News and Media Resources:

Immunization Works! July 2007 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.

Front Page News

New ACIP Recommendations: On June 27-28, 2007, the Advisory Committee on Immunization Practices (ACIP) met in Atlanta, GA. The ACIP meets three times annually and provides recommendations to the Director of the CDC and the Secretary of the Department of Health and Human Services (HHS) concerning the prevention of vaccine-preventable diseases in the United States. Following are summaries of key votes from the meeting:

Meningococcal Conjugate Vaccine

The ACIP voted to recommend that all persons 11 through 18 years-old should be vaccinated against meningococcal disease. This recommendation would replace the current ACIP recommendation for routine vaccination with MCV4 of children at 11 through 12 years of age, of adolescents before high school entry (approximately 15 years of age), and other people at increased risk (such as college freshmen living in dorms.) An estimated 1,400 to 2,800 cases of meningococcal disease occur in the United States annually; morbidity and mortality are high.

Hepatitis A Vaccine (for Post-Exposure Prophylaxis)

The ACIP voted to recommend the option of using hepatitis A vaccine instead of immune globulin (IG) after exposure to Hepatitis A Virus (HAV). In deciding to use vaccine or IG, immunization providers should take into account patient characteristics associated with more severe manifestations of HAV, including older age and chronic liver disease. Also, the magnitude of the risk of HAV transmission from the exposure should be considered. Generally, hepatitis A vaccine is preferred for healthy persons 12 months to 40 years of age, and IG for persons 40 years of age and older. While rates of HAV have declined dramatically in the United States since 2000, the need for post-exposure prophylaxis remains.

Adult Immunization Schedule

The ACIP approved the new Adult Immunization Schedule (October 2007-September 2008) to ensure that the schedule reflects current recommendations for use of licensed vaccines in people 19 years of age and older. Changes include the addition of zoster vaccine to the schedule. ACIP annually reviews the recommended Adult Immunization Schedule, first approved in 2002. This schedule also will be approved by the American Academy of Family Physicians (AAFP), the American College of Obstetricians and Gynecologists (ACOG), and the American College of Physicians (ACP). Approximately 43,000 adults in the United States die each year from vaccine-preventable diseases.

Slide presentations and the full report from the ACIP meeting will be posted soon at www.cdc.gov/vaccines/recs/acip/default.htm
The next ACIP meeting will be held at the CDC Global Communications Center in Atlanta, Georgia, on October 24-25, 2007.

Other News & Summaries

Prevention of Influenza: A new report published in CDC’s Morbidity and Mortality Weekly Report (MMWR) updates the 2006 influenza recommendations of the Advisory Committee on Immunization Practices (ACIP) for prevention and control of influenza. The groups of persons for whom vaccination is recommended and the antiviral medications recommended for chemoprophylaxis or treatment (oseltamivir or zanamivir) have not changed. Estimated vaccination coverage remains less than 50% among certain groups for whom routine annual vaccination is recommended, including young children and adults with risk factors for influenza complications, health-care personnel (HCP), and pregnant women. Strategies to improve vaccination coverage, including use of reminder/recall systems and standing orders programs, should be implemented or expanded. The 2007 recommendations include new and updated information, specifically:

1. Reemphasizing the importance of administering 2 doses of vaccine to all children aged 6 months to 8 years if they have not been vaccinated previously at any time with either live, attenuated influenza vaccine (for healthy children over 5 years of age; doses separated by more than 6 weeks) or trivalent inactivated influenza vaccine (doses separated by more than 4 weeks), with single annual doses in subsequent years.

2. Recommending that children aged 6 months–8 years who received only 1 dose in their first year of vaccination receive 2 doses the following year,with single annual doses in subsequent years.

3. Highlighting a previous recommendation that all persons, including school-aged children, who want to reduce the risk of becoming ill with influenza or of transmitting influenza to others should be vaccinated.

4. Emphasizing that immunization providers should offer influenza vaccine and schedule immunization clinics throughout the influenza season.

5. Recommending that health-care facilities consider the level of vaccination coverage among HCP to be one measure of a patient safety quality program and implement policies to encourage HCP vaccination (e.g., obtaining signed statements from HCP who decline influenza vaccination).

6. Using the 2007–2008 trivalent vaccine virus strains A/Solomon Islands/3/2006 (H1N1)-like (new for this season), A/Wisconsin/67/2005 (H3N2)-like, and B/Malaysia/2506/2004-like antigens.

The full report and other information are available at CDC’s influenza website (www.cdc.gov/flu). Updates or supplements to these recommendations (e.g., expanded age or risk group indications for currently licensed vaccines) might be required. Immunization providers should be alert to announcements of recommendation updates and should check the CDC influenza website periodically for additional information.

Prevention of Varicella: A new report published in CDC’s Morbidity and Mortality Weekly Report (MMWR) updates the recommendations of the Advisory Committee on Immunization Practices (ACIP) concerning the prevention of varicella. The new ACIP recommendations, from June 2005 and June 2006, will replace the 1996 and 1999 ACIP statements for prevention of varicella. The new recommendations include:

1. Implementation of a routine 2-dose varicella vaccination program for children, with the first dose administered at age 12 to 15 months and the second dose at age 4 to 6 years.

2. A second dose catch-up varicella vaccination for children, adolescents, and adults who previously had received 1 dose.

3. Routine vaccination of all healthy persons over 13 years of age without evidence of immunity.

4. Prenatal assessment and postpartum vaccination.

5. Expanding the use of the varicella vaccine for HIV-infected children with age-specific CD4+T lymphocyte percentages of 15% to 24% and adolescents and adults with CD4+T lymphocyte counts greater than 200 cells/µL.

6. Establishing middle school, high school, and college entry vaccination requirements. ACIP also approved criteria for evidence of immunity to varicella.

The full report can be found at www.cdc.gov/mmwr/preview/mmwrhtml/rr5604a1.htm

VZV Bulk Temporarily Suspended: Production of Varicella Zoster Virus (VZV) bulk has been temporarily suspended due to low yields. VZV bulk is used to manufacture varicella vaccine, MMR-V vaccine, and zoster vaccine. Stocks of ProQuad® (MMR-V) have been depleted as of June 15, 2007. Current projections are for adequate supply to fully implement the recommended immunization schedule for varicella vaccine for all age groups and for the recommended use of zoster vaccine. As more information becomes available, it will be posted at www.cdc.gov/vaccines/vac-gen/shortages

Measles Vaccination Campaign – Pakistan: CDC, along with the American Red Cross, UN Foundation, UNICEF and the World Health Organization (WHO), are partnering with the government of Pakistan, in leading a Measles Vaccination Campaign in Pakistan. Targeting 63 million children 9 months to 13 years-old, it will be Pakistan’s largest-ever national measles vaccination campaign. An estimated 21,000 children die each year from measles in Pakistan. Successful implementation of this campaign will protect millions of children against measles in Pakistan, and will also be a significant step toward reaching the global goal of reducing measles deaths by 90 percent by the year 2010 (compared to 2000). More information about the campaign can be found in the American Red Cross press release at www.redcross.org/pressrelease/0,1077,0_314_6818,00.html (exit)

Meetings, Conferences, & Resources

2008 Yellow Book: The CDC Yellow Book, entitled CDC Health Information for International Travel 2008, is now available free of charge at wwwn.cdc.gov/travel/contentYellowBook.aspx

CDC’s Yellow Book is published every two years by CDC, and includes information about recommended vaccines for global travel. The Yellow Book is written primarily for health care providers, although others might find it useful. Hard copies of the Yellow Book are available for sale at most major bookstores or can be purchased online at www.us.elsevierhealth.com/product.jsp?isbn=9780323048859 (exit)

Upcoming Immunization Satellite Broadcasts: Please mark your calendars for several upcoming satellite broadcasts from the CDC’s National Center for Immunization and Respiratory Diseases (NCIRD). These include Immunization Update 2007 (August 9, 2007) and Surveillance of Vaccine-Preventable Diseases (December 13, 2007). Also, the annual four-part series broadcast, Epidemiology and Prevention of Vaccine-Preventable Diseases, will occur on January 31, February 7, February 14, and February 21, 2008. As more information becomes available, it will be posted at www2.cdc.gov/phtn

Reminder: Training Resources Website: To find out about current training opportunities for health professionals, visit the Education and Training section of CDC’s National Center for Immunization and Respiratory Diseases website. The website, which can be found at www.cdc.gov/vaccines/ed/default.htm, offers information about satellite broadcasts, netconferences, webcasts, podcasts, and self-study courses. Course materials, including slide presentations, are provided. Many of these courses can be completed anytime, and most offer continuing education credit.

CDC Job Openings: CDC is committed to recruiting and hiring qualified candidates for a wide range of immunization positions. Researchers, Medical Officers and Epidemiologists as well as other specialties are often needed to fill positions within CDC. For a current listing of positions available at CDC, please visit www.cdc.gov/employment/

Staff Awards

Note: Leadership and staff from CDC’s National Center for Immunization and Respiratory Diseases (NCIRD) have recently been recognized for their dedication, hard work and successes in reducing the impact of vaccine-preventable diseases. From this issue forward, on an occasional basis, this space will be used to recognize those individuals and programs that have been publicly recognized for their contributions.

Charles C. Shepard Science Awards: The annual Charles C. Shepard Sciences Award ceremony honors CDC/ATSDR scientists who have made important research contributions to public health. The awards are given in four categories (Assessment and Epidemiology Laboratory and Methods, Prevention and Control, and Lifetime Scientific Achievement). On June 14, 2007, three of the four Shepard awards went to leaders in vaccine-preventable disease and immunization research. Roger I. Glass, MD, MPH, PhD, received the Lifetime Scientific Achievement award for his leadership and accomplishments in rotavirus and norovirus research. Dr. Glass retired from CDC in 2006 but continues his scientific work at the National Institutes of Health (NIH). Mary A. Hoelscher, Sanjay Garg, Dinesh S. Bangari, Jessica A. Belser, Xiuhua Lu, Iain Stephenson, Rick A. Bright, Jacqueline M. Katz, Suresh K. Mittal, and Suryaprakash Sambhara, received the Shepard award in the Laboratory and Methods category for their manuscript Development of Adenoviral-Vector-Based Pandemic Influenza Vaccine Against Antigenically Distinct Human H5N1 Strains in Mice (The Lancet 2006;367:475-481). In addition, Cynthia G. Whitney, Tamar Pilishvili, Monica M. Farley, William Schaffner, Allen S. Craig, Ruth Lynfield, Ann-Christine Nyquist, Kenneth A. Gershman, Marietta Vazquez, Nancy M. Bennett, Arthur Reingold, Ann Thomas, Mary P. Glode, Elizabeth R. Zell, James H. Jorgensen, Bernard Beall, and Ann Schuchat received the Shepard award in the Prevention and Control category for their manuscript Effectiveness of Seven-Valent Pneumococcal Conjugate Vaccine Against Invasive Pneumococcal Disease: A Matched Case-Control Study (The Lancet 2006;368:1495-1502).

APAOC Award Goes to Pamela Ching: Pamela Ching, RD/LD, MS, ScD, CAPT, USPHS, Senior Research Epidemiologist with CDC’s National Center for Immunization and Respiratory Diseases (NCIRD) received the RADM Samuel Lin Award from the Asian Pacific American Officers Committee (APAOC) of the U.S. Public Health Service (USPHS). The award, announced at a USPHS Symposium held in Cincinnati, OH in June, recognizes a senior USPHS officer for contributions to the advancement of the nation's health, outstanding leadership qualities, and dedication and involvement in professional/community organizations/activities.

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