February 8, 2017

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Summit Announcements
Information from CDC
Summit Call Recap – February 2, 2016
Announcements

SUMMIT ANNOUNCEMENTS


The 2017 National Adult and Influenza Immunization Summit in-person meeting will be held May 9-11, 2017 in Atlanta, Georgia. Please mark your calendars! We also urge that you reserve your hotel room through the rooming link that pops up after registration for the in-person meeting. This will facilitate your access to the preferred rooming rate and help the Summit meet its rooming commitment. Thank you!

The National Adult and Influenza Immunization Summit (NAIIS) is soliciting candidates for the 2017 NAIIS Immunization Excellence Awards. The 2017 awards recognize individuals and organizations that have made extraordinary contributions towards improving vaccination rates within their communities during 2016. The deadline for nominations is February 24, 2017.

The Summit would love to highlight your work or activities to improve adult and influenza immunization during the 2017 NAIIS Summit Meeting in Atlanta, Georgia. Please consider submitting a poster for Summit partners to view over two poster sessions scheduled at the in-person meeting. Please visit the Summit website for abstract submission information. The deadline is March 15, 2017.


INFORMATION FROM CDC


Updated 2017 ACIP Childhood and Adolescent Immunization Schedule Has Been Released

As announced in the MMWR on February 10, 2017, changes in the Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States, 2017, include new or revised ACIP recommendations for influenza; human papillomavirus; hepatitis B; Haemophilus influenzae type B; pneumococcal; meningococcal; and diphtheria and tetanus toxoids and acellular pertussis vaccines.

 

Figure 1. Changes to the 2017 figure from the 2016 schedule are as follows:

  • The 16-year age column has been separated from the 17–18-year age column to highlight the need for a meningococcal conjugate vaccine booster dose at age 16 years.
  • Live attenuated influenza vaccine (LAIV) has been removed from the influenza row.
  • A blue bar was added for human papillomavirus vaccine (HPV) for children aged 9–10 years, indicating that persons in this age group may be vaccinated (even in the absence of a high-risk condition.)

 

Figure 3. A new figure, “Figure 3. Vaccines that might be indicated for children and adolescents aged 18 years or younger based on medical indications,” has been added. The purpose of this figure is to do the following:

  • Demonstrate most children with medical conditions can (and should) be vaccinated according to the routine child/adolescent immunization schedule.
  • Indicate when a medical condition is a precaution or contraindication to vaccination.
  • Indicate when additional doses of vaccines may be necessary because of a child’s or adolescent’s medical condition. Providers should consult the relevant footnotes for additional information.

 

Footnotes. Changes to the footnotes for the figures are as follows:

  • The Hepatitis B vaccine (HepB) footnote was revised to reflect that the birth dose of HepB should be administered within 24 hours of birth.
  • The diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) footnote was revised to more clearly present recommendations following an inadvertently early administered fourth dose of DTaP.
  • Within the Haemophilus influenzaetype b vaccine (Hib) footnote, Comvax was removed from the routine vaccination portion of footnote. This vaccine has been removed from the market, and all available doses have expired. Additionally, Hiberix has been added to the list of vaccines that may be used for the primary vaccination series.
  • Within the pneumococcal vaccine footnote, references to 7-valent pneumococcal conjugate vaccine (PCV7) have been removed. All healthy children who might have received PCV7 as part of a primary series have now aged out of the recommendation for pneumococcal vaccine.
  • The influenza vaccine footnote has been updated to indicate that LAIV should not be used during the 2016–2017 influenza season.
  • The meningococcal vaccines footnote has been updated to include recommendations for meningococcal vaccination of children with human immunodeficiency virus (HIV) infection and to reflect recommendations for the use of a 2-dose Trumenba (meningococcal B vaccine) schedule.
  • The tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap) footnote for vaccination of pregnant adolescents between gestational weeks 27–36 has been updated to reflect a preference for vaccination earlier during this period. Currently available data suggest that vaccinating earlier in the 27 through 36–week period will maximize passive antibody transfer to the infant.
  • The footnote for HPV vaccine has been updated to include the new 2-dose schedule for persons initiating the HPV vaccination series before age 15 years. In addition, bivalent HPV vaccine has been removed from the schedule. This vaccine has been removed from the U.S. market, and all available vaccine doses have expired.

 

Past immunization schedules also are available online.


Updated 2017 ACIP Adult Immunization Schedule Has Been Released

As announced in the MMWR on February 10, 2017, changes in the ACIP Recommended Immunization Schedule for Adults Age 19 Years or Older, United States, 2017 adult immunization schedule from the previous year’s schedule include new or revised ACIP recommendations for influenza, human papillomavirus, hepatitis B, and meningococcal vaccines:

 

Influenza vaccination. Changes are related to the low effectiveness of the live attenuated influenza vaccine (LAIV) (FluMist, MedImmune) against influenza A(H1N1)pdm09 in the United States during the 2013–2014 and 2015–2016 influenza seasons and revised recommendations for the use of influenza vaccine among patients with egg allergy. These changes are reflected in the 2017 adult immunization schedule as follows:

  • LAIV should not be used during the 2016–2017 influenza season.
  • Adults with a history of egg allergy who have only hives after exposure to egg should receive age-appropriate inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV).
  • Adults with a history of egg allergy with symptoms other than hives (e.g., angioedema, respiratory distress, lightheadedness, or recurrent emesis, or who required epinephrine or another emergency medical intervention) may receive age-appropriate IIV or RIV. The selected vaccine should be administered in an inpatient or outpatient medical setting and supervised by a health care provider who is able to recognize and manage severe allergic conditions.

 

Human papillomavirus vaccination. Healthy adolescents who start their human papillomavirus (HPV) vaccination series before age 15 years are recommended to receive 2 doses of HPV vaccine. Adults and adolescents who did not start their HPV vaccination series before age 15 years should receive 3 doses of HPV vaccine. Changes in recommendations in the adult immunization schedule include updates regarding HPV vaccination for adults who did not complete the HPV vaccination series as adolescents. These changes are described in the 2017 adult immunization schedule as follows:

  • Adult females through age 26 years and adult males through age 21 years who have not received any HPV vaccine should receive a 3-dose series of HPV vaccine at 0, 1–2, and 6 months. Males aged 22 through 26 years may be vaccinated with a 3-dose series of HPV vaccine at 0, 1–2, and 6 months.
  • Adult females through age 26 years and adult males through age 21 years (and males aged 22 through 26 years who may receive HPV vaccine) who initiated the HPV vaccination series before age 15 years and received 2 doses at least 5 months apart are considered adequately vaccinated and do not need an additional dose of HPV vaccine.
  • Adult females through age 26 years and adult males through age 21 years (and males aged 22 through 26 years who may receive HPV vaccine) who initiated the HPV vaccination series before age 15 years and received only 1 dose, or 2 doses less than 5 months apart, are not considered adequately vaccinated and should receive 1 additional dose of HPV vaccine.

 

Hepatitis B vaccinationThe ACIP updated chronic liver disease conditions for which a hepatitis B vaccine (HepB) series is recommended. This change is described in the 2017 adult immunization schedule as follows:

  • Adults with chronic liver disease, including, but not limited to, hepatitis C virus infection, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an alanine aminotransferase (ALT) or aspartate aminotransferase (AST) level greater than twice the upper limit of normal should receive a HepB series.

 

Meningococcal vaccination. There are two changes in meningococcal vaccination recommendations for 2017. First, the ACIP recommended that adults with human immunodeficiency virus (HIV) infection receive a 2-dose primary series of serogroups A, C, W, and Y meningococcal conjugate vaccine (MenACWY). Second, the ACIP provided updated dosing guidance for one of the serogroup B meningococcal vaccines (MenB) (MenB-FHbp [Trumenba, Pfizer]). Three doses of MenB-FHbp should be administered at 0, 1–2, and 6 months to adults who are at increased risk for meningococcal disease, and those who are vaccinated during serogroup B meningococcal disease outbreaks. When MenB-FHbp is given to healthy adolescents and young adults who are not at increased risk for meningococcal disease, 2 doses of MenB-FHbp should be administered at 0 and 6 months (MenB-FHbp was previously recommended as a 3-dose series at 0, 2, and 6 months, consistent with the original vaccine licensure for this population). The dosing frequency and interval for the other MenB, MenB-4C (Bexsero, GlaxoSmithKline), have not changed: MenB-4C remains a 2-dose series, with doses administered at least 1 month apart. Either MenB vaccine can be used when vaccination is indicated. The change in ACIP recommendations on the use of MenB-FHbp does not imply a preference for one MenB over the other. These updates in meningococcal vaccination are reflected in the 2017 adult immunization schedule as follows:

  • Adults with anatomical or functional asplenia or persistent complement component deficiencies should receive a 2-dose primary series of MenACWY, with doses administered at least 2 months apart, and be revaccinated every 5 years. They should also receive a series of MenB with either MenB-4C (2 doses administered at least 1 month apart) or MenB-FHbp (3 doses administered at 0, 1–2, and 6 months).
  • Adults with HIV infection who have not been previously vaccinated should receive a 2-dose primary MenACWY vaccination series, with doses administered at least 2 months apart, and be revaccinated every 5 years. Those who previously received 1 dose of MenACWY should receive a second dose at least 2 months after the first dose. MenB is not routinely recommended for adults with HIV infection, because meningococcal disease in this population is caused primarily by serogroups C, W, and Y.
  • Microbiologists who are routinely exposed to isolates of Neisseria meningitidisshould receive 1 dose of MenACWY and be revaccinated every 5 years if the risk for infection remains, as well as either MenB-4C (2 doses administered at least 1 month apart) or MenB-FHbp (3 doses administered at 0, 1–2, and 6 months).
  • Adults at risk because of a meningococcal disease outbreak should receive 1 dose of MenACWY if the outbreak is attributable to serogroup A, C, W, or Y; or, if the outbreak is attributable to serogroup B, either MenB-4C (2 doses administered at least 1 month apart) or MenB-FHbp (3 doses administered at 0, 1–2, and 6 months).
  • Young adults aged 16 through 23 years (preferred age range is 16 through 18 years) who are healthy and not at increased risk for serogroup B meningococcal disease may receive either MenB-4C (2 doses administered at least 1 month apart) or MenB-FHbp (3 doses administered at 0, 1–2, and 6 months) for short-term protection against most strains of serogroup B meningococcal disease.

 

Notable changes to Figures 1 and 2. Changes in “Figure 1. Recommended immunization schedule for adults aged 19 years or older, by age group” and “Figure 2. Recommended immunization schedule for adults aged 19 years or older by medical condition and other indications” are as follows:

  • In Figures 1 and 2, standardized acronyms for vaccines are used to promote simplicity and consistency, and their listing has been reordered. Ancillary information previously contained in the figures has been consolidated and moved to the cover page. Colored blocks instead of colored bars are used to denote indications. These figures must be used in conjunction with the footnotes, which contain important information for each vaccine and considerations for special populations.
  • In Figure 2, the columns for medical conditions and other indications have been reordered to keep medical conditions together and special populations together. Additional footnotes mark appropriate columns of medical conditions and other indications to refer the reader to view relevant vaccine-specific information.
  • In Figure 2, the color of the indication block for MenACWY for HIV infection has been changed to yellow (recommended for adults who meet the age requirement, lack documentation of vaccination, or lack evidence of past infection) from purple (recommended for adults with additional medical conditions or other indications).

 

Changes to footnotes.

  • Footnotes are limited to the information pertaining to vaccines listed in Figures 1 and 2 and are organized by vaccine-specific information and considerations for special populations (e.g., pregnant women and adults with HIV infection). The footnote labeled “additional information,” contained in previous versions of the adult immunization schedule, has been moved to the cover page. The footnote related to immunocompromising conditions has been removed, but vaccine-specific information on immunocompromising conditions has been added to the appropriate footnotes (e.g., the footnote for pneumococcal vaccination).
  • The format for the footnotes has been condensed, simplified, and standardized. The format for pneumococcal; human papillomavirus; meningococcal; varicella; and measles, mumps, and rubella vaccination footnotes has undergone substantial revision.

 

Other changes. Lastly, the table of contraindications and precautions for vaccines routinely recommended for adults, which previously was a stand-alone document, has been incorporated into the adult immunization schedule. The content of the table has been consolidated and simplified.

 

More Information

 

Details on these updates and information on other vaccines recommended for adults are available online from the Centers for Disease Control and Prevention and in the Annals of Internal Medicine. The full ACIP recommendations for each vaccine are also available online.


CDC Influenza Division Releases Weekly Influenza Surveillance Reports

CDC’s FluView report for Week 4  (ending January 28), the seasonal influenza talking points from February 3, 2017, and the Master Key Points on influenza in both English and Spanish  are now available online. In addition, the latest key points on the H7N9 outbreak in China are available.


Take 3 Messages and Infographic from CDC

Take 3 Messages: As flu activity continues to increase in the United States, remind others of actions to take to protect themselves and their loved ones from the flu. CDC recommends a three-step approach to fight the flu: vaccination, everyday preventative actions, and use of antiviral drugs if your doctor prescribes them. Flu vaccination can reduce flu illnesses, doctors’ visits, and missed work and school due to flu, as well as prevent flu-related hospitalizations. If you have not gotten vaccinated yet this season, you should get vaccinated now— it’s not too late! Healthy people can get very sick from the flu and spread it to friends and loved ones. This week’s CDC feature discusses the steps to Protect Yourself & Your Family Against the Flu.

 

Share the Fight Flu infographic to inform yourself, your patients and your loved ones of the important steps to take to fight flu this season.


SUMMIT CALL RECAP – February 2, 2017


Influenza Surveillance Update – Noreen Alabi (CDC)

Noreen provided highlights of the influenza surveillance report from week 3, ending on January 21, 2017.  Influenza activity in the U.S. continues to increase. The percentage of respiratory specimens testing positive for influenza in clinical laboratories increased to 18.4%. Influenza A viruses were most common during week 3, with H3 viruses predominating.

 

Nationwide, influenza-like illness (ILI) activity was at 3.3%, above the national baseline of 2.2% for the week. Three pediatric deaths were reported during Week 3. Two deaths occurred during week 49 and were as associated with nfluenza A (H3). The third death occurred during week 3 and was associated with influenza B. A total of eight pediatric deaths have been reported for the current (2016–2017) season.

 

Between October 1, 2016 and January 21, 2017, 4,317 lab-confirmed influenza associated hospitalizations were reported. The overall hospitalization rate was 15.4 per 100,000, with 92.8$ positive for influenza A. Of those that were typed, 98.3% were influenza A (H3).

 

Based on reports from the National Center for Health Statistics (NCHS) surveillance system available on January 26 (for week 1 ending January 7), 7.4% of deaths were due to pneumonia and influenza (P&I). This percentage is above the epidemic threshold of 7.3% for the week.


Other Items – L.J Tan (IAC)

The 2017 National Adult and Influenza Immunization Summit is scheduled for May 9–11, 2017 in Atlanta, GA. There is no registration fee for the meeting. Attendees are responsible for their own travel and lodging. L.J encouraged partners to check out the following meeting-related sites:

  • Meeting registration link (Partners needing the password for registration may contact J Tan.) Note: After registering, please be sure to reserve your hotel room using the link provided. This helps ensure the Summit receives credit for filling the rooming block.)
  • Excellence Awards call for nominations: The website outlines this year’s six award categories, including a new award for a Non-Healthcare Employer Campaign. The deadline for submitting a nomination is February 24.
  • Poster session abstract submission: Two poster viewing sessions will be held during the meeting. The deadline for abstract submission is March 15, and authors will be notified of the committee’s selections by March 31.


ANNOUNCEMENTS


Please Help the Summit, AIRA, and CDC Engage EHR Vendors in Immunization IT

The Summit has been active and interested in improving interoperability and utilization of EHRs and immunization information systems (IIS) for several years. Indeed, for the past two years, there has been a lot of prioritization of IIS and health information technology (HIT) activity within the Summit workgroups.

 

However, engagement by vendors of EHRs remains difficult. We hope that, with the Summit’s support, we can begin to change that in little steps. If you are connected with an EHR vendor, perhaps you can start by encouraging them to simply join in two activities in the IIS community that are not demanding on their time.

 

The first is the AIRA Standards & Interoperability Steering Committee (SISC). SISC provides technical support and guidance to interoperability efforts of AIRA members and the IIS community. They act as a liaison between national organizations involved with interoperability, such as the Office of the National Coordinator (ONC) and others, and serve as a technical resource for AIRA members and the IIS community.  SISC meets the 2nd Wednesday of every month from 1–2 pm ET. Participation of EHR, pharmacy, health information exchange (HIE), and other IIS partners trading perspectives is welcomed to help drive forward increased interoperability. For more information, please connect with Mary Beth Kurilo.

 

The second is the CDC Clinical Decision Support for Immunization (CDSi) project. This project provides a single, authoritative, implementation-neutral foundation for development and maintenance of CDS engines. It captures ACIP recommendations in an unambiguous manner and improves the uniform representation of vaccine decision guidelines, as well as the ability to automate vaccine evaluation and forecasting. Interested parties can reach out to Eric Larson.


ESWI 6th Conference on Influenza

The European Scientific Working group on Influenza (ESWI) is organizing the sixth edition of its ESWI Influenza Conference in Riga, Latvia, on September 10 – 13, 2017. Over the past years, the ESWI Influenza Conferences have grown into the largest European scientific conferences entirely dedicated to influenza. As with its previous meeting, there will be a parallel science policy track.


Introducing the Partnership for Influenza Vaccine Introduction (PIVI)

The Partnership for Influenza Vaccine Introduction (PIVI) is an effort led by the Center for Vaccine Equity at the Task Force for Global Health (TFGH) and the U.S. Centers for Disease Control and Prevention (CDC). This partnership provides seasonal influenza vaccines and technical assistance to help low- and middle-income countries develop sustainable national seasonal influenza vaccination programs, thereby reducing morbidity and mortality from influenza and enhancing pandemic preparedness. For more information about PIVI, please contact Joe Bresee or Samantha Kluglein.


Prolonged New Cough in Housemates Linked to Pertussis among Infants

Pertussis affliction among infants shared a strong association with a prolonged cough in close household contacts, mostly among mothers, fathers and siblings, according to recent findings. In particular, infants whose mothers had prolonged new cough had a 43.8-fold (95% CI, 6.45-298) risk for pertussis. A news article about this study provides additional information.


Adults Urged to Get Vaccinated

Too many U.S. adults are not getting vaccinated, putting themselves and others at risk, immunization experts say. According to the latest available data, about 44 percent of adults over age 19 had a flu shot; 20 percent had a Tdap vaccine, which protects against tetanus, diphtheria and pertussis; and 20 percent of 19-to-64-year-olds at risk of pneumonia had that vaccine (compared to 60 percent of those over 65).

 

Just 27 percent of those over age 60 were vaccinated against herpes zoster, which cuts the risk of shingles in half, according to new guidelines from the Advisory Committee on Immunization Practices (ACIP) published in Annals of Internal Medicine.


Please Help the Summit, AIRA, and CDC Engage EHR Vendors in Immunization IT

The Summit has been active and interested in improving interoperability and utilization of EHRs and immunization information systems (IIS) for several years. Indeed, for the past two years, there has been a lot of prioritization of IIS and health information technology (HIT) activity within the Summit workgroups.

 

However, engagement by vendors of EHRs remains difficult. We hope that, with the Summit’s support, we can begin to change that in little steps. If you are connected with an EHR vendor, perhaps you can start by encouraging them to simply join in two activities in the IIS community that are not demanding on their time.

 

The first is the AIRA Standards & Interoperability Steering Committee (SISC). SISC provides technical support and guidance to interoperability efforts of AIRA members and the IIS community. They act as a liaison between national organizations involved with interoperability, such as the Office of the National Coordinator (ONC) and others, and serve as a technical resource for AIRA members and the IIS community.  SISC meets the 2nd Wednesday of every month from 1–2 pm ET. Participation of EHR, pharmacy, health information exchange (HIE), and other IIS partners trading perspectives is welcomed to help drive forward increased interoperability. For more information, please connect with Mary Beth Kurilo.

 

The second is the CDC Clinical Decision Support for Immunization (CDSi) project. This project provides a single, authoritative, implementation-neutral foundation for development and maintenance of CDS engines. It captures ACIP recommendations in an unambiguous manner and improves the uniform representation of vaccine decision guidelines, as well as the ability to automate vaccine evaluation and forecasting. Interested parties can reach out to Eric Larson.


Three Slide Decks Available to Support New Standards for Adult Immunization Practice

The Summit’s Access and Collaboration workgroup has developed three separate slide decks with talking notes to support partners and others who wish to present on the Standards to their peers and colleagues. The three audiences targeted by the decks are: healthcare providers; patients/public; and public health. These are now available, along with tips and tools on how to use them, at the Summit website.

 

Also do not forget that Medscape has produced two modules to support the implementation of the Standards:


Every Child By Two (ECBT) Compiles Media Information on Its Website

On a daily basis, ECBT assembles significant news media coverage on immunizations in their “Daily Clips.” Summit partners may find this effort useful.


Summit Website Offers Wonderful Resources on Influenza Vaccination

Remember to visit the Summit website for the latest on influenza immunization resources. You also can find archived copies of The Summit Buzz there.


Reminder

Summit calls are scheduled every Thursday at 3 p.m. Eastern time, unless cancelled. Please email L.J Tan or LaDora Woods if you have any updates on activities to provide to the Summit.

 

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