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Immunization Works August 2014

Immunization Works August 2014 Newsletter


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National, State, and Selected Local Area Vaccination Coverage Among Children Aged 19-35 Months in the U.S., 2013: Among children born in the U.S. during 1994-2013, vaccination will prevent an estimated 322 million illnesses, 21 million hospitalizations, and 732,000 deaths during their lifetimes. Since 1994, the National Immunization Survey (NIS) has monitored vaccination coverage among children aged 19-35 months in the U.S. The August 29 MMWR describes national, regional, state, and selected local area vaccination coverage estimates for children born January 2010-May 2012, based on results from the 2013 NIS. In 2013, vaccination coverage achieved the 90% national Healthy People 2020 target for more than one dose of measles, mumps, and rubella vaccine (91.9%); more than three doses of hepatitis B vaccine (90.8%); more than three doses of poliovirus vaccine (92.7%); and more than one dose of varicella vaccine (91.2%). Coverage was below the Healthy People 2020 targets for more than four doses of diphtheria, tetanus, and pertussis vaccine (83.1%, target 90%); more than four doses of pneumococcal conjugate vaccine (82.0%, target 90%); the full series of Haemophilus influenzae type b vaccine (82.0%, target 90%); more than two doses of hepatitis A vaccine (54.7%, target 85%); rotavirus vaccine (72.6%, target 80%); and the hepatitis B birth dose (74.2%, target 85%).

Coverage remained stable relative to 2012 for all of the vaccinations with Healthy People 2020 objectives except for increases in the HepB birth dose (by 2.6 percentage points) and rotavirus vaccination (by 4.0 percentage points). The percentage of children who received no vaccinations remained below 1.0% (0.7%). Children living below the federal poverty level had lower vaccination coverage compared with children living at or above the poverty level for many vaccines, with the largest disparities for more than four doses of DTaP (by 8.2 percentage points), full series of Hib (by 9.5 percentage points), more than four doses of PCV (by 11.6 percentage points), and rotavirus (by 12.6 percentage points). MMR coverage was below 90% for 17 states. Reaching and maintaining high coverage across states and socioeconomic groups is needed to prevent resurgence of vaccine-preventable diseases.

Human Papillomavirus Vaccination - Recommendations of the ACIP: The August 29 MMWR summarizes the epidemiology of human papillomavirus (HPV) and associated diseases, describes the licensed HPV vaccines, provides updated data from clinical trials and postlicensure safety studies, and compiles recommendations from CDC's Advisory Committee on Immunization Practices (ACIP) for use of HPV vaccines. Persistent infection with oncogenic HPV types can cause cervical cancer in women, as well as other anogenital and oropharyngeal cancers in women and men. HPV also causes genital warts. Two HPV vaccines are licensed in the United States. Both are composed of type-specific HPV L1 protein, the major capsid protein of HPV. Expression of the L1 protein using recombinant DNA technology produces noninfectious virus-like particles (VLPs). Quadrivalent HPV vaccine (HPV4) contains four HPV type-specific VLPs prepared from the L1 proteins of HPV 6, 11, 16, and 18. Bivalent HPV vaccine (HPV2) contains two HPV type-specific VLPs prepared from the L1 proteins of HPV 16 and 18. Both vaccines are administered in a 3-dose series.

ACIP recommends routine vaccination with HPV4 or HPV2 for females aged 11 or 12 years and with HPV4 for males aged 11 or 12 years. Vaccination also is recommended for females aged 13 through 26 years and for males aged 13 through 21 years who were not vaccinated previously. Males aged 22 through 26 years may be vaccinated. ACIP recommends vaccination of men who have sex with men and immunocompromised persons (including those with HIV infection) through age 26 years if not previously vaccinated. As a compendium of all current recommendations for use of HPV vaccines, information in this report is intended for use by clinicians, vaccination providers, public health officials, and immunization program personnel as a resource. ACIP recommendations are reviewed periodically and are revised as indicated when new information and data become available.

Update on Recommendations for Use of Herpes Zoster Vaccine: Herpes zoster vaccine (Zostavax [Merck & Co., Inc.]) was licensed in 2006 and recommended by the ACIP in 2008 for prevention of herpes zoster (shingles) and its complications among adults aged 60 years and older. The Food and Drug Administration (FDA) approved the use of Zostavax in 2011 for adults aged 50-59 years based on a large study of safety and efficacy in this age group. ACIP initially considered the use of herpes zoster vaccine among adults aged 50-59 years in June 2011, but declined to recommend the vaccine in this age group, citing shortages of Zostavax and limited data on long-term protection afforded by herpes zoster vaccine. In October 2013, ACIP reviewed the epidemiology of herpes zoster and its complications, herpes zoster vaccine supply, short-term vaccine efficacy in adults aged 50-59 years, short- and long-term vaccine efficacy and effectiveness in adults aged 60 years and older, an updated cost-effectiveness analysis, and deliberations of the ACIP herpes zoster work group. Please read the August 22 MMWR for a summarized report. ACIP maintained its current recommendation that herpes zoster vaccine be routinely recommended for adults aged 60 years and older.

Closure of Varicella Zoster Virus-containing Vaccines Pregnancy Registry in the U.S. During 2013: Vaccines that contain live, attenuated varicella zoster virus (VZV) (Varivax, ProQuad, and Zostavax [all products of Merck & Co., Inc.]) are contraindicated during pregnancy. To monitor the pregnancy outcomes of women inadvertently vaccinated with VZV-containing vaccines immediately before or during pregnancy, Merck and CDC established the Merck/CDC Pregnancy Registry for VZV-containing Vaccines in 1995. The August 22 MMWR updates previously published summaries of registry data, provides the rationale for the closure of the registry, and describes plans for continued monitoring of the safety of these vaccines when inadvertently administered to pregnant women or immediately before pregnancy. From inception of the registry in 1995 through March 2012, no cases of congenital varicella syndrome and no increased prevalence of other birth defects have been detected among women vaccinated within three months before or during pregnancy. Although a small risk for congenital varicella syndrome cannot be ruled out, the number of exposures being registered each year (approximately two varicella-susceptible women exposed during the high-risk period for congenital varicella syndrome) is now too low to improve on the current estimate of the risk.

Vaccine Storage and Handling Education Resources: CDC has released vaccine storage and handling resources to help vaccine providers maintain the potency and viability of the nation’s vaccine supply. The resources are based on best practices and reflect the latest ACIP guidelines and manufacturer recommendations. CDC worked with the provider community on the content and design of these resources and, using audience research and instructional designers, crafted these resources to be clear for all audiences.

Updated Vaccine Storage and Handling Toolkit: From guidance to checklists to draft plans, this detailed document [4.33 MB, 109 pages] contains comprehensive information about vaccine storage and handling. The toolkit was updated in June 2014.

Vaccine Storage and Handling Fact Sheets: Four storage and handling fact sheets illustrate best practices for both refrigerated and frozen vaccines. Written in plain language, they include assessments to reinforce key points. While the fact sheets are CDC-developed and branded, each contains an area where you can insert your organization’s logo.

On-demand Training Video — Keys to Storing and Handling Your Vaccine Supply: The “Keys to Storing and Handling Your Vaccine Supply” on-demand training video highlights storage and handling recommendations and best practices to help providers protect their patients.

Vaccines are among the most powerful tools available to protect patient and public health. Proper storage and handling helps ensure vaccine potency. Vaccines are fragile, and storage and handling errors are costly. Reduced vaccine potency may leave patients unprotected from diseases such as pertussis, measles, and HPV.

Please visit the vaccine storage and handling resources web page for additional information and updates. Keep the vaccine storage and handling conversation going on Twitter @CDCIZLearn, and send your vaccine questions to

National Immunization Conference – United States Immunization in a Time of Change (NIC-USITC): CDC, the Task Force for Global Health, and the CDC Foundation will host the NIC-USITC September 29-30, 2014, at the Crowne Plaza Ravinia in Atlanta, Georgia.

This two-day conference with four plenary sessions, 18 breakout sessions, two immunization Q&A sessions, and the Hilleman Lecture will highlight the following major topics:

  • Immunization communications with partners and the general public
  • Issues related to the immunization of adults
  • Current status of vaccine-preventable diseases in the United States
  • Global immunization
  • HPV vaccine communication, science, and safety
  • Advances in information technology
  • Improving vaccine management and accountability
  • Quality improvement in vaccine programs

Please note that this conference will be limited to approximately 800 people.

Please contact the Conference Planning Team if you have questions and visit the NIC web page for additional information and registration.

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Influenza Information

Prevention and Control of Seasonal Influenza with Vaccines in the U.S. During the 2014-15 Influenza Season, ACIP Recommendations: The August 15 MMWR updates the 2013 ACIP recommendations regarding use of seasonal influenza vaccines. Updated information for the 2014-15 influenza season includes 1) antigenic composition of U.S. seasonal influenza vaccines; 2) vaccine dose considerations for children aged 6 months through 8 years; and 3) a preference for the use, when immediately available, of live attenuated influenza vaccine (LAIV) for healthy children aged 2 through 8 years, to be implemented as feasible for the 2014-15 season but not later than the 2015-16 season. Information regarding issues related to influenza vaccination not addressed in this report is available in the 2013 ACIP seasonal influenza recommendations.

New Influenza Vaccine Information Statements (VIS): The new Live, Intranasal Influenza VIS and the Inactivated Influenza VIS are now available for viewing/downloading from the VIS web page.

Flu Season Resources: CDC provides a variety of free materials for all audiences, including print, audio/video, social media tools, and web tools. This includes 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 flu season. Submit your flu prevention activities/events and share ideas with others.

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 healthcare providers.

Health Map Vaccine Finder: Help consumers find flu vaccine within their communities by referring them to the Health Map Vaccine Finder.

Healthcare 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 how to mirror CDC Web content on your site 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 next netconference is scheduled for December 3, 2014. Please visit the netconference web page for additional information and archived webcasts.

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 Human Papillomavirus module has recently been updated and is 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.

Public Health Vaccinology Course: You are invited to attend a Public Health Vaccinology Course on September 3-4, 2014, in Atlanta, Georgia. The course, sponsored by NCIRD, will focus on: the biologic basis of vaccine development; vaccine licensure and recommendations; specific vaccines and vaccine-preventable diseases; immunization program implementation; vaccine hesitancy and risk communication; vaccine safety issues; global vaccines; and maternal immunization. Space is limited, so early registration is recommended. Continuing Medical Education (CME) will be available for the course.

Please visit the course web page to register and view the course agenda, goals, and objectives. If you have any questions, please contact L. Reed Walton.

ACIP Meeting: The next ACIP meeting will be October 29-30, 2014. Please visit the ACIP meeting web page for agendas, presentation slides, meeting minutes, archived video broadcasts, and additional information.

ACIP held a special meeting on August 13, 2014, and voted to recommend a dose of PCV13 for all adults age 65 years and older. Recommendations for the use of PPSV23 in adults age 65 years and older were updated as well. The main points of the new vaccine recommendations that were presented and voted upon are as follows:

  • Adults 65 years of age and older who have not previously received pneumococcal vaccine or whose previous pneumococcal vaccination history is unknown should receive a dose of PCV13 first, followed by a dose of PPSV23. The PPSV23 dose should be given 6 to 12 months following the PCV13 dose. If a dose of PPSV23 cannot be given in this time frame, it should be given at the next visit. PCV13 and PPSV23 should not be administered at the same visit.
  • Adults aged 65 years and older who have not received PCV13 and who have previously received one or more doses of PPSV23 should receive a dose of PCV13. The PCV13 dose should be given one year after receipt of the most recent dose of PPSV23. For those for whom an additional dose of PPSV23 is indicated, this dose should be given 6 to 12 months after PCV13 and at least five years after the most recent dose of PPSV23.

The recommendations will be published in the MMWR once they are reviewed and approved by CDC and HHS.

Rotavirus Article in Lancet Infectious Diseases: Rotavirus is the most common cause of severe gastroenteritis in infants and young children worldwide and causes nearly half a million deaths each year in children under 5 years old. Two different rotavirus vaccines are currently available for use.

A meta-analysis, led by Eyal Leshem of CDC, titled “Distribution of Rotavirus Strains and Strain-specific Effectiveness Following Vaccine Introduction: Systematic Review and Meta-analysis,” addresses concerns as to whether the two rotavirus vaccines provide adequate protection against diverse strains in various settings. The study, published in Lancet Infectious Diseases in July, found that both the monovalent (RV1) and pentavalent (RV5) rotavirus vaccines perform similarly against a variety of rotavirus strains and in a variety of settings. The researchers included 15 studies with data from eight middle- and high-income countries in their meta-analysis. No data were available for low-income countries. Expanding rotavirus surveillance efforts in low-income countries will improve understanding of how rotavirus vaccines perform in these settings.

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 to assist doctors, nurses, and other healthcare providers in effectively speaking with patients and their parents about HPV vaccine.

  • Continuing Education Opportunity: You Are the Key to HPV Cancer Prevention: This is a one-hour web-on-demand video. It was posted for CE credit on February 26, 2014, and CE credit is available until February 26, 2016 for immunization providers, including physicians, nurses, nurse practitioners, pharmacists, physician’s assistants, DoD paraprofessionals, medical students, etc.
  • Medscape CME – Framing the Conversation with Parents about the
    HPV Vaccine: This new CME activity is for pediatricians, family physicians, nurses, and other healthcare providers who care for adolescent patients in their practice or clinic. The goal of this activity is to educate clinicians on the importance of the HPV vaccine for children approaching adolescence and to provide strategies to educate parents about the importance of the vaccine for their child's wellbeing. (You may need to sign up and log in as a member to participate.)

Adult Immunization Materials: Adult resource materials are available for order from the Public Health Foundation, including a prescription pad with a checklist healthcare 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 healthcare providers. In this series, experts from CDC offer video commentaries on current topics important to practicing clinicians. You may need to sign up and log in as a member to view the videos. Registration is free.

Immunization Resources: Publications are available for ordering at CDC-INFO on Demand. You can search for immunization publications by using the “Programs” drop-down menu and selecting “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.

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Calendar of Events

Immunize Georgia Conference, September 11, 2014, Atlanta, GA

Nevada Two-day Epidemiology and Prevention of Vaccine-Preventable Diseases Course (VPD), October 20-22, 2014, Reno, NV

Fall Clinical Vaccinology Course (NFID), November 7-8, 2014, Houston, TX

National Influenza Vaccination Week, December 7-13, 2014, Nationwide

CDC Calendar and Events


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