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MMWR – Morbidity and Mortality Weekly Report

1. Investigation of Hepatitis E Outbreak Among Refugees — Upper Nile, South Sudan, 2012–2013

CDC Media Relations
404-639-3286

Hepatitis E virus outbreaks are difficult to control in crowded populations with poor access to water and sanitation. Improving water, sanitation and hygiene conditions is essential to reduce the transmission of hepatitis E. It is also essential to determine the efficacy of a hepatitis E vaccine in outbreak settings. In mid-2012, Sudanese fearing conflict in their country fled to Upper Nile State, South Sudan. The refugees faced crowded and flooded living conditions as the rainy season arrived leading to a humanitarian emergency. From July 2012 through January 27, 2013, an outbreak of hepatitis E sickened 5,080 refugees. The outbreak strained available health resources. It required increased humanitarian assistance especially in the areas of water supply, sanitation and hygiene. Hepatitis E virus is a leading cause of acute hepatitis globally with approximately 3.4 million cases per year. A person can become infected with hepatitis E virus by drinking water or food contaminated with fecal matter. Hepatitis E outbreaks have commonly occurred in crowded settings with poor hygiene and limited access to clean drinking water. In the future, hepatitis E vaccine may play an important role in controlling outbreaks, but an evaluation is urgently needed to determine the vaccine's efficacy in outbreak settings.

2. Hepatitis B Vaccine Birthdose Practices in a Country Where Hepatitis B is Endemic – Laos, December 2011-February 2012

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
404-639-8895
NCHHSTPMediaTeam@cdc.gov

An analysis of multiple health facilities in Laos finds low coverage for the first of three hepatitis B vaccine doses provided to newborns at birth (HepB-BD) in order to prevent mother-to-child transmission.  Hepatitis B is commonly transmitted in highly endemic countries such as Laos from mother-to-child at birth and during early childhood. In 2012, the World Health Organization and the Laos Ministry of Healthsurveyed 37 facilities in Laos to assess gaps in HepB-BD coverage and identify possible areas for improvement. Researchers found only 74 percent HepB-BD vaccination coverage, as well as multiple challenges in implementing vaccination of newborns. Many facilities reported vaccine stock outages (49 percent) and a lack of trained staff to provide the vaccine (29 percent). Many sites relied on untrained staff members to administer the vaccine. Of the facilities surveyed, 89 percent described facility policies for vaccination that indicated a misunderstanding of when the vaccine should be used. Low rates of medical attendance of home births also led to missed opportunities for vaccination. Authors identified several opportunities to further increase vaccination coverage, including each facility designating a staff member to implement vaccination and ensure proper training is provided, as well as ensuring availability of the vaccine stock. Also key are vaccinating all infants born in health facilities and improving outreach for home births.

3. Human Papillomavirus Vaccination Coverage Among Adolescent Girls and Postlicensure Vaccine Safety Monitoring — United States, 2007–2012

CDC Media Relations
404-639-3286

Despite the availability of safe and effective HPV vaccine, many girls remain unprotected for HPV infections and therefore HPV-related cancer and disease. However, high HPV vaccination coverage is possible in the United States with existing infrastructure and healthcare utilization.  HPV vaccination coverage of adolescent girls failed to increase from 2011 to 2012. Only 53.4 percent of girls received 1 or more doses of HPV vaccine and only 33.4 percent received the complete 3-dose series.  National safety monitoring data continue to indicate that HPV vaccine is safe.  Large post-licensure studies have shown no serious safety concerns have been identified in seven years.  However, despite the availability of safe and effective vaccines, many girls remain unprotected for HPV infections. If HPV vaccine was administered at healthcare encounters when other recommended vaccines were administered, vaccination coverage could be as high as 93 percent.  Improving providers' practice patterns so they use every opportunity to offer HPV vaccines and are well-equipped to address questions from parents will be necessary to further reduce HPV-associated cancers.

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