Issue 1292: March 1, 2017
Ask the Experts—Question of the Week: If a child falls behind on immunizations, is it recommended to use . . . read more
TOP STORIES
OFFICIAL RELEASES AND ANNOUNCEMENTS
WORLD NEWS
FEATURED RESOURCES
JOURNAL ARTICLES AND NEWSLETTERS
EDUCATION AND TRAINING
CONFERENCES AND MEETINGS
TOP STORIES
February ACIP meeting vote: For infants born to HBsAg-positive mothers who are nonresponders to the initial 3-dose HepB series, 1 additional HepB dose is now preferred over a repeated 3-dose series
CDC’s Advisory Committee on Immunization Practices (ACIP) met in Atlanta on
February 22–23. In addition to the hepatitis B vaccine vote described below,
topics discussed at the meeting included updates on the upcoming influenza
vaccine season and a new herpes zoster vaccine, informational sessions on future
meningococcal vaccine deliberations, an overview of vaccine administration
errors, presentations on mumps epidemiology, and updates on flavivirus (dengue,
Zika, and yellow fever) vaccines.
In the sole ACIP vote at this session, the Committee expressed its preference regarding the revaccination of infants born to hepatitis B surface antigen-positive (HBsAg+) mothers who were nonresponders to the initial 3-dose vaccine series. Previously, the ACIP recommended that these infants who did not respond (i.e., had antibody to hepatitis B surface antigen [anti-HBs] levels less than 10 mIU/mL after a properly administered 3-dose series) should be revaccinated with a second 3-dose series.
After reviewing data indicating many revaccinated infants need only one
additional dose to achieve protective anti-HBs levels, the ACIP voted to give
preference to a schedule that calls for a single additional dose of vaccine
followed by serologic testing 1–2 months later. If the testing indicates the
infant remains unprotected, 2 more doses should be given, followed by final
re-testing 1–2 months after the final dose.
In reaching this decision, the ACIP considered that the 1-dose revaccination regimen allowed for fewer vaccine doses for most infants, reduced the duration of case management, and was less costly overall. However, the ACIP affirmed that, based on clinical circumstances or family preference, infants may continue to be revaccinated per the previous recommendation, i.e., a second complete 3-dose series may be given before testing occurs.
All recommendations approved by ACIP are provisional until they are approved by the director of the Centers for Disease Control and Prevention (CDC) and published in MMWR. Presentation slides from the February meeting should be posted on the ACIP website [www.cdc.gov/vaccines/acip]
in the next 4–6 weeks.
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Institute for Safe Medication Practices reports on vaccine abbreviations and acronyms that can lead to errors
The Institute of Safe Medication Practices (ISMP) published an article titled DTaP, LAIV, MCV4, PPSV23, HZV, 9vHPV ... Alphabet soup vaccine abbreviations and acronyms lead to errors in the February 23 issue of its Medication Safety Alert newsletter. Two sections of the report are reprinted below.
PROBLEM:
Advances in immunization technology and knowledge of diseases have led to an ongoing stream of new vaccines. To date, the U.S. Food and Drug Administration (FDA) has approved 48 different single and combination vaccines that target 24 vaccine-preventable diseases. The large number of vaccines and long, often complex, nonproprietary (generic) vaccine names have spurred the use of abbreviations, most often in the form of acronyms that attempt to describe the vaccine components.
SAFE PRACTICE RECOMMENDATIONS:
While a single vaccine error may not place a patient in immediate jeopardy, the risk to society of a vaccination program that is lessened in effectiveness by preventable errors is significant. Therefore, we urge FDA, CDC, ACIP, and vaccine experts from around the country to further explore the risk of errors caused by vaccine abbreviations and acronyms, and to ultimately establish safer alternatives than relying on the use of error-prone abbreviations to help vaccine manufacturers and healthcare practitioners reduce the risk of confusion among the various vaccines.
Until such alternative strategies have been established, consider the following recommendations to reduce the risk of vaccine errors associated with abbreviations and acronyms:
- If vaccine abbreviations or acronyms are permitted, allow only current, uniform, CDC-approved abbreviations and acronyms to be used. Prohibit the use of coined or informal names for vaccines.
- Establish standard order sets or protocols for frequently
administered vaccines that include the vaccine’s brand name (if applicable)
and full nonproprietary name on forms and computer screens. The Immunization
Action Coalition (IAC) and Defense Health Agency Immunization Healthcare
Branch provide sample standing orders for most vaccines. If CDC-approved
vaccine abbreviations or acronyms are permitted, follow the CDC
recommendations to list both the full nonproprietary name (and brand, if
needed) along with the approved abbreviation or acronym on all order sets to
reinforce their correct use.
- Review all standard order sets for vaccines at least annually, and update the order sets as conditions warrant (e.g., change in hepatitis B vaccine brands).
- If CDC-approved vaccine abbreviations or acronyms are permitted in electronic formats (e.g., electronic medication administration records [eMARs], electronic order sets), configure the display to allow viewing of the full nonproprietary vaccine name when hovering over the vaccine abbreviation or acronym.
- On vaccination records and MARs, list the vaccine brand name (if applicable) and the full nonproprietary name of the vaccines administered. In electronic formats, nonproprietary names may be provided by hovering over the vaccine abbreviation or acronym if space is an issue.
- Use patient vaccination records with enough space to list full vaccine names. Give patients a copy of the larger, provider immunization record with full vaccine names, even if wallet-sized immunization cards with CDC abbreviations are provided.
We also encourage practitioners to report vaccine errors or potential hazards that could lead to an error to the ISMP VERP [Vaccine Error Reporting Program] at: http://verp.ismp.org. Your reports will allow us to continue to learn about the types and causes of vaccine errors, and we are very interested in your thoughts on how to prevent similar vaccine errors.
Read the complete report: DTaP, LAIV, MCV4, PPSV23, HZV, 9vHPV ... Alphabet soup vaccine abbreviations and acronyms lead to errors.
The Institute for Safe Medication Practices (ISMP)
is the nation’s only 501(c)(3) nonprofit organization devoted entirely to
medication error prevention and safe medication use. The Vaccine Error Reporting Program (VERP) was created to allow healthcare professionals and patients to report vaccine errors confidentially. By collecting and quantifying information about these errors, ISMP will be better able to advocate for changes in vaccine names, labeling, or other appropriate modifications that could reduce the likelihood of vaccine errors in the future. Reporting vaccination administration errors via this link will help improve health care for everyone.
In March 2015, VERP published an excellent guide on avoiding vaccine errors.
Note: If an adverse event occurs following a vaccine administration error, a report should also be sent to Vaccine Adverse Event Reporting System (VAERS). Adverse events should be reported to VAERS regardless of whether a healthcare professional thinks the event is related to the vaccine or not, as long as it follows administering a dose of vaccine.
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CDC updates materials for healthcare professionals, patients, and parents to include ACIP's 2-dose HPV vaccination recommendation
CDC has recently updated a number of HPV resources for healthcare professionals and teen/young adult patients and their parents. These materials now include the current ACIP recommendation related to the 2-dose HPV vaccine schedule for immunocompetent people who start the series before age 15 years.
For Healthcare Professionals
For Parents and Patients
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IAC Spotlight! "News & Information" web page provides breaking immunization news
The Immunization Action Coalition (IAC) maintains a web page called News & Information on Immunize.org, IAC's website for healthcare professionals. This web page provides easy access to many of the recent recommendations and official releases from ACIP, CDC, WHO, the FDA, and AAP.
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Vaccine Education Center plans Current Issues in Vaccines webinar on March 22
The Vaccine Education Center (VEC) at the Children's Hospital of Philadelphia, together with the Pennsylvania chapter of the American Academy of Pediatrics, will present a one-hour webinar, beginning at 12:00 p.m. (ET) on March 22. Part of its Current Issues in Vaccines series, the webinar will feature Paul Offit, MD, director of VEC. Dr. Offit's topic for this webinar will be: "Was Katie Couric Right? Does the HPV Vaccine Cause Chronic Diseases?"
Free continuing education credits (CME, CEU, and CPE) will be available for both the live and archived events.
Registration (required) is open now.
The archived event will be available by Friday, March 24, and questions asked during the event will be posted on the archive page shortly after the event. Find this and other archived webinars on the webinar archive page.
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National Adult and Influenza Immunization Summit Excellence Awards application deadline extended through March 2
The National Adult and Influenza Immunization Summit (NAIIS) is still soliciting nominations for the 2017 Immunization Excellence Awards. These prestigious awards recognize individuals and organizations that have made extraordinary contributions towards improving vaccination rates within their communities during 2016. The awards focus on individuals and organizations that exemplify the meaning of the "immunization neighborhood" (collaboration, coordination, and communication among immunization stakeholders dedicated to meeting the immunization needs of the patient and protecting the community from vaccine-preventable diseases).
The national winner in each category will be invited to present their program
at the 2017 NAIIS meeting, to be held May 9–11 in Atlanta, Georgia. The deadline for receipt of nominations has been extended through Thursday, March 2.
Nominations are being accepted for the following six award categories:
- NEW: Non-Healthcare Employer Campaign
- Laura Scott NAIIS Immunization Excellence Award for Outstanding Influenza Season Activities Campaign
- “Immunization Neighborhood” Champion
- Adult Immunization Champion
- Corporate Campaign
- Adult Immunization Publication Award
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OFFICIAL RELEASES AND ANNOUNCEMENTS
NVPO announces the publication of "National Adult Immunization Plan: A Path to Implementation"
The National Vaccine Program Office (NVPO) has announced that a companion document to the National Adult Immunization Plan (NAIP), the National Adult Immunization Plan: A Path to Implementation, is now available online.
The National Adult Immunization Plan provides an overview of actions needed to be undertaken by federal and nonfederal partners to protect public health and achieve optimal prevention of infectious diseases and their consequences through vaccination of adults. The plan establishes 4 key goals, each of which is supported by objectives and strategies to guide implementation through 2020. The 4 goals are:
- Strengthen the adult immunization infrastructure.
- Improve access to adult vaccines.
- Increase community demand for adult immunizations.
- Foster innovation in adult vaccine development and vaccination related technologies.
The companion document, the "National Adult Immunization Plan: A Path to Implementation," facilitates action on the goals outlined in the NAIP by identifying 8 implementation priorities and suggesting potential activities to support each priority.
Access the National Adult Immunization Plan web section.
Access the National Adult Immunization Plan (67 pages; PDF format).
Access the National Adult Immunization Plan: A Path to Implementation (17 pages; PDF format).
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National Viral Hepatitis Action Plan for 2017–20 available on HHS website;
related webinar scheduled for March 8
The U.S. Department of Health and Human Services (HHS) has posted the
2017–2020 National Viral Hepatitis Action Plan on its website. The National
Viral Hepatitis Action Plan is the nation’s battle plan for fighting viral
hepatitis in the United States. The updated plan outlines strategies to
achieve four major goals and includes indicators to help track progress
between now and 2020. The goals:
- Prevent new viral hepatitis infections.
- Reduce deaths and improve the health of people living with viral hepatitis.
- Reduce viral hepatitis health disparities.
- Coordinate, monitor, and report on implementation of viral hepatitis activities.
Access the full
National Viral Hepatitis Action Plan 2017–2020 (84 pages; PDF format).
Access a Viral Hepatitis Action Plan Overview (web page).
HHS and partners will be presenting a webinar about the action plan on March
8, from 3:00–4:30 p.m. (ET). For more information or to register, click here.
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WORLD NEWS
CDC and WHO report on continued endemic wild poliovirus transmission in Nigeria in this week's MMWR and Weekly Epidemiological Report, respectively
CDC published Continued
Endemic Wild Poliovirus Transmission in Security-Compromised Areas—Nigeria,
2016 in the February 24 issue of MMWR (pages
190–3) On the same day, WHO's Weekly Epidemiological Record published a similar article titled Continued
endemic wild poliovirus transmission in security-compromised areas—Nigeria,
2016. A media summary of the MMWR article is reprinted below.
In August 2016, after a period of two years of no polio virus detection in Nigeria, four cases of wild polio virus (WPV) were reported in Borno State. These cases occurred among families from security-compromised, inaccessible areas in the state. CDC, the Nigerian Ministry of Health, and partners are conducting a robust, large-scale immunization response in the Lake Chad Basin region following detection of these cases. This immediate response to the confirmed cases minimized the potential that the outbreak would spread beyond the infected areas. However, conflict-related inaccessibility continues to limit surveillance and immunization activities, raising concerns about undetected WPV and circulating vaccine-derived poliovirus (cVDPV) transmission. While there has been an increase in access to populations in Borno State, approximately 40% of settlements remain inaccessible and surveillance and immunization activities are therefore limited.
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Guide released on cost and financing of national immunization programs in low- and middle-income countries
A new open-access tool, Immunization Financing Resource Guide, is now available for advocates, policymakers, and program managers in low- and middle-income countries. The guide includes 26 briefs, including 8 country case studies, and covers a range of topics such as evaluating the pros and cons of potential sources of financing; understanding and planning for the costs of immunization programs; assessing which vaccines to adopt; getting more value for money through improved purchasing and procurement practices; and building broad political support for these programs. The guide was produced by Results for Development, based on research funded in part by the Bill & Melinda Gates Foundation.
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Weekly e-newsletter on vaccine ethics and policy available free of charge—just
subscribe!
Vaccines and Global Health: The Week in Review is a weekly e-newsletter that targets news, events, announcements, articles, and research in the vaccine and global health ethics and policy space. The content is aggregated from key governmental, non-governmental organizations (NGOs), international organization and industry sources, key peer-reviewed journals, and other media channels. This summary proceeds from the broad base of themes and issues monitored by the Center for Vaccine Ethics and Policy (CVEP) in its work: it is not intended to be exhaustive in its coverage.
CVEP is a program of the GE2P2 Global Foundation whose purpose and mission is
to advance ethical and scientific rigor in research and evidence generation
for governance, policy and practice in health, human rights action,
humanitarian response, heritage stewardship, education and sustainable
development—serving governments, international agencies, INGOs, civil society
organizations (CSOs), commercial entities, consortia and alliances. CVEP
maintains primary affiliations with the Division of Medical Ethics, NYU School
of Medicine, and the Vaccine Education Center of Children's Hospital of
Philadelphia (CHOP).
If you would like to receive this email summary every Saturday night, please send your request to david.r.curry@centerforvaccineethicsandpolicy.org.
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Flu activity continues to increase; 46 states report widespread activity
CDC has reported that during the week of February 5–11, influenza activity
increased in the United States, with 46 states and Puerto Rico reporting
widespread activity. Nine influenza-associated pediatric deaths were reported.
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
Vaccine Education Center's newsletter for healthcare professionals features a
summary of the changes in the 2017 immunization schedules, including information
on the new “16-year-old vaccination platform” in the 2017 U.S. child/teen
immunization schedule
The Vaccine Education Center (VEC) at the Children's Hospital of Philadelphia publishes a monthly immunization-focused newsletter titled Vaccine Update for Healthcare Professionals. The February issue includes the following articles:
Additional articles are available in the full newsletter.
Access the sign-up form to subscribe to Vaccine Update for Healthcare Professionals.
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MMWR Surveillance Summary about access to health care and healthcare utilization includes information about influenza vaccination
CDC published Surveillance
for Health Care Access and Health Services Use, Adults Aged 18–64
Years—Behavioral Risk Factor Surveillance System, United States, 2014 as a February 24 MMWR Surveillance Summary. The section related to influenza vaccination is reprinted below.
Among adults aged 18–64 years, the median estimated prevalence of influenza
vaccination within the preceding 12 months was 34.6% and ranged from 24.1% in
Florida to 44.7% in South Dakota. Crude and age-standardized state-specific
estimates for CPS use (including influenza vaccination) are available. ... No
difference in the estimated prevalence by state Medicaid expansion status was
found. Among expanded geographic regions, the estimated prevalence ranged from
31.3% in the South Atlantic region to 38.2% in the New England region.
In Medicaid expansion states, the estimated prevalence of influenza vaccination
was similar among adults with household income <100% of FPL (29.9%) and those
with household income ≥100%–≤400% of FPL (30.2%); in nonexpansion states, the
estimated prevalence of influenza vaccination increased with increasing level of
income (% of FPL). Estimates of influenza vaccination were similar among adults
with household income <100% of FPL and those with household income ≥100%–≤400%
of FPL in six of the nine expanded geographic regions (New England, Middle
Atlantic, East North Central, West North Central, Mountain, and Pacific),
whereas estimates of influenza vaccination increased with increasing level of
income (% of FPL) in the South Atlantic, East South Central, and West South
Central regions.
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EDUCATION AND TRAINING
NFID webinar on vaccinations in the workplace scheduled for March 30
The National Foundation for Infectious Diseases (NFID) will present a webinar titled "Occupational Health: Vaccinations in the Workplace" on March 30 at 12:00 p.m. (ET). NFID board member Ruth M. Carrico, PhD, FNP-C, CIC, associate professor of medicine, Division of Infectious Diseases, and founding associate director, University of Louisville Global Health Center, will present an update on CDC recommendations regarding healthcare worker immunization programs relevant to all healthcare settings. At the conclusion, participants will be able to:
- Review current ACIP guidelines outlining elements of a healthcare worker immunization program
- Identify challenges in implementation and quality monitoring
- Explore safety, effectiveness, and operational improvement opportunities
Registration information
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HepB United to sponsor March 2 webinar on screening for hepatitis B in clinical and community-based settings
Hep B United is sponsoring a webinar on March 2 at 4:00 p.m. (ET) titled "Screening for Hepatitis B in Clinical and Community-Based Settings." Participants in this interactive session will discuss models to increase hepatitis B screening among communities at high risk for HBV infection. Panelists will discuss community-based screening models and the effectiveness of nonclinical versus clinical settings in screening for hepatitis B.
Registration information
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CONFERENCES AND MEETINGS
14th Annual Immunize Nebraska Conference will be held June 9 in Omaha
The 14th Annual Immunize Nebraska Conference will take place in Omaha on June 9. For more information, including the agenda and list of speakers, access the conference brochure.
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ASK THE EXPERTS
Question of the Week
If a child falls behind on immunizations, is it recommended to use only minimum intervals to get the child caught up? Or should we use a minimum interval for the same vaccine only once?
If a child is behind on immunizations, the Advisory Committee on Immunization Practices (ACIP) recommends using the minimum intervals between each dose until the child is caught up. The minimum interval for a vaccine can be used as many times as necessary, until the child is back on schedule.
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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