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Issue 1308
Issue 1308: May 31, 2017

Ask the Experts
Ask the Experts—Question of the Week: Does live oral cholera vaccine need to be administered at an interval . . . read more


TOP STORIES


VACCINE INFORMATION STATEMENTS


OFFICIAL RELEASES AND ANNOUNCEMENTS


WORLD NEWS


FEATURED RESOURCES


JOURNAL ARTICLES AND NEWSLETTERS


EDUCATION AND TRAINING


CONFERENCES AND MEETINGS

 


TOP STORIES


New slide set! "How to Implement Standing Orders in Your Practice" now available from IAC

The Immunization Action Coalition (IAC) has just added a new slide set to the collection of presentations available on its website. The "How to Implement Standing Orders in Your Practice" presentation is a how-to guide for implementing standing orders protocols in your medical setting to improve immunization rates.

View How to Implement Standing Orders in Your Practice as a 6-slide per page handout.

Visit IAC's PowerPoint Slide Sets web page to view this and other available presentations.

All slide sets are available in PowerPoint format by email request. Simply click on the link "Request the PowerPoint slide set" for the slide sets you want to order.

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

The 6th edition of The Vaccine Handbook: A Practical Guide for Clinicians ("The Purple Book") is considered a vital source of practical, up-to-date information for vaccine providers and educators. Now printed in color and updated with the latest vaccine information through early 2017, "The Purple Book" draws 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.

The sixth edition of this valuable guide (592 pages) is available on IAC's website at www.immunize.org/vaccine-handbook. The price of the handbook is $34.95 per copy, plus shipping charges. Order copies for your staff or for distribution at an upcoming conference.

Discount pricing is available for more than 10 copies. 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!

The Vaccine Handbook App for Apple iPhones and iPads is available free from IAC. Sorry, the app is not available for android devices. Book purchase is not necessary but registration to obtain the app is required.

The app is fully searchable, allows for bookmarking, highlighting and annotation, and contains hyperlinks to valuable content from nonprofit and governmental sources.

Click on the image below to visit the The Vaccine Handbook App page in the iTunes store.

Download new app!

About the Author
Gary S. 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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CDC reports on a measles outbreak at an immigration and customs enforcement facility in Arizona

CDC published Notes from the Field: Measles Outbreak at a United States Immigration and Customs Enforcement Facility—Arizona, May–June 2016 in the May 26 issue of MMWR. Selected text is reprinted below.

On May 25, 2016, a detainee at a U.S. Immigration and Customs Enforcement (ICE) detention center in Arizona who had been hospitalized with fever and a generalized maculopapular rash was confirmed to have measles by real-time polymerase chain reaction (rPCR). A second case of measles in a staff member was confirmed by rPCR the next day. The privately operated, city-contracted facility housed 1,425 detainees, and employed 510 staff members, including 95 federal ICE staff and 415 contract staff of four distinct employers. Outbreak control measures consisted of administration of measles-mumps-rubella (MMR) vaccine to 1,424 detainees housed at the facility during May 29–31 and isolation of the detainee patient and any additional detainee patients identified during their remaining infectious period (until 4 days after rash onset). Recommendations were made by federal, state, and local public health partners to exclude staff members with measles-compatible symptoms as well as exposed staff members without presumptive evidence of immunity to measles.

Epidemiologic investigations by local and state health departments and CDC identified 31 total cases of measles in 22 detainees and nine staff members, with rash onsets occurring May 6–June 26....

Outbreak response is expensive and resource-intensive; specific strategies for measles prevention and control can be in place in advance to expedite and optimize containment in the event of an outbreak. First, persons working in congregate settings with populations that include people who have traveled internationally from measles-endemic regions or others whose immunity levels are unknown or difficult to assess should have documented evidence of measles immunity. Second, a means to quickly verify presumptive measles immunity among staff members in the event of occurrence of a case of measles can facilitate containment. Finally, contingency plans that allow for the exclusion of infectious staff members and exposed nonimmune staff members can prevent spread of measles. Adherence to these recommendations in high-risk settings, such as health care facilities, has been shown to limit transmission, optimize resources, and reduce costs.

Recommendations for implementing measles control policies for detention and correctional facilities, similar to those recommended in health care facilities, could be considered. If permissible, contractual and interagency agreements could include similar provisions, such as requiring MMR vaccination for staff members who work in detention facilities and do not have documented evidence of immunity.


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VACCINE INFORMATION STATEMENTS


IAC posts Indonesian-language translation of the Hepatitis B VIS

IAC recently posted an Indonesian-language translation of the Hepatitis B VIS. IAC thanks Wentworth-Douglass Hospital of Dover, New Hampshire, for the translation.

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OFFICIAL RELEASES AND ANNOUNCEMENTS


WHO publishes document on vaccination and trust

The World Health Organization (WHO) recently published a report titled Vaccinations and Trust: How concerns arise and the role of communication in mitigating crises. A description from the WHO website is reprinted below.

This document presents the scientific evidence behind WHO’s recommendations on building and restoring confidence in vaccines and vaccination, both in ongoing work and during crises. The evidence draws on a vast reserve of laboratory research and fieldwork within psychology and communication. It examines how people make decisions about vaccination; why some people are hesitant about vaccination; and the factors that drive a crisis, covering how building trust, listening to and understanding people, building relations, communicating risk and shaping messages to the audiences may mitigate crises.

Access the 50-page document in PDF format: Vaccinations and Trust: How concerns arise and the role of communication in mitigating crises. A Russian-language version is also available.

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CDC publishes "Malaria Surveillance—United States, 2014" in MMWR

CDC published Malaria Surveillance—United States, 2014 in a May 26 issue of MMWR Surveillance Summaries (PDF format). A summary from CDC is reprinted below.

Malaria in humans is caused by intraerythrocytic protozoa of the genus Plasmodium. These parasites are transmitted by the bite of an infective female Anopheles mosquito. Most malaria infections in the United States occur among persons who have traveled to regions with ongoing malaria transmission. CDC received reports of 1,724 confirmed malaria cases with onset of symptoms in 2014. This report summarizes those cases, as well as trends during previous years.

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WORLD NEWS


CDC and WHO report monitoring of poliovirus type 2 after oral vaccine withdrawal in this week's MMWR and Weekly Epidemiological Report, respectively

CDC published Virologic Monitoring of Poliovirus Type 2 After Oral Polio Vaccine Withdrawal—Worldwide, 2016–2017 in the May 26 issue of MMWR. On the same day, WHO's Weekly Epidemiological Record published a similar article titled Virologic monitoring of poliovirus type 2 after OPV2 withdrawal in April 2016: an important advance in eradicating poliomyelitis and eliminating live oral poliovirus vaccines worldwide, 2016–2017. A summary made available to the press from CDC is reprinted below.

In April 2016, 155 countries synchronized withdrawal of OPV2. To confirm the success of this important global public health milestone, it is important to ensure that effective global virologic monitoring mechanisms are in place. This paper describe how poliovirus type 2 (PV2) was tracked and detected worldwide in both human populations and in the environment using acute flaccid paralysis and environmental surveillance systems. The Global Polio Laboratory Network, which comprises 146 laboratories in 92 countries, worked closely with field surveillance officers to quickly detect and report PV2 to the Global Polio Eradication Initiative (GPEI). This unprecedented work allowed the GPEI to identify unplanned use of PV2-containing vaccines in some countries and propose adequate solutions.

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An additional 23 human infections with Asian H7N9 bird flu in China reported for a total of 688 in current epidemic; CDC prepares to ship a new candidate vaccine virus

On May 23, the World Health Organization (WHO) reported another 23 human infections with Asian H7N9 bird flu, bringing the total number during the current epidemic to 688 cases. CDC provides the following background on its website:

Human infections with an Asian lineage avian influenza A (H7N9) virus (“Asian H7N9”) were first reported in China in March 2013. Annual epidemics of sporadic human infections with Asian H7N9 viruses in China have been reported since that time. China is currently experiencing its 5th epidemic of Asian H7N9 human infections. This is the largest annual epidemic to date. As of May 23, 2017, the World Health Organization (WHO) has reported 688 human infections with Asian H7N9 virus during the 5th epidemic, making it the largest epidemic to date. This brings the total cumulative number of human infections with Asian lineage H7N9 reported by WHO to 1,486. Additional infections have been reported, but not yet publically announced by WHO. During epidemics one through four, about 40 percent of people confirmed with Asian H7N9 virus infection died.

Selections from a related May 23 update from CDC are reprinted below.

Today the World Health Organization (WHO) reported another 23 human infections with Asian H7N9 bird flu, bringing the total number of such infections during the current (fifth) epidemic to 688. This is the largest epidemic of Asian H7N9 human infections in China since this virus emerged to infect people in 2013. CDC has completed development of a new Asian H7N9 candidate vaccine virus (CVV) that is matched to a recently emerged lineage of Asian H7N9 viruses which have predominated during the fifth epidemic and which could be used to make vaccine if one were needed.

CDC has been monitoring the Asian H7N9 situation closely since 2013 and taken routine preparedness measures, including previously developing three candidate vaccine viruses. Besides an increase in the number of infections being reported during the current epidemic and an increase in the geographic areas in China where human infections with Asian H7N9 are being reported, the epidemiology of H7N9 virus infections in humans does not appear to have changed. Most human infections with Asian H7N9 continue to be associated with exposure to poultry and there is no sustained person-to-person spread of this virus, however, there have been some changes in recent Asian H7N9 viruses identified that are of public health concern....

The new CDC CVV was derived from a low pathogenic avian influenza A/Hunan/2650/2016-like virus and was made using reverse genetics. Creating a candidate vaccine virus is a multistep process that takes months to complete. At this time, CDC is coordinating shipping of the new Asian H7N9 CVV to various manufacturers....


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FEATURED RESOURCES


Still available! IAC's sturdy laminated versions of the 2017 U.S. child/teen immunization schedule and the 2017 U.S. adult immunization schedule—order a supply for your healthcare setting today!


IAC's laminated versions of the 2017 U.S. child/teen immunization schedule and the 2017 U.S. adult immunization schedule are covered with a tough, washable coating; they will stand up to a year's worth of use in every area of your healthcare setting where immunizations are given. Both schedules are eight pages (i.e., four double-sided pages) and are folded to measure 8.5" x 11". 

Laminated Child and Teen Laminated Schedule

Adult Laminated Immunization Schedules

Laminated schedules are printed in color for easy reading, come complete with essential tables and footnotes, and include contraindications and precautions—a feature that will help you make an on-the-spot determination about the safety of vaccinating patients of any age.

PRICING
1–4 copies: $7.50 each
5–19 copies: $5.50 each
20–99 copies: $4.50 each
100–499 copies: $4.00 each
500–999 copies: $3.50 each

For quotes on customizing or placing orders for 1,000 copies or more, call (651) 647-9009 or email admininfo@immunize.org.

You can access specific information on both schedules, view images of both, order online, or download an order form at the Shop IAC: Laminated Schedules web page.

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JOURNAL ARTICLES AND NEWSLETTERS


Vaccine Education Center's monthly newsletter for healthcare professionals includes an article about the implications of anti-vaccine sentiment, a summary of research about influenza vaccine efficacy in children, Technically Speaking column on updated recommendations for the use of Tdap, and more

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 May issue includes the following articles:

Additional information is available in the full newsletter.

Access the sign-up form to subscribe to Vaccine Update for Healthcare Professionals.

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Study shows that 2-dose HPV schedule reduces genital warts about same as 3 doses

The June issue of the journal Sexually Transmitted Diseases includes an article titled Impact of Number of Human Papillomavirus Vaccine Doses on Genital Warts Diagnoses Among a National Cohort of U.S. Adolescents. The abstract is reprinted below.

BACKGROUND
The impact of fewer than 3 doses of human papillomavirus (HPV) vaccine on genital warts is uncertain.

METHODS
Using the Truven Health Analytics Marketscan administrative database, we compared rates of genital warts among women receiving 0, 1, 2, or 3 doses of HPV vaccine. Females aged 9 to 18 years on January 1, 2007, who were continuously enrolled in the database through December 31, 2013, were included. Patients were assigned an HPV dose state (0, 1, 2, or 3) based on the last recorded dose. The exposure period began on January 1, 2007, or the date of the final HPV dose, and lasted until the first diagnosis of genital warts or December 31, 2013. Multivariable Poisson regression was performed to determine the risk of genital warts associated with vaccine doses.

RESULTS
Among 387,906 subjects, mean age and exposure period were 14.73 and 5.64 years, respectively. The proportions of doses received were: 52.1%, 7.8%, 9.4%, and 30.7% for 0, 1, 2, and 3 doses, respectively. The rate of genital warts was 1.97/1000 person-years. Receipt of 0 or 1 dose was associated with more genital warts than 3 doses. The effectiveness of 2 doses following current Centers for Disease Control and Prevention guidelines was similar to 3 doses. The risk of genital warts rose with age.

CONCLUSIONS
Prevention of genital warts is higher with completion of 3 vaccine doses than with 1 dose, though 2-dose recommendations appear to provide similar protection. Prospective effectiveness studies of recommended 2-dose schedules against clinical endpoints including persistent infection, genital warts, and cervical dysplasia are necessary to ensure long-term protection of vaccinated cohorts.


Access the abstract: Impact of Number of Human Papillomavirus Vaccine Doses on Genital Warts Diagnoses Among a National Cohort of U.S. Adolescents.


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EDUCATION AND TRAINING


Reminder: One session left in CDC's NetConference series about adult immunization

CDC has been sponsoring a 6-part NetConference series on vaccinating adults to address key issues related to protecting adults from vaccine-preventable diseases. A collaborative effort between CDC and Maryland’s adult immunization coalition and state immunization program, the "Vaccinating Adults" series features 6 presentations by experts in promoting, administering, and securing reimbursement for adult immunizations. The following presentation is the only one remaining in the series:
  • Wednesday, May 31—Clinic Logistics: Vaccine Administration, Storage, and Handling

The session will start at 12:00 p.m. (ET).

Continuing education will be available for each event. The series will be archived later on CDC's website.

Advanced registration is required to participate.

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CONFERENCES AND MEETINGS


Draft agenda for June ACIP meeting available

ACIP will hold its next meeting on June 21–22 in Atlanta. The draft agenda is now available online.

To attend the meeting, ACIP attendees (participants and visitors) must register online. The registration deadline for non-U.S. citizens was May 22; for U.S. citizens, it's June 7. Registration is not required to watch the meeting via webcast or listen to the proceedings via phone. See the first link below for the toll-free phone number and passcode.

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ASK THE EXPERTS

Question of the Week

Does live oral cholera vaccine need to be administered at an interval from other live oral or injectable vaccines?    

No. According to ACIP's General Best Practice Guidelines for Immunization, concerns about spacing between doses of live vaccines not given at the same visit applies only to live injectable or intranasal vaccines. So, live oral cholera vaccine may be administered simultaneously with another vaccine, or at any interval before or after administration of another 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. 6NH23IP922550 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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Video of the Week
"Our privilege allows us to make a decision about having a vaccine": These parents are grateful to be able to make the decision to vaccinate their baby. The dad tells about his father who was born in a Lebanon village and suffered all his life from the damage inflicted by polio. Home visit pediatrician believes that people need better science education to understand the importance of vaccines. (Source: NewsWorks)
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Editorial Information
Editor: Deborah L. Wexler, MD
Managing Editor: Teresa Anderson, DDS, MPH
Consulting Editor: Marian Deegan, JD
Assistant Managing Editor: Liv Augusta Anderson, MPP
Issue Abbreviations
AAFP: American Academy of Family Physicians
AAP: American Academy of Pediatrics
ACIP: Advisory Committee on Immunization Practices
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
VIS: Vaccine Information Statement
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