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Issue 1272
Issue 1272: October 26, 2016

Ask the Experts
Ask the Experts—Question of the Week: We have a patient who has selective IgA deficiency. We also have patients with selective…read more


TOP STORIES


VACCINE INFORMATION STATEMENTS


FEATURED RESOURCES


JOURNAL ARTICLES AND NEWSLETTERS


EDUCATION AND TRAINING


CONFERENCES AND MEETINGS

 


TOP STORIES


Reminder! October issues of Needle Tips and Vaccinate Adults are available online

The October issues of Needle Tips and Vaccinate Adults are now available online. Vaccinate Adults is an abbreviated version of Needle Tips with the pediatric content removed. Both publications feature important information about the 2016–17 influenza recommendations, including related "Ask the Experts" Q&As from CDC medical officer Andrew T. Kroger, MD, MPH, and nurse educator Donna L. Weaver, RN, MN, both with the National Center for Immunization and Respiratory Diseases, CDC. In addition, they include many immunization resources that healthcare professionals can use in their practice settings, including IAC's standing orders templates for administering influenza and pneumococcal vaccines (PCV13 and PPSV23).

Click on the images below to download the October issues (PDF) of Needle Tips and/or Vaccinate Adults.

Download the November issue of Needle TipsDownload the November issue of Vaccinate Adults

Needle Tips: View the Table of Contents, Ask the Experts section, magazine viewer, and back issues.

Vaccinate Adults: View the Table of Contents, Ask the Experts section, magazine viewer, and back issues.

If you would like to receive immediate email notification whenever new issues of Needle Tips or Vaccinate Adults are released, visit IAC's subscribe page to sign up.

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ACIP votes to recommend 2-dose HPV vaccine series for younger adolescents; related CDC webinar on October 26

The Advisory Committee on Immunization Practices (ACIP) met October 19–20. A selection from the October 19 press release about their vote to recommend 2 doses of HPV vaccine for younger adolescents is reprinted below.

The Advisory Committee on Immunization Practices (ACIP) voted today to recommend a 2-dose HPV vaccine schedule for young adolescents. ACIP is a panel of experts that advises the CDC on vaccine recommendations in the United States. CDC Director Frieden approved the committee’s recommendations shortly after the vote. ACIP recommendations approved by the CDC Director become agency guidelines on the date published in the Morbidity and Mortality Weekly Report (MMWR)
 
CDC and ACIP made this recommendation after a thorough review of studies over several meetings. CDC and ACIP reviewed data from clinical trials showing two doses of HPV vaccine in younger adolescents (aged 9
14 years) produced an immune response similar or higher than the response in young adults (aged 1626 years) who received three doses.
 
Generally, preteens receive HPV vaccine at the same time as whooping cough and meningitis vaccines. Two doses of HPV vaccine given at least six months apart at ages 11 and 12 years will provide safe, effective, and long-lasting protection against HPV cancers. Adolescents ages 13
14 are also able to receive HPV vaccination on the new 2-dose schedule.
 
CDC will provide guidance to parents, healthcare professionals, and insurers on the change in recommendation. On October 7, 2016, the U.S. Food and Drug Administration (FDA) approved adding a 2-dose schedule for 9-valent HPV vaccine (Gardasil® 9) for adolescents ages 9 through 14 years. CDC encourages clinicians to begin implementing the 2-dose schedule in their practice to protect their preteen patients from HPV cancers.


CDC’s Immunization Services Division is hosting a one-hour webinar about the new HPV vaccine recommendations on October 26 at 12:00 p.m. (ET). Dr. Lauri Markowitz of the Division of Viral Diseases will be discussing the HPV vaccine recommendation changes that occurred during the October ACIP meeting. 

If you are unable to participate in the NetConference, it will be posted on CDC’s Current Issues in Immunization website after November 1. CE credits will continue to be available for 30 days.

Registration is now open.

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IAC provides summary article about votes taken at Oct 19–20 ACIP meeting

The Advisory Committee on Immunization Practices (ACIP) met in Atlanta on October 19–20. In addition to the votes described below, topics discussed at the meeting included herpes zoster, pneumococcal, influenza, yellow fever, and respiratory syncytial virus (RSV) vaccines. Six votes were taken at the meeting.

Hepatitis B Vaccine
The rate of acute hepatitis B virus (HBV) infections in the United States has declined by more than 90 percent since recommendations for hepatitis B vaccine (HepB) were first issued in 1982. Since that time, HepB recommendations have been updated multiple times; since 2005, five statements have been published which offered recommendations based on differing criteria such as the recipient’s age, chronic health condition, pregnancy status, or occupation.

At the October meeting, ACIP voted to approve a single guidance document that consolidated these previously published recommendations into a comprehensive statement. The committee reemphasized the importance of the HepB birth dose as a safety net against chronic HBV infection passed from a mother to her infant by recommending that all infants of hepatitis B surface antigen (HBsAg)-negative mothers should be immunized with HepB within 24 hours of birth. This removes previous policy language that allowed for a delay in administering the birth dose in certain rare circumstances and on a case-by-case basis. Additional areas updated on the statement include prioritization of HBsAg-positive women for HBV management and therapy, guidance on post-vaccination serologic testing for infants whose mother’s HBsAg status remains unknown indefinitely (e.g., infant surrendered anonymously after birth), and provision of specific examples of chronic liver disease to further define whom to vaccinate.

Tdap Vaccine
Previous ACIP recommendations called for prenatal care providers to vaccinate all pregnant women with tetanus-diphtheria-acellular pertussis (Tdap) vaccine during each pregnancy with optimal timing for this dose designated between 27 and 36 weeks gestation. Following a presentation of data indicating increased immunogenicity of the vaccine when mothers were vaccinated earlier, ACIP voted to recommend administering Tdap vaccination early in the 27- through 36-week “window” to maximize passive antibody transfer to the infant. The new recommendations also clarify that persons 7–10 years of age who receive Tdap as part of a catch-up series may be given an additional Tdap for the routinely recommended adolescent dose at 11–12 years of age.

Human Papillomavirus (HPV) Vaccine
Although HPV vaccine has been recommended for females since 2006 and males since 2011, the 2015 NIS-Teen indicated that for adolescents 13–17 years of age, less than one-half (41.9%) of girls and less than one-third (28.1%) of boys had received the recommended three doses. On October 7, the Food and Drug Administration (FDA) approved adding a 2-dose schedule for 9vHPV (Gardasil 9, Merck) vaccine for adolescents 9–14 years of age. After reviewing the immunogenicity data and efficacy trials of the 2-dose schedule, ACIP voted to recommend that younger adolescents who begin the series at 9 through 14 years of age receive two doses of HPV at least six months apart, rather than the previously recommended 3-dose series. Two doses (not three) are recommended for anyone who receives the first dose before the 15th birthday, regardless of age at series completion. It is anticipated this schedule will increase vaccine initiation and series completion in the U.S. Teens and young adults who start the series later, at 15–26 years of age, will continue to need three doses.

According to CDC’s official press release, “CDC encourages clinicians to begin implementing the 2-dose schedule in their practice to protect their preteen patients from HPV cancers.” The 9vHPV vaccine will soon be the only HPV vaccine available in this country; Merck will distribute only 9vHPV after the end of October, and supplies of 2vHPV (Cervarix, GlaxoSmithKline) in the U.S. are expected to be depleted by November. 9vHPV may be used to complete a series begun with 4vHPV or 2vHPV.

To assist providers in implementing the new recommendation, CDC is offering a webinar as part of its Current Issues in Immunization NetConference (CIINC) series. Recommendations for HPV Vaccination: 2016 Update will be presented on October 28, 2016, from 12 noon –1 p.m. ET.

Meningococcal Serogroup B Vaccine
In 2015, ACIP recommended routine meningococcal serogroup B (MenB) vaccination for persons 10 years of age or older who were at increased risk of meningococcal infection. The committee also recommended the vaccine may be provided to healthy adolescents and young adults 16 through 23 years of age. ACIP did not express a preference for use of MenB-4C (Bexsero, GlaxoSmithKline) or MenB-FHbp (Trumenba, Pfizer), although the same product must be used for the entire series.

Bexero has previously been recommended for use with a 2-dose schedule for high-risk individuals and in outbreak settings, and may be administered to healthy individuals 16 through 23 years of age. In April, the FDA approved a label change giving Trumenba a 2-dose (0, 6 months) or 3-dose (0, 1–2, 6 months) schedule. The ACIP voted to recommend that providers who use Trumenba continue to use the 3-dose schedule when vaccinating persons at increased risk of meningococcal serogroup B disease (e.g., persons with persistent complement component deficiencies or anatomical or functional asplenia) or during serogroup B outbreaks. The 2-dose schedule of Trumenba at 0, 6 months can be used for routine vaccination for healthy persons 16 through 23 years of age.

Child and Adolescent Immunization Schedule
ACIP annually updates the recommended immunization schedule for children and adolescents. Although ACIP voted on edits for the 2017 schedule during the October meeting, the final schedule is not slated to be published until February 2017. Many changes approved for the 2017 schedule incorporate policies previously approved by ACIP during 2016. The majority of the edits involve changes to help improve readability and usability of the document. Users should review the schedule when it is published in 2017 for specific details.

One of the significant formatting changes in the schedule was made to the age columns. The vaccine recommendations for adolescents 16 years of age have been emphasized by placing them in a separate column from the recommendations for persons 17 through 18 years of age. In making this distinction, ACIP is highlighting the importance of the 16-year-old visit to administer the recommended meningococcal conjugate (Men-ACWY) booster dose, as well as to provide the opportunity to deliver MenB vaccine and catch-up on other recommended adolescent vaccines such as HPV and Tdap. Previously there was one column for ages 16 through 18 years.

Adult Immunization Schedule
Similar to the child and adolescent schedule, the updated adult immunization recommendations are scheduled for publication in early 2017. In addition to multiple revisions being made to improve the readability and clarity of the schedule, a significant change to the table format is that the ages 27 through 59 years will be shown as one age group in a single column. Previously the age groups were in two columns, one for 27 through 49 years, and the other for 50 through 59 years.

All recommendations approved by ACIP are provisional until they are approved by the director of CDC and published in MMWR. Presentation slides from the October meeting should be posted on the ACIP website in the next 4–6 weeks.

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CDC reports on status of new vaccine introduction worldwide in MMWR

CDC published Status of New Vaccine Introduction—Worldwide, September 2016in the October 21 issue of MMWR (pages 1136–40). A summary made available to the press is reprinted below.

Historically, new vaccines became available in low- and middle-income countries decades after being introduced in high-income countries. However, this gap is rapidly decreasing with support from global partners. As of September 2016, nearly all countries have introduced hepatitis B vaccine. Over three-quarters have introduced Haemophilus influenzae type b (Hib), second dose of measles-containing (MCV2), and rubella vaccines. Two-thirds have introduced pneumococcal conjugate vaccine (PCV) and fewer than half have introduced rotavirus or human papillomavirus vaccine (HPV). Despite donor support, countries might choose not to introduce a vaccine because of country policies, financial constraints, lack of disease burden data, or vaccine hesitancy. Vaccine introduction provides opportunities for strengthening a country’s immunization program and overall health system.

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CDC NetConference about vaccines during pregnancy scheduled for November 9

CDC will present a one-hour "Current Issues in Immunization NetConference" on November 9 at 12:00 p.m. (ET). The topic is "Vaccines during Pregnancy: A Strong Record of Safety." The NetConference will be moderated by Andrew Kroger, MD, MPH, medical officer, CDC, NCIRD.

This is a limited registration event. Registration is required.

Related Link

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Join Voices for Vaccines for a November 10 conference call about online vaccine advocacy

If you work in healthcare or are a healthcare consumer, you are invited to join Voices for Vaccines' speaker Melody Butler on the next Voices for Vaccines conference call on November 10 at 12:00 (ET). Ms. Butler, founder and director of Nurses Who Vaccinate, will explore how professionalism and advocacy intersect. The call is free and open to the public but you must register online ahead of time.

Voices for Vaccines is a national organization of parents and others who are dedicated to raising the level of the voices of immunization supporters. VFV invites everyone who appreciates vaccines to become a member of their organization. Please spread the word to your friends and colleagues to register for the conference call and to join VFV!

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Join CDC’s #FightFlu campaign on social media

CDC's #FightFlu social media campaign captures and shares flu vaccination activities. During or after getting a flu shot, share photos and videos of yourself using the hashtag #FightFlu on digital platforms (Twitter, Facebook, Instagram, and YouTube). CDC will post weekly updates to the campaign timeline. For more information, contact fluinbox@cdc.gov.

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VACCINE INFORMATION STATEMENTS

IAC posts Armenian-language translation of the HPV9 VIS

IAC recently posted an Armenian-language translation of the HPV9 vaccine VIS.

Related Links

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FEATURED RESOURCES


Influenza is serious; many resources are available to help health professionals vaccinate patients

Influenza vaccination is recommended for everyone six months of age and older. If you don't provide influenza vaccination in your clinic, please recommend vaccination to your patients and refer them to a clinic or pharmacy that provides vaccines or to the HealthMap Vaccine Finder to locate sites near their workplaces or homes that offer influenza vaccination services.

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


Study shows economic impact of adult vaccine-preventable diseases

In October, the journal HealthAffairs published an article titled Modeling the Economic Burden of Adult Vaccine-Preventable Diseases in the United States. The abstract is reprinted below.

Vaccines save thousands of lives in the United States every year, but many adults remain unvaccinated. Low rates of vaccine uptake lead to costs to individuals and society in terms of deaths and disabilities, which are avoidable, and they create economic losses from doctor visits, hospitalizations, and lost income. To identify the magnitude of this problem, we calculated the current economic burden that is attributable to vaccine-preventable diseases among U.S. adults. We estimated the total remaining economic burden at approximately $9 billion (plausibility range: $4.7–$15.2 billion) in a single year, 2015, from vaccine-preventable diseases related to ten vaccines recommended for adults ages nineteen and older. Unvaccinated individuals are responsible for almost 80 percent, or $7.1 billion, of the financial burden. These results not only indicate the potential economic benefit of increasing adult immunization uptake but also highlight the value of vaccines. Policies should focus on minimizing the negative externalities or spillover effects from the choice not to be vaccinated, while preserving patient autonomy.

Related Links

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EDUCATION AND TRAINING


NFID to offer webinar “Updates from October 2016 ACIP Meeting” on November 16
 
The National Foundation for Infectious Diseases (NFID) will present a one-hour webinar at 12:00 p.m. (ET) on November 16. Titled Updates from October 2016 ACIP Meeting, the webinar will be moderated by William Schaffner, MD, medical director, NFID and Patricia Stinchfield, MS, CPNP, CIC, senior director, infection prevention and control and pediatric nurse practitioner, infectious disease/immunology, Children's Hospitals of Minnesota.

Registration (required) is open now.

Related Link

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CDC updates its "You Call the Shots" module on influenza; free CE credit available

CDC recently updated the Influenza module of its web-based training course You Call the Shots. The nurse education training program has 11 modules on a variety of immunization topics (e.g., DTaP, Hepatitis A, Pneumococcal, Vaccine Storage and Handling, Vaccines for Children). Continuing education credit is available for viewing a module and completing an evaluation. The training course is supported by CDC through a cooperative agreement with the Association for Prevention Teaching and Research.

The Influenza module was updated in October. Participants can access information about obtaining CE credit from the You Call the Shots main page.

Related Links

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CONFERENCES AND MEETINGS


Immunize Ohio Conference to be held November 16

The Immunize Ohio Conference will take place November 16 in Wadsworth, OH. For information on the location, agenda, CE credits available, and hotel booking please visit the event's website at immunizeohio.org.

More information about registering online or through the mail is available online.

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Early-bird registration ends November 18 for Hawaii Immunization Coalition's "Pink Book" course offering

The Hawaii Immunization Coalition (HIC) will be offering a two-day, in-person course covering Epidemiology and Prevention of Vaccine-Preventable Diseases ("The Pink Book") with CDC faculty reviewing immunization principles, as well as vaccine-preventable diseases and the recommended vaccines to prevent them. The course will take place January 10–11, 2017. Early-bird registration ends November 18.

Registration is available on HIC's website.

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ASK THE EXPERTS

Question of the Week

We have a patient who has selective IgA deficiency. We also have patients with selective IgM deficiency. Can MMR or varicella vaccine be administered to these patients?

There is no known risk associated with MMR or varicella vaccination in someone with selective IgA or IgM deficiency. It is possible that the immune response may be weaker, but the vaccines are likely effective.


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.

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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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Issue Abbreviations
AAFP: American Academy of Family Physicians
AAP: American Academy of Pediatrics
ACIP: Advisory Committee on Immunization Practices
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