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

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

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

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

Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation use. No rights are implied or extended for use in printing or any use by other CDC CIOs or any external audiences.

Immunization Update 2017Children and Adolescents

JoEllen Wolicki, RN, BSN

Nurse Educator

Immunization Services Division

2017 Texas Immunization ConferenceNovember 28–30, 2017

▪ JoEllen Wolicki is a federal government employee with no financial interest in or conflict with the manufacturer of any product named in this presentation

▪The speaker will not discuss the off-label use of any vaccine except influenza vaccine

▪The speaker will not discuss a vaccine not currently licensed by the FDA

Disclosures

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▪ The recommendations to be discussed are primarily those of the Advisory Committee on Immunization Practices (ACIP):• Composed of 15 non-government experts in

clinical medicine and public health

• Provides guidance on use of vaccines and other biologic products to DHHS, CDC, and the U.S. Public Health Service

▪ Watch the live webcast • www.cdc.gov/vaccines/acip/meetings/webcast-

instructions.html

Disclosures

CDC ACIP meeting website http://www.cdc.gov/vaccines/acip/meetings/upcoming-dates.html

Next ACIP meetingFebruary 21-22, 2019

Vaccination Coverage Rates

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State/Area Combined Series*4:3:1:3:3:1:4

United States 70.7%

Texas 69.4%

Estimated Vaccination Coverage Among Children Age 19-35 Months, NIS 2016

MMWR 2017;65(39):1065–107

*The combined (4:3:1:3:3:1:4) vaccine series includes ≥4 doses of DTaP, ≥3 doses of poliovirus vaccine, ≥1 dose of measles-containing vaccine, full series of Hib vaccine (≥3 or ≥4 doses, depending on product type), ≥3 doses of HepB, ≥1 dose of varicella vaccine, and ≥4 doses of PCV

Estimated Vaccination Coverage among Adolescents Age 13-17 Years, NIS-Teen, United States, 2016

HPV vaccine, nine-valent (9vHPV), quadrivalent (4vHPV), or bivalent (2vHPV). For ≥1-, ≥2-, and ≥3-dose measures, percentages are reported among females and males combined (n = 20,475) and for females only (n = 9,661) and males only (n = 10,814).

HPV UTD includes those with ≥3 doses, and those with 2 doses when the first HPV vaccine dose was initiated before age 15 years and time between the first and second dose was at least 5 months minus 4 days.

MMWR 2017; 66(33):874–882

Vaccine United States Texas

≥1 Tdap 88.0% 85.0%

≥1 HPV (All–boys and girls) 60.4% 49.3%

HPV UTD (All–boys and girls) 43.4% 32.9%

≥1 MenACWY 82.2% 85.5%

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2017 ACIP Immunization ScheduleChildren 18 Years of Age and Younger

Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, 2017

ACIP Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, UNITED STATES, 2017

www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html

▪ Figure 1 – Routinely recommended vaccines based on age

▪ Figure 2 – Catch-up schedule for children who start late or are more than 1 month behind

▪ Figure 3 – Vaccines that might be indicated based on medical indications

New!

Download the App!

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Childhood Immunization ScheduleFigure 3: Vaccines Based on Medical Indications

▪Demonstrates most children with medical conditions can, and should be vaccinated according to the routine immunization schedule

▪ Indicates when a medical condition is a precaution or contraindication

▪ Indicates when additional doses of vaccines may be necessary secondary to the child’s/adolescent’s medical condition

Vaccine Supply Updates

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▪ Ongoing outbreaks of hepatitis A in adults in a number of states, has substantially increased the demand for vaccine and constrained supply

▪ HepA vaccine manufacturers (GlaxoSmithKline and Merck Vaccines) also report an unexpected demand globally which has constrained supply

▪ CDC staff are working with public health officials to provide guidance about how best to target vaccine distribution

▪ Vaccine manufacturers are exploring options to increase domestic supply and working with CDC to monitor and manage public and private vaccine orders to make the best use supplies of the adult vaccine

▪ NOTE: Supply constraints do NOT apply to pediatric HepA vaccine

Hepatitis A

CDC Current Vaccine Shortages & Delays https://www.cdc.gov/vaccines/hcp/clinical-resources/shortages.html

▪ Merck is not currently distributing the hepatitis B vaccine: • Adult formulation: Does not expect to be distributing vaccine

between now and the end of 2018• Pediatric formulations will be unavailable between early August

2017 and early 2018▪ Merck’s supply of the dialysis formulation of Hepatitis B vaccine is

not affected▪ GSK has sufficient supplies of adult and pediatric Hepatitis B

vaccines to address these anticipated gap in Merck’s supply • Preferences for a specific presentation (i.e., vial versus syringe)

may not be consistently met

RecombivaxHB (HepB)

CDC Current Vaccine Shortages & Delays https://www.cdc.gov/vaccines/hcp/clinical-resources/shortages.html

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Seasonal Influenza Update

▪ Seasonal influenza activity continues to increase

▪ Several flu activity indicators are higher than is typically seen for this time of year • 2 states report widespread flu

activity • 6 states report regional flu activity• 20 states report local flu activity

▪ 5 influenza-associated pediatric death has been reported to CDC

2017–18 Influenza Season

*This map indicates geographic spread and does not measure the severity of influenza activity

CDC Fluview www.cdc.gov/flu/weekly/index.htm#ISTE

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▪Trivalent vaccines for use during the 2017-2018 influenza season should contain the following:• A/Michigan/45/2015 (H1N1)pdm09-like virus [NEW]• A/Hong Kong/4801/2014 (H3N2)-like virus• B/Brisbane/60/2008-like virus

▪Quadrivalent vaccines should contain the above three viruses and an additional influenza B virus• B/Phuket/3073/2013

Recommended Composition of Seasonal Influenza Vaccines for the 2017-2018 Influenza Season

MMWR 2017;66(RR-2):1–20

Inactivated Influenza Vaccines 2017–2018 Season

Product/Manf Presentation Age Indications Route Number of Strains

Afluria/Seqirus 0.5 mL MFS5 years and older

IM

IIV3 and IIV4 5.0 MDV IM: needle/syringe

18 through 64 years IM: needle/syringe or

Jet injector

Fluad/Seqirus 0.5 mL MFS 65 years and older IM IIV3

Fluarix/GSK 0.5 mL MFS 3 years and older IM IIV4

Flublok/Protein Sciences 0.5 SDV 18 years and older IM RIV3 and RIV4

Flucelvax/Seqirus 0.5 mL MFS 4 years and older IM ccIIV4

Flulaval/ID Biomedical 0.5 mL MFS6 months and older IM IIV4

5.0 mL MDV

Fluvirin/Seqirus 0.5 mL MFS4 years and older IM IIV3

5.0 mL MDV

Fluzone/SP 0.25 mL MFS 6 months and older

IM IIV40.5 mL MFS

3 years and older0.5 mL SDV

5.0 mL MDV 6 months and older

Fluzone High-Dose/SP 0.5 mL MFS 65 years and older IM HD-IIV3

Fluzone Intradermal/SP 0.1 mL microinjection system 18 through 64 years ID IIV4

MFS = manufacturer-filled syringe SDV = single-dose vial MDV = multidose vial

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▪Afluria is approved for children 5 years of age and older

▪ FluLaval is now approved for children 6 months of age and older

What Has Changed or New With Influenza Vaccine Products?

2017–18 Pediatric Flu Vaccine Products forChildren 6 Months and Older

Product Age Dose (Amount)

FluLaval 6 months and older 0.5 mL

Fluzone 6 through 35 months 0.25 mL

Fluzone 36 months and older 0.5 mL

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▪Administering the wrong dose (amount) including:• 0.25ml dose of FluLaval to a child 6-35 months

• 0.5 ml dose of Fluzone to a child 6-35 months

• 0.25 ml dose of Fluzone to a person 3 years of age and older

Potential Vaccine Administration Errors

▪ACIP does not express a preference for the product used • Trivalent versus quadrivalant vaccine • High dose versus standard dose vaccine in persons 65 years of

age and older

Which Product Should We Use?

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▪Annual influenza vaccination continues to be recommended for persons without contraindications or precautions 6 months of age and older

▪ FluMist Quadrivalent (LAIV4) should not be used during the 2017–18 season due to concerns about its effectiveness against influenza A(H1N1)pdm09 viruses in the United States during the 2013–14 and 2015–16 influenza seasons

2017-18 Influenza ACIP Recommendations

MMWR 2017;66(RR-2):1–20

▪What was the impact of the lack of availability of LAIV on influenza vaccination coverage among children for the 2016–17 season? a. Coverage went down b. Coverage went upc. Coverage did not change

What Do You Think?

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Preliminary Influenza Vaccination Coverage for the 2016 – 17 Season Compared with the 2015–16 Final Season Estimates, Children, NIS-Flu

▪Ben is 4 years of age and is at your clinic for a flu shot. His immunization history includes:• IIV3 at 1 year of age • IIV4 at 3 years of age

How many doses of influenza vaccine does Ben need this season? a. One (1)b. Two (2)

What Do You Think?

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▪ Administer 2 doses, separated by at least 4 weeks, to children 6 months through 8 years of age who:• Are receiving influenza vaccine for the first time, OR• Vaccination history is unknown• Did not receive a total of at least two doses of influenza vaccine before July 1,

2017, OR• Remember: o Either product may be used for either doseo Dose (amount) is based on the product

▪ Administer 1 dose to: • Children 6 months through 8 years of age, who previously received 2 doses o Both doses do not have to be administered during the same season or consecutive

seasons• Children 9 years of age and older, regardless of immunization history

2017–18 Pediatric Schedule for Children

MMWR 2017;66(RR-2):1–20

Influenza Job Aids

Guide for Determining the Number of Doses of Influenza Vaccine to Give to Children Age 6 Months Through 8 Years During the 2017–2018 Influenza Season www.immunize.org/catg.d/p3093.pdf

Influenza Vaccine Products for the 2017–2018 Influenza Season www.immunize.org/catg.d/p4072.pdf

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▪You administered seasonal flu vaccine (FluLaval; 0.5 mL) to a 6-month old, 6 weeks ago. He is back today.

a. Administer 0.5 mL of FluLaval b. Nothing–no vaccine is due

What Do You Think?

▪There is no FluLaval in your facility’s inventory. Can Fluzone be administered for the 2nd dose? a. Yesb. No

▪What dose (amount) should be administered? a. 0.5 mLb. 0.25 mL

What Do You Think? Part 2

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▪ You Call the Shots–Influenza module www.cdc.gov/vaccines/ed/youcalltheshots.html

▪ Influenza Vaccine FAQs video www.youtube.com/watch?v=TXaNvFJDv_c

▪ Current influenza activity www.cdc.gov/flu

▪ Influenza labels for storage units www.cdc.gov/vaccines/hcp/admin/storage/guide/vaccine-storage-labels-flu.pdf

▪ Fact sheet for health care providers of pregnant women www.cdc.gov/flu/professionals/vaccination/vaccination-possible-safety-signal.html

▪ Tools to Assist Satellite, Temporary, and Off-Site Vaccination Clinics www.izsummitpartners.org/naiis-workgroups/influenza-workgroup/off-site-clinic-resources/

CDC Clinical Resources for Health Care Personnel

ACIP Immunization Recommendations Updates

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ACIP Vaccine Recommendations and Guidelines

https://www.cdc.gov/vaccines/hcp/acip-recs/index.html

ACIP General Best Practice Guidelines on Immunization

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▪ Originally published in 1976

▪ No longer published in the MMWR or Recommendations and Reports

▪ “On-line, living document”

▪ Sections include:

ACIP Recommendations Formerly Known as General Recommendations

• Timing and Spacing • Contraindications and precautions • Preventing and managing adverse

reactions • Vaccine administration

• Storage and handling • Special situations • Vaccination records • Vaccination programs

Hepatitis B (HepB)

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▪ Administer monovalent Hepatitis B vaccine within 24 hours of birth to medically stable infants weighing ≥2,000 grams born to hepatitis B surface antigen (HBsAg)-negative mothers

▪ ACIP immunization recommendations have NOT changed for: • Infants less than 2,000 grams have NOT changedoPreterm infants weighing less than 2,000 g born to HBsAg-negative

mothers should receive the first dose of vaccine 1 month after birth or at hospital discharge

• Infants born to HBsAg-positive mothers• Infants born to mothers whose hepatitis B status is unknown

Hepatitis B

ACIP meeting October 2016

www.cdc.gov/vaccines/acip/meetings/downloads/slides-2016-10/hepatitis-02-schillie-october-2016.pdf

Human Papillomavirus (HPV)

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Human Papillomavirus (HPV) HPV Yoga

▪ Administer 2 doses of HPV vaccine to healthy adolescents starting the series at 9 through 14 years of age

▪ Follow the routine 2-dose schedule • Administer the 2nd dose 6-12 months after the 1st dose• Minimum interval between doses is 5 months

▪ If a 2nd dose is inadvertently administered prior to 6 months default to a 3-dose series• Remember–minimum intervals for dose 3: oAt least 12 weeks after dose 2 ANDo5 months after dose 1

ACIP HPV Immunization RecommendationsPreviously Unvaccinated Adolescents

MMWR 2016;65(49):1405-08

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▪Administer 3 doses of HPV vaccine to adolescents starting the series at 15 years of age and older

▪Routine 3-dose schedule: 0, 1-2, 6 months • Dose #2: Administer at least 1 to 2 months after dose 1• Dose #3: Administer at least: o12 weeks after dose 2 ANDo6 months after dose 1

ACIP Immunization Recommendations Previously Unvaccinated Adolescents

MMWR 2016;65(49):1405-08

▪ ACIP recommends HPV vaccination for immunocompromised females and males aged 9 through 26 years with 3 doses of HPV vaccine (0, 1-2, 6 months)

▪ Administer a 3-dose series to immunocompromised persons including those with: • Primary or secondary immunocompromising conditions that might

reduce cell-mediated or humoral immunity, such as B lymphocyte antibody deficiencies, T lymphocyte complete or partial defects, HIV infection, malignant neoplasm, transplantation, autoimmune disease or immunosuppressive therapy

ACIP HPV Immunization RecommendationsMedical Condition Considerations

MMWR 2016;65(49):1405-08

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▪ Number of recommended doses is based on:• Age the first dose was administered OR• Health status–immunosuppression

▪ The 2-dose series intervals may be used to assess doses previously administered• Both doses do NOT have to be before 15 years of age

▪ Series does not need to be restarted if interrupted• There is NO maximum interval between HPV vaccine doses

▪ 9vHPV may be used to continue or complete a series started with 4vHPV or 2vHPV regardless of the dosing schedule

ACIP HPV Immunization RecommendationsSchedule Considerations

MMWR 2016;65(49):1405-08

▪Erica is 17-years of age and presents for influenza vaccine today with her mother. Her immunization history includes: • 4vHPV #1 at 11 years of age • 9vHPV #2 at 16 years of age

Does she need a dose of HPV vaccine? a. Yesb. No

What Do You Think?

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▪The newly updated Tips and Timesavers for Talking with Parents about HPV vaccine addresses common questions parents may have

▪Clinician FAQ: Consult this factsheet for explanations on the 2-dose HPV immunization schedule

▪Visit the HPV clinician webpage for more HPV facts, how to promote vaccination, and how to successfully communicate with parents

CDC HPV Resources: Clinicians

Tips and Timesavers: www.cdc.gov/hpv/hcp/for-hcp-tipsheet-hpv.pdf

2-dose HPV Vaccine Factsheet: www.cdc.gov/hpv/downloads/hcvg15-ptt-hpv-2dose.pdf

HPV Clinician Webpage: www.cdc.gov/hpv/hcp/index.html

Meningococcal B Vaccine

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▪Persons aged 10 years and older who are at increased risk for meningococcal disease should receive MenB vaccine* including persons with: • Persons with persistent complement component deficiencies• Persons with anatomic or functional asplenia• Microbiologists routinely exposed to isolates of Neisseria

meningitidis• Persons identified as at increased risk because of a serogroup

B meningococcal disease outbreak

Meningococcal Serogroup B Vaccine

*Category A

MMWR 2015 64(22); 608-612

▪Adolescents and young adults 16 through 23 years of age may be given MenB vaccine to provide short-term protection against most strains of serogroup B meningococcal disease*

▪Clinical considerations: • 2 MenB vaccine products are available

1. MenB-4C (Bexsero) 2. MenB-FHbp (Trumenba)

• ACIP does not express a preference for the product used • The series should be completed with the same product

Meningococcal Serogroup B Vaccine

*Category B

MMWR 2015 64(41); 1171-1176

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▪Changes to the dosage and administration section for MenB-FHbp approved by FDA on April 14, 2016

▪ FDA approved schedules: • 3-dose schedule: 0, 2, and 6 months• 2-dose schedule: 0 and 6 months

▪Recommended schedule is based on the risk of exposure and the patient’s susceptibility to meningococcal serogroup B disease

Use of 2- and 3-Dose Schedules of MenB-FHbp (Trumenba) Meningococcal Serogroup B Vaccine

MMWR 2017 66(19);509–513

▪ Follow the 3-dose schedule for persons at increased risk for meningococcal disease and during serogroup B outbreaks• Administer 3 doses of Trumenba at 0, 1-2, 6 months intervals to

provide early protection and maximize short-term immunogenicity • However, if the second dose of Trumenba is administered at an

interval of 6 months or more, a third dose does not need to be administered

▪ Follow the 2-dose schedule for healthy adolescents who are not at increased risk for meningococcal disease• Administer 2 doses of Trumenba at 0 and 6 months intervals

Use of 2- and 3-Dose Schedules of MenB-FHbp (Trumenba) Meningococcal Serogroup B Vaccine

MMWR 2017 66(19);509–513

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Meningococcal B Job Aids

Immunization Action Coalition www.immunize.org

Pediatric Vaccine Administration ErrorsInfluenza Vaccine

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▪National spontaneous (or passive) reporting system for adverse events (AEs) after US-licensed vaccines • In recent years, received around 35,000 US reports annually • Accepts reports from health care providers, manufacturers, and the

public• Signs/symptoms of adverse event are coded using MedDRA terms and

entered into database• Primarily for signal detection and hypothesis generation

▪ Jointly administered by CDC and FDA since 1990

Vaccine Adverse Event Reporting System (VAERS)

Vaccine Adverse Event Reporting System: https://vaers.hhs.gov/

MedDRA: http://www.meddra.org/

Strengths

▪ National data; accepts reports from anyone

▪ Can rapidly detect safety signals

▪ Can detect rare adverse events

▪ Data available to public

Limitations▪ Reporting bias

▪ Inconsistent data quality and completeness

▪ Lack of unvaccinated comparison group

▪ Generally cannot assess if vaccine or error caused an adverse health event

▪ VAERS coding practices can affect types and numbers of errors reported

Vaccine Adverse Event Reporting System (VAERS)

Vaccine Adverse Event Reporting System: http://vaers.hhs.gov 52

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Influenza Vaccination Errors in Children Reported to VAERS*, 2016–2017

*Primary U.S. reports with one or more codes describing vaccination errors in persons aged 0-18 years July 1, 2016–April 28, 2017

†Health problem following vaccination

§If one of the following is reported: death, life-threatening illness, hospitalization, or prolongation of hospitalization or permanent disability (Code of Federal Regulations)

Total U.S. VAERS reports following influenza vaccine in children (1,672)

No adverse health event

in error reports

(137, 89%)

Adverse health event†

in error reports

(17, 11%)Serious reports§

(2, 1%)

Vaccination error reports in children (159, 9%)*

Vaccine error group* 0–18 years N (%)1. Inappropriate schedule 82 (52)

2. Incorrect dose (amount) 45 (28)

3. Wrong vaccine 18 (11)

Administration error 7 (4)

Product quality 4 ( 3)

Contraindication 1 (<1)

Equipment 1 (<1)

General error 1 (<1)

Prescribing/dispensing 0 (0)

Product labeling/packaging 0 (0)

Total errors† 159 errors

Influenza Vaccine Administration Errors Reported to VAERS, 2016–2017

*Some groupings contain more than one MedDRA code; error groups are not mutually exclusive

†In persons aged 0–18 years: 154 reports; all ages: 549 reports. Individual report may be associated with more than one vaccination error or error group depending on assigned MedDRA terms

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▪ Keep current reference materials available for staff, including:• Recommended childhood schedule• Minimum age and interval table

▪ Educate staff who administer immunizations about vaccines in the facility’s inventory

▪ Educate staff to schedule immunization appointments AFTER the child’s birthday

▪ Participate with and assess for vaccines using ImmTrac2

1. Inappropriate Schedule

ACIP General Best Practices, Table 3-1: www.cdc.gov/mmwr/pdf/rr/rr6002.pdf

ACIP Immunization Schedules for Children and Adults: www.cdc.gov/vaccines/schedules/

Immunization Information Systems: www.cdc.gov/vaccines/programs/iis/index.html

ImmTrac2: www.dshs.texas.gov/immunize/immtrac/default.shtm

▪ Only administer vaccines you have prepared and triple-checked• Ask an another staff member to check

vaccines prior to administration

▪ Educate staff on the vaccine products in the facility’s inventory • New employee orientation• New products are added • New recommendations and/or

indications

▪ Consider using standing orders

2. Wrong Dose (Amount)

ACIP vaccine abbreviations www.cdc.gov/vaccines/acip/committee/guidance/vac-abbrev.html

Immunization Action Coalition: standing orders templates www.immunize.org/standing-orders/

IAC standing orders template

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▪ Label vaccines with age indications, type, etc.: • Color coding labels can help staff

distinguish between vaccines

▪ Store some vaccines on separate shelves: • Pediatric and adult formulations of

the same vaccine• Sound-alike and look-alike vaccines

3. Wrong Vaccine

CDC vaccine label examples www.cdc.gov/vaccines/hcp/admin/storage/guide/vaccine-storage-labels.pdf

CDC vaccine labels

▪ HCP are encouraged to report all significant adverse events and vaccination errors that occur after vaccination of adults and children

▪ VAERS accepts all reports, including reports of vaccination errors including shoulder injury related to vaccine administration and others

Report Vaccination Errors to Vaccine Adverse Event Reporting System (VAERS)

Vaccine Adverse Event Reporting System www.vaers.hhs.gov/esub/index

There are 3 ways to report to VAERS – online, fax or mail

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▪ Before administering vaccines, all personnel who will administer vaccines should:• Receive competency-based training • Have knowledge and skills validated

▪ Integrate competency-based training into:• New staff orientation• Annual education requirements

▪ Ongoing education:• Whenever vaccine administration

recommendations are updated• When new vaccines are added to

inventory

Strategies to Prevent Vaccination ErrorsKnowledgeable Staff

Immunization Action Coalition: Skills Checklist for Immunization www.immunize.org/catg.d/p7010.pdf

Skills checklist for immunization

▪ AND establish an environment that values reporting and investigating errors as part of risk management and quality improvement

▪CDC vaccine administration materials for health care personnel include:• Vaccine Administration e-Learn • Printable clinical job aids• Demonstration videos

Vaccine Administration Resources for Health Care Personnel

CDC Vaccine Administration: www.cdc.gov/vaccines/hcp/admin/admin-protocols.html

Free continuing education = 1 credit

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Immunization Resources

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▪Multiple education products available free through the CDC website:• Immunization courses (webcasts and

online self-study)• Netconferences• You Call the Shots self-study modules

▪Continuing education available

CDC Resources for Staff Education

Immunization Education and Training: www.cdc.gov/vaccines/ed/index.html

Questions? Email CDC

nipinfo@cdc.gov or www.cdc.gov/cdcinfo

Immunization website www.cdc.gov/vaccines

Twitter @DrNancyM_CDC

Influenza www.cdc.gov/flu

Vaccine Safety www.cdc.gov/vaccinesafety

CDC Vaccine and Immunization Resources

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CDC Immunization Apps for Health Care Personnel

Childhood and adult immunization schedules www.cdc.gov/vaccines/schedules/hcp/schedule- app.html

Influenza information www.cdc.gov/flu/apps/cdc-influenza-hcp.html

Morbidity and Mortality Weekly Report (MMWR) www.cdc.gov/mobile/applications/mobileframework/mmwrpromo.html

Travel well www.nc.cdc.gov/travel/page/apps-about

▪ Texas Immunization Program www.dshs.texas.gov/immunize/

▪ Immunization Action Coalition www.immunize.org

▪ Vaccine Education Center www.chop.edu

▪ American Academy www.aap.org/immunizeof Pediatrics (AAP)

▪ National Foundation for www.nfid.orgInfectious Diseases (NFID)

Additional Immunization Resources

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For more information, contact CDC1-800-CDC-INFO (232-4636)TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation use. No rights are implied or extended for use in printing or any use by other CDC CIOs or any external audiences.

Questions?

JoEllen Wolicki, BSN, RN

jwolicki@cdc.gov