CDC has released the General Best Practice Guidelines for Immunization as an online report, and it is available on the Advisory Committee on Immunization Practices (ACIP) web page (https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/index.html). The General Best Practice Guidelines for Immunization replace the General Recommendations on Immunization, last published in the Morbidity and Mortality Weekly Report (MMWR) in 2011.
The General Best Practice Guidelines for Immunization goes beyond vaccination recommendations to give providers guidelines on vaccination practice. The document will help vaccination providers to assess vaccine benefits and risks, use recommended administration practices, understand the most effective strategies for ensuring that vaccination coverage in the population remains high, and communicate the importance of vaccination to reduce the effects of vaccine-preventable disease.
By releasing the General Best Practice Guidelines for Immunization as an online report, ACIP will be able to update the document more quickly, giving vaccination providers the most up-to-date guidance on vaccination practice.
We encourage you to share General Best Practice Guidelines for Immunization with your partners and health care professionals. Attached is a sample announcement you can modify to post online or share through a newsletter, as well as sample tweets.
The updated guidelines include:
1. Confirmation that if a patient is not acutely, moderately, or severely ill, vaccination during hospitalization is a best practice;
2. New information on simultaneous vaccination and febrile seizures;
3. Enhancement of the definition of “precaution” to include any condition that might confuse diagnostic accuracy;
4. More descriptive characterization of anaphylactic allergy;
5. Incorporation of protocols for management of anaphylactic allergy;
6. Allowances for alternate route (subcutaneous instead of intramuscular) for hepatitis A vaccination;
7. An age cutoff of 12 years through 17 years for validating a dose of intradermal influenza vaccine;
8. Deletion of much of the storage and handling content, including information on storage units, temperature monitoring, and expiration dates (this content is now contained and continually updated in CDC’s Vaccine Storage and Handling Toolkit, available at https://www.cdc.gov/vaccines/hcp/admin/storage/toolkit/index.html);
9. Incorporation of the Infectious Diseases Society of America guidance on vaccination of persons with altered immunocompetence;
10. Timing of intramuscular administration in patients with bleeding disorders;
11. Updated data on vaccination record policy;
12. Additional impacts of the Affordable Care Act on adult vaccination; and
13. Updated programmatic contact information on source material for vaccine information.
Continuing education (CE) credit is available for the General Best Practice Guidelines for Immunization.
To receive updates on this and other ACIP recommendations and guidelines, sign up at https://www.cdc.gov/vaccines/hcp/acip-recs/index.html.
If you have questions regarding immunization practice, please send them to NIPinfo@cdc.gov. As always, if you have questions about immunizations please call the MDPH Immunization Program at 617-983-6800 and ask to speak to an immunization epidemiologist.
The quarterly reports are intended to facilitate collaboration between awardees and partners to help increase HPV vaccination coverage. This quarter’s report focuses on establishing partnerships to increase rates and highlights CDC’s HPV Partner Vaccination Toolkit.
You are receiving a copy of your city or state report. The report has been distributed to you, yourstate or city health official, and executive directors or presidents of your local AAP and AAFP chapters.
If you have any questions regarding this report, please contact your project officer. If you would like more information on HPV resources and materials, feel free to contact us at email@example.com and CC your project officer.
We hope this report can serve as a tool for engaging stakeholders and continue conversations about raising HPV vaccination coverage rates. We appreciate your ongoing commitment to increasing HPV vaccination coverage.
Massachusetts HPV Report
The 2017 Immunization Schedule for those 19 years and older has been published. The changes in the schedule are discussed in the MMWR from February 10, 2017 (attachment 1) and are outlined below. The MMWR can be found at: https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6605e2.pdf
The figures, footnotes, and tables of the schedule (attachment 2) are published on the CDC immunization schedule website at: http://www.cdc.gov/vaccines/schedules/index.html. This provides readers electronic access to the most current version of the schedules and footnotes on the CDC website.
Changes to the 2017 immunization schedule for adults 19 years of age and older are outlined below (significant ones are highlighted):
· Live Attenuated Intranasal Influenza Vaccine (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.
Hepatitis B (Hep B) Vaccine
· 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.
Human papillomavirus (HPV) Vaccine
· 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.
· The number of doses of HPV vaccine a person needs is determined by their age when they initiated the series and whether they have certain high risk conditions.
o 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 HPV vaccination series before their 15th birthday and received 2 doses at least 5 months apart are considered adequately vaccinated and do not need an additional dose of HPV vaccine.
o 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 HPV vaccination series before their 15th birthday 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.
o Certain immunocompromising conditions might reduce cell-mediated or humoral immunity and immune response to vaccine might be attenuated. A 3-dose HPV series is indicated for individuals in these groups (regardless of age). Such conditions include: B lymphocyte antibody deficiencies, complete or partial T lymphocyte defects, HIV infection, malignant neoplasm, transplantation, autoimmune disease or immunosuppressive therapy.
High Risk Adults
· 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 revaccinate every 5 years. They should also receive a series of MenB with either Bexsero (MenB-4C) (2 doses administered at least 1 month apart) or Trumenba (MenB-FHbp) (3 doses administered at 0, 1–2, and 6 months).
o Please note: high risk adults, including those exposed during outbreaks, who will be receiving Trumenba should be vaccinated with the 3-dose series. Healthy adults not at increased risk for risk for serogroup B meningococcal disease may receive a 2-dose series of either Trumenba or Bexsero. See, the first bullet in the section below under ‘Healthy Young Adults’ for more guidance.
· Adults withHIV 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 meningitidis should 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).
· Meningococcal Polysaccharide Quadrivalent Vaccine(MPSV4), Menomune, will no longer be available in the US. The last doses of this vaccine to will expire between June and September. Adults >56 years at increased risk for meningococcal disease should be vaccinated with MenACWY conjugate vaccine (MCV4).
Healthy Young Adults
· Healthy young adults aged 16 through 23 years (preferred age range is 16 through 18 years) who are not at increased risk for serogroup B meningococcal disease may receive either a 2-dose series of MenB-4C at least 1 month apart or a 2-dose series of MenB-FHbp at 0 and 6 months for short-term protection against most strains of serogroup B meningococcal disease. Please note: high risk adults, including those exposed during outbreaks, receiving Trumenba should be vaccinated with the 3 dose series. See the first bullet and sub-bullet in the section above under ‘High Risk Adults' for more guidance about the series in these groups.
The 2017 Adult Immunization Schedule was also published on February 7, 2017 in the Annals of Internal Medicine and can be found at:
Immunization coverage rates among adults remain unacceptably low. The latest data can be found on the CDC website: www.cdc.gov/vaccines/imz-managers/coverage/adultvaxview/.
Please make sure you are assessing adults at every clinical encounter and making a strong recommendation for immunization! More information about evidence-based strategies to improve adult immunization rates can be found at:
Join us at the 22nd Annual Massachusetts Adult Immunization Conference on Tuesday, April 25, 2017 if you are interested in learning more about adult immunizations, including recent changes to the immunization schedule, evidence-based strategies to improve adult immunization rates, and networking opportunities to build and maintain partnerships. Find out more by visiting the conference website.
If you have questions about the immunization schedule, please call the MDPH Immunization Program at 617-983-6800 and ask to speak to an immunization epidemiologist or nurse.
2017 US Adult Combined Schedule CDC
Perinatal hepatitis B virus (HBV) transmission from mother to child has been dramatically reduced in Massachusetts, as a result of your efforts. However, despite timely post-exposure prophylaxis, mother-to-child HBV transmission still occurs in approximately 1% of infants born to hepatitis B surface antigen (HBsAg)-positive mothers.
Emerging evidence suggests that HBV treatment of pregnant women in the 3rd trimester is safe and reduces rates of transmission. In partnership with the American College of Obstetricians and Gynecologists (ACOG), CDC developed a Screening and Referral Algorithm for Hepatitis B Virus Infection among Pregnant Women (attachment). It is now recommended that all women who are found to be HBsAg-positive during pregnancy should have the following additional testing performed:
· HBeAg (hepatitis B e antigen)
· HBV DNA (viral load)
· ALT (alanine aminotransferase)
If any of the following results are obtained, pregnant women should be referred to a specialist immediately for further evaluation and consideration for possibleantiviral treatment:
HBeAg postive; or
HBV DNA >20,000 IU/mL (approximately 112,000 viral copies per mL); or
ALT > 19 IU/L
Providers of prenatal care should ensure that certain positive laboratory reports of hepatitis B infection (HBsAg, HBeAg, IgM anti-HBc and HBV DNA testing) in pregnant women are reported to the local board of health and the Massachusetts Department of Public Health (MDPH). In addition, providers should work with their laboratories to ensure that these postive results indicating hepatitis B infection in this group are also reported to the Massachusetts Department of Health within 24 hours.
In an effort to aid in the early identification of pregnant women with hepatitis B virus infection, four major commercial laboratories (ARUP Laboratories, LabCorp, Mayo Medical Laboratories and Quest Diagnostics) are now reporting pregnancy status as part of electronic laboratory reporting. Additional commercial and clinical laboratories are encouraged to participate in this initiative. To support this effort, it is recommended that providers order prenatal testing panels or prenatal HBsAg testing when available. Providers should also consult with their laboratory to determine the best method to indicate pregnancy status when ordering hepatitis B testing (e.g., "OB", "PRENATAL", ICD-10 code, etc.).
Thank you for your continued efforts to reduce the spread of HBV infection. We will be incorporating these new considerations into our MDPH perinatal hepatitis B prevention program. If you have any questions, please call the MDPH Immunization Program at 617-983-6800 and ask to speak to an immunization nurse or epidemiologist.
Resources for managing HBV infection in pregnant women can be found on the ACOG and CDC websites. For the latest recommendations for treatment of chronic HBV infection in pregnant women, see pages 276 and 277 in the American Association for the Study of Liver Diseases Guidelines for Treatment of Chronic Hepatitis (attachment).
Terrault, NA, et.al. AASLD guidelines for treatment of chronic hepatitis B. Hepatology 2016.
Brown, RS et.al. Antiviral therapy in chronic HBV infection: a systematic review and meta-analysis. Hepatology 2016.
Fan L., et al. Antiviral treatment among pregnant women with chronic hepatitis B. Infect Dis Obstet Gynecol 2014.
Kubo A., et al. Prevention of vertical transmission of hepatitis B: an observational study. Ann Intern Med 2014.
Schille S., et al. Outcomes of infants born to women infected with hepatitis B. Pediatrics 2015.
Wang L., et al. Safety of tenofovir during pregnancy for the mother and fetus: a systematic review. Clin Infect Dis 2013
Zhang H., et al. Telbivudine or lamivudine use in late pregnancy safely reduces perinatal transmission of hepatitis B virus in real-life practice. Hepatology 2014.