Issue 1325: September 13, 2017
Ask the Experts—Question of the Week: My adult patient is traveling to Nigeria in three days. She is already immune to hepatitis A, but . . . read more
TOP STORIES
IAC HANDOUTS
OFFICIAL RELEASES AND ANNOUNCEMENTS
WORLD NEWS
FEATURED RESOURCES
JOURNAL ARTICLES AND NEWSLETTERS
EDUCATION AND TRAINING
CONFERENCES AND MEETINGS
TOP STORIES
San Diego County Board of Supervisors ratifies a local health emergency declaration regarding the county's ongoing hepatitis A outbreak
On September 6, the San Diego County Board of Supervisors ratified a local health emergency declaration to try to stem the county's hepatitis A outbreak. A section of a related article from the County of San Diego Communications Office is reprinted below.
At a special meeting Wednesday, the San Diego County Board of Supervisors ratified a local health emergency declared for the ongoing hepatitis A outbreak in the county....
Since the outbreak was identified in early March, 15 people have died, all of whom had underlying medical conditions. Additionally, 279 of the 398 reported cases have been hospitalized. Approximately 65 percent of the cases have been among people who are homeless, use illicit drugs, or a combination of those two factors.
The County has implemented a three-part strategy to combat the outbreak that includes immunization, sanitation, and education efforts.
So far the County and community partners have immunized over 19,000 people, including approximately 7,300 to the at-risk population. There have been 256 mass vaccination events and 109 “foot teams” of public health nurses have gone out into areas with heavy homeless populations to offer vaccinations....
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Medical exemptions to immunization rise in California after elimination of personal belief exemptions
A recently published Research Letter by P.L. Delamater et al. in JAMA found that medical exemptions to immunization in California had risen after the elimination of personal belief exemptions. The first paragraph of the letter titled Change in Medical Exemptions From Immunization in California After Elimination of Personal Belief Exemptions is reprinted below.
California Senate bill (SB) 277 eliminated the personal belief exemption (PBE) provision from the state’s school-entry vaccine mandates prior to the 2016–2017 school year. Previously, vaccine-hesitant parents could acquire a PBE for their child based on philosophical or religious beliefs. Now, the only pathway for an unvaccinated kindergartener to enter a public or private school in California is with a medical exemption (ME), which requires a written statement from a licensed physician describing the medical reasons that immunization is unsafe. Previously, MEs were only granted to children with a contraindication to vaccination; however, SB 277 gave physicians broader discretion to grant MEs for reasons other than a contraindication, including family medical history.
A related article in Medical Press provides a summary of the findings.
In the 20 years prior to SB 277, the percentage of kindergarteners with MEs was largely stable, whereas PBE use increased. In the first year under SB 277, the ME percentage increased from 0.17 percent to 0.51 percent. The PBE percentage decreased from 2.37 percent in 2015 to 0.56 percent in 2016, as PBEs for children who entered multiyear transitional kindergarten programs prior to 2016 remained valid. The total exemption percentage (PBEs + MEs) decreased from 2.54 percent in 2015 to 1.06 percent in 2016.
The authors found a positive relationship between county-level change in ME percentage and previous PBE use, indicating that counties with high PBE use prior to SB 277 had the largest increases in MEs after its implementation.
Finally, Dr. Paul A. Offit, MD, director of the Vaccine Education Center (VEC) at Children's Hospital of Philadelphia, contributed a column on this topic to The Daily Beast titled Who’s Cheating California’s Tough New Vaccine System? The concluding paragraphs are reprinted below.
Typically, about 0.5 percent of children require a medical exemption. Indeed, the 2,850 medical exemptions requested represent 0.5 percent of California’s kindergarten population. But according to the Los Angeles Times, in 58 schools, more than 10 percent of kindergarteners chose medical exemptions; at seven schools, more than 20 percent did. Many of these exemptions occurred in Los Angeles, San Diego, and Orange counties: the same counties that produced the 2014–2015 measles epidemic.
The unusual resource? After SB277 passed, anti-vaccine websites appeared across the state coaching parents on how to request medical exemptions; many of these websites included a list of doctors sympathetic to parents who felt they were being unfairly coerced into vaccinating their children—doctors who, by requiring an office visit, were essentially selling a medical exemption. “It would be very unfortunate if there were physicians who’ve shirked their professionalism, and basically are trying to monetize their professional license by putting children at risk and betraying public health,” said Richard Pan (D-Sacramento), a physician who co-authored SB277.
Given this most recent development, it would take a counsel of the gods to determine which aspect of the anti-vaccine movement is most upsetting: parents choosing to put their children in harm’s way unnecessarily; state governments, through philosophical and religious exemptions, allowing them to do it; or doctors, in some misguided sympathy for freedom of choice, writing bogus medical exemptions for a price. At the very least, public health officials and licensing boards in California need to take a closer look at the reasons behind the dramatic increase in medical exemptions. And if they find that these exemptions have no basis in fact, doctors should be held accountable for their fraudulent behavior.
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AAP News reports on shoulder injury related to vaccine administration
On September 1, AAP News published Shoulder Injury Related to Vaccine Administration Reported More Frequently by H. Cody Meissner, MD, FAAP. Three paragraphs are reprinted below.
Shoulder injury related to vaccine administration (SIRVA) is believed to be caused by an immune response following inadvertent, direct injection of a vaccine into the deltoid bursa or joint space.
The presentation of SIRVA typically includes rapid onset of severe, long-lasting shoulder pain following vaccination in the deltoid muscle, resultant limited range of motion and absence of infection. Data from the Vaccine Adverse Event Reporting System suggest SIRVA is being reported with increasing frequency....
SIRVA identifies a specific condition that is associated with vaccine inadvertently administered into the deltoid bursa or joint space. Patients with SIRVA experience shoulder injury that is more severe than would be expected from just needle trauma. One theory suggests that an immune reaction to one or more components of the vaccine may be responsible for signs and symptoms of SIRVA....
Access the complete article in PDF format for more information, including guidance on avoiding such injuries with proper vaccine administration, including details on anatomic area, route, and needle length.
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International vaccine expert Dr. Peter Hotez and his daughter who has autism are targeted with threats
International vaccine expert Dr. Peter Hotez has experienced attacks by the anti-vaccine lobby previously, but now the attacks are more frequent, mean-spirited, and personal. Attacks are even directed against his daughter, who has autism. Dr. Hotez, who is director of the Texas Children’s Hospital Center for Vaccine Development and dean of the National School of Tropical Medicine at Baylor College of Medicine, is renowned for his work in vaccine development. The attacks against him and his daughter have come through Twitter, email, and phone calls. In a televised interview, Dr. Hotez stated:
The anti-vaccine lobby has really . . . scaled up both the frequency by which they’ve been going after me and the tenor of the comments . . . It is very hurtful, but I try not to respond to it directly; I try to stick to the scientific evidence . . . I do have a lot of support in the science community.
To fight back against this barrage of attacks against him, his daughter, and vaccination, Dr. Hotez is writing a book, Vaccines Did Not Cause Rachel’s Autism.
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National Adult Immunization and Influenza Summit offers tools to assist satellite, temporary, and off-site influenza vaccination clinics
The National Adult and Influenza Immunization Summit (NAIIS) has developed tools to assist satellite, temporary, and off-site vaccination clinics in implementing best practices. These clinics, functioning in non-traditional settings, face unique challenges. Information about these tools and their purpose can be found on the new Tools to Assist Satellite, Temporary, and Off-Site Vaccination Clinics web section of the NAIIS website.
The following tools are available on this NAIIS web section for downloading and printing:
In particular, NAIIS is urging partners holding these clinics to take the pledge. The pledge is for organizations that conduct satellite, temporary, or off-site vaccination clinics to sign annually affirming that they will adhere to best practices, including using the "Checklist of Best Practices for Vaccination Clinics Held at Satellite, Temporary, or Off-Site Locations." Organizations that sign the pledge will be recognized on the NAIIS website for their commitment to provide safe and effective vaccine clinics. Companies seeking to hire an organization to conduct a vaccination clinic can check to see if that organization has signed the pledge and is recognized on the NAIIS website.
If your organization has signed the pledge, please send an email to vaxclinicpledge@izsummitpartners.org with the subject “Vaccine Clinic Pledge Form.” In the message area, include your organization's name and an email address for an organization contact. Please be sure to attach a copy of your signed pledge so that we can properly recognize you!
Read more about the launch of these new tools and their purpose in the NAIIS web section titled Tools to Assist Satellite, Temporary, and Off-Site Vaccination Clinics.
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IAC Spotlight! Three healthcare organizations join IAC's Influenza Vaccination Honor Roll for mandatory healthcare worker vaccination
There are now 636 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 August 16, when IAC Express last reported on the Influenza Vaccination Honor Roll, three additional healthcare organizations have been enrolled.
IAC urges qualifying healthcare organizations to apply.
Newly added healthcare organizations, hospitals, government agencies, and medical practices
- Kalamazoo County Health and Community Services, Kalamazoo, MI
- Mercy Health Lourdes Hospital, Paducah, KY
- Mercy Health Springfield, Springfield, OH
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Join NFID and the Washington Nationals for the 6th Annual Flu Awareness Night in Washington, DC, on September 15
Everyone is invited to join the National Foundation for Infectious Diseases (NFID) and the Washington Nationals for the 6th Annual Flu Awareness Night in Washington, DC this Friday, September 15. The Nationals will take on the Los Angeles Dodgers, and $5 from each ticket sold will be donated to NFID to help support the prevention and treatment of infectious diseases, including influenza.
Access more information and/or purchase tickets.
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IAC HANDOUTS
IAC posts "Influenza Vaccine Products for the 2017–2018 Influenza Season"
IAC has posted an updated version of its Influenza Vaccine Products for the 2017–2018 Influenza Season. Changes were made to incorporate all available influenza vaccine products for the 2017–2018 influenza vaccination season.
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 "Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination"
IAC recently revised Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination to delete a duplicative statement about oculorespiratory syndrome and to update a reference. Both of the changes are on the second page, which is a reference guide for healthcare providers.
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IAC updates "Standing Orders for Administering Influenza Vaccine to Adults" and "Standing Orders for Administering Influenza Vaccine to Children and Adolescents"
IAC recently revised both its sample standing orders for administering influenza vaccine.
Related Link
- IAC's Standing Orders web section contains standing orders templates for administering all routinely recommended vaccines and for the medical management of vaccine reactions
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IAC updates "Guide for Determining the Number of Doses of Influenza Vaccine to Give to Children Age 6 Months through 8 Years during the 2017–2018 Influenza Season"
IAC recently posted the updated version of Guide for Determining the Number of Doses of Influenza Vaccine to Give to Children Age 6 Months Through 8 Years During the 2017–2018 Influenza Season. The title and ACIP reference were changed to be current with the 2017–2018 influenza season.
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IAC posts revised "Influenza Vaccination of People with a History of Egg Allergy"
IAC recently revised Influenza Vaccination of People with a History of Egg Allergy for the 2017–2018 season by incorporating the quadrivalent recombinant vaccine (RIV4) and updating the references.
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IAC updates "How to Administer Intramuscular, Intradermal, and Intranasal Influenza Vaccines"
IAC has posted an updated version of its resource for healthcare professionals, How to Administer Intramuscular, Intradermal, and Intranasal Influenza Vaccines. Changes were made to add newer inactivated influenza vaccine (IIV) products to the intramuscular (IM) section (i.e., ccIIV, aIIV) and to incorporate a slight change in needle length for administering IM injections to children and adolescents.
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OFFICIAL RELEASES AND ANNOUNCEMENTS
AAP issues recommendations for influenza vaccination for 2017–2018 season
The American Academy of Pediatrics (AAP) published a policy statement online titled Recommendations for Prevention and Control of Influenza in Children, 2017–2018. The recommendations are also available in PDF format, and will be published in the October issue of Pediatrics. AAP recommends annual seasonal influenza immunization for everyone 6 months and older, including children and adolescents.
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WORLD NEWS
WHO provides summary of cholera cases and deaths worldwide in 2016
The World Health Organization (WHO) published Cholera, 2016 in the September 8 issue of its Weekly Epidemiological Record. The first paragraph is reprinted below.
Cholera remains a significant public health problem in many parts of the world. In 2016, 38 countries reported a total of 132,121 cases including 2,420 deaths, resulting in an overall case fatality rate (CFR) of 1.8%. Although this represents a 23% decrease in the number of cases reported compared with 2015 (172,454 cases), the decline is, nonetheless, accompanied by a more than doubling of the CFR (0.8% in 2015). Cholera was reported from countries in all regions: 17 countries in Africa, 12 in Asia, 4 in Europe, 4 in the Americas, and 1 in Oceania. Five countries, the Democratic Republic of the Congo (DRC), Haiti, Somalia, the United Republic of Tanzania Yemen, together accounted for 80% of all cases. Of cases reported globally, 54% were from Africa, 13% from Asia, and 32% from Hispaniola. Imported cases were reported from 9 countries.
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WHO publishes report on the estimated economic impact of vaccinations in 73 low- and middle-income countries
On September 1, the Bulletin of the World Health Organization published Estimated economic impact of vaccinations in 73 low- and middle-income countries, 2001–2020. Three sections of the abstract are reprinted below.
OBJECTIVE
To estimate the economic impact likely to be achieved by efforts to vaccinate against 10 vaccine-preventable diseases between 2001 and 2020 in 73 low- and middle-income countries largely supported by Gavi, the Vaccine Alliance.
FINDINGS
We estimated that, in the 73 countries, vaccinations given between 2001 and 2020 will avert over 20 million deaths and save US$ 350 billion in cost of illness. The deaths and disability prevented by vaccinations given during the two decades will result in estimated lifelong productivity gains totalling US$ 330 billion and US$ 9 billion, respectively. Over the lifetimes of the vaccinated cohorts, the same vaccinations will save an estimated US$ 5 billion in treatment costs. The broader economic and social value of these vaccinations is estimated at US$ 820 billion.
CONCLUSION
By preventing significant costs and potentially increasing economic productivity among some of the world’s poorest countries, the impact of immunization goes well beyond health.
Access the abstract.
Access the complete article in PDF format: Estimated economic impact of vaccinations in 73 low- and middle-income countries, 2001–2020.
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FEATURED RESOURCES
CDC offers infographic and text to promote adolescent HPV vaccination
CDC has developed an infographic that healthcare professionals can share on social media to help parents understand the importance of HPV vaccination for their adolescent children. Click on the image below to go to the appropriate CDC web page. The image can also be printed out and used as a poster or flyer.
The text can also be adapted for use in practice newsletters, letters to the editor, Facebook posts, and more.
6 Reasons to Get HPV Vaccine for Your Child (Text Version)
1. HPV is a common virus that infects men and women.
80% of people will get an HPV infection in their lifetime.
Most HPV infections will go away on their own. Infections that don’t go away can cause precancers and cancers.
2. HPV vaccination works.
Infections with HPV types that cause most HPV cancers and genital warts have dropped 71 percent among teen girls.
3. HPV vaccination prevents cancer.
More than 29,000 cases of cancers each year could be prevented with HPV vaccination.
Same as the average attendance for a baseball game.
4. Preventing cancer is better than treating cancer.
HPV infections can cause many types of cancer, but there is only cervical cancer screening.
HPV vaccination is prevention for the other types of cancer caused by HPV infections.
5. Your child can get the HPV vaccine when they receive the other preteen vaccines.
Three vaccines are recommended for 11–12 year olds to protect against the infections that can cause meningitis, HPV cancers, and whooping cough.
6. Preventing cancer is easier than ever before
Data now shows 2 doses of HPV vaccine provide similar protection to 3 doses, when given before the 15th birthday.
6 OUT OF 10 parents are choosing to get the HPV vaccine for their children.
Talk to your child’s doctor about HPV cancer prevention at ages 11–12.
Related Links
- “Dear Colleague” letter from AAFP, AAP, ACOG, ACP, CDC, and IAC: Give a strong recommendation for HPV vaccine to increase uptake!
- IAC's HPV handouts for healthcare professionals, parents, and patients
- Human Papillomavirus (HPV) web page on immunize.org
- CDC's You Are the Key to HPV Cancer Prevention campaign web section
- Vaccine Education Center's Questions and Answers About HPV and the Vaccine
- Human Papillomavirus (HPV) web section on AAP's website for parents, www.healthychildren.org
- ACOG's Toolkit: Human Papillomavirus Vaccination 2016
- National Cervical Cancer Coalition's Cervical Health Awareness Month web page
- Watch "Someone You Love: the HPV Epidemic," a documentary that presents the struggles and triumphs of five women whose lives were changed forever by this deadly virus. Access the trailer on YouTube. Physicians, nurses, and pharmacists can earn free continuing credit for viewing the complete film. Others can view the film for free, courtesy of PKIDs (not for continuing education credit).
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Hepatitis B Foundation and the ShotByShot project release new video about a man with a history of drug use who is infected with both HIV and HBV
The Hepatitis B Foundation and the ShotByShot project have jointly released a video titled Jason's Story: #justB Aware. Jason learned he was infected with the hepatitis B virus (HBV) as well as HIV after a history of drug addiction. He struggled to find any hepatitis B specialists in his home town and became depressed, but finally located a caring and knowledgeable doctor who, along with his husband, gave him hope and improved health.
This video is part of the storytelling campaign: #justB: Real People Sharing their Stories of Hepatitis B. The volunteers sharing their stories do so to put a human face on this serious disease, decrease stigma and discrimination, and promote the importance of testing and treatment for hepatitis B.
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Free app of The Vaccine Handbook available from the Immunization Action Coalition
A new app of The Vaccine Handbook is now available from the Immunization Action Coalition. The free app, which is available for Apple iPhones and iPads only, contains the complete 2017 (6th) edition of The Vaccine Handbook (“The Purple Book”), by Dr. Gary Marshall, professor of pediatrics and chief of the Division of Pediatric Infectious Diseases at the University of Louisville. The app is fully searchable, with functionality that includes bookmarking, highlighting, user annotation, and links to important vaccination resources.
"The Purple Book" is a comprehensive source of vaccine information, drawing together vaccine science, guidance, and practice into a user-friendly resource for the private office, public health clinic, academic medical center, classroom, and hospital. The first section provides background on vaccine immunology, development, infrastructure, policy, standards, implementation, special circumstances, and—perhaps most importantly—addressing concerns. The second section contains details about every vaccine currently licensed in the U.S., including the burden and epidemiology of the respective disease, history of the immunization program, vaccine constituents, efficacy, safety, and recommendations.
The free app may be found by searching the iTunes App Store for “The Vaccine Handbook App” or clicking on the following link:
https://itunes.apple.com/us/app/the-vaccine-handbook-app/id1043246009?ls=1&mt=8.
Print copies of the book ($34.95 each; bulk discounts are available from the publisher) can be ordered from the Immunization Action Coalition website at www.immunize.org/vaccine-handbook.
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Still available! IAC's sturdy laminated versions of the 2017 U.S. child/teen immunization schedule and the 2017 U.S. adult immunization schedule—order a supply for your healthcare setting today!
IAC's laminated versions of the 2017 U.S. child/teen immunization schedule and the 2017 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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JOURNAL ARTICLES AND NEWSLETTERS
August issue of CDC's Immunization Works newsletter now available
CDC recently released the August issue of its monthly newsletter Immunization Works and posted it on the website of the National Center for Immunization and Respiratory Diseases (NCIRD). The newsletter offers the immunization community information about current topics. The information is in the public domain and can be reproduced and circulated widely.
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Study found that third dose of MMR helped control a college mumps outbreak
On September 7, The New England Journal of Medicine (NEJM) published Effectiveness of a Third Dose of MMR Vaccine for Mumps Outbreak Control (C.V. Cardemil et al.), which showed that a third dose of MMR helped protected college students against a mumps outbreak. Three sections of the abstract are reprinted below.
BACKGROUND
The effect of a third dose of the measles–mumps–rubella (MMR) vaccine in stemming a mumps outbreak is unknown. During an outbreak among vaccinated students at the University of Iowa, health officials implemented a widespread MMR vaccine campaign. We evaluated the effectiveness of a third dose for outbreak control and assessed for waning immunity.
RESULTS
Before the outbreak, 98.1% of the students had received at least two doses of MMR vaccine. During the outbreak, 4,783 received a third dose. The attack rate was lower among the students who had received three doses than among those who had received two doses (6.7 vs. 14.5 cases per 1000 population, P<0.001). Students had more than nine times the risk of mumps if they had received the second MMR dose 13 years or more before the outbreak. At 28 days after vaccination, receipt of the third vaccine dose was associated with a 78.1% lower risk of mumps than receipt of a second dose (adjusted hazard ratio, 0.22; 95% confidence interval, 0.12 to 0.39). The vaccine effectiveness of two doses versus no doses was lower among students with more distant receipt of the second vaccine dose.
CONCLUSIONS
Students who had received a third dose of MMR vaccine had a lower risk of mumps than did those who had received two doses, after adjustment for the number of years since the second dose. Students who had received a second dose of MMR vaccine 13 years or more before the outbreak had an increased risk of mumps. These findings suggest that the campaign to administer a third dose of MMR vaccine improved mumps outbreak control and that waning immunity probably contributed to propagation of the outbreak.
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Mott Poll Report investigates parents' understanding of teen vaccine recommendations
In January 2017, a survey underwritten by C.S. Mott Children’s Hospital asked a national sample of parents about getting vaccines for their age 13–17 teen children, and found that many parents likely overestimate their teens’ vaccination status. The Mott Poll Report was published on July 2017, and the "Highlights" section and selections from its "Implications" section are reprinted below.
HIGHLIGHTS
- Most parents think their teen has received all recommended vaccines, despite national data suggesting otherwise
- Over one-third of parents do not know when or if their teen is due for another vaccine
- Parents expect child health providers to guide them on teen vaccines, by scheduling appointments or sending reminders
IMPLICATIONS
This Mott Poll indicates that many parents likely overestimate their teens’ vaccination status. Over 90% of poll respondents thought their teen had received all vaccines recommended for that age, but CDC data indicate that nationally, only one-third of teens have received the second dose of meningitis vaccine by age 17. Similarly, less than half of boys age 13–17 have completed the HPV vaccine series, and less than half of adolescents receive an annual flu shot....
Flu vaccine is recommended every year for all ages, yet only 1 out of 5 Mott Poll respondents thought their teen was due for another vaccine within the next year....
It is clear from this Mott Poll that parents view their teen’s health care provider as the main source of information about when their teen is due for another vaccine. Nearly half of parents believe the provider will schedule an appointment when the teen’s next vaccine is due. This is common during the early childhood period, when practices schedule the child’s next well-child visit to coincide with the timing of vaccine doses. However, as children get older and well-child visits occur less frequently, both parents and practices find it difficult to schedule a year or more in advance. Thus, parents may perceive that a lack of scheduled appointment means that no vaccines are due....
Read the complete Mott Poll Report: Parents Not Keeping Up with Teen Vaccines.
The Mott Poll Report is a publication of C.S. Mott Children’s Hospital, University of Michigan Department of Pediatrics and Communicable Diseases, and University of Michigan Child Health Evaluation and Research (CHEAR) Unit.
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CDC reports on human infections with novel avian influenza A(H7N9) viruses in China during the fifth epidemic
CDC published Update: Increase in Human Infections with Novel Avian Influenza A(H7N9) Viruses During the Fifth Epidemic and Pandemic Preparedness—China, October 1, 2016–August 18, 2017 in the September 8 issue of MMWR (pages 928–32). A summary made available to the press is reprinted below.
The fifth annual epidemic of Asian Lineage Avian Influenza A(H7N9) Viruses in China is marked by extensive geographic spread in poultry and in humans. The number of human infections reported in the fifth epidemic is almost as many as were reported during the previous four epidemics combined. The increased number of human infections appears to be associated with wider geographic spread and higher prevalence of Asian H7N9 viruses among poultry rather than any increased incidence of poultry-to-human or human-to-human spread. Human infections with Asian H7N9 viruses from poultry are rare, and no efficient or sustained human-to-human transmission has been detected. Among all influenza viruses assessed using CDC’s Influenza Risk Assessment Tool, the Asian H7N9 virus is ranked as the influenza virus with the highest potential pandemic risk. Continued vigilance is important to identify changes in the virus that have epidemiologic implications, such as increased transmission from poultry to humans or transmission between humans.
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EDUCATION AND TRAINING
NFID announces three upcoming webinars: the first on hepatitis B and A vaccination, the second a recap of the October ACIP meeting, and the third about shingles vaccines
The National Foundation for Infectious Diseases (NFID) will present three new webinars as listed below. CME and CNE credit is available for completing any of these activities.
Hepatitis A and B Vaccines: Recommendations and Impact
October 18, 12:00–1:00 p.m. (ET)
Registration information
Updates from October 2017 ACIP Meeting
November 9, 12:00–1:00 p.m. (ET)
Registration information
Shingles Vaccines: What You Need to Know
December 6, 12:00–1:00 p.m. (ET)
Registration information
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Reminder: Weekly CDC webinar series on "The Pink Book" chapter topics runs through October 11; 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 weekly 1-hour webinars that started June 14 and will run through October 11. Recordings of sessions will be available online within 2 weeks after each webinar. All sessions begin at 12:00 p.m. (ET). Continuing education will be available for each event.
The webinar series will provide an overview of vaccines and the diseases they prevent, general recommendations for vaccines, vaccination principles, and immunization strategies for providers.
Registration and more information is available on CDC's Pink Book Webinar Series web page.
All the sections of "The Pink Book" (i.e., chapters, appendices, 2017 supplement) are available to download at no charge at www.cdc.gov/vaccines/pubs/pinkbook/index.html.
You can also order this resource from the Public Health Foundation for $40 plus shipping and handling. This print version does not include the 2017 supplement.
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CONFERENCES AND MEETINGS
The Indiana Immunization Coalition (IIC) will host a meeting on October 5 about the importance of incorporating standing orders for vaccines in clinical practice settings. The speakers, William Atkinson, MD, MPH, and Litjen Tan, MS, PhD, both from the Immunization Action Coalition, are nationally recognized experts on this topic. CME and CNE credits are being offered to participants.
Access more information about IIC's October 5 "Take a Stand" conference.
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ASK THE EXPERTS
Question of the Week
My adult patient is traveling to Nigeria in three days. She is already immune to hepatitis A, but we want to provide protection for hepatitis B. She received Twinrix two weeks ago and then a dose of single-component hepatitis B vaccine one week ago. How can we best provide protection in this circumstance?
Even though ACIP does not recommend an accelerated hepatitis B vaccine schedule in routine circumstances, a 4-dose series at 0, 7, 14 days, and 6 months is acceptable (see https://www.cdc.gov/mmwr/PDF/rr/rr5516.pdf, page 27). Although this schedule deviates from the routine recommendation, travel is imminent. Give a dose of hepatitis B vaccine now which will complete 3 of the 4-dose accelerated schedule. She will need a fourth and final dose 6 months after the first dose in the accelerated schedule.
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 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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