownups dont like shots. People dont like needles and Healthcare Professionals just like the general population does. So, making the event is not just something to think about for children, its important to think about for adults so what do you do when you go against the flu shots which all of you will insert in, breathe through your mouth, just relax. Relax your arm, let it hang down like a spaghetti noodle, headed up slightly from your body and then imagine your favorite place in the whole wide world. The vaccine makes a difference in children and those over 65 but there is not the same evidence for healthy adults but seemed to be. So what is being done about that . Im not sure that i totally understand the question about the flu vaccine efficacy. It is influenza a bad illness. So in otherwise Healthy People who begin dont have underlying disease and young or middleaged adults are a far less likely to end up in the hospital or died of influenza. It still happens almost every single year in Young HealthyCollege Student and 40yearolds. Our influenza vaccines, efficacy i would actually disagree with that. There are randomized placebo trials and studies that support the influenza vaccines do work in the young and middleaged population. Certainly the immune responses are the most robust in that population if that is most of our evidence now. Generally, you randomized controlled trials and they are very expensive to do. How many do you need to do to show that the vaccine works. Im very happy afterwards. I think it is a specific question for the audience to provide you with those papers and the trials. Any questions . Thank you very much. Thank you all for joining us as we do every year lets hope for a quiet flu season. The best defense is a good offense. We all invite you to get vaccinated to help fight the flu. So, our nurses in the back will be happy to accommodate you. We have plenty of vaccines, so you all should get vaccinated also to help fight influenza and we thank you again for getting this message out to the general population of the United States. You are doing a terrific publict Public Health service each and every year. To my colleagues and friends here, thank you very much. [applause] [inaudible conversations]. Mental health care is currently offered suppose the the more people need to receive more treatment regardless of the quality. So now they will repeal obamacare the the Health Care System is such a fiasco that even if you have insurance doesnt mean you can care. So Congress Needs to provide services but they have to be good quality care. You as well as anyone would know the discussions over the decades and had we have meaningful quality outcome measurements . And offering those new methods but it isnt supplemented and theres no culture of the enforcement. That is why i have argued it is an epidemic of Behavioral Health even within the legal system because the reality of the malpractice attorneys is they dont take the case unless someone has died