Immunization Works July 2017

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Dr. Wharton on Detail to NVPO: On August 7, Dr. Melinda Wharton, Immunization Services Division (ISD) director, will join the National Vaccine Program Office (NVPO) at HHS on a 120-day detail as NVPO director. In this position, she will be responsible for coordinating and ensuring collaboration among the federal agencies involved in vaccine and immunization activities, including carrying out the goals of the National Vaccine Plan. Dr. Wharton is well qualified for this temporary assignment, given her extensive experience on issues related to vaccine policy, vaccine science, and public health response. Dr. Cindy Weinbaum will be Acting Director for ISD during this period.

National Immunization Awareness Month: August is National Immunization Awareness Month (NIAM), an annual observance sponsored by the National Public Health Information Coalition (NPHIC) to highlight the importance of vaccines for people of all ages. The 2017 communications toolkit is now available. It contains key messages, digital ads, social media messages, web banners, posters, logos, and graphics to use with social media. It also includes a media outreach toolkit and a place to share your NIAM activities and view what others are doing, using the hashtag #NIAM17. For more information on the observance, visit NPHIC’s NIAM website and the CDC NIAM web page.

The observance features a different group during each week of August:

July 31–August 6—Babies and young children: a healthy start begins with on-time vaccinations
August 7–13—Pregnant women: protect yourself and pass protection on to your baby
August 14–20—Adults: vaccines are not just for kids
August 21–27—Preteens/teens: ensure a healthy future with vaccines

Updated Vaccine Adverse Event Reporting System (VAERS) Website: VAERS, which is co-managed by CDC and the Food and Drug Administration (FDA), is the national postmarketing safety monitoring system that accepts reports about adverse events that occur after administration of U.S.-licensed vaccines. On June 30, 2017, CDC and FDA updated the VAERS website and implemented a revised reporting form and a new process for submitting reports to VAERS. Persons reporting adverse events are now able to use the VAERS 2.0 online reporting tool to submit reports directly online; alternatively, they may download and complete the writable and savable VAERS 2.0 form and submit it using an electronic document upload feature.

Transition to the VAERS 2.0 form is expected to be completed by the end of December 2017. Accommodations will be made for persons unable to submit reports electronically. The revised VAERS reporting form and system is intended for health care professionals, patients, parents, guardians, caregivers, and other non-manufacturers. Vaccine manufacturers will submit reports to VAERS by a separate process through the FDA Electronic Submissions Gateway. Additional assistance is available at info@vaers.org or by telephone at 1-800-822-7967.

New Vaccine Administration e-Learn Now Available: A new e-Learn on vaccine administration is now available. Proper vaccine administration is critical for ensuring that vaccines are both safe and effective. Vaccine administration errors happen more often than you might think. Of the average 36,000 reports received annually by VAERS, about 1,500 of those reports are directly related to administration error.

Some of the most common vaccine 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, using 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.

Webinar Series for Pink Book: This online series of 15 webinars provides an overview of the principles of vaccination, general recommendations, immunization strategies, and specific information about vaccine-preventable diseases and the vaccines that prevent them. Each webinar will explore a chapter from the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (the Pink Book). The webinars started on June 14 and will air live most Wednesdays from 12–1 p.m. EDT through October 11, 2017. Check the schedule for live webcasts, and view recordings at your convenience online at the Pink Book webinar web page.

You must register in advance for the live webinars. After registering, you will receive event access information via e-mail. Each webinar is limited to 1,500 participants, so please log in early to secure a virtual “seat.” If a webinar is full or if you miss a live event, you can watch it later at the Pink Book webinar web page. Webcasts will be posted within a few days after the live event. Continuing Education (CE) will be available for each event.

Vaccine Information Statement (VIS) Update: The cholera VIS has recently been updated and is now available. Please visit the CDC VIS web page for additional information on VISs.

High Risk for Meningococcal Disease among Patients Receiving Eculizumab (Soliris) Despite Vaccination: Recent data suggest that meningococcal vaccines likely provide incomplete protection against invasive meningococcal disease in eculizumab (Soliris) recipients. In addition to vaccination, health care providers could consider antimicrobial prophylaxis for the duration of eculizumab therapy to potentially reduce the risk of meningococcal disease. Please visit the meningococcal disease web page or read the recent MMWR for additional information.

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MMWR

Measles Outbreak in Minnesota, April–May 2017: On April 10, 2017, the Minnesota Department of Health (MDH) was notified about a suspected measles case. The patient was a hospitalized child aged 25 months who was evaluated for fever and rash, with onset on April 8. The child had no history of receipt of measles-mumps-rubella (MMR) vaccine and no travel history or known exposure to measles. On April 11, MDH received a report of a second hospitalized, unvaccinated child, aged 34 months, with an acute febrile rash illness with onset on April 10. The second patient’s sibling, aged 19 months, who had also not received MMR vaccine, had similar symptoms, with rash onset on March 30. Real-time reverse transcription–polymerase chain reaction (rRT-PCR) testing of nasopharyngeal swab or throat specimens performed at MDH confirmed measles in the first two patients on April 11 and in the third patient on April 13; subsequent genotyping identified genotype B3 virus in the three patients, who attended the same child care center. MDH implemented outbreak investigation and response activities in collaboration with local health departments, health care facilities, child care facilities, and schools in affected settings. Because the outbreak occurred in a community with low MMR vaccination coverage, measles spread rapidly, resulting in thousands of exposures in child care centers, schools, and health care facilities. By May 31, 2017, a total of 65 confirmed measles cases had been reported to MDH. Please read the July 14 MMWR for the full report.

Pneumococcal Vaccination among Medicare Beneficiaries Occurring After the ACIP Recommendation for Routine Use Of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine for Adults Aged 65 Years and Older: On September 19, 2014, CDC published the Advisory Committee on Immunization Practices (ACIP) recommendation for the routine use of 13-valent pneumococcal conjugate vaccine (PCV13) among adults aged 65 years and older, to be used in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23). This replaced the previous recommendation that adults aged 65 years and older should be vaccinated with a single dose of PPSV23. As a proxy for estimating PCV13 and PPSV23 vaccination coverage among adults aged 65 years and older before and after implementation of these revised recommendations, CDC analyzed claims for vaccination submitted for reimbursement to the Centers for Medicare and Medicaid Services (CMS). Claims from any time during a beneficiary’s enrollment in Medicare Parts A (hospital insurance) and B (medical insurance) since reaching age 65 years were assessed among beneficiaries continuously enrolled in Medicare Parts A and B during annual periods from September 19, 2009, through September 18, 2016. By September 18, 2016, 43.2% of Medicare beneficiaries aged 65 years and older had claims for at least 1 dose of PPSV23 (regardless of PCV13 status), 31.5% had claims for at least 1 dose of PCV13 (regardless of PPSV23 status), and 18.3% had claims for at least 1 dose each of PCV13 and PPSV23. Claims for either type of pneumococcal vaccine were highest among beneficiaries who were older, white, or who had chronic and immunocompromising medical conditions than among healthy adults. Implementation of the National Vaccine Advisory Committee’s standards for adult immunization practice to assess vaccination status at every patient encounter, recommend needed vaccines, and administer vaccination or refer to a vaccinating provider might help increase pneumococcal vaccination coverage and reduce the risk for pneumonia and invasive pneumococcal disease among older adults. Please read the July 14 MMWR for the full report.

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Influenza Information

A Season in Review–Influenza Activity in the U.S. During the 2016–17 Season: The 2016–17 U.S. influenza season (October 2, 2016–May 20, 2017), was moderate with influenza-like-illness at or above the baseline for 17 consecutive weeks. This is a little longer than the average over the past decade, which is 13 weeks with a range of 1 week to 20 weeks. Activity remained low through November, increased during December, and peaked in February nationally, although there were regional differences in the timing of influenza activity. Influenza A(H3N2) viruses predominated through mid-March and were predominant overall for the season, but influenza B viruses were more commonly identified from late March through May. Severity indicators (e.g., hospitalization and mortality rates) were within the range that has been observed during previous seasons when influenza A(H3N2) viruses predominated. Previous influenza A(H3N2)–predominant seasons have been associated with increased hospitalizations and deaths compared with seasons that were not influenza A(H3N2)–predominant, especially among children under 5 years of age and adults aged 65 years and older. The hospitalization rate was highest among adults aged 65 years and older, who accounted for approximately 60% of reported influenza-associated hospitalizations. The majority of viruses have been like the components recommended for the 2016–17 Northern Hemisphere seasonal influenza vaccine.

Although summer influenza activity in the U.S. is typically low, influenza cases and outbreaks have occurred during summer months. Clinicians should remain vigilant in considering influenza in the differential diagnosis of summer respiratory illnesses. Testing for seasonal influenza viruses and monitoring for novel influenza A virus infections should continue year-round. Health care providers also are reminded to consider novel influenza virus infections in persons with influenza-like illness and swine or poultry exposure, or with severe acute respiratory infection after travel to areas where avian influenza viruses have been detected. Clinical laboratories using a commercially available influenza diagnostic assay that includes influenza A virus subtype determination should contact their state public health laboratory to facilitate transport and additional testing of any specimen that is positive for influenza A, but for which the subtype cannot be determined. Public health laboratories should immediately send influenza A virus specimens that they cannot subtype using standard methods to CDC and submit all specimens that are otherwise unusual as soon as possible after identification. The June 30 MMWR summarizes influenza activity in the U.S. during the 2016–17 influenza season and reports the vaccine virus components recommended for the 2017–18 Northern Hemisphere influenza vaccines.

Composition of the 2017–18 Influenza Vaccine: The Food and Drug Administration (FDA) has recommended that the 2017–18 influenza trivalent vaccine to be used in the U.S. contain an A/Michigan/45/2015 (H1N1)pdm09-like virus, an A/Hong Kong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008-like (B/Victoria lineage) virus. It is recommended that quadrivalent vaccines, which have two influenza B viruses, contain the viruses recommended for the trivalent vaccines, as well as a B/Phuket/3073/2013-like (B/Yamagata lineage) virus. This represents an update to the influenza A(H1N1) component compared with the composition of the 2016–17 influenza vaccines. The recommended Northern Hemisphere 2017–18 vaccine viruses are the same as the vaccine viruses recommended for inclusion in the 2017 Southern Hemisphere influenza vaccines. These vaccine recommendations were based on numerous factors, including global influenza virologic and epidemiologic surveillance, genetic and antigenic characterization, human serology studies, antiviral susceptibility, and candidate influenza virus availability.

For more information about the 2017–18 flu season, visit CDC’s influenza website.

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Resources and Information

Epidemiology and Prevention of Vaccine-Preventable Diseases, 13th 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.

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 September 13, 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 for the use of vaccines in the U.S. The recommendations stand as public health guidance for the safe use of vaccines and related biological products. ACIP meetings are held quarterly. The latest ACIP meeting was held June 21–22, 2017, and included presentations on hepatitis A vaccine, influenza, herpes zoster vaccines, varicella, anthrax vaccine, dengue virus vaccines, yellow fever vaccine, mumps disease and vaccine, HPV, meningococcal vaccines, and VAERS. Please visit the ACIP meeting web page for additional information to include the presentation slides from the latest meeting.

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 also 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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Calendar of Events

Immunize South Dakota, Sioux Falls Area Immunization Coalition, August 4, Sioux Falls, SD

American College of Obstetricians and Gynecologists (ACOG) webinar, “Best Practices to Improve Maternal Immunization,” August 7, free with 1 CME credit and open to all

ACOG webinar, “Don’t Wait, Vaccinate! Tips and Resources for Communicating with Adult Patients about Vaccination,” August 17, free with 1 CME credit and open to all

24th Annual Immunize Georgia Conference, September 15, Columbus, GA

Washington Vaccine Update, Washington State Department of Health and WithinReach, October 27, Seattle, WA

Fall Clinical Vaccinology Course, National Foundation for Infectious Diseases (NFID), November 3–5, Bethesda, MD

NCIRD Calendar of Events

Upcoming ACIP Meetings

Immunization Action Coalition (IAC) Calendar

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