News and Media Resources:

Immunization Works! August 2005 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.

In the Event of a Vaccine Shortage, CDC and ACIP Recommend a Tiered Vaccine Strategy

In the event of a possible shortage of inactivated influenza vaccine shortage in the United States, the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) will recommend prioritization of the vaccine supply. ACIP and CDC have determined the priority groups, ranked in three tiers, on the basis of influenza-associated mortality and hospitalization rates.

Although total vaccine supply for the upcoming influenza season (2005--06) is currently unknown, the minimum anticipated supply is about 58 to 60 million doses of inactivated vaccine and 3 million doses of live, attenuated vaccine. This estimated supply is similar to that available during the last influenza season (2004--05) and would be adequate to satisfy historical demand for influenza vaccine among persons at high risk for serious complications associated with influenza virus infection, health-care workers, and household contacts of children less than six months old. These groups were prioritized for vaccination last influenza season. While additional doses of inactivated influenza vaccine may be available for the U.S. market this influenza season; this cannot yet be confirmed. Availability of additional vaccine would allow for expansion of the priority groups and, preferably, vaccination of all persons who desire it.

CDC and ACIP recommend the use of vaccination priority groups only in the event of vaccine supply disruptions. Currently, CDC and ACIP do not recommend prioritization of inactivated influenza vaccine for the upcoming season. However, to help vaccine providers plan for a possible shortfall in the upcoming influenza season, priority groups have been established. A listing of these priority groups can be found within the MMWR article at www.cdc.gov/mmwr/preview/mmwrhtml/mm5430a4.htm

Other Immunization News

Childhood Immunization Rates Surpass Healthy People 2010 Goal

The Centers for Disease Control and Prevention (CDC) recently announced that the nation’s childhood immunization coverage rates continue at record high levels, with about 81 percent of the nation’s 19-to-35-month-old children receiving all the vaccinations in the recommended series. This is the first time coverage for the base line series of vaccines (4:3:1:3:3 series) has exceeded 80 percent which also represents the Healthy People 2010 goal.

In 2004, coverage for the 4:3:1:3:3 series, which includes four doses of Diphtheria, Tetanus and Pertussis (DTaP), three or more doses of polio vaccine, one or more doses of measles-containing vaccine, three or more doses of Hib vaccine which can prevent meningitis and pneumonia, and three doses of hepatitis B vaccine, increased to 80.9 percent, compared to 79.4 percent in 2003, 74.8 percent in 2002, 73.7 percent in 2001 and 72.8 percent in 2000.

The 2004 National Immunization Survey also found significant increases in the percentage of young children receiving chickenpox vaccine and the childhood pneumococcal vaccine, two relatively recent additions to the childhood immunization schedule. National coverage with chickenpox (varicella) vaccine increased to 87.5 percent in 2004 from 84.8 percent in 2003. Coverage for three or more doses of pneumococcal conjugate vaccine (PCV7) increased to 73.2 percent in 2004 from 68.1 percent in 2003. Coverage for doses of PCV7 increased to 43.4 percent compared with 35.8 percent in 2003, the first year coverage was measured for the fourth dose.

The overall results indicated that vaccination rates for the fourth dose of DTaP vaccine, at 85.5 percent coverage, continued to lag behind other vaccines in the 4:3:1:3:3 series. As a result, the coverage estimates for the overall series is reduced. The high immunization rates are also an indication that temporary shortages of some of the routinely recommended childhood vaccines primarily affected when, rather than whether, children were vaccinated. For example, some of the older children included in the 2004 NIS survey would have been eligible to receive DTaP during a March 2001-June 2002 shortage; however, DTaP coverage remained comparable to 2003.

Please visit www.cdc.gov/mmwr/preview/mmwrhtml/mm5429a1.htm to view the MMWR article. The 2004 NIS survey dataset may be accessed at
www.cdc.gov/vaccines/stas-surv/nis/data/tables_2004.htm

ACIP Recommends Adolescent Vaccination for Tetanus, Diphtheria and Pertussis Vaccine

At the recent Advisory Committee on Immunization Practices (ACIP) meeting in Atlanta , Georgia , ACIP members voted to recommend newly licensed booster tetanus, diphtheria and pertussis (whooping cough) vaccines (Tdap) to help reduce the number of cases of pertussis among adolescents while continuing to control diphtheria and tetanus.

ACIP recommended that adolescents 11 and 12 years of age be given Tdap in place of the tetanus-diphtheria (Td) booster currently given to adolescents. The committee also recommended that Tdap be given to adolescents 13 through 18 who missed the 11 to 12 year dose of Td. Adolescents 11 to 18 who have already been vaccinated with Td are encouraged to receive a dose of Tdap to further protect against the pertussis.

Most reported pertussis cases among adolescents and adults occur because of decline in protective immunity over time. Immunity against pertussis wanes five to ten years after the last childhood vaccination.

Infants acquire pertussis, often from siblings and parents at home, when they are still too young to be vaccinated against the disease, or when not yet vaccinated. Children are recommended to be vaccinated against diphtheria, tetanus and pertussis (DTaP) at two, four, six and 15 to 18 months of age, and at four to six years of age.

The Food and Drug Administration (FDA) recently licensed two Tdap vaccines for adolescents in the United States. BOOSTRIX®, manufactured by GlaxoSmithKline Biologicals, was licensed by the FDA on May 3, 2005 for use in adolescents 10 through 18 years of age. The second, ADACEL™, manufactured by sanofi pasteur, was licensed on June 10, 2005 for persons 11 through 64 years of age. These are the first pertussis vaccines licensed for use in adolescents and adults.

The committee did not make a recommendation for use of Tdap among adults. Background information on adult immunization was presented and the committee will consider a vote on adult immunization at future ACIP meetings to allow members more time to review adult pertussis immunization data.

A summary of the provisional recommendations can be found at this location on this site:
www.cdc.gov/vaccines/recs/provisional/

ACIP Updates Influenza Recommendations

Influenza vaccination is the primary method for preventing influenza and its severe complications. Each year, the Advisory Committee on Immunization Practices (ACIP) provides updated recommendations on influenza vaccination. The 2005 recommendations include five principal changes or updates:

• ACIP recommends that persons with any condition (e.g. cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk for aspiration be vaccinated against influenza (see Target Groups for Vaccination).
• ACIP emphasizes that all health-care workers should be vaccinated against influenza annually, and that facilities that employ health-care workers be strongly encouraged to provide vaccine to workers by using approaches that maximize immunization rates.
• Use of both available vaccines (inactivated and LAIV) is encouraged for eligible persons every influenza season, especially persons in recommended target groups. During periods when inactivated vaccine is in short supply, use of LAIV is especially encouraged when feasible for eligible persons (including health-care workers) because use of LAIV by these persons might considerably increase availability of inactivated vaccine for persons in groups at high risk.
• The 2004–05 trivalent vaccine virus strains are A/California/7/2004 (H3N2)-like, A/New Caledonia/20/99 (H1N1)-like, and B/Shanghai/361/2002-like antigens. For the A/California/7/2004 (H3N2)-like antigen, manufacturers may use the antigenically equivalent A/New York/55/2004 virus, and for the B/Shanghai/361/2002-like antigen, manufacturers may use the antigenically equivalent B/Jilin/20/2003 virus or B/Jiangsu/10/2003 virus (see Influenza Vaccine Composition).
• CDC and other agencies will assess the vaccine supply throughout the manufacturing period and will make recommendations preceding the 2005–06 influenza season regarding the need for tiered timing of vaccination of different risk groups.

To view the MMWR article, please visit www.cdc.gov/mmwr/preview/mmwrhtml/rr54e713a1.htm

Media Briefing on Vaccines and Public Health

In July 19th, the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH) and the Food and Drug Administration (FDA) conducted a media briefing on vaccines and child health. Participants included Dr. Julie Gerberding, Director, Centers for Disease Control & Prevention; Dr. Duane Alexander, Director, National Institute of Child Health Development, National Institutes of Health; Dr. Murray M. Lumpkin, Acting Deputy Commissioner for International and Special Programs, Food and Drug Administration; Dr. Eileen Ouellette, President-Elect, American Academy of Pediatrics; Dr. Robert M. Wah, member of the Board of Trustees, American Medical Association; and Dr. Peter Hotez, father of a child with autism.

Please visit www.cdc.gov/od/oc/media/transcripts/t050719.htm for a transcript of the briefing. In addition, below are some of the key points:

• CDC – along with the Food and Drug Administration, National Institutes of Health, and the Public Health Service – is fully committed to the health and safety of children. Our highest priority is protecting the health of children from all perils, including infectious diseases and anything else that harms or threatens their lives and well-being. Vaccines have vastly improved human health and have prevented devastating disease in children.
• The people and organizations represented at the briefing have an extraordinary record of success in protecting the health and safety of children and adults who receive immunizations. Our immunization recommendations and efforts are a public health program that touches every person in the nation, and because of that, they have a deep and longstanding commitment to ensuring the safest vaccines possible for children and adults.
• We recognize that parents want answers; they want to know how best to protect their children from harm and what they can do to keep them healthy. If children have autism, parents understandably also want to know what may have caused it, what are the best or most effective treatments, and how can they lower the risk for other children they may plan to have.
• Confusion and uncertainty about the safety of vaccines is harmful because delaying or forgoing immunizations can place children and communities at risk for potentially serious, even life-threatening, diseases.
• Autism and autism spectrum disorders (ASDs) are an urgent public health issue, and affect the lives of too many families. Parents and families who have children affected by ASD are understandably interested in finding the causes of this lifelong disability as well as effective treatments. We fully share these interests and are dedicated to scientific research into any biological, environmental, genetic or other causes of autism and other developmental disabilities.
• Much is unknown about autism and autism spectrum disorders. We simply don’t know what causes most cases of autism, how many children are affected, or how best to treat the condition. Furthermore, there is little known about trends (e.g., whether there is a rising or stable incidence of autism). We also need much better information regarding treatments.
• With the exception of influenza vaccines, childhood vaccines in the U.S. no longer contain thimerosal as a preservative.
• As the Institute of the Medicine (IOM) concluded in a recent report, the vast majority of studies, which have involved hundreds of thousands of children in a number of countries, have failed to find any association between exposure to thimerosal in vaccines and autism.

Progress Report on Immunization Registries

Tne of the national health objectives for 2010 is to increase to at least 95 percent the proportion of children less than 6 years old who participate in fully operational, population-based immunization registries (objective 14-26). The Centers for Disease Control and Prevention (CDC) recently announced that in 2003, approximately 44 percent of U.S. children less than 6 years old participated in an IIS (Immunization Information System). In addition, 76 percent of public vaccination provider sites and 36 percent of private vaccination provider sites submitted immunization data to an IIS during the last six months of 2003. Increasing health-care provider participation by linking EMRs to IISs is vital to meeting the national health objective. To view the MMWR article, please visit www.cdc.gov/mmwr/preview/mmwrhtml/mm5429a2.htm

Typhim Vi® Vaccine Now Available

Sanofi-Pasteur MSD, manufacturer of the injectable typhoid vaccine (Typhim Vi ®), announced that the vaccine is now available in single-dose Luer-Lok pre-filled syringes. The 20-dose vials are expected to be available in late July or early August. A temporary shortage of the vaccine, which began in February 2005, was attributed to unexpected demand. For more information about travel vaccines, please visit www.cdc.gov/travel/index.htm

Meetings, Conferences, and Resources

HPV and Cervical Cancer Webcast

CDC will host a webcast entitled “HPV and Cervical Cancer: An Update on Prevention Strategies” on August 9, 2005 , from 1:00 PM – 2:00 PM ET . The webcast will provide viewers with information on cervical cancer screening guidelines and strategies for preventing genital HPV infection, including appropriate patient counseling messages. The intended audience is all healthcare providers who see patients who could be at risk for HPV and cervical cancer. For more information, please visit
www2a.cdc.gov/phtn/webcast/HPV-05/default.asp

Job Openings within 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. Interested parties are encouraged to apply for these positions. For a current listing of positions available at NIP, please visit www.cdc.gov/hrmo/hrmo.htm

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