IAC provides summary article about votes taken at October 21 ACIP meeting

The most recent meeting of the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) was held October 21 in Atlanta. Although the ACIP-approved recommendations do not become official until they are approved by the CDC Director and published in the Morbidity and Mortality Weekly Report (MMWR), the following provides a summary of the decisions as they were voted on at the meeting:
 
2016 Child and Adolescent Immunization Schedule

ACIP approved changes from the 2015 schedule that include:
 
For the colored chart displaying vaccine recommendations by age of administration

• Reordering of the vaccines to reflect, as much as possible, the ages at which routine vaccination should occur;
• Addition of a new bar for meningococcal B vaccine to indicate vaccination of children ages 10 and older with high-risk conditions, and a permissive recommendation to vaccinate children ages 16 through 18 years;
• Addition of a purple bar for Hib vaccine denoting the need to vaccinate children ages 5 through 18 years who have high-risk conditions. 

In the footnotes accompanying the colored chart

• Addition of a new recommendation for a dose of IPV for children age 5 years and older whose only polio vaccine has been OPV given before the age of 4 years;
• Incorporation of HPV recommendations for high-risk children ages 9 through 10 years;
• Incorporation of meningococcal B vaccine recommendations into the meningococcal vaccines footnote. 

2016 Adult Immunization Schedule

ACIP approved changes from the 2015 schedule that include:
 
For the colored chart displaying vaccine recommendations by age of administration AND the colored chart displaying vaccine recommendations for adults with specified medical and other indications

• Addition of a new bar for meningococcal B vaccine to indicate vaccination of adults ages 19 years and older with high-risk conditions;
• Addition of clarifying text in many of the colored bars.

In the footnotes accompanying the colored charts

• Revision to the interval for PCV13 following PPSV23;
• Clarification that residents of nursing homes and other long-term-care facilities should be assessed for need for PPSV23 (previously stated that all should be vaccinated);
• Incorporation of meningococcal B vaccine recommendations into the meningococcal vaccines footnote.  

Current plans are for these revised schedules to be referenced in MMWR and posted on the CDC website in early February 2016.
 
The official minutes and presentation slides from the October meeting will be available on the ACIP Meeting Information web page within the next few weeks. Registration is now open for in-person attendance of the February 2016 meeting. Registration is not required to view the meeting via web stream.

Related Links

• ACIP Meeting Information on CDC's website

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CDC publishes ACIP recommendations for the use of serogroup B meningococcal vaccines in adolescents and young adults

In the October 23 issue of MMWR (pages 1171–1175), CDC published Use of Serogroup B Meningococcal Vaccines in Adolescents and Young Adults: Recommendations of the Advisory Committee on Immunization Practices, 2015. At its June 2015 meeting, ACIP recommended that adolescents and young adults aged 16–23 years may be vaccinated with a serogroup B meningococcal (MenB) vaccine to provide short-term protection against most strains of serogroup B meningococcal disease. This report summarizes the deliberations of ACIP, the rationale for its decision, and recommendations for use of MenB vaccines in adolescents and young adults. The "Recommendations" section is reprinted below in its entirety.

Recommendations 

A MenB vaccine series may be administered to adolescents and young adults aged 16–23 years to provide short-term protection against most strains of serogroup B meningococcal disease. The preferred age for MenB vaccination is 16–18 years (recommendation Category B).

MenB vaccine should either be administered as a 3-dose series of MenB-FHbp [Trumenba; Wyeth Pharmaceuticals, Inc.] or a 2-dose series of MenB-4C [Bexsero; GSK]. The two MenB vaccines are not interchangeable; the same vaccine product must be used for all doses. On the basis of available data and expert opinion, MenB-FHbp or MenB-4C may be administered concomitantly with other vaccines indicated for this age, but at a different anatomic site, if feasible.

No randomized controlled clinical trials have been conducted to evaluate use of MenB vaccines in pregnant or lactating women. Vaccination should be deferred in pregnant and lactating women unless the woman is at increased risk, and, after consultation with her health care provider, the benefits of vaccination are considered to outweigh the potential risks.

Additional information for health care providers and parents can be found on the CDC website at http://www.cdc.gov/meningococcal.

In February 2015, ACIP recommended routine use (recommendation Category A) of MenB vaccines in certain groups of persons at increased risk for serogroup B meningococcal disease, including during outbreaks of serogroup B meningococcal disease. College campuses that have recently experienced an outbreak of serogroup B meningococcal disease should continue to follow the recommendations for use of MenB vaccines in outbreak settings that recommend vaccination for persons aged ≥10 years.

Related Links

• Use of Serogroup B Meningococcal Vaccines in Adolescents and Young Adults: Recommendations of the Advisory Committee on Immunization Practices, 2015
• IAC's ACIP Recommendations section on immunize.org
• MMWR main page provides access to MMWR Weekly, MMWR Recommendations and Reports, MMWR Surveillance Summaries, and MMWR Supplements
• Free MMWR electronic subscription

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Editors' note: Beginning in November, IAC Express will be published every Wednesday

Beginning in November, IAC will change the weekly publication day of IAC Express from Tuesday to Wednesday. We are making this change in order to streamline our production process. Subscribers will receive the next issue (#1212) of IAC Express on Wednesday, November 4.

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CDC releases combined summary of notifiable infectious, noninfectious diseases; all nationally notifiable conditions are now in the same MMWR volume

CDC published the summaries of all notifiable conditions—infectious and noninfectious—in the October 23 volume of Supplements to MMWR. The reports being released are in the Summary of Notifiable Noninfectious Conditions and Disease Outbreaks—United States. Together, the reports are referred to as the "Summary (Infectious and Noninfectious)." The reports were prepared by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE). The following is a selection of excerpts from a related CDC press release:
 
Notifiable diseases and conditions are those for which regular, frequent, and timely information is necessary for prevention and control. Monitoring this data gives CDC and other public health authorities the ability to detect and respond to sudden changes in the occurrence and distribution of health threats. State and local health departments voluntarily submit the data to CDC....
 
The Summary (Infectious) summarizes data on dozens of nationally notifiable diseases and conditions in the United States. Highlights include:

...Influenza-associated pediatric deaths: From Dec. 30, 2012, to Dec. 28, 2013, CDC received reports of 161 deaths among people under the age 18 years—a more than three-fold increase compared with 2012, and a two-fold decrease compared with the pandemic year 2009. There were 69 pediatric deaths from seasonal influenza per calendar year during 2005–2012 and 358 pediatric deaths reported during the 2009–2010 flu pandemic.

Measles: There were 10 measles outbreaks in 2013, accounting for three-fourths of reported cases. The three largest outbreaks accounted for more than half of cases. In each outbreak, measles spread after a U.S. resident who caught measles abroad introduced the extremely contagious viral infection into communities with pockets of people unvaccinated because of philosophical or religious beliefs.

Meningococcal disease: In 2013, U.S. rates of meningococcal disease continued to be at historic lows. However, there were serogroup B outbreaks at two universities—one in California and one in New Jersey—resulting in 13 cases and one death.

Novel flu viruses: In 2013, there were 21 cases of human infection with variant flu viruses in the U.S.—all associated with direct or indirect contact with swine. There were no human-to-human transmissions. Any public health laboratory that receives a suspicious specimen of flu virus—one that cannot be subtyped using standard methods—immediately submits that specimen to CDC for further testing.

Whooping cough (pertussis): Reported pertussis cases decreased from 2012 to 2013. However, cases continue to exceed those reported during the 1990s and early 2000s.

Salmonellosis: Salmonella causes an estimated 1.2 million illnesses per year in the U.S. The largest multistate outbreak in 2013 was traced to contaminated chicken. Other notable outbreaks were linked to live poultry, tahini sesame paste, cucumbers, and small pet turtles.

Hepatitis C (HCV): After receiving reports of about 800 to 1,000 cases of acute HCV infection per year from 2006-2010, there was an increase of 73.9 percent to 2,138 cases in 2013. Investigations show a marked increase in the number of acute cases of HCV among young, nonminority people who inject drugs, many of whom also abuse oral prescription opioid drugs....

Related Links

• Summary of Notifiable Noninfectious Conditions and Disease Outbreaks—United States
• MMWR Supplements

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IAC Spotlight! Three health care organizations join IAC's Influenza Vaccination Honor Roll for mandatory health care worker vaccination

More than 575 organizations are now 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 health care personnel. 

Since October 16, when IAC Express last reported on the Influenza Vaccination Honor Roll, three additional health care organizations have been enrolled.

IAC urges qualifying health care organizations to apply.

Newly added health care organizations, hospitals, government agencies, and medical practices

• Kootenai Health, Coeur d’Alene, ID
• University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA
• University of Toledo Medical Center, Toledo, OH

Related Links

• Listing of all honorees by state
• Position statements from professional societies and leading health care organizations in support of mandatory influenza vaccination
• Influenza Vaccination Honor Roll section on immunize.org, which includes access to the application form (see the gold honor badge in right column, and click on the words "Apply for the Influenza Vaccination Honor Roll")
• IAC's one-page promotional handout that describes the honor roll, titled "Influenza Vaccination Honor Roll from the Immunization Action Coalition: Honoring health care institutions with stellar influenza vaccination policies"
• IAC's Honor Roll for Patient Safety web page
• IAC's Hepatitis B Birth Dose Honor Roll section on immunize.org

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IAC HANDOUTS

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FEATURED RESOURCES

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Influenza is serious; many resources are available to help health care professionals in vaccinating

Vaccination remains the single most effective means of preventing influenza, and is recommended for everyone age six months 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 health care professionals and the public:

• CDC's Seasonal Flu web section
• CDC's Flu View web section
• CDC's Free Resources related to influenza
• National Adult and Influenza Immunization Summit website
• The Summit Buzz: Newsletter of the National Adult and Influenza Immunization Summit 
• Influenza web page on immunize.org
• IAC's handouts related to influenza
• HealthMap Vaccine Finder
• Influenza Vaccine Availability Tracking System—IVATS: a resource for health care settings looking to purchase influenza vaccine

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IAC makes available The Vaccine Handbook: A Practical Guide for Clinicians, a.k.a. "The Purple Book," by Dr. Gary Marshall

The Vaccine Handbook: A Practical Guide for Clinicians  (“The Purple Book,” 2015, 560 pages) is a uniquely comprehensive source of practical, up-to-date information for vaccine providers and educators. Its author, Gary S. Marshall, MD, has drawn together the latest vaccine science and guidance into a concise, user- friendly, practical resource for the private office, public health clinic, academic medical center, and hospital.

IAC Executive Director Deborah Wexler, MD, is enthusiastic about helping get this book circulated as widely as possible. “During more than 20 years in the field of immunization education, I have not seen a book that is so brimming with state-of-the-science vaccine information,” she states. "This book belongs in the hands of every medical student, physician-in-training, doctor, nursing student, and nurse who provides vaccines to patients.”
 
The Vaccine Handbook provides:

• Information on every licensed vaccine in the United States
• Rationale behind authoritative vaccine recommendations
• Contingencies encountered in everyday practice
• A chapter dedicated to addressing vaccine concerns
• Background on how vaccine policy is made
• Standards and regulations
• Office logistics, including billing procedures, and much more

About the Author
Gary Marshall, MD, is professor of pediatrics at the University of Louisville School of Medicine in Kentucky, where he serves as chief of the division of pediatric infectious diseases and director of the Pediatric Clinical Trials Unit. In addition to being a busy clinician, he is nationally known for his work in the areas of vaccine research, advocacy, and education.

The newly released fifth edition of this invaluable guide is now available on IAC’s website at www.immunize.org/vaccine-handbook.

The price of the handbook is $29.95 each, plus shipping charges. Discount pricing is available for more than 10 copies. Order copies for your staff or for distribution at an upcoming conference.

Quantity Discount Pricing

• 1–10 books: no discount + shipping
• 11–50 books: 5% + shipping
• 51–100 books: 10% + shipping
• 101–500 books: 15% + shipping
• 501–1000 books: 20% + shipping

For quotes on larger quantities, email admininfo@immunize.org.

Order your copy today!

• Visit www.immunize.org/vaccine-handbook
• Promotional leaflet about The Vaccine Handbook

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JOURNAL ARTICLES AND NEWSLETTERS

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CDC Vaccine Datalink study: Tdap vaccination during pregnancy following other recent tetanus-containing vaccines is safe

On October 20, the Journal of the American Medical Association published an article titled Association of Tdap Vaccination with Acute Events and Adverse Birth Outcomes among Pregnant Women with Prior Tetanus- Containing Immunizations. A summary provided to the press is reprinted below in its entirety.

Among women who received the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine during pregnancy, there was no increased risk of adverse events in the mothers or adverse birth outcomes in newborns for women who had received a tetanus-containing vaccine in the previous 5 years, according to a study in the October 20 issue of JAMA.

Pertussis (whooping cough) is a vaccine-preventable illness that has been increasing in incidence over the past decade in the United States. Neonates (a baby from birth to four weeks) and infants are at increased risk of pertussis-related hospitalization and death compared with older children and adults. The Advisory Committee on Immunization Practices recommends the Tdap vaccine for pregnant women during each pregnancy, regardless of prior immunization status. However, safety data on repeated Tdap vaccination in pregnancy has been lacking, according to background information in the article.
 
Lakshmi Sukumaran, M.D., M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues conducted a study that included 29,155 pregnant women, ages 14 through 49 years, using data from 2007 to 2013 from 7 Vaccine Safety Datalink sites in California, Colorado, Minnesota, Oregon, Washington, and Wisconsin. The authors examined outcomes for women who received Tdap in pregnancy following a prior tetanus-containing vaccine less than 2 years before, 2 to 5 years before, and more than 5 years before.
 
The researchers found no significant differences in rates of acute adverse events in the mothers (fever, allergy, and local reactions) or adverse birth outcomes in neonates (small for gestational age, preterm delivery, and low birth weight) when comparing women who were vaccinated with Tdap during pregnancy regardless of the length of time since a prior tetanus-containing vaccine.
 
“Our findings should reassure patients and clinicians who might be hesitant to give Tdap vaccine to pregnant women who recently received a Tdap or other tetanus-containing vaccination,” the authors write.
 
The researchers add that future studies are needed to determine if there are differences in other important adverse pregnancy outcomes, such as stillbirth and spontaneous abortion, when Tdap is given in pregnancy in close intervals from prior tetanus-containing vaccines.

Related Links

• JAMA abstract: Association of Tdap Vaccination with Acute Events and Adverse Birth Outcomes among Pregnant Women with Prior Tetanus-Containing Immunizations
• Tetanus, Diphtheria, and Pertussis web pages on immunize.org
• IAC's handouts related to pregnancy and immunization
• Vaccinations for Pregnant Women [PDF] – also available in Spanish (Note: Translation is in process of being updated.)

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CDC and WHO report on progress toward polio eradication in Afghanistan in this week's MMWR and Weekly Epidemiological Report, respectively

CDC published Progress toward Poliomyelitis Eradication—Afghanistan, January 2014–August 2015 in the October 23 issue of MMWR (pages 1166–1170). On the same day, WHO's Weekly Epidemiological Record published a similar article titled Progress towards poliomyelitis eradication: Afghanistan, January 2014–August 2015. A media summary of the MMWR article is reprinted below.
 
There is an urgent need to improve on the level of coordination and oversight of polio eradication activities, particularly with respect to supplementary immunization, in order to eliminate poliovirus transmission in Afghanistan. After having made significant progress towards the eradication of polio in 2013, Afghanistan experienced an increase in wild poliovirus transmission in 2014, with the number of reported polio cases doubling compared with the previous year. While there have been encouraging signs of reduced transmission in the traditional polio reservoirs of Helmand and Kandahar in the Southern Region in 2015, immunity gaps in the conflict-affected Farah Province of the Western Region and cross-border transmission from Pakistan into Nangarhar Province of the Eastern Region have accounted for a majority of polio cases reported this year. To address this problem, the government of Afghanistan should urgently establish emergency operation centers to improve oversight and coordination of polio eradication activities, including the planning and implementation of supplementary immunization activities.

Related Links

• MMWR main page provides access to MMWR Weekly, MMWR Recommendations and Reports, MMWR Surveillance Summaries, and MMWR Supplements
• Free MMWR electronic subscription
• Current issue and archives of the Weekly Epidemiological Record

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MMWR Announcement: World Polio Day is October 24

CDC published World Polio Day—October 24, 2015 in the October 23 issue of MMWR (1179). The announcement is reprinted below in its entirety.

October 24 is World Polio Day, which recognizes the global progress made against a disease that at its height crippled over 100 children per week and now has been reduced to fewer than 100 cases per year. World Polio Day serves as a reaffirmation of the global commitment to eradicate this childhood disease. 

The concerted effort of the Global Polio Eradication Initiative partners, including Rotary International, the World Health Organization, the United Nations Children’s Fund, CDC, and the Bill and Melinda Gates Foundation, as well as polio vaccinators and public health workers in the field, has resulted in the World Health Organization announcing the removal of Nigeria from the list of polio-endemic countries in 2015, after a year without a reported wild poliovirus case in that country. Pakistan and Afghanistan are the only remaining polio-endemic countries, with a total of 51 cases reported between them this year as of October 14. 

Related Link

• Global Polio Eradication Initiative website

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EDUCATION AND TRAINING

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