Issue 1329: October 4, 2017
Ask the Experts—Question of the Week: If you choose to give Trumenba brand MenB vaccine (Pfizer) to a 16-year-old with HIV. . . read more
TOP STORIES
IAC HANDOUTS
FEATURED RESOURCES
JOURNAL ARTICLES AND NEWSLETTERS
EDUCATION AND TRAINING
CONFERENCES AND MEETINGS
TOP STORIES
CDC releases "Dear Colleague" letter about the importance of influenza and Tdap vaccination for pregnant women; letter also signed by 12 medical organizations
On September 27, CDC released a "Dear Colleague" letter to healthcare professionals about the importance of influenza and Tdap vaccination for pregnant women in the 2017–18 influenza season. The letter is signed by CDC and 12 professional societies and nonprofit organizations, including IAC. Some of the key messages are reprinted below.
- Flu vaccines given during pregnancy protect both the mother and her baby from flu. Vaccination has reduced the risk of flu-associated acute respiratory infection in pregnant women by up to one-half. Babies of women who get a flu vaccine during their pregnancy are protected from flu infection for their first several months of life, when they are still too young to get vaccinated.
- Flu shots have a good safety record. Millions of flu vaccines have been given for decades, including to pregnant women, with a good safety record. Observational and prospective studies in pregnant women support the safety of influenza vaccine during pregnancy. However, data on first trimester flu vaccine administration is more limited than for second or third trimester vaccination. One recent study of data from the 2010-2012 seasons found that women who received two consecutive annual flu vaccines containing an H1N1 pdm 09 component early in pregnancy had an increased risk of miscarriage (median gestational age was 7 weeks) during 28 days after receiving the second vaccine the following season. In contrast, other studies have not found a link between flu vaccination and miscarriage. Follow up studies are ongoing. The Advisory Committee on Immunization Practices (ACIP), the American College of Obstetricians and Gynecologists, and CDC continue to recommend that pregnant women get a flu vaccine because flu poses a danger to pregnant women and their babies.
- Tdap vaccines are important and safe for pregnant women and their infants. Several prospective and observational studies have shown that Tdap is safe and well tolerated in pregnant women. Multiple studies show Tdap vaccination during the second or third trimester of pregnancy prevents pertussis in at least 9 out of 10 infants younger than 2 months of age. Receipt of Tdap between 27 through 36 weeks of pregnancy is 85% more effective at preventing pertussis in babies younger than 2 months of age compared with administering this vaccine to postpartum mothers in the hospital after giving birth.
Access the complete CDC "Dear Colleague" letter.
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CDC reports on influenza vaccination coverage of healthcare professionals in 2016–17
CDC published Influenza Vaccination Coverage Among Health Care Personnel—United States, 2016–17 Influenza Season in the September 29 issue of MMWR (pages 1009–15). The first paragraph is reprinted below.
The Advisory Committee on Immunization Practices (ACIP) recommends that all health care personnel (HCP) receive an annual influenza vaccination to reduce influenza-related morbidity and mortality among HCP and their patients and to reduce absenteeism among HCP. To estimate influenza vaccination coverage among HCP in the United States during the 2016–17 influenza season, CDC conducted an opt-in Internet panel survey of 2,438 HCP. Overall, 78.6% of survey respondents reported receiving vaccination during the 2016–17 season, similar to reported coverage in the previous three influenza seasons. Vaccination coverage continued to be higher among HCP working in hospitals (92.3%) and lower among HCP working in ambulatory (76.1%) and long-term care (LTC) (68.0%) settings. As in previous seasons, coverage was highest among HCP who were required by their employer to be vaccinated (96.7%) and lowest among HCP working in settings where vaccination was not required, promoted, or offered on-site (45.8%). Implementing workplace strategies found to improve vaccination coverage among HCP, including vaccination requirements or active promotion of on-site vaccinations at no cost, can help ensure that HCP and patients are protected against influenza.
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CDC reports on influenza vaccination coverage of pregnant women in 2016–17
CDC published Influenza Vaccination Coverage Among Pregnant Women—United States, 2016–17 Influenza Season in the September 29 issue of MMWR (pages 1016–22). The first paragraph is reprinted below.
Pregnant women and their infants are at increased risk for severe influenza-associated illness, and since 2004, the Advisory Committee on Immunization Practices (ACIP) has recommended influenza vaccination for all women who are or might be pregnant during the influenza season, regardless of the trimester of the pregnancy. To assess influenza vaccination coverage among pregnant women during the 2016–17 influenza season, CDC analyzed data from an Internet panel survey conducted during March 28–April 7, 2017. Among 1,893 survey respondents pregnant at any time during October 2016–January 2017, 53.6% reported having received influenza vaccination before (16.2%) or during (37.4%) pregnancy, similar to coverage during the preceding four influenza seasons. Also similar to the preceding influenza season, 67.3% of women reported receiving a provider offer for influenza vaccination, 11.9% reported receiving a recommendation but no offer, and 20.7% reported receiving no recommendation; among these women, reported influenza vaccination coverage was 70.5%, 43.7%, and 14.8%, respectively. Among women who received a provider offer for vaccination, vaccination coverage differed by race/ethnicity, education, insurance type, and other sociodemographic factors. Use of evidence-based practices such as provider reminders and standing orders could reduce missed opportunities for vaccination and increase vaccination coverage among pregnant women.
Access the CDC report: Influenza Vaccination Coverage Among Pregnant Women—United States, 2016–17 Influenza Season.
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CDC publishes final 2016–17 influenza vaccination estimates coverage on its website
CDC published Announcement: Final 2016–17 Influenza Vaccination Coverage Estimates Available Online in the September 29 issue of MMWR (page 1028). The complete announcement is reprinted below.
Final 2016–17 influenza season vaccination coverage estimates for selected local areas, states, U.S. Department of Health and Human Services regions, and the United States overall are available online at FluVaxView (https://www.cdc.gov/flu/fluvaxview). The online information includes estimates of the cumulative percentage of persons receiving influenza vaccination through the end of each month during July 2016–May 2017.
Analyses were conducted using National Immunization Survey–Flu influenza vaccination data for children aged 6 months–17 years and Behavioral Risk Factor Surveillance System influenza vaccination data for adults aged ≥18 years. Estimates are provided by age group and race/ethnicity. These estimates are presented in interactive reports (https://www.cdc.gov/flu/fluvaxview/interactive.htm) and are complemented by an online summary report (https://www.cdc.gov/flu/fluvaxview/coverage-1617estimates.htm).
View the key findings of this report: Flu vaccination coverage, United States, 2016–17 influenza season.
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CDC issues press release on study showing Tdap vaccination during pregnancy can prevent whooping cough in babies
CDC issued a press release on September 28 regarding a CDC study reporting that Tdap vaccination during pregnancy can prevent whooping cough in babies. The study, Impact of the US maternal tetanus, diphtheria, and acellular pertussis vaccination program on preventing pertussis in infants <2 months of age: A case-control evaluation, by T.H. Skoff, et al., was published in Clinical Infectious Diseases on September 28. Using data from six states from 2011–14, the study reported that the vaccine prevented 78% of whooping cough cases in babies younger than two months. The study also showed that Tdap vaccination during the third trimester was 90% effective at preventing serious cases of whooping cough requiring hospitalization.
Read the press release: New study shows Tdap vaccination during pregnancy can prevent whooping cough in babies (September 28).
View the abstract of the study.
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CDC issues media release on study reporting that 12% of physicians and 3% of nurses indicate reuse of syringes for more than one patient in their workplace
CDC issued a media release on a paper reporting that 12% of physicians and 3% of nurses indicated the reuse of syringes in their workplace. The paper, titled One needle, one syringe, only one time? A survey of physician and nurse knowledge, attitudes, and practices around injection safety, was published in the September issue of the American Journal of Infection Control. According to the paper, based on a study using data conducted with 370 physicians and 320 nurses in 8 states, nearly 5% of physicians reported that this practice occurs usually or always.
View the abstract of the study.
Access the complete article through the American Journal of Infection Control: One needle, one syringe, only one time? A survey of physician and nurse knowledge, attitudes, and practices around injection safety
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Vaccine Education Center offers three new educational resources for healthcare professionals to give to patients
The Vaccine Education Center (VEC) at Children's Hospital of Philadelphia is offering three new educational resources for healthcare professionals to give to patients.
The first, "Pneumococcus: What You Should Know," is available in English and Spanish. Using a question-and-answer format, this educational resource provides comprehensive, information for families on the bacteria and on pneumococcal vaccine.
View the English-language version.
View the Spanish-language version.
The second educational resource, a 30-page guide titled Rashes: What You Should Know, provides summaries of 19 common and uncommon rashes that are important to identify. The guide includes photographs of each rash as well as two worksheets to help document a family's rash history and to help share information with the diagnosing physician.
The third educational resource, Vaccinated or Unvaccinated: What You Should Know, provides information on collective immunity, prevention measures to take if a family member is unvaccinated, and issues to consider if a family member has been vaccinated.
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Dr. Paul Offit responds to interview with Robert Kennedy Jr. and study about influenza vaccination of pregnant women
Dr. Paul Offit, professor of pediatrics and director of the Vaccine Education Center at the Children's Hospital of Philadelphia, published a response to an interview by STAT News reporter Helen Branswell and Robert F. Kennedy, Jr. In his response, titled Correcting Robert F. Kennedy Jr.'s vaccine "facts" and published in STAT News on September 22, Dr. Offit explains why the claims made by Robert F. Kennedy, Jr., that mercury in vaccines is poisoning children and that vaccines do not receive adequate testing or oversight, are false.
In an article for the Daily Beast, The Pregnancy Vaccine Scare That Should Have Never Been, Dr. Offit responds to the warning published by CDC that influenza given to pregnant women in the first trimester may have caused miscarriages. Dr. Offit presents several reasons refuting the warning, including the inconsistency of the research and inadequacies in the study on which the warning was based. He quotes the study's authors, who stated, “This study does not and cannot establish a causal relationship between repeated influenza vaccination and spontaneous abortions.”
Read the complete STAT News article by Dr. Offit: Correcting Robert F. Kennedy Jr.'s vaccine "facts" (9/22)
Read the complete Daily Beast article by Dr. Offit: The Pregnancy Vaccine Scare That Should Have Never Been (9/24)
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San Diego hepatitis A outbreak continues, with 17 deaths and over 325 people hospitalized; cases reported in Los Angeles County, Santa Cruz County, and Salt Lake County (UT)
The County of San Diego Board of Supervisors has extended the local health emergency as the number of hepatitis A cases continues to rise in San Diego County. According to Dr. Wilma Wooten, Public Health Officer for the San Diego County Health and Human Services Agency, the number of cases has risen to 461, with 325 hospitalizations since November and 17 confirmed fatalities. The outbreak has spread to Los Angeles County, with 12 cases; Santa Cruz County, with 70 cases; and Salt Lake County, Utah, with 25 cases. In each area affected by this outbreak, intensive vaccination and other prevention measures are under way. CDC will be sending two workers to assist the San Diego public health department with its plans to combat the outbreak.
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IAC Spotlight! IAC's "What's New" page provides links to new and recently updated IAC handouts and staff education materials for free downloading and printing, VISs and their translations, and immunize.org web sections
IAC's What's New at IAC web section is a fast way to check out what has been recently added to the immunize.org website. This page lists IAC's new and recently updated free print materials, Vaccine Information Statements (VISs) and translations, and changes to IAC web sections such as "Ask the Experts." Just click on "What's New at IAC" in the rotating box at the top of the IAC home page, or bookmark www.immunize.org/new for an easy way to check what's new.
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IAC enrolls four new birthing institutions into its Hepatitis B Birth Dose Honor Roll; two qualify for additional years
The Immunization Action Coalition (IAC) is pleased to announce that four new institutions have been accepted into its Hepatitis B Birth Dose Honor Roll. The birthing institutions are listed below with their reported hepatitis B birth dose coverage rates in parentheses.
- Community Health Center of Branch County, Coldwater, MI (94%)
- Hiawatha Community Hospital, Hiawatha, KS (93%)
- St. John's Riverside Hospital, Yonkers, NY (93%)
- St. Mary Mercy Hospital, Livonia, MI (90%)
The following two institutions are being recognized for a second year:
- Community Health Center of Branch County, Coldwater, MI (97%)
- St. John's Riverside Hospital, Yonkers, NY (90%)
In addition, the same two institutions are being recognized for a third year:
- Community Health Center of Branch County, Coldwater, MI (93%)
- St. John's Riverside Hospital, Yonkers, NY (93%)
Finally, the following institution was recognized for a fourth and fifth year:
- St. John's Riverside Hospital, Yonkers, NY (91% for both periods)
Note: Two of these institutions qualified for multiple 12-month periods at one time.
The Honor Roll now includes 360 birthing institutions from 39 states, Puerto Rico, and Guam. Seventy-six institutions have qualified for two years, 40 institutions have qualified three times, 11 institutions have qualified four times, and 4 institutions have qualified five times.
The Honor Roll is a key part of IAC’s major initiative urging the nation’s hospitals to Give birth to the end of Hep B. Hospitals and birthing centers are recognized for attaining high coverage rates for administering hepatitis B vaccine at birth and meeting specific additional criteria. The initiative urges qualifying healthcare organizations to apply for the Hepatitis B Birth Dose Honor Roll online.
To be included in the Hepatitis B Birth Dose Honor Roll, a birthing institution must have: (1) reported a coverage rate of 90 percent or greater, over a 12-month period, for administering hepatitis B vaccine before hospital discharge to all newborns, including those whose parents refuse vaccination, and (2) implemented specific written policies, procedures, and protocols to protect all newborns from hepatitis B virus infection prior to hospital discharge.
Honorees are also awarded an 8.5" x 11" color certificate suitable for framing and their acceptance is announced to IAC Express’s approximately 50,000 readers.
Please visit the Hepatitis B Birth Dose Honor Roll web page that lists these institutions and their exceptional efforts to protect infants from perinatal hepatitis B transmission.
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IAC HANDOUTS
IAC updates "Administering Vaccines: Dose, Route, Site, and Needle Size"
IAC recently revised its popular one-page guidance document for healthcare professionals titled Administering Vaccines: Dose, Route, Site, and Needle Size. Changes were made to remove several vaccine products no longer available and also to incorporate a change in needle length guidance for administering IM injections to children and adolescents.
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IAC updates "How to Administer Intramuscular and Subcutaneous Vaccine Injections"
IAC recently revised its resource for healthcare professionals titled How to Administer Intramuscular and Subcutaneous Vaccine Injections. This piece was updated to incorporate a slight change in needle length for administering intramuscular injections to children and adolescents.
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 posts nine updated translations of "Screening Checklist for Contraindications to Vaccines for Adults"
IAC recently posted nine updated translations of its Screening Checklist for Contraindications to Vaccines for Adults. The second page of each also now matches the revised English-language version posted earlier in September. The first page is intended for the patient to complete, while the second page—in English—provides an explanation of why each question is asked as a reference for the patient's healthcare provider.
Access the English-language version.
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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ShotByShot releases video about woman suffering from subacute sclerosing panencephalitis, a complication from her childhood measles infection
ShotByShot, a website of the California Immunization Coalition, released a video about Sarah Walton, a young woman who is suffering from subacute sclerosing panencephalitis (SSPE), a rare complication from her childhood measles infection at 11 months. In the video, Jo Walton, Sarah's mother, explains that this tragic complication only began to emerge 24 years later. SSPE leads to progressive destruction of the central nervous system.
View the video, Sarah W's Story (4:06 minutes)
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National Foundation for Infectious Diseases releases summary of September 28 news conference about influenza and pneumococcal disease
On September 28, the National Foundation for Infectious Diseases (NFID) hosted the 2017 Influenza/ Pneumococcal News Conference in collaboration with CDC and other leading medical and public health groups. The event served to communicate critical messages, including a call to action for everyone to get vaccinated. Two paragraphs from a related September 28 press release are reprinted below.
With influenza (flu) vaccine readily available and sufficient doses expected throughout the season, the National Foundation for Infectious Diseases (NFID), along with public health and medical organizations, urged the public and healthcare professionals to follow the Centers for Disease Control and Prevention (CDC) recommendation that everyone age six months and older be vaccinated against influenza each year.
Influenza vaccination coverage across the entire U.S. population was 46.8 percent, an increase of 1.2 percentage points from the previous season. That level of coverage means that more than half of the U.S. population was unprotected against flu last season.
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Influenza is serious; many resources are available to help healthcare professionals vaccinate patients
Influenza vaccination is recommended for everyone six months of age and older. If you don't provide influenza vaccination in your clinic, please recommend vaccination to your patients and refer them to a clinic or pharmacy that provides vaccines or to the HealthMap Vaccine Finder to locate sites near their workplaces or homes that offer influenza vaccination services.
Following is a list of resources related to influenza disease and vaccination for healthcare professionals and the public:
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New edition of The Vaccine Handbook: A Practical Guide for Clinicians, a.k.a. "The Purple Book," by Dr. Gary Marshall available for purchase from IAC; free app for iPhones and iPads available from IAC
The 6th edition of The Vaccine Handbook: A Practical Guide for Clinicians ("The Purple Book") is considered a vital source of practical, up-to-date information for vaccine providers and educators. Now printed in color and updated with the latest vaccine information through early 2017, "The Purple Book" draws 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.
The sixth edition of this valuable guide (592 pages) is available on IAC's website at www.immunize.org/vaccine-handbook. The price of the handbook is $34.95 per copy, plus shipping charges. Order copies for your staff or for distribution at an upcoming conference.
Discount pricing is available for more than 10 copies. 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.
The Vaccine Handbook App for Apple iPhones and iPads is available free from IAC. Sorry, the app is not available for android devices. Book purchase is not necessary but registration to obtain the app is required.
The app is fully searchable, allows for bookmarking, highlighting and annotation, and contains hyperlinks to valuable content from nonprofit and governmental sources.
Click on the image below to visit the The Vaccine Handbook App page in the iTunes store.
About the Author
Gary S. 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
CDC issues press release on study indicating that just over half of adults with work-related asthma reported receiving a pneumococcal vaccine
CDC recently issued a press release regarding a CDC study published on September 27 indicating that just over half of adults with work-related asthma reported receiving a pneumococcal vaccine. CDC recommends that all adults 19 through 64 years old with asthma get the pneumococcal polysaccharide vaccine. The study, titled Pneumococcal Vaccination among Adults with Work-related Asthma (K. Dodd, et al.) was published in the American Journal of Preventive Medicine. A selection from the press release appears below:
Adults with asthma are at increased risk for pneumococcal disease, yet according to a new CDC study published today in the American Journal of Preventive Medicine, just 54 percent of adults with work-related asthma—asthma triggered by an exposure at work—have been vaccinated against the infection. CDC recommends all adults 19 through 64 years old with asthma get the pneumococcal polysaccharide vaccine.
CDC’s National Institute for Occupational Safety and Health (NIOSH) researchers found that adults with work-related asthma were more likely to have reported receiving a pneumococcal vaccine than adults with non-work-related asthma—54 percent compared with 35 percent, respectively. Among adults with work-related asthma, pneumococcal vaccine coverage was lowest among Hispanics (36 percent), those without health insurance (39 percent), and adults ages 18 to 44 years (42 percent).
“People with work-related asthma are particularly vulnerable to pneumococcal pneumonia,” said NIOSH Director John Howard, M.D. “Vaccination is the best way to prevent pneumococcal disease, including pneumonia, and CDC recommends that all adults with asthma, whether work-related or not, get the pneumococcal polysaccharide vaccine.”
Read the full CDC press release.
Read the full study: Pneumococcal Vaccination among Adults with Work-related Asthma.
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EDUCATION AND TRAINING
The National Viral Hepatitis Roundtable and the Hepatitis B Foundation to sponsor October 11 webinar on the #justB project, a national story bank featuring people living with hepatitis B infection
The National Viral Hepatitis Roundtable (NVHR) and the Hepatitis B Foundation (HBF) will sponsor a webinar on October 11 at 3 p.m. on the #justB project, a national story bank featuring people living with hepatitis B infection. This webinar, which will feature three hepatitis B patients telling their stories, aims to decrease the stigma of hepatitis B and to encourage testing, immunization, and treatment.
Register for the webinar.
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Reminder: National Foundation for Infectious Diseases sponsoring three upcoming webinars: the first on hepatitis A and B vaccination, the second a recap of the October ACIP meeting, and the third about shingles vaccines
The National Foundation for Infectious Diseases (NFID) is sponsoring three upcoming webinars listed below. CME and CNE credit are 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
Texas Immunization Conference scheduled for November 28–30 in San Antonio
A statewide Texas Immunization Conference will be held on November 28–30 at the Hyatt Regency Hotel in San Antonio. The goal of this conference is to provide a platform for networking, exchanging ideas, and fostering change for private and public healthcare professionals throughout Texas.
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ASK THE EXPERTS
Question of the Week
If you choose to give Trumenba brand MenB vaccine (Pfizer) to a 16-year-old with HIV infection (under the Category B recommendation for all adolescents), should you use the 2-dose (standard) schedule or the 3-dose (high-risk) schedule?
The CDC meningococcal subject matter experts recommend that the 3-dose Trumenba schedule should be used for people with HIV infection. People with HIV infection do not appear to be at higher risk for meningococcal serogroup B disease, but because of their HIV infection they might not respond to the vaccine as well, so the 3-dose schedule is preferred. When Bexsero brand MenB vaccine (GSK) is used, the schedule is 2 doses, regardless of risk status.
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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