Issue 1433: July 3, 2019
TOP STORIES
IAC HANDOUTS
VACCINE INFORMATION STATEMENTS
WORLD NEWS
FEATURED RESOURCES
JOURNAL ARTICLES AND NEWSLETTERS
EDUCATION AND TRAINING
CONFERENCES AND MEETINGS
TOP STORIES
Total number of U.S. measles cases for 2019 climbs to 1,095 with 18 new cases reported since last week
CDC has posted its latest update on 2019 measles cases in the U.S. on its Measles Cases and Outbreaks web page. The web page shows a preliminary estimate of 1,044 cases across 28 states as of June 13. This is the greatest number of cases reported in the U.S. since 1992 and since measles was declared eliminated from the U.S. in 2000.
The states that have reported cases to CDC are Arizona, California, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, New Mexico, Nevada, New Hampshire, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Texas, Tennessee, Virginia, and Washington.
Access additional information about U.S. measles cases in 2019 on CDC's Measles Cases and Outbreaks web page.
Measles outbreaks (defined as 3 or more cases) are currently ongoing in 2019 in the following jurisdictions:
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IAC provides a summary article about votes taken at June 26–27 ACIP meeting
The Advisory Committee on Immunization Practices (ACIP) met in Atlanta on June 26–27, 2019.
During the meeting, several topics were discussed for informational purposes only. Specifically, the Committee received an update on the current measles outbreak in the United States, discussed updated safety data on recombinant zoster vaccine (Shingrix, GSK), considered future policy options for use of tetanus-diphtheria-pertussis (Tdap) vaccine, and reviewed dengue epidemiology and Dengvaxia (Sanofi) Phase III clinical trials.
In addition, ACIP broke a single meeting record by taking 18 separate votes during the June meeting, encompassing 11 votes on five different vaccines and seven votes related to inclusion of specific vaccines into the Vaccines For Children (VFC) program. These individual votes are highlighted below.
Human Papillomavirus Vaccine (HPV)
ACIP approved two new recommendations for use of HPV vaccine (Gardasil-9, Merck).
- Harmonization of upper age limit for routine catch-up vaccination of males and females: The current HPV recommendation calls for routine catch-up vaccination of females through age 26 and males through age 21, though males with risk factors or who want to be protected may be vaccinated through age 26. ACIP voted unanimously to harmonize the routine catch-up vaccination schedule for both males and females through age 26.
- Shared clinical decision making* for vaccination of persons age 27 through 45 years: In a split (10 to 4) vote, ACIP approved vaccination of persons age 27–45 years based on “shared clinical decision making” between the patient and clinician. Members in support of the recommendation noted this option offers providers case-by-case flexibility and allows potential insurance coverage for HPV vaccine in this age group.
*Shared clinical decision making means the decision to vaccinate persons age 27 through 45 years should be based on a discussion of benefits and risks between the patient and the clinician.
Pneumococcal Conjugate Vaccine (PCV13) for Immunocompetent Older Adults
When the PCV13 (Pfizer) recommendation for adults age ≥65 years was initially passed in 2014, ACIP recommended that all immunocompetent adults in this age group receive a dose of PCV13, followed by a dose of pneumococcal polysaccharide vaccine (PPSV23) at least one year later. At the time this was approved, Committee members requested the recommendation be revisited after several years to examine the indirect impact of childhood PCV13 immunization on the rates of invasive pneumococcal disease in adults. Due to high rates of childhood immunization resulting in decreased transmission of vaccine-containing serotypes, available data indicate the anticipated impact from continued PCV13 use in older adults is minimal.
ACIP took three separate votes in the process of agreeing on the final recommendation. After the majority of committee members failed to approve policy options to (1) continue the current recommendation of PCV13 followed by PPSV23 or (2) eliminate the PCV13 recommendation in this age group entirely, the committee approved (in a 13 to 1 vote) the following recommendation:
- Shared clinical decision making*: ACIP recommends PCV13 based on shared clinical decision making for adults 65 years and older who do not have an immunocompromising condition** and who have not previously received PCV13. All adults 65 years and older should receive a dose of PPSV23.
* Shared clinical decision making” means the decision to vaccinate persons age 65 years and older who are not at high risk for invasive pneumococcal diseases should be based on a discussion of benefits and risks between the patient and the clinician.
** Immunocompromising conditions are defined as chronic renal failure, nephrotic syndrome, immunodeficiency, iatrogenic immunosuppression, generalized malignancy, HIV, Hodgkin disease, leukemia, lymphoma, multiple myeloma, solid organ transplants, cochlear implants, CSF leaks, congenital or acquired asplenia, sickle cell disease, or other hemoglobinopathies.
Of note, the recommendations for vaccination of adults at high risk of invasive pneumococcal disease (MMWR, Vol. 61, No. 40, pages 816–819) have not changed.
Hepatitis A Vaccine
Unlike in the pre-vaccine era, when hepatitis A virus (HAV) transmission was most often associated with asymptomatic children, recent outbreaks have primarily affected adults. Although sporadic foodborne outbreaks occur, person-to-person spread is now the dominant mode of HAV transmission. In addition, persons with HIV are recognized to have increased HAV infection severity.
In recognition of this changing epidemiology, ACIP unanimously approved the following recommendations for use of hepatitis A vaccine:
- Catch-up vaccination of children and adolescents: ACIP recommends that all children and adolescents age 2 through 18 years who have not previously received hepatitis A vaccine be vaccinated at any age (i.e., children and adolescents are recommended for catch-up vaccination).
- Vaccination of persons with HIV infection: ACIP recommends that all persons with HIV age ≥ 1 year be vaccinated with hepatitis A vaccine.
- Updated HAV vaccine recommendations to be published: ACIP affirms the updated statement “Prevention of Hepatitis A Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices.”
When the updated HAV vaccine recommendations are published in Morbidity and Mortality Weekly Reports (MMWR), they will include guidance related to consideration of pre-vaccination testing for certain populations expected to have high rates of previous HAV infection (pre-vaccination testing is not recommended for the general population) and post-vaccination testing of persons whose subsequent clinical management depends on knowledge of their immune status, such as persons with HIV infection and other immunocompromised persons. The publication also will incorporate changes to the list of high-risk persons for hepatitis A infection, specifically (1) persons with clotting factor disorders will be removed from this listing (changes in clotting factor preparation practices and donor screening have greatly reduced the risk for hepatitis A for clotting factor recipients) and (2) pregnant women and persons with chronic liver disease will be added. Finally, the updated MMWR will contain guidance on handling interrupted schedules, minimum dosing intervals, and other immunization management issues and considerations.
Meningococcal B Vaccine (MenB)
When ACIP initially passed a recommendation for meningococcal B vaccine (MenB) for persons at increased risk of infection, the committee did not recommend booster doses for persons who remain at increased risk or who are at risk in an outbreak setting. Since that time, additional data has indicated waning immunity 1–2 years following primary MenB vaccination and a robust immune response following receipt of a booster dose. Armed with this new information, ACIP unanimously approved the following recommendations:
- Booster doses for persons at increased risk
- Persons with certain conditions and microbiologists: For persons >10 years with complement deficiency, complement inhibitor use, asplenia, or who are microbiologists, ACIP recommends a MenB booster dose 1 year following completion of a MenB primary series followed by MenB booster doses every 2–3 years thereafter, for as long as increased risk remains.
- During an outbreak: For persons age >10 years determined by public health officials to be at increased risk during an outbreak, ACIP recommends a one-time booster dose if it has been >1 year since completion of a MenB primary series. A booster dose interval of >6 months may be considered by public health officials depending on the specific outbreak, vaccination strategy, and projected duration of elevated risk.
- Updated MenB recommendations to be published: ACIP affirms the updated statement “Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices.” When published, this updated statement will include the new booster recommendations and will incorporate all existing ACIP recommendations for MenACWY and MenB vaccines into a single document.
Influenza Vaccine
ACIP discussed vaccine availability and updated guidance for the 2019–2020 influenza season and unanimously approved the following recommendation:
- Updated influenza vaccine statement to be published: ACIP affirms the updated statement “Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2019–20 Influenza Season.”
The new statement will include information about vaccine licensure changes and a new table highlighting the dose volume differences between the four IIV preparations expected to be available for children age 6 through 35 months. In addition, updated guidance will outline optimal timing for vaccination, groups that should be the focus of efforts if vaccine supply is limited, clarification on the number of vaccine doses needed for 8-year-olds who have their ninth birthday before receipt of a recommended second dose of vaccine, and concomitant receipt of two vaccines containing novel adjuvants.
Vaccines For Children (VFC) Program Resolutions
ACIP unanimously approved 7 resolutions to include specific vaccines in the VFC program and to encompass updated ACIP recommendations. The resolutions do not alter the vaccine recommendations themselves.
- Combination Pediatric Hexavalent Vaccine (4 resolutions): Although Vaxcelis (DTaP-IPV-Hib-HepB, Merck-Sanofi) is not expected to reach the U.S. market until 2021, ACIP is supportive of its inclusion as an available option in the VFC program. This required four separate resolutions for each vaccine component, i.e., DTaP, polio, Hib, and hepatitis B.
- Influenza: This purpose of this resolution is to update the table of inactivated influenza vaccines in the VFC Program.
- Hepatitis A: This purpose of this resolution is to streamline the Recommended Vaccination Schedule and Intervals section, update the language related to catch-up vaccination, add information about the accelerated Twinrix (GSK) schedule, clarify the timing of vaccine and immunoglobulin receipt, and remove pregnancy as a precaution.
- Meningococcal B: The purpose of this revision is to update the resolution to reflect (a) currently available meningococcal conjugate vaccines and (b) new recommendations for booster doses for serogroup B meningococcal vaccines. In addition, the language regarding the intervals for one of the serogroup B vaccines covered by the resolution has been updated to more closely reflect the current ACIP recommended language.
All recommendations approved by ACIP are provisional until they are approved by the CDC director 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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New! “FLU VACCINE” buttons and stickers now available for purchase from IAC
Start your preparations for the 2019–20 influenza season by ordering IAC's new “FLU VACCINE” buttons and stickers from SHOP IAC. These new resources are modeled after “I Voted” stickers, which are given to voters in many states as they leave the polls on Election Day. The flu vaccine buttons and stickers are bright red to help broadcast your important vaccination message. And the cost is low!
“FLU VACCINE” BUTTONS
Demonstrate your clinic-wide support for protecting everyone from influenza by purchasing buttons for all staff to wear. Measuring 1.25" across, the button is understated in size but carries a bold message! Brightly colored red, round button with white text and a metal pin that clasps on the back.
Pin on your lab coat, uniform, other clothing, tote bags, or backpacks to show support for influenza vaccination. Wear it when flu vaccine is available in your clinic to remind patients and the public to protect themselves from influenza.
Buttons are delivered in bags of 10 buttons per bag. Click here for pricing and ordering.
“FLU VACCINE” STICKERS
These brightly colored red, round stickers, measure 1.5" across. Printed on Avery labels, they adhere well to clothing and have an easy-peel-off back.
Wearing these brightly colored stickers, your patients will be letting their communities know that influenza vaccination is important.
Suitable for clinic staff, too! Urge all staff (including receptionists!) to wear them at work during flu vaccination season. This sends a powerful reminder to patients to get vaccinated.
Stickers are delivered to you cut individually (not on rolls)—available in bundles of 100. Click here for pricing and ordering information.
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IAC Spotlight! IAC's "Talking about Vaccines: Importance of Vaccines" web page features resources to help providers communicate with parents and patients about how vaccines save lives
IAC's Talking about Vaccines: Importance of Vaccines web page on immunize.org was recently updated. This page contains many resources from IAC, CDC, and others to help healthcare professionals explain to parents and patients how, for more than 50 years, vaccinations have saved more than a billion lives and prevented countless illnesses and disabilities in the United States.
The resources listed in the left column of this web page link to materials on the websites of the following organizations:
- IAC
- CDC
- Center for Vaccine Awareness and Research, Texas Children's Hospital
- American Academy of Pediatrics
- History of Vaccines
- Vaxopedia
In the right column of the web page, you will find more resources, including the following:
To easily locate this web page from anywhere on immunize.org, go to the light blue band of tabs across the top, choose the "Talking About Vaccines" tab (far right), and then select "Importance of Vaccines" from the drop-down menu.
The direct link is www.immunize.org/importance-of-vaccines.
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FDA approves change in storage temperature requirements for Vaxchora (Emergent Biosolutions) oral cholera vaccine
The U.S. Food and Drug Administration (FDA) has approved a change in storage temperature requirements for Vaxchora (Emergent BioSolutions), an oral cholera vaccine. The change is from frozen storage to refrigerated storage at 2°C to 8°C (35.6°F to 46.4°F).
Access the new Vaxchora package insert from the FDA website.
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Two healthcare organizations join IAC's Influenza Vaccination Honor Roll for mandatory healthcare worker vaccination
There are now 837 organizations enrolled in IAC's Influenza Vaccination Honor Roll. The honor roll recognizes hospitals, long-term care facilities (LTCFs), medical practices, pharmacies, professional organizations, health departments, and other government entities that have taken a stand for patient safety by implementing mandatory influenza vaccination policies for healthcare personnel.
Since June 5, when IAC Express last reported on the Influenza Vaccination Honor Roll, two additional healthcare organizations have been enrolled.
IAC urges qualifying healthcare organizations to apply by visiting the Application page.
Newly added healthcare organizations, hospitals, government agencies, and medical practices
- 81st Keesler Medical Center, Biloxi, MS
- Physicians Primary Care Pediatrics, Fort Myers, FL
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IAC HANDOUTS
IAC updates its two standing orders templates for administering meningococcal ACWY vaccine—one for children and teens and the other for adults
IAC recently revised the following 2 resources for healthcare professionals:
- Standing Orders for Administering Meningococcal ACWY Vaccine to Adults
- Standing Orders for Administering Meningococcal ACWY Vaccine to Children and Teens
Both pieces were revised to remove the upper age limit for vaccination of first-year college students living in a residential facility.
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IAC posts updated handout for the public titled "Meningococcal: Questions and Answers"
IAC recently revised its 4-page handout for the public titled Meningococcal: Questions and Answers—Information about the Disease and Vaccines. Changes were made to remove the upper age limit for vaccination of first-year college students living in a residential facility, to update morbidity data, and to clarify that healthcare personnel should administer MenACWY vaccine to high-risk pregnant women and may administer MenB vaccine to high-risk pregnant women.
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VACCINE INFORMATION STATEMENTS
New and updated Bengali-language VIS translations now available
IAC recently posted 12 new and 1 updated Bengali-language VIS translations. IAC thanks the New York City Department of Health and Mental Hygiene for their donation of these translations.
Access the new Bengali-language VIS translations below.
Access the updated Bengali-language VIS translation below.
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WORLD NEWS
WHO reports on validation of elimination of maternal and neonatal tetanus in Chad
WHO published Validation of Elimination of Maternal and Neonatal Tetanus in Chad in the June 28 issue of its Weekly Epidemiological Record. The beginning of the article is reprinted below.
In 1999, tetanus was still a major cause of maternal and neonatal morbidity and mortality in 59 countries. The aim of the global Maternal and Neonatal Tetanus Elimination (MNTE) Initiative, launched in 2000, was to eliminate (fewer than 1 case of neonatal tetanus (NT)/1000 live births (LBs) per district) the deadly but preventable disease by 2020. Deadline after deadline had previously been missed.
During the past 2 decades, elimination of tetanus was validated in 45 of the 59 countries with country commitment and technical and financial support from partners and donors. As of December 2018, however, elimination had yet to be validated in 14 countries, mainly in the African and Eastern Mediterranean regions....
As of December 2018, Chad was 1 of the 14 countries for which elimination was yet to be validated....
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Still available! IAC’s sturdy laminated 2019 U.S. child/adolescent immunization schedules—order some for your exam rooms today! Bulk purchase prices available.
IAC's laminated 2019 U.S. child/adolescent immunization schedule is still available. The adult schedules have sold out. These schedules are covered with a tough coating you can wipe down; they will stand up to a year's worth of use in every area of your healthcare setting where immunizations are given. The child/adolescent schedule is eight pages (i.e., four double-sided pages) and is folded to measure 8.5" x 11".
Laminated schedules are printed in color for easy reading. They come complete with essential tables and notes, and they replicate the newly designed CDC schedule format.
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 the schedule, view an image, order online, or download an order form at the Shop IAC: Laminated Schedules web page.
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IAC's comprehensive Vaccinating Adults: A Step-by-Step Guide is available for free download either by chapter or in its entirety (142 pages)
In late 2017, the Immunization Action Coalition (IAC) announced the publication of its new book, Vaccinating Adults: A Step-by-Step Guide (Guide).
This completely updated "how to" guide on adult immunization provides easy-to-use, practical information covering essential adult immunization activities. It helps vaccine providers enhance their existing adult immunization services or introduce them into any clinical setting. Topics include:
- 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 available to download/print either by chapter or in its entirety free of charge at www.immunize.org/guide. The downloaded version is suitable for double-sided printing. The National Vaccine Program Office and CDC both supported the development of the Guide and provided early technical review.
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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JOURNAL ARTICLES AND NEWSLETTERS
New international study collects opinions from people in 140 countries about science and health, with a focus on vaccines
The Wellcome Global Monitor 2018, a large global survey of public attitudes toward health and science, was published on June 19. A section of a related press release is reprinted below.
The Wellcome Global Monitor 2018 shows high overall global trust in doctors, nurses, and scientists, and confidence in vaccines.
It also shows that half the world’s population say they know little, if anything, about science. And almost one in five feels excluded from the benefits of science.
The survey asks more than 140,000 people, aged 15 and older, in over 140 countries, how they think and feel about health and science.
It is the first global survey of its kind and highlights questions that need to be answered to ensure science and health research benefits everyone equally, wherever they are in the world. It also reveals attitudes about science that are important to improving global health, including a complex picture of confidence in vaccines in high-income countries.
The following text is taken from the Summary of Key Findings section of the full report.
- Globally, eight in ten people (79%) ‘somewhat’ or ‘strongly agree’ that vaccines are safe, while 7% ‘somewhat’ or ‘strongly disagree.' Another 11% ‘neither agree nor disagree,' and 3% said they ‘don’t know.'
- In high-income regions, only 72% of people in Northern America and 73% in Northern Europe agree that vaccines are safe. In Western Europe, this figure is lower, at 59%, and in Eastern Europe is only 50%. In low-income regions, the proportion tends to be much higher, with highs of 95% of people in South Asia and 92% in Eastern Africa.
- In France, one in three people disagree that vaccines are safe, the highest percentage for any country worldwide.
- 92% of parents worldwide said that their children had received a vaccine to prevent them from getting childhood diseases, while 6% said they did not, and 2% said they did not know. The highest percentage of parents who said their children did not receive a vaccine were [from] Southern Africa, 9% and East Asia and Southeast Asia, 8%.
- In most regions, people who have high trust in doctors and nurses are very likely to consider that vaccines are safe. However, this is less true in Western and Eastern Europe.
- There is a positive relationship between overall trust in scientists and attitudes towards vaccines, though the relationship is strongest in high-income countries.
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EDUCATION AND TRAINING
NFID to summarize the June ACIP meeting in July 18 webinar
The National Foundation for Infectious Diseases (NFID) will present a webinar titled Updates from June 2019 ACIP Meeting on July 18 at 12:00 p.m. (ET). William Schaffner, MD, NFID medical director and liaison to the Advisory Committee on Immunization Practices (ACIP), and H. Keipp B. Talbot, MD, MPH, NFID secretary and ACIP member, will discuss updates from the June 2019 ACIP meeting, including current U.S. vaccination recommendations for children, adolescents, and adults.
Reminder: Weekly CDC webinar series on "The Pink Book" chapter topics runs through September 25; register now
Register for CDC's 15-part, live CE-accredited series of 1-hour webinars designed 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"). Topics include specific vaccines and the diseases they prevent, general recommendations for vaccines, vaccination principles, and immunization strategies for providers.
All sessions begin at 12:00 p.m. (ET). This series began on June 5 and will run through September 25, 2019. The next two webinars are scheduled as follows:
- July 10: Immunization Strategies
- July 17: Vaccine Storage and Handling and Administration and Vaccine Administration
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Want to learn more about immunization and improve your clinical skills? Check out these archived webinars and training modules from CDC and other organizations!
IAC informs readers about upcoming educational opportunities in each weekly IAC Express newsletter. What you may not know is that most of these webinars and training modules are archived online, so you can watch them at your convenience any time after the live session. Here are some outstanding free learning opportunities.
CDC
IAC
Vaccine Education Center, Children's Hospital of Philadelphia (VEC)
- Current Issues in Vaccines is a webinar series offered four times per year for healthcare providers. Each event is co-sponsored by the VEC and the Pennsylvania Chapter, American Academy of Pediatrics and features Paul Offit, MD, director of VEC. The archived versions are available to watch for continuing education credit.
National Foundation for Infectious Diseases (NFID)
- The NFID Webinar Library offers a variety of online continuing education activities led by key opinion leaders enabling participants to earn credits and gain practical knowledge, tools, and skills.
National AHEC Organization
- The National AHEC Organization HPV Vaccination Project has sponsored a number of educational webinars about HPV vaccination, These are available on demand from their website. Continuing education is only available when participating in the live session.
National Association of County and City Health Officials (NACCHO)
- NACCHO is offering a 5-part webinar series to help local health departments build capacity to engage in public health communication. These webinars are open to all healthcare professionals. Access Principles to Address Vaccine Resistance and Hesitancy to find upcoming and archived webinars on this topic. Continuing education credit is not available.
If you know of other free continuing education opportunities for immunization providers, please let IAC know by emailing admin@immunize.org.
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American Immunization Registry Association annual meeting to be held August 13–15; early registration ends July 14
The American Immunization Registry Association (AIRA) annual meeting will be held August 13–15 in Indianapolis. AIRA will be celebrating its 20th anniversary of supporting and promoting the use of immunization information to ensure healthy communities through the development and implementation of immunization information systems (IIS).
The preliminary agenda includes presentations and interactive breakout sessions on a variety of timely IIS topics, including outbreak response and more.
The early bird registration rate ends July 14. Visit the National Meeting website to register, book your hotel room, and learn more about the conference.
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2019 Arkansas Immunization Summit to be held August 16; early registration ends July 15
The 2019 Arkansas Immunization Summit will be held August 16 in North Little Rock. This meeting is an educational event targeting immunization leaders and healthcare providers from around the state and region who have an interest in addressing and improving immunization issues in Arkansas. This activity has been approved for 6.25 hours of continuing education for physicians, pharmacists, and nurses.
The early bird registration rate ends July 15. Visit the conference web page for information on the agenda and registration.
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Texas Immunization Conference scheduled for October 23–25; early registration ends September 13
The Texas Immunization Conference will be held October 23–25 in Addison. The conference is targeted towards private and public sector healthcare professionals throughout Texas. This includes physicians and residents, physician assistants, nurse practitioners, pharmacists, nurses, epidemiologists, public health staff, health educators, healthcare and public health students, school personnel, coalition members, stakeholders, and anyone else interested in improving immunization rates in Texas.
Early registration ends September 13. The tabs on the conference web page will link you to more information on the program and speakers.
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