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Immunization Works! February 2006 issue

The Centers for Disease Control and Prevention’s Immunization Works Monthly Update is provided to national health care provider and consumer groups for distribution to their members and constituencies. The immunization information provided is non-proprietary and is encouraged to be widely disseminated and shared.

Meet Anne Schuchat

Anne Schuchat, MD, pictured here in her office, is the new Director of CDC’s National Immunization Program (NIP). Dr. Schuchat began her career at CDC as an Epidemic Intelligence Service (EIS) Officer in 1988 and most recently served as the Acting Director of the National Center for Infectious Diseases (NCID). In her work at NCID, Dr. Schuchat was involved in emergency response activities for the 2001 anthrax bioterrorism response and the 2003 severe acute respiratory syndrome (SARS) outbreak, where she led the Beijing City epidemiology team for the World Health Organization (WHO) China office. She has also made important contributions to prevention of group B streptococcal disease and evaluation of foodborne listeriosis. Dr. Schuchat graduated with highest honors from Swarthmore College and with honors from Dartmouth Medical School. She served as resident and chief resident in internal medicine at NYU’s Manhattan VA Hospital before beginning her public health career at CDC. Recently, Dr. Schuchat spoke with NIP’s Stacey Hoffman.

You have many significant accomplishments in the field of public health and infectious disease. What are you most proud of?

I was part of a CDC team that worked with many partner organizations to create a new standard of care for prevention of group B streptococcal infection in babies. It’s one of those incredible stories in public health; there wasn’t a new vaccine or new scientific breakthrough, but there was information, community concerns, and a willingness on the part of healthcare professional organizations, the legislatures and the health departments to do something, without waiting for some new innovation. The new guidelines have accounted for more than 40,000 prevented infections in newborns, a greater than 80% drop in infection rate, and a 75% narrowing of the racial disparity between blacks and white with that condition. I’m proud of the impact this has had for families, the use of science to bring policy and decision makers together, and the realization that I’m doing something that’s good for people.

I understand you worked on the SARS response. Tell me about that experience.

Being part of the SARS response was an incredible honor and privilege. When I arrived in Beijing City in May, 2003, the city had essentially shut down, and concern could not have been higher. Initially, there had been a delay in information acknowledgement. People had lost their jobs, and there was an acting mayor and a new health minister for the country. But Beijing had finally acknowledged the problem, and my role was to work with the public health leaders in the city to try to help control SARS. It was exciting and exhilarating to see public health interrupt the transmission, and control for something very serious that, as far as we know, didn’t even exist before 2002. To stop human-to-human transmission, we used very traditional public health tools, including infection control, isolation, quarantine, and social distancing.

How will you apply your experiences working with SARS to your new role as NIP’s director?

All of the things that were done with SARS – epidemiologic evaluation, surveillance, communication, partnership – are also needed in preventing vaccine preventable diseases and in having strong immunization programs. The other thing that I enjoyed about working on SARS, and that I’m really looking forward to at NIP, is working with the whole network of people and expertise that’s needed to keep infections at bay. You need to make new vaccines, keep production of old vaccines going, distribute vaccines to the places that need them, and finance vaccines so that people can actually get them. It’s really the kind of thing that no one can do independently; you need lots of different people. I think that’s what makes public health fun.

What are your short-term priorities for NIP?

In the short-term, I’m really trying to learn the program, meet the people, and understand what we do. I’m also trying to understand our partners’ needs, what’s expected of us, and how I can lead the program. Also, a short-term priority is to help transition NIP into the new Center to be focused on immunizations and respiratory diseases. I can help smooth that transition, and get all of us excited about the things we can do now. I can also help reduce uncertainty and anxiety about what this means to people individually, or what this means to a program that they really care about. (Editor’s Note: More information about CDC’s reorganization was published in the MMWR report: CDC Announces Landmark Reorganization.)

Immunizations are in the news a lot these days. How do you balance issues getting a lot of media attention, e.g. pandemic preparedness, with core immunization issues, such as increasing adult influenza vaccination rates?

Despite available vaccines, policies and recommendations, and lots of educational activities, it’s been hard to get adult immunization to be as strong as the childhood program. There are many reasons for that. On the other hand, pandemic influenza has concerned the public health community for years, but now it actually has the attention of the highest levels of government. But the pandemic concerns just highlight the critical role of our response to seasonal influenza, which is part of our adult immunization program. The more we handle seasonal influenza – having an ample vaccine supply, a strong vaccine delivery system, knowledgeable providers, informed consumers, a public that is ready to be vaccinated, and a system that can vaccinate very large numbers of people – then the better we’ll do when the next pandemic occurs.

Immunization Works is a publication for our partners. How do see the role of partners within the reorganized National Immunization Program?

The new Center will bring together immunizations from vaccine development through program implementation. Many of the partners that NIP has had are similar to the partners that NCID has had in terms of healthcare groups, state health departments, vaccine manufacturers, the research community, and the policy community. I hope that our new Center can be one-stop shopping for vaccine related issues; that partners will find us easy to work with, accessible, and responsive. We will need our partners more than ever, in the sense that we’ll have the full range of immunization responsibilities. The new Center brings together vaccine delivery and adult immunization, the influenza branch, the surveillance research, and the laboratory activities involved with that. I hope that we can really strengthen our partnerships and raise the profile of these programs.

While vaccine safety has been taken out of NIP, issues concerning vaccine safety continue to be of critical concern to our partners. What would you tell partners that are concerned about the impact of the reorganized CDC on vaccine safety issues?

I’m committed to making sure that information is available to partners quickly, and that we learn what we need to learn about vaccines before and after they are licensed. I think that the changes in location of the immunization safety office have been made, and learning to work well with the new structure is an important priority for all of us. It’s important for CDC to make this transition be successful, to fulfill the obligations that we have for an independent safety office, but strong communications internally and externally.

What do you see as your biggest challenge as NIP’s new director?

I actually think the biggest challenge is to deliver on the incredible opportunities we have. I know that we’re already making a huge difference, but there’s so much more we can do during the next few years with the recent licensure of new vaccines and several new vaccines on the horizon. There are also enormous opportunities for improving our adult and adolescent immunization programs, narrowing some of the gaps in the childhood immunization program, and assuring equity throughout the U.S. population. And there are opportunities on a global front, with polio eradication and measles mortality reduction. It’s really tremendous to think about how much of a difference we could make.

What do you see as the most significant challenges to continuing to sustain high immunization rates, and addressing current gaps in immunization coverage?

I think that vaccine financing is an important area that underpins a lot of the barriers we have to ensuring vaccine gets to the persons who can benefit from it. I’d like to learn more about that as an issue and start working together on possible solutions.

I’m sure you don’t have a lot of it with your new job, but how do you like to spend what little free time you have?

Work is busy, but when I have it, I like to spend time with my husband. I also read quite a bit.

Other Immunization News

2006 National Influenza Vaccine Summit

The 2006 National Influenza Vaccine Summit was held January 24-25 in Atlanta, GA, with 112 organizations represented and 226 persons in attendance. The Summit is an informal partnership co-sponsored by the CDC and the American Medical Association (AMA). Through its co-chairs, executive committee and standing work groups, it seeks to address year-round issues related to the production, regulation, distribution and administration of influenza vaccine.

The focus of this year's Summit was on vaccine supply and distribution issues. The Summit opened with a welcome and overview provided by J. Edward Hill, M.D., President of the AMA, and a keynote address by Julie Gerberding, M.D., Director of CDC. Next, Raymond Strikas, M.D., of CDC’s National Immunization Program (NIP), summarized data from surveys conducted by CDC, or in collaboration with partners.

The purpose of the surveys, conducted in mid-to-late November, 2005, was to learn about the experiences of various types of providers in acquiring/administering influenza vaccine and the general public in seeking influenza vaccination. Below are key points from the presentation:

• At least 50% in all provider groups reported they received >40% of their orders except Family Physicians (43%).
• More government providers -- including state and local federal immunization grantees (86%), and county and city health departments (70%) -- received >80% of their orders than providers in other groups [median 50%; range 24%-64%].
• Those ordering from non-Chiron source were more likely to report >60% of their order received.
• At least 50% in all provider groups reported that they referred priority group patients to other locations for flu shots due to inadequate vaccine supplies, except Pediatricians (39%) and Occupational Health Groups (25%).
• Of the public surveyed, 38% reported having received the vaccine, and 10% had not yet been vaccinated, but intended to seek vaccination. Four percent tried to, but vaccine was not available, and 48% said that they did not plan to be vaccinated. These estimates are similar to those in 2003, when over 83 million doses of vaccine were distributed.
• Among those who received the flu shot, the locations where they were vaccinated included: Doctor’s Office/HMO (39%); Workplace (17%); Other Clinic/Health Center (10%);  Store e.g. Grocery/Pharmacy (10%); Health Department (8%); Hospital (6%); Senior/Recreation Center (4%); Other (4%); School (2%).

During the Summit, participants identified supply and distribution issues experienced during the 2005-2006 Influenza Vaccination Season. The influenza vaccine manufacturers, the Food and Drug Administration (FDA), the Healthcare Distribution Management Association (HDMA), and the Health Industry Distributors Association (HIDA) offered their perspectives followed by extensive open discussion. Initial projections for the 2006-07 Season suggest as many as 120 million doses may be produced for the U.S. market, a substantial increase over the approximately 86 million doses produced in 2005.

Slides from the presentations, including Summit recommendations and proposed activities, are available on the The National Influenza Vaccine Summit home page of the AMA website.

FDA Approves Rotavirus Vaccine

The Food and Drug Administration (FDA) recently announced the approval of RotaTeq™, a live, oral, vaccine for use in preventing rotavirus gastroenteritis in infants. It is the only vaccine approved in the United States that can help protect against rotavirus, a viral infection that may cause diarrhea, vomiting, fever, and dehydration.

Infection with rotavirus is a leading cause of severe diarrhea in infants and young children in the United States and worldwide. CDC has estimated that rotavirus infection results in approximately 55,000 hospitalizations annually of infants and young children in this country. Death from rotavirus is rare in the United States. However, in developing countries, rotavirus gastroenteritis has been estimated to cause up to several hundred thousand deaths annually in infants and young children. You can view the FDA’s press release, FDA Approves New Vaccine to Prevent Rotavirus Gastroenteritis in Infants on the FDA's site.

National Infant Immunization Week

Love Them. Protect Them. Immunize Them.” That is the theme for this year’s National Infant Immunization Week (NIIW), to be held April 22-29, 2006. This annual observance promotes the benefits of immunizations and highlights the importance of vaccinating children by the age of two. Communities from across the United States are expected to participate in NIIW by planning community awareness and media events to promote infant immunizations to parents, caregivers, and healthcare providers. Special NIIW kick off events will be held in Utah and Arizona. This year, NIIW will again be held in conjunction with the Pan American Health Organization’s Vaccination Week in the Americas (VWA). The U.S. will join together with 35 countries in the Western Hemisphere to concurrently promote the need for routine vaccinations for infants and children during the last week in April.

To assist communities in promoting infant immunization during this special week, CDC has web-based technical assistance materials for ideas on creating an NIIW-VWA event for parents, providers and community leaders, as well as sample planning tools, campaign materials, and public relation materials.

Robert Davis to Direct CDC’s Immunization Safety Office

Robert Davis, M.D., M.P.H., was recently selected as the Director of the CDC’s Immunization Safety Office (ISO). Dr. Davis received his M.D. from the University of California at San Diego and his M.P.H. from the University of Washington School of Public Health and Community Medicine. He served as an Epidemic Intelligence Service (EIS) Officer at the CDC from 1987-1989 and then as an epidemiologist for the Washington State Department of Health. He returns to CDC from the University of Washington where he was a Professor in the Department of Pediatrics in the School of Medicine and a Professor in the Department of Epidemiology in the School of Public Health. Dr. Davis has served as a leader in the field of immunization safety for many years. He is well positioned to lead the ISO as it evolves to take advantage of emerging capabilities in genomics and information technology, and to operate in a transparent, efficient, and accountable manner that ensures the public's trust.

Meetings, Conferences, and Resources

Read the 2006 Pink Book

The 9th Edition of NIP's textbook, "Epidemiology and Prevention of Vaccine-Preventable Diseases" (the Pink Book) has been completed and is now available online. The Pink Book provides immunization providers with comprehensive information about routinely recommended vaccines, vaccine preventable diseases and much more. Updates and corrections to the book will be made in the online edition as they occur. PowerPoint slide sets for each chapter will also be available online. A hard copy of the Pink Book can be purchased for $29 from the Public Health Foundation.

Access Spanish Version of Adult Schedule

The October 2005-September 2006, Adult Immunization Schedule is now available in Spanish and can be printed from the CDC website. The Adult Immunization Schedule -- which was released in English in October 2005 -- has been approved by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Family Physicians (AAFP), and the American College of Obstetricians and Gynecologists (ACOG). You can view, download, or print the Schedule.

Next ACIP Meeting

The Advisory Committee on Immunization Practices (ACIP) will hold its next meeting February 21-22, 2006 at the CDC in Atlanta, Georgia. Agenda topics include informational updates and discussion on a variety of topics, and votes on vaccine recommendations for Rotavirus; Influenza; Tetanus, Diphtheria, Acellular Pertussis (Tdap); and recommendations that apply to all vaccines broadly (e.g. timing and spacing between doses, vaccine storage, and vaccination in the context of altered immunocompetence). The meeting is open to the general public, but please note that advanced registration is now required. Submit Abstracts for Coalition Conference The deadline for abstracts for the 7^th National Conference on Immunization Coalitions has been extended until February 28, 2006. The Conference will be held from August 9-11, 2006 in Denver, Colorado. You can submit an abstract or find more information on the conference on the NCIC website.

Satellite Broadcasts Series

Three parts remain of the annual four-part satellite series titled “Epidemiology and Prevention of Vaccine-Preventable Diseases”.  Broadcasts will be held on February 16, 23 and March 2, 2006 from 12 noon to 3:30 pm Eastern Time. The satellite broadcast will provide a comprehensive look at the field of immunization and vaccine-preventable diseases. Each broadcast features a live question-and-answer session in which participants can phone in, fax or email their questions to instructors. The series can be viewed as a satellite broadcast from a registered site, or through a concurrent broadcast on your personal home or office computer.

Register for NIC

The 40th National Immunization Conference (NIC) – to be held March 6-9, 2006, at the Omni Hotel at CNN Center in Atlanta, Georgia -– will comprise six topic tracks: Adult and Adolescent Immunization, Epidemiology and Vaccine Safety, Health and Risk Communications, Immunization Information Systems, Programmatic Issues, and Policy and Legislation. Participants can register online on the NIC web page.

NIP Needs Pilot Testers

The National Immunization Program (NIP) has an ongoing need for volunteers to pilot test immunization training courses. Volunteers are particularly needed in the following occupations: physicians, pharmacists, health educators, medical assistants and nurses. To learn more about becoming a pilot tester, please send an email to nippilot@cdc.gov.

NIP Job Openings

The National Immunization Program (NIP) is committed to recruiting and hiring qualified candidates for a wide range of positions.  Researchers, Medical Officers and Epidemiologists as well as other specialties are often needed to fill positions within NIP. For a current listing of positions available at NIP, please visit CDC's HRMO website.

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