cdc immunization updates 2020...centers for disease control and prevention national center for...

Centers for Disease Control and PreventionNational Center for Immunization and Respiratory Diseases




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April 16, 2020

Mark Freedman, DVM, MPH

Centers for Disease Control and Prevention

CDC Immunization Updates 2020

• The planners and speakers of this activity have no relevant financial relationships with any commercial interests pertaining to this activity.

• Information about obtaining CEs will be available at the end of this webinar.

Disclosure and Continuing Education

This webinar is not funded by any commercial entity.

As an organization accredited by the ACCME, the Federation of State Medical Boards (FSMB) requires that the content of CME activities and related materials provide balance, independence, objectivity, and scientific rigor. Planning must be free of the influence or control of a commercial entity and promote improvements or quality in healthcare. All persons in the position tocontrol the content of an education activity are required to disclose all relevant financial relationships in any amount occurring within the past 12 months with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients.

The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. The FSMB has implemented a mechanism to identify and resolve all conflicts of interest prior to the activity. The intent of this policy is to identify potential conflicts of interest so participants can form their own judgments with full disclosure of the facts. Participants will be asked to evaluate whether the speaker’s outside interests reflect a possible bias in the planning or presentation of the activity.

The speakers, course director and planners at the Federation of State Medical Boards, Washington Medical Commission and the Washington State Department of Health have nothing to disclose.

This educational activity may contain discussion of published and/or investigational uses of agents that are not approved by theU.S. Food and Drug Administration. For additional information about approved uses, including approved indications, contraindications, and warnings, please refer to the prescribing information for each product, or consult the Physicians’ Desk Reference.

No speakers or persons in control of content reported intent to reference unlabeled/unapproved uses of drugs or products.

Continuing Medical Education Disclosure

Presenter has no conflict of interest

Use of trade names is for identification purposes only and does not imply endorsement

Discussions on unlicensed products and off-label uses are in the context of ACIP recommendations

Opinions expressed in this presentation are those of the presenter and do not necessarily represent official positions of CDC or ACIP

Disclosure and Disclaimer

Background

ACIP policy updates

Changes in the 2020 child/adolescent and adult immunization schedules

Children with foreign records/vaccinations

Guidelines for titer testing for immunity

Overview

Updated each year– Represents current, approved ACIP policy– Designed for implementation of ACIP policy

Approved by– CDC Director– American Academy of Pediatrics– American College of Physicians– American Academy of Family Physicians– American College of Obstetricians and Gynecologists– American College of Nurse-Midwives

Published in February, 2020– MMWR Notice to Readers – announcement of availability on ACIP website– Annals of Internal Medicine – published in entirety

Immunization Schedules – Background

ACIP Updates to the Child/Adolescent and Adult Immunization Recommendations

Influenza vaccination (June 2019)– 2019–20 Influenza vaccine recommendations

– Grohskopf et al. MMWR Aug 2019; 68(3); 1-21

Hepatitis A vaccination (June 2019)– Recommendation for routine catch-up vaccination for all children and adolescents age 2

through 18 years

Meningococcal B vaccination (June 2019)– Recommendation for booster doses for those at increased risk

Tdap vaccination (October 2019 vote)– Havers et al. MMWR Jan 2020; 69(3); 77-83– Option to use Td or Tdap– Vaccination of persons who received Tdap at 7–10 years of age

Updates in ACIP Recommendations:2020 Child and Adolescent Immunization Schedule

Human Papillomavirus (HPV) – June 2019 ACIP Meeting– Meites et al. MMWR Aug 2019; 68(32); 698-702– Catch-up vaccination for all persons through age 26– Shared clinical decision-making for persons 27-45 years

Pneumococcal Vaccines – June 2019 ACIP Meeting– Matanock et al. MMWR Nov 2019; 68(46); 1069-1075– PPSV23 recommended for all persons 65 and older– Shared clinical decision-making for PCV13 in persons 65 and older

Influenza Vaccines – June 2019 ACIP Meeting– Grohskopf et al. MMWR Aug 2019; 68(3); 1-21– Annual influenza vaccination recommended for all persons 6 months and older who do not have

contraindications

Updates in ACIP Recommendations for AdultsPolicy Statements Published after 2019 Adult Schedule Approval

Hepatitis A Vaccines– All persons with HIV aged ≥1 year be routinely vaccinated – Vaccination recommended in settings for exposure

Serogroup Meningococcal B Vaccines – June 2019 ACIP Meeting– For persons aged ≥10 years with complement deficiency, complement inhibitor use, asplenia, or who are

microbiologists, MenB booster dose 1 year after primary series; booster every 2-3 years if risk remains– For persons aged ≥10 years determined by public health officials to be at increased risk during an outbreak,

MenB booster dose if it has been ≥1 year since completion of primary series

Tdap Vaccines – October 2019 ACIP Meeting– Havers et al. MMWR Jan 2020; 69(3); 77-83– Either Td vaccine or Tdap to be used for the decennial Td booster, tetanus prophylaxis for wound

management, and for additional required doses in the catch-up immunization schedule if a person has received at least 1 Tdap dose

Updates in ACIP Recommendations for AdultsPolicy Statements Published after 2019 Adult Schedule Approval

Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. A licensed, recommended, and age-appropriate vaccine should be used

2 doses are recommended for children age 6 months through 8 years who have received fewer than 2 influenza vaccine doses before July 1, 2019

Dose 2 should be administered even if the child turns 9 during the influenza season.

Influenza Updates – Children/Adolescents

Grohskopf et al . Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2019–20 Influenza Season. MMWR 2019; 68(3); 1-21

Routine annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications. A licensed, recommended, and age-appropriate vaccine should be used

Inactivated influenza vaccines (IIVs), recombinant influenza vaccine (RIV), and live attenuated influenza vaccine (LAIV) are to be available for the 2019–20 season

No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended, and appropriate product is available

Influenza Updates – Adults

Grohskopf et al . Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2019–20 Influenza Season. MMWR 2019; 68(3); 1-21

Routine catch-up vaccination is recommended for all children and adolescents 2 through 18 years who have not previously received Hepatitis A vaccine

All persons aged ≥1 year living with HIV should receive Hepatitis A vaccine

Hepatitis A Updates – Children/Adolescents

ACIP recommends all persons with HIV aged ≥1 year be routinely vaccinated with Hepatitis A vaccine

Hepatitis A vaccination is recommended in settings of exposure (e.g., health care settings for injection or noninjection drug users or group homes and nonresidential day care facilities for developmentally disabled persons)

Clotting factor disorders have been removed as an indication for Hepatitis A vaccine

Hepatitis A Updates – Adults

A booster dose of MenB is recommended for high-risk individuals one year after completing the primary series and every 2-3 years thereafter

A booster dose is also recommended for anyone who may have previously received a series and are not currently exposed to serogroup B

The interval from primary series to booster is one year, although providers may use a 6 months window in communication with public health– Off-label recommendation

Meningococcal B Updates – Children/Adolescents

Persons ≥10 years with complement deficiency, complement inhibitor use, or asplenia or who are microbiologists should receive a MenB booster dose 1 year following completion of a MenB primary series– MenB booster doses every 2–3 years thereafter, for as long as the increased risk

remains

For persons ≥10 years determined by public health officials to be at increased risk during an outbreak, ACIP recommends a one-time booster dose if it has been 1 year or more since completion of a MenB primary series

Adolescents and young adults 16-23 years (16-18 years preferred) not at increased risk for meningococcal disease may be vaccinated based on shared clinical decision-making

Meningococcal B Updates - Adults

Tdap vaccine may be used any time Td is recommended

Children 10 years of age who receive a dose of Tdap do not need the routine 11-12 year old dose

Tdap Updates – Children/Adolescents

Havers et al. Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2019. MMWR 2020; 69(3); 77-83

Either Td or Tdap to be used for:– The decennial Td booster– Tetanus prophylaxis for wound management– For additional required doses in the catch-up immunization schedule if a person

has received at least 1 Tdap dose

Tdap Updates - Adults

Havers et al. Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2019. MMWR 2020; 69(3); 77-83

Routine recommendations for HPV vaccination of adolescents have not changed

Catch-up HPV vaccination is now recommended for all persons through age 26 years

For adults aged 27 through 45 years, public health benefit of HPV vaccination in this age range is minimal; shared clinical decision-making is recommended because some persons who are not adequately vaccinated might benefit

HPV Updates

Meites et al. Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR 2019; 68(32);698–702

ACIP recommends a routine single dose of PPSV23 for adults aged ≥65 years

Shared clinical decision-making is recommended regarding administration of PCV13 to persons aged ≥65 years who do not have an immunocompromising condition, cerebrospinal fluid leak, or cochlear implant and who have not previously received PCV13

If a decision to administer PCV13 is made, PCV13 should be administered first, followed by PPSV23 at least 1 year later.

Pneumococcal Updates

Matanock et al. Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR 2019; 68(46); 1069-1075

ACIP asked CDC to examine the data on the PCV13 recommendation

Pediatric use of PCV13 has indirectly reduced the incidence of PCV13-type disease among adults age 65 years and older

Implementation of a PCV13 recommendation for all adults age 65 years and older in 2014 has had minimal impact on PCV13-type disease at the population level in this age group

Pneumococcal Update


The following adults aged ≥65 years are potentially at increased risk for exposure to PCV13 serotypes and might attain higher than average benefit from PCV13 vaccination:– Persons residing in nursing homes or other long-term care facilities– Persons residing in settings with low pediatric PCV13 uptake– Persons traveling to settings with no pediatric PCV13 program

Incidence of PCV13-type invasive pneumococcal disease and pneumonia increases with increasing age and is higher among persons with chronic heart, lung, or liver disease, diabetes, or alcoholism, and those who smoke cigarettes or who have more than one chronic medical condition– Providers/practices caring for patients with these medical conditions may consider offering PCV13 to such

patients who are aged ≥65 years and who have not previously received PCV13

Pneumococcal Update


Ahmed SS, Pondo T, Xing W, et al. Early impact of 13-valent pneumococcal conjugate vaccine use on invasive pneumococcal disease among adults with and without underlying medical conditions—United States. Clin Infect Dis 2019. Epub August 12, 2019

Shared clinical decision-making (SCDM) vaccinations are not recommended for everyone in a particular age group or everyone in an identifiable risk group

SCDM recommendations are individually based and informed by a decision process between the health care provider and the patient or parent/guardian

The key distinction between routine, catch-up, and risk-based recommendations and SCDM recommendations is the default decision to vaccinate

ACIP makes SCDM recommendations when individuals may benefit from vaccination, but broad vaccination of people in that group is unlikely to have population‐level impacts

Shared Clinical Decision-Making Recommendation

https://www.cdc.gov/vaccines/acip/acip-scdm-faqs.html

https://www.cdc.gov/vaccines/acip/acip-scdm-faqs.html

Poll Question

If a person who is 30 years old received only 1 dose of quadrivalent HPV vaccine at age 18, should they complete the series now, and if so, how many doses would they need?A. None, they are too oldB. 1 dose of the 9-valent vaccine C. If the clinician and the patient have a discussion of the risks and benefits of vaccination and come to a shared

agreement to vaccinate, 2 additional doses of 9-valent vaccine at least 3 months apartD. No other doses can be given since the 4-valent vaccine is no longer available in the U.S.

Recommended Child/Adolescent and Adult Immunization Schedules, United States, 2020

Included trade names on list (trade names used in HepA, HepB, MenACWY, MenBnotes)

Organized notes by heading (“routine vaccination,” “shared clinical decision-making,” and “special situations”

Revised notes for brevity, clarity, consistency

Used bold text to highlight population or indication for which vaccination recommended, minimized use of specialized text

Removed articles, conjunctions, other words if meaning not compromised

Used consistent text structure and language (e.g., 3-dose series HPV vaccine at 0, 1-2, 6 months)

Harmonization of Child/Adolescent and Adult Schedules

Cover Pages

Child/Adolescent ScheduleTable 1

Routine Immunization Schedule

Adult ScheduleTable 1Recommended Schedule by Age Group

Age groups 19–21 years and 22–26 years have been combined

HPV row combined for males and females

Blue shading indicates shared clincial decision-making


The Catch-Up Table

Adult ScheduleTable 2Recommended Schedule by Medical Condition and Other Indications

Red text states not recommended instead of contraindicated

HPV row combined for males and females

HepA vaccine recommended for all persons ≥1 year living with HIV


The Vaccination by Medical Indication Table

NotesChild/Adolescent Schedule

Catch-up vaccination Dose 5 is not necessary if dose 4 was administered at

age 4 years or older and at least 6 months after dose 3.

For other catch-up guidance, see Table 2.

Catch-up vaccination Dose 1 at 7–11 months: Administer dose 2 at

least 4 weeks later and dose 3 (final dose) at

12–15 months or 8 weeks after dose 2

(whichever is later).

Dose 1 at 12–14 months: Administer dose 2

(final dose) at least 8 weeks after dose 1.

Dose 1 before 12 months and dose 2 before 15

months: Administer dose 3 (final dose) 8 weeks

after dose 2.

2 doses of PedvaxHIB before 12 months:

Administer dose 3 (final dose) at 12–59 months

and at least 8 weeks after dose 2.

Unvaccinated at 15–59 months: 1 dose

Previously unvaccinated children age 60

months or older who are not considered high

risk do not require catch-up vaccination.


Hepatitis A vaccination______________________

(minimum age: 12 months for routine vaccination)Routine vaccination

2-dose series (minimum interval 6 months) beginning at age 12

months.

Catch-up vaccination

Unvaccinated persons through 18 years should complete a 2-

dose series (minimum interval 6 months).

Persons who previously received 1 dose at age 12 months or

older should receive dose 2 at least 6 months after dose 1.

Adolescents 18 years and older may receive the combined

HepA and HepB vaccine, Twinrix, as a 3-dose series (0, 1, and 6

months) or 4-dose series (0, 7, and 21–30 days, followed by a

dose at 12 months).

International travel

Persons traveling to or working in countries with high or

intermediate endemic hepatitis A (wwwnc.cdc.gov/travel/):

– Infants age 6–11 months: 1 dose before departure;

revaccinate with 2 doses, separated by at least 6 months,

between 12 to 23 months of age.

– Unvaccinated age 12 months and older: Administer dose 1 as

soon as travel considered

Special Situations

Revaccination is not generally recommended

for persons with a normal immune status who

were vaccinated as infants, children,

adolescents, or adults.

Revaccination may be recommended for

certain populations, including:

o Infants born to HBsAg-positive mothers

o Hemodialysis patients

o Other immunocompromised persons

For detailed revaccination recommendations,

please see the HepB MMWR publications at

https://www.cdc.gov/vaccines/hcp/acip-

recs/vacc-specific/hepb.html.

Influenza vaccination___________________

(minimum age: 6 months [IIV], 2 years [LAIV],

18 years [Recombinant influenza vaccine, RIV])

Routine vaccination

Use any influenza vaccine appropriate for age

and health status annually.

o 2 doses, separated by at least 4 weeks, for

children age 6 months–8 years who have

received fewer than 2 influenza vaccine

doses before July 1, 2019 (administer dose 2

even if the child turns 9 during the influenza

season)

o 1 dose for children age 6 months–8 years

who have received at least 2 influenza

vaccine doses before July 1, 2019

o 1 dose for all persons age 9 years and older

For the 2020–21 season, see the 2020–21 ACIP

influenza vaccine recommendations..

Special situations

Egg allergy, hives only: Any influenza vaccine appropriate for age and

health status annually

Egg allergy with symptoms other than hives (e.g., angioedema, respiratory

distress, need for emergency medical services or epinephrine): Any

influenza vaccine appropriate for age and health status annually in medical

setting under supervision of health care provider who can recognize and

manage severe allergic conditions

LAIV should not be used in persons with the following conditions or

situations:

o History of severe allergic reaction to a previous dose of any influenza

vaccine or to any vaccine component (excluding egg, see details above)

o Receiving aspirin or salicylate-containing medications

o Age 2–4 years with history of asthma or wheezing

o Immunocompromised due to any cause (including medications and

HIV infection)

o Anatomic or functional asplenia

o Cochlear implant

o Cerebrospinal fluid-oropharyngeal communication

o Close contacts or caregivers of severely immunosuppressed persons

who require a protected environment

o Pregnancy

o Received influenza antiviral medications within the previous 48 hours

Special situations

Anatomic or functional asplenia (including sickle cell

disease), HIV infection, persistent complement component

deficiency, complement inhibitor (e.g., eculizumab,

ravulizumab) use:

Menveo

– Dose 1 at age 8 weeks: 4-dose series at 2, 4, 6,

12 months

– Dose 1 at age 7–23 months: 2-dose series (dose

2 at least 12 weeks after dose 1 and after the 1st

birthday)

– Dose 1 at age 24 months or older: 2-dose series

at least 8 weeks apart

Menactra

– Persistent complement component deficiency

or complement inhibitor use:

Age 9–23 months: 2 doses at least 12

weeks apart

Age 24 months or older: 2 doses at least

8 weeks apart

– Anatomic or functional asplenia, sickle cell

disease, or HIV infection:

Age 9–23 months: Not recommended

24 months or older: 2 doses at least 8

weeks apart

Menactra must be administered at least

4 weeks after completion of PCV13

series.

Adolescent vaccination of children who

received MenACWY prior to age 10 years:

Children in whom boosters are not

recommended due to an ongoing

increased risk of meningococcal disease

(e.g., a healthy child who traveled to a

country where meningococcal disease is

endemic): Administer MenACWY

according to the recommended

adolescent schedule with dose 1 at age

11–12 years and dose 2 at age 16 years.

Children in whom boosters are

recommended due to an ongoing

increased risk of meningococcal disease

(e.g., those with complement deficiency,

HIV, or asplenia): Follow the booster

schedule for persons at increased risk.

For MenB booster dose recommendations for

groups listed under “Special situations” and in an

outbreak setting and for additional meningococcal

vaccination information, see

www.cdc.gov/vaccines/acip/recommendations.html and

www.cdc.gov/vaccines/hcp/acip-recs/vacc-

specific/mening.html.

Poliovirus vaccination

(minimum age: 6 weeks)Routine vaccination

4-dose series at ages 2, 4, 6–18 months, 4–6 years; administer the final dose on or

after the 4th birthday and at least 6 months after the previous dose.

4 or more doses of IPV can be administered before the 4th birthday when a

combination vaccine containing IPV is used. However, a dose is still recommended

after the 4th birthday and at least 6 months after the previous dose.


In the first 6 months of life, use minimum ages and intervals only for travel to a

polio-endemic region or during an outbreak.

IPV is not routinely recommended for U.S. residents 18 years and older.

Series containing oral polio vaccine (OPV), either mixed OPV-IPV or OPV-only series:

Total number of doses needed to complete the series is the same as that

recommended for the U.S. IPV schedule. See

www.cdc.gov/mmwr/volumes/66/wr/mm6601a6.htm?s_ cid=mm6601a6_w.

Only trivalent OPV (tOPV) counts toward the U.S. vaccination requirements.

o Doses of OPV administered before April 1, 2016, should be counted (unless

specifically noted as administered during a campaign).

o Doses of OPV administered on or after April 1, 2016, should not be counted.

o For guidance to assess doses documented as “OPV,” see

www.cdc.gov/mmwr/volumes/66/wr/mm6606a7.htm?s_cid=mm6606a7_w.


http://www.cdc.gov/mmwr/volumes/66/wr/mm6601a6.htm?s_


Adolescents age 13–18 years who have not received

Tdap:

1 dose Tdap, then Td or Tdap booster every 10 years

Persons age 7–18 years not fully vaccinated* with

DTaP:

1 dose Tdap as part of the catch-up series (preferably

the first dose); if additional doses are needed, use Td or

Tdap.

Tdap administered at 7–10 years

– Children age 7–9 years who receive Tdap should

receive the routine Tdap dose at age 11–12

years.

– Children age 10 years who receive Tdap do not

need to receive the routine Tdap dose at age 11–

12 years.

DTaP inadvertently administered after the 7th

birthday:

– Children age 7–9 years: DTaP may count as

part of catch-up series. Administer routine

Tdap dose at age 11–12 years.


For information on use of Tdap or Td as tetanus

prophylaxis in wound management, see

www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm.

– Children age 10–18 years: Count dose of DTaP

as the adolescent Tdap booster.

*Fully vaccinated = 5 valid doses of DTaP OR 4 valid doses

of DTaP if dose 4 was administered at age 4 years or older.

http://www.cdc.gov/mmwr/volumes/67/rr/rr6702a1.htm

Poll Question

A healthy 9 year old child with no underlying health conditions presents to your clinic for influenza vaccination. She has never been vaccinated for influenza. How many doses of influenza vaccine will she need?A. One doseB. None, she is too young to vaccinateC. 2 doses, separated by at least 4 weeksD. None, since she has no underlying medical conditions

NotesAdult Immunization Schedule

Recommended in settings for exposure

Recommended for all persons ≥1 year living with HIV

Catch up recommended for all persons through age 26 years

Shared clinical decision-making recommended for persons 27-45 years

Bulleted list of situations where LAIV should not be used

Shared clincial decision-making for adolescents and young adults aged 16–23 years who are not at increased risk

Recommendation for booster doses every 2-3 years if risk remains

Shared clinical decision-making recommendation for PCV-13

Td or Tdap may be used for decennial booster

Foreign Immunization Records

Vaccines administered outside the United States generally can be accepted as valid if the schedule (i.e., minimum ages and intervals) is similar to that recommended in the United States

With the exception of influenza vaccine, only written documentation should be accepted as evidence of previous vaccination

Written records are more likely to predict protection if the vaccines, dates of administration, intervals between doses, and age at the time of vaccination are comparable to U.S. recommendations

Health-care providers may use one of multiple approaches if the immunogenicity of vaccines or the completeness of series administered to persons outside the United States is in question– Repeating the vaccinations is an acceptable option– Serologic testing might help determine which vaccinations are needed


https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/special-situations.html

https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/special-situations.html

Checking for laboratory evidence of immunity (i.e., antibody levels) is an acceptable alternative to vaccination, when previous vaccinations or disease exposure are likely. However, the clinician should be familiar with the efficacy and interpretation of available serologic tests when relying on testing as proof of immunity

Refugees are offered some pre-departure vaccines through the Vaccination Program for US-bound Refugees


https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/immunizations-guidelines.html

https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/immunizations-guidelines.html

Doses before April, 2016– Doses of OPV, that meet minimum age and intervals, can count towards

completion of a series regardless of how the dose is documented (unless it says “campaign”)

Doses from April 1, 2016 – April 30, 2016– OPV administered April 1, 2016 through April 30, 2016 should be documented as

tOPV for it to count towards completion of a series (unless it says “campaign”)

Doses on or after May, 2016– OPV doses should not be counted

If the dose includes the phrase “campaign,” the dose does NOT count

Foreign Immunization Records:Assessing Polio Vaccines

Foreign Vaccine Terms– https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/b/foreign-

products-tables.pdf– https://www.immunize.org/catg.d/p5122.pdf

Foreign Vaccine Record Translations– Email [email protected]

Foreign Immunization Records - Resources

https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/b/foreign-products-tables.pdfhttps://www.immunize.org/catg.d/p5122.pdfmailto:[email protected]

Titer Testing for Immunity

Serologic testing for immunity (i.e., antibody testing) is an alternative

Multiple factors influence the clinician’s decision to check serology– Cost of the vaccine course vs. serologic testing– Likelihood of previous infection– Availability of antibody testing and acceptance that antibody presence confers

immunity– The number of doses needed to complete a series– The level (titer) of antibody known to confer immunity– The likelihood that the patient will return for results and further management

Vaccination in a person who might be immune from natural infection does not increase risk for adverse events


Hepatitis A– Testing of children is not indicated because of expected low prevalence of infection– For adults, the decision to test should be based on:

1. The expected prevalence of immunity2. The cost of vaccination compared with the cost of serologic testing (including

the cost of an additional visit)3. The likelihood that testing will not interfere with initiation of vaccination.

Hepatitis B– In populations that have high rates of previous HBV infection, prevaccination

testing might reduce costs by avoiding vaccination of persons who are already immune

– In settings where testing is not feasible, vaccination of recommended persons should continue


MMR– Serologic screening for measles, rubella, or mumps immunity is not necessary and

not recommended if a person has other acceptable evidence of immunity– Documented age-appropriate vaccination supersedes the results of subsequent

serologic testing– If a person who has 2 documented doses of measles- or mumps-containing

vaccines is determined to have negative or equivocal measles or mumps titer results, it is not recommended that the person receive an additional dose of MMR vaccine

– Women of childbearing age who have 1 or 2 documented doses of rubella-containing vaccine and have rubella-specific IgG levels that are not clearly positive should be administered 1 additional dose of MMR vaccine (maximum of 3 doses)


VAR– Persons aged >13 years without evidence of varicella immunity should receive 2

doses of single-antigen varicella vaccine administered SQ, 4--8 weeks apart– Evidence of immunity:

1. Birth before 1980*2. Laboratory confirmation of immunity3. Health care provider confirmation of varicella disease or zoster disease

– Commercial assays can be used to assess immunity from natural infection, but lack the sensitivity to always detect vaccine-induced immunity


*Except in health care providers, pregnant women, and immunocompromised persons

ACIP Members

Hank Bernstein (Chair)

Jose Romero

Peter Szilagyi

Ex Officio Members

Thomas Weiser (IHS)

Consultants

Diane Peterson (IAC)

CDC Staff

Candice Robinson (CDC Lead)

Liaison Representatives

Sarah Coles (AAFP)

Sean O’Leary (PIDS)

Sarah McQueen (AAPA)

Amy Middleman (SAHM)

Patsy Stinchfield (NAPNAP)

Katherine Debiec (ACOG)

Susan Lett (CSTE)

Child/Adolescent Immunization Work Group

ACIP Members

Paul Hunter (Chair)

Kevin Ault

Ex Officio Members

David Kim (OASH)

Consultants

Kathy Harriman (CA DOH)

Diane Peterson (IAC)

LJ Tan (IAC)

Carolyn Bridges (IAC)

Maria Lanzi (VA)

CDC Staff

Mark Freedman (CDC Lead)

Liaison Representatives

John Epling (AAFP)

Sandra Fryhofer (AMA, ACP)

Robert Hopkins (ACP)

Molly Howell (AIM)

Laura Pinkston Koenigs (SAHM)

Maria Lanzi (AANP)

Marie-Michèle Léger (AAPA)

Susan Lett (CSTE)

Chad Rittle (ANA)

William Schaffner (NFID)

Ken Schmader (AGS)

Rhoda Sperling (ACOG)

David Weber (SHEA)

Adult Immunization Work Group

Continuing Education

This continuing nursing education activity was approved by the Montana Nurses Association, an accredited approver with distinction by the American Nurses Credentialing Center’s Commission on Accreditation. Upon successful completion of this activity, 1.0 contact hours will be awarded.

This program has been granted prior approval by the American Association of Medical Assistants (AAMA) for 1.0 administrative continuing education unit.

This training was approved by the Washington State Pharmacy Quality Assurance Commission (PQAC) for pharmacist education. Upon successful completion of this activity, 1.0 credit hour of continuing education will be awarded.

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Federation of State Medical Boards, the Washington Medical Commission and the Washington State Department of Health. The Federation of State Medical Boards is accredited by the ACCME to provide continuing medical education for physicians.

The Federation of State Medical Boards designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Education

Continuing education is available for nurses, medical assistants, physicians, and

pharmacists.

Successful completion of this continuing education activity includes the following:

– Attending the entire live webinar or watching the webinar recording

– Completing the evaluation available after the webinar or webinar recording

Expiration date is 4/16/21

After completing the evaluation, send an email to [email protected] to request

a certificate

If you have any questions about CEs, contact Trang Kuss at [email protected]

Obtaining Continuing Education

mailto:[email protected]:[email protected]

Questions?

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