Immunization Works January 2017

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MMWR

Coverage with Tetanus, Diphtheria, and Acellular Pertussis Vaccine and Influenza Vaccine Among Pregnant Women in Minnesota, March 2013–December 2014: Pertussis and influenza infections can result in severe disease in infants. The diphtheria, tetanus, acellular pertussis (DTaP) vaccine is recommended for infants beginning at age 2 months, and influenza vaccine is recommended for infants aged 6 months and older. Vaccination of pregnant women induces the production of antibodies that are transferred across the placenta to the fetus and provide passive protection until infants are old enough to receive DTaP and influenza vaccines. To protect young infants before they are age-eligible for vaccination, ACIP has recommended since 2004 that all women who are or will be pregnant during influenza season receive inactivated influenza vaccine and, since 2013, that all pregnant women receive the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine. The January 20 MMWR provided information on an assessment of Tdap and influenza vaccination coverage that was assessed among pregnant women in Minnesota. Vital records data containing maternal demographic characteristics, prenatal care data, and delivery payment methods were matched with vaccination data from the Minnesota Immunization Information Connection (MIIC) to assess vaccination coverage. MIIC stores vaccination records for Minnesota residents. Overall, Tdap vaccine coverage was 58.2% and, influenza vaccine coverage was 45.9%. Coverage was higher for each vaccine among women who received adequate prenatal care compared with those who received inadequate or intermediate care, based on the initiation of prenatal care and the number of recommended prenatal visits attended. Coverage also varied based on mother’s race, country or region of birth, and other demographic characteristics. Further study is needed to better understand the maternal vaccination disparities found in this study and to inform future public health initiatives.

Use of Social Media as a Communication Tool During a Mumps Outbreak in New York City, 2015: On August 16, 2015, a case of parotitis in a resident of the Rockaways neighborhood of Queens, New York City (NYC), was reported to the NYC Department of Health and Mental Hygiene (DOHMH) as a suspected mumps case. Subsequent investigations by DOHMH discovered an outbreak of mumps in the Rockaways, with 52 confirmed and probable mumps cases. DOHMH conducted a Facebook advertising campaign targeted at Facebook users in the Rockaways, to provide information about mumps and the outbreak. During a period of approximately 2 weeks, 86,111 persons viewed the ad, which provided a timely and inexpensive means of effectively communicating with a large, targeted population. After the initial case of parotitis was reported on August 16, 2015, DOHMH identified 2 additional cases through investigation of the patient’s close contacts. These cases were the first indication DOHMH saw of a mumps outbreak in the Rockaways. Because the first patient mentioned other persons in the neighborhood with parotitis, DOHMH contacted health care providers in the Rockaways for information about other patients with parotitis and any mumps laboratory testing not previously reported. Please read the January 20 MMWR for the full report.

Guidance for Assessment of Poliovirus Vaccination Status and Vaccination of Children Who Have Received Poliovirus Vaccine Outside the U.S.: In 1988, the World Health Assembly resolved to eradicate poliomyelitis (polio). Since then, wild poliovirus (WPV) cases have declined by more than 99.9%, from an estimated 350,000 cases of polio each year to 74 cases in two countries in 2015. This decrease was achieved primarily through the use of trivalent oral poliovirus vaccine (tOPV), which contains types 1, 2, and 3 live, attenuated polioviruses. Since 2000, the U.S. has exclusively used inactivated polio vaccine (IPV), which contains all three poliovirus types. In 2013, the World Health Organization (WHO) set a target of a polio-free world by 2018. Of the three WPV types, type 2 was declared eradicated in September 2015. To remove the risk for infection with circulating type 2 vaccine-derived polioviruses (cVDPV), which can lead to paralysis similar to that caused by WPV, all OPV-using countries simultaneously switched in April 2016 from tOPV to bivalent OPV (bOPV), which contains only types 1 and 3 polioviruses. The January 13 MMWR summarizes current ACIP recommendations for poliovirus vaccination and provides CDC guidance, in the context of the switch from tOPV to bOPV, regarding assessment of vaccination status and vaccination of children who might have received poliovirus vaccine outside the U.S. The guidance aims to ensure that children living in the U.S. (including immigrants and refugees) are protected against all three poliovirus types. This guidance is not new policy and does not change the ACIP recommendations for poliovirus vaccination in the U.S. Children living in the U.S. who might have received poliovirus vaccination outside the U.S. should meet ACIP poliovirus vaccination recommendations which require protection against all three poliovirus types by age-appropriate vaccination with IPV or tOPV. In the absence of vaccination records indicating receipt of these vaccines, only vaccination or revaccination in accordance with the age-appropriate U.S. IPV schedule is recommended. Serology to assess immunity for children with no or questionable documentation of poliovirus vaccination will no longer be an available option and, therefore, is no longer recommended because of increasingly limited availability of antibody testing against type 2 poliovirus.

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Influenza Information

Flu Season Update: The 2016–17 flu season is underway. Influenza activity in the U.S. was low in October, increased slowly through November, and was considered elevated by mid-December. Activity is expected to continue to increase for several weeks. So far this season, influenza A (H3N2) flu viruses have been most common. H3N2 virus-predominant seasons are usually more severe among older adults and young children. Almost all viruses characterized thus far this season remain similar to the recommended components of the 2016–17 Northern Hemisphere vaccines. Annual influenza vaccination is the best way to prevent influenza and its complications. Because flu activity usually peaks between December and February, and can continue as late as May, receiving a flu vaccination now can still be beneficial. CDC recommends that vaccination continue as long as flu activity is ongoing. As of early November 2016, approximately 60% of the U.S. population had not been vaccinated against influenza for the 2016–17 season. Overall, influenza vaccination coverage last season (2015–16) was 45.6%.

Although influenza vaccination is the best way to prevent influenza, antiviral medications can be used to treat influenza illness. CDC recommends prompt treatment with influenza antiviral drugs for people who are very sick with flu or people who are at high risk of complications from flu illness. All influenza viruses collected and tested to date this flu season have been sensitive to the recommended antiviral drugs oseltamivir, zanamivir, and peramivir.

Please read the December 30 MMWR for more information on 2016–17 flu season activity.

Share Our “Fight Flu” Infographic: As flu season progresses, it’s important to remember what actions to take to protect yourself and others from the flu. CDC recommends a three-step approach to fight the flu: vaccination, everyday preventive actions, and use of antiviral drugs if your doctor prescribes them. Share our “Fight Flu” infographic [5 MB, 1 page] to inform yourself, your patients, and your loved ones of the important steps to take to fight flu this season.

Take Three Actions to Fight the Flu: Influenza is a contagious disease that can be serious. CDC urges you to take the following actions to protect yourself and others from flu.

Take time to get a flu vaccine. A yearly flu vaccine is the first and most important step to protect against the flu, and everyone 6 months of age and older should get vaccinated. Flu vaccines are offered in many locations. Find a place near you to get vaccinated.
Take everyday preventive actions to stop the spread of germs. For example, cover your nose and mouth with a tissue when you cough or sneeze, and wash your hands often with soap and water. If you become sick, limit contact with others to keep from infecting them.
Take flu antiviral drugs if your doctor prescribes them. If you get the flu, prescription antiviral medicines can be used to treat flu illness. Antiviral drugs can make illness milder and shorten the time you are sick. They may also prevent serious flu complications. Learn more about how you can fight the flu this season on the “Flu and You” web page.

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Resources and Information

Epidemiology and Prevention of Vaccine-Preventable Diseases, 13^th Edition (the Pink Book): The 13^th edition of the textbook, Epidemiology and Prevention of Vaccine-Preventable Diseases, is available. Published by CDC, NCIRD, and the Public Health Foundation (PHF), the Pink Book provides 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. The human papillomavirus (HPV), meningococcal disease, and pneumococcal disease chapters have recently been updated and are now available.

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. Please visit the netconference web page for other archived webcasts and information on upcoming netconferences. The next netconference is scheduled for March 22.

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 Vaccines for Children (VFC) module and the Vaccine Storage and Handling module have recently been updated and are 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 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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