Immunization Works January 2020

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January 30, 2020: Content on this page kept for historical reasons.

Influenza

Attention Clinicians: CDC Health Advisory for Elevated Influenza Activity: On January 10, 2020, CDC issued a Health Alert Network (HAN) advisory to clinicians regarding ongoing elevated influenza activity in the U.S. The HAN reported that U.S. flu activity this season is due to influenza B/Victoria viruses, increasing circulation of influenza A(H1N1)pdm09 viruses, and low levels of influenza B/Yamagata and influenza A(H3N2) viruses. These circulating viruses can cause severe illness and death, so this health advisory serves as a reminder that early treatment with antiviral medications improves outcomes in patients with flu. Early treatment with antivirals is recommended for hospitalized patients and outpatients with severe disease or at high risk of complications, including children younger than 2 years old. Clinicians should continue efforts to vaccinate patients for as long as flu viruses are circulating, and promptly start antiviral treatment of severely ill and high-risk patients with suspected flu without waiting for laboratory confirmation. Please read the advisory for additional information.

Information on dosage and more detailed treatment considerations can be found in the Influenza Antiviral Medications: Summary for Clinicians and you can also view the latest FluView report for details on national flu activity.

Early Season Pediatric Influenza B/Victoria Virus Infections Associated with a Recently Emerged Virus Subclade in Louisiana during 2019: A recent Morbidity and Mortality Weekly Report (MMWR) describes an investigation conducted by CDC and Louisiana health officials of the state’s unusually early and intense flu activity. Starting in August, influenza activity in Louisiana began increasing, before influenza vaccination efforts usually begin. Illnesses were caused by influenza B/Victoria viruses. Most Louisiana patients were children–the median age of patients with influenza B virus was 6–and most had mild illness. However, some patients had severe complications of influenza, requiring hospitalization, and a death of a child with influenza B was reported. While influenza B typically circulates in the spring, as of early January it has been the most common virus circulating nationally this season. Influenza B viruses have not predominated nationally in the U.S. since 1992–93, and over the last three seasons have accounted for less than 10% of circulating flu viruses. However, between September 29 and December 28, 2019, influenza B accounted for 60% of viruses circulating in the U.S. and was most common among children.

While it is a common misconception that influenza B infections are less severe than influenza A, this investigation shows that they can be severe in all age groups, including children. All people age 6 months and older should receive an annual flu vaccine if they have not already been vaccinated. Antiviral treatment of flu is recommended as soon as possible for all hospitalized patients and for outpatients with severe disease or at high risk for flu complications, including children younger than 2 years old and persons with underlying medical conditions. Read the January 10, 2020 MMWR for the full report.

CDC Releases 2018–2019 Flu Burden and Burden-Averted Estimates: The 2018–19 flu season was one of moderate severity based on levels of outpatient influenza-like illness, hospitalization rates, and proportions of pneumonia and influenza-associated deaths. CDC estimates that the burden of flu illness during the 2018–19 season included an estimated 35.5 million people getting sick with flu, 16.5 million people going to a health care provider for their illness, 490,600 hospitalizations, and 34,200 flu deaths. Influenza A viruses were the predominant circulating viruses during the 2018–19 season. While influenza A(H1N1pdm09) viruses predominated from October 2018 through mid-February 2019, influenza A(H3N2) viruses were more commonly reported starting in late February 2019. Influenza B viruses were not commonly reported among circulating viruses during the 2018–19 season. Visit the flu burden estimates web page for additional information.

CDC also estimates the burden of flu disease averted by seasonal flu vaccination. During the 2018–19 flu season, approximately 49% of the U.S. population was vaccinated, resulting in the prevention of an estimated:

4 million flu illnesses
58,000 flu hospitalizations
3,500 flu deaths

You can find out more about CDC’s burden-averted estimates for 2018–19 here.

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MMWR

Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines in the U.S., 2019: Since 2005, a single dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine has been recommended by the Advisory Committee on Immunization Practices (ACIP) for adolescents and adults. After receipt of Tdap, booster doses of tetanus and diphtheria toxoids (Td) vaccine are recommended every 10 years or when indicated for wound management. During the October 2019 ACIP meeting, the organization updated its recommendations to allow use of either Td or Tdap where previously only Td was recommended. These situations include decennial Td booster doses, tetanus prophylaxis when indicated for wound management in persons who had previously received Tdap, and for multiple doses in the catch-up immunization schedule for persons age 7 years and older with incomplete or unknown vaccination history. Allowing either Tdap or Td to be used in situations where Td only was previously recommended increases provider point-of-care flexibility. The January 24 MMWR updates ACIP recommendations and guidance regarding the use of Tdap vaccines.

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Resources and Information

Epidemiology and Prevention of Vaccine-Preventable Diseases, 13th Edition (the Pink Book): 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 or downloaded from the NCIRD vaccines site.

2019 Pink Book Webinar Series: This 2019 online series of 15 webinars, which concluded on September 25, 2019, provides an overview of vaccination principles, general recommendations, immunization strategies, and specific information about vaccine-preventable diseases and the vaccines that prevent them. Each webinar explored a chapter from the 13th edition of the Pink Book. The webinars can be viewed online at the Pink Book webinar web page. Continuing Education (CE) is available for each webinar.

“Keys to Storing and Handling Your Vaccine Supply” Video: Two of the most important safeguards for the nation’s vaccine supply are proper vaccine storage and handling. An updated web-on-demand video, titled “Keys to Storing and Handling Your Vaccine Supply,” is designed to decrease vaccine storage and handling errors by demonstrating recommended best practices and addressing frequently asked questions. Continuing Education (CE) is available.

Vaccine Administration e-Learn: An e-Learn on vaccine administration is now available. Proper vaccine administration is critical for ensuring that vaccines are both safe and effective. Vaccine administration errors happen more often than you might think. Of the average 36,000 reports received annually by the Vaccine Adverse Event Reporting System (VAERS), about 1,500 are directly related to administration error. Some of the most common vaccine administration errors include:

Not following the recommended immunization schedule
Administering improperly stored or expired vaccine and/or diluent
Administering the wrong vaccine—confusing look-alike or sound-alike vaccines such as DTaP/Tdap or administering products outside age indications

The e-Learn is a free, interactive, online educational program that serves as a useful introductory course or a great refresher on vaccine administration. The self-paced e-Learn provides comprehensive training, using videos, job aids, and other resources to accommodate a variety of learning styles, and offers a certificate of completion and/or Continuing Education (CE) for those that complete the training.

Updated Vaccine Storage and Handling Toolkit Now Available: The Vaccine Storage and Handling Toolkit has recently been updated. The toolkit is a comprehensive guide that reflects best practices for vaccine storage and handling from Advisory Committee on Immunization Practices (ACIP) recommendations, product information from vaccine manufacturers, and scientific studies. The toolkit has been updated to clarify language, including:

Beyond use date (BUD)
Routine maintenance for vaccine storage units
New definition added to the glossary

Current Issues in Immunization Webinars: Immunization webinars 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. During the latest webinar on December 11, 2019, Dr. Lauri Markowitz gave an update on HPV vaccination recommendations. View the webinar web page for additional information and the archived webinars.

You Call the Shots Modules: You Call the Shots is a series of interactive, web-based training courses developed through the Project to Enhance Immunization Content in Nursing Education and Training. These courses are ideal for medical or nursing students, new vaccination providers, or seasoned health care providers seeking a review. The Vaccines for Children (VFC) and Vaccine Storage and Handling modules have recently been updated. Please visit the You Call the Shots web page to view all the modules. Continuing Education (CE) is available for viewing a module and completing an evaluation.

Updated Infographic: Cervical Cancer is Just the Tip of the Iceberg: January is Cervical Cancer Awareness Month! Although cervical cancer is the most well-known of the cancers caused by HPV, it is just the tip of the iceberg. This infographic [1 page] features updated data and a revamped layout to help educate parents and the entire office staff about the burden of HPV cancers and precancers. The infographic also emphasizes the importance of HPV vaccination for preteens as the best protection against six types of cancer.

New Handout: Talking to Pregnant Women about Vaccines: Vaccines are an important part of a healthy pregnancy and pregnant women may have questions about them. Addressing their questions and any concerns about vaccines–including side effects, safety, and vaccine effectiveness–in plain and understandable language is key. CDC created the Talking to Pregnant Women about Vaccines handout [1 page] for prenatal care providers to help address commonly asked questions about vaccines during pregnancy.

New Free CE Activity: How to Foster a Culture of Immunization: Nurses and medical assistants play a key role in improving vaccine acceptance as they come in contact with parents throughout the office visit. CDC has launched a new free Continuing Education (CE) activity titled “How Nurses and Medical Assistants can Foster a Culture of Immunization in the Practice.” The new CE activity teaches practical strategies to improve vaccination coverage in the practice, including how to deliver clear and concise vaccine recommendations and address parents’ frequently asked questions. Speakers include Virginia Chambers, director of the Medical Assisting program at Portland Community College, and Andrea Polkinghorn, enterprise immunization strategy leader at Sanford Health.

Redesigned HPV Vaccine Website for Health Care Professionals: As part of its effort to optimize digital content for use on multiple devices, CDC has redesigned the HPV vaccine website for health care professionals. The new website includes HPV cancer statistics, continuing education resources, tips for answering parents’ questions, and more. It also features a new page on HPV vaccine safety and effectiveness data, which outlines the key data that health care professionals need to know as they address questions from parents. Please share this new resource with colleagues or members of your health care professional association.

Release of Functional Standards v4.1: Immunization Information System (IIS) Functional Standards v4.1 are now available on the IIS web page. The update includes changes to the IIS Functional Standard (18.0) and Operational Guidance Statements related to vaccination coverage assessment. They were updated in 2019 to reflect the Vaccine for Children program’s launch of Immunization Quality Improvement for Providers (IQIP), which replaced Assessment Feedback Incentive eXchange. (AFIX). The subject matter expert workgroup and the IIS community provided vital input on the updates.

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 will need to sign up and log in as a member to view the commentaries and registration is free.

Immunization Resources: Various 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.” The 2020 recommended immunization schedules will be available in early March.

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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