1. Donna L. Weaver, RN, MN Nurse Educator Immunization Services Division
Immunization Update 2014
Donna L. Weaver, RN, MN
Nurse Educator
Immunization Services Division
CT AAP
December 10, 2014
National Center for Immunization & Respiratory Diseases
Immunization Services Division

2. Disclosures
Donna Weaver is a federal government employee with no financial interest or conflict with the manufacturer of any product named in this presentation
The speaker will discuss the off-label use of MMR vaccine
The speaker will not discuss a vaccine not currently licensed by the FDA

3. What’s New with Pediatric Immunizations
Vaccination coverage rates of children
VIS update
Measles
Hib
Influenza
HPV
Immunization resources

5. immunization coverage Rates

6. Estimated Coverage of Vaccines Among Children Aged 19-35 Months, NIS 2013
State/Area
Vaccine Series*
4:3:1:4:3:1:4
United States
70.4%
Connecticut
78.2%
*Includes >4 doses DTaP/DT/DTP, > 3 doses polio, > 1 dose MMR, Full Series Hib, > 3 doses Hep B, dose > 1 varicella, and doses > 4 PCV.
MMWR 2014; 63(34):

7. Estimated Coverage of Vaccines Among Children in Kindergarten, 2013-14 School Year
Connecticut
Vaccine
MMR
DTaP
Varicella
96.9%
97.0%
96.7%
MMWR 2014; 63(41):

8. Estimated Percentage of Kindergarten Children Who Have Been Exempted from Receiving One or More Vaccines, School Year
MMWR 2014; 63(41):

9. National Estimated Vaccination Coverage Levels among Adolescents Years, National Immunization Survey-Teen,
US 89.1
CT 93.2
US 77.8
CT 90.6
US 57.3
CT 56.0
US 37.6
CT 40.1
US 34.6
CT 52.3
US 13.9
CT 23.4
CDC. National and State Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2012
MMWR 2013; 62(34);

10. Multi-VIS www.cdc.gov/vaccines/hcp/vis/vis-statements/multi.pdf

11. Rotavirus (RV) Vaccine Administration Errors, United States, 2006-2013
66 reports of RV vaccine administration errors to Vaccine Adverse Event Reporting System (VAERS)
39 reports of injecting RV vaccine (RV1: 33; RV5: 6)
19 of 39 reports (49%) documented an adverse event
Irritability (7) and injection site redness (5) most common
27 reports of eye splashes
21 cases: infants coughed, sneezed, or spit vaccine into the eyes of vaccination providers (17), parents (1), or themselves (3)
21/27 reported non-serious adverse events-minor eye irritation
MMWR 2014; 63(04);81

12. Measles Update

13. U.S Measles Reaches 20-year High
Measles, U.S., * Cumulative Number by Month of Rash Onset
603
2014*
2011
2013*
2008
2001
2009
*2014 data reported as of October 31, 2014
Source: National Notifiable Diseases Surveillance System (NNDSS) and direct report to CDC

15. Measles Keep Your Guard Up
Any patient with fever and rash should be assumed to have measles until proven otherwise
Immediate isolation
Be highly suspect of patients with fever and coryza and/or conjunctivitis, particularly if unvaccinated or international travel
Be certain of your measles immunity status
MMWR 2013;62(RR-4)

16. *ACIP Off-label recommendation
MMR Vaccine
First dose at months, second dose routinely at 4-6 years of age
Minimum interval between doses is 4 weeks
Infants as young as 6 months should receive MMR before international travel*
Infants older than 12 months of age can receive a 2nd dose of MMR before international travel as long as there is a minimum 28-day interval between doses
*ACIP Off-label recommendation
MMWR 2013;62(RR-4)

17. Evidence of Measles Immunity for Healthcare Personnel
Appropriate vaccination
2 doses of measles-containing vaccine (preferably MMR), or
Laboratory evidence of immunity, or
Laboratory confirmation of disease
MMWR 2013;62(RR-4)

18. Hepatitis B and Healthcare Personnel

19. Hepatitis B Vaccine and Healthcare Personnel (HCP)
Management of HCP who have written documentation of a complete series of hepatitis B vaccine doses in the past who were not tested for antibody response following the vaccination series and who now test negative for anti-HBs
Administer 1 dose of hepatitis B vaccine then test for anti-HBs 1 to 2 months later
If anti-HBs <10mIU/L, give 2 more doses to complete a second series, then test again 1to 2 months later.
If negative, manage as hepatitis B vaccine non-responder
MMWR 2013;62(RR-10):1-19

20. MMWR 2013;62(RR-10):1-19

21. Haemophilus influenzae type B
Updated ACIP recommendations were published February 2014
Includes recommendations for:
Routine vaccination of infants
Guidance for catch-up of previously unvaccinated infants and children starting late
High-risk groups

22. Hib-containing Vaccines
Product Name
Schedule
PRP-OMP containing vaccines
PedvaxHib (Hib)
Comvax (Hib-HepB)
2 dose primary series at 2 and 4 months; booster dose at 12 – 15 months
PRP-T containing vaccines
Acthib (Hib)
Pentacel
(DTaP-IPV-Hib)
3 dose primary series at 2, 4, and 6 months; booster dose at months
MenHibrix
(Hib-MenCY)
3 dose primary series at 2, 4, and 6 months; booster dose at months
Hiberix (Hib)
Booster dose at months for previously vaccinated children; do NOT use for the primary series

23. Updated Guidance for High-risk Children
High-risk group
Vaccine Guidance
Patients less than 12 months of age
Follow routine Hib vaccination recommendations
Patients 12 through 59 months of age
If unimmunized or received 0 or 1 dose before age 12 months: 2 doses 2 months apart
If received 2 or more doses before age 12 months:1 dose
If completed a primary series and received a booster dose at age 12 months or older: No additional doses
Courtesy E. Briere, CDC

24. Updated Guidance for High-risk Children(2)
High-risk group
Vaccine guidance
Patients undergoing chemotherapy or radiation therapy, age <59 months
If routine Hib doses given 14 or more days before starting therapy: revaccination not required
If dose given within 14 days of starting therapy or given during therapy: repeat doses starting at least 3 months following therapy completion
Patients undergoing elective splenectomy, age > 15 months
If unimmunized:1 dose prior to procedure
Asplenic patients >59 months of age
If unimmunized:1 dose
HIV-infected children>59 months of age
Recipients of hematopoietic stem cell transplant, all ages
Regardless of Hib vaccination history: 3 doses (at least 1 month apart) beginning 6-12 months after transplant
Courtesy E. Briere, CDC

25. Hib Disease and Healthy Children
Risk of disease
Age
Less doses needed to provide protection
Response to vaccine better as age increase

26. Seasonal Influenza
Updated ACIP recommendations were published August 2014
Includes:
Vaccine composition
Vaccination schedules for those
6 months thru 8 years
9 years and older
LAIV preference for healthy children 2 thru 8 years

31. Influenza Vaccine Products/Presentations 2014-2015
Name
Age Range
# Antigens
Presentation
Route
Type/Abbrev.
Afluria
5 yrs and older
Trivalent
Pre-Filled Syringe IM
Inactivated
IIV3
Multi-Dose Vial
18 yrs thru 64 yrs
Pharmajet Injectors
Fluarix
3 yrs and older
Quadrivalent
IIV4
FluBlok
18 yrs and older
Single-Dose Vial
Recombinant
RIV3
Flucelvax
Cell Culture
FluLaval
3 years and older
FluMist
2 yrs thru 49 yrs
Pre-Filled Sprayer
Intranasal
Live Attenuated
LAIV4
Fluvirin
4 yrs and older
Now Cat. B Pregnancy
Multi-dose Vial
Fluzone
6 months and older
Fluzone High-Dose
65 yrs and older
Fluzone Intradermal
Pre-Filled Microinjection System
Intradermal
(ID)

32. Choosing Influenza Vaccine
When immediately available, use LAIV for healthy children aged 2 through 8 years who have no contraindications or precautions
If LAIV not immediately available, use IIV. Vaccination should not be delayed to procure LAIV
8 years is the upper age limit for this recommendation based on
demonstration of superior efficacy of LAIV (ages 2 to 6 years), and
for programmatic consistency (8 years is the upper age limit for receipt of 2 doses of influenza vaccine in a previously unvaccinated child)
Implement this recommendation for the 2014–15 season as feasible, but not later than the 2015–16 season
MMWR Aug 15, 2014; 63(32):691-7

33. Choice of Influenza Vaccine
Where more than one type of vaccine is appropriate and available, ACIP has no other preferential recommendation for use of any influenza vaccine product over another
Quadrivalent vs trivalent
High-dose vs standard dose
MMWR Aug 15, 2014; 63(32):691-7

34. Influenza Vaccination Schedule
Annual vaccination for persons 6 months of age and older without contraindications or precautions
IIV dosage varies by age
6 months through 35 months = 0.25 mL
3 years and older = 0.5 mL
Administer 1 dose per season to persons years of age and older
Some children 6 months through 8 years of age will need 2 doses

37. Vaccine Administration Errors and LAIV
LAIV generally has an 18-week shelf life
Vaccine Adverse Event Reporting System (VAERS) Reports of expired LAIV administered from July 1, 2007, through June 30, 2014
4,699 LAIV reports, 866 (18.4%) involved administration of expired vaccine
95.1% of expired LAIV reports, vaccination occurred after the first week in November
CHECK THE EXPIRATION DATE BEFORE ADMINISTERING ANY VACCINE
MMWR. 2014;63;

38. Updated Human Papillomavirus (HPV)
Updated ACIP recommendations were published August 2014
Includes compendium of all current recommendations for use of HPV vaccines:
Epidemiology
Updated data for clinical trials and post-licensure safety studies
All recommendations for vaccine use

39. CDC HPV Vaccination Resources

40. Avoid Missed Opportunities
Recommend HPV vaccine
Include HPV vaccine when discussing other needed vaccines
HPV vaccine can safely be given at the same time as the other recommended adolescent vaccines
Integrate standard procedures
Assess for needed vaccines at every clinical encounter, including acute care visits
Immunize at every opportunity
Use standing orders
Document doses in the medical record
Use reminder and recall
Tools for improving uptake of HPV:

43. Immunization Resources

44. Immunization Twitter Just for You
@CDCIZlearn is a leading source for health care providers on immunization training, recommendations, and information across the lifespan

45. CDC Training Resources

46. Vaccine Storage and Handling

47. CDC Safe Injection Practices
NCIRD Vaccine Administration

48. CDC Vaccines and Immunization Contact Information
Telephone
Website
Vaccine Safety
800-CDC-INFO ( )
For patients and providers
For providers 48

49. Thank You!
Questions?
Donna L. Weaver, RN, MN