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Immunization Works! March 2009 issue

The Centers for Disease Control and Prevention's (CDC) Immunization Works Monthly Immunization Update is provided to professional organization partners for broad distribution to their members and constituencies. The information provided is non-proprietary.

Front Page News

ACIP Recommends Hepatitis A Vaccine for Household Contacts of International Adoptee's: Due to the identification of recent cases of hepatitis A in family members, the Advisory Committee on Immunization Practices (ACIP) voted to recommend hepatitis A vaccine for all household contacts of international adoptee's. Those potential household contacts that travel abroad should be vaccinated prior to departure; the remaining household contacts should ideally be vaccinated prior to the arrival of the adoptee. ACIP meets three times annually and provides recommendations to the Director of the CDC and the Secretary of HHS concerning the prevention of vaccine-preventable diseases in the United States. Below are other key votes from the February meeting:

Anthrax Vaccine:
The ACIP voted to change its recommendations regarding the timing and route of administration for Anthrax vaccination. This vaccine is now recommended as 5 intramuscular doses at time 0, 4 weeks, 6 months, 12 months, and 18 months, with annual boosters thereafter.

Influenza Vaccine:
With the removal of the phrase "if feasible" from the previous recommendation, the ACIP now recommends influenza vaccine for all children 6 months through 18 years of age. The strains to be included in this year’s vaccine are (A/Brisbane/59/2007 (H1N1)-like virus, A/Brisbane/10/2007 (H3N2)-like and B/Brisbane/60/2008-like). The two "A" strains are unchanged from last year. The "B" strain represents a change in the lineage to the Victoria strain. Information on ocular and respiratory symptoms following TIV will be added to the safety section of this year’s ACIP recommendations.

General Recommendations on Immunization:
The ACIP voted to revise language in the General Recommendations on Immunization including a stated preference for stand-alone storage units (single refrigeration or single freezer units) over combination units.

Other topics discussed, but not voted on, include: a modified schedule for rabies vaccine, use of pneumococcal polysaccharide vaccine during an influenza pandemic, potential use of HPV vaccine among males, and the status of the global polio initiative. The next ACIP meeting will be held June 24-25 in Atlanta, GA.

Other News and Summaries

Adolescent Vaccination Recommendations Update: In 2006, the Assistant Secretary for HHS asked the National Vaccine Advisory Committee (NVAC) to assess issues and make recommendations for developing a comprehensive and successful adolescent immunization program in the U.S. Years of research have culminated in the publication of a report, entitled Adolescent Vaccination, Recommendations from the National Vaccine Advisory Committee, which appears in the March 2009 issue of the American Journal of Preventive Medicine and details recommendations for five key areas: venues for vaccine administration, consent for immunizations, communication, surveillance, and the potential for school mandates.

Survey of Hib Carriage in Minnesota: Concerned that the increase in invasive Hib disease may be the result of increased Hib circulation among children in Minnesota, the Minnesota Department of Health (MDH) is conducting a survey of Hib carriage. "Carriage" occurs when bacteria live in the nose and throat without causing illness. Vaccine reduces not only Hib disease among children, but also Hib carriage. The MDH survey aims to estimate the current proportion of Hib carriage among children less than five years-old in Minnesota. Using roughly a dozen pediatric clinics across the state, MDH staff are enrolling approximately 2,000 children in the study when they come to these clinics for well or sick child visits. In addition to obtaining a throat swab of the child and reviewing the child’s immunization records, the child’s caregiver will be asked to complete a brief questionnaire. MDH is hopeful that this evaluation will help them understand reasons why some children are not vaccinated. While the Hib vaccine shortage continues, completion of the primary series in all children is essential to safeguarding individual protection as well as to strengthening herd immunity. Visit CDC’s Hib Resource Webpage for the latest tools and information.

Measles Elimination in European Region: The European Region of the World Health Organization has made substantial progress toward achieving the regional goal of measles elimination by 2010. During 2007-2008, overall measles incidence in the region declined to its lowest levels to date (less than 10 cases per one-million persons). In 2007, the immunization coverage among children 13-23 months-old with 1 dose of measles-containing vaccine reached a high of 94 percent in this region. In the same year, 26 of the region’s 53 countries achieved coverage rates of 95% or higher for 2 doses of measles-containing vaccine. Measles surveillance has also been strengthened by expanding case-based reporting and laboratory testing. Nevertheless, major challenges to measles elimination in the region remain. Because of unfounded concerns about vaccine safety, measles vaccine uptake has declined in some countries, leading to continued outbreaks and recent resurgence of endemic measles in parts of Western Europe. Unsubstantiated vaccine safety concerns have also led to setbacks with implementation of supplementary immunization campaigns for measles and rubella in 2008 in Eastern Europe. Achieving the elimination goal by 2010 will require overcoming barriers to reaching and sustaining very high vaccination coverage for measles throughout the region, promoting effective outbreak prevention and control measures, and further strengthening surveillance. For more information, please see the full MMWR measles Elimination article in CDC’s Morbidity and Mortality Weekly Report.

More Wild Poliovirus Cases in Afghanistan and Pakistan: In addition to continued support from the international polio eradication partnership, interruption of wild poliovirus (WPV) transmission in Afghanistan and Pakistan will require overcoming barriers to access and vaccination of children in large, remote, and security-compromised areas. Efforts to engage political and tribal leaders will need to be enhanced to secure access and safe passage of vaccination teams to these areas. In the interim, critical improvements are needed in the quality of immunization campaigns and delivery of routine immunization in both countries. During 2008, Afghanistan and Pakistan continued to conduct coordinated immunization campaigns against WPV. Despite these efforts, 149 WPV cases (31 in Afghanistan and 118 in Pakistan) were confirmed in 2008, compared with 49 cases (17 in Afghanistan and 32 in Pakistan) in 2007. Security problems in areas along the common border limited access by vaccination teams to large numbers of children in the two countries. In Pakistan, continued managerial and operational problems impeded full implementation of immunization campaigns and adversely affected vaccination coverage. Further progress toward interruption of WPV transmission in Afghanistan and Pakistan will require continued measures to overcome access problems in conflict-affected areas of both countries and improvements in the quality of immunization activities and delivery of routine immunization services in Pakistan. For more information, please see the full MMWR Poliomyelitis Eradication article in CDC’s Morbidity and Mortality Weekly Report.

Meetings, Conferences & Resources

Immunization Update 2009: Please mark your calendars for the July 30, 2009 Live Satellite Broadcast and Webcast from CDC’s National Center for Immunization and Respiratory Diseases (NCIRD). The event will take place from 9:00 AM – 11:30 AM and noon – 2:30 PM EST. More information about this broadcast will soon be available at the CDC Vaccine Education and Training Webpage.

Talking about Flu-Related Hospitalizations and Deaths: It is estimated that every year in the United States, on average, more than 200,000 people are hospitalized and about 36,000 people die from flu-related causes. CDC has posted questions and answers regarding influenza-associated hospitalizations and deaths in the United States at http://www.cdc.gov/flu/about/qa/hospital.htm and http://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm.

How You Can Get Fast and Free CE at NIC: Did you know that free Continuing Education credits will be offered at The National Immunization Conference (NIC) in Dallas? Come to the CE Room/Cyber Cafe at the conference for more information. And here's a tip: You can avoid the Number One Headache for CE seekers: Come to the conference with your password and login in hand! Go online beforehand if you need a password reset: http://www2a.cdc.gov/TCEOnline/. Contact sfarrall@cdc.gov if you have questions. 

NIC will be held March 30–April 2, 2009 at the Sheraton Dallas. The draft NIC agenda is now posted.

Sortable Table of Standardized Vaccine Abbreviations: CDC has developed a new tool, a Sortable Table of Standardized Vaccine Abbreviations. This tool will enable users to sort by vaccine name, abbreviation, trade name, or manufacturer.

Monovalent M-M-R Vaccines during Supply Shortage: CDC has posted on its Vaccines Webpage Q&A about Monovalent M-M-R Vaccine during Supply Shortages for healthcare providers who see the parents of young children. On December 15, 2008, Merck communicated with CDC that it was not currently producing or taking orders for the monovalent vaccines ATTENUVAX® (measles vaccine), MUMPSVAX® (mumps vaccine) and MERUVAX® (rubella vaccine).

Get Ready for National Infant Immunization Week: National Immunization Week (NIIW) will be celebrated April 25-May 2, 2009 in conjunction with Vaccination Week in the Americas (VWA). The theme for NIIW is "Love them. Protect them. Immunize Them." Visit the NIIW Events Webpage for planning and evaluation resources, public relations materials, and communication campaign materials. Add your local activity to the National Calendar of NIIW Events.

Annual Conference on Vaccine Research: CDC and 11 other national and international agencies and organizations will collaborate with the National Foundation for Infectious Diseases in sponsoring the Twelfth Annual Conference on Vaccine Research, April 27-29, 2009, at the Marriott Waterfront Hotel, Baltimore, Maryland. For more information on the Annual Conference on Vaccine Research ,visit the Conference Webpage.

CDC Training Opportunities: Through established programs, CDC offers many unique training opportunities in infectious disease, including international opportunities. For a current listing of CDC training opportunities, please visit the CDC Public Health Training Webpage.

CDC Job Openings: CDC is committed to recruiting and hiring qualified candidates for a wide range of immunization positions. Researchers, Medical Officers and Epidemiologists and other specialties are often needed to fill positions within CDC. For a current listing, including international opportunities, please visit the CDC Employment Webpage.

Respiratory News and Resources

Since 2006, respiratory diseases have been part of CDC’s National Center for Immunization and Respiratory Diseases. As a result, readers of this e-letter can periodically expect to see news about respiratory diseases.

Save the Date: Get Smart about Antibiotics Week: Mark your calendars for "Get Smart about Antibiotics Week", October 5th-11th, 2009.
For more information, please contact Darcia Johnson at clq7@cdc.gov or visit the "Get Smart" Webpage.

Appropriate Antibiotic Prescribing Training: CDC is offering a free, interactive case-based on-line learning experience for clinicians, Improving Appropriate Antibiotic Prescribing for Acute Respiratory Infections . Participants can choose to take the course for credit (CME, CNE, or AAFP).

The Immunization Works Database Manager can be contacted at: nipimmzwrks@cdc.gov.

 Links to non-federal organizations are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the federal government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.

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