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Immunization Works! July 2009 issue

The Centers for Disease Control and Prevention's (CDC) Immunization Works Monthly Immunization Update is provided to professional organization partners for broad distribution to their members and constituencies. The information provided is non-proprietary.

Front Page News

ACIP Highlights: The Advisory Committee on Immunization Practices (ACIP) met June 24–26 in Atlanta, adding an extra half-day to their usual schedule to address the issue of influenza vaccination now that novel influenza A H1N1 is considered a pandemic influenza virus strain. The meeting produced several new and updated recommendations. These recommendations are provisional until they are reviewed by the director of CDC and published in the MMWR. Full minutes of the meeting, including slides from presentations, will be available soon on the ACIP Meetings web page.

• General Recommendations: A clarification was made to the General Recommendations regarding combination vaccines, maintaining a general preference for combination vaccine products, but stating specific criteria by which a provider might choose the single-component products. Important considerations include provider assessment, patient preference, and potential for adverse events.
  
• Rabies Vaccine: The committee voted to reduce the number of doses recommended for post-exposure prophylaxis for human rabies prevention from five to four. The schedule for administration of the doses is days 0, 3, 7, and 14. For more information, please see the Rabies Provisional Recommendation [PDF- 25KB].
  
• Polio Vaccine: The minimum interval between dose 3 and dose 4 of polio-containing vaccines was changed from 4 weeks to 6 months.
  
• Measles-Mumps-Rubella Vaccine: Modifications were made to the criteria for acceptable evidence of immunity to measles, mumps, and rubella for healthcare providers. Documentation of physician-diagnosed disease (previously considered evidence of measles and mumps immunity) is no longer an acceptable criterion. Birth before 1957 is still evidence of immunity, but facilities should consider vaccinating health-care providers born before 1957 who have no other criterion for immunity with two doses of MMR vaccine. In an outbreak, two doses of vaccine are specifically recommended for health-care providers born before 1957.
  
• Meningococcal Vaccine: A recommendation was made for revaccination using meningococcal conjugate vaccine for persons who remain at high risk for meningococcal disease after their first vaccination (with either the polysaccharide or the conjugate meningococcal vaccine). These include persons with persistent complement component deficiencies, persons with anatomic or functional asplenia, persons infected with HIV, microbiologists who are routinely exposed to Neisseria meningitidis, and frequent travelers to or people living in areas with high rates of meningococcal disease, such as the African meningitis belt. For children 2 through 6 years of age the dose should be given at an interval of 3 years, for persons older than 6 years, at an interval of 5 years.
  
• Japanese Encephalitis Vaccine: The ACIP voted to include the recently licensed Japanese encephalitis virus (JEV) vaccine, Ixiaro®, in the list of recommended vaccines for U.S. travelers. Clarifications were also made to the existing recommendations for the use of Japanese encephalitis vaccine. The vaccine is recommended for travelers who will spend 1 month or more in an endemic-disease area during the JEV transmission season, or for short-term travelers if they have an increased risk of JEV exposure. The vaccine is not recommended for short-term travelers whose visit will be restricted to urban areas or times outside of a well-defined JEV transmission season. For more information, please see the Japanese Encephalitis Provisional Recommendation [PDF-26 KB].
  
• Measles-Mumps-Rubella-Varicella Vaccine: Additional language was added to the recommendation for MMRV vaccine regarding combination vaccines versus separate injections of equivalent component vaccines. Combination vaccines are preferred, but considerations should include provider assessment, patient preference, and the potential for adverse events. In addition, a personal or family history of seizures was included as a precaution for MMRV vaccine use.

More News & Summaries

Novel H1N1 influenza Update: CDC estimates that there have been at least one-million cases of novel H1N1 influenza in the United States. CDC’s goals during this public health emergency are to reduce transmission and illness severity, and to provide information to assist health care providers, public health officials and the public in addressing the challenges posed by this newly identified influenza virus.

Vaccines are a very important part of a response to pandemic influenza. CDC has isolated the novel H1N1 virus, made a candidate vaccine virus strain that can be used to create vaccine, and has provided this virus to industry so they can begin scaling up for production of a vaccine. It is expected that novel H1N1 influenza vaccine may be available as early as mid-October. On July 8, 2009, CDC issued guidance for state and local public health departments to assist them in planning for a novel H1N1 influenza vaccine campaign.

For the latest information about the novel Influenza A (H1N1) outbreak and CDC’s response, visit CDC's H1N1 influenza website, sign up to receive CDC e-mail updates, subscribe to RSS, or follow CDC Emergency on Twitter . Updated world-wide country counts can be found at the World Health Organization website .

Hib Booster Dose Reinstated: CDC, in consultation with ACIP, the American Academy of Family Physicians, and the American Academy of Pediatrics, is recommending reinstatement of the booster dose of Haemophilus influenzae type b vaccine for children aged 12–15 months who have completed the primary 3-dose series. Infants should continue to receive the primary Hib vaccine series at ages 2, 4, and 6 months. Children aged 12–15 months should receive the booster dose on time. Older children for whom the booster dose was deferred should receive their Hib booster dose at the next routinely scheduled visit or medical encounter. Although supply is sufficient to reinstate the booster dose and begin catch-up vaccination, supply is not yet ample enough to support a mass notification process to contact all children with deferred Hib booster doses. For more information, please see the Updated Recommendations for Use of Hib full article in CDC’s Morbidity and Mortality Weekly Report. Also, CDC has posted Hib Vaccine: Q&A for Providers about the Return to the Hib "Booster" Dose.

Progress toward Poliomyelitis Eradication in India: Frequent mass campaigns with high vaccination coverage have reduced wild poliovirus (WPV) circulation to just a few areas in two states. Eliminating all poliovirus transmission in India will require stopping WPV circulation in both states simultaneously, with the emphasis first on WPV1. Wild poliovirus circulation in India has been restricted to small areas in two northern states, Bihar and Uttar Pradesh. These states have been the source of other cases in India since 2002, and sometimes the source for polio cases in other countries. With an accelerated effort to stop transmission of WPV type 1 (WPV1) before WPV type 3 (WPV3) with preferential use of a monovalent vaccine directed against WPV1 in campaigns, WPV1 is currently circulating in the smallest historical area in each state. Uttar Pradesh state, a densely populated area where the oral poliovirus vaccine appears to be less effective than elsewhere, had been free of WPV1 transmission for six months. However, an outbreak in Uttar Pradesh started in May 2008 because of WPV imported from Bihar; this outbreak is now waning. Bihar has had relatively few WPV1 cases in 2008-09 but because some areas are flood-prone, populations can be difficult to access. While new approaches are being explored to improve the effectiveness of vaccination, current levels of WPV circulation make polio elimination in India within reach. For more information, please see the Progress Toward Poliomyelitis Eradication full article in CDC’s Morbidity and Mortality Weekly Report.

CDC Immunization Staff Transitions

Frank DeStefano, Director for Immunization Safety Office: Frank DeStefano, MD, MPH, has accepted the position of Director of the Immunization Safety Office (ISO) and began his duties on July 13. Dr. DeStefano has had extensive epidemiologic research experience at CDC and the National Institutes of Health and at the Marshfield Medical Research Foundation in Marshfield, Wisconsin. During the time he worked at CDC, he held several leadership positions in the Immunization Safety Branch, including the Acting Director of the branch in 2005. He is coming back to CDC after being a senior research epidemiologist at RTI International.

Carol Friedman, Associate Director for Adult Immunization: Carol Friedman, DO, is the new Associate Director for Adult Immunization in the Immunization Services Division, National Center for Immunization and Respiratory Diseases. She had served most recently as chief of the Comprehensive Cancer Control Branch, Division of Cancer Prevention. Dr. Friedman began her CDC career in the Epidemic Intelligence Service in 1991 and has worked extensively with CDC partners and on health promotion projects, including efforts to increase vaccination rates among adults.

Meetings, Conferences & Resources

New Funding Opportunity for Healthcare Provider Groups: A new funding opportunity is available from CDC called “Increasing Immunization Rates through Healthcare Provider Partnerships.” The purpose of the program is to develop and implement innovative programs for healthcare providers to improve immunization coverage. This opportunity is limited to national healthcare provider organizations. For more information, please go to the grants government website and search for funding opportunity CDC-RFA-IP09-903. 

Special ACIP Meeting, July 29: The ACIP will hold a special meeting on July 29, 2009 in Atlanta to discuss novel influenza A (H1N1); vaccine development; and planning, implementation, and communication strategies for vaccination. The meeting agenda meeting agenda [PDF- 105KB] is now available.

Immunization Update 2009: Please mark your calendars for the July 30, 2009 Live Satellite Broadcast and Webcast from CDC’s National Center for Immunization and Respiratory Diseases. This 2.5-hour program focuses on the most recent developments in the rapidly changing field of immunization, including new vaccine recommendations. The event will take place from 9:00 AM-11:30 AM and noon-2:30 PM Eastern time. For more information, visit CDC’s Immunization Education and Training Webcasts web page.

August is National Immunization Awareness Month: August is recognized as National Immunization Awareness Month, a time to make an extra effort to increase awareness about immunizations across the life span, from infants to the elderly. August is the month when parents, students, and immunization providers are all preparing for the upcoming school year—as well as the upcoming influenza season. Communities are encouraged to plan health screenings, media events, or other outreach efforts to promote the benefits of immunization. For information and links to resources for outreach efforts, see CDC’s National Immunization Awareness Month web page.

2010 National Coalition Conference: Please mark your calendars for the 9th National Conference on Immunization and Health Coalitions "Strengthening Our Connections." The conference will take place from May 26 – 28 in Chicago, Illinois. More information will be available in future issues of this publication.

National Infant Immunization Week: An early reminder: National Infant Immunization Week will be held April 24–May 1, 2010.

CDC Training Opportunities: Through established programs, CDC offers many unique training opportunities in infectious disease, including international opportunities. For a current listing of CDC training opportunities, please visit CDC’s Public Health Training web page.  

CDC Job Openings: CDC is committed to recruiting and hiring qualified candidates for a wide range of immunization positions. Researchers, Medical Officers and Epidemiologists and other specialties are often needed to fill positions within CDC. For a current listing, including international opportunities, please visit CDC’s Employment web page.

Respiratory News and Resources

Since 2006, respiratory diseases have been part of CDC’s National Center for Immunization and Respiratory Diseases. As a result, readers of this e-letter can periodically expect to see news about respiratory diseases.

Meningitis Website: A new CDC Meningitis website was launched June 24. The site contains comprehensive information on bacterial, viral, and other types of meningitis, as well as on meningococcal vaccines. Links on the site lead to a variety of additional educational and vaccine-related resources.

World Pneumonia Day: Mark your calendars for "World Pneumonia Day", November 2, 2009. This event - led by child health groups and Save the Children Artist Ambassadors Gwyneth Paltrow and Hugh Laurie - will bring needed attention to a neglected disease that kills more than two million children under the age of five each year, worldwide. For more information or to sign up to receive e-mail updates, visit the World Pneumonia Day website .

Get Smart about Antibiotics Week: Mark your calendars for "Get Smart about Antibiotics Week", October 5th-11th, 2009.

For more information, please contact Darcia Johnson at clq7@cdc.gov or visit the "Get Smart" Webpage.

The Immunization Works Database Manager can be contacted at:  nipimmzwrks@cdc.gov.

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