Smallpox

"Every site that ships smallpox vaccines and their diluents should have its own standard operating procedures (SOPs), which describe procedures, training, supervision and record keeping to ensure continuous quality assurance year after year. In order to help you develop your procedures, the National Immunization Program of the Centers for Disease Control and Prevention has prepared the following guidelines for smallpox vaccine packing and shipping. These guidelines are based in part on CDC's research on different shipping and handling methods under strenuous test conditions. These guidelines are not intended to be rules and regulations. They are suggestions written primarily for personnel who pack and ship vaccines. "Mode of access: Internet from the CDC web site. Address as of 2/23/2007: http://www.bt.cdc.gov/agent/smallpox/vaccination/pdf/packing-shipping.pdf; current access is available via PURL

Measles eradication: recommendations from a meeting cosponsored by the World Health Organization, the Pan American Health Organization, and CDC

"Recent successes in interrupting indigenous transmission of measles virus in the Americas and in the United Kingdom prompted the World Health Organization (WHO), Pan American Health Organization (PAHO), and CDC to convene a meeting in July, 1996 to consider the feasibility of global measles eradication. Presentations at the meeting included an overview of global measles control and elimination efforts; detailed reviews of successful measles elimination efforts in Latin America, the English-speaking Caribbean, Canada, and the United States; surveillance for clinical disease; laboratory tools for antibody detection and virus identification; and other factors that might influence the feasibility of disease eradication. With this background information, meeting organizers asked participants to address five questions: 1) Is global measles eradication feasible? 2) Is measles eradication feasible with current vaccines? 3) What are the appropriate vaccination strategies for measles eradication? 4) How should surveillance for measles be carried out? 5) What role should outbreak control play in the strategy to eliminate measles? Participants agreed that measles eradication is technically feasible with available vaccines and recommended adoption of the goal of global eradication with a target date during 2005-2010, with the proviso that measles eradication efforts should not interfere with poliomyelitis eradication but should build on the successes of the global Poliomyelitis Eradication Initiative. Although existing vaccines are adequate for eradication, vaccination strategies that rely on administration of a single dose of vaccine are not. In the Americas, sustained interruption of indigenous measles virus transmission has been achieved through a three-tiered vaccination strategy that includes a) "catch-up" vaccination of all persons aged 1-14 years, regardless of disease history or vaccination status; b) "keep-up" vaccination of > or = 90% of children in each successive birth cohort at age 12 months and c) "follow-up" campaigns designed to vaccinate all persons within a specific age range whenever the number of susceptible persons in the preschool-aged population approximates the size of a typical birth cohort (in practice, every 3-5 years). In other regions, different strategies may be optimal. Surveillance, a critical component of any strategy to eliminate or eradicate measles, has two functions: to assess the effectiveness of the measles elimination strategy and to detect circulation of measles virus in a population. Systematic surveillance based on clinical diagnosis should be implemented early in any measles elimination program. In countries attempting to eliminate indigenous measles, all isolated cases of measles and at least one case in each chain of transmission should be confirmed by laboratory tests. Specimens for virus isolation (e.g., urine, nasopharyngeal swabs, or blood) should be collected in conjunction with field investigations. Vaccination campaigns generally have not proved to be effective responses to measles outbreaks. Outbreaks should be treated as opportunities to reinforce surveillance and to identify measures to prevent future outbreaks. The major obstacles to measles eradication are not technical but perceptual, political, and financial. Measles is often mistakenly perceived as a mild illness. This misperception, which is particularly prevalent in industrialized countries, can inhibit the development of public and political support for the allocation of resources required for an effective elimination effort. The disease burden imposed by measles should be documented, particularly in industrialized countries, so that this information can be used to educate parents, medical practitioners, public health workers, and political leaders about the benefits of measles eradication." - p. 1Cover title.June 13, 1997."This report was prepared by the staffs of the following organizations: Expanded Programme on Immunization, World Health Organization; Special Program for Vaccines and Immunization, Pan American Health Organization; National Immunization Program, Centers for Disease Control and Prevention; Task Force for Child Survival and Development." - p. iiIncludes bibliographical references (p. 19-20)

Preventing tetanus, diphtheria, and pertussis among adults: use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine : recommendations of the Advisory Committee on Immunization Practices (ACIP)

On June 10, 2005, a tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) formulated for use in adults and adolescents was licensed in the United States for persons aged 11--64 years (ADACEL\uae, manufactured by sanofi pasteur, Toronto, Ontario, Canada). Prelicensure studies demonstrated safety and efficacy, inferred through immunogenicity, against tetanus, diphtheria, and pertussis when Tdap was administered as a single booster dose to adults. To reduce pertussis morbidity among adults and maintain the standard of care for tetanus and diphtheria prevention and to reduce the transmission of pertussis to infants and in health-care settings, the Advisory Committee on Immunization Practices (ACIP) recommends that: 1) adults aged 19--64 years should receive a single dose of Tdap to replace tetanus and diphtheria toxoids vaccine (Td) for booster immunization against tetanus, diphtheria, and pertussis if they received their last dose of Td >10 years earlier and they have not previously received Tdap; 2) intervals shorter than 10 years since the last Td may be used for booster protection against pertussis; 3) adults who have or who anticipate having close contact with an infant aged <12 months (e.g., parents, grandparents aged <65 years, child-care providers, and health-care personnel) should receive a single dose of Tdap to reduce the risk for transmitting pertussis. An interval as short as 2 years from the last Td is suggested; shorter intervals can be used. When possible, women should receive Tdap before becoming pregnant. Women who have not previously received Tdap should receive a dose of Tdap in the immediate postpartum period; 4) health-care personnel who work in hospitals or ambulatory care settings and have direct patient contact should receive a single dose of Tdap as soon as feasible if they have not previously received Tdap. An interval as short as 2 years from the last dose of Td is recommended; shorter intervals may be used. These recommendations for use of Tdap in health-care personnel are supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC). This statement 1) reviews pertussis, tetanus and diphtheria vaccination policy in the United States; 2) describes the clinical features and epidemiology of pertussis among adults; 3) summarizes the immunogenicity, efficacy, and safety data of Tdap; and 4) presents recommendations for the use of Tdap among adults aged 19--64 years.Introduction -- Pertussis Vaccination Policy -- Objectives of Adult Pertussis Vaccination Policy -- -- Background: Pertussis -- General Characteristics -- Clinical Features and Morbidity Among Adults with Pertussis -- Infant Pertussis and Transmission to Infants -- Pertussis Diagnosis -- Burden of Pertussis Among Adults -- -- Background: Tetanus and Diphtheria -- Tetanus -- Diphtheria -- -- Adult Acellular Pertussis Vaccine Combined with Tetanus and Diphtheria Toxoids -- ADACEL\uae -- -- Safety Considerations for Adult Vaccination with Tdap -- Spacing and Administration Sequence of Vaccines Containing Tetanus Toxoid, Diphtheria Toxoid, and Pertussis Antigens -- Neurologic and Systemic Events Associated with Vaccines with Pertussis Components or Tetanus Toxoid-Containing Vaccines -- -- Economic Considerations for Adult Tdap Use -- Economic Burden -- -- Implementation of Adult Tdap Recommendations -- Routine Adult Tdap Vaccination -- Vaccination of Adults in Contact with Infants -- Vaccination of Pregnant Women -- -- Pertussis Among Health-Care Personnel -- -- Recommendations -- Routine Tdap Vaccination -- Contraindications and Precautions for Use of Tdap -- Special Situations for Tdap Use -- Reporting of Adverse Events After Vaccination -- Vaccine Injury Compensation -- Areas of Future Research Related to Tdap and Adults -- -- Acknowledgments -- References -- Appendix A. Summary of Recommendations for Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine (Tdap) Use Among Adults -- Appendix B. CDC and Council of State and Territorial Epidemiologists (CSTE) Pertussis Case Definition -- Appendix C. Abbreviations Used in This Reportprepared by Katrina Kretsinger ... [et al.]"The material in this report originated in the National Center for Immunization and Respiratory Diseases (proposed), Anne Schuchat, MD, Director; Division of Bacterial Diseases (proposed), Alison Mawle, PhD, (Acting) Director, and the Office of the Chief Science Officer, Tanja Popovic, MD, (Acting) Chief Science Officer; and Immunization Safety Office, Robert Davis, MD, Director.Includes bibliographical references (p. 27-33).Infectious DiseasePrevention and ControlCurrentACIPJCSmith1/13/201

Surveillance guidelines for smallpox vaccine (vaccinia) adverse reactions

"CDC and the U.S. Food and Drug Administration rely on state and local health departments, health-care providers, and the public to report the occurrence of adverse events after vaccination to the Vaccine Adverse Event Reporting System. With such data, trends can be accurately monitored, unusual occurrences of adverse events can be detected, and the safety of vaccination intervention activities can be evaluated. On January 24, 2003, the U.S. Department of Health and Human Services (DHHS) implemented a preparedness program in which smallpox (vaccinia) vaccine was administered to federal, state, and local volunteers who might be first responders during a biologic terrorism event. As part of the DHHS Smallpox Preparedness and Response Program, CDC in consultation with experts, established surveillance case definitions for adverse events after smallpox vaccination. Adverse reactions after smallpox vaccination identified during the 1960s surveillance activities were classified on the basis of clinical description and included eczema vaccinatum; fetal vaccinia; generalized vaccinia; accidental autoinoculation, nonocular; ocular vaccinia; progressive vaccinia; erythema multiforme major; postvaccinial encephalitis or encephalomyelitis; and pyogenic infection of the vaccination site. This report provides uniform criteria used for the surveillance case definition and classification for these previously recognized adverse reactions used during the DHHS Smallpox Preparedness and Response Program. Inadvertent inoculation was changed to more precisely describe this event as inadvertent autoinoculation and contact transmission, nonocular and ocular vaccinia. Pyogenic infection also was renamed superinfection of the vaccination site or regional lymph nodes. Finally, case definitions were developed for a new cardiac adverse reaction (myo/pericarditis) and for a cardiac adverse event (dilated cardiomyopathy) and are included in this report. The smallpox vaccine surveillance case definitions presented in the report can be used in future vaccination programs to ensure uniform reporting guidelines and case classification." - p. 1Introduction -- -- Reporting Guidelines -- -- Case Definition and Classification -- Localized Reactions -- Unintentional Transfer of Vaccinia Virus -- Diffuse Dermatologic Complications -- Progressive Vaccinia -- Rare Reactions -- Cardiac -- -- Case Classification -- Vaccinia Laboratory Diagnostics -- Surveillance Results and Outcome -- Conclusions -- Referencesprepared by Christine Casey, Claudia Vellozzi, Gina T. Mootrey, Louisa E. Chapman, Mary McCauley, Martha H. Roper, Inger Damon, David L. Swerdlow."February 3, 2006."Cover title.The material in this report originated in the National Immunization Program, Anne Schuchat, MD, Director."Vaccinia Case Definition Development Working Group .... Advisory Committee on Immunization Practices-Armed Forces Epidemiological Board Smallpox Vaccine Safety Working Group" - p. 16Also available via the World Wide Web.Includes bibliographical references (p. 14-15)

Recommended childhood immunization schedule - United States, 1995

The need for a single childhood immunization schedule prompted the unification of previous vaccine recommendations made by the American Academy of Pediatrics (AAP) and the Advisory Committee on Immunization Practices (ACIP). In addition to presenting the newly recommended schedule for the administration of vaccines during childhood, this report addresses the previous differences between the AAP and ACIP childhood vaccination schedules and the rationale for changing previous recommendations.Introduction -- Rationale for change and current recommendations -- Simultaneous administration of multiple vaccines -- Conclusion -- References.June 16, 1995.The following CDC staff members prepared this report: Jacqueline S. Gindler, Stephen C. Hadler, Peter M. Strebel, John C. Watson, Epidemiology and Surveillance Division, National Immunization Program,Includes bibliographical references p. 8-9

Tetanus surveillance -- United States, 1998-2000

PROBLEM/CONDITION: Tetanus is a severe and often fatal infection. The incidence of reported cases in the United States has declined steadily since introduction of tetanus toxoid vaccines in the 1940s. REPORTING PERIOD: This report covers surveillance data for 1998--2000. DESCRIPTION OF SYSTEM: Physician-diagnosed cases of tetanus were reported to CDC's National Notifiable Disease Surveillance System. Supplemental clinical and epidemiologic information were provided by states. RESULTS AND INTERPRETATION: During 1998--2000, an average of 43 cases of tetanus was reported annually; the average annual incidence was 0.16 cases/million population. The highest average annual incidence of reported tetanus was among persons aged >60 years (0.35 cases/million population), persons of Hispanic ethnicity (0.37 cases/million population), and older adults known to have diabetes (0.70 cases/million population). Fifteen percent of the cases were among injection-drug users. The case-fatality ratio was 18% among 113 patients with known outcome; 75% of the deaths were among patients aged >60 years. No deaths occurred among those who were up-to-date with tetanus toxoid vaccination. Seventy-three percent of 129 cases with known injury information available reported an acute injury; of these, only 37% sought medical care for the acute injury, and only 63% of those eligible received tetanus toxoid for wound prophylaxis. INTERPRETATION: The majority of tetanus cases occurred among persons inadequately vaccinated or with unknown vaccination history who sustained an acute injury. Adults aged >60 years were at highest risk for tetanus and tetanus-related death. PUBLIC HEALTH ACTIONS: Tetanus is preventable through routine vaccination (i.e., primary series and decennial boosters) and appropriate management. A shortage of tetanus and diphtheria toxoids vaccine that began during 2000 ended in 2002. Efforts by health-care providers are warranted to vaccinate persons with delayed or incomplete vaccination, with emphasis on older persons and persons with high-risk conditions.F. Brian Pascual, Emily L. McGinley, Lynn R. Zanardi, Margaret M. Cortese, Trudy V. Murphy, Epidemiology and Surveillance Division, National Immunization Program.June 20, 2003.Also available via the World Wide Web as an Acrobat .pdf file (3. 21 MB, 12 p.).Includes bibliographical references (p. 7-8)

Learning lessons from field surveys in humanitarian contexts: a case study of field surveys conducted in North Kivu, DRC 2006-2008

Survey estimates of mortality and malnutrition are commonly used to guide humanitarian decision-making. Currently, different methods of conducting field surveys are the subject of debate among epidemiologists. Beyond the technical arguments, decision makers may find it difficult to conceptualize what the estimates actually mean. For instance, what makes this particular situation an emergency? And how should the operational response be adapted accordingly. This brings into question not only the quality of the survey methodology, but also the difficulties epidemiologists face in interpreting results and selecting the most important information to guide operations. As a case study, we reviewed mortality and nutritional surveys conducted in North Kivu, Democratic Republic of Congo (DRC) published from January 2006 to January 2009. We performed a PubMed/Medline search for published articles and scanned publicly available humanitarian databases and clearinghouses for grey literature. To evaluate the surveys, we developed minimum reporting criteria based on available guidelines and selected peer-review articles. We identified 38 reports through our search strategy; three surveys met our inclusion criteria. The surveys varied in methodological quality. Reporting against minimum criteria was generally good, but presentation of ethical procedures, raw data and survey limitations were missed in all surveys. All surveys also failed to consider contextual factors important for data interpretation. From this review, we conclude that mechanisms to ensure sound survey design and conduct must be implemented by operational organisations to improve data quality and reporting. Training in data interpretation would also be useful. Novel survey methods should be trialled and prospective data gathering (surveillance) employed wherever feasible

Analysis of multidrug resistance in the predominant Streptococcus pneumoniae serotypes in Canada:the SAVE study, 2011-15

Objectives: This study assessed MDR invasive isolates of Streptococcus pneumoniae, in relation to serotype evolution in Canada between 2011 and 2015 as part of the annual SAVE study. Methods: As part of a collaboration between the Canadian Antimicrobial Resistance Alliance and Public Health Agency of Canada-National Microbiology Laboratory, 6207 invasive isolates of S. pneumoniae were evaluated. All isolates were serotyped and had antimicrobial susceptibility testing performed, in accordance with CLSI guidelines (M07-A10, 2015). Complete susceptibility profiles were available for 6001 isolates. MDR was defined as resistance to three or more classes of antimicrobial agents (with penicillin MIC ≥2 mg/L defined as resistant). Results: The overall rate of MDR S. pneumoniae was 6.2% (372/6001) in SAVE, decreasing significantly from 8.5% in 2011 to 5.6% in 2015 (P = 0.0041). MDR was observed in 32 serotypes, with serotypes 15A and 19A predominating (26.6% and 41.7% of the MDR isolates, respectively). The overall proportion of serotypes 19A, 7F and 33A decreased significantly (P 5%) for 24F and 33F. Conclusions: In 2015, 56.3% of invasive MDR S. pneumoniae were serotypes included in the PCV-13 vaccine. PCV-13 includes the most commonly identified serotype, 19A; however, other increasingly important MDR serotypes, such as 15A, 24F and 33F, are notably not in the currently used vaccines