Immunization Works April 2014
Reminder: National Infant Immunization Week is April 26–May 3
National Infant Immunization Week (NIIW), scheduled this year for April 26–May 3, is an annual observance to promote the benefits of immunizations and improve the health of children age two years and younger. Since 1994, local and state health departments, national immunization partners, healthcare professionals, community leaders from across the United States, and CDC have worked together during NIIW to highlight the positive impact of vaccination on the lives of infants and children, and to call attention to immunization achievements. This year marks the 20th anniversary of NIIW!
NIIW will be celebrated as part of World Immunization Week (WIW), an initiative of the World Health Organization (WHO). 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.
CDC provides many resources to help you celebrate NIIW and promote vaccination. Visit the NIIW web section for promotional materials and educational resources.
Benefits from Immunization During the Vaccines for Children Program Era in the United States, 1994–2013: The Vaccines for Children (VFC) program is a federally funded program that provides vaccines at no cost to uninsured children. This year marks the 20th anniversary of its implementation.
The April 25 Morbidity and Mortality Weekly Report (MMWR) summarizes the impact of the U.S. immunization program on the health of all children (both VFC-eligible and not VFC-eligible) born during the 20 years since VFC began.
From 1989 to 1991, a resurgence of measles in the United States resulted in about 55,000 cases and more than 100 deaths. The epidemic was largely fueled by widespread failure to vaccinate uninsured children. The VFC program was created in response to this epidemic.
CDC estimates that, among children born between 1994 and 2013, vaccination will prevent about 322 million illnesses, 21 million hospitalizations, and 732,000 deaths over the course of their lifetimes. This will net a savings of $295 billion in direct costs and $1.4 trillion in total societal costs.
CDC used information on immunization coverage from the National Immunization Survey (NIS) and a previously published cost-benefit model to estimate illnesses, hospitalizations, and premature deaths prevented and costs saved by routine childhood vaccination.
While VFC has helped strengthen the U.S. immunization program and vaccine coverage levels have improved, current outbreaks of measles remind us that our work is not done. Maintaining high immunization rates is critical to protecting the health of children in our communities.
Notes from the Field—Measles in California, January 1–April 18, 2014: As of April 18, 129 people from 13 states have been reported as having measles, and there have been 13 outbreaks of the disease. Thirty-four of these people brought measles into the U.S. after getting infected in other countries; 17 of these importations were from the Philippines, where there is a large outbreak occurring with about 20,000 confirmed or suspected cases and 69 deaths as of late February. Most (84%) of the 129 cases were not vaccinated or did not know their vaccination status. California reported the highest number of cases with 58, followed by New York City with 24, and Washington with 13. Please visit the April 25 MMWR for the full report.
Progress Toward Measles Preelimination in the African Region, 2011–2012: During 2008, the 46 member states of the World Health Organization (WHO) African Region (AFR) adopted a measles preelimination goal to reach by the end of 2012 with the following targets: 1) greater than 98% reduction in estimated regional measles mortality compared with 2000, 2) annual measles incidence of fewer than five reported cases per million population nationally, 3) greater than 90% national first dose of measles-containing vaccine (MCV1) coverage and greater than 80% MCV1 coverage in all districts, and 4) greater than 95% MCV coverage in all districts by supplementary immunization activities (SIAs). Surveillance performance objectives were to report two or more cases of nonmeasles febrile rash illness per 100,000 population, one or more suspected measles cases investigated with blood specimens in more than 80% of districts, and 100% completeness of surveillance reporting from all districts. The April 4 MMWR updates previous reports and describes progress toward the measles preelimination goal during 2011–2012. In 2011, the WHO Regional Committee for AFR established a goal to achieve measles elimination by 2020. To achieve this goal, intensified efforts to identify and close population immunity gaps and improve surveillance quality are needed, as well as committed leadership and ownership of the measles elimination activities and mobilization of adequate resources to complement funding from global partners.
Measles Outbreak Associated with Adopted Children from China in Missouri, Minnesota, and Washington, July 2013: On July 5, 2013, CDC was notified of two cases of laboratory-confirmed measles in recently adopted children from an orphanage in Henan Province, China. To find potentially exposed persons, CDC collaborated with state and local health departments, the children’s adoption agency, and airlines that carried the adoptees. Two additional measles cases were identified, one in a family member of an adoptee and one in a third adopted child from China. To prevent further importation of measles, CDC worked with health officials in China, including “panel physicians” contracted by the U.S. Department of State, to conduct the overseas medical examinations required for all immigrants and refugees bound for the United States. The following measures were recommended: 1) all adoptees examined at panel physician facilities should be screened for fever and rash illness, 2) measles immunity should be ensured among all adoptees from Henan Province who are scheduled for imminent departure to the United States, and 3) all children at the orphanage in Henan Province should be evaluated for measles. The April 11, 2014 MMWR summarizes the results of the outbreak investigation and underscores the importance of timely routine vaccination for all international adoptees.
National Adult and Influenza Immunization Summit: The National Adult and Influenza Immunization Summit (NAIIS) will be held May 13–15 in Atlanta, Georgia. It is led by IAC, CDC, and the National Vaccine Program Office, and includes more than 400 partners. For information about the NAIIS annual meeting and NAIIS workgroups, as well as links to many resources related to adult vaccination, see the recently launched NAIIS website.
If you are an adult vaccine advocate who would like to become part of NAIIS, please e-mail Dr. Litjen Tan, chief strategy officer at IAC and co-chair of NAIIS, for more information.
CDC Issues Response to Report on Antiviral Effectiveness with Influenza: On April 10, 2014, the Cochrane Collaboration published an updated review of randomized clinical trial data for the influenza neuraminidase inhibitor antiviral medications. The review is accompanied by a series of editorials and analyses posted on the British Medical Journal website. In the review, the authors raise questions about the value of influenza antiviral medications for the prevention and treatment of influenza.
Based on all available data, including both randomized control trials and observational studies, CDC continues to recommend the use of the neuraminidase inhibitor antiviral drugs (oral oseltamivir and inhaled zanamivir) as an important adjunct to influenza vaccination in the treatment of influenza.
CDC has published a “Have You Heard” article highlighting current influenza antiviral recommendations.
Flu Season Resources: Are you promoting 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 resources and more at the free flu resources web page; it’s one-stop shopping for up-to-date flu information!
Also, check out our flu partner website, where partners enter 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 website 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 locations 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 firstname.lastname@example.org.
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 next netconference is scheduled for July 30, 2014. 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. The Influenza, Vaccine Storage and Handling, and Vaccines for Children (VFC) modules have recently been updated and are now available. Please visit You Call the Shots for additional information and other modules. Continuing Education (CE) credit is available for viewing a module and completing an evaluation.
ACIP Meeting: The next ACIP meeting will be held June 25–26, 2014. Please visit the ACIP meeting web page for the agenda, presentation slides, meeting minutes, archived video broadcasts, and additional information.
Vaccines for Preteens and Teens: CDC understands that a strong recommendation for HPV vaccine from a healthcare provider can make an impact on vaccination rates, but we know there can be some challenges with messaging. To remedy these challenges, CDC has developed two new CME courses in an effort to assist doctors, nurses and other health providers in effectively speaking with patients and their parents about HPV vaccine.
- Continuing Education Opportunity: You Are the Key to HPV Cancer Prevention:
You Are the Key to HPV Cancer Prevention is presented as a web-on-demand video. It was posted for CE credit on February 26, 2014. CE credit is available until February 26, 2016. Credit is available for immunization providers such as physicians, nurses, nurse practitioners, pharmacists, physician’s assistants, DoD paraprofessionals, medical students, etc. The course is approximately one hour in length.
- COMING SOON: Medscape CME—How to Make the Recommendation:
This CME activity is intended for pediatricians, family physicians, nurses, and other healthcare providers who care for adolescent patients in their practice or clinic. The goal of the CME is to enhance decision-making skills and knowledge, building both confidence and competence in the care of adolescent patients. Included in this CME are Skill-Building Video Vignettes that are custom-developed videos illustrating provider-patient encounters that demonstrate educational gaps that cannot be as effectively achieved with text alone, such as clinician/patient communication.
New! CDC Resources on Implementing the “Standards for Adult Immunization Practice:” CDC has developed resources to support healthcare providers in implementing NVAC’s recently updated adult immunization practice standards. In addition to an overview of the new standards, there are a series of fact sheets on improving vaccine assessment, recommendation, administration, and referral.
Each two-sided fact sheet (8.5" x 11") includes key information, tips, and resources relevant for all healthcare providers—whether they provide vaccination services or not. CDC encourages wide distribution of these resources. NOTE: A fact sheet on documentation will be available in the coming weeks.
Adult Immunization Materials: Adult 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 Adult Vaccination Information for Healthcare and Public Health Professionals, 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).
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, including the recently released Adult Vaccines: Never Miss a Chance featuring Dr. Carolyn Bridges. You may need to sign up and log in as a member to view the videos. Registration is free.
Polio Eradication Operations Research Project Wins 2014 Franz Edelman Award: Congratulations to CDC’s Dr. Mark Pallansch, Dr. Stephen Cochi, and Dr. Steven Wassilak, and their Kid Risk, Inc., collaborators Dr. Kimberly Thompson and Dr. Radboud Duintjer Tebbens on winning the 2014 Franz Edelman Award. This award represents the leading prize in analytics and operations research, and it recognizes outstanding examples of applications that have transformed companies, entire industries, and people’s lives.
The judges recognized CDC and the Kid Risk, Inc., team for their project entitled Polio Eradicators Use Integrated Analytical Models to Improve Decisions. This project used analytics and operations research to further polio eradication in many ways, including motivating more rapid response to outbreaks and demonstrating that pursuing eradication instead of control is the “best buy” to prevent cases of paralysis and save lives and money. The team clearly showed the number of cases prevented and lives saved as a result of policy maker’s decisions to eradicate polio. The team’s work also demonstrated the need for coordinated cessation of the oral poliovirus vaccine after successful global eradication.
You can read more about the winning project and the award on the INFORMS website.
CDSi Phase I Project: The Immunization Information System Support Branch (IISSB) has recently initiated a second phase of its Clinical Decision Support for Immunizations (CDSi) Project to incorporate both adult vaccines and special immunization considerations into its Logic Specification for ACIP recommendations and supporting resources. To enable this effort, an expert panel has been formed, and it has initiated efforts. Panel membership includes a mix of professionals from IIS programs and vendors, EHR-focused organizations, the Indian Health Service, the Veterans Administration, the American College of Physicians, and the American Academy of Family Practitioners. An in-person panel session is scheduled to be held in Atlanta May 20–22, 2014. The updated CDSi Logic Specification and supporting resources will be available to the immunization community by summer 2015.
In 2010, in an effort to harmonize the outcomes of existing immunization clinical decision support (CDS) tools, IISSB funded a project to:
- Increase the accuracy and consistency of immunization evaluation and forecasting
- Improve the ease of developing and maintaining immunization CDS products
- Improve the process of updating CDS logic with new and/or changed ACIP recommendations
- Improve CDS engines to ultimately ensure that patients receive proper immunizations (i.e., “the right immunization at the right time")
The project formed an expert panel and developed the Logic Specification, which captures ACIP recommendations in an unambiguous manner and provides uniform representation of vaccine decision guidelines to be used in automated vaccine evaluation and forecasting systems. The Logic Specification provides a single, authoritative, implementation-neutral foundation for development and maintenance of CDS engines. The scope of the original logic specification is vaccine groups routinely recommended for healthy children from birth to 18 years of age. This document, along with supporting data and a full suite of test cases, was published in November 2013.
To learn more, please contact Jennifer Austin Wain.
Immunization Resources: NCIRD publications are available for ordering at CDC-INFO on Demand. You can search for immunization publications by using the “Programs” drop down menu (Immunization and Vaccines), or you can search by “Title.” Numerous items, including the 2014 printed and laminated immunization schedules, the Parents Guide to Childhood Immunizations, and flu campaign materials, can be ordered…
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.
Calendar of Events
National Infant Immunization Week (NIIW), April 26–May 3, 2014, nationwide
17th Annual Conference on Vaccine Research, April 28–30, 2014, Bethesda, MD
California Immunization Coalition Summit, May 4–5, 2014, Sacramento, CA
2014 National Adult and Influenza Immunization Summit, May 12–15, 2014, Atlanta, GA
2014 Massachusetts Adult Immunization Conference, May 20, 2014, Worcester, MA
11th National Conference on Immunization & Health Coalitions, May 21–23, 2014, Seattle, WA
National Vaccine Advisory Committee (NVAC) Meeting, June 10–11, 2014, Washington, DC
Immunization Summit, June 17–18, 2014, Charleston, WV
Pennsylvania Immunization Conference, June 19, 2014, Wyomissing, PA
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