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Issue 1265
Issue 1265: September 14, 2016

Ask the Experts
Ask the Experts—Question of the Week: I know that live attenuated influenza vaccine (LAIV, FluMist) is not recommended…read more


TOP STORIES


IAC HANDOUTS


VACCINE INFORMATION STATEMENTS


WORLD NEWS


FEATURED RESOURCES


JOURNAL ARTICLES AND NEWSLETTERS


EDUCATION AND TRAINING


CONFERENCES AND MEETINGS



TOP STORIES


AAP issues recommendations for influenza vaccination for 2016–2017 season

On September 6, the American Academy of Pediatrics (AAP) published a policy statement online titled Recommendations for Prevention and Control of Influenza in Children, 2016–2017. The recommendations are also available as a PDF. The Academy recommends pediatricians immunize all children starting at 6 months of age with inactivated influenza vaccine (IIV), and does not recommend the nasal spray vaccine this flu season, after studies show poor effectiveness. This is the same as the ACIP recommendations published on August 26.

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CDC and WHO report on global cessation of trivalent OPV use in MMWR and Weekly Epidemiological Report, respectively

CDC published Cessation of Trivalent Oral Poliovirus Vaccine and Introduction of Inactivated Poliovirus Vaccine—Worldwide, 2016 in the September 9 issue of MMWR (pages 934–938). On the same day, WHO's Weekly Epidemiological Record published a similar article titled Cessation of use of trivalent oral polio vaccine and introduction of inactivated poliovirus vaccine worldwide, 2016. A media summary of the MMWR article is reprinted below.

In an unprecedented feat of coordination and synchronization, all countries using oral polio vaccines (OPV) have stopped using trivalent OPV (tOPV), which contains weakened types 1, 2, and 3 polioviruses. All 155 countries and territories using OPV in 2015 reported that they had stopped use of tOPV by May 12, 2016; 150 switched to bivalent OPV (bOPV), which contains only types 1 and 3 polioviruses. Use of tOPV was stopped to prevent future type 2 vaccine-derived polioviruses. More than 140 polio vaccination campaigns were held, more than 160,000 vaccine stores and health facilities were checked for remaining tOPV, and 105 countries started use of inactivated polio vaccine to minimize the risk from type 2 vaccine-derived polioviruses after tOPV use ceased. The global polio surveillance system has detected a few type 2 vaccine-derived polioviruses since the switch, triggering vaccination campaigns with stockpiled polio vaccine. So far the experience with cessation of tOPV use shows that bOPV can be successfully withdrawn in a coordinated manner after type 1 wild poliovirus is eradicated to eliminate all risks from vaccine-derived polioviruses.

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MMWR reports on varicella outbreak associated with riding on a bus in Michigan

In the September 9 issue of MMWR (pages 941–942), CDC published Notes from the Field: Varicella Outbreak Associated with Riding on a School Bus—Muskegon County, Michigan, 2015. An excerpt from the article is reprinted below.

This outbreak of varicella appears to have begun with an adult case of herpes zoster and resulted in nine cases of varicella in children residing in three households. The timeline of rash onsets is consistent with the 10- to 21- day incubation period for varicella. With continued 2-dose childhood varicella vaccination and declining incidence of varicella among children, transmission of varicella initiated by adults with herpes zoster might become increasingly more likely. This investigation also strongly suggests that transmission of varicella to children residing in households B and C occurred while riding the same school bus as the index patient. Varicella transmission on school buses is plausible and was implicated previously as a risk factor for transmission in a large varicella outbreak reported in China. Public health investigators who see similar findings might consider the close proximity of students in a relatively small, enclosed space, such as a school bus, as a risk factor for airborne transmission of diseases such as varicella.

This investigation underscores the importance of maintaining high 2-dose varicella immunization levels to reduce risk for disease transmission. The high immunization rates achieved in this school likely limited the scope of the varicella outbreak. Two doses of varicella vaccine are routinely recommended for children at age 12–15 months and age 4–6 years. In addition, contacts of patients with varicella or herpes zoster should immediately be evaluated for evidence of varicella immunity to determine need for postexposure varicella vaccination. Early vaccination of exposed susceptible persons can prevent disease and transmission.


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IAC HANDOUTS


IAC posts "Standing Orders for Administering Influenza Vaccine to Adults" and "Standing Orders for Administering Influenza Vaccine to Children and Adolescents"

IAC recently posted updated standing orders templates for administering influenza vaccines. They were updated to include a note of non-recommendation of LAIV for the 2016-17 vaccination season, updated recommendations regarding egg allergy, and updated vaccine options for adults.

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IAC posts "Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination" and "Screening Checklist for Contraindications to Live Attenuated Intranasal Influenza Vaccination"

IAC recently posted updated influenza vaccination resources for healthcare professionals to use during the 2016–2017 influenza season. 

Changes to the IIV screening questionnaire were made only on page two and include revision of recommendations for vaccination of people with egg allergy, and clarification of oculorespiratory syndrome as a non-allergic response to IIV.

Changes to the screening questionnaire for LAIV include a box inserted at the top of page one noting the use of LAIV is not recommended by ACIP for the 2016-17 vaccination season, on page two, a statement about the revision of recommendations for vaccination of people with egg allergy, and also on page two, the addition of the antiviral peramivir as a precaution to LAIV.

IAC's Handouts for Patients & Staff web section offers healthcare professionals and the public more than 250 FREE English-language handouts (many also available in translation), which we encourage website users to print out, copy, and distribute widely.

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IAC updates "When Do Children and Teens Need Vaccinations?" and "Vaccinations for Preteens and Teens, Age 11–19 Years," user-friendly schedules for parents of children and preteens/teens

IAC recently updated the following schedules for parents to clarify the number of MenB vaccine doses needed as well as other minor changes.

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IAC updates English- and Spanish-language versions of "Cocooning Protects Babies: Everyone in a baby’s life needs to get vaccinated against whooping cough and flu!"

IAC recently reviewed "Cocooning Protects Babies: Everyone in a baby’s life needs to get vaccinated against whooping cough and flu!" and determined that the information was still current. The date on the bottom of the English- and Spanish-language versions has been updated to reflect this review.

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VACCINE INFORMATION STATEMENTS


IAC posts nine translations of the Polio-IPV VIS

IAC recently posted nine translations of the Polio-IPV VIS dated July 20, 2016. These translations are provided by IAC through a cooperative agreement with CDC.

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WORLD NEWS


Nigeria polio vaccination drive targets areas formerly held by militant insurgency groups

The World Health Organization recently published a news release titled WHO scales up response to humanitarian crisis in Nigeria. An excerpt is reprinted below.

WHO has already deployed expert staff to Nigeria for emergency operations, coordination, and data management. Another team is on the ground in Borno State to help with the polio outbreak response. The government has already launched emergency polio vaccination activities, with support from WHO and partners. The first round of vaccinations will soon be completed, targeting 1 million children. Subsequent large-scale polio immunization rounds are planned before November. WHO has also dispatched emergency drugs and supplies, while the organization’s emergency operations will be further reinforced by an expanded, experienced response team in coming days.

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Millions vaccinated against yellow fever in the Democratic Republic of the Congo

On September 2, the United Nations News Centre published Millions vaccinated against yellow fever in Africa in record time–UN health agency. An excerpt from the article is reprinted below.

Together with its partners, the United Nations health agency has vaccinated more than 7.7 million people in Kinshasa, capital of the Democratic Republic of the Congo (DRC), in less than two weeks.

These vaccinations are a major part of the largest emergency vaccination campaign against yellow fever ever attempted in Africa.

According to the agency, planning a vaccination campaign of this scale usually takes up to six months, however, this campaign was put in place in a matter of weeks to end transmission of yellow fever before the rainy season starts in September.

Furthermore, a “dose sparing” strategy—using one fifth of the full dose of yellow fever vaccine—was employed for this campaign, under the recommendation of the WHO Strategic Advisory Group of Experts on Immunization, as a short-term emergency measure to reach as many people as possible given limited supplies of the vaccine.

WHO, along with the Ministry of Public Health and more than 50 global partners, worked closely together to roll out the vaccination drive in more than 8,000 locations across the DRC—both in dense, urban areas and in hard-to-reach, remote border regions, the agency said in the release.

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FEATURED RESOURCES


The One & Only campaign offers resources to raise awareness about safe injection practices

The One & Only Campaign is a public health campaign, led by CDC and the Safe Injection Practices Coalition (SIPC), to raise awareness among patients and healthcare professionals about safe injection practices. A selection of background information from the campaign's website is reprinted below.

Since 2001, more than 150,000 patients in the United States have been notified of potential exposure to hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV due to lapses in basic infection control practices. Many of these lapses involved healthcare providers reusing syringes, resulting in contamination of medication vials or containers which were used then on subsequent patients.

The goal of the One & Only Campaign is to ensure patients are protected each and every time they receive a medical injection. This will be attained by empowering patients and re-educating healthcare providers regarding safe injection practices. Targeted education and awareness campaigns focus on influencing the culture of patient safety. Patients and providers must both insist on nothing less than One Needle, One Syringe, Only One Time for each and every injection.


Order print publications related to injection safety from CDC-INFO on Demand or download them from the campaign website.

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Download Dr. Gary Marshall's The Vaccine Handbook: A Practical Guide for Clinicians (“The Purple Book") as an app for iOS devices or purchase as a print book

The Vaccine Handbook: A Practical Guide for Clinicians (“The Purple Book,” 2015) is a 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. This book is also available as an app for iOS devices.

Information about the iOS app version of The Vaccine Handbook: A Practical Guide for Clinicians

The Vaccine Handbook App contains the 5th edition of the book, updated with the latest immunization schedules and recommendations. The app enhances the utility of an already valuable print resource by including functions like keyword search, internal links, bookmarking, quick access to schedules and tables, hyperlinks to external sources, and the ability for real-time updates. A resources section provides ready access to authoritative immunization-related websites. Available through a collaboration between the publisher and Sanofi Pasteur, registration as well as reporting under Open Payments is required. (Offer void in Minnesota.) Click on the image below to visit the relevant App Store page to download this resource today.
Download new app!
Information about the print version of The Vaccine Handbook: A Practical Guide for Clinicians

The fifth edition of this valuable guide (560 pages) is 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! Click on the image below to visit the "Shop IAC: The Vaccine Handbook" web page.
Order your copy of The Vaccine Handbook today!
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.

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JOURNAL ARTICLES AND NEWSLETTERS


Survey of pediatricians finds increase in vaccine refusal

A review of the American Academy of Pediatrics Periodic Surveys from 2006 and 2013, titled Vaccine Delays, Refusals, and Patient Dismissals: A Survey of Pediatricians, found increases in vaccine refusals and delays as well as an increase in pediatricians dismissing patients. The "Results" and "Conclusions" sections of the abstract are reprinted below.

RESULTS: The proportion of pediatricians reporting parental vaccine refusals increased from 74.5% in 2006 to 87.0% in 2013 (P < .001). Pediatricians perceive that parents are increasingly refusing vaccinations because parents believe they are unnecessary (63.4% in 2006 vs 73.1% in 2013; P = .002). A total of 75.0% of pediatricians reported that parents delay vaccines because of concern about discomfort, and 72.5% indicated that they delay because of concern for immune system burden. In 2006, 6.1% of pediatricians reported “always” dismissing patients for continued vaccine refusal, and by 2013 that percentage increased to 11.7% (P = .004).

CONCLUSIONS: Pediatricians reported increased vaccine refusal between 2006 and 2013. They perceive that vaccine-refusing parents increasingly believe that immunizations are unnecessary. Pediatricians continue to provide vaccine education but are also dismissing patients at higher rates.


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August issue of CDC's Immunization Works newsletter now available

CDC recently released the August issue of its monthly newsletter Immunization Works and posted it on the website of the National Center for Immunization and Respiratory Diseases (NCIRD). The newsletter offers the immunization community information about current topics. The information is in the public domain and can be reproduced and circulated widely.

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EDUCATION AND TRAINING


Weekly CDC webinar series on "The Pink Book" chapter topics continues through September 21; register now

CDC is presenting a 15-part webinar series to provide a chapter-by-chapter overview of the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book"). This is a live series of one-hour webinars that started June 1. Recordings of sessions will be available online after each webinar. All sessions begin at 12:00 p.m. (ET). Information about receiving continuing education credit will be available for each session after it is archived. CE credit may be available for up to a year after the date it was live.

Registration and more information is available on CDC's Pink Book Webinar Series web page.

Download Epidemiology and Prevention of Vaccine-Preventable Diseases

Order Epidemiology and Prevention of Vaccine-Preventable Diseases

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CONFERENCES AND MEETINGS


"Pink Book" training scheduled for October 25–26 in Austin, TX

The Texas "Pink Book" training will take place October 25–26 in Austin. The Centers for Disease Control and Prevention's (CDC) National Center for Immunization and Respiratory Diseases will present a live, two-day comprehensive review of immunization principles, as well as vaccine-preventable diseases and the recommended vaccines to prevent them. The course is designed for anyone seeking the most comprehensive and current knowledge of immunization, including physicians, nurses, medical assistants, pharmacists, immunization providers, program managers, and nursing and medical students.

For information on the location, agenda, CE credits available, and hotel booking information please visit the event's website at TexasEpiVac.com.

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ASK THE EXPERTS

Question of the Week

I know that live attenuated influenza vaccine (LAIV, FluMist) is not recommended to be used this season. If a dose of LAIV is administered this year, does it count or should we repeat it with inactivated influenza vaccine?

The dose can be counted. It does not need to be repeated with inactivated influenza vaccine. 


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 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.
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