Volume 17 – Number 1 February 2013
VACCINATE ADULTS!from the Immunization Action Coalition — www.immunize.org
(Content current as of Feb. 20)
What’s In This Issue
Immunization questions?• CalltheCDC-INFOContactCenterat
(800)232-4636or(800)CDC-INFO• [email protected]• Callyourstatehealthdept.(phonenumbers
atwww.immunize.org/coordinators)
Ask the ExpertsIAC extends thanks to our experts, medical epi-demiologist Andrew T. Kroger, MD, MPH; nurse educator Donna L. Weaver, RN, MN; and medical officer Iyabode Akinsanya-Beysolow, MD, MPH. All are with the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC).
Why Give Tdap during Each Pregnancy? ......... 1Ask the Experts: CDC answers questions ......... 1
New! IAC Launches Major Redesign of vaccineinformation.org ..................................... 2
Vaccine Highlights: Recommendations, schedules, and more ......................................... 4
IAC Welcomes Dr. Litjen (L.J) Tan as Chief Strategy Officer ....................................... 5
Summary of Recommendations for Adult Immunization ..................................................... 6
Pneumococcal Vaccines — CDC answers your questions ................................................... 10
New! Pneumococcal Vaccination Recommendations by Age/Risk Factor ............. 11
Do I Need Any Vaccinations Today? ................. 12
IAC’s Immunization Resources Order Form ...... 14
(continued on page 5)
Immunization questionsIs it still acceptable to use combination household units for storing vaccines? CDCstronglyrecommendsusingstand-alonere-frigeratorsandfreezersforthefollowingreasons:•Mostcombinationhouseholdrefrigerator/freez-
ershaveacombinedtemperaturecontrolunitthatcancreatecoldspotsandtemperaturefluctua-tionsintherefrigeratorportionoftheunit.
•Theriskoffreezedamagetorefrigeratedvac-cinesisincreasedincombinationunitsbecauseairfromthefreezerisventedintotherefrigeratortocoolit.Thiscanfreezetemperature-sensitivevaccines.
•Thefreezerportionsofmanycombinationunitsarenotcapableofmaintainingthecorrectstoragetemperatureforfrozenvaccines.
Purchasing new vaccine storage equipment re-quiresplanning,andyoumayneedtouseexistingequipmentforawhileuntilyoucanpurchasenewequipment. In this situation, CDC recommendsusingacombinationrefrigerator/freezerunitforrefrigerated vaccine only and using a separate
stand-alonefreezertostorefrozenvaccines.It is important to note that most combination
refrigerator/freezersshareasinglecondenser,andtheverycoldairfromthefreezercompartmentisventedintotherefrigeratorcompartmenttocooltherefrigerator.Youshouldnotturnoffthefreezerportionofthecombinationunitbecauseitwillnotmaintainthepropertemperaturefortherefriger-atedvaccinesstoredintherefrigeratorportionoftheunit.Ifyouareusingtherefrigeratorportion
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Why Give Tdap during Each Pregnancy?AtitsOctober2012meeting,theAdvisoryCom-mitteeonImmunizationPractices(ACIP)votedtorecommendthathealthcarepersonneladministeradoseofTdapvaccinetopregnantwomendur-ingeachpregnancy—ideallyatbetween27and36weeks’gestation—regardlessofthewoman’spriorhistoryofreceivingTdap.Accordingtoinforma-tionpresentedatthemeeting,Tdapisrecommend-edforeverypregnancyforthefollowingreasons:
Reported cases of pertussis have spiked.AsofOctober 2012, 32,645 pertussis cases had beenreportedintheU.S.fortheyear.Itisanticipatedthatmorecaseswillhavebeenreportedbytheendof2012thaninanyotheryearsince1959.
Youngest infants are the most vulnerable.Amonginfants,thoseyoungerthanage2monthshavethehighestreportedincidenceofpertussiscasesandhighestpercentageofhospitalizationsanddeaths.InfantsthisagearetooyoungtoreceiveeventhefirstdoseintheDTaPseries.Therefore,wemustprotectthemthrough other means.
Vaccinating the mother during pregnancy can protect the youngest infants.Severalstudiespro-videevidencesupportingtheexistenceofefficienttransplacentaltransferofpertussisantibodies.Thisislikelytoprovideprotectionearlyinaninfant’slife,beforeheorsheisoldenoughtobegintheprimaryDTaPseries.
Tdap given at one pregnancy provides insufficient
protection for subsequent pregnancies.Inhealthynon-pregnantadultswhoreceivedTdap,antibodylevelspeakedduringthefirstmonthaftervaccina-tion.Thiswas followedby substantial antibodydecayafteroneyear.ACIPpresentersconcludedthat“antibodyresponseinpregnantwomenwouldnotlikelybemuchdifferent.”
Data support the safety of Tdap for pregnant women and their infants.In2011,ACIPreviewedtheVaccineAdverseEventReportingSystem’ssafety data reports on use of Tdap in pregnantwomen.Thereportsshowednounusualorunex-pected patterns of adverse events. Additionally,TdandTThavebeenusedextensivelyinpregnantwomen,andnoevidenceindicatesthatadminister-ingeithervaccineduringpregnancycausesharmto the fetus.TheACIPpertussisworkinggroupconcluded,“thebenefitsofvaccinationoutweighthetheoreticalrisksofsevereadverseeventswithmultipledosesofTdap.”
AdministeringTdapduringeachpregnancyallowsamothertobuildanimmuneresponseandtransferittoherinfant.Itisastrategythatcanprotectouryoungestinfantsfromaseriousdiseasebeforetheyareoldenoughtobevaccinatedagainstit.
Note: For more information on administering Tdap during pregnancy, see “Ask the Experts” on page 5 of VaccinateAdultsand refer to the materials on CDC’s pertussis web page at www.cdc.gov/pertussis.
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Please note: A clarification has been published for an “Ask the Experts” answer for this issue. To view the clarification, please click here.
Vaccinate Adults! •February2013•ImmunizationActionCoalition•(651)647-9009•www.immunize.org•www.vaccineinformation.org 5
Ask the Experts . . . continued from page 1
of thecombinationunit, it is important thatyounotstorevaccinesdirectlyundertheventcomingfromthefreezerandthatyouaddwaterbottlestotherefrigeratortoabsorbcoldairblowninfromthefreezer.Thiswillreducetheriskofvaccinesbecomingtoocold.
What temperature is considered a temperature excursion on refrigerated vaccine? Frozen vaccine?Anytemperaturereadingsoutsidetherangesnotedbelowareconsideredtemperatureexcursions.•Forrefrigeratedvaccines,theminimumtempera-
tureis35oF(2oC),andthemaximumis46oF(8oC).
•Forfrozenvaccines,theminimumtemperatureis -58o F (-50o C), and the maximum is 5o F(-15oC).
Ifthereisaquestionaboutwhetheravaccinehasbeenexposedtoatemperatureexcursion,labelthevaccines“DONOTUSE”andstore themunderappropriateconditions, separate fromothervac-
cines.Then,contactthevaccinemanufacturerforfurtherguidance.IfyouareaVFCprovider,contacteitherthevaccinemanufacturerand/oryourstateorlocalimmunizationprogramasdirectedbytheVFCPrograminyourarea.
I keep hearing about changes to vaccine stor-age and handling recommendations. Why is CDC making these changes? And how can I make sure I am up to date with all the newest information?Goodquestions!Thewhybehind thesechangeshastwoparts. First, ithadbecomeincreasinglyapparenttoCDCandstatehealthdepartmentsthatimproper vaccine storage and handling is a bigproblem,leadingtoahugewasteofproduct,time,andmoney,andmoreimportantly,tounprotectedpeople.Second,improvedtechnology(e.g.,digi-taldataloggers)providestoolsthatuncoverandmeasureproblemsandalsopreventthem.
As far as how to keep up, on November 27,2012,CDCreleaseditsupdatedVaccine Storage and Handling Toolkit atwww.cdc.gov/vaccines/recs/storage/toolkit/storage-handling-toolkit.pdfandposteditonCDC’sVaccineStorageandHandling Toolkit web section at www.cdc.gov/vaccines/recs/storage/toolkit.TheVaccine Storage and Handling Toolkitisbasedontherecommenda-tionsofACIP,equipmentmanufacturers’productinformation,andstudiesfromtheNationalInstituteforScientificTechnology.Thetoolkitoutlinesbest
practicestrategiesandrecommendationsonthefol-lowingtopics:•Equipmentconsiderationsforstorageunitsand
thermometers•Maintenanceofthecoldchain•Routinestorageandhandlingpractices•Inventorymanagement•Emergency procedures for protecting vaccine
inventoriesEveryvaccineprovidershouldprintoutthisdocu-ment and readand reread it carefully.CDChasprovidedanoverviewofthenewinformationasa separate item at www.cdc.gov/vaccines/recs/storage/interim-storage-handling.pdf, as well asasetofFAQsaboutthenewrecommendationsatwww.cdc.gov/vaccines/recs/storage/interim-faq-storage-handling.pdf.
What are the new ACIP recommendations for vaccinating pregnant women with Tdap?InOctober2012,ACIPvotedtorecommendthata
New!CDC’s Vaccine Storage and Handling Toolkitwww.cdc.gov/vaccines/recs/storage/toolkit
Vaccinate Adults correction policyIfyoufindanerror,pleasenotifyusimmediatelybysendinganemailmessagetoadmin@immunize.org.Wepublishnotificationofsignificanterrors inouremailannouncementservice,IAC Express.Be sure you’re signed up for this service. Tosubscribe,visitwww.immunize.org/subscribe.
(continued on page 13)
TheImmunizationAc-tionCoalition(IAC)ispleased to announcethat Litjen (L.J) Tan,MS, PhD, has comeon board as its chiefstrategyofficer.Inthiscapacity,Dr.Tanwillexpand the alreadyconsiderable rangeof projects that makeIAC a national leaderin immunization edu-cation and policy. He
willalsoleadIAC’sstrategicplanning,whichisaimedatmovingthenation’simmunizationratestothenextlevel,acrosstheagespan.
In speaking about Dr. Tan, Dr. Deborah L.Wexler, executivedirector of IAC, said, “L.J isaworld-class leader inpublichealthandanab-solutelyunique talent.His accomplishments arealready tremendous; for example, he co-found-ed two marvelous national summits that havebrought hundreds of immunization leaders to-getheraspartnersinunprecedentedways.WearethrilledtobeworkingwithL.Jinexpandingandimproving the nation’s immunization servicesandpolicies.”
PriortojoiningIAC,Dr.TanwasthedirectorofmedicineandpublicheathattheAmericanMedi-calAssociation(AMA),apositionheheldsince2008. From 1997 to 2008, he was the AMA’sdirector of infectious disease, immunology, andmolecularmedicine.
Dr. Tan is a voting member of the DepartmentofHealthandHumanServices’NationalVaccineAdvisory Committee, where he served on theadult immunization, vaccine safety, and health-care worker immunization working groups, andiscurrentlychairoftheimmunizationinfrastruc-tureworkinggroup.Healsoservedformorethanten years as the AMA’s liaison to the Centersfor Disease Control and Prevention’s AdvisoryCommitteeonImmunizationPractices,wherehecurrentlyservesontheinfluenza,pneumococcal,zoster,andadultimmunizationworkinggroups.
Heco-foundedandcurrentlyco-chairstheNationalAdultImmunizationSummitandtheNationalIn-fluenzaVaccineSummit.Heservesorhasservedon the steering committees of the 317 Coalition,theNationalNetworkforImmunizationInforma-tion,andtheNationalViralHepatitisRoundtableandontheIACscientificadvisoryboard.In2007,he founded the National Immunization Congressandorganizedits2007and2010meetings.
Askilledandsought-after speaker,Dr.Tanhasbeen invited to address international, national,andstateimmunizationaudiencesonissuesrang-ing fromvaccine financing to riskmanagementinvaccinesafetytoemerginginfectiousdiseases.Heservesorhasservedonahostofexpertandtechnical advisory panels, including panels fortheCentersforMedicareandMedicaidServices,TheJointCommission,andtheCentersforDis-easeControlandPrevention.Inaddition,heistheauthor or coauthor of many peer-reviewed arti-clesandabstracts.DuringhistenureattheAMA,hewrotenumerousscientificreportstoguidetheassociation’spoliciesonadiverserangeofpublichealthtopics.
Dr.Tanhas receivedseveralawards forhisad-vocacyworkandmostrecentlywasawardedtheAmerican Pharmacists Association’s nationalFriendofPharmacyAward.Asapart-time fac-ultymemberat the Institute forScienceEduca-tionandScienceCommunication,ColumbiaCol-lege,Chicago,hereceivedthe2000ExcellenceinTeachingAward.
Dr. Tan’s photograph has been added to IAC’sstaff web page at www.immunize.org/aboutus/iacstaff.asp.
IAC Welcomes Dr. Litjen (L.J) Tan as Chief Strategy Officer
L.J Tan, MS, PhD
Vaccinate Adults! •February2013•ImmunizationActionCoalition•(651)647-9009•www.immunize.org•www.vaccineinformation.org 13
Andrew T. Kroger, MD, MPH Donna L. Weaver, RN, MN Iyabode Akinsanya-Beysolow, MD, MPH
IAC’s“Ask theExperts”
teamfromCDC
Ask the Experts . . . continued from page 5
pregnantwomanreceiveTdapvaccineduringeachpregnancy,evenifthewomanhadreceivedTdappreviously.TheoptimaltimetoadministerTdapisbetween27and36weeks’gestation.Vaccina-tionduringthistimemaximizesmaternalantibodyresponseandpassiveantibodytransfertotheinfant.WomenwhohaveneverreceivedTdapandwhodonotreceiveitduringpregnancyshouldreceiveitimmediatelypostpartum.
WhenawomangetsTdapduringpregnancy,ma-ternalpertussisantibodiestransfertothenewborn,likelyprotectingthebabyagainstpertussisinearlylife,beforethebabyisoldenoughtohavereceivedat least3dosesofDTaP.Tdapalsoprotectsthemother,makingitlesslikelythatshewillgetin-fectedwithpertussisduringorafterpregnancyandthuslesslikelythatshewilltransmitittoherinfant.
The related provisional recommendations fortheuseofTdapinpregnancywerepublishedonDecember6,2012.CDCanticipatesreleasingthefinalupdatedrecommendationsintheFeb.22issueofMMWR.Toaccessthenewrecommendations,visitwww.cdc.gov/vaccines/pubs/ACIP-list.htm.
If a woman did not receive Tdap during pregnancy, and it is uncertain whether she received a dose of Tdap prior to her preg-nancy, should she receive a dose of Tdap postpartum?Yes.IfthereisnowrittendocumentationthatshereceivedadoseofTdappriortoorduringpreg-nancy,adoseofTdapshouldbeadministeredtoherimmediatelypostpartum.
How soon after taking prednisone for an asthma attack can a person receive a flu shot? Steroid treatment is not a contraindication for
vaccination with inactivated influenza vaccine.Asthisvaccineisnotalivevirusvaccine,youcan(andshould)giveittopeoplewhoareimmunosup-pressed,althoughthepatient’simmuneresponsemay not be optimal. Immunosuppression (e.g.,fromcertainsteroidtreatments)isaconcernonlywhenadministeringlivevirusvaccines.Is fainting after the first or second dose of HPV vaccine a contraindication to administer-ing subsequent doses?No.Faintingisnotacontraindicationtoadminis-teringasubsequentdoseofanyvaccine.Faintingaftervaccinationisfairlycommoninadolescence.Providers should prepare for the possibility byhavingpatientssitorliedownwhenreceivingthevaccineandobservingpatientsfor15minutesaftervaccination.Formoreinformationonsyncopeandvaccination,visit theCDCwebsiteatwww.cdc.gov/vaccinesafety/Concerns/syncope_faqs.html.Some single-dose pre-loaded vaccines come with an air pocket in the syringe chamber. Do we need to expel the air pocket before vac-cinating?No.Youdonotneedtogetridoftheairpocket.Theairwillbeabsorbed.Thisisnottrueforsy-ringesthatyoufillyourself;youshouldexpelairbubblesfromthesesyringespriortovaccinationtotheextentthatyoucanreadilydoso.*(Seeeditor’sclarification.)Is it recommended to use a new alcohol swab to cleanse the skin before administering a vac-cine, or can we swab the skin with the same alcohol swab that we used to wipe off the stopper on the vial?Youshoulduseseparatealcoholwipestocleanthevialtopandthepatient’sskin.
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