News and Media Resources:

Immunization Works! June 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.

News & Summaries

The Advisory Committee on Immunization Practices (ACIP) Meeting:
The ACIP met in Atlanta, GA on June 23-24, 2010. During the two days the committee deliberated and made the following recommendations.

Meningococcal Conjugate Vaccine (MCV4): A history of Guillain-Barré Syndrome (GBS) should not be considered a contraindication or precaution for meningococcal conjugate vaccine (MCV4). Safety surveillance demonstrates that if there is any risk of subsequent GBS following MCV4, it is outweighed by the benefit of receiving MCV4.

13-Valent Pneumococcal Conjugate Vaccine (PCV13): The ACIP voted to harmonize the 13-valent Pneumococcal Conjugate Vaccine VFC resolution with the February 24, 2010 ACIP recommendation for use of PCV13 in 6 through 18 year olds.For more information, please see the full article, Licensure of a 13-Valent Pneumococcal Conjugate Vaccine (PCV13) and Recommendations for Use Among Children -- ACIP, 2010 in CDC’s Morbidity and Mortality Weekly Report.

Influenza Vaccine: New dosing guidance was issued for 2010-2011 influenza vaccine for children 6 months through 8 years:

• A child with an unknown or uncertain history of seasonal influenza vaccine should get 2 doses.
  
• A child who did not get H1N1 vaccine during the 2009-10 influenza season should get 2 doses.
• A child who got H1N1 vaccine during the 2009-2010 season and who got seasonal influenza vaccine prior to the 2009-10 season flu season should get 1 dose.
• For children not previously vaccinated, or vaccinated for the first time during the 2009-2010 influenza season, use the following table.

Number of influenza vaccine doses received in 2009-2010 season for H1N1	Number of influenza vaccine doses received in 2009-2010 season for Seasonal	Number of doses recommended for the 2010-2011 season
0	0, 1 or 2	2
1	0	2
1	1	2
1	2	1
2	2	1
2	0	2
2	1	2

Other Discussions: The ACIP also discussed the use of evidence-based recommendations, Human Papillomavirus Vaccine, Hepatitis B vaccine, pertussis vaccines, rotavirus vaccines, respiratory-syncytial virus immunoprophylaxis, health-care reform, vaccine supply, and vaccine safety.

Please visit the ACIP website for additional information.

Addition of Severe Combined Immunodeficiency as a Contraindication for Administration of Rotavirus Vaccine: In response to reported cases of vaccine-acquired rotavirus infection in infants with severe combined immunodeficiency (SCID) following rotavirus vaccine administration, both Merck & Co. and GlaxoSmithKline Biologicals have revised the prescribing information and patient labeling for their respective rotavirus vaccine products, pentavalent rotavirus vaccine (RV5) and monovalent rotavirus vaccine (RV1), with approval from the Food and Drug Administration (FDA). Merck revised the prescribing information and patient labeling for RV5 in December 2009, and GlaxoSmithKline Biologicals did so for RV1 in February 2010. After the revision to the RV5 prescribing information, CDC sought consultation from members of the former Rotavirus Vaccine Work Group of the Advisory Committee on Immunization Practices (ACIP). On the basis of that consultation and available data, CDC is updating the list of contraindications for rotavirus vaccine. Rotavirus vaccine (both RV5 and RV1) is contraindicated in infants diagnosed with SCID. For more information, please see the full article, Addition of Severe Combined Immunodeficiency as a Contraindication for Administration of Rotavirus Vaccine in CDC’s Morbidity and Mortality Weekly Report.

Pertussis outbreak in California: On June 17, 2010, California declared a pertussis (whooping cough) epidemic, and warned that the state is on pace to suffer the most illnesses and deaths due to pertussis in 50 years. They are urging children to be vaccinated against the disease and that parents, family members and caregivers of infants need a booster shot. Lean more at the California Department of Public Health (CDPH) web page.

CDC Pertussis Resources

• Pertussis vaccination
• Pertussis web feature (English and Spanish)
• Preteen Vaccine Campaign/materials
• CDC/Medscape video commentary (recognition/treatment of pertussis; Tdap recommendations video available early July)
• RSS Feeds for Office of Women’s Health (women’s health RSS and kids’ health RSS)
• APHL brochure for laboratorians [PDF-1.9MB - 2 pages] (summary of pertussis diagnostics)

FDA Licensure of Bivalent Human Papillomavirus Vaccine (HPV2, Cervarix) for Use in Females and Updated HPV Vaccination Recommendations from the ACIP: In October 2009, the FDA licensed bivalent human papillomavirus vaccine (HPV2; Cervarix, GlaxoSmithKline) for use in females aged 10 through 25 years. Cervarix is the second human papillomavirus (HPV) vaccine licensed for use in females in the United States. Quadrivalent HPV vaccine (HPV4; Gardasil, Merck & Co, Inc.) was licensed in 2006 for use in females aged 9 through 26 years, and the ACIP recommended routine HPV4 vaccination of females aged 11 or 12 years, and catch-up vaccination for females aged 13 through 26 years. This report provides updated recommendations for routine and catch-up vaccination of females with either HPV2 or HPV4. HPV2 is directed against two oncogenic types (HPV 16 and 18). HPV4 is directed against two oncogenic types (HPV 16 and 18) and two nononcogenic types (HPV 6 and 11). Both vaccines have high efficacy against HPV 16 and 18-related cervical precancer lesions. HPV4 also has high efficacy against HPV 6 and HPV 11-related genital warts and HPV 16 and 18-related vaginal and vulvar precancer lesions. For more information, please see the full article, FDA Licensure of Bivalent Human Papillomavirus Vaccine (HPV2, Cervarix) for Use in Females and Updated HPV Vaccination Recommendations from the ACIP in CDC’s Morbidity and Mortality Weekly Report.

FDA Licensure of Quadrivalent Human Papillomavirus Vaccine (HPV4, Gardasil) for Use in Males and Guidance from the ACIP: On October 16, 2009, the FDA licensed quadrivalent human papillomavirus vaccine (HPV4; Gardasil, Merck & Co. Inc.) for use in males aged 9 through 26 years for prevention of genital warts caused by human papillomavirus (HPV) types 6 and 11. On October 21, 2009, ACIP provided guidance that HPV4 may be given to males aged 9 through 26 years to reduce their likelihood of acquiring genital warts; ACIP does not recommend HPV4 for routine use among males.

HPV4 had been licensed previously for use in females aged 9 through 26 years for prevention of HPV 6, 11, 16, and 18-related outcomes (i.e., vaginal, vulvar, and cervical precancers and cancers and genital warts). HPV-associated cancers in males include certain anal, penile, and oropharyngeal and oral cavity cancers caused primarily by HPV 16. HPV types 6 and 11 cause approximately 90% of genital warts and most cases of recurrent respiratory papillomatosis. Approximately 500,000 cases of genital warts are estimated to occur each year in the United States among sexually active men and women. Direct medical costs related to genital warts are estimated at $200 million per year; in addition, genital warts can have an adverse impact on quality of life.

This report presents the ACIP policy statement and summarizes background data. Issues reviewed by ACIP included efficacy, immunogenicity, and safety of the HPV4 vaccine in males, epidemiology of HPV and burden of HPV-associated diseases and cancers in males, cost-effectiveness of male vaccination, and programmatic considerations. For more information, please see the full article,
FDA Licensure of Quadrivalent Human Papillomavirus Vaccine (HPV4, Gardasil) for Use in Males and Guidance from the ACIP in CDC’s Morbidity and Mortality Weekly Report.

Countermeasure and Response Administration System (CRA): The CRA system is CDC’s computer based informatics application developed to track and report the use of countermeasures, such as vaccines, during public health emergencies. CDC used CRA during the first eight weeks of the H1N1 Vaccine Program to track vaccine doses administered during the response to the H1N1 influenza pandemic of 2009-10. Other surveillance systems, such as the Behavioral Risk Factor Surveillance System (BRFSS) and the National 2009 H1N1 Flu Survey (NHFS), ran in parallel with CRA. CRA tracked doses administered according to pre-specified age groups in the early stages of the response when supplies of the vaccine were limited and before population based surveys (BRFSS and NHFS) could effectively monitor vaccine coverage.

The 62 CDC Public Health Emergency Preparedness Project Areas participated, covering all 50 states, 4 metropolitan areas (Chicago, Los Angeles County, New York City, and the District of Columbia), and 8 territories and Pacific Island states. For the event, CRA tracked 14,788,795 vaccine doses administered out of 41,583,300 doses shipped from October 3 through November 21, 2009. Of the doses administered, 35% went to children aged 5-18 years and more than 83% went to persons younger than 65 years of age.

Project Areas were required to submit aggregate counts of H1N1 vaccine doses administered for each reporting period (Sunday through Saturday). They used a variety of techniques and systems to capture the information and report the aggregate counts to CDC. Examples include existing immunization information systems, telephone dial-up systems, specially designed web-based surveys, faxes, scan forms, and the CRA’s individual data collection modules.

Information collected from these reports was used to brief CDC leadership involved in the response. This approach can be applied to other public health emergency events to help increase our knowledge of trends in countermeasures use.

A New Look at Improving the Vaccine Cold Chain: The loss of vaccines due to improper transport and storage has been a major problem for global immunization efforts. Vaccines are sensitive to extremes of both heat and cold and they must be maintained within strict temperature parameters to retain their efficacy. A critical element of any immunization program is the integrity of its cold chain system.

With funding from the Bill and Melinda Gates Foundation, Atlanta-based SEEDR L3C is building on a request from the Global Immunization Division (GID) of the CDC to address this problem. Through this grant, SEEDR L3C is reengineering a vaccine carrier, long-range cold box, and specimen transport container using new materials and manufacturing technologies to increase cold life, decrease container weight, and improve the containers’ ergonomics, carbon footprint, and affordability.

Another objective of the project is the development of a container for the transport of temperature-sensitive specimens and other biologicals. This includes a wide range of products including blood, diagnostic kits, and reagents that require transport between the field and laboratories in a temperature-controlled environment. A custom-designed container has the potential to strengthen diagnostics and disease surveillance in the global fight against major diseases such as HIV/AIDS, polio, and measles by ensuring that specimens arrive at laboratories intact and viable. The collaboration with CDC has significantly informed the design process, helping drive the development of a more intelligent and higher performing product.

GID will partner later this year with other CDC Divisions and international agencies to field test the containers. As part of their agreement with the Gates Foundation, SEEDR L3C will focus on maximizing the affordability and sustainability of the new product technology as it brings it to market for use in low and middle-income countries. For further information, please contact Victoria Gammino (vgammino@cdc.gov; 404-639-1572) in GID or Sue Gerber (gerbers@cdc.gov) with the Global AIDS Program.

Save the Date: Join us for CDC’s annual Immunization Update on August 5, 2010. This live satellite broadcast and webcast will provide up-to-date information on the rapidly changing field of immunization. Anticipated topics include influenza, pneumococcal conjugate, human papillomavirus, and meningococcal vaccines. The 2.5-hour broadcast will occur live from 9:00 to 11:30 AM (Eastern Time) and will be re-broadcast that day from 12:00 noon to 2:30 PM (Eastern Time). Both broadcasts will feature a live question-and-answer session in which participants nationwide can interact with the course instructors via toll-free telephone lines.

To register to attend the broadcast at a specific location, or to search for available locations, visit the CDC/ATSDR Training and Continuing Education Online System. Site registration is open now and individual registration begins on July 8, 2010. For questions about registration, call 800-418-7246 or e-mail ce@cdc.gov. You do not need to register to participate in the webcast.

Save the Date: World Pneumonia Day is November 12, 2010. The day will mobilize efforts to fight a neglected disease that kills more than two million children younger than the age of five worldwide each year. Nearly 100 organizations came together to commemorate the first-ever World Pneumonia Day in 2009. Events took place in more than 30 countries across 6 continents. More than 200 people attended the Global Pneumonia Summit in New York City and many more followed the live webcast online. Global media outreach efforts generated widespread international coverage on pneumonia.

Save the Date: Get Smart About Antibiotics Week is November 15-21, 2010. The event marks an annual effort to coordinate the work of CDC’s Get Smart: Know When Antibiotics Work campaign, state-based appropriate antibiotic use campaigns, non-profit partners, and for-profit partners. This one week observance highlights the issue of antibiotic resistance and the importance of appropriate antibiotic use. For the first time in 2010, CDC’s event will coincide with the European Antibiotic Awareness Day as an international partnership.

Influenza Update

Stay Informed! Information is updated frequently. Please visit the following websites for the latest updates:

• Seasonal Flu Home Page
  
• CDC Free Flu Resources
  

Preliminary Results: Surveillance for Guillain-Barré Syndrome After Receipt of Influenza A (H1N1) 2009 Monovalent Vaccine: Guillain-Barré syndrome (GBS) is an uncommon peripheral neuropathy causing paralysis and in severe cases respiratory failure and death. GBS often follows an antecedent gastrointestinal or upper respiratory illness but, in rare cases, can follow vaccination. In 1976, vaccination against a novel swine-origin influenza A (H1N1) virus was associated with a statistically significant increased risk for GBS in the 42 days after vaccination (approximately 10 excess cases per 1 million vaccinations), a consideration in halting the vaccination program in the context of limited influenza virus transmission. To monitor H1N1 2009 monovalent vaccine safety, several federal surveillance systems, including CDC's Emerging Infections Program (EIP), are being used. In October 2009, EIP began active surveillance to assess the risk for GBS after 2009 H1N1 vaccination. Preliminary results from an analysis in EIP comparing GBS patients hospitalized through March 31, 2010, who did and did not receive 2009 H1N1 vaccination showed an estimated age-adjusted rate ratio of 1.77 (GBS incidence of 1.92 per 100,000 person-years among vaccinated persons and 1.21 per 100,000 person-years among unvaccinated persons). If end-of-surveillance analysis confirms this finding, this would correspond to 0.8 excess cases of GBS per 1 million vaccinations, similar to that found in seasonal influenza vaccines. No other federal system to date has detected a statistically significant association between GBS and 2009 H1N1 vaccination. Surveillance and further analyses are ongoing. The 2009 H1N1 vaccine safety profile is similar to that for seasonal influenza vaccines, which have an excellent safety record. Vaccination remains the most effective method to prevent serious illness and death from 2009 H1N1 influenza infection; illness from the 2009 H1N1 influenza virus has been associated with a hospitalization rate of 222 per 1 million and a death rate of 9.7 per 1 million population. For more information, please see the full article, Preliminary Results: Surveillance for Guillain-Barré Syndrome After Receipt of Influenza A (H1N1) 2009 Monovalent Vaccine -- United States, 2009-2010 in CDC’s Morbidity and Mortality Weekly Report.

Meetings, Conferences & Resources

Newsletter Available: The Division of Bacterial Diseases (DBD), part of the National Center for Immunization and Respiratory Diseases (NCIRD), publishes a newsletter titled DBD Bulletin. The newsletter offers a glimpse into work being done by DBD staff, among other updates. Newsletters are available at the DBD website.

CDC and Medscape Partnership: This special series of commentaries is part of a collaboration between CDC and Medscape and is designed to deliver CDC's authoritative guidance directly to Medscape's physicians, nurses, pharmacists, and other healthcare professionals. In this series, experts from CDC offer video commentaries on the current topics important to practicing clinicians. NCIRD has contributed to available commentaries on pertussis, meningococcal disease, seasonal and H1N1 influenza/vaccines, and pneumococcal disease/PCV13. Stay tuned for a Tdap commentary and many more.

New Conjunctivitis Website: NCIRD launched a new website, which offers information about conjunctivitis, or pink eye. Learn more by visiting the conjunctivitis website.

International Conference on Emerging Infectious Diseases: The International Conference on Emerging Infectious Diseases (ICEID) will be held July 11-14, 2010 in Atlanta, GA. The conference brings together public health professionals and encourages the exchange of scientific and public health information on global emerging infectious disease issues. ICEID 2010 will focus on the impact of various intervention and preventive strategies that have been implemented to address emerging infectious disease threats. Registration is now open. For more information, visit the ICEID website.

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 and other 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.

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

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