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Immunization Works! October 2009 Issue

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.

H1N1 and Seasonal Influenza Update

CDC Publishes VISs for Influenza Vaccines: On October 6, CDC published new vaccine information statements (VISs) for the live, intranasal influenza A (H1N1) 2009 monovalent vaccine and inactivated influenza A (H1N1) 2009 monovalent vaccine. Also available on CDC's website are VISs for the 2009 seasonal live, intranasal influenza vaccine and inactivated influenza vaccine. VISs for both influenza vaccines are available in English and Spanish. Additional translations are available on the Immunization Action Coalition website.

Update on Influenza A (H1N1) 2009 Monovalent Vaccines: On September 15, 2009, 4 influenza vaccine manufacturers received approval from the Food and Drug Administration for use of Influenza A (H1N1) 2009 monovalent vaccines in the prevention of influenza caused by the 2009 pandemic influenza A (H1N1) virus. CDC's Advisory Committee on Immunization Practices had previously made recommendations regarding which persons should be initially given priority for immunization with influenza A (H1N1) 2009 monovalent vaccines, and had issued guidelines on decisions for expansion of vaccination efforts to other population groups. Children ages 6 months through 9 years receiving influenza A (H1N1) 2009 monovalent vaccines should receive 2 doses, with doses separated by approximately 4 weeks; persons 10 years of age and older should receive 1 dose. For more information, please see the full article, Update on Influenza A (H1N1) 2009 Monovalent Vaccines in CDC’s Morbidity and Mortality Weekly Report.

Standing Orders for Administering Influenza A (H1N1) 2009 Monovalent Vaccines Now Available: States have begun receiving influenza A (H1N1) 2009 monovalent vaccine. The Immunization Action Coalition has developed a guideline document entitled "Standing Orders for Administering Influenza A (H1N1) 2009 Monovalent Vaccines (pdf)." It contains information about administering both the H1N1 inactivated vaccine (injectable) and the H1N1 live, attenuated (nasal spray) vaccine. Under these standing orders, eligible nurses and other healthcare professionals (e.g., physician assistants and pharmacists), where allowed by state law, may assess a child or adult’s immunization status and administer vaccinations according to an institution- or physician-approved protocol without the need for a physician’s examination or direct order at the time of the interaction. Standing orders can also be used as an evidence-based strategy for administration of seasonal influenza vaccine.

Stay Informed! Because information surrounding 2009 pandemic influenza A (H1N1) is updated frequently, please look to the following websites for the most up-to-date information:

• General information:
  http://www.cdc.gov/h1n1flu/
• Decision tool for providers and healthcare facilities: http://www.cdc.gov/H1N1flu/vaccination/decisiontree.htm
• List of state contacts for providers interested in providing H1N1 vaccine: http://www.cdc.gov/h1n1flu/vaccination/statecontacts.htm

Front Page News

Nation's Teen Vaccination Coverage Increasing-Variability Observed by Area, Race/Ethnicity, and Poverty Status: Vaccine coverage rates for the nation’s preteens and teens are increasing, but nationally, rates remain low for the vaccines specifically recommended for preteens, according to 2008 estimates released by CDC.

The National Immunization Survey (NIS) estimates the proportion of teens 13 through 17 years of age who have received 6 recommended vaccines by the time they are surveyed. Three of these are recommended to be given at 11 or 12 years of age: the tetanus-diphtheria-acellular pertussis vaccine (Tdap), the meningococcal conjugate vaccine (MCV4), and, for girls, the human papillomavirus vaccine (HPV4 and HPV2). (On October 21, the ACIP voted to recommend that CDC permit use of the quadrivalent human papillomavirus (HPV4) vaccine in boys and men ages 9 through 26 years.) If missed at the 11–12-year visit, the vaccines can be given in the teen years. The survey also covers three other vaccines, which are recommended to be given earlier in life: measles, mumps and rubella vaccine (MMR), hepatitis B vaccine (HepB), and varicella (chickenpox) vaccine. Preteens and teens should get all recommended doses of these vaccines if they missed them when they were younger. All doses are counted, no matter when they were received

The survey found that, compared with 2007, there was a substantial increase in the percentage of teens who had received the recommended vaccines. Coverage went up about 10 percentage points for a dose of Tdap and a dose of MCV4, reaching about 40 percent for each vaccine. Coverage rates for tetanus-containing vaccine remained steady at 72 percent. Coverage went up about 12 percentage points for girls who received at least one dose of HPV4, to about 37 percent, and coverage for the recommended 3 doses of HPV4 was about 18 percent. Fifteen percent more teens without a history of varicella received the recommended 2 doses of varicella vaccine, but coverage is only about 34 percent. Coverage rose about 6 percent for one dose of varicella vaccine, to about 82 percent. For the first time, Healthy People 2010 goals of 90 percent coverage for 13- through 15-year-olds were met for the recommended 2 doses of MMR and 3 doses of HepB. Fourteen states and the District of Columbia had greater than 50 percent coverage for one or more of the vaccines recommended at age 11 or 12. In other states, coverage was lower. Differences were observed among racial/ethnic groups and by poverty status, including higher coverage for HPV4 among Hispanic females compared with whites, and higher coverage among teens living in poverty compared with those living at or above the poverty level. Blacks had lower coverage than whites for Tdap, and fewer were protected from varicella. Survey data are posted online.

Increased Hib Vaccine Supplies: On August 19, 2009, the Food and Drug Administration (FDA) licensed Hiberix, a Haemophilus influenzae type b (Hib) conjugate vaccine. Hiberix is licensed for use as the booster (final) dose of the Hib vaccine series for children 15 months through 4 years of age who have already received the primary series of Hib vaccinations. The ACIP recommends Hib booster vaccination for children at ages 12 through 15 months; however, because of the recent shortage of Hib vaccines, the booster dose has been deferred for many children, who now require catch-up vaccination. A MMWR report published September 18, 2009, summarizes the indications for Hiberix use and provides guidance on Hib booster dose administration based on increasing vaccine supplies. Vaccination recommendations in this report update the previous advisory on Hib booster administration (for more information, please see the full mmwr article, Licensure of a Haemophilus influenzae Type b (Hib) Vaccine (Hiberix) and Updated Recommendations for Use of Hib Vaccine), which advised that children with deferred booster doses receive it at the next regularly scheduled visit. Vaccination providers should now recall children in need of the booster dose when feasible and Hib vaccine supply in the office is adequate. A CDC Web Feature on Hib Disease is also available.

More News & Summaries

CDC Publishes Revised VISs for PPSV23, Rabies, and Shingles: On October 6, CDC published revised VISs for pneumococcal polysaccharide (PPSV23), rabies, and shingles vaccines. Specifics about the changes follow.

• PPSV23 VIS. The paragraph on pregnancy under Section 5 of the PPSV23 VIS has received a minor update. In the previous edition, the term "is not recommended" was used in a way that could be misinterpreted to mean "should never be given." In fact, while PPSV23 is not routinely recommended for pregnant women, it may be given under some circumstances. The previous edition may be used until stocks are depleted.
  
• Rabies VIS. The rabies VIS was updated primarily to incorporate the new 4-dose postexposure regimen, but also to make minor updates throughout.
  
• Shingles VIS. The shingles VIS was changed slightly, mainly to remove active, untreated tuberculosis as a contraindication, which had been erroneously included in the previous editions. Several other minor updates were also made. Existing stocks may be used up, but patients should be made aware of this change when appropriate.
  

Provisional Recommendations for Use of Anthrax Vaccine Adsorbed: The Advisory Committee on Immunization Practices updated its website with its provisional recommendations for the use of anthrax vaccine adsorbed (pdf). Provisional recommendations are those ACIP has voted on but that are not yet approved by CDC or the Department of Health and Human Services and have not yet been published in CDC's Morbidity and Mortality Weekly Report (MMWR).

Updated Recommendations for Use of Hepatitis A Vaccine in Close Contacts of Newly Arriving International Adoptees: Close personal contacts of children adopted from countries with high rates of the hepatitis A virus (HAV) are at an increased risk for contracting the virus; for this reason the Advisory Committee on Immunization Practices has expanded its hepatitis A vaccine recommendations to include these close personal contacts. These recommendations are critical because HAV can be passed on to others even when an infected person does not show signs of illness, and because most children adopted from abroad (99.8%) are from countries where HAV rates are high. The updated recommendations state that the hepatitis A vaccine should be given to people who have not previously received it and who will be a close personal contact (such as a household member or regular babysitter) of the adopted child. The hepatitis A vaccine is given in 2 doses; close personal contacts should receive the first dose as far in advance of contact with the child as possible, ideally, once the adoption is planned. The second dose should be administered 6–18 months later. An existing recommendation states that all persons traveling from the United States to countries with high or intermediate rates of HAV, including those who travel because of international adoption, should receive the hepatitis A vaccination. For more information, please see the full article, Updated Recommendations from the Advisory Committee on Immunization Practices (ACIP) for Use of Hepatitis A Vaccine in Close Contacts of Newly Arriving International Adoptees in CDC’s Morbidity and Mortality Weekly Report.

MMWR Report Underscores the Importance of Pneumococcal Vaccination: Studies have shown that influenza infections increase a person’s risk for developing bacterial pneumonia. In previous flu pandemics, many flu-associated deaths occurred among persons who had bacterial pneumonia along with influenza. To help determine the role of bacterial coinfection during the current influenza pandemic, postmortem lung specimens from patients with fatal 2009 pandemic influenza A (H1N1) were examined. In a September 29, 2009, report, MMWR summarizes a detailed investigation that studied the role of bacterial infections in a small sample of flu-related deaths during the current pandemic. A total of 22 (29%) of 77 U.S. patients with fatal pandemic influenza A (H1N1) had concurrent bacterial lung infections. These findings underscore the importance of pneumococcal vaccination for persons at increased risk for pneumococcal pneumonia and the need for early recognition of bacterial pneumonia in persons with influenza. For more information, please see the full article, Bacterial Coinfections in Lung Tissue Specimens from Fatal Cases of 2009 Pandemic Influenza A (H1N1), United States, May—August 2009 in CDC’s Morbidity and Mortality Weekly Report.

ACIP Recommends Revaccination of Persons at Prolonged Increased Risk for Meningococcal Disease: Because of the high risk for meningococcal disease among certain groups and limited data on duration of protection conferred by meningococcal vaccine, at its June 2009 meeting the Advisory Committee on Immunization Practices voted to recommend that persons previously vaccinated with either MCV4 or MPSV4 who are at prolonged increased risk for meningococcal disease should be revaccinated with MCV4. For more information, please see the full article, Updated Recommendation from the Advisory Committee on Immunization Practices (ACIP) for Revaccination of Persons at Prolonged Increased Risk for Meningococcal Disease in CDC’s Morbidity and Mortality Weekly Report.

Update on Vaccine-Derived Polioviruses: In 1988, the World Health Assembly resolved to eradicate poliomyelitis worldwide. In a report released September 18, 2009, MMWR updates previous summaries and describes vaccine-derived polioviruses (VDPVs) detected worldwide during January 2008–June 2009. For more information, please see the full article, Update on Vaccine-Derived Polioviruses in CDC’s Morbidity and Mortality Weekly Report.

American Recovery and Reinvestment Act Funds Awarded: The American Recovery and Reinvestment Act (ARRA) made funds available to partner organizations, allowing them to address immunization training and information needs of health department staff, coalitions, nurses and medical residents. This funding provides an opportunity for CDC to broaden its immunization partnership activities through the creation of new partnerships. These newly funded organizations will address specific, unmet needs in immunization information and education and use theory-based approaches to communicate this information in efforts to increase immunization coverage.

Seven groups received awards in September for 2-year projects aimed at addressing the immunization training needs of healthcare providers in 3 categories. In the category of Technical Assistance and Training for Immunization Coalitions and Health Departments, grants were awarded to the National Public Health Information Coalition and Parents for Kids with Infectious Diseases. In the category of Development and Implementation of Materials and Programs to Educate Nurses about Immunization Issues, grants were awarded to the American Nurses Association, the SUNY Albany School of Public Health, and the University of Oklahoma Health Sciences Center. In the category of Development of Vaccine Safety Communication Materials and Curriculum for Medical Residents, grants were awarded to the Academic Pediatric Association and the American Academy of Pediatrics/California Foundation.

Meetings, Conferences & Resources

Human Papillomavirus Vaccination NetConference: On November 12, from noon to 1:00 PM ET, CDC will present a live NetConference program about human papillomavirus vaccination. Dr. Lauri Markowitz will be speaking and Dr. Andrew Kroger moderating. This program will combine a telephone audio conference with simultaneous online visual content. Participants can take part in a question-and-answer segment by telephone and/or via the Internet. Registration is required.

Seasonal and H1N1 Influenza Articles Available for Reprinting: The Academy for Educational Development (AED) has worked with CDC to release a new series of articles covering seasonal and 2009 H1N1 influenza. The articles detail the seriousness of influenza and explain why vaccination is so important for the indicated groups. The articles, which are 400–800 words in length, are designed for republication in magazines, newsletters and on the Web. The articles are available at no cost and some will be offered in Spanish. For more information, please contact AED's Allison Bozniak at abozniak@aed.org or (202) 884-8374.

Clinical Vaccinology Course: A clinical vaccinology course for healthcare professionals will be held November 13–15, 2009, at the Grand Hyatt Atlanta in Buckhead, Georgia. Information is available at NFID’s website, or by e-mail at idcourse@nfid.org.

Epidemiology & Prevention of Vaccine-Preventable Diseases course: CDC personnel will present a 2-day Epidemiology & Prevention of Vaccine-Preventable Diseases course in Colorado, November 16–17 and in California, November 19–20. This course is also available for self-study in web-on-demand and DVD formats.

National Immunization Conference: The 44th National Immunization Conference is scheduled for April 19–22, 2010. The conference will be held in Atlanta, Georgia, at the Hyatt Regency Atlanta. Check for updates at the NIC website.

National Infant Immunization Week: An early reminder: National Infant Immunization Week (NIIW) will be held April 24–May 1, 2010. Check the NIIW website for more details as they become available.

2010 National Coalition Conference: Please mark your calendars for the 9th National Conference on Immunization and Health Coalitions "Strengthening Our Connections." The conference, which will take place May 26–28 in Chicago, Illinois, will showcase successful ways in which health coalitions can improve immunization protection, prevent disease, improve access to care and health outcomes for underserved populations, reduce racial, ethnic, and geographic health disparities, educate new populations, and build community health infrastructures. Abstracts for the conference are being accepted until February 1, 2010.

CDC Training Opportunities: Through established programs, CDC offers many unique training opportunities in infectious diseases, 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 (NCIRD). As a result, readers of this e-letter can periodically expect to see news about respiratory diseases.

Antibiotic Use Video: CDC is now featuring a new video to educate parents about appropriate antibiotic use and how to feel better when you or your child has a sore throat, ear or sinus pain, fever, cough, or runny nose. The video features a doctor who is also a concerned mother of two. Using a mix of humor and concrete advice, this video will encourage parents to learn when antibiotics are really needed and how to work with their healthcare provider or pharmacist to seek the best treatment (see CDC: Snort, Sniffle, Sneeze).

Pharmacist–Parent Podcast: CDC’s Get Smart: Know When Antibiotics Work campaign has launched a new podcast, Pharmacists Can Make the Difference. In this podcast, a pharmacist counsels a frustrated mother about appropriate antibiotic use and symptomatic relief options for her son's cold.

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

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