National Influenza Vaccination Week: Interview with HHS Region 3 Administrator Paxman

December 9, 2013 Karie Youngdahl

Dalton G. Paxman, PhDFor National Influenza Vaccination Week, I had the pleasure of interviewing Dalton Paxman, PhD, FCPP, Regional Health Administrator for the mid-Atlantic region, where he oversees public health initiatives for the Office of the Assistant Secretary for Health (OASH), U.S. Department of Health and Human Services (HHS). NIVW is a national observance that was established to highlight the importance of continuing influenza vaccination, as well as fostering greater use of flu vaccine after the holiday season into January and beyond. Dr. Paxman is a Fellow here at The College of Physicians of Philadelphia. His biographical information is below. Many thanks to Dr. Paxman and to Mahak Nayyar, MPA, FCPP, Deputy Regional Health Administrator, for her coordination.

1. Influenza season has begun – has there been much influenza in our region (Region 3) yet? What kind of activity are we seeing?

During week 48 (November 24-30, 2013), influenza activity increased slightly in the United States, as reported in CDC’s latest FluView

Sporadic influenza activity was reported by the District of Columbia, Delaware, Pennsylvania, and West Virginia. Maryland and Virginia reported local activity.

Across the country, regional influenza activity was reported by nine states; a total of 13 states (including Virginia and Maryland) reported local influenza activity; the District of Columbia, 27 states, Guam and Puerto Rico reported sporadic influenza activity, and the U.S. Virgin Islands and one state reported no influenza activity. (‘Regional, ‘local’ and ‘sporadic’ summarize the number of regions within each state that identified any influenza activity.)

In terms of the amount of influenza-like illness (ILI) in the region, the same report shows that Delaware experienced low ILI activity, and Maryland, Pennsylvania, and West Virginia each experienced minimal ILI activity. The District of Columbia did not have sufficient data to calculate an ILI activity level.

Across the country, two states (Mississippi and Texas) experienced high ILI activity, two states (Alabama and Louisiana) experienced moderate ILI activity, two states and New York City experienced low ILI activity, and 44 states experienced minimal ILI activity.

2.     Are we able to tell yet if the circulating influenza virus strains match the strains in this year’s vaccine? If so, how are we doing?

Over the course of a flu season, CDC studies samples of flu viruses circulating during that season to evaluate how close a match there is between viruses used to make the vaccine and circulating viruses. Data are published in the weekly FluView.

As reported in the Week 48 FluView, CDC has antigenically characterized 156 influenza viruses, including 120 2009 influenza A (H1N1) viruses, 31 influenza A (H3N2) viruses, and five influenza B viruses, collected since October 1, 2013.

  • All 120 of the 2009 influenza A (H1N1) viruses tested were characterized as A/California/7/2009-like. This is the influenza A (H1N1) component of the Northern Hemisphere quadrivalent and trivalent vaccines for the 2013-2014 season.
  • All 31 of the influenza A (H3N2) viruses tested were characterized as Texas/50/2012-like. This is the influenza A (H3N2) component of the Northern Hemisphere quadrivalent and trivalent vaccines for the 2013-2014 season.
  • Two of the five influenza B viruses tested belonged to the B/Yamagata lineage of viruses, and were characterized as B/Massachusetts/02/2012-like, which is included as an influenza B component in both the 2013-2014 Northern Hemisphere trivalent and quadrivalent influenza vaccines.
  • Three of the five influenza B viruses tested belonged to the B/Victoria lineage of viruses, and were characterized as B/Brisbane/60/2008-like, which is included as a component of the 2013-2014 Northern Hemisphere quadrivalent influenza vaccine.

3.     What activities is your office involved with for this year’s National Influenza Vaccination Week? 

We have been partnering with Walgreens Pharmacies to distribute vouchers for the influenza vaccine, which can be redeemed at the Pharmacy at no charge to the public.  We are also working with Walgreens to identify areas with the lowest rates of flu vaccination and find partners to set up flu clinics in those areas.

4.     Are there any recent changes to the federal government’s involvement in influenza vaccination efforts as a result of the ACA or other factors? 

 As a result of the ACA, Medicare Part B covers one influenza vaccination and its administration per influenza season for Medicare beneficiaries without co-pay or deductible. Starting in 2014, all ACA-compliant health plans will also cover the influenza vaccine, and a number of others, at no charge.  The ACA removes the financial burden of getting vaccinated. 

Under the ACA, all recommended vaccines are fully covered.  This includes the flu vaccine, recommended childhood and adolescent vaccines, and recommended adult vaccinations.

Individuals who enroll in new group or individual private health plans after September 23, 2010, won’t have to pay any cost-sharing for certain recommended preventive services, including the influenza and pneumococcal vaccines.  No cost-sharing means no deductibles, no co-pays, and no co-insurance.

Medicare also covers both flu and pneumonia vaccines with no co-pay or deductible. Children eligible for Medicaid and CHIP are eligible for flu and pneumococcal vaccine.

5.     Last year, you reported that your office worked to increase influenza vaccination in African American residents. What did those efforts involve, and how did they work out?

In 2011, CDC initiated the National Influenza Vaccination Disparities Partnership in an effort to bring to the table local leaders who were committed to promoting influenza vaccination in their communities. In collaboration with HHS, Walgreens has provided free vaccine and vaccinators to support local grassroots activities held in underserved communities. For many underserved African American communities, the opportunity of being offered free vaccine at venues they frequent has helped to increase flu vaccination awareness and in many cases receipt of flu vaccine for the very first time among older adults. The National Medical Association has provided doctors to serve as spokespersons at local events and for ethnic media interviews. CDC has also provided Flu 101 webinars to partners who take the message to their constituents in an effort to raise awareness about the benefits and importance of flu vaccination, especially for high risk individuals. Through efforts of the NIVDP, the Georgia Conference of Black Mayors signed a resolution to promote flu vaccination in their cities. This statewide resolution bloomed into a much larger show of support in June (2013) when a number of mayors from the U.S. Conference of Mayors officially adopted a resolution entitled “Promotion of Influenza Vaccination among Medically Vulnerable AA and Hispanic Populations,” which was unanimously supported by the Children, Health, and Human Services Standing Committee during their national conference in Las Vegas, NV. 

6.     You also reported last year that our HHS region had the second highest rate of influenza vaccination of all the regions, and that only the New England region had a higher rate. Did that remain true for the 2012-13 season?

For the 2012-13 flu season, New England (Region 1) had the highest influenza vaccination coverage estimate, vaccinating approximately 52.9% of its population. Region 3 had the second highest vaccination coverage estimate of 48.8%.

For comparison:

Region 1

52.9%

Region 2

46.1%

Region 3

48.8%

Region 4

42.2%

Region 5

43.5%

Region 6

44.9%

Region 7

46.8%

Region 8

47.0%

Region 9

43.5%

Region 10

43.8%

United States

45.0%

7.    I know that we’re particularly focused on influenza immunization because this is National Influenza Vaccination Week, but is your office involved in other vaccination efforts we should know about? 

Yes, we are also encouraging providers to tell their patients, especially those over 65, to get the pneumococcal vaccine.  Pneumococcal disease can be complication of a flu infection which can lead to pneumonia, meningitis, and blood infections.  Treatment for pneumococcal disease may require hospitalization, and patients may need weeks or months to recover before returning to normal activities.  Getting the vaccine is the safest, most effective way to protect against pneumococcal disease. Unfortunately, too few adults who need this vaccine have received it. Medicare generally covers the pneumococcal vaccination and its administration once in a lifetime for all Medicare beneficiaries. Medicare may provide coverage of additional pneumococcal vaccinations based on risk or uncertainty of beneficiary pneumococcal vaccination status.   

We are also working to promote getting the Human Papillomavirus (HPV) vaccine, which has been clinically proven to prevent infection by cancer-associated HPV types 16 and 18.  Unfortunately, despite the availability of these safe and effective vaccines, coverage rates for completion of the HPV vaccine series remain well below HP2020 goals.

About Dalton G. Paxman, PhD, FCPP

Dalton Paxman is the Regional Health Administrator for the mid-Atlantic region (Delaware, District of Columbia, Maryland, Pennsylvania, Virginia,  West Virginia), where he oversees public health initiatives for the Office of the Assistant Secretary for Health (OASH), U.S. Department of Health and Human Services (HHS).  He administers regional public health programs in Minority Health, Population Affairs, Women’s Health, Medical Reserve Corps, and the HIV/AIDS Regional Resource Network.

From 1996-2000, Dr. Paxman served as the Senior Environmental Health Advisor, Office of Disease Prevention and Health Promotion, providing advice to the Assistant Secretary for Health/Surgeon General on environmental health issues.  He was the senior staff on key multi-agency environmental health and science policy initiatives, including the President’s Food Safety Initiative and the President’s Task Force on Children’s Environmental Health and Safety.  He also served as the Department’s liaison to the National Science and Technology Council for the White House Office of Science and Technology Policy. 

Dr. Paxman was a Senior Policy Analyst in the Environment Program at the Office of Technology Assessment in the U.S. Congress, where he directed congressional studies in the areas of health risk assessment research, comparative risk assessment, and environmental regulations.  He was a research toxicologist and a post-doctoral scholar for the UC Berkeley, School of Public Health.  He received his PhD in Environmental Health Sciences from the Johns Hopkins University, School of Hygiene and Public Health, where he received the Kruze Award for Excellence in Environmental Health Research.

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