Immunization Works November 2016 Newsletter | CDC

Immunization Works November 2016

MMWR

Progress toward Poliomyelitis Eradication in Pakistan, January 2015—September 2016: Pakistan, Afghanistan, and Nigeria remain the only countries where endemic wild poliovirus type 1 (WPV1) transmission continues. The November 24 MMWR describes the activities, challenges, and progress toward polio eradication in Pakistan between January 2015 and September 2016, and updates previous reports. In 2015, a total of 54 WPV1 cases were reported, an 82% decrease from 2014. Fifteen WPV1 cases have been reported as of November 1, 2016, representing a 61% decrease compared with 38 cases reported during the same time period in 2015. Among the 15 WPV1 cases reported in 2016, children aged 36 months and younger accounted for 13 (87%) cases, 4 (31%) of whom had received only a single dose of oral poliovirus vaccine (OPV). Seven (47%) of the 15 WPV1 cases occurred in the province of Khyber Pakhtunkhwa, 5 (33%) in Sindh, 2 (13%) in the Federally Administered Tribal Areas, and 1 (7%) in Balochistan. During January through September 2016, WPV1 was detected in 9% (36 of 384) of environmental samples collected, compared with 19% (69 of 354) of samples collected during the same period in 2015. Rigorous implementation of the 2015–16 National Polio Eradication Emergency Action plan (NEAP), coordinated by the National Emergency Operations Center, has resulted in a substantial decrease in overall WPV1 circulation compared with the previous year. However, detection of WPV1 cases in high-risk areas and the detection of WPV1 in environmental samples from geographic areas where no polio cases are identified highlight the need to continue to improve the quality of supplemental immunization activities (SIAs), immunization campaigns focused on immunizing children with OPV outside of routine immunization services, and surveillance for acute flaccid paralysis. Continuation and refinement of successful program strategies, as outlined in the new 2016–17 NEAP, with particular focus on identifying children missed by vaccination, community-based vaccination, and rapid response to virus identification, are needed to stop WPV transmission.

Global Routine Vaccination Coverage, 2015: In 1974, the World Health Organization (WHO) established the Expanded Program on Immunization to provide protection against six vaccine-preventable diseases through routine infant immunization. Based on 2015 WHO and United Nations Children’s Fund (UNICEF) estimates, global coverage with the third dose of diphtheria-tetanus-pertussis vaccine (DTP3), the first dose of measles-containing vaccine (MCV1), and the third dose of polio vaccine (Pol3) has remained stable (84%–86%) since 2010. From 2014 to 2015, estimated global coverage with the second MCV dose (MCV2) increased from 39% to 43% by the end of the second year of life and from 58% to 61% when older age groups were included. Global coverage was higher in 2015 than in 2010 for newer or underused vaccines, including rotavirus vaccine, pneumococcal conjugate vaccine (PCV), rubella vaccine, Haemophilus influenzae type b (Hib) vaccine, and 3 doses of hepatitis B (HepB3) vaccine. Coverage estimates varied widely by WHO Region, country, and district; in addition, for the vaccines evaluated (MCV, DTP3, Pol3, HepB3, Hib3), wide disparities were found in coverage by country income classification. Improvements in equity of access are necessary to reach and sustain higher coverage and increase protection from vaccine-preventable diseases for all persons. Please read the November 18 MMWR for the full report.

Progress toward Regional Measles Elimination—Worldwide, 2000–2015: Adopted in 2000, United Nations Millennium Development Goal 4 set a target to reduce child mortality by two-thirds before 2015, with measles vaccination coverage as one of the progress indicators. In 2010, the World Health Assembly (WHA) set three milestones for measles control by 2015: 1) increase routine coverage with the first dose of measles-containing vaccine (MCV1) for children aged 1 year to more than 90% nationally and more than 80% in every district; 2) reduce global annual measles incidence to less than 5 cases per 1 million population; and 3) reduce global measles mortality by 95% from the year 2000 estimate. In 2012, WHA endorsed the Global Vaccine Action Plan with the objective of eliminating measles in four World Health Organization (WHO) regions by 2015. Countries in all six WHO regions have adopted measles elimination goals. Measles elimination is the absence of endemic measles transmission in a region or other defined geographical area for more than 12 months in the presence of a well-performing surveillance system. The November 11 MMWR updates a previous report and describes progress toward global measles control milestones and regional measles elimination goals between 2000 and 2015. During this period, annual reported measles incidence decreased 75%, from 146 to 36 cases per 1 million persons, and annual estimated measles deaths decreased 79%, from 651,600 to 134,200. However, none of the 2015 milestones or elimination goals were met. Countries and their partners need to act urgently to secure political commitment, raise the visibility of measles, increase vaccination coverage, strengthen surveillance, and mitigate the threat of decreasing resources for immunization once polio eradication is achieved.

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Influenza Information

What’s New for the 2016–17 Flu Season: CDC recommends use of injectable influenza vaccines (flu shots) during the 2016–17 season. (This includes inactivated influenza vaccines [IIVs] or the recombinant influenza vaccine [RIV]). The nasal spray flu vaccine (live, attenuated influenza vaccine [LAIV]) should not be used during the 2016–17 season. More information on this recommendation is available in the August 26 MMWR.

Two new flu vaccine options are available during the 2016–17 flu season. One new vaccine, Fluad, which contains MF59, a type of adjuvant (ingredient that helps create a stronger immune response in the patient’s body), is licensed for use in people aged 65 years and older. A quadrivalent flu shot made with virus grown in cell culture also will be available for the first time this season and is licensed for use in people aged 4 years and older.

The egg allergy recommendations have been updated. CDC now recommends that anyone with an egg allergy can receive any licensed flu vaccine; however, the vaccine should be administered in an inpatient or outpatient medical setting where the patient is supervised by a health care provider who is able to recognize and manage severe allergic conditions. People with egg allergies no longer have to be observed for 30 minutes after receiving their vaccine.

For more information about how serious flu can be and the benefits of flu vaccination, talk to your doctor or other health care professional, visit the CDC influenza website, or call 1‒800‒CDC‒INFO. For answers to questions commonly asked by the general public, please see Frequently Asked Questions 2016–17 Influenza Season.

Final 2015–16 Flu Season Vaccination Coverage Estimates: Vaccination coverage estimates are now available online at FluVaxView. The coverage estimates include the cumulative percentage of persons vaccinated through the end of each month between July 2015 and May 2016 for selected local areas, states, and regions, as designated by the U.S. Department of Health and Human Services and the U.S. overall. Key findings include: flu vaccination coverage among children for the 2015–16 season did not change from the 2014–15 season; flu vaccination coverage among adults aged 18–49 years was similar to 2014–15 coverage, but coverage among adults aged 50–64 years and 65 years and older fell by more than 3%. Surveys continue to find state-to-state variability in child and adult flu vaccination coverage.

The Influenza Vaccination Coverage Among Health Care Personnel MMWR was released in September. CDC conducted an opt-in Internet panel survey of 2,258 health care personnel (HCP) between March 28 and April 14, 2016. Overall, 79.0% of survey participants reported receiving an influenza vaccination during the 2015–16 season, similar to the 77.3% coverage reported for the 2014–15 season. Coverage in long-term care settings increased by 5.3 percentage points (to 69.2%) compared with the previous season. Vaccination coverage continued to be higher among HCP working in hospitals (91.2%) and lower among HCP working in ambulatory settings (79.8%). Coverage continued to be highest among physicians (95.6%), lowest among assistants and aides (64.1%), and highest overall among HCP who were required by their employer to be vaccinated (96.5%). Among HCP working in settings where vaccination was neither required, promoted, nor offered on site, vaccination coverage continued to be low (44.9%). An increased percentage of HCP reporting a vaccination requirement or on-site vaccination availability compared with earlier influenza seasons might have contributed to the overall increase in vaccination coverage among HCP during the past six influenza seasons.

Coverage estimates for pregnant women are in a separate online report. Key findings include: as of early April 2016, flu vaccination coverage among pregnant women (before and during pregnancy) was 49.9%; 14.1% were vaccinated before pregnancy and 35.8% were vaccinated during pregnancy. Overall vaccination coverage was similar to that in the 2014–15 (50.3%), 2013–14 (52.2%), and 2012–13 (50.5%) flu seasons, but higher than that in the 2010–11 season (44.0%).

2016–17 National Flu Season Vaccination Campaign: CDC is encouraging everyone 6 months and older to “fight the flu” by getting a flu vaccine. You can support and follow the campaign on social media using the hashtag #FightFlu. CDC’s #FightFlu Social Media Campaign captures and shares flu vaccination activities. Share photos and videos of yourself during or after getting a flu shot (tag #FightFlu) on digital platforms such as Twitter, Facebook, Instagram, and YouTube. CDC will post weekly updates to the campaign timeline.

Learn more about how you can fight the flu this season and stay up to date on the latest flu information from CDC by following @CDCFlu on Twitter and signing up for CDC’s weekly Influenza Newsletter.

2016–17 Communication Resources for Clinicians: CDC has developed new resources specific to the 2016–17 season to communicate new CDC recommendations and prepare for the flu season. Resources include a “Dear Colleague[2 pages]” letter, which provides an overview of updates for the 2016–17 flu season and urges clinicians to continue efforts to vaccinate patients against influenza. This letter is signed and supported by a number of leading health organizations, including the American Academy of Pediatrics, the American Academy of Family Physicians, the National Foundation for Infectious Diseases, and others. CDC’s “Only Flu Shots This Season” fact sheet[2 pages] is designed to help health care personnel communicate to parents of young patients why the nasal spray flu vaccine is not recommended this flu season and how the flu shot is a child’s best shot at protection. Other materials have been updated to support efforts to communicate information about the current influenza season.

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Resources and Information

Epidemiology and Prevention of Vaccine-Preventable Diseases, 13th Edition (the Pink Book): The 13th edition of the text-book, Epidemiology andPrevention of Vaccine-Preventable Diseases, is available. Published by CDC, NCIRD, and the Public Health Foundation (PHF) the Pink Book provides health care professionals with the most comprehensive information available on vaccines and vaccine-preventable diseases. The Pink Book is available for purchase from the PHF Learning Resource Center , and the chapters and appendices can be viewed/downloaded from the NCIRD vaccines site.

Webinar Series for Pink Book: The 2016 Pink Book webinar series concluded on September 21, but recasts are available for viewing on CDC’s website. Continuing Education (CE) is still available for some of the webinars. The total number of registrants for the 15-episode series was 4,571, with 1,181 people registering for the most popular webinar, “Principles of Vaccination.”

Current Issues in Immunization NetConferences: Immunization netconferences are live, one-hour events combining an online visual presentation with simultaneous audio via telephone conference call, along with a live question and answer session. Registration, Internet access, and a separate phone line are needed to participate. The most recent netconference was held November 9, 2016, and the archived replay is now available. The subject was “Vaccines during Pregnancy: A Strong Record of Safety.” Please visit the netconference web page for other archived webcasts, and information on upcoming netconferences.

You Call the Shots Modules: You Call the Shots is a web-based training course developed through the Project to Enhance Immunization Content in Nursing Education and Training. The influenza module has just been updated and is now available. Please visit the You Call the Shots web page for additional information and other modules. Continuing Education (CE) is available for viewing a module and completing an evaluation.

Measles Resources: CDC aims to continue increasing awareness of measles among individuals and families and to encourage MMR vaccination. To support disease prevention and vaccination educational efforts, CDC has developed a variety of measles and vaccination resources, including fact sheets, podcasts, and matte articles. There are also infographics available in English and Spanish.

CDC and Medscape: This special series of commentaries , part of a collaboration between CDC and Medscape, is designed to deliver CDC’s authoritative guidance directly to Medscape’s physicians, nurses, pharmacists, and other health care providers. In this series, CDC experts offer video commentaries on current topics important to practicing clinicians. NCIRD has contributed to a variety of commentaries. You may need to sign up and log in as a member to view the commentaries. Registration is free.

Immunization Resources: Publications are available for ordering at CDC-INFO on Demand. You can search for immunization publications by using the “Programs” drop-down menu and selecting “Immunization and Vaccines,” or you can search by “Title.” Numerous items are available, including the 2016 immunization schedules, the Parents’ Guide to Childhood Immunizations, and various campaign materials.

CDC Job Openings: CDC is committed to recruiting and hiring qualified candidates for a wide range of immunization and other positions. Researchers, medical officers, epidemiologists, and other specialists are often needed to fill positions within CDC. For a current listing, including international opportunities, please visit CDC’s employment web page.

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Calendar of Events

Annual Louisiana Shots for Tots State Conference , December 1–2, 2016, New Orleans, LA

California Immunization Coalition Summit , April 3–4, 2017, Riverside, CA

NCIRD Calendar of Events

Upcoming ACIP Meetings

Immunization Action Coalition (IAC) Calendar

The Immunization Works editor can be contacted at wfh6@cdc.gov.

Please visit the newsletter web page, where you can view archived copies of the newsletter and also subscribe to receive e-mail updates when newsletters are posted.

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