Immunization Works May 2017

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MMWR

Updated Recommendations for Use of MenB-FHbp Serogroup B Meningococcal Vaccine, 2016: Two serogroup B meningococcal (MenB) vaccines are currently licensed for use in persons aged 10–25 years in the U.S. The two vaccines are MenB-FHbp (Trumenba, Pfizer, Inc.) and MenB-4C (Bexsero, GlaxoSmithKline Biologicals, Inc.). In February 2015, the Advisory Committee on Immunization Practices (ACIP) recommended use of MenB vaccines among certain groups of persons aged 10 years and older who are at increased risk for serogroup B meningococcal disease (Category A). In June 2015, ACIP recommended that adolescents and young adults aged 16–23 years may be vaccinated with a MenB vaccine to provide short-term protection against most strains of serogroup B meningococcal disease (Category B). Consistent with the original Food and Drug Administration (FDA) licensure for the two available MenB vaccines, ACIP recommended either a 3-dose series of MenB-FHbp or a 2-dose series of MenB-4C. Either MenB vaccine can be used when indicated. ACIP does not state a product preference. The two MenB vaccines are not interchangeable; the same vaccine product must be used for all doses in a series.

In April 2016, changes to the dosage and administration of MenB-FHbp were approved by FDA to allow for both a 2-dose series (administered at 0 and 6 months) and a 3-dose series (administered at 0, 1–2, and 6 months). In addition, the package insert now states that the choice of dosing schedule depends on the patient’s risk for exposure and susceptibility to serogroup B meningococcal disease. The recommendations published in the May 19 MMWR regarding use of the 2- and 3-dose schedules of MenB-FHbp vaccine (Trumenba) replace previous ACIP recommendations for use of MenB-FHbp vaccine published in 2015. Recommendations regarding use of MenB-4C (Bexsero) are unchanged.

ACIP Recommendations for Use of Cholera Vaccine: Cholera, caused by infection with toxigenic Vibrio cholerae bacteria of serogroup O1 (more than 99% of global cases) or O139, is characterized by watery diarrhea that can be severe and rapidly fatal without prompt rehydration. Cholera is endemic in approximately 60 countries and causes epidemics as well. Globally, cholera results in an estimated 2.9 million cases of disease and 95,000 deaths annually.

Cholera is rare in the U.S., and most U.S. cases occur among travelers to countries where cholera is endemic or epidemic. Forty-two U.S. cases were reported in 2011 after a cholera epidemic began in Haiti; however, less than 25 cases per year have been reported in the U.S. since 2012.

In 2016, lyophilized CVD 103-HgR (Vaxchora, PaxVax, Redwood City, California), a single-dose, live attenuated oral cholera vaccine, was approved by FDA for the prevention of cholera caused by V. cholerae O1 in adults traveling to cholera-affected areas. Lyophilized CVD 103-HgR is the only cholera vaccine licensed for use in the U.S.

In June 2016, ACIP voted to recommend use of lyophilized CVD 103-HgR for prevention of cholera among adult travelers to areas with endemic or epidemic cholera caused by toxigenic V. cholerae O1. This includes areas with cholera activity during the last year that are prone to recurrence of cholera epidemics. ACIP considered evidence on safety and efficacy of the currently available formulation of CVD 103-HgR, as well as that of a previously available formulation with identical phenotypic and genomic properties. That formulation was licensed and marketed in other industrialized countries before manufacturing ceased in 2003 for business reasons (i.e., not because of safety or efficacy concerns). The May 12 MMWR provides new recommendations and guidance for vaccination providers and travelers about the use of lyophilized CVD 103-HgR. These recommendations apply to adults aged 18–64 years traveling to areas with endemic or epidemic cholera.

Surveillance of Vaccination Coverage Among Adult Populations in the U.S., 2015: Vaccinations are recommended throughout a person’s lifetime to prevent vaccine-preventable diseases and their sequelae. However, adult vaccination coverage remains low for most routinely recommended vaccines. In February 2016, a comprehensive report on adult vaccination coverage was released–the first that included assessment of associations with expanded data on respondent demographics and access to care. The May 5 MMWR updates the vaccination coverage estimates in the 2016 report. The findings in this report can be used by public health practitioners, adult vaccination providers, and the general public to better understand factors that contribute to low vaccination rates and to modify strategies and interventions to improve vaccination coverage.

Progress Toward Measles Elimination in the African Region, 2013–2016: In 2011, the 46 World Health Organization (WHO) African Region (AFR) member states established a goal of measles elimination by 2020, by achieving, 1) more than 95% coverage of their target populations with the first dose of measles-containing vaccine (MCV1) at national and district levels; 2) more than 95% coverage with measles-containing vaccine (MCV) per district during supplemental immunization activities (SIAs); and 3) confirmed measles incidence of less than 1 case per 1 million population in all countries. Two key surveillance performance indicator targets include 1) investigating more than 2 cases of nonmeasles febrile rash illness per 100,000 population annually, and 2) obtaining a blood specimen from more than 1 suspected measles case in more than 80% of districts annually.

The May 5 MMWR updates the previous report and describes progress toward measles elimination in AFR during 2013 through 2016. Estimated regional MCV1 coverage increased from 71% in 2013 to 74% in 2015. Seven (15%) countries achieved more than 95% MCV1 coverage in 2015. The number of countries providing a routine second MCV dose (MCV2) increased from 11 (24%) in 2013 to 23 (49%) in 2015. Forty-one (79%) of 52 SIAs during 2013 through 2016 reported more than 95% coverage. Both surveillance targets were met in 19 (40%) countries in 2016. Confirmed measles incidence in AFR decreased from 76.3 per 1 million population to 27.9 during 2013 through 2016.

To eliminate measles by 2020, AFR countries and partners need to: 1) achieve more than 95% 2-dose MCV coverage through improved immunization services, including second-dose (MCV2) introduction; 2) improve SIA quality by preparing 12–15 months in advance and using readiness, intra-SIA, and post-SIA assessment tools; 3) fully implement elimination-standard surveillance; 4) conduct annual district-level risk assessments; and 5) establish national committees and a regional commission for the verification of measles elimination.

Addressing a Yellow Fever Vaccine Shortage in the U.S., 2016–2017: Recent manufacturing problems resulted in a shortage of the only U.S.-licensed yellow fever vaccine. This shortage is expected to lead to a complete depletion of yellow fever vaccine available for the immunization of U.S. travelers by mid-2017. CDC, FDA, and Sanofi Pasteur are collaborating to ensure a continuous yellow fever vaccine supply in the U.S.

As part of this collaboration, Sanofi Pasteur submitted an expanded access investigational new drug (eIND) application to FDA in September 2016 to allow for the importation and use of an alternative yellow fever vaccine manufactured by Sanofi Pasteur France, with safety and efficacy comparable to the U.S.-licensed vaccine. The eIND was accepted by FDA in October 2016. The implementation of this eIND protocol included developing a systematic process for selecting a limited number of clinic sites to provide the vaccine. CDC and Sanofi Pasteur will continue to communicate with the public and other stakeholders, and CDC will provide a list of locations that will be administering the replacement vaccine at a later date. Please read the May 5 MMWR for the full report.

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Influenza Information

Flu Season Update: According to the FluView report for the week ending May 13, 2017 (week 19), the 2016–2017 flu season has peaked and is on the decline. While influenza A (H3N2) viruses were predominant earlier in the season, influenza B viruses have been most common in recent weeks. Based on early estimates, flu vaccines this season have reduced a vaccinated person’s risk of getting sick and having to go to the doctor because of flu by about half (48%). CDC recommends annual flu vaccination for everyone 6 months of age and older. Vaccination efforts should continue as long as influenza viruses are circulating.

Start Your Planning for Next Flu Season’s Vaccination Campaign: CDC has a partnership with the National Influenza Vaccination Disparities Partnership (NIVDP), a national multi sector campaign led by local influential partners that commit to promoting the importance of flu vaccination among underserved populations. In April, NIVDP hosted a webinar featuring a panel of four immunization coalition leaders who shared strategies they use to protect underserved populations in their regions. The webinar can be found on YouTube and on CDC’s website, along with previous webinars highlighting useful flu vaccination lessons and tips.

It’s not too early to begin making plans for next flu season. Check out our Tips Sheet [2 pages] for information and resources to start planning successful flu vaccination promotion events in your community.

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Resources and Information

Epidemiology and Prevention of Vaccine-Preventable Diseases, 13^th Edition (the Pink Book): 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 following items in the online appendices were just updated:

Pages A-13–A-14 (Appendix A) “Recommended and Minimum Ages and Intervals Between Doses of Routinely Recommended Vaccines” [2 pages]
Pages B-1–B-4 (Appendix B) “U.S. Vaccines” [4 pages]
Pages D-5–D-6 (Appendix D) “National Childhood Vaccine Injury Act: Vaccine Injury Table” [2 pages]

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 information on upcoming netconferences and to view archived webcasts. The next netconference is scheduled for July 12, 2017.

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 United States. The recommendations stand as public health guidance for the safe use of vaccines and related biological products. The next ACIP meeting is scheduled for June 21–22, 2017. 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 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 will 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 are now available for ordering.

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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