Immunization Works April 2020
April 28, 2020: Content on this page kept for historical reasons.
Top Stories
COVID-19 Update: Pandemic spread of the 2019 coronavirus disease (COVID-19) is a serious threat to communities and health care systems across the country. As of April 9, nearly 80 COVID-19 vaccine candidates [32 pages] were reported to be under development worldwide, primarily in the pre clinical stage. Multiple vaccine technologies are under evaluation, including subunit, nucleic acid, virus vector, and live attenuated virus vaccines. Many of these vaccines target the spike (S) protein of SARS-CoV-2, which is a major virulence factor as it mediates viral attachment and entry to the host cell.
One candidate vaccine is currently in Phase II clinical trials:
- An adenovirus type 5 vector vaccine, China
Four candidate vaccines are currently undergoing Phase I clinical trials:
- A messenger ribonucleic acid (mRNA) vaccine (mRNA-1273, Moderna TX, Inc.), U.S.
- A deoxyribonucleic acid (DNA) vaccine (INO-4800, Inovio Pharmaceuticals, Inc.), U.S.
- A lentiviral vector vaccine (pathogen-specific aAPC, Shenzhen Geno-Immune Medical Institute), China
- A lentiviral vector vaccine with cytoxic T lymphocytes (LV-SMENP-DC, Shenzhen Geno-Immune Medical Institute), China
The mRNA and DNA technologies used for the first COVID-19 vaccine clinical trials in the U.S. are novel, with no licensed human vaccine products. These technologies have the advantages of rapid vaccine development and scale-up, and thus have been used to develop candidate vaccines for other pathogens that are emerging or have pandemic potential.
Results of these and additional clinical trials will be necessary to demonstrate safety and efficacy of these and other COVID-19 vaccines in the development pipeline. An Advisory Committee on Immunization Practices (ACIP) COVID-19 vaccine work group has recently been initiated to help inform ACIP’s recommendations on potential use of COVID-19 vaccines in the U.S.
Maintaining Clinical Preventive Services, Including Immunizations, During the COVID-19 Pandemic The COVID-19 pandemic is changing rapidly and continues to affect communities across the U.S. in different ways. Clinicians must maintain access to clinical services in environments that are safe for all. Some of the strategies [1 page] used to slow the spread of disease in communities include postponing or cancelling non-urgent elective procedures and using telemedicine instead of face-to-face encounters for routine medical services.
Clinics Working with Children: Health care providers in communities affected by COVID-19 are using strategies to separate well visits from sick visits. Examples include:
- Scheduling well visits in the morning and sick visits in the afternoon
- Separating patients by placing patients with sick visits in different areas of the clinic or at a different location from patients with well visits
- Collaborating with providers in the community to identify separate locations for holding well visits for children
Because of personal, practice, or community circumstances related to COVID-19, some providers may not be able to provide well-child visits or vaccinations for all patients in their practice. If a practice can provide only limited well-child visits, health care providers are encouraged to prioritize newborn care and vaccination of infants and young children (through 24 months of age) when possible.
Clinics Working with Adults: Delivery of some clinical preventive services for adults, such as immunizations, requires face-to-face encounters and in areas with community transmission of SARS-CoV-2, these should be postponed except when:
- An in-person visit must be scheduled for some other purpose and the clinical preventive service can be delivered during that visit with no additional risk.
- An individual patient and their clinician believe there is a compelling need to receive the service because the potential benefit outweighs the risk of exposure to the virus that causes COVID-19.
CDC is monitoring the situation and will continue to provide guidance for adult recommendations and for pediatric recommendations.
Vaccine Information Statements (VISs): Updated VISs for DTaP (diphtheria, tetanus, pertussis), Td (tetanus, diphtheria) , Tdap (tetanus, diphtheria, pertussis), yellow fever, and multiple vaccines (DTaP, Hib, hepatitis B, polio, and PCV13) have been posted. The multiple vaccines VIS may be used in place of the individual VISs for DTaP, Hib, hepatitis B, polio, and PCV13 when two or more of these vaccines are administered during the same visit. It may be used for infants through children receiving their routine vaccines at age 4–6 years. We encourage providers to begin using these VISs immediately, but stocks of the previous editions may be used until they run out. For more information please visit the VIS website.
MMWR
Progress Toward Measles Elimination in the Eastern Mediterranean Region, 2013–2019: In 1997, during the 41st session of the Regional Committee for the Eastern Mediterranean, the 21 countries in the World Health Organization (WHO) Eastern Mediterranean Region (EMR) passed a resolution to eliminate measles. In 2015, this goal was included as a priority in the Eastern Mediterranean Vaccine Action Plan 2016–2020 (EMVAP), endorsed at the 62nd session of the Regional Committee. To achieve this goal, the WHO Regional Office for the Eastern Mediterranean developed a four-pronged strategy: 1) achieve more than 95% vaccination coverage with the first dose of measles-containing vaccine (MCV1) among children in every district of each country through routine immunization services; 2) achieve more than 95% vaccination coverage with a second MCV dose (MCV2) in every district of each country either through implementation of a routine 2-dose vaccination schedule or through supplementary immunization activities (SIAs); 3) conduct high-quality, case-based surveillance in all countries; and 4) provide optimal measles clinical case management, including dietary supplementation with vitamin A. The April 17 MMWR describes progress toward measles elimination in EMR during 2013–19 and updates a previous report. Estimated MCV1 coverage increased from 79% in 2013 to 82% in 2018. MCV2 coverage increased from 59% in 2013 to 74% in 2018. In addition, during 2013–19, approximately 326.4 million children received MCV during SIAs. Reported confirmed measles incidence increased from 33.5 per 1 million persons in 2013 to 91.2 in 2018, with large outbreaks occurring in Pakistan, Somalia, and Yemen; incidence decreased to 23.3 in 2019. In 2019, the rate of discarded nonmeasles cases was 5.4 per 100,000 population. To achieve measles elimination in the EMR, increased visibility of efforts to achieve the measles elimination goal is critically needed, as are sustained and predictable investments to increase MCV1 and MCV2 coverage, conduct high-quality SIAs, and reach populations at risk for not accessing immunization services or living in areas with civil strife.
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 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: The 2020 child and adolescent immunization schedule and adult immunization schedule were the topics for the most recent Current Issues in Immunization webinar on March 18, 2020. These webinars, held several times during the year, are designed to provide clinicians with the most up-to-date information on immunizations. The 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. View the webinar web page for additional information and archived webinars.
CDC Immunization Champion Award Update: The National Center for Immunization and Respiratory Diseases (NCIRD) has postponed announcing winners of the 2020 Childhood Immunization Champion Award and the 2020 HPV is Cancer Prevention Award. NCIRD is currently evaluating how to move forward with these award programs and will notify state grantees and partners of the new timeline in the future. We greatly value the work that health care providers, public health professionals, and other immunization partners are doing to ensure that their communities are protected from vaccine-preventable diseases and look forward to recognizing their work next year.
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 Rotavirus, DTaP, and Tdap 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.
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 Vaccine [1 page]” handout for prenatal care providers to help address commonly asked questions about vaccines during pregnancy.
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.
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. Check out the newest video titled, “Updated Pneumococcal Vaccine Recommendations for Older Adults,” to hear considerations for the shared clinical decision-making recommendation. 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.” Hard copies of the 2020 recommended immunization schedules are now available for ordering and the schedules are free of charge.
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.
Calendar of Events
ACIP Meeting, June 24–25, 2020, Atlanta, GA
Pink Book Training, Indiana Immunization Coalition and CDC, July 13–14, 2020, Plainfield, IN
North Dakota Immunization Conference, North Dakota Department of Health, July 14–15, 2020, Bismarck, ND
American Immunization Registry Association (AIRA) National Meeting, August 11–13, 2020, Portland, OR
Tennessee Immunization Summit, Tennessee Department of Health, August 21, 2020, Franklin, TN
Vaccine Summit Ohio, American Public Health Association, October 5–7, 2020, Columbus, OH
ACIP Meeting, October 28–29, 2020, Atlanta, GA