Immunization Works February 2017

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MMWR

Assessing Poliovirus Vaccination Status of Children who have Received Poliovirus Vaccine Outside the U.S.: CDC recently provided guidance regarding assessment of poliovirus vaccination status and vaccination of children who have received poliovirus vaccine outside the U.S. The “Guidance for Assessment of Poliovirus Vaccination Status and Vaccination of Children who have Received Polio Vaccine Outside the U.S.” can be found in the January 13, 2017 MMWR. An errata was issued in the February 17, 2017 MMWR. The errata provides clarification that previous poliovirus vaccination is valid if a child’s documentation indicates receipt of IPV or tOPV. tOPV was used for routine poliovirus vaccination before April 1, 2016 in all OPV-using countries.

Specifically, the guidance offers additional clarification and changes impacting the IPV footnote in the 2017 catch-up schedule:

If both OPV and IPV were administered as part of a series, the total number of doses needed to complete the series is the same as that recommended for the U.S. IPV schedule. A minimum interval of 4 weeks should separate doses in the series, with the final dose administered on or after the fourth birthday and at least 6 months after the previous dose.

If only OPV was administered, and all doses were given before age 4 years, 1 dose of IPV should be given at 4 years or older and at least 6 months after the last OPV dose. This 6-month period is a change from the current footnote which indicates the period is 4 weeks after the last OPV dose.

Only trivalent OPV (tOPV) counts toward the U.S. vaccination requirements (tOPV was used for routine poliovirus vaccination in all OPV-using countries until April 1, 2016). Therefore, if a child has documentation of receipt of OPV doses (even if they are not marked “tOPVâ€) before April 1, 2016, the doses should be counted toward the U.S. vaccination schedule. The only exception to this would be if there is a specific notation a vaccine was administered during a vaccination campaign; in those instances, the dose would not count towards the U.S. vaccination requirements. The errata provides the full guidance.

Knowledge, Attitudes, and Practices Regarding Yellow Fever Vaccination Among Men During an Outbreak in Luanda, Angola (Notes from the Field): In January 2016, the Angola Ministry of Health reported an outbreak of yellow fever, a vaccine-preventable disease caused by a flavivirus transmitted through the bite of Aedes or Haemagogus species mosquitoes. Although endemic in rural areas of Angola, the last outbreak was in 1988, when 37 cases and 14 deaths were reported. Large yellow fever outbreaks occur when the virus is introduced by an infected person to an urban area with a high density of mosquitoes and a large, crowded population with little or no immunity. By May 8, a total of 2,267 suspected cases were reported nationally, of which 696 (31%) were laboratory-confirmed; 293 (13%) persons died. Most confirmed cases lived in Luanda Province. As part of the public health response that included strengthened surveillance, vector control, case management, and social mobilization, mass vaccination campaigns were implemented in Luanda during February 2–April 16. Despite more than 90% administrative vaccination coverage (the number of vaccine doses administered divided by the most recent census estimates for the target population), the province continued to report cases. Field teams reported low numbers of men being vaccinated, which was a concern because of a preliminary analysis that indicated approximately 70% of confirmed yellow fever cases occurred in males. A rapid assessment to identify and address potential barriers to vaccination among men was designed, using a knowledge, attitudes, and practices survey. Please read the February 3 MMWR for the full report.

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Influenza Information

Flu Season Update: As of February 10, 2017, influenza activity continues to be elevated in the U.S., with most states reporting widespread influenza activity. The current flu season is likely to continue 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. As of January 27, 2017, approximately 145 million doses of flu vaccine had been distributed in the U.S. for the 2016–17 flu season.

Annual influenza vaccination is the best way to prevent influenza and its complications. Because flu activity has not yet peaked, receiving a flu vaccination now can still offer benefit. CDC recommends vaccination as long as flu activity is ongoing. During some seasons, significant activity has continued as late as May. Although influenza vaccination is the best way to prevent influenza, antiviral medications can 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 flu-related complications. All influenza viruses collected and tested to date this flu season have been sensitive to the recommended antiviral drugs oseltamivir, zanamivir, and peramivir. For more information on the 2016–17 flu season, please read the February 17 MMWR and visit the flu activity and surveillance site.

Interim influenza vaccine effectiveness for the 2016–17 season was estimated to be 43% against illness caused by influenza A (H3N2) virus and 73% against influenza B virus. These estimates indicate that flu vaccination reduced the risk for influenza-associated medical visits by approximately half. Please read the February 17 MMWR for the full report.

Take 3 Actions to Fight the Flu: Flu 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 vaccine is 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 avoid 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 answersession. 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 29.

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 HPV module, Vaccines for Children (VFC) module, and 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.

ACIP Meeting: ACIP comprises medical and public health experts who develop recommendations on the use of vaccines in the U.S. The recommendations stand as public health guidance for safe use of vaccines and related biological products. The most recent ACIP meeting was held February 22–23, 2017. Topics discussed included influenza, herpes zoster, meningococcal disease, and mumps. Minutes and issues discussed will be posted within the next few weeks. Please visit the ACIP meeting web page for agendas, presentation slides, meeting minutes, and archived video broadcasts.

New Vaccine Administration e-Learn to Launch in March 2017: A new e-Learn on vaccine administration will be available online in March 2017.

Proper vaccine administration is critical for ensuring that vaccines are both safe and effective. Vaccine administration errors happen more often than you might think, with the Vaccine Adverse Events Reporting Syste (VAERS) receiving an average of 36,000 reports a year. About 1,500 of those reports are directly related to administration error.

Some of the most common vaccination administration errors include:

Not following the recommended immunization schedule
Administering improperly stored or expired vaccine and/or diluent
Administering the wrong vaccine,—confusing look-alike or sound-alike vaccines such as DTaP/Tdap or administering products outside age indications

The e-Learn is a free, interactive, online educational program that serves as a useful introductory course or a great refresher on vaccine administration. The self-paced e-learn provides comprehensive training, including videos, job aids, and other resources, to accommodate a variety of learning styles and offers a certificate of completion and/or Continuing Education (CE) for those that complete the training.

For more information please contact nipinfo@cdc.gov.

Vaccine Storage and Handling—Vaccine Labels: The vaccine labels examples were recently updated on the CDC Vaccine Storage and Handling web page. Staff can easily become confused about vaccines within storage units and these examples can be used to organize vaccines within storage units. Labeling the area where vaccines are stored can help staff quickly locate and choose the correct vaccineâ€”perhaps preventing a vaccine administration error. Proper vaccine storage and handling practices play a very important role in protecting individuals and communities from vaccine-preventable diseases. Vaccine quality is the shared responsibility of everyone, from the time vaccine is manufactured until it is administered.

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. The 2017 immunization schedules should be available in late March.

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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