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Issue 1348
 
Issue 1348: February 7, 2018


TOP STORIES


IAC HANDOUTS


FEATURED RESOURCES


EDUCATION AND TRAINING



TOP STORIES


2018 U.S. recommended immunization schedule for 0 through 18 years and "catch up" now available

On February 6, CDC published Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger—United States, 2018 as an MMWR Early Release.

The Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States, 2018 is available on the CDC website as an 8-page color document in PDF format. 
 
Each year, the Advisory Committee on Immunization Practices (ACIP) updates the immunization schedules to reflect current recommendations for licensed vaccines. In October 2017, ACIP approved the recommended immunization schedules for 2018. The "Changes in the 2018 Child and Adolescent Immunization Schedule" section of the article is reprinted below.

Changes in the 2018 Child and Adolescent Immunization Schedule
Changes in the 2018 immunization schedules for children and adolescents aged 18 years or younger include new or revised ACIP recommendations for poliovirus (1), influenza (2), and measles, mumps, and rubella vaccines (3), and clarification of the recommendations for rotavirus and pneumococcal vaccines.

Changes Affecting Multiple Portions of the Schedule
Mention of MenHiberix (Hib-MenCY) vaccine has been removed from Figure 1 and Figure 2 and the relevant footnotes (Hib and meningococcal A,C,W,Y). Manufacturing of MenHibrix has been discontinued in the United States and all available doses have expired.

Cover Page. Changes to the 2018 figure from the 2017 schedule are as follows:

  • A table was added outlining vaccine type, abbreviation, and brand names for vaccines discussed in the child/adolescent immunization schedule.

Figure 2. Changes to the 2018 figure from the 2017 schedule are as follows:

  • The maximum ages for the first and last doses in the rotavirus vaccination series were added to the rotavirus vaccine row.
  • The inactivated poliovirus vaccine rows were edited to clarify the catch-up recommendations for children 4 years of age and older.

Figure 3. Changes to the 2018 figure from that in the 2017 schedule are as follows:

  • A reference was added to the HIV column of the figure. The reference provides additional information regarding HIV laboratory parameters and use of live vaccines.
  • Within the pneumococcal conjugate row, stippling was added to heart disease/chronic lung disease, chronic liver disease, and diabetes columns to clarify that, in some situations, an additional dose of vaccine might be recommended for children with these conditions.

Footnotes. The footnotes are presented in a new simplified format. The goal was to remove unnecessary text, preserve all pertinent information, and maintain clarity. This was accomplished by a transition from complete sentences to bullets, removal of unnecessary or redundant language, and formatting changes. In addition to this overall simplification, content changes were made as follows:

  • The Hepatitis B vaccine (HepB) footnote was revised to include information regarding vaccination of <2,000-g infants born to hepatitis B virus surface antigen (HBsAg)–negative mothers.
  • The poliovirus vaccine footnote was revised to include updated guidance for persons who received oral poliovirus vaccine as part of their vaccination series.
  • The influenza vaccine footnote has been updated to indicate that live attenuated influenza vaccine (LAIV) should not be used during the 2017–2018 influenza season. A reference link to the 2017–2018 season influenza recommendations has been added.
  • The measles, mumps, and rubella vaccine (MMR) footnote was updated to include guidance regarding the use of a third dose of mumps virus–containing vaccine during a mumps outbreak.
  • The meningococcal vaccine footnote has been edited to create separate footnotes for MenACWY and MenB vaccines.

The recommended birth through 18 years and catch-up immunization schedules have been approved by ACIP, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists.

Related Links

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2018 U.S. recommended immunization schedule for adults now available

On February 6, CDC published Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older—United States, 2018.

The Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2018 is available on the CDC website as an 6-page color document in PDF format. 

Each year, the Advisory Committee on Immunization Practices (ACIP) updates the immunization schedules to reflect current recommendations for licensed vaccines. In October 2017, ACIP approved the recommended immunization schedules for 2018. The adult immunization schedule also contains information on general principles of immunization for adults; considerations for special populations, such as pregnant women; reference resources pertinent to adult immunization; instructions for reporting adverse events associated with vaccinations and suspected cases of reportable vaccine-preventable diseases; and an ACIP-approved list of standardized abbreviations for vaccines recommended for adults. 

Changes in the 2018 adult immunization schedule from the previous year’s schedule include new ACIP recommendations for the use of recombinant zoster vaccine (RZV) for adults aged 50 years or older and the use of an additional dose of measles, mumps, and rubella vaccine (MMR) in a mumps outbreak setting. You can read about what changed in the adult schedule and footnotes in the article referenced above.

The recommended adult immunization schedule has been approved by ACIP, the American Academy of Family Physicians, the American College of Physicians, the American College of Obstetricians and Gynecologists, and the American College of Nurse-Midwives.

Related Links

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Influenza has killed 53 children in the U.S.; CDC provides related media advisory about widespread influenza activity

CDC has reported in its Weekly U.S. Influenza Surveillance Report, FluView, that as of the week ending January 27, influenza activity increased. The proportion of outpatient visits for influenza-like illness (ILI) was 7.1%, which is above the national baseline of 2.2%. All 10 regions reported ILI at or above region-specific baseline levels. Fifty-three related pediatric deaths have been reported since October 1, 2017.

On February 2, CDC held an update for the media titled "CDC Update on Flu Activity." Part of the introductory statement from CDC acting director Dr. Anne Schuchat is reprinted below.

Right now, one of the biggest health threats we are facing is influenza. Flu is incredibly complex and difficult to predict and this season is a somber reminder of why flu is one of the world’s greatest public health challenges and why we at CDC focus so intensely on efforts to fight flu. In the past week, we have seen increased influenza-like illness activity, more hospitalizations, and tragically, more flu-associated deaths in children and adults. And as of this week, overall hospitalizations are now the highest we’ve seen—even higher than the 2014–15 season, our previous high season. We also continue to hear reports of crowded hospitals and spot shortages of antiviral medications and rapid influenza tests. Unfortunately, our latest tracking data indicate that the flu activity is still high and widespread across most of the nation and increasing overall. Influenza A H3N2 viruses continue to dominate this season. However, we are seeing other flu viruses including H1N1, and influenza B causing illness as well, and in some cases, disproportionately affecting certain age groups. I know many of you are concerned about this flu season and have seen the heart-breaking stories of those who have lost loved ones.

This week, we are reporting an additional 16 flu-related pediatric deaths for this season, meaning there are even more families now devastated by flu. That means we’ve received reports for a total of 53 children who have died of the flu so far this season. I also know there are ongoing concerns about whether the flu vaccine that many people received will be effective or whether you’ll be able to fill a prescription for antiviral medicine. While we don’t have all the answers, here’s what I can tell you. We continue to recommend the flu vaccine even though we know most flu vaccines have low effectiveness against H3N2 viruses. Effectiveness against other flu viruses is better, and there is more than one flu virus circulating this season. The vaccine may also reduce the severity of symptoms if you catch the flu in spite of being vaccinated, and it is not too late to get the vaccine....


Access the complete transcript or audio recording from this media advisory.

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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It's the 100th anniversary of the 1918 influenza pandemic; watch a powerful 1998 PBS documentary about the virus that caused at least 50 million deaths worldwide

This year is the 100th anniversary of the 1918 influenza epidemic that killed at least 50 million people worldwide, including approximately 675,000 deaths in the U.S. It was caused by an H1N1 virus with genes of avian origin. This virus was unusual because it spread so quickly, was so deadly, and exacted its worst toll among the young and healthy. About one-third of the world's population (~500 million people) were infected.

Twenty years ago, the PBS American Experience series released a documentary titled "Influenza 1918." You can watch this powerful 55-minute film on YouTube.

Related Links

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CDC updates its shingles disease and vaccine web pages to reflect the new ACIP vaccination recommendations

In light of the licensure of recombinant zoster vaccine (Shingrix; GSK) and the new ACIP zoster recommendations published in MMWR on January 26, CDC has updated the following related pages on its website:

Related Link

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CDC director Dr. Brenda Fitzgerald resigns over financial conflicts; Dr. Anne Schuchat resumes role of acting director

On January 31, Brenda Fitzgerald, MD, stepped down as CDC director due to financial conflicts. A statement from the U.S. Department of Health and Human Services is reprinted below.

This morning Secretary Azar accepted Dr. Brenda Fitzgerald’s resignation as Director of the Centers for Disease Control and Prevention. Dr. Fitzgerald owns certain complex financial interests that have imposed a broad recusal limiting her ability to complete all of her duties as the CDC Director. Due to the nature of these financial interests, Dr. Fitzgerald could not divest from them in a definitive time period. After advising Secretary Azar of both the status of the financial interests and the scope of her recusal, Dr. Fitzgerald tendered, and the Secretary accepted, her resignation. The Secretary thanks Dr. Brenda Fitzgerald for her service and wishes her the best in all her endeavors.

Anne Schuchat, MD, is now CDC's acting director and acting administrator of the Agency for Toxic Substances and Disease Registry. She is also CDC principal deputy director, a role she has held since September 2015. She served as director of CDC’s National Center for Immunization and Respiratory Diseases from 2006–2015.

Related Link

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IAC Spotlight! IAC recently updated its Clinic Tools: Vaccine Recommendations web page

Recently updated, IAC's Clinic Tools: Vaccine Recommendations web page on immunize.org is a collection of resources from IAC and CDC related to vaccine recommendations. This web page can be found by selecting the "Clinic Tools" tab (third from the left) in the light gray banner across the top of every immunize.org web page and then selecting "Recommendations" in the drop-down menu.

In the left-hand column of the page you will find IAC's educational materials related to vaccine recommendations. From here, you can access IAC's popular Summary of Recommendations for Child/Teen Immunization, Summary of Recommendations for Adult Immunization, and Healthcare Personnel Vaccination Recommendations, as well as links to other related resources available on immunize.org. The right-hand column of the page includes resources from CDC, including links to ACIP recommendations.

Visit the Clinic Tools: Vaccine Recommendations on immunize.org.

Related Links

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Voices for Vaccines wants to know why you choose to immunize—add your photo to their gallery

Voices for Vaccines (VFV) wants to know why you choose to immunize! Their Why I Choose gallery highlights photos from people all over the world who are glad to vaccinate. Submit your photo and story today. If you have questions about this, or anything else Voices for Vaccines-related, please join their discussion forum on Facebook.

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 values vaccines to become a member. Please spread the word to your friends and colleagues to register for the conference call and to join VFV!
 
Related Links

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IAC's new 142-page book, Vaccinating Adults: A Step-by-Step Guide, describes how to implement adult vaccination services in your healthcare setting and provides a review for staff who already vaccinate adults; IAC Guide available for free download or purchase

The Immunization Action Coalition (IAC) recently announced the publication of its new book, Vaccinating Adults: A Step-by-Step Guide (Guide).



This completely updated guide on adult immunization (originally published in 2004) provides easy-to-use, practical information covering important “how-to” activities to help providers enhance their existing adult immunization services or introduce them into any clinical setting, including:

  • setting up for vaccination services,
  • storing and handling vaccines,
  • deciding which people should receive which vaccines,
  • administering vaccines,
  • documenting vaccinations (including legal issues), and
  • understanding financial considerations and billing information. 

In addition, the Guide is filled with hundreds of web addresses and references to help providers stay up to date on the latest immunization information, both now and in the future.

Two options are available to obtain a copy of the updated Guide:

  • Purchase a copy
    A limited number of printed editions of this 142-page book are available for purchase at www.immunize.org/shop. The Guide’s lie-flat binding and 10 tabbed sections make it easy to locate the information being sought. Purchased copies are delivered in a box that includes Immunization Techniques: Best Practices with Infants, Children, and Adults, a 25-minute training DVD developed by the California Department of Public Health. Also included are several selected IAC print materials, such as the "Skills Checklist for Vaccine Administration," an assessment tool to assist in evaluating the skill level of staff who administer vaccines.
  • Download for free and print it yourself
    The entire Guide is available to download/print free of charge at www.immunize.org/guide. The downloaded version is suitable for double-sided printing. Options are available online to download the entire book or selected chapters.

The development of the Guide was supported by the National Vaccine Program Office (NVPO) and the Centers for Disease Control and Prevention (CDC). Expert staff from both agencies also provided early technical review of the content.

The Guide is a uniquely valuable resource to assist providers in increasing adult immunization rates. Be sure to get a copy today!

Related Links

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IAC HANDOUTS


IAC posts updated "Standing Orders for Administering Zoster Vaccine to Adults"

IAC recently updated Standing Orders for Administering Zoster Vaccine to Adults to incorporate the new ACIP recommendations for administration of recombinant zoster vaccine (Shingrix) into the existing recommendations for use of zoster vaccine live (Zostavax).

Access IAC's Standing Orders for Administering Vaccines web page with templates for all routinely recommended vaccines.

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 revises two standing orders templates for administering MMR vaccine to children/teens as well as to adults

IAC recently revised the following two standing orders templates:

Access IAC's Standing Orders for Administering Vaccines web page with templates for all routinely recommended vaccines.

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IAC revises two standing orders templates for administering hepatitis A vaccine to children/teens as well as to adults

IAC recently revised the following two standing orders templates:

Access IAC's Standing Orders for Administering Vaccines web page with templates for all routinely recommended vaccines.

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FEATURED RESOURCES


Vaxopedia website helps answer parents' questions about vaccines, including those related to misconceptions and rumors

Vaxopedia is a website created in 2016 by board- certified pediatrician Vincent Iannelli, MD, to help answer parents' questions about vaccines, including those related to misconceptions and rumors. This website is a great source of up-to-date information not only for parents, but for the healthcare professionals who work with parents and patients who have questions about vaccination. Some sections of special interest:

Explore Vaxopedia yourself and then share the link with your patients.

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CDC releases new Spanish-language immunization education materials for parents

CDC has recently made available three new Spanish-language education materials for parents.

The first is a listicle: "9 Things to Make Shots Less Stressful." You can access both the Spanish and English versions by clicking on the images below.






The second resource is an infographic titled "How Vaccines Strengthen Your Baby's Immune System." Access both the Spanish and English versions by clicking on the images below.



The third new offering is a 11" x 48" family-friendly wall chart for measuring children's height up to 56 inches that includes recommended immunizations and important developmental milestones from birth through age 6 years. A limited number of these growth charts in English or Spanish are available to order from CDC.

 

Explore more resources for parents from CDC by visiting their Infant and Childhood Immunization Resources web section.

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CDC offers drop-in articles about immunization in English and Spanish you can use in newsletters, websites, blogs, and more

CDC has developed English and Spanish-language sample drop-in articles directed to parents and members of the public that can be sent to state and local media outlets, or used in your newsletters, blogs, or other publications. The available articles can be accessed from the links below.

Articles for Parents/Public (in English and Spanish)

In addition, CDC has developed three drop-in articles for health and child care professionals that can be inserted into professional publications or websites.

Articles for Health and Child Care Professionals

Access CDC's Drop-In Articles and Web Features web page.

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EDUCATION AND TRAINING


Dr. Paul Offit discusses how lives are saved even with an imperfect influenza vaccine in his Medscape commentary 
 
Paul Offit, MD, director, Vaccine Education Center at Children’s Hospital of Philadelphia, has recorded a new expert commentary for Medscape titled "A Bad Flu Year: Lives Are Saved Even With a 'Less Effective' Vaccine." This commentary explores the three ways influenza virus is elusive, but concludes: 

Now, with that said, if you look at the number of deaths that have been prevented by the influenza vaccine between the 2005–2006 season and the 2013–2014 season, we have saved an estimated 40,000 lives with the influenza vaccine. The efficacy of the influenza vaccine when you don't get it is 0%, and 40% is better than 0%. So although the vaccine isn't perfect, it's still of value and therefore should be used. 

Access A Bad Flu Year: Lives Are Saved Even With a 'Less Effective' Vaccine on Medscape (free, but log-in is required).

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Immunize Nevada to host day-long adult immunization web conference on February 16 

Immunize Nevada will host a day-long adult immunization web conference on February 16 from 9:00 a.m.–2:30 p.m. PT.  People can sign up for one, several, or all of the following sessions:

  • Pharmacists' Role within the Immunization Neighborhood, presented by Mitchel C. Rothholz, RPh, MBA, chief strategy officer, American Pharmacists Association 
  • Adult Immunizations, presented by JoEllen Wolicki, BSN, nurse educator, National Center for Immunization and Respiratory Diseases, CDC
  • Pneumococcal Vaccines for Adults, presented by CDR Tina S. Objio, RN, MSN, MHA, nurse educator, Communication and Education Branch, CDC
  • Nevada Web IZ: Adult Immunization Improvement Project, presented by Kristy Zigenis, MA, adult immunization coordinator for the state of Nevada

This program offers one free nursing or pharmacy CEU credit (CEU credit requires completion of the post-webinar survey). 

Registration information

Related Link

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VICNetwork webinar on March 7 to feature information to help plan your National Infant Immunization Week activities

On March 7 at 12:00 p.m. (ET), the California Immunization Coalition's VICNetwork will sponsor a webinar titled "Get Ready for National Infant Immunization Week 2018!" During this planning webinar, participants will learn about National Infant Immunization Week (NIIW) planning tools, digital communication resources, and CDC activities planned for the week. The Houston Health Department will also share lessons learned from NIIW 2017, including outreach to pregnant women about infant immunization, as well as plans for this year.

Featured speakers will be Jenny Mullen, MPH, health communication specialist, National Center for Immunization and Respiratory Diseases, CDC, and LaTasha Hinckson Callis, MBA, administration manager, Houston Health Department.

Registration information

National Infant Immunization Week (NIIW) is an annual observance to highlight the importance of protecting infants from vaccine-preventable diseases and celebrate the achievements of immunization programs and their partners in promoting healthy communities. This year, NIIW is scheduled for April 21–28.

The VICNetwork is a nationwide "virtual immunization community" of health educators, public health communicators, and others who promote immunizations to exchange and share resources, materials, and best practices.

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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.; Merck Sharp & Dohme Corp.; Pfizer, Inc.; and Sanofi Pasteur.

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ACIP Change Magnifies Importance of MCV4 at 16: Dr. L.J Tan, Immunization Action Coalition, discusses the risks of meningococcal disease in adolescents. With ACIP recommending a second dose of meningococcal conjugate vaccine (MCV4) since 2011, and the official U.S. immunization schedule highlighting a routine 16-year-old visit, Dr. Tan presents steps providers can take to increase immunizations in 16-year-olds. Free to view but log-in is required.
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Editorial Information
Editor:
Deborah L. Wexler, MD
Managing Editor:
Teresa Anderson, DDS, MPH

Consulting Editors:
Marian Deegan, JD
Jane Myers, EdM

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
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This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 6NH23IP22550) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC.