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Immunization Action Coalition
IAC Express 2009
Issue number 815: August 10, 2009
Please click here to subscribe to IAC Express as well as other FREE IAC periodicals.
Contents of this Issue
Select a title to jump to the article.
  1. CDC issues updated recommendations for routine polio vaccination
  2. CDC issues updated school guidance for H1N1 influenza
  3. CDC issues a health advisory about updated recommendations for the amount of time people with influenza-like illness should stay away from others
  4. CDC's H1N1 influenza web section updated with additional information for schools, exclusion guidance for people with influenza-like illness, and more
  5. Important: During H1N1 influenza outbreak, administer PPSV to all people with existing indications
  6. IAC's Video of the Week features a re-cast of CDC's July 16 Current Issues in Immunization Net Conference on H1N1 influenza
  7. IAC's padded screening questionnaires for contraindications now have English on front, Spanish on back--a popular translation at no added cost!
  8. HHS's website for the public--www.healthfinder.gov--presents information on pre-teen vaccination
  9. CDC website posts presentation slide sets from ACIP's July 29 meeting on H1N1 influenza
  10. MMWR publishes article on the ability of rapid influenza diagnostic tests to detect H1N1 influenza viruses
  11. Clinical Vaccinology course scheduled for Atlanta on November 13-15
 
Abbreviations
AAFP, American Academy of Family Physicians; AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; AMA, American Medical Association; 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; NIVS, National Influenza Vaccine Summit; VIS, Vaccine Information Statement; VPD, vaccine-preventable disease; WHO, World Health Organization.
  
Issue 815: August 10, 2009
1.  CDC issues updated recommendations for routine polio vaccination CDC published "Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP) Regarding Routine Poliovirus Vaccination" in the August 7 issue of MMWR. It is reprinted below in its entirety, excluding references and a table titled "Currently licensed vaccines containing inactivated poliovirus vaccine (IPV)--United States, 2009." The table presents the vaccine composition of all available products, their trade names, manufacturers, and approved use in the Recommended Immunization Schedules for Persons Aged 0 Through 18 Years--United States, 2009.


This report updates Advisory Committee on Immunization Practices (ACIP) recommendations for routine poliovirus vaccination. These updates aim to (1) emphasize the importance of the booster dose at age >=4 years, (2) extend the minimum interval from dose 3 to dose 4 from 4 weeks to 6 months, (3) add a precaution for the use of minimum intervals in the first 6 months of life, and (4) clarify the poliovirus vaccination schedule when specific combination vaccines are used.

On June 17, 1999, ACIP recommended that all poliovirus vaccine administered in the United States be an inactivated poliovirus vaccine (IPV) beginning January 1, 2000. This policy was implemented to eliminate the risk for vaccine-associated paralytic poliomyelitis, a rare condition that has been associated with use of the live oral poliovirus vaccine (OPV). Since 1999, no OPV has been distributed in the United States. Under these ACIP recommendations, the routine IPV vaccination schedule in the United States consists of 4 doses administered at ages 2 months, 4 months, 6-18 months, and 4-6 years with the minimum interval between all IPV doses as 4 weeks.

Since the ACIP recommendation was made 10 years ago, three different combination vaccines containing IPV have been licensed for routine use in the United States. Because of potential confusion in using different vaccine products for routine and catch-up immunization, ACIP recommends the following:
  • The 4-dose IPV series should continue to be administered at ages 2 months, 4 months, 6-18 months, and 4-6 years.
     
  • The final dose in the IPV series should be administered at age >=4 years regardless of the number of previous doses.
     
  • The minimum interval from dose 3 to dose 4 is extended from 4 weeks to 6 months.
     
  • The minimum interval from dose 1 to dose 2, and from dose 2 to dose 3, remains 4 weeks.
     
  • The minimum age for dose 1 remains age 6 weeks.

ACIP also is making a new recommendation concerning the use of minimum age and minimum intervals for children in the first 6 months of life. Use of the minimum age and minimum intervals for vaccine administration in the first 6 months of life are recommended only if the vaccine recipient is at risk for imminent exposure to circulating poliovirus (e.g., during an outbreak or because of travel to a polio-endemic region). ACIP is making this precaution because shorter intervals and earlier start dates lead to lower seroconversion rates.

In addition, ACIP is clarifying the poliovirus vaccination schedule to be used for specific combination vaccines. When DTaP-IPV/Hib (Pentacel) is used to provide 4 doses at ages 2, 4, 6, and 15-18 months, an additional booster dose of age-appropriate IPV-containing vaccine (IPV [Ipol] or DTaP-IPV [Kinrix]) should be administered at age 4-6 years. This will result in a 5-dose IPV vaccine series, which is considered acceptable by ACIP. DTaP-IPV/Hib is not indicated for the booster dose at age 4-6 years. ACIP recommends that the minimum interval from dose 4 to dose 5 should be at least 6 months to provide an optimum booster response. In accordance with existing recommendations, if a child misses an IPV dose at age 4-6 years, the child should receive a booster dose as soon as feasible.


To access the full article in web-text (HTML) format, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5830a3.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to
 http://www.cdc.gov/mmwr/PDF/wk/mm5830.pdf

To receive a FREE electronic subscription to MMWR (which includes new ACIP recommendations), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html

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2 CDC issues updated school guidance for H1N1 influenza On August 7, the Department of Health and Human Services (HHS) posted a press release to its website regarding a CDC guidance document titled "CDC Guidance for State and Local Public Health Officials and School Administrators for School (K-12) Response to Influenza during the 2009-2010 School Year." The press release is reprinted below in its entirety. A link to the CDC guidance document is given at the end of this IAC Express article.


UPDATED FEDERAL GUIDELINES FOR 2009 H1N1 INFLUENZA IN SCHOOLS OFFER MANY OPTIONS
Guidance Says Officials Should Consider Local Needs in Making Decisions

Updated federal guidelines offer state and local public health and school officials a range of options for responding to 2009 H1N1 influenza in schools, depending on how severe the flu may be in their communities. The guidance says officials should balance the risk of flu in their communities with the disruption that school dismissals will cause in education and the wider community.

The guidance from the Centers for Disease Control and Prevention (CDC) was announced today at a joint news conference by Health and Human Services Secretary Kathleen Sebelius, Education Secretary Arne Duncan, Homeland Security Secretary Janet Napolitano, and CDC Director Thomas R. Frieden, MD, MPH.

The school guidance is a part of a broader national framework to respond to novel H1N1 influenza, which includes encouraging people to be vaccinated against the virus and to take other actions to avoid infection. The CDC anticipates more illness after the school year starts, because flu typically is transmitted more easily in the fall and winter.

"We're going to continue to do everything possible to keep our children--and all Americans--healthy and safe this fall," Secretary Sebelius said. "But all Americans also have a part to play. The best way to prevent the spread of flu is vaccination. A seasonal flu vaccine is ready to go, and we should have one for the 2009 H1N1 flu by mid-October."

"The federal government continues to coordinate closely with state and local governments, school districts, and the private sector on H1N1 preparation as we head into the fall flu season--and the upcoming school year," said Secretary Napolitano. "Readiness for H1N1 is a shared responsibility, and the guidance released today provides communities with the tools they need to protect the health of their students and teachers."

For an outbreak similar in severity to the spring 2009 H1N1 infection, the guidelines recommend basic good hygiene, such as hand washing. In addition, students or staff members with flu-like illness (showing symptoms of flu) should stay home at least 24 hours after fever symptoms have ended.

"We can all work to keep our children healthy now by practicing prevention, close monitoring, and using common sense," Secretary Duncan said. "We hope no schools have to close. But if they do, we need to make sure that children keep learning."

The guidelines also recommend schools have plans in place to deal with possible infection. For instance, people with flu-like illness should be sent to a room away from other people until they can be sent home. Schools should have plans for continuing the education of students who are at home, through phone calls, homework packets, Internet lessons and other approaches. And schools should have contingency plans to fill important positions such as school nurses.

If H1N1 flu causes higher rates of severe illness, hospitalizations, and deaths, school officials could add to or intensify their responses, the guidelines say. Under these conditions, the guidelines advise parents to check their children every morning for illness, and keep the children home if they have a fever.

In addition, schools could begin actively screening students upon arrival and sending ill students home immediately. If one family member is ill, students should stay home for five days from the day the illness develops, the guidelines say.

"Influenza can be unpredictable, so preparation and planning are key," said Dr. Frieden. "We can't stop the tide of flu, but we can reduce the number of people who become very ill by preparing well and acting effectively."


To access the press release, go to:
http://www.hhs.gov/news/press/2009pres/08/20090807a.html

To access the CDC guidance document, go to:
http://flu.gov/plan/school/schoolguidance.html

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3 CDC issues a health advisory about updated recommendations for the amount of time people with influenza-like illness should stay away from others On August 6, CDC's Health Alert Network issued an official CDC Health Advisory titled "CDC Updates Recommendations for the Amount of Time Persons with Influenza-Like Illness Should be Away from Others." The Health Advisory is reprinted below in its entirety.


On August 5, 2009, CDC changed its recommendation related to the amount of time people with influenza-like illness should stay away from others (the exclusion period). New guidance indicates that people with influenza-like illness should stay home for at least 24 hours after their fever is gone (without the use of fever-reducing medicine). A fever is defined as having a temperature of 100 degrees Fahrenheit or 37.8 degrees Celsius or greater.

This is a change from the previous recommendation that ill persons stay home for 7 days after illness onset or until 24 hours after the resolution of symptoms, whichever was longer.

The new recommendation applies to camps, schools, businesses, mass gatherings, and other community settings where the majority of people are not at increased risk for influenza complications. CDC recommends this exclusion period regardless of whether or not antiviral medications are used. This guidance does not apply to healthcare settings where the exclusion period continues to be for 7 days from symptom onset or until 24 hours after the resolution of symptoms, whichever is longer. (See http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm for guidance on infection control in healthcare settings.)

Decisions about extending the exclusion period should be made at the community level, in conjunction with local and state health officials. More stringent guidelines and longer periods of exclusion--for example, until complete resolution of all symptoms--may be considered for people returning to a setting where high numbers of high-risk people may be exposed.

This exclusion period guidance for the community setting is based on epidemiologic data about the overall risk of severe illness and death. The new recommendation attempts to balance the risks of acquiring illness from influenza and the potential benefits of decreasing transmission through the exclusion of ill persons with the goal of minimizing social disruption. This guidance will continue to be updated as more information becomes available.

To read the complete revised guidance, see:
http://www.cdc.gov/h1n1flu/guidance/exclusion.htm

This change in our recommendation has affected content on a number of other pages, including the following:

For more general information on H1N1, go to
http://www.cdc.gov/h1n1flu

To access the Health Advisory, go to:
http://www.cdc.gov/h1n1flu/HAN/080609.htm

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4 CDC's H1N1 influenza web section updated with additional information for schools, exclusion guidance for people with influenza-like illness, and more CDC recently posted new or updated information to various sub-sections of its H1N1 Flu web section. Following are the titles and URLs of documents that have been posted since the August 3 issue of IAC Express:

Preparing for Flu: A Communication Toolkit for Schools (Grades K-12)
http://flu.gov/plan/school/toolkit.html

Technical Report for State and Local Public Health Officials and School Administrators on CDC Guidance for School (K-12) Responses to Influenza during the 2009-2010 School Year
http://flu.gov/plan/school/k12techreport.html

CDC Guidance for State and Local Public Health Officials and School Administrators for School (K-12) Responses to Influenza during the 2009-2010 School Year
http://flu.gov/plan/school/schoolguidance.html

School Dismissal Monitoring System [generates real-time, national summary data daily on the number of school dismissals and number of affected students/teachers]
http://www.cdc.gov/h1n1flu/schools/dismissal_form

CDC Recommendations for the Amount of Time Persons with Influenza-Like Illness Should be Away from Others
http://www.cdc.gov/h1n1flu/guidance/exclusion.htm

Updated: Questions & Answers: Novel H1N1 Flu (Swine Flu) and You [for the public; updated with information on the time people with influenza-like illness should be away from others]
http://www.cdc.gov/h1n1flu/qa.htm

FOR MORE INFORMATION
The home page of CDC's H1N1 Flu web section can be accessed from http://www.cdc.gov/h1n1flu

IAC has gathered information related to H1N1 influenza into a single web section at http://www.immunize.org/h1n1

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5 Important: During H1N1 influenza outbreak, administer PPSV to all people with existing indications CDC advises healthcare professionals that during the current outbreak of novel influenza A (H1N1), all people who have existing indications for PPSV should be vaccinated according to current ACIP recommendations. This is important because people with existing indications are not only at increased risk for pneumococcal disease, but are also at increased risk for serious complications from influenza. Use of PPSV among people without current indications for vaccination is not recommended at this time.

To access CDC's comprehensive document "Interim guidance for use of 23-valent pneumococcal polysaccharide vaccine during  novel influenza A (H1N1) outbreak," go to:
http://www.cdc.gov/h1n1flu/guidance/ppsv_h1n1.htm

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6 IAC's Video of the Week features a re-cast of CDC's July 16 Current Issues in Immunization Net Conference on H1N1 influenza IAC encourages IAC Express readers to watch the 1-hour re-cast of CDC's July 16 Current Issues in Immunization Net Conference. Topics include an update on the epidemiology and clinical features of H1N1 influenza, H1N1 influenza vaccine development and manufacturing, and program implementation of H1N1 influenza vaccine. The presenters are Joseph Bresee, MD; Tom Shimabukuro, MD, MPH, MBA; and Pascale Wortley, MD, MPH. All are with CDC. Viewers of the re-cast can register for continuing education credit at  http://www.cdc.gov/vaccines/ed/ciinc/2009July.htm This continuing education opportunity expires on August 17, 2009.

The video will be available on the home page of IAC's website through August 16. To access it, go to: http://www.immunize.org and click on the image under the words Video of the Week. It may take a few moments for the video to begin playing; please be patient!

Remember to bookmark IAC's home page to view a new video every Monday. To view an IAC Video of the Week from the past, go to the video archive at http://www.immunize.org/votw/jul09.asp

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7 IAC's padded screening questionnaires for contraindications now have English on front, Spanish on back--a popular translation at no added cost! In response to demand, IAC now has a Spanish-language translation of the questions on its padded Screening Questionnaire for Child and Teen Immunization and Screening Questionnaire for Adult Immunization. Printed on the back of the English page, the Spanish page has been added to this product at no additional cost.

The questionnaires give you and your patients a quick, easy, and thorough way to determine if they have contraindications and precautions to vaccination. Patients fill out the questionnaire with yes-or-no answers while waiting to be seen, allowing you to review their responses quickly and be confident you're not missing any contraindications or precautions.

The questionnaires come in convenient tear-off pads of 100 sheets. The price per pad is economical (discounts for two pads or more), so you'll be able to keep pads at the receptionist's desk, the nurse's station, and in every exam room. Each pad comes with four English-language reference sheets (printed on heavy-weight paper) for health professionals.

Prices start at $16 each for one pad and drop to $12 each for two, $11 each for three, and $10 each for four. For quotes on larger quantities or customizing, call (651) 647-9009 or email admininfo@immunize.org

To learn more about the padded screening questionnaires, or to order online or download an order form, visit

Screening Questionnaire for Child and Teen Immunization
http://www.immunize.org/shop/pad_sqchild.asp

Screening Questionnaire for Adult Immunization
http://www.immunize.org/shop/pad_sqadult.asp

IAC's offers other products for sale, including educational videos and personal immunization record cards, at
http://www.immunize.org/shop

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8 HHS's website for the public--www.healthfinder.gov--presents information on pre-teen vaccination www.healthfinder.gov is a federal government website that offers the public tools and information to help them and those they care about stay healthy. Recently, the site posted information for parents on vaccinations that 11- and 12-year-olds need. It presents the basics about Tdap, MCV4, and (for girls) HPV vaccines and encourages parents to take action by scheduling a health check-up for their pre-teen. To access this information, go to:
http://www.healthfinder.gov/prevention/ViewTopic.aspx?topicId=60

The site has resources on a wide range of health topics selected from more than 1,600 government and non-profit organizations. Materials are available in English and Spanish in the form of print materials, interactive tools, subscription services, and more.

To access the home page, which offers a tutorial, go to:
http://www.healthfinder.gov

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9 CDC website posts presentation slide sets from ACIP's July 29 meeting on H1N1 influenza The CDC website recently posted the PowerPoint slide sets presented at the special July 29 ACIP meeting on H1N1 influenza. To access the slide sets, go to:
http://www.cdc.gov/vaccines/recs/acip/slides-july09-flu.htm

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10.  MMWR publishes article on the ability of rapid influenza diagnostic tests to detect H1N1 influenza viruses CDC published Evaluation of Rapid Influenza Diagnostic Tests for Detection of Novel Influenza A (H1N1) Virus--United States, 2009" in the August 7 issue of MMWR. A summary made available to the press is reprinted below in its entirety.


Rapid influenza diagnostic tests (RIDTs) may miss detecting novel influenza A (H1N1) virus infections, especially when the amount of virus in a specimen is low. Decisions regarding treatment and further testing among patients with negative results from RIDT testing should be based upon clinician suspicion, underlying medical conditions, severity of illness, and risk for complications in those persons suspected of having novel H1N1 virus infection.

This article assessed commercially available RIDTs for their ability to detect novel influenza A (H1N1) virus in respiratory specimens. RIDTs are tests that detect influenza A or B virus antigens and can provide results within 15 minutes. RIDTs from three companies are presented and results indicate that these tests can detect novel influenza A (H1N1) in respiratory specimens with high viral titers, but the overall sensitivities range from 40-69 percent, meaning that many influenza virus infections will be missed.


To access the full article in web-text (HTML) format, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5830a2.htm

To access a ready-to-print (PDF) version of this issue of MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5830.pdf

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11.  Clinical Vaccinology course scheduled for Atlanta on November 13-15 A Clinical Vaccinology course will be held in Atlanta on November 13-15.

To access a comprehensive course brochure, go to:
http://www.nfid.org/pdf/conferences/course1109.pdf

To register online, go to:
https://secure.bnt.com/webresponse/nfid/course1109

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Immunization Action Coalition  •  1573 Selby Ave  •  St. Paul, MN 55104
tel 651-647-9009  •  fax 651-647-9131
 
This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No. 5U38IP000290) 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.