The Centers for Disease Control and Prevention’s (CDC) 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.
CDC Releases Safety Data on Rotavirus Vaccine: The Centers for Disease Control and Prevention (CDC) released new safety data in its Morbidity and Mortality Weekly Report (MMWR) on a recently licensed rotavirus vaccine given to infants. After one year of experience with the RotaTeq ® vaccine, there is no evidence of an association between the vaccine and intussusception. Intussusception, a form of bowel obstruction, occurs spontaneously in the absence of vaccination. There are a number of intussusception cases that occur every year in children in the age group recommended for RotaTeq ® (6-32 weeks of age) and are not related to the vaccine.
According to the data, 35 confirmed cases of intussusception were reported to the Vaccine Adverse Event Reporting System (VAERS) between February 1, 2006, and February 15, 2007. Of the 35 reports, 17 cases occurred within 21 days following RotaTeq ® vaccination, considerably fewer than the 52 intussusception cases expected to occur naturally among infants without vaccination, which is known as the background rate. As of January 31, the manufacturer had distributed 3.6 million doses of RotaTeq®.
These cases were detected through routine monitoring of new vaccines like RotaTeq® using the Vaccine Adverse Event Reporting System (VAERS). This routine monitoring is done to ensure the safety of all vaccines. CDC is closely monitoring VAERS reports associated with the rotavirus vaccine, as CDC would be with any newly licensed vaccine. However, because an earlier rotavirus vaccine was found to be associated with intussusception, CDC is closely watching for cases of intussusception following rotavirus vaccination. CDC and FDA encourage all healthcare providers and other individuals to report any cases of intussusception or other serious adverse events to VAERS. For a copy of the vaccine reporting form, call 1-800-822-7967 or report online at www.vaers.hhs.gov
RotaTeq is recommended for routine vaccination of U.S. infants to protect against rotavirus, which causes severe diarrhea, vomiting, fever and dehydration (gastroenteritis) in children.
More information can be found in the MMWR article at www.cdc.gov/mmwr/preview/mmwrhtml/mm5610a3.htm
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Quadrivalent Human Papillomavirus (HPV) Vaccine: On March 12, CDC published the recommendations of the Advisory Committee on Immunization Practices (ACIP) for HPV vaccine in its Morbidity and Mortality Weekly Report (MMWR).
These recommendations represent the first statement by ACIP on the use of a quadrivalent human papillomavirus (HPV) vaccine licensed by the U.S. Food and Drug Administration (FDA) on June 8, 2006. This report summarizes the epidemiology of HPV and associated diseases, describes the licensed HPV vaccine, and provides recommendations for its use for vaccination among females aged 9--26 years in the United States.
Genital HPV is the most common sexually transmitted infection in the United States; an estimated 6.2 million persons are newly infected every year. The majority of infections cause no clinical symptoms. However, persistent infection with oncogenic types can cause cervical cancer in women. HPV infection also is the cause of genital warts and is associated with other anogenital cancers. In 2007 -- even with the widespread use of Papanicolaou (Pap) testing, which can detect precancerous lesions of the cervix before they develop into cancer -- an estimated 11,100 new cases will be diagnosed and approximately 3,700 women will die from cervical cancer. In certain countries where cervical cancer screening is not routine, cervical cancer is a common cancer in women. In the United States, certain ethnic groups (black women, Hispanic women, and certain subgroups of Asian women) have higher rates of cervical cancer.
The HPV vaccine is administered by intramuscular injection, and the recommended schedule is a 3-dose series with the second and third doses administered 2 and 6 months after the first dose. The recommended age for vaccination of females is 11--12 years; however, vaccine can be administered as young as age 9 years. Catch-up vaccination is recommended for females aged 13--26 years who have not been previously vaccinated. Vaccination is not a substitute for routine cervical cancer screening, and vaccinated females should have cervical cancer screening as recommended. More information can be found in the MMWR article at www.cdc.gov/mmwr/preview/mmwrhtml/rr56e312a1.htm
Change to ACIP Influenza Recommendation: On February 21-22, 2007, 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.
During the meeting, ACIP recommended that children 6 months through 8 years old who received only one dose of influenza vaccine in their first season should receive two doses of influenza vaccine in their second season. This is a change from the prior recommendation. The prior recommendation was that these children only needed one dose in their second season.
Several studies suggest this strategy provides better protection. More detailed information can be found in the influenza slides from the ACIP meeting, available at
www.cdc.gov/nip/ACIP/slides/mtg-slides-feb07.htm#influenza
This change is expected to be reflected in the 2007-2008 influenza recommendations, to be published in CDC’s Morbidity and Mortality Weekly Report (MMWR) this Spring .
Varicella Vaccine Supply Update: CDC received notice from Merck & Co., Inc., that it has lower amounts of varicella-zoster virus (VZV) than expected from recently manufactured bulk vaccine. Bulk vaccine production is an intermediate step in the manufacture of VZV-containing vaccines. Varicella bulk is stored frozen until it is needed in the final preparation phase of each vaccine. Production of VZV bulk has been suspended temporarily while the manufacturer identifies the cause of the low virus yield. Merck is the only U.S. supplier of VZV-containing vaccine, including varicella vaccine (Varivax®); combined measles, mumps, rubella, and varicella (MMR-V) vaccine (ProQuad®); and zoster vaccine (Zostavax®). This lower virus yield does not affect the quality of any of Merck's VZV-containing vaccines currently on the market, any lots of vaccine manufactured and ready for release to the market, or any VZV-containing vaccines presently being manufactured.
Current supply assessments in the United States indicate that this interruption in bulk vaccine supply will not affect the supply of either varicella vaccine or zoster vaccine, and health care providers should continue to follow current vaccine recommendations. More information can be found in the article in CDC’s Morbidity and Mortality Weekly Report (MMWR) at www.cdc.gov/mmwr/preview/mmwrhtml/mm5607a4.htm Information about vaccine shortages and delays is updated frequently at CDC’s website at www.cdc.gov/nip/news/shortages/default.htm
Adult measles Associated with Adoption of Children in China: A recent report in CDC’s CDC’s Morbidity and Mortality Weekly Report (MMWR) describes three cases of measles in adults associated with adoption-related travel to China. Public health officials were notified of the first case on August 15, 2006. The cases occurred in three states: California, Missouri and Washington. China is the leading country of origin for foreign-born children adopted in the United States. National and local measles outbreaks in China present an increased risk for measles exposure to travelers and potential importation into the United States. Health care providers should continue to promote appropriate pre-travel vaccination for their patients. More information can be found in the MMWR article at www.cdc.gov/mmwr/preview/mmwrhtml/mm5607a3.htm
(Note: Please see Upcoming Netconferences under “Meetings, Conferences & Resources” for health care provider trainings related to international travel and safety.)
Big Draw for 41st NIC: Nearly 1500 attendees participated in the 41st National Immunization Conference (NIC), which was held March 5-8, 2007, in Kansas City, KS. The 3 ½ day conference included 3 full plenaries, 12 topic track plenaries, 60 workshop sessions, and 2 Immunization Q &A sessions. Sessions focused on six different topic tracks: 1) Adult/Adolescent Immunizations, 2) Epidemiology/New Vaccines, 3) Health/Risk Communications, 4) Immunization Information Systems, 5) Influenza, and 6) Programmatic Issues.
Senior leadership from HHS and CDC participated in the conference’s opening session. Dr. Anne Schuchat, Director of CDC’s proposed National Center for Immunization and Respiratory Diseases (NCIRD), opened the session, along with state/local leaders in the community and public health. They included Kansas City Councilman Alvin Brooks, Director of Missouri Department of Health and Senior Services Ms. Jane Drummond, and Kansas City Health Department Director Dr. Rex Archer. HHS Assistant Secretary for Health Dr. John Agwunobi delivered the keynote address. During the opening session, awards were presented to state and local immunization leaders, and The Phil Horne Award was presented to CDC’s Dr. Jon Andrus. Additional conference highlights included The Hilleman Lecture, presented by Dr. Steve Cochi, and the closing session, featuring remarks by Dr. Melinda Wharton,
Conference participants can continue to receive Continuing Education (CE) credits for participation in the 41 st NIC until April 13, 2006. Please visit www.cdc.gov/nip/NIC/41st/cestatements.htm for CE information. Also, handouts and audio/video recordings will soon be available online from www.cdc.gov/nip
Remember to mark your calendars for the 41st NIC, to be held March 17-20, 2007, in Atlanta, GA.
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