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Immunization Works July 2011 Issue
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News and Summaries
Vaccine-Preventable Diseases, One of the Ten Great Public Health Achievements – Worldwide, 2001-2010: During the 20th century, life expectancy at birth among U.S. residents increased by 62%, from 47.3 years in 1900 to 76.8 in 2000, and unprecedented improvements in population health status were observed at every stage of life. In 1999, MMWR published a series of reports highlighting 10 public health achievements that contributed to those improvements. The June 24 Ten Great Public Health Achievements -- Worldwide MMWR assesses advances in public health during the first 10 years of the 21st century. Public health scientists at CDC were asked to nominate noteworthy public health achievements that occurred in the United States during 2001-2010. From those nominations, 10 achievements, not ranked in any order, have been summarized in the MMWR. Vaccine-Preventable Diseases is one of these achievements.
The past decade has seen substantial declines in cases, hospitalizations, deaths, and healthcare costs associated with vaccine-preventable diseases. New vaccines (i.e., rotavirus, quadrivalent meningococcal conjugate, herpes zoster, pneumococcal conjugate, and human papillomavirus vaccines, as well as tetanus, diphtheria, and acellular pertussis vaccine for adults and adolescents) were introduced, bringing to 17 the number of diseases targeted by U.S. immunization policy. A recent economic analysis indicated that vaccination of each U.S. birth cohort with the current childhood immunization schedule prevents approximately 42,000 deaths and 20 million cases of disease, with net savings of nearly $14 billion in direct costs and $69 billion in total societal costs.
The impact of two vaccines has been particularly striking. Following the introduction of pneumococcal conjugate vaccine in 2000, an estimated 211,000 serious pneumococcal infections and 13,000 deaths were prevented during 2000-2008. Routine rotavirus vaccination, implemented in 2006, now prevents an estimated 40,000-60,000 rotavirus hospitalizations each year. Advances also were made in the use of older vaccines, with reported cases of hepatitis A, hepatitis B, and varicella at record lows by the end of the decade. Age-specific mortality (i.e., deaths per million population) from varicella for persons younger than 20 years of age, declined by 97% from 0.65 in the prevaccine period (1990-1994) to 0.02 during 2005-2007. Average age-adjusted mortality (deaths per million population) from hepatitis A also declined significantly, from 0.38 in the prevaccine period (1990-1995) to 0.26 during 2000-2004.
Update on Worldwide Vaccine-Derived Polioviruses, July 2009-March 2011: In 1988, the World Health Assembly resolved to eradicate poliomyelitis worldwide. The live, attenuated oral poliovirus vaccine (OPV) has many advantages favoring its use in polio eradication: it is administered easily by mouth; confers intestinal immunity, making recent OPV recipients resistant to infection by wild polioviruses (WPVs); provides long-term protection against paralytic disease through durable humoral immunity; and is inexpensive. Despite its many advantages, OPV use carries the risk for occurrence of rare cases of vaccine-associated paralytic poliomyelitis among immunologically normal OPV recipients and their contacts and the additional risk for emergence of vaccine-derived polioviruses (VDPVs). Because of these risks, OPV use will be discontinued worldwide once the goal of eradicating all WPV transmission is achieved. VDPVs can cause polio outbreaks in areas with low OPV coverage and can replicate for years in immunodeficient persons; therefore, strategies to strengthen global polio immunization and surveillance are needed to limit emergence of VDPVs.
The July 1 Update on Vaccine-Derived Polioviruses -- Worldwide MMWR updates previous surveillance summaries and describes VDPVs detected worldwide during July 2009-March 2011 and reported as of June 20, 2011. Three new outbreaks of circulating VDPVs (cVDPVs), ranging in size from six to 16 cases, were identified in Afghanistan, Ethiopia, and India; three previously identified outbreaks in Nigeria, Democratic Republic of Congo (DRC), and Somalia continued through late 2010 or into 2011 and resulted in 355, 37, and 13 total cases, respectively; two countries experienced importations of cVDPVs from Nigeria; nine newly identified paralyzed immunodeficient persons in seven middle-income and developing countries were found to excrete VDPVs; and VDPVs were found among persons and environmental samples in 15 countries. With the use of alternate OPV formulations since 2005 and with enhanced poliovirus surveillance sensitivity and laboratory screening, the number of identified cVDPV outbreaks per year has increased. To prevent VDPV emergence and spread, all countries should maintain high poliovirus vaccination coverage against all three poliovirus serotypes. Sensitive poliovirus surveillance to detect VDPVs will continue to increase in importance.
Multiple Cases of Measles After Exposure During Air Travel to Australia and New Zealand: In January 2011, measles was diagnosed in three New Zealand residents recently returned from a 17-day trip to Singapore and the Philippines. On January 11, they had flown on a 7.5-hour flight from Singapore to Brisbane, Australia, remained in a transit lounge for 9.5 hours, and then continued on a 4-hour flight to Auckland, New Zealand. Searches in Australia and New Zealand for secondary cases among passengers on either flight resulted in the identification of three cases among passengers on the Singapore-to-Brisbane flight and five cases among passengers on the Brisbane-to-Auckland flight.
The three index cases had rash onsets occurring January 11-15 and tested positive for measles immunoglobulin M (IgM). One Australian case and one New Zealand case were diagnosed clinically, but the remaining six secondary cases, with rash onsets occurring January 21-26, were positive for measles. Only three of the eight secondary cases were in persons seated within two rows of a person with an index case: two in unvaccinated persons and one in a person whose measles vaccination status was unknown. One secondary case was in a person of unknown vaccination status seated four rows away from the nearest person with an index case, one was in a person with a history of having been vaccinated against measles twice who was seated six rows away, and three were in unvaccinated children 11 rows away, in a separate cabin. The three index cases were in unvaccinated children aged 12-17 years.
Australian contact investigation guidelines for exposure to a single passenger with infectious measles aboard an aircraft focus on the seats within two rows of where index cases are located. Five of the eight secondary cases in this outbreak were in persons who were farther away. Three persons likely were infectious aboard the aircraft, not one, and recent literature suggests that exposure might extend farther than two rows. In addition, because measles is readily transmissible through airborne transmission, the opportunity for exposure existed in the jetways, the arrival and departure terminals, and the transit lounge. This outbreak highlights the transmissibility of measles and the risk for exposure during international travel, which might start at the airport before departure, and the need for travelers to be protected against measles by vaccination. Please visit the MMWR web site for the full report, Notes from the Field: Multiple Cases of Measles After Exposure During Air Travel.
Stay Informed! Influenza information is updated frequently. Please visit the seasonal flu web site for the latest updates.
PAHO’s XIX Technical Advisory Group (TAG) Meeting: On July 6-8, 2011, Pan American Health Organization’s (PAHO) XIX Technical Advisory Group (TAG) on Vaccine-preventable Diseases met in Buenos Aires, Argentina. The theme for the conference was "Vaccinate Your Family Protect Your Community" following the shift in regional focus from vaccinating children to vaccinating their entire family and community. Review topics at the meeting included the status of immunization programs in the Americas, documentation for the elimination of measles and rubella, and a plan of action to maintain the Americas free of polio. The Americas Region was the first in the world to eradicate smallpox and polio; eliminate measles, rubella, and Congenital Rubella Syndrome; and, it is also at the forefront of introducing the rotavirus, pneumococcal, and human papillomavirus (HPV) vaccines.
The PAHO/WHO Technical Advisory Group on Vaccine-Preventable Diseases was created in 1985 to provide support to the Organization for polio eradication in the Region. Since then, it has become the leading forum for promoting and discussing goals and strategies for immunization programs—particularly those linked to sustaining the gains of disease eradication in an inter-dependent world; completing the unfinished vaccines agenda by promoting influenza vaccination and improving vaccine communications; and, continuing the Regional introduction of vaccines against such diseases as rotavirus, pneumococcal and human papillomavirus (HPV).
Journal of Infectious Diseases - Measles Supplement: CDC published a special supplement on global progress toward measles eradication and prevention of rubella and congenital rubella syndrome in the July 1st issue of the Journal of Infectious Diseases. The supplement is a comprehensive review of the global efforts to eradicate measles and reaffirms a WHO Advisory Group conclusion that "measles can and should be eradicated."
While endemic measles virus transmission has not occurred in the United States since the late 1990s, and in the entire Western Hemisphere since November 2002, the U.S. is currently experiencing the highest number of measles cases since 1996. The U.S. has already seen 152 measles cases in 2011 and 86% are linked to direct imports of the disease from other countries.
Worldwide measles vaccination efforts since 1980 have dropped childhood deaths from the disease from 2.6 million to just 164,000 in 2008 and saved an estimated 12.7 million lives between 2000 and 2008. The Measles Initiative led by the American Red Cross, UN Foundation, CDC, UNICEF, and WHO as spearheading partners, has helped make this significant achievement possible. However, since 2009, a widespread resurgence of measles has affected 28 African countries with more than 200,000 reported cases and 1,400 measles–related deaths. Another 30,000 cases were reported in Europe since 2010.
Abstracts of the articles are available online or call (404) 639-3286 to receive printed copies.
Meetings, Conferences and Resources
Pink Book Now Available to Order or Download: The 12th edition of Epidemiology and Prevention of Vaccine-Preventable Diseases (The Pink Book) is now available to order or download. The book provides healthcare professionals with comprehensive information on vaccine-preventable diseases. The Pink Book can be downloaded for free from the NCIRD Vaccines and Immunizations web site or it can be purchased from the Public Health Foundation. The Pink Book is also available in E-reader format from Amazon.com, Google E-books, and Barnes and Noble.
Immunization Update Broadcast: On August 4, 2011, NCIRD will present Immunization Update 2011. This will be a live satellite broadcast and web cast that will provide up-to-date information on the rapidly changing field of immunization. Anticipated topics include influenza, meningococcal, zoster, Tdap, and human papillomavirus vaccines. The 2.5-hour broadcast will occur live from 9:00 to 11:30 AM (Eastern Time) and will be re-broadcast that day from 12:00 noon to 2:30 PM (Eastern Time). This program will be edited and made available as a self-study program 4 to 6 weeks after the broadcast. It will be available in DVD and web-on-demand formats.
Epidemiology and Prevention of Vaccine-Preventable Diseases 2011, Ten-Module Series: This comprehensive immunization course provides the most current information in the constantly changing field of immunization. It is updated annually to provide the latest recommendations from the ACIP. Each of the ten modules is 60 to 90 minutes in length and includes case studies and a discussion of frequently-asked questions. The web-on-demand course is now available and the DVD will be available soon. Continuing education is available. Additional information is provided in each module. For information and updates on other courses please visit the NCIRD Education and Training web page.
Current Issues in Immunization NetConference: The next netconference is scheduled for September 15, 2011. Topics and speakers will be announced at a later date. Please visit the netconference web page for updates and archived netconferences.
ACIP Meeting: The next ACIP meeting will be held October 25-26, 2011. Please visit the ACIP meeting web page for additional information.
New Scarlet Fever Podcast: A podcast about scarlet fever is now available. In this podcast a pediatrician discusses scarlet fever, its cause, how to treat it, and how to prevent its spread.
Group B Strep Awareness Month: International Group B Strep (GBS) Awareness Month takes place annually during July. During the observance materials are distributed with the goal of raising awareness. Learn more at the GBS web page.
Save the Date: World Pneumonia Day is November 12, 2011. The day will mobilize efforts to fight a neglected disease that kills more than two million children younger than five years of age worldwide each year. More than 120 organizations came together to commemorate the second annual World Pneumonia Day in 2010.
Save the Date: Get Smart About Antibiotics Week is November 14-20, 2011. The event marks an annual effort to coordinate the work of CDC’s Get Smart: Know When Antibiotics Work program, CDC’s Get Smart for Healthcare program, state-based appropriate antibiotic use campaigns, non-profit partners, and for-profit partners during a one week observance of antibiotic resistance and the importance of appropriate antibiotic use. CDC’s event will coincide with the European Antibiotic Awareness Day as an international partnership.
Immunization Publications: Please visit the NCIRD Publications Order Form for the latest immunization publications. Copies of the MMWR General Recommendations on Immunization, the 2011 Parents Guide to Childhood Immunizations, the 2011 childhood and adult immunization schedules and the 2011 Immunization Works CD 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 specialties are often needed to fill positions within CDC. For a current listing, including international opportunities, please visit CDC’s Employment web page.
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Content last reviewed on July 29, 2011
Content Source: National Center for Immunization and Respiratory Diseases