Immunization Works April 2013
Varicella Death of an Unvaccinated, Previously Healthy Adolescent: Varicella usually is a self-limited disease but sometimes can result in severe complications and death. Infants, adults, and immunocompromised persons are at increased risk for severe disease. Before varicella vaccine was introduced in 1995, the majority of hospitalizations and deaths from varicella occurred among healthy persons aged 20 years and younger. Introduction of varicella vaccine has substantially decreased varicella incidence, hospitalizations, and deaths in the United States. The April 12 MMWR describes a varicella death in an unvaccinated, previously healthy 15-year-old adolescent. In April 2012, as part of the routine review of vital statistics records, the Ohio Department of Health identified a 2009 death with the International Classification of Diseases, 10th Revision code for varicella as the underlying cause. Because varicella deaths are nationally reportable, the Ohio Department of Health conducted an investigation to validate that the coding was accurate. On March 12, 2009, investigators learned the adolescent girl was admitted to a hospital with a three-day history of a rash consistent with varicella and a one-day history of fever and shortness of breath. The patient was started on intravenous acyclovir (on day four of illness) and broad-spectrum antibiotics and antifungals, but she died three weeks later. The case underscores the importance of varicella vaccination, including catch-up vaccination of older children and adolescents, to prevent varicella and its serious complications.
Evaluating Surveillance Indicators Supporting the Global Polio Eradication Initiative, 2011-2012: Polio cases are detected through surveillance for acute flaccid paralysis (AFP) with linked stool specimens tested for polioviruses (PVs) at accredited laboratories within the Global Polio Laboratory Network (GPLN). AFP surveillance findings are supplemented by testing sewage samples (environmental surveillance) collected at selected sites. Virologic data guide where targeted immunization activities should be conducted or improved. Key performance indicators are used to 1) Monitor AFP surveillance quality at national and subnational levels to identify gaps where PV transmission could occur undetected; 2) Provide evidence of where PV circulation has been interrupted; and 3) Allow timely detection of an outbreak. Standardized surveillance indicators allow progress to be monitored over time and compared among countries. The April 12 MMWR presents AFP surveillance performance indicators at national and subnational levels for countries affected by polio during 2011-2012, and trends in environmental surveillance, updating previous reports. In the 19 countries with transmission of PV (WPV and/or circulating vaccine-derived poliovirus [cVDPV]) during 2011-2012, national performance indicator targets were met in 12 countries in 2011 (63%) and 13 countries in 2012 (68%). Seven countries (37%) had greater than 80% of the population living in areas meeting performance indicators in 2011, increasing to nine countries (47%) in 2012. Performance indicators for timely reporting of PV isolation and characterization were met in four of six World Health Organization (WHO) regions in 2011 and five regions in 2012. To achieve global polio eradication, efforts are needed to improve and maintain AFP surveillance and laboratory performance.
NIIW 2013: National Infant Immunization Week (NIIW) was held 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 website for additional information.
You can access CDC’s newest materials to help you promote infant immunizations in your communities. These pieces are designed to be “evergreen” so that you can use them throughout the year but consider utilizing them by asking your local newspapers to publish the print ads and drop-in articles, or your partners to use the materials in their newsletters. You can view and download the new video PSAs, print ads, web buttons, and more from the NIIW website.
Also, see what other activities are going on for NIIW and share your activities through the NIIW activity registry.
Influenza A (H7N9) Virus Update: It’s been an eventful 2012-2013 influenza season and just as things seemed to be settling down, flu made the headlines once again. On April 1, 2013, the World Health Organization (WHO) reported three human infections with a new influenza A (H7N9) virus in China. Since then, additional cases have been reported. Most of the people reportedly infected have had severe illness and, in some cases, have died. So far, no sustained human-to-human transmission has been detected. While there are no reported cases of H7N9 in the United States, CDC is taking standard pandemic preparedness precautions, including beginning to develop a candidate vaccine virus to produce an H7N9 influenza vaccine should it become necessary. To learn more about H7N9 and to stay informed about the current situation, please visit the H7N9 web page.
2012-2013 Seasonal Flu Wrap-Up: Seasonal influenza activity continues to decline in the United States, though it could spread at low levels and cause illness for several more weeks. Since flu season is winding down and because it takes two weeks for vaccine to become protective, the window for 2012-2013 seasonal influenza vaccination is closing. Ongoing vaccination is still recommended in institutional outbreak settings, for children needing to complete the second dose in their two-dose regimen, and for people preparing to travel to the Southern Hemisphere, where flu season is just beginning. Because of ongoing influenza activity, CDC continues to urge people at high risk from flu complications, including people 65 and older, to seek treatment quickly if they develop flu symptoms such as cough, fever, sore throat, and body aches. The final issue of CDC’s Seasonal Influenza Key Points for the 2012-2013 season was distributed on April 19. Routine key points for the upcoming season should begin in October 2013. If you would like to receive future flu-related information and updates (including for H7N9 please email your request to email@example.com.
Seasonal Influenza Vaccines for 2013-2014: On April 19, 2013, CDC posted “Interim Recommendations: Prevention and Control of Influenza With Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP) 2013.” The interim statement summarizes recommendations for the use of influenza vaccines approved on February 21, 2013 by ACIP. An expanded 2013 ACIP influenza vaccination recommendation statement will be published in MMWR Recommendations and Reports prior to the start of the 2013-2014 influenza season.
Meetings and Conferences
ACIP Meeting: The most recent ACIP meeting was held on February 20-21, 2013, in Atlanta, Georgia. Please visit the ACIP meeting web page for presentation slides, meeting minutes, an archived video broadcast of the latest meeting, and additional information. The next ACIP meeting will be held on June 19-20, 2013.
Resources and Information
Current Issues in Immunization Netconference: The most recent netconference was held on March 21, 2013. The moderator was Andrew Kroger. Carolyn Bridges presented “Update on Adult Immunizations,” Jennifer Liang presented “Updated Tdap Vaccine Recommendations for Pregnant Women,” and Iyabode (Yabo) Beysolow presented “2013 Childhood and Adolescent Immunization Schedules.”
You Call the Shots Modules: The Hepatitis A module was just added to the NCIRD web-based training course You Call the Shots, and the Vaccine Storage and Handling and Vaccines for Children (VFC) modules were added in February. Please visit the You Call the Shots web page for additional information. Continuing Education (CE) credit is also available.
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 pertussis 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 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 10 additional adult vaccines. You can also register your location on this website.
Adult Immunization Materials: Resource materials 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.
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 vaccines for adults 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 and older).
Resources From the Vaccines for Preteens and Teens Campaign: A 30-second Spanish language television PSA available on the website shows a busy Hispanic mother receiving 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 materials focused on vaccines recommended for adolescents.
Also, 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. A new fact sheet is available 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 the 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, including a recently released study titled “Vaccines and Autism: CDC Study Says No Connection.” You will need to sign up as a member to view the article.
Vaccines for Preteens and Teens: The 2011 NIS-teen coverage data showed that for the third year in a row, the increase in coverage for human papillomavirus (HPV) vaccine was half of the increases seen for Tdap and MCV4 vaccine coverage. CDC is urging parents, health care professionals, and immunization partners to make HPV vaccination a priority by educating their communities on the importance of getting HPV vaccine for girls and boys at the recommended ages of 11 or 12 years to prevent HPV-related cancer and disease. Help spread the word that HPV vaccine is cancer prevention.
CDC data show that Hispanic women have the highest rates of cervical cancer in the United States and black women are more likely to die of this disease than women of other races or ethnicities. April is National Minority Health Month and we are calling on our partners to help achieve health equity by spreading the word about the importance of HPV vaccination for racial and ethnic minority populations. The following resources, tailored specifically to minority populations, will help you promote this message: 1) Add our newest HPV minority health matte articles to your newsletter, website or blog; and/or 2) Share HPV vaccine fact sheets with teens, parents, caregivers, and health care professionals.
CDC's Division of STD Prevention released updated HPV statistics. Approximately 79 million Americans are currently infected with HPV, and about 14 million people become newly infected each year. HPV is so common that nearly all sexually active men and women get it at some point in their lives. A presentation containing HPV statistics and HPV vaccine information, along with tips for helping vaccinators strengthen their recommendation of the HPV vaccine will be available online this spring.
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 the 2013 immunization schedules are available for ordering.
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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