Issue 1424: May 8, 2019
TOP STORIES
IAC HANDOUTS
VACCINE INFORMATION STATEMENTS
WORLD NEWS
FEATURED RESOURCES
JOURNAL ARTICLES AND NEWSLETTERS
EDUCATION AND TRAINING
TOP STORIES
Following the MMWR Early Release last week of an article on the increase in U.S. measles cases, CDC published the same article in the current issue of MMWR
On May 3, CDC published Increase in Measles Cases—United States, January 1–April 26 (pages 402–404). The same article was published as an MMWR Early Release on April 29; this was covered in IAC Express on May 1.
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Total measles cases in the U.S. for 2019 climb to 764 with 60 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 764 cases across 23 states as of May 3. This is the highest number of cases since measles was eliminated in 2000.
The states that have reported cases to CDC are Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, Pennsylvania, Texas, Tennessee, and Washington.
Access additional information about U.S. measles cases in 2019 on CDC's Measles Cases and Outbreaks web page.
Click on the following links for information about specific outbreaks:
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CDC's measles outbreak digital toolkits with resources for healthcare
providers and local/state health departments now available
To help support healthcare professionals in responding to patients' questions and concerns about vaccines and the diseases they prevent, CDC has developed a comprehensive Measles Outbreak Digital Toolkit for Healthcare Providers with accurate, science-based evidence to counter misinformation about measles and MMR vaccine, as well as a Measles Outbreak Digital Toolkit for Local/State Health Departments.
This Measles Outbreak Digital Toolkit for Healthcare Providers includes the following resources:
Resources for effective vaccine conversations with parents:
Resources to share with parents:
Posters to display in your office:
Visit CDC's Measles Outbreak Digital Toolkit for Local/State Health Departments web page for links to information about measles to share with the community, as well as graphics and templates for health department websites.
For up-to-date answers to your patients’ frequently asked questions about measles, visit CDC’s Measles FAQ web page: Frequently Asked Questions about Measles in the U.S. (also available in Spanish version).
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May is Hepatitis Awareness Month; promote hepatitis awareness and prepare for May 19, national Hepatitis Testing Day
It's time to celebrate Hepatitis Awareness Month and the seventh annual national Hepatitis Testing Day on May 19! CDC has shared many tools and resources to help your efforts during May and beyond.
The Hepatitis Awareness Month and Testing Day Resource Center has free tools to help support your awareness activities and testing events. Resources include buttons or badges for your website or email signatures, live-read radio scripts templates to pitch your events to local radio stations, and sample proclamations for Hepatitis Awareness Month and/or national Hepatitis Testing Day. Sample social media posts are also available for both Twitter and Facebook to help spread the word about Hepatitis Awareness Month resources.
The new Division of Viral Hepatitis’s website has information and resources on all types of hepatitis, including fact sheets, posters, provider resources, and much more.
CDC also has resources to address the widespread outbreaks of hepatitis A that are occurring across the United States. Find information about the outbreaks and resources to support the outbreak response.
Free resources are also available for the multilingual Know Hepatitis B campaign, which promotes hepatitis B testing among Asian Americans, and the Know More Hepatitis campaign, which encourages people born from 1945–1965 to get tested for hepatitis C. Campaign resources include video and radio PSAs, posters, infographics, fact sheets, customizable event flyers, and other materials.
Sign up for monthly emails from the Division of Viral Hepatitis about new publications, recommendations, new materials, or significant events.
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FDA announces approval of Dengvaxia (Sanofi Pasteur) for prevention of dengue disease in endemic regions
On May 1, the U.S. Food and Drug Administration (FDA) issued a news release announcing its approval of the dengue vaccine Dengvaxia (Sanofi Pasteur). The vaccine is intended for people ages 9 through 16 with laboratory-confirmed previous dengue infection who live in areas where the disease is endemic. Dengue disease is endemic in the U.S. territories of American Samoa, Guam, Puerto Rico, and the U.S. Virgin Islands.
Read the entire FDA news release: First FDA-Approved Vaccine for the Prevention of Dengue Disease in Endemic Regions.
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IAC Spotlight! Just in case you missed them—these IAC materials and web pages were updated during March and April
In almost every issue of IAC Express, our editorial staff provide readers with information about new and updated educational materials for healthcare professionals and handouts for patients that have been posted during the past week on IAC’s website for healthcare professionals, immunize.org. All these materials are CDC-reviewed and available free for you to download, print, copy, and distribute in your healthcare settings. We also announce major updates to the content on various web sections and pages on immunize.org.
Below you’ll find a listing of the new and updated items and web pages we’ve announced in IAC Express during the months of March and April, in case you’ve missed any of them.
Educational Materials for Healthcare Professionals
Handouts for Your Patients
Updated Web Sections and Pages
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“Ask the Experts: Meningococcal ACWY” web page recently updated
CDC recently updated its Ask the Experts: Meningococcal ACWY Q&As on immunize.org. Revisions to the MenACWY Ask the Experts set were made to reflect updated CDC guidance that there is no maximum age for a dose of MenACWY vaccine for previously unvaccinated first-year college students living in residential housing (previous guidance was a maximum of age 21 years for this risk group) and a recommendation for a 6-month interval between DTaP and Menactra (MenACWY, Sanofi Pasteur) vaccine if Menactra was not given before or at the same visit as DTaP.
IAC’s Ask the Experts web section is a compilation of common as well as challenging Q&As about vaccines and their administration. William Atkinson, MD, MPH, IAC's associate director for immunization education, manages this web section, with answers provided by Andrew T. Kroger, MD, MPH; Mark S. Freedman, DVM, MPH, DACVPM; Tina S. Objio, MSN, MHA, RN; Candice L. Robinson, MD, MPH; Raymond A. Strikas, MD, MPH, FACP, FIDSA; and JoEllen Wolicki, BSN, RN, all from the National Center for Immunization and Respiratory Diseases, CDC.
Some of the most frequently visited sections of Ask the Experts Q&As include the following:
IAC Express publishes five special editions each year of Ask the Experts Q&As answered by CDC experts. You can access the four most recent IAC Express Ask the Experts sets of Q&As from the main web page of Ask the Experts, in the right-hand column.
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Influenza activity has continued to decrease but remains elevated; 5 additional pediatric deaths reported
According to CDC, influenza activity decreased again in the U.S. in the period ending April 27. The proportion of outpatient visits for influenza-like illness (ILI) decreased to 1.8%, which is below the national baseline of 2.2%. All regions reported ILI below their region-specific baseline level. CDC estimates that flu has caused as many as 42.7 million flu illnesses, 637,000 hospitalizations, and 59,600 deaths so far this season.
CDC has reported 5 additional influenza-associated pediatric deaths this season, for a total of 101. Last season, there was a record-setting 185 pediatric deaths in the U.S.
CDC stated in its Weekly U.S. Influenza Surveillance Report, FluView, that during the week ending April 27, the geographic spread of influenza in five states was reported as widespread; Puerto Rico and seven states reported regional activity; 18 states reported local activity; the District of Columbia; the U.S. Virgin Islands, and 22 states reported sporadic activity; and Guam did not report.
Following is a list of resources related to influenza disease and vaccination for healthcare professionals and the public:
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IAC HANDOUTS
IAC updates its resource for healthcare professionals titled “Don't Be Guilty of These Preventable Errors in Vaccine Administration!”
IAC recently posted its updated resource for healthcare professionals titled Don't Be Guilty of These Preventable Errors in Vaccine Administration! by incorporating new direction on how to respond if less than a full dose of Shingrix (RZV, GSK) was administered or if only the Shingrix diluent was injected.
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IAC updates its handout for patients titled “Vaccination for Adults without a Spleen”
IAC recently updated its handout for patients titled Vaccination for Adults without a Spleen. Changes were made to incorporate the newest recommendation to not use live attenuated influenza vaccine (FluMist, AstraZeneca) in persons not having a spleen.
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IAC revises its handout for adult patients titled “Vaccinations for Adults with Chronic Liver Disease or Infection”
IAC recently revised its patient handout titled Vaccinations for Adults with Chronic Liver Disease or Infection. Changes were made to more directly address recommendations for persons with chronic hepatitis B or hepatitis C infection or with chronic liver disease, as seen primarily in the hepatitis B and pneumococcal sections. Also, an upper age limit has been eliminated for MenACWY vaccination of first-year college students living in a residence hall.
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IAC revises its resource for healthcare professionals titled “Quick Chart of Vaccine-Preventable Disease Terms in Multiple Languages”
IAC recently revised its staff education resource titled Quick Chart of Vaccine-Preventable Disease Terms in Multiple Languages by adding new terms for vaccines in non-English languages that were not previously included.
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IAC's Handouts for Patients & Staff web section offers healthcare professionals and the public more than 250 FREE English-language handouts (many also available in translation), which we encourage website users to print out, copy, and distribute widely.
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VACCINE INFORMATION STATEMENTS
IAC posts new Hindi translations of the DTaP, pneumococcal conjugate (PCV13), and typhoid VISs
IAC has posted new Hindi translations of the DTaP, pneumococcal conjugate (PCV13), and typhoid VISs. IAC thanks Avinash Bansal, MD, Keshav Swarnkar, and Geeta Bansal, MD, of Kota, India for their donation of these translations.
Access these new Hindi-language versions of the VISs below.
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IAC posts updated Nepali and Oromo translations of the hepatitis B VIS
IAC recently posted updated Nepali and Oromo translations of the hepatitis B VIS. IAC thanks the Minnesota Department of Health for their donation of these translations.
Access these updated translations of the hepatitis B VIS below.
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Updated Amharic, Karen, Kinyarwanda, Kiswahili, and Oromo translations of the MenACWY VIS now available
IAC recently posted updated Amharic, Karen, Kinyarwanda, Kiswahili, and Oromo translations of the MenACWY VIS. IAC thanks the Minnesota Department of Health for their donation of these translations.
Access these updated translations of the MenACWY VIS below.
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IAC posts new or updated Karen, Oromo, and Tigrinya VIS translations of the DTaP VIS
IAC recently posted Karen, Oromo, and Tigrinya translations of the DTaP VIS. IAC thanks the Minnesota Department of Health for their donation of these VIS translations.
Access these translations below.
Access all DTaP VIS translations, as well as the English-language version.
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WORLD NEWS
UNICEF press release states 20 million children annually missed first dose of measles vaccine in past 8 years, contributing to global outbreaks
UNICEF issued a press release on April 25 titled Over 20 million children worldwide missed out on measles vaccine annually in past 8 years, creating a pathway to current global outbreaks. This total amounts to 169 million children missing their first dose of measles vaccine between 2010 and 2017. The press release included the following statements from UNICEF's executive director, Henrietta Fore:
"The ground for the global measles outbreaks we are witnessing today was laid years ago. The measles virus will always find unvaccinated children. If we are serious about averting the spread of this dangerous but preventable disease, we need to vaccinate every child, in rich and poor countries alike...Measles is far too contagious. It is critical not only to increase coverage but also to sustain vaccination rates at the right doses to create an umbrella of immunity for everyone.”
Read the entire press release.
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CDC and WHO report on progress toward measles elimination in the European region, 2009–2018, in this week’s MMWR and Weekly Epidemiological Record, respectively
CDC published Progress Toward Measles Elimination—European Region, 2009–2018 in the May 3 issue of MMWR (pages 396–401). On the same day, WHO's Weekly Epidemiological Record published a similar articled titled Progress Towards Measles Elimination in the WHO European Region, 2009–2018. A summary made available to the press is reprinted below.
In the World Health Organization European Region, measles cases tripled from 2017 to 2018. Immunization programs need to vaccinate 95% of their populations to protect individuals and communities, stop measles outbreaks from occurring, and achieve elimination. A new report describes progress toward measles elimination in the European Region during 2009–2018. After a low of 4,240 measles cases in 2016, measles cases tripled from 2017 to 2018 with 82,596 cases reported (37% among adults), including 179 deaths. Ukraine reported the highest number of measles cases in 2018 at 53,218. Other countries reporting large outbreaks in 2018 were France, Georgia, Greece, Israel, Italy, the Russian Federation, and Serbia. Several factors have caused this resurgence, including measles virus transmission in countries with weak immunization programs, an accumulation of susceptible young children in marginalized communities, prevalent anti-vaccine sentiment, and a growing population of young adults who had not received measles vaccine.
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FEATURED RESOURCES
National Public Health Information Coalition releases new Measles Communication Resources website The National Public Health Information Coalition (NPHIC) has unveiled its new Measles Communication Resources website. In addition to links to state measles resources and current outbreak jurisdictions, the site includes the following:
NPHIC requests your help to further populate the site with additional resources from state and local governments, as well as from non-profits and other public health organizations. Please send a link and a brief explanatory note to Joe Rebele at jrebele@nphic.org for any resource you wish to share.
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Still available! IAC’s sturdy laminated versions of the 2019 U.S. child/adolescent immunization schedule and the 2019 U.S. adult immunization schedule—order them for your exam rooms today! Bulk purchase prices available.
IAC's laminated versions of the 2019 U.S. child/adolescent immunization schedule and the 2019 U.S. adult immunization schedule are available now. 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 the adult schedule is six pages (i.e., three double-sided pages). Both schedules are 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 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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Check out CDC's “#HowIRecommend HPV Vaccination Video Series” web page with peer-to-peer advice from nurse practitioners and other practicing clinicians on effectively recommending HPV vaccines
On CDC's #HowIRecommend HPV Vaccination Video Series web page you will find short videos for and by healthcare professionals on how to effectively recommend HPV vaccine. The latest videos address topics such as how to make an effective HPV vaccine recommendation, how to address questions about vaccine safety and side effects, and how to get your entire practice on board to make effective recommendations.
Below are two new videos that respond to the question: "How do you recommend the HPV vaccine?"
Visit CDC's #HowIRecommend web page for additional videos responding to this question. The videos are organized by the particular question that was asked. Clicking on the question itself brings up several videos responding to that question. Here are just two examples:
These videos also are featured on Twitter at #HowIRecommend. You don't have to be a Twitter user to access the page.
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IAC's 142-page book, Vaccinating Adults: A Step-by-Step Guide, describes how to implement adult vaccination services in your healthcare setting and provides a review for staff who already vaccinate adults; IAC Guide available for free download
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 guide on adult immunization (originally published in 2004) provides easy-to-use, practical information covering important “how-to” activities to help providers enhance their existing adult immunization services or introduce them into any clinical setting, including:
- setting up for vaccination services,
- storing and handling vaccines,
- deciding which people should receive which vaccines,
- administering vaccines,
- documenting vaccinations (including legal issues), and
- understanding financial considerations and billing information.
In addition, the Guide is filled with hundreds of web addresses and references to help providers stay up to date on the latest immunization information, both now and in the future.
The entire Guide is available to download/print free of charge at www.immunize.org/guide. The downloaded version is suitable for double-sided printing. Options are available online to download the entire book or selected chapters. The development of the Guide was supported by the National Vaccine Program Office (NVPO) and the Centers for Disease Control and Prevention (CDC). Expert staff from both agencies also provided early technical review of the content.
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
April issue of CDC's Immunization Works newsletter now available
CDC recently released the April issue of its monthly newsletter Immunization Works. 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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CDC publishes “University-Based Outbreaks of Meningococcal Disease Caused by Serogroup B, United States, 2013–2018” in the March issue of Emerging Infectious Diseases
CDC published University-Based Outbreaks of Meningococcal Disease Caused by Serogroup B, United States, 2013–2018, by H.M. Soeters, et al., in the March issue of Emerging Infectious Diseases. The abstract is reprinted below.
We reviewed university-based outbreaks of meningococcal disease caused by serogroup B and vaccination responses in the United States in the years following serogroup B meningococcal (MenB) vaccine availability. Ten university-based outbreaks occurred in 7 states during 2013–2018, causing a total of 39 cases and 2 deaths. Outbreaks occurred at universities with 3,600–35,000 undergraduates. Outbreak case counts ranged from 2 to 9 cases; outbreak duration ranged from 0 to 376 days. All 10 universities implemented MenB vaccination: 3 primarily used MenB-FHbp and 7 used MenB-4C. Estimated first-dose vaccination coverage ranged from 14% to 98%. In 5 outbreaks, additional cases occurred 6–259 days following MenB vaccination initiation. Although it is difficult to predict outbreak trajectories and evaluate the effects of public health response measures, achieving high MenB vaccination coverage is crucial to help protect at-risk persons during outbreaks of meningococcal disease caused by this serogroup.
Read the full article in CDC's Emerging Infectious Diseases web section.
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Viewpoint article titled “The Physician-Scientist: Defending Vaccines and Combating Antiscience” by Dr. Peter Hotez published by The Journal of Clinical Investigation
On April 29, The Journal of Clinical Investigation published a Viewpoint article titled The Physician-Scientist: Defending Vaccines and Combating Antiscience, by Dr. Peter Hotez. The following excerpt from the article is from the beginning of a section titled "Physician-Scientists as 21st-Century Science Defenders and Health Advocates":
Synthesizing the information that de-links vaccines from autism requires a strong scientific background, while conveying this message requires the interest and willingness to take the time to engage in public discussions. Unfortunately, health communication and messaging are still often neglected in most physician-scientist training programs. Indeed in my MD/PhD training during the 1980s, we received a strong message that speaking with journalists or engaging in public discourse was not looked upon favorably and was even criticized or condemned. However, times have changed, and now the antivax and other antiscience movements have conquered the Internet and disseminate misinformation on a scale that far exceeds the accurate messaging from scientists. We therefore must look to new roles for at least some physician-scientists in taking on high-profile public engagement activities....
Dr. Hotez is also the author of Vaccines Did Not Cause Rachel’s Autism: My Journey as a Vaccine Scientist, Pediatrician, and Autism Dad.
Read the entire article: The Physician-Scientist: Defending Vaccines and Combating Antiscience.
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EDUCATION AND TRAINING
NACCHO webinar on strategic responses to hepatitis A outbreaks scheduled for May 22
The National Association of County and City Health Officials (NACCHO) is hosting a one-hour webinar on May 22 at 2:00 p.m. (ET) titled A Strategic Response to Hepatitis A Outbreak. The webinar presenters will be Monique A. Foster, MD, MPH, medical epidemiologist, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Marla M. Sievers, MPH, infectious disease epidemiologist, New Mexico Department of Health, and Dominic Rodriguez, MSN, RN, director of nursing services for the NW Region.
Learn more about the webinar.
Register for the webinar.
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