Vaccine storage and handling toolkit

In response to recent scientific studies on equipment used for vaccine storage and a better understanding of best practices for storage and handling, the Centers for Disease Control and Prevention (CDC) is providing updated guidance on appropriate vaccine storage and handling practices. This guidance is intended as the approved standard of care for all public and private sector providers. While recognizing that cost may be a barrier, we encourage practices to move toward implementing these recommendations as soon as possible. CDC is currently evaluating the most efficient and cost-effective method to phase in these recommendations.Introduction -- The Vaccine cold chain -- Storage and handling plans -- Vaccine personnel -- Vaccine storage equipment -- Vaccine storage practices -- Temperature monitoring -- Storage troubleshooting -- Vaccine inventory management -- Vaccine shipments -- Vaccine transport -- Vaccine preparation and disposal -- ResourcesNovember 2012.System requirements: Adobe Acrobat Reader.Mode of access: World Wide Web.Includes bibliographical references.Electronic monograph in PDF format (4.47 MB, 135 p.)

Influenza Division international activities

In 2010, the Division provided funding support and technical assistance for influenza activities to 48 countries in the form of direct cooperative agreements or indirectly through our partners. Under these agreements, partner countries have made significant progress in the development of their influenza surveillance capacity and pandemic preparedness. Their collective progress is evident in the positive movement of scores captured in 2010 using the Division's National Inventory of Core Capacities for Pandemic Preparedness and Response monitoring and evaluation tool (see page 258). There is no doubt the hard work countries have put in to developing both their laboratory and epidemiologic surveillance systems and strengthening their pandemic preparedness not only enhanced their response to the 2009 influenza pandemic but has also helped to build general capacity for all emerging infectious diseases. In other achievements for 2010, China's National Influenza Center in Beijing was designated a WHO Collaborating Center for Reference and Research on Influenza. The Division has worked closely with the National Influenza Center in Beijing for over two decades and congratulates China on becoming just one of five such Centers globally. Likewise, the Division wishes to congratulate its partner countries who achieved WHO National Influenza Center status in 2010 in the following locations: Guatemala City, Guatemala; Kathmandu, Nepal; Accra, Ghana; Ho Chi Minh City, Vietnam and Vientiane, Lao People's Democratic Republic.Influenza Division international overview -- WHO African Region (AFR) -- WHO Eastern Mediterranean Region (EMR) -- WHO European Region (EUR)...-- WHO Region of the Americas (AMR) -- WHO South-East Asia Region (SEAR) -- WHO Western Pacific Region (WPR) -- influenza research -- Meetings and training -- Influenza Division organization -- ReferencesSpecial thanks to Ann Moen, Emily Cramer, Sarah O'Brien, Howard Hall, Lucinda Johnson and Meg McCarron for editing and producing this 2010 International Influenza Report."Publication date: August 2011."System requirements: Adobe Acrobat Reader.Mode of access: World Wide Web.Includes bibliographical references (p. 292-296).Centers for Disease Control and Prevention. International Influenza Report FY 2010. Atlanta: U.S. Department of Health and Human Services; 2010.Electronic monograph in PDF format (24.29 MB, 304 p.)

Treating influenza (flu)

Do you have asthma, diabetes or chronic heart disease? If so, you are at high risk of serious illness if you get the flu. In past flu seasons, as many as 80 percent of adults hospitalized from flu complications had a long-term health condition; as did about 50 percent of hospitalized children. Asthma, diabetes and chronic heart disease were the most common of these. This fact sheet provides information about treating influenza in high risk people with prescription influenza antiviral drugs. Treatment with an antiviral drug can mean the difference between having a milder illness versus a very serious illness that could result in a hospital stay.Do you have asthma, diabetes or chronic heart disease? -- Why am I at greater risk of serious flu complications? -- Can the flu be treated? -- What should I do if I think I have the flu? -- Should I still get a flu vaccine? -- What are the benefits of antiviral drugs? -- What are the possible side effects of antiviral drugs? -- When should antiviral drugs be taken for treatment? -- What antiviral drugs are recommended? -- How long should antiviral drugs be taken? -- Can children and pregnant women take antiviral drugs? -- Who should take antiviral drugs? -- Following is a list of all the health and age factors that are known to increase a person's risk of getting serious complications from the flu."07/12/2012"CS233807A.Available via the World Wide Web as an Acrobat .pdf file (702.81 KB, 2 p.)

Outbreaks of acute gastroenteritis transmitted by person-to-person contact -- United States, 2009-2010

Problem/Condition: Approximately 179 million cases of acute gastroenteritis (AGE) occur in the United States each year, and outbreaks of AGE are a substantial public health problem. Although CDC has conducted national surveillance for waterborne and foodborne AGE outbreaks since 1971 and 1973, respectively, no national surveillance existed for AGE outbreaks resulting primarily from person-to-person transmission before implementation of the National Outbreak Reporting System (NORS) in 2009. Reporting Period: 2009-2010. Description of System: NORS is a national surveillance system launched in 2009 to support the reporting of all waterborne outbreaks and enteric disease outbreaks from foodborne, person-to-person, animal contact, environmental, and unknown modes of transmission. State and local public health agencies in the 50 U.S. states, the District of Columbia, five U.S. territories, and three Freely Associated States report these outbreaks to CDC via NORS using a standardized online data entry system. Data are collected on general outbreak characteristics (e.g., dates, number of illnesses, and locations), demographic characteristics of cases (e.g., age and sex), symptoms, case outcomes, and laboratory testing information and results. Only outbreaks reported in NORS with a primary mode of transmission of person-to-person contact are included in this report. Results: During 2009-2010, a total of 2,259 person-to-person AGE outbreaks were reported in NORS from 42 states and the District of Columbia. These outbreaks resulted in 81,491 reported illnesses, 1,339 hospitalizations, and 136 deaths. No etiology was reported in approximately 40% (n = 840) of outbreaks. Of the remaining 1,419 outbreaks with a reported etiology, 1,270 (89%) were either suspected or confirmed to be caused solely by norovirus. Other reported etiologies included Shigella (n = 86), Salmonella (n = 16), Shiga toxin-producing Escherichia coli (STEC) (n = 11), and rotavirus (n = 10). Most (82%) of the 1,723 outbreaks caused by norovirus or an unknown etiology occurred during the winter months, and outbreaks caused by Shigella or another suspected or confirmed etiology most often occurred during the spring or summer months (62%, N = 53 and 60%, N = 38, respectively). A setting was reported for 1,187 (53%) of total outbreaks. Among these reported settings, nursing homes and other long-term-care facilities were most common (80%), followed by childcare centers (6%), hospitals (5%), and schools (5%). Interpretation: NORS provides the first national data on AGE outbreaks spread primarily through person-to-person transmission and describes the frequency of this mode of transmission. Norovirus is the most commonly reported cause of these outbreaks and, on the basis of epidemiologic characteristics, likely accounts for a substantial portion of the reported outbreaks of unknown etiology. In the United States, sporadic and outbreak-associated norovirus causes an estimated 800 deaths and 70,000 hospitalizations annually, which could increase by an additional 50% during epidemic years. During 2009-2010, norovirus outbreaks accounted for the majority of deaths and health-care visits in person-to-person AGE outbreaks reported to NORS. Public Health Action: Prevention and control of person-to-person AGE outbreaks depend primarily on appropriate hand hygiene and isolation of ill persons. NORS surveillance data can help identify the etiologic agents, settings, and populations most often involved in AGE outbreaks resulting primarily from person-to-person transmission and guide development of targeted interventions to avert these outbreaks or mitigate the spread of infection. Surveillance for person-to-person AGE outbreaks via NORS also might be important in clarifying the epidemiology and role of certain pathogens (e.g., STEC) that have been traditionally considered foodborne but can also be transmitted person-to-person. As ongoing improvements and enhancements to NORS are introduced, participation in NORS has the potential to increase, allowing for improved estimation of epidemic person-to-person AGE and its relative importance among other modes of transmission.Mary E. Wikswo, Aron J. Hall, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC ."December 14, 2012."Also available via the World Wide Web as an Acrobat .pdf file (919.1 KB, 16 p.).Includes bibliographical references (p. 11-12)

Prevention of perinatal Group B streptococcal disease: revised guidelines from CDC, 2010

"Despite substantial progress in prevention of perinatal group B streptococcal (GBS) disease since the 1990s, GBS remains the leading cause of early-onset neonatal sepsis in the United States. In 1996, CDC, in collaboration with relevant professional societies, published guidelines for the prevention of perinatal group B streptococcal disease (CDC. Prevention of perinatal group B streptococcal disease: a public health perspective. MMWR 1996;45 [No. RR-7]); those guidelines were updated and republished in 2002 (CDC. Prevention of perinatal group B streptococcal disease: revised guidelines from CDC. MMWR 2002;51 [No. RR-11]). In June 2009, a meeting of clinical and public health representatives was held to reevaluate prevention strategies on the basis of data collected after the issuance of the 2002 guidelines. This report presents CDC's updated guidelines, which have been endorsed by the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American College of Nurse- Midwives, the American Academy of Family Physicians, and the American Society for Microbiology. The recommendations were made on the basis of available evidence when such evidence was sufficient and on expert opinion when available evidence was insufficient. The key changes in the 2010 guidelines include the following: expanded recommendations on laboratory methods for the identification of GBS, clarification of the colony-count threshold required for reporting GBS detected in the urine of pregnant women, updated algorithms for GBS screening and intrapartum chemoprophylaxis for women with preterm labor or preterm pre- mature rupture of membranes, a change in the recommended dose of penicillin-G for chemoprophylaxis, updated prophylaxis regimens for women with penicillin allergy, and a revised algorithm for management of newborns with respect to risk for early-onset GBS disease. Universal screening at 35-37 weeks' gestation for maternal GBS colonization and use of intrapartum antibiotic prophylaxis has resulted in substantial reductions in the burden of early-onset GBS disease among newborns. Although early-onset GBS disease has become relatively uncommon in recent years, the rates of maternal GBS colonization (and therefore the risk for early-onset GBS disease in the absence of intrapartum antibiotic prophylaxis) remain unchanged since the 1970s. Continued efforts are needed to sustain and improve on the progress achieved in the prevention of GBS disease. There also is a need to monitor for potential adverse consequences of intrapartum antibiotic prophylaxis (e.g., emergence of bacterial antimicrobial resistance or increased incidence or severity of non-GBS neonatal pathogens). In the absence of a licensed GBS vaccine, universal screening and intrapartum antibiotic prophylaxis continue to be the cornerstones of early-onset GBS disease prevention." - p. 1Introduction -- Methods -- Invasive group G streptococcal disease -- Prevention of early-onset group B streptococcal disease -- Identification of candidates for intrapartum antibiotic prophylaxis -- Specimen collection and processing for GBS screening -- Secondary prevention of early-onset GBS among infants -- Implementation and impact of GBS prevention efforts -- Recommendations -- Future of GBS prevention -- Referencesprepared by Jennifer R. Verani, Lesley McGee, Stephanie J. Schrag."The material in this report originated in the National Center for Immunization and Respiratory Diseases, Anne Schuchat, MD, Director, and the Division of Bacterial Diseases, Rana Hajjeh, MD, Director." - p. 1Revision of: Prevention of perinatal group B streptococcal disease : revised guidelines from CDC. MMWR 2002;51 (RR-11):1--24.Includes bibliographical references (p. 18-22).1088663Infectious DiseasePrevention and ControlCurrentHICPA

Global immunization strategic framework: 2006-2010

"Since 1991, CDC has provided substantial financial and technical support for polio eradication and measles elimination. CDC's yearly investment in global immunization has grown from $3.1 million to$140 million in 2006. In addition, CDC currently has more than 30 staff seconded to international health organizations, such as WHO, UNICEF, Pan American Health Organization, World Bank, and the American Red Cross, providing full-time technical and operational support to priority countries and regions. In keeping with this growth, CDC has a much broader role and greater influence in the field of global immunization than it did even five years ago. In addition to being a key partner in both the global polio eradication initiative and the Measles Initiative, CDC has played a critical role in developing the Global Immunization Vision and Strategy for 2006-2015 (GIVS); has a representative on the Global Alliance for Vaccines and Immunization (GAVI) working group; is an implementing partner in the Hib Initiative, charged by the GAVI Alliance to assist countries to make evidence-based decisions regarding the introduction of Hib vaccine into national programs; and is supporting pilot projects in three countries to strengthen the delivery of routine immunization. In addition, since CDC's last five-year strategic plan for global immunization, much has changed. There has been a renewed commitment from global partners for preventing VPDs among the world's children. This includes $4 billion from the International Finance Facility for Immunization (IFFIm) over the next 10 years and a$750 million investment from the Bill and Melinda Gates Foundation for 2006-2015. Both of these investments will support the GAVI Fund for several initiatives including supporting measles SIAs, strengthening immunization and health systems, eliminating maternal and neonatal tetanus, establishing the polio vaccine stockpile, improving access to underused vaccines, and speeding the development and introduction of new vaccines in GAVI-eligible countries. Investment cases for introduction of rotavirus vaccine and pneumococcal conjugate vaccine are under development." - p. 8The Cold chain -- Storage and handling plans -- Vaccine personnel -- Vaccine storage equipment -- Vaccine storage practices -- Temperature monitoring -- Storage troubleshooting -- Selected biologicals -- Vaccine inventory management -- Vaccine shipments -- Vaccine preparation and disposalTitle from title screen (viewed on May 3, 2010).System requirements: Adobe Acrobat Reader.Mode of access: World Wide Web.Includes bibliographical references.Electronic monograph in PDF format (554 KB, 36 p.)

Clinical characteristics of children with 2009 pandemic influenza A (H1N1) admitted in a single institution

PurposeThis study aims to investigate the clinical characteristics of children diagnosed with the novel influenza A (H1N1) in the winter of 2009 at a single medical institution.MethodsOut of 545 confirmed cases of influenza A (H1N1) in children, using the real time RT-PCR method at Kosin University Gospel Hospital from September to December of 2009, 149 patients and their medical records were reviewed in terms of symptoms, laboratory findings, complications and transmission within a family.ResultsMedian age of subjects was 7 years (range: 2 months-18 years). New cases increased rapidly from September to reach a peak in November, then declined rapidly. Most frequently observed symptoms were fever (96.7%), cough (73.2%), rhinorrhea (36.9%) and sore throat (31.5%). Average body temperatures on the 1st, 2nd and 3rd hospital day were 38.75±0.65℃, 38.08±0.87℃ and 37.51±0.76℃, respectively. Complete blood counts and biochemical tests performed on the first admission day showed within the reference values in most cases. Of the 82 patients with simple chest radiography, 18 (22%) had pneumonic lesions; multi-focal bronchopneumonia in eleven, single or multi-segmental lobar pneumonia in five, and diffuse interstitial pneumonia in two patients. All of the 149 patients improved from their symptoms and discharged within 9 days of admission without any late complication.ConclusionChildren with 2009 pandemic influenza A (H1N1) at our single institution displayed nonspecific symptoms and laboratory findings, resembling those of common viral respiratory illnesses, and did not appear to develop more severe disease