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The Children's Hospital of Philadelphia

Vaccine Update for Healthcare Providers

March 2013

This newsletter is meant to keep you up to date on issues related to vaccines quickly and easily. We welcome your comments and questions; please email us at vacinfo@email.chop.edu.

VEC Announcements: Awards, webinar archive, and new Medscape videos

Awards
Dr. Offit’s work to keep children healthy with vaccines was recently rewarded with two honors:
 

  • Top 50 most influential people in vaccines – In an online vote hosted by a vaccine advocacy blog in advance of the World Vaccine Congress in April, Dr. Offit was named sixth in the world for his influence related to vaccines. Learn more about the survey and view the complete list»
  • National Foundation of Infectious Diseases’ Maxwell Finland Award for Scientific Achievement – Earlier this month, the National Foundation of Infectious Diseases (NFID) presented the Maxwell Finland Award for Scientific Achievement to Dr. Offit at their annual awards dinner in Virginia. The recipient is chosen based on work in the fields of infectious diseases and public health that advances clinical or scientific understanding, trains future leaders in the field or has a positive impact on the health of humankind. Learn more about the award and view the list of previous recipients»
     

Webinar archive
The March “Current Issues in Vaccines” webinar presented by Dr. Offit is now available online; viewers can get CME by completing a post-test and evaluation. Instructions are provided at the end of the webinar. Webinars are co-sponsored by the VEC and the Pennsylvania Chapter, American Academy of Pediatrics and are supported by the Thomas F. McNair Scott Endowed Research and Lectureship Fund.

As a reminder, topics for this event included:
 

  • Pertussis: Are vaccine-resistant strains emerging?
  • Influenza: Conceptually different vaccines will be available for 2013-2014
  • HibMenCY: One component routinely recommended for all infants, the other for high-risk infants; what to do?
  • Pneumococcal vaccine: Update to PCV-13 recommendation
     

New Medscape videos
VEC-associated CHOP doctors presented four Medscape videos related to vaccines and vaccine-preventable diseases in recent weeks:
 

If you are not registered with Medscape, you will need to register (free) prior to viewing the videos. You can also access all four videos from the VEC website without having to register.

News and Views: Healthcare, science and the sequestration

Charlotte A. Moser, Assistant Director, and Paul A. Offit, Director, Vaccine Education Center at The Children’s Hospital of Philadelphia 

The looming deadline for the sequestration has come and gone and it may seem as though not much has changed. In fact, in the short term, it is likely that not much will change, but without any congressional votes to undo the required budget cuts, change will come.

The sequestration means that almost all federally funded agencies and programs will need to implement spending cuts to the tune of 5.3 to 7.9 percent. While some programs are shielded from these cuts, most are not. Agencies such as the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) will be required to adhere to these measures. Because the cuts are discretionary within programs, we cannot know for sure what each agency will decide to cut in order to meet the requirements. However, we have gotten a chance to see what they could mean with the White House’s state-by-state analysis.

Find out what the sequester means for healthcare providers, your patients, and science»

In the Journals: Efficacy of influenza vaccine in adults

Paul A. Offit, MD, Director, Vaccine Education Center at The Children’s Hospital of Philadelphia

In February 2013, investigators at Vanderbilt University in collaboration with the Centers for Disease Control and Prevention (CDC) evaluated the efficacy of influenza vaccine at preventing hospitalizations caused by influenza virus in adults (Talbot HK, Zhu Y, Chen Q, Williams JV, Thompson MG, Griffin MR. Effectiveness of influenza vaccine for preventing laboratory-confirmed influenza hospitalizations in adults, 2011-2012 influenza season. Clin Infect Dis. 2013 Feb 28).

Investigators evaluated adults admitted with acute respiratory disease to one academic and three community hospitals in the Nashville, Tennessee area. Eligibility criteria included an admission diagnosis of pneumonia, influenza, or acute respiratory disease plus at least two of the following: temperature greater than 100oF or less than 96.8oF, new onset of cough, dyspnea, chills, headache, myalgia or sore throat. Patients with symptoms lasting longer than 10 days or having been treated with antivirals were excluded. Diagnosis of influenza virus infection was made by reverse-transcriptase polymerase chain reaction (RT-PCR). Of 191 eligible patients, 21 had confirmed influenza.

Read about the findings of the study»

Technically Speaking: What to do if the wrong dose of a vaccine is administered

Deborah L. Wexler, MD, Executive Director, Immunization Action Coalition

Sometimes healthcare personnel inadvertently administer the wrong dose of a vaccine to a child or adult patient. This often happens with vaccines that come in both pediatric and adult formulations, such as hepatitis A and hepatitis B vaccines, which are available in both 0.5 mL and 1.0 mL formulations. Routinely used injectable influenza vaccines come in two dosing amounts as well, with 0.25 mL for use in children younger than age 3 years and 0.5 mL for people age 3 years and older.

Read more about what to do when such dosing errors occur, and how to avoid these errors in the future»

From the Media â€” Influenza vaccine as a cause of narcolepsy

One version of the H1N1 vaccine used in Europe during the 2009 pandemic has been questioned as a cause of narcolepsy in children. The vaccine, known as Pandemrix, contained an adjuvant known as ASO3. The media has carried stories related to this concern on both sides of the ocean.

Read about what you should know if patients or their families are concerned, and get more information»

On the Calendar

Pennsylvania and Idaho have announced their 2013 immunization conferences. Also, remember that you can always check for online opportunities to get vaccine-related information and, in some cases, continuing education credits.

Check the calendar»

On the Bookshelf: Special issue South Dakota Medicine

Charlotte A. Moser, Assistant Director, Vaccine Education Center at The Children’s Hospital of Philadelphia

South Dakota Medicine, the journal of the South Dakota State Medical Association, recently produced a special edition of the journal dedicated to vaccines. Featuring authors from South Dakota as well as national experts, the journal contains articles about all aspects of vaccines.

Read more»

Resources: Voices for Vaccines, CDC and IAC resources and understanding statistics

Voices for Vaccines
Voices for Vaccines (VFV) is a non-profit group composed of parents who believe in the importance of vaccines. Supported by scientists and public health officials, the group aims to get science-based information about vaccines into the conversations that parents are having.

After a lag in activity, VFV has been re-energized by Ashley Shelby and Karen Ernst, dedicated parents who are volunteering their time to get more people involved and affect change. The group is currently working on adding members, following some state bills related to vaccines, and gathering a collection of personal stories. To see what VFV is doing or to join their efforts, visit their website at www.voicesforvaccines.org.

CDC and IAC resources
The Centers for Disease Control and Prevention (CDC) has recently updated the following resources:
 

The Immunization Action Coalition (IAC) recently published the February 2013 issues of Needle Tips and Vaccinate Adults. Both contain ready-to-print educational materials for healthcare professionals and their patients, vaccine news and “Ask the Experts” columns. Check out the latest issues: Needle Tips and Vaccinate Adults.

Understanding statistics
The journal, Vaccine, recently published an article titled “5 ways statistics can fool you — Tips for practicing clinicians.” Co-authors Colin P. West and Denise M. Dupras discuss five ways that statistical data can impact the interpretation of medical literature. Using examples in vaccine-related literature, the authors focus on the following:
 

  • The differences between statistical and clinical significance
  • The relevance of absolute versus relative risk to clinical significance
  • The importance of confidence intervals and not just p values
  • Considerations related to isolated p values in the midst of multiple tests
  • Non-significant p values and their potential to have clinical significance
     

The paper may be a useful review or one to file for discussing vaccinology and the scientific findings of different studies.

West Cp and Dupras DM.5 ways statistics can fool you — tips for practicing clinicians. Vaccine 2013; 31:1550-52.

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