The Centers for Disease Control and Prevention’s 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.
On February 21-22, 2006, the Advisory Committee on Immunization Practices (ACIP) met in Atlanta, GA. The ACIP meets quarterly and provides recommendations to the Director of the CDC and the Secretary of the Department of Health and Human Services (HHS) concerning the prevention of vaccine-preventable diseases (VPDs) in the United States. ACIP’s fifteen voting members – experts in the fields of vaccines, immunologic agents, and clinical and preventive medicine, and a person knowledgeable about consumer perspectives and/or social and community aspects of immunization programs – are
selected by the Secretary of HHS to
serve overlapping 4-year terms. In
addition to the voting members, the
ACIP includes ex officio members from
federal agencies working in the field
of immunization, and non-voting liaison
representatives from medical organizations
and immunization interest groups.
Also, members of the public are welcome
to attend the meetings and to address
the committee. Recommendations of
the ACIP become recommendations of
CDC once they are accepted by the
director of CDC and the Secretary
of HHS and are published in the Morbidity
and Mortality Weekly Report (MMWR).
More information about the ACIP can
be found on the ACIP
website.
Following is a summary of key votes from the ACIP’s February meeting:
Rotavirus: The ACIP voted to recommend a newly licensed vaccine to protect against rotavirus, a viral infection that can cause severe diarrhea, vomiting, fever and dehydration (gastroenteritis) in infants and young children. Also, rotavirus vaccine was added to the CDC’s Vaccines for Children (VFC) Program, which helps families by providing free vaccines to doctors and nurses who serve eligible children.
The ACIP recommendation is for infants to receive three doses of the oral vaccine at two, four, and six months of age. Children should receive the first dose of the vaccine by 12 weeks of age and should receive all doses of the vaccine by 32 weeks of age. There are insufficient data on safety and efficacy outside of these age ranges to make a broader recommendation. The new vaccine, RotaTeq™ (marketed by Merck and Company), is the only vaccine approved in the United States for prevention of rotavirus gastroenteritis.
Each year, rotavirus is responsible for more than 400,000 doctor visits, more than 200,000 emergency room visits, 55,000 to 70,000 hospitalizations, and between 20 and 60 deaths in US children younger than 5 years of age, leading to about $300 million in direct medical costs and $900 million in total societal costs.
View the CDC press release about the new ACIP rotavirus recommendations, at CDC’s Advisory Committee Recommends New Vaccine to Prevent Rotavirus. A rotavirus fact sheet is also available.
Influenza: The ACIP voted to recommend an expansion of routine influenza vaccination for children. With the expansion, the recommended influenza vaccination age will be from 6 months to up to 5 years old. The previous recommendation was for children 6 months to 23 months old. The new recommendation expands that recommendation to also cover children from 2 years to up to their fifth birthday.
The committee also voted to recommend expanding routine vaccination for household contacts (anyone who spends a significant amount of time in the home) and out-of-home caregivers of children 24-59 months old. The previous recommendation had been for household contacts and caregivers for children 6 months to 23 months old. This new recommendation takes into consideration a broader view of the burden of illness than the earlier recommendation for vaccination of children, which was based upon the prevention of hospitalization among children 6 months to 23 months old. The ACIP voted to update the VFC resolution for influenza vaccine to include the newly recommended group of children along with any other VFC-eligible children who desire the vaccine.
Presenters at the meeting indicated that otherwise healthy children are at increased risk for requiring influenza-related medical care and that rates of medial outpatient visits for influenza-related illnesses are high in all childhood ages. It was also noted that children 24 months to 59 months old with influenza are nearly as likely to require visits to healthcare providers and emergency rooms as children 6 months to 23 months old. Approximately 5.3 million children and 11.4 million healthy household contacts or caregivers for these children will also be covered by the new recommendations. Vaccination of all children who have certain chronic medical conditions such as asthma, diabetes, kidney disease or weakened immune systems continues to be strongly recommended by ACIP. Children younger than nine years who will be receiving the influenza vaccine for the first time should receive two doses. View the CDC press release about the new ACIP expanded influenza recommendations.
In addition to expanding the influenza recommendations, the ACIP recommended that neither amantadine nor rimantadine be used in the United States for treatment or chemoprophylaxis of influenza until further notice. Finally, the ACIP recommended that prioritization of vaccination (“tiering”) not occur unless there is an indication of a significant delay or an inadequate supply of influenza vaccine.
Pertussis: The ACIP voted to recommend the administration of Tetanus and Diphtheria Toxoids and Acellular Pertussis (Tdap) to protect healthcare personnel (HCP) from pertussis and to reduce transmission in health-care facilities. The ACIP recommendation is for HCP who work in hospitals or ambulatory care settings and have direct patient contact to receive a single dose of Tdap as soon as feasible, at an interval as short as 2 years from the last dose of Td. Priority should be given to the vaccination of HCP who have direct contact with infants less than 12 months of age. Hospitals and ambulatory care facilities should provide Tdap for HCP, using approaches that will maximize vaccination rates.
Tdap is not licensed for use among adults 65 years and older, and ACIP does not recommend Tdap for this age group. Recommendations for the use of Tdap in adults 65 years and older will be updated as new data become available.
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Influenza Vaccination of Healthcare Personnel (HCP): Influenza transmission and outbreaks in hospitals and nursing homes are well documented. HCP can acquire influenza from patients or transmit influenza to patients and to other staff. Despite clear benefits to patients and to staff, vaccination coverage among HCP remains low (less than 50%). Because HCP provide care to patients at high risk for complications of influenza, vaccinating HCP is a high priority for expanding influenza vaccine use. In addition, older HCP, those with underlying chronic medical conditions, and those who might be pregnant, are at increased risk for influenza-related complications. Achieving and sustaining high vaccination coverage among HCP will protect staff and their patients, and reduce disease burden and health-care costs.
A
new report summarizes the recommendations
of the Healthcare Infection Control
Practices Advisory Committee (HICPAC)
and the Advisory Committee on Immunization
Practices (ACIP) concerning influenza
vaccination of HCP in the United States.
These recommendations are targeted
at health-care facility administrators,
infection control professionals, and
occupational health professionals
responsible for influenza vaccination
programs and influenza infection control
programs in their institutions. HICPAC
and ACIP recommend that all HCP be
vaccinated annually against influenza.
Facilities that employ HCP are strongly
encouraged to provide vaccine to their
staff by using evidence-based approaches
that maximize vaccination rates. For
more information, view the complete
report, Influenza
Vaccination of Healthcare Personnel, published
in CDC’s MMWR.
Preventing Tetanus, Diphtheria, and Pertussis Among Adolescents: During spring 2005, two tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) products formulated for use in adolescents (and, for one product, use in adults) were licensed in the United States (BOOSTRIX®, GlaxoSmithKline Biologicals, Rixensart, Belgium [licensed May 3, 2005, for use in persons aged 10-18 years], and ADACEL™, sanofi pasteur, Toronto, Ontario, Canada [licensed June 10, 2005, for use in persons aged 11-64 years]). Prelicensure studies demonstrated safety and efficacy against tetanus, diphtheria, and pertussis when Tdap was administered as a single booster dose to adolescents.
The
report, Preventing
Tetanus, Diphtheria, and Pertussis
Among Adolescents: Use of Tetanus
Toxoid, Reduced Diphtheria Toxoid
and Acellular Pertussis Vaccine, recently
published in CDC’s
MMWR, 1) reviews tetanus, diphtheria
and pertussis vaccination policy in
the United States, with emphasis on
adolescents; 2) describes the clinical
features and epidemiology of pertussis
among adolescents; 3) summarizes the
immunogenicity, efficacy, and safety
data of the two Tdap vaccines licensed
for use among adolescents; and 4)
presents recommendations for tetanus,
diphtheria, and pertussis vaccination
among adolescents aged 11-18 years.
New
Drug for Postexposure Prophylaxis of Varicella: A
new product (VariZIG™) for Postexposure
Prophylaxis of Varicella is available
under an investigational new drug application
expanded access protocol. In October,
2004, the Advisory Committee on Immunization
Practices (ACIP) was informed by the only
U.S.-licensed manufacturer of varicella
zoster immune globulin (VZIG) that the
company had discontinued production of
VZIG. The supply of the licensed VZIG
product is now nearly depleted. In February
2006, an investigational (not licensed)
VZIG product, VariZIG™ (Cangene
Corporation, Winnipeg, Canada) became
available under an investigational new
drug application (IND) submitted to the
Food and Drug Administration (FDA). This
product can be requested from the sole
authorized U.S. distributor, FFF Enterprises
(Temecula, California), for patients who
have been exposed to varicella and who
are at increased risk for severe disease
and complications. For more information,
view the article, A
New Product (VariZIG™)
for Postexposure Prophylaxis of Varicella
Available Under an Investigational New
Drug Application Expanded Access Protocol,
in CDC’s
MMWR.
Childhood Influenza Vaccination
Coverage: A recent report in
CDC’s Morbidity and Mortality
Weekly Report (MMWR) provides an assessment
of childhood influenza vaccination coverage
in the United States for the 2003-04
influenza season. This represents the
second year since the Advisory Committee
on Immunization Practices recommended
influenza vaccination of children aged
6-23 months. According to the report,
vaccination coverage increased from
the previous influenza season but remained
low, with substantial variability among
states and urban areas. The MMWR report
is based on data from the 2004 National
Immunization Survey (NIS), which provides
estimates of vaccination coverage among
noninstitutionalized children aged 19-35
months. For more information, view the
MMWR report, Childhood
Influenza Vaccination Coverage -- United
States, 2003-04 Influenza Season.
Mumps Epidemic in United Kingdom: During
2004-2005, the United Kingdom (UK) experienced
a nationwide epidemic of mumps, which
peaked during 2005 when 56,390 notified
cases were reported in England and Wales.
The majority of confirmed cases during
2004-2005 were in persons 15-24 years
old, most of whom had not been eligible
for routine mumps vaccination. Mumps generally
is a mild and self-limited viral infection
but can also lead to serious complications
such as encephalitis or pancreatitis.
For more information, view the article,
Mumps
Epidemic -- United Kingdom, 2004-2005,
in CDC’s
MMWR.
Mumps Outbreak at New York Summer
Camp: On July 26, 2005, the Sullivan
County Health Department (SCHD) and the
New York State Department of Health (NYSDOH)
were notified of a cluster of cases of
parotitis among campers and staff members
at a summer camp. An investigation conducted
by NYSDOH identified 31 cases of mumps,
likely introduced by a camp counselor
who had traveled from the United Kingdom
(UK) and had not been vaccinated for mumps.
A subsequent investigation by NYSDOH,
determined that even in a population with
96% vaccination coverage, as in this population,
a mumps outbreak can result from exposure
to virus imported from a country with
an ongoing mumps epidemic. Mumps generally
is a mild and self-limited viral infection
but can also lead to serious complications
such as encephalitis or pancreatitis.
For more information, view the article, Mumps
Outbreak at a Summer Camp -- New York,
2005, in
CDC’s MMWR.
National Infant Immunization Week (NIIW)
NIIW will be held April 22-29, 2006 to promote, through community and media events, the benefits of immunizations and highlight the importance of vaccinating children by the age of 2. This year, NIIW will be held in conjunction with the Pan American Health Organization’s Vaccination Week in the Americas (VWA). The U.S. and 35 countries in the Western Hemisphere will promote the need for routine vaccinations for infants and children.
To assist communities in promoting infant immunization during NIIW-VWA, CDC is providing technical assistance and English and Spanish-language resources to support local activities.
Technical Assistance: Learn
about the 2006 Spanish-language childhood
campaign and tips for local placement
of the campaign, especially through
Spanish-language media outlets. NIP
will provide two teleconferences to
assist program coordinators, health
departments, coalitions, and others
in their efforts to disseminate infant
immunization messages. The calls will
take place on March 14, from 12:00 PM
to 1:00 PM EST, and March 15, from 3:00
PM to 4:00 PM EST. To register for the
teleconference, please send an email
to calvarez@cdc.gov.
English and Spanish-language Resources: Build NIIW awareness with materials and planning tools available for download from the National Infant Immunization Week website. Materials include:
- Posters
- Web Buttons and Banners
- English and Spanish-language Television Public Service Announcements (PSAs); Available online the week of March 13, 2006
- Spanish-language Radio Public Service Announcement (PSA); Available online the week of March 13, 2006
- Sample Key Messages
- Sample Proclamations
- Sticker Templates
- And more!
Share Your Activities: Let CDC know what you are doing to promote childhood immunization during the week of April 22-29 and find out how others will celebrate NIIW-VWA. Add your events to the NIIW activity form.
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New Module Released in “You Call the Shots” Series: CDC’s National Immunization Program (NIP) announces the release of the third instructional module in the Immunization: You Call the Shots series of web-based training materials. This latest module, titled “Haemophilus influenzae type b (Hib),” discusses characteristics of Hib-related diseases, the Hib vaccine, and recommendations for vaccine use. Extra learning opportunities, self-test practice questions, reference and resource materials, and an extensive glossary are all provided in an attractive, easy-to-use format.
Immunization: You Call the Shots is an interactive, self-study course that participants can complete at their own pace. It is intended for introductory training of healthcare professionals who provide immunizations and can serve as a reference or refresher for all immunization providers. The course is available free of charge. Continuing education credits are provided.
Jobs Teleconference: NIP’s Global Immunization Division (GID) and the National Center for HIV, STD and TB Prevention’s Global AIDS Program (GAP) are hosting a WEB/NET Recruitment Conference on Thursday, March 30, 2006 at 1:30 p.m. EST. The conference can be accessed via the Internet from any computer.
Participants will learn about opportunities for CDC employment and placement for medical officers, epidemiologists, public health advisors, behavioral scientists, and other health professionals with public health experience. Permanent positions and term appointments are available in a variety of international locations and with partner organizations, including WHO and UNICEF. During the WEBMET Recruitment Conference, participants will have the opportunity to ask questions of program leaders. For more information, please visit About NIP.
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 nippilot@cdc.gov.
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