Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book) Table of Contents Chapter 1: Principles of Vaccination Immunology and Vaccine-Preventable Diseases: 1 Classification of Vaccines: 4 Selected References: 8 Chapter 2: General Recommendations on Immunization Timing and Spacing of Vaccines: 9 Adverse Reactions Following Vaccination: 15 Contraindications and Precautions to Vaccination: 16 Invalid Contraindications to Vaccination: 23 Screening for Contraindications and Precautions: 27 Selected References: 30 Chapter 3: Immunization Strategies for Healthcare Practices and Providers The Need for Strategies to Increase Immunization Levels: 31 The AFIX Approach: 33 Other Essential Strategies: 38 Selected References: 43 Chapter 4: Vaccine Safety The Importance of Vaccine Safety Programs: 45 Sound Immunization Recommendations and Policy: 46 Methods of Monitoring Vaccine Safety: 47 Vaccine Injury Compensation: 52 The Immunization Provider’s Role: 52 Selected References: 57 Chapter 5: Diphtheria Corynebacterium diphtheriae: 59 Pathogenesis: 59 Clinical Features: 59 Complications: 61 Laboratory Diagnosis: 61 Medical Management: 62 Epidemiology: 63 Secular Trends in the United States: 64 Diphtheria Toxoid: 65 Vaccination Schedule and Use: 66 Adverse Reactions Following Vaccination: 67 Contraindications and Precautions to Vaccination: 67 Vaccine Storage and Handling: 68 Suspect Case Investigation and Control: 68 Selected References: 69 Chapter 6: Tetanus Clostridium tetani: 71 Pathogenesis: 72 Clinical Features: 72 Complications: 73 Laboratory Diagnosis: 73 Medical Management: 73 Wound Management: 74 Epidemiology: 74 Secular Trends in the United States: 75 Tetanus Toxoid: 76 Vaccination Schedule and Use: 77 Adverse Reactions Following Vaccination: 78 Contraindications and Precautions to Vaccination: 79 Vaccine Storage and Handling: 79 Selected References: 80 Chapter 7: Pertussis Bordetella pertussis: 81 Pathogenesis: 81 Clinical Features: 81 Complications: 82 Laboratory Diagnosis: 83 Medical Management: 84 Epidemiology: 85 Secular Trends in the United States: 85 Case Definition: 87 Pertussis Vaccines: 87 Vaccination Schedule and Use: 89 Combination Vaccines Containing DTaP: 92 Other DTaP Issues: 94 Adverse Reactions Following Vaccination: 95 Contraindications and Precautions to Vaccination: 96 Vaccine Storage and Handling: 98 Selected References: 98 Chapter 8: Poliomyelitis Poliovirus: 101 Pathogenesis: 101 Clinical Features: 102 Laboratory Diagnosis: 103 Epidemiology: 103 Secular Trends in the United States: 104 Poliovirus Vaccines: 105 Vaccination Schedule and Use: 107 Polio Vaccination of Adults: 108 Adverse Reactions Following Vaccination: 110 Contraindications and Precautions to Vaccination: 111 Vaccine Storage and Handling: 111 Outbreak Investigation and Control: 112 Polio Eradication: 112 Postpolio Syndrome: 113 Selected References: 113 Chapter 9: Haemophilus influenzae Type b (Hib) Haemophilus influenzae: 115 Pathogenesis: 116 Clinical Features: 117 Laboratory Diagnosis: 117 Medical Management: 118 Epidemiology: 118 Secular Trends in the United States: 119 Haemophilus influenzae type b Vaccines: 121 Vaccination Schedule and Use: 122 Combination Vaccines: 124 Adverse Reactions Following Vaccination: 126 Contraindications and Precautions to Vaccination: 126 Vaccine Storage and Handling: 127 Surveillance and Reporting of Hib Disease: 127 Selected References: 127 Chapter 10: Measles Measles Virus: 129 Pathogenesis: 129 Clinical Features: 130 Complications: 130 Laboratory Diagnosis: 132 Epidemiology: 133 Secular Trends in the United States: 134 Classification of Measles Cases: 137 Measles Vaccine: 138 Vaccination Schedule and Use: 139 Adverse Reactions Following Vaccination: 143 Contraindications and Precautions to Vaccination: 144 Vaccine Storage and Handling: 147 Selected References: 147 Chapter 11: Mumps Mumps Virus: 149 Pathogenesis: 149 Clinical Features: 149 Complications: 150 Laboratory Diagnosis: 151 Epidemiology : 151 Secular Trends in the United States: 152 Case Definition: 153 Mumps Vaccine: 153 Vaccination Schedule and Use: 154 Adverse Reactions Following Vaccination: 155 Contraindications and Precautions to Vaccination: 156 Vaccine Storage and Handling: 57 Selected References: 157 Chapter 12: Rubella Rubella Virus: 159 Pathogenesis: 159 Clinical Features: 159 Complications: 160 Congenital Rubella Syndrome: 160 Laboratory Diagnosis: 161 Epidemiology: 163 Secular Trends in the United States: 163 Classification of Rubella Cases: 164 Rubella Vaccine: 165 Vaccination Schedule and Use: 166 Rubella Immunity: 168 Adverse Reactions Following Vaccination: 169 Contraindications and Precautions to Vaccination: 170 Rubella Vaccination of Women of Childbearing Age: 171 Vaccine Storage and Handling: 172 Strategies to Decrease Rubella and CRS: 173 Selected References: 173 Chapter 13: Varicella Varicella Zoster Virus: 175 Pathogenesis: 175 Clinical Features: 175 Complications: 177 Laboratory Diagnosis: 179 Epidemiology: 180 Secular Trends in the United States: 181 Vaccines Containing Varicella Virus: 182 Vaccination Schedule and Use: 185 Varicella Immunity: 189 Adverse Reactions Following Vaccination: 189 Contraindications and Precautions to Vaccination: 191 Transmission of Varicella Vaccine Virus: 193 Vaccine Storage and Handling: 193 Varicella Zoster Immune Globulin (VZIG) : 194 Selected References: 195 Chapter 14: Hepatitis A Hepatitis A Virus: 197 Pathogenesis: 197 Clinical Features: 198 Complications: 198 Laboratory Diagnosis: 198 Medical Management: 199 Epidemiology: 199 Secular Trends in the United States: 201 Case Definition: 202 Hepatitis A Vaccine: 202 Vaccination Schedule and Use: 203 Adverse Reactions Following Vaccination: 207 Contraindications and Precautions to Vaccination: 208 Vaccine Storage and Handling: 208 Postexposure Prophylaxis: 208 Selected References: 209 Chapter 15: Hepatitis B Hepatitis B Virus: 211 Clinical Features: 212 Complications: 213 Laboratory Diagnosis: 213 Medical Management: 215 Epidemiology: 215 Secular Trends in the United States: 217 Hepatitis B Prevention Strategies: 219 Hepatitis B Vaccine: 219 Vaccination Schedule and Use: 222 Serologic Testing of Vaccine Recipients: 227 Postexposure Management: 230 Adverse Reactions Following Vaccination: 233 Contraindications and Precautions to Vaccination: 233 Vaccine Storage and Handling: 234 Selected References: 234 Chapter 16: Influenza Influenza Virus: 235 Pathogenesis: 237 Clinical Features: 237 Complications: 238 Impact of Influenza: 238 Laboratory Diagnosis: 239 Epidemiology: 240 Secular Trends in the United States: 240 Influenza Vaccine: 241 Vaccination Schedule and Use: 243 Adverse Reactions Following Vaccination: 247 Contraindications and Precautions to Vaccination: 249 Vaccine Storage and Handling: 250 Year 2010 Objectives and Coverage Levels: 251 Strategies for Improving Influenza Vaccine Coverage: 251 Antiviral Agents for Influenza: 252 Nosocomial Influenza Control: 253 Influenza Surveillance: 253 Selected References: 254 Chapter 17: Pneumococcal Disease Streptococcus pneumoniae: 257 Clinical Features: 258 Laboratory Diagnosis: 260 Medical Management: 260 Epidemiology: 261 Secular Trends in the United States: 261 Pneumococcal Vaccines: 262 Vaccination Schedule and Use: 264 Adverse Reactions Following Vaccination: 267 Contraindications and Precautions to Vaccination: 268 Vaccine Storage and Handling: 268 Goals and Coverage Levels: 269 Selected References: 269 Chapter 18: Meningococcal Disease Neisseria meningitidis: 271 Pathogenesis: 272 Clinical Features: 272 Laboratory Diagnosis: 273 Medical Management: 274 Epidemiology: 274 Secular Trends in the United States: 275 Meningococcal Vaccines: 276 Vaccination Schedule and Use: 277 Adverse Reactions Following Vaccination: 279 Contraindications and Precautions to Vaccination: 280 Vaccine Storage and Handling: 280 Surveillance and Reporting of Meningococcal Disease: 281 Antimicrobial Chemoprophylaxis: 281 Selected References: 282 Chapter 19: Human Papillomavirus Human Papillomavirus: 283 Pathogenesis: 283 Clinical Features: 284 Laboratory Diagnosis: 284 Medical Management: 285 Epidemiology: 285 Disease Burden in the United States: 286 Prevention: 287 Human Papillomavirus Vaccine: 288 Vaccination Schedule and Use: 289 Adverse Reactions Following Vaccination: 291 Contraindications and Precautions to Vaccination: 292 Vaccine Storage and Handling: 292 Selected References: 292 Chapter 20: Rotavirus Rotavirus: 295 Pathogenesis: 295 Clinical Features: 296 Complications: 296 Laboratory Diagnosis: 296 Epidemiology: 297 Secular Trends in the United States: 298 Rotavirus Vaccine: 299 Vaccination Schedule and Use: 301 Adverse Reactions Following Vaccination: 302 Contraindications and Precautions: 302 Vaccine Storage and Handling: 304 Rotavirus Surveillance: 305 Selected References: 305 Smallpox Available online only at http://www.cdc.gov/nip/publications/pink/default.htm#download Anthrax Available online only at http://www.cdc.gov/nip/publications/pink/default.htm#download APPENDICES Appendix A: Schedules and Recommendations Immunization Schedules on the Web: A-1 Childhood Immunization Schedule 2007: A-2 Adult Immunization Schedule 2006–2007: A-5 Recommended Minimum Ages and Intervals: A-8 Summary of Recommendations for Childhood & Adolescent Immunizations: A-10 Summary of Recommendations for Adult Immunizations: A-13 Antibody—Live Vaccine Interval Table: A-16 Healthcare Worker Vaccination Recommendations: A-17 Immunization of Immunocompromised Patients Tables: A-18 Appendix B: Vaccines U.S. Vaccines: B-1 Selected Discontinued U.S. Vaccines: B-4 Vaccine Excipient and Media Summary, by Excipient: B-6 Vaccine Excipient and Media Summary, by Vaccine: B-12 Thimerosal Content in Some U.S. Licensed Vaccines: B-15 Pediatric/VFC Vaccine Price List: B-16 Adult Vaccine Price List: B-18 Influenza Vaccine Price List: B-18 Foreign Language Terms: B-19 Appendix C: Vaccine Storage and Handling Vaccine Storage & Handling Recommendations (2007): C-1 Manufacturer Quality Control Phone Numbers: C-16 Checklist for Safe Vaccine Handling & Storage: C-17 Vaccine Handling Tips: C-18 Sample Refrigerator Warning Signs: C-19 Announcement: Storage & Handling Toolkit: C-20 Appendix D: Vaccine Administration "Vaccine Administration" Guidelines: D-1 Skills Checklist for Immunization: D-14 Immunization Site Maps: D-16 Medical Management of Vaccine Reactions (Children & Teens): D-18 Medical Management of Vaccine Reactions (Adults) : D-20 "Comforting Restraint" for Immunizations: D-22 Appendix E: Vaccine Information Statements It’s Federal Law: E-1 Instructions for Use of VISs: E-2 How to Get Vaccine Information Statements: E-3 VIS Questions and Answers: E-4 CDC’s Vaccine Information Statement Webpage: E-8 Appendix F: Vaccine Safety The Vaccine Adverse Event Reporting System (VAERS): F-1 Table of Reportable Events Following Vaccination: F-2 Vaccine Adverse Event Reporting System (VAERS) Form: F-4 The Vaccine Injury Compensation Program (VICP) : F-6 The VICP Vaccine Injury Table: F-7 Qualification and Aids to Interpretation of the Vaccine Injury Table: F-8 Appendix G: Data and Statistics Reported Cases and Deaths from Vaccine-Preventable Diseases: 1950–2005: G-1 Impact of Vaccines in the 20th Century: G-7 Vaccine Coverage Levels: 1962–2005: G-8 Appendix H: Standards Standards for Child and Adolescent Immunization Practices: H-1 Standards for Adult Immunization Practices: H-23 Essential Public Health Services: H-43 Adult Immunization: Summary of the National Vaccine Advisory Committee Report, JAMA 1994;272:1133–7: H-45 Appendix I: Immunization Resources National Immunization Program Contact Information: I-1 IAC Online Directory of Immunization Resources: I-2 Sample IAC Print Materials: I-3 IAC Express Information Sheet: I-4 “Immunization Techniques” Video Order Form: I-5 Global Vaccination Information Websites: I-6 State and Local Immunization Grantee Contact Information: I-7