WEBVTT 1 00:00:21.270 --> 00:00:32.820 COCA CDC (Moderator): Good afternoon. I'm commander he bought con and I'm representing the clinician outreach and communication activity coca with the emergency risk communication branch of the Centers for Disease Control and Prevention. 2 00:00:34.020 --> 00:00:42.300 COCA CDC (Moderator): I like to welcome you to today's cocoa call 2022 2021 influenza vaccine recommendations and clinical guidance during the covert 19 pandemic. 3 00:00:44.160 --> 00:00:51.120 COCA CDC (Moderator): Pre continuing education is offered for this webinar instructions on how to earn continuing education will be provided at the end of the call. 4 00:00:52.230 --> 00:01:02.280 COCA CDC (Moderator): In compliance with continuing education requirements CDC our planners our presenters and their spouses, partners wish to disclose. They have no financial interests or other relationships. 5 00:01:02.580 --> 00:01:12.030 COCA CDC (Moderator): With the manufacturers of commercial products suppliers of commercial services or commercial supporters planners have reviewed content to ensure there is no bias. 6 00:01:12.630 --> 00:01:18.420 COCA CDC (Moderator): Content will not include any discussion of the unlabeled use of a product or a product under investigation use 7 00:01:18.780 --> 00:01:28.320 COCA CDC (Moderator): Except Captain Lisa gross coughs discussion on the recommendations of the Advisory Committee on Immunization Practices With Dr. Girls scarf is the CDC lead for the influence of our group. 8 00:01:29.190 --> 00:01:38.730 COCA CDC (Moderator): The ACP recommendations for persons with a history of severe allergic reaction to egg is labelled contradiction. The country indication for receipt of most influence of vaccines. 9 00:01:39.210 --> 00:01:50.760 COCA CDC (Moderator): However, is tip recommends that person's with egg allergies. You have any severity should receive any license influenza vaccine appropriate for their agent health status. This will be further explained during the presentation. 10 00:01:52.050 --> 00:02:03.030 COCA CDC (Moderator): At the conclusion of the session, the participant will be able to accomplish the following summarize updates to a Civ recommendations for the 2022 2021 influenza vaccination season. 11 00:02:03.660 --> 00:02:16.950 COCA CDC (Moderator): Discuss the standards for adult immunization practice in general vaccination guidance during the covert 19 pandemic and described flu vaccination planning and guidance for large vaccination clinics held in satellite temporary or off site locations. 12 00:02:19.380 --> 00:02:25.170 COCA CDC (Moderator): All participants. Joining us today are in listen only mode. After the presentation. There will be a Q AMP a session. 13 00:02:26.040 --> 00:02:37.290 COCA CDC (Moderator): You may submit questions at any time during the presentation to ask a question using the webinar system. Click the Q AMP a button at the bottom of your screen. Then type your question in the Q AMP a box and submit your question. 14 00:02:38.940 --> 00:02:50.130 COCA CDC (Moderator): Due to unforeseen technical difficulties. Closed captioning is not available for the live webinar today. However, you will be able to access the on demand version with this feature. Once it's posted to the cocoa page. 15 00:02:52.560 --> 00:02:59.130 COCA CDC (Moderator): The video recording of this cocoa call will be posted on coca web page and available to view on demand a few hours after the call ends. 16 00:03:00.870 --> 00:03:03.900 COCA CDC (Moderator): If you are a patient, please refer your questions to your health care provider. 17 00:03:05.280 --> 00:03:15.690 COCA CDC (Moderator): For those who have media questions, please contact CDC Media Relations at 404-639-3286 or send an email to media at CDC dot Govt 18 00:03:18.330 --> 00:03:24.780 COCA CDC (Moderator): I would now like to welcome our presenters for today's cocoa call, we are pleased to have with us. Captain Lisa grow scarf. 19 00:03:25.170 --> 00:03:38.340 COCA CDC (Moderator): The influencer ACP lead with the epidemiology and prevention branch in the influencer division at CDC Lieutenant Commander Tara gentler way, who is a co lead for the influencer response team in the vaccine planning unit at CDC. 20 00:03:39.810 --> 00:03:50.340 COCA CDC (Moderator): And Captain any Parker fiber corn, who is a co lead for the influencer response team in the vaccine planning unit CDC as well. I'll turn it over to Captain Lisa grow scoffs Captain gross cough. 21 00:03:50.460 --> 00:03:51.270 Please proceed. 22 00:03:53.580 --> 00:03:58.230 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Thank you very much and thanks everyone for being here today. We're going to move on to Slide two 23 00:04:00.870 --> 00:04:11.850 Lisa Grohskopf, MD, MPH, CAPT, USPHS: So I'll be highlighting some aspects of the ACP influenza vaccine recommendations for this year. Before getting started, just a quick reminder about the vaccine abbreviations. We use because you'll see them on the slides. 24 00:04:13.380 --> 00:04:26.790 Lisa Grohskopf, MD, MPH, CAPT, USPHS: We have essentially the same three main types of vaccine for the season. We still have the three main types and activated influence of vaccines or IV use recombinant influenza vaccine or our IV and live attenuated influenza vaccine or La IV. 25 00:04:27.600 --> 00:04:35.880 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Numbers after these letters, tell us whether the vaccine is tribe calendar Quadro Vaillant both kinds of to a viruses in each one and one and an H3 into 26 00:04:36.300 --> 00:04:42.990 Lisa Grohskopf, MD, MPH, CAPT, USPHS: The main difference between these is the number of influence of the viruses in the vaccine try balance have one Quadro valence have to 27 00:04:44.190 --> 00:05:01.080 Lisa Grohskopf, MD, MPH, CAPT, USPHS: For the inactivated vaccines are Ivy's when we need to refer specifically to a few particular kinds. We use CC IV for the cell culture based vaccine. A IV for the advent of vaccine and HDI be for the high dose vaccine. Next slide please. 28 00:05:03.900 --> 00:05:04.980 Lisa Grohskopf, MD, MPH, CAPT, USPHS: So moving on to the 29 00:05:06.600 --> 00:05:19.530 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Influenza statement, the core recommendation is unchanged from previous seasons annual influenza vaccination is recommended for all persons age six months and older, we did not have contraindications. Next slide please. 30 00:05:23.190 --> 00:05:37.860 Lisa Grohskopf, MD, MPH, CAPT, USPHS: This slide gives an overview of the updates for this year, the primary updates include discussion of the US influenza vaccine viral composition for the season, as well as discussion of to newly licensed vaccines Luzon high dose Quadro Vaillant and fluid quadri balance. 31 00:05:39.120 --> 00:05:55.710 Lisa Grohskopf, MD, MPH, CAPT, USPHS: There are also updates in the discussion of live attenuated influence vaccine and influence antivirals in the discussion and table of content indications and precautions to influenza vaccination and in the recommendations for persons with a history of severe egg allergy. 32 00:05:57.060 --> 00:05:57.870 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Next slide please. 33 00:06:01.650 --> 00:06:03.900 Lisa Grohskopf, MD, MPH, CAPT, USPHS: First, let's go over a few points concerning the 34 00:06:05.100 --> 00:06:07.050 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Influenza Vaccine composition 35 00:06:08.280 --> 00:06:17.460 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Because it was the vaccines are constantly changing influenza vaccine viral composition is reevaluated each season by the World Health Organization and the Food and Drug Administration. 36 00:06:17.910 --> 00:06:23.880 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Review global influence of surveillance data in February and March of each year ahead of each influenza season. 37 00:06:24.900 --> 00:06:36.840 Lisa Grohskopf, MD, MPH, CAPT, USPHS: This slide summarizes the composition for us vaccines for the 20 2021 season. You'll also find this list in the ACP statement, rather than to read through it. I just want to point out a few things. 38 00:06:37.710 --> 00:06:43.200 Lisa Grohskopf, MD, MPH, CAPT, USPHS: One is that you'll see that there are separate compositions listed for egg based and non egg based vaccines. 39 00:06:43.860 --> 00:06:53.970 Lisa Grohskopf, MD, MPH, CAPT, USPHS: This might appear to be new, but isn't really each season, a number of candidate vaccine viruses are selected that are energetically similar to the viruses that are expected to circulate 40 00:06:54.570 --> 00:07:00.990 Lisa Grohskopf, MD, MPH, CAPT, USPHS: They're also selected on the basis of how well they can grow in the medium, that's going to be used in manufacturing for the specific vaccine. 41 00:07:02.190 --> 00:07:11.010 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Because we now have some non egg based vaccines for the past few seasons. Some viruses have been selected that are egg derived and some that are cell derived 42 00:07:11.760 --> 00:07:18.810 Lisa Grohskopf, MD, MPH, CAPT, USPHS: The important thing to remember is that they are antigenic Lee similar to one another and to the viruses that are expected to circulate in the coming season. 43 00:07:20.550 --> 00:07:25.770 Lisa Grohskopf, MD, MPH, CAPT, USPHS: As an extension of that concept. You'll notice that after the name of each virus, we have the word like 44 00:07:26.670 --> 00:07:40.380 Lisa Grohskopf, MD, MPH, CAPT, USPHS: This is because, in general, there can be more than one specific virus that is similar to the listed one and can be used. That's why sometimes when you look at an influenza vaccine package insert the specific name of the virus might differ from what is on this list. 45 00:07:42.300 --> 00:07:56.790 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Finally, I want to point out that the viruses in red are the ones which have been updated with last since last season influence that ah one and one age three and two and be Victoria viruses. The be Yamagata virus is unchanged since last season. 46 00:07:58.380 --> 00:07:59.190 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Next slide please. 47 00:08:04.740 --> 00:08:17.370 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Sorry, one sec. Here we go. Next, um, as mentioned, the top of the presentation. We have two newly licensed vaccines. This chart tries to put those into the context of all the vaccines that are expected to be available this season. 48 00:08:17.970 --> 00:08:25.230 Lisa Grohskopf, MD, MPH, CAPT, USPHS: 20 2021 we expect will have a total of 10 individual vaccines. This slide breaks them down by the age groups for which there are approved. 49 00:08:26.370 --> 00:08:38.850 Lisa Grohskopf, MD, MPH, CAPT, USPHS: A few comments here. One is that for this season. Nearly all of the available vaccines will be Quadro Vaillant one exception is the edge invented IV fluid which is a try valid vaccine or IV three 50 00:08:39.870 --> 00:08:49.410 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Next, as in previous seasons no influence of vaccines are currently licensed for children under six months of age. So influenza vaccination starts with age six months. 51 00:08:50.580 --> 00:09:00.480 Lisa Grohskopf, MD, MPH, CAPT, USPHS: For children in the age group six through 35 months. There are a few important points related to the inactivated vaccines, with regard to how they are dosed we'll go over that on a later slide. 52 00:09:01.800 --> 00:09:08.400 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Note that from any age groups. If you scan the green areas of the chart, there's more than one vaccine that's appropriate to use based on age alone. 53 00:09:09.180 --> 00:09:18.780 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Well, in general, any given vaccination setting, of course, will not have stopped all 10 vaccines. It's possible that you may have situations where more than one appropriate vaccine is available for a given recipients 54 00:09:19.560 --> 00:09:26.250 Lisa Grohskopf, MD, MPH, CAPT, USPHS: However, currently ACP expresses no preference for any one influenza vaccine over another were more than was appropriate. 55 00:09:28.560 --> 00:09:40.710 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Next briefly concerning Li before, just a reminder that it's licensed for ages two through 49 years and is not recommended for some groups, including pregnant women and people with certain chronic medical conditions will discuss this a little more later. 56 00:09:42.060 --> 00:09:47.100 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Lastly, the new vaccines. Both of these are vaccines that are approved for ages 65 years and older. 57 00:09:47.640 --> 00:09:59.490 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Is a flus on high dose quarter Vaillant which is expected to replace the previous trial and formulation of Luzon high dose and fluid Quadro balance which will be available in addition to the previous tribal and formulation of fluid. 58 00:10:01.350 --> 00:10:02.130 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Next slide please. 59 00:10:05.970 --> 00:10:15.660 Lisa Grohskopf, MD, MPH, CAPT, USPHS: So a little more about these two new influenza vaccine. Specifically, they're both an activated influence of vaccines or Ivy's again licensed only for 65 years of age and older. 60 00:10:16.140 --> 00:10:27.330 Lisa Grohskopf, MD, MPH, CAPT, USPHS: They're both Quadro valid versions of vaccines for which we've previously had previous tribal and counterparts. So the main differences that there's the addition of the second influenza B virus and the vaccine. 61 00:10:28.410 --> 00:10:39.240 Lisa Grohskopf, MD, MPH, CAPT, USPHS: lucid high dose quadruple, it was licensed by FDA and November 2019 and like the previous tribal and formulation of high dose it contains four times the amount of hemoglobin antigen per virus. 62 00:10:39.480 --> 00:10:47.160 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Compared to a standard dose and activated vaccine. It's 60 micrograms per virus as compared to 15 micrograms in a standard dose IV. 63 00:10:47.940 --> 00:11:02.400 Lisa Grohskopf, MD, MPH, CAPT, USPHS: It's going to replace the previous travail and high dose vaccine for this season. It's also a little different than some of the other inactivated vaccines and that the dose volume. The volume that's in that pre filled syringe is slightly higher at 0.7 ML rather than 0.5 ML. 64 00:11:04.080 --> 00:11:16.920 Lisa Grohskopf, MD, MPH, CAPT, USPHS: lot quieter balance was licensed in February 2020 like it's tribal and predecessor fluid. It contains MF 59 adjutant it's expected for this season that both try valid and Quadro valence fluid will be available. 65 00:11:18.750 --> 00:11:19.290 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Next slide. 66 00:11:22.890 --> 00:11:28.560 Lisa Grohskopf, MD, MPH, CAPT, USPHS: So on to the next update with regard to influence antivirals and Li before 67 00:11:29.670 --> 00:11:36.840 Lisa Grohskopf, MD, MPH, CAPT, USPHS: The ACP statement for several years has contained guidance concerning use of influence antivirals, which was also time of reruns enamel here. 68 00:11:37.230 --> 00:11:47.580 Lisa Grohskopf, MD, MPH, CAPT, USPHS: In the context of giving lamb for for vaccination and that guidance has been that antivirals given from 48 hours before to two weeks after the administration of La before 69 00:11:47.970 --> 00:11:57.000 Lisa Grohskopf, MD, MPH, CAPT, USPHS: May interfere with the at the activity or the action of the vaccine this guidance reflects information that's also a fan and the lamb for package insert 70 00:11:58.380 --> 00:12:09.480 Lisa Grohskopf, MD, MPH, CAPT, USPHS: In recent seasons. We've seen the development of newer influenza antiviral agents for example parameter and bulk severe which have longer half lives than the older agents also Tamar variance enamel here. 71 00:12:10.380 --> 00:12:17.850 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Now I should say it's not known for certain whether any of these medications actually interfere with the action of La I before because it hasn't been studied. 72 00:12:18.450 --> 00:12:29.310 Lisa Grohskopf, MD, MPH, CAPT, USPHS: However, Li before contains live viruses which have to multiply in the nasal passages so interferences biologically plausible, which is probably why it's something that's acknowledged on the LA IV package insert 73 00:12:30.600 --> 00:12:39.360 Lisa Grohskopf, MD, MPH, CAPT, USPHS: In the absence of specific data or study of the situation based on the half lives of the individual medications and assuming normal medication clearance 74 00:12:39.690 --> 00:12:45.090 Lisa Grohskopf, MD, MPH, CAPT, USPHS: The following windows are proposed as guidance to consider is periods where interference with lamb might be an issue. 75 00:12:45.690 --> 00:13:02.880 Lisa Grohskopf, MD, MPH, CAPT, USPHS: For also tam events and NAM of your from 48 hours before to two weeks after lamb for for parameter from five days before to two weeks after Li before and for blocks of year, which has a rather long half life of 79 hours from 17 days before to two weeks after Li before 76 00:13:04.290 --> 00:13:05.130 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Next slide please. 77 00:13:09.090 --> 00:13:18.990 Lisa Grohskopf, MD, MPH, CAPT, USPHS: The next area of update or concerns Li before us and settings of a splendid cochlear implant and active cranium of cerebral spinal fluid weeks. 78 00:13:19.950 --> 00:13:28.320 Lisa Grohskopf, MD, MPH, CAPT, USPHS: On this is some updated information in the previous seasons guidance. These conditions were discussed in the section on immunocompromised hosts. 79 00:13:28.770 --> 00:13:42.690 Lisa Grohskopf, MD, MPH, CAPT, USPHS: And in that section. It was recommended that other vaccines, other than LA for be used in these populations as there's insufficient data under use in these populations and alternative vaccines are available, such as an activated a recombinant vaccine. 80 00:13:43.830 --> 00:13:50.910 Lisa Grohskopf, MD, MPH, CAPT, USPHS: For this season. These conditions have been added to the list of contra indications for LA I before or table to them. The guidance. 81 00:13:52.110 --> 00:14:02.700 Lisa Grohskopf, MD, MPH, CAPT, USPHS: One. Not specifically concerning cochlear implant the basis of this recommendation that la before not be used as that for some period of time after implantation of a cochlear implant to there can be a CSF leak. 82 00:14:03.360 --> 00:14:18.030 Lisa Grohskopf, MD, MPH, CAPT, USPHS: In the event that an age appropriate injectable vaccine, such as I I V or RV can't be used the table also contains a footnote, suggesting consultation with an expert regarding risk for persistent CSF leak in the particular case in the individual recipient. 83 00:14:20.820 --> 00:14:21.600 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Next slide please. 84 00:14:25.500 --> 00:14:30.150 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Explanation of persons with egg allergy. This is the last among the updates. 85 00:14:30.990 --> 00:14:38.340 Lisa Grohskopf, MD, MPH, CAPT, USPHS: And it specifically concerns, those with a history of severe allergic reaction to egg, which is defined for our purposes, any symptom, other than hives. 86 00:14:38.880 --> 00:14:41.070 Lisa Grohskopf, MD, MPH, CAPT, USPHS: As mentioned at the top of our session. 87 00:14:41.670 --> 00:14:44.010 Lisa Grohskopf, MD, MPH, CAPT, USPHS: History of severe allergic reaction to the vaccine or 88 00:14:44.040 --> 00:14:56.190 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Any of its components, including egg is a label country indication for most inactivated influenza vaccines and also for LA IV, because those are egg based vaccines and might contain residual quantities of old albumin or other egg proteins. 89 00:14:56.760 --> 00:15:07.830 Lisa Grohskopf, MD, MPH, CAPT, USPHS: However, is tip has recommended for several seasons. Now that person's with a history of severe egg allergy have any severity, whether it's mild severe reaction to egg should receive influenza vaccine. 90 00:15:09.030 --> 00:15:17.340 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Specifically for the case of those that have a history of severe reaction to egg that is that have any symptom of other in high, other than hives and response to egg congestion. 91 00:15:17.820 --> 00:15:26.760 Lisa Grohskopf, MD, MPH, CAPT, USPHS: It was recommended that those individuals get their vaccine in a medical setting supervised by healthcare provider who's able to recognize and manage severe allergic reactions. 92 00:15:27.750 --> 00:15:36.030 Lisa Grohskopf, MD, MPH, CAPT, USPHS: We currently have two egg free vaccines. Now, however, and so the guidance has now been updated to reflect that for these individuals. 93 00:15:36.390 --> 00:15:42.120 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Specifically, if a vaccine, other than CC IV for the cell culture based vaccines. 94 00:15:42.510 --> 00:15:50.070 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Or our ID for the recombinant vaccine is selected. It is recommended that is be administered in an inpatient or outpatient medical setting. 95 00:15:50.400 --> 00:16:02.460 Lisa Grohskopf, MD, MPH, CAPT, USPHS: supervised by health care provider who's able to manage severe allergic reactions. So this additional safety measure of having the additional medical the medical setting and a person who can recognize your allergic reactions. 96 00:16:02.790 --> 00:16:10.440 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Is specifically event the vaccine, other than CCI before or are before or two egg free vaccines is used. Next slide. 97 00:16:15.000 --> 00:16:21.840 Lisa Grohskopf, MD, MPH, CAPT, USPHS: That completes the updates. I want to highlight a couple of points concerning vaccines for children ages six through 35 months. 98 00:16:23.610 --> 00:16:27.510 Lisa Grohskopf, MD, MPH, CAPT, USPHS: And specifically, this is about our an activated influenza vaccines. 99 00:16:27.990 --> 00:16:38.280 Lisa Grohskopf, MD, MPH, CAPT, USPHS: There for quite rebalance inactivated influenza vaccine or IP for is that are licensed for this age group. I just want to highlight that the volume of these vaccines per dose. 100 00:16:38.910 --> 00:16:48.270 Lisa Grohskopf, MD, MPH, CAPT, USPHS: This age group is different for the various vaccines here should be taken that the vaccine being used as being given at the appropriate dose volume for 101 00:16:51.300 --> 00:17:01.980 Lisa Grohskopf, MD, MPH, CAPT, USPHS: The appropriate volume is 0.5 mil per dose. Both of these vaccines are available. I believe only as pre filled syringes. The season, which simplifies things as far as selecting the appropriate dose volume. 102 00:17:03.120 --> 00:17:08.610 Lisa Grohskopf, MD, MPH, CAPT, USPHS: A flurry acquired. Your valid is approved for this age group at 0.25 ml per dose only 103 00:17:09.960 --> 00:17:20.100 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Lose on quadruple, it may be given at either 0.25 or 0.5 mm per dose for this age group. Both of those are approved those volumes. According to the FDA. 104 00:17:20.670 --> 00:17:34.920 Lisa Grohskopf, MD, MPH, CAPT, USPHS: The FDA approved packaging information just to note though that for flu zone Quadro Vaillant which was previously available and 0.25 mo pre filled syringes, it is no longer available in the 0.25 ML pre field pre filter interest for the season. 105 00:17:36.570 --> 00:17:37.020 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Next slide. 106 00:17:42.030 --> 00:17:53.910 Lisa Grohskopf, MD, MPH, CAPT, USPHS: So some final points that I just want to go over concerning the importance of influenza vaccine. The season and I'm actually going to start with some results from the US movie network that's our CDC network of five. 107 00:17:54.660 --> 00:18:10.050 Lisa Grohskopf, MD, MPH, CAPT, USPHS: healthcare organizations that study and monitor vaccine effectiveness each season. This is data that was presented at the June 24 ACP meeting its data that's complete as of June 9 2020 this preliminary so these figures will be adjusted over time. 108 00:18:11.250 --> 00:18:14.070 Lisa Grohskopf, MD, MPH, CAPT, USPHS: But we thought it would be useful to illustrate some points. 109 00:18:14.520 --> 00:18:22.650 Lisa Grohskopf, MD, MPH, CAPT, USPHS: influenza vaccine effectiveness varies with a number of factors, including the agent health of the recipient and the types and subtypes of influenza viruses that are circulating 110 00:18:23.010 --> 00:18:27.210 Lisa Grohskopf, MD, MPH, CAPT, USPHS: And also, importantly, the degree of match between the vaccine viruses and the circulating viruses. 111 00:18:28.050 --> 00:18:33.780 Lisa Grohskopf, MD, MPH, CAPT, USPHS: This slide shows preliminary data from us movie network for this past season 2019 2020 112 00:18:34.530 --> 00:18:46.740 Lisa Grohskopf, MD, MPH, CAPT, USPHS: And you can see that the overall for any influenza vaccine effectiveness was estimated at 39% as of that date was slightly higher for the be viruses than it was for the viruses that were in the sample as at that 113 00:18:48.330 --> 00:18:48.810 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Next slide. 114 00:18:51.870 --> 00:19:02.010 Lisa Grohskopf, MD, MPH, CAPT, USPHS: So, as we mentioned influenza vaccine effectiveness does vary from season to season and in a season where match is good between the vaccine and the circulating viruses. We can generally expect 115 00:19:02.820 --> 00:19:08.670 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Effectiveness of approximately 40 to 60% for influenza vaccine. However, in some seasons. He is lower. 116 00:19:09.300 --> 00:19:27.270 Lisa Grohskopf, MD, MPH, CAPT, USPHS: I wanted to use this example the 20 1819 season were estimated vaccine effectiveness for the season was 29% overall and estimated vaccine covered was only a little less than half overall 49%. However, despite those factors estimated burden diverted through vaccination for that season. 117 00:19:28.320 --> 00:19:36.900 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Was 4.4 million illnesses 58,000 hospitalizations associated with influenza and 3500 influenza related deaths. 118 00:19:37.650 --> 00:19:43.200 Lisa Grohskopf, MD, MPH, CAPT, USPHS: These points highlight that potentially even greater importance of influenza vaccine. 119 00:19:43.470 --> 00:19:54.300 Lisa Grohskopf, MD, MPH, CAPT, USPHS: During the coming influenza season as a means to reduce the overall burden of acute respiratory illness in our communities and healthcare systems, particularly in a setting where we're going to have co circulation of code 19 120 00:19:55.410 --> 00:19:55.920 Next slide. 121 00:19:58.890 --> 00:20:05.610 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Briefly, because this is something that comes up frequently we get questions this time of year about southern hemisphere influence activity. 122 00:20:06.570 --> 00:20:12.780 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Just some brief comments for this year southern hemisphere influenza activity has been reported at much lower rates than is typical. 123 00:20:13.140 --> 00:20:17.730 Lisa Grohskopf, MD, MPH, CAPT, USPHS: If you were countries are reporting data and fewer viruses overall are being reported in general. 124 00:20:18.240 --> 00:20:26.970 Lisa Grohskopf, MD, MPH, CAPT, USPHS: From the data that are available. It does seem that ah one in 1pm oh 983 and two and be Victoria viruses are co circulating 125 00:20:27.900 --> 00:20:36.930 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Important points to consider here is that it's possible that social distancing and other preventive measures to produce reduce spread of source code to may have helped reduce spread of influenza viruses. 126 00:20:37.260 --> 00:20:47.910 Lisa Grohskopf, MD, MPH, CAPT, USPHS: It's also possible that the coven 19 pandemic has influenced tell seeking behaviors and testing priorities and capacities. These factors make interpretation of the current surveillance information somewhat challenging 127 00:20:49.050 --> 00:20:49.620 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Next slide. 128 00:20:52.200 --> 00:20:53.700 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Looking forward to our upcoming 129 00:20:54.750 --> 00:21:03.210 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Northern Hemisphere influenza season. It's really unclear present what impact the ongoing Copa 19 pandemic will have on the upcoming influenza season here in the US. 130 00:21:03.600 --> 00:21:09.000 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Or maybe less influenza than usual because of social distancing and other measures to reduce spread of stars Kofi to 131 00:21:09.540 --> 00:21:17.610 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Influenza virus and stars, Coby to Maiko circulate and people may conceivably be Kovac co infected with influence and source code to 132 00:21:18.300 --> 00:21:25.800 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Present some stars copy to influence at the same time, good place tremendous burden on the healthcare system and result in many illness hospitalizations and deaths. 133 00:21:26.220 --> 00:21:32.760 Lisa Grohskopf, MD, MPH, CAPT, USPHS: This again highlights the importance of influenza vaccination as a tool to help reduce the overall burden of acute respiratory illnesses season. 134 00:21:34.140 --> 00:21:39.210 Lisa Grohskopf, MD, MPH, CAPT, USPHS: And I believe that's my next last slide, I would like to turn it over to Kevin 135 00:21:42.240 --> 00:21:45.690 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Thank you, Captain gross coffin. Good afternoon, everyone. 136 00:21:48.720 --> 00:21:59.310 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Today I'll be presenting the standards for adult immunization, and we'll review interim guidance for immunization services during the pivot 19 pandemic. Next slide. 137 00:22:03.180 --> 00:22:10.950 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: As the ACP makes recommendations for routine vaccination of adults. The standards for implementing those recommendations. 138 00:22:11.670 --> 00:22:18.810 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Have been released from the National Vaccine advisory committee with the last update published in 2014 139 00:22:19.470 --> 00:22:29.310 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: The purpose of the standards is to provide guidance across the spectrum of healthcare delivery, including healthcare providers higher level systems and organizations. 140 00:22:29.700 --> 00:22:42.270 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: And public health departments to promote vaccination all providers, including those who do and those who don't provide vaccinations have an important role in ensuring patients receive recommended vaccinations. 141 00:22:42.960 --> 00:22:53.310 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: According to the standards all providers should incorporate immunization needs assessment into every clinical encounter and should strongly recommend needed vaccines. 142 00:22:54.120 --> 00:23:05.700 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Which has been shown to influence patients decisions to receive vaccines providers should either administer those vaccines or refer patients to a provider who can immunize 143 00:23:06.300 --> 00:23:15.000 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: It's the providers responsibility to stay up to date on and educate patients about vaccine recommendations which you are doing today. 144 00:23:15.540 --> 00:23:29.100 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Finally providers should document vaccines received by their patients in state vaccine registries. And while these may not happen in the medical home assessment again remains important. Next slide. 145 00:23:32.820 --> 00:23:40.920 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: For those in the audience who have a role in healthcare related organizations associations or systems. The following standards apply 146 00:23:41.700 --> 00:23:56.190 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Provide immunization education and training of members, including trainees provide resources to implement protocols to routinely assess vaccinate or refer encourage members to be up to date on their own immunizations. 147 00:23:56.670 --> 00:24:05.430 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Partner with other immunization stakeholders to educate the public seek out collaboration opportunities with other immunization stakeholders. 148 00:24:05.730 --> 00:24:13.950 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Collect and share best practices for immunization and advocate policies that support adult immunization standards. 149 00:24:14.370 --> 00:24:25.860 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Finally ensures payers entities assure their network is adequate to provide timely immunization access and augment with additional vaccination providers, if necessary. Next slide. 150 00:24:31.320 --> 00:24:41.370 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Successful vaccination programs use a combination of approaches that are evidence based and include strategies listed here which you can find in the Community Guide 151 00:24:42.060 --> 00:24:56.010 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: In the vaccine section with the link at the bottom of this slide. These include having an immunization champion and management support as well as effective policy provider assessment and feedback. 152 00:24:56.760 --> 00:25:09.870 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Programmatically it's important to have vaccinations on site to reduce financial barriers implement standing orders for vaccination, as well as reminder recall systems and the use of information in 153 00:25:10.620 --> 00:25:22.980 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Immunization information systems or is patient values and needs should also be assessed and incorporated into communications as well as provider recommendations. Next slide. 154 00:25:25.620 --> 00:25:31.470 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: As I mentioned before, a strong vaccine recommendation from a health care provider is critical. 155 00:25:32.370 --> 00:25:39.330 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Adults believe vaccines are important and are likely to get them if recommended by their health care provider. 156 00:25:39.870 --> 00:25:52.800 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: CDC series of how I recommend videos feature a variety of health care professionals walking through how they make a strong vaccine recommendation to a variety of adult patients. Next slide. 157 00:25:56.850 --> 00:26:17.220 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: There's a med scape module highlighted here that provides some scenarios for vaccines for a certain patient populations and can also be extremely helpful in learning how to give a strong recommendation and there's a few examples for influence a here as well. 158 00:26:18.690 --> 00:26:19.290 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Next slide. 159 00:26:24.270 --> 00:26:32.670 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: In the next few slides I'm going to be reviewing interim guidance for vaccination during the pandemic. Next slide. 160 00:26:37.350 --> 00:26:47.850 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: The main message of the guidance include those listed here. The guidance identifies vaccination as an essential medical service for all children and adolescents. 161 00:26:48.210 --> 00:26:59.070 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: That ideally should be delivered in the medical home all do are overdue vaccines should be administered according to their routine immunization schedule during the same visit 162 00:26:59.490 --> 00:27:04.140 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: And strategies to catch up patients on vaccines. A message should be implemented. 163 00:27:04.740 --> 00:27:21.090 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: For pediatric providers recommend starting with the youngest children and extending through adolescence and the guidance also addresses safe delivery of vaccines, including use of personal protective equipment and visible distancing, which I'll be describing in a few slides. Next slide. 164 00:27:25.680 --> 00:27:39.540 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: The guidance highlights that routine immunization services remain critical that routine vaccination prevents illnesses that Lita unnecessary medical visits and hospitalizations further straining that healthcare system. 165 00:27:40.320 --> 00:27:58.500 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Getting a flu vaccine is always the most important thing we can do to help protect ourselves, including our patients, our loved ones in our community from flu and reducing the risk of serious outcomes that can lead to hospitalization and death, especially while SARS, Coby to is circulating 166 00:27:59.820 --> 00:28:00.780 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Next slide please. 167 00:28:03.840 --> 00:28:14.640 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: To address decreases that we have seen an immunization rates. Again, we recommend providers assess the vaccination status of all patients to avoid missed opportunities. 168 00:28:15.030 --> 00:28:32.160 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: And ensure timely vaccination catch up. This is the one, one of the standards that I mentioned earlier. Additionally, it's important to administer all vaccines do we're overdue according to the recommended CDC immunization schedule during a visit. Next slide. 169 00:28:35.400 --> 00:28:41.430 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: While we recommend patients receive vaccinations in their medical home vaccination out locations outside 170 00:28:42.300 --> 00:28:55.590 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: The medical home may help increase access to vaccines in some populations or situations, particularly when the patient does not have a primary care provider when care in the medical home is not available or feasible. 171 00:28:56.250 --> 00:29:06.090 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Therefore, it's critical all vaccines are documented for accurate and timely information on path patient vaccination status. Next slide. 172 00:29:11.430 --> 00:29:17.130 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: routine vaccination should be deferred for persons with suspected or confirmed 173 00:29:18.360 --> 00:29:24.990 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Regardless of whether they have symptoms until criteria has been met for them to discontinue isolation. 174 00:29:25.560 --> 00:29:38.550 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: While mild illness is not a country indication of vaccination vaccination visits for these individuals should be postponed to avoid exposing healthcare personnel and other patients to the virus that causes 175 00:29:41.100 --> 00:29:52.110 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: When scheduling your confirming appointments for vaccination patients should be instructed to notify their providers office in advance if they currently have, or they develop any symptoms of 176 00:29:53.970 --> 00:29:54.570 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Next slide. 177 00:29:58.200 --> 00:30:08.670 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: The potential for asymptomatic transmission of the virus that causes pivot 19 underscores the importance of applying infection prevention practices to encounters with all patients. 178 00:30:09.300 --> 00:30:17.910 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: These include physical distancing respiratory in hand hygiene surface decontamination and the use of masks one wall and a health care facility. 179 00:30:18.540 --> 00:30:27.900 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Specific recommendations also include screening patients for symptoms before and during the visit physical distancing 180 00:30:28.500 --> 00:30:36.570 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: And limiting a monitoring facility points of entry and installing barriers to limit physical contact with patients at triage. 181 00:30:37.320 --> 00:30:43.830 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Recommendations also include use a face mask for staff and face coverings for patients over two years of age of tolerated. 182 00:30:44.310 --> 00:30:58.800 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: And cough etiquette use of hand hygiene and advanced decontamination according to guidelines this interim guidance also links to other code 19 responses sites for additional useful recommendations. 183 00:31:00.000 --> 00:31:00.540 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Next line. 184 00:31:04.860 --> 00:31:05.730 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: As for 185 00:31:06.870 --> 00:31:20.160 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: personal protection equipment or p, p, we recommend facemask for all healthcare personnel I protection is recommended in areas with moderate or substantial community transmission 186 00:31:20.880 --> 00:31:31.560 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: For those with minimal or no transmission of I protection is optional, following a tip recommendations gloves may be used for 187 00:31:32.010 --> 00:31:44.130 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: I am or sub q vaccines and should be replaced between patients and hand hygiene performed gloves are recommended for intranasal or oral vaccines and hand hygiene performed 188 00:31:45.330 --> 00:31:46.350 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Next slide please. 189 00:31:50.850 --> 00:32:00.660 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Physical distancing is critical in order and in order to accomplish that in normally busy clinics or clinical settings. This may include separating sick from well patients. 190 00:32:00.990 --> 00:32:07.740 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Ensuring physical distancing measures and reducing crowding in waiting rooms and some examples are highlighted here. 191 00:32:08.580 --> 00:32:13.920 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: It's also really helpful when communicating the importance of vaccination to patients. 192 00:32:14.340 --> 00:32:29.580 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: And parents or caregivers that you also communicate that there are safety protocols and procedures in place for your office to help reassure and inform patients of what to expect in order to receive immunization services safely. 193 00:32:30.600 --> 00:32:31.710 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Next slide please. 194 00:32:34.620 --> 00:32:36.600 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Any changes and guidance. 195 00:32:37.800 --> 00:32:50.310 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Will be updated on this website in the box. You see here you can sign up to be notified by email if or when any information changes. Next slide. 196 00:32:52.770 --> 00:32:56.730 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: I'll now turn it over to cat to Captain Parker five Alcorn 197 00:32:58.830 --> 00:32:59.370 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Next one. 198 00:33:01.980 --> 00:33:15.330 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: But now that we've covered the updated a CIC vaccination recommendations and channel vaccination guidance during the pandemic. We wanted to spend a few minutes, assessing students vaccinations and 199 00:33:16.560 --> 00:33:16.830 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Next, 200 00:33:20.010 --> 00:33:27.390 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Because we expect that far as Cody to the virus, which causes causes nights we continue to circulate in the fall. 201 00:33:27.960 --> 00:33:43.380 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Influenza vaccinations will be an important strategy to decrease possible stress on our healthcare system by decreasing doctors and hospitalization, as well as increasing the number of people who will need diagnostic 202 00:33:45.060 --> 00:33:47.790 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Given the risk that have been identified for 203 00:33:49.530 --> 00:34:05.970 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: influenza vaccination will be particularly important for staff and residents of long term care facilities adults with underlying health conditions, African Americans and Hispanics and adults who are part of the core infrastructure. Next five 204 00:34:09.960 --> 00:34:28.050 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Manufacturers of US license influenza vaccine. Our founding a record high amount of back with more than 190 million doses expected, which as you can see in the picture on the right are more than we've ever had, you know, higher influenza season. 205 00:34:29.100 --> 00:34:47.520 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: That we will need affected outage, the person that higher risk planning for the need for physical distancing and fasting delivery and to emphasize, and our messaging that influenza vaccination just continues for the duration of this event, which for us is we just 206 00:34:48.960 --> 00:34:51.330 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Ongoing covered in prevention that 207 00:34:52.350 --> 00:35:04.980 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: provides opportunities to share in terms of prevention know particularly with individuals who are at high risk for the complication. Many of them are also proportionately actually 208 00:35:07.980 --> 00:35:25.980 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: And similarly, similarly to how you made as ordinary extraordinary adjustments your daily practice to protect yourself and your patients by these things up and Telehealth services. You may also need to think about vaccinations different 209 00:35:33.240 --> 00:35:42.900 COCA CDC (Moderator): Captain Gordon, can I ask you to please speak up a little bit. We were getting some messages that you are a little bit harder to hear for our audience, if you don't mind, speaking up a little bit, please. 210 00:35:46.050 --> 00:35:50.850 COCA CDC (Moderator): Yes, I think there is some sort of a scratchy sound like an echo in the background. 211 00:35:51.420 --> 00:35:52.470 COCA CDC (Moderator): I don't know if you're further 212 00:35:52.470 --> 00:35:55.410 COCA CDC (Moderator): Away from your device. But if you can speak up a little bit might help. Thank you. 213 00:36:00.390 --> 00:36:12.690 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: We have many barriers to overcome to increasing flu vaccination during the pandemic, because so many workplaces are now the know there might be your workplace vaccination. 214 00:36:13.440 --> 00:36:18.660 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Physically about 15% of adults with the flu vaccination is the workplace. 215 00:36:19.650 --> 00:36:38.100 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: People might not feel safe going into the clinic or the pharmacy setting to be vaccinated either fear of being exposed because it might seem in person clinic visit where the need for flu vaccine might have center stacks and offer this one might be cancelled or move the tele health 216 00:36:39.630 --> 00:36:47.130 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Concerns about Stacey of 19 vaccine to translate the more about safety of vaccines. 217 00:36:48.390 --> 00:36:58.110 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Kobe's my team related unemployment might intact, both in town and insurance status and subsequent newsy abilities ability to afford flu vaccination. 218 00:36:59.190 --> 00:37:08.820 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Working parents might have limited three times are focused on staying up to date on vaccinations, including annual flu vaccination due to 219 00:37:09.240 --> 00:37:21.570 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Working homeschooling and childcare responsibilities and people might not think they need a flu vaccinations here because they're physically distant and not going in other environments. Next slide. 220 00:37:25.980 --> 00:37:34.830 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: So in order to overcome some of these barriers, we need to ensure that we have coordinated messages across the healthcare spectrum. 221 00:37:35.280 --> 00:37:47.880 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: From the CDC providers, health departments and medical professional societies and the importance of flu vaccination, as well as where patients can receive vaccinations. 222 00:37:49.380 --> 00:38:00.180 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Providers can highlight a cove is a late and safety precautions being implemented in their clinics, so that patients feel safe and keeping their routine in the United States, an appointment. 223 00:38:00.840 --> 00:38:08.250 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: This can be done on the web page on the pre recorded messages that patients, listen to when they set up their appointments 224 00:38:08.760 --> 00:38:23.280 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: And information that isn't reminding them that it's time for their last visit, we need to implement creative approaches to addressing access and disparity issues and common misperceptions about some vaccination. 225 00:38:24.390 --> 00:38:44.670 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: And providers can get information on Medicaid. Vaccines for Children insurance subsidies or payment options for patients who have recently loss insurance coverage or are experiencing economic hardship and we will need to continue vaccination efforts for the duration of the next fight. 226 00:38:51.450 --> 00:39:06.330 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: For those who organized workplace vaccinations or community level vaccinations and it's a temporary satellite or hospitalizations, we now have updated guidance on how to do this safely sign covered my screen. Next slide. 227 00:39:09.690 --> 00:39:20.640 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: This is a website link to the landing page the website goes through planning activities pre planning activities during the clinic activities and post on each activity. 228 00:39:21.060 --> 00:39:31.410 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: And throughout the website, you will find these green collar passage which provides Pacific islands and how to safely send us a vaccination are encoded 229 00:39:33.450 --> 00:39:42.660 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: The landing page also makes the checklist of best practices for vaccinations and it's held in these non traditional setting next five years. 230 00:39:46.200 --> 00:39:53.730 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: The checklist of best practices is a step by step guide that helps the next coordinators overseeing vaccinations connect 231 00:39:54.300 --> 00:40:08.820 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: How the satellite temporary or off site locations follow CDC guidelines and best practices for vaccine shipments transport storage, handling preparation administration and documentation. Next slide. 232 00:40:13.080 --> 00:40:30.900 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: I'll go through the first section and the guidance as an example. This is the planning activity section, which covers leaders system staffing clinical staffing vaccination finish location and layout in coordinating with various partners in the government, as well as nonprofit and 233 00:40:37.350 --> 00:40:47.400 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: We developed a couple flow charts of different types of vaccinations finish this one shows the vaccinations fittings layouts for indoor or outdoor walk through 234 00:40:48.480 --> 00:41:00.990 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Even if the same spaces us as a vaccinations and is held in previous years, it will likely need to be set up and function differently because of proverbs 19 requirements for instance. 235 00:41:01.530 --> 00:41:13.680 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: For Washington. So it's important to establish lines is that maintain separation between individuals or to ask individuals to wait and their vehicles or another location until all 236 00:41:14.340 --> 00:41:27.870 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: The next flow should be one way and also consider conducting appointment only temporary vaccination for net including walk through clinics other schools, churches and pharmacy. Next slide. 237 00:41:31.110 --> 00:41:37.020 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: This slide. So the flow chart for a destination clinic layout have occurred side or drive to clinic. 238 00:41:37.560 --> 00:41:55.410 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Which may provide the best option for staff and patient safety. During the mid 90s and diamonds pandemics. Y'all know so. Step four. Highlights but there should be an area. So we asked her about the nation, which is particularly important if the driver is this evening about the next slide. 239 00:42:00.030 --> 00:42:00.660 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Next slide. 240 00:42:03.840 --> 00:42:10.680 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: We wanted to make you aware of vaccine finder, which supports improved and timely access the vaccine. 241 00:42:11.460 --> 00:42:20.340 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Is partners with over 34,000 care providers who asked in the participate and update for vaccine availability. 242 00:42:20.850 --> 00:42:32.190 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Providers registered to participate and Western side on the map. The goal is to make it simple for users to find a nearby locations to receive a vaccine. 243 00:42:32.820 --> 00:42:45.540 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Users can simply select the vaccine saving enter in their zip code and click Search the results to play in a map and list format in order of distance from the search location. 244 00:42:46.200 --> 00:43:02.070 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: New this month or updates to modernize the website and improve user experience as well as improve processes that allow any providers to participate and report consecutive backing supplies for their site. Next slide. 245 00:43:06.930 --> 00:43:23.910 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Providers are participating providers can easily update vaccine availabilities for their site by setting up an automated data feed working with their own IT support or report manually via an online contributor dashboard. 246 00:43:24.510 --> 00:43:32.940 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: starting August 24 participating vaccine providers will be able to estimate their site executive vaccines five 247 00:43:33.630 --> 00:43:44.700 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: These estimates are updated indexing Finder or higher supply represents you are more than two days of vaccines apply medium supply represents one day. 248 00:43:45.150 --> 00:44:01.140 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: One day, two days of the vaccine supply and most of five represents less than one day of fasting by end users do the projected basking supply levels in a satellite format that meaning yellow and red that is shown. Next slide. 249 00:44:05.130 --> 00:44:18.090 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: This influenza season, we will be encouraging partners to update vaccine availabilities more frequently to ensure after information is available to the public to find the vaccine. 250 00:44:18.570 --> 00:44:32.040 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: And just have no vaccine finder will also be used to help people find covert 19 back in. We encourage providers to enroll. If you expect to be a covenant new vaccines provider. 251 00:44:33.000 --> 00:44:45.450 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Thanks for the update older than to be will not display on vaccines finder and for more information. I'm participating in Fact finders test vaccine basking at health map that 252 00:44:46.380 --> 00:44:47.070 Nice slice 253 00:44:50.550 --> 00:44:59.400 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: The vaccine. Find a team is hosting several webinars for interested in participating providers and the dates are shown. Next slide. 254 00:45:03.990 --> 00:45:04.560 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Next slide. 255 00:45:07.650 --> 00:45:21.660 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Influences and it is going to be important to his family from our flu vaccinations, especially this season in the context of the pandemic and particularly among among vulnerable population. 256 00:45:22.140 --> 00:45:29.160 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: That help your patients find where they can be back in and to continue back to the meeting for the duration of this 257 00:45:30.210 --> 00:45:30.780 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Thanks. Bye. 258 00:45:33.000 --> 00:45:33.480 Amy Parker Fiebelkorn, MSN, MPH, CAPT, USPHS: Thank you. 259 00:45:36.510 --> 00:45:41.250 COCA CDC (Moderator): Presenters thank you for providing our audience with such useful information. 260 00:45:42.300 --> 00:45:50.700 COCA CDC (Moderator): We will now go into our Q AMP a session, please remember, you must submit questions to the webinar system by clicking the Q AMP a button at the bottom of your screen and then typing your question. 261 00:45:52.380 --> 00:46:04.680 COCA CDC (Moderator): We have quite a few questions here for our presenters. So one of our question asks, is there a recommended interval between treatment with REM disappear for covert 19 and flu vaccination. 262 00:46:09.000 --> 00:46:11.160 Lisa Grohskopf, MD, MPH, CAPT, USPHS: And this is Lisa gross captured. I think that one. 263 00:46:13.140 --> 00:46:27.360 Lisa Grohskopf, MD, MPH, CAPT, USPHS: And then the, the short answer would be no. We don't have any any data that I'm aware of, concerning vaccination in the context of somebody who's recently received from disappear so that that would be a difficult one to formulate any kind of a 264 00:46:28.710 --> 00:46:30.330 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Interval for at least at this point. 265 00:46:34.590 --> 00:46:37.770 COCA CDC (Moderator): Thank you very much. Our next, next question asks 266 00:46:38.520 --> 00:46:47.460 COCA CDC (Moderator): We are considering giving flu shots in the emergency department one concern is that patients might end up getting a double dose. They don't realize they previously got the shot. 267 00:46:47.910 --> 00:47:00.840 COCA CDC (Moderator): Or they might get it from there are empty and clinic later in the season and forget they got it in the emergency department either case, is this a legitimate concern is there possibility of a significant negative event. If a patient was to get two shots. 268 00:47:02.730 --> 00:47:14.460 Lisa Grohskopf, MD, MPH, CAPT, USPHS: And this is Lisa Grossman. Again, I can take that one. This is actually a question that comes up from time to time in various contexts about, you know, is it hazardous. If somebody gets another shot or should they get a second shot over the course of the season. 269 00:47:15.870 --> 00:47:24.270 Lisa Grohskopf, MD, MPH, CAPT, USPHS: So as far as the should part just to address that there's currently no recommendation of re vaccinating people sometimes people ask if they should get booster shots. 270 00:47:24.930 --> 00:47:35.310 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Looking at it from the other side of the coin, are we concerned if people get two shots. There are not a lot of studies that look at re vaccination within the same season of people 271 00:47:36.630 --> 00:47:49.980 Lisa Grohskopf, MD, MPH, CAPT, USPHS: But we're not aware of any data to suggest that it would be necessarily harmful or that you're more likely to have an adverse event. There are some older studies that were done probably about a decade ago. 272 00:47:51.090 --> 00:47:57.810 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Of, particularly among older adults of giving two doses over the course of a season, whether it was a couple of weeks apart or two months apart. 273 00:47:58.980 --> 00:48:06.930 Lisa Grohskopf, MD, MPH, CAPT, USPHS: There weren't any safety concerns that emerged from those studies. It also didn't seem like they got much of an antibody boost. So, at least from those studies, it didn't seem like it helped 274 00:48:07.650 --> 00:48:20.910 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Um, so it's a difficult thing to integrate a dancer very definitively. We don't have any reason to believe that it would cause a safety issue least based on what we know. But on the other hand, it also really hasn't been studied. 275 00:48:22.830 --> 00:48:33.390 COCA CDC (Moderator): Thank you very much. Our next question asks, is there a population where we would avoid administrating the quad developed vaccine and prefer to administer a traveling vaccine instead 276 00:48:35.550 --> 00:48:39.720 Lisa Grohskopf, MD, MPH, CAPT, USPHS: This is Lisa. Again, I'm probably not. 277 00:48:40.740 --> 00:48:52.110 Lisa Grohskopf, MD, MPH, CAPT, USPHS: The quandary valid vaccines, most of them that are licensed now actually all of them that are licensed currently had tribal and predecessors that had been on the market for at least a couple of years. 278 00:48:52.620 --> 00:49:00.420 Lisa Grohskopf, MD, MPH, CAPT, USPHS: And in general, when those vaccines submitted their data for licensure. Most of them were licensed on the basis of studies where they compared the trial. 279 00:49:00.660 --> 00:49:08.310 Lisa Grohskopf, MD, MPH, CAPT, USPHS: version with the new quadrupling version and they compare two things. One was, if you add them up another be antigen is there interference. Does it make them less 280 00:49:09.030 --> 00:49:16.170 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Less of a good stimulant for the immune system. And the second thing was safety where you're more likely to have side effects when that second be antigen was added. 281 00:49:16.620 --> 00:49:25.950 Lisa Grohskopf, MD, MPH, CAPT, USPHS: And for the most part, it depends on the vaccine and the exact study, you might have been slightly more likely to have, you know, some of the local like injection site and systemic adverse events. 282 00:49:26.310 --> 00:49:31.860 Lisa Grohskopf, MD, MPH, CAPT, USPHS: If you got the Quadro Vaillant than the trial and, but for the most part, all of those reactions were mild and 283 00:49:32.250 --> 00:49:39.600 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Really there wasn't a huge difference. Overall, you know, I'm just trying to drive a general general description of how those trials were 284 00:49:39.990 --> 00:49:43.230 Lisa Grohskopf, MD, MPH, CAPT, USPHS: So there's not a lot of reason. 285 00:49:43.650 --> 00:49:54.450 Lisa Grohskopf, MD, MPH, CAPT, USPHS: At least based on what we know to consider a trial balance as opposed to a quadrupling down at least for this season. The options are pretty much all quadri valid unless you're talking about the advent of vaccine, because that's the only one that has a trial balance out 286 00:49:57.300 --> 00:50:06.810 COCA CDC (Moderator): Thank you very much. Our next question asks, Do you have any guidance on the use of covert 19 therapeutics. When a patient also has influenza, such as REM disappear or dexamethasone 287 00:50:10.980 --> 00:50:16.320 Lisa Grohskopf, MD, MPH, CAPT, USPHS: This is least again I'm not to my knowledge, I'll ask my colleagues, if they're aware of anything. 288 00:50:19.350 --> 00:50:22.230 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: No, not that I'm aware of, either. This is Tara shop only 289 00:50:25.470 --> 00:50:25.950 COCA CDC (Moderator): Thank you. 290 00:50:27.180 --> 00:50:37.800 COCA CDC (Moderator): Next question asks if a patient is 65 years or older and discovered positive and asymptomatic or symptomatic, do they need to go ahead and get their influence of vaccine now or wait 291 00:50:42.150 --> 00:50:44.220 Lisa Grohskopf, MD, MPH, CAPT, USPHS: I'm Tara. Do you want me to start with this one. 292 00:50:44.760 --> 00:50:47.580 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Sure, go ahead and I can fill in any gaps. If there are any 293 00:50:47.970 --> 00:50:53.880 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Thank you. Okay, so 65 and older. That's, that's obviously one of the populations that we worry about 294 00:50:54.450 --> 00:51:02.190 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Particularly with regard to influenza. There are the population that are higher risk among the highest risk for hospitalization and that's from flute each year. 295 00:51:03.480 --> 00:51:12.630 Lisa Grohskopf, MD, MPH, CAPT, USPHS: And the concept of timing just on its own without coven is always a little bit fraught because we can never really predict exactly every year. What is the ideal time to vaccinate 296 00:51:13.020 --> 00:51:20.820 Lisa Grohskopf, MD, MPH, CAPT, USPHS: We say by the end of October. We do think that July and August are probably too early and most seasons. For most people, particularly older adults. 297 00:51:22.020 --> 00:51:27.300 Lisa Grohskopf, MD, MPH, CAPT, USPHS: If in the specific case of somebody that you know has suspected or confirm coven 298 00:51:28.020 --> 00:51:34.980 Lisa Grohskopf, MD, MPH, CAPT, USPHS: You can you can think of whether or not to vaccinate that person from sort of two different perspectives from the perspective of the recipient. 299 00:51:35.940 --> 00:51:54.750 Lisa Grohskopf, MD, MPH, CAPT, USPHS: The ACP guidance for this year. Basically recommends is that if a person is acutely ill with suspected or Blab confirm coven 19 that providers can consider deferring vaccination for influenza until they're no longer acutely ill. So that would mean that for people that are asymptomatic. 300 00:51:56.370 --> 00:52:02.490 Lisa Grohskopf, MD, MPH, CAPT, USPHS: They could go ahead and get vaccinated. On the other hand, as we pointed out. 301 00:52:04.350 --> 00:52:18.090 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Scheduling visits for people to come in and get vaccinated. You wouldn't want to do that while they're infected, because from the point of view of infection control back could be an issue and and dr john let's let you take it from there. If that that's okay. 302 00:52:18.510 --> 00:52:21.240 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: No, I think you covered it. Thank you. Okay. 303 00:52:23.910 --> 00:52:29.880 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: I think I guess the only thing I would add is, you know, is bringing them in when they meet 304 00:52:30.930 --> 00:52:34.260 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Criteria for discontinuing isolation. 305 00:52:34.680 --> 00:52:34.860 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Yes. 306 00:52:34.890 --> 00:52:35.520 Lisa Grohskopf, MD, MPH, CAPT, USPHS: With that, yeah. 307 00:52:35.550 --> 00:52:36.240 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: That in mind. 308 00:52:37.050 --> 00:52:38.520 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: And that because we can get vaccinated 309 00:52:38.970 --> 00:52:44.670 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Yeah, we do want them to get vaccinated. But there. There may be reasons to wait. 310 00:52:46.170 --> 00:52:49.320 Lisa Grohskopf, MD, MPH, CAPT, USPHS: From an infection control standpoint or or if they're symptomatic we'll 311 00:52:52.710 --> 00:52:58.800 COCA CDC (Moderator): The next question asks the ACP guidelines came out August 24 last year. Do you have an estimated 312 00:52:59.820 --> 00:53:01.140 COCA CDC (Moderator): Debut date for this year. 313 00:53:02.700 --> 00:53:08.760 Lisa Grohskopf, MD, MPH, CAPT, USPHS: The data is officially the 21st, which is tomorrow, but they went live at 1pm today. So they're out 314 00:53:09.330 --> 00:53:09.990 COCA CDC (Moderator): Great, thank you. 315 00:53:18.840 --> 00:53:19.710 Lisa Grohskopf, MD, MPH, CAPT, USPHS: There was one 316 00:53:19.920 --> 00:53:22.050 Lisa Grohskopf, MD, MPH, CAPT, USPHS: One question that came up on the 317 00:53:23.160 --> 00:53:23.670 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Chat. 318 00:53:24.930 --> 00:53:27.060 Lisa Grohskopf, MD, MPH, CAPT, USPHS: That might be worth my clarifying 319 00:53:27.300 --> 00:53:29.490 COCA CDC (Moderator): Please, please, issued. Yes, of course. 320 00:53:29.850 --> 00:53:32.250 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Um, so, with regard to CSF leaks. 321 00:53:32.400 --> 00:53:40.620 Lisa Grohskopf, MD, MPH, CAPT, USPHS: One of my slides had a little bit of a discussion about some groups for whom la before is not recommended. So that would be people with anatomic or functional is plenty a 322 00:53:41.490 --> 00:53:50.370 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Cranial CSF leaks or or cochlear implants and I just wanted to clarify, because one person had asked about UCLA IV in the context of say somebody has a lumbar puncture 323 00:53:50.820 --> 00:54:02.520 Lisa Grohskopf, MD, MPH, CAPT, USPHS: So for LA IV where we're concerned about specifically CSF leaks that verbal communication with the cerebral spinal fluid and the oral firings the nasal pharyngeal, the nose, the year 324 00:54:03.210 --> 00:54:11.010 Lisa Grohskopf, MD, MPH, CAPT, USPHS: Or something in the cranium. So basically anything that will communicate with the general area where lamb or is administered 325 00:54:11.940 --> 00:54:21.120 Lisa Grohskopf, MD, MPH, CAPT, USPHS: So a lumbar puncture a spinal tap usually is done in the back. So something like a lumbar puncture that's done in the lower back would not communicate with those spaces. 326 00:54:22.950 --> 00:54:34.890 Lisa Grohskopf, MD, MPH, CAPT, USPHS: So just to clarify that, you know, if it were chiefly concerned about again cranial CSF looks like seeing a surfer going to RIA CSF coterie of other things that can can occur in the in the head. 327 00:54:37.740 --> 00:54:39.960 COCA CDC (Moderator): Thank you so much for that clarification, appreciate it. 328 00:54:41.130 --> 00:54:51.240 COCA CDC (Moderator): We have other questions regarding our children and influenza vaccination because of the concerns for Cobra 19 in general infection prevention, control the questions asked about 329 00:54:52.110 --> 00:55:04.500 COCA CDC (Moderator): The administration of flu mist and the occasional sneezing or blowing of the nose. Is there any other pp that you recommend other than the obvious for those instances for providers. 330 00:55:08.580 --> 00:55:12.180 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Know, and I you know those. This is Tara. Exactly. 331 00:55:13.200 --> 00:55:22.800 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: The pp that's that's recommended include, like I mentioned facemasks and then depending on the Community transmission of 332 00:55:25.170 --> 00:55:29.040 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: I protection as well. Loves as were mentioned 333 00:55:30.060 --> 00:55:49.050 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: But that's also with the consideration that patients with suspected or confirmed would not be getting vaccinated. So with that in mind, those are the recommendations for pp E for for children and adults. 334 00:55:50.670 --> 00:55:51.810 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: That answer the question. 335 00:55:52.140 --> 00:56:04.470 COCA CDC (Moderator): Yes, thank you very much. We have time for one more question. And this question goes along to some of the similar topics we discussed, but it's a little bit of a variation. And the question asks if 336 00:56:05.640 --> 00:56:16.410 COCA CDC (Moderator): If people in a household or in occupational environment have been exposed to someone with covered 19. Do they also need to first test negative for covered 19 before they can get a flu shot. 337 00:56:21.270 --> 00:56:25.650 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: This is terrorists out the way I can, I can take that question and know a negative 338 00:56:26.910 --> 00:56:42.450 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Test is not required prior to being vaccinated because like Dr. Scott mentioned, it's not really a safety issue if that patient is asymptomatic. However, the consideration is for 339 00:56:43.860 --> 00:56:45.060 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: It exposure. 340 00:56:46.170 --> 00:56:49.320 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Of others in the healthcare setting to 341 00:56:50.460 --> 00:56:50.970 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: So, 342 00:56:52.380 --> 00:56:57.810 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: That you know those patients should follow guidance that we have 343 00:56:58.830 --> 00:57:09.390 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: For for exposure and and staying home. So if they've been in close contact, which it sounds like that's what they're referring to 344 00:57:09.990 --> 00:57:19.800 Tara Jatlaoui, MD, MPH, FACOG, LCDR, USPHS: Those patients should stay home and self monitor for qubit symptoms for 14 days and then can go ahead and get their flu vaccine but a negative test is not necessary. 345 00:57:22.620 --> 00:57:28.980 COCA CDC (Moderator): Thank you very much. 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