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Issue 1037
IAC Express: Weekly immunization news and information
Issue 1037: January 29, 2013

TOP STORIES

FEATURED RESOURCES

JOURNAL ARTICLES AND NEWSLETTERS

CONFERENCES AND MEETINGS



TOP STORIES

“Vaccine Information You Need”: A great immunization website for the public!
We have completed a major transformation of our website for the public, www.vaccineinformation.org, making it one of the most comprehensive and user-friendly sources of scientifically accurate and easily navigable immunization information on the Web today. Visitors to the website can now easily find what they need, whether they are looking for information on a particular vaccine or on vaccines needed by a particular age group, personal stories or video clips, or other resources, such as those from CDC and state health departments. Titled “Vaccine Information You Need,” the website offers parents, other adults, legislators, the media, and all interested Web users a one-stop shop for learning about vaccines and their importance.

Information on the website is organized into sections based on the four age groups listed below. This arrangement allows visitors to easily find vaccine schedules and other information pertinent to people of a specific age:

Highlights of Vaccineinformation.org
  • Vaccines You Need: Detailed information about the immunization schedules, arranged by age group—infants and children, preteens, teens, and adults
  • Personal Testimonies: Stories of suffering and loss from vaccine-preventable diseases, organized by age group and disease
  • Video Library: Searchable collection of videos and public service announcements about vaccine-preventable diseases and the importance of vaccination
  • Vaccine-Preventable Diseases: Information and resources for all vaccine-preventable diseases, including those associated with international travel
  • Vaccine Basics: Basic and helpful information on vaccines and vaccination, ranging from “Paying for Vaccines” to “How Vaccines Work”
  • Resources: Frequently updated listing of helpful resources, including brochures, blogs, videos, and more, for people in all age groups who seek information about vaccines
Please take a moment to enjoy the colorful experience of “Vaccine Information You Need.” We would love to hear your comments.

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2013 U.S. Recommended Immunization Schedules for people age 0—18 years and adults age 19 years and older are now available
CDC published Advisory Committee on Immunization Practices (ACIP) Recommended Immunization Schedules for Persons Aged 0 Through 18 years and Adults Aged 19 Years and Older—United States, 2013 in an MMWR Early Release dated January 28

The recommended child and adolescent immunization schedules have been approved by the ACIP, the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP).

The recommended adult immunization schedule has been approved by the Advisory Committee on Immunization Practices, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American College of Nurse-Midwives.

Related Links
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CDC publishes recommendations for infant meningococcal vaccination with Hib-MenCY-TT
CDC published Infant Meningococcal Vaccination: Advisory Committee on Immunization Practices (ACIP) Recommendations and Rationale in the January 25 issue of MMWR (pages 52–54). The first paragraph of the article is reprinted bellow, as is the section titled "ACIP Recommendations for Infants at Increased Risk for Meningococcal Disease" and the section titled "Guidance for Use of Hib-MenCY-TT."

At its October 2012 meeting, the Advisory Committee on Immunization Practices (ACIP) voted to recommend vaccination against meningococcal serogroups C and Y for children aged 6 weeks through 18 months at increased risk for meningococcal disease. Meningococcal groups C and Y and Haemophilus b tetanus toxoid conjugate vaccine (Hib-MenCY-TT [MenHibrix, GlaxoSmithKline Biologicals]) is licensed for active immunization for prevention of invasive disease caused by Haemophilus influenzae type b (Hib) and meningococcal serogroups C and Y. Hib-MenCY-TT is not indicated for prevention of disease caused by meningococcal serogroup B, the most common serogroup causing disease in infants, or serogroups W135 or A, which are represented in quadrivalent meningococcal vaccines. Before licensure of Hib-MenCY-TT, no meningococcal conjugate vaccine was licensed for infants aged 2 through 8 months. MenACWY-D (Menactra, Sanofi Pasteur) is licensed as a 2-dose series for infants and toddlers aged 9 through 23 months, and MenACWY-D and MenACWY-CRM (Menveo, Novartis Vaccines) are licensed for persons aged 2 through 55 years as a single dose. These vaccines are recommended routinely for persons aged 11 through 18 years and persons aged 2 through 55 years at increased risk for meningococcal disease (and persons aged 9 months through 55 years for MenACWY-D). This report summarizes the deliberations of ACIP, the rationale for its decision, and recommendations for use of Hib-MenCY-TT in infants at increased risk for meningococcal disease.

ACIP Recommendations for Infants at Increased Risk for Meningococcal Disease
Infants at increased risk for meningococcal disease should be vaccinated with a 4-dose series of Hib-MenCY-TT. These include infants with recognized persistent complement pathway deficiencies and infants who have anatomic or functional asplenia including sickle cell disease. Additionally, Hib-MenCY-TT can be used in infants aged 6 weeks through 18 months who are in communities with serogroups C and Y meningococcal disease outbreaks, but Hib-MenCY-TT is not adequate for infants traveling to the Hajj or the "meningitis belt" of sub-Saharan Africa (a quadrivalent meningococcal vaccine that contains serogroups A and W135 is required for those infants and may be given starting at age 9 months).

If an infant at increased risk for meningococcal disease is behind on his or her Hib vaccine doses, Hib-MenCY-TT may be used following the same catch-up schedule used for Hib vaccine. However, if the first dose of Hib-MenCY-TT is given at or after 12 months of life, 2 doses should be given at least 8 weeks apart to ensure protection against serogroups C and Y meningococcal disease. For infants at increased risk for meningococcal disease who have received or are going to receive a different Hib vaccine product, ACIP recommends a 2-dose series of MenACWY-D if they are aged 9 through 23 months or either of the two quadrivalent meningococcal vaccine products after age 23 months.

Hib-MenCY-TT may be co-administered with other routine infant vaccinations, including 13-valent pneumococcal conjugate vaccine. Hib-MenCY-TT should not be co-administered with other Hib-containing vaccines.

Guidance for Use of Hib-MenCY-TT
Based on an assessment of the potential public health impact, including the current low incidence of meningococcal disease in the United States, at this time ACIP does not recommend routine meningococcal vaccination for infants who are not at increased risk for meningococcal disease. Hib-MenCY-TT is safe and immunogenic against Hib and
N. meningitidis serogroups C and Y. Hib-MenCY-TT may be used in any infant for routine vaccination against Hib and will offer some protection against serogroups C and Y meningococcal disease. Four doses of Hib-MenCY-TT fulfill the primary series and booster dose Hib immunization recommendations. If Hib-MenCY-TT vaccine is used to achieve protection against serogroups C and Y, Hib-MenCY-TT should be used for all 4 doses of Hib vaccine. Because the protection offered by meningococcal vaccines wanes over time, an infant series will be unlikely to provide persistent protection against meningococcal disease until age 11–12 years, the age of recommended adolescent vaccination. Infants and children who received Hib-MenCY-TT and are travelling to areas with high endemic rates of meningococcal disease such as the "meningitis belt" are not protected against serogroups A and W-135 and should receive a quadrivalent meningococcal conjugate vaccine licensed for children aged ≥9 months before travel.

ACIP will continue to reevaluate trends in epidemiology to determine whether meningococcal vaccines should be added to the routine infant schedule and what schedule should be implemented for reimmunization. Vaccines that provide long-term protection against meningococcal disease early in life have the potential to reduce the burden of meningococcal disease, especially if they provide protection against serogroup B meningococcal disease. Health-care providers should be aware of the continued need for early recognition and treatment of meningococcal disease.


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Vaccines that use thimerosal as a preservative are exempted from international treaty that curbs mercury releases and emissions
On January 19, the United Nations Environment Programme (UNEP) issued a press release titled Minamata Convention Agreed by Nations: Global Mercury Agreement to Lift Health Threats from Lives of Millions World-Wide. Significantly, the press release reports that vaccines that use thimerosal (ethyl mercury) as a preservative are excluded from the treaty's provisions; this will allow vaccine manufacturers to continue using thimerosal. As recently as December 2012, UNEP had considered recommending worldwide removal of thimerosal from vaccines, even though thimerosal has no recognized serious toxic effects as currently used. Had the Minamata treaty required eliminating thimerosal from vaccines, the global vaccine supply could have been affected. Thimerosal is used in production of multi-dose vials of vaccine, which are widely used in resource-poor countries because they are more affordable than single-dose vials.

Background Information
In 2012, the World Health Organization's Strategic Advisory Group of Experts (SAGE) on Immunization recommended that thimerosal continue to be used in the global vaccine supply; a summary of the discussion was published in the May 25, 2012, issue of the World Epidemiological Record (WER; see link below). The American Academy of Pediatrics (AAP) concurred, outlining its position in an article published in the June 2012 issue of AAP News and in a series of articles published in the December 2012 issue of the AAP journal Pediatrics; links to all are listed below.

Related Links
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HealthMap Vaccine Finder lets public find provider locations that administer a range of adult vaccinations
The HealthMap Vaccine Finder has recently been expanded. Previously, it allowed members of the public to use their zip codes to find influenza vaccination providers in their area. Now the public can use the same service to find providers who administer any or all of the following 10 vaccines recommended for adults by the Advisory Committee on Immunization Practices:
  • Hepatitis A
  • Hepatitis B
  • HPV
  • MMR
  • Meningococcal
  • Pneumococcal
  • Td
  • Tdap
  • Varicella
  • Zoster
The HealthMap Vaccine finder continues to list influenza vaccination providers. Users of the Flu Vaccine Finder will be able to access information on providers of the 10 vaccines listed above, as well as on providers of influenza vaccinations.

The HealthMap Vaccine Finder was developed in collaboration with the Department of Health and Human Services, Centers for Disease Control and Prevention, American Pharmacists Association, National Community Pharmacists Association, Immunization Action Coalition, American Medical Association, National Influenza Vaccine Summit, Association of State and Territorial Health Officials, and National Association of County and City Health Officials. The website currently provides information on more than 50,000 locations across the United States.

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CDC publishes report on noninfluenza vaccination coverage among U.S. adults in 2011
CDC published Noninfluenza Vaccination Coverage Among Adults—United States, 2011 in an MMWR Early Release dated January 29. Stating that adult vaccination coverage remains low for most routinely recommended vaccines and well below the Health People 2020 targets, the article gives detailed information on 2011 vaccination coverage for the following recommended adult vaccines:
  • Pneumococcal
  • Tetanus
  • Hepatitis A
  • Hepatitis B
  • Zoster
  • HPV
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Clinicians: The Influenza Vaccine Availability Tracking System (IVATS) can help you find influenza vaccine
The National Influenza Vaccine Summit has recently added information to the Influenza Vaccine Availability Tracking System (IVATS). A resource for healthcare settings looking to purchase influenza vaccine, IVATS contains information from approved, enrolled, and participating wholesale vaccine distributors or manufacturers of U.S. licensed influenza vaccine. Information was posted to the IVATS chart on January 28. Ongoing updates are being made and will continue to be throughout the 2012–2013 influenza vaccination season. Keep checking back.

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FEATURED RESOURCES

CDC posts influenza information for clinicians who care for older adults; also posts the FluView Update for January 13–19
In light of current high and widespread influenza activity throughout much of the nation, on January 23, CDC posted CDC Influenza Update for Geriatricians and Other Clinicians Caring for People 65 and Older: 2012–2013 Influenza Season, Impact on the Elderly, Summary Guidance. The document contains a summary of geriatric hospitalization and death data to date this season, as well as a summary of CDC’s influenza vaccine and antiviral recommendations for people age 65 and older.

Weekly FluView for week ending January 19
Reprinted below is the Key Flu Indicators section of CDC's Summary of Weekly FluView for the week ending January 19.

According to the latest FluView report, influenza activity remains elevated in most of the country. Similar to last week, some national indicators are declining while others are increasing. In general, influenza-like-illness (ILI) activity levels are declining in the South, Southeast, New England, and the Midwest, but increasing in the Mid-Atlantic, Southwest, and the Northwest. Key indicators reflecting severity, such as hospitalizations and deaths, increased significantly again this week, with the greatest impact among people 65 and older.

The complete 13-page FluView Update for the week ending January 19 is available in HTML and PDF formats.

Resources for Clinicians

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ACOG posts algorithm for assessing and treating pregnant women for influenza like illness
On January 14, the American College of Obstetricians and Gynecologists (ACOG) posted a "Dear Colleagues" letter written by the organization's president, James T. Breeden, MD. In the letter, Dr. Breeden states that in response to the recent hospitalization of many pregnant women and 20 pediatric deaths, ACOG has developed an algorithm for clinicians titled Influenza Season Assessment and Treatment for Pregnant Women with Influenza-Like Illness.

Dr. Breeden's letter reminds clinicians that "It is not too late to vaccinate. The College recommends that all pregnant women be immunized for seasonal influenza (flu) regardless of trimester due to their increased morbidity and mortality from the flu. Additionally, it is important to provide anti-viral treatment immediately to pregnant women with flu-like symptoms to help prevent more severe illness. Do not wait for test results to initiate treatment."

Dr. Breeden's letter also includes links to several tools that can help healthcare professionals get information about protecting their patients during flu season. Links related to the tools are given below.

Related Links
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Influenza is spreading and serious, and vaccination is recommended for nearly everyone, so please keep vaccinating your patients
Influenza vaccination is recommended for everyone age 6 months and older, so please continue to vaccinate your patients. If you don't provide influenza vaccination in your clinic, please recommend vaccination to your patients and refer them to the HealthMap Vaccine Finder to locate sites near their workplace or home that offer influenza vaccination services.

If you are seeking influenza vaccine for your clinic, check the Influenza Vaccine Availability Tracking System (IVATS), which is a resource for healthcare settings looking to purchase influenza vaccine. It contains information from approved, enrolled, and participating wholesale vaccine distributors or manufacturers of U.S. licensed influenza vaccine. Information was updated as recently as January 28 and will be updated on an ongoing basis.

Following is a list of resources related to influenza disease and vaccination for healthcare professionals and the public.

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JOURNAL ARTICLES AND NEWSLETTERS

CDC reports on progress made in U.S. immunization information systems in 2011
CDC published Progress in Immunization Information Systems—United States, 2011 in the January 25 issue of MMWR (pages 48–51). The first paragraph of the article is reprinted below.

Immunization information systems (IIS) are confidential, computerized, population-based systems that collect and consolidate vaccination data from vaccination providers and provide important tools for designing and sustaining effective immunization strategies. A Healthy People 2020 objective (IID-18) is to increase to 95% the proportion of children aged <6 years whose immunization records are in fully operational, population-based IIS. The National Vaccine Advisory Committee (NVAC) has published goals for IIS, including required and optional core data elements for which IIS should collect information. Two of the required core data elements are vaccine manufacturer and vaccine lot number. To monitor progress toward achieving these and other program goals, CDC annually surveys 56 immunization program grantees using the IIS Annual Report (IISAR). Results from the 2011 IISAR (completed by 54 grantees) indicate that 84% (19.2 million) of U.S. children aged <6 years participated in IIS, as defined by having at least two recorded vaccinations, an increase from 82% (18.8 million) in 2010. Grantees reported that an average of 63% of vaccination records for these children contained data in the field for vaccine manufacturer and 60% contained data in the field for lot number. A new project under way to capture vaccine product information, expiration date, and lot number on two-dimensional (2D) barcodes on vaccine vials might increase completeness, accuracy, and availability of these data elements in patient medical records and IIS, which in turn might enhance vaccine safety and support vaccine inventory management.

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CDC's surveillance of foodborne disease outbreaks includes information on hepatitis A
CDC published Surveillance for Foodborne Disease Outbreaks—United States, 2009–2010 in the January 25 issue of MMWR (pages 41–47). Table 1 and Table 2, which present statistical information on reported foodborne disease outbreaks, outbreak-associated illnesses, and hospitalizations, include information on hepatitis A.

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CONFERENCES AND MEETINGS

Minutes of the October 2012 ACIP meeting now online
The CDC website recently posted the minutes of ACIP's October 2012 meeting. In addition, extensive meeting information is available—including details on past and upcoming ACIP meetings, meeting dates, registration, draft agendas, minutes, live archives, and presentation slides.

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Meeting on therapeutic vaccines for reprogramming immunity to infectious diseases, allergy, and cancer is planned for March 25–27 in Annecy, France
A program titled Therapeutic Vaccines: Reprogramming Immunity in Infectious Diseases, Allergy, and Cancer is planned for March 25–27 at Les Pensieres Conference Center, Annecy, France.

Online registration is available. For additional information, email Catherine Dutel at catherine.dutel@fondation-merieux.org.

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About IAC Express
The Immunization Action Coalition welcomes redistribution of this issue of IAC Express or selected articles. When you do so, please add a note that the Immunization Action Coalition is the source of the material and provide a link to this issue.
If you have trouble receiving or displaying IAC Express messages, visit our online help section.
IAC Express is supported in part by Grant No. U38IP000589 from the National Center for Immunization and Respiratory Diseases, CDC. Its contents are solely the responsibility of IAC and do not necessarily represent the official views of CDC. IAC Express is also supported by educational grants from the following companies: CSL Biotherapies; GlaxoSmithKline; MedImmune, Inc.; Merck Sharp & Dohme Corp.; Novartis Vaccines; Ortho Clinical Diagnostics, Inc.; Pfizer, Inc.; and sanofi pasteur.
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Video: Risk of Pertussis and DTaP Vaccine Series
Risk of Pertussis and DTaP Vaccine Series: In an examination of cases of childhood pertussis in California, researchers found that children with pertussis had lower odds of having received all 5 doses of the diphtheria, tetanus, and acellular pertussis vaccine (DTaP) vaccine series, however the odds increased as the time since last DTaP dose lengthened, which is consistent with a progressive decrease in estimated vaccine effectiveness each year after the final dose of DTaP vaccine, according to JAMA.
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Issue Abbreviations
AAFP, American Academy of Family Physicians; AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; AMA, American Medical Association; CDC, Centers for Disease Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NCIRD, National Center for Immunization and Respiratory Diseases; NIVS, National Influenza Vaccine Summit; VIS, Vaccine Information Statement; VPD, vaccine-preventable disease; WHO, World Health Organization.
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Editor: Deborah L. Wexler, MD
Managing Editor: Dale Thompson, MA
Associate Editor: Teresa Anderson, DDS, MPH
Editorial Assistant: Janelle Tangonan Anderson
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This page was reviewed on January 27, 2014
 
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This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 5U38IP000290) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC.