Thursday, November 16, 2017

CDC: Nationwide Shortage of Hepatitis A Vaccine

By Sandee LaMotte, CNN

(CNN) - The battle against Hepatitis A outbreaks across the US is being stymied by a national shortage of the vaccine needed to combat it.
"Current supply is not sufficient to support demand for vaccine," the US Centers for Disease Control and Prevention told CNN in a written statement.
Southeast Michigan has seen 495 cases of Hepatitis A and 19 deaths, mostly in Macomb and Wayne counties and in Detroit. The outbreak began in August of 2016, and after a drop off during the winter, has been climbing since February of this year, said Michigan Department of Health and Human Services spokesperson Angela Minicuci.
"We have a limited supply of vaccine," said Minicuci, "so we are prioritizing delivery to high-risk populations."
In California an outbreak of the virus has sickened at least 644 people and claimed 21 lives, mostly in the cities of San Diego, Santa Cruz, and Los Angeles, according to the CDC.
Persons infected with the virus there have also spread it to Arizona, Utah, and Colorado, said Dr. Wilma Wooten, Public Health Director at San Diego's Health and Human Services Agency.
To manage the current shortage, the CDC said, staff have been working closely with public health officials to target vaccinations toward at-risk populations, as well as coordinating with vaccine manufacturers "to monitor and manage public and private vaccine orders to make the best use of supplies... during this period of unexpected increased demand."
An unexpected demand
"It's unprecedented what we are seeing out of California and other parts of the country," said GlaxoSmithKline spokesperson Robin Gaitens. "The shortage is simply an issue of supply and demand."
Outbreaks of Hepatitis A are normally small, because the vast majority of the US population was inoculated as children at approximately one year of age. GlaxoSmithKline and Merck are the only companies approved by the Food and Drug Administration to sell a Hepatitis A adult or pediatric vaccine in the US.
"We typically provide 1.2 million adult doses each year to the US market, and the demand this year has vastly surpassed the supply on hand," Gaitens said. She stressed there is no shortage of the pediatric version, which is given in a two-dose series about six months apart. Nor is there a shortage of their combination hepatitis A/B vaccine.
The current outbreaks of hepatitis A, virus genotype (IB), is normally not found in the US; it's more common to the Mediterranean, Turkey and South Africa. However, the current vaccine is effective against all strains of the virus.
In an emailed statement, Merck said it has been taking steps to increase the manufacturing capacity of both their adult and pediatric versions of their vaccine due to "unexpected demand in markets."
"At the end of October, we began shipping single-dose vials (in packages of 10 vials) for adults, which previously had been on backorder," the statement said. "We anticipate the availability of adult and pediatric pre-filled syringes of the vaccine in the first quarter of 2018."
GlaxoSmithKline also began shipping backordered single-dose syringes at the end of October, Gaitens said, adding that the company is working closely with the CDC and California officials on "how to distribute and to ensure the vaccines are actually going to where there is the greatest need."
What is hepatitis A?
Hepatitis A is a highly contagious liver disease caused by the HAV virus. The virus is found in the feces of people with the disease, and is most frequently transmitted by eating food or drinking water handled by someone who has not properly washed their hands. It's also transmitted by sex and by illicit drug use.
Some of the most common symptoms include nausea, vomiting, fever, fatigue, loss of appetite and jaundice, or yellowing of the skin or eyes. It can take 15 to 50 days to show symptoms of the infection; however, an infected person is most contagious during the two weeks before their skin turns yellow.
According to the CDC, the hepatitis A virus is very hard to kill and can live for months outside the body. Hand sanitizers are not effective against the virus, so frequent hand washing is critical to controlling any outbreak.
A growing threat
California is in the middle of the biggest person-to-person outbreak of hepatitis A since the vaccine first became available in the mid-90s, according to the California Department of Public Health.
San Diego has been hardest hit, with 546 confirmed cases and 20 deaths as of November 14, the latest numbers released by the County of San Diego Health and Human Services Agency.
Cases were first seen in November 2016 and in March officials determined they were dealing with an outbreak. It has spread predominantly among the homeless and drug users in the city, said agency spokesperson Craig Sturak. Homelessness is a year-round problem for San Diego, he added, and accompanying issues of sanitation helped fuel the spread.
"We've focused on a couple of different strategies," said Sturak. "A large vaccination effort---we've vaccinated over 100,000 people -- and the city is doing a big clean up by power-washing streets and cleaning up trash in areas where the homeless are congregating."
Despite the current shortage, Public Health Director Wooten said her agency has had enough vaccine on hand to deliver a first dose to most of the estimated 150,000 at-risk population in the San Diego area.
"With an outbreak you want to get those first doses into the arms of as many people as possible as fast as possible," said Wooten "At that point they will be 90% to 95% protected. It's the second dose that takes you up to 100% protection."
Wooten said the county had planned to start a campaign soon to administer the second dose, but delayed the program until spring due to the shortage. But she stressed that nurses out in the at-risk community are administering the additional dose if they come across anyone who requires it.
"We're also targeting those who fall under the CDC guidelines, such as the MSM, or men having sex with men population, or anyone who currently has hepatitis B or C," said Wooten. "We have access to 15,000 doses for the month of November to meet that need, and if we need additional doses in December we will ask the state for those as well."
California's outbreak led Governor Jerry Brown to declare a state of emergency in mid-October. The declaration allowed the state to "immediately purchase additional vaccines directly from manufacturers and coordinate distribution to people at greatest risk in affected areas." 

Monday, August 28, 2017

NACCHO highlights Broward HPV campaign

Kim Rodgers of the National Association of County and City Health Officials highlighted Broward County's campaign on HPV vaccine on her immunization blog. Thanks Kim.


NIAM Blog Series 2017: Turning the Tide on HPV Vaccination Rates


Throughout the month of August, NACCHO’s National Immunization Awareness Month (NIAM) Blog Series highlights the importance of immunizations across the lifespan. This week’s NIAM Blog Series post takes us to Florida, where high rates of human papilloma virus (HPV)-associated cancers and low HPV vaccination rates led the Florida Department of Health in Broward County (DOH-Broward) to take action.


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The Problem
The Centers for Disease Control and Prevention (CDC) estimates that nearly 40,000 HPV-associated cancers occur in the United States each year – 23,300 among women and 16,500 among men – and that these cancers are responsible for more than 90% of anal and cervical cancers, about 70% of vaginal and vulvar cancers, and more than 60% of penile cancers.
In the state of Florida, these statistics are all too familiar.


According to CDC data (2006-2010), Florida ranks in the top third of states in HPV-associated cervical cancer, anal cancer in males and females, and oropharyngeal cancer in males; while ranking in the mid-third of states in HPV-associated penile cancer and vaginal cancer. The state’s high rates of HPV-associated cancers have a lot to do with its low rates of HPV vaccination coverage. In 2013, CDC data indicated that HPV vaccination rates of adolescent girls (ages 13-17) in Florida was between 30-37.6%, placing Florida among the lower third in state ranking. In fact, that same year, Florida had the lowest coverage for =1 HPV vaccine dose (39.4%) compared to the rest of the nation’s states.
The connection between the low rates of HPV vaccination and high rates of HPV-associated cancers led Broward County – which represents 9% of the State’s population and is the second most populous county in Florida – to take action to increase HPV vaccination rates.


The Intervention
In May 2015, DOH-Broward and the Broward County Immunization Action Coalition (the Coalition) held a community planning meeting to develop an action plan to increase HPV vaccine rates in Broward County. The Coalition, which was developed in 1996 through the leadership of DOH-Broward, was established to develop, implement, and monitor immunization strategies that further the goals of providing complete protection against, and eventual elimination of, vaccine-preventable diseases.
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DOH-Broward Immunization Clinic at Lauderhill Mall
As part of the community action plan, stakeholders agreed that DOH-Broward could offer HPV vaccine at its annual back-to-school immunization point of dispensing (POD). Consequently, DOH-Broward offered HPV vaccine during the 2015 and 2016 back-to-school immunization PODs, hosting extended night and weekend hours to maximize community reach. In addition, DOH-Broward attended a Broward County Pediatric Society meeting to educate providers about recommending the HPV vaccine as part of routine immunization clinical visits and speaking about the vaccine as cancer prevention. Further, by developing and distributing an HPV palm card to the community and providers, DOH-Broward was able to increase awareness of HPV and the HPV vaccine.


Through this series of activities, DOH-Broward produced a major shift in the county’s HPV vaccination rates.
The Impact
Prior to the intervention, DOH-Broward was only providing HPV vaccine at its immunization clinics and had not engaged the county’s provider community. However, by distributing more than 5,000 palm cards, offering the HPV vaccine at PODs, and making it a part of routine immunizations, the health department was able to increase vaccine acceptance in doses administered from 2015 (1,772) to 2016 (4,217), representing a 138% increase.


During the 2016 POD, 1,640 HPV vaccines were provided as compared to 903 in 2015 – an 81% increase. Of those, 1,256 were initial doses, 228 were second doses and 156 were third dose. HPV vaccine rates have also significantly increased at DOH-Broward clinics, which saw a 196.5% increase in doses provided from 2015 (869) to 2016 (2,577). Of those, 1,236 were initial doses, 944 were second doses, and 397 were third dose.
While this intervention is still relatively new, the hope is that DOH-Broward’s continued efforts to drive HPV immunization rates up will eventually help to curb the rates of HPV-associated cancers.


Best Practices & Lessons Learned
While increasing awareness and expanding opportunities for the community to receive the HPV vaccine had much to do with DOH-Broward’s success, there were other contributing factors. In particular, training immunization nurses to reference HPV as cancer prevention rather than STD prevention was critical. When HPV becomes a part of routine vaccination and is presented as cancer prevention, parents are more apt to agree to the vaccination for their child. Further, the engagement of stakeholders and partners during the community planning meeting produced up-front buy-in that will allow DOH-Broward to continue increasing HPV vaccination uptake and vaccines delivered.
NACCHO is pleased to support local health departments in their participation of NIAM. Download NACCHO’s updated Guide to HPV Resources for Local Health Departments and be sure to check out our previous posts in the NIAM Blog Series:


About Kim Rodgers
Kim Rodgers serves as a Communications Specialist at NACCHO. Her work includes promoting local health departments' best practices, as well as partner tools and resources, in infectious disease and preparedness through NACCHO's communications channels, storytelling, and outreach to various audiences.

Friday, August 11, 2017

DOH Webinar on HPV


TRAINING OPPORTUNITY: Human Papillomavirus Quality Improvement Webinar


The Florida Department of Health, Immunization Section would like to share with its partners and colleagues information regarding an upcoming educational webinar from the National Area Health Education Center Organization (NAO). NAO is offering a free webinar, Human Papillomavirus (HPV) Quality Improvement: Small-Scale Efforts for Practice Transformation,   focused on how to transform your practice by utilizing a sustainable intervention that fits or even simplifies your current work flows.

Learning objectives:

 

  • Define specific goals for adolescent vaccination rates based upon accurate data mining and reporting within your organization.
  • Utilize implementation science concepts to select specific, relevant strategies to apply to your organization in a deliberate, sustainable intervention.
  • Improve addressing of adolescent vaccines with patients and parents utilizing processes, tools and scripting.

 

Date: Thursday, August 24, 2017

Time: 3:00 p.m.–4:00 p.m. EST

 

FREE Continuing Education opportunity!

 


 

Please remember to distribute this information to colleagues, members, coalitions, and partners who provide or have an interest in immunizations. Also, please post this information prominently on your website. If you have any questions or need any additional information regarding vaccine recommendations, please contact Dearline Thomas-Brown, MPH, BSN, RN, Executive Community Health Nursing Director for the Immunization Section at 850-245-4342 or Dearline.Thomas-Brown@flhealth.gov.

Thursday, August 3, 2017

New vaccine adverse event reports

Here is a second news item from the Florida Department of Health Immunization Section in Tallahassee, which originally came from the CDC.


New Vaccine Adverse Event Reporting System (VAERS) Website
The Florida Department of Health, Immunization Section would like to share with its partners and colleagues an update from the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). The CDC and FDA has implemented new system changes pertaining to Vaccine Adverse Event Reporting System (VAERS) Website and Ways to Report to VAERS—please see below regarding this new change.

CDC and FDA are pleased to announce VAERS 2.0 includes a new reporting form and a new website that allows you to:


·         Easily submit a VAERS report electronically
·         Access VAERS data VAERS 2.0
·         Learn more about how CDC and FDA monitor the safety of vaccines
·         Coming soon: VAERS 2.0 video!

There are now two ways to report an adverse event following vaccination to VAERS:

1. Use the online reporting tool
2. Complete a fillable VAERS PDF form and upload it into the new VAERS system

By the end of 2017, CDC and FDA will phase out the old VAERS-1 paper form and fully transition to the new VAERS 2.0 electronic submission process. Accommodations will be made for persons unable to submit reports electronically.
  

If you have any questions or need any additional information regarding vaccine recommendations, please contact Dearline Thomas-Brown, MPH, BSN, RN, Executive Community Health Nursing Director for the Immunization Section at 850-245-4342 or Dearline.Thomas-Brown@flhealth.gov.

Vaccine Update from DOH


Here is a news item from the Florida Department of Health Immunization Section in Tallahassee...

Vaccine Updates and Resources for Providers

The Florida Department of Health, Immunization Section would like to share with it’s partners and colleagues a partner resource from the Children’s Hospital of Philadelphia’s Vaccine Education Center. The recent newsletter, Vaccine Updates for Providers, is a valuable resource and provides vaccine updates, free provider tools and resources available in English and Spanish, best practice guidelines and various updated immunization articles, materials and information.

To view this resource, please visit Vaccine Updates for Providers. (If the link doesn't work, the web address is http://mailchi.mp/email/vaccine-update-fetal-cells-and-vaccines-new-qa-sheets-vis-update-hpv-vaccine-and-pregnancy-and-next-years-influenza-vaccine-1525877?e=c38f27a1d9
 

If you have any questions or need any additional information regarding vaccine recommendations, please contact Dearline Thomas-Brown, MPH, BSN, RN, Executive Community Health Nursing Director for the Immunization Section at 850-245-4342 or Dearline.Thomas-Brown@flhealth.gov.

Monday, June 5, 2017

Where to get your back-to-school immunizations

The best place to have your child immunized for admission to school in 2017-18 is at your regular family doctor. But if that is not possible, several health organizations in Broward County are offering free back-to-school vaccinations over the summer. 

Here are three:

BROWARD HEALTH



HOLY CROSS HOSPITAL

FL DEPARTMENT OF HEALTH - BROWARD

Edgar P. Mills Health Center, Fort Lauderdale.
Paul Hughes Health Center, Pompano Beach.
Appointments 954-467-4705.

Also at Lauderhill Mall (see flyer)




Tuesday, April 18, 2017

National Infant Immunization Week

Hello. Here is some information and a link to the CDC's Toolkit for National Infant Immunization Week (NIIW), April 22 to 29.

The toolkit details events and activities, online resources, sample social media content and materials for the annual observance of NIIW. The CDC's welcome message and a link to the NIIW web site are found below. We hope you will find these resources helpful as you engage and promote NIIW messages. Thank you.

Samhara Estrada, Acting Chair of the Broward Immunization Action Coalition

DIGITAL TOOLKIT FOR PARTNERS

To assist partners in our collective efforts to spread the word about the positive impact of vaccination, and to call attention to immunization achievements, we have created this digital toolkit for partners which details events and activities, online resources, sample social media content, and materials. We hope you will find these resources helpful as you engage and promote NIIW messages.

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, local and state health departments, national immunization partners, healthcare professionals, community leaders from across the United States, and the Centers for Disease Control and Prevention (CDC) have worked together through NIIW.

CDC relies heavily on partners like you to promote our messages about the critical role vaccination plays in protecting our children, communities, and public health. This year, NIIW will be observed from April 22—April 29. We encourage you to get involved in NIIW and thank you helping us spread the word about childhood immunizations.