• Multi-state Outbreak / New ACIP Recommendations
• Other immunization news and summaries
• Meetings, conferences, and resources
  

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.

CDC and state and local health departments continue to investigate an outbreak of mumps that began in Iowa in December 2005 and involved at least 12 additional states as of May 19, 2006. The following data are preliminary; the case count is likely to change as additional data become available.

Through May 24, 2006, 12 states reported 4,016 cases of mumps. Of these, 1,824 confirmed, probable and suspect cases have been reported from Iowa; 177 of these cases are asymptomatic, laboratory confirmed mumps infections designated by Iowa health department as suspect cases. Another 2,144 probable and confirmed mumps cases have been reported from seven states where outbreaks are occurring - Kansas (682 cases), Illinois (374), Nebraska (304), Missouri (127), South Dakota (109), Pennsylvania (13) and Wisconsin. Another four states ( Colorado, Minnesota, Mississippi and New York) have reported a total of 48 probable and confirmed mumps cases, 10 of which are related to travel to one of the eight mumps outbreak states. The current reported number of hospitalizations is 55 persons. Some hospitalizations are for complications of mumps including meningitis, encephalitis and orchitis, and others are coincidental hospitalizations.

As of May 22, 2006, 17 persons are known to have been potentially infectious with mumps while traveling on 40 different commercial flights involving 11 different airlines between March 26 and May 10, 2006. Passenger manifests have been requested for the first 29 flights (11 index cases), involving 883 passengers and 75 crew members. Notification and follow-up interviews for these passengers and crew are in progress. Follow-up interviews have been completed for approximately 200 of those 883 potentially exposed passengers (23%), and for 11 of approximately 75 (15%) crew members. No additional suspect secondary cases have been discovered beyond the two cases previously reported.

High vaccination coverage with 2 doses of MMR vaccine, especially in school-aged populations in the United States, likely prevented thousands of additional cases of mumps in this outbreak. To prevent mumps, the Advisory Committee on Immunization Practices (ACIP) continues to recommend a 2-dose MMR vaccination series for all children, with the first dose administered at ages 12--15 months and the second dose at ages 4--6 years. Two doses of MMR vaccine are also recommended for school and college entry unless the student has other evidence of immunity. In addition, in a specially convened meeting on May 17, 2006, the ACIP recommended key changes to the 1998 ACIP recommendations on mumps:

• Acceptable Presumptive Evidence of Immunity
  • Documentation of adequate vaccination is now 2 doses of a live mumps virus vaccine instead of 1 dose for
    • School-aged children (i.e., grades K-12)
    • Adults at high risk (i.e., persons who work in health-care facilities, international travelers, and students at post-high school educational institutions
• Routine Vaccination for Health-Care Workers
  • Persons born during or after 1957 without other evidence of immunity: 2 doses of a live mumps virus vaccine
  • Persons born before 1957 without other evidence of immunity: consider recommending 1 dose of a live mumps virus vaccine
• For Outbreak Settings
  • Children aged 1-4 years and adults at low risk: if affected by the outbreak, consider a second dose of live mumps virus vaccine (minimum interval between doses = 28 days)
  • Health-care workers born before 1957 without other evidence of immunity: strongly consider recommending 2 doses of live mumps virus vaccine

CDC continues to work with state and local health departments to conduct mumps surveillance, assist with prevention and control activities, and evaluate vaccine effectiveness, duration of immunity, and risk factors for mumps illness. For more information, view CDC's Morbidity and Mortality Weekly Report (MMWR), "Update: Multistate Outbreak of Mumps -- United States, January 1-May 2, 2006." Also, view the revised ACIP recommendations concerning mumps. For fact sheets, late-breaking information and additional mumps resources for healthcare professionals, the general public and travelers, please visit CDC’s mumps website.

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Defer MCV4 Vaccination of 11-12 Year Olds:
Due to a limited supply of meningococcal polysaccharide-protein conjugate vaccine (MCV4), CDC -- in consultation with the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics, American Academy of Family Physicians, American College Health Association, and Society for Adolescent Medicine -- recommends that healthcare professionals defer vaccination of 11-12 years olds until further notice. Providers should continue to vaccinate adolescents at high school entry who have not previously received MCV4 and college freshmen living in dormitories. Other persons at high risk for meningococcal disease also should be vaccinated (i.e., military recruits, travelers to areas where meningococcal disease is hyperendemic or epidemic, microbiologists who are routinely exposed to isolates of Neisseria meningitidis, persons with anatomic or functional asplenia, and persons with terminal complement deficiency). Current supply projections from Sanofi Pasteur, the manufacturer for MCV4, suggest that enough MCV4 will be available to meet vaccine demand for these groups. If possible, providers should track 11-12 year olds for whom MCV4 has been deferred and recall them for vaccination when supply improves.

Sanofi Pasteur currently anticipates that MCV4 demand will outpace supply at least through summer 2006. Periodic updates of vaccine supply will be available at CDC's vaccine shortages webpage. Providers who have questions about their orders may contact Sanofi Pasteur at 800-VACCINE (800-822-2463) or via Sanofi Pasteur website. Also, view the complete article in CDC’s MMWR, "Notice to Readers: Limited Supply of Meningococcal Conjugate Vaccine, Recommendation to Defer Vaccination of Persons Aged 11-12 Years."

Prevention of Hepatitis A Through Immunization:  
Routine vaccination of children is an effective way to reduce hepatitis A incidence in the United States. A new report in CDC’s Morbidity and Mortality Weekly Report (MMWR) updates the 1999 Advisory Committee on Immunization Practices (ACIP) recommendations concerning the prevention of hepatitis A through immunization. The report includes

1. new data on the epidemiology of hepatitis A in the era of hepatitis A vaccination of children in selected U.S. areas,
2. results of analyses of the economics of nationwide routine vaccination of children, and
3. recommendations for the routine vaccination of children in the United States.

Previous recommendations for vaccination of persons in groups at increased risk for hepatitis A or its adverse consequences and recommendations regarding the use of immune globulin for protection against hepatitis A are unchanged from the 1999 recommendations. Also, view the complete CDC's MMWR report, "Prevention of Hepatitis A Through Active or Passive Immunization."

Hepatitis B Vaccinations Increase Among High-risk Adults:
New data suggest that hepatitis B vaccination coverage among adults at high risk has increased substantially from 30% in 2000 to 45% in 2004. Hepatitis B virus (HBV) infection is a major cause of cirrhosis and liver cancer in the United States. The Advisory Committee on Immunization Practices (ACIP) has recommended a comprehensive strategy to eliminate HBV transmission, including prevention of perinatal HBV transmission; universal vaccination of infants; catch-up vaccination of unvaccinated children and adolescents; and vaccination of unvaccinated adults at increased risk for infection. The incidence of acute hepatitis B has declined 75 percent from 8.5 per 100,000 population in 1990 to 2.1 per 100,000 population in 2004, with the greatest declines (94%) among children and adolescents. Incidence remains highest among adults, who accounted for approximately 95% of the estimated 60,000 new infections in 2004. During 2004, 34.6% of adults aged 18-49 years reported receiving hepatitis B vaccine, including 45.4% of adults at high risk for HBV infection. To accelerate elimination of HBV transmission in the United States, public health programs and clinical care providers should implement strategies to ensure that adults at high risk are offered hepatitis B vaccine. View the complete CDC MMWR article, "Hepatitis B Vaccination Coverage Among Adults -- United States, 2004".

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ACIP Meeting: The Advisory Committee on Immunization Practices (ACIP) will hold its next meeting on June 29-30, 2006 at the CDC in Atlanta, Georgia. The draft agenda is now available. Agenda topics include informational updates and discussions on a variety of topics including vaccine recommendations for human papillomavirus (HPV), varicella, rabies, influenza and mumps. Votes will be taken on new ACIP recommendations. This meeting is open to the general public, but advanced registration is required.

Upcoming Satellite Broadcasts: The annual summer offering of Immunization Update 2006 is scheduled for August 10, 2006. Anticipated topics include: influenza vaccine, pertussis vaccine for adolescents and adults, revised recommendations for hepatitis A vaccination of children and the new vaccines for rotavirus and herpes zoster. For further details, please visit http://www2.cdc.gov/phtn/immup-2006

Interim Tdap VIS: An interim Tdap Vaccine Information Statement (VIS) has been developed that applies to adults as well as adolescents receiving the vaccine. A final VIS statement will be issued after the adult Tdap Advisory Committee on Immunization Practices (ACIP) recommendations are published in CDC’s Morbidity and Mortality Weekly Report (MMWR).

CDC Needs Pilot Testers: CDC 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.

CDC Job Openings: CDC is committed to recruiting and hiring qualified candidates for a wide range of immunization positions. Researchers, Medical Officers and Epidemiologists as well as other specialties are often needed to fill positions within CDC. For a listing of current job openings at CDC, please visit the Atlanta Human Resources Center page.

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