Issue 1253: June 29, 2016
Ask the Experts—Question of the Week: We did a hepatitis B panel for a new hospital employee from Gambia…read more
TOP STORIES
IAC HANDOUTS
VACCINE INFORMATION STATEMENTS
WORLD NEWS
FEATURED RESOURCES
JOURNAL ARTICLES AND NEWSLETTERS
EDUCATION AND TRAINING
CONFERENCES AND MEETINGS
TOP STORIES
ACIP votes that live attenuated influenza vaccine (LAIV) should not be used during the 2016–2017 flu season
The Advisory Committee on Immunization Practices (ACIP) met in Atlanta on June 22–23. Because of data indicating poor effectiveness of live attenuated influenza vaccine (LAIV, FluMist) in children age 2 through 17 years of age during the past three influenza seasons, ACIP voted to recommend that LAIV should not be used in any setting during the 2016–2017 influenza season. ACIP also voted to remove LAIV from the VFC program for the 2016–2017 influenza season. A media statement on this issue from CDC is reprinted below.
CDC’s Advisory Committee on Immunization Practices (ACIP) today voted that live attenuated influenza vaccine (LAIV), also known as the “nasal spray” flu vaccine, should not be used during the 2016–2017 flu season. ACIP continues to recommend annual flu vaccination, with either the inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV), for everyone 6 months and older.
ACIP is a panel of immunization experts that advises the Centers for Disease Control and Prevention (CDC). This ACIP vote is based on data showing poor or relatively lower effectiveness of LAIV from 2013 through 2016.
In late May, preliminary data on the effectiveness of LAIV among children 2 years through 17 years during 2015–2016 season became available from the U.S. Influenza Vaccine Effectiveness Network. That data showed the estimate for LAIV VE among study participants in that age group against any flu virus was 3 percent (with a 95 percent Confidence Interval (CI) of -49 percent to 37 percent). This 3 percent estimate means no protective benefit could be measured. In comparison, IIV (flu shots) had a VE estimate of 63 percent (with a 95 percent CI of 52 percent to 72 percent) against any flu virus among children 2 years through 17 years. Other (non-CDC) studies support the conclusion that LAIV worked less well than IIV this season. The data from 2015–2016 follows two previous seasons (2013–2014 and 2014–2015) showing poor and/or lower than expected vaccine effectiveness (VE) for LAIV.
How well the flu vaccine works (or its ability to prevent flu illness) can range widely from season to season and can be affected by a number of factors, including characteristics of the person being vaccinated, the similarity between vaccine viruses and circulating viruses, and even which vaccine is used. LAIV contains live, weakened influenza viruses. Vaccines containing live viruses can cause a stronger immune response than vaccines with inactivated virus. LAIV VE data before and soon after licensure suggested it was either comparable to, or better than, IIV. The reason for the recent poor performance of LAIV is not known.
Vaccine manufacturers had projected that as many as 171 million to 176 million doses of flu vaccine, in all forms, would be available for the United States during the 2016–2017 season. The makers of LAIV had projected a supply of as many as 14 million doses of LAIV/nasal spray flu vaccine, or about 8 percent of the total projected supply. LAIV is sold as FluMist Quadrivalent and it is produced by MedImmune, a subsidiary of AstraZeneca. LAIV was initially licensed in 2003 as a trivalent (three-component) vaccine. LAIV is currently the only non-injection-based flu vaccine available on the market.
Today’s ACIP vote could have implications for vaccine providers who have already placed vaccine orders. The ACIP recommendation may particularly affect pediatricians and other vaccine providers for children since data from recent seasons suggests nasal spray flu vaccine accounts for about one-third of all flu vaccines given to children. CDC will be working with manufacturers throughout the summer to ensure there is enough vaccine supply to meet the demand.
CDC conducts vaccine effectiveness (VE) studies each season to estimate flu vaccine effectiveness. Today’s ACIP vote highlights the importance of measuring and evaluating the effectiveness of public health interventions, which can have significant implications for public health policy. The change in the ACIP recommendation is an example of using new available data to ensure public health actions are most beneficial. Influenza is a serious disease that causes millions of illnesses, hundreds of thousands of hospitalizations, and thousands or tens of thousands of deaths each year. While the protection offered by flu vaccines can vary, the flu shot’s overall VE estimate of 49 percent suggests that millions of people were protected against flu last season.
Today's ACIP recommendation must be reviewed and approved by CDC's director before it becomes CDC policy. The final annual recommendations on the prevention and control of influenza with vaccines will be published in a CDC Morbidity and Mortality Weekly Report (MMWR), Recommendations and Reports in late summer or early fall.
CDC has recommended an annual influenza vaccination for everyone ages 6 months and older since February 24, 2010. CDC and ACIP briefly had a preferential recommendation for nasal spray vaccine for young children (during 2014–2015); however, during the 2015–2016 season, influenza vaccination was recommended without any preference for one vaccine type or formulation over another.
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IAC provides summary article about votes taken at June 22–23 ACIP meeting
The Advisory Committee on Immunization Practices (ACIP) met in Atlanta on June 22–23. Topics discussed included cholera vaccine, meningococcal vaccines, influenza vaccine, respiratory syncytial virus (RSV) vaccine, the safety of maternal Tdap immunization, the laboratory containment of poliovirus, and human papillomavirus (HPV) vaccine. Three votes were taken.
Cholera Vaccine
The U.S. Food and Drug Administration (FDA) approved a live-attenuated single dose oral cholera vaccine on June 10. The vaccine is approved for people age 18 through 64 years, and has been shown to be safe and effective against toxigenic Vibrio cholerae 01 infection. ACIP voted to recommend the vaccine for persons who travel to an area of active toxigenic V. cholerae 01 transmission.
MenACWY Vaccine for People with HIV Infection
An estimated one million persons are living with human immunodeficiency virus (HIV) infection in the United States. A growing body of evidence demonstrates an increased risk of meningococcal disease among this population, primarily due to serogroups C, W and Y. ACIP voted to recommend that persons with HIV infection who are two months of age and older should routinely receive MenACWY vaccine. Children younger than age two years should receive an age-appropriate multi-dose schedule. Because people with HIV infection have not been shown to be at increased risk of serogroup B disease, no changes were made to the meningococcal serogroup B vaccine recommendations.
Live Attenuated Influenza Vaccine (LAIV, FluMist)
Preliminary U.S. influenza vaccine effectiveness network data for the 2015–2016 influenza season indicates that quadrivalent live attenuated influenza vaccine (LAIV) provided no significant protection against influenza A (H1N1) in children age 2 through 17 years. Poor vaccine effectiveness for quadrivalent LAIV was also observed during two preceding influenza seasons among this age group. The reason for this observed decreased vaccine effectiveness is not known. Although the effectiveness of all influenza vaccine formulations was poor during the 2014–2015 season because of a poor match of the vaccine with circulating virus, inactivated influenza vaccine was more effective than LAIV during the 2013–2014 and 2015–2016 seasons. Because of the persistent poor effectiveness of LAIV, particularly against influenza A (H1N1), ACIP voted to recommend that LAIV should not be used in any setting during the 2016–2017 influenza season. Only inactivated influenza vaccine should be used. ACIP also voted to remove LAIV from the VFC program for the 2016–2017 influenza season. A media statement on this issue has been posted on the CDC website.
Recommendations approved by ACIP are provisional until they are approved by the director of CDC and published in MMWR. Presentation slides from the June meeting should be posted on the ACIP website in the next 4–6 weeks.
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FDA approves plans for first human Zika vaccine trial
The U.S. Food and Drug Administration (FDA) recently approved plans for the first human Zika vaccine trial. A news article about the upcoming trial, titled FDA paves way for first human Zika vaccine trial, is available from the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP). A press release, titled Inovio Pharmaceuticals and GeneOne Life Science Receive Approval for First-in-Man Zika Vaccine Clinical Trial, is available from Inovio Pharmaceuticals, the maker of the vaccine.
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Free bulk quantities of pneumococcal and zoster vaccination laminated pocket guides available from IAC for distribution within your organization and at conferences
Bulk quantities of two recently updated laminated pocket guides for use by healthcare professionals are yours free for the ordering! The guides address issues related to the administration of (1) pneumococcal conjugate (PCV13) and polysaccharide (PPSV23) vaccines and (2) zoster vaccine.
These concise pocket guides provide front-line healthcare personnel with quick reference information highlighting:
- Indications and contraindications for each vaccine
- Targeted populations to be vaccinated
- Details on how to administer the vaccines
- Talking points for discussions with patients
Each guide is laminated for durability, and the compact size (3¾" x 6¾") is designed to fit in a shirt or lab coat pocket.
The pocket guides are available at no cost to your organization. However, to assist us in controlling our mailing costs, we ask that you order in bulk (with a minimum order of 25) and that you manage the distribution of the guides (e.g., through internal networks, educational forums, member meetings, mass mailings) to your constituents.
To view the pocket guides and place your order, please visit www.immunize.org/pocketguides or click on either image below. These cards are for healthcare professional use only, not for distribution to patients.
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IAC HANDOUTS
Reminder: “10 Steps to Implementing Standing Orders for Immunization in Your Practice Setting” now available
IAC's standing orders workshops are completed, but you can still benefit by reviewing 10 Steps to Implementing Standing Orders for Immunization in Your Practice Setting. This six-page “cookbook” about how to implement standing orders has been presented in 22 workshops across the U.S. over the past nine months. It provides step-by-step guidance about developing and implementing standing orders in your practice.
Standing orders are written protocols approved by a physician or other authorized practitioner that allow qualified healthcare professionals (who are eligible to do so under state law, such as registered nurses or pharmacists) to assess the need for and administer vaccine to patients meeting certain criteria, such as age or underlying medical condition. The qualified healthcare professionals must also be eligible by state law to administer certain medications, such as epinephrine, under standing orders should a medical emergency (rare event) occur.
Having standing orders in place streamlines your practice workflow by eliminating the need to obtain an individual physician’s order to vaccinate each patient. Standing orders carried out by nurses or other qualified healthcare professionals are the most consistently effective means for increasing vaccination rates and reducing missed opportunities for vaccination, improving the quality of care for patients.
Standing orders are straightforward to use. The challenge is to integrate them into the practice setting so they can be used to their full potential. This process requires some preparation up front to assure that everyone in the practice understands both the reasons why standing orders are being implemented and how their roles contribute to successful implementation of them. The new resource from IAC includes suggested steps to help you work through this process.
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VACCINE INFORMATION STATEMENTS
IAC posts Yiddish-language translations of the HPV9 and Meningococcal ACWY VISs
IAC recently posted Yiddish-language translations of the HPV9 and Meningococcal ACWY VISs. IAC thanks the New York City Department of Health and Mental Hygiene for the translations.
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WORLD NEWS
WHO publishes report on maternal and neonatal tetanus prevention in Indonesia
The World Health Organization (WHO) published Maternal and neonatal tetanus validation assessment in Region 4, Indonesia, May 2016 in the June 24 issue of its Weekly Epidemiological Report. Selections from the article are reprinted below.
Tetanus is an acute, potentially fatal disease caused by a neurotoxin produced by the bacterium Clostridium tetani. Maternal and neonatal tetanus (MNT) are forms of generalized tetanus affecting mothers during pregnancy, due to unclean abortion or delivery, and infants during the first month of life. Neonatal tetanus (NT) infection begins when C. tetani spores are introduced into the umbilical tissue during delivery.
In the 1980s, over 1 million deaths every year were attributable to tetanus, with an estimated 787,000 deaths in 1988 from NT alone.
The spores of tetanus are very resistant and remain in the environment in extremes of temperature for long periods. Hence, technically it is not possible to eradicate tetanus, including NT. However, MNT can be eliminated by reducing the disease incidence to such low levels that it ceases to be a public health problem. The disease is easily preventable through:
- clean delivery and umbilical cord care practices to ensure infection is not contracted by mother or newborn during the delivery process;
- delivery of appropriate doses of TTCV [tetanus toxoid-containing vaccine] to pregnant women through antenatal care services and other routine contacts;
- vaccination campaigns with TTCV targeting all women of reproductive age in high-risk areas; and
- strengthening surveillance to identify women at risk, reasons for the risk, and potential clustering.
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Vaccine Education Center's newsletter for healthcare professionals includes a rabies Q&A and other new resources
The Vaccine Education Center (VEC) at Children's Hospital of Philadelphia publishes an immunization-focused newsletter titled V accine Update for Healthcare Professionals. The June issue includes the following:
- A new Q&A on rabies. Questions & Answers: Rabies, part of VEC's Special Topics Series that includes fact sheets about medical topics, most having some information about immunization
- An article by Ralph Berberich, MD, FAAP, titled Successful Distraction for Childhood Immunizations: A Novel Technique
- Updated International Vaccine- and Vaccine Safety-Related Informational Materials. There are now materials available for Kazakhstan (Russian language) and Poland in addition to Czech Republic, Slovakia, and Ukraine (in both Ukrainian language and Russian language).
- An updated Travel Health Resources web page with information for both providers and the general public
- The Technically Speaking column by IAC's executive director, Deborah Wexler, MD, titled Give a Strong Recommendation for HPV Vaccine for All Preteens and Young Adults
Access the sign-up form to subscribe to Vaccine Update for Healthcare Professionals.
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CDC's “You are the key to HPV cancer prevention” slide deck for providers available in Spanish
CDC offers a Spanish-language translation of the slide deck for providers titled You Are the Key to HPV Prevention. The presentation was developed to help pediatric and family medicine providers talk to their colleagues about the importance of recommending HPV vaccine to 11- or 12-year-olds in the same way and on the same day as Tdap and meningococcal conjugate vaccines.
CDC's "You are the key to HPV cancer prevention" campaign also includes tips for providers, a slide set, fact sheets, Medscape commentaries for provider education, and handouts for parents and patients in English and Spanish. The goal is to help healthcare professionals talk to parents and young adults about HPV vaccination. Access all these resources from CDC's Human Papillomavirus (HPV) web section.
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Now available! IAC's sturdy laminated versions of the 2016 U.S. child/teen immunization schedule and the 2016 U.S. adult immunization schedule—order a supply for your healthcare setting today!
IAC's laminated versions of the 2016 U.S. child/teen immunization schedule and the 2016 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 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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Download Dr. Gary Marshall's The Vaccine Handbook: A Practical Guide for Clinicians (“The Purple Book") as a new app for iOS devices or purchase as a print book
The Vaccine Handbook: A Practical Guide for Clinicians (“The Purple Book,” 2015) is a comprehensive source of practical, up-to-date information for vaccine providers and educators. Its author, Gary S. Marshall, MD, has drawn 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. This book is now available as a new app for iOS devices.
Information about the iOS app version of The Vaccine Handbook: A Practical Guide for Clinicians
The Vaccine Handbook App contains the 5th edition of the book, updated with the latest immunization schedules and recommendations. The app enhances the utility of an already valuable print resource by including functions like keyword search, internal links, bookmarking, quick access to schedules and tables, hyperlinks to external sources, and the ability for real-time updates. A resources section provides ready access to authoritative immunization-related websites. Available through a collaboration between the publisher and Sanofi Pasteur, registration as well as reporting under Open Payments is required. (Offer void in Minnesota.) Click on the image below to visit the relevant App Store page to download this resource today.
Information about the print version of The Vaccine Handbook: A Practical Guide for Clinicians
The fifth edition of this valuable guide (560 pages) is available on IAC's website at www.immunize.org/vaccine-handbook. The price of the handbook is $29.95 each, plus shipping charges. Discount pricing is available for more than 10 copies. Order copies for your staff or for distribution at an upcoming conference.
Quantity Discount Pricing
- 1–10 books: no discount + shipping
- 11–50 books: 5% + shipping
- 51–100 books: 10% + shipping
- 101–500 books: 15% + shipping
- 501–1000 books: 20% + shipping
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.
About the Author
Gary 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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JOURNAL ARTICLES AND NEWSLETTERS
Studies find association between rotavirus vaccination and reduction of childhood seizures
The Vaccine Education Center (VEC) at Children's Hospital of Philadelphia recently reported the findings of two studies about the effects of rotavirus vaccination on childhood seizures. Its summary article, In the Journals: Febrile Seizures, is available on the VEC website. The summary reviews the following two studies, both of which found a reduction in febrile seizures among vaccinated children:
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EDUCATION AND TRAINING
Time sensitive! VICNetwork webinar about social media will be held today (Wednesday), June 29, at 2:00 p.m. (ET)
There is a brief time to register for the VICNetwork webinar to be held today, Wednesday, June 29 at 2:00 p.m. (ET). The featured speaker, Mark Avera, will discuss social media strategies and message development to engage audiences and build your social media network. Maureen Marshall will highlight the new digital and social media resources from CDC, and Catherine Martin will provide an overview of the 2016 National Immunization Awareness Month (NIAM) toolkit, produced in partnership with the National Public Health Information Coalition (NPHIC).
NIAM is an annual observance held in August to highlight the importance of vaccination for people of all ages. For more information on the observance, visit NPHIC’s NIAM website
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Weekly CDC webinar series on "The Pink Book" chapter topics continues through September 21; register now
CDC is presenting a 15-part webinar series to provide a chapter-by-chapter overview of the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book"). This is a live series of one-hour webinars that started June 1. Recordings of sessions will be available online after each webinar. All sessions begin at 12:00 p.m. (ET). Information about receiving continuing education credit will be available for each session after it is archived. CE credit may be available for up to a year after the date it was live.
Registration and more information is available on CDC's Pink Book Webinar Series web page.
Download Epidemiology and Prevention of Vaccine-Preventable Diseases
Order Epidemiology and Prevention of Vaccine-Preventable Diseases
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CONFERENCES AND MEETINGS
Registration deadline for October 19–20 ACIP meeting is September 28 for non-U.S. citizens and October 10 for citizens
CDC's Advisory Committee on Immunization Practices (ACIP) will hold its next meeting on October 19–20 in Atlanta at CDC's Clifton Road campus. To attend the meeting, ACIP attendees (participants and visitors) must register online. The registration deadline for non-U.S. citizens is September 28; for citizens, it's October 10. Registration is not required to watch the live webcast of the meeting.
More information available from the CDC website.
In addition, the summary report from the February ACIP meeting is now available.
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North Dakota Immunization Conference scheduled for August 3–4
The 2016 North Dakota Immunization Conference will be held in Bismarck on August 3–4. The conference is targeted to healthcare professionals, including nurses, nurse practitioners, physician assistants, public health professionals, and anyone interested in immunizations. Topics include HPV-associated cancers and prevention, immunization best practices from North Dakota providers, school immunizations, and vaccine storage and handling. Category I CME and North Dakota Nursing Contact Hours will be available for attendees, pending application approvals.
Access more information and registration on the conference website.
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ASK THE EXPERTS
Question of the Week
We did a hepatitis B panel for a new hospital employee from Gambia. She had no documentation of having been vaccinated. Her results showed HBsAg nonreactive, anti-HBc reactive, IgM anti-HBc nonreactive, and anti-HBs borderline. We don’t know how to interpret these results. Should she be immunized?
Most likely this person has a resolved hepatitis B infection and is immune. However, it would be preferable to test her again for all these serologic markers, and also quantify the anti-HBs result. If the results are still positive for anti-HBc, and anti-HBs is less than the immune level of 10mIU/mL, you can give her one dose of hepatitis B vaccine and test again in 1–2 months. If the anti-HBs is positive (10 mIU/mL or higher), she is immune. No further action is needed other than to document the results. If the anti-HBs is still negative, complete the vaccine series and test again 1–2 months after the last dose of vaccine.
If she is still anti-HBs negative after 3 doses of vaccine, test again for HBsAg to be sure she is not chronically infected (unlikely) and counsel her as a nonresponder. See www.cdc.gov/mmwr/pdf/rr/rr6210.pdf for more information about hepatitis B vaccination of healthcare personnel. Information about persons with isolated positive anti-HBc is available at www.cdc.gov/hepatitis/hbv/hbvfaq.htm#general.
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 new 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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