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Immunization Works! January 2010 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.

2009 H1N1 and Seasonal Influenza Update

Stay Informed! Information on 2009 pandemic influenza A (H1N1) is updated frequently. Please visit the following websites for the latest updates:

• 2009 H1N1 Flu home page
• CDC Free Flu Resources
  

Influenza A (H1N1) 2009 Monovalent Vaccination Coverage Rates: In July 2009, the Advisory Committee on Immunization Practices (ACIP) issued recommendations for use of the influenza A (H1N1) 2009 monovalent vaccine. Recognizing that the vaccine supply would not be ample immediately but would grow over time, ACIP identified initial target groups, to receive first priority while the 2009 H1N1 vaccine supply was limited. ACIP recommended expanding vaccination to the rest of the population as vaccine supplies increased. To estimate 2009 H1N1 vaccination coverage to date for the 2009–10 influenza season, CDC analyzed results from the National 2009 H1N1 Flu Survey (NHFS) and the Behavioral Risk Factor Surveillance System (BRFSS) survey, conducted during December 27, 2009–January 2, 2010, and December 1–27, 2009, respectively. The results indicated that, as of January 2, an estimated 20.3% of the U.S. population (61 million persons) had been vaccinated, including 27.9% of persons in the initial target groups. An estimated 29.4% of U.S. children ages 6 months–18 years had been vaccinated. Now that an ample supply of 2009 H1N1 vaccine is available, efforts should continue to increase vaccination coverage among persons in the initial target groups and to offer vaccination to the rest of the U.S. population, including those over 65 years of age. For more information, please see the full article, Interim Results: Influenza A (H1N1) 2009 Monovalent Vaccination Coverage--United States, October–December 2009 in CDC’s Morbidity and Mortality Weekly Report.

Intent to Receive Influenza A (H1N1) 2009 Monovalent and Seasonal Influenza Vaccines—Two Counties, North Carolina, August 2009: On September 15, 2009, the Food and Drug Administration approved the manufacture of four influenza A (H1N1) 2009 monovalent vaccines. Before release of the first batches of the vaccine on September 30, intent to receive the vaccine was estimated at 50% among selected U.S. adult populations and as high as 70% for children. However, studies in previous years of seasonal influenza vaccination among children, who might require 2 doses based on age and prior vaccination status, have indicated poor compliance with recommendations. To measure intent to receive H1N1 and seasonal influenza vaccines among children and adults, during August 28–29, 2009, the North Carolina Center for Public Health Preparedness, with state and local public health officials, conducted a community assessment in two counties. MMWR published a report on December 25, 2009 that summarizes the results of that assessment, which determined that 64% of adults reported intent to receive H1N1 vaccine. In addition, 65% of parents reported intent to have all their children (aged 6 months to 18 years) vaccinated with H1N1 vaccine, and 51% said they would have all their children vaccinated with both H1N1 and seasonal influenza vaccines. The most commonly reported reasons for not intending to receive H1N1 vaccine were belief in a low likelihood of infection (18%) and concern over vaccine side effects (14%); 85% of participants said they received their H1N1 information from television. To increase coverage with H1N1 and seasonal influenza vaccines, public health departments should use television to focus public health messages on the risks for infection and severe illness and the safety profile of the vaccine. For more information, please see the full article, Intent to Receive Influenza A (H1N1) 2009 Monovalent and Seasonal Influenza Vaccines--Two Counties, North Carolina, August 2009 in CDC’s Morbidity and Mortality Weekly Report.

MMWR Reports Influenza Activity: The emergence and spread of the 2009 pandemic influenza A (H1N1) virus resulted in significant influenza activity in the United States throughout the summer and fall months of 2009. Influenza activity reached its highest level to date in the 2009–10 influenza season during the week ending October 24, 2009, with 49 of 50 jurisdictions reporting geographically widespread disease. As of January 9, 2010, overall influenza activity has substantially declined. Since April 2009, pandemic influenza A (H1N1) virus has remained the dominant circulating influenza virus. MMWR has released a summary of U.S. influenza activity from August 30, 2009, through January 9, 2010. For more information, please see the full article, Update: Influenza Activity--United States, August 30, 2009–January 9, 2010 in CDC’s Morbidity and Mortality Weekly Report.

Front Page News

NIVW Promoted Awareness, Provided Vaccination Opportunities Nationwide
Established in 2006, National Influenza Vaccination Week (NIVW), is a national observance highlighting the importance of continuing influenza vaccination after the holiday season and into the new year. NIVW kicked off on Sunday, January 10, with an official proclamation from President Barack Obama. The week seized an important window of opportunity to prevent influenza by getting more people vaccinated and encouraging others to do the same.

Historically, after the end of November, public interest in influenza vaccination wanes. In order to counteract apathy towards vaccination, an important objective of this season’s NIVW was to remind the public that influenza is unpredictable, that the flu season can last until May, and that it is possible that other waves of influenza activity may occur this flu season – caused by either 2009 H1N1 or regular seasonal flu viruses.

Armed with a strategic mix of media and public events to underscore the importance of vaccination, HHS and CDC, in conjunction with multiple partners, launched a comprehensive NIVW campaign with the objective of raising awareness about the importance of vaccination against H1N1 flu, and providing educational opportunities, free resources, and vaccination clinics. Starting with a strong national media presence, NIVW full-page ads had prominent placement in the New York Times; the Washington Post; the Los Angeles Times; the Chicago Tribune and USA Today. Other ads were placed in approximately 140 weekly papers across the country.

By utilizing an effective variety of social media, webinars, and satellite media tours, partners, news media and members of the public from around the country benefited from real-time access to federal spokespersons like Secretary of Health and Human Services, Kathleen Sebelius, CDC Director, Dr. Tom Frieden, and influenza experts Dr. Anne Schuchat and Dr. Anthony Fiore.

NIVW spotlight on groups more vulnerable to 2009 H1N1 flu—Because certain populations are at greater risk of infection or health complications from the 2009 H1N1 influenza virus, each day of NIVW featured events focused on these at-risk groups: healthcare workers, people with underlying health conditions, infant caregivers, children and pregnant women, young adults and seniors.

President Obama issued a proclamation in support of NIVW on Saturday, January 9, urging all Americans to get vaccinated, particularly those in these high-risk groups. Secretary Sebelius kicked off NIVW on Sunday, January 10 with a visit to the 19th Street Baptist Church in Washington, DC, where she urged congregants to get vaccinated with the H1N1 flu vaccine. The focus for Monday, January 11 included vaccination among health care workers as well as the general public.

The events on Tuesday, January 12 centered on people with chronic medical conditions, who are at a higher risk of serious influenza-related complications. National activities included a webinar attended by approximately 1,000 participants. This joint effort was hosted by HHS; CDC; the American Cancer Society; the American Diabetes Association and the American Lung Association. In addition, Secretary Sebelius participated in two press conference calls announcing new public service announcements targeted at both African American and American Indian/Alaska Native audiences. Dr. Yvette Roubideaux, Director of the Indian Health Service, joined the Secretary in stressing the importance and benefits of vaccination.

Events on Wednesday, January 13, focused on children, pregnant women, and caregivers of infants less than 6 months old. National activities included Family Flu Vaccination Day, a neighborhood event on Capitol Hill in which HHS and CDC partnered with the Congressional Study Group on Public Health and the Campaign for Public Health Foundation to encourage families to get the 2009 H1N1 flu vaccine. Participants included Representatives James McGovern and Judy Chu; Dr. Bruce Gellin, Director of the National Vaccine Program Office; Henry Lin, a member of Families Fight Flu and parent of a young child who died of the H1N1 flu; and Luke Duvall, a high school football player who nearly died from the H1N1 flu and was recently featured on CBS News' 60 minutes. The DC Department of Public Health and Georgetown University Hospital’s KIDS Mobile Medical Clinic offered free 2009 H1N1 flu vaccinations to children and families during the event.

Also on January 13, CDC presented "Protect Yourself, Protect Your Baby: A Bloginar about Pregnancy and Flu." In addition, Wednesday’s activities reached out to the Spanish-speaking community, with a special guest appearance by CDC’s Dr. R.L. Felipe Lobelo on Despierta America, a talk show with a larger viewership than Today and Good Morning America combined.

Thursday, January 14 focused on young adults, specifically those 19 through 24 years old, who are often characterized by a false sense of invincibility. Secretary Sebelius attended a roundtable discussion with students and faculty at Hunter College in New York. Discussions centered the importance of H1N1 vaccination for young people.

Friday, January 15, highlighted senior citizens. Secretary Sebelius and the Assistant Secretary for Aging, Kathy Greenlee, visited a flu clinic for seniors at the Congress Heights Wellness Center. Dr. Howard Koh, HHS' Assistant Secretary for Health, and Massachusetts Health Secretary, JudyAnn Bigby, participated in an H1N1 vaccination event at the Massachusetts State House. NIVW wrapped up events Saturday, January 16.

NIVW success hinges on local efforts—Although federal officials played a role actively promoting events, the real success of NIVW hinged on the support and efforts of thousands of dedicated and hard-working state and local public health professionals and an infrastructure of national partners. For example, a NIVW calendar of events web page was developed so partners could post their own national, state, local and/or regional NIVW activities. As a result, over 300 influenza vaccine-related events have been posted for public access. Those submissions included national events, along with many activities held within 7 regions and 39 states.

From Asian-Pacific American H1N1 outreach and education in Boston, Massachusetts, to New York City’s Department of Aging vaccination clinics, to Phoenix, Arizona’s social media network to faith-based communities and organizations, NIVW’s broad multi-strategy, multi-audience campaign reached millions of Americans with messages aimed at increasing their understanding of influenza and the importance of getting vaccinated.

More News & Summaries

Study Documents Decline in Diarrhea-Related Deaths among Mexican Children Following Introduction of Rotavirus Vaccine: An article in the January 28, 2010, issue of the New England Journal of Medicine, entitled "Effect of Rotavirus Vaccination on Death from Childhood Diarrhea in Mexico," noted that deaths due to diarrhea among children significantly declined following the introduction of rotavirus vaccine in Mexico.

In 2006, Mexico became one of the first countries to introduce rotavirus vaccine into its national immunization program. Study authors, Vesta Richardson, Joselito Hernandez-Pichardo, Manjari Quintanar-Solares, Marcelino Esparza-Aguilar, Brian Johnson, Cesar Misael Gomez-Altamirano, Umesh Parashar, and Manish Patel, compared childhood diarrhea–related mortality before and after introduction of rotavirus vaccine in Mexico. Their results showed that among infants 11 months and younger (the targeted population for rotavirus vaccination), the number of deaths due to diarrhea declined by 42%. Three key findings support a causal role of vaccination in the reduction of diarrhea-related deaths:

• The largest reduction in diarrhea-related deaths was among the vaccinated age-group (infants 11 months and younger).
• The most prominent reduction occurred during the typical rotavirus season in Mexico (December through May).
• The reduction was sustained through the two rotavirus seasons (2008 and 2009) after vaccine introduction.
  

In addition, the study showed that among children 12-24 months of age, diarrhea-related deaths declined by 29%. Only 10%–15% of these children were eligible for rotavirus immunization; thus, the reduction demonstrates that vaccination of part of the population could possibly reduce rotavirus transmission overall.

Improved sanitation, promotion of breastfeeding and oral rehydration, and vitamin A supplementation have helped reduce the overall number of childhood diarrhea–related deaths in Mexico, but deaths during the rotavirus season remained prevalent. This persistent burden revealed the importance of immunization as the primary tool for preventing rotavirus.

MMWR Publishes Immunization Schedules: The Advisory Committee on Immunization Practices (ACIP) annually reviews the recommended immunization schedules to ensure that each schedule reflects current recommendations for the licensed vaccines. MMWR published ACIP’s Recommended Immunization Schedules for Persons Aged 0 Through 18 Years--United States, 2010 which summarizes recommendations for currently licensed vaccines for children ages 18 years and younger and includes recommendations in effect as of December 15, 2009. Changes to the previous schedule include the following:

• The statement concerning use of combination vaccines in the introductory paragraph has been changed to reflect the revised ACIP recommendation on this issue.
• The last dose in the inactivated poliovirus vaccine series is now recommended to be administered on or after the fourth birthday and at least 6 months after the previous dose. In addition, if 4 doses are administered before age 4 years, an additional (fifth) dose should be administered at age 4 through 6 years.
• The hepatitis A footnote has been revised to allow vaccination of children older than 23 months for whom immunity against hepatitis A is desired.
• Revaccination with meningococcal conjugate vaccine is now recommended for children who remain at increased risk for meningococcal disease after 3 years (if the first dose was administered at age 2 through 6 years), or after 5 years (if the first dose was administered at age 7 years or older).
• Footnotes for human papillomavirus (HPV) vaccine have been modified to include 1) the availability of and recommendations for bivalent HPV vaccine, and 2) a permissive recommendation for administration of quadrivalent HPV vaccine to males aged 9 through 18 years to reduce the likelihood of acquiring genital warts.
  

MMWR also published ACIP’s Recommended Adult Immunization Schedule--United States, 2010, which summarizes recommendations for currently licensed vaccines for adults. Changes to the previous schedule include the following:

• The human papillomavirus (HPV) footnote (#2) includes language that a bivalent HPV vaccine (HPV2) has been licensed for use in females. Either HPV2 or the quadrivalent human papillomavirus vaccine (HPV4) can be used for vaccination of females aged 19 through 26 years. In addition, language has been added to indicate that ACIP issued a permissive recommendation for use of HPV4 in males.
  
• The measles, mumps, rubella (MMR) footnote (#5) has language added to clarify which adults born during or after 1957 do not need 1 or more doses of MMR vaccine for the measles and mumps components, and clarifies which women should receive a dose of MMR vaccine. Also, dosing interval information has been added to indicate when a second dose of MMR vaccine should be administered. Language has been added to highlight recommendations for vaccinating health-care personnel born before 1957 routinely and during outbreaks.
  
• The term "seasonal" has been added to the influenza footnote (#6).
  
• The hepatitis A footnote (#9) has language added to indicate that unvaccinated persons who anticipate close contact with an international adoptee should consider vaccination.
  
• The hepatitis B footnote (#10) has language added to include schedule information for the 3-dose hepatitis B vaccine.
  
• The meningococcal vaccine footnote (#11) clarifies which vaccine formulations are preferred for adults ages 55 years and younger and 56 years and older, and which vaccine formulation can be used for revaccination. New examples have been added to demonstrate who should and should not be considered for revaccination.
  
• The selected conditions for Haemophilus influenzae type b (Hib) footnote (#13) clarifies which high-risk persons may receive 1 dose of Hib vaccine.
  

National Action Plan Open for Review: Following its 2006 "National Leadership Summit on Eliminating Racial and Ethnic Disparities in Health," HHS launched the "National Partnership for Action to End Health Disparities (NPA)." The main objectives of the NPA include drawing national attention to longstanding, pervasive racial and ethnic health disparities, and fostering community involvement and broad-based partnerships to improve coordination and utilization of research and outcome evaluation to shape strategies and actions to address health disparities.

To develop the plan, HHS conducted a series of "Regional Conversations" throughout the 10 HHS regions involving individual, public health and community leaders, to identify strategies and actions needed to address health disparities effectively on a regional basis.

CDC and its partners have been asked to review the National Partnership for Action to End Health Disparities Action Plan, which will be posted for public comment until February 12, 2010.

Meetings, Conferences & Resources

Vaccine Education Center Videos Now Available on YouTube: The Vaccine Education Center at the Children's Hospital of Philadelphia (CHOP) has posted many vaccine-related videos on YouTube. The CHOP channel has a 14-video playlist titled Vaccines and Your Baby, which covers disease-specific vaccination topics and other vaccine-related topics, such as immunity, viruses, and vaccine safety. Other video titles include New Vaccines, Should You Wait?, and Vaccines: Good Information vs. Bad Information.

New for Parents: ECBT's Video Clip Collection: Every Child by Two recently launched a new web page titled Video FAQs on its Vaccinate Your Baby website. The new web page features video clips of experts on immunization and autism briefly answering parents' most frequently asked questions about vaccination. Questions are grouped under four categories:

1. Why Vaccinate
2. Why Follow the Recommended Immunization Schedule
3. Vaccine Testing, Ingredients, and Safety
4. Vaccines and Autism
   

The video clips vary from 30 seconds to 2 minutes in length and are a valuable resource for health care professionals and the general public.

CDC Posts Q&As for the Public on Human Papillomavirus Vaccine: On December 22, CDC posted "HPV Vaccine: Questions and Answers" on its website.

Check Out IAC's Redesigned VIS Web Section: The Immunization Action Coalition's VIS web section is easily the most popular single feature on its website, racking up more than 1.5 million VIS downloads in 2009 alone. Now, its main page has been redesigned to offer users an at-a-glace understanding of what is available to them.

New Websites Launched for Employers: The National Business Group on Health, a nonprofit organization devoted to representing large employers' perspective on national health issues and assisting its members with health care problems, has introduced Moving Science into Coverage: An Employer's Guide to Preventive Service, a website designed to help employers select, define and implement evidence-based clinical preventive services. Based on A Purchaser's Guide to Clinical Preventive Services, this website provides employers with up-to-date information and resources on high-impact, effective and value-driven services to prevent chronic conditions.

"Moving Science into Coverage: An Employer's Guide to Preventive Service" offers a user-friendly way for employers to access:

• Information on scientific evidence, value and effectiveness of recommended preventive services;
  
• Private-sector costs of preventive interventions;
  
• Up-to-date summary plan description (SPD) language;
  
• Up-to-date CPT codes for benefit design;
  
• Employer case studies highlighting innovative approaches to implementing preventive service benefits;
  
• Additional prevention resources for employers; and
  
• Interactive tools to help employers prioritize and evaluate their current preventive benefits.

Preventable chronic conditions result in substantial costs for employers, including lost productivity, absenteeism and turnover. Purchasers can avoid or reduce costs associated with these conditions by offering appropriate coverage for - and promoting the use of — clinical preventive services.

For more information about this website, please contact healthservices@businessgrouphealth.org.

ACIP Meeting Scheduled for February 24–25 in Atlanta: The Advisory Committee on Immunization Practices (ACIP) will hold its next meeting on February 24–25, at CDC's Clifton Road campus in Atlanta. The meeting is open to the general public.

ACIP meeting attendees (participants and visitors) must register online. The online ACIP meeting registration deadline for the February meeting for non-U.S. citizens is February 2. The deadline for U.S. citizens is February 9. For detailed information about the meeting agenda, driving directions, and other useful material, see ACIP website.

Clinical Vaccinology Course—March 12–14, 2010: A Clinical Vaccinology Course for healthcare professionals will be held March 12–14, 2010, at the San Diego Marriott Mission Valley in San Diego, California. Through lectures and interactive case presentations, the course will focus on new developments and concerns related to the use of vaccines in pediatric, adolescent, and adult populations. Leading infectious disease experts will present the latest information on newly available vaccines, vaccines in development, and vaccines whose continued administration is essential to improving disease prevention efforts.

The National Foundation for Infectious Diseases (NFID), the Emory University School of Medicine, and the Emory Vaccine Center are collaborating with CDC and four other national organizations to sponsor this course. Continuing medical education, continuing nursing education, and continuing pharmacy education credits will be offered. Information regarding the preliminary program, registration, and hotel accommodations is available at NFID’s website.

National Immunization Conference: The 44^th 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.

Individuals who would like to request non-profit exhibit space or request ad hoc meeting space during the conference must submit their request through the conference website by the Early Bird registration deadline of February 19.

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 9^th 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.

Save the Date: April 24, 2010, is World Meningitis Day, which seeks to raise awareness about meningitis and the importance of being vaccinated. World Meningitis Day is organized by The Confederation of Meningitis Organizations (CoMO), which was formed in 2004 and whose members include organizations and individuals in 19 countries across Europe, North and South America, Australia, the Philippines and Africa. In addition to encouraging participation in local events, CoMO invites all to log on to their CoMO’s Meningitis website during April and join hands against meningitis in a global virtual community. You can also join the cause on Facebook.

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

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