Immunization Works February 2013
ACIP Meeting: The most recent Advisory Committee on Immunization Practices (ACIP) meeting was held on February 20-21, 2013, in Atlanta, Georgia.
During the meeting, ACIP voted to recommend pneumococcal conjugate vaccine (PCV13) for children at high-risk for invasive pneumococcal disease between the ages of 6 years through 18 years if they have not previously received a dose of PCV13. The vaccine will be available in the Vaccines for Children (VFC) program as well. ACIP also voted to expand recommendations for Hib vaccine to now include patients 15 months or older undergoing elective splenectomy, asplenic patients older than 59 months, and HIV-infected children between 59 months through 18 years. ACIP also recommends that if a dose of Hib vaccine is received within 14 days of immunosuppressive cancer therapy and radiation the dose should be repeated at least three months following the therapy. The combination vaccine Hib-MenCY will be available in the VFC program pending a federal contract for this vaccine. Finally ACIP voted to continue the current recommendation for annual influenza vaccination for all persons six months and older, and as public health and private provider offices are now pre-booking vaccine with many new choices of influenza vaccine product, ACIP voted to recommend age indication as the primary basis for the choice of vaccine to be ordered or used. Information about influenza vaccine effectiveness will be included in this year’s annual influenza recommendation.
Please visit the ACIP meeting web page for presentation slides, meeting minutes, and additional information. The next ACIP meeting will be held on June 19-20, 2013.
Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis (Tdap) in Pregnant Women: In October 2011, in an effort to reduce the burden of pertussis in infants, the ACIP recommended that unvaccinated pregnant women receive a dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap). Vaccination of women with Tdap during pregnancy is expected to provide some protection to infants from pertussis until they are old enough to be vaccinated themselves. Tdap given to pregnant women will stimulate the development of maternal antipertussis antibodies, which will pass through the placenta, likely providing the newborn with protection against pertussis in early life, and will protect the mother from pertussis around the time of delivery, making her less likely to become infected and transmit pertussis to her infant. The 2011 Tdap recommendation did not call for vaccinating pregnant women previously vaccinated with Tdap. On October 24, 2012, ACIP voted to recommend use of Tdap during every pregnancy. The February 22 MMWR summarizes data considered and conclusions made by ACIP and provides guidance for implementing its recommendations. These updated recommendations on use of Tdap in pregnant women aim to optimize strategies for preventing pertussis morbidity and mortality in infants.
Noninfluenza Vaccination Coverage Among Adults in the United States, 2011: Vaccinations are recommended throughout life to prevent vaccine-preventable diseases and their sequelae. Adult vaccination coverage, however, remains low for most routinely recommended vaccines and well below Healthy People 2020 targets. In October 2012, the ACIP approved the adult immunization schedule for 2013. Apart from influenza vaccination, which is now recommended for all adults, other vaccines recommended for adults target different populations based on age, certain medical conditions, behavioral risk factors (e.g., injection drug use), occupation, travel, and other indications. To assess adult (19 years of age and older) vaccination coverage for select vaccines, CDC analyzed data from the 2011 National Health Interview Survey (NHIS). The February 1 MMWR summarizes the results of that analysis for pneumococcal vaccine, tetanus toxoid-containing vaccines (including tetanus and diphtheria toxoid [Td] with acellular pertussis vaccine [Tdap]), and hepatitis A, hepatitis B, herpes zoster (shingles), and human papillomavirus (HPV) vaccines, by selected characteristics (age, race/ethnicity, and vaccination target criteria). Influenza vaccination coverage estimates for the 2011-12 influenza season have been published separately. Compared with 2010, the data indicate modest increases in Tdap vaccination among persons aged 19-64 years and HPV vaccination among women, but only little improvement in coverage for the other vaccines among adults in the United States. Coverage for tetanus vaccination (with any tetanus toxoid-containing vaccine) during the past ten years was unchanged. Substantial increases in vaccination coverage are needed to reduce the occurrence of vaccine-preventable diseases among adults. The Community Preventive Services Task Force and other authorities have recommended that health care providers incorporate vaccination needs assessment, recommendation, and offer of vaccination into routine clinical practice for adult patients.
A media telebriefing was also conducted on January 29, 2013.
Infant Meningococcal Vaccination: ACIP Recommendations and Rationale: At the October 2012 meeting, the ACIP voted to recommend vaccination against meningococcal serogroups C and Y for children aged 6 weeks through 18 months at increased risk for meningococcal disease. Meningococcal groups C and Y and Haemophilus influenzae type b tetanus toxoid conjugate vaccine (Hib-MenCY-TT [MenHibrix, GlaxoSmithKline Biologicals]) is licensed for active immunization for prevention of invasive disease caused by Haemophilus influenzae type b (Hib) and meningococcal serogroups C and Y. Hib-MenCY-TT is not indicated for prevention of disease caused by meningococcal serogroup B, the most common serogroup causing disease in infants, or serogroups W135 or A, which are represented in quadrivalent meningococcal vaccines. Before licensure of Hib-MenCY-TT, no meningococcal conjugate vaccine was licensed for infants aged two through eight months. MenACWY-D (Menactra, Sanofi Pasteur) is licensed as a 2-dose series for infants and toddlers aged 9 through 23 months, and MenACWY-D and MenACWY-CRM (Menveo, Novartis Vaccines) are licensed for persons aged 2 through 55 years as a single dose. These vaccines are recommended routinely for persons aged 11 through 18 years and persons aged 2 through 55 years at increased risk for meningococcal disease (and MenACWY-D for persons aged 9 months through 55 years). The January 25 MMWR summarizes the deliberations of ACIP, the rationale for its decision, and recommendations for use of Hib-MenCY-TT in infants at increased risk for meningococcal disease.
VTrckS Update: As of February 2013, 45 (70%) grantees have successfully transitioned to CDC’s new vaccine tracking system (VTrckS) for ordering vaccine and tracking inventory. Of the 45 grantees that have deployed to VTrckS, 28 (62%) submit or plan to submit vaccine orders via an external information system (ExIS), such as a state immunization information system (IIS). A total of 17 (38%) grantees will enroll and train providers to submit orders directly into VTrckS.
ExIS grantees already rely on their IIS to collect and consolidate data from vaccination providers and to sustain effective immunization strategies through use of clinical decision support, vaccination coverage reports, interoperability with electronic health record systems, vaccine inventory management, and reminder/recall messages. Adding IIS ordering functionality and an interface between VTrckS and the IIS builds on existing relationships with providers and might provide additional incentive for vaccination providers to participate in IIS while promoting greater accountability of publicly purchased vaccine.
For vaccination providers that currently access or plan to access VTrckS to order publicly-funded vaccine, VTrckS offers a secure system to place and track orders online and submit accountability data. The provider interface is a user-friendly, web-based, shopping-cart-style ordering system with a catalogue of available vaccines.
The Wyoming Department of Health’s Immunization Program made the transition to full VTrckS using an ExIS interface and shared how VTrckS has improved their vaccine business processes:
“The transition to using our registry for online ordering has increased our efficiency and productivity and saved our program countless hours. Our monthly ordering period has been cut in half and providers are receiving their vaccines in a matter of days, rather than weeks. After anticipating the VTrckS transition for so long, we are thankful to have broken through the barrier and are happy to be on the other side.” — Lisa Wordeman, Immunization Program Manager
The Alabama Department of Public Health’s State Immunization Program enters vaccine orders directly into VTrckS and shared how they see VTrckS supporting their vaccine management processes:
“So far, VTrckS appears to be working fine on the vaccine management side. Entering orders has gone smoothly, we are growing more attentive to what our providers are reporting, and provider inventories are better managed. Using this integrated system also relieves us of the burden of having to transmit data every day to CDC. We are confident that VTrckS will become an indispensable tool in our vaccine management arsenal.” — Alabama Immunization Program staff
Update on Influenza Activity in the United States From September 30, 2012-February 9, 2013: Influenza activity in the United States began to increase in mid-November and remained elevated through February 9, 2013. During that time, influenza A (H3N2) viruses predominated overall, followed by influenza B viruses. The February 22 MMWR summarizes influenza activity in the United States since the beginning of the 2012-13 influenza season and updates the previous summary from December 2012.
Interim Adjusted Estimates of Seasonal Influenza Vaccine Effectiveness in the United States: Early influenza activity during the 2012-13 season enabled estimation of the unadjusted effectiveness of the seasonal influenza vaccine. The February 22 MMWR presents updated adjusted estimates based on 2,697 children and adults enrolled in the United States Influenza Vaccine Effectiveness (Flu VE) Network during December 3, 2012-January 19, 2013. During this period, overall vaccine effectiveness (VE) (adjusted for age, site, race/ethnicity, self-rated health, and days from illness onset to enrollment) against influenza A and B virus infections associated with medically attended acute respiratory illness was 56%, similar to the earlier interim estimate (62%). VE was estimated as 47% against influenza A (H3N2) virus infections and 67% against B virus infections. When stratified by age group, the point estimates for VE against influenza A (H3N2) and B infections were largely consistent across age groups, with the exception that lower VE against influenza A (H3N2) was observed among adults older than 65 years of age. These adjusted VE estimates indicate that vaccination with the 2012-13 influenza season vaccine reduced the risk for outpatient medical visits resulting from influenza by approximately one half to two thirds for most persons, although VE was lower and not statistically significant among older adults. Antiviral medications should be used as recommended for treatment of suspected influenza in certain patients, including those older than 65 years of age, regardless of their influenza vaccination status.
Flu Season Resources: Will you continue to promote flu vaccination this season? CDC provides a variety of free materials for all audiences, including print, audio/video, social media tools, and web tools. This season, the website features expanded materials for American Indians and Alaska Natives. You can order these free resources and more at the resources web page; it’s one-stop shopping for up-to-date flu information!
And check out our new partner website, where partners are already entering activities into the calendar of events for the 2012-2013 flu season. Submit your flu prevention activities/events and see what others are planning now.
You can also visit our flu main website to read relevant questions and answers, get the latest information on the H3N2v virus, learn more about the most recent ACIP recommendations, keep up with national and international flu activity, surveillance, and vaccine coverage data, or view information tailored specifically for health care professionals.
Meetings and Conferences
Save the Date: The Spring Clinical Vaccinology Course will be held March 8-10, 2013, in Chicago, Illinois.
This course will focus on new developments and issues related to the use of vaccines. Expert faculty will provide the latest information on both current and prospective vaccines, updated recommendations for vaccinations across the life span, and innovative and practical strategies for ensuring timely and appropriate vaccination. The target audience includes physicians (family, internists, pediatricians, and infectious disease specialists); nurses; nurse practitioners; physician assistants; pharmacists; vaccine program administrators; federal, state, and local public health professionals; and other health care professionals interested in clinical aspects of vaccine delivery.
NIIW 2013: National Infant Immunization Week (NIIW) is set for April 20-27, 2013. NIIW is an annual observance to promote the benefits of immunizations and to improve the health of children younger than two years old. Since 1994, local and state health departments, national immunization partners, health care professionals, community leaders from across the United States, and CDC have worked together through NIIW to highlight the positive impact of vaccination on the lives of infants and children, and to call attention to immunization achievements. NIIW will be celebrated as part of World Immunization Week (WIW), an initiative of the World Health Organization (WHO) scheduled for April 24-30, 2013. During WIW, all six WHO regions, including more than 180 Member States, territories, and areas, will simultaneously promote immunization, advance equity in the use of vaccines and universal access to vaccination services, and enable cooperation on cross-border immunization activities. Please visit the NIIW web page for additional information.
Annual Conference on Vaccine Research: The 16th Annual Conference on Vaccine Research will be held April 22-24, 2013, in Baltimore, Maryland. The conference provides high-quality and current reports of scientific progress featured in both invited presentations and submitted oral abstracts and posters. By drawing upon an international audience of scientists and researchers, health care professionals and trainees, veterinarians, vaccine manufacturers, and public health officials, the conference organizers aim to encourage the exchange of ideas across a broad range of disciplines. The opening keynote presentation features Dr. D.A. Henderson discussing Eradication of Disease Through Vaccination. Early registration is open until March 11, 2013.
Save the Date: April 24, 2013, is World Meningitis Day, which seeks to encourage individuals, families and communities to learn the signs and symptoms of meningitis, the importance of urgent treatment of the disease, and that prevention is available through vaccination against some forms of meningitis. 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 25 countries across the Americas, Asia Pacific, and Europe/Africa. In addition to encouraging participation in local events, CoMO invites all to log on to their website to join hands against meningitis in a global virtual community. You can also join the cause on Facebook.
Resources and Information
New You Call the Shots Modules: The Vaccine Storage and Handling and Vaccines for Children (VFC) modules were recently added to the NCIRD web-based training course You Call the Shots. Please visit the You Call the Shots web page for additional information. Continuing Education (CE) credit is also available.
New Legionella Website: A new website has been launched for legionellosis (Legionnaires’ disease and Pontiac fever). This user friendly website provides a comprehensive experience for those seeking information about legionellosis, including epidemiologic investigation tools.
Pertussis (Whooping Cough) Infographic: Pregnant women now need a Tdap shot during every pregnancy to protect them from pertussis and pass some protection to their newborns. Learn the three best ways to protect babies from whooping cough in this new CDC infographic.
Pertussis Educational Posters: With rising rates of pertussis in many states across the country, efforts are underway to raise awareness about vaccine recommendations. See new downloadable posters at the pertussis print material web page.
Adult Immunization Materials: Prescription pads are now available for order from the Public Health Foundation. Health care providers may find the new prescription pads very helpful. The pad is actually a checklist health care providers can use to counsel patients about which vaccines are right for them. Each sheet lists 17 possible vaccinations and serves as a convenient resource for patients and providers. Help us strengthen that all-important provider recommendation to any group of adult patients.
Also visit the CDC Vaccines for Adult Patients resource web page which has various materials available for download to educate and encourage adult patients to get vaccinated. The resources are part of a new website providing general information on adult vaccination. Targeted groups include young adults (19-26 years), pregnant women, adults with special health conditions, and older adults (60+ years).
Adult Vaccine Finder Now Available: If you are interested in letting the public know about vaccines offered at your practice or clinic, please visit the HealthMap Vaccine Finder. The site already includes more than 54,000 locations that provide flu shots and has provided this information to 500,000 users from the general public. On January 28, 2013, the site expanded to include ten additional adult vaccines. You can also register your location on this website.
Resources From the Vaccines for Preteens and Teens Campaign: In this 30-second Spanish language television PSA, a busy Hispanic mother receives a call from her doctor reminding her to get her adolescent son and daughter caught up on their shots. Please visit the Preteen and Teen Campaign web page to view this PSA and the accompanying English PSA.
New plain-language fact sheets provide detailed information about each of the vaccines routinely recommended for adolescents, including Tdap, meningococcal vaccine, the HPV vaccine, and the seasonal influenza vaccine. There is also a new fact sheet summarizing all of the vaccine recommendations for adolescents. Spanish versions will be coming soon, so please check back with the website. Health care providers will find this new teen fact sheet[4 pages] full of useful information about adolescent vaccine recommendations, side effects, and contraindications. The fact sheet also includes tips for ensuring that their adolescent patients are fully vaccinated. CDC has also created a new reminder/recall e-card that providers can send to parents of adolescents.
An updated HPV matte article explains the latest HPV vaccine recommendations for girls and boys. It is approximately 450 words, and can be placed directly into your newsletter or posted on your website.
CDC and Medscape Videos: 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 health care professionals. In this series, experts from CDC offer video commentaries on the current topics important to practicing clinicians. NCIRD has contributed to a variety of commentaries.
Immunization Publications: Please visit the NCIRD publications ordering form for the latest immunization publications. Copies of the 2012 Immunization Works DVD, Surveillance of Vaccine-Preventable Diseases DVD, the Parents Guide to Childhood Immunizations, and various campaign materials are available for ordering. Copies of the 2013 immunization schedules should be available in late March.
CDC Job Openings: CDC is committed to recruiting and hiring qualified candidates for a wide range of immunization and other positions. Researchers, Medical Officers, Epidemiologists, and other specialists are often needed to fill positions within CDC. For a current listing, including international opportunities, please visit CDC’s employment web page.
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