Immunization News Archive

Haemophilus influenzae Type b Vaccine Interim Recommendations Update

May 5, 2008 -- The Florida Department of Health, Bureau of Immunization would like to remind providers that the Haemophilus influenzae Type b (Hib) vaccine booster dose administered at 12 to 15 months of age should continue to be deferred, except for specific high-risk groups described below and in the Morbidity and Mortality Weekly Report (MMWR).

The basic interim recommendations are as follows:

• Do not give the Hib vaccine booster to healthy children 12 to 15 months of age. Defer administering the routine Hib vaccine booster administered at 12 to 15 months of age, except for specified high-risk groups. Stocking vaccine to give the booster dose during the shortage can take away from providers who are struggling to provide the primary series. 
• Continue to give booster to high-risk children with asplenia, sickle cell disease, HIV, other immune syndromes, or those who are Alaskan or Native American. 
• Plan for when the shortage is over. Utilize best practice/recall-reminder systems and review the catch-up schedule at: http://www.cdc.gov/vaccines/recs/schedules/child-schedule.htm#catchup.

Temporary Medical Exemptions (TMEs) can/should be extended for children 12 to 15 months of age who are attending/entering child care as the Florida Certification of Immunization (DH Form 680) is issued or expires. Continue to keep track of children given TME extensions in order to recall them when vaccine supplies allow.

Please ensure that providers are reminded of the interim recommendations and that everything is done to follow them.

Please provide this information to colleagues, members, coalitions, and partners with an interest in the supply, distribution, management, and administration of Hib conjugate vaccines.

For questions regarding vaccine supply, contact the bureau at 850-245-4342.

Please remember that revised Hib recommendations are NOT office-specific—these affect the whole country.

Following are some Centers for Disease Control and Prevention (CDC) resources related to the Hib vaccine shortage:

• Flyer for clinicians [PDF 552 KB]
• Q&A for providers and public health agencies [DOC 62 KB]
• Interim Hib recommendations
• Q&A for parents

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Report from the Advisory Committee on Immunization Practices: Decision Not to Recommend Routine Vaccination of All Children 2 to 10 Years of age with Quadrivalent Meningococcal Conjugate Vaccine

At its February 2008 meeting, the Advisory Committee on Immunization Practices (ACIP) decided not to recommend routine vaccination of children 2 to 10 years of age against meningococcal disease, unless the child is at increased risk for the disease. This report summarizes the deliberations of the ACIP and the rationale for its decision, and restates existing recommendations for meningococcal vaccination among children 2 to 10 years of age at increased risk for meningococcal disease. The ACIP continues to recommend routine vaccination against meningococcal disease for all persons 11 to 18 years of age and those persons 2 to 55 years who are at increased risk for meningococcal disease.

The Morbidity and Mortality Weekly Report; volume 57, number 12, released on May 2, 2008, can be accessed at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5717a4.htm.

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Fact Sheet and Talking Points:  Measles United States, January 1 - April 25, 2008

The Florida Department of Health, Bureau of Immunization announces publication of the Centers for Disease Control and Prevention (CDC), Morbidity and Mortality Weekly Report (MMWR) Early Release 2008; volume 57; 1-4 on May 1, 2008, concerning important information regarding  measles outbreaks in the U.S. The outbreak information includes 64 measles cases in 9 states, with outbreaks in 4 states from January 1 through April 24, 2008. While none of the cases are in Florida, a number of county health departments are conducting surveillance with contacts to the cases referenced in the attachment.

These cases and outbreaks resulted primarily from failure to vaccinate, many because of personal or religious belief exemption. This fact highlights:

• Ongoing risk of measles in unvaccinated persons.
• Risk that unvaccinated persons may transmit measles to others, including infants too young to be vaccinated, and the importance of maintaining high levels of vaccination.

Transmission has occurred in community and healthcare settings, including homes, childcare centers, schools, hospitals, emergency rooms, and physicians’ offices. The majority of cases are associated with importation from other countries.

Most important: immunization with the measles-mumps-rubella (MMR) vaccine is the most effective preventive measure. Unless there is other evidence of measles immunity, two doses of MMR vaccine are recommended for all school students, students in post–high school educational facilities, healthcare personnel, and international travelers who are older than 12 months of age (NOTE: infants 6 to 11 months of age should receive one dose prior to travel abroad).

The MMWR: Measles --- United States, January 1--April 25, 2008 can be accessed at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm57e501a1.htm. Further information is available in the CDC Fact Sheet: Measles, United States, January 1--April 25, 2008 [PDF 91 KB].

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National Infant Immunization Week

Working together with Vaccination Week in the Americas

April 21-28, 2007

National Infant Immunization Week (NIIW) is an annual observance to highlight the importance of protecting infants from vaccine-preventable diseases and celebrate the achievements of immunization programs and their partners in promoting healthy communities. Since 1994, NIIW has served as a call to action for parents, caregivers, and healthcare providers to ensure that infants are fully immunized against 14 vaccine-preventable diseases. This year NIIW will be held April 19-26, 2008. (National Infant Immunization Week).

Additionally, the National Immunization for Polio Prevention in Infants and Toddlers - or "NIPP IT" Campaign is being highlighted during this week. NIPP IT promotes immunization of all children against polio at two months of age, four months of age, six months of age, and a booster at four years of age. The NIPP IT theme is, “Don't wait to vaccinate!”

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Update to Immunization Schedules for Human Papillomavirus

April 4, 2008 -- The Florida Department of Health, Bureau of Immunization directs your attention to the Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report (MMWR) 2008; volume 57, number 12 on March 28, 2008. This MMWR contains an erratum on page 319 (Errata: Vol 57, No. 1) for the Recommended Immunization Schedules for Persons Aged 0--18 Years---United States, 2008.

Most important is the change/clarification to the intervals on the catch-up schedule for Human Papillomavirus (HPV) vaccine as follows:

On page Q-4, in the lower section of the Table titled, "Catch-up schedule for persons aged 7--18 years," in row Human Papillomavirus, under column heading Dose 2 to Dose 3, the text should read: "12 weeks (and 24 weeks after the first dose)." This change reflects addition of a 24-week minimum interval for the HPV series between dose 1 and dose 3. This means that the third dose needs to be administered no earlier than 6 months/24 weeks from the first dose. The minimum intervals between dose one and dose two, as well as between dose two and dose three, remain unchanged.

• Dose 1 to 2: 4 weeks
• Dose 2 to 3: 12 weeks (and 24 weeks after the first dose)

The erratum may be viewed at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5712a6.htm.

The revised HPV interval was published on March 5, 2008 , and the correction to the human papillomavirus (HPV) vaccine regimen can be viewed on the CDC web-site at: http://www.cdc.gov/vaccines/recs/schedules/child-schedule.htm.

The MMWR may be viewed at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5701a8.htm.

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Food and Drug Administration Approves New Vaccine to Prevent Gastroenteritis Caused by Rotavirus

April 3, 2008 -- The U.S. Food and Drug Administration (FDA) today announced the approval of Rotarix®, the second oral U.S. licensed vaccine for the prevention of rotavirus, an infection that causes gastroenteritis (vomiting and diarrhea) in infants and children. Rotarix® is a liquid, given in a two-dose series to infants from 6 to 24 weeks of age. (FDA Press Release)

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Updated Recommendation for Use of 7-Valent Pneumococcal Conjugate vaccine

April 7, 2008 -- The Florida Department of Health, Bureau of Immunization announces publication of the Centers for Disease Control and Prevention (CDC), Morbidity and Mortality Weekly Report (MMWR) 2008; volume 57, number 13 on April 4, 2008, concerning 7-valent pneumococcal conjugate vaccine (PCV7). The complete MMWR can be accessed on the web at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5713a4.htm

This notice updates the recommendation for use of PCV7 vaccine among children 24 to 59 months of age, who are either unvaccinated or who have a lapse in PCV7 administration. The Advisory Committee on Immunization Practices (ACIP) Pneumococcal Vaccines Work Group reviewed data on PCV7, and on the basis of that review, the ACIP approved the following revised recommendation for use of PCV7 in children 24 to 59 months of age:

• For all healthy children 24 to 59 months of age, who have not completed any recommended schedule for PCV7, administer 1 dose of PCV7.
• For all children with underlying medical conditions, 24 to 59 months of age, who have received 3 doses, administer 1 dose of PCV7.
• For all children with underlying medical conditions, 24 to 59 months of age, who have received less than 3 doses, administer 2 doses of PCV7 at least 8 weeks apart.

No changes were made to previously published recommendations regarding the use of PCV7 in children 24 to 59 months of age; the list of underlying medical or immunocompromising conditions; or the use of 23-valent pneumococcal polysaccharide vaccine in children over 2 years of age, who have previously received PCV7.

The childhood immunization schedule is found at: http://www.cdc.gov/vaccines/recs/schedules/default.htm

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Update: Interim Recommendations for the Use of Haemophilus influenzae Type b Conjugate Vaccines

March 6, 2008 -- The Florida Department of Health, Bureau of Immunization reminds providers that the Haemophilus influenzae Type b (Hib) Conjugate vaccine booster dose administered at 12 to 15 months of age should be deferred, except for specific high-risk groups described below and in the Morbidity and Mortality Weekly Report (MMWR). At this time, there are no immediate plans to change the interim recommendations. A cooperative effort for the appropriate use of a valuable resource currently in limited supply will work towards an equitable and appropriate public health use of the vaccine. Interim Recommendations for the Use of Haemophilus influenzae Type b (Hib) Conjugate Vaccines Related to the Recall of Certain Lots of Hib-Containing Vaccines (PedvaxHIB® and Comvax®) were posted on December 19, as an MMWR Dispatch. Additional information regarding the affected lots is available online from the Food and Drug Administration (FDA) at: http://www.fda.gov/consumer/updates/hib121307.html. Merck has suspended production of its Hib conjugate vaccines and does not expect to resume distribution of these vaccines until the fourth quarter of 2008. The recall of PedvaxHIB® and Comvax® and suspension of production are expected to result in short-term disruption to the Hib vaccine supply in the United States.

The basic interim recommendations are as follows:

• Defer administering the routine Hib vaccine booster administered at 12 to 15 months of age, except for specified high-risk groups.
• Certain children at increased risk for Hib disease, including children with asplenia, sickle cell disease, human immunodeficiency virus infection, and certain other immunodeficiency syndromes, and malignant neoplasms should continue to receive the full routinely recommended schedule, including the 12- to 15-month booster dose.
• American Indian/Alaska Native (AI/AN) children should also continue to receive the full routinely recommended schedule, including the 12- to 15-month booster dose. Providers who currently use PRP-OMP-containing Hib vaccines (PedvaxHib® and Comvax®) to serve predominantly AI/AN children in AI/AN communities should continue to use only PRP-OMP-containing Hib vaccines.

The original MMWR is available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5650a4.htm

The CDC shortage web-site can be found at: http://www.cdc.gov/vaccines/vac-gen/shortages/default.htm#hib. A flyer that providers will receive in vaccine shipments is at: http://www.cdc.gov/vaccines/vac-gen/shortages/downloads/hib-flyer-022008.pdf [PDF 552 KB].

Temporary Medical Exemptions (TMEs) can/should be extended 6 months for children 12 to 15 months of age who are attending/entering child care as the Certification of Immunization (DH Form 680) is issued or expires. Continue to keep track of children given TME extensions in order to recall them when vaccine supplies allow.

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Wipe Out the Whoop

February 5, 2008 -- Wipe Out the Whoop is the National Foundation for Infectious Disease's (NFID) campaign to raise awareness of whooping cough risks and prevention. Campaign products include TV and radio public service announcments, national and local broadcast and print media interviews, and a consumer education brochure. To access these materials, please visit:

• http://www.nfid.org/whoop/
• http://wipeoutthewhoop.nfidinitiatives.org/video60.html

A public education initiative made possible through an unrestricted educational grant to NFID from Sanofi Pasteur.

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Multi-Vaccine Information Statement

February 8, 2008 -- On January 30, 2008, the Centers for Disease Control and Prevention (CDC) posted a multi-vaccine Vaccine Information Statement (VIS) on its website. This new four-page (two pages front & back) VIS contains information on routine 0-6 month vaccines -- i.e., diptheria-tetanus-pertussis (DTaP), hepatitis B (hep B), inactivated polio vaccine (IPV), pneumococcal conjugate vaccine (PCV), Haemophilus influenzae type b (Hib), and rotavirus. It can be used as an optional alternative to the existing individual VISs when any combination of these vaccines are administered during the same visit (This includes combinations like Pediarix® or Comvax®.). In addition to the birth, 2, 4, & 6 month visits, this VIS could also be used for the 4th and 5th doses of DTaP and the 4th doses of  PCV, IPV, or Hib, if they are given at the recommended ages. The publication date is 01/30/08.

Use of the multi-vaccine VIS is optional and an alternative to providing single-vaccine VISs for each of these six vaccines. The individual VISs for these vaccines may still be used. 

Please note: This multi-vaccine VIS should NOT be used when any of these vaccines are administered to adolescents or adults because it doesn't contain information about risk factors, etc. for those ages.

Before you hand this new VIS to the patient, you MUST go to page one of the VIS and place a check-mark in front of the name of each vaccine you will be administering at that visit.

The multi-vaccine VIS is available from the CDC website: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-multi.pdf [PDF 105 KB] and the the Immunization Action Coalition (IAC) website at http://www.immunize.org/vis/vis_multi1.asp. For instructions on how to use this new VIS, go to: http://www.cdc.gov/vaccines/pubs/vis/vis-news.htm#multi. For additional information about the use of VISs, and for VISs in more than 30 languages, visit IAC's VIS webpage at: http://www.immunize.org/vis.

Florida SHOTS:  This new VIS form covers DTaP, Hep B, IPV, PCV, Hib, and rotavirus. When recording new vaccinations of these types, the VIS option available by default will be this new form. To record the VIS publication date of any of the other single vaccine forms, click the "Other VIS Options" button.

See the complete list of available VISs on the CDC's VIS webpage: http://www.cdc.gov/vaccines/pubs/vis/default.htm.

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Updated Meningococcal Vaccine Information Statement

February 8, 2008 -- The Vaccine Information Statement (VIS) for meningococcal conjugate vaccine (MCV) has been updated to incorporate the recent licensure of MCV for children 2 to 10 years of age, who are at increased risk from meningococcal disease. The new edition is dated 1/28/08. Existing stocks of the last version can be used up, although the new version should be used when administering MCV to anyone in the 2 to 10 age group.

The new VIS is available at: http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-mening.pdf [PDF 63 KB].

See the complete list of available VISs on the CDC's VIS webpage: http://www.cdc.gov/vaccines/pubs/vis/default.htm.

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Recommended Immunization Schedules for Persons 0 to 18 Years of Age --- United States, 2008

January 11, 2008 -- The Florida Department of Health, Bureau of Immunization is pleased to announce the 2008 immunization schedule recommendations for children and adolescents. The 2008 Childhood and Adolescent Immunization Schedules represents joint recommendations from the American Academy Of Pediatrics (AAP), the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC), and the American Academy of Family Physicians (AAFP). Key changes to the previous schedules are as follows:

1. The pneumococcal conjugate vaccine (PCV) footnote reflects updated recommendations for incompletely vaccinated children 24 to 59 months of age, including those with underlying medical conditions.
2. Recommendations for use of the live attenuated influenza vaccine (LAIV) now include healthy children as young as 2 years of age.
3. LAIV should not be administered to children less than 5 years of age with recurrent wheezing.
4. Children less than 9 years of age who are receiving influenza vaccine for the first time or who were vaccinated for the first time last season, but only received one dose, should have two doses of vaccine, at least four weeks apart.
5. For meningococcal vaccines, changes affect certain children 2 to 10 years of age.
6. Vaccinating with meningococcal conjugate vaccine (MCV4) is preferred to meningococcal polysaccharide vaccine (MPSV4) for children at increased risk for meningococcal disease, including children who are traveling to, or residents of, countries in which the disease is hyperendemic or epidemic, children who have terminal complement component deficiencies, and children who have anatomic or functional asplenia.
7. The catch-up schedule for youths 13 to 18 years of age has been updated.
8. MPSV4 is an acceptable alternative for short-term (i.e., 3 to 5 years) protection against meningococcal disease for persons 2 to 18 years of age.
9. The tetanus and diphtheria toxoids/tetanus and diphtheria toxoids and acellular pertussis vaccine (Td/Tdap) catch-up schedule for persons 7 to 18 years of age who received their first dose before 12 months of age now indicates that these youths should receive four doses, with at least four weeks (not eight weeks) between doses two and three.
10. The catch-up bars for hepatitis B and Haemophilus influenzae type b (Hib) conjugate vaccine have been deleted on the routine schedule for persons 0 to 6 years of age.

The National Childhood Vaccine Injury Act requires that healthcare providers provide parents or patients with copies of Vaccine Information Statements before administering each dose of the vaccines listed in the schedule. Additional information is available from state health departments and from CDC at: http://www.cdc.gov/vaccines/pubs/vis/default.htm.

The complete 2008 schedules can be viewed online at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5701a8.htm?s_cid=mm5701a8_e.