COCA Digest: March 5, 2018

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Vaccines and Immunizations


Updated Vaccine Information Statements (VISs) for Rotavirus Vaccine is Available Now

The rotavirus VIS has been updated to replace an outdated link to information about porcine circovirus. No other changes have been made to the VIS. While we encourage providers to begin using the updated VIS as soon as possible, stocks of the previous edition may still be used until exhausted.


Recombinant Zoster VIS, and Updated MMR, MMRV, Varicella, and Live Zoster VISs, are Available Now

A VIS for recombinant zoster vaccine was posted on February 12, 2018 and may be used immediately.  Also, updated VISs for live zoster vaccine, MMR, MMRV, and varicella have been posted. We encourage providers to begin using these VISs immediately, but stocks of the previous editions may be used until exhausted.

For more information about VIS requirements for healthcare staff, go here. For 2018 Vaccine Schedules, go here. To access easy-to read versions of vaccine schedules, go here. View updated vaccine labels based on the new Shingles Vaccine here.


Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, United States, 2018

In October 2017, the Advisory Committee on Immunization Practices (ACIP) approved the 2018 immunization schedule for children and adolescents birth through 18 years, effective February 2018. The schedule has been approved by CDC, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists.

The comprehensive summary of the ACIP recommended changes to the schedule can be found in the February 6, 2018 MMWR here.

Clinical Update Announcement: Temporary Total Depletion of US Licensed Yellow Fever Vaccine Addressed by Availability of Stamaril Vaccine at Selected Clinics

Sanofi Pasteur, the manufacturer of the only yellow fever vaccine (YF-Vax) licensed in the United States, announced on February 22, 2018, that YF-Vax for civilian use is expected to be available from the manufacturer again by the end of 2018. However, YF-VAX might be available at some clinics, until remaining supplies at those sites are used up. Sanofi Pasteur applied and received approval from the US Food and Drug Administration (FDA) to make another yellow fever vaccine available in the United States under an investigational new drug (IND) program. Manufactured by Sanofi Pasteur in France, this vaccine, Stamaril, is registered and distributed in more than 70 countries. It is comparable in safety and efficacy to YF-Vax.

To meet the requirements of the IND program, Sanofi Pasteur can provide Stamaril to a limited number of clinics. Sanofi has identified sites throughout the United States to include in the program so patients can have continued access to yellow fever vaccine.

Travelers and health care providers can find locations that can administer Stamaril, and those clinics with remaining doses of YF-VAX, by visiting the yellow fever vaccination clinic search page. For information about which countries require yellow fever vaccination for entry and which countries CDC recommends yellow fever vaccination, visit the CDC Travelers’ Health website here. Read the full clinical update announcement here.

COCA News and Announcements

Recent COCA Calls

Topic: Don't Overlook Assessing Environmental Exposures – During a Disaster and Every Day

Date: February 13, 2018

Topic: Update on the 2017-2018 Influenza Season for Clinicians

Date: February 8, 2018

Archived COCA conference calls are available here. Free continuing education is available for most calls. More information about free CE is available here.

Seasonal Influenza


While influenza activity continued to decrease according to the latest FluView report, it remains high across much of the United States. Influenza-like illness (ILI) dropped from 6.4% reported last week to 5.0%, and is now similar to ILI observed at the peak of last season. Current data indicate that the 2017-2018 flu season peaked at 7.4% in early February (during weeks 5 and 6) and is now on the decline, however 45 states plus Puerto Rico continue to report widespread flu activity and 32 states plus New York City and the District of Columbia continue to experience high ILI activity. The overall hospitalization rate and all age-specific hospitalization rates, with the exception of children 5-17 years, are now higher than the end-of-season hospitalization rates for 2014-2015; a high severity, H3N2-predominant season. The hospitalization rate for children 5-17 is similar to that of 2014-2015. CDC also is reporting an additional 17 flu-related pediatric deaths during week 8, bringing the total number of flu-related pediatric deaths reported this season to 114. Flu activity is likely to remain elevated for several more weeks.

CDC continues to recommend influenza vaccination for all persons 6 months of age and older as flu viruses are likely to continue circulating for weeks. While H3N2 viruses remain predominant overall this season, the proportion of B viruses versus A viruses is now almost even. In recent weeks, B viruses have been increasing while H3N2 viruses have been decreasing. Early vaccine effectiveness (VE) estimates show that flu vaccine has reduced the risk of having to go to the doctor due to flu by 36% overall through February 3, 2018. VE against H3N2 viruses was 25%. VE against H1N1 67% and VE against B viruses was 42%. In addition, in the context of widespread influenza activity, CDC clinicians and the public are reminded of importance of prompt treatment with influenza antiviral medications in people who are severely ill and people who are at high risk of serious flu complications who develop flu symptoms.

Read the full Situational Update here. Read the FluView report for 2017-2018 Influenza Season Week 8 ending February 24, 2018 here


Information for Health Care Professionals

For key information about vaccination, infection control, prevention, treatment, and diagnosis of seasonal influenza related to the 2017-2018 season specific to public health and health care professionals, go here.

For information regarding the latest recommendations from the Advisory Committee on Immunization Practices (ACIP) for the prevention and control of seasonal influenza, go here.

CDC offers other resources, such as the link to the full presentation of the January 16 session of CDC Grand Rounds: Public Health Response to Severe Influenza, the transcript for CDC update on widespread flu activity on February 9, links to the latest Morbidity and Mortality Weekly Reports (MMWRs) about influenza, videos as part of the CDC Expert Commentary Series on Medscape, and a link to the CDC Health Advisory: Seasonal Influenza A(H3N2) Activity and Antiviral Treatment of Patients with Influenza.

CDC's seasonal flu vaccination campaign materials are available to assist partners in communicating about the importance of vaccination. This digital toolkit includes details on events and activities, sample social media and newsletter content, graphics, web assets, and media prep material. This material is available to download and share; some of the material can be customized.

Current United States Flu Activity Map

The influenza activity reported by state and territorial epidemiologists indicates geographic spread of influenza viruses, but does not measure the severity of influenza activity. To view the current United States Flu Activity Map, go here.

Week 8

CDC News and Announcements

World TB Day

World TB Day is March 24

Each year, CDC recognizes World TB Day on March 24. This annual event commemorates the date in 1882 when Dr. Robert Koch announced his discovery of Mycobacterium tuberculosis, the bacillus that causes tuberculosis (TB).

Although TB is preventable and curable, many people in the United States still suffer from this disease. Anyone can get TB, and our current efforts to find and treat latent TB infection and TB disease are not sufficient. Misdiagnosis of TB still exists and health care professionals often do not “think TB.”

The U.S. theme for World TB Day 2018 is “Wanted: Leaders for a TB Free United States. We can make history. End TB.” CDC and its domestic and international partners, including the National TB Controllers Association, Stop TB USA, and the global Stop TB Partnership are working together to eliminate this deadly disease. But we need your help.

Be sure to check back for more information and resources as we get closer to World TB Day.  You can also follow us on Twitter @CDC_TB and Facebook @CDCTB and sign up for email updates through GovDelivery.

Birth defects

World Birth Defect Day is March 3

Birth defects are common, costly, and critical. Most of us have been touched by someone living with a birth defect—a family member, friend, or neighbor.

In recent years, birth defects have received increased attention as CDC and researchers worldwide worked toward clarifying the relationship between Zika virus disease and birth defects from Zika virus infection (congenital Zika syndrome). The Zika virus disease outbreak and its impact on birth defects have emphasized the need for and benefits of international collaboration and communication about birth defects prevention.

Birth Defects COUNT (Countries and Organizations United for Neural Tube Defects Prevention) is CDC’s global initiative to reduce death and lifelong disability resulting from neural tube defects. Neural tube defects are serious birth defects of the brain and spine. They are a major cause of death and lifelong disability worldwide. Each year, there are more than 300,000 babies born around the world with a neural tube defect. Many neural tube defects can be prevented by adding folic acid, a B vitamin, to foods like bread and rice, a process called folic acid fortification. Since the start of folic acid fortification in the United States in 1998, the number of babies born with neural tube defects has decreased by 35%. This means that more than 1,300 U.S. babies are now born each year without a neural tube defect. Recently, the FDA approved the addition of folic acid to corn masa flour. Corn masa flour is used to make foods such as corn chips, tortillas, and taco shells.

Learn more about how CDC and its partners work together to expand birth defects monitoring and prevention initiatives worldwide here.

Press Release: Is the U.S. Export Economy at Risk from Global Infectious Outbreaks?

In addition to tragic loss of life, the next global infectious disease outbreak could harm the U.S. export economy and threaten U.S. jobs—even if the disease never reaches our shores. Two CDC articles published in Health Security analyze the risks and show potential losses to the American export economy from an overseas outbreak. The two articles underscore the importance of the President’s request this week for $59 million in support of the Global Health Security Agenda (GHSA) in Fiscal Year 2019.

“The President’s Budget request of $59 million for Fiscal Year 2019 for GHSA demonstrates the Administration’s commitment to global health security and provides an important bridge to the extension of the GHSA announced in October 2017 in Uganda,” said Anne Schuchat, M.D., acting Director of CDC. “This new funding continues the U.S. commitment to this multi-national effort and supplements U.S. Government multisector support for this initiative.”

The two articles discuss the potential disruption to the U.S. export economy if an infectious disease outbreak were to take hold in CDC’s 49 global health security priority countries as well as examines what could happen to the U.S. economy if an epidemic were to strike a key region.

Read the articles here and here. Read the full press release here.

CDC Science Clips

Each week, select science clips are shared with the public health community to enhance awareness of emerging scientific knowledge. The focus is applied public health research and prevention science that has the capacity to improve health now.

Volume 10, Issue 7

Volume 10, Issue 6

Volume 10, Issue 5

Volume 10, Issue 4

Public Health Preparedness

Emergency Preparedness and Response

Emergency Preparedness and Response for Health Professionals

For a variety of resources for clinicians, communicators, laboratorians, emergency planners and responders, and disaster relief volunteers to prepare them to respond to a public health emergency, as well as Health Alert Network (HAN) archives, go here.

Emergency Preparedness and Response Training Resources for Clinicians

For scheduled and on-demand emergency preparedness and response training resources offered by CDC, other federal agencies, and COCA partners, go here.

Natural Disasters and Severe Weather

Severe weather

Natural Disasters and Severe Weather

For information about specific types of disasters and information for specific groups, go here.

Health and Safety Concerns

For information on health and safety concerns for all disasters, including animals and insects, food and water, carbon monoxide, illness and injury prevention, power outages, safe cleanup, and more, go here.

Food and Water Needs: Preparing for a Disaster or Emergency

For food, water, sanitation, and hygiene information for use before and after a disaster or emergency, go here.

Disaster Resources

For educational materials by topic or language, PSAs for disasters, resources for emergency health professionals, and social media, go here.

Food, Drug, and Device Safety


Multistate Outbreak of Salmonella I 4,[5],12:b:- Infections Linked to Kratom

CDC, public health and regulatory officials in several states, and the FDA are investigating a multistate outbreak of Salmonella I 4,[5],12:b:- infections.

Twelve more ill people from seven states were added to this investigation since the last update on February 20, 2018. As of February 28, 40 people infected with the outbreak strain of Salmonella I 4,[5],12:b:- have been reported from 27 states. A list of the states and the number of cases in each can be found on the Case Count Map page.

Epidemiologic evidence indicates that kratom is a likely source of this multistate outbreak. No common brands or suppliers of kratom products have been identified at this time.

At this time, CDC recommends that people not consume kratom in any form. CDC’s recommendation may change as more information becomes available. This investigation is ongoing and we will provide updates as needed.

Read the full outbreak investigation report and view epi curve graphs here. Read additional advice to consumers here.


Multistate Outbreak of Salmonella Montevideo Infections Linked to Raw Sprouts (Final Update)

CDC, public health and regulatory officials in several states, and the FDA investigated a multistate outbreak of Salmonella Montevideo infections. Ten people infected with the outbreak strain of Salmonella Montevideo were reported from three states. No hospitalizations and no deaths were reported.

This outbreak appears to be over. Regardless of where they are served or sold, raw and lightly cooked sprouts are a known source of foodborne illness. CDC recommends that consumers, restaurants, and other retailers always follow food safety practices to avoid illness from eating sprouts.

Read the full update here.

chicken salad

Multistate Outbreak of Salmonella Typhimurium Linked to Chicken Salad

CDC, public health and regulatory officials in several states, and the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) are investigating a multistate outbreak of Salmonella Typhimurium infections. Epidemiologic and laboratory evidence indicates that chicken salad produced by Triple T Specialty Meats, Inc. from January 4, 2018 to February 9, 2018, and sold at Fareway grocery stores is the likely source of this multistate outbreak.

As of February 21, 2018, 65 people infected with the outbreak strain of Salmonella Typhimurium have been reported from 5 states, Illinois, Iowa, Minnesota, Nebraska, and South Dakota. Twenty-eight hospitalizations have been reported. No deaths have been reported.

Click here to view additional key resources such as the Epi Curve and Case Count Maps. Click here to read the full press release.

MedWatch: The FDA Safety Information and Adverse Event Reporting Program—(FDA)
MedWatch is your FDA gateway for clinically important safety information and reporting serious problems with human medical products. Reports of FDA and USDA Food Recalls, Alerts, Reporting, and Resources—(HHS/USDA/FDA/CDC/NIH) lists notices of recalls and alerts from both FDA and the U.S. Department of Agriculture. Visitors to the site can report a problem or make inquiries.