Immunization Works May 2016

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MMWR/ACIP

Progress Toward Polio Eradication—Worldwide, 2015–2016: In 1988, the World Health Assembly resolved to eradicate poliomyelitis. Wild poliovirus (WPV) transmission persists in only two countries (Afghanistan and Pakistan) after the removal of Nigeria from the list of countries with endemic polio in September 2015. Indigenous WPV type 2 has not been detected since 1999 and was declared eradicated by the Global Commission for the Certification of Poliomyelitis Eradication in September 2015. Since November 2012, when the last case of WPV type 3 was detected in Nigeria, WPV type 1 has been the sole circulating type of WPV. The May 13 MMWR summarizes global progress toward polio eradication during 2015–16 and updates previous reports. In 2015, 74 WPV cases were reported in two countries (Afghanistan and Pakistan), a decrease of 79% from the 359 WPV cases reported in 2014 in nine countries; 12 WPV cases have been reported in 2016 (to date), compared with 23 during the same period in 2015. Paralytic polio caused by circulating vaccine-derived poliovirus (cVDPV) remains a risk in areas with low oral poliovirus vaccine (OPV) coverage. Seven countries, including Pakistan, reported 32 cVDPV cases in 2015. In four of these countries, more than six months have passed since the most recent case or isolate. One country (Laos) with VDPV transmission in 2015 has reported three additional cVDPV cases in 2016 to date. Progress toward polio eradication over the last year has been encouraging; however, interrupting WPV transmission will require focus on reaching and vaccinating every missed child through high-quality supplementary immunization activities (SIAs) and cross-border coordination between Afghanistan and Pakistan.

Global Measles and Rubella Laboratory Network Support for Elimination Goals, 2010–2015: In 2012, the World Health Assembly endorsed the Global Vaccine Action Plan (GVAP), with the objective of eliminating measles and rubella in five World Health Organization (WHO) regions by 2020. By September 2013, countries in all six WHO regions had established measles elimination goals, and additional goals for elimination of rubella and congenital rubella syndrome were established in three regions. Capacity for surveillance, including laboratory confirmation, is fundamental to monitoring and verifying elimination. The 2012–20 Global Measles and Rubella Strategic Plan of the Measles and Rubella Initiative calls for effective case-based surveillance with laboratory testing for case confirmation. In 2000, the WHO Global Measles and Rubella Laboratory Network (GMRLN) was established to provide high-quality laboratory support for surveillance. The GMRLN is the largest globally coordinated laboratory network, with 703 laboratories supporting surveillance in 191 countries. During 2010–15, 742,187 serum specimens were tested, and 27,832 viral sequences were reported globally. Expansion of the GMRLN’s capacity will support measles and rubella elimination efforts, as well as surveillance for other vaccine-preventable diseases (VPDs), including rotavirus, and for emerging pathogens of public health concern. Please read the May 6 MMWR for the full report.

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Influenza Information

Flu Season Update: Flu activity for the 2015–16 flu season continues to decrease in the U.S. Influenza-like illness is below baseline. For the last 13 seasons, the average duration of a flu season by this measure has been 13 weeks, with a range of 1–20 weeks. While flu activity has peaked nationally for this season, some parts of the country are still experiencing widespread flu activity. There are likely still a number of weeks of flu activity to come. If you or your patients haven’t been vaccinated yet, it’s not too late. CDC continues to recommend vaccination as long as flu viruses are circulating. Vaccination remains the first and most important step to prevent influenza. Vaccination can reduce flu illnesses, doctors’ visits, and absences from work and school due to flu, as well as prevent flu-related hospitalizations. CDC also recommends that patients suspected of having influenza who are at high risk or very sick should receive prompt treatment with influenza antiviral drugs without waiting for confirmation from testing.

In recent weeks, an increasing proportion of influenza B viruses have been detected; however, overall, H1N1 flu viruses have been most common this season. H1N1 flu viruses emerged in 2009 and caused a pandemic. They have circulated globally since that time and have been associated with severe disease in some children, as well as in young and middle-aged adults. The good news is that all flu vaccines this season have an influenza A (H1N1)pdm09 component.

So far, surveillance data show that the flu viruses currently circulating, including H1N1 viruses, remain similar to the vaccine virus components. How similar circulating viruses are to the vaccine viruses is one factor that influences how well the flu vaccine works each year. In February, CDC reported that this season’s vaccine had been 60% effective in preventing medically-attended influenza. Flu vaccines are made to protect against the three or four flu viruses (depending on which vaccine you get) that research suggests will be most common during the upcoming season.

Remember that it takes 2 weeks after vaccination for protection to begin. Protecting yourself from flu also protects the people around you who may be more vulnerable to serious flu illness. Pregnant women, babies, and people with asthma, for example, can suffer more serious flu illness and other complications. If you haven’t been vaccinated yet, you should get a flu vaccine now to protect yourself, your family, your colleagues, and your community against influenza.

Flu vaccines are offered by many doctor’s offices, clinics, health departments, pharmacies, health centers, and urgent care centers, as well as by many employers and schools, so you can get vaccinated even if you don’t have a regular doctor or nurse. Find a place near you to get flu and other recommended vaccines.

Antiviral drugs for treatment of flu illness serve as a second line of defense against the flu. Antiviral drugs can lessen symptoms and shorten the time that a patient is sick. They can also prevent serious flu complications. CDC recommends that people who are very sick with flu, or people who are at high risk of flu complications, should be treated as quickly as possible with flu antiviral drugs. Antiviral treatment works best when started early (within 2 days of getting sick). However, starting treatment later can still be helpful, especially if the person has a high-risk condition or is very sick from flu.

The three prescription antiviral medications recommended for treatment of influenza are oral oseltamivir (Tamiflu), inhaled zanamivir (Relenza), and intravenous peramivir (Rapivab). These drugs are chemically-related antiviral medications, known as neuraminidase inhibitors, that work against activity of both influenza A and B viruses. Decisions about starting antiviral treatment should not wait for test results or laboratory confirmation of influenza.

CDC Flu Selfie Campaign: Just a reminder to participate in CDC’s #VaxWithMe, a selfie social media campaign that encourages individuals to share photos and videos of themselves (tagged #VaxWithMe) while getting their flu vaccination. The campaign seeks to spark engagement around the importance of vaccination and to encourage more people to get their flu vaccination each year. CDC posts weekly updates to the interactive campaign timeline. To get involved, take a selfie while getting your flu vaccine and post it using the hashtag #VaxWithMe.

For more information about the potentially serious consequences and the benefits of flu vaccination, talk to your doctor or other health care professional, visit the CDC influenza website, or call 1-800-CDC-INFO.

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Resources and Information

Epidemiology and Prevention of Vaccine-Preventable Diseases, 13^th Edition (the Pink Book): CDC, NCIRD, and the Public Health Foundation (PHF) are pleased to announce that the book, Epidemiology and Prevention of Vaccine-Preventable Diseases, 13^th Edition, is available. The Pink Book provides public health and health care professionals with the most comprehensive information on vaccines and vaccine-preventable diseases. The Pink Book is available for purchase from the PHF Learning Resource Center, and the chapters and appendices can be viewed/downloaded from the NCIRD vaccines site.

Current Issues in Immunization Netconferences: Immunization netconferences are live, one-hour events combining an online visual presentation with simultaneous audio via telephone conference call, along with a live question and answer session. Registration, Internet access, and a separate phone line are needed to participate. The next netconference will be November 9, 2016. Please visit the netconference web page for the archived webcasts, upcoming netconferences, and additional information.

You Call the Shots Modules: You Call the Shots is a web-based training course developed through the Project to Enhance Immunization Content in Nursing Education and Training. Several updated modules are now available, including Rotavirus and Hepatitis B. Please visit the You Call the Shots web page for additional information and other modules. Continuing Education (CE) credit is available for viewing a module and completing an evaluation.

ACIP Meeting: The next ACIP meeting will be held June 22–23, 2016. Please visit the ACIP meeting web page for agendas, presentation slides, meeting minutes, and archived video broadcasts.

Measles Resources: CDC aims to continue increasing awareness of measles among individuals and families and to encourage MMR vaccination. To support disease prevention and vaccination education efforts, CDC has developed a variety of measles and vaccination resources, including fact sheets, podcasts, and matte articles. There are also infographics available in English and Spanish.

CDC and Medscape: This special series of commentaries, part of a collaboration between CDC and Medscape, is designed to deliver CDC’ s authoritative guidance directly to Medscape’ s physicians, nurses, pharmacists, and other health care providers. In this series, CDC experts offer video commentaries on current topics important to practicing clinicians. NCIRD has contributed to a variety of commentaries. You may need to sign up and log in as a member to view the commentaries. Registration is free.

Immunization Resources: Publications are available for ordering at CDC-INFO on Demand. You can search for immunization publications by using the “Programs” drop-down menu and selecting “Immunization and Vaccines,” or you can search by “Title.” Numerous items are available, including the 2016 immunization schedules, the Parents’ Guide to Childhood Immunizations, and various campaign materials.

CDC Job Openings: CDC is committed to recruiting and hiring qualified candidates for a wide range of immunization and other positions. Researchers, medical officers, epidemiologists, and other specialists are often needed to fill positions within CDC. For a current listing, including international opportunities, please visit CDC’s employment web page.

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