Immunization Works October 2016

November 4, 2016: Content on this page kept for historical reasons.

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Advisory Committee on Immunization Practices (ACIP) Meeting: The most recent ACIP meeting was held October 19–20, 2016. Topics for the meeting included discussion and votes on recommendations for hepatitis B (HepB), meningococcal B (MenB), tetanus-diphtheria acellular pertussis (Tdap), and human papillomavirus (HPV) vaccines, and votes to approve the child/adolescent and adult immunization schedules for 2017. The committee also reviewed updated information about herpes zoster, pneumococcal disease, yellow fever, zika virus infections, and respiratory syncytial virus (RSV) disease and vaccines. The recommendations approved are now available on the ACIP meeting web page. The next ACIP meeting will be held February 22–23, 2017. Please visit the ACIP meeting web page for agendas, presentation slides, meeting minutes, and archived video broadcasts.

Human Papillomavirus (HPV) Vaccine Update: ACIP voted to recommend that teens starting the HPV vaccine series before age 15 receive 2 doses of HPV vaccine 6–12 months apart rather than the previously recommended 3 doses to protect against cancers caused by HPV infections. Teens and young adults who start the series later, at ages 15 through 26 years, will continue to need 3 doses of HPV vaccine to protect against cancer-causing HPV infections. Please read the CDC press release for additional information.

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MMWR

Status of New Vaccine Introduction—Worldwide, September 2016: Sustaining the health gains made through introduction of new vaccines will require commitment from countries to secure funding, ensure vaccine supply, create and maintain new age and target-population delivery platforms, and address competing demands on health care systems and resources. Historically, new vaccines became available in low- and middle-income countries decades after being introduced in high-income countries. However, this gap is rapidly decreasing with support from global partners. As of September 2016, nearly all countries have introduced hepatitis B vaccine. More than three-quarters have introduced Haemophilus influenzae type b (Hib) vaccine, a second dose of measles–containing vaccine (MCV2), and rubella vaccine. Two-thirds have introduced pneumococcal conjugate vaccine (PCV) and fewer than half have introduced rotavirus or human papillomavirus vaccine (HPV). Despite donor support, countries might choose not to introduce a vaccine because of country policies, financial constraints, insufficient disease burden data, or vaccine hesitancy. Vaccine introduction provides opportunities to strengthen a country’s immunization program and overall health system. Please read the October 21 MMWR for the full report.

Vaccination Coverage among Children in Kindergarten in the U.S. during the 2015–16 School Year: State-mandated vaccination requirements for school entry protect children and communities against vaccine-preventable diseases. Each school year, federally funded immunization programs (e.g., states, territories, jurisdictions) collect and report kindergarten vaccination data to CDC. The October 7 MMWR describes vaccination coverage estimates in all 50 states and the District of Columbia (DC), as well as the estimated number of kindergartners with at least one vaccine exemption in 47 states and DC, during the 2015–16 school year. Median vaccination coverage was 94.6% for 2 doses of measles, mumps and rubella (MMR) vaccine; 94.2% for diphtheria, tetanus, and acellular pertussis (DTaP) vaccine; and 94.3% for 2 doses of varicella vaccine. MMR coverage increased in 32 states during the last year, and 22 states reported coverage of more than 95%. A total of 45 states and DC had either a grace period allowing students to attend school before providing documentation of vaccination or provisional enrollment that allows undervaccinated students to attend school while completing a catch-up schedule. Among the 23 states that were able to voluntarily report state-level data on grace period or provisional enrollment to CDC, a median of 2.0% of kindergartners were not documented as completely vaccinated and were attending school within a grace period or were provisionally enrolled. The median percentage of kindergartners with an exemption from one or more vaccinations was 1.9%. State and local immunization programs, in cooperation with schools, can improve vaccination coverage by ensuring that all kindergartners are vaccinated during the grace period or provisional enrollment.

Vaccination Coverage among Children Aged 19–35 Months in the U.S., 2015: Sustained high coverage among children for recommended vaccinations has kept many vaccine-preventable diseases at low levels in the U.S. To assess coverage among children for vaccinations recommended by age 2 years in the U.S., CDC analyzed data collected by the 2015 National Immunization Survey (NIS) for children aged 19–35 months (born January 2012–May 2014). Overall, coverage did not change during 2014–15. Coverage in 2015 was highest for more than 3 doses of poliovirus vaccine (93.7%), more than 3 doses of hepatitis B (HepB) vaccine (92.6%), more than 1 dose of measles, mumps, and rubella (MMR) vaccine (91.9%), and more than 1 dose of varicella vaccine (91.8%). The data were also examined for potential vaccination coverage differences by race/ethnicity and poverty status. Although disparities were noted for each of these factors, the most striking differences were seen for poverty status. Children living below the federal poverty level had lower coverage for most of the vaccinations assessed compared with children living at or above the poverty level. Although coverage was high in some groups, opportunities exist to continue to address disparities. Implementation of evidence-based interventions, including strategies to enhance access to vaccination services and strategies employing systems that can reduce missed opportunities, has the potential to increase vaccination coverage for children living below the poverty level and in rural areas. Please read the October 7 MMWR for the full report.

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Influenza Information

What’s New for the 2016–17 Flu Season: CDC recommends use of injectable influenza vaccines (flu shots) during 2016–17. (This includes inactivated influenza vaccines [IIVs] or the recombinant influenza vaccine [RIV]). The nasal spray flu vaccine (live, attenuated influenza vaccine [LAIV]) should not be used during the 2016–17 season. More information on this recommendation is available in the August 26 MMWR.

Two new flu vaccine options will be available during the 2016–17 flu season. One new vaccine, Fluad, which contains MF59, a type of adjuvant (ingredient that helps create a stronger immune response in the patient’s body), is licensed for use in people 65 years and older. A quadrivalent flu shot made with virus grown in cell culture also will be available for the first time this season and is licensed for use in people 4 years and older.

The egg allergy recommendations have been updated. CDC recommends anyone with an egg allergy can receive any licensed flu vaccine; however, the vaccine should be administered in an inpatient or outpatient medical setting where they are supervised by a health care provider who is able to recognize and manage severe allergic conditions. People with egg allergies no longer have to be observed for 30 minutes after receiving their vaccine.

For more information about how serious flu can be 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. For answers to questions commonly asked by the general public, please see Frequently Asked Questions 2016–17 Influenza Season.

Final 2015–16 Flu Season Vaccination Coverage Estimates: Vaccination coverage estimates are now available online at FluVaxView. The coverage estimates include the cumulative percentage of persons vaccinated through the end of each month during July 2015–May 2016 for selected local areas, states, and regions, as designated by the U.S. Department of Health and Human Services and the U.S. overall. Key findings include: Flu vaccination coverage among children for the 2015–16 season did not change from the 2014–15 season; flu vaccination coverage among adults 18 to 49 was similar to 2014–15 coverage, but coverage among adults 50–64 and 65 years and older fell by more than 3%. State variability in child and adult flu vaccination coverage continues to be great.

The Influenza Vaccination Coverage Among Health Care Personnel MMWR was released in September. CDC conducted an opt-in Internet panel survey of 2,258 health care personnel (HCP) during March 28–April 14, 2016. Overall, 79.0% of survey participants reported receiving an influenza vaccination during the 2015–16 season, similar to the 77.3% coverage reported for the 2014–15 season. Coverage in long-term care settings increased by 5.3 percentage points (to 69.2%) compared with the previous season. Vaccination coverage continued to be higher among HCP personnel working in hospitals (91.2%) and lower among HCP working in ambulatory settings (79.8%). Coverage continued to be highest among physicians (95.6%) and lowest among assistants and aides (64.1%) and highest overall among HCP who were required by their employer to be vaccinated (96.5%). Among HCP working in settings where vaccination was neither required, promoted, nor offered on site, vaccination coverage continued to be low (44.9%). An increased percentage of HCP reporting a vaccination requirement or on-site vaccination availability compared with earlier influenza seasons might have contributed to the overall increase in vaccination coverage among HCP during the past six influenza seasons.

Coverage estimates for pregnant women are in a separate online report. Key findings include: As of early April 2016, flu vaccination coverage among pregnant women (before and during pregnancy) was 49.9%; 14.1% were vaccinated before pregnancy and 35.8% were vaccinated during pregnancy. Overall vaccination coverage was similar to that in the 2014–15 (50.3%), 2013–14 (52.2%), and 2012–13 (50.5%) flu seasons, but higher than that in the 2010–11 season (44.0%).

2016–17 National Flu Season Vaccination Campaign: CDC is encouraging everyone 6 months and older to “fight the flu” by getting a flu vaccine. You can support and follow the campaign on social media using the hashtag #FightFlu. CDC’s #FightFlu Social Media Campaign captures and shares flu vaccination activities. Share photos and videos of yourself during or after getting a flu shot (tag #FightFlu) on digital platforms (Twitter, Facebook, Instagram, and YouTube). CDC will post weekly updates to the campaign timeline.

Learn more about how you can fight the flu this season and stay up to date on the latest flu information from CDC by following @CDCFlu on Twitter and signing up for CDC’s weekly Influenza Newsletter.

2016–17 Communication Resources for Clinicians: CDC has developed new communication resources specific to the 2016–17 season to communicate new CDC recommendations and prepare for the upcoming flu season. Resources include a “Dear Colleague [2 pages]” letter, which provides an overview of updates for the 2016–17 flu season and urges clinicians to continue efforts to vaccinate patients against influenza. This letter is signed and supported by a number of leading health organizations, including the American Academy of Pediatrics, the American Academy of Family Physicians, the National Foundation for Infectious Diseases and others. CDC’s “Only Flu Shots This Season” fact sheet [2 pages] is designed to help health care personnel communicate to parents of young patients why the nasal spray flu vaccine is not recommended this flu season and how the flu shot is a child’s best shot at protection this flu season. Other materials have been updated to support efforts to communicate information about the upcoming influenza season.

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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 available 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.

Webinar Series for Pink Book: The 2016 webinar series ended on September 21. There were 4,571 total registrants for the overall series and 1,181 registrants for the most popular webinar, “Principles of Vaccination,” on June 1. Continuing Education (CE) is still available for some of the webinars. Please visit the webinar series web page for the recasts and CE information.

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. The subject will be “Vaccines during Pregnancy: A Strong Record of Safety”. Please visit the netconference web page for the list of speakers and topics. You can also view archived webcasts, and find information on upcoming netconferences.

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. The influenza module has just been updated and is now available. Please visit the You Call the Shots web page for additional information and other modules. Continuing Education (CE) is available for viewing a module and completing an evaluation.

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 educational 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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Calendar of Events

Pink Book Training, Idaho Immunization Program, November 2–3, Boise, ID

Fall Clinical Vaccinology Course, National Foundation for Infectious Diseases (NFID), November 4–6, Philadelphia, PA

Ohio Immunization Conference, Immunize Ohio, November 16, Wadsworth, OH

Annual Louisiana Shots for Tots State Conference, December 1–2, New Orleans, LA

NCIRD Calendar of Events

Upcoming ACIP Meetings

Immunization Action Coalition (IAC) Calendar

The Immunization Works editor can be contacted at wfh6@cdc.gov.

Please visit the newsletter web page, where you can view archived copies of the newsletter and also subscribe to receive e-mail updates when newsletters are posted.

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