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How Pharmacists Can Prepare Today for the 2022-2023 Flu Season

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Jordan Cardinal, EM/CC PharmD, a Medical Science Liaison in Integrated Diagnostic Solutions at BD, joins Drug Topics® to discuss the current outlook on the upcoming 2022-2023 flu season, and how the prevalence of the BA.5 variant of the SARS-CoV-2 virus might affect the health care outlook over the coming months.

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Drug Topics®: I just want to kick off our conversation by giving you a chance to introduce yourself to the audience.

Jordan Cardinal: Thank you so much for having me. My name is Jordan Cardinal. I'm the US Regional Medical Science Liaison for BD (Becton Dickinson and Company) in our diagnostics branch and I cover our microbiology product portfolio. Clinically, I'm a trained emergency medicine pharmacist and have staffed over the past few years in emergency rooms and ICUs in response to the COVID-19 pandemic, which you can imagine it has been quite devastating to be on the reactionary side of this. So, I'm excited today to be able to emphasize the importance of proactive approaches we can take, as we approach the upcoming flu season and specifically diagnostics.

Drug Topics®: What is the current outlook for the upcoming 2022-2023 flu season? Is it anticipated to be worse than usual due to the prevalence of the BA.5 COVID-19 variant?

Cardinal: So no one can predict exactly what's to come in our upcoming flu season, but we do have some clues. So, we can look at the past few years of when SARS-CoV-2 has also been present during our flu seasons and we can also look at what's happening in the southern hemisphere, which usually can foreshadow a little bit of what's going to happen in the United States, although not perfectly. In the past few years you might be surprised, but with co-occurring COVID-19 and flu, the flu burden was actually more mild than pre-COVID-19 years. This could be partially due to the mitigating measures we were taking to prevent COVID-19 transmission, but this year, it's important to note that this trend is not holding through. The southern hemisphere is actually looking to have one of its tougher flu seasons in the past few years. Specifically, Australia was hit with its worst flu season in the past 5 years and it affected children especially hard. This could have been because the more mild past 2 years of flu has exposed us less to new strains of flu. So maybe our children haven’t had opportunities to have that exposure and develop that immunity. While these 2 factors aren't perfect predictors of what's to come in the United States, it certainly gives us cause for concern that we may be in for a more severe season and we want to really encourage pharmacists, especially our retail pharmacy colleagues who happen to be the most accessible health care providers to the general public, to take a proactive approach in this as we approach the upcoming flu season and stay ahead of it, instead of behind. As we do anticipate it might be more severe.

In response to your BA.5 variant question, you're exactly right that is the most prevalent strain that's in the United States right now. I can't say for sure that it'll be the one that's around in our upcoming flu season, but we do know some things about BA.5 to keep in mind. So overall, we're still gathering data, but it is the most transmissible variant we've seen to date and it has the unique ability to evade immunity, whether you have that immunity through vaccination or previous infection. So, there's definitely still cause for concern there. Again, I won't say that a variant of COVID-19 itself is going to lead to more flu. It's just a concern that we need to be aware of that will be present and very transmissible along with the flu.

Drug Topics®: As far as you can tell, does the prevalence of these COVID-19 variants impact the effectiveness of testing for influenza?

Cardinal: So in terms of the COVID-19 variant BA.5, again I'm not positive that it'll be the most predominant one during our flu season, we do know that some of these variants can affect some of the proteins we're trying to test for in antigen tests. Fortunately, I know at BD, our research and development team has done a very good job at trying to anticipate all potential strains that are happening worldwide. So, in regards to our SARS-CoV-2 variants, we continue to actively monitor all isolates that we see emerging worldwide and testing it on our BD Veritor point-of-care testing to ensure we maintain acceptable sensitivity. We have not seen any undetectable variants thus far, which is really promising. Another promising piece that we trend is our own prevalence data and compare it to the global prevalence data that's captured by the CDC and other guiding bodies. We continue to see parallel trends and a lot of reliable findings that give us confidence that our test is continuing to capture these new variants with high sensitivity.

Drug Topics®: How can BD Veritor and BD testing products support independent pharmacists during the upcoming flu season?

Cardinal: I'm really excited about this question, especially in regards to our retail pharmacy colleagues. We have an exciting new tool they can use to help their patient population a lot, especially considering we're going to have the co-prevalence of flu as well as SARS-CoV-2. BD Veritor actually has a new triplex assay that pharmacists can utilize to test COVID-19, influenza A, and influenza B, all at once from 1 patient sample and get the results in 15 minutes. We all know how confusing it can be when you develop these kind of generic respiratory symptoms. There's a lot of overlap between COVID-19 symptoms as well as flu symptoms. It's really hard to know what they're suffering from and potentially the right measures to take. This information is going to be very huge for our general population and a tool I really encourage retail pharmacists to utilize. The BD Veritor testing solution is also going to open additional doors for pharmacists to be able to test for other common respiratory illnesses like RSV and group A strep. Whether pharmacists are using the triplex assay or our other individual respiratory viral assays, it's going to be an easy process for them. Just a quick swab, a dip into the reagent tube to acquire the sample and get it extracting, and then 3 drops on to our incubation strip that will then be inserted into the analyzer for analysis. So, it's a very quick test. Again if SARS-CoV-2 is one that you're testing for, that assay is a 15-minute turnaround time. A really exciting tool we need to take advantage of.

Drug Topics®: Can you expand on if and how these products are capable of accurately distinguishing between COVID-19 and influenza when people are testing?

Cardinal: Absolutely. Like I said, not only can our BD Veritor triplex assay distinguish between COVID-19 and both influenza A and B, it can also detect a co-infection, that we do know can be more rare, but does happen. When it does, that's especially concerning for some of our higher-risk individuals and populations, so it's not something to be ignored, especially if someone's infected with both at the same time. It's a really unique capability of this test to be able to not only say ‘yes’ to one or the other but [also] if you have both at the same time. We're really excited about that feature.

Drug Topics®: What are some steps that independent pharmacists should take to prepare for the potentially high number of patients who will be seeking point-of-care testing for influenza in the coming months?

Cardinal: You're exactly right. We do anticipate this could be a pretty high number, especially when people realize the usefulness of this triplex assay. We do want to recognize that retail pharmacists have a lot on their plates between filling prescriptions, calling physicians, confirming insurance coverage, etc. So, BD has really tried to think ahead and implement everything they can into the BD Veritor testing process system to enable smooth integration that works with a pharmacy's specific needs and workflow. There are 2 modes that we built into the BD analyzer to help enable this. One is Analyze Now, which would allow you to have more flexibility and turn through more tests per hour. If your demand is really, really high, we do recommend using the Analyze Now mode and you can even take it further and do a batch testing approach, which will allow you to optimize throughput and testing per hour. Secondly, if you have lower needs and you see that you're in an area where demand is low or it's a day when demand is low, we have built in a walkaway mode so the tests can sit there unmonitored, hands-free for 15 minutes and it will analyze the test when it sees fit. You can go and handle your other duties for the day, whether it's checking out a customer, calling a physician, clarifying your script, etc. We've really tried to build those in and BD wants to do everything we can to help figure out the best workflow integration for your specific retail pharmacy.

Drug Topics®: The ACIP just recently announced that for the upcoming flu season, there's a preferential recommendation for the use of a higher dose or adjuvanted influenza vaccine for adults who are 65 and older. What does the point-of care testing landscape look like for these older patients who might be more vulnerable to respiratory viruses?

Cardinal: I'm very passionate about this question, as it's very evident, well-published that the older population is definitely one we should pay attention to during this flu season. We know that increasing age is one of the highest risk factors for developing dangerous symptoms from both the flu and COVID-19. We want to encourage pharmacists to strongly encourage their patient populations, especially their older patient population groups to get their annual vaccinations. Vaccinations continue to be the number one defense we have against viruses. We know especially with these Omicron variants: BA.5, BA.1, our immunity from the vaccine wanes quickly, so getting updated with the COVID-19 booster is highly encouraged. Then lastly, we do recommend that pharmacists follow those new CDC ACIP recommendations on how to dose those vaccines.

In terms of testing, pharmacists should have a low threshold in referring their older patient populations to the appropriate health care providers for further evaluation, if one of those tests come back positive, whether it's for COVID-19, influenza A or B, or both off of the BD Veritor test. Pharmacists can also provide education on the importance of seeking care soon in response to those results because we know there's time sensitive windows for when antivirals can be started, such as Tamiflu or Paxlovid, which can decrease our older patient population’s risk of hospitalization. The sooner they can get to a health care provider and possibly be considered for antiviral appropriateness and get on those antivirals, that'll be a huge benefit.

Drug Topics®: Are there any final key takeaways or last points that you wanted to leave the audience with before we wrap up?

Cardinal: Absolutely, I kind of started with this concept of ’I'm really hoping as we approach this flu season, we can take proactive measures, instead of reactive measures.’ Again, it's really devastating having been on the back-end of the acute care and emergency medicine response to these respiratory declines from both COVID-19 and the flu, and seeing how futile some of our efforts can be when a patient's progressed, in terms of respiratory decline. The more we can encourage our retail pharmacists, who are again in a unique position of being the most accessible health care provider to our general public, the more we can emphasize proactive use of vaccination and proactive use of diagnostics to inform appropriate treatment strategies, the better off we'll all be.

Drug Topics®: Thank you again, Jordan for taking the time to be with us.

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