Immunization Works June 2013
Prevention of Measles, Rubella, Congenital Rubella Syndrome, and Mumps—Summary Recommendations of ACIP: Measles, rubella, and mumps are acute viral infections that can cause serious disease and complications of disease but can be prevented with vaccination. Vaccines for prevention of measles, rubella, and mumps were licensed and recommended for use in the United States in the 1960s and 1970s. Because of successful vaccination programs, measles, rubella, congenital rubella syndrome (CRS), and mumps are now uncommon in the United States. However, recent outbreaks of measles and mumps have occurred from import-associated cases because these diseases are common in many other countries. Persons who are unvaccinated put themselves and others at risk for these diseases and related complications.
Two live attenuated vaccines are licensed and available in the United States to prevent measles, mumps, and rubella: MMR vaccine (measles, mumps, and rubella [M-M-R II, Merck & Co., Inc.]), which is indicated routinely for persons aged 12 months and older and infants aged six months and older who are traveling internationally, and MMRV vaccine (measles, mumps, rubella, and varicella [ProQuad, Merck & Co., Inc.]), licensed for children aged 12 months through 12 years. For the purposes of this report, MMR vaccine will be used as a general term for measles, mumps, and rubella vaccination; however, age-appropriate use of either licensed vaccine formulation can be used to implement these vaccination recommendations.
For the prevention of measles, mumps, and rubella, vaccination is recommended for persons older than 12 months. For the prevention of measles and mumps, the Advisory Committee on Immunization Practices (ACIP) recommends two doses of MMR vaccine routinely for children with the first dose administered at age 12 through 15 months and the second dose administered at age four through six years before school entry. Two doses are recommended for adults at high risk for exposure and transmission (e.g., students attending colleges or other post-high school educational institutions, health care personnel, and international travelers) and one dose for other adults older than 18 years. For prevention of rubella, one dose of MMR vaccine is recommended for persons older than 12 months. The June 14, 2013 MMWR is a compendium of all current recommendations for the prevention of measles, rubella, congenital rubella syndrome (CRS), and mumps. The report also presents the recent revisions adopted by the ACIP on October 24, 2012, and also summarizes all existing ACIP recommendations that have been published previously during 1998-2011. As a compendium of all current ACIP recommendations, the information in this report is intended for use by clinicians as guidance for scheduling of vaccinations for these conditions and considerations regarding vaccination of special populations.
Nationwide Rubella Epidemic in Japan: Rubella usually is a mild, febrile rash illness in children and adults; however, infection early in pregnancy, particularly during the first 16 weeks, can result in miscarriage, stillbirth, or an infant born with birth defects (i.e., congenital rubella syndrome [CRS]). As of 2013, goals to eliminate rubella have been established in two World Health Organization regions (the Region of the Americas by 2010 and the European Region by 2015), and targets for accelerated rubella control and CRS prevention have been established by the Western Pacific Region (WPR). In 1976, Japan introduced single-antigen rubella vaccine in its national immunization program, targeting girls in junior high school. In 1989, a measles-mumps-rubella (MMR) vaccine was introduced; targeting children aged 12-72 months. However, adult males remain susceptible to rubella. From January 1 to May 1, 2013, a total of 5,442 rubella cases were reported through the rubella surveillance system in Japan, with the majority (77%) of cases occurring among adult males. Ten infants with CRS were reported during October 2012-May 1, 2013. Countries and regions establishing a goal of accelerated control or elimination of rubella should review their previous and current immunization policies and strategies to identify and vaccinate susceptible persons and to ensure high population immunity in all cohorts, both male and female. Please visit the June 14, 2013 MMWR for the full report.
Progress Toward Measles Elimination in the Western Pacific Region: In 2005, the World Health Organization (WHO) Regional Committee for the Western Pacific Region (WPR) resolved that WPR should aim to eliminate measles by 2012. The recommended measles elimination strategies in WPR include 1) achieving and maintaining high (greater than 95%) coverage with two doses of measles-containing vaccine (MCV) through routine immunization services and by implementing supplementary immunization activities (SIAs), when required; 2) conducting high-quality, case-based measles surveillance; 3) ensuring high-quality laboratory surveillance, with timely and accurate testing of specimens to confirm or discard suspected cases and detect measles virus for genotyping and molecular analysis; and 4) establishing and maintaining measles outbreak preparedness for rapid response and ensuring appropriate case management. The June 7, 2013 MMWR updates the previous report and describes progress toward eliminating measles in WPR during 2009-2012. During this period, measles incidence reached a historic low, decreasing by 83%, from 34.0 to 5.9 cases per million population. However, to achieve measles elimination in WPR, additional efforts are needed to strengthen routine immunization services in countries and areas with less than 95% coverage with the routine first (MCV1) or second dose of MCV (MCV2), to introduce an MCV2 dose in the four remaining countries and areas that do not yet have a routine 2-dose MCV schedule, and to use SIAs to close immunity gaps among measles-susceptible populations in countries and areas that have ongoing measles virus transmission.
VTrckS Update: NCIRD leadership is pleased to announce a major achievement—as of May 6, 2013, all 64 awardees have successfully transitioned to CDC’s new vaccine tracking system (VTrckS) for ordering and management of publicly-funded vaccines. Of these awardees, 47 (73%) are submitting or plan to submit orders via an external information system (ExIS), such as their state immunization information system (IIS), while 17 awardees (27%) will enroll and train their providers to submit orders directly into VTrckS. As of May 31, more than 1,800 provider users are ordering publicly-funded vaccines directly in VTrckS.
The entire CDC project team would like to thank everyone who was involved with the intensive VTrckS deployment process. From the launch of Release 1.0 at four pilot sites in December 2010, to Release 2.0 in February 2012, and culminating in the past year and a half of deployment across all awardees, we have all worked together to prepare for, deploy, and refine VTrckS. And our efforts have paid off—since VTrckS went live in December 2010, we have shipped more than 210 million vaccine doses, with over 98% of routine orders shipping in four business days or less. By enabling significant improvements in vaccine order tracking, inventory visibility, fiscal and dosage accountability, and safety response capability at the federal, state, and local levels, VTrckS represents a crucial enhancement to our nation’s ability to respond to public health crises.
Health Alert Network—Health Update on Human Infections With Avian Influenza A (H7N9) Viruses: The June 7, 2013, health advisory provides an update on the avian influenza A (H7N9) virus [H7N9] situation and includes new recommendations on who should be tested for H7N9 in the United States. This document replaces guidance published on April 5, 2013, in CDC Health Advisory 344 “Human Infections with Novel Influenza A (H7N9) Viruses”. The updated guidance reflects the most current epidemiology of H7N9 cases, which indicates that almost all H7N9 human infections have resulted in severe respiratory illness; H7N9 has been found rarely among those with milder disease. For that reason, CDC is changing its recommendations for H7N9 testing: The primary changes from previous guidance are a new recommendation to test only patients with an appropriate exposure history and severe respiratory illness requiring hospitalization and a request that only confirmed and probable cases of human infection with H7N9 be reported to CDC.
Influenza Activity in the United Sates During the 2012-2013 Season and Composition of the 2013-2014 Influenza Vaccine: During the influenza season in the United States, influenza activity increased through November and December before peaking in late December. Influenza A (H3N2) viruses predominated overall, but influenza B viruses and, to a lesser extent, influenza A (H1N1) pdm09 (pH1N1) viruses also were reported in the United States. This influenza season was moderately severe, with a higher percentage of outpatient visits for influenza-like illness (ILI), higher rates of hospitalization, and more reported deaths attributed to pneumonia and influenza compared with recent years. The June 14, 2013 MMWR summarizes influenza activity in the United States during the 2012-2013 influenza season (September 30, 2012-May 18, 2013) as of June 7, 2013, and also reports the recommendations for the components of the 2013-2014 Northern Hemisphere influenza vaccine.
Meetings and Conferences
ACIP Meeting: The most recent ACIP meeting is being held June 19-20, 2013, in Atlanta, Georgia. Please visit the ACIP meeting web page for presentation slides, meeting minutes, archived video broadcast, and additional information. The next ACIP meeting will be held on October 23-24, 2013.
Resources and Information
Current Issues in Immunization Netconference: Immunization Netconferences are live, one-hour presentations combining an online visual presentation with simultaneous audio via telephone conference call and a live question and answer session. Internet access and a separate phone line are needed to participate. On-demand replays and presentations will be available shortly after each event. The next netconference is scheduled for July 25, 2013. Please visit the netconference web page for additional information.
You Call the Shots Modules: This is a web-based training course that was developed through the Project to Enhance Immunization Content in Nursing Education and Training. The Hepatitis A module, Vaccine Storage and Handling, and Vaccines for Children (VFC) modules have been added within the past few months. Please visit the You Call the Shots web page for additional information. Continuing Education (CE) credit is also available.
New CDC Websites
- Diphtheria Website: CDC’s diphtheria and diphtheria antitoxin content provides clinicians information on clinical features, medical management, preventive measures, and challenges with this disease.
- Pneumococcal Website: CDC’s pneumococcal disease content provides clinicians with information about the bacteria, risk factors, transmission, clinical features, prevention, diagnosis, management guidelines, and more.
These user-friendly disease websites also provide information for parents, general public, kids, laboratorians, and public health professionals. Patients can be referred to the “about” section to learn more about the disease and getting vaccinated.
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 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).
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. You will need to sign up as a member to view the videos.
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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