Issue 1737: January 31, 2024

Immunize.org recently launched a new section of its popular Ask the Experts resource, Ask the Experts: RSV, that covers RSV disease and use of RSV vaccines and preventive antibody product (nirsevimab).

The clinical questions and answers covered in this new section address issues such as the safety and effectiveness of vaccination and nirsevimab, explaining that older adults may benefit most from protection against RSV, and defining the time of year to administer RSV vaccine during pregnancy (hint: today is the last day for most of the United States!).

Immunize.org’s Ask the Experts main page leads you to 22 web pages on vaccines and 10 on broader immunization topics. Ask the Experts offers answers to more than 1,300 common or challenging questions. Immunize.org’s team of experts includes Kelly L. Moore, MD, MPH (team lead), Carolyn B. Bridges, MD, FACP, and Iyabode Beysolow, MD, MPH.

Related Links

• Immunize.org: Ask the Experts main page with more than 1,300 questions and answers
• Immunize.org: Ask the Experts: RSV web page
• CDC, Morbidity and Mortality Weekly Report: Use of the Pfizer Respiratory Syncytial Virus Vaccine during Pregnancy for the Prevention of Respiratory Syncytial Virus–Associated Lower Respiratory Tract Disease in Infants: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023 (10/13/23)
• CDC, Morbidity and Mortality Weekly Report: Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023
  (8/25/23)
• CDC, Morbidity and Mortality Weekly Report: Use of Respiratory Syncytial Virus Vaccines in Older Adults: Recommendations of the Advisory Committee on Immunization Practices (7/21/23)

Following the redesign of our flagship Immunize.org website last fall, we welcome you to visit our updated educational website for the general public, www.vaccineinformation.org.

This website is suitable for anyone with questions about vaccines and vaccination. The updated site offers straightforward and accurate information including:

• Basic facts about recommended vaccines and the diseases they prevent
• Patient-oriented vaccine resources from Immunize.org
• Links to resources from trusted partner organizations
• Information available by age groups: infants and children, preteens, teens, and adults
• Personal testimonies from people affected by vaccine-preventable diseases
• Videos and historic public service announcements in our video library
• Links to information to help people find where to get vaccinated

VaccineInformation.org now provides pages with basic information and key links on COVID-19, mpox, RSV, and dengue vaccines.

We encourage you to share www.vaccineinformation.org with your patients or with anyone interested in learning more about vaccines or vaccine-preventable diseases.

On January 26, CDC issued a Clinician Outreach and Communication Activity (COCA) Now message titled, Reminder of Recommendations for Seasonal Administration of Maternal RSV Vaccine. It reminds vaccine providers that CDC recommends RSV vaccination (Abrysvo, Pfizer) for pregnant people 32 through 36 weeks and 6 days gestation to protect infants against RSV-associated lower respiratory tract disease after birth. The recommended season for vaccination during pregnancy ends on January 31 in most of the continental United States. A portion of the message is shown below.

• In most of the continental United States, administer the maternal RSV vaccine (Pfizer Abrysvo) from September 1 through January 31.
  • Healthcare providers who administer the RSV vaccine to pregnant people after January 31 should encourage patients to check with their insurance plans on coverage details, as coverage and cost-sharing by private insurance plans may vary after January 31. Providers should consider submitting an insurance test claim to estimate out-of-pocket costs.
• In jurisdictions where seasonality differs from most of the continental United States, such as Alaska, southern Florida, Guam, Hawaii, Puerto Rico, the U.S.-affiliated Pacific Islands, and the U.S. Virgin Islands, healthcare providers should follow state, local, or territorial guidance on timing of administering the RSV vaccine (Pfizer Abrysvo) for pregnant people.
• CDC recommends protecting all infants against RSV-associated LRTD through either the RSV vaccine for pregnant people (Pfizer Abrysvo) or infant receipt of nirsevimab. Administration of both products is not needed for most infants.
  • For infants age less than 8 months born to unvaccinated mothers, healthcare providers should administer nirsevimab from October 1 through March 31; however, healthcare providers can administer nirsevimab outside of this timeframe based on local epidemiology

Related Links

• Clinician Outreach and Communication Activity (COCA) web page
• CDC: Healthcare Providers: RSV Vaccination for Pregnant People web page
• CDC: Frequently Asked Questions about RSVpreF (Abrysvo) Vaccine for Pregnant People web page
• CDC: Frequently Asked Questions about RSV Immunization with Monoclonal Antibody for Children 19 Months and Younger web page

CDC’s Weekly U.S. Influenza Surveillance Report, FluView, provides a valuable picture of laboratory-confirmed influenza and influenza-like-illness (ILI) activity state by state. ILI activity is caused by a variety of respiratory illnesses, including three vaccine-preventable infections: influenza, COVID-19, and RSV.

Influenza Surveillance
For week 3, ending January 20, CDC’s Weekly U.S. Influenza Surveillance Report, FluView shows that 22 jurisdictions experienced high or very high activity. Nationwide, 4.3% of patient visits reported through the Outpatient Influenza-Like Illness Surveillance Network (ILINet) were due to respiratory illness that included fever plus a cough or sore throat (i.e., ILI). The national baseline is 2.5%. Ten pediatric influenza-associated deaths were reported this week, bringing the total to 57 pediatric deaths thus far during the 2023–24 season.



RESP-NET
Visit the CDC Respiratory Virus Hospitalization Surveillance Network (RESP-NET) for weekly reports of hospitalizations across the United States due to three vaccine-preventable seasonal respiratory viruses: COVID-19, influenza, and RSV.

Influenza Vaccination Dashboard
CDC's Weekly Flu Vaccination Dashboard shows that as of January 13, 156 million doses of flu vaccine have been distributed in the United States. As of January 13, national vaccination coverage estimates for all adults for the 2023–24 season is 46.7%, and coverage among states and DC ranges from 36.8% to 61.8%. It is important to continue to vaccinate people as long as influenza remains active.

CDC recommends everyone age 6 months and older get annual influenza vaccination. Influenza and other vaccines (including COVID-19 and RSV vaccines) may be given at the same visit, if indicated. Infants 6 months of age and older may receive influenza and COVID-19 vaccines at the same visit when they receive the RSV preventive antibody, nirsevimab.

Locate influenza and COVID-19 vaccines in your area by entering your zip code in the VaccineFinder on Vaccines.gov or Vacunas.gov. To be listed as a provider by VaccineFinder, see the information on this website.

Related Links

• CDC: Weekly National Flu Vaccination Dashboard main page
• CDC: FluView main page
• CDC: RESP-NET main page
• Immunize.org: free clinical resources and patient handouts related to influenza
• Immunize.org: Vaccines: Influenza main page
• Immunize.org: Ask the Experts: Influenza main page

This week, our featured question from the Ask the Experts Video Series is Which People Who Work in Healthcare Settings Need Hepatitis B Vaccine? The video briefly describes the Occupational Safety and Health Administration's requirement to offer HepB vaccine to healthcare personnel who have a reasonable expectation of being exposed to blood and body fluids on the job.

The 1-minute video is available on our YouTube channel, along with our full collection of quick video answers to popular Ask the Experts questions.

Like, follow, and share Immunize.org’s social media accounts and encourage colleagues and others interested in vaccination to do likewise:

• Facebook at ImmunizeOrg
• Instagram at ImmunizeOrg
• LinkedIn at ImmunizeOrg
• YouTube at ImmunizeOrg

Immunize.org's Influenza Vaccination Honor Roll recognizes facilities that take a stand for patient safety by implementing policies requiring healthcare personnel influenza vaccination. Immunize.org recently welcomed two additional healthcare organizations.

• Newman Regional Health, Emporia, KS
• Boulder Post Acute, Boulder, CO

Eligibility:

• Eligible organizations: hospitals, long-term care facilities, medical practices, pharmacies, professional organizations, health departments, and other government entities
• Requirements:
  • Your policy must require influenza vaccination for all staff
  • The application must describe measures to prevent transmission of influenza from unvaccinated personnel to patients (e.g., masking for the entire work shift)

• Immunize.org: Honor Roll Honorees: Influenza
• About the Influenza Vaccination Honor Roll

These recent articles convey the potential risks of vaccine-preventable diseases and the importance of vaccination.

• NBC: As Measles Spreads in England, Health Authorities Warn the Outbreak Could Snowball (1/25/24)
• Time: Measles and Misinformation Are Two Huge Public Health Threats (1/23/24)

Immunize.org made important updates to two clinical resources important to anyone who administers pneumococcal vaccines to children. These updates incorporate the latest CDC recommendations for use of pneumococcal conjugate vaccines (PCV15 or PCV20), as well as indications for pneumococcal polysaccharide vaccine (PPSV23) in certain high-risk children when PCV20 is unavailable.

The two resources, Recommendations for Pneumococcal Vaccines Use in Children and Teens and Standing Orders for Pneumococcal Vaccine to Children and Teens, address what pneumococcal vaccination is needed in every scenario, in children from age 6 weeks through 18 years. They include risk-based recommendations, divided into immunocompromising and non-immunocompromising conditions, and further divided by the pneumococcal vaccination history of the child. A QR code links to the online version of each document.

     

Related Links

• Immunize.org: Clinical Resources: Standing Orders Templates main page
• Immunize.org: Clinical Resources: Vaccine Recommendations main page
• Immunize.org: Vaccines A–Z: Pneumococcal main page
• CDC: PneumoRecs VaxAdvisor mobile app website

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Spotlight on the website

This week we spotlight two pages with important information for clinicians, public health authorities, vaccination advocates, and families: State Vaccine-Specific Requirements and State Exemptions. These can be found by choosing the Official Guidance tab at the top of every page, then selecting States from the lefthand list.

Vaccine-Specific Requirements contains links to vaccine-specific requirements state by state for daycare, school, and post-secondary education settings. Each vaccine listed on the page can be expanded to view links to each state’s requirements in a data table and as a downloadable map. Requirement information was collected from state immunization program managers in March 2023.



The State Exemptions page links to a data table showing which states accept medical, religious, and personal vaccination exemptions and a map of exemptions permitted for school and childcare. In addition, it includes Clinical Resources and links to policy statements from medical organizations endorsing strong school and childcare vaccination requirements.

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In response to recent reports of infants being mistakenly administered RSV vaccines intended for adults and pregnant people being erroneously given Arexvy (GSK) vaccine not licensed for use during pregnancy, CDC released simple job aids to reduce the risk of administration errors.



It’s important to note:

• Pregnant people should only receive the RSV vaccine Abrysvo (Pfizer), never Arexvy (GSK) or the RSV preventive antibody, nirsevimab (Beyfortus, Sanofi)
• Infants should only receive Beyfortus (“B” is for “baby”!)
• Arexvy and Abrysvo RSV vaccines are only for adults (“A” is for “adult”!)

Practices that carry both RSV vaccine and Beyfortus should review their immunization administration safety procedures to ensure only the correct product is administered to recipients.

CDC encourages vaccinators to promptly report all vaccine administration errors to VAERS. In the event that a vaccine administration error involving RSV vaccine occurs and further clinical guidance is needed, contact your state or local immunization program, or contact CDC experts email at NIPINFO@cdc.gov.

Related Links

• CDC: Only Administer Abrysvo (Pfizer) Vaccine to Pregnant People
• CDC: Infant RSV Prevention At-a-Glance
• CDC: Only Administer Nirsevimab (Beyfortus, Sanofi) to Young Children
• CDC: Vaccine Administration Protocols
• CDC: Vaccine Administration: Preventing Vaccine Administration Errors
• CDC: RSV (Respiratory Syncytial Virus) Immunizations
• CDC: Healthcare Providers: RSV Immunization for Children 19 Months and Younger
• CDC: Frequently Asked Questions about RSV Immunization with Monoclonal Antibody for Children 19 Months and Younger
• Immunize.org: Ask the Experts: RSV web page
• Immunize.org: Vaccines: RSV (Respiratory Syncytial Virus): Clinical Resources
• AAP Red Book Online: ACIP and AAP Recommendations for Nirsevimab
• AAP News: CDC Cautions against RSV Immunization Errors, Offers Guidance (1/23/24)

Laminated versions of the 2024 U.S. child and adolescent immunization schedule and the 2024 U.S. adult immunization schedule are now available for order in the Immunize.org shop. The schedules are being printed now and will begin shipping in the next few days.

While the schedules are available online from CDC at no cost, Immunize.org’s printed, laminated booklets are ideal for use in any busy healthcare setting where vaccinations are given.

• Durable: their tough coating can be wiped down, and they’re durable enough to stand up to a year's worth of use
• Format: each schedule is produced in a 16-page, 8.5” X 11” booklet format; with color coding for easy reading, our laminated schedules replicate the original CDC formatting, including all tables and notes
• Easy access to CDC updates: CDC added an online addendum page to the schedule, where new recommendations from ACIP made during 2024 can be posted. The laminated schedule addendum pages include custom QR codes you can scan to view or print the current CDC addendum from CDC's website, as needed.
• Adult schedule bonus: the adult schedule includes a bonus page with Immunize.org’s popular 1-page handout summarizing the dose, route, and needle size recommendations for all adult vaccines and recipients

    

Pricing

• 1 copy: $10.00
• 2–4 copies: $9.50 each
• 5–19 copies: $8.50 each
• 20–99 copies: $7.50 each
• 100–499 copies: $6.00 each
• 500–999 copies: $5.00 each
• 1,000–1,999 copies: $4.00 each
• 2,000+ copies: $3.25 each

Visit the Shop Immunize.org: Laminated Schedules web page to view images of all the pages, to download the order form, and to order today!

For additional information, call 651-647-9009 or email admininfo@immunize.org.

Related Links

• Immunize.org: Laminated Child and Adolescent Immunization Schedules (0–18 years) web page
• Immunize.org: Laminated Adult Immunization Schedules (19 and older) web page
• Immunize.org: Shop Immunize.org main page

In the January 22 issue, Journal of the National Cancer Institute published Invasive Cervical Cancer Incidence following Bivalent Human Papillomavirus Vaccination: A Population-Based Observational Study of Age at Immunization, Dose, and Deprivation. Most notably, no cases of invasive cancer were recorded in women immunized at age 12 or 13, whether they received 1, 2, or 3 doses of vaccine. The conclusion appears below.

Our findings confirm that the bivalent vaccine prevents the development of invasive cervical cancer and that even 1 or 2 doses 1 month apart confer benefit if given at 12–13 years of age. At older ages, 3 doses are required for statistically significant vaccine effectiveness. Women from more deprived areas benefit more from vaccination than those from less deprived areas.

Related Links

• Medical Xpress: No Cervical Cancer Cases Detected in Vaccinated Women in Scotland Following HPV Immunization (1/23/24)
• STAT: HPV Vaccine Study Finds Zero Cases of Cervical Cancer among Women Vaccinated before Age 14 (1/25/24)