#17,819
While we'll get the latest weekly FluView update later today, the above graphic shows the rate of mixed respiratory infections (Flu/COVID/RSV/ etc.) are rising rapidly - particularly across the southern tier of states - which has prompted the CDC to issue a HAN advisory for clinicians and for the public.
In our new post-pandemic reality, we have the added threat of seasonal COVID, along with influenza A & B and the usual mix of non-influenza viruses (RSV, Adenovirus, Rhiniovirus, Parainfluenza, etc.). We are also seeing outbreaks of Mycoplasma pneumonia - a CAP (Community Acquired Pneumonia) - both here in the United States and around the globe.
Against this backdrop of increased respiratory illness, we are also seeing a worrisome drop in the uptake of seasonal influenza vaccines, and even more disappointing uptake of the updated XBB monovalent COVID vaccine released last September.
With a new, and highly immune evasive JN.1 variant rapidly gaining ground in the U.S. (see CDC Update On SARS-CoV-2 Variant JN.1) - and existing immunity from previous vaccines or infections waning rapidly - there are genuine concerns we could see a winter surge in COVID hospitalizations.
The CDC is also tracking a rise in multisystem inflammatory syndrome in children (MIS-C), a rare but serious condition associated with COVID-19 infection.
When added to the expected seasonal burdens of influenza, RSV, and CAP, you have the potential for a severe respiratory season in months ahead. Already some hospitals are feeling the strain, and that could grow much worse after the holidays.
Yesterday the CDC published two releases. First, for the general public, in their Respiratory Viruses Update.
Peak Season for Respiratory Diseases Is Near: There Is Still Time to Get Vaccinated
December 14, 2023, 5:00 PM EDT
Low vaccination rates leave people at greater risk of serious illness
The end of 2022 was a December we might not want to remember, as the fall and winter virus season came early. The combination of COVID-19, influenza, and RSV strained emergency departments and hospitals across the United States.
COVID-19, influenza, and RSV activity are still below levels seen last year at this time. This season, illnesses have started later, returning to patterns typically seen before the COVID-19 pandemic. This means that the peak of respiratory illness activity is likely yet to come.
Respiratory illness activity is rising
COVID-19 hospitalizations are rising quickly. Since the summer, public health officials have been tracking a rise in multisystem inflammatory syndrome in children (MIS-C), which is caused by COVID-19. Influenza activity is growing in most parts of the country. RSV activity remains high in many areas. In some parts of the country, hospital beds for children are already nearly as full as they were this time last year. If these trends continue, the situation at the end of this month could again strain emergency departments and hospitals. Strain on the healthcare system could mean that patients with other serious health conditions may face delays in receiving care.
On December 14, CDC issued a Health Alert Network (HAN) advisory to healthcare providers and public health officials highlighting the increased respiratory disease activity occurring in the United States, particularly in the southern part of the country, and internationally. The HAN noted that low vaccination rates for COVID-19, influenza, and RSV could lead to more severe disease and a strained healthcare system for the rest of the season. These low rates can also lead to more days of missed work and school.
More than just respiratory viruses are spreading
Other respiratory germs are also circulating. This year, public health officials are also tracking a recent increase of pneumonia in children around the world, which can be caused by many types of bacteria, fungi, and viruses. Staying up to date with vaccines against pneumococcal disease and pertussis (whooping cough) can reduce the risk of pneumonia from those bacterial infections.
It’s worth noting that getting vaccinated against respiratory viruses can also help reduce the risk of getting pneumonia caused by bacteria and fungi. By preventing a viral infection, you keep your immune system strong and help prevent other germs from taking advantage when you’re sick.
Get vaccinated today
Getting yourself and your loved ones vaccinated will help keep all of you healthy during the holiday season and into the new year. If more Americans are protected against severe respiratory illnesses, we will likely see fewer hospitalizations. Lives can be saved.
Vaccination is especially important for people at higher risk of severe illness from respiratory diseases, including young children, older adults, people with underlying medical conditions, and pregnant people.
Find out who needs COVID-19, flu, and RSV vaccines during the 2023-2024 season. And, get all the details on vaccines recommended for:
The second update, a HAN Health Advisory, is primarily geared for clinicians and public health workers, although it will be of interest to some members of the public as well. Due to its length, I've only posted some excerpts. Follow the link to read it in its entirety.
Urgent Need to Increase Immunization Coverage for Influenza, COVID-19, and RSV and Use of Authorized/Approved Therapeutics in the Setting of Increased Respiratory Disease Activity During the 2023 – 2024 Winter Season
Distributed via the CDC Health Alert Network
December 14, 2023, 12:15 PM ET
CDCHAN-00503
Summary
The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Advisory to alert healthcare providers to low vaccination rates against influenza, COVID-19, and RSV (respiratory syncytial virus). Low vaccination rates, coupled with ongoing increases in national and international respiratory disease activity caused by multiple pathogens, including influenza viruses, SARS-CoV-2 (the virus that causes COVID-19), and RSV, could lead to more severe disease and increased healthcare capacity strain in the coming weeks.In addition, a recent increase in cases of multisystem inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection in the United States has been reported Healthcare providers should administer influenza, COVID-19, and RSV immunizations now to patients, if recommended. Healthcare providers should recommend antiviral medications for influenza and COVID-19 for all eligible patients, especially patients at high-risk of progression to severe disease such as older adults and people with certain underlying medical conditions. Healthcare providers should also counsel patients about testing and other preventive measures, including covering coughs/sneezes, staying at home when sick, improving ventilation at home or work, and washing hands to protect themselves and others against respiratory diseases.
Background
Reports of increased respiratory disease have been described in multiple countries recently. CDC is tracking increased respiratory disease activity in the United States for several respiratory pathogens, including influenza viruses, SARS-CoV-2, and RSV,across multiple indicators such as laboratory test positivity, emergency department visits, wastewater, and hospitalizations. Currently, the highest respiratory disease activity in the United States is occurring across the southern half of the country, with increasing activity in northern states.
In the past 4 weeks, hospitalizations among all age groups increased by 200% for influenza, 51% for COVID-19, and 60% for RSV. As of December 1, 2023, the weekly percentages of pediatric emergency department visits for pneumonia due to multiple etiologies were increasing since September in children, but remains consistent with prior fall and winter respiratory activity. To date, 12 pediatric influenza deaths have been reported during the 2023–2024 season. From September 1 through December 10, 2023, CDC received 30 reports of MIS-C, a rare complication that typically occurs 1 month after SARS-CoV-2 infection, with illness onset among cases occurring from August 6 to November 9, 2023, a relative increase compared with previous months. High RSV activity is also occurring across much of the United States.
Influenza, COVID-19, and RSV can result in severe disease, especially among unvaccinated persons. Infants, older adults, pregnant people, and people with certain underlying medical conditions remain at increased risk of severe COVID-19 and influenza disease. Infants and older adults remain at highest risk of severe RSV disease; it is the leading cause of infant hospitalization in the United States.
Vaccination for influenza, COVID-19, and RSV reduces the risk of severe disease, including pneumonia, hospitalization, and death. Vaccination for COVID-19 can also reduce the risk of MIS-C and post-COVID conditions.
- Influenza vaccination: Vaccination coverage for the seasonal 2023-2024 influenza vaccine is low in all age groups compared with the same period of the 2022–2023 season (Table 1). As of November 18, 2023, there were 7.4 million fewer influenza vaccine doses administered to adults in pharmacies and physician offices compared with the 2022–2023 influenza season.
- COVID-19 vaccination: Vaccination coverage for the updated 2023-2024 COVID-19 vaccine remains low. As of December 2, 2023, the percent of the population reporting receipt of this vaccine was 7.7% in children 6 months–17 years (including 2.8% in children 6 months–4 years), 17.2% in adults ≥18 years (including 36% in adults ≥65 years), and 9.6% in pregnant persons.
- RSV vaccination: As of December 2, 2023, 15.9% of U.S. adults aged ≥60 years reported receiving an RSV vaccine.
Key reasons for low vaccination uptake of influenza, COVID-19, and RSV vaccines based on survey results from a nationally representative sample of U.S. adults (Ipsos KnowledgePanel and NORC AmeriSpeak Omnibus Surveys), include:
- lack of provider recommendation,
- concerns or issues about unknown or serious side effects,
- occurrence of mild side effects, and
- lack of time or forgetting to get vaccinated.
Recommendations for Healthcare Providers
Healthcare providers should administer influenza, COVID-19, and RSV immunizations now to patients, if recommended. Immunizations can prevent hospitalization and death associated with these respiratory diseases. Immunizations are especially important for people at increased risk for severe disease, including infants, older adults, pregnant people, and people with certain underlying medical conditions. COVID-19 vaccination can also reduce the chance of MIS-C and post-COVID conditions. Vaccination of pregnant people against influenza and COVID-19 protects both the patient and their infants who are too young to be vaccinated. Vaccination of pregnant people against RSV protects the infant against RSV after birth and is especially important given supply issues with nirsevimab this season. Antiviral medications for influenza and COVID-19 should be recommended for all eligible patients, especially patients at high-risk of progression to severe disease such as older adults and people with certain underlying medical conditions.
Although we often see calls from the CDC urging increased uptake of vaccines before the holidays, the sense of urgency behind these messages is unmistakable.
Sadly, between incessant and highly misleading vaccine information on social media - and inevitable pandemic fatigue after 4 frustrating years of COVID - it is getting harder to convince the public to roll up their sleeves for seasonal and routine vaccinations.
Hopefully it won't take a devastatingly severe inter-pandemic flu season to turn public opinion around.
