CDC launches campaign to educate and remind vaccination providers about proper administration technique in time for influenza season
To promote safe vaccination, CDC has launched a campaign to educate and remind providers about proper influenza vaccine administration technique to help avoid shoulder injuries and other adverse events. Shoulder injuries like bursitis and tendinitis resulting from improper injection technique are errors that can easily be avoided. Preliminary data from both the Vaccine Adverse Event Reporting System and the National Vaccine Injury Compensation Program indicate reports of shoulder injury related to vaccine administration have increased in the last several years. These reports occur more commonly among adults than children.
Get
comprehensive vaccine administration information from CDC's website and watch a
short video on the correct technique for intramuscular injection. Healthcare professionals can earn free continuing education by completing CDC's new
Vaccine Administration e-Learn.
The graphic below is an example of the resources available from the vaccine administration section of CDC's website. Click on the image to access a larger version to print out for your office or clinic.
It is imperative that healthcare personnel always follow safe injection practices, so please explore these materials and share them with your healthcare colleagues.
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CDC releases "Dear Colleague" letter for 2017–18 influenza season also signed by 17 medical organizations
On September 20, CDC released a "Dear Colleague" letter to healthcare professionals about influenza vaccination in the 2017–18 influenza season. The letter is signed by CDC and 17 professional societies and nonprofit organizations, including IAC. Some of the key messages are reprinted below.
2017–2018 Recommendation Highlights. The Advisory Committee on Immunization Practices (ACIP) and CDC continue to recommend annual influenza vaccination with an injectable influenza vaccine for everyone 6 months and older, including pregnant women. The recommendation not to use live attenuated influenza vaccine (LAIV) was extended for the 2017–2018 season. Full recommendations for the 2017–2018 influenza season are online at https://www.cdc.gov/mmwr/indrr_2017.html.
Vaccine Supply. Manufacturers have projected they will produce between 151 million and 166 million doses of injectable influenza vaccine for the 2017–2018 influenza season, which should ensure sufficient supply of vaccine.
When to Vaccinate. Optimally, vaccination should occur before onset of influenza activity in the community. We recommend vaccination by the end of October, if possible. To avoid missed opportunities for vaccination, providers should offer vaccination during routine health care visits and hospitalizations when vaccine is available. Vaccination efforts should continue throughout the season because the duration of the influenza season varies and influenza activity might not occur in certain communities until February or March. Vaccine administered in December or later is likely to be beneficial even if given after the influenza season has begun.
Safe Vaccine Administration. When you “know the site and get it right,” you can help prevent one type of vaccine administration error—shoulder injuries such as deltoid bursitis—generally caused when vaccines are injected high on the shoulder and the needle enters a shoulder bursa. This is an error reported to occur mostly among adults. CDC provides comprehensive vaccine administration resources at https://www.cdc.gov/vaccines/hcp/admin/admin-protocols.html.
Access the complete CDC "Dear Colleague" letter.
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CDC announces changes made to ACIP's "Best Practice Guidelines for Immunization" in July
On April 20, CDC published General Best Practice Guidelines for Immunization Best Practices: Guidance of the Advisory Committee on Immunization Practices (also available in PDF format). This document replaced ACIP's "General Recommendations on Immunization," published in 2011. By releasing these guidelines as an online report, CDC is able to update the document more quickly. CDC recently announced that the following changes were made to the guidelines in July:
Table 3-1. Recommended and minimum ages and intervals between vaccine doses
Footnote f has been clarified:
It now reads, “The minimum recommended interval between DTaP-3 and DTaP-4 is 6 months. However, DTaP-4 need not be repeated if administered at least 4 months after DTaP-3. This is a special grace period of 2 months which can be used if evaluating records retrospectively. An additional 4 days cannot be added to this grace period prospectively, but can be added retrospectively.”
This change is to accommodate a recent subject-matter expert email that allows double dipping of the grace period (adding 4 days to the 2 months) for retrospective validation of series WHOSE 4th DOSE WAS ADMINISTERED AT 12 months of age. This double dipping cannot be applied prospectively, meaning we will only allow a 4-day grace period added to a prospective 6-month interval, and we will only allow a four-month interval prospectively (not four months plus four days) if the fourth dose would be administered after 12 months of age. CDSi [Clinical Decision Support for Immunization] has been updated to accommodate this.
TABLE 4-1. Contraindications and precautions to commonly used vaccines
- Added to LAIV contraindications: “LAIV4 should not be administered to persons who have taken influenza antivirals medications within the previous 48 hours.” This addition is to harmonize this table with the 2017–18 adult schedule.
- Serogroup B meningococcal vaccine has been added to the table.
- Added to MMR and Varicella contraindications: “Family history of altered immunocompetence.” To harmonize with the vaccine-specific statements in accommodating infants and toddlers with occult heritable congenital immunodeficiencies.
- Added to Varicella and Zoster precautions: “Receipt of specific antiviral drugs (acyclovir, famiciclovir, or valacyclovir) 24 hours before vaccination (avoid use of these antiviral drugs for 14 days after vaccination).”
To be informed whenever this guidance is updated, go to https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html and provide your email address in the "Get Email Updates" box in the right column.
Continuing education credit is available for reading ACIP's "General Best Practice Guidelines for Immunization."
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San Diego hepatitis A outbreak spreads to Los Angeles County
The Los Angeles County Department of Public Health issued a news release on September 19 declaring a local outbreak of hepatitis A, with 10 confirmed cases. At least four of those infected in Los Angeles County had been in San Diego, where 444 have been infected and 16 have died of the disease.
One Los Angeles case has been linked to Santa Cruz County, where the county’s Health Services Agency has confirmed 69 cases. The large majority of those infected in these cities are people who are homeless, who use illicit drugs, or who provide services to those who are homeless. The Los Angeles Department of Public Health is providing free vaccinations as well as education for those at risk for hepatitis A. Like San Diego, Los Angeles is also intensifying its sanitation efforts to limit the outbreak, including cleaning the streets with bleach in the areas most at risk.
Access the Los Angeles County news release.
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CDC reports on increase in hepatitis A infections among men who have sex with men in New York City
CDC published Notes from the Field: Increase in Reported Hepatitis A Infections Among Men Who Have Sex with Men—New York City, January–August 2017 in the September 22 issue of MMWR (pages 999–1000). The first and last paragraphs are reprinted below.
Since 2011, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has typically been notified of three or fewer cases of hepatitis A virus (HAV) infection each year among men who have sex with men (MSM) who reported no travel to countries where HAV is endemic. This year, DOHMH noted an increase in HAV infections among MSM with onsets in January–March 2017, and notified other public health jurisdictions via Epi-X, CDC’s communication exchange network. As a result, 51 patients with HAV infection involving MSM were linked to the increase in NYC.
Only three patients with HAV infection reported previous receipt of HAV vaccine; this ongoing investigation highlights the importance of HAV vaccination among MSM, and of determining MSM status during HAV investigations. One patient received 1 dose (as postexposure prophylaxis), but the doses for the other two patients were unknown; both reported previous receipt of HAV vaccine but did not know the number of doses. Since 1996, the Advisory Committee on Immunization Practices has recommended that all MSM receive 2 doses of HAV vaccine administered at least 6 months apart. In NYC, the incidence of HAV infection for 2013–2015 was 6.8 times higher among MSM adults who had not traveled to countries where HAV is endemic than among non-MSM adults. HAV vaccine was added to the routine childhood immunization schedule in 2006, but many susceptible adults might still be unvaccinated. Efforts to promote HAV vaccine in MSM, including targeted messaging campaigns, will help prevent transmission among MSM.
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Annual NFID influenza/pneumococcal news conference will be held on September 28; listen to the event and join the Thunderclap
The annual National Foundation for Infectious Diseases (NFID) Influenza/Pneumococcal Vaccination Kick-Off news conference will be held in Washington, DC, on September 28 at 10:00 a.m. (ET). At the event, U.S. Secretary of Health and Human Services Dr. Tom Price will join a panel of experts in discussions about the previous and upcoming flu seasons. To listen to this 1-hour press conference live, you must pre-register.
In conjunction with this event, two MMWR publications will be released, outlining 2016–2017 season vaccination rates in the general population and among healthcare professionals.
In addition, CDC and NFID are hosting a Thunderclap that will go live on the same day at 10:30 a.m. (ET). At the Thunderclap page, choose one of the red buttons to select which channel (Facebook, Twitter, and/or Tumblr) you want to use to support the campaign and authorize Thunderclap to use your account. Then watch #FightFlu on September 28 as Thunderclap supporters proclaim #FightFlu together! Thunderclap is a social media tool that allows supporters to sign up in advance to share a unified message at a specific time via their individual social media accounts. The collective action creates a wave of support—or “thunderclap”—across social media.
Click on the image below to check out CDC’s digital toolkit for this year's influenza season, which includes social media text, newsletter blurbs, graphics, and posters.
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IAC Spotlight! July 10 webinar of Dr. William L. Atkinson presenting “Adolescent Immunization Update and the 16-Year-Old Platform” can be viewed on IAC website; slide set and presenter's notes also available for your use
On July 10, Dr. William L. Atkinson, MD, MPH, IAC’s associate director for immunization education, presented a webinar titled “Adolescent Immunization Update and the 16-Year-Old Platform.” The webinar provided a review of immunization platforms —healthcare visits where specific vaccines are indicated—specifically the 16-year-old immunization platform added to the Child and Adolescent Immunization Schedule in 2017. It also included a discussion of current immunization rates among adolescents and recommendations for Tdap, HPV, and meningococcal vaccines (both meningococcal conjugate and meningococcal serogroup B), with emphasis on the second dose of meningococcal conjugate vaccine recommended at the 16-year-old visit. Strategies to improve immunization rates among adolescents were also summarized.
This presentation is now available on the home page of IAC’s main website at www.immunize.org. To view it, scroll down to the middle of the page to Dr. Atkinson’s photo and click on the link.
In addition, the slide presentation and presenter's notes are available on IAC’s PowerPoint Slide Set web page. At this link, you can request the full PowerPoint slide set and presenter's notes to create your own adolescent immunization presentation.
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IAC HANDOUTS
IAC posts 7 updated translations of "Screening Checklist for Contraindications to Vaccines for Children and Teens"
IAC recently posted 7 updated translations of its Screening Checklist for Contraindications to Vaccines for Children and Teens. The second page of each also now matches the revised English-language version posted earlier in September. The first page is intended for a parent to complete, while the second page–in English— provides an explanation of why each question is asked as a reference for the patient's healthcare provider.
Access the English-language version.
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IAC posts 7 updated translations of "When Do Children and Teens Need Vaccinations?"
IAC recently posted 7 updated translations of its 1-page chart for healthcare providers to give to parents titled When Do Children and Teens Need Vaccinations? These updated translations are listed below.
Access the English-language version.
Related Links
- IAC's parent and patient schedules web page
- IAC's Handouts for Patients & Staff web section offers healthcare professionals and the public more than 250 FREE English-language handouts (many also available in translation), which we encourage website users to print out, copy, and distribute widely
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IAC posts updated Spanish-language version of "Vaccinations for Preteens and Teens, Age 11–19 Years" as well as 6 new translations
IAC recently posted a revised Spanish-language translation and 6 additional new translations of its handout for healthcare providers to give to parents, Vaccinations for Preteens and Teens, Age 11–19 Years. These new translations are listed below.
Access the English-language version.
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IAC posts updated Spanish-language version of "Vaccinations for Pregnant Women," as well as 6 new translations
IAC recently posted a revised Spanish-language translation and 6 new translations of its handout for healthcare providers to give to pregnant women titled Vaccinations for Pregnant Women. These new translations are listed below.
Access the English-language version.
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IAC posts 7 updated translations of "Vaccinations for Adults—You're Never Too Old to Get Vaccinated!"
IAC recently posted 7 updated translations of its handout for healthcare providers to give to adult patients 19 years and older titled Vaccinations for Adults—You're Never Too Old to Get Vaccinated! These updated translations are listed below.
Access the English-language version.
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IAC posts 5 revised and 2 new Spanish translations of 1-page immunization schedules for adult patients in various risk groups
IAC recently posted 5 revised and 2 new Spanish translations of its 1-page immunization schedules for adult patients in various risk groups. The English-language and Spanish-language handouts are listed below.
Vaccinations for Adults with HIV infection
Vacunas para adultos con infección por VIH
Vaccinations for Adults with Hepatitis C Infection
Vacunas para adultos con infección por hepatitis C
Vaccinations for Adults with Diabetes
Vacunas para adultos con diabetes
Vaccinations for Adults with Heart Disease
Vacunas para adultos con enfermedad cardiaca
Vaccinations for Adults with Lung Disease
Vacunas para adultos con enfermedad pulmonar
Vaccinations for Men Who Have Sex with Men
Vacunas para hombres que tienen relaciones sexuales con hombres (new)
Vaccinations for Adults without a Spleen
Vacunas para adultos sin bazo (new)
Visit IAC's Adult Vaccination web page to access all handouts in this series for adult patients, as well as resources for healthcare professionals providing vaccination services to adults.
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IAC posts updated Spanish-language translation of "Keep your kids safe—get them vaccinated every fall or winter"
IAC recently posted an updated Spanish-language translation of Keep your kids safe—get them vaccinated every fall or winter. This handout for parents stresses the importance of influenza vaccination for children and the people around them, and includes additional hints on staying well.
Access the updated Spanish translation: Mantenga seguros a sus hijos: ¡Vacúnelos cada otoño o invierno!
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WORLD NEWS
WHO asks Yemen to accept offered cholera vaccines as outbreak continues
The World Health Organization (WHO) is asking Yemen to reconsider accepting a million doses of cholera vaccine. The war-torn country asked for doses of the vaccine earlier this year, but when WHO sent a million doses in June, the Yemeni government changed its mind.
France 24 article: WHO urges Yemen to accept vaccines as cholera crisis deepens (9/18/17)
Since the end of April, WHO has reported over 600,000 suspected cases of cholera and over 2,000 associated deaths in Yemen. The number of cholera cases in Yemen has easily surpassed the largest number ever recorded in a single year. After two years of civil war, Yemen’s sewage system has stopped functioning, its clean water system has been crippled, and the country is on the brink of famine. The rise of malnutrition has made the population especially vulnerable to cholera.
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Dr. Litjen (LJ) Tan, IAC's chief strategy officer, writes guest column for NFID about the value of the 16-year-old immunization platform
Litjen (LJ) Tan, MS, PhD, chief strategy officer at the Immunization Action Coalition and co-moderator of the Adolescent Immunization Initiative, has written a guest blog post for
NFID News that focuses on the importance of improving adolescent immunization rates through a 16-year-old immunization platform. The complete blog post is reprinted below.
The Centers for Disease Control and Prevention (CDC) recently released the annual National Immunization Survey (NIS)-Teen data, and while there has been some improvement since the 2015 survey, vaccination rates are still well below public health goals. Of note:
- Only 39.1% of teens received the recommended second dose of quadrivalent meningococcal conjugate vaccine (MenACWY)—this is significantly lower than the 82.2% of teens who received the recommended first dose
- A second MenACWY vaccination at age 16 years is important due to waning protection after the first dose (which should be administered at 11–12 years of age) and because adolescents are at increased risk for meningococcal disease
- Only 49.5% of girls and 37.5% of boys completed the human papillomavirus (HPV) vaccination series
- Less than 50% of adolescents age 13–17 years received the flu vaccine during the 2015–16 flu season
To increase teen vaccination rates, particularly around the critical age of 16 years, the CDC Advisory Committee on Immunization Practices (ACIP) modified the Childhood and Adolescent Immunization Schedule earlier this year. Highlighting the 16-year-old immunization visit will help emphasize the importance of ensuring teens are up-to-date with all recommended immunizations.
While this change is certainly an important step, it will not be effective until immunizations become routine during the 16-year-old visit—just like the 11–12-year-old visit. The established 11–12-year-old immunization platform directly contributed to surpassing Healthy People 2020 goals for tetanus, diphtheria, and acellular pertussis (Tdap) vaccination and the first dose of MenACWY in this age group. In light of this, the Adolescent Immunization Initiative (AII) convened a multidisciplinary group of experts specializing in adolescent health and immunization, with the single mission to work with stakeholders to firmly establish an immunization platform at 16 years of age. The AII whitepaper, Rationale for an Immunization Platform at 16 Years of Age, presents the rationale for establishing an immunization platform for 16-year-olds that combines vaccination with preventive services focused on the overall well-being of older adolescents.
AII is not alone. There are several additional efforts that are dedicated to implementing a 16-year-old immunization platform, including:
Through our collective efforts we can help routinize using the 16-year-old visit to include recommended and catch-up vaccines. Together, we can help healthcare professionals and the public become more aware of, and motivated to comply with, U.S. vaccine recommendations and, ultimately, help protect older teens against vaccine-preventable diseases.
Access the post on the NFID News web page: Increasing Adolescent Vaccination Rates: Establishing a 16-Year-Old Immunization Platform.
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CDC has produced a series of short vaccination-related videos with Alix Casler, MD, FAAP, a pediatrician and mother from Orlando, FL. In one of these segments, Dr. Casler explains how she makes a short, matter-of-fact recommendation for HPV vaccination as part of a package of preteen vaccines (meningococcal, HPV, and Tdap). Healthcare professionals who provide vaccination services may find this video and her other videos helpful in increasing HPV vaccination rates among their patients.
Access Dr. Alix Casler Describes How She Recommends HPV Vaccine.
More videos:
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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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Still 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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EDUCATION AND TRAINING
National Viral Hepatitis Action Plan Priority Populations webinar to take place on September 28
In March, the U.S. Department of Health and Human Services (HHS) posted the 2017–2020 National Viral Hepatitis Action Plan (Action Plan) on its website. The Action Plan identified 11 priority populations that require special consideration because they have higher rates of viral hepatitis and/or are at higher risk for transmitting viral hepatitis.
On September 28 at 3:30 p.m. (ET), the HHS Office of HIV/AIDS and Infectious Disease Policy will host a related webinar titled "National Viral Hepatitis Action Plan Priority Populations–Part 2" that will include perspectives from members of the priority populations and healthcare professionals who work with them, including baby boomers, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, African Americans, and pregnant women.
Registration information
Access the full
National Viral Hepatitis Action Plan 2017–2020 (84 pages; PDF format).
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NAIIS webinar on improving adult immunization within healthcare systems archived and available for viewing at your convenience
On August 31, IAC and the National Adult and Influenza Immunization Summit (NAIIS) sponsored a webinar titled "Overcoming Challenges to Providing Adult Immunizations in Healthcare Systems." A panel of healthcare experts discussed evidence-based approaches for adult immunization initiatives to become a cost-effective preventive care strategy for hospitals and to improve outcomes for vulnerable populations. The archived webinar and the related slide set are now available online.
Webinar recording on YouTube:
Overcoming Challenges to Providing Adult Immunizations in Healthcare Systems
Slide set:
Adult Immunization in the United States
Related
Becker's Hospital Review article:
The importance of preventive care strategies in a changing healthcare environment (9/19/17)
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Reminder: Weekly CDC webinar series on "The Pink Book" chapter topics runs through October 11; register now
CDC is presenting a 15-part webinar series to provide a chapter-by-chapter overview of the 13th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (also known as "The Pink Book"). This is a live series of weekly 1-hour webinars that started June 14 and will run through October 11. Recordings of sessions will be available online within 2 weeks after each webinar. All sessions begin at 12:00 p.m. (ET). Continuing education will be available for each event.
The webinar series will provide an overview of vaccines and the diseases they prevent, general recommendations for vaccines, vaccination principles, and immunization strategies for providers.
Registration and more information is available on CDC's Pink Book Webinar Series web page.
All the sections of "The Pink Book" (i.e., chapters, appendices, 2017 supplement) are available to download at no charge at www.cdc.gov/vaccines/pubs/pinkbook/index.html.
You can also order this resource from the Public Health Foundation for $40 plus shipping and handling. This print version does not include the 2017 supplement.
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ASK THE EXPERTS
Question of the Week
Is it okay to administer rotavirus vaccine and immune globulin at the same time?
Yes. The effectiveness concerns with antibody-containing blood products (ACBP) do not apply to rotavirus vaccine, since it is administered orally and replication of the vaccine virus occurs in the GI tract, “separate” from the site of the ACBP. Note that the child should be carefully screened for other potential contraindications or precautions to vaccination since administration of immune globulin could indicate immunosuppression.
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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