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Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP)

September 23, 2014 Comments off

Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP)
Source: Morbidity and Mortality Weekly Report (CDC)

A single dose of PPSV23 is recommended for routine use in the United States among adults aged ≥65 years. Effectiveness of PPSV23 in preventing IPD in adults has been demonstrated, but the data on the effectiveness of this vaccine in preventing noninvasive pneumococcal pneumonia among adults aged ≥65 years have been inconsistent. PPSV23 contains 12 serotypes in common with PCV13 and 11 additional serotypes. In 2013, 38% of IPD among adults aged ≥65 years was caused by serotypes unique to PPSV23. Given the high proportion of IPD caused by serotypes unique to PPSV23, broader protection is expected to be provided through use of both PCV13 and PPSV23 in series. ACIP considered multiple factors when determining the optimal interval between a dose of PCV13 and PPSV23, including immune response, safety, the risk window for protection against disease caused by serotypes unique to PPSV23, as well as timing for the next visit to the vaccination provider.

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National, State, and Selected Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2013

September 16, 2014 Comments off

National, State, and Selected Local Area Vaccination Coverage Among Children Aged 19–35 Months — United States, 2013
Source: Morbidity and Mortality Weekly Report (CDC)

In the United States, among children born during 1994–2013, vaccination will prevent an estimated 322 million illnesses, 21 million hospitalizations, and 732,000 deaths during their lifetimes (1). Since 1994, the National Immunization Survey (NIS) has monitored vaccination coverage among children aged 19–35 months in the United States. This report describes national, regional, state, and selected local area vaccination coverage estimates for children born January 2010–May 2012, based on results from the 2013 NIS. In 2013, vaccination coverage achieved the 90% national Healthy People 2020 target* for ≥1 dose of measles, mumps, and rubella vaccine (MMR) (91.9%); ≥3 doses of hepatitis B vaccine (HepB) (90.8%); ≥3 doses of poliovirus vaccine (92.7%); and ≥1 dose of varicella vaccine (91.2%). Coverage was below the Healthy People 2020 targets for ≥4 doses of diphtheria, tetanus, and pertussis vaccine (DTaP) (83.1%; target 90%); ≥4 doses of pneumococcal conjugate vaccine (PCV) (82.0%; target 90%); the full series of Haemophilus influenzae type b vaccine (Hib) (82.0%; target 90%); ≥2 doses of hepatitis A vaccine (HepA) (54.7%; target 85%); rotavirus vaccine (72.6%; target 80%); and the HepB birth dose (74.2%; target 85%).† Coverage remained stable relative to 2012 for all of the vaccinations with Healthy People 2020 objectives except for increases in the HepB birth dose (by 2.6 percentage points) and rotavirus vaccination (by 4.0 percentage points). The percentage of children who received no vaccinations remained below 1.0% (0.7%). Children living below the federal poverty level had lower vaccination coverage compared with children living at or above the poverty level for many vaccines, with the largest disparities for ≥4 doses of DTaP (by 8.2 percentage points), full series of Hib (by 9.5 percentage points), ≥4 doses of PCV (by 11.6 percentage points), and rotavirus (by 12.6 percentage points). MMR coverage was below 90% for 17 states. Reaching and maintaining high coverage across states and socioeconomic groups is needed to prevent resurgence of vaccine-preventable diseases.

Notes from the Field: Hospitalizations for Respiratory Disease Among Unaccompanied Children from Central America — Multiple States, June–July 2014

August 18, 2014 Comments off

Notes from the Field: Hospitalizations for Respiratory Disease Among Unaccompanied Children from Central America — Multiple States, June–July 2014
Source: Morbidity and Mortality Weekly Report (CDC)

During October 2013–June 2014, approximately 54,000 unaccompanied children, mostly from the Central American countries of El Salvador, Guatemala, and Honduras, were identified attempting entry into the United States from Mexico, exceeding numbers reported in previous years (1). Once identified in the United States, U.S. Customs and Border Protection, an agency of the U.S. Department of Homeland Security, processes the unaccompanied children and transfers them to the Office of Refugee Resettlement (ORR), an office of the Administration for Children and Families, U.S. Department of Health and Human Services. ORR cares for the children in shelters until they can be released to a sponsor, typically a parent or relative, who can care for the child while their immigration case is processed. In June 2014, in response to the increased number of unaccompanied children, U.S. Customs and Border Protection expanded operations to accommodate children at a processing center in Nogales, Arizona. ORR, together with the U.S. Department of Defense, opened additional large temporary shelters for the children at Lackland Air Force Base, Texas; U.S. Army Garrison Ft. Sill, Oklahoma; and Naval Base Ventura County, California.

On July 10, 2014, CDC was informed by the California Department of Public Health and ORR about four unaccompanied male children aged 14–16 years with respiratory illnesses at Naval Base Ventura County, three of whom were hospitalized with pneumonia. Among the three patients with pneumonia, two were bacteremic with Streptococcus pneumoniae, ultimately determined to be serotype 5, one of whom also had laboratory-confirmed influenza B virus by polymerase chain reaction (PCR). The fourth patient, without pneumonia, had PCR-confirmed influenza A(H1N1)pdm09. Pneumococcal bacteremia is uncommon among U.S. adolescents, particularly serotype 5, with only three such cases identified in the past 10 years by CDC (2). In addition, influenza activity in the United States is typically lowest in the middle of summer, and Ventura County had no reports of an unusual increase in influenza activity in the community at the time. ORR asked CDC to investigate the scope of this apparent outbreak and implement measures to interrupt transmission.

During July 6–19, 2014, CDC was informed of other clusters of hospitalized children with respiratory disease, increasing the total to 16 cases. The cases were from Naval Base Ventura County (eight cases), Ft. Sill (three), Lackland Air Force Base (two), a standard ORR shelter near Houston, Texas (two), and the Nogales processing center (one). Cases were in persons aged 14–17 years. Diagnoses included laboratory-confirmed pneumococcal pneumonia with laboratory-confirmed influenza (three cases) and without laboratory-confirmed influenza (four cases), influenza pneumonia (one case), and pneumonia with no identified etiology (eight cases). Five patients experienced septic shock requiring intensive care. No case was fatal. All six cases for which pneumococcal isolates were available were identified as serotype 5, a serotype included in 13-valent pneumococcal conjugate vaccine (PCV13) (Prevnar-13, Pfizer). Of the 16 patients identified in this cluster, 11 were tested for influenza viruses; four (36%) were positive (two for influenza A[H1N1]pdm09, one for influenza B, and one for influenza A by rapid test).

Because of the concern that unaccompanied children were at increased risk for influenza and pneumococcal pneumonia in this outbreak setting and the clinically important interaction between influenza and pneumococcal infections (3), CDC recommended that all children residing in temporary or standard ORR shelters receive influenza vaccine and PCV13 in addition to routinely recommended vaccines. Approximately 2,000 children in four affected shelters were vaccinated during July 18–30 with PCV13 and with Food and Drug Administration–approved extended expiration date–specific lots of 2013–14 seasonal influenza vaccine, which includes influenza A(H1N1)pdm09 and influenza B viruses. The shelters reported no serious adverse events.

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP) — United States, 2014–15 Influenza Season

August 15, 2014 Comments off

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP) — United States, 2014–15 Influenza Season
Source: Morbidity and Mortality Weekly Report (CDC)

This report updates the 2013 recommendations by the Advisory Committee on Immunization Practices (ACIP) regarding use of seasonal influenza vaccines (1). Updated information for the 2014–15 influenza season includes 1) antigenic composition of U.S. seasonal influenza vaccines; 2) vaccine dose considerations for children aged 6 months through 8 years; and 3) a preference for the use, when immediately available, of live attenuated influenza vaccine (LAIV) for healthy children aged 2 through 8 years, to be implemented as feasible for the 2014–15 season but not later than the 2015–16 season. Information regarding issues related to influenza vaccination not addressed in this report is available in the 2013 ACIP seasonal influenza recommendations (1).

Notes from the Field: Outbreak of Pertussis in a School and Religious Community Averse to Health Care and Vaccinations — Columbia County, Florida, 2013

August 3, 2014 Comments off

Notes from the Field: Outbreak of Pertussis in a School and Religious Community Averse to Health Care and Vaccinations — Columbia County, Florida, 2013
Source: Morbidity and Mortality Weekly Report (CDC)

On August 30, 2013, the Florida Department of Health in Columbia County was notified of a Bordetella pertussis laboratory-positive unimmunized child attending a local charter school (316 students from pre-K through 8th grade) in a large religious community averse to health care and vaccinations. Kindergarten immunization records showed that only five (15%) of 34 students were fully immunized with pertussis-antigen–containing vaccines. In seventh grade, only one (5%) of 22 students was fully immunized with pertussis-antigen–containing vaccines. Of the children who were not fully immunized in these two grades, 84% had religious exemptions (1).

Interviews confirmed that a sibling of the patient had symptoms consistent with pertussis. By September 3, two additional children from the same school were confirmed by polymerase chain reaction to have pertussis. On September 12, the Florida Department of Health in Columbia County declared a communicable disease emergency; children with cough illness were excluded from school, and reentry required an evaluation by a health care provider. After this declaration, 38 additional students were excluded. Prophylaxis or treatment with antibiotics following current guidelines were provided to patients and household contacts (2). The local health department offered to provide these services free of charge to persons without health care coverage. Pertussis vaccine administered at the health department was available; however, fewer than five persons from the community used this opportunity for vaccination.

Human Papillomavirus Vaccination Coverage Among Adolescents, 2007–2013, and Postlicensure Vaccine Safety Monitoring, 2006–2014 — United States

July 30, 2014 Comments off

Human Papillomavirus Vaccination Coverage Among Adolescents, 2007–2013, and Postlicensure Vaccine Safety Monitoring, 2006–2014 — United States
Source: Morbidity and Mortality Weekly Report (CDC)

Since mid-2006, a licensed human papillomavirus (HPV) vaccine has been available and recommended by the Advisory Committee on Immunization Practices (ACIP) for routine vaccination of adolescent girls at ages 11 or 12 years (1). Two vaccines that protect against HPV infection are currently available in the United States. Both the quadrivalent (HPV4) and bivalent (HPV2) vaccines protect against HPV types 16 and 18, which cause 70% of cervical cancers; HPV4 also protects against HPV types 6 and 11, which cause 90% of genital warts (1,2). In 2011, the ACIP also recommended HPV4 for the routine vaccination of adolescent boys at ages 11 or 12 years (3). HPV vaccines can be safely co-administered with other routinely recommended vaccines, and ACIP recommends administration of all age-appropriate vaccines during a single visit (4). To assess progress with HPV vaccination coverage among adolescents aged 13–17 years,* characterize adherence with recommendations for HPV vaccination by the 13th birthday, and describe HPV vaccine adverse reports received postlicensure, CDC analyzed data from the 2007–2013 National Immunization Survey-Teen (NIS-Teen) and national postlicensure vaccine safety data among females and males. Vaccination coverage with ≥1 dose of any HPV vaccine increased significantly from 53.8% (2012) to 57.3% (2013) among adolescent girls and from 20.8% (2012) to 34.6% (2013) among adolescent boys. Receipt of ≥1 dose of HPV among girls by age 13 years increased with each birth cohort; however, missed vaccination opportunities were common. Had HPV vaccine been administered to adolescent girls born in 2000 during health care visits when they received another vaccine, vaccination coverage for ≥1 dose by age 13 years for this cohort could have reached 91.3%. Postlicensure monitoring data continue to indicate that HPV4 is safe. Improving practice patterns so that clinicians use every opportunity to recommend HPV vaccines and address questions from parents can help realize reductions in vaccine-preventable infections and cancers caused by HPV.

National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2013

July 30, 2014 Comments off

National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2013
Source: Morbidity and Mortality Weekly Report (CDC)

The Advisory Committee on Immunization Practices (ACIP) recommends that adolescents routinely receive 1 dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine, 2 doses of meningococcal conjugate (MenACWY) vaccine, and 3 doses of human papillomavirus (HPV) vaccine (1,2).* ACIP also recommends administration of “catch-up”† vaccinations, such as measles, mumps, and rubella (MMR), hepatitis B, and varicella, and, for all persons aged ≥6 months, an annual influenza vaccination (1). ACIP recommends administration of all age-appropriate vaccines during a single visit (3). To assess vaccination coverage among adolescents aged 13–17 years, CDC analyzed data from the 2013 National Immunization Survey-Teen (NIS-Teen).§ This report summarizes the results of that analysis, which show that from 2012 to 2013, coverage increased for each of the vaccines routinely recommended for adolescents: from 84.6% to 86.0% for ≥1 Tdap dose; from 74.0% to 77.8% for ≥1 MenACWY dose; from 53.8% to 57.3% for ≥1 HPV dose among females, and from 20.8% to 34.6% for ≥1 HPV dose among males. Coverage varied by state and local jurisdictions and by U.S. Department of Health and Human Services (HHS) region. Healthy People 2020 vaccination targets for adolescents aged 13–15 years (4) were reached in 42 states for ≥1 Tdap dose, 18 for ≥1 MenACWY dose, and 11 for ≥2 varicella doses. No state met the target for ≥3 HPV doses.¶ Use of patient reminder and recall systems, immunization information systems, coverage assessment and feedback to clinicians, clinician reminders, standing orders, and other interventions can help make use of every health care visit to ensure that adolescents are fully protected from vaccine-preventable infections and cancers (5), especially when such interventions are coupled with clinicians’ vaccination recommendations.

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