|Issue 1006: July 24, 2012
JOURNAL ARTICLES AND NEWSLETTERS
CDC publishes report on the 2012 pertussis epidemic in Washington state
CDC published Pertussis Epidemic—Washington, 2012 in the July 20 issue of MMWR (pages 517–522). The first paragraph is reprinted below.
Note: Anne Schuchat, MD, director, National Center for Immunization and Respiratory Diseases, and Mary Selecky, secretary, Washington State Department of Health, conducted a telebriefing about the epidemic; a transcript is available. In addition, pertussis cases reported through the National Notifiable Diseases Surveillance System during 1922–2011 are available in graph format.
Since mid-2011, a substantial rise in pertussis cases has been reported in the state of Washington. In response to this increase, the Washington State Secretary of Health declared a pertussis epidemic on April 3, 2012. By June 16, the reported number of cases in Washington in 2012 had reached 2,520 (37.5 cases per 100,000 residents), a 1,300% increase compared with the same period in 2011 and the highest number of cases reported in any year since 1942. To assess clinical, epidemiologic, and laboratory factors associated with this increase, all pertussis cases reported during January 1–June 16, 2012, were reviewed. Consistent with national trends, high rates of pertussis were observed among infants aged <1 year and children aged 10 years. However, the incidence in adolescents aged 13–14 years also was increased, despite high rates of vaccination with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine, suggesting early waning of immunity. The focus of prevention and control efforts is the protection of infants and others at greatest risk for severe disease and improving vaccination coverage in adolescents and adults, especially those who are pregnant. Pertussis vaccination remains the single most effective strategy for prevention of infection.
Severe varicella reported in an immunocompromised child exposed to an unvaccinated sibling with varicella
CDC published Notes from the Field: Severe Varicella in an Immunocompromised Child Exposed to an Unvaccinated Sibling with Varicella—Minnesota, 2011 in the July 20 issue of MMWR (page 541). The article is reprinted below.
Varicella usually is a self-limited disease but can result in serious complications (e.g., encephalitis, pneumonia, sepsis, hemorrhagic varicella, and death), especially among immunocompromised persons. Implementation of the varicella vaccination program in the United States, beginning in 1995, has led to declines of >95% in varicella-related hospitalizations and deaths among populations routinely vaccinated.
On December 13, 2011, the Minnesota Department of Health was notified of varicella in a girl, aged 3 years, admitted to a hospital after a 2-day history of fever of 102.7°F (39.3°C) and an extensive maculopapulovesicular rash (>500 skin lesions) with vesicles in the mouth and throat. The child received weekly immunosuppressive therapy with methotrexate (12.5 mg) for juvenile rheumatoid arthritis diagnosed at age 18 months. Neither she nor her younger sibling, aged 21 months, had received a first dose of varicella vaccine (routinely recommended at age 12–15 months). Their parents refused vaccination because of personal beliefs. The parents reported varicella in the younger sibling 2 weeks before her older sister was admitted. The older sister had not received prophylactic varicella zoster immune globulin (VariZIG); however, her parents monitored her for varicella symptoms.
The patient was treated with intravenous acyclovir for 7 days. Her fever resolved, and no new skin lesions appeared after hospital day 2. Moderate thrombocytopenia (platelet count: 103,000/µL; normal: 150,000–450,000/µL) resolved by hospital day 6. No other substantial laboratory abnormalities or signs of organ dysfunction were reported. She was discharged in good condition on hospital day 8.
Varicella vaccination is not recommended for children with congenital or acquired T-lymphocyte immunodeficiency (except certain categories of human immunodeficiency virus–infected children), including children receiving long-term immunosuppressive therapy, because of risk for complications from live vaccine virus infection. However, these patients are at high risk for severe or fatal varicella and depend on indirect protection through high levels of varicella immunity among the general population, and especially among their close contacts, to prevent exposure. Varicella vaccination of household contacts of immunocompromised patients is recommended if contacts lack evidence of varicella immunity. If exposure to varicella zoster virus occurs, postexposure prophylaxis with VariZIG (available through an Investigational New Drug protocol) is recommended for immunocompromised patients and other persons at high risk for severe disease who lack evidence of varicella immunity. In 2011, the period after exposure during which a contact may receive VariZIG was extended from 96 hours to 10 days; VariZIG should be administered as soon as possible after exposure.
Clinicians should remain vigilant for opportunities to prevent varicella through vaccination of household members of immunocompromised patients and administration of passive immunoprophylaxis (VariZIG) for up to 10 days after a susceptible, immunocompromised patient is exposed. Resources to help clinicians discuss vaccination with hesitant parents are available at http://www.cdc.gov/vaccines/spec-grps/hcp/conv-materials.htm.
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Tuesday, July 24, is last day to register for CDC's July 26 NetConference on influenza, pertussis, and childhood immunization
The next Current Issues in Immunization NetConference will be held on July 26 from noon to 1 p.m. ET. Lisa Grohskopf, MD, MPH, will present information about the 2012–13 influenza vaccination recommendations. In addition, CDC's materials on the pertussis outbreak will be presented, as will its materials for promoting early childhood immunization. Andrew Kroger, MD, MPH, will moderate the discussion.
Registration, which is required, will close on July 24 or when the course is full.
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Spotlight on immunize.org: IAC provides resources and vaccination information on hepatitis B
July 28 is World Hepatitis Day! IAC offers access to essential information on hepatitis B, including links to CDC vaccination recommendations, patient and staff handouts, as well as many other resources to help you carry out your vaccination activities.
Please consider signing the End of Polio petition
With polio endemic in just three countries, and India reported to have been polio free for more than a year, it looks like polio could soon be eradicated. But a funding shortfall of almost $1 billion for 2012–13 is stymieing eradication efforts.
That is why the End of Polio campaign is calling on people everywhere to demonstrate their support for eradicating polio by signing onto the End of Polio petition (located in the right column of the End of Polio home page). The goal of the petition is to convince delegates to the United Nations General Assembly to announce further funding for polio eradication, closing the funding gap that is currently leaving millions of children vulnerable to polio.
The End of Polio is a grassroots campaign coordinated by the Global Poverty Project in support of global polio eradication efforts led by the Global Polio Eradication Initiative, Rotary International, UNICEF, World Health Organization, and Gates Foundation.
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IAC updates its staff education document "Healthcare Personnel Vaccination Recommendations"
IAC recently revised Healthcare Personnel Vaccination Recommendations to clarify information about the evidence of measles, mumps, and rubella immunity required for healthcare personnel born after 1957.
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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Partnership for Prevention report shows businesses how to conduct work site influenza immunization programs
Partnership for Prevention has published a 24-page report, Give Productivity a Shot in the Arm: How Influenza Immunization Can Enhance Your Bottom Line. The report makes the case that influenza can adversely affect the lives of employees and take a toll on workplace productivity. It encourages employers to start an on-site influenza immunization program or increase employee participation in an existing one. Most important, it gives employers the resources needed to accomplish this goal.
The report is available for purchase at $7 per copy or for download at no charge.
Partnership for Prevention was founded in 1991 by leaders dedicated to making disease prevention and health promotion a national priority. The organization seeks to increase understanding and use of clinical preventive services and population-based prevention to improve health.
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JOURNAL ARTICLES AND NEWSLETTERS
CDC publishes erratum to "Updated CDC Recommendations for the Management of Hepatitis B Virus–Infected Health-Care Providers and Students"
CDC published Erratum: Vol. 61, No. RR-3 in the July 20 issue of MMWR (page 542). The erratum states that on page 4 of the MMWR Recommendations and Reports titled Updated CDC Recommendations for the Management of Hepatitis B Virus–Infected Health-Care Providers and Students, a therapeutic agent licensed for treatment of chronic hepatitis B was incorrectly given as "abacavir." The correct treatment name is "adefovir."
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Editor-in-ChiefKelly L. Moore, MD, MPH
Managing EditorJohn D. Grabenstein, RPh, PhD
Associate EditorSharon G. Humiston, MD, MPH
Writer/Publication CoordinatorTaryn Chapman, MS
Courtnay Londo, MA
Style and Copy EditorMarian Deegan, JD
Web Edition ManagersArkady Shakhnovich
Contributing WriterLaurel H. Wood, MPA
Technical ReviewerKayla Ohlde