Arizona Vaccine News Karen Lewis, M.D. Medical Director Arizona Immunization Program Office June 21, 2010 TOPICS VACCINE PREVENTABLE DISEASE ALERTS • Mumps Cases in Arizona • Pertussis Cases Increasing in Arizona and California VACCINE NEWS • A New Contraindication for Rotavirus Vaccine: Severe Combined Immunodeficiency Disease • CSL Pediatric Influenza Vaccine Shows a Higher Rate of Febrile Seizures • Russia Confirms First Polio Death in More than a Decade • Use Initials to Search for Patients in ASIIS • AZ Vaccine Exemption Rates Increasing VACCINE LITERATURE • Multiple Vaccines Are Safe in Infants • ACIP Updates Use of Combination Measles, Mumps, Rubella, and Varicella Vaccine (MMRV) • ACIP Publishes Recommendations for Bivalent Human Papillomavirus Vaccine (HPV2) • ACIP Publishes Recommendations for use of Quadrivalent Human Papillomavirus Vaccine (HPV4) in Males VACCINE RESOURCES • Arizona vaccine requirements for 2010-2011 school year • CDC Pink Book Site Map for Where to Give Vaccines • Catch-up Immunization Scheduler VACCINE PREVENTABLE DISEASE ALERTS Mumps Cases in Arizona • Arizona has identified the third case of mumps in 2010. • A young boy from Maricopa County who had foreign travel became symptomatic at the end of May. • The incubation period for mumps is 12-25 days, so secondary cases could be seen at any time. • Of the two other mumps cases identified earlier this year, one was epidemiologically linked to the Iowa outbreak at Dordt College, and the other was epidemiologically linked to a high school basket ball game in Nebraska. • Mumps infection can occur even after two MMR vaccines • Health care providers who see a patient with parotitis should use droplet precautions (including a surgical mask) while examining the patient, even if they are fully vaccinated. • http://www.cdc.gov/mumps/prev-control-settings/index.html More information on mumps prevention and control in health care settings can be found at Pertussis Cases Increasing in Arizona and California • Pertussis outbreaks tend to occur every 3-4 years. • Arizona had a large outbreak in 2005, so history suggests that we are due for another large outbreak soon. • Between January-May 2010, Arizona had 113 cases of pertussis compared with 82 cases in January-May 2009. • http://cbs13.com/health/whooping.cough.spike.2.1732515.html California is seeing a much larger increase. Since January 2010, California has had 584 pertussis cases, in contrast to 190 cases from the same period in 2009. In the same time period there have been 5 deaths in California infants from pertussis. • Full blown whooping cough is fairly easy to diagnose. However, providers need to be aware of the subtle early symptoms of pertussis: an increasing cough in an otherwise afebrile and nontoxic patient. • If you suspect that a patient could have pertussis, notify your county health department for assistance in testing and epidemiologic investigation. • http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/pert.pdf A macrolide is the drug of choice for pertussis (azithromycin, clarithromycin, or erythromycin). Additional information on pertussis can be found at VACCINE NEWS A New Contraindication for Rotavirus Vaccine: Severe Combined Immunodeficiency Disease • Patients with SCID experience prolonged diarrhea when they receive rotavirus vaccine. Therefore, SCID has been added as a contraindication for rotavirus vaccination (either Rotarixฎ or RotaTeqฎ). • Consultation with an immunologist or infectious disease specialist is advised for infants with known or suspected altered immunocompetence before rotavirus vaccine is administered. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5922a3.htm?s_cid=mm5922a3_e CSL Pediatric Influenza Vaccine Shows a Higher Rate of Febrile Seizures • CSL, an Australian vaccine manufacturer, has withdrawn their 0.25 ml pediatric formulation of influenza vaccine from the Australian market due to a 9-fold increase in febrile seizures rate in children under 5 years of age. • CSL's pediatric single-dose 0.5 ml formulation has not been withdrawn, but will be relabeled with a note that physicians should make a risk/benefit analysis in using the vaccine in children ages 3-5 years. • The CSL 0.25 ml formulation will also be withdrawn from the US market. Only the 0.5 ml formulation of CSL influenza vaccine will be available. Merck distributes CSL influenza vaccine in the US. • Sanofi Pasteur will remain as the only manufacturer in the US who provides a 0.25 ml pediatric formulation for children 6-35 months old. http://www.health.gov.au/internet/main/publishing.nsf/Content/mr-yr10-dept- dept010610.htm Russia Confirms First Polio Death in More than a Decade • There has been the first death in Russia from polio in 13 years. This and other Russian cases have been linked to patients in central Asia. • Wild polio is still endemic in India, Pakistan, Afghanistan and Nigeria. • Inactivated polio vaccine protects against disease from wild polio and the rare occurrence of vaccine-associated paralytic disease http://www.reuters.com/article/idUSLDE65C07W Use Initials to Search for Patients in ASIIS • Please search the Arizona State Immunization Information System (ASIIS) with initials only when searching for a patient in ASIIS. • Providers who search with a full name may not find the individual that they are looking for due to misspellings and other mismatches. Then they may create a new patient file which results in duplicate records for the same patient. • If you search by first initials and the date of birth, you will be better able to find an existing record and avoid creating a new patient record. AZ Vaccine Exemption Rates Increasing • Arizona Department of Health Services (ADHS) collects Immunization Data Reports from schools and child care centers. • The rates of Arizona parents requesting exemption from vaccine requirements for their children due to religious or personal beliefs have more than doubled since 2001. • The more unimmunized people there are in a community, the more risk there is for outbreaks of vaccine-preventable diseases. Arizona Vaccine Exemption Rates by Facility & Grade School Year Child Care Kindergarten 6thth/7 Grade 2001-2002 1.2% 1.2% 1.4% (7th grade) 2009-2010 2.6% 2.8% 3.2% (6th grade) VACCINE LITERATURE Multiple Vaccines Are Safe in Infants • A new article in the June 2010 issue of Pediatrics documents that vaccinating infants on schedule has no adverse effect on a child’s neuropsychological outcomes 7 to 10 years later. • This is another resource for providers to reassure parents who are concerned about the number of recommended vaccines in early childhood. http://pediatrics.aappublications.org/cgi/reprint/peds.2009-2489v1 ACIP Updates Use of Combination Measles, Mumps, Rubella, and Varicella Vaccine (MMRV) • ACIP supports either MMR and varicella vaccine or MMRV for the first dose of measles, mumps, rubella, and varicella vaccines at age 12–47 months. However, ACIP expressed a preference in this age group for separate MMR and varicella vaccines. • For the second dose at any age (15 months–12 years) and for the first dose at age >48 months, the use of MMRV vaccine generally is preferred over separate injections of MMR and varicella vaccines. • A new precaution for MMRV vaccine is a personal or family (i.e., sibling or parent) history of seizures of any etiology. Children with a personal or family history of seizures of any etiology generally should be vaccinated with MMR vaccine and varicella vaccine. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5903a1.htm ACIP Publishes Recommendations for Bivalent Human Papillomavirus Vaccine (HPV2) • Details of ACIP’s recommendations on the use of HPV2 can be found in the May 28, 2010 issue of Morbidity and Mortality Weekly Report (MMWR) http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5920a4.htm?s_cid=mm5920a4_e ACIP Publishes Recommendations for use of Quadrivalent Human Papillomavirus Vaccine (HPV4) in Males • Details of ACIP’s recommendations on the use of HPV4 in males ages 9-26 can be found in the May 28, 2010 issue of the MMWR http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5920a5.htm?s_cid=mm5920a5_e VACCINE RESOURCES Arizona vaccine requirements for 2010-2011 school year • http://www.azdhs.gov/phs/immun/back2school.htm Back to school information about vaccines required for child care and school attendance for the 2010-2011 school year in Arizona can be found on the ADHS website at CDC Pink Book Site Map for Where to Give Vaccines • Documents showing photographs of infants, a toddler, and an adolescent with recommended locations for vaccinations can be found on pages D-18 to D-22 of the 11th edition of the CDC Pink book. http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/D/site-map.pdf Catch-up Immunization Scheduler • The CDC website has an interactive, web based adult immunization scheduler for people 19 years of age and older http://www.cdc.gov/vaccines/recs/Scheduler/AdultScheduler.htm • Users of the adult scheduler can sign up for “email updates” to ensure they are notified when there are changes to the adult recommended immunization schedule. • There is also an interactive, web based childhood Immunization scheduler for children 6 years old and younger http://www.cdc.gov/vaccines/recs/Scheduler/catchup.htm • Both schedulers can be downloaded onto a personal computer. When immunization recommendations change, CDC will update both immunization schedulers. http://www.azdhs.gov/phs/immun/index.htm Please feel free to distribute ADHS’ Arizona Vaccine News to any of your partners who may be interested. Past issues of Arizona Vaccine News can be found at