Issue 1393: November 7, 2018
TOP STORIES
IAC HANDOUTS
OFFICIAL RELEASES AND ANNOUNCEMENTS
FEATURED RESOURCES
EDUCATION AND TRAINING
TOP STORIES
CDC publishes ACIP recommendations on use of hepatitis A vaccine for pre- and post-exposure prophylaxis for international travel in MMWR
CDC published Update: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel in the November 2 issue of MMWR (pages 1216–1220). The first paragraph is reprinted below.
Postexposure prophylaxis (PEP) with hepatitis A (HepA) vaccine or immune globulin (IG) effectively prevents infection with hepatitis A virus (HAV) when administered within 2 weeks of exposure. Preexposure prophylaxis against HAV infection through the administration of HepA vaccine or IG provides protection for unvaccinated persons traveling to or working in countries that have high or intermediate HAV endemicity. The Advisory Committee on Immunization Practices (ACIP) Hepatitis Vaccines Work Group conducted a systematic review of the evidence for administering vaccine for PEP to persons aged >40 years and reviewed the HepA vaccine efficacy and safety in infants and the benefits of protection against HAV before international travel. The February 21, 2018, ACIP recommendations update and supersede previous ACIP recommendations for HepA vaccine for PEP and for international travel. Current recommendations include that HepA vaccine should be administered to all persons aged ≥12 months for PEP. In addition to HepA vaccine, IG may be administered to persons aged >40 years depending on the provider’s risk assessment. ACIP also recommended that HepA vaccine be administered to infants aged 6–11 months traveling outside the United States when protection against HAV is recommended. The travel-related dose for infants aged 6–11 months should not be counted toward the routine 2-dose series. The dosage of IG has been updated where applicable (0.1 mL/kg). HepA vaccine for PEP provides advantages over IG, including induction of active immunity, longer duration of protection, ease of administration, and greater acceptability and availability.
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American Dental Association adopts policy to support the use and administration of HPV vaccine for the prevention of oral HPV infection
The American Dental Association (ADA) adopted a new policy on HPV vaccination for the prevention of oral HPV infection. Portions of the press release are reprinted below.
With the number of cases of HPV-associated cancers on the rise, the American Dental Association (ADA) has adopted a policy that urges dentists to support the use and administration of the human papillomavirus (HPV) vaccine.
The combined estimate by the American Cancer Society is that there will be more than 50,000 new cases of oral and oropharyngeal cancers in 2018, of which 70 to 80 percent will be attributable to HPV. The HPV vaccine could help prevent the vast majority of the oropharyngeal cases, but compared to other vaccines in the U.S., it is underutilized. According to the ADA Council on Scientific Affairs, the single best predictor of whether a young person or adolescent receives the vaccine is a recommendation from a trusted health care professional.
“There is incontrovertible evidence that this virus is responsible for the sharp uptick in oropharyngeal cancers, especially in younger patients and young adults,” said Paul Eleazer, D.D.S., immediate past chair of the ADA Council on Scientific Affairs. “I’m pleased the ADA is taking action to combat this crisis.”
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CDC reports on hepatitis A outbreaks in four states related to drug use and homelessness
CDC published Hepatitis A Virus Outbreaks Associated with Drug Use and Homelessness — California, Kentucky, Michigan, and Utah, 2017 in the November 2 issue of MMWR (pages 1208–1210). The first paragraph is reprinted below.
During 2017, CDC received 1,521 reports of acute hepatitis A virus (HAV) infections from California, Kentucky, Michigan, and Utah; the majority of infections were among persons reporting injection or noninjection drug use or homelessness. Investigations conducted by local and state health departments indicated that direct person-to-person transmission of HAV infections was occurring, differing from other recent, large HAV outbreaks attributed to consumption of contaminated commercial food products. Outbreaks with direct HAV transmission among persons reporting drug use or homelessness signals a shift in HAV infection epidemiology in the United States, and vaccination of these populations at high risk can prevent future outbreaks.
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IAC Spotlight! IAC's Vaccinating Adults: A Step-by-Step Guide is available free of charge to help you enhance your adult vaccination services
If you vaccinate adults in your practice, be sure to check out IAC's Vaccinating Adults: A Step-by-Step Guide (Guide) web page if you haven't already. The 142-page Guide was totally updated in late 2017, when it was made available in print and as a free downloadable copy. The original 5,000 print copies were soon gone, but the book continues to be available as a free download at www.immunize.org/guide. Between November 2017 and September 2018, users downloaded over 8,700 complete copies of the book and more than 22,000 individual chapters.
Although all the hard copies have been sold or distributed, IAC will provide a quote if you are interested in ordering a quantity of 200 copies or more (e-mail admininfo@immunize.org).
The development of the Guide was supported by the National Vaccine Program Office (NVPO) and the Centers for Disease Control and Prevention (CDC). Expert staff from both agencies also provided early technical review of the content.
This completely updated guide on adult immunization (originally published in 2004) provides easy-to-use, practical information covering important “how-to” activities to help providers enhance their existing adult immunization services or introduce them into any clinical setting, including:
- setting up for vaccination services,
- storing and handling vaccines,
- deciding which people should receive which vaccines,
- administering vaccines,
- documenting vaccinations (including legal issues), and
- understanding financial considerations and billing information.
In addition, the Guide is filled with hundreds of web addresses and references to help providers stay up to date on the latest immunization information, both now and in the future.
The Guide is a uniquely valuable resource to assist providers in increasing adult immunization rates. Be sure to get a copy today!
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Six healthcare organizations join IAC's Influenza Vaccination Honor Roll for mandatory healthcare worker vaccination
There are now 796 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 October 24, when IAC Express last reported on the Influenza Vaccination Honor Roll, six additional healthcare organizations have been enrolled.
IAC urges qualifying healthcare organizations to apply by visiting the Application page.
Newly added long-term care/assisted living facilities (LTCFs), healthcare organizations, hospitals, government agencies, and medical practices
- Holmes County Long Term Care, Durant, MS
- Rutgers University, New Brunswick, NJ
- Saratoga County Public Health, Saratoga Springs, NY
- Rosebud PHS Indian Hospital, Rosebud, SD
- MultiCare Rockwood Clinic, Spokane, WA
- Spokane Regional Health District, Spokane, WA
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Just for fun! Two-minute video parody of the Broadway musical Hamilton song
titled “My Shot” to share with patients, colleagues, and friends
The Science Rap Academy is a class taught at The Nueva School in Hillsborough, California, where middle school students can research, write, record, shoot, and edit parody music videos about science. Last year, the students produced an excellent parody of the song "My Shot" from the hit musical Hamilton, in which they explored the safety and efficacy of vaccines. If you haven't already watched this short musical video, take a look and then share with your patients, colleagues, and friends!
Watch My Shot (Vaccine Version).
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IAC HANDOUTS
IAC updates its standing orders templates for administering pneumococcal conjugate vaccine to children and inactivated polio vaccine to children and teens
IAC recently updated Standing Orders for Administering Pneumococcal Conjugate Vaccine to Children as well as Standing Orders for Administering Inactivated Poliovirus Vaccine to Children and Teens.
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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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OFFICIAL RELEASES AND ANNOUNCEMENTS
CDC releases national progress report on hepatitis elimination
On November 1, CDC published the 2018 National Viral Hepatitis Progress Report, which is the annual update to the 2017 inaugural report titled Progress Toward Viral Hepatitis Elimination in the United States. In this report, CDC provides information on progress in the implementation of recommended interventions and the impact these interventions are having on prevention of viral hepatitis transmission, disease, and associated mortality. Portions of the report are published below.
The seven indicators and accompanying 2020 goals compiled specifically for the National Progress Report were adapted from other initiatives, including Healthy People 2020, HHS’s National Viral Hepatitis Action Plan, 2017–2020 (PDF—84 pages), and CDC’s Viral Hepatitis Strategic Plan, 2016–2020 (PDF—17 pages).
- Hepatitis A vaccination coverage has increased, but not enough to meet the annual target. The large increase in the hepatitis A incidence rate for 2016 highlights the importance of vaccination as well as public health surveillance to identify and respond to outbreaks of hepatitis A.
- The incidence of acute hepatitis B among adults increased from 2014 through 2015, and then decreased slightly from 2015 through 2016, but not enough to meet the annual goal. Furthermore, newborn hepatitis B vaccination coverage declined in 2016, when almost 30% of newborns did not receive hepatitis B vaccination within 3 days of birth, leaving these young children unnecessarily vulnerable to hepatitis B virus infection.
- Of great concern are the ongoing and apparent large increases in the incidence of reported acute hepatitis C. The lack of a hepatitis C vaccine and increases in injection-drug use related to the nation’s opioid crisis have contributed to these increases in acute hepatitis C. Efforts to curb hepatitis C virus (HCV) transmission and identify all new (acute) and existing (chronic) infections must continue, especially since well-tolerated, short-course treatments are available that can cure almost all HCV-infected persons.
- The nation has made progress towards reducing deaths related to hepatitis B and hepatitis C, and the 2016 annual targets were met for both mortality indicators.
Access the online report: 2018 National Viral Hepatitis Progress Report.
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Federal panel reports that HPV vaccination rates are too low to achieve full cancer prevention potential
The President's Cancer Panel recently released a report titled HPV Vaccination for Cancer Prevention: Progress, Opportunities, and a Renewed Call to Action. The following is the lead paragraph from the report's website:
HPV vaccination provides a compelling opportunity to prevent six cancers and other diseases, but vaccine uptake in the United States and many other countries is too low to achieve its cancer prevention potential. In its 2012–2013 report, the President’s Cancer Panel concluded that underuse of HPV vaccines was a serious but correctable threat to progress against cancer. In this report, the Panel Chair provides an overview of progress made over the past five years and presents priorities and strategies to accelerate HPV vaccine uptake and eliminate the unnecessary burden of preventable HPV cancers.
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Reminder: New 65+ Flu Defense website features information and resources for healthcare professionals serving adults age 65 and older
Last month, IAC and Seqirus launched the new 65+ Flu Defense website at www.influenza-defense.org to help with vaccinating adults 65 years of age and older.
The website equips healthcare professionals with information, tools, and resources needed to proactively discuss flu vaccination with patients age 65 and older and to better communicate the impact of flu and its complications in older adults.
Annual influenza vaccination is the best way to prevent influenza, but vaccination coverage among older adults in the U.S. has stagnated, and in some years has declined significantly over the previous season’s rate. In the 2016–2017 season, only 65.3% of adults age 65 and older were vaccinated against influenza.
Seniors are at greater risk of severe complications from influenza, due both to their increased likelihood of having chronic conditions and to the decline of their immune systems as they age.
As a healthcare professional, your strong, confident recommendation for flu vaccine is a very powerful and persuasive tool in determining if your patients are vaccinated.
65+ Flu Defense is divided into several easy-to-use topic areas, including:
Two new patient handouts are also available on the website:
 
Be sure to check out the information and printable materials for your patients available on the 65+ Flu Defense website at www.influenza-defense.org and boost your efforts aimed at protecting this vulnerable population.
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Influenza season has begun; many resources available to help you vaccinate your patients
Influenza season is now under way, and CDC has reported three influenza-associated pediatric deaths. One pediatric death occurred during the 2018–2019 season and two occurred during the 2017–2018 season. Last season, there was a record-setting number of pediatric deaths in the U.S. (185), so be sure to protect all your patients for whom vaccination is recommended.
CDC has stated in its Weekly U.S. Influenza Surveillance Report, FluView, that as of the week ending October 27, local influenza-like illness (ILI) has been reported in five states (Kentucky, Massachusetts, North Dakota, Oregon, and West Virginia), with sporadic ILI reported in 43 states and the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. No ILI was reported for Mississippi and Virginia; Guam did not report.
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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Check out CDC's #HowIRecommend Twitter page for short videos about how to effectively recommend influenza and HPV vaccines
CDC maintains a page on Twitter called #HowIRecommend that includes informative videos for and by healthcare professionals about how to effectively recommend vaccines. A number of physicians provide practical and pithy advice on such situations as recommending influenza vaccine to pregnant women and children, and HPV vaccine to preteens, teens, and their parents.
Take some time to view these videos on #HowIRecommend. You don't have to be a Twitter user to access this page.
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ZDoggMD interviews Dr. Paul Offit about the dangers of celebrity health advice
Dr. Zubin Damaria (also know as "ZDoggMD") recently interviewed Dr. Paul Offit (Children's Hospital of Philadelphia) in a 70-minute video about the dangers of celebrity health advice. Dr. Damaria interviews Dr. Offit because, as he says, "Dr. Paul Offit is the most hated MD in the antivax world...which means he's our favorite doc EVER."
Dr. Damaria is a UCSF/Stanford-trained internal medicine physician who has built a second career as an entertaining source of medical information and a satirist of the U.S. healthcare system. Dr. Offit is the director of the Vaccine Education Center at Children's Hospital of Philadelphia, and a well-known writer and speaker.
Check out The Danger of Celebrity Health Advice.
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EDUCATION AND TRAINING
CDC's Current Issues in Immunization NetConference to address hepatitis A guidelines for homelessness, post-exposure prophylaxis, and international travel scheduled for November 28
CDC will present a Current Issues in Immunization NetConference on November 28 at 1:00 p.m. (ET). Immunization NetConferences are live, 1-hour presentations combining an online visual presentation with simultaneous audio via telephone conference call, plus a live question and answer session. On-demand replays and presentations will be available shortly after each event.
The November 28 session will feature the following topic and speaker:
- Hepatitis A Guidelines: Homelessness, Post-exposure Prophylaxis, and International Travel: Noele Nelson, MD, PhD, MPH, branch chief (acting), Prevention Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
This is a limited registration event. Registration is required.
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CDC to offer November 13 webinar about what healthcare professionals need to know about acute flaccid myelitis
CDC will present a one-hour webinar, Acute Flaccid Myelitis (AFM): What Health Care Providers Need to Know, beginning at 2:00 p.m. (ET) on November 13. Part of its Clinician Outreach and Communication Activity (COCA) series, CDC has provided the following description of this session:
The Centers for Disease Control and Prevention (CDC) is actively investigating acute flaccid myelitis, or AFM, a serious condition that causes weakness in the arms or legs. From August 2014 through October 2018, CDC has received information on a total of 396 confirmed cases of AFM across the U.S.; most of the cases have occurred in children. As of October 26, there are 72 confirmed cases of AFM so far in 2018. The patients’ symptoms have been most similar to complications of infection with certain viruses, including poliovirus, non-polio enteroviruses, adenoviruses, and West Nile virus. CDC has not confirmed the cause for the majority of these cases.
During this COCA call, subject matter experts from CDC will highlight the importance of reporting cases to learn more about this condition and the process for reporting. They will also cover specimen collection and testing, and what CDC is doing for its AFM investigation.
Free continuing education credits (CME, CNE, CEU, CECH, and CPE) will be available.
Bookmark this page and then click on the link provided a few minutes before the webinar is scheduled to begin.
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New! Free continuing education from MMWR and Medscape: "Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season"
CDC’s MMWR and Medscape have jointly introduced a new free continuing education (CE) activity that describes current recommendations from the Advisory Committee on Immunization Practices (ACIP) regarding CDC's recently published Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the ACIP—United States, 2018–19 Influenza Season.
If you are not a registered user on Medscape, you can register for free or login without a password and get unlimited access to all continuing education activities and other Medscape features.
This activity is intended for public health officials, family medicine practitioners, infectious disease clinicians, nurses, obstetrician-gynecologists, pediatricians, pharmacists, and other clinicians caring for patients for whom vaccination against influenza may be indicated.
Access the course on Medscape by visiting CDC's Medscape CME Activity web page and scroll down to the first item: Prevention and Control of Seasonal Influenza With Vaccines: Recommendations of the ACIP—United States, 2018–19 Influenza Season.
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Reminder: Vaccine Education Center’s "Current Issues in Vaccines" webinar with Dr. Paul Offit to be held November 14
Reminder: the Vaccine Education Center (VEC) at Children's Hospital of Philadelphia, together with the Pennsylvania chapter of the American Academy of Pediatrics, will present a one-hour webinar, beginning at 12:00 p.m. (ET) on November 14. Part of its Current Issues in Vaccines series, the webinar will feature Paul Offit, MD, director of VEC, discussing:
- Influenza Vaccine: Latest Updates
- Impact of PCV13 Vaccine
- HPV Vaccine: Possible Expanded Recommendation
Free continuing education credits will be offered, and the event archive will be available later during the week of the event. Current Issues in Vaccines webinars are co-sponsored by the Children's Hospital of Philadelphia and the Pennsylvania Chapter of the American Academy of Pediatrics.
Registration (required) is open now.
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