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Issue 1230
Issue 1230: February 17, 2016

Ask the Experts
Ask the Experts—Question of the Week: Do we need to wait for the vaccine to reach room temperature before…read more


TOP STORIES


FEATURED RESOURCES


JOURNAL ARTICLES AND NEWSLETTERS


EDUCATION AND TRAINING

 


TOP STORIES


CDC reports on influenza-related hospitalizations and poverty levels

CDC published Influenza-Related Hospitalizations and Poverty Levels—United States, 2010–2012 in the February 12 issue of MMWR (pages 101–105). A summary made available to the press is reprinted below.

Some people are more at risk for severe influenza than others but few studies have looked at whether there are differences by socioeconomic status. An examination of data collected over two influenza seasons in 14 states representing 27 million people found that those living in census tracts with ≥ 20% of residents living below the federal poverty level had double the rate of influenza hospitalization compared to those where <5% lived below the poverty level. This relationship was present in all age and race/ethnic groups and for those needing intensive care and/or who died. People living in high-poverty census tracts represent a demographic group at higher risk for severe influenza outcomes and should be a focus for enhanced influenza vaccination and antiviral treatment efforts. 

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CDC publishes MMWR Supplement on strategies for reducing health disparities in the U.S.; includes chapter on disparities in hepatitis A virus disease in the U.S.

On February 12, CDC published an MMWR Supplement titled Strategies for Reducing Health Disparities—Selected CDC-Sponsored Interventions, United States, 2016. This document includes a chapter (pages 29–41) related to immunization titled Progress Toward Eliminating Hepatitis A Disease in the United States. The "Summary" section of this chapter is reprinted below.

Hepatitis A virus (HAV) disease disproportionately affects adolescents and young adults, American Indian/Alaska Native and Hispanic racial/ethnic groups, and disadvantaged populations. During 1996–2006, the Advisory Committee on Immunization Practices (ACIP) made incremental changes in hepatitis A (HepA) vaccination recommendations to increase coverage for children and persons at high risk for HAV infection. This report examines the temporal association of ACIP-recommended HepA vaccination and disparities (on the absolute scale) in cases of HAV disease and on seroprevalence of HAV-related protection (measured as antibody to HAV [anti-HAV]). ACIP-recommended childhood HepA vaccination in the United States has eliminated most absolute disparities in HAV disease by age, race/ethnicity, and geographic area with relatively modest ≥1-dose and ≥2-dose vaccine coverage. However, the increasing proportion of cases of HAV disease among adults with identified and unidentified sources of exposure underscores the importance of considering new strategies for preventing HAV infection among U.S. adults. For continued progress to be made toward elimination of HAV disease in the United States, additional strategies are needed to prevent HAV infection among an emerging population of susceptible adults. Notably, HAV infection remains endemic in much of the world, contributing to U.S. cases through international travel and the global food economy.

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Registration now open for CDC’s 47th National Immunization Conference on September 13–15

Registration is now open for the 47th National Immunization Conference (NIC), scheduled for September 13–15 at the Hilton Hotel in Atlanta, Georgia. The theme of the conference is Immunization: It Takes a Community. This three-day conference will include three plenary sessions, 12 breakout sessions, workshops, two immunization Q&A sessions, posters, exhibits, and the Hilleman Lecture. The meeting will highlight the following major topics:

  • Adult Immunization
  • Immunization Information Systems
  • Programmatic Issues
  • Health and Risk Communications
  • Epidemiology and Surveillance
  • Childhood and Adolescent Immunization 

There is no charge to attend the conference, but space is limited.  The organizers recommend registering well in advance of the registration deadline of August 22, 2016, to guarantee availability.

Access the conference web page, which includes information about conference and hotel registration, abstract submission, and more

For questions related to the 47th NIC, email NIPNIC@cdc.gov.


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IAC Spotlight! Standing orders templates can help practices and clinics improve vaccination rates

Standing orders authorize nurses, pharmacists, and other appropriately trained healthcare personnel, where allowed by state law, to assess a patient’s immunization status and administer vaccinations according to a protocol approved by an institution, physician, or other authorized practitioner. Standing orders work by enabling assessment and vaccination of the patient without the need for clinician examination or direct order from the attending provider at the time of the interaction. 

IAC has developed 31 standing orders templates for vaccines that are routinely recommended for children and adults. They are updated as needed and reviewed for technical accuracy by immunization experts at CDC. The most current versions can be accessed by going to www.immunize.org/standing-orders

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IAC’s “Take a Stand™” workshops proving highly successful around the country: Register NOW for a session in Seattle, Phoenix, or Tucson in March

The Immunization Action Coalition (IAC), with support from Pfizer, has implemented Take a Stand™, a national effort designed to improve adult immunization rates by increasing the use of standing orders in medical practices.*
 
At the core of this project are free workshops led by national experts, including L.J Tan, MS, PhDWilliam Atkinson, MD, MPH; and Deborah Wexler, MD, from IAC, and Alexandra Stewart, JD, from George Washington University. These workshops already have been conducted in Louisville, KY; Chicago, IL; Portsmouth, VA; Nashville, TN; Little Rock, AR; San Francisco, Sacramento, Los Angeles and San Diego, CA; and Fort Worth and San Antonio, TX. To illustrate how these have been going, here is a small sampling of comments received from attendees:
 
“Not only does this workshop provide great education, but it provides you with the tools and resources you need to implement this within your practice.” J.M., APN, MPH (Chicago, IL)
 
“This workshop gave us great ideas and information. Can’t wait to go back and start this process to get our Standing Orders going.” 
T.S., clinical manager (Fredericksburg, VA)
 
“Fantastic—great expertise, resources, tools and advice.” 
D.S. (Nashville, TN)
 
“This workshop is excellent for nursing directors/managers in the ambulatory setting. Excellent resources for preventive services.” 
L.R., primary care service line nursing director (Little Rock, AR)
 
Don’t miss your chance to join these satisfied attendees. The next workshops are scheduled in the following three cities.

Be sure to note that these are one-time-only events in each city. 

Who should attend? Clinicians, nurses, and practice managers in medical offices that serve adults, as well as pharmacists and quality improvement managers, will benefit from the workshops.
 
In addition to the Washington and Arizona sessions, other workshop locations and schedules, a sample agenda, and online registration are available on the Take a Stand™ website at www.standingorders.org

Please “take a stand” with us and spread the word about this unique opportunity for medical practices to improve their adult immunization rates while empowering staff and streamlining facility operations.
 
* Standing orders are written protocols approved by a physician or other authorized practitioner that allow qualified healthcare professionals (who are eligible to do so under state law, such as registered nurses or pharmacists) to assess the need for vaccination and to vaccinate patients meeting certain criteria. 
 
Workshop Information

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FEATURED RESOURCES


CDC offers online quiz for healthcare professionals about use of antivirals during the influenza season

CDC has posted a ten-question quiz on its website to help healthcare professionals learn about the recommended use of antiviral medications during the 2015–16 influenza season. Access the online Influenza Antiviral Quiz for Clinicians and see how you score!

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The Vaccine Handbook: A Practical Guide for Clinicians, a.k.a. "The Purple Book," by Dr. Gary Marshall available for purchase from IAC 

The Vaccine Handbook: A Practical Guide for Clinicians (“The Purple Book,” 2015, 560 pages) is a uniquely comprehensive source of practical, up-to-date information for vaccine providers and educators. Its author, Gary S. Marshall, MD, has drawn together the latest vaccine science and guidance into a concise, user-friendly, practical resource for the private office, public health clinic, academic medical center, and hospital.
Order your copy of The Vaccine Handbook today!
IAC Executive Director Deborah Wexler, MD, is enthusiastic about helping get this book circulated as widely as possible. “During more than 20 years in the field of immunization education, I have not seen a book that is so brimming with state-of-the-science vaccine information,” she states. "This book belongs in the hands of every medical student, physician-in-training, doctor, nursing student, and nurse who provides vaccines to patients.”
 
The Vaccine Handbook provides:

  • Information on every licensed vaccine in the United States
  • Rationale behind authoritative vaccine recommendations
  • Contingencies encountered in everyday practice
  • A chapter dedicated to addressing vaccine concerns
  • Background on how vaccine policy is made
  • Standards and regulations
  • Office logistics, including billing procedures, and much more

About the Author
Gary Marshall, MD, is professor of pediatrics at the University of Louisville School of Medicine in Kentucky, where he serves as chief of the division of pediatric infectious diseases and director of the Pediatric Clinical Trials Unit. In addition to being a busy clinician, he is nationally known for his work in the areas of vaccine research, advocacy, and education.

The newly released fifth edition of this invaluable guide is now available on IAC’s website at www.immunize.org/vaccine-handbook.

The price of the handbook is $29.95 each, plus shipping charges. Discount pricing is available for more than 10 copies. Order copies for your staff or for distribution at an upcoming conference.

Quantity Discount Pricing

  • 1–10 books: no discount + shipping
  • 11–50 books: 5% + shipping
  • 51–100 books: 10% + shipping
  • 101–500 books: 15% + shipping
  • 501–1000 books: 20% + shipping

For quotes on larger quantities, email admininfo@immunize.org.

Order your copy today!

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JOURNAL ARTICLES AND NEWSLETTERS


CDC and WHO report on circulating vaccine-derived poliovirus outbreaks in five countries in this week's MMWR and Weekly Epidemiological Report, respectively

CDC published Notes from the Field: Circulating Vaccine-Derived Poliovirus Outbreaks—Five Countries, 2014–2015 in the February 12 issue of MMWR (pages 128–129). On the same day, WHO's Weekly Epidemiological Record published a similar article titled Circulating vaccine-derived poliovirus outbreaks in 5 countries, 2014–2015. The first paragraph of the MMWR article is reprinted below.
 
In 2015, wild poliovirus (WPV) transmission was identified in only Afghanistan and Pakistan. The widespread use of live, attenuated oral poliovirus vaccine (OPV) has been key in polio eradication efforts. However, OPV use, particularly in areas with low vaccination coverage, is associated with the low risk for emergence of vaccine-derived polioviruses (VDPV), which can cause paralysis. VDPVs vary genetically from vaccine viruses and can cause outbreaks in areas with low vaccination coverage. Circulating VDPVs (cVDPVs) are VDPVs in confirmed outbreaks. Single VDPVs for which the origin cannot be determined are classified as ambiguous (aVDPVs), which can also cause paralysis. Among the three types of WPV, type 2 has been declared to be eradicated. More than 90% of cVDPV cases have been caused by type 2 cVDPVs (cVDPV2). Therefore, in April 2016, all OPV-using countries of the world are discontinuing use of type 2 Sabin vaccine by simultaneously switching from trivalent OPV (types 1, 2, and 3) to bivalent OPV (types 1 and 3) for routine and supplementary immunization. The World Health Organization recently broadened the definition of cVDPVs to include any VDPV with genetic evidence of prolonged transmission (i.e., >1.5 years) and indicated that any single VDPV2 event (a case of paralysis caused by a VDPV or isolation of a VDPV from an environmental specimen) should elicit a detailed outbreak investigation and local immunization response. A confirmed cVDPV2 detection should elicit a full poliovirus outbreak response that includes multiple supplemental immunization activities (SIAs); an aVDPV designation should be made only after investigation and response. Since 2005, there have been 1–8 cVDPV outbreaks and 3–12 aVDPV events per year. There are currently five active cVDPV outbreaks in Guinea, Laos, Madagascar, Myanmar, and Ukraine, and four other active VDPV events.


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"Health Affairs" issue focuses on vaccination, with a special emphasis on the value of vaccines

The February issue of the journal Health Affairs focuses on the topic of vaccines, with a special emphasis on the cost-effectiveness and value of vaccines.

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Study finds that less than half of U.S. infants receive recommended influenza vaccination

The March issue of the journal Pediatrics includes an article titled Complete Influenza Vaccination Trends for Children Six to Twenty-Three Months. The abstract is reprinted below.

OBJECTIVE
Prevention of influenza among infants and young children is a public health priority because of their high risk for influenza-related complications. Depending on a child’s age and previous influenza vaccination history, they are recommended to receive either 1 dose or 2 doses of influenza vaccine to be considered fully vaccinated against influenza for the season. We compared estimates of full (complete) influenza vaccination coverage of children 6 to 23 months across 10 consecutive influenza seasons (2002–2012), by race/ethnicity, age group, and by number of doses required to be fully vaccinated given child’s vaccination history.

METHODS 
National Immunization Survey data were used to estimate full influenza vaccination status among children 6 to 23 months on the basis of provider report. Estimates were computed by using Kaplan-Meier survival analysis methods.

RESULTS
Full influenza vaccination coverage among children 6 to 23 months increased from 4.8% in the 2002–2003 influenza season to 44.7% in the 2011–2012 season. In all 10 influenza seasons studied, non-Hispanic black children and Hispanic children had lower full influenza vaccination coverage than non-Hispanic white children. For all 10 influenza seasons, full influenza vaccination coverage was higher among children requiring only 1 dose compared with those requiring 2 doses.

CONCLUSIONS
Less than half of children 6 to 23 months in the United States, and an even a smaller percentage of Hispanic and non-Hispanic black children, are fully vaccinated against influenza. More implementation of evidence-based strategies that increase the percentage of children who are fully vaccinated is needed.


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EDUCATION AND TRAINING


Access archived webinars from CDC and the Vaccine Education Center
 
Healthcare professionals who missed recent Current Issues in Immunization NetConferences from CDC, or Current Issues in Vaccines webinars from the Vaccine Education Center (VEC) at the Children's Hospital of Philadelphia, can view some of the more recent offerings online.
  • Ten NetConference webinars are archived on CDC's Current Issues in Immunization NetConference web page, including CDC's 15-part series on the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases ("The Pink Book").
  • Three Current Issues in Vaccines webinars with continuing education credit (CPE, CME, and CEU) are available at VEC's Vaccine Webinar Archive

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ASK THE EXPERTS

Question of the Week

Do we need to wait for the vaccine to reach room temperature before we administer it to a patient?   

There is no recommendation to wait until a vaccine reaches room temperature before administration. The vaccine should be administered as soon as it is prepared.


About IAC's Question of the Week

Each week, IAC Express highlights a new, topical, or important-to-reiterate Q&A. This feature is a cooperative venture between IAC and CDC. William L. Atkinson, MD, MPH, IAC's associate director for immunization education, chooses a new Q&A to feature every week from a set of Q&As prepared by experts at CDC’s National Center for Immunization and Respiratory Diseases.

We hope you enjoy this new feature and find it helpful when dealing with difficult real-life scenarios in your vaccination practice. Please encourage your healthcare professional colleagues to sign up to receive IAC Express at www.immunize.org/subscribe.

If you have a question for the CDC immunization experts, you can email them directly at nipinfo@cdc.gov. There is no charge for this service.

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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: AstraZeneca, Inc.; bioCSL Inc.; Merck Sharp & Dohme Corp.; Pfizer, Inc.; and Sanofi Pasteur.
IAC Express Disclaimer
ISSN: 1526-1786

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