Issue 1306: May 17, 2017
Ask the Experts—Question of the Week: A 16-year-old refugee’s record indicates 2 doses of Td separated by 1 month . . . read more
TOP STORIES
IAC HANDOUTS
OFFICIAL RELEASES AND ANNOUNCEMENTS
FEATURED RESOURCES
JOURNAL ARTICLES AND NEWSLETTERS
EDUCATION AND TRAINING
CONFERENCES AND MEETINGS
TOP STORIES
Free app of The Vaccine Handbook available from the Immunization Action Coalition
A new app of The Vaccine Handbook is now available from the Immunization Action Coalition. The free app, which is available for Apple iPhones and iPads only, contains the complete 2017 (6th) edition of The Vaccine Handbook (“The Purple Book”), by Dr. Gary Marshall, professor of pediatrics and chief of the Division of Pediatric Infectious Diseases at the University of Louisville. The app is fully searchable, with functionality that includes bookmarking, highlighting, user annotation, and links to important vaccination resources.
"The Purple Book" is a comprehensive source of vaccine information, drawing together vaccine science, guidance, and practice into a user-friendly resource for the private office, public health clinic, academic medical center, classroom, and hospital. The first section provides background on vaccine immunology, development, infrastructure, policy, standards, implementation, special circumstances, and—perhaps most importantly—addressing concerns. The second section contains details about every vaccine currently licensed in the U.S., including the burden and epidemiology of the respective disease, history of the immunization program, vaccine constituents, efficacy, safety, and recommendations.
The free app may be found by searching the iTunes App Store for “The Vaccine Handbook App” or clicking on the following link:
https://itunes.apple.com/us/app/the-vaccine-handbook-app/id1043246009?ls=1&mt=8.
Print copies of the book ($34.95 each; bulk discounts are available from the publisher) can be ordered from the Immunization Action Coalition website at www.immunize.org/vaccine-handbook.
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New! 2018 edition of CDC Health Information for International Travel ("The Yellow Book") now available online
CDC Health Information for International Travel (also known as "The Yellow Book") is published every two years as a reference for those who advise international travelers about health risks. "The Yellow Book" is written primarily for healthcare professionals, but is a useful resource for anyone interested in healthy international travel. The fully revised and updated edition codifies the U.S. government's most current travel health guidelines, including pre-travel vaccine recommendations, destination-specific health advice, and easy-to-reference maps, tables, and charts.
Updates to CDC Health Information for International Travel include:
- The latest information about emerging infectious disease threats such as Zika, Ebola, and MERS
- New cholera vaccine recommendations
- Updated guidance on the use of antibiotics in the treatment of travelers' diarrhea
- Special considerations for unique types of travel, such as wilderness expeditions, work-related travel, and study abroad
- Destination-specific recommendations for popular itineraries, including new sections for travelers to Cuba and Burma
CDC has posted the 2018 edition of "The Yellow Book" online at https://wwwnc.cdc.gov/travel/page/yellowbook-home.
CDC Health Information for International Travel is also available for sale from Oxford University Press, and can also be ordered from major online booksellers.
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CDC publishes ACIP recommendations for use of cholera vaccine in MMWR
CDC published Recommendations of the Advisory Committee on Immunization Practices for Use of Cholera Vaccine in the May 12 issue of MMWR. The "Recommendations for Prevention of Severe Cholera Among Travelers" section is reprinted below.
Personal Protective Measures
All travelers to cholera-affected areas should follow safe food and water precautions and proper sanitation and personal hygiene measures as primary strategies to prevent cholera. Travelers who develop severe diarrhea should seek prompt medical attention, particularly fluid replacement therapy.
Use of CVD 103-HgR
CVD 103-HgR is recommended for adult travelers (aged 18–64 years) from the United States to an area of active cholera transmission. An area of active cholera transmission is defined as a province, state, or other administrative subdivision within a country with endemic or epidemic cholera caused by toxigenic V. cholerae O1 and includes areas with cholera activity within the last year that are prone to recurrence of cholera epidemics; it does not include areas where only rare imported or sporadic cases have been reported.
The vaccine is not routinely recommended for travelers who are not visiting areas of active cholera transmission. Most travelers from the United States do not visit areas with active cholera transmission (https://wwwnc.cdc.gov/travel).
Booster Doses
At this time, no data exist about the safety and efficacy of booster doses of lyophilized CVD 103-HgR for the prevention of cholera. The duration of protection conferred by the primary dose beyond the evaluated 3-month period is unknown. There is no recommendation for use of booster doses at this time.
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CDC publishes article about Hepatitis Awareness Month and Testing Day
The month of May is designated as Hepatitis Awareness Month in the United States, and May 19th is Hepatitis Testing Day. During May, CDC and its public health partners work to shed light on this hidden epidemic by raising awareness of viral hepatitis and encouraging priority populations to get tested. CDC published Hepatitis Awareness Month and Testing Day—May 2017 in the May 12 issue of MMWR. The complete article is reprinted below.
May 19th is National Hepatitis Testing Day in the United States to emphasize the importance of testing persons at risk for hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, most of whom are unaware of their infection status. Recognizing the effectiveness of testing and other preventive and treatment measures, the National Academies of Science, Engineering, and Medicine recently set goals for the elimination of HBV and HCV as public health threats in the United States.*
HCV is the most common form of viral hepatitis in the United States and in 2013, accounted for approximately 19,000 deaths per year, a number that was greater than that of 60 other nationally notifiable infectious diseases combined. During 2010–2015, HCV incidence increased by 294% with the highest rates among young persons who inject drugs (PWID).†
This issue of MMWR includes two reports describing trends in HCV incidence and the availability of HCV prevention and treatment services that stop transmission. In the first report, only three states had comprehensive laws providing full access to HCV preventive and treatment services for PWID. The second report estimates rates of HCV infection among pregnant women in the United States and Tennessee; in the United States, HCV rates nearly doubled during 2009–2014, and in Tennessee, the rate in 2014 was approximately three times the national rate. Data from both reports emphasize the importance of viral hepatitis surveillance to identify communities at risk for HCV and public health policies that make available interventions that prevent HCV transmission and disease.
* http://www.nationalacademies.org/hmd/reports/2017/national-strategy-for-the-elimination-of-hepatitis-b-and-c.aspx
† https://www.cdc.gov/hepatitis/statistics/index.htm
Access the complete May 12 issue of MMWR, which includes the HCV reports referenced above.
More information about Hepatitis Awareness Month and Testing Day, including resources and events, was offered in the May 3 issue of IAC Express.
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Fifty-eight cases of measles reported in Minnesota outbreak
The measles outbreak in Minnesota covered in the April 26 and May 10 issues of IAC Express is ongoing.
- 58 total cases have been confirmed; 49 in Hennepin County, 3 in Ramsey County, 4 in Crow Wing County, and 2 in Le Sueur County
- 55 have been confirmed to be unvaccinated; 1 had received 1 dose of MMR and 2 had received 2 doses of MMR
- 55 cases have occurred in children ages 0 through 17 years; there have been 3 cases in adults
- 49 of the cases are in Somali-Minnesotan individuals
The local Somali community has been targeted for years with misinformation about a connection between vaccination and autism, including visits from anti-vaccine activists, including Andrew Wakefield, the controversial figure stripped of his license to practice medicine by Britain's General Medical Council as a result of ethical and financial misconduct.
The following is a sample of the coverage of this outbreak and its causes in the last week:
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Three people have died in San Diego County hepatitis A outbreak
Three people have died as part of a large outbreak of hepatitis A in San Diego County, CA. A selection from a press release from the county is reprinted below.
A third person has died as a result of the hepatitis A outbreak in San Diego County, and as of May 1 the total case count has risen to 80, the County Health and Human Services Agency announced today.
Sixty-six people have been hospitalized during the outbreak. Public health investigators are still evaluating cases; no common food, drink, or drug source has been identified.
The County has been conducting vaccination clinics in the community and working with partners, such as local homeless outreach and faith-based community organizations, in an effort to reach those most at risk....
Non-health care individuals who work closely with homeless people and illicit drug users on a frequent and ongoing basis, such as those who work or volunteer at homeless services agencies, are recommended to get the hepatitis A vaccine, if they are not already vaccinated....
Seven cases have been reported in local detention facilities where they may have exposed others.
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IAC Spotlight! “Handouts” section on IAC’s website one of our busiest places! Find out what’s there.
IAC's Handouts for Patients & Staff web section offers healthcare professionals and members of the public free access to hundreds of vaccination-related patient handouts and staff education materials. Choose one or more of the following tabs at the top of the section to explore the offerings:
As an example, the "Clinic Resources" section is sub-divided into:
Every month, about a third of a million of these materials are downloaded from IAC's website. CDC immunization experts have reviewed all these materials for technical accuracy (except for a few pieces authored by individual experts). All items are ready to print, copy, and distribute widely—check them out!
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IAC HANDOUTS
IAC updates "DTaP, Tdap, and Td Catch-up Vaccination Recommendations by Prior Vaccine History and Age"
IAC recently revised DTaP, Tdap, and Td Catch-up Vaccination Recommendations by Prior Vaccine History and Age. Changes were made to modify the time period in which it is preferred for pregnant women to receive Tdap, and to indicate that children who received a dose of Tdap at age 7–10 as part of a catch-up series may also receive a second Tdap at 11–12 years.
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 revises "Suggestions to Improve Your Immunization Services"
IAC recently revised Suggestions to Improve Your Immunization Services. Changes were made to expand on some of the sections, add a new section called "Best Practices," improve the readability and usefulness of many of the suggestions, and to add a section of reference materials.
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OFFICIAL RELEASES AND ANNOUNCEMENTS
WHO issues updated position paper on human papillomavirus vaccines
WHO published Human papillomavirus vaccines: WHO position paper, May 2017 in the May 12 issue of its Weekly Epidemiological Record. This is the most recent addition to a WHO-issued series of regularly updated position papers on vaccines that have an international public health impact. These papers are concerned primarily with the use of vaccines in large-scale immunization programs.
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CDC updates its online Adult Vaccine Quiz
CDC has recently updated its Adult Vaccine Quiz. The adolescent (ages 11 through 18) portion has been removed because the updated Childhood Vaccine Quiz now covers adolescent ages.
After an individual (age 19 and older) answers 11 simple questions, the Adult Vaccine Quiz lists recommended vaccines based on age, health conditions, job, lifestyle, travel, and other factors. He/she can then print the customized list to discuss with a healthcare professional to ensure he/she is up to date.
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Now available! IAC's sturdy laminated versions of the 2017 U.S. child/teen immunization schedule and the 2017 U.S. adult immunization schedule—order a supply for your healthcare setting today!
IAC's laminated versions of the 2017 U.S. child/teen immunization schedule and the 2017 U.S. adult immunization schedule are covered with a tough, washable coating; they will stand up to a year's worth of use in every area of your healthcare setting where immunizations are given. Both schedules are eight pages (i.e., four double-sided pages) and are folded to measure 8.5" x 11".
Laminated schedules are printed in color for easy reading, come complete with essential tables and footnotes, and include contraindications and precautions—a feature that will help you make an on-the-spot determination about the safety of vaccinating patients of any age.
PRICING
1–4 copies: $7.50 each
5–19 copies: $5.50 each
20–99 copies: $4.50 each
100–499 copies: $4.00 each
500–999 copies: $3.50 each
For quotes on customizing or placing orders for 1,000 copies or more, call (651) 647-9009 or email admininfo@immunize.org.
You can access specific information on both schedules, view images of both, order online, or download an order form at the Shop IAC: Laminated Schedules web page.
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JOURNAL ARTICLES AND NEWSLETTERS
April issue of CDC's Immunization Works newsletter now available
CDC recently released the April issue of its monthly newsletter Immunization Works and posted it on the website of the National Center for Immunization and Respiratory Diseases (NCIRD). The newsletter offers the immunization community information about current topics. The information is in the public domain and can be reproduced and circulated widely.
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EDUCATION AND TRAINING
WithinReach offers new e-learning course on vaccine hesitancy; HPV immunization course updated with information about 2-dose schedule
WithinReach of Washington State is offering two e-learning courses for healthcare professionals.
In "There Never Was An Age Of Reason: Vaccines, Vaccine Hesitancy, and Vaccine Decision Making," Dr. Edgar K. Marcuse, MD, MPH, FPIDS, emeritus professor, Pediatrics, University of Washington, explores the history, origins, and impact of vaccine hesitancy on vaccination rates and outbreaks of disease. Get information and tips on how parents make decisions about vaccines, the provider’s role in vaccine decisions, and how best to approach parent conversations about vaccines. This one-hour course is designed for health professionals who work in the immunization field. To find out more or register, go to: www.withinreachwa.org/age-of-reason-register.
"You Are the Key to HPV Cancer Prevention" course is a free, hour-long continuing education course designed for health professionals who work with adolescents and their parents. This course helps providers frame the HPV vaccine conversation, encourages providers to make a strong vaccination recommendation and offers responses for parents' most common questions. The course was recently updated to cover the new 2-dose schedule. To find out more or register, go to: www.cardeaservices.org/resourcecenter/you-are-the-key-to-hpv-cancer-prevention.
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Reminder: CDC's NetConference series about adult immunization runs every Wednesday, April 12–May 31
CDC is sponsoring a 6-part NetConference series on vaccinating adults that will address key issues related to protecting adults from vaccine-preventable diseases. A collaborative effort between CDC and Maryland’s adult immunization coalition and state immunization program, the "Vaccinating Adults" series will feature 6 presentations by experts in promoting, administering, and securing reimbursement for adult immunizations. Remaining presentations are:
- Wednesday, May 17—Immunizing Older Adults and the Chronically Ill
- Wednesday, May 24—Immunizing Pregnant Women, Health Care Personnel, and in the Workplace
- Wednesday, May 31—Clinic Logistics: Vaccine Administration, Storage, and Handling
Each session will start at 12:00 p.m. (ET).
Continuing education will be available for each event. The series will be archived later on CDC's website.
Advanced registration is required to participate.
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CONFERENCES AND MEETINGS
Michigan's Adult Immunization Summit to be held June 14 in Lansing
The Michigan Department of Health and Human Services is sponsoring Michigan's Adult Immunization Summit, Healthier Together, on June 14 in Lansing. This one-day conference will provide participants with a variety of practice-management tools, techniques, and information that will help assure that all of their adult patients are fully immunized.
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ASK THE EXPERTS
Question of the Week
A 16-year-old refugee’s record indicates 2 doses of Td separated by 1 month and 1 dose of Tdap given 4 months after the second Td. Is he up to date?
The first two doses of Td are valid because they are separated by at least 4 weeks. However, the minimum interval between the second and third doses of tetanus-containing vaccine is 6 calendar months. So, the Td component of the Tdap dose is not valid because it was given only 4 months after the second dose. The pertussis component can be counted as valid. The patient should receive another dose of Td 6 months after the invalid Tdap dose. If Td is not available, Tdap can be used for this dose.
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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