The Centers for Disease Control and Preventionís Immunization Works Monthly Update is provided to national health care provider and consumer groups for distribution to their members and constituencies. The immunization information provided is non-proprietary and is encouraged to be widely disseminated and shared.
ACIP Expands Hepatitis A Vaccination for Children: A universal recommendation for hepatitis A vaccination of children between 1 Ė 2 years of age will be integrated into the routine childhood vaccination schedule.
CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended that all children in the United States receive hepatitis A vaccine. The previous (1999) recommendation called for vaccinations in states with the highest rates of hepatitis A.
About two-thirds of cases are now reported from states in which hepatitis A vaccination of children was not recommended. The ACIP recommendation is for children to receive the first dose of a two dose series of hepatitis A vaccine between 1 and 2 years of age and that the vaccine be integrated into the routine childhood vaccination schedule.
Hepatitis A is a liver disease caused by the hepatitis A virus. Hepatitis A vaccine was first licensed in the United States in 1995. During the 1980s and 1990s, an average of 26,000 cases of hepatitis A was reported annually. The actual number of infections per year was estimated to be around 270,000 because there are many infections without symptoms and some people with symptoms do not see their physician for diagnosis. Following the introduction of selective hepatitis A vaccination, the number of hepatitis A cases has fallen dramatically. During 2004, there were a total of 5,683 cases nationwide, the lowest number of cases ever reported.
In 1999, the ACIP recommended routine hepatitis A vaccination for children living in 11 states with the highest rates of hepatitis A. During the period before vaccine was available, the average incidence of hepatitis A in these states (Alaska, Arizona, California, Idaho, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Utah, and Washington) had been at least 20 cases per 100,000 people, about twice the national average. In 1999, the ACIP also recommended that vaccination be considered in an additional six states (Arkansas, Colorado, Missouri, Montana, Texas, and Wyoming) where the average incidence had been at least 10 but less than to 20 cases per 100,000 people. During the period before vaccine was available, each year about two thirds of all hepatitis A cases nationwide were reported in these 17 states.
The two vaccines licensed for use in children, Havrix and Vaqta, were approved for use in children 12 months and above by FDA earlier this year.
To view a press release on the new recommendation, please visit www.cdc.gov/od/oc/media/pressrel/r051028.htm
ACIP Recommends Adult Vaccination with (Tdap): CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended that adults from 19 to 64 years of age be vaccinated with a newly licensed adult booster tetanus, diphtheria and pertussis (whooping cough) vaccine (Tdap). The vaccine will help protect adults from pertussis, an illness with severe and prolonged cough, and reduce the risk of transmitting pertussis to infants. Under the ACIP recommendation, the Tdap vaccine would replace the currently recommended tetanus-diphtheria (Td) vaccine that is used as the adult booster vaccine. The new vaccine is the first vaccine against pertussis licensed for use in adults in the United States.
ACIP voted to recommend that adults receive a booster dose of Tdap vaccine against tetanus, diphtheria and pertussis if they have not received a tetanus and diphtheria (Td) booster dose in ten or more years. Adults should receive a single dose of Tdap to replace a single dose of Td. Pertussis causes an estimated 600,000 cases of pertussis every year among adults 20 to 64 years of age, and can result in weeks of coughing, cracked ribs from severe coughing spells, pneumonia, and other complications.
Tdap should also be given to adults who will have close contact with an infant less than 12 months of age, ideally at least one month before beginning close contact with infants. Tdap may be given less than 10 years after the last Td vaccination. A 2 year or greater interval between Td and Tdap is suggested to reduce the risk of reactions; shorter intervals may be used.
Immunization Works will announce when the new Tdap recommendations are posted on the National Immunization Program (NIP) website. For more information about pertussis disease, please visit www.cdc.gov/nip/diseases/pertussis
Influenza Vaccine Supply Update:
Influenza vaccine manufacturers expect to produce more than 80 million doses of influenza vaccine this year, and as of the end of October, more than 57 million doses have been distributed. However, many providers still do not have any vaccine and others have only a portion of their order. Because a portion of the vaccine distribution has been delayed this year, healthcare professionals are encouraged to continue to vaccinate their patients into December as vaccine becomes available. Influenza peeks most often in January and February so the coming weeks on into December afford opportunities for vaccination. For the latest information about the influenza vaccine supply, as well as links to weekly surveillance reports, press releases and educational materials, please visit CDC’s influenza website at www.cdc.gov/flu
Influenza Vaccination Among High Risk Persons Below Target Levels: Influenza vaccination is an effective tool for preventing hospitalization and death among persons 65 years and older and among persons aged 18-64 years old with medical conditions that increase the risk for influenza-related complications. Two national health objectives for 2010 are to increase influenza vaccination coverage to 90% among persons 65 years old and older and to 60% among persons 18-64 years old who have one or more high-risk conditions. To determine influenza vaccination coverage among persons in both targeted groups, CDC analyzed data from the 2003 National Health Interview Survey (NHIS). The results of that analysis reveal that influenza vaccination coverage among persons 65 years and older and persons 18-64 years old with high-risk conditions remains substantially below 2010 target levels (65.6 % for persons 65 years and older and 34.1% for persons 18-64 years old with high risk conditions). In addition, racial/ethnic disparities in coverage levels persist in both targeted populations. To improve overall influenza vaccination coverage and reduce racial/ethnic disparities, combinations of evidence-based effective interventions should be implemented, and the influenza vaccine supply should be stabilized. To view the article published in a recent edition of CDC’s Morbidity and Mortality Weekly Report (MMWR), please visit www.cdc.gov/mmwr/preview/mmwrhtml/mm5441a3.htm
Survey of Influenza Vaccination Practices Among OB/GYNs:
Women infected with influenza virus during pregnancy are at increased risk for serious complications and hospitalization. ACIP currently recommends vaccination of women who will be pregnant during influenza season, regardless of their stage of pregnancy. However, during 1997-2003, the ACIP recommendation only included healthy pregnant women who would be in their second or third trimester of pregnancy during the influenza season among those persons at high risk for whom influenza vaccination was indicated. Also included were women at any stage of pregnancy with certain chronic medical conditions, such as asthma, diabetes mellitus, or heart disease. ACIP emphasized that the influenza vaccine was safe for breastfeeding mothers and their infants and that household contacts of children aged <2 years also should be vaccinated. However, despite these recommendations, only 13% of pregnant women received influenza vaccination in 2003.
To assess understanding of the ACIP recommendations among obstetrician-gynecologists (OB/GYNs), the American College of Obstetricians and Gynecologists (ACOG), with support from CDC, surveyed a national sample of OB/GYNs in May 2004. The results show that 52% of OB/GYNs surveyed would recommend influenza vaccination for a healthy woman in the first trimester of pregnancy, 95% would recommend the vaccine for a healthy pregnant woman beyond the first trimester, and 63% would recommend vaccination for a woman with a medical condition in the first trimester. However, of the physicians who would recommend vaccination, 36%-38% reported that influenza vaccination was not offered in their practices. Increased efforts are needed to improve vaccine availability and to educate OB/GYNs regarding the updated ACIP recommendations on the use of influenza vaccine in the first trimester for both healthy pregnant women and pregnant women at high risk. To view the article published in a recent edition of CDCís Morbidity and Mortality Weekly Report (MMWR), please visit www.cdc.gov/mmwr/preview/mmwrhtml/mm5441a4.htm
Polio Infections in Minnesota Update: On September 29, 2005, the Minnesota Department of Health (MDH) identified poliovirus type 1 in an unvaccinated, immunocompromised 7 month-old infant girl in an Amish community whose members predominantly were unvaccinated for polio. Since then, poliovirus infections in four other unvaccinated children and adolescents in 2 other families within the index patient's community have been documented as well as serological evidence of infection with type 1 poliovirus in the 3 unvaccinated siblings of the index patient.
These cases represent the first identification of a vaccine-derived poliovirus (VDPV) in the United States and the first occurrence of VDPV transmission in a community since oral polio vaccine (OPV) vaccinations were discontinued in 2000. To date, among 5 families tested in the MN community, members from 3 families show evidence of current or past infection with this poliovirus. Although there is no paralytic disease reported among any of those infected with the VDPV or their contacts, based on previous experience with VDPVs, the virus is considered to have potential for causing paralytic disease. There is concern that transmission to other affiliated communities may have occurred. Collaborative investigations are ongoing in other states (Wisconsin and Michigan) and with Canadian provinces (Ontario) with known close affiliation with this community.
Persons in communities with low vaccination coverage should be warned of the potential risk for poliomyelitis. Physicians should be aware of and vigilant for poliomyelitis and other causes of AFP in patients.
IPV, the polio vaccine currently used in the United States, provides immunity against this vaccine-derived poliovirus strain. The Advisory Committee on Immunization Practices (ACIP) recommends that a full 3-dose IPV series be administered on an accelerated schedule if polio immunization status is unknown or not documented. A booster dose of IPV is recommended for adults in susceptible communities and health-care workers at high risk for exposure who have completed a primary series but have not received an adult booster dose.
To view the complete article published in a recent edition of CDC’s Morbidity and Mortality Weekly Report (MMWR), please visit www.cdc.gov/mmwr/preview/mmwrhtml/mm54d1014a1.htm
The President of the United States has announced a new website concerning pandemic flu. The website contains the national strategy for pandemic planning, as well as links to information for healthcare professionals and the general public. To access this website, please visit www.pandemicflu.gov. In addition, the Department of Health and Human Services (DHHS) has posted its pandemic plan. To view the pandemic plan, please visit www.hhs.gov/pandemicflu/plan. CDC continues to update its own website on pandemic planning and avian influenza, and to provide information on recent avian influenza outbreaks in Asia and Europe. To access CDC’s website, please visit www.cdc.gov/flu/avian/index.htm
Upcoming Satellite Broadcast, December 8, 2005:
CDC’s next satellite broadcast, titled Surveillance of Vaccine-Preventable Diseases, will be on December 8, 2005 from 12:00 PM – 3:30 PM ET. This course is designed to provide information on case investigation, outbreak control, and disease reporting for vaccine-preventable diseases. It will stress the most epidemiologically important data to collect and will discuss methods of enhancing surveillance and completing case investigations. For more information, please visit www2.cdc.gov/phtn/VPD-05/. CE credits will be provided.
Register for NIC:
The 40th National Immunization Conference (NIC) — to be held March 6-9, 2006, at the Omni Hotel at CNN Center in Atlanta, Georgia — will comprise six topic tracks: Adult and Adolescent Immunization, Epidemiology and Vaccine Safety, Health and Risk Communications, Immunization Information Systems, Programmatic Issues, and Policy and Legislation. Please register before January 13, 2006 to obtain the best rate. Participants can register online at the NIC Web site, www.cdc.gov/nip/nic
Save the Date: 7th National Conference on Immunization Coalitions: The 7th National Conference on Immunization Coalitions will be held from August 9 - 11, 2006 in Denver, Colorado. For details, please contact Roberta Smith (Colorado Influenza and Pneumococcal Alert Coalition, Adult Immunizations) at 303-692-2332 or email@example.com. In addition, more information will be forthcoming in future editions of Immunization Works.
NIP Needs Pilot Testers:
The National Immunization Program (NIP) has an ongoing need for volunteers to pilot test immunization training courses. Volunteers are particularly needed in the following occupations: physicians, pharmacists, health educators, medical assistants and nurses. To learn more about becoming a pilot tester, please send an email to firstname.lastname@example.org
Job Openings within NIP: The National
Immunization Program (NIP) is committed to recruiting and
hiring qualified candidates for a wide range of positions.
Researchers, Medical Officers and Epidemiologists as well
as other specialties are often needed to fill positions within
NIP. Interested parties are encouraged to apply for these
positions. For a current listing of positions available at
NIP, please visit www.cdc.gov/hrmo/hrmo.htm