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Immunization Works December 2013

Immunization Works December 2013 Newsletter


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Progress in Immunization Information Systems in the United States in 2012: Immunization information systems (IIS) are confidential, computerized, population-based systems that collect and consolidate vaccination data from vaccination providers that can be used in designing and sustaining effective immunization strategies. To monitor progress toward achieving IIS program goals, CDC annually surveys immunization program grantees using the IIS Annual Report (IISAR).

Results from the 2012 IISAR, completed by 54 of 56 grantees, indicate that 86% (19.5 million) of U.S. children younger than six years of age, and 25% (57.8 million) of U.S. adults participated in IIS. Eight of 12 minimum functional standards for IIS published by the National Vaccine Advisory Committee (NVAC) have been met by more than 90% of grantees. During 2011–12, progress was also made in meeting three additional functional standards, including the presence of core data element fields, timeliness of vaccine records, and Health Level 7 (HL7) messaging, and will be monitored in new functional standards for IIS published in 2013. Several new and ongoing initiatives, including interoperability between IIS and electronic health records (i.e., ensuring systems can work together and exchange information), the use of IIS to support vaccine ordering and inventory management, the use of two-dimensional barcodes to record vaccination information, and collaboration with pharmacies, federal agencies, and other adult vaccination providers, will support further progress in meeting functional standards and enhance reporting of adult vaccinations to IIS.

2012 IISAR data were available for 54 of the 56 immunization program grantees (50 states, five cities, and the District of Columbia). The District of Columbia did not report and New Hampshire did not have an IIS in 2012. The self-administered survey asked about participation in IIS, data quality indicators, and IIS functionality (e.g., interoperability with electronic health records). Please visit the December 13 MMWR for the full report.

Rubella and Congenital Rubella Syndrome Control and Elimination—Global Progress From 2000–12: Rubella virus usually causes a mild fever and rash in children and adults. However, infection during pregnancy, especially during the first trimester, can result in miscarriage, stillbirth, or infants with congenital malformations, known as congenital rubella syndrome (CRS). In 2011, the World Health Organization (WHO) updated guidance on the preferred strategy for introduction of rubella-containing vaccine (RCV) into national routine immunization schedules with an initial wide-age-range vaccination campaign that includes children aged nine months–15 years. WHO also urged all member states to take the opportunity offered by accelerated measles control and elimination activities as a platform to introduce RCVs. The Global Measles and Rubella Strategic Plan (2012–20) published by the Measles Rubella Initiative partners in 2012 and the Global Vaccine Action Plan endorsed by the World Health Assembly in 2012 include milestones to eliminate rubella and CRS in two WHO regions by 2015, and eliminate rubella in five WHO regions by 2020.

The December 6 MMWR summarizes the global progress of rubella and CRS control and elimination during 2000–2012. As of December 2012, 132 (68%) WHO member states had introduced RCV, a 33% increase from 99 member states in 2000. A total of 94,030 rubella cases were reported to WHO in 2012 by 174 member states, an 86% decrease from the 670,894 cases reported in 2000 by 102 member states. The WHO Region of the Americas (AMR) established a rubella elimination goal of 2010, and has started to document the elimination of measles, rubella, and CRS. The WHO European Region (EUR) has established a rubella elimination goal of 2015; rubella incidence has decreased significantly, although outbreaks continue to occur.

2014 Immunization Schedules: Every year, recommendations for routine use of vaccines in children, adolescents, and adults are developed by the Advisory Committee on Immunization Practices (ACIP) and, when adopted by the Director of CDC, become official CDC/HHS policy. In early 2014, MMWR will publish a summary of schedule changes but will not publish the figures, footnotes, and tables. 2014 figures, footnotes, and tables will only be published on the CDC website.

The 2014 child and adolescent schedule is scheduled to be released on January 31 and the adult schedule is scheduled to be released on February 3. Until then, the 2013 schedules will remain on the website.

CDC encourages organizations to content syndicate rather than copy a PDF version of the schedule onto their websites to share with visitors. Content syndication allows other organization’s websites to mirror CDC web content, with immediate and automatic updates whenever changes are made on the CDC site. This helps ensure all schedules are current across the Internet.

Recent internet searches reveal hundreds of old copies of the schedules; please use this best practice. Prepare now for the release of the 2014 schedules by following the steps to display the schedules on your site.

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Influenza Information

Update on Influenza Activity in the United States: CDC collects, compiles, and analyzes data on influenza activity year-round in the United States. The influenza season generally begins in the fall and continues through the winter and spring months. However, the timing and severity of circulating influenza viruses can vary by geographic location and season. Influenza activity in the United States continued to increase from mid-November through the beginning of December and is expected to continue to increase in the coming weeks. Health care providers should offer vaccine to all unvaccinated persons aged six months and older throughout the influenza season. The December 20 MMWR summarizes influenza activity in the United States during September 29–December 7, 2013.

Estimated Influenza Illness and Hospitalizations Averted by Influenza Vaccination in the United States During the 2012–13 Influenza Season: Influenza is associated with substantial morbidity and mortality each year in the United States. From 1976 to 2007, annual deaths from influenza ranged from approximately 3,300 to 49,000. Vaccination against influenza is recommended to prevent illness and related complications. Since 2010, the ACIP has recommended that all persons aged six months and older be vaccinated against influenza each year.

In 2013, CDC published a model to quantify the annual number of influenza-associated illnesses and hospitalizations averted by influenza vaccination during the 2006–07 through 2010–11 influenza seasons. Using that model with 2012–13 influenza season vaccination coverage rates, influenza vaccine effectiveness, and influenza hospitalization rates, CDC estimated that vaccination resulted in 79,000 (17%) fewer hospitalizations during the 2012–13 influenza season than otherwise might have occurred. Based on estimates of the percentage of influenza illnesses that involve hospitalization or medical attention, vaccination also prevented approximately 6.6 million influenza illnesses and 3.2 million medically attended illnesses. Influenza vaccination during the 2012–13 season led to a substantial reduction in influenza-associated illness. However, less than half of persons aged six months and older were vaccinated. Higher vaccination rates would have resulted in prevention of a substantial number of additional cases and hospitalizations. Please visit the December 13 MMWR for the full report.

Vaccination Coverage Among Persons with Asthma in the United States During the 2010–11 Influenza Season: Asthma was the most common underlying condition among persons hospitalized with pandemic influenza A (H1N1) virus infection in 2009. Although persons with asthma are not more likely than others to get influenza, it can make asthma symptoms worse, trigger asthma attacks, and lead to pneumonia or other complications that may result in hospitalization and even death. From 1964–2010, the ACIP recommended that all adults and children aged six months and older with asthma receive an influenza vaccination annually. Beginning with the 2010–11 influenza season, ACIP expanded its annual vaccination recommendation to include all persons aged six months and older, while emphasizing that protection of persons at higher risk for influenza-related complications continue as a focus of vaccination efforts.

CDC analyzed data from the 2010 and 2011 National Health Interview Survey (NHIS) to provide the first update of national vaccination coverage among persons aged two years and older with asthma since the new ACIP recommendation. The December 6 MMWR describes the results of that analysis, which indicated that influenza vaccination during the 2010–11 season among persons with asthma was 50%, up from 36% five years earlier. However, vaccination coverage across all age groups, including among those with health insurance, a usual place for health care, and one or more health care visits in the past 12 months, remained well below Healthy People 2020 targets of 80% for children aged six months–17 years and 90% for adults 18 years and older who are at high risk. These findings highlight the need to educate health care providers and persons with asthma about the importance of annual influenza vaccination.

Seasonal Influenza Vaccination Coverage Among Women Who Delivered a Live-Born Infant in 21 States and New York City During the 2009–10 and 2010–11 Influenza Seasons: Because influenza can be especially severe during pregnancy, the American College of Obstetricians and Gynecologists and the ACIP recommend influenza vaccination for pregnant women. Pregnant women experience increased morbidity from influenza infection, and they were at increased risk for severe disease and mortality from 2009 influenza A (H1N1) pdm09 (pH1N1) pandemic virus infection. During the 2009–10 influenza season, CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS) began collecting data on pregnant women’s vaccination coverage, and 22 areas continued to collect data during the 2010–11 season.

To estimate state-specific seasonal influenza vaccination coverage among pregnant women for the 2010–11 influenza season, the most recent data available, CDC analyzed data from women who delivered a live-born infant during September 2010–May 2011. The December 13 MMWR describes the results of that analysis, which indicated that, for the 2010–11 season, 53.6% women were vaccinated (44.2% during pregnancy, 8.8% postpartum, and less than 1% at an unknown time during pregnancy). Among those vaccinated during pregnancy, most were vaccinated during the second or third trimester. Wide state-to-state variation in vaccination coverage was observed, with a range of 32.6% to 75.9% and a median of 54.8%. Compared with the 2009–10 season, coverage was either the same or higher in all areas. Strategies that contributed to increased vaccination coverage need to be promoted.

Flu Season Resources: Are you ready 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 CDC has added new flu promotional materials for grassroots outreach to health disparate populations. Order these free resources and more at the free resources web page; it’s one-stop shopping for up-to-date flu information!

And check out our flu partner website, where partners are entering activities into the calendar of events for the 2013–14 flu season. Submit your flu prevention activities/events and see what others are planning now.

You can also visit CDC’s main flu web site to access relevant Q&As; 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.

Health Map Vaccine Finder: Need help finding flu vaccine? The Health Map Vaccine Finder helps consumers find flu vaccine within their communities.

Health care providers can register their location on this site, which now shows availability for more than 38,000 locations. Spread the word to immunization providers about how they can register.

Flu-related questions and information requests (including web content syndication or how to receive updates via subscription) should be directed to CDC at

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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. The most recent netconference was December 12, 2013. Please visit the netconference web page for additional information and archived webcasts of past presentations.

You Call the Shots Modules: You Call the Shots is a web-based training course developed through the Project to Enhance Immunization Content in Nursing Education and Training. Several courses, including the Hepatitis A, Vaccine Storage and Handling, and Vaccines for Children (VFC) modules, are now available; additional modules will be added in the future. Please visit the You Call the Shots web page for additional information. Continuing Education (CE) credit is available for the course.

ACIP Meeting: The next ACIP meeting will be held February 26–27, 2014. Please visit the ACIP meeting web page for presentation slides, meeting minutes, archived video broadcasts, and additional information.

Vaccines for Preteens and Teens: CDC has introduced a web portal resource to increase clinician recommendations for HPV.

  • HPV Vaccine Resources for Health Care Professionals: This new web portal includes resources for clinicians, as well as handouts to give to parents. Features on the portal include a Tips for Talking to Parents about the HPV Vaccine [1 page] fact sheet and an Understanding the Burden of HPV-Cancers slide presentation. The fact sheet provides helpful responses to answer parents’ questions about the HPV vaccine. The customizable presentation offers a detailed overview about the disease, the vaccine, and tips on making a strong HPV vaccine recommendation.

Adult Immunization Materials: Resource materials are available for order from the Public Health Foundation, including a new prescription pad with a checklist health care providers can use to counsel patients about which vaccines are right for them. Each sheet on the pad lists 17 possible vaccinations and serves as a convenient resource for patients and providers.

Also visit CDC’s 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, along with the new Vaccines for Adults website provide 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).

Princeton University Serogroup B Meningococcal Vaccine Campaign: Princeton University is experiencing a prolonged outbreak of serogroup B meningococcal disease, with eight cases now reported. A serogroup B meningococcal vaccine, which is only licensed for use in Europe, Canada, and Australia, is being used at Princeton University. FDA has allowed the use of the vaccine at Princeton under an Investigational New Drug application. Learn more at the Serogroup B Meningococcal Vaccine Q&A web page.

CDC Commemorates the 50th Anniversary of Measles Vaccine: On December 5, CDC held a press conference to commemorate the 50th anniversary of measles vaccine. CDC Director Tom Frieden discussed the spike in measles importations to the U.S. this year. Dr. Peter Strebel, the Accelerated Disease Coordinator for Immunization, Vaccines, and Biologicals at the World Health Organization (WHO), presented a global view of measles and the prospects for eliminating the disease worldwide. Dr. Alan Hinman, Director for Programs with the Center for Vaccine Equity at the Task Force for Global Health, spoke about the profound effect measles vaccine has had on the health of children worldwide and the work that lies ahead. Special guest Dr. Sam Katz, co-inventor of measles vaccine, praised the vaccinators who work in the trenches to deliver and administer vaccines and highlighted advances in measles vaccine delivery. Dr. Frieden and Dr. Rebecca Martin, Director of the Global Immunization Division (GID) in the Center for Global Health (CGH) at CDC, presented Dr. Katz with an award to honor him for the millions of lives saved because of measles vaccine.

In a JAMA Pediatrics article published December 5, 2013, in conjunction with the press conference, CDC’s Mark Papania and colleagues report that U.S. measles elimination, announced in 2000, has been sustained through 2011.

All six WHO regions have goals to eliminate measles by the year 2020. Now “the challenge is not whether we shall see a world without measles, but when,” Dr. Katz said.

Examination of Links Between Herpes Zoster Incidence and Childhood Varicella Vaccination: The incidence of herpes zoster (HZ) in older adults is increasing. Since routine varicella vaccination was recommended in the U.S. in 1996, there have been dramatic declines in chickenpox. In a new article published in the Annals of Internal Medicine, CDC scientists explore concerns that increased rates of HZ may be due to routine childhood varicella vaccination which prevents adults from experiencing a natural boost in varicella-specific immunity through exposure to children with chickenpox. Information from a Medicare database showed that the age-specific increase in HZ incidence began before the introduction of routine childhood varicella vaccination and does not vary by state vaccination coverage in models adjusted for sex, age, and calendar year. Introduction and widespread use of the chickenpox vaccine did not seem to affect the increase in HZ. This finding confirms the results of other studies before and after chickenpox vaccination.

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 providers. 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 and log in as a member to view the videos. Registration is free.

Immunization Resources: Please visit the NCIRD publications ordering form for the latest immunization publications. Numerous items, including the Parents Guide to Childhood Immunizations and flu campaign materials, 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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Calendar of Events

9th International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD), March 9–13, 2014, Hyderabad, India

2014 Spring Clinical Vaccinology Course, March 21–13, 2014, Seattle, WA

New Hampshire Immunization Conference, March 26, 2014, Manchester, NH

National Infant Immunization Week (NIIW), April 26–May 3, 2014, Nationwide

17th Annual Conference on Vaccine Research, April 28–30, 2014, Bethesda, MD

2014 National Adult and Influenza Immunization Summit, May 12–15, 2014, Atlanta, GA


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