Immunization Works October 2020

November 5, 2020: Content on this page kept for historical reasons.

Top Stories

New COVID-19 Vaccine Web Pages: CDC has added vaccine-specific content to its extensive COVID-19 website. CDC’s new resources include information on vaccination planning and vaccine safety, as well as frequently asked questions. These resources are intended to build trust and confidence in future COVI9-19 vaccines by clarifying how COVID-19 vaccine recommendations will be made and how the vaccines will be monitored.

Look for frequent updates to this website and CDC’s Vaccines and Immunization website as more information becomes available and as vaccines are authorized or approved and recommended for use in the United States. CDC is committed to ensuring jurisdictions and federal entities that will be receiving vaccine have the needed information and guidance to implement an effective COVID-19 vaccination program.

HHS Video “Tell Me More About Vaccines”: HHS recently released a video entitled “Tell Me More About Vaccines” to help answer commonly asked questions about the COVID-19 vaccine. The video shares why vaccines are so important and provides expert commentary and graphic illustration to help viewers understand the science of vaccine development. Tune in to hear from various experts including Dr. Anthony Fauci (NIH), Dr. Stephen Hahn (FDA), and Dr. Robert Kadlec (ASPR), on the steps researchers and scientists are taking to develop a safe and effective vaccine. You are encouraged to add the video link to your website or promote it on social media.

Childhood Vaccination Coverage: The COVID-19 pandemic that has disrupted our lives so much this year also severely impacted delivery of ambulatory medical services, especially in the spring. We saw dramatic drops in provider ordering of public-sector childhood vaccines beginning in mid-March. Since then, as well-child visits have resumed, ordering has increased, but there still remains a substantial deficit compared with last year. That shortfall represents about 9 million doses, including almost a million doses of measles-containing vaccine (either MMR or MMRV) and more than a million doses of HPV vaccine. Claims data suggest that recovery has been faster on the private-sector side, highlighting the need for additional focus on populations eligible for the Vaccines for Children program.

We know that if children don’t get caught up on vaccine doses they missed earlier this year, they will be left vulnerable to diseases that otherwise could have been prevented. There is an urgent need to work together to get children back into their healthcare providers’ offices for well-child visits and vaccinations that were missed earlier this year. CDC recently published vaccination coverage data from our 2019 National Immunization Survey. If we don’t act now, we can expect childhood vaccination coverage in 2020 to be much lower than our report for last year.

Health care systems and health care providers can:

• Identify families whose children have missed doses and contact them to schedule appointments.
• Prompt clinicians when these children are seen to deliver vaccines that are due or overdue.
• Let families know what precautions are in place for safe delivery of in-person services.
• Encourage members to identify and follow up with families whose children have missed doses to get appointments scheduled.

State government agencies can:

• Send reminders to families about school immunization requirements.
• Implement follow-up for children who are not in compliance with requirements to encourage compliance.
• Use the state immunization information system’s reminder-recall capacity to notify families whose children have fallen behind on vaccinations.

We all can:

• Communicate directly to families the importance of well child visits and getting caught up on any recommended vaccines that were missed.

Updates to the Interim Guidance for Routine and Influenza Immunization Services During the COVID-19 Pandemic: CDC recently added a new section to the webpage Interim Guidance for Immunization Services During the COVID-19 Pandemic. The section, entitled, Additional Considerations for Influenza Vaccination of Persons in Healthcare Facilities and Congregate Settings During the COVID-19 Pandemic, provides recommendations specific for individuals living in supportive/congregate settings (such as long-term care facilities, group homes and shelters). General measures for COVID-19 infection prevention and control are discussed, along with vaccination recommendations for patients who have come in close contact with an individual with COVID-19, patients with asymptomatic or pre-symptomatic COVID-19, and patients with symptomatic COVID-19.

Updates were also made related to vaccinating persons with suspected or confirmed COVID-19 or in quarantine because of COVID-19 exposure. The section, “Deferring Routine Vaccination Visits for Persons with Suspected or Confirmed COVID-19 Who are In Isolation or Persons with A Known COVID-19 Exposure Who Are in Quarantine,” recommends postponing all vaccination visits for these individuals:

1. Asymptomatic and pre-symptomatic persons who have tested positive: 10 days from a positive test result
2. Symptomatic persons: Met criteria to discontinue isolation; 10 days after symptom onset and 24 hours with no fever without the use of fever-reducing medications, and COVID-19 symptoms improving; and no longer moderately to severely ill
3. Persons exposed to a person with COVID-19: After 14-day quarantine period has ended

See the section for additional guidance.

Other specific topics covered are considerations for routine vaccination, advice regarding vaccination of people with suspected or confirmed COVID-19, infection prevention practices, personal protective equipment(PPE), and strategies for promoting catch-up immunizations. This guidance will be updated as the COVID-19 pandemic evolves.

We encourage you to share this guidance widely.

Mass Vaccination Clinic Guidance: CDC has issued revised Guidance for Planning Vaccination Clinics Held at Satellite, Temporary, or Off-Site Locations to assist with jurisdictional planning and implementation of satellite, temporary, or off-site vaccination clinics by public and private vaccination organizations.

The guidance is broken down into four categories:

• Planning activities
• Pre-clinic activities
• During the clinic activities
• Post-clinic activities

The guidance also provides information on additional considerations are required during the COVID-19 pandemic, including physical distancing, personal protective equipment (PPE), and enhanced sanitation efforts.

Morbidity and Mortality Weekly Report (MMWR)

Vaccination Coverage by Age 24 Months Among Children Born in 2016 and 2017–National Immunization Survey-Child, U.S., 2017–2019: Immunization has been described as a “global health and development success story,” and is estimated to prevent 2 to 3 million global deaths annually. In the U.S., the Advisory Committee on Immunization Practices (ACIP) currently recommends vaccination against 14 potentially serious illnesses by the time a child reaches 24 months of age. CDC monitors coverage with ACIP-recommended vaccines through the National Immunization Survey-Child (NIS-Child); data from the survey were used to estimate vaccination coverage at the national, regional, state, territorial, and selected local area levels among children born in 2016 and 2017. National coverage by age 24 months was at least 90% for ≥3 doses of poliovirus vaccine, ≥3 doses of hepatitis B vaccine (HepB), ≥1 dose of varicella vaccine (VAR), and ≥1 dose of measles, mumps, and rubella vaccine (MMR), although 14 states had MMR coverage less than 90%. Coverage with ≥2 doses of influenza vaccine was higher for children born during 2016–17 (58.1%) compared to 2014–15 (53.8%) but was the lowest among all vaccines studied. Only 1.2% of children had received no vaccinations by age 24 months. Children enrolled in Medicaid or with no health insurance had lower vaccination coverage compared with privately insured children and a higher prevalence of being completely unvaccinated (Medicaid: 1.3% unvaccinated; uninsured: 4.1% unvaccinated; private insurance: 0.8% unvaccinated). The largest disparities by health insurance status occurred for ≥2 doses of influenza vaccine and for rotavirus vaccination. Considering the disruptions to health care provider operations caused by the COVID-19 pandemic, extra effort will be required to achieve and maintain high levels of coverage with routine childhood vaccinations. This will be especially important for 2020–21 seasonal influenza vaccination to mitigate the effect of two potentially serious respiratory viruses circulating in the community simultaneously. Read the October 23 MMWR for the full report.

Influenza and Tdap Vaccination Coverage Among Pregnant Women in the U.S., April 2020: Vaccination of pregnant women with influenza vaccine and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) can decrease the risk for influenza and pertussis among pregnant women and their infants. ACIP recommends that all women who are or might be pregnant during the influenza season receive influenza vaccine, which can be administered at any time during pregnancy. ACIP also recommends that women receive Tdap during each pregnancy, preferably during the early part of gestational weeks 27–36. Despite these recommendations, vaccination coverage among pregnant women has been found to be suboptimal, with racial/ethnic disparities persisting. To assess influenza and Tdap vaccination coverage among pregnant women during the 2019–20 influenza season, CDC analyzed data from an Internet panel survey conducted during April 2020. Among 1,841 survey respondents who were pregnant anytime during October 2019–January 2020, 61.2% reported receiving influenza vaccine before or during their pregnancy, an increase of 7.5 percentage points compared with the rate during the 2018–19 season. Among 463 respondents who had a live birth by their survey date, 56.6% reported receiving Tdap during pregnancy, similar to the 2018–19 season. Vaccination coverage was highest among women who reported receiving a provider offer of or referral for vaccination (influenza=75.2%; Tdap=72.7%). Compared with the 2018–19 season, increases in influenza vaccination coverage were observed during the 2019–20 season for non-Hispanic Black (Black) women (14.7 percentage points, to 52.7%), Hispanic women (9.9 percentage points, to 67.2%), and women of other non-Hispanic (other) races (7.9 percentage points, to 69.6%), and did not change for non-Hispanic White (White) women (60.6%). As in the 2018–19 season, Hispanic and Black women had the lowest Tdap vaccination coverage (35.8% and 38.8%, respectively), compared with White women (65.5%) and women of other races (54.0%); in addition, a decrease in Tdap vaccination coverage was observed among Hispanic women in 2019–20 compared with the previous season. Racial/ethnic disparities in influenza vaccination coverage decreased but persisted, even among women who received a provider offer of or referral for vaccination. Consistent provider offers or referrals, in combination with conversations culturally and linguistically tailored for patients of all races/ethnicities, could increase vaccination coverage among pregnant women in all racial/ethnic groups and reduce disparities in coverage. Read the full report in the October 2 MMWR.

Resources and Information

Zostavax Expiration Date Reminder: The Zostavax vaccine, which is no longer sold in the United States, expires November 18, 2020. After that date, healthcare providers who have any remaining Zostavax vaccine in stock should discard the vaccine following medical waste disposal requirements. Since some pharmacies and clinics may still have Zostavax still in stock, please take an opportunity to remind providers about the upcoming expiration date.

Strengthening Vaccine Confidence in Pediatric and Family Practice Offices During the COVID-19 Pandemic Webinar: CDC and the Public Health Foundation hosted a webinar on August 19, 2020, about how to strengthen vaccine confidence among parents, ensure safe well-child visits, and implement CDC guidance for immunization during the COVID-19 pandemic. Speakers included CAPT Sarah Schillie and Jessica MacNeil from NCIRD’s Immunization Services Division. View the archived webinar.

Epidemiology and Prevention of Vaccine-Preventable Diseases (the Pink Book) 2020 Video Series: CDC is offering a series of weekly, one-hour, web-on-demand videos that provide an overview of vaccination principles, general best practices, immunization strategies, and specific information about vaccine-preventable diseases and the vaccines that prevent them. Each video will include updated information from recent Advisory Committee on Immunization Practices (ACIP) meetings and votes. The series started July 1, 2020, and ended October 14, 2020. This year, because of limited staff availability during the ongoing COVID-19 response, the videos were prerecorded rather than live webinars. Visit the Pink Book video series web page for the videos and additional information. Continuing Education (CE) will be available for each video.

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. A certificate of completion and/or Continuing Education (CE) is available for those that complete the training.

“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 Storage and Handling Toolkit: The Vaccine Storage and Handling Toolkit is a comprehensive guide that describes best practices for vaccine storage and handling from ACIP recommendations, product information from vaccine manufacturers, and scientific studies.

Current Issues in Immunization Webinars (CIIW): The latest webinar on October 21, 2020, offered an update on the recommendations for the 2020–21 influenza season. The webinars, held several times during the year, are designed to provide clinicians with the most up-to-date information on immunization. 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. The latest webinar, archived webinars, and additional information are available on the CIIW web page.

Vaccines for Children (VFC) Fact Sheet for Providers: CDC has posted a new VFC fact sheet for health care providers. This accompanies the updated VFC fact sheet for parents that was recently posted in English and Spanish.

“#HowIRecommend” Videos: CDC has posted 19 “#HowIRecommend” videos featuring three new health care professionals. In these one-minute videos they discuss how to address parents’ questions about vaccine safety, how they recommend flu vaccine, how they foster support for immunization in the practice, and more. View videos by Neonatologist Dr. Shetal Shah, Registered Nurse Andrea Polkinghorn, and Certified Medical Assistant Virginia Chambers.

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 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.

Updated Infographic: HPV is the Best Protection Against 6 Types of Cancer: CDC has updated its “HPV iceberg” infographic to include the latest data about HPV cancers. Share it on social media or download and print it to post in provider offices.

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.” Free hard copies of the 2020 recommended immunization schedules are now available for ordering.

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

Clinical Vaccinology Course (virtual event), National Foundation for Infectious Diseases (NFID), November 15–17, 2020.

ACIP Meeting, February 24–25, 2021, Atlanta, GA

Vaccine Summit Ohio, March 1–3, 2021, Columbus, OH

Massachusetts Adult Immunization Conference, April 13, 2021, Framingham, MA

North Dakota Immunization Conference, June 22–23, 2021, Bismarck, ND

ACIP Meeting, June 23–24, 2021, Atlanta, GA

ACIP Meeting, October 20–21, 2021, Atlanta, GA

NCIRD Calendar of Events

Immunization Action Coalition (IAC) Calendar