Immunization Works September 2014
New Pneumococcal Conjugate Vaccine and Pneumococcal Polysaccharide Vaccine Recommendations of the ACIP: Adults aged 65 and older are now recommended to get both the pneumococcal conjugate vaccine (PCV13, Prevnar-13) and the pneumococcal polysaccharide vaccine (PPSV23, Pneumovax). This new, age-based recommendation for pneumococcal vaccination has been released, based on a recent vote by the Advisory Committee on Immunization Practices (ACIP). The ACIP voted to recommend PCV13 for all adults 65 years or older after the results of a large, randomized, placebo-controlled trial evaluating efficacy of PCV13 against community-acquired pneumonia among adults 65 years or older. The Community Acquired Pneumonia Immunization Trial in Adults (CAPiTA) [3.91 MB, 289 pages] was released in June 2014.The results of the CAPiTA trial among approximately 85,000 adults 65 years or older demonstrated 45% efficacy of PCV13 against vaccine-type pneumococcal pneumonia and 75% efficacy against vaccine-type invasive pneumococcal disease.
The new recommendations are for adults 65 years of age or older who have not previously received pneumococcal vaccine or whose previous vaccination history is unknown. These adults should receive a dose of PCV13 first, followed by a dose of PPSV23 6 to 12 months later. However, if PPSV23 cannot be given during this time window, a dose of PPSV23 should be given during the next visit after 12 months. The PPSV23 vaccine should not be given less than 8 weeks after the PCV13 dose. It is important to note the two vaccines, PCV13 and PPSV23, should not be administered at the same visit.
Adults 65 years of age or older who have previously received 1 or more doses of PPSV23 should also receive a dose of PCV13 if they have not yet received a dose. The dose of PCV13 should be given at least 1 year after the receipt of the most recent PPSV23 dose. For those who require an additional dose of PPSV23 (i.e., persons with functional or anatomic asplenia and immunocompromised persons), this subsequent PPSV23 dose should be given 6 to 12 months after PCV13 and at least 5 years since the most recent dose of PPSV23.
Recommendations for routine use of PCV13 in adults aged 19 years and older with immunocompromising conditions, functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants, remain unchanged.
The implementation and impact of the recommendation for PCV13 use among adults 65 years of age or older will be assessed, including uptake of PCV13 and PPSV23, and impact on PCV13-type invasive pneumococcal burden and community-acquired pneumonia. The recommendations for routine PCV13 use among adults 65 years or older will be re-evaluated in 2018 and revised as needed.
The September 19 MMWR outlines the new recommendations for PCV13 use, provides guidance for use of PCV13 and PPSV23 among adults older than 65 years, and summarizes the evidence considered by ACIP to make these recommendations.
Measles Outbreak in an Unvaccinated Family and a Possibly Associated International Traveler in Orange County, Florida, December 2012-January 2013: The Florida Department of Health in Orange County was notified by a child care facility on January 11, 2013, that a parent had reported that an attendee and three siblings were ill with measles. All four siblings were unvaccinated for measles and had no travel history outside of Orange County during the periods when they likely had been exposed. A fifth possibly associated case was later reported in a Brazilian citizen who had become ill while vacationing in Florida. The outbreak investigation that was conducted at multiple community settings in Orange County, including at an Orlando-area theme park, identified no additional cases. The genotype sequence was identical for cases 2-5, and visits to the same theme park suggested an unknown, common exposure and link between the cases. Sources of measles exposure can be difficult to identify for every measles case. Measles should be considered in the differential diagnosis of febrile rash illness, especially in unvaccinated persons. Reporting a confirmed or suspected case immediately to public health authorities is critical to limit the spread of measles.
Measles cases in the U.S. are evaluated by state and local health departments using standard case definitions and classifications. For this investigation, the CDC definition of exposure period as 7-21 days before rash onset and the American Academy of Pediatrics 2009 Red Book definition for infectious period as 2 days before symptom onset through 4 days after rash onset were used. Please read the September 12 MMWR for the full report.
Influenza Vaccination Coverage Among Healthcare Personnel in the U.S. During the 2013-14 Influenza Season: The ACIP recommends that all healthcare personnel (HCP) be vaccinated annually against influenza. Vaccination of HCP can reduce influenza-related morbidity and mortality among both HCP and their patients. To estimate influenza vaccination coverage among HCP during the 2013-14 season, CDC analyzed results of an opt-in Internet panel survey of 1,882 HCP conducted during April 1-16, 2014. Overall, 75.2% of participating HCP reported receiving an influenza vaccination during the 2013-14 season, similar to the 72.0% coverage among participating HCP reported in the 2012-13 season. Coverage was highest among HCP working in hospitals (89.6%) and lowest among HCP working in long-term care (LTC) settings (63.0%). By occupation, coverage was highest among physicians (92.2%), nurses (90.5%), nurse practitioners and physician assistants (89.6%), pharmacists (85.7%), and "other clinical personnel" (87.4%), compared with assistants and aides (57.7%) and nonclinical personnel (e.g., administrators, clerical support workers, custodians, and food service workers) [68.6%]. HCP working in settings where vaccination was required had higher coverage (97.8%) compared with HCP working in settings where influenza vaccination was not required but promoted (72.4%), or settings where there was no requirement or promotion of vaccination (47.9%). Among HCP without an employer requirement for vaccination, coverage was higher for HCP working in settings where vaccination was offered on-site at no cost for one day (61.6%) or multiple days (80.4%), compared with HCP working in settings not offering free on-site vaccination (49.0%). Comprehensive vaccination strategies that include making vaccine available at no cost at the workplace along with active promotion of vaccination might be needed to increase vaccination coverage among HCP and minimize the risk for influenza to HCP and their patients. Please read the September 19 MMWR for the full report.
Influenza Vaccination Performance Measurement Among Acute Care Hospital-based Healthcare Personnel in the U.S. During the 2013-14 Influenza Season: Annual influenza vaccination is recommended for all healthcare personnel (HCP). In August 2011, the Centers for Medicare and Medicaid Services (CMS) published a final rule requiring acute care hospitals that participate in its Hospital Inpatient Quality Reporting Program to report HCP influenza vaccination data through the National Healthcare Safety Network (NHSN) beginning January 1, 2013. Data reported by 4,254 acute care hospitals, covering the period October 1, 2013, through March 31, 2014, were analyzed to collect estimates of the proportion of HCP vaccinated nationally and by state for three groups: 1) employees, 2) licensed independent practitioners (LIPs), and 3) adult students/trainees and volunteers. Overall in the U.S., 81.8% of hospital-based HCP were reported vaccinated, with the highest proportion (86.1%) among employees and the lowest (61.9%) among LIPs. The proportion reported vaccinated varied widely by state, with ranges of 69.0%-97.6% for employees, 33.8%-93.6% for LIPs, and 50.3%-96.3% for adult students/trainees and volunteers. Public reporting of vaccination data has been shown to increase HCP influenza vaccination coverage. These new NHSN data provide a baseline for measuring changes in future hospital-based reporting of HCP influenza vaccination. Please read the September 19 MMWR for the full report.
Influenza Vaccination Coverage Among Pregnant Women in the U.S. During the 2013-14 Influenza Season: Pregnant women and infants are at increased risk for influenza-related complications and hospitalization. Influenza vaccination among pregnant women can reduce their risk for respiratory illness and reduce the risk for influenza in their infants younger than 6 months. Since 2004, the ACIP and the American College of Obstetricians and Gynecologists have recommended influenza vaccination for all women who are or will be pregnant during the influenza season, regardless of trimester. To assess influenza vaccination coverage among pregnant women during the 2013-14 influenza season, CDC analyzed data from an Internet panel survey conducted March 31-April 11, 2014. Among 1,619 survey respondents pregnant at any time during October 2013-January 2014, 52.2% reported vaccination before or during pregnancy (17.6% before and 34.6% during pregnancy), similar to the coverage in the preceding season. Overall, 65.1% of women reported receiving a clinician recommendation and offer of influenza vaccination, 15.1% received a clinician recommendation but no offer of vaccination, and 19.8% received no clinician recommendation or offer. Vaccination coverage among these women was 70.5%, 32.0%, and 9.7%, respectively. Continued efforts are needed to encourage clinicians to strongly recommend and offer influenza vaccination to their pregnant patients. Please read the September 19 MMWR for the full report.
Final 2013-14 Influenza Vaccination Coverage Estimates for Selected Areas and the U.S.: The final 2013-14 influenza season vaccination coverage estimates are now available. The online information includes estimates of the cumulative percentage of persons vaccinated by the end of each month, from July 2013 through May 2014, for select local areas, each state, each U.S. DHHS region, and the U.S. overall.
Analyses were conducted using National Immunization Survey influenza vaccination data for children aged 6 months-17 years and Behavioral Risk Factor Surveillance System data for adults older than 18 years. Estimates are provided by age group and race/ethnicity. These estimates are presented in an interactive report and complemented by an online summary report.
2014-15 Flu Season: Are you ready to promote flu vaccination this season? Flu vaccine has already started shipping and is available in many locations. CDC provides a variety of free resources for many audiences, including print, audio/video, social media tools, and web tools. You can order these free resources and more. It’s one-stop shopping for up-to-date flu information!
Everyone is encouraged to go online and take the new CDC Flu Vaccination Pledge. Find a flu vaccination clinic near you with the vaccine finder and encourage your friends and family to use this tool to find available flu vaccine. And check out our partner website, where partners can enter activities into the calendar of events for the 2014-15 flu season. Submit your flu prevention activities/events and see what others are planning now. Also, check out upcoming CDC national and disparate populations. These events are consistently posted on the partner website throughout the season.
On September 18, 2014, NFID brought together leading public health and medical experts at a news conference to emphasize the importance of annual flu vaccination for everyone 6 months of age and older. At the conference, CDC released new data on final vaccination coverage estimates for the 2013-14 season, including estimates for the general population and special groups like pregnant women and healthcare personnel.
National Influenza Vaccination Week (NIVW) will be held December 7-13, 2014. This event highlights the importance of continuing influenza vaccination throughout the season. The NIVW site will be updated as we get closer to December, so check back for NIVW-related information and resources. The NIVW calendar of events submission form is now available, so don’t forget to share your plans with us!
Please send your flu-related questions and information requests (including web content syndication or to receive updates via subscription) 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 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 (HPV) 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.
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.
Fall Clinical Vaccinology Course: The Fall course will be held November 7-9, 2014, in Houston, Texas. The 2 1/2 day course focuses on developments and issues related to the use of vaccines. Faculty will provide the latest information on current and prospective vaccines, updated recommendations for vaccinations, and practical strategies for ensuring timely and appropriate vaccination. Please visit the course web page for more information
Save the Date: World Pneumonia Day is being observed November 12, 2014, to raise awareness about pneumonia's toll and to promote interventions to protect against, treat, and prevent the disease globally. The day will mobilize efforts to fight a neglected disease that kills more than 1 million children younger than 5 years of age worldwide each year.
Save the Date: Get Smart About Antibiotics Week is November 17-23, 2014. The event marks an annual observance to raise awareness of the threat of antibiotic resistance and the importance of appropriate antibiotic prescribing and use. The observance is an international collaboration, coinciding with European Antibiotic Awareness Day, Australia's Antibiotic Awareness Week, and Canada's Antibiotic Awareness Week.
Vaccines for Preteens and Teens: CDC has developed new resources for the adolescent vaccine campaign, including an updated Vaccines for Preteens and Teens website, new materials, and a CME. The updated website includes more resources for parents and physicians about the HPV vaccine and other adolescent vaccines. In addition to the website, CDC has developed new materials such as fact sheets and digital ads that can be distributed by partners and programs. In the last week of July, CDC released the 2013 NIS-Teen data, and while reflecting modest increases in coverage for all adolescent vaccines, still showed low intake of HPV vaccine by adolescents. CDC has partnered with the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Nurses Association to develop a Continuing Education activity on Medscape, Framing the Conversation with Parents About HPV the Vaccine. This CE focuses on how clinicians can make a strong recommendation to parents and patients for HPV vaccination and answer any questions parents may have.
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 Schedules: Syndicated immunization schedules, as well as the mobile version of the adult schedules and the adult quiz, do not currently reflect the new, age-based recommendation for pneumococcal vaccination. Updates to these digital schedules are in the works and will be implemented as quickly as possible. (The 2014 print versions will not be updated.) Please see the MMWR and PCV13 Vaccine for complete vaccine recommendations.
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.
Calendar of Events
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
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