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IAC Express 2009 |
| Issue number 815: August 10, 2009 |
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as well as other FREE IAC periodicals. |
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Contents
of this Issue
Select a title to jump to the article. |
-
CDC issues updated recommendations for routine polio
vaccination
-
CDC issues updated school guidance for H1N1 influenza
- CDC issues a health advisory about updated
recommendations for the amount of time people with
influenza-like illness should stay away from others
- CDC's H1N1 influenza web section updated with additional
information for schools, exclusion guidance for people
with influenza-like illness, and more
- Important: During H1N1 influenza outbreak, administer
PPSV to all people with existing indications
- IAC's Video of the Week features a re-cast of CDC's July
16 Current Issues in Immunization Net Conference on H1N1
influenza
- IAC's padded screening questionnaires for
contraindications now have English on front, Spanish on
back--a popular translation at no added cost!
- HHS's website for the public--www.healthfinder.gov--presents information on pre-teen vaccination
- CDC website posts presentation slide sets from ACIP's
July 29 meeting on H1N1 influenza
- MMWR publishes article on the ability of rapid influenza
diagnostic tests to detect H1N1 influenza viruses
- Clinical Vaccinology course scheduled for Atlanta on
November 13-15
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| Abbreviations |
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AAFP, American Academy of Family Physicians; AAP,
American Academy of Pediatrics; ACIP, Advisory Committee on Immunization
Practices; AMA, American Medical Association; CDC, Centers for Disease
Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization
Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NCIRD,
National Center for Immunization and Respiratory Diseases; NIVS, National
Influenza Vaccine Summit; VIS, Vaccine Information Statement; VPD,
vaccine-preventable disease; WHO, World Health Organization. |
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Issue 815: August 10, 2009 |
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1. |
CDC issues updated
recommendations for routine polio vaccination
CDC published "Updated Recommendations of the
Advisory
Committee on Immunization Practices (ACIP) Regarding Routine
Poliovirus Vaccination" in the August 7 issue of MMWR. It is
reprinted below in its entirety, excluding references and a
table titled "Currently licensed vaccines containing
inactivated poliovirus vaccine (IPV)--United States, 2009."
The table presents the vaccine composition of all available
products, their trade names, manufacturers, and approved use
in the Recommended Immunization Schedules for Persons Aged 0
Through 18 Years--United States, 2009.
This report updates Advisory Committee on Immunization
Practices (ACIP) recommendations for routine poliovirus
vaccination. These updates aim to (1) emphasize the
importance of the booster dose at age >=4 years, (2) extend
the minimum interval from dose 3 to dose 4 from 4 weeks to 6
months, (3) add a precaution for the use of minimum
intervals in the first 6 months of life, and (4) clarify the
poliovirus vaccination schedule when specific combination
vaccines are used.
On June 17, 1999, ACIP recommended that all poliovirus
vaccine administered in the United States be an inactivated
poliovirus vaccine (IPV) beginning January 1, 2000. This
policy was implemented to eliminate the risk for vaccine-associated paralytic poliomyelitis, a rare condition that
has been associated with use of the live oral poliovirus
vaccine (OPV). Since 1999, no OPV has been distributed in
the United States. Under these ACIP recommendations, the
routine IPV vaccination schedule in the United States
consists of 4 doses administered at ages 2 months, 4 months,
6-18 months, and 4-6 years with the minimum interval between
all IPV doses as 4 weeks.
Since the ACIP recommendation was made 10 years ago, three
different combination vaccines containing IPV have been
licensed for routine use in the United States. Because of
potential confusion in using different vaccine products for
routine and catch-up immunization, ACIP recommends the
following:
- The 4-dose IPV series should continue to be administered
at ages 2 months, 4 months, 6-18 months, and 4-6 years.
- The final dose in the IPV series should be administered
at age >=4 years regardless of the number of previous
doses.
- The minimum interval from dose 3 to dose 4 is extended
from 4 weeks to 6 months.
- The minimum interval from dose 1 to dose 2, and from dose
2 to dose 3, remains 4 weeks.
- The minimum age for dose 1 remains age 6 weeks.
ACIP also is making a new recommendation concerning the use
of minimum age and minimum intervals for children in the
first 6 months of life. Use of the minimum age and minimum
intervals for vaccine administration in the first 6 months
of life are recommended only if the vaccine recipient is at
risk for imminent exposure to circulating poliovirus (e.g.,
during an outbreak or because of travel to a polio-endemic
region). ACIP is making this precaution because shorter
intervals and earlier start dates lead to lower
seroconversion rates.
In addition, ACIP is clarifying the poliovirus vaccination
schedule to be used for specific combination vaccines. When
DTaP-IPV/Hib (Pentacel) is used to provide 4 doses at ages
2, 4, 6, and 15-18 months, an additional booster dose of
age-appropriate IPV-containing vaccine (IPV [Ipol] or DTaP-IPV [Kinrix]) should be administered at age 4-6 years. This
will result in a 5-dose IPV vaccine series, which is
considered acceptable by ACIP. DTaP-IPV/Hib is not indicated
for the booster dose at age 4-6 years. ACIP recommends that
the minimum interval from dose 4 to dose 5 should be at
least 6 months to provide an optimum booster response. In
accordance with existing recommendations, if a child misses
an IPV dose at age 4-6 years, the child should receive a
booster dose as soon as feasible.
To access the full article in web-text (HTML) format, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5830a3.htm
To access a ready-to-print (PDF) version of this issue of
MMWR, go to
http://www.cdc.gov/mmwr/PDF/wk/mm5830.pdf
To receive a FREE electronic subscription to MMWR (which
includes new ACIP recommendations), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html
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2. |
CDC issues updated school
guidance for H1N1 influenza
On August 7, the Department of Health and Human
Services
(HHS) posted a press release to its website regarding a CDC
guidance document titled "CDC Guidance for State and Local
Public Health Officials and School Administrators for School
(K-12) Response to Influenza during the 2009-2010 School
Year." The press release is reprinted below in its entirety.
A link to the CDC guidance document is given at the end of
this IAC Express article.
UPDATED FEDERAL GUIDELINES FOR 2009 H1N1 INFLUENZA IN
SCHOOLS OFFER MANY OPTIONS
Guidance Says Officials Should Consider Local Needs in
Making Decisions
Updated federal guidelines offer state and local public
health and school officials a range of options for
responding to 2009 H1N1 influenza in schools, depending on
how severe the flu may be in their communities. The guidance
says officials should balance the risk of flu in their
communities with the disruption that school dismissals will
cause in education and the wider community.
The guidance from the Centers for Disease Control and
Prevention (CDC) was announced today at a joint news
conference by Health and Human Services Secretary Kathleen
Sebelius, Education Secretary Arne Duncan, Homeland Security
Secretary Janet Napolitano, and CDC Director Thomas R.
Frieden, MD, MPH.
The school guidance is a part of a broader national
framework to respond to novel H1N1 influenza, which includes
encouraging people to be vaccinated against the virus and to
take other actions to avoid infection. The CDC anticipates
more illness after the school year starts, because flu
typically is transmitted more easily in the fall and winter.
"We're going to continue to do everything possible to keep our
children--and all Americans--healthy and safe this fall,"
Secretary Sebelius said. "But all Americans also have a part to
play. The best way to prevent the spread of flu is vaccination.
A seasonal flu vaccine is ready to go, and we should have one
for the 2009 H1N1 flu by mid-October."
"The federal government continues to coordinate closely with
state and local governments, school districts, and the
private sector on H1N1 preparation as we head into the fall
flu season--and the upcoming school year," said Secretary
Napolitano. "Readiness for H1N1 is a shared responsibility,
and the guidance released today provides communities with
the tools they need to protect the health of their students
and teachers."
For an outbreak similar in severity to the spring 2009 H1N1
infection, the guidelines recommend basic good hygiene, such
as hand washing. In addition, students or staff members with
flu-like illness (showing symptoms of flu) should stay home
at least 24 hours after fever symptoms have ended.
"We can all work to keep our children healthy now by
practicing prevention, close monitoring, and using common
sense," Secretary Duncan said. "We hope no schools have to
close. But if they do, we need to make sure that children
keep learning."
The guidelines also recommend schools have plans in place to
deal with possible infection. For instance, people with flu-like illness should be sent to a room away from other people
until they can be sent home. Schools should have plans for
continuing the education of students who are at home,
through phone calls, homework packets, Internet lessons and
other approaches. And schools should have contingency plans
to fill important positions such as school nurses.
If H1N1 flu causes higher rates of severe illness,
hospitalizations, and deaths, school officials could add to
or intensify their responses, the guidelines say. Under
these conditions, the guidelines advise parents to check
their children every morning for illness, and keep the
children home if they have a fever.
In addition, schools could begin actively screening students
upon arrival and sending ill students home immediately. If
one family member is ill, students should stay home for five
days from the day the illness develops, the guidelines say.
"Influenza can be unpredictable, so preparation and planning
are key," said Dr. Frieden. "We can't stop the tide of flu,
but we can reduce the number of people who become very ill
by preparing well and acting effectively."
To access the press release, go to:
http://www.hhs.gov/news/press/2009pres/08/20090807a.html
To access the CDC guidance document, go to:
http://flu.gov/plan/school/schoolguidance.html
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3. |
CDC issues a health advisory
about updated recommendations for the amount of time people with
influenza-like illness should stay away from others
On August 6, CDC's Health Alert Network issued an
official
CDC Health Advisory titled "CDC Updates Recommendations for
the Amount of Time Persons with Influenza-Like Illness
Should be Away from Others." The Health Advisory is
reprinted below in its entirety.
On August 5, 2009, CDC changed its recommendation related to
the amount of time people with influenza-like illness should
stay away from others (the exclusion period). New guidance
indicates that people with influenza-like illness should
stay home for at least 24 hours after their fever is gone
(without the use of fever-reducing medicine). A fever is
defined as having a temperature of 100 degrees Fahrenheit or
37.8 degrees Celsius or greater.
This is a change from the previous recommendation that ill
persons stay home for 7 days after illness onset or until 24
hours after the resolution of symptoms, whichever was
longer.
The new recommendation applies to camps, schools,
businesses, mass gatherings, and other community settings
where the majority of people are not at increased risk for
influenza complications. CDC recommends this exclusion
period regardless of whether or not antiviral medications
are used. This guidance does not apply to healthcare
settings where the exclusion period continues to be for 7
days from symptom onset or until 24 hours after the
resolution of symptoms, whichever is longer. (See
http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm
for guidance on infection control in healthcare settings.)
Decisions about extending the exclusion period should be
made at the community level, in conjunction with local and
state health officials. More stringent guidelines and longer
periods of exclusion--for example, until complete resolution
of all symptoms--may be considered for people returning to a
setting where high numbers of high-risk people may be
exposed.
This exclusion period guidance for the community setting is
based on epidemiologic data about the overall risk of severe
illness and death. The new recommendation attempts to
balance the risks of acquiring illness from influenza and
the potential benefits of decreasing transmission through
the exclusion of ill persons with the goal of minimizing
social disruption. This guidance will continue to be updated
as more information becomes available.
To read the complete revised guidance, see:
http://www.cdc.gov/h1n1flu/guidance/exclusion.htm
This change in our recommendation has affected content on a
number of other pages, including the following:
For more general information on H1N1, go to
http://www.cdc.gov/h1n1flu
To access the Health Advisory, go to:
http://www.cdc.gov/h1n1flu/HAN/080609.htm
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4. |
CDC's H1N1 influenza web section
updated with additional information for schools, exclusion guidance for
people with influenza-like illness, and more
CDC recently posted new or updated information to
various
sub-sections of its H1N1 Flu web section. Following are the
titles and URLs of documents that have been posted since the
August 3 issue of IAC Express:
Preparing for Flu: A Communication Toolkit for Schools
(Grades K-12)
http://flu.gov/plan/school/toolkit.html
Technical Report for State and Local Public Health Officials
and School Administrators on CDC Guidance for School (K-12)
Responses to Influenza during the 2009-2010 School Year
http://flu.gov/plan/school/k12techreport.html
CDC Guidance for State and Local Public Health Officials and
School Administrators for School (K-12) Responses to
Influenza during the 2009-2010 School Year
http://flu.gov/plan/school/schoolguidance.html
School Dismissal Monitoring System [generates real-time,
national summary data daily on the number of school
dismissals and number of affected students/teachers]
http://www.cdc.gov/h1n1flu/schools/dismissal_form
CDC Recommendations for the Amount of Time Persons with
Influenza-Like Illness Should be Away from Others
http://www.cdc.gov/h1n1flu/guidance/exclusion.htm
Updated: Questions & Answers: Novel H1N1 Flu (Swine Flu) and
You [for the public; updated with information on the time
people with influenza-like illness should be away from
others]
http://www.cdc.gov/h1n1flu/qa.htm
FOR MORE INFORMATION
The home page of CDC's H1N1 Flu web section can be accessed
from http://www.cdc.gov/h1n1flu
IAC has gathered information related to H1N1 influenza into
a single web section at http://www.immunize.org/h1n1
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5. |
Important: During H1N1 influenza
outbreak, administer PPSV to all people with existing indications
CDC advises healthcare professionals that during
the current
outbreak of novel influenza A (H1N1), all people who have
existing indications for PPSV should be vaccinated according
to current ACIP recommendations. This is important because
people with existing indications are not only at increased
risk for pneumococcal disease, but are also at increased
risk for serious complications from influenza. Use of PPSV
among people without current indications for vaccination is
not recommended at this time.
To access CDC's comprehensive document "Interim guidance for
use of 23-valent pneumococcal polysaccharide vaccine during
novel influenza A (H1N1) outbreak," go to:
http://www.cdc.gov/h1n1flu/guidance/ppsv_h1n1.htm
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6. |
IAC's Video of the Week features
a re-cast of CDC's July 16 Current Issues in Immunization Net Conference on
H1N1 influenza
IAC encourages IAC Express readers to watch the
1-hour re-cast of CDC's July 16 Current Issues in Immunization Net
Conference. Topics include an update on the epidemiology and
clinical features of H1N1 influenza, H1N1 influenza vaccine
development and manufacturing, and program implementation of
H1N1 influenza vaccine. The presenters are Joseph Bresee,
MD; Tom Shimabukuro, MD, MPH, MBA; and Pascale Wortley, MD,
MPH. All are with CDC. Viewers of the re-cast can register
for continuing education credit at
http://www.cdc.gov/vaccines/ed/ciinc/2009July.htm This
continuing education opportunity expires on August 17, 2009.
The video will be available on the home page of IAC's
website through August 16. To access it, go to:
http://www.immunize.org and click on the image under the
words Video of the Week. It may take a few moments for the
video to begin playing; please be patient!
Remember to bookmark IAC's home page to view a new video
every Monday. To view an IAC Video of the Week from the
past, go to the video archive at
http://www.immunize.org/votw/jul09.asp
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7. |
IAC's padded screening
questionnaires for contraindications now have English on front, Spanish on
back--a popular translation at no added cost!
In response to demand, IAC now has a
Spanish-language
translation of the questions on its padded Screening
Questionnaire for Child and Teen Immunization and Screening
Questionnaire for Adult Immunization. Printed on the back of
the English page, the Spanish page has been added to this
product at no additional cost.
The questionnaires give you and your patients a quick, easy,
and thorough way to determine if they have contraindications
and precautions to vaccination. Patients fill out the
questionnaire with yes-or-no answers while waiting to be
seen, allowing you to review their responses quickly and be
confident you're not missing any contraindications or
precautions.
The questionnaires come in convenient tear-off pads of 100
sheets. The price per pad is economical (discounts for two
pads or more), so you'll be able to keep pads at the
receptionist's desk, the nurse's station, and in every exam
room. Each pad comes with four English-language reference
sheets (printed on heavy-weight paper) for health
professionals.
Prices start at $16 each for one pad and drop to $12 each
for two, $11 each for three, and $10 each for four. For
quotes on larger quantities or customizing, call (651) 647-9009 or email
admininfo@immunize.org
To learn more about the padded screening questionnaires, or
to order online or download an order form, visit
Screening Questionnaire for Child and Teen Immunization
http://www.immunize.org/shop/pad_sqchild.asp
Screening Questionnaire for Adult Immunization
http://www.immunize.org/shop/pad_sqadult.asp
IAC's offers other products for sale, including educational
videos and personal immunization record cards, at
http://www.immunize.org/shop
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8. |
HHS's website for the public--www.healthfinder.gov--presents
information on pre-teen vaccination
www.healthfinder.gov is a federal government
website that
offers the public tools and information to help them and
those they care about stay healthy. Recently, the site
posted information for parents on vaccinations that 11- and
12-year-olds need. It presents the basics about Tdap, MCV4,
and (for girls) HPV vaccines and encourages parents to take
action by scheduling a health check-up for their pre-teen.
To access this information, go to:
http://www.healthfinder.gov/prevention/ViewTopic.aspx?topicId=60
The site has resources on a wide range of health topics
selected from more than 1,600 government and non-profit
organizations. Materials are available in English and
Spanish in the form of print materials, interactive tools,
subscription services, and more.
To access the home page, which offers a tutorial, go to:
http://www.healthfinder.gov
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9. |
CDC website posts presentation slide
sets from ACIP's July 29 meeting on H1N1 influenza
The CDC website recently posted the PowerPoint
slide sets
presented at the special July 29 ACIP meeting on H1N1
influenza. To access the slide sets, go to:
http://www.cdc.gov/vaccines/recs/acip/slides-july09-flu.htm
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10. |
MMWR publishes article on the
ability of rapid influenza diagnostic tests to detect H1N1 influenza viruses
CDC published Evaluation of Rapid Influenza
Diagnostic Tests
for Detection of Novel Influenza A (H1N1) Virus--United
States, 2009" in the August 7 issue of MMWR. A summary made
available to the press is reprinted below in its entirety.
Rapid influenza diagnostic tests (RIDTs) may miss detecting
novel influenza A (H1N1) virus infections, especially when
the amount of virus in a specimen is low. Decisions
regarding treatment and further testing among patients with
negative results from RIDT testing should be based upon
clinician suspicion, underlying medical conditions, severity
of illness, and risk for complications in those persons
suspected of having novel H1N1 virus infection.
This article assessed commercially available RIDTs for their
ability to detect novel influenza A (H1N1) virus in
respiratory specimens. RIDTs are tests that detect influenza
A or B virus antigens and can provide results within 15
minutes. RIDTs from three companies are presented and
results indicate that these tests can detect novel influenza
A (H1N1) in respiratory specimens with high
viral titers, but the overall sensitivities range from 40-69
percent, meaning that many influenza virus infections will
be missed.
To access the full article in web-text (HTML) format, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5830a2.htm
To access a ready-to-print (PDF) version of this issue of
MMWR, go to:
http://www.cdc.gov/mmwr/PDF/wk/mm5830.pdf
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11. |
Clinical Vaccinology course
scheduled for Atlanta on November 13-15
A Clinical Vaccinology course will be held in
Atlanta on
November 13-15.
To access a comprehensive course brochure, go to:
http://www.nfid.org/pdf/conferences/course1109.pdf
To register online, go to:
https://secure.bnt.com/webresponse/nfid/course1109
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