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Issue 1352
Issue 1352: February 28, 2018


TOP STORIES


IAC HANDOUTS


OFFICIAL RELEASES AND ANNOUNCEMENTS


WORLD NEWS


JOURNAL ARTICLES AND NEWSLETTERS


EDUCATION AND TRAINING



TOP STORIES


IAC provides a summary article about votes taken at February 21–22 ACIP meeting

The Advisory Committee on Immunization Practices (ACIP) met in Atlanta on February 21–22. During the meeting, votes were taken on the reintroduction of live attenuated influenza vaccine (LAIV, FluMist; MedImmune/AstraZeneca), the use of a new hepatitis B vaccine (Heplisav-B; Dynavax), guidance on the use of hepatitis A vaccine for post-exposure prophylaxis and for infants prior to international travel, and a new framework to clarify ACIP review of evidence in developing recommendations. In addition, ACIP discussed new age indications for Fluarix (GSK) vaccine, dose-sparing strategies for use of anthrax vaccine when vaccine demand exceeds supply, safety data for human papillomavirus (HPV) vaccine, and the epidemiology of HPV infection in males. The Committee also received updates on preliminary data on the direct and indirect effects of PCV13 (Prevnar; Pfizer) vaccination among adults ≥65, vaccines for the prevention and treatment of healthcare-associated infections, the epidemiology of meningococcal disease among college students, and activities being conducted by the Japanese encephalitis vaccine workgroup.

Live Attenuated Influenza Vaccine (LAIV)

ACIP voted to reinstate live attenuated influenza vaccine (LAIV, FluMist; MedImmune/AstraZeneca) as an option in the list of recommended influenza vaccines for the 2018–2019 influenza season. ACIP had withdrawn its recommendation for use of LAIV during the last two influenza seasons due to data indicating greatly decreased efficacy of the H1N1 component of the live vaccine. The reinstatement decision was reached after the Committee reviewed extensive data provided by the manufacturer and CDC’s examination of LAIV use in other countries. MedImmune/AstraZeneca provided information on its efforts to identify reasons for the vaccine’s reduced effectiveness. The company’s studies evaluating the shedding and antibody responses of the H1N1 strain in children 2–4 years of age demonstrated the vaccine performed significantly better following inclusion of a new H1N1 component strain (A/Slovenia). Study participants developed increased antibody levels and exhibited increased viral shedding, an indicator of improved vaccine virus replication.

In making this vote, the Committee chose not to offer a preferential statement for inactivated influenza vaccine (IIV). Rather, all approved vaccines will be listed as viable options for the prevention of influenza infection.

ACIP also approved the addition of LAIV to the Vaccines For Children (VFC) program for eligible children.

Because LAIV has continued to be used in Canada and the European Union during the last two years, it is anticipated the manufacturer should be able to ramp up production quickly. The company will announce details about vaccine supply in the future. However, vaccine availability may be limited during the 2018–2019 season because many providers, including state health department VFC programs, have already completed vaccine orders for the upcoming season. In addition, it already is too late for CDC to add a contract permitting health department purchase of LAIV during the 2018–2019 season.

New Hepatitis B Vaccine

ACIP voted to include Heplisav-B (Dynavax), a recombinant hepatitis B vaccine, in the list of recommended vaccines to use against hepatitis B virus infection. Heplisav-B received FDA approval in November 2017. This vaccine, which is approved for use in adults ≥18 years of age, is recommended as a 2-dose schedule, with a minimum interval of 1 month between doses. This shortened and simplified dosage schedule is anticipated to improve hepatitis B vaccine coverage. Heplisav-B is not interchangeable with the 3-dose vaccines currently on the market; if it is given in combination with a 3-dose vaccine, a total of 3 doses of hepatitis B vaccine are needed for series completion. ACIP will review additional data to determine if improved seroconversion and vaccine uptake warrant providing the vaccine with a preferential recommendation; however, currently all hepatitis B vaccines are considered equivalent for provider use.

Hepatitis A Vaccine and IG

The Committee voted on two questions related to hepatitis A vaccine use for post-exposure prophylaxis (PEP) and for infants prior to international travel.

ACIP voted to approve use of hepatitis A vaccine for post-exposure prophylaxis (PEP) in all persons ≥12 months of age. This guidance is focused on vaccine use in outbreaks settings. Previously, immune globulin (IG) was recommended for exposed persons. However, IG use is challenging, as it is not routinely stocked in many medical settings. This can cause delays in providing appropriate PEP. In addition, the amount of hepatitis A antibody found in IG has declined in recent years as fewer people are exposed to the disease. The new recommendation allows providers to leverage the benefits provided by hepatitis A vaccine’s availability for more timely PEP. ACIP voted to recommend use of hepatitis A vaccine alone in persons ≤40 years of age who do not have immunocompromising conditions. For persons >40, vaccine may be used in conjunction with IG, at the provider’s discretion. Additional guidance for who should receive IG will be made in consultation with public health and will consider issues such as the patient’s age, health status, and type of exposure.

ACIP also voted to approve use of hepatitis A vaccine (rather than IG) in infants 6–11 months of age when traveling outside the U.S. when protection against hepatitis A virus infection is recommended. IG previously had been recommended for these infants. However, this caused problems related to potential interference when administered simultaneously with live MMR vaccine, which also is recommended for these infants prior to international travel. Use of hepatitis A vaccine rather than IG eliminates this problem. Just as with MMR, these infants should receive appropriate vaccine doses after reaching 12 months of age, i.e., the hepatitis A vaccine administered at 6–11 months of age does not count toward completion of the recommended vaccine series. In an additional vote, ACIP approved inclusion of vaccine in the VFC program to fulfill this recommendation.

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

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CDC updates rotavirus VIS with a minor change

CDC recently released an updated VIS, Rotavirus Vaccine: What You Need to Know, to replace an outdated link to information about porcine circovirus. No other changes were made to the VIS. Providers are encouraged to begin using the updated VIS as soon as possible, but stocks of the previous edition may still be used until exhausted.

View information about the updated vaccine on CDC's Rotavirus VIS web page.

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CDC reports 13 additional pediatric deaths from influenza in the U.S. between October 1 and February 17, bringing total to 97; influenza still widespread

CDC has reported in its Weekly U.S. Influenza Surveillance Report, FluView, that as of the week ending February 17, influenza activity remained elevated in the United States. The total number of pediatric deaths has climbed to 97 since October 1, 2017. The proportion of outpatient visits for influenza-like illness (ILI) was 6.4%, which is above the national baseline of 2.2%. All 10 regions reported ILI at or above region-specific baseline levels. New York City, the District of Columbia, Puerto Rico and 39 states experienced high ILI activity; five states experienced moderate ILI activity; three states experienced low ILI activity; and three states experienced minimal ILI activity.

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.

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FDA commissioner issues statement on FDA's ongoing efforts to help improve effectiveness of influenza vaccines

In a February 26 media release, FDA's commissioner, Scott Gottlieb, M.D., issued a statement on the FDA's ongoing efforts to help improve the effectiveness of influenza vaccines. The first three paragraphs are reprinted below.

Statement

The current influenza season has been especially difficult, causing widespread illness that has affected all fifty states and resulted in a record number of hospitalizations. While healthcare professionals continue to combat this year’s flu—which may continue to affect Americans into April—we’re already partnering with other public health agencies to conduct essential work to produce next season’s influenza vaccines.

As part of this process, we’re striving to better understand why we saw reduced effectiveness of this year’s influenza vaccines against one strain of influenza A, called H3N2. It was this strain that caused much of the influenza-related illness this flu season. Moreover, this year is not the first time we have seen vaccines be less effective against this particular strain of influenza, H3N2.

As such, we are taking a number of actions to better understand why effectiveness tends to be lower against the H3N2 strain and what we can do about it. By looking closely at the available data and applying the lessons we learn each flu season to the vaccine development process, we offer the greatest chance of developing vaccines that even more effectively prevent the flu in the future....


Access this statement on the FDA website.

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CDC publishes “QuickStats: Age-Adjusted Percentage of Adults Aged ≥65 Years Who Had an Influenza Vaccine in the Past 12 Months by Poverty Status—National Health Interview Survey, U.S., 1999–2001 and 2014–2016” in this week’s MMWR

CDC published QuickStats: Age-Adjusted Percentage of Adults Aged ≥65 Years Who Had an Influenza Vaccine in the Past 12 Months by Poverty Status—National Health Interview Survey, United States, 1999–2001 and 2014–2016 in the February 23 issue of MMWR.

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IAC Spotlight! IAC's newest slide set, "The Importance of Minimum Ages and Intervals in the Vaccine Schedule," now available for viewing and obtaining on immunize.org

IAC's newest slide set, The Importance of Minimum Ages and Intervals in the Vaccine Schedule, provides the information needed to avoid giving a vaccine too soon, and on what to do if that occurs.

This 46-slide set addresses a timely need: among the approximately 1,180 questions regarding medical errors related to vaccination that IAC received between 2015 and 2017, the most prevalent category of errors was vaccine scheduling, which comprised 34% of the total. This slide set is now available for viewing in PDF format on the PowerPoint Slide Sets web page of immunize.org.

To obtain this PowerPoint slide set, click on "Request the PowerPoint slide set" below the presentation's title and description on the PowerPoint Slide Sets web page, and IAC will email the PowerPoint presentation to you. Once you have the presentation, you can edit and use it as you see fit.

Additional PowerPoint slide sets are also available on the PowerPoint Slide Sets web page.

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Nine healthcare organizations join IAC's Influenza Vaccination Honor Roll for mandatory healthcare worker vaccination

There are now 659 organizations enrolled in IAC's Influenza Vaccination Honor Roll. The honor roll recognizes hospitals, medical practices, professional organizations, health departments, and government entities that have taken a stand for patient safety by implementing mandatory influenza vaccination policies for healthcare personnel.

Since January 10, when IAC Express last reported on the Influenza Vaccination Honor Roll, nine additional healthcare organizations have been enrolled.

IAC urges qualifying healthcare organizations to apply.

Newly added healthcare organizations, hospitals, government agencies, and medical practices

  • Southeast Alaska Regional Health Consortium, Juneau, AK
  • Hayes Green Beach Memorial Hospital, Charlotte, MI
  • Pediatric Nurse Practitioner House Calls, Massapequa Parkmar, NY
  • NYU Winthrop, Mineola, NY
  • Carson Tahoe Regional Medical Center, Carson City, NV
  • The Glen at Willow Valley, Lancaster, PA
  • Ivinson Memorial Hospital, Laramie, WY
  • North Big Horn Hospital, Lovell, WY
  • Electra Hospital, Electra, TX

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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

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.

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!

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IAC HANDOUTS


IAC revises "Influenza Vaccine Products for the 2017–2018 Influenza Season"

IAC recently revised Influenza Vaccine Products for the 2017–2018 Influenza Season. Changes were made to the list of influenza products to reflect the expanded age indication for Fluarix to include infants from 6 months of age.

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

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IAC updates “Vaccine Handling Tips”

IAC recently updated Vaccine Handling Tips to incorporate Shingrix, the recently licensed zoster vaccine, into the listing of vaccines to be stored in a refrigerator. Minor additional edits elsewhere in the text were also made.

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IAC revises “Standing Orders for Administering Varicella Vaccine to Children and Teens"

IAC's revised Standing Orders for Administering Varicella Vaccine to Children and Teens to expand the charts in sections 1 and 5 in order to incorporate additional possibilities of varicella vaccine history and schedules for vaccination.

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OFFICIAL RELEASES AND ANNOUNCEMENTS


WHO recommends changing two strains in quadrivalent flu vaccines for 2018–2019 influenza season

On February 22 the World Health Organization (WHO) issued a recommendation regarding the composition of influenza vaccines to be used in the 2018–2019 influenza season in the northern hemisphere.

The following is WHO's brief summary of the WHO recommendation:

It is recommended that quadrivalent vaccines for use in the 2018–2019 northern hemisphere influenza season contain the following:

  • an A/Michigan/45/2015 (H1N1)pdm09-like virus;
  • an A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus;
  • a B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage); and
  • a B/Phuket/3073/2013-like virus (B/Yamagata/16/88 lineage).

It is recommended that the influenza B virus component of trivalent vaccines for use in the 2018–2019 northern hemisphere influenza season be a B/Colorado/06/2017-like virus of the B/Victoria/2/87-lineage.

Access the above summary of the recommendations on the WHO website.

View the full report: Recommended composition of influenza virus vaccines for use in the 2018–2019 northern hemisphere influenza season.

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WHO publishes position paper on the Bacille Calmette Guérin (BCG) vaccine in its Weekly Epidemiological Record

WHO published BCG vaccines: WHO position paper—February 2018 in the February 23 issue of its Weekly Epidemiological Record. This is the most recent addition to a WHO-issued series of regularly updated position papers on vaccines that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programs.

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WORLD NEWS


WHO Regional Office for Europe issues press release regarding four-fold surge in measles cases in 2017 compared to previous year

The World Health Organization's Regional Office for Europe issued a press release on February 19 regarding the four-fold surge in the number of measles cases in Europe between 2016–17. The first paragraph is reprinted below.

Measles has rebounded in the WHO European Region. The disease affected 21,315 people and caused 35 deaths in 2017, following a record low of 5,273 cases in 2016. The WHO Regional Office for Europe has released new data for 2017 one day ahead of a health ministerial meeting on immunization in Montenegro on 20 February 2018.

Read the full press release.

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Pan American Health Organization reports highest number of yellow fever cases in South America in decades

The Pan American Health Organization (PAHO) published Epidemiological Update Yellow Fever, on February 16, reporting the highest number of yellow fever cases in South America in decades. The opening paragraph is excerpted below.

Situation summary in the Americas
Between January 2016 and January 2018, seven countries and territories of the Region of the Americas reported confirmed cases of yellow fever: the Plurinational State of Bolivia, Brazil, Colombia, Ecuador, French Guiana, Peru, and Suriname. The number of human cases and epizootics collectively reported in this period in the Region of the Americas is the highest observed in decades.


Read the full report: Epidemiological Update Yellow Fever.

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JOURNAL ARTICLES AND NEWSLETTERS

Pediatrics publishes large-scale study results supporting safety of current recommendations for influenza and Tdap vaccinations during pregnancy

In its February issue, Pediatrics published Infant Hospitalizations and Mortality after Maternal Vaccination, by L. Sukumaran, MD, MPH, et al., a large-scale study whose results support the safety of current recommendations for influenza and Tdap vaccinations during pregnancy. The abstract is reprinted below.

BACKGROUND: The Advisory Committee on Immunization Practices currently recommends pregnant women receive influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines. There are limited studies of the long-term safety in infants for vaccines administered during pregnancy. We evaluate whether maternal receipt of influenza and Tdap vaccines increases the risk of infant hospitalization or death in the first 6 months of life.

METHODS: We included singleton, live birth pregnancies in the Vaccine Safety Datalink between 2004 and 2014. Outcomes were infant hospitalizations and mortality in the first 6 months of life. We performed a case-control study matching case patients and controls 1:1 and used conditional logistic regression to estimate odds ratios for maternal exposure to influenza and/or Tdap vaccines in pregnancy.

RESULTS: There were 413, 034 live births in our population. Of these, 25,222 infants had hospitalizations and 157 infants died in the first 6 months of life. We found no association between infant hospitalization and maternal influenza (adjusted odds ratio: 1.00; 95% confidence interval [CI]: 0.96–1.04) or Tdap (adjusted odds ratio: 0.94; 95% CI: 0.88–1.01) vaccinations. We found no association between infant mortality and maternal influenza (adjusted odds ratio: 0.96; 95% CI: 0.54–1.69) or Tdap (adjusted odds ratio: 0.44; 95% CI: 0.17–1.13) vaccinations.

CONCLUSIONS: We found no association between vaccination during pregnancy and risk of infant hospitalization or death in the first 6 months of life. These findings support the safety of current recommendations for influenza and Tdap vaccination during pregnancy.

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CDC publishes “Notes from the Field: Increase in Acute Hepatitis B Infections—Pasco County, Florida, 2011–2016” in this week’s MMWR

CDC published Notes from the Field: Increase in Acute Hepatitis B Infections—Pasco County, Florida, 2011–2016 in the February 23 issue of MMWR (pages 230–231).

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EDUCATION AND TRAINING


NFID offers webinar on March 7 on updates from the February 2018 ACIP meeting
 
The National Foundation for Infectious Diseases (NFID) will present a webinar titled Updates from February 2018 ACIP Meeting on March 7 at 12:00 p.m. (ET). William Schaffner, MD, NFID medical director and liaison to the ACIP, and Amanda C. Cohn, MD, MPH, ACIP's executive secretary, will discuss updates from the February 2018 ACIP meeting, including the current vaccination recommendations for adults, adolescents, and children.

At the conclusion, participants will be able to:
  • Describe current ACIP recommendations for adult and childhood/adolescent immunization
  • Explain the impact of recent changes to vaccine recommendations on vaccination programs
  • Discuss information on new and/or future vaccines for potential use in practice

Registration open for Vaccine Education Center’s March 28 “Current Issues in Vaccines” webinar with Dr. Paul Offit

The Vaccine Education Center (VEC) at 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 28, as part of its Current Issues in Vaccines series. The webinar will feature Paul Offit, MD, director of VEC, discussing:
  • Novel hepatitis B vaccine: ACIP recommendations
  • Influenza: Updates on vaccine efficacy and disease burden
  • HPV: Updates on vaccine safety and long-term efficacy
  • PCV13: Evidence for herd immunity
  • Meningococcal disease: Revised data on risk for college students

Free continuing education credits (CME, CEU, and CPE) are available; instructions for obtaining credits are provided at the end of the recording.

Registration (required) is open now.

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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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Could There Be Another Polio Epidemic in the U.S.? Having contracted polio in 1952 at age 5, Paul Alexander, whose career was practicing law, is one of the last polio survivors in an iron lung. Able to leave the device for just a few hours at a time, he has struggled to find people who can maintain his machine. He wants to remind people of why we need to prevent polio. (Source: Gizmodo)
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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.