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.
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Welcome to the New Immunization Works |
Immunization Works is expanding to reflect the new National Center for Immunization and Respiratory Diseases (see Immunization Works April 2006 edition). In addition to articles about vaccines and vaccine-preventable diseases, readers can now expect to see articles about respiratory diseases. As always, Immunization Works is committed to providing CDC partners with new information and resources that can help frontline health professionals.
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Update: Mumps Outbreak: In what has now become the largest number of cases of mumps reported in the United States since 1992, the current mumps outbreak has now affected 10 states: Iowa, Nebraska, Kansas, Illinois, Wisconsin, Minnesota, Missouri, Pennsylvania, Colorado and South Dakota. Of the outbreak-affected states, Iowa has reported 1273 of the 2059 reported mumps cases.
States throughout the country have enhanced surveillance for mumps and a number of states are actively investigating cases. The majority of cases reported from all states are in 2-dose measles, mumps, and rubella (MMR) recipients. This pattern is what would be expected in populations with high 2-dose MMR vaccine coverage. One dose of MMR vaccine protects about 80 percent of persons from mumps. Limited data suggest that 2 doses protect about 90 percent of persons from mumps. In most states, the predominant age group affected is 18-24 year olds, but cases range from persons less than 1 year to persons greater than 90 years old.
Mumps generally is a mild and self-limited viral infection but can also lead to serious complications such as meningitis, encephalitis or orchitis. The principal strategy to prevent mumps is to achieve and maintain high immunization levels. The Advisory Committee on Immunization Practices (ACIP) recommends that all preschool-aged children 12 months of age and older receive one dose of MMR, that all school-aged children and students attending post-high school educational institutions receive two doses of MMR, and that all adults have evidence of immunity against mumps.
In response to the outbreak, CDC has issued a national health advisory, and Iowa has issued a state health advisory and initiated an MMR vaccination campaign targeting 18-22-year olds living in 35 counties with large universities and colleges. Iowa has also issued a “Public Health Bulletin Mass Gathering Policy for Mumps.” The policy encourages individuals attending large gatherings in Iowa -- such as the upcoming Special Olympics -- to be fully vaccinated, unless they have a history of mumps infection.
In addition, public health officials are notifying persons who may have been exposed to mumps through air travel. A total of eight persons potentially infected with mumps have been identified on 24 different commercial flights from March 26, 2006 through April 18, 2006. Plans are to follow-up with all potentially exposed passengers and crew on all identified flights.
This policy may be reconsidered as more data about the efficiency of mumps transmission during air travel becomes available from the investigations. To date, no cases of mumps associated with transmission during air travel have been identified.
More information about the mumps outbreak and mumps educational resources can be found on CDC’s
website, including an article
about the Iowa outbreak in
CDC’s Morbidity and Mortality Weekly Report (MMWR), as well
as an MMWR article
concerning exposure to mumps during air travel.
For fact sheets, late-breaking information and additional mumps resources for healthcare professionals, the general public and travelers, please visit CDC’s mumps website.
Pneumococcal Conjugate Vaccine Has Unexpected Benefits: Two recent journal articles solidify the importance of the pneumococcal conjugate vaccine (PCV7). While the protection of vaccinated children--those aged 2 to 23 months—was expected; additional, unexpected benefits from the vaccine were also found.
An
article in the Journal of the American Medical
Association (JAMA) looked at invasive pneumococcal
disease among infants before and after introduction
of PCV7. This prospective, population-based study
of infants in the U.S. found conclusive results;
since the introduction of PCV7, rates of invasive
pneumococcal disease in infants too young to have
been vaccinated have decreased significantly,
along with rates for the vaccinated children themselves.
JAMA
has an abstract for this article on its website.
An
article in the New England Journal
of Medicine (NEJM) looked at the effect
of introducing the pneumococcal conjugate
vaccine on drug-resistant Streptococcus
pneumoniae. It tracked cases of serious
pneumococcal disease in a population
of nearly 17 million people between 1998 and 2004—both
before and after the introduction
of the vaccine. In 2004, four years
after the introduction of the vaccine,
there were 13,000 fewer severe illnesses
caused by resistant pneumococcal strains
than in 1999, the year before the vaccine was
licensed.
An
unexpected and strong finding also
points to how many cases of serious
pneumococcal disease were prevented
in adults, who do not receive the
vaccine, by vaccinating children – a
great demonstration of the ‘herd immunity’ effect
crossing generations, and offering
benefits to the community as a whole.
The abstract
for this article can be found on the NEJM’s
website.
Update: Guillain-Barré Syndrome among Recipients of Menactra®: In October 2005, a possible association between Guillain-Barré Syndrome (GBS) and receipt of Menactra® meningococcal conjugate vaccine was reported. GBS is a serious neurologic disorder involving inflammatory demyelination of the peripheral nerves. At the time of the first report, five confirmed cases of GBS after receipt of MCV4 had been reported to the Vaccine Adverse Events Reporting System (VAERS). During the four months since, three additional confirmed cases of GBS have been reported. Because available evidence neither proves nor disproves a causal relation between MCV4 and GBS, further monitoring and studies are ongoing within VAERS and the Vaccine Safety Datalink (VSD).
While CDC continues to recommend use
of MCV4 for persons for whom vaccination
is indicated, information regarding
the current investigation should
be shared with adolescents and caregivers
before MCV4 vaccination. A Vaccine
Information Statement (VIS) and
fact sheet noting
the information on the reported
GBS cases is available. An updated fact
sheet
for healthcare workers is also available.
CDC
continues to recommend that health-care
workers and any other persons aware
of adverse events associated with
MCV4 or any other vaccination report
to VAERS cases of GBS or any other
clinically significant adverse events.
Reports may be submitted securely
online at VAERS or
by fax at 877-721-0366. Reporting
forms and additional information
is available by telephone at 800-822-7967. View
the complete
MMWR article.
Progress Toward Interruption of Wild Poliovirus Transmission: Progress toward global poliomyelitis eradication was made in 2005, despite the diversion of major financial and human resources to control outbreaks resulting from wild poliovirus (WPV) importations primarily from Nigeria. The number of countries with endemic polio has decreased to four, compared with 125 in 1988, when the Polio Eradication Initiative was initiated by the World Health Assembly. In Africa and Asia, only eight of the 22 previously polio-free countries that were re-infected since 2003 reported WPV transmission after July 2005 and transmission was curtailed substantially in all eight of these countries except Somalia. Of the three remaining polio-endemic countries in Asia (Afghanistan, India, and Pakistan), India and Pakistan also moved closer to eradication in 2005, reporting approximately half as many cases in 2005, compared with 2004. The greatest risk to global polio eradication and to the polio-free status of most countries of the world remains the ongoing uncontrolled poliovirus transmission in several northern Nigerian states. Eradication efforts will ultimately require ongoing commitment by governments and health workers at all levels to ensure that all children are appropriately vaccinated. The complete article is part of CDC’s Morbidity and Mortality Weekly Report (MMWR).
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